Dislocation risk after robotic arm-assisted total hip arthroplasty: a comparison of anterior, lateral and posterolateral approaches.

Aims: Dislocation is a major cause of early failure after THA and is highly influenced by surgical approach and component positioning. Robotic-arm assisted arthroplasty has been developed in an attempt to improve component positioning and reduce postoperative complications.The purpose of this study was to compare the rate of dislocation after robotic total hip arthroplasty through 3 different surgical approaches.

Survivorship, complications, and outcomes following distal femoral arthroplasty for non-neoplastic indications.

Aims: Endoprosthetic reconstruction with a distal femoral arthroplasty (DFA) can be used to treat distal femoral bone loss from oncological and non-oncological causes. This study reports the short-term implant survivorship, complications, and risk factors for patients who underwent DFA for non-neoplastic indications.

Methods: We performed a retrospective review of 75 patients from a single institution who underwent DFA for non-neoplastic indications, including aseptic loosening or mechanical failure of a previous prosthesis (n = 25), periprosthetic joint infection (PJI) (n = 23), and native or periprosthetic distal femur fracture or nonunion (n = 27).

On Emerging Technology: What to Know When Your Patient Has a Microchip in His Hand.

Radio-frequency identification (RFID) technology uses an antenna to respond to an incoming signal by sending an outgoing message. This technology has been in use for over 50 years and is common in daily activities such as tapping a credit card to a reader, swiping an ID badge to open a door, paying highway tolls, and operating keyless entry cars. This technology can be implanted, such as in the microchips used to identify domestic pets.

Shoulder Arthroplasty Utilization Based on Race - Are Black Patients Underrepresented?

Background: This study aimed to analyze national and institutional trends in shoulder arthroplasty utilization based on patient race.

Methods: The Nationwide Inpatient Sample (NIS) was employed to determine racial trends in shoulder arthroplasty utilization at a national level. An institutional database was then utilized to retrospectively identify all patients, undergoing shoulder arthroplasty within 2011-2013.

The Optimal Position for Arthrodesis of the Proximal Interphalangeal Joints of the Border Digits.

Purpose: This study aimed to determine the functional characteristics of various arthrodesis angles of the proximal interphalangeal (PIP) joints of the border fingers.

Methods: The dominant hands of 48 volunteers were tested using custom orthoses to simulate PIP joint arthrodesis. For the index finger (IF), orthoses were made in 25°, 40°, and 55° of flexion (IF25, IF40, and IF55).

Preoperative Exposure to Benzodiazepines or Sedative/hypnotics Increases the Risk of Greater Filled Opioid Prescriptions After Surgery.

Background: The effect of the preoperative exposure to controlled substances such as benzodiazepines and sedative/hypnotics on prolonged opioid consumption after hand surgery is not known.

Questions/purposes: (1) Is preoperative exposure to benzodiazepines and sedative/hypnotics associated with greater numbers of filled postoperative opioid prescriptions after hand surgery? (2) Is a positive history of the use of more than one controlled substance, a mood disorder, or smoking associated with greater numbers of filled opioid prescriptions after surgery? (3) Is preoperative exposure to opioids associated with greater numbers of filled postoperative opioid prescriptions after hand surgery?

Methods: Patients undergoing upper extremity surgery at one academic outpatient surgical center were prospectively enrolled. The Pennsylvania Drug Monitoring Program (PDMP) website was used to document prescriptions of opioids, benzodiazepines, and sedative/hypnotics filled 6 months before and after the procedure.

Modifying Patient Expectations Can Enhance Total Hip Arthroplasty Postoperative Satisfaction.

Background: A better understanding of patient expectations within the perioperative setting will enable clinicians to better tailor care to the needs of the total hip arthroplasty (THA) recipient. Such an approach will promote patient-centered decision-making and optimize recovery times while enhancing mandated hospital quality metrics. In the present study, we preoperatively and postoperatively surveyed THA candidates to elucidate the relationship between patient expectations and length of stay (LOS).

Does an Elastic Compression Bandage Provide Any Benefit After Primary TKA?

Background: Compression bandages often are used after TKA to reduce swelling. However, the degree to which they are helpful has not been well characterized.

Questions/purposes: The purpose of this study was to determine whether use of a compression bandage after TKA was associated with (1) less leg swelling (our primary endpoint); or (2) secondary study endpoints, including improved ROM of flexion and extension, lower visual analog scale (VAS) pain scores for worst pain and pain during physical therapy just before surgery, postoperative day (POD) 1, POD 2, and POD 28, or fewer wound complications within 90 days of surgery.

Reverse Sural Adipofascial Flaps with Acellular Dermal Matrix and Negative-Pressure Wound Therapy.

The reverse sural adipofascial flap (RSAF) is used to reconstruct challenging wounds of the foot and ankle. It offers several advantages over the traditional reverse sural flap, including less venous congestion. To complete the reconstruction, split-thickness skin grafting (STSG) may be done immediately or in a delayed fashion; however, both scenarios result in suboptimal take rates and prolonged healing.

Postoperative Pain Management Following Carpal Tunnel Release: A Prospective Cohort Evaluation.

Background: Managing postoperative pain in hand surgery is important for both patients and surgeons. However, there is growing concern over prescription opioid abuse. We hypothesized: (1) that pain medications after carpal tunnel release (CTR) surgery are over-prescribed; and (2) that opioids are unnecessary in the majority of patients.

An Assessment of Online Reviews of Hand Surgeons.

Background: The purpose of this study is to evaluate the number of reviews and scores for active members of the American Society for Surgery of the Hand (ASSH) in popular physician rating websites (Healthgrades.com and Vitals.com).

The Periosteal Medial Femoral Condyle Free Flap: A New Option for Soft Tissue Reconstruction of the Distal Lower Extremity.

Background: Small (<30 cm) soft tissue defects of the distal leg, foot, and ankle pose a complicated issue with regard to wound healing. Multiple flaps have been proposed for reconstruction of these wounds with varying levels of success. The medial femoral condyle flap is a free bone flap supplied by the descending geniculate artery.

Frequency of Incidental Median Thenar Motor Nerve Branch Visualization During Mini-Open and Endoscopic Carpal Tunnel Release.

Clinical studies using extensile approaches for carpal tunnel release (CTR) report a fairly high incidence of thenar motor branch (TMB) variants. As mini-open and endoscopic CTRs have become commonplace, the likelihood of encountering one of these variants in current practice is unknown. The purpose of the present study was to assess prospectively the frequency with which TMB variants are encountered during routine surgery.

Instability After Reverse Total Shoulder Arthroplasty: Which Patients Dislocate?

Given the increasing use of reverse total shoulder arthroplasty (RTSA), it is important to study the complications associated with this procedure. We conducted a study of the incidence, predisposing factors, and treatment of RTSA dislocations. Using our institutional database, we retrospectively searched for RTSAs performed between September 27, 2010 and December 31, 2013 and identified postoperative dislocations.

Tailoring Tendon Transfer Surgery and Rehabilitation for a Musician: A Case Study.

Tendon transfers in hand patients are a commonly performed procedure after extensor tendon rupture. However, the standard side to side technique is not applicable in every patient. We present a case of a musician with unique demands to demonstrate the option to customize surgical technique and therapy regimen to the unique needs of each patient.

Blood management after total joint arthroplasty in the United States: 19-year trend analysis.

Background: Recent studies have failed to show reductions in rates of red blood cell (RBC) transfusion after total joint arthroplasty (TJA) in the United States. This study aims to report the 19-year trend analysis of blood use in TJA, to determine predictors of RBC transfusion and association between RBC transfusion and in-hospital mortality after TJA using a nationally representative database.

Study Design And Methods: Nationwide inpatient sample (NIS) data from 1993 to 2011 were used.

Measurement of the radiographic anatomy of the small and ring metacarpals using computerized tomographic scans.

Background: To date, only plain radiographic definitions of normal anatomical parameters have been described. Our study aims to describe normal anatomic measurements of small and ring metacarpals using a novel digital reconstruction technique based on raw CT image data. We hypothesize that current plain radiographic data incorrectly describes normal metacarpal anatomy in the lateral plane.

Elevated Hemoglobin A1C Levels Correlate with Blood Glucose Elevation in Diabetic Patients following Local Corticosteroid Injection in the Hand: A Prospective Study.

Background: Diabetic patients develop hand conditions that are managed with local corticosteroid injections. Injections can result in a transient elevation in serum glucose in diabetic patients. Hemoglobin A1c is the accepted measure of long-term plasma glucose control in diabetics (levels ≥7 percent reflect poor blood glucose control).

Thromboelastography predictive of death in trauma patients.

Objectives: To determine if thromboelastography (TEG) is predictive of patient outcomes following traumatic injury.

Methods: A retrospective review of 131 patients with pelvic trauma admitted to a Level II trauma center was conducted over four years from 1 January 2009 to 31 December 2012. Patients were identified retrospectively from a prospectively collected database of acute pelvic trauma (n = 372).

Trends in treatment of advanced ankle arthropathy by total ankle replacement or ankle fusion.

Background: Total ankle replacement (TAR) and ankle fusion (AF) are the 2 major operative options for treatment of advanced ankle arthropathy; there is, however, no large epidemiologic study comparing nationwide trends of these 2 procedures. The current study used a nationwide database to compare epidemiologic profiles of TAR and AF.

Methods: Data collected for the Nationwide Inpatient Sample (NIS) from 2000 to 2010 were reviewed.

Unplanned readmission after total joint arthroplasty: rates, reasons, and risk factors.

Background: There has been a major and alarming increase in readmission rates following total joint arthroplasty. With proposed changes in reimbursement policy, increased rates of unplanned readmission following arthroplasty will penalize providers. In particular, it has been proposed that specific complications--so-called "zero-tolerance" complications--are unacceptable and that their treatment will not qualify for reimbursement.

Patients with atrial fibrillation undergoing total joint arthroplasty increase hospital burden.

Background: More than 3 million people in the United States have atrial fibrillation, most of whom are being managed with anticoagulation therapy for life. The goal of the present study was to examine the effect of chronic anticoagulation therapy on patients with atrial fibrillation who undergo total joint arthroplasty.

Methods: We retrospectively reviewed all patients undergoing aseptic primary or revision total joint arthroplasty at our facility from March 2007 to August 2011.

Fasciotomy following total knee arthroplasty: beware of terrible outcome.

There is a paucity of literature on compartment pressure thresholds and complications following fasciotomy in postoperative Total Knee Arthroplasty (TKA) patients. The purpose of this study is to identify the postoperative course in a series of patients who had surgical decompression following TKA. We identified six patients who underwent fasciotomy for proven or suspected compartment syndrome following primary TKA between 2000 and 2010.

Outcome of one-stage cementless exchange for acute postoperative periprosthetic hip infection.

Background: Acute postoperative infection after total hip arthroplasty (THA) is typically treated with irrigation and débridement and exchange of the modular femoral head and acetabular liner. Given a rate of failure exceeding 50% in some series, a one-stage exchange has been suggested as a potential alternative because it allows more thorough débridement and removal of colonized implants. To date, most studies published on the one-stage exchange have used microbe-specific antibiotic-laden bone cement with only one small single-institution series that reported outcomes after a cementless one-stage exchange.

Mechanical properties of bioresorbable self-reinforced posterior cervical rods.

Study Design: A biomechanical study.

Objective: To test the mechanical and physical properties of self-reinforced copolymer bioresorbable posterior cervical rods and compare their mechanical properties to commonly used Irene titanium alloy rods.

Summary Of Background Data: Bioresorbable instrumentation is becoming increasingly common in surgical spine procedures.