Orthopedics Commons^™

Republication Of "Uses Of Braces And Orthotics For Conservative Management Of Foot And Ankle Disorders"., Osama Elattar, Tyler Smith, Adam Ferguson, Daniel Farber, Keith Wapner

Orthopedic Surgery Resident Research

Nonsurgical management is almost always considered the first-line treatment for the vast majority of foot and ankle pathologies. Foot orthoses, shoe modifications, and therapeutic footwear are considered essential tools for successful conservative management of different foot and ankle disorders. Orthopedic foot and ankle surgeons should have a meticulous understanding of the lower extremity biomechanics as well as the pathoanatomy and the sequelae of diseases affecting the foot and/or ankle. This is essential to the understanding of the desired effects of the different inserts, orthotics, shoe modifications, or braces that may be prescribed for these conditions. In this article, we will …

Comparing Pain And Pain Coping Mechanisms In Patients Undergoing Total Joint Arthroplasty As Part Of A Mission Trip To Those In The United States., Yash P. Chaudhry, Kevin L Mekkawy, Alyssa Wenzel, Claudia Campbell, Robert S Sterling, Harpal S Khanuja

Orthopedic Surgery Resident Research

BACKGROUND: Access to total joint arthroplasty can be difficult in low-resource settings. Service trips are conducted to provide arthroplasty care to populations in need around the world. This study aimed to compare the pain, function, surgical expectations, and coping mechanisms of patients from one such service trip to the United States.

METHODS: In 2019, the Operation Walk program conducted a service trip in Guyana during which 50 patients had hip or knee arthroplasties. Patient demographics, patient-reported outcome measures, questionnaires assessing pain attitudes and coping, and pain visual analog scales were collected preoperatively and at 3 months postoperatively. These outcomes were …

Comparison Of Sports Medicine Questions On The Orthopaedic In-Training Examination Between 2009 And 2012 And 2017 And 2020 Reveals An Increasing Number Of References, Brandon Klein, Mark Lagreca, Peter B. White, Robert Trasolini, Randy M. Cohn

Orthopedic Surgery Resident Research

Purpose

To provide an updated analysis of the sports medicine section of the Orthopedic In-Training Examination (OITE).

Methods

A cross-sectional review of OITE sports medicine questions from 2009 to 2012 and 2017-2020 was performed. Subtopics, taxonomy, references, and use of imaging modalities were recorded and changes between the time periods were analyzed.

Results

The most tested sports medicine subtopics included ACL (12.6%), rotator cuff (10.5%), and throwing injuries to the shoulder (7.4%) in the early subset, while ACL (10%), rotator cuff (6.25%), shoulder instability (6.25%), and throwing injuries to the elbow (6.25%) were the most common in the later subset. …

Comparing Five Equations To Calculate Estimated Glomerular Filtration Rate To Predict Acute Kidney Injury Following Total Joint Arthroplasty., Kevin L Mekkawy, Yash P Chaudhry, Sandesh S Rao, Micheal Raad, Raj M Amin, Harpal S Khanuja

Orthopedic Surgery Resident Research

BACKGROUND: Acute kidney injury (AKI) following total joint arthroplasty (TJA) is associated with increased morbidity and mortality. Estimated glomerular filtration rate (eGFR) is used as an indicator of renal function. The purpose of this study was (1) to assess each of the five equations that are used in calculating eGFR, and (2) to evaluate which equation may best predict AKI in patients following TJA.

METHODS: The National Surgical Quality Improvement Program (NSQIP) was queried for all 497,261 cases of TJA performed from 2012 to 2019 with complete data. The Modification of Diet in Renal Disease (MDRD) II, re-expressed MDRD II, …

One And A Half-Stage Revision With Prosthetic Articulating Spacer For Definitive Management Of Knee Periprosthetic Joint Infection., Ahmed Siddiqi, Yusuf Mahmoud, Salvador A. Forte, Thomas A Novack, James Nace

Orthopedic Surgery Resident Research

This paper is a comprehensive review that describes indications, contraindications, clinical outcomes, and pearls and pitfalls of 1.5-stage revision total knee arthroplasty (TKA) utilizing a primary TKA femoral component, all-polyethylene tibial component, and hand-crafted antibiotic cement for the management of chronic periprosthetic joint infection. The 1.5-stage exchange TKA details placement of an articulating spacer for an indefinite period, prolonging revision until reinfection, deterioration of functional status, or construct failure. A 1.5-stage revision TKA technique is a viable option for treatment of chronic periprosthetic knee infections. The inherent advantages of decreased health-care costs, decreased morbidity and mortality, and improved emotional ease …

Not All Patients Need Supervised Physical Therapy After Primary Total Knee Arthroplasty: A Systematic Review And Meta-Analysis., Yash P Chaudhry, Hunter Hayes, Zachary Wells, Efstratios Papadelis, Harpal S Khanuja, Carl Deirmengian

Orthopedic Surgery Resident Research

Although postoperative physical therapy (PT) has long been considered essential to successful total knee arthroplasty (TKA) recovery, recent literature has suggested that unsupervised home exercise regimens may offer similar benefits to formal supervised sessions. We aimed to compare objectively measured physical function and subjective patient-reported outcomes (PROs) between primary TKA patients who received formal supervised physical therapy sessions and those who received unsupervised home exercise regimens after discharge. Six electronic databases were queried to identify randomized controlled trials comparing supervised physical therapy to unsupervised home exercise regimens in primary TKA patients after discharge. Outcomes of interest included change from baseline …

Arthroscopic Suprapectoral Biceps Tenodesis: The Best Of Both Worlds, Tyler Pratte, Tyler Smith, Alfonso Arevalo, Joseph Wazen, David Rubenstein

Orthopedic Surgery Resident Research

Biceps tendinopathy and superior labrum anterior posterior lesions are a common source of shoulder pain and disability and can be effectively treated with biceps tenodesis. There are a variety of open and arthroscopic tenodesis techniques, but no one technique has demonstrated superiority. Arthroscopic techniques often disregard the extra-articular portions of the biceps tendon as a potential source of pain. Open techniques address this concern; however, they can be associated with wound complications, increased blood loss, nerve injury, and disruptions to surgical workflow. Here, we describe an all arthroscopic tenodesis technique at the suprapectoral zone of the tendon. This method addresses …

Unsupervised Home Exercises Versus Formal Physical Therapy After Primary Total Hip Arthroplasty: A Systematic Review, Yash P. Chaudhry, Hunter Hayes, Zachary Wells, Efstratios Papadelis, Alfonso Arevalo, Timothy Horan, Harpal S Khanuja, Carl Deirmengian

Orthopedic Surgery Resident Research

Historically, postoperative exercise and physical therapy (PT) have been viewed as crucial to a successful outcome following primary total hip arthroplasty (THA). This systematic review and meta-analysis aimed to assess differences in both short- and long-term objective and self-reported measures between primary THA patients with formal supervised physical therapy versus unsupervised home exercises after discharge. A search was conducted of six electronic databases from inception to December 14, 2020, for randomized controlled trials (RCTs) comparing changes from baseline in lower extremity strength (LES), aerobic capacity, and self-reported physical function and quality of life (QoL) between supervised and unsupervised physical therapy/exercise …

Laboratory-Reported Normal Value Ranges Should Not Be Used To Diagnose Periprosthetic Joint Infection., Salvador A. Forte, Joseph A. D'Alonzo, Zachary Wells, Brett Levine, Stephen Sizer, Carl Deirmengian

Orthopedic Surgery Resident Research

INTRODUCTION: Clinical laboratories offer several multipurpose tests, such as the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), which are not intended to diagnose any specific disease but are used by clinicians in multiple fields. The results and laboratory interpretation (normal/abnormal) of these multipurpose tests are based on laboratory-reported normal thresholds, which vary across clinical laboratories. In 2018, the International Consensus Meeting on Musculoskeletal Infection (2018 ICM) provided a gold-standard definition to diagnose periprosthetic joint infection (PJI) which included many multipurpose laboratory tests, along with thresholds optimized to diagnose PJI. The discrepancy between laboratory-reported normal thresholds and 2018 ICM-recommended PJI-optimized …

Systematic Review Of Prevalence, Risk Factors, And Management Of Instability Following Reverse Shoulder Arthroplasty, Jeffrey J. Olson, Michael D. Galetta, Rachel E. Keller, Luke S. Oh, Evan A. O'Donnell

Orthopedic Surgery Resident Research

Background

Since its approval for use, reverse shoulder arthroplasty (RSA) has become the primary treatment for cuff tear arthropathy, with indications expanding more recently to include revision fracture, osteoarthritis with significant glenoid bone loss, tumor, and chronic instability. Instability is a well-described postoperative complication, occurring in 1to 31% of relatively small cohorts and case series. Given the relative infrequency of instability, there remains a need for a comprehensive review of instability with a focus on risk factors and management. Our goal of this systematic review is to describe the prevalence, risk factors, and management strategies for instability …

A Scoping Review Of Injuries In Amateur And Professional Men's Ice Hockey, Patrick F Szukics, Peters T Otlans, Alfonso Arevalo, Matthew Meade, Peter Deluca, John P Salvo

Orthopedic Surgery Resident Research

Background: Orthopaedic injuries are common in ice hockey at all levels and can result in physical and psychological adverse effects on these athletes.

Purpose: Primarily, to summarize published data on orthopaedic hockey injuries at the junior through professional level. Secondarily, to characterize the literature based on anatomic site injured, return-to-play rates, cause/mechanism of injury, time lost, and treatments used.

Study Design: Scoping review; Level of evidence, 4.

Methods: PubMed, EMBASE, Cochrane library, and SCOPUS were searched using the terms "hockey" and "injuries" using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, and 4163 studies involving orthopaedic injuries were …

A Scoping Review Of Injuries In Amateur And Professional Men's Ice Hockey., Patrick F Szukics, Peters T Otlans, Alfonso Arevalo, Matthew Meade, Peter Deluca, John P Salvo

Orthopedic Surgery Resident Research

Background: Orthopaedic injuries are common in ice hockey at all levels and can result in physical and psychological adverse effects on these athletes.

Purpose: Primarily, to summarize published data on orthopaedic hockey injuries at the junior through professional level. Secondarily, to characterize the literature based on anatomic site injured, return-to-play rates, cause/mechanism of injury, time lost, and treatments used.

Study Design: Scoping review; Level of evidence, 4.

Methods: PubMed, EMBASE, Cochrane library, and SCOPUS were searched using the terms "hockey" and "injuries" using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, and 4163 studies involving orthopaedic injuries were …

Reducing Unnecessary Crossmatching For Hip Fracture Patients By Accounting For Preoperative Hemoglobin Concentration, Raj M Amin, Varun Puvanesarajah, Yash P Chaudhry, Matthew J Best, Sandesh S Rao, Steven M Frank, Erik A Hasenboehler

Orthopedic Surgery Resident Research

BACKGROUND: Maximum surgical blood order schedules were designed to eliminate unnecessary preoperative crossmatching prior to surgery in order to conserve blood bank resources. Most protocols recommend type and cross of 2 red blood cell (RBC) units for patients undergoing surgery for treatment of hip fracture. Preoperative hemoglobin has been identified as the strongest predictor of inpatient transfusion, but current maximum surgical blood order schedules do not consider preoperative hemoglobin values to determine the number of RBC units to prepare prior to surgery.

AIM: To determine the preoperative hemoglobin level resulting in the optimal 2:1 crossmatch-to-transfusion (C:T) ratio in hip fracture …

A Clinical Review Of Robotic Navigation In Total Knee Arthroplasty: Historical Systems To Modern Design., Ahmed Siddiqi, Timothy Horan, Robert M Molloy, Michael R Bloomfield, Preetesh D Patel, Nicolas S Piuzzi

Orthopedic Surgery Resident Research

Robotic-assisted total knee arthroplasty (RA-TKA) has shown improved reproducibility and precision in mechanical alignment restoration, with improvement in early functional outcomes and 90-day episode of care cost savings compared to conventional TKA in some studies. However, its value is still to be determined.Current studies of RA-TKA systems are limited by short-term follow-up and significant heterogeneity of the available systems.In today's paradigm shift towards an increased emphasis on quality of care while curtailing costs, providing value-based care is the primary goal for healthcare systems and clinicians. As robotic technology continues to develop, longer-term studies evaluating implant survivorship and complications will determine …

Return To Play Rates After Ulnar Nerve Transposition And Decompression Surgery: A Retrospective Analysis., Christopher J Hadley, Anant Dixit, John Kunkel, Alex E White, Michael G Ciccotti, Steven B Cohen, Christopher C Dodson

Orthopedic Surgery Resident Research

Background: Medial elbow pain is a common complaint in overhead throwing athletes. The throwing motion places repetitive tensile and compressive forces on the elbow resulting in significant stress across the ulnohumeral joint. This stress can result in soft-tissue, ligamentous, and ulnar nerve injury. The purpose of this study was to retrospectively investigate the clinical findings and outcomes, including return to play rates, of patients who underwent ulnar nerve transposition surgery for isolated ulnar neuritis.

Methods: Throwing athletes who underwent isolated, primary ulnar nerve transposition surgery over an eight-year period, 2009 to 2017, were identified and included in our analysis. Nonthrowing …

The Modern Use Of The Extended Humeral Head (Cuff Tear Arthropathy) Hemiarthroplasty., Tyler J Smith, Sarav S Shah, Justin W Peterson, Glen Ross

Orthopedic Surgery Resident Research

Today, the treatment of osteoarthritis in the rotator cuff-deficient population is largely dominated by reverse shoulder arthroplasty (RSA). Despite the popularity of and increased familiarity with this procedure, the complication rate of RSA remains significant. An extended humeral head hemiarthroplasty may provide a less invasive alternative for select patients with cuff tear arthropathy (CTA) and preserved glenohumeral active elevation. With the indications for reverse arthroplasty expanding to younger patients, there are concerns about the longevity of this implant, as well as the associated revision burden. In the setting of failed RSA, the bone stock available for glenosphere baseplate fixation can …

Clinical Outcomes Of Superior Capsular Reconstruction For Massive, Irreparable Rotator Cuff Tears: A Systematic Review Comparing Acellular Dermal Allograft And Autograft Fascia Lata, Tyler J. Smith, Anirudh K. Gowd, John Kunkel, Lisa Kaplin, John B. Hubbard, Kevin E. Coates, Benjamin R. Graves, Brian R. Waterman

Orthopedic Surgery Resident Research

Purpose: To investigate clinical outcomes after superior capsular reconstruction (SCR) for the treatment of massive and/or irreparable rotator cuff tears treated with either allograft or autograft. Methods: Using the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines, in April 2020 a systematic review was performed using PubMed, MEDLINE, EMBASE, and Cochrane databases. Clinical studies were assessed for patient-reported outcomes and range of motion, comparing dermal allografts to fascia lata autografts, with a minimum follow-up of 12 months. Results: A total of 16 clinical studies involving 598 patients (606 shoulders) were included for data analysis, with a weighted …

Obesity And Its Effect On Outcomes In Same-Day Bilateral Total Knee Arthroplasty, Ethan A Remily, Nequesha S Mohamed, Wayne A Wilkie, Tyler Smith, Anthony Judice, Salvador Forte, James Nace, Ronald E Delanois

Orthopedic Surgery Resident Research

Background: The niche surgery of same-day bilateral total knee arthroplasty (sd-BTKA) continues to create debate amongst specialists in arthroplasty. To date, there is a significant lack of literature on obese patients undergoing sd-BTKA, and no study has evaluated outcomes of this procedure when compared to non-obese patients. Therefore, this study will perform a retrospective analysis to compare (I) incidence, (II) demographics, and (III) complications of sd-BTKA in non-obese, obese, and morbidly obese patients in the United States from 2009 to 2016.

Methods: The National Inpatient Sample (NIS) database was queried for all individuals that underwent sd-BTKA from 2009 to 2016. …

Risk Factors For Liposomal Bupivacaine Resistance After Total Hip Or Knee Arthroplasties: A Retrospective Observational Cohort In 237 Patients, Scott Buzin, Arianna L. Gianakos, Deborah Li, Anthony Viola, Sherif Elkattawy, David M. Keller, Richard S. Yoon, Frank A. Liporace

Orthopedic Surgery Resident Research

Purpose: Liposomal bupivacaine demonstrated promise decreasing postoperative pain in total hip and total knee arthroplasty (THA/TKA). Some randomized trials have shown non-superior results; however, confounding variables were not accounted for in such analyses. This study attempts to determine risk factors associated with failure of pain management in patients receiving liposomal bupivacaine.

Methods: Postoperative pain scores were collected following primary or revision arthroplasties between January 2016 and December 2017. Retrospective analysis of institutional total joint quality and outcomes registry was screened and patients undergoing primary or revision arthroplasties who completed a multi-modal pain management including liposomal bupivacaine were included in the …

Isolated Large Glenoid Fracture In Acute Glenohumeral Dislocation In The Elderly: A Novel Indication For Reverse Shoulder Arthroplasty, Tyler Smith, Joseph D'Alonzo, Alfonso Arevalo, Jack Kazanjian

Orthopedic Surgery Resident Research

Case: Two elderly males presented with traumatic shoulder dislocation and bony Bankart fracture consisting of greater than 25% of the glenoid width. Due to several concomitant factors such as polytrauma, activity level, rotator cuff pathology, optimization of comorbidities, risk of complications, and potential for revision surgery, the patients were treated with reverse shoulder arthroplasty (RSA).

Conclusion: RSA may be a satisfactory treatment option for isolated, large glenoid fractures associated with anterior glenohumeral instability in the elderly. These patients are susceptible to rapid deconditioning with prolonged immobilization and may not be medically suited to undergo the prolonged recovery period associated with …

Marjolin's Tumor Complicating Chronic Periprosthetic Infection Of A Total Knee Arthroplasty, Timothy Horan, Matthew T. Wallace, Albert J. Aboulafia, Janet D. Conway

Orthopedic Surgery Resident Research

Marjolin's tumor is a term used to describe a malignancy developing in the setting of a chronic wound, infection, or other tissue subject to chronic inflammatory changes. These malignancies usually present after many years of chronicity, and can range from lower grade basal cell carcinomas to high-grade sarcomas. We present the case of a squamous cell carcinoma that developed within a chronic periprosthetic infection of a total knee arthroplasty of 7 years duration. The intra-articular location, association with an orthopaedic implant, and brief latency period are all unique features of this case.

Intraoperative Femoral Head Dislodgement During Total Hip Arthroplasty: A Report Of Four Cases, Ahmed Siddiqi, Carl T. Talmo, James V. Bono

Orthopedic Surgery Resident Research

Dislodgment of trial femoral heads and migration into the pelvis during total hip arthroplasty is a rarely reported complication with limited published cases. There are three primary mechanisms of femoral head separation: dislodgement during reduction attempt, disassociation from anterior dislocation while assessing anterior stability, and during dislocation after implant trialing. If the trial femoral migrates beyond the pelvic brim, it is safer to finish the total hip arthroplasty and address the retained object after repositioning or in a planned second procedure with a general surgeon. We recommend operative retrieval since long-term complications from retention or clinical results are lacking.