Management of the Floating Knee: Ipsilateral Fractures of the Femur and Tibia.
Authors: Vallier HA, Manzano GW Abstract The "floating knee" is defined as fractures of the ipsilateral femur and tibia, which consists of a spectrum of injury, and may be in isolation or part of multiple system trauma for a given patient. A floating knee may compromise limb viability due to severe soft-tissue and vascular injury. Expeditious fracture reduction and patient resuscitation are crucial, while type and timing of provisional and definitive management is guided by the extent of injury to the involved extremity and associated systemic injuries. Numerous surgical techniques are available to treat ...
Source: The Journal of the American Academy of Orthopaedic Surgeons - July 16, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Rheumatoid Hand and Wrist Surgery: Soft Tissue Principles and Management of Digital Pathology.
Authors: Blazar PE, Gancarczyk SM, Simmons BP Abstract Since the advent of disease-modifying antirheumatic drugs for rheumatoid arthritis, orthopedic surgeons see fewer patients in the office who require hand surgery. However, a significant number of patients still seek surgical intervention to improve pain and function. These patients often present with isolated soft tissue pathologies, but even bone and joint pathology require meticulous soft tissue handling in this cohort. This review highlights the principles and techniques relevant to the management of soft tissue deformity in rheumatoid hand and wrist surgery...
Source: The Journal of the American Academy of Orthopaedic Surgeons - July 16, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Outcome of Patients Treated With Porous Tantalum Acetabular Implants for Neoplastic Periacetabular Lesions.
This study expands our previous report on longer follow-up, with specific emphasis on patient and implant survivorship, radiographic results, and clinical outcomes. METHODS: Fifty-eight patients (32 women and 26 men) were treated using a tantalum acetabular implant and total hip arthroplasty to reconstruct a nonprimary neoplastic process between 2001 and 2014. The mean age and body mass index were 62 years and 28 kg/m, respectively. The most common diagnosis was metastatic disease (n = 29). The patients' medical records and radiographs were reviewed to assess Harris hip scores and radiographic fixation. The mean follow...
Source: The Journal of the American Academy of Orthopaedic Surgeons - July 16, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Orthopaedic Faculty and Resident Racial/Ethnic Diversity is Associated With the Orthopaedic Application Rate Among Underrepresented Minority Medical Students.
This study examines the degree to which the racial/ethnic diversity of the orthopaedic faculty and residency program influences underrepresented in medicine (URM) medical students at that institution to pursue a career in orthopaedics. METHODS: Using data provided by the Association of American Medical Colleges, we identified all US medical schools that were affiliated with an orthopaedic department and an orthopaedic residency program (n = 110). For each institution, data were collected on URM representation among the orthopaedic faculty and residents (2013 to 2017), as well as the proportion of URM medical students w...
Source: The Journal of the American Academy of Orthopaedic Surgeons - July 16, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Cost Analysis of Treating Pediatric Supracondylar Humerus Fractures in Community Hospitals Compared With a Tertiary Care Hospital.
This study assesses the costs of performing closed reduction percutaneous pinning (CRPP) of pediatric supracondylar humerus fractures (SCHFs) at a CH compared with a TCH. METHODS: A retrospective review of 133 consecutive SCHFs treated with CRPP at a CH versus a TCH over a 6-year period was performed. Total encounter and subcategorized costs were compared between the procedures done at a CH versus those done at a TCH. RESULTS: Performing CRPP for a SCHF at a CH compared with a TCH saved 44% in costs (P
Source: The Journal of the American Academy of Orthopaedic Surgeons - July 16, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Quadriceps Tendon Autograft in Anterior Cruciate Ligament Reconstruction.
Authors: Mehran N, Damodar D, Shu Yang J Abstract Quadriceps tendon (QT) autograft in anterior cruciate ligament reconstruction has received increased attention, as more studies compare clinical outcomes between QT, bone-patellar tendon-bone (BPTB), and hamstring tendon (HT) autografts. Biomechanically, QT has similar properties to BPTB and to HT. QT has shown equivalent stability, patient-reported outcome measures, strength and graft failure rates, and decreased donor site morbidity compared with BPTB and HT. All three autografts have excellent clinical outcomes. Ultimately, anterior cruciate ligament graft select...
Source: The Journal of the American Academy of Orthopaedic Surgeons - July 16, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Alternatives to Traditional Cast Immobilization in Pediatric Patients.
Authors: Shirley ED, Maguire KJ, Mantica AL, Kruse RW Abstract Casts are commonly used for fracture management and postoperative immobilization in pediatric patients. However, cast immobilization is not without complications (eg, thermal injuries, pressure sores, infection, and neurovascular injury) and may be associated with additional costs and increased loss of school/work days for cast removal or other complications. The disadvantages of traditional casting can be minimized by alternative management strategies: waterproof casts to facilitate bathing and swimming; a Pavlik harness in infants, a single-leg spica ...
Source: The Journal of the American Academy of Orthopaedic Surgeons - July 12, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Hamstring Injuries in Athletes: Evidence-based Treatment.
Authors: Arner JW, McClincy MP, Bradley JP Abstract Hamstring injuries are common in athletes and can cause notable disability. They can be separated based on proximal, muscle belly, and distal injuries, with proximal and distal injuries more commonly requiring surgical intervention. Most injuries do not require acute MRI; however, MRI is useful in proximal and distal injuries as well as muscle belly tears that fail to respond to nonsurgical treatment. Acute repair of proximal avulsions, both partial and complete, result in successful outcomes, whereas chronic complete repairs are more difficult and less reliable. ...
Source: The Journal of the American Academy of Orthopaedic Surgeons - July 11, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Effect of Preoperative Opioid Usage on Pain After Total Shoulder Arthroplasty.
This study evaluates the effect of preoperative opioid use on postoperative pain and duration of opioid use after total shoulder arthroplasty (TSA). METHODS: We retrospectively identified 138 TSAs (69.1% reverse and 30.9% anatomic) between January 2013 and April 2017 that met inclusion criteria. Patients were stratified into two groups based on opioid usage within the 4 weeks before surgery. Primary outcome was resting pain at 3 months postoperatively using a 10-point numerical rating scale system. Duration of postoperative opioid consumption was also recorded and compared between cohorts. RESULTS: The opioid cohor...
Source: The Journal of the American Academy of Orthopaedic Surgeons - July 11, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Three-dimensional Printing Technology in Orthopaedics.
Authors: Skelley NW, Smith MJ, Ma R, Cook JL Abstract Three-dimensional (3-D) printing technology is affecting how orthopaedic surgeries are planned and executed. Like many innovations, 3-D printers are becoming smaller, more affordable, and more accessible. Free access to open-source 3-D imaging software has also made clinical implementation of this technology widely feasible. Within the last decade, 3-D printing advancements have improved the way orthopaedic surgeons can approach both common and complex cases. Advanced imaging studies can be used to create musculoskeletal models, which can then be used to create ...
Source: The Journal of the American Academy of Orthopaedic Surgeons - July 5, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Early Postoperative Radiographs Have No Effect on Orthopaedic Trauma Patient's Satisfaction With Their Clinic Visit.
CONCLUSION: Eliminating routine early postoperative radiographs had no effect on overall patient satisfaction with the clinic visit, but it did affect satisfaction with the surgeon's explanation of their injury. This could save time, money, and radiation exposure without adversely affecting patient outcome or satisfaction, but an equivalent educational tool should be identified for clinic visits. PMID: 31268869 [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 - July 5, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Current Concepts in the Treatment of Lateral Condyle Fractures in Children.
Authors: Abzug JM, Dua K, Kozin SH, Herman MJ Abstract Lateral condyle fractures of the humerus are the second most common fracture about the elbow in children. The injury typically occurs as a result of a varus- or valgus-applied force to the forearm with the elbow in extension. Plain radiographs are sufficient in making the diagnosis; however, an elbow arthrogram permits optimal visualization of the articular surface in minimally displaced fractures. Traditionally, nonsurgical management is indicated for fractures with ≤2 mm of displacement and a congruent articular surface. Closed reduction and percutaneous p...
Source: The Journal of the American Academy of Orthopaedic Surgeons - July 5, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Preoperative Management of Antithrombotics in Arthroplasty.
Authors: Barlow BT, Hannon MT, Waldron JE Abstract Antithrombotic therapy is common in the arthroplasty patient population; the preoperative management of chronic antithrombotic medications requires coordination among the medical team. It is estimated that approximately 250,000 or 10% of patients on chronic antithrombotic medication undergo treatment interruption for surgical procedures annually in North America. Although the description of postoperative anticoagulation management after arthroplasty is extensive, orthopaedic literature describing the preoperative management of antithrombotic therapy is lacking. The...
Source: The Journal of the American Academy of Orthopaedic Surgeons - July 3, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Effect of Heart Failure With Preserved Ejection Fraction on Perioperative Outcomes in Patients Undergoing Hip Fracture Surgery.
CONCLUSION: HFpEF confers a significant perioperative risk of MACCE in patients undergoing hip fracture surgery. PMID: 31259845 [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 - July 3, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Treatment of Incarcerated Impaction of Acetabular Fractures With Concomitant Osteochondral Femoral Head Fractures by the Use of a Posterior Wall Osteotomy and Surgical Hip Dislocation: A Novel Technique.
We describe a technique to treat a posterior column acetabular fracture in association with incarcerated articular impaction and concomitant osteochondral femoral fracture. Posterior wall osteotomy combined with surgical hip dislocation facilitates the restoration of femoral head anatomy and acetabular surface integrity. This technique should be considered when dealing with this difficult scenario. PMID: 31246642 [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 - June 29, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Hypoxia Preconditioning of Bone Marrow Mesenchymal Stem Cells Before Implantation in Orthopaedics.
Authors: Tsiapalis D, Zeugolis DI PMID: 31246643 [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 - June 29, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Superior Laryngeal Nerve Palsy in Revision Anterior Cervical Surgery.
Authors: Konopka JA, Armaghani SJ, Dao AM, Rhee JM Abstract Most spine surgeons routinely obtain preoperative ENT evaluation of recurrent laryngeal nerve function when contemplating revision anterior approaches to the cervical spine to avoid the potentially catastrophic consequences of bilateral vocal cord palsy. By contrast, there is less awareness of the potential for superior laryngeal nerve (SLN) injury-although a bilateral injury can, like bilateral injuries of the recurrent laryngeal nerve, have serious clinical consequences. This case report describes a 74-year-old man who, after a contralateral revision ant...
Source: The Journal of the American Academy of Orthopaedic Surgeons - June 29, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Artistic Gymnastics Injuries; Epidemiology, Evaluation, and Treatment.
Authors: Desai N, Vance DD, Rosenwasser MP, Ahmad CS Abstract Artistic gymnastics is a physically demanding sport that requires flexibility, agility, and extreme upper and lower body strength. The specific biomechanics of the sport leads to a unique injury profile. Gymnastic skills require intense upper body weight-bearing, placing unusual forces across the upper extremity joints and predisposing them to injury. In addition, the required body control during air aerobatics (tumbling, twisting, flipping) necessitates precise landing techniques to avoid spine and lower extremity injury. Common gymnastic injuries inclu...
Source: The Journal of the American Academy of Orthopaedic Surgeons - June 26, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Rationale for Biologic Augmentation of Rotator Cuff Repairs.
Authors: Mirzayan R, Weber AE, Petrigliano FA, Chahla J Abstract The structural integrity of rotator cuff repair (RCR) has been a primary focus for shoulder surgeons seeking long-term clinical and functional success. Improvements in surgical techniques have allowed for superior initial biomechanical fixation. However, tendon healing remains a significant clinical problem even after rigid time-zero repair. The lack of long-term healing has led to increased interest in biologic augmentation to improve tendon-to-bone healing. This interest has led to a rise in the investigation of small molecular therapies, cell-based...
Source: The Journal of the American Academy of Orthopaedic Surgeons - June 26, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Musculoskeletal-based Patient-reported Outcome Performance Measures, Where Have We Been-Where Are We Going.
This article reviews the current state of PROs and discusses future directions. Specifically, this article will review the current history and background of PROs; it will highlight the perspective of the National Quality Forum and review the efforts of the musculoskeletal community related to PROs. Goals, positive aspects, limitations, and barriers related to PROs will be discussed. Additionally, development considerations and strategies will be highlighted. Finally, development recommendations from the American Academy of Orthopaedic Surgery position statement "principles for musculoskeletal based PRO performance mea...
Source: The Journal of the American Academy of Orthopaedic Surgeons - June 26, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Clinical Approach in Youth Sports Medicine: Patients' and Guardians' Desired Characteristics in Sports Medicine Surgeons.
CONCLUSIONS: Both adolescent patients and their guardians reported shared decision making and understanding patients' sports and goals as surgeon qualities that were more important to them than surgeon sex. LEVEL OF EVIDENCE: Level IV, cross-sectional study. PMID: 31232794 [PubMed - in process] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - June 26, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Obstructive Sleep Apnea and Arthroscopic Rotator Cuff Repair-Are Complication Rates Really Increased?
Authors: Cancienne JM, Brockmeier SF, Deasey MJ, Werner BC Abstract BACKGROUND: A few investigations exist which evaluate the influence of obstructive sleep apnea (OSA) on complications after arthroscopic rotator cuff repair. METHODS: A database was queried for patients undergoing rotator cuff repair with and without OSA and further subdivided into those with and without a billing code for a continuous positive airway pressure (CPAP) device. Thirty-day and 6-month adverse events were assessed. RESULTS: After regression analysis, patients with OSA had markedly increased emergency department visits and hospital admission (P
Source: The Journal of the American Academy of Orthopaedic Surgeons - June 26, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

A 46-year Analysis of Gender Trends in Academic Authorship in Orthopaedic Sports Medicine.
Authors: Kim CY, Sivasundaram L, Trivedi NN, Gilmore A, Gillespie RJ, Salata MJ, Liu RW, Voos JE Abstract INTRODUCTION: Participation of women in medicine has increased markedly in recent decades, but gender disparities still exist, particularly in academic medicine. To provide insight into the gender gap, specifically in academic orthopaedic sports medicine, we investigated the relationship between gender and authorship in orthopaedic sports literature from 1972 to 2018. METHODS: Information about every original article in four prominent orthopaedic sports medicine journals between 1972 and 2018 was extracted ...
Source: The Journal of the American Academy of Orthopaedic Surgeons - June 26, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Interventions for Distal Radius Fractures: A Network Meta-analysis of Randomized Trials.
CONCLUSIONS: A network meta-analysis of randomized trials revealed that open reduction and internal fixation with a plate offers the best results for adult patients with a distal radius fracture, in terms of early and sustained functional recovery and a reduction in fracture healing complications. Determining whether one approach to PF or plate design is superior requires further study. PMID: 31232797 [PubMed - in process] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - June 26, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Insurance Status Affects Complication Rates After Total Hip Arthroplasty.
This study evaluates the effect of patient insurance status on complications after primary elective THA using the Nationwide Inpatient Sample. METHODS: All patients undergoing primary elective THA from 1998 to 2011 were included. Patient demographics, comorbidities, and complications were collected and compared based on insurance type. Multivariable logistic regression and a matched cohort analysis were performed. RESULTS: About 515,037 patients (53.7% Medicare, 40.1% private insurance, 3.9% Medicaid/uninsured, and 2.2% other) were included, who underwent elective THA. Privately insured patients had fewer medical c...
Source: The Journal of the American Academy of Orthopaedic Surgeons - June 26, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Business Modeling of Orthopaedic Trauma in the Emergency Department: An Untapped Revenue Stream.
CONCLUSION: A notable, previously unrecognized and uncaptured source of revenue was identified and quantified. Professional fee billing for distal radius fracture reduction in the ED did not have a negative effect on outpatient professional fee revenue received for these patients. PMID: 31232799 [PubMed - in process] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - June 26, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

The Application of Medicare Data for Musculoskeletal Research in the United States: A Systematic Review.
DISCUSSION: Medicare claims data provide a unique way for researchers to study a nationally representative patient population longitudinally. A significant limitation of using claims data has been a lack of granularity on defining severity of a condition. LEVEL OF EVIDENCE: Therapeutic level III. PMID: 31232800 [PubMed - in process] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - June 26, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Variations in Revenue Generation for the Care of Orthopaedic Trauma Patients.
Authors: Rascoe AS, Flanagan CD, Kim CY, Vallier HA Abstract BACKGROUND: In the background of increasing competition between trauma centers, this study investigated the relative reimbursement of trauma care provided in an urban trauma setting, comparing patients previously unknown (new) to the system, representing potential sources of new revenue, and those who were known (established), having received medical care previously in the same system. METHODS: A retrospective review of 440 patients with high-energy fractures at a single level 1 trauma center was conducted. Payment to charge (P/C) ratios for professio...
Source: The Journal of the American Academy of Orthopaedic Surgeons - June 22, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Augmented Fixation for Fractures of the Appendicular Skeleton.
Authors: Marecek G, Centomo H Abstract Despite advances in technology such as locked plating, osteoporotic bone and bone defects remain challenging complications for orthopaedic surgeons. The concept of augmented fixation is useful in these settings. Augmented fixation can be described as improving construct strength and stability by enhancing the surrounding environment. By understanding and using the techniques of alternative fixation strategies, endosteal or medullary support, structural grafting, or the use of bone graft substitutes in combination with standard or integrated fixation, surgeons can improve the c...
Source: The Journal of the American Academy of Orthopaedic Surgeons - June 19, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Management of the Irreparable Rotator Cuff Tear.
Authors: Cvetanovich GL, Waterman BR, Verma NN, Romeo AA Abstract When evaluating patients with irreparable rotator cuff tears, orthopaedic surgeons have an increasingly wide array of surgical options, including both established techniques and emerging technologies. However, significant variability exists in the clinical evaluation and surgical indications in this subset, and definitions for pseudoparalysis and tear irreparability are inconsistent. In older patients with symptomatic rotator cuff arthropathy and relatively sedentary demands, the reverse total shoulder arthroplasty has been established as the preferr...
Source: The Journal of the American Academy of Orthopaedic Surgeons - June 19, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Preoperative Warming Reduces Intraoperative Hypothermia in Total Joint Arthroplasty Patients.
This study evaluates the effect of preoperative warming measures on PH in TJA patients. METHODS: A retrospective review was conducted of 672 patients undergoing TJA at our institution between April 1 and October 31, 2017. Under the new normothermia protocol, patients received warmed intravenous fluids and forced-air warming gowns in the preoperative holding area. Time and temperature data for the perioperative period were collected from the electronic health record. Chi-square and paired t-tests were used to compare between total knee arthroplasty and total hip arthroplasty patients and between new and old protocols. ...
Source: The Journal of the American Academy of Orthopaedic Surgeons - June 19, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Normal and Pathoanatomy of the Arthritic Shoulder: Considerations for Shoulder Arthroplasty.
Authors: Getz CL, Ricchetti ET, Verborgt O, Brolin TJ Abstract The glenohumeral joint is a highly mobile, complex articulation that relies not only on the bony support between the humeral head and glenoid but also on appropriate balance and tension of the surrounding soft-tissue structures. Recreating the normal anatomic relationships is a basic premise in joint arthroplasty, which can be challenging in shoulder arthroplasty, as the normal glenohumeral anatomy has considerable variation from patient to patient. Also, as the anatomy of the glenohumeral joint becomes distorted with advanced shoulder pathology, it bec...
Source: The Journal of the American Academy of Orthopaedic Surgeons - June 19, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Use of Imaging Prior to Referral to a Musculoskeletal Oncologist.
Authors: Miller BJ Abstract The Musculoskeletal Tumor Society and American Academy of Orthopaedic Surgeons recently collaborated on a clinical practice guideline Use of Imaging Prior to Referral to an Orthopaedic Oncologist. The complete manuscript is available on OrthoGuidelines (www.orthoguidelines.org) and the Musculoskeletal Tumor Society website (www.msts.org). This clinical practice guideline is designed to assist practitioners without specialization in musculoskeletal tumors to determine the most efficacious imaging modalities for establishing an accurate diagnosis and treatment plan when confronted with a b...
Source: The Journal of the American Academy of Orthopaedic Surgeons - June 19, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Validity of a Novel Free-Hand Pedicle Screw Placement Training Tool.
This study establishes the construct validity of a low-cost training platform designed for high-repetition training of the skills required for fluent use of the five specific tools described for free-hand pedicle screw placement and breach avoidance. METHODS: A total of 19 participants were included and divided into three groups based on spine surgery experience. Participants were asked to place five pedicle screws into the model. The performance was assessed by recording breaches, technical criteria (0 to 44 points), time to completion, and angulation of the screws. Success (no breaches, no protrusions) frequency (suc...
Source: The Journal of the American Academy of Orthopaedic Surgeons - June 19, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Determinants of Cost Variation in Total Hip and Knee Arthroplasty: Implications for Alternative Payment Models.
DISCUSSION: Patient demographics and medical complexity had minimal impact on variation in direct cost of index hospitalization for elective THA/TKA compared with surgical characteristics but were markedly associated with discharge with home health services or to rehabilitation facility. Having additional risk adjustment in these payment models could mitigate concerns about access to care for higher risk, higher cost patients. PMID: 31192883 [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 - June 15, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Predictors for Nonaccidental Trauma in a Child With a Fracture-A National Inpatient Database Study.
CONCLUSION: Using a large, national inpatient database, we identified an overall prevalence of 1.54% of NAT in children admitted to the hospital with a fracture. Based on five independent predictors of NAT, we generated an estimated probability chart that can be used in the clinical workup of a child with a fracture and possible NAT. This evidence-based algorithm needs to be validated in clinical practice. LEVEL OF EVIDENCE: Prognostic study, Level III (case-control study). PMID: 31192884 [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 - June 15, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Technical Considerations and Fluoroscopy in Percutaneous Fixation of the Pelvis and Acetabulum.
This article details the necessary fluoroscopic views and general methods used in percutaneous techniques around the pelvis and acetabulum. Despite most studies reporting good-to-excellent clinical and radiographic results, further work is needed to facilitate standardization and optimization of these outcomes. PMID: 31192885 [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 - June 15, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Preoperative Expectations Associated With Postoperative Dissatisfaction After Total Knee Arthroplasty: A Cohort Study.
Authors: Ghomrawi HMK, Lee LY, Nwachukwu BU, Jain D, Wright T, Padgett D, Bozic KJ, Lyman S Abstract INTRODUCTION: Unfulfilled expectations, assessed postoperatively, have been consistently associated with dissatisfaction after total knee arthroplasty (TKA). However, identifying these expectations preoperatively has been a challenge. We aimed at identifying specific expectations that are most likely to affect postoperative dissatisfaction. METHODS: We included all patients in our institutional registry with a body mass index of
Source: The Journal of the American Academy of Orthopaedic Surgeons - June 15, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Total Joint Arthroplasty in Patients With Cerebral Palsy.
This study sought to determine the following: (1) the inherent differences of in-hospital characteristics and comorbidities between CP and non-CP patients undergoing total joint arthroplasty (TJA) and (2) do patients with CP have an increased risk of perioperative complications after TJA? METHODS: The Nationwide Inpatient Sample database from 2005 to 2014 was queried in this retrospective cohort study to compare patient demographics and comorbidities, hospital characteristics, perioperative complications, and length of stay in patients with CP undergoing TJA compared with their non-CP counterparts. Statistical analyses...
Source: The Journal of the American Academy of Orthopaedic Surgeons - June 12, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Best Practice Guidelines for Hip Arthroscopy in Femoroacetabular Impingement: Results of a Delphi Process.
CONCLUSION: We developed the first national consensus-based BPG for the surgical and nonsurgical management of FAI. The resulting consensus items can serve as a tool to reduce the variability in preoperative, intraoperative, and postoperative practices and guide further research for the arthroscopic management of FAI. PMID: 31181030 [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 - June 12, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Orthopaedic Osseointegration: State of the Art.
This article will review the history and biology of osseointegration, indications and contraindications for use of currently available implant systems, and reported outcomes. Future directions of orthopaedic osseointegration technology, including electronic systems capable of biomimetic bidirectional volitional motor control of, and sensory/proprioceptive feedback from, external prosthetic devices, will also be discussed. PMID: 31181031 [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 - June 12, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Revision Reverse Shoulder Arthroplasty.
Authors: Chalmers PN, Boileau P, Romeo AA, Tashjian RZ Abstract As shoulder arthroplasty becomes increasingly common, the burden of revision shoulder arthroplasty is also increasing. Revision reverse shoulder arthroplasty requires an understanding of the causes of failure and the evaluation of these causes and their sequelae, including infection, instability, component loosening, humeral bone loss, and glenoid bone loss. Revision reverse shoulder arthroplasty is technically complex. On the humeral side, corticotomy may be required for component removal, and bone grafting may be necessary to achieve rotational stabi...
Source: The Journal of the American Academy of Orthopaedic Surgeons - June 8, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Cervical Spine Deformity: Indications, Considerations, and Surgical Outcomes.
Authors: Cho SK, Safir S, Lombardi JM, Kim JS Abstract Cervical spinal deformity (CSD) in adult patients is a relatively uncommon yet debilitating condition with diverse etiologies and clinical manifestations. Similar to thoracolumbar deformity, CSD can be broadly divided into scoliosis and kyphosis. Severe forms of CSD can lead to pain; neurologic deterioration, including myelopathy; and cervical spine-specific symptoms such as difficulty with horizontal gaze, dysphagia, and dyspnea. Recently, an increased interest is shown in systematically studying CSD with introduction of classification schemes and treatment al...
Source: The Journal of the American Academy of Orthopaedic Surgeons - June 8, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Proximal Interphalangeal Joint Arthroplasty in Young Patients.
CONCLUSIONS: Younger age leads higher revision rates after PIP arthroplasty, particularly in the posttraumatic setting. LEVEL OF EVIDENCE: Therapeutic, level III. PMID: 31170098 [PubMed - in process] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - June 8, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Fracture of a Carbon Fiber Reinforced Intramedullary Femoral Nail.
We present the case of a failure of a carbon fiber reinforced intramedullary femoral nail used in a closed distal femur fracture. PMID: 31170099 [PubMed - in process] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - June 8, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Outcomes in Multidisciplinary Team-based Approach in Geriatric Hip Fracture Care: A Systematic Review.
CONCLUSIONS: Although a heterogeneous group of studies, the aggregate data from several studies using an orthogeriatrics care model or a geriatrics-led care model trend toward improvements across several clinical and cost-related outcome measures: decreased time to surgery, shorter length of stay, improved postoperative clinical outcomes, decreased mortality, and lower cost. PMID: 31157757 [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 - June 5, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Direct Lateral Approach for Triple Pelvic Osteotomy.
CONCLUSION: The direct lateral approach for TPO is equivalent to the anterolateral approach on radiographic evaluation. Advantages of the direct lateral approach include direct visualization of the ischial osteotomy, effective mobilization of the acetabulum, and safety of the sciatic nerve. PMID: 31157758 [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 - June 5, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Early Sport Specialization.
Authors: Popkin CA, Bayomy AF, Ahmad CS Abstract Recent estimates are that close to 30 million children between the ages of 6 and 18 years participate in team sport and close to 60 million in some type of organized athletics in the United States. This has resulted in an increase in sport-related injuries, but the reasons for this are complex and multifactorial. Sport participation offers multiple benefits for children and adolescents, but there is concern that early sport specialization (ESS) may lead to adverse health and social effects. ESS has been defined as intensive training or competition in organized sport ...
Source: The Journal of the American Academy of Orthopaedic Surgeons - June 5, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Posttraumatic Avascular Necrosis After Proximal Femur, Proximal Humerus, Talar Neck, and Scaphoid Fractures.
Authors: Large TM, Adams MR, Loeffler BJ, Gardner MJ Abstract Posttraumatic avascular necrosis (AVN) is osteonecrosis from vascular disruption, commonly encountered after fractures of the femoral neck, proximal humerus, talar neck, and scaphoid. These locations have a tenuous vascular supply; the diagnosis, risk factors, natural history, and treatment are reviewed. Fracture nonunion only correlates with AVN in the scaphoid. In the femoral head, the risk is increased for displaced fractures, but the time to surgery and open versus closed treatment do not seem to influence the risk. Patients with collapse are frequen...
Source: The Journal of the American Academy of Orthopaedic Surgeons - June 3, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Treating Preoperative Anemia to Improve Patient Outcomes After Orthopaedic Surgery.
Authors: Shanbhag SP, Solano MA, Botros MA, Khanuja HS Abstract For patients undergoing orthopaedic surgery, preoperative risk modification and control of comorbidities can maximize safety and improve outcomes. Anemia is common among orthopaedic patients, and its prevalence increases with patient age. Although surgeons are well versed in intraoperative blood conservation, preoperative anemia treatment is often deferred to primary care physicians, who may not understand the importance of a thorough assessment and treatment. Orthopaedic surgeons should understand the causes and treatments of anemia to advocate that p...
Source: The Journal of the American Academy of Orthopaedic Surgeons - June 3, 2019 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research