Meniscal allograft with or without osteotomy: a 15-year follow-up study.

Purpose: To assess survivorship of meniscal allografts and the benefit of concomitant osteotomy.

Methods: A retrospective review was performed of all patients who had meniscal allograft surgery ± osteotomy. Fresh frozen meniscal allograft was sutured in place using an onlay technique.

The incidence of hematoma formation in patients with continuous femoral catheters following total knee arthroplasty while receiving rivaroxaban as thromboprophylaxis: an observational study.

Background And Objectives: Multimodal analgesia, including continuous femoral block, is often used to manage postoperative pain following total knee arthroplasty. To reduce the risk of deep vein thrombosis and pulmonary embolus formation, anticoagulation is also a part of the care for patients who undergo total knee arthroplasty. However, the concurrent use of continuous peripheral nerve block and anticoagulation can lead to hematoma formation.

How to assess communication, professionalism, collaboration and the other intrinsic CanMEDS roles in orthopedic residents: use of an objective structured clinical examination (OSCE).

Background: Assessing residents' understanding and application of the 6 intrinsic CanMEDS roles (communicator, professional, manager, collaborator, health advocate, scholar) is challenging for postgraduate medical educators. We hypothesized that an objective structured clinical examination (OSCE) designed to assess multiple intrinsic CanMEDS roles would be sufficiently reliable and valid.

Methods: The OSCE comprised 6 10-minute stations, each testing 2 intrinsic roles using case-based scenarios (with or without the use of standardized patients).

The pathophysiology, diagnosis and current management of acute compartment syndrome.

Acute compartment syndrome (ACS) is a surgical emergency warranting prompt evaluation and treatment. It can occur with any elevation in interstitial pressure in a closed osseo-fascial compartment. Resultant ischaemic damage may be irreversible within six hours and can result in long-term morbidity and even death.

Outcome of distal clavicle resection in patients with acromioclavicular joint osteoarthritis and full-thickness rotator cuff tear.

Purpose: The purpose of this study was to examine the impact of distal clavicle resection (DCR) on subjective and objective outcome measures in patients with acromioclavicular (AC) joint osteoarthritis (OA) and rotator cuff tear.

Methods: Prospectively collected data of consecutive patients with arthroscopic evidence of OA of the ACJ with complete data at 2 years were used for the data analysis. Patients with moderate-to-severe OA of the AC joint underwent a DCR in conjunction with rotator cuff repair, while patients with mild OA of the ACJ underwent surgery related to concomitant rotator cuff tear without a DCR.

Patient-reported compliance with thromboprophylaxis using an oral factor Xa inhibitor (rivaroxaban) following total hip and total knee arthroplasty.

This prospective study examines patient non-compliance (NC) for an oral factor Xa inhibitor (Rivaroxaban) when used as venous thromboembolic (VTE) prophylaxis following lower limb arthroplasty. A total of 3145 patients underwent surgery from May 2010 to December 2011. At 6 weeks patients completed an anonymous self-administered questionnaire.

Patients' perceptions of joint replacement care in a changing healthcare system: a qualitative study.

Background: Ontario has introduced strategies over the past decade to reduce wait times and length of stay and improve access to physiotherapy for orthopaedic and other patients. The aim of this study is to explore patients' experiences of joint replacement care during a significant system change in their care setting.

Methods: A secondary analysis was done on semi-structured qualitative interviews that were conducted in 2009 with 12 individuals who had undergone at least two hip or knee replacements five years apart at a specialized orthopaedic centre in Ontario, Canada.

Postoperative pain management after total knee arthroplasty in elderly patients: treatment options.

Total knee arthroplasty (TKA) is a common surgical procedure in the elderly and is associated with severe pain after surgery and a high incidence of chronic pain. Several factors are associated with severe acute pain after surgery, including psychological factors and severe preoperative pain. Good acute pain control can be provided with multimodal analgesia, including regional anesthesia techniques.

Reversed assembly of total hip arthroplasty components: a surgical tip to facilitate implant reduction during minimally invasive surgery.

Total hip arthroplasty (THA) using minimally invasive surgery (MIS) can result in soft tissue damage during the trial reduction and actual implantation. We present a surgical technique that reduces soft tissue trauma and facilitates implant reduction while protecting the prosthetic head from scratching during MIS THA. Primary THA using MIS was performed in 16 hips through a transgluteul direct lateral approach.

Nineteen year results of THA using modular 9 mm S-ROM femoral component in patients with small femoral canals.

A retrospective analysis was undertaken of 30 consecutive THA performed in 25 patients with hypoplastic proximal femurs, who had received a 9-mm uncemented modular S-ROM stem. The mean patient age was 42 years (17-69 years), mean height was 152.5 cm (130-170.

Total knee arthroplasty in patients with excessive external tibial torsion >45° and patella instability--surgical technique and follow up.

Patients presenting with advanced knee osteoarthritis (OA), excessive external tibial torsion (EETT) and chronic patella subluxation pose significant surgical challenges. A combination of TKA, tibial derotation osteotomy, and tibial tuberosity transfer was performed in ten patients (twelve knees) with OA secondary to EETT and patellar instability. Six weeks of non weight-bearing and flexion limited to 45° was mandated after surgery.

Training femoral neck screw insertion skills to surgical trainees: computer-assisted surgery versus conventional fluoroscopic technique.

Background: : Femoral neck fractures are among the most common orthopaedic injuries impacting the health care system. Surgical management of such fractures with cannulated screws is a commonly performed procedure. The acquisition of surgical skills necessary to perform this procedure typically involves learning on real patients with fluoroscopic guidance.

Strategies Aimed at Preventing Chronic Post-surgical Pain: Comprehensive Perioperative Pain Management after Total Joint Replacement Surgery.

Purpose: Chronic post-surgical pain (CPSP) is a frequent outcome of musculoskeletal surgery. Physiotherapists often treat patients with pain before and after musculoskeletal surgery. The purposes of this paper are (1) to raise awareness of the nature, mechanisms, and significance of CPSP; and (2) to highlight the necessity for an inter-professional team to understand and address its complexity.

The impact of response shift on perceived disability two years following rotator cuff surgery.

Background: Understanding how patients appraise their health-related problems is important for an accurate assessment of recovery over time. It has been proposed that the response shift phenomenon has an impact on self-report measures, and this may subsequently affect measurement of true treatment effects. The objective of the present study was to explore the impact of response shift on the subjective perception of disability following rotator cuff surgery.

Total knee replacement with rotational proximal tibial osteotomy for osteoarthritis with severe external tibial torsion and patellar instability.

The management of osteoarthritis of the knee associated with patellar instability secondary to external tibial torsion > 45 degrees is challenging. Patellofemoral biomechanics in these patients cannot be achieved by intra-articular correction using standard techniques of total knee replacement. We reviewed seven patients (eight knees) with recurrent patellar dislocation and one with bilateral irreducible lateral dislocation who had undergone simultaneous total knee replacement and internal tibial derotational osteotomy.

Impact of work-related compensation claims on surgical outcome of patients with rotator cuff related pathologies: a matched case-control study.

Background: The purpose of this matched case-control study was to examine the impact of an active compensation claim following a work-related shoulder injury on reporting disability, as measured by subjective and objective outcomes at 1 year postoperatively.

Methods: Data of 517 consecutive patients who had undergone a decompression or rotator cuff repair were reviewed. One-hundred and ten patients were on compensation related to their shoulder problems.

Long-term outcome of shelf grafts in total hip arthroplasty for developmental hip dysplasia.

Primary total hip arthroplasty (THA) in patients with osteoarthrosis secondary to developmental hip dysplasia is often complex due to anterolateral acetabular bone deficiency. The use of femoral head (shelf) autograft during the index arthroplasty provides nonimmunogenic, osteoconductive support with the potential for enhanced bone stock should revision surgery be required. Few long-term studies document the outcome of the use of shelf grafts in primary THA or quantify the need for further bone graft at revision surgery.

Bilateral total hip replacement in osteogenesis imperfecta with hyperplastic callus.

Osteogenesis imperfecta is a rare inherited disorder of connective tissue which may present with recurrent fractures which are prone to nonunion and malunion resulting in deformity. Some patients develop osteoarthritis of the hip. Formation of hyperplastic callus after recurrent fractures may deform the shape of the femur and preclude the use of standard implants at joint replacement.

Evaluating equivalency of treatment effectiveness: the example of arthroscopic and mini-open rotator cuff repairs.

In the fast evolving world of surgical technology, selecting the best surgical treatment in the absence of sufficient evidence is challenging. With the increasing interest in using less invasive surgeries, arthroscopic rotator cuff repair has become popular. Large randomized controlled studies with rigorous methodology are required to examine the differences between this approach and more traditional methods.

Factors contributing to failure of rotator cuff surgery in persons with work-related injuries.

Purpose: Shoulder pain is a major musculoskeletal and economic concern in industrialized countries, with the rate of surgical failure reportedly higher in patients injured at work. The purposes of this study were (1) to examine the prevalence of identifiable causes of rotator cuff surgery failure and (2) to examine the relationship among the existence of these causes and outcome scores, patient expectations, and overall satisfaction.

Methods: This was a cross-sectional study of patients who experienced continued impairments following surgical treatment for work-related injuries.

A framework for the development and implementation of an advanced practice role for physiotherapists that improves access and quality of care for patients.

A new model of care has been implemented at the Sunnybrook Holland Orthopaedic and Arthritic Centre that expands the role of physiotherapists to improve access and quality of care for patients requiring hip and knee replacement surgery. An advanced practice physiotherapist (APP) role was created to support both referral management and post-operative care to reduce surgeon workload and better streamline services. This article describes our nine-step framework for implementing an APP role and can be used as a template for other organizations evolving similar roles.

Convergent validity of the constant-murley outcome measure in patients with rotator cuff disease.

Purpose: Despite the popularity of the Constant-Murley score (CMS), a combined patient-report and objective (health professional administered) shoulder outcome measure, minimal information exists on its reliability or validity. The purpose of this study was to examine (1) internal consistency and convergent validity of the CMS and (2) the degree to which other shoulder measures explain variation in range of motion and strength components of the CMS.

Methods: In this cross-sectional study of outcome measures, 45 patients undergoing conservative or surgical treatment for rotator cuff disease participated.

Toward a joint health and disease management program. Toronto hospitals partner to provide system leadership.

The Joint Health and Disease Management Program in the Toronto Central Local Health Integration Network (TC LHIN) is envisioned as a comprehensive model of care for patients with hip and knee arthritis. It includes access to assessment services, education, self-management programs and other treatment programs, including specialist care as needed. As the first phase of this program, the hospitals in TC LHIN implemented a Hip and Knee Replacement Program to focus on improving access and quality of care, coordinating services and measuring wait times for patients waiting for hip or knee replacement surgery.

Positive predictive value of maximal posterior joint-line tenderness in diagnosing meniscal pathology: a pilot study.

Objective: The purpose of this prospective study was to determine the positive predictive value (PPV) of the point of maximal posterior joint line tenderness (JLT), as a clinical sign, to diagnose underlying meniscal tears.

Methods: We conducted a prospective study of patients requiring arthroscopic surgery, who consecutively presented to the University of Calgary's Sport Medicine Centre. The femurotibial joint line was palpated for the point of maximal tenderness.

Response shift in outcome assessment in patients undergoing total knee arthroplasty.

Background: A response shift is a psychological change in one's perception of the quality of life following a change in health status. This phenomenon initially was recognized in patients with terminal diseases who, despite a worsening of the physical condition, did not necessarily report deterioration in quality of life. The purpose of the present study was to examine the role of response shift in patients undergoing total knee replacement surgery.