The potential of accelerometers in the evaluation of stability of total knee arthroplasty.

An accelerometer attached to the anterior proximal tibia was investigated as an evaluation of knee stability of Total Knee Arthroplasty (TKA) patients while performing daily activities. Acceleration data of 38 TKA knees with a minimum follow up of 6months were compared with 34 control knees. The activities performed were: walking three steps forward and coming to a sudden stop; turning in the direction of non-tested knee; sit-to-stand; and stepping up and down from a 7 inch step.

Hip fracture management: tailoring care for the older patient.

Hip fracture is a potentially devastating condition for older adults. Hip fracture leads to pain and immobilization with complications ranging from delirium to functional loss and death. Although a mainstay of treatment is orthopedic repair, a multidisciplinary comanagement approach, including medical specialists and rehabilitation, may maximize patient recovery.

The rising incidence of arthroscopic superior labrum anterior and posterior (SLAP) repairs.

Background: Superior labrum anterior-posterior (SLAP) lesions of the shoulder that require surgical repair are relatively uncommon. However, recent observations suggest that there may be a rise in the incidence of SLAP lesion repair.

Materials And Methods: The Statewide Planning and Research Cooperative Systems (SPARCS) database from the New York State Department of Health was used to acquire data for all outpatient ambulatory surgery procedures that were performed in New York State from 2002 to 2010.

The rotator cable: magnetic resonance evaluation and clinical correlation.

The rotator cable is an extension of the coracohumeral ligament coursing along the undersurface of the supraspinatus and infraspinatus tendons. The rotator cable is thought to play a role in the biomechanical function of the intact and torn rotator cuff. It can be seen on all the imaging planes used for the conventional magnetic resonance imaging of the shoulder.

Reverse total shoulder arthroplasty for failed shoulder arthroplasty.

Introduction: Shoulder arthroplasty provides excellent outcomes for most patients; however, a subset of these patients with a failed arthroplasty will require revision. Recently, the reverse total shoulder arthroplasty (rTSA) has been used in these difficult clinical situations. Therefore, we sought to examine our initial experience using rTSA as a treatment for failed shoulder arthroplasty.

Luxatio erecta: case series with review of diagnostic and management principles.

We reviewed 11 cases of luxatio erecta (inferior shoulder dislocation) managed acutely at our institutions to gain insight into the diagnostic and management principles of this condition. We then compared our findings with those in the current literature. Luxatio erecta requires careful clinical and radiographic evaluation and a high index of suspicion for associated injuries, as they occur frequently and can be significant given their tendency to be associated with higher energy trauma.

Degenerative arthritis of the knee secondary to ochronosis.

Alkaptonuria is a rare disease in which a deficiency in the homogentisate 1, 2-dioxygenase enzyme results in a buildup of homogentisic acid. Ochronosis, the deposition of excess homogentisic acid in connective tissue, causes brownish-black pigmentation and weakening of the tissue ultimately resulting in chronic inflammation, degeneration, and osteoarthritis. There is currently no definitive cure for alkaptonuric ochronosis, and management is usually symptomatic.

Fracture site augmentation with calcium phosphate cement reduces screw penetration after open reduction-internal fixation of proximal humeral fractures.

Background: We sought to examine fracture settling and screw penetration after open reduction-internal fixation of 2-, 3-, and 4-part proximal humeral fractures and determine whether the use of calcium phosphate cement reduced these unwanted complications.

Methods: We performed a retrospective study of prospective data. Inclusion criteria included patient age of 18 years or older and an acute traumatic fracture of the proximal humerus that was treated with open reduction-internal fixation with a locked plate.

Three- and four-part fractures have poorer function than one-part proximal humerus fractures.

Background: Locking plates have become a commonly used fixation device in the operative treatment of three- and four-part proximal humerus fractures. Examining function in patients treated nonoperatively and operatively should help determine whether and when surgery is appropriate in these difficult-to-treat fractures.

Questions/purposes: We compared functional scores, ROM, and radiographs in patients with one-part proximal humerus fractures treated nonoperatively to those in patients with displaced three- and four-part proximal humerus fractures treated with open reduction and internal fixation using locking plates.

Return to sports after shoulder arthroplasty: a survey of surgeons' preferences.

Background: Shoulder arthroplasty has become more prevalent, and patients undergoing shoulder arthroplasty are becoming more active. Recommendations for return to athletic activity have not recently been updated and do not consider the newest arthroplasty options.

Methods: A survey was distributed to 310 members of the American Shoulder and Elbow Surgeons, inquiring about allowed participation in 28 different athletic activities after 5 types of shoulder arthroplasty options (total shoulder arthroplasty, hemiarthroplasty, humeral resurfacing, total shoulder resurfacing, and reverse shoulder arthroplasty).

Blood, bugs, and motion - what do we really know in regard to total joint arthroplasty?

In total joint arthroplasty, it is often necessary to formulate decisions that are not clearly evidence-based. This review presents some current controversial topics in total joint arthroplasty, including preoperative autologous blood donation versus erythropoietin (EPO) usage, preoperative screening and treatment for methicillin resistant Staphylococcus aureus (MRSA), and the use of continuous passive motion (CPM) following total knee arthroplasty, providing an evidence-based guide for the treating orthopaedic surgeon. Our review shows that preoperative autologous blood donation is over utilized, with EPO being under utilized.

Success in orthopaedic training: resident selection and predictors of quality performance.

Multiple studies have attempted to determine which attributes are predictive of success during residency as well as the optimal method of selecting residents who possess these attributes. Factors that are consistently ranked as being important in the selection of candidates into orthopaedic residency programs include performance during orthopaedic rotation, United States Medical Licensing Examination (USMLE) Step 1 score, Alpha Omega Alpha Honor Medical Society membership, medical school class rank, interview performance, and letters of recommendation. No consensus exists regarding the best predictors of resident success, but trends do exist.

Analysis of reverse total shoulder joint forces and glenoid fixation.

Reverse total shoulder arthroplasty (rTSA) implants are intended to restore stability and function to shoulders with rotator cuff deficiency. The implant consists of a glenosphere projecting from a glenoid baseplate and articulating in a socket at the proximal end of a humeral component. Despite the demonstrated clinical efficacy, little information is available regarding the joint forces about this construct and the stability of the glenoid component against these forces.

Management of humeral and glenoid bone loss--associated with glenohumeral instability.

Unlabelled: Anterior glenohumeral instability complicated by bone loss is a challenging problem and, when severe, may require surgical treatment with bone grafting. We review our institution's experience with humeral head and glenoid bone grafting for large Hill-Sachs lesions and glenoid defects.

Materials And Methods: Patients who underwent intra-articular bone reconstruction for Hill-Sachs and large glenoid defects for anterior instability at our institution during 2002-2008 were retrospectively reviewed.

Frozen shoulder: a consensus definition.

Introduction: Frozen shoulder (FS) is a common diagnosis treated by orthopaedic surgeons and other physicians caring for musculoskeletal problems. However, there is no standard definition and classification for this common condition.

Materials And Methods: We asked 211 clinician members of the American Shoulder and Elbow Surgeons to review our proposed definition of FS and its classification into primary and secondary types.

Athletic participation after hip and knee arthroplasty.

The issue of athletic participation after hip and knee arthroplasty has become more relevant in recent years, with an increase in the number of young and active patients receiving joint replacements. This article reviews patient-, surgery-, implant-, and sports-related factors, and discusses currently available guidelines that should be considered by the physician when counseling patients regarding a return to athletic activity after total joint arthroplasty. Current evidence regarding appropriate athletic participation after total hip arthroplasty, resurfacing hip arthroplasty, total knee arthroplasty, and unicondylar knee arthroplasty is reviewed.

Bilateral stress fractures of the pubic rami following THA--an unusual case of groin pain.

Stress fractures of the pubic rami are rare occurrences and most frequently occur in association with total hip arthroplasty (THA). Reported historically with both cemented and noncemented THA components, postoperative stress fractures likely occur secondary to a rapid postoperative increase in patient activity following years of disability. Though stress fractures of the pubic rami should be considered in the differential diagnosis of groin pain following THA, they require a high degree of suspicion.

Assessment of arthroscopic training in U.S. orthopedic surgery residency programs--a resident self-assessment.

Background: There has been an increasing number of arthroscopic surgeries performed in general orthopedic surgery practice, as well as a rapid evolution of arthroscopic techniques. The objective of this investigation was to assess the adequacy of arthroscopic training in U.S.

Recovery of shoulder strength and proprioception after open surgery for recurrent anterior instability: a comparison of two surgical techniques.

Background: Previous studies have documented a decrease in proprioceptive capacity in the unstable shoulder. The degree to which surgical approach affects recovery of strength and proprioception is unknown.

Materials And Methods: The recovery of strength and proprioception after open surgery for recurrent anterior glenohumeral instability was compared for 2 surgical procedures.