Assessment of Team Dynamics and Operative Efficiency in Hip and Knee Arthroplasty.

Importance: Surgical team communication is a critical component of operative efficiency. The factors underlying optimal communication, including team turnover, role composition, and mutual familiarity, remain underinvestigated in the operating room.

Objective: To assess staff turnover, trainee involvement, and surgeon staff preferences in terms of intraoperative efficiency.

Influence of team composition on turnover and efficiency of total hip and knee arthroplasty.

Aims: Surgical costs are a major component of healthcare expenditures in the USA. Intraoperative communication is a key factor contributing to patient outcomes. However, the effectiveness of communication is only partially determined by the surgeon, and understanding how non-surgeon personnel affect intraoperative communication is critical for the development of safe and cost-effective staffing guidelines.

Initial Presentation and Progression of Secondary Osteonecrosis of the Knee.

Background: Early detection and intervention are critical to maintaining the native articular cartilage before collapse in secondary osteonecrosis of the knee (SOK). We conducted a retrospective study documenting the initial stage of presentation and the progression of SOK.

Methods: Our database was reviewed for patients younger than 65 years of age diagnosed with atraumatic SOK between 2002 and 2018.

Diagnosis of Osteonecrosis of the Femoral Head: Too Little, Too Late, and Independent of Etiology.

Background: Joint preservation is more effective in early-stage osteonecrosis of the femoral head (ONFH); thus, prompt diagnosis when the femoral head is still salvageable is important. We report a 20-year retrospective study that summarizes age at presentation, etiology, and Association Research Circulation Osseous stage at diagnosis.

Methods: Our database was reviewed to identify patients younger than 65 years of age who were diagnosed with atraumatic ONFH between 1998 and 2018.

Prophylactic Tibial Stem Fixation in the Obese: Comparative Early Results in Primary Total Knee Arthroplasty.

Purpose: Obesity is a risk factor for aseptic loosening after total knee arthroplasty (TKA). Prophylactic use of tibial stems may enhance tibial fixation in obese patients. The aim of this study was to determine whether a tibial stem extension decreases rates of early failure in obese patients.

Medial Epicondyle Fractures in the Pediatric Overhead Athlete.

The medial epicondyle serves as the proximal attachment of the medial ulnar collateral ligament and the origin of the flexor pronator musculature and as such it is responsible for resisting the main static and dynamic restraints to valgus force at the elbow. Fractures through the physis in the developing elbow are common and treatment remains controversial. Biomechanical modeling predicts that anterior should be the direction of greatest displacement.

Increased thermal pain sensitivity in animals exposed to chronic high dose Vicodin but not pure hydrocodone.

Vicodin, the combination drug of acetaminophen and the opioid hydrocodone, is one of the most prescribed drugs on the market today. Opioids have demonstrated the ability to paradoxically cause increased pain sensitivity to users in a phenomena called opioid-induced hyperalgesia (OIH). While selected opioids have been shown to produce OIH symptoms in an animal model, hydrocodone and the combination drug Vicodin have yet to be studied.