The potential influence of regionalization strategies on delivery of care for elective total joint arthroplasty.

Regionalization of total joint arthroplasty (TJA) to high volume hospitals (HVHs) may affect access to care and complication risk. Using administrative data, 2,560,314 patients who underwent primary total hip or knee arthroplasty from 1991 to 2006 were categorized by whether an HVH (>200 annual TJAs) was available locally. Associations among patient characteristics, hospital utilization, and in-hospital complications were estimated using regression modeling.

Current status of cost utility analyses in total joint arthroplasty: a systematic review.

Background: Total joint arthroplasty (TJA), although considered to be highly beneficial, is associated with substantial costs to the US healthcare system. Cost utility analysis has become an increasingly important means to objectively evaluate the value of a healthcare intervention from the perspective of both extending the quantity and improving the quality of life. Relatively little is known about the overall cost utility analysis evidence base in TJA.

Postoperative Analgesia with Saphenous Block Appears Equivalent to Femoral Nerve Block in ACL Reconstruction.

Background: Adequate pain control following anterior cruciate ligament reconstruction (ACL) often requires regional nerve block. The femoral nerve block (FNB) has been traditionally employed. Ultrasound application to regional nerve blocks allows for the use of alternatives such as the saphenous nerve block following ACL reconstruction.

Cost-effectiveness analyses in orthopaedic sports medicine: a systematic review.

Background: As increasing attention is paid to the cost of health care delivered in the United States (US), cost-effectiveness analyses (CEAs) are gaining in popularity. Reviews of the CEA literature have been performed in other areas of medicine, including some subspecialties within orthopaedics. Demonstrating the value of medical procedures is of utmost importance, yet very little is known about the overall quality and findings of CEAs in sports medicine.

The impact of blood management on length of stay after primary total knee arthroplasty.

The current study investigates the impact of patient factors, surgical factors, and blood management on postoperative length of stay (LOS) in 516 patients who underwent primary total knee arthroplasty. Age, gender, type of anticoagulation, but not body mass index (BMI) were found to be highly significant predictors of an increased LOS. Allogeneic transfusion and the number of allogeneic units significantly increased LOS, whereas donation and/or transfusion of autologous blood did not.

A rare presentation of triple-negative apocrine breast carcinoma with metastases.

Apocrine breast carcinoma is a rare subtype of the invasive ductal carcinoma and accounts for as little as 0.3-1% of all breast cancers. It is usually positive for human epidermal growth factor receptor 2 (HER-2) and negative for both estrogen receptor and progesterone receptor.

Symptoms of pain do not correlate with rotator cuff tear severity: a cross-sectional study of 393 patients with a symptomatic atraumatic full-thickness rotator cuff tear.

Background: For many orthopaedic disorders, symptoms correlate with disease severity. The objective of this study was to determine if pain level is related to the severity of rotator cuff disorders.

Methods: A cohort of 393 subjects with an atraumatic symptomatic full-thickness rotator-cuff tear treated with physical therapy was studied.

Epidemiology of multiligament knee reconstruction.

Background: The multiple-ligament-injured knee represents a special challenge, being an uncommon injury that is both severe and complicated to treat. Many studies have evaluated patients treated for this injury, but most are limited in their scope. The evaluation of this injury and its treatment using an administrative database might provide a different perspective.

A decade of bisphosphonate bone complications: what it has taught us about bone physiology.

While the AIDS epidemic of the 1980s taught the medical and dental professions much about immune cells and the immune system's cellular relationships, the bisphosphonate-induced osteonecrosis epidemic of the past decade has taught these same professions much about bone turnover, bone cell cross talk, the response and functional relationship of bone cells to loading, and drug effects on cellular dynamic relationships. The present article explores the literature as well as both evidence- and experience-based data to discuss known bone pathologies and physiologic mechanisms as well as uncover new findings: (1) bone remodeling is the mechanism by which bone adapts to loading stresses, termed either bone modeling or Wolff's law, and it is also the mechanism for bone renewal; (2) osteoclastic bone resorption triggers bone renewal at a rate of about 0.7%/day by its release of growth factors; (3) bisphosphonates prevent the renewal of old and injured bone, thus making it brittle and more likely to fracture over time; (4) bisphosphonates have a half-life in bone of 11 years because of their irreversible binding to bone via their central carbon atom; (5) when administered intravenously, bisphosphonate loads bone and accumulates in bone 142.

Translational research: The CD34+ cell is crucial for large-volume bone regeneration from the milieu of bone marrow progenitor cells in craniomandibular reconstruction.

Purpose: This study investigated the role of the bone marrow-derived CD34+ cell in a milieu of osteoprogenitor cells, bone marrow plasma cell adhesion molecules, recombinant human bone morphogenetic protein (rhBMP), and a matrix of crushed cancellous allogeneic bone in the clinical regeneration of functionally useful bone in craniomandibular reconstructions. The history and current concepts of bone marrow hematopoietic stem cells and mesenchymal stem cells are reviewed as they relate to bone regeneration in large continuity defects of the mandible.

Materials And Methods: Patients with 6- to 8-cm continuity defects of the mandible with retained proximal and distal segments were randomized into two groups.

Are articular cartilage lesions and meniscus tears predictive of IKDC, KOOS, and Marx activity level outcomes after anterior cruciate ligament reconstruction? A 6-year multicenter cohort study.

Background: Identifying risk factors for inferior outcomes after anterior cruciate ligament reconstruction (ACLR) is important for prognosis and future treatment.

Hypothesis: Articular cartilage lesions and meniscus tears/treatment would predict International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score (KOOS) (all 5 subscales), and Marx activity level at 6 years after ACLR.

Study Design: Cohort study (prognosis); Level of evidence, 1.

Does arthroscopic knee surgery work?

A recent randomized trial from the Finnish Degenerative Meniscal Lesion Study Group was published in the New England Journal of Medicine and attempted to determine the efficacy of partial meniscectomy without osteoarthritis. Patients were randomized to either arthroscopic partial meniscectomy or sham surgery. The authors concluded that the clinical outcomes after arthroscopic partial meniscectomy were no better than those after the sham surgical procedure.

Redox-induced spin-state switching and mixed valency in quinonoid-bridged dicobalt complexes.

The complexes [{(tmpa)Co(II) }2 (μ-L(1) )(2-) ](2+) (1(2+) ) and [{(tmpa)Co(II) }2 (μ-L(2) )(2-) ](2+) (2(2+) ), with tmpa=tris(2-pyridylmethyl)amine, H2 L(1) =2,5-di-[2-(methoxy)-anilino]-1,4-benzoquinone, and H2 L(2) =2,5-di-[2-(trifluoromethyl)-anilino]-1,4-benzoquinone, were synthesized and characterized. Structural analysis of 2(2+) revealed a distorted octahedral coordination around the cobalt centers, and cobalt-ligand bond lengths that match with high-spin Co(II) centers. Superconducting quantum interference device (SQUID) magnetometric studies on 1(2+) and 2(2+) are consistent with the presence of two weakly exchange-coupled high-spin cobalt(II) ions, for which the nature of the coupling appears to depend on the substituents on the bridging ligand, being antiferromagnetic for 1(2+) and ferromagnetic for 2(2+) .

Is changing hospitals for revision total joint arthroplasty associated with more complications?

Background: Many patients change hospitals for revision total joint arthroplasty (TJA). The implications of changing hospitals must be better understood to inform appropriate utilization strategies.

Questions/purposes: (1) How frequently do patients change hospitals for revision TJA? (2) Which patient, community, and hospital characteristics are associated with changing hospitals? (3) Is there an increased complication risk after changing hospitals?

Methods: We identified 17,018 patients who underwent primary TJA and subsequent same-joint revision in New York or California (1997-2005) from statewide databases.

Socioeconomic factors are associated with frequency of repeat emergency department visits for pediatric closed fractures.

Background: Previous research has demonstrated both greater difficulty in obtaining follow-up appointments and increased likelihood of return visits to the emergency department (ED) for patients with government-funded insurance plans. The purpose of the current study is to determine whether socioeconomic factors, such as race and insurance type, are associated with the frequency of repeat ED visits in pediatric patients with closed fractures.

Methods: A review of ED visit data over a 2-year period from a statewide hospital discharge database in New York was conducted.

20 years of pediatric anterior cruciate ligament reconstruction in New York State.

Background: There have been no population-based studies to evaluate the rate of pediatric anterior cruciate ligament (ACL) reconstruction.

Purpose: The primary aim of the current study was to determine the yearly rate of ACL reconstruction over the past 20 years in New York State. Secondary aims were to determine the age distribution for ACL reconstruction and determine whether patient demographic and socioeconomic factors were associated with ACL reconstruction.

Restructuring the orthopedic resident research curriculum to increase scholarly activity.

Background: Limited time and funding are challenges to meeting the research requirement of the orthopedic residency curriculum.

Objective: We report a reorganized research curriculum that increases research quality and productivity at our academic orthopedic medical center.

Methods: Changes made to the curriculum, which began in 2006 and were fully phased in by 2008, included research milestones for each training year, a built-in support structure, use of an accredited bio-skills laboratory, mentoring by National Institutes of Health-funded scientists, and protected time to engage in required research and prepare scholarly peer-reviewed publications.

The deception and fallacies of sponsored randomized prospective double-blinded clinical trials: the bisphosphonate research example.

The randomized prospective double-blinded clinical trial (RCT) is accepted as Level I evidence and is highly regarded. However, RCTs that gained FDA approval of drugs such as Vioxx, Fen-Phen, and oral and intravenous bisphosphonates have proven to generate misleading results and have not adequately identified serious adverse reactions. The development, research, and clinical marketing of the oral and intravenous bisphosphonates can serve as a representative example for the deteriorated value of many of today's RCTs.

Anterior glenoid perforation with suture anchor causing subscapularis irritation and pain.

Background: Suture anchors for labral repair have been associated with complications including suprascapular notch encroachment and osteolysis.

Case Description: We present a case of suture anchor penetration of the anterior glenoid neck leading to pain secondary to subscapularis muscle irritation in a 14-year-old boy. The patient had labral repair and subsequent anterior shoulder pain which resolved after anchor removal.

Predictors of success of corticosteroid injection for the management of rotator cuff disease.

Background: The use of subacromial corticosteroid injection (CSI) to treat rotator cuff tendinopathy is controversial. We hypothesized that characteristics such as activity level, American Shoulder and Elbow Surgeons (ASES) score, duration of symptoms, and status of the rotator cuff may be prognostic factors for resolution of symptoms postinjection.

Methods: During a 12-month period, consecutive patients with rotator cuff disease were analyzed.