Intraosseous Administration of Medications in Total Knee Arthroplasty: An Opportunity for Improved Outcomes and Superior Compliance.

Background: Vancomycin is a prophylactic antibiotic with bactericidal activity against methicillin-resistant that is commonly used in total joint replacement surgery. In total knee arthroplasty (TKA), intraosseous infusions administered following tourniquet inflation have demonstrated improved local vancomycin concentrations with decreased systemic absorption. This administration method results in no adverse reactions locally, as well as equivalent or lower systemic complications compared with other vancomycin administration methods.

Management of Hip Abductor Tears and Recalcitrant Trochanteric Bursitis in Native Hips.

Hip abductor tears have recently gained recognition as a more prevalent injury than previously thought. This article will detail the pathophysiology of injury, physical symptoms commonly found at presentation, diagnostic imaging to best diagnose tears and when they should be ordered, and how to properly classify the injury and finally summarize the treatment options available with expert opinions about which are most successful.

Initiation of a Comprehensive Early Discharge Program at a Veterans Affairs Hospital.

Introduction: Early discharge protocols have become a major surgical paradigm, but this protocol is not routinely used in the Veteran Affairs (VA) system. The primary objective was to demonstrate the feasibility of a comprehensive joint program (CJP) protocol, including same-day discharge, at a VA hospital. Secondary objectives are to determine whether an increase in postoperative complications, increased readmissions, and increased ER visits compared with previous management protocols occur.

Otto Aufranc Award: Intraosseous Vancomycin in Total Hip Arthroplasty - Superior Tissue Concentrations and Improved Efficiency.

Background: Literature shows that intraosseous (IO) infusions are capable of providing increased local concentrations compared to those administered via intravenous (IV) access. Successes while using the technique for antibiotic prophylaxis administration in total knee arthroplasty (TKA) prompted consideration for use in total hip arthroplasty (THA) however; no study exists for the use of IO vancomycin in THA.

Methods: This single-blinded randomized control trial was performed from December 2020 to May 2022.

A Consistent Anatomic Landmark for Identifying the Lateral Femoral Circumflex Artery in a Direct Anterior Hip Approach.

A direct anterior approach (DAA) is a technique practiced by arthroplasty surgeons that can be technically challenging, most notably for inexperienced surgeons. The lateral femoral circumflex artery (LFCA) is a branch of the femoral artery that crosses the surgical field during DAA and is an important landmark for superficial surgical dissection. If the vessel is not identified, significant bleeding may occur, and visualization may be impaired.

Evaluation of local tissue peri-implant reaction in total knee arthroplasty failure cases.

Introduction: Implant-related hypersensitivity is emerging as a causative factor as a potential source of total knee arthroplasty (TKA) failure. Mechanistically, this type IV hypersensitivity reaction (T4HR) is mediated by effector T-cells, macrophages, and leukocytes that infiltrate to the site of implant and react to metal exposure and induce inflammatory tissue damage.

Methods: A case-control study was performed where cortical bone was taken at the time of revision surgery for all patients operated on for primary TKA in which metal allergy was suspected and for revision TKA cases done for presumed metal allergy.

Total Joint Arthroplasties in Transgender Patients: Unique Considerations for an Emerging Patient Population.

Currently, no studies exist on transgender patients undergoing orthopaedic procedures within the orthopaedic literature at large. This echoes a trend within medicine in general, where despite their unique characteristics, transgender patients are largely ignored in medical research. As gender reassignment surgery becomes more commonplace and these patients' age into joint arthroplasties, orthopaedic surgeons will rapidly be faced with treating this patient group.

Onlay Patellofemoral Arthroplasty in Patients With Isolated Patellofemoral Arthritis: A Systematic Review.

Background: Patellofemoral arthroplasty (PFA) for isolated patellofemoral osteoarthritis (OA) remains controversial due to variable postoperative outcomes and high failure rates. Second-generation (2G) onlay prostheses have been associated with improved postoperative outcomes. This systematic review was performed to assess the current overall survivorship and functional outcomes of 2G PFA.

DEXA overestimates bone mineral density in adults with knee replacements.

We examined bone mineral density (BMD) measurements made by dual-energy-xray-absorptiometry (DEXA) taken from 100 patients (♂46/♀54, 66±6yr) who previously underwent single total-knee arthroplasty (TKA) to determine if automated software-based artifact detection (ASAD) adequately removes implant artifact from the DXA image before analysis and if potential inaccuracies could be overcome through manual artifact correction (MAC). We also sought to determine if software-based inaccuracies would result in fracture risk misclassification (Low-BMD/Osteopenia = Young-Adult T-Score < -1). Select Results: When using ASAD, limbs with implants had higher BMD (+12.

Open Hip Abductor Tendon Repair into a Bone Trough: Improved Outcomes for Hip Abductor Tendon Avulsion.

Unlabelled: Hip abductor tendon tears are a well-recognized entity that results in progressive lateral hip pain, weakness, and limping. These can occur in patients with native hips or in patients following total hip arthroplasty. However, treatment of these 2 distinct groups does not differ.

Clinical outcome evaluation of intraosseous vancomycin in total knee arthroplasty.

Background: Vancomycin is a commonly used prophylactic antibiotic for total joint replacement surgery to protect against methicillin-resistant . Studies have suggested intraosseous (IO) infusions provide superior local tissue antibiotic concentration compared with intravenous (IV) access in total knee arthroplasty (TKA). We reviewed patients receiving IO vancomycin before TKA, comparing complication rates to a matched group receiving IV prophylactic vancomycin.

Short-Stem Prostheses in Total Hip Arthroplasty: An Unexpected Short-Term Complication: A Report of 2 Cases.

Case: We present here 2 cases of postoperative stress fractures in the setting of a short-stem implant. Both patients had well-aligned implants with good bone quality and presented with delayed onset and atraumatic thigh pain. They were diagnosed with periprosthetic fractures around stable implants.

Technical Obstacles in Total Knee Arthroplasty Learning: A Steps Breakdown Evaluation.

Introduction: Total knee arthroplasty (TKA) is a common procedure practiced in both the community and academic setting and one that all orthopaedic surgery residents are expected to become competent in. The aim of this study is to determine the most common technical obstacles encountered during TKA learning.

Methods: This is a prospective, cohort observational study performed from September 2017 to April 2018.

Complete Traumatic Trifocal Failure of the Extensor Mechanism of the Knee: A Case Report and Review of the Literature.

The unique case of a rare 3-level extensor mechanism failure in a 28-year-old male, involving a tibial tubercle avulsion fracture, a patellar tendon avulsion off the tibial tubercle fragment, and a severely comminuted patella fracture, and the surgical technique required to repair such an injury is presented. Focus is spent on the unique repair of a tendon injury when both proximal and distal bony attachments are damaged. Trifocal knee extensor mechanism is a rare clinical entity with minimal literature available-to date, this injury has only been reported in a retrospective review of combat-related injuries in military personnel.

Drug reaction with eosinophilia and systemic symptoms syndrome after total knee arthroplasty infection and placement of antibiotic spacer.

Though 2-stage revision is considered the gold standard in North America for treatment of periprosthetic joint infection, complications can be associated with use of antibiotic-impregnated spacers. We present a unique case of drug reaction with eosinophilia and systemic symptoms syndrome in a patient with retained antibiotic-impregnated spacer placed for the treatment of a periprosthetic joint infection. Although drug reactions in general are common, severe drug reactions like the one described in this article are exceedingly rare.

Acute traumatic thoracolumbar paraspinal compartment syndrome: case report.

Although compartment syndrome can occur in any compartment in the body, it rarely occurs in the paraspinal musculature and has therefore only been reported in a few case reports. Despite its rare occurrence, acute paraspinal compartment syndrome has been shown to occur secondary to reperfusion injury and traumatic and atraumatic causes. Diagnosis can be based on clinical examination findings, MRI or CT studies, or through direct measurement of intramuscular pressures.

Administration of intravenous antibiotics in patients with open fractures is dependent on emergency room triaging.

Background: Recent literature has demonstrated that emergent administration of antibiotics is perhaps more critical than even emergent debridement. Most recent studies recommend patients receive antibiotics no later than 1 hour after injury to prevent infection. The objective of this study is to evaluate the time to antibiotic administration after patients with open fractures arrive to a trauma center depending on triaging team.

Why Not Life Limb? Vasopressor Use in Intensive Care Unit Patients the Cause of Acute Limb Ischemia.

Acute limb ischemia (ALI) of the upper extremity is a rare yet severe condition in intensive care unit (ICU) patients that generally leads to amputation. The aim of this study is to determine risk factors for development of upper extremity limb ischemia in ICU patients requiring vasopressor support. This is a retrospective study conducted from 2010 to 2015.

Use of Osteofasciocutaneous Fibular Free Flap and Radial Head Arthroplasty in Trauma for Limb Salvage and Continued Elbow Function.

Reconstructive flaps have revolutionized the ability of surgeons to restore function and cosmesis for patients. While reconstructive flaps have been used to bridge large defects due to oncologic or congenital maladies necessitating large debridements, few cases have observed salvage flaps in traumas which provide additional challenges secondary to an injury trajectory. This case report details use of an osteofasciocutaneous fibular free flap and radial head prosthesis to restore forearm function in a 64-year-old female with a comminuted fracture of the proximal radius.

"Hidden" Preoperative Blood Loss With Extracapsular Versus Intracapsular Hip Fractures: What Is the Difference?

Purpose: Excessive blood loss with hip fracture management has been shown to result in increased rates of complications. Our goal is to compare blood loss and transfusion rates between patients with intracapsular and extracapsular (both intertrochanteric (IT) and subtrochanteric (ST)) hip fractures.

Methods: 472 patients were evaluated over a five-year period.

The Relative Effects of Manual Versus Automatic Exposure Control on Radiation Dose to Vital Organs in Total Hip Arthroplasty.

Introduction: Technologic advances have reduced medical radiation exposure while maintaining image quality. The purpose of this study was to determine the effects of the presence of total hip arthroplasty implants, compared with native hips, on radiation exposure of the most radiosensitive organs when manual and automatic exposure control settings are used.

Methods: Detection probes were placed at six locations (stomach, sigmoid colon, right pelvic wall, left pelvic wall, pubic symphysis, and anterior pubic skin) in a cadaver.