Joint Stability in Total Knee Arthroplasty: What Is the Target for a Stable Knee?

Instability remains a common cause of failure in total knee arthroplasty. Although approaches for surgical treatment of instability exist, the target for initial stability remains elusive, increasing the likelihood that failures will persist because adequate stability is not restored when performing the primary arthroplasty. Although the mechanisms that stabilize the knee joint-contact between the articular surfaces, ligamentous constraints, and muscle forces-are well-defined, their relative importance and the interplay among them throughout functions of daily living are poorly understood.

Value-based Purchasing for Osteoarthritis and Total Knee Arthroplasty: What Role for Patient-reported Outcomes?

Prompted by the aims to improve the patient experience of care (including quality and satisfaction), improve the health of populations, and reduce the per capita cost of health care, the US healthcare system is embarking upon a new era in care delivery that seeks to optimize healthcare value. Value, the consideration of quality relative to cost, can be increased by improving quality, reducing cost, or doing both. Given that patient-reported outcomes related to pain, function, and quality of life underlay both the reason patients seek care for and the benchmarks by which treatment success is measured for osteoarthritis, measures of these patient-reported outcomes figure prominently in understanding the quality and hence value.

Patient-reported Outcome Measurement for Patients With Total Knee Arthroplasty.

Total knee arthroplasty is a large contributor to Medicare costs. In an effort to lower costs and improve outcomes, the Centers for Medicaid and Medicare Services has implemented the Comprehensive Care for Joint Replacement model, which incentivizes surgeons to submit both general health and joint-specific patient-reported outcome measures (PROMs). However, in addition to using PROMs for reporting purposes, surgeons should also consider incorporating PROMs into clinical practice.

Cost Savings From Utilization of an Ambulatory Surgery Center for Orthopaedic Day Surgery.

Introduction: Healthcare providers are increasingly searching for ways to provide cost-efficient, high-quality care. Previous studies on evaluating cost used estimated cost-to-charge ratios, which are inherently inaccurate. The purpose of this study was to quantify actual direct cost savings from performing pediatric orthopaedic sports day surgery at an ambulatory surgery center (ASC) compared with a university-based children's hospital (UH).

Systemic Lupus Erythematosus Does Not Increase Risk of Adverse Events in the First 6 Months After Total Knee Arthroplasty.

Background: Increasing numbers of patients with systemic lupus erythematosus (SLE) are undergoing total knee arthroplasty (TKA). Whether postsurgical adverse events (AEs) are higher in patients with SLE than patients with osteoarthritis (OA) is unknown.

Objectives: This study aims to compare AEs within 6 months of TKA.

Femoral Deformity May Be More Predictive of Hip Range of Motion Than Severity of Acetabular Disease in Patients With Acetabular Dysplasia: An Analysis of the ANCHOR Cohort.

Background: It is generally believed that acetabular dysplasia (AD) is associated with increased hip range of motion (ROM). The purpose of this study was to investigate the associations between dysplasia severity and hip ROM in a large multicenter cohort.

Methods: A prospective registry of patients undergoing periacetabular osteotomy for symptomatic AD by 1 of 13 surgeons was used to analyze 1,051 patients (mean age, 26 ± 10 years).

Proximal Junctional Kyphosis.

Proximal junctional kyphosis (PJK) is a common complication following adult spinal deformity surgery. It is defined by two criteria: a proximal junctional sagittal Cobb angle (1) ≥ 10° and (2) at least 10° greater than the preoperative measurement. PJK is multifactorial in origin and likely stems from surgical, radiographic, and patient-related risk factors.

Refractory sarcoid arthritis in World Trade Center-exposed New York City firefighters: a case series.

Objective: The objective of this study was to describe cases of sarcoid arthritis in firefighters from the Fire Department of the City of New York (FDNY) who worked at the World Trade Center (WTC) site.

Methods: All WTC-exposed FDNY firefighters with sarcoidosis and related chronic inflammatory arthritis (n = 11) are followed jointly by the FDNY-WTC Health Program and the Rheumatology Division at the Hospital for Special Surgery. Diagnoses of sarcoidosis were based on clinical, radiographic, and pathological criteria.

Physical and psychological comorbidity independently associated with spine-related disability.

Study Design: Cross sectional analysis of patient-reported spine-related disability and comorbidity.

Objective: To determine if nonorthopedic physical and psychological comorbidity are independently associated with self-reported spine-related disability in patients scheduled for spine surgery.

Summary Of Background Data: The association between psychological comorbidity and spine-related disability is well known; less is known about the contribution of nonorthopedic physical comorbidity to patients' ratings of spine-related disability.

Secondary reconstructive surgery following major upper extremity replantation.

Background: Little literature currently exists on reconstructive strategies following successful upper extremity replantation. The authors hypothesized that the type of secondary surgery would vary predictably depending on mechanism and amputation level.

Methods: The authors performed a retrospective review of upper extremity replantations performed at their institution between 2003 and 2012.

Patients' expectations of cervical spine surgery.

Study Design: Cross-sectional analysis of patients' expectations of cervical spine surgery using the Hospital for Special Surgery Cervical Spine Surgery Expectations Survey (Expectations Survey).

Objective: To preoperatively describe patients' long-term expectations of surgery in terms of demographic, clinical, and psychological characteristics.

Summary Of Background Data: Although important components of patient-centered care, few studies have systematically considered patients' expectations of cervical spine surgery.

The structure and function of the coracohumeral ligament: An anatomic and microscopic study.

Twelve fresh-frozen cadaver shoulders were dissected to study the anatomy and histology of the coracohumeral ligament. Based on the gross and microscopic anatomy, the ligament was found in three variations. In the most common pattern (nine of 12 specimens), the coracohumeral ligament represented a folded portion of glenohumeral joint capsule in the rotator interval between subscapularis and supraspinatus.

Arthroscopic shoulder stabilization using a bioabsorbable fixation device.

Arthroscopic stabilization using the Suretac is indicated in patients with anterior instability in whom the pathology is limited to labral detachment. A successful outcome requires an adequate debridement of the glenoid neck, proper retensioning of the labral ligament complex, and use of a robust portion of the tissue for fixation.

Multidirectional instability: medial T-plasty and selective capsular repairs.

Multidirectional instability of the shoulder present a unique challenge in management. The patient with multidirectional instability classically is seen without a history of significant trauma to the shoulder; however, posttraumatic multidirectional instability may be encountered in the athletic population. Patients with an atraumatic etiology often respond to nonoperative rehabilitative measures, whereas those with a traumatic etiology are more likely to require surgical intervention.