Occupational and Functional Outcomes following Patellofemoral Arthroplasty in U.S. Military Servicemembers.

The functional outcomes in patients undergoing patellofemoral arthroplasty (PFA) with high occupational demands have not been fully examined. This study assessed return to work and conversion to TKA rates following PFA in a young, military cohort. Patient demographics, pain scores, and surgical information were retrospectively collected for all active-duty military members who underwent PFA over a 4-year period.

Occupational Outcomes and Revision Rates for Medial Unicondylar Knee Arthroplasty in U.S. Military Servicemembers.

This study evaluates return to work and revision rates for medial unicondylar knee arthroplasty (UKA) in a high-demand military cohort. Patient demographic and clinical variables were isolated from the medical records of active-duty military servicemembers with at least 2 years of postoperative follow-up and correlated with return to work, medial UKA survivorship, and perioperative complications. The medial UKA annual revision rate was calculated as the percentage of implants revised per observed component year.

Quality of prospective controlled randomized trials regarding platelet-rich plasma injection for osteoarthritis of the knee.

Background: Randomized controlled trials (RCTs) are the gold standard for study design and are considered to have the highest level of evidence. The purpose of this study is to evaluate quality of evidence of prospective RCTs that investigated the clinical efficacy of platelet-rich plasma (PRP) treatments for knee osteoarthritis. We hypothesized that a high level of clinical evidence does not correlate with a high-quality scientific study.

Occupational Outcomes and Return to Running After Operative Management of Lisfranc Injuries in a High-Demand Population.

Literature evaluating outcomes following operative fixation of Lisfranc injuries has demonstrated high rates of chronic disability, particularly in those returning to prior levels of physical function. The purpose of this study is to evaluate the occupational outcomes and return to running after open reduction and internal fixation (ORIF) or arthrodesis for Lisfranc fracture-dislocations in a moderate- to high-demand military cohort. All active-duty servicemembers undergoing ORIF or primary arthrodesis (Current Procedural Terminology 28615 and 28730, respectively) for confirmed Lisfranc fracture-dislocations (International Classification of Diseases, Ninth Revision codes 838.

Early Stabilization of Femur Fractures in the Setting of Polytrauma Is Associated With Decreased Risk of Pulmonary Complications and Mortality.

Timing of definitive fixation of femoral shaft fractures is a subject of continued controversy. The purpose of this study was to determine if early definitive fixation of femoral shaft fractures in the setting of polytrauma decreased the risk of pulmonary complications and mortality. The 2009-2012 National Sample Program of the National Trauma Data Bank was queried for all patients 18 to 65 years with Injury Severity Scores (ISS) >15 who underwent definitive fixation of femoral shaft fractures.

Autologous Chondrocyte Implantation and Tibial Tubercle Osteotomy for Patellofemoral Chondral Defects: Improved Pain Relief and Occupational Outcomes Among US Army Servicemembers.

Background: The occupational and functional results of patellofemoral autologous chondrocyte implantation (ACI) are underreported. This investigation sought to establish clinical outcomes and rates for return to work in a predominantly high-demand military cohort undergoing this procedure.

Purpose: To determine the return-to-work, pain relief, and perioperative complication rates in a high-demand athletic cohort undergoing patellofemoral ACI.

Sustained Preoperative Opioid Use Is a Predictor of Continued Use Following Spine Surgery.

Background: Preoperative opioid use is known to increase the likelihood of complications and inferior outcomes following spine surgery. We evaluated the association of preoperative opioid use and other risk factors with postoperative opioid use.

Methods: We queried 2006-2014 TRICARE insurance claims to identify adults who underwent lumbar interbody arthrodesis, lumbar discectomy, lumbar decompression, or lumbar posterolateral arthrodesis.

Occupational outcomes following combat-related gunshot injury: Cohort study.

Background: The long-term impact of gun violence on physical function and occupational disability remains poorly explored. We sought to examine the effect of combat-related gunshot injury on work capacity within a cohort of military servicemembers and identify clinical characteristics that influence the capacity to return to work.

Methods: A query was performed to identify all servicemembers injured by gunshot in the years 2005-2009.

Anteromedializing Tibial Tubercle Osteotomy for Patellofemoral Instability: Occupational and Functional Outcomes in U.S. Military Service Members.

This article sought to determine rates for return to work, pain relief, and recurrent patellofemoral instability for military service members undergoing tibial tubercle osteotomy (TTO) for persistent lateral patellar subluxation or dislocation. Patient demographic and surgical variables were isolated from the medical records of active duty service members with at least 2 years of postoperative follow-up, and correlated with return to work, pain improvement, recurrent patellofemoral instability, and perioperative complications. There were 51 service members (58 primary TTOs) with an average follow-up of 3.

Long versus short cephalomedullary nail for trochanteric femur fractures (OTA 31-A1, A2 and A3): a systematic review.

Background: Both long and short cephalomedullary nails (CMN) may be used to treat trochanteric femur fractures. The objective of this paper was to compare the clinical outcomes between long and short CMN in the treatment of trochanteric hip fractures.

Materials And Methods: A literature search was performed, identifying 135 papers; 4 of which met inclusion and exclusion criteria.

Epidemiology of Lower Extremity Stress Fractures in the United States Military.

Purpose: To comprehensively quantify established risk factors for the development of lower extremity stress fractures within a contemporary U.S. military cohort.

Protected Resident Research Time Does Not Increase the Quantity or Quality of Residency Program Research Publications: A Comparison of 3 Orthopedic Residencies.

Introduction: The effect of dedicated resident research time in terms of residency program research productivity remains largely unknown. We hypothesize that the quantity and quality of a residency program's peer-reviewed publications (PRPs) increase proportionately with the amount of dedicated research time given to residents.

Methods: Three residency programs (P1, P2, and P3) were examined.

Predictors of Hospital Readmission After Total Shoulder Arthroplasty.

The study was conducted to determine the incidence rate, risk factors, and postoperative conditions associated with 30-day readmission after total shoulder arthroplasty (TSA). A total of 3547 patients who underwent primary TSA were identified from the 2011-2013 American College of Surgeons National Surgical Quality Improvement Program. The 30-day readmission rate was 2.

Results and Functional Outcomes of Structural Fresh Osteochondral Allograft Transfer for Treatment of Osteochondral Lesions of the Talus in a Highly Active Population.

Introduction: Structural fresh osteochondral allograft transfer is an appropriate treatment option for large osteochondral lesions of the talus (OLTs), specifically lesions involving the shoulder of the talus. Sparse literature exists regarding functional outcome following this surgery in high-demand populations.

Materials And Methods: Over a 2-year period, a single surgeon performed 8 structural allograft transfers for treatment of large OLTs in an active duty US military population.

Vascular Injuries in Combat-Specific Soldiers during Operation Iraqi Freedom and Operation Enduring Freedom.

Background: This study sought to identify vascular injury patterns among combat-specific cavalry scout personnel within the Iraq and Afghanistan Wars.

Methods: The Armed Forces Medical Examiner System and Joint Theater Trauma Registry were queried for all injuries with the cavalry scout designation from 2003 to 2011, including those both wounded in action (WIA) and killed in action (KIA). A description of vascular injury, combat causality care statistics, mechanism of injury, and demographic data were recorded.

Tibial Tubercle Osteotomy for Patellar Chondral Pathology in an Active United States Military Population.

Purpose: To quantify rates of perioperative complications, secondary surgery, subjective pain relief, and knee-related medical separation in an active military population after a tibial tubercle osteotomy (TTO) for the primary indication of chondral pathology.

Methods: All active-duty service members undergoing TTO with a minimum of 2 years' follow-up were isolated from the Military Health System database. The exclusion criteria were patients with patellar instability, other periarticular osteotomy, and insufficient follow-up.

The Rising Incidence of Degenerative and Posttraumatic Osteoarthritis of the Knee in the United States Military.

Background: This investigation sought to quantify incidence rates (IRs) and risk factors for primary and secondary (ie, posttraumatic) osteoarthritis (OA) of the knee in an active military population.

Methods: We performed a retrospective review of United States military active duty servicemembers with first-time diagnosis of primary (International Classification of Disease, 9th Edition code: 715.16) and secondary (International Classification of Disease, 9th Edition code: 715.

Simulation Training Improves Surgical Proficiency and Safety During Diagnostic Shoulder Arthroscopy Performed by Residents.

Although virtual reality simulators have established construct validity, no studies have proven transfer of skills from a simulator to improved in vivo surgical skill. The current authors hypothesized that simulation training would improve residents' basic arthroscopic performance and safety. Twenty-two orthopedic surgery trainees were randomized into simulation or standard practice groups.

Musculoskeletal Injuries in Iraq and Afghanistan: Epidemiology and Outcomes Following a Decade of War.

The combined wars in Afghanistan and Iraq represent the longest ongoing conflicts in American military history, with a combined casualty estimate of >59,000 service members. The nature of combat over the last decade has led to precipitous increases in severe orthopaedic injuries, including traumatic amputations and injuries to the spine. Nearly 75% of all injuries sustained in combat now are caused by explosive mechanisms, and fractures comprise 40% of all musculoskeletal injuries.

The Total Joint Arthroplasty Cardiac Risk Index for Predicting Perioperative Myocardial Infarction and Cardiac Arrest After Primary Total Knee and Hip Arthroplasty.

Background: Current indices fail to consistently predict risk for major adverse cardiac events after major total joint arthroplasty.

Methods: All primary total knee arthroplasty (TKA) and total hip arthroplasty (THA) were identified from the National Surgical Quality Improvement Program data set. Based on prior analyses, age ≥80 years, history of hypertension, and history of cardiac disease were evaluated as predictors of myocardial infarction and cardiac arrest using stepwise multivariate logistic regression.

Success of High Tibial Osteotomy in the United States Military.

Background: Historically, high tibial osteotomy (HTO) has been performed to treat isolated medial gonarthrosis with varus deformity.

Purpose: To evaluate the occupational outcomes of HTO in a high-demand military cohort.

Study Design: Case-control study; Level of evidence, 3.

Assessing the utility of a clinical prediction score regarding 30-day morbidity and mortality following metastatic spinal surgery: the New England Spinal Metastasis Score (NESMS).

Background Context: The New England Spinal Metastasis Score (NESMS) was recently proposed to help predict 1-year survival following surgery for spinal metastases. Its ability to predict short-term outcomes, including 30-day morbidity, mortality, and hospital length of stay, has not been evaluated.

Purpose: Assess the capacity of NESMS to predict 30-day morbidity and mortality, as well as hospital length of stay, following surgery for spinal metastases.

Predictors of hospital readmission following revision total knee arthroplasty.

Purpose: Hospital readmission is emerging as an important quality measure, yet modifiable predictors of readmission remain unknown. This study was designed to identify risk factors for readmission following revision total knee arthroplasty.

Methods: The National Surgical Quality Improvement Program dataset was queried to identify patients undergoing revision total knee arthroplasty from 2011 to 2012.

Arthroscopic Shoulder Surgical Simulation Training Curriculum: Transfer Reliability and Maintenance of Skill Over Time.

Background: Surgical education is evolving as work hour constraints limit the exposure of residents to the operating room. Potential consequences may include erosion of resident education and decreased quality of patient care. Surgical simulation training has become a focus of study in an effort to counter these challenges.