Pub Date : 2022-11-15DOI: 10.1097/BCO.0000000000001181
G. Wolf, R. O'Leary, Nicholas M. Tranchitella, Charles A. Johnson, Sara S. Van Nortwick, Matthew A. Dow, R. Murphy
Background: The current procedural terminology (CPT) coding system is used in medical record maintenance and billing. CPT coding is a skill that residents should acquire through training. The purpose of this study was to assess concordance between attending and resident coding practices in pediatric orthopaedic surgery. Methods: Case log reports were collected from 14 residents on the pediatric orthopaedic surgery service over 2 yr, then compared to operating room billing records from three pediatric orthopaedic surgeons. CPT code concordance rates were generated between residents and attendings for individual cases. Results: Three attending surgeons performed 1,372 cases over the two years. To accommodate cases in which multiple residents participated, 38 cases were duplicated (1,410 total attending cases). There was no corresponding resident case entry for 31.3% of attending cases. Of the 968 cases logged by residents, a 78.2% concordance rate was observed. Residents who rotated on pediatric orthopaedics only as a post-graduate year (PGY) 3 during the study period exhibited 73.8% concordance rates, versus residents that rotated as both a PGY-3 and PGY-4 who exhibited 78.7% and those who rotated only as a PGY-4 who exhibited 82.0% (P<0.001). Closed reduction and percutaneous pinning of supracondylar humerus fractures had the highest concordance rate (93.5%) among ACGME-required minimum category cases. Conclusions: Residents and attendings demonstrate a relatively high CPT code concordance among pediatric orthopaedic surgeries. Concordance rates were significantly higher when reported by more experienced residents. Among minimum category cases, percutaneous pinning of supracondylar humeral fractures demonstrated the highest concordance rate. Level of Evidence: Level IV
{"title":"Discordance in current procedural terminology coding for pediatric orthopaedic surgeries between residents and attending surgeons: a retrospective comparative study","authors":"G. Wolf, R. O'Leary, Nicholas M. Tranchitella, Charles A. Johnson, Sara S. Van Nortwick, Matthew A. Dow, R. Murphy","doi":"10.1097/BCO.0000000000001181","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001181","url":null,"abstract":"Background: The current procedural terminology (CPT) coding system is used in medical record maintenance and billing. CPT coding is a skill that residents should acquire through training. The purpose of this study was to assess concordance between attending and resident coding practices in pediatric orthopaedic surgery. Methods: Case log reports were collected from 14 residents on the pediatric orthopaedic surgery service over 2 yr, then compared to operating room billing records from three pediatric orthopaedic surgeons. CPT code concordance rates were generated between residents and attendings for individual cases. Results: Three attending surgeons performed 1,372 cases over the two years. To accommodate cases in which multiple residents participated, 38 cases were duplicated (1,410 total attending cases). There was no corresponding resident case entry for 31.3% of attending cases. Of the 968 cases logged by residents, a 78.2% concordance rate was observed. Residents who rotated on pediatric orthopaedics only as a post-graduate year (PGY) 3 during the study period exhibited 73.8% concordance rates, versus residents that rotated as both a PGY-3 and PGY-4 who exhibited 78.7% and those who rotated only as a PGY-4 who exhibited 82.0% (P<0.001). Closed reduction and percutaneous pinning of supracondylar humerus fractures had the highest concordance rate (93.5%) among ACGME-required minimum category cases. Conclusions: Residents and attendings demonstrate a relatively high CPT code concordance among pediatric orthopaedic surgeries. Concordance rates were significantly higher when reported by more experienced residents. Among minimum category cases, percutaneous pinning of supracondylar humeral fractures demonstrated the highest concordance rate. Level of Evidence: Level IV","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"34 1","pages":"28 - 33"},"PeriodicalIF":0.3,"publicationDate":"2022-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41812731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-01Epub Date: 2022-09-15DOI: 10.1097/bco.0000000000001167
Jessica M Welch, Thompson Zhuang, Lauren M Shapiro, Michael J Gardner, Michelle Xiao, Robin N Kamal
Background: Operative treatment of olecranon fractures in the elderly can lead to greater complications with similar outcomes to nonoperative treatment. The purpose of this study was to analyze cost differences between operative and nonoperative management of isolated closed olecranon fractures in elderly patients.
Methods: Using a United States Medicare claims database, the authors identified 570 operative and 1,863 nonoperative olecranon fractures between 2005 and 2014. The authors retrospectively determined cost of treatment from the payer perspective for a 1-year period after initial injury, including any surgical procedure, emergency room care, follow-up care, physical therapy, and management of complications.
Results: One year after diagnosis, mean costs per patient were higher for operative treatment (United States dollars [US$]10,694 vs US$2,544). 31.05% of operative cases were associated with a significant complication compared with 4.35% of nonoperative cases. When excluding complications, mean costs per patient were still higher for operative treatment ($7,068 vs $2,320).
Conclusions: These findings show that nonoperative management for olecranon fractures in the elderly population leads to fewer complications and is less costly. Nonoperative management may be a higher-value management option for this patient population. These results will help inform management of olecranon fractures as payers shift toward value-based reimbursement models in which quality of care and cost influence surgical decision making.
{"title":"Cost minimization analysis of the treatment of olecranon fracture in elderly patients: a retrospective analysis.","authors":"Jessica M Welch, Thompson Zhuang, Lauren M Shapiro, Michael J Gardner, Michelle Xiao, Robin N Kamal","doi":"10.1097/bco.0000000000001167","DOIUrl":"10.1097/bco.0000000000001167","url":null,"abstract":"<p><strong>Background: </strong>Operative treatment of olecranon fractures in the elderly can lead to greater complications with similar outcomes to nonoperative treatment. The purpose of this study was to analyze cost differences between operative and nonoperative management of isolated closed olecranon fractures in elderly patients.</p><p><strong>Methods: </strong>Using a United States Medicare claims database, the authors identified 570 operative and 1,863 nonoperative olecranon fractures between 2005 and 2014. The authors retrospectively determined cost of treatment from the payer perspective for a 1-year period after initial injury, including any surgical procedure, emergency room care, follow-up care, physical therapy, and management of complications.</p><p><strong>Results: </strong>One year after diagnosis, mean costs per patient were higher for operative treatment (United States dollars [US$]10,694 vs US$2,544). 31.05% of operative cases were associated with a significant complication compared with 4.35% of nonoperative cases. When excluding complications, mean costs per patient were still higher for operative treatment ($7,068 vs $2,320).</p><p><strong>Conclusions: </strong>These findings show that nonoperative management for olecranon fractures in the elderly population leads to fewer complications and is less costly. Nonoperative management may be a higher-value management option for this patient population. These results will help inform management of olecranon fractures as payers shift toward value-based reimbursement models in which quality of care and cost influence surgical decision making.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"33 6","pages":"559-564"},"PeriodicalIF":0.3,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9977169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9410779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-26DOI: 10.1097/bco.0000000000001178
A. Crenshaw
{"title":"“Letter from the Editor”—Dr. Andrew H. Crenshaw, Editor-in-Chief","authors":"A. Crenshaw","doi":"10.1097/bco.0000000000001178","DOIUrl":"https://doi.org/10.1097/bco.0000000000001178","url":null,"abstract":"","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41798563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-09DOI: 10.1097/BCO.0000000000001171
Brett D. Haislup, Brian P. McCormick, Brandon Smith, Melissa A. Wright, A. Murthi
Background: The purpose of this study was to determine the selection criteria and interview-day structure used by shoulder and elbow fellowship program directors. Methods: An anonymous 14-question survey was distributed to the program directors of the 31 American Shoulder and Elbow Surgeons (ASES) recognized orthopaedic shoulder and elbow fellowship programs. Surveys were sent via email, and responses were collected from March 31, 2021 to May 10, 2021. Results: All 31 fellowship directors responded (100%). The most valuable selection criteria for applicants were subjective measures: quality of interview, letters of recommendation, and quality of residency program. Objective criteria such as United States Medical Licensing Examination (USMLE) scores and Orthopaedic In-Training Examination (OITE) scores were less important. Fifteen (50%, 15/30) programs required applicants to have one to two publications, while 15 (50%, 15 of 30) required three to five publications. Programs most commonly interviewed 16 to 20 residents (38.7%). The interview day was a half day for the majority of programs (n=20; 64.5%), with most programs utilizing three (25.8%) or four (45.2%) separate interviews. Current fellows interviewed applicants in about half of the programs (51.6%). Conclusions: Shoulder and elbow fellowship program directors prioritize subjective over objective attributes when selecting applicants. The interview day is most commonly a half day with each applicant undergoing multiple interviews at each institution. Understanding the selection process used by shoulder and elbow fellowship directors provides a valuable resource for residents. Level of Evidence: Level V.
{"title":"Applicant characteristics and interview-day structure of shoulder and elbow surgery fellowships","authors":"Brett D. Haislup, Brian P. McCormick, Brandon Smith, Melissa A. Wright, A. Murthi","doi":"10.1097/BCO.0000000000001171","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001171","url":null,"abstract":"Background: The purpose of this study was to determine the selection criteria and interview-day structure used by shoulder and elbow fellowship program directors. Methods: An anonymous 14-question survey was distributed to the program directors of the 31 American Shoulder and Elbow Surgeons (ASES) recognized orthopaedic shoulder and elbow fellowship programs. Surveys were sent via email, and responses were collected from March 31, 2021 to May 10, 2021. Results: All 31 fellowship directors responded (100%). The most valuable selection criteria for applicants were subjective measures: quality of interview, letters of recommendation, and quality of residency program. Objective criteria such as United States Medical Licensing Examination (USMLE) scores and Orthopaedic In-Training Examination (OITE) scores were less important. Fifteen (50%, 15/30) programs required applicants to have one to two publications, while 15 (50%, 15 of 30) required three to five publications. Programs most commonly interviewed 16 to 20 residents (38.7%). The interview day was a half day for the majority of programs (n=20; 64.5%), with most programs utilizing three (25.8%) or four (45.2%) separate interviews. Current fellows interviewed applicants in about half of the programs (51.6%). Conclusions: Shoulder and elbow fellowship program directors prioritize subjective over objective attributes when selecting applicants. The interview day is most commonly a half day with each applicant undergoing multiple interviews at each institution. Understanding the selection process used by shoulder and elbow fellowship directors provides a valuable resource for residents. Level of Evidence: Level V.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"33 1","pages":"596 - 599"},"PeriodicalIF":0.3,"publicationDate":"2022-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48755493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-09DOI: 10.1097/BCO.0000000000001177
Erik A. Magnusson, A. Novak, Joshua J. Bagley, Zakk Walterscheid, Madeleine Jackson, C. Claudi, M. Elhaddad, Adam Albaba, Jessica Doan, Kiet V. Vo, R. Firoozabadi
Background: Patient-reported outcome score measures (PROM) are valuable tools in assessing patient function following management of orthopaedic conditions. The purpose of this study was to investigate and characterize the use of PROM in the orthopaedic trauma literature. Methods: Articles published in the Journal of Orthopaedic Trauma (JOT), Journal of Bone and Joint Surgery (JBJS), Clinical Orthopaedics and Related Research (CORR), Foot and Ankle International (FAI), Journal of Hand Surgery (JHS), and Journal of Shoulder and Elbow Surgery (JSES) from 2011 to 2019 were reviewed. Publications pertaining to outcomes after trauma were included. Publication year, number of patient-reported outcome measures (PROM) used, and the specific PROMs published per study were recorded. Results: Of the 11,873 articles reviewed, 3,583 (30%) articles pertained to trauma. Twenty-nine percent of orthopaedic trauma articles utilized at least one PROM. There was a gradual increase in trauma publications with PROMs over 9 yr. An average of two PROMs were reported per publication. The percentage of trauma studies that included PROMs varied by journal. In JOT, 35% of trauma articles published included PROM, 30% of articles published in JBJS, 27% in CORR, 48% in JSES, 30% in JHS, and 49% of trauma articles in FAI utilized PROM. The most commonly used PROMs included: visual analog scale (VAS) (n=411), Disabilities of the Arm and Hand Score (DASH) (n=281), Constant-Murley Score (n=145), Short Form Survey-36 (n=123), the Mayo Elbow Performance Index (n=101), and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment (n=93). Conclusions: Clinical outcome studies utilizing PROMs after orthopaedic trauma represented a minority of publications across six major journals between 2011 to 2019. Standardization of PROMs is lacking, making comparison between studies challenging. The VAS and DASH scores were the most frequently PROMs reported followed by additional PROMs for the upper extremity. Characterizing the use of PROMs directs future investigators toward selecting applicable PROMs to evaluate patient outcomes following orthopaedic trauma. Level of Evidence: Level IV.
{"title":"The utility of patient-reported outcome measures in orthopaedic trauma research: a systematic review","authors":"Erik A. Magnusson, A. Novak, Joshua J. Bagley, Zakk Walterscheid, Madeleine Jackson, C. Claudi, M. Elhaddad, Adam Albaba, Jessica Doan, Kiet V. Vo, R. Firoozabadi","doi":"10.1097/BCO.0000000000001177","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001177","url":null,"abstract":"Background: Patient-reported outcome score measures (PROM) are valuable tools in assessing patient function following management of orthopaedic conditions. The purpose of this study was to investigate and characterize the use of PROM in the orthopaedic trauma literature. Methods: Articles published in the Journal of Orthopaedic Trauma (JOT), Journal of Bone and Joint Surgery (JBJS), Clinical Orthopaedics and Related Research (CORR), Foot and Ankle International (FAI), Journal of Hand Surgery (JHS), and Journal of Shoulder and Elbow Surgery (JSES) from 2011 to 2019 were reviewed. Publications pertaining to outcomes after trauma were included. Publication year, number of patient-reported outcome measures (PROM) used, and the specific PROMs published per study were recorded. Results: Of the 11,873 articles reviewed, 3,583 (30%) articles pertained to trauma. Twenty-nine percent of orthopaedic trauma articles utilized at least one PROM. There was a gradual increase in trauma publications with PROMs over 9 yr. An average of two PROMs were reported per publication. The percentage of trauma studies that included PROMs varied by journal. In JOT, 35% of trauma articles published included PROM, 30% of articles published in JBJS, 27% in CORR, 48% in JSES, 30% in JHS, and 49% of trauma articles in FAI utilized PROM. The most commonly used PROMs included: visual analog scale (VAS) (n=411), Disabilities of the Arm and Hand Score (DASH) (n=281), Constant-Murley Score (n=145), Short Form Survey-36 (n=123), the Mayo Elbow Performance Index (n=101), and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment (n=93). Conclusions: Clinical outcome studies utilizing PROMs after orthopaedic trauma represented a minority of publications across six major journals between 2011 to 2019. Standardization of PROMs is lacking, making comparison between studies challenging. The VAS and DASH scores were the most frequently PROMs reported followed by additional PROMs for the upper extremity. Characterizing the use of PROMs directs future investigators toward selecting applicable PROMs to evaluate patient outcomes following orthopaedic trauma. Level of Evidence: Level IV.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"33 1","pages":"607 - 612"},"PeriodicalIF":0.3,"publicationDate":"2022-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43670660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-08DOI: 10.1097/BCO.0000000000001169
Farshad Nikouei, M. Chehrassan, M. Shakeri, Seyed Mani Mahdavi, E. Ameri, Arvin Eslami, A. Habibollahzadeh, Hasan Ghandhari
Background: Deep vein thrombosis (DVT) is a great postoperative challenge in all orthopaedic surgeries. To the authors’ knowledge, this study is the first to evaluate the efficacy of aspirin administration in the prevention of DVT in patients undergoing lumbar spinal surgery. Methods: In this double-blind parallel randomized clinical trial, a total of 126 candidates (age 40 yr and older) were admitted between June 2021 to December 2021. Patients were randomly assigned to the intervention chemoprophylaxis group (41 patients receiving 325 mg aspirin) and controls. The DVT occurrence was recorded by clinical features (Well’s criteria), Doppler lower limbs ultrasound, and D-dimer levels in all participants at baseline (24 hr before the time of surgery) and 2, 6, and 12 wk after surgery in postoperative visits. Results: The mean age of the participants was 63.72±6.87 yr. Baseline demographic values were similar in both groups (P>0.05). The mean follow-up duration was 6.11±2.33 mo. No cases of DVT or abnormal findings on Doppler ultrasound were observed in either group. The mean duration of hospitalization or intensive care unit (ICU) admission was similar between the two groups. Mean baseline D-dimer levels were significantly higher in the intervention group compared with the controls (P=0.047), while it was similar in both groups 3 mo after the operation (P=0.13). Conclusions: In the current study, no case of DVT was observed in either study group. These data do not support the use of aspirin as an anticoagulant for DVT prophylaxis following regular lumbar spinal surgeries. Level of Evidence: Level II.
{"title":"Effect of aspirin in preventing deep vein thrombosis (DVT) after lumbar canal spinal stenosis surgeries: a double-blind parallel randomized clinical trial","authors":"Farshad Nikouei, M. Chehrassan, M. Shakeri, Seyed Mani Mahdavi, E. Ameri, Arvin Eslami, A. Habibollahzadeh, Hasan Ghandhari","doi":"10.1097/BCO.0000000000001169","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001169","url":null,"abstract":"Background: Deep vein thrombosis (DVT) is a great postoperative challenge in all orthopaedic surgeries. To the authors’ knowledge, this study is the first to evaluate the efficacy of aspirin administration in the prevention of DVT in patients undergoing lumbar spinal surgery. Methods: In this double-blind parallel randomized clinical trial, a total of 126 candidates (age 40 yr and older) were admitted between June 2021 to December 2021. Patients were randomly assigned to the intervention chemoprophylaxis group (41 patients receiving 325 mg aspirin) and controls. The DVT occurrence was recorded by clinical features (Well’s criteria), Doppler lower limbs ultrasound, and D-dimer levels in all participants at baseline (24 hr before the time of surgery) and 2, 6, and 12 wk after surgery in postoperative visits. Results: The mean age of the participants was 63.72±6.87 yr. Baseline demographic values were similar in both groups (P>0.05). The mean follow-up duration was 6.11±2.33 mo. No cases of DVT or abnormal findings on Doppler ultrasound were observed in either group. The mean duration of hospitalization or intensive care unit (ICU) admission was similar between the two groups. Mean baseline D-dimer levels were significantly higher in the intervention group compared with the controls (P=0.047), while it was similar in both groups 3 mo after the operation (P=0.13). Conclusions: In the current study, no case of DVT was observed in either study group. These data do not support the use of aspirin as an anticoagulant for DVT prophylaxis following regular lumbar spinal surgeries. Level of Evidence: Level II.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"10 3 1","pages":"543 - 547"},"PeriodicalIF":0.3,"publicationDate":"2022-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62061698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-07DOI: 10.1097/BCO.0000000000001176
M. J. Markel, Caleb V. Grieme, Paulina Szakiel, Nijo Abraham, Paolo Rigor, Xue Geng, Ji Won Lee, H. Boucher
Background: With projected increases in total knee arthroplasties (TKA), patient outcomes without complications are essential. Arthrofibrosis, a potential complication after TKA that may impact long-term patient outcome, may be remedied by manipulation under anesthesia (MUA); however, it is not risk-free. This study investigated the association between manipulation and newer implants and sophisticated techniques, which hold promise for preventing arthrofibrosis and improving patient outcomes. Methods: The authors retrospectively reviewed 1260 primary knee arthroplasty cases (717 conventional, 217 customized, and 326 robot-assisted) performed by an orthopaedic surgeon from January 1, 2016 to May 31, 2020. Patient records were reviewed for manipulation and demographics (type of implant, sex, body mass index [BMI], smoking status, and prior surgery). Results: Overall manipulation rate was 1.3% (n=17). Manipulation rates for conventional customized and robot-assisted TKAs did not vary significantly (1.84%, n=6; 0.46%, n=1; 1.39%, n=10, respectively; P=0.466). Multivariable logistic regression showed no statistically significant difference in the odds of manipulation depending on the type of implant. However, those who smoked were 4 times more likely to have a manipulation (OR: 4.187, 95% CI: 1.119 to 15.673) when controlling for covariates (type of implant, sex, BMI, and prior surgery). Additionally, those with prior surgery were 2.8 times as likely to have a manipulation (OR: 2.808, 95% CI: 1.039 to 7.589) when controlling for covariates. Conclusions: There were no statistically significant differences in manipulation rates among conventional, customized, and robot-assisted TKAs. However, current smoking status and prior surgery were associated with higher risk of manipulation. Level of Evidence: Level III.
{"title":"Comparison of manipulation rates for robot-assisted, customized, and conventional total knee arthroplasty: a retrospective cohort study","authors":"M. J. Markel, Caleb V. Grieme, Paulina Szakiel, Nijo Abraham, Paolo Rigor, Xue Geng, Ji Won Lee, H. Boucher","doi":"10.1097/BCO.0000000000001176","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001176","url":null,"abstract":"Background: With projected increases in total knee arthroplasties (TKA), patient outcomes without complications are essential. Arthrofibrosis, a potential complication after TKA that may impact long-term patient outcome, may be remedied by manipulation under anesthesia (MUA); however, it is not risk-free. This study investigated the association between manipulation and newer implants and sophisticated techniques, which hold promise for preventing arthrofibrosis and improving patient outcomes. Methods: The authors retrospectively reviewed 1260 primary knee arthroplasty cases (717 conventional, 217 customized, and 326 robot-assisted) performed by an orthopaedic surgeon from January 1, 2016 to May 31, 2020. Patient records were reviewed for manipulation and demographics (type of implant, sex, body mass index [BMI], smoking status, and prior surgery). Results: Overall manipulation rate was 1.3% (n=17). Manipulation rates for conventional customized and robot-assisted TKAs did not vary significantly (1.84%, n=6; 0.46%, n=1; 1.39%, n=10, respectively; P=0.466). Multivariable logistic regression showed no statistically significant difference in the odds of manipulation depending on the type of implant. However, those who smoked were 4 times more likely to have a manipulation (OR: 4.187, 95% CI: 1.119 to 15.673) when controlling for covariates (type of implant, sex, BMI, and prior surgery). Additionally, those with prior surgery were 2.8 times as likely to have a manipulation (OR: 2.808, 95% CI: 1.039 to 7.589) when controlling for covariates. Conclusions: There were no statistically significant differences in manipulation rates among conventional, customized, and robot-assisted TKAs. However, current smoking status and prior surgery were associated with higher risk of manipulation. Level of Evidence: Level III.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"33 1","pages":"565 - 570"},"PeriodicalIF":0.3,"publicationDate":"2022-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48473759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-06DOI: 10.1097/BCO.0000000000001161
R. Serri, Amir Farahanchi Baradaran, F. Mirzaee, Z. Zafarani, Hamidreza Aslani
Background: Acromioclavicular joint dislocation (ACJD) is a common shoulder injury that can be classified into six types using the Rockwood classification. Surgical management of type III ACJD remains controversial. Methods: The authors performed a retrospective review of 36 patients who underwent surgical management of their type III ACJD using an arthroscopic technique with an EndoButton (Smith & Nephew, Watford, UK). Patients were followed for a minimum of 2 years and assessed by University of California-Los Angeles (UCLA) Shoulder Score and radiographs. The average follow-up period was 3.8 yr (2 to 6 yr); all patients were between 20 and 65 yr old. Results: There was no recurrence of dislocation or subluxation. All patients reached a normal range of motion by the final follow-up. No significant pain was reported after the surgery. UCLA score improved to an average of 31.73±3.05 at final follow-up. Conclusions: The surgical management of type III ACJD with arthroscopic EndoButton fixation leads to satisfactory patient outcomes with a low complication rate. Level of Evidence: Level IV.
{"title":"Arthroscopic treatment of type III acromioclavicular joint dislocation: a retrospective case series","authors":"R. Serri, Amir Farahanchi Baradaran, F. Mirzaee, Z. Zafarani, Hamidreza Aslani","doi":"10.1097/BCO.0000000000001161","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001161","url":null,"abstract":"Background: Acromioclavicular joint dislocation (ACJD) is a common shoulder injury that can be classified into six types using the Rockwood classification. Surgical management of type III ACJD remains controversial. Methods: The authors performed a retrospective review of 36 patients who underwent surgical management of their type III ACJD using an arthroscopic technique with an EndoButton (Smith & Nephew, Watford, UK). Patients were followed for a minimum of 2 years and assessed by University of California-Los Angeles (UCLA) Shoulder Score and radiographs. The average follow-up period was 3.8 yr (2 to 6 yr); all patients were between 20 and 65 yr old. Results: There was no recurrence of dislocation or subluxation. All patients reached a normal range of motion by the final follow-up. No significant pain was reported after the surgery. UCLA score improved to an average of 31.73±3.05 at final follow-up. Conclusions: The surgical management of type III ACJD with arthroscopic EndoButton fixation leads to satisfactory patient outcomes with a low complication rate. Level of Evidence: Level IV.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"33 1","pages":"580 - 584"},"PeriodicalIF":0.3,"publicationDate":"2022-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41354085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-06DOI: 10.1097/BCO.0000000000001175
Tiziano Conti, M. Majewski
Background: Hansson Pins® (The Swemac Group, Linköping, Sweden) are devices for the internal fixation of femoral neck fractures that are widely used in Scandinavia. The authors hypothesized that the pins could be used with satisfactory results outside of Scandinavia, that they were a valid alternative to cancellous screws and the dynamic hip screw, and that they also could be used in elderly patients. Methods: Sixty-five consecutive patients with femoral neck fractures who received internal fixation with Hansson Pins between January 2007 and December 2016 at the Oberengadin Hospital in Switzerland were included in this retrospective study. The hospital’s electronic database was searched for information, and questionnaires were sent to the patients. Results: After internal fixation with Hansson Pins, 22% of the patients needed a hip prosthesis. For patients 70 yr and older, this rate was 33%. For 60% of the patients who needed a hip prosthesis, the reason for arthroplasty was nonunion. For 20%, the reason was avascular necrosis of the femoral head, and for another 20% of the patients symptomatic coxarthrosis was the cause. Conclusions: The rate of salvage arthroplasties in this study was similar to the rates in the literature of Hansson Pins (mostly from studies performed in Scandinavia), cancellous screws and dynamic hip screws. The findings suggested that Hansson pins could be used with good results outside of Scandinavia and that they were a reasonable alternative to cancellous screws and the dynamic hip screw. The pins also could be used with satisfactory outcomes in elderly patients, but the rate of salvage arthroplasties would be higher. Level of Evidence: Level IV.
{"title":"A retrospective study on internal fixation of femoral neck fractures with Hansson Pins® in Switzerland","authors":"Tiziano Conti, M. Majewski","doi":"10.1097/BCO.0000000000001175","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001175","url":null,"abstract":"Background: Hansson Pins® (The Swemac Group, Linköping, Sweden) are devices for the internal fixation of femoral neck fractures that are widely used in Scandinavia. The authors hypothesized that the pins could be used with satisfactory results outside of Scandinavia, that they were a valid alternative to cancellous screws and the dynamic hip screw, and that they also could be used in elderly patients. Methods: Sixty-five consecutive patients with femoral neck fractures who received internal fixation with Hansson Pins between January 2007 and December 2016 at the Oberengadin Hospital in Switzerland were included in this retrospective study. The hospital’s electronic database was searched for information, and questionnaires were sent to the patients. Results: After internal fixation with Hansson Pins, 22% of the patients needed a hip prosthesis. For patients 70 yr and older, this rate was 33%. For 60% of the patients who needed a hip prosthesis, the reason for arthroplasty was nonunion. For 20%, the reason was avascular necrosis of the femoral head, and for another 20% of the patients symptomatic coxarthrosis was the cause. Conclusions: The rate of salvage arthroplasties in this study was similar to the rates in the literature of Hansson Pins (mostly from studies performed in Scandinavia), cancellous screws and dynamic hip screws. The findings suggested that Hansson pins could be used with good results outside of Scandinavia and that they were a reasonable alternative to cancellous screws and the dynamic hip screw. The pins also could be used with satisfactory outcomes in elderly patients, but the rate of salvage arthroplasties would be higher. Level of Evidence: Level IV.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"33 1","pages":"525 - 529"},"PeriodicalIF":0.3,"publicationDate":"2022-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46481968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-06DOI: 10.1097/BCO.0000000000001173
Scott A. Smith, Robert J. Pettit, D. Flanigan, R. Magnussen
Background: Arthroscopic knee surgery has been associated with a low risk of symptomatic deep vein thrombosis (DVT), with previous studies demonstrating a risk of 0.12% to 3.7%. This risk of DVT and ideal prophylaxis in cases of meniscus root repair are unknown. The authors sought to determine the effectiveness of aspirin as DVT prophylaxis after meniscus root repair. The hypothesis was that there is no significant difference in the risk of symptomatic DVT after meniscus root repair with aspirin prophylaxis as compared with low molecular weight heparin (LMWH) or apixiban. Methods: Patients treated with repair of medial or lateral meniscus root tears over a 3 yr period were identified retrospectively. The risk of subsequent development of a symptomatic DVT was compared based on whether postoperative DVT prophylaxis was undertaken with aspirin or a stronger anticoagulant such as LMWH or apixiban. Results: Fifty-eight patients who underwent root repair (19 lateral and 39 medial) were identified. No symptomatic DVTs were identified in 42 patients (0%) who received LMWH or apixiban, but DVTs were identified in 3 of 16 patients (19%) who received aspirin (P=0.018). No significant differences in patient gender or body mass index, laterality of repair, associated procedures, or smoking history were noted between the groups. The aspirin group included older patients (mean age 49 yr) than those in the LMWH/apixiban group (mean age 39 yr). Conclusions: Aspirin alone may not be sufficient to prevent DVT after meniscus root repair. Additional work is required to clarify ideal DVT prophylaxis following this procedure. Level of Evidence: Level III.
{"title":"Aspirin may not be effective in prevention of deep vein thrombosis after meniscus root repair: a retrospective cohort study","authors":"Scott A. Smith, Robert J. Pettit, D. Flanigan, R. Magnussen","doi":"10.1097/BCO.0000000000001173","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001173","url":null,"abstract":"Background: Arthroscopic knee surgery has been associated with a low risk of symptomatic deep vein thrombosis (DVT), with previous studies demonstrating a risk of 0.12% to 3.7%. This risk of DVT and ideal prophylaxis in cases of meniscus root repair are unknown. The authors sought to determine the effectiveness of aspirin as DVT prophylaxis after meniscus root repair. The hypothesis was that there is no significant difference in the risk of symptomatic DVT after meniscus root repair with aspirin prophylaxis as compared with low molecular weight heparin (LMWH) or apixiban. Methods: Patients treated with repair of medial or lateral meniscus root tears over a 3 yr period were identified retrospectively. The risk of subsequent development of a symptomatic DVT was compared based on whether postoperative DVT prophylaxis was undertaken with aspirin or a stronger anticoagulant such as LMWH or apixiban. Results: Fifty-eight patients who underwent root repair (19 lateral and 39 medial) were identified. No symptomatic DVTs were identified in 42 patients (0%) who received LMWH or apixiban, but DVTs were identified in 3 of 16 patients (19%) who received aspirin (P=0.018). No significant differences in patient gender or body mass index, laterality of repair, associated procedures, or smoking history were noted between the groups. The aspirin group included older patients (mean age 49 yr) than those in the LMWH/apixiban group (mean age 39 yr). Conclusions: Aspirin alone may not be sufficient to prevent DVT after meniscus root repair. Additional work is required to clarify ideal DVT prophylaxis following this procedure. Level of Evidence: Level III.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"33 1","pages":"548 - 552"},"PeriodicalIF":0.3,"publicationDate":"2022-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47172930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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