Do We Need to Wait 3 Months After Corticosteroid Injections to Reduce the Risk of Infection After Total Knee Arthroplasty?
DISCUSSION: Our results suggest that TKA performed within four weeks of a corticosteroid injection may be associated with a higher risk of postoperative infection; however, delaying surgery more than four weeks may not provide additional infection risk reduction. Further prospective randomized studies are needed to determine the optimal timing of TKA after corticosteroid injections. LEVEL OF EVIDENCE: Level III. PMID: 33229905 [PubMed - as supplied by publisher] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - November 25, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

AAOS Clinical Practice Guideline: Management of Acute Compartment Syndrome.
Authors: Coe MP, Osborn CPM, Schmidt AH PMID: 33201042 [PubMed - as supplied by publisher] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - November 18, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

MRI Characteristics of Adverse Local Tissue Reactions Associated With Intraoperative Tissue Damage and Poor Revision Surgery Outcomes: A Systematic Review.
This study aims to evaluate the current literature regarding the characteristics of MARS MRI associated with intraoperative tissue necrosis and postoperative complications in patients undergoing revision THA because of ALTR. METHODS: We systematically searched the literature that included reporting MRI characteristics of ALTR in failed THA and their correlation with intraoperative findings and postoperative outcomes. RESULTS: A total of 617 studies were assessed, and 15 studies met the inclusion criteria. Synovial wall thickness correlated with increasing ALVAL grade, however, weakly with tissue necrosis. Synovial ...
Source: The Journal of the American Academy of Orthopaedic Surgeons - November 18, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Conversion to Total Hip Arthroplasty After Hip Arthroscopy: A Cohort-Based Survivorship Study With a Minimum of 2-Year Follow-up.
DISCUSSION: Using our methods, the rate of THA after HA was 9.3% at 2 years. The rate of revision arthroplasty was 6.3% at 1 year. Patients who underwent labral resection, isolated OCP, and/or were of increased age were at increased independent risk of conversion to THA. Those treated by the highest-volume HA surgeons were found to be at reduced risk of conversion to THA. PMID: 33201044 [PubMed - as supplied by publisher] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - November 18, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

The Impact of Mental Health and Substance Use on Opioid Demand After Hip Fracture Surgery.
DISCUSSION: Pre-op opioid filling and drug abuse were the main mental health-related drivers of increased perioperative opioid prescription filling. Depression, psychoses, alcohol abuse, and tobacco abuse had small effects on prescription filling. These results can help identify patients at risk for increased opioid demand who may benefit from additional counseling, maximizing alternative pain management strategies, and possible referral to pain management specialists. LEVEL OF EVIDENCE: Level III, retrospective, prognostic cohort study. PMID: 33201045 [PubMed - as supplied by publisher] (Source: The Journal of the...
Source: The Journal of the American Academy of Orthopaedic Surgeons - November 18, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Current Trends in the Evaluation and Management of Nondisplaced Femoral Neck Fractures in the Elderly.
Authors: Okike K, Hasegawa IG Abstract Nondisplaced (Garden I and II) femoral neck (FN) fractures are commonly encountered by the practicing orthopaedic surgeon. Although these fractures are primarily classified based on the AP radiograph, the lateral radiograph should be closely scrutinized as well because posterior tilt has emerged as a consistent predictor of fixation failure. Internal fixation has for many years been the standard of care, with both cannulated screws and the sliding hip screw representing acceptable options. However, the outcomes after fixation of Garden I and II FN fractures have not been unifo...
Source: The Journal of the American Academy of Orthopaedic Surgeons - November 18, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

The Readability of Online Educational Materials for Femoroacetabular Impingement Syndrome.
In this study of 59 unique websites on FAI, using five different validated readability formulas, we demonstrated that none of the top 30 webpages were written at the recommended reading level. They were found through three different search queries on the three most used search engines. Current FAI online education materials accessible to patients are written above the recommended levels, and it seems that to improve equity and accessibility in healthcare, universities, hospitals, and healthcare professional societies have a responsibility to ensure that the online materials are provided at more appropriate levels. Early de...
Source: The Journal of the American Academy of Orthopaedic Surgeons - November 18, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Acute Fractures of the Glenoid.
Authors: Seidl AJ, Joyce CD Abstract Glenoid fractures are unique in which they span the fields of orthopaedic traumatology and sports medicine. Treatment of glenoid fractures, whether surgical or nonsurgical, may be challenging and have long-term implications on pain and shoulder function. Plain radiographs are always indicated, and most glenoid fractures will require advanced imaging in the form of CT scan. Two general categories of glenoid fractures exist and differ in mechanism of injury, fracture morphology, and treatment. The first category is glenoid fractures with extension into the scapular neck and body. ...
Source: The Journal of the American Academy of Orthopaedic Surgeons - November 11, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Letter to the Editor: Pelvic Tilt and Range of Motion in Hips With Femoroacetabular Impingement Syndrome.
Authors: Zhong M PMID: 33156211 [PubMed - as supplied by publisher] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - November 11, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Staying Out of Trouble With Intramedullary Nailing of Distal Tibia Fractures.
Authors: Lee C, Brodke DJ, Stefanski JT, Gurbani A Abstract As the biologically friendly and biomechanically sound technique of intramedullary fixation has been increasingly applied to distal tibia diaphyseal fractures, challenges with the technique have emerged. Malalignment, most often valgus and recurvatum, is more common than with mid-diaphyseal patterns, given the lack of endosteal fit, and this can be challenging to prevent. Key technical steps can ensure success. These include recognition and initial fixation of intra-articular fracture planes, the use of percutaneous clamps, a slightly lateral terminal nail...
Source: The Journal of the American Academy of Orthopaedic Surgeons - November 11, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Online Information and Mentorship: Perspectives From Orthopaedic Surgery Residency Applicants.
CONCLUSION: Applicants reference online resources frequently, despite valuing mentorship more. If the orthopaedic community fostered better mentorship for applicants, they may not feel compelled to rely on subpar online information. Both online information and mentorship can be improved to create a more effective application experience. PMID: 33156213 [PubMed - as supplied by publisher] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - November 11, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Letter to the Editor: Technical Considerations and Fluoroscopy in Percutaneous Fixation of the Pelvis and Acetabulum.
Authors: Lo YC PMID: 33156214 [PubMed - as supplied by publisher] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - November 11, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Restarting Orthopaedic Care in a Pandemic: Ethical Framework and Case Examples.
Authors: Humbyrd CJ, Dunham AM, Xu AL, Rieder TN Abstract The question about how to resume typical orthopaedic care during a pandemic, such as coronavirus disease 2019, should be framed not only as a logistic or safety question but also as an ethical question. The current published guidelines from surgical societies do not explicitly address ethical dilemmas, such as why public health ethics requires a cessation of nonemergency surgery or how to fairly allocate limited resources for delayed surgical care. We propose ethical guidance for the resumption of care on the basis of public health ethics with a focus on cli...
Source: The Journal of the American Academy of Orthopaedic Surgeons - November 11, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Case Studies AAOS Clinical Practice Guideline: Management of Rotator Cuff Injuries.
This study will illustrate the use of these guidelines through presentation and discussion of hypothetical clinical cases. PMID: 33156216 [PubMed - as supplied by publisher] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - November 11, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

An Evaluation of Risk Factors for Patient "No Shows" at an Urban Joint Arthroplasty Clinic.
DISCUSSION: Appointment no shows are associated with sociodemographic and environmental factors. This information is valuable to help better delineate novel ways to better serve these patient populations. PMID: 33156587 [PubMed - in process] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - November 11, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Thirty-day Outcomes After Surgery for Metastatic Bone Disease of the Extremities: An Analysis of the NSQIP Database.
In this study, we aim to describe the rates of complications and mortality in the first 30 days after surgical treatment of metastatic bone disease of the femur and humerus. METHODS: A retrospective review of patients in the National Surgical Quality Improvement Program database who underwent surgery between 2005 and 2016 was performed. Demographics, comorbidities, preoperative factors, surgical parameters, and postoperative complications were extracted. The cohort was also partitioned by surgical site and surgical modality. RESULTS: One thousand one hundred fifty-four patients were identified, 13.1 percent of pati...
Source: The Journal of the American Academy of Orthopaedic Surgeons - November 11, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Talus Fractures: Evaluation and Treatment.
Authors: Lee C, Brodke D, Perdue PW, Patel T Abstract The talus is unique in having a tenuous vascular supply and 57% of its surface covered by articular cartilage. Fractures of the head, neck, or body regions have the potential to compromise nearby joints and impair vascular inflow, necessitating surgical treatment with stable internal fixation in many cases. The widely preferred approach for many talar neck and body fractures is a dual anterior incision technique to achieve an anatomic reduction, with the addition of a medial malleolar osteotomy as needed to visualize the posterior talar body. Percutaneous screw ...
Source: The Journal of the American Academy of Orthopaedic Surgeons - October 9, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Spinopelvic Dissociation: Assessment, Reduction Strategies, and Fixation Techniques.
Authors: Quacinella MA, Morrissey PB, Parry JA, Mauffrey C Abstract Spinopelvic dissociation is a rare injury associated with 2% to 3% of transverse sacral fractures and 3% of sacral fractures associated with pelvic ring injuries. When spinopelvic dissociation is expediently identified and treated appropriately, patient outcomes can be maximized, highlighting the importance of early diagnosis and treatment. Because of its rarity and complexity, there remains a paucity of high-level evidence-based guidance on treating this complex issue. No consensus exists on fixation techniques or reduction maneuvers to achieve st...
Source: The Journal of the American Academy of Orthopaedic Surgeons - October 4, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Total Joint Arthroplasty and Golf Play: Analysis of Regional Golf Handicap Database.
Authors: Gorbaty JD, Rao AJ, Varkey DT, Muña K, Saltzman BM, Hamid N Abstract BACKGROUND: As the numbers of senior golfers increase, many will consider a hip or knee joint replacement (JR) over their lifetime. The relationship of JR to the rate of return and validated level of play has not been well defined. METHODS: A regional golf association's membership was mailed a questionnaire regarding their JR. Members with valid Golf Handicap Information Network numbers and with at least five pre- and post-JR scores were included. Prospectively collected rounds of play and handicap differentials were used for t...
Source: The Journal of the American Academy of Orthopaedic Surgeons - October 3, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Management of Glenohumeral Joint Osteoarthritis.
Authors: Khazzam M, Gee AO, Pearl M Abstract The Management of Glenohumeral Joint Osteoarthritis Evidence-Based Clinical Practice Guideline is based on a systematic review of published studies for the treatment of glenohumeral joint osteoarthritis. The purpose of this clinical practice guideline is to address the management of patients with glenohumeral joint osteoarthritis. It is not intended to address the management of glenohumeral joint arthritis from etiologies other than osteoarthritis (ie, rheumatoid arthritis, inflammatory arthritis, posttraumatic arthritis, osteonecrosis, rotator cuff tear arthroplasty, ca...
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 30, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

The Cost of Robot-assisted Total Hip Arthroplasty: Comparing Safety and Hospital Charges to Conventional Total Hip Arthroplasty.
This study screened more than 35 million hospital discharges between 2010 to 2014 using the National Inpatient Sample. The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure codes were used to identify 292,836 patients who underwent C-THA (ICD 81.51) and 946 patients who underwent RA-THA (ICD 81.51 and ICD 17.41, 17.49). Perioperative complications were identified using ICD-9-CM diagnosis codes. Patient mortality was determined using the Uniform Bill patient disposition. The RA-THA cohort was statistically matched 1:1 to C-THA about patient age, sex, race, comorbidities, ho...
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 30, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

A Case Illustrating the Practical Application of the AAOS Clinical Practice Guideline: Diagnosis and Prevention of Periprosthetic Joint Infection.
Authors: Chen AF, Riedel S Abstract The American Academy of Orthopaedic Surgeons Clinical Practice Guideline "Diagnosis and Prevention of Periprosthetic Joint Infections (PJI)" is a summary of the available literature designed to help guide surgeons and other qualified physicians in the management of PJI. Obesity and intra-articular joint injections are associated with an increased risk of PJI according to this Clinical Practice Guideline. Serum erythrocyte sedimentation rate, C-reactive protein, and/or interleukin-6 should be obtained when diagnosing PJI. Synovial fluid leukocyte count, neutrophil percen...
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 30, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Tension Band Wiring in Upper Extremity Surgery.
Authors: Tosti R, Hozack BA, Mudgal CS Abstract Tension band wiring is a simple, inexpensive, and effective technique to treat many upper extremity fractures. When tension forces result in a mechanical failure of bone, tension band wiring provides stability and promotes early mobilization by converting tensile forces across a fracture into compressive forces. The tension band principle has distinct advantages of reducing periosteal stripping, technical ease, and cost effectiveness when compared with other operative strategies. This technique can be implemented in a variety of fractures and avulsions about the upper...
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 30, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

A Matched Control Analysis on the Effects of Alcohol Use Disorder After Primary Total Knee Arthroplasty in Medicare Patients.
Authors: Luo TD, Vakharia RM, Gwam CU, Zuskov A, Plate JF, Roche MW Abstract INTRODUCTION: Several studies have found the negative impact of alcohol use disorder (AUD), most notably coagulation derangements. We sought to investigate the effects of AUD after primary total knee arthroplasty (TKA) for (1) postoperative complications, (2) lengths of stay, and (3) costs of care. METHODS: This was a retrospective database analysis of Medicare patients with AUD undergoing primary TKA performed between 2005 and 2014. Patients with AUD were matched to controls in a 1:5 ratio by age, sex, and medical comorbidities. The q...
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 30, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Impact of Smoking and Drinking on Complications After Revision Total Joint Arthroplasty: A Matched Cohort Analysis.
This study aimed to evaluate the potential impact of smoking and drinking on complications after revision TJA. METHODS: We retrospectively evaluated a total of 4,302 consecutive patients who underwent revision TJA. Patient demographics and complications were compared between four cohorts based on smoking and drinking status: (1) nonusers (nonsmokers and nondrinkers), (2) smokers, (3) drinkers, and (4) concurrent users. RESULTS: A total of 1,924 patients were matched using propensity score analysis: 808 nonusers (42.0%), 421 smokers (21.9%), 483 drinkers (25.0%), and 212 concurrent users (11.1%). When compared with ...
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 20, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

A Tensionable Suture-based Cerclage Is an Alternative to Stainless Steel Cerclage Fixation for Stabilization of a Humeral Osteotomy During Shoulder Arthroplasty.
DISCUSSION: A DLTC has higher load to failure and trends toward lower gap displacement compared with a SSWC. The DLTC construct may therefore be a viable alternative for fixation of periprosthetic fractures or osteotomies of the humeral shaft during shoulder arthroplasty. PMID: 32947346 [PubMed - as supplied by publisher] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 20, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Outcome of Spinal Versus General Anesthesia in Revision Total Hip Arthroplasty: A Propensity Score-Matched Cohort Analysis.
This study aimed to evaluate the potential differences in perioperartive and postoperative outcomes in revision total hip arthroplasty (THA) between spinal or general anesthesia. METHODS: A total of 2,656 consecutive patients who underwent revision THA were evaluated. Propensity-score-adjusted multivariate logistic regression analyses were applied to control for intergroup variability and evaluate the differences in outcomes and complications with anesthesia type. RESULTS: Propensity score matching resulted in 1:1 matching with 265 patients in each anesthesia cohort. Multivariate analyses demonstrated that patients...
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 20, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Intraoperative Indocyanine Green Fluorescence Angiography Is Sensitive for Predicting Postoperative Wound Complications in Soft-Tissue Sarcoma Surgery.
CONCLUSION: ICG angiography has a high predictive value in the lower extremity for postoperative wound complications. LEVEL OF EVIDENCE: Level III, Diagnostic. PMID: 32947348 [PubMed - as supplied by publisher] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 20, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Orthopaedic Injuries Associated With Cell Phone Use Resulting in Emergency Department Visits: A 20-year Analysis.
Authors: Moore HG, Halperin SJ, Berson ER, Burroughs PJ, Paskhover B, Grauer JN Abstract INTRODUCTION: Cell phones are an integral part of daily life but are distractors that can contribute to injury. The present study uses a large national emergency department (ED) database to evaluate the frequency, anatomic location, and type of injuries associated with cell phone use. We hypothesize that orthopaedic injuries related to cell phone use have increased over time and affect certain body parts and age groups more than others. METHODS: The 1999 to 2018 Nation Electronic Injury Surveillance System was queried for c...
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 20, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Trends in Spinal Surgery Performed by American Board of Orthopaedic Surgery Part II Candidates (2008 to 2017).
DISCUSSION: Recent spine fellowship graduates are performing more cervical disk arthroplasties and ACDFs while decreasingly using structural autograft as well as performing fewer PSFs and lumbar diskectomies. Techniques such as anterior lumbar interbody fusion/lateral lumbar interbody fusions and transforaminal lumbar interbody fusions have not changed significantly over the last decade. LEVEL OF EVIDENCE: Level IV (retrospective case series study). PMID: 32947350 [PubMed - as supplied by publisher] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 20, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Soft-tissue Sarcoma of the Hand: Patient Characteristics, Treatment, and Oncologic Outcomes.
CONCLUSION: Hand STSs are aggressive tumors with a high metastatic potential. Even with adequate oncologic treatment, long-term clinical follow-up (10 years) in these tumors is advised. The treating surgical oncologist should not be deceived by their smaller size. PMID: 32932303 [PubMed - as supplied by publisher] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 17, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Patient Opioid Requirements Are Often Far Less Than Their Discharge Prescription After Orthopaedic Surgery: the Results of a Prospective Multicenter Survey.
Authors: Wyles CC, Thiels CA, Hevesi M, Ubl DS, Gazelka HM, Turner NS, Trousdale RT, Pagnano MW, Mabry TM, Habermann EB Abstract INTRODUCTION: Evidence-based, procedure-specific guidelines for opioid prescribing after orthopaedic surgery are urgently needed to standardize care and minimize excess opioids. METHODS: We developed a prospective, multicenter survey study conducted from March 2017 to January 2018 including 7 common elective orthopaedic surgical procedures (total knee arthroplasty, total hip arthroplasty, lumbar fusion, lumbar laminectomy, rotator cuff repair, arthroscopic meniscectomy, and carpal tun...
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 16, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Shared Decision-making in Orthopaedic Surgery.
This article is intended to give the practicing orthopaedic surgeon an understanding of the concept of SDM and how it can improve physician-patient communication. We will explore the key elements of SDM, attendant benefits, indications, and barriers to implementation and propose steps to begin the incorporation of SDM into practice. PMID: 32925380 [PubMed - as supplied by publisher] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 16, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Dual-Mobility Articulations in Femoral Neck Fractures: A Systematic Review of the Literature and Meta-analysis of the Outcomes.
CONCLUSIONS: Our study revealed overall lower risk of dislocation using DMC compared with both CTHA and HA. There were also lower revision and revision surgery rates when DMC were used compared with HA. Further studies are required to elucidate cost-effectiveness and long-term outcomes of DMC in these scenarios. LEVEL OF EVIDENCE: Level III-meta-analysis. PMID: 32925381 [PubMed - as supplied by publisher] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 16, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Patient-reported Outcomes Associated With Preoperative Opioid Use in Revision Total Hip Arthroplasty: A Propensity Score-Matched Cohort Study.
Authors: Smith E, Klemt C, Sabeh K, Tirumala V, Kwon YM Abstract BACKGROUND: Opioid use is a public health crisis in the United States and an area of increased focus within the arthroplasty literature. The aim of this study was to investigate the effect of preoperative opioid use on patient-reported outcome measures (PROMs) before and after revision total hip arthroplasty (THA). METHODS: A total of 381 consecutive revision THA patients with both preoperative and postoperative PROMs were identified. Because of differences in baseline characteristics, 104 opioid users were matched to 208 nonusers using nearest-ne...
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 16, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Resident Selection in the Wake of United States Medical Licensing Examination Step 1 Transition to Pass/Fail Scoring.
DISCUSSION: As Step 2 CK is expected to become more important in the residency application process, current applicant stress on Step 1 scores may simply move to Step 2 CK scores. Performance on subinternships will remain a critical aspect of residency application, as it was viewed as the most important resident selection factor and has grown in importance compared with a previous report. PMID: 32925383 [PubMed - as supplied by publisher] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 16, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Does Surgeon Subspecialty Training Affect Outcomes in the Treatment of Displaced Supracondylar Humerus Fractures in Children?
The objective of this study was to examine patient outcomes and treatment variables for these injuries based on the surgeon subspecialty training. METHODS: A retrospective study of children who had undergone primary closed reduction and percutaneous fixation for displaced supracondylar humerus fractures was done from January 2012 through May 2019. The following four groups with differing orthopaedic subspecialty training were evaluated: (1) pediatric fellowship trained (2) trauma fellowship trained, (3) sports medicine fellowship trained, and (4) all others. Outcomes examined included time to surgery, surgical time, fl...
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 16, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Defining Outpatient Hip and Knee Arthroplasties: A Systematic Review.
DISCUSSION: We propose "DASH" (Discharge from ASC to Home) as a new term to define arthroplasties done in an outpatient setting with the patient discharged home the same day. PMID: 32925385 [PubMed - as supplied by publisher] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 16, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Preoperative Opioid Use Increases the Cost of Care in Total Joint Arthroplasty.
Authors: Bell KL, Detweiler M, Yayac M, Penna S, Chen AF Abstract INTRODUCTION: Predictors of financial costs related to total joint arthroplasty (TJA) have become increasingly important becuase payment methods have shifted from fee for service to bundled payments. The purpose of this study was to assess the relationship between preoperative opioid use and cost of care in primary TJA. METHODS: A retrospective study was conducted in Medicare patients who underwent elective unilateral primary total knee or hip arthroplasty between 2015 and 2018. Preoperative opioid usage, comorbidities, length of stay, and demogr...
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 16, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Antibiotic Stewardship for Total Joint Arthroplasty in 2020.
Authors: Myers TG, Lipof JS, Chen AF, Ricciardi BF Abstract Projections indicate an increase in primary and revision total joint arthroplasties (TJAs). Periprosthetic joint infections (PJIs) are one of the most common and devastating causes of failure after TJA. Perioperative administration of systemic and/or local antibiotics is used for both prophylaxis and treatment of PJI. Antibiotic stewardship is a term that has been met with clinical acceptance and success in other specialties of medicine. Identifying antibiotic best practice use in the fight against PJI is limited by studies that are extremely heterogeneous...
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 10, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Demographics and Clinical Presentation of Early-Stage Legg-Calv é-Perthes Disease: A Prospective, Multicenter, International Study.
DISCUSSION: This prospective study provides a new international multicenter representation of early LCPD. The frequency of pain and missed school highlights the substantial morbidity and potential social cost and burden for children and families. The prevalence of being overweight/obese in our LCPD cohort was comparable to rates within the pediatric cohort as a whole, and fewer children have a history of smoke exposure than in previous reports. LEVEL OF EVIDENCE: Level II, prospective comparative study. PMID: 32868700 [PubMed - as supplied by publisher] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 3, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Surface Modification Techniques to Enhance Osseointegration of Spinal Implants.
Authors: Possley D, Baker E, Baker K, Khalil JG Abstract Biomechanical function, specifically implantation technique and immediate surgical fixation, of orthopaedic implants is the primary consideration during the development of orthopaedic implants. Biologic and material characteristics are additional factors to include in the design process because of the direct impact on short- and long-term implant performance. The body's initial interaction with implant materials can affect protein- and cell-based function, thereby either promoting or impeding osseointegration. An understanding and inclusion of the biologic re...
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 3, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Development of Distal Femoral Metastasis is Rare in Cases of Isolated Proximal Femoral Metastases.
DISCUSSION: Our findings show that there is an extremely low likelihood of developing distal femoral metastases when isolated proximal femoral metastases are present and thus protecting the entire femur may not be necessary in this clinical scenario. LEVEL OF EVIDENCE: IV, therapeutic study. PMID: 32868702 [PubMed - as supplied by publisher] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 3, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Performing a Safe and Effective Total Hip Arthroplasty on Patients With Inactive or Stably Active Systemic Lupus Erythematosus With Osteonecrosis.
This study evaluated the outcome of THA in this patient group. METHODS: From January 2004 to January 2017, we retrospectively studied 92 THAs for patients with SLE and 92 THAs for age- and sex-matched patients suffering from ONFH due to nonrheumatic etiologies Both groups were treated with cementless THA and followed up for an average of 50.9 ± 30.6 months. Their surgical outcomes and complications were evaluated and compared. RESULTS: No significant difference existed in age, sex, weight, height, follow-up time, and Ficat staging between the groups. All patients with SLE were in inactive or stably active di...
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 3, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Major Orthopaedic Conference Abstract Publication: An Analysis of Abstracts Accepted for the AAOS Annual Meetings Between 2014 and 2017.
Authors: Le R, Anderson A, Chalmers CE, Scolaro JA, Lee YP, Bhatia N Abstract INTRODUCTION: The American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting provides an opportunity for clinicians to attain the most recent advancements in the orthopaedic field. However, the most recent study analyzing publication rates from the 2001 Annual Meeting determined that only 49% of the podium and poster abstracts were eventually published. The purpose of this study was to determine the publication rate, likelihood of publication based on the presentation format, and time to publication for abstracts presented at the 2014...
Source: The Journal of the American Academy of Orthopaedic Surgeons - August 28, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Factors Associated With Perioperative Transfusion in Lower Extremity Revision Arthroplasty Under a Restrictive Blood Management Protocol.
DISCUSSION: Patients with preoperative anemia, those undergoing revision TJA because of infection, those who did not receive TXA, and those undergoing more complex TJA procedures may have greater odds of requiring ABT. We recommend preoperative optimization of the health of these patients to reduce the need for ABT. LEVEL OF EVIDENCE: Level III, prognostic study. PMID: 32852330 [PubMed - as supplied by publisher] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - August 28, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Letter to the Editor: Venous Thromboembolism Prophylaxis After Pelvic and Acetabular Fractures: A Survey of Orthopaedic Surgeons' Current Practices.
Authors: Liang ZC, OʼNeill G, Murphy D, Hui JHP PMID: 32852331 [PubMed - as supplied by publisher] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - August 28, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Reply to Letter to the Editor: Venous Thromboembolism Prophylaxis After Pelvic and Acetabular Fractures: A Survey of Orthopaedic Surgeons' Current Practices.
Authors: Lim P, Scolaro J PMID: 32852332 [PubMed - as supplied by publisher] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - August 28, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Socioeconomic Status Is Associated With the Risk of Girdlestone Resection Arthroplasty After Periprosthetic Infection of the Hip.
Authors: Kirchner GJ, Lieber AM, Kim RY, Kerbel YE, Moretti VM, Nikkel LE Abstract INTRODUCTION: Girdlestone resection arthroplasty (GRA) is a radical but sometimes necessary treatment of periprosthetic joint infection (PJI) of the hip. The purpose of this of this study was to identify the independent risk factors for GRA after PJI of the hip. METHODS: This is a retrospective, cross-sectional analysis of the National (Nationwide) Inpatient Sample from 2010 to 2014. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) was used to identify 27,404 patients with PJI of the hi...
Source: The Journal of the American Academy of Orthopaedic Surgeons - August 28, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Malignant Tumors of the Hand.
Authors: Chapman T, Athanasian E Abstract Primary malignant tumors in the hand are rare as compared to benign lesions; however, it is essential for orthopeadic surgeons to be familiar with their clinical presentation. The approach to working up a mass in the hand must be methodical and thorough, and clinicians must maintain high index of suspicion when evaluating these lesions. Successful identification and treatment of malignant tumors of the hand may include referral to a sarcoma center for staging, workup, and multidisciplinary treatment. Surgical treatment of malignant tumors in the hand is uniquely complicated...
Source: The Journal of the American Academy of Orthopaedic Surgeons - August 27, 2020 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research