Does Surgery for Concomitant Cruciate and Meniscus Injuries Increase or Decrease Subsequent Comorbidities at 2 Years?

Concomitant cruciate and meniscus injuries of the knee are generally associated with acute trauma and commonly treated with surgical intervention. Comorbidities (simultaneous presence of two or more medical conditions) may be acquired from changes in activity levels and lifestyle after an injury and/or treatment. This study aimed to compare differences in comorbidity proportions between surgical and nonsurgical approaches in Military Health System beneficiaries who had concurrent cruciate and meniscus injuries.

Fungal osteomyelitis and septic arthritis in an immune competent man: The first report of invasive osteoarticular infection due to .

Invasive osteoarticular infections (IOI) due to Scedosporium spp. are rare in the immune competent patient, but have been associated with direct inoculation from antecedent trauma. Here we describe a case of IOI due to Scedosporium dehoogii in a previously healthy man.

Generating the American Shoulder and Elbow Surgeons Score Using Multivariable Predictive Models and Computer Adaptive Testing to Reduce Survey Burden.

Background: The preferred patient-reported outcome measure for the assessment of shoulder conditions continues to evolve. Previous studies correlating the Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive tests (CATs) to the American Shoulder and Elbow Surgeons (ASES) score have focused on a singular domain (pain or physical function) but have not evaluated the combined domains of pain and physical function that compose the ASES score. Additionally, previous studies have not provided a multivariable prediction tool to convert PROMIS scores to more familiar legacy scores.

What Is the Critical Tibial Resection Depth During Unicompartmental Knee Arthroplasty? A Biomechanical Study of Fracture Risk.

Background: Fracture after medial unicompartmental knee arthroplasty (UKA) is a rare complication. Biomechanical studies evaluating association between depth of resection and maximum load to failure are lacking. The purpose of this study is to establish the relationship between depth of resection of the medial tibial plateau and mean maximum load to failure.

A Protocol of Pose Avoidance in Place of Hip Precautions After Posterior-Approach Total Hip Arthroplasty May Not Increase Risk of Post-operative Dislocation.

Background: Post-operative rehabilitation after posterior-approach total hip arthroplasty (P-THA) includes the use of standard hip precautions, defined as no hip flexion beyond 90°, hip adduction, or hip internal rotation for 6 to 12 weeks after surgery (sometimes for life). Since they were first implemented in the 1970s, subsequent advances may have made standard hip precautions no longer necessary, although little evidence supports that hypothesis. A modified set of precautions, a "pose avoidance protocol," could be effective in enhancing recovery, but its effectiveness on early dislocation and post-surgical outcomes is not known.

Preoperative Management of Antithrombotics in Arthroplasty.

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.

Editorial Commentary: Hip Arthroscopy in a Military Population: Are the Results Comparable to an Athletic Population?

Hip pain is common in the military population and has led to an increase in hip arthroscopy as a means of therapeutic treatment. Return to duty (RTD) is the measure by which military surgeons tend to judge their outcomes; could the servicemember "get back in the fight?" Return to play (RTP) is a common metric in sports medicine for assessing the effectiveness of a surgical intervention. The results of prior studies of RTD hip arthroscopy in the US military population have been underwhelming when compared with RTP in athletic cohorts.

Contact Dermatitis Reaction to 2-Octyl Cyanoacrylate Following 3 Orthopedic Procedures.

Two-octyl cyanoacrylate is a popular skin adhesive used for closing surgical incisions. Since Food and Drug Administration approval in 1998, the few reports of adverse reactions following its use have primarily been limited to the nonorthopedic literature. The authors present a case series of contact dermatitis associated with 2-octyl cyanoacrylate following orthopedic surgery and a review of the literature on the diagnosis and treatment of this complication.

Using a non-invasive secure skin closure following total knee arthroplasty leads to fewer wound complications and no patient home care visits compared to surgical staples.

Background: Superficial wound complications occur in up to 10% of total knee arthroplasty (TKA) procedures and have been associated with periprosthetic joint infection. The ideal material for TKA closure should offer: 1) fast intraoperative application, 2) minimal wound complications and 3) removable by patients without assistance. We evaluated a novel, non-invasive, removable skin closure system for TKA to determine its effect on wound complications.

The Cost-Effectiveness of Dual Mobility Implants for Primary Total Hip Arthroplasty: A Computer-Based Cost-Utility Model.

Background: Dislocation remains a clinically important problem following primary total hip arthroplasty, and it is a common reason for revision total hip arthroplasty. Dual mobility (DM) implants decrease the risk of dislocation but can be more expensive than conventional implants and have idiosyncratic failure mechanisms. The purpose of this study was to investigate the cost-effectiveness of DM implants compared with conventional bearings for primary total hip arthroplasty.

What Are Normal Metal Ion Levels After Total Hip Arthroplasty? A Serologic Analysis of Four Bearing Surfaces.

Background: The recent experiences with adverse local tissue reactions have highlighted the need to establish what are normal serum levels of cobalt (Co), chromium (Cr), and titanium (Ti) after hip arthroplasty.

Methods: Serum Co, Cr, and Ti levels were measured in 80 nonconsecutive patients with well-functioning unilateral total hip arthroplasty and compared among 4 bearing surfaces: ceramic-on-ceramic (CoC); ceramic-on-polyethylene (CoP); metal-on-polyethylene (MoP), and dual mobility (DM). The preoperative and most recent University of California, Los Angeles (UCLA) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores were compared among the different bearing surfaces.

Capsular Preservation Using Suture Suspension Technique in Hip Arthroscopy for Femoroacetabular Impingement.

This article describes the use of sutures to enhance visualization while protecting the capsule in both the central and peripheral compartments during hip arthroscopy. We describe first a technique to preserve the proximal capsule cuff while working in the central compartment and then an alternative to the T-capsulotomy while maintaining excellent visualization of the peripheral compartment during femoroplasty of cam-type femoroacetabular impingement. By use of suture suspension of the capsule, multiple goals are achieved: The integrity of the proximal capsule cuff is maintained while aiding in visualization of the central compartment; the iliofemoral ligament is spared, which plays a critical role in preventing microinstability; the necessary space is created to obtain adequate visualization of the peripheral compartment for complete femoroplasty; and operative time is reduced because creation and subsequent repair of the T-capsulotomy can be avoided.

Incidence, indications, outcomes, and survivorship of stems in primary total knee arthroplasty.

Purpose: The indications, incidence, outcomes, and survivorship of stems in primary total knee arthroplasty (TKA) are lacking in the contemporary literature. Our hypothesis is stems in primary TKA would result in worse outcomes and survivorship.

Methods: All primary TKAs between 2007 and 2011 with 2-year follow-up were identified.

Magnetic Resonance Imaging Predicts Adverse Local Tissue Reaction Histologic Severity in Modular Neck Total Hip Arthroplasty.

Background: The association between advanced imaging, serum metal ion levels, and histologic adverse local tissue reaction (ALTR) severity has not been previously reported for Rejuvenate modular neck femoral stems.

Methods: A cohort of 90 patients with 98 Rejuvenate modular neck femoral stems was revised by a single surgeon from July 2011 to December 2014. Before revision, patients underwent multiacquisition variable resonance image combination sequence magnetic resonance imaging (MRI), and serum cobalt and chromium ion levels were measured.

Does Degenerative Lumbar Spine Disease Influence Femoroacetabular Flexion in Patients Undergoing Total Hip Arthroplasty?

Background: Sitting pelvic tilt dictates the proximity of the rim of the acetabulum to the proximal femur and, therefore, the risk of impingement in patients undergoing total hip arthroplasty (THA). Sitting position is achieved through a combination of lumbar spine segmental motions and/or femoroacetabular articular motion in the lumbar-pelvic-femoral complex. Multilevel degenerative disc disease (DDD) may limit spine flexion and therefore increase femoroacetabular flexion in patients having THAs, but this has not been well characterized.

Short-Term Outcomes and Complications After Rejuvenate Modular Total Hip Arthroplasty Revision.

Background: The early short-term outcomes and complications after revision of the recalled Rejuvenate modular neck hip arthroplasty have not been previously reported. This study's purpose is to describe the early outcomes and complications after revision of the Rejuvenate modular femoral neck.

Methods: A retrospective cohort included 92 patients with 92 Rejuvenate modular neck total hip arthroplasty (THA) who underwent revision surgery between July 2011 and April 2014.

Outcomes of Custom Flange Acetabular Components in Revision Total Hip Arthroplasty and Predictors of Failure.

Background: Custom triflange acetabular components (CTAC) have become more popular in the treatment of Paprosky type IIIB defects with an average survivorship of 80% at 4 years. Many studies report survivorship of CTAC, but radiographic parameters of CTAC success or failure have not been previously reported. The purpose of the study was to assess radiographic and patient factors predictive of failure in CTAC.

Short-Term Metal Ion Trends Following Removal of Recalled Modular Neck Femoral Stems.

Elevated serum metal ions have been well documented with the Rejuvenate modular neck femoral stem (Stryker, Mahwah, NJ); however, the rate at which ion levels decline following revision is less clear. This study included fifty-nine consecutive revisions of Rejuvenate stems for symptomatic ALTR. Blood tests prior to revision and postoperatively at 6weeks, 3months, 6months, and 1year measured serum cobalt and chromium concentrations, ESR, and CRP.

Management of segmental bone defects.

Segmental bone defects cause significant disability in patients. Modern orthopaedic surgical techniques have proved to be reliable for reconstruction of these defects. Autogenous bone graft remains the standard of care for reconstruction of small defects (<5 cm).

Arthroscopic and magnetic resonance arthrogram features of Kim's lesion in posterior shoulder instability.

Purpose: The purpose of this study was to describe the anatomic features of the glenoid and labrum for shoulders with and without Kim's lesions, as well as define the sensitivity, specificity, and reliability of magnetic resonance arthrogram for the detection of these lesions and determine the interobserver reliability of Kim's classification for posterior labral tears.

Methods: A retrospective, blinded analysis of 41 shoulders was performed. Twenty-one shoulders composed the Kim's lesion group.