Outcomes of Scapular Osteosarcoma.

Background/aim: Scapular osteosarcoma is a rare malignancy, and the understanding of its optimal treatment strategies and long-term outcomes remains limited. The purpose of the current study was to evaluate our institutional experience.

Patients And Methods: We reviewed 14 patients (8 females, 5 males; mean age 44±17 years) treated for scapular osteosarcoma from 1985 to 2022.

Upper Extremity Mass as First Presentation of Metastatic Urothelial Carcinoma.

A 77-year-old woman presented with metastatic urothelial carcinoma as an elbow mass. To our knowledge, this is only the third reported case of urothelial carcinoma metastasizing to the upper extremity. The presence of metastatic disease at the time of diagnosis of urothelial carcinoma is rare, with metastases to the upper extremities even less common.

Do All Postoperative Vancouver B2 Fractures Require Revision Arthroplasty With Cementless Stems?

Background: Management of periprosthetic fractures has been guided by the Vancouver classification, which recommends revision for fractures around a loose femoral implant (B2). New studies have challenged this approach, demonstrating acceptable outcomes with internal fixation. This study evaluates our experience with Vancouver B2 fractures, comparing internal fixation to femoral revision.

Dexamethasone, Glycemic Control, and Outcomes in Patients With Type 2 Diabetes Mellitus Undergoing Elective, Primary Total Joint Arthroplasty.

Background: Dexamethasone (DEX) has been shown to reduce pain and postoperative nausea and vomiting for patients undergoing elective total joint arthroplasty (TJA). We investigated the impact of DEX on glycemic control and outcomes in patients with type 2 diabetes mellitus undergoing elective primary TJA.

Methods: All patients with type 2 diabetes mellitus undergoing primary elective TJA between January 2016 and December 2021 at 4 sites within 1 hospital system were identified.

Transplant selection simulation: Liver transplantation for alcohol-associated hepatitis.

Liver transplantation (LT) for alcohol-associated hepatitis (AH) remains controversial due to concerns about candidate selection subjectivity, post-LT alcohol relapse, and the potential exacerbation of LT disparities. Our aim was to design, perform, and examine the results of a simulated selection of candidates for LT for AH. Medical histories, psychosocial profiles and scores, and outcomes of 4 simulation candidates were presented and discussed at 2 multidisciplinary societal conferences with real-time polling of participant responses.

Patient specific implants versus conventional implants in primary total knee arthroplasty: No significant difference in patient reported outcomes at 5 years.

Background: Patient specific implants (PSI) represent a novel innovation aimed to improve patient satisfaction and function after total knee arthroplasty (TKA); however, longitudinal patient reported outcome measures (PROMs) for PSI are not well described. We sought to primarily evaluate PROMs of patients undergoing TKA with either PSI or off-the-shelf (OTS) implants at mid-term follow-up.

Methods: A retrospective review was performed on a prospectively collected cohort of 43 primary, cruciate-retaining TKAs performed with PSI (n = 23) and OTS implants (n = 20) by a single surgeon.

The Development and Early Experience of a Destination Center of Excellence Program for Total Joint Arthroplasty.

High-volume total joint arthroplasty centers are becoming designated as destination centers of excellence to ensure quality of care while containing costs. This study aimed to evaluate the surgical patient journey through a new destination center of excellence program, review acute perioperative course trajectories, and report clinical outcomes. Our institution developed and implemented a destination center of excellence program to integrate into the existing total joint arthroplasty practice.

Total Hip and Knee Arthroplasty in Solid Organ Transplant Patients: Perioperative Optimization and Outcomes.

The success of renal, liver, cardiac, pulmonary, and other solid organ transplantation (SOT) has resulted in increasing volume of transplant procedures and recipient survivorship. Subsequently, many SOT patients develop end-stage degenerative joint disease and are presenting for total hip or total knee arthroplasty more frequently. Surgeons must be aware of the medical complexities and prepare for the perioperative risks associated with these immunocompromised patients.

Soft Tissue Tumors: Diagnosis, Treatment, and Follow-up from the Orthopedic Oncologist Perspective.

This article focuses on soft tissue sarcomas, including the workup, management, and potential complications in dealing with these rare mesenchymal tumors. We present the information that is critical in the decision-making process for orthopedic oncologists to help facilitate a multidisciplinary approach to these complex cases.

Skeletal Sarcomas: Diagnosis, Treatment, and Follow-up from the Orthopedic Oncologist Perspective.

This article focuses on skeletal sarcomas, a group of rare, heterogenous malignant tumors. We present information on the multi-disciplinary approach to the diagnosis, staging, treatment, and surveillance of these complex tumors that are critical to enhancing function and improving survival.

A Prospective Evaluation of Intraoperative Indocyanine Green Fluorescence Angiography for Soft Tissue Sarcomas.

Introduction: Postoperative wound complications after resection of soft-tissue sarcomas are challenging. Indocyanine green (ICG) angiography has previously been used to predict wound complications, but not for soft-tissue sarcomas. We aimed to evaluate whether this technology could help lower wound complications after soft-tissue sarcoma resections.

Immersive Virtual Reality Used as Adjunct Anesthesia for Conversion Total Hip Arthroplasty in a 100-Year-Old Patient.

Immersive virtual reality (IVR) is an adjunctive form of anesthesia intended to distract patients from their intraoperative environment and reduce other side effects of sedating or narcotic agents. While this technology has been applied sparingly in various orthopedic procedural environments, its clinical utility has not been widely evaluated in major, nonelective surgical settings. The use of IVR in the geriatric hip fracture population represents a novel indication with potential benefit to reduced cognitive dysfunction and delirium.

A Comparison of Interobserver Reliability Between Orthopedic Surgeons Using the Centers for Disease Control Surgical Wound Class Definitions.

Background: The Centers for Disease Control (CDC) created a classification to help stratify surgical wounds based on contamination and risk of developing a surgical site infection. The classification includes four options (I to IV) depending on the level of contamination present. Although universally applied to a variety of surgical specialties, it is unknown whether the current system is reliable when considering orthopaedic surgeries.

Outcomes of Total Hip Arthroplasty Via the Direct Anterior vs Alternative Approaches for Acute Femoral Neck Fractures.

Background: Total hip arthroplasty (THA) performed for displaced femoral neck fractures (FNF) is becoming a more frequent treatment in the active elderly population. The complication profiles associated with THA surgical approaches in the fracture setting are unclear. The purpose of this study was to compare a series of THA for FNF performed via the direct anterior (DA) approach vs alternative approaches (anterolateral and posterolateral).

Reconstruction of Quadriceps Muscle Function Using the Latissimus Dorsi Muscle Transfer in an Elderly Patient: A Case Report.

Case: We report a case of a 71-year-old man diagnosed with high-grade undifferentiated pleomorphic sarcoma in the left thigh. He underwent partial resection of the quadriceps and proximal femoral bone, followed by reconstruction with a latissimus dorsi free muscle flap through end-to-end vascular and nerve anastomosis with the femoral vessels and a branch of the femoral nerve, respectively. Recovery of 3/5 knee extension function was achieved 3 months postsurgery without complications.

Disseminated Legionella micdadei infection in a liver transplant patient presenting as pulmonary nodules and a laryngeal lesion.

We report a liver transplant patient with disseminated Legionella micdadei infection with pulmonary, laryngeal, and suspected muscle involvement. This organism, which stains weakly acid-fast, primarily affects immunocompromised patients. The diagnosis is difficult to make; in this case, the organism was identified via molecular diagnostics on laryngeal and pulmonary biopsy tissue.

Provider Attitudes and Practices for Alcohol Screening, Treatment, and Education in Patients With Liver Disease: A Survey From the American Association for the Study of Liver Diseases Alcohol-Associated Liver Disease Special Interest Group.

Background & Aims: While abstinence-promoting behavioral and pharmacotherapies are part of the therapeutic foundation for alcohol use disorder (AUD) and alcohol-associated liver disease (ALD), these therapies, along with alcohol screening and education, are often underutilized. Our aim was to examine provider attitudes and practices for alcohol screening, treatment and education in patients with liver disease.

Methods: We conducted a survey of primarily (89%) hepatology and gastroenterology providers within (80%) and outside the United States (20%).

A Crossover Cohort of Direct Anterior vs Posterolateral Approach in Primary Total Hip Arthroplasty: What Does the Patient Prefer?

Background: The utilization of the direct anterior approach (DAA) for total hip arthroplasty (THA) continues to markedly increase. Despite proposed advantages, there are limited data regarding outcomes of staged bilateral THA via 2 different approaches in the same patient. The purpose of this study was to elucidate patient perspective on the THA approach in a crossover cohort of patients who underwent consecutive THAs via the posterolateral approach (PLA) followed by a contralateral DAA.

Intraoperative Indocyanine Green Fluorescence Angiography Is Sensitive for Predicting Postoperative Wound Complications in Soft-Tissue Sarcoma Surgery.

Introduction: Indocyanine green (ICG) angiography is a novel technology that has been predictive of postoperative wound complications. It is unknown whether this technology can successfully predict complications after sarcoma resection. In this study, we aimed to evaluate the sensitivity and specificity of ICG angiography in predicting postoperative wound complications after soft-tissue sarcoma resection.

Robotic-Assisted versus Manual Total Knee Arthroplasty in a Crossover Cohort: What Did Patients Prefer?

Background: Robotic-assisted total knee arthroplasty represents an increasingly utilized surgical technology; however, there remains clinical question whether the technique produces improved clinical and patient-reported outcomes. The purpose of this study was to evaluate early clinical outcomes and patient preference of robotic-assisted total knee arthroplasty (rTKA) versus manual TKA (mTKA) in a direct crossover cohort of patients who underwent consecutive TKAs by each technique.

Materials And Methods: A retrospective chart review and telephone interview was performed on 36 patients who underwent both rTKA and mTKA by a single surgeon between 2012-2018.