Orthopedics最新文献

Background: The recent addition of biceps tendon augmentation to partial arthroscopic rotator cuff repair (ARCR) for the treatment of large-to-massive rotator cuff tears is proposed to improve clinical outcomes and reduce re-tears.

Materials and methods: The purpose of this systematic review and meta-analysis (5 studies) was to compare outcomes between partial ARCR with (142 patients) and without (149 patients) biceps augmentation.

Results: Partial ARCR with and without biceps augmentation were comparable in pain, function, and range of motion. However, biceps augmentation vs no augmentation at all during ARCR may lower re-tear rates for irreparable large-to-massive rotator cuff tears (42.9% vs 72.5%, P=.007).

Conclusion: More research is needed to investigate this technique and guide surgical decision-making. [Orthopedics. 20XX;4X(X):XXXXXX.].

Background: The purpose of this study was to externally validate a predictive score for fracture-related infections, establishing generalizability for absolute and relative risk of infection in the setting of orthopedic fracture surgery.

Materials and methods: This was a retrospective, case-control study performed at a level I academic trauma center that included 147 patients with fracture-related infection in the study group and 300 control patients. We analyzed the same 8 independent predictors of fracture-related infection cited by a previous study. We then used the area under the receiver operating characteristics curve (AUC) to compare the derivation and validation cohorts. The validation and derivation cohorts were then compared by grouping patients into 4 strata of Wise score groups. This allowed for comparison of AUC and risk of fracture-related infection in our institution with those in the previously studied institution.

Results: The resulting data yielded an AUC (0.74) nearly identical to that of the previously studied institution. It was also found that the relative risk of infection correlated with the Wise score in the same way the initial model did with the absolute risks being similar.

Conclusion: The previous predictive model was externally validated and shown to be generalizable to a different patient population. The relative risk of a fracture-related infection can be determined using this scoring model preoperatively with the goal of aiding in patient counseling and surgical decision-making, giving a quantitative value to patient risk factors. [Orthopedics. 202x;4x(x):xx-xx.].

Background: Noise-induced hearing loss (NIHL) is a serious concern for orthopedic surgeons. The National Institute for Occupational Safety and Health (NIOSH) sets the safe exposure limit at 85 dB for 8 hours, yet operating rooms often surpass this limit. This study investigated if using an automated broaching system exposes orthopedic surgeons to dangerous decibel (dB) levels.

Materials and methods: A prospective study analyzed 138 intraoperative sound recordings from 92 total hip arthroplasty (THA) surgeries and 46 baseline measurements at an academic-affiliated private practice, using the NIOSH Sound Level Meter (SLM) application and a microphone. The surgeries were categorized into manual and automated broaching. Key metrics measured included maximal dB level (MDL), peak sound pressure (LC_peak), average continuous sound (LA_eq), and average weighted sound in an 8-hour period (TWA), along with dose representations, to identify hazardous noise levels.

Results: Of the 92 THA sound recordings, 50 used manual broaching and 42 employed automated broaching. Automated broaching exhibited higher noise levels, with an average MDL of 109.92 dBA, a LA_eq of 86.09 dBA, a TWA of 76.48 dBA, and a projected noise dose of 137.74%. In contrast, manual broaching exhibited an average MDL of 105.87 dBA, a LA_eq of 83.06 dBA, a TWA of 72.82 dBA, and a projected noise dose of 82.02%.

Conclusion: This study highlights the auditory risks from automated broach and manual THA surgeries that orthopedic surgeons experience. Manufacturers should focus on reducing instrument noise when designing surgical tools and orthopedic surgeons and operating room staff should take measures to protect themselves from NIHL during surgery. [Orthopedics. 202x;4x(x):xx-xx.].

Background: Altmetric Attention Score (AAS) captures online attention received by a research article in addition to traditional bibliometrics. We present a comprehensive bibliometric analysis of high AAS articles and identify predictors of AAS in orthopedics.

Materials and methods: The top 30 articles with highest AAS were selected from orthopedic journals using the Dimensions App. Multilevel mixed-effects linear regression was used to address clustering in articles from the same journal, with journals as the leveling variable.

Results: A total of 750 articles from 25 journals were included. In the final multivariable model, the funding source (none, industry, government, foundation, university, or multiple), findings (positive, negative, neutral, or not applicable), and the journal's impact factor were significant at P<.05.

Conclusion: Predictors of AAS are similar to predictors of traditional bibliometrics. Future studies need prospective dynamic data to further elucidate the AAS. [Orthopedics. 20XX;4X(X):XXX-XXX.].

Background: This study compared perioperative outcomes as well as encounter and 90-day costs between patients undergoing traditional vs robotic total knee arthroplasty (rTKA).

Materials and methods: A total of 430 TKAs (215 rTKAs, 215 traditional) were retrospectively reviewed. All rTKAs were performed with an imageless, second-generation robotic system. Cohorts were propensity score matched by age, sex, body mass index, and American Society of Anesthesiologists score. Perioperative data and 90-day complications were subsequently compared. Cox regression analyses evaluated survival to all-cause revisions. Univariable analyses compared total cost of care for the initial encounter and 90-day postoperative period. Multivariable regression analyses were then performed to evaluate associations with increased encounter and 90-day costs.

Results: Patients undergoing rTKA had a higher incidence of discharge home (86.5% vs 60.0%; P<.001). The rTKA cohort trended toward a lower incidence of 90-day emergency department visits, and there was a significantly lower percentage of 90-day readmissions (4.2% vs 13.5%; P=.001). Cox hazard ratio demonstrated no difference in survival to all-cause revisions (hazard ratio, 1.3; 95% CI, 0.5-3.7; P=.64). The cost of surgery was significantly higher in the rTKA cohort ($9292 vs $8392; P<.001); however, there was no difference in cost of encounter ($10,356.86 vs $10,396.44; P=.110) or at 90 days postoperatively ($11,103.89 vs $11,040.13; P=.739). rTKA did not have a significant association with increased cost at 90 days postoperatively (odds ratio, 0.96; 95% CI, 0.90-1.02; P=.180).

Conclusion: rTKA had a higher intraoperative cost compared with traditional TKA. However, with increased home discharges and fewer 90-day readmissions, rTKA was not associated with increased cost at 90 days. [Orthopedics. 202x;4x(x):xx-xx.].

Extensor mechanism (EM) disruption after total knee arthroplasty (TKA) is devastating, especially in cases of re-rupture. A 67-year-old man with diabetes had patellar tendon rupture after revision TKA and then had migration of the bone block after Achilles tendon allograft with bone block (ATBB) augmentation with cerclage. A third reconstruction was performed with open reduction and internal fixation and high-strength braided suture augmentation. Five months postoperatively, the patient had regained full range of motion with intact EM and hardware. The risk of re-rupture is high in ATBB, and the primary issues in this case were nonunion and tendinous compromise. A construct that encompasses compression and buttressing of the bone block with tendon augmentation potentially addresses the risks of recurrent EM rupture in more complex cases. [Orthopedics. 20XX;4X(X):XXX-XXX.].

Background: We conducted a study to investigate the relationship between a mental health diagnosis (MHD) and postoperative outcomes in orthopedic patients with bone and soft tissue sarcoma. We hypothesized that patients with sarcoma with a preoperative MHD would have worse outcomes and more postoperative complications.

Materials and methods: A retrospective review was performed of 356 patients who underwent surgical treatment for bone or soft tissue sarcoma. Patients were divided into two groups: those with a diagnosis of depression, anxiety, bipolar disorder, and/or schizophrenia and those with no previous MHD. Statistical analysis was performed using independent t, Mann-Whitney U, and chi-square tests.

Results: Statistical analysis demonstrated significant differences between the MHD group and the control group in three outcomes: length of stay, 90-day readmission rate, and incidence of surgical site infections. Subgroup analysis of the MHD group yielded significantly higher 90-day readmission rates for patients who were diagnosed during sarcoma treatment.

Conclusion: Patients with sarcoma and an MHD had a longer postoperative hospital stay, an increased 90-day readmission rate, and a greater risk of surgical site infection. Given the rising prevalence of mental health disorders nationwide, orthopedic surgeons should be aware of differences in postoperative outcomes between patients with sarcoma with and without mental illness. [Orthopedics. 20XX;4X(X):XXX-XXX.].

Background: In this study, we tested the null hypothesis that robotic-assisted total hip arthroplasty (THA) vs conventional THA was not associated with (1) the amount of postoperative opioid use and (2) the incidence of new, persistent opioid use.

Materials and methods: We used a large, national administrative database to identify patients 50 years and older undergoing primary robotic or conventional THA. Patients with hip fractures or a history of malignancy, hip infection, or opioid use disorder were excluded. Patients who filled an opioid prescription within 1 year to 30 days preoperatively or who underwent a subsequent procedure within 1 year after THA were excluded. Outcomes included the morphine milligram equivalents (MMEs) filled within the THA perioperative period and the incidence of new, persistent opioid use. Multivariable logistic regression models were used to evaluate associations between robotic-assisted THA and new, persistent opioid use, adjusting for age, sex, insurance plan, region, location of surgery, and comorbidities.

Results: In the postoperative period, robotic-assisted THA, compared with conventional THA, was associated with a lower mean total MMEs filled per patient (452.2 vs 517.1; P<.001) and a lower mean MMEs per patient per day (71.53 vs 74.64; P<.001). Patients undergoing robotic-assisted THA had decreased odds of developing new, persistent opioid use compared with patients undergoing conventional THA (adjusted odds ratio, 0.82 [95% CI, 0.74-0.90]).

Conclusion: Robotic-assisted THA is associated with lower postoperative opioid use and a decreased odds of developing new, persistent opioid use compared with conventional THA. For the purposes of reducing opioid use, our results support the adoption of robotic-assisted THA. [Orthopedics. 202x;4x(x):xx-xx.].

Background: Displaced diaphyseal fractures can be reduced using the push-pull technique, wherein a plate is affixed to the distal fragment of the fracture, a post screw is placed proximal to the plate, and a lamina spreader creates distraction. This study evaluated the load to failure and mechanism of failure of bicortical and unicortical post screws during reduction.

Materials and methods: Four matched pairs of cadaver legs were subjected to a 2-cm oblique osteotomy simulating a displaced, oblique diaphyseal fracture. A 6-hole compression plate was affixed to the distal fragment with 2 unicortical locking screws, and a 12-mm uni-cortical or 20-mm bicortical screw was inserted as a post screw proximal to the plate. A lamina bone spreader was used to exert a distraction force between the plate and the post screw. A mechanical actuator simulated the distraction procedure until failure. Maximum applied load, displacement, and absorbed energy were recorded and compared across unicortical and bicortical groups by paired t tests.

Results: At maximum load, we found statistically significant differences in displacement (P=.003) and energy absorbed (P=.022) between the two groups. All unicortical screws failed through screw toggle and bone cut-out. Bicortical screws failed through bending, with no visible damage to the bone at the screw site.

Conclusion: When diaphyseal fractures are significantly shortened and require a greater distraction force to achieve reduction, bicortical screws demonstrate a higher mechanical load to failure and increased bone loss from the screw-removal site. A unicortical post screw may be used if minimal distraction is needed. [Orthopedics. 202x;4x(x):xx-xx.].

Background: Optimizing operating room (OR) scheduling accuracy is important for improving OR efficiency and maximizing value of total knee arthroplasty (TKA). However, data on factors that may impact TKA OR scheduling accuracy are limited.

Materials and methods: A retrospective review of 7655 knee arthroplasties (6999 primary TKAs and 656 revision TKAs) performed between January 2020 and May 2023 was conducted. Patient baseline characteristics, surgeon experience (years in practice), as well as actual vs scheduled OR times were collected. Actual OR times that were at least 15% shorter or longer than scheduled OR times were considered to be clinically important. Logistic regression analyses were employed to assess the influence of specific patient and surgeon factors on OR scheduling inaccuracies.

Results: Using adjusted odds ratio, patients with primary TKA who had a lower body mass index (P<.001) were independently associated with overestimation of scheduled surgical time. Conversely, younger age (P<.001), afternoon procedure start time (P<.001), surgeons with less than 10 years of experience (P=.037), and higher patient body mass index (P<.001) were associated with underestimation of scheduled surgical time. For revision TKA, female sex (P=.021) and morning procedure start time (P=.038) were associated with overestimation of scheduled surgical time, while surgeons with less than 10 years of experience (P=.014) and patients who underwent spinal/epidural/block anesthesia (P=.038) were associated with underestimation of scheduled surgical time.

Conclusion: This study highlights patient, surgeon, and intraoperative variables that impact the accuracy of scheduling for TKA procedures. Health systems should take these variables into consideration when creating OR schedules to fully optimize resources and available space. [Orthopedics. 202x;4x(x):xx-xx.].