Orthopedics最新文献

Background: Whether the implementation of robotic-assisted technology in total knee arthroplasty (Ra-TKA) translates into better clinical results remains uncertain. We investigated the impact of Ra-TKA on quality of life and mental health as measured by patient-reported outcome measures (PROMs).

Materials and methods: In this retrospective review, a consecutive series of 204 patients who underwent Ra-TKA were matched by age, sex, and body mass index in a 1:1 ratio to conventional TKAs. The primary outcome was improvement in Knee Injury and Osteoarthritis Outcome Score (KOOS) and Veterans RAND 12-Item Health Survey (VR-12) as measured by minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) scores. Secondary outcomes included hospital length of stay (LOS), skin-to-skin time, tourniquet time, and active knee range of motion. Bivariate analyses were performed between groups.

Results: A total of 314 patients (Ra-TKA=156; TKA=158) had 1-year PROMS available and were included in the study. Conventional TKA patients had significantly longer LOS and shorter skin-to-skin time and tourniquet time (all P<0.001) than Ra-TKA patients. More patients achieved full extension in the Ra-TKA cohort, but both groups ended up with similar postoperative PROMs at 1-year follow-up. A higher number of patients achieved the VR-12 mental component score MCID in the conventional TKA group compared to the Ra-TKA group (50.3% vs 29.5%, P<0.001).

Conclusion: Our results suggest Ra-TKA results in shorter LOS and better short-term knee extension but no improvement in joint-specific PROMs. Additionally, the association between lower quality of life, mental health outcomes, and Ra-TKA may be mediated by patient expectations. Therefore, documenting the use of Ra-TKA is important when reporting these quality metrics.

Quadriceps tendon rupture is typically caused by severe trauma, such as a fall, leading to substantial restriction of knee joint movements. However, pathological ruptures (one third of all quadriceps ruptures) can occur spontaneously or caused by minor trauma. Pathological ruptures are usually caused by chronic systemic diseases, such as systemic lupus erythematosus, chronic renal failure, and rheumatoid arthritis, and rarely by osteogenesis imperfecta (OI), a genetic disorder that affects the musculoskeletal system. Defective type 1 collagen formation in OI leads to bone fragility, ligamentous laxity, tendon rupture, and short stature. Here, we report the case of a 55-year-old man diagnosed with OI who experienced a pathological rupture of the right quadriceps tendon. The patient also had a leg-length discrepancy in the left leg due to the malunion of several femoral fractures. The rupture was repaired using the Krackow suture technique. The patient regained preinjury range of motion within 3 months postoperatively and could walk without pain.

Background: We characterize outpatient prescribing trends of orthopedic surgery providers in the United States.

Materials and methods: A retrospective analysis of the Medicare Part D Prescribers - by Provider and Drug was conducted between 2013 and 2021, including anti-osteoporotic medications (AOMs), antibiotics, opioids, and nonsteroidal anti-inflammatory drugs (NSAIDs). Outcomes included claims, claims per 1,000 prescribers, combined annual growth rate, and percentage growth.

Results: Claims for AOMs decreased from 29,024 in 2013 to 12,500 in 2021. Claims for alendro-nate, ibandronate, risedronate, and teriparatide all significantly decreased, whereas claims for abaloparatide and romosozumab significantly increased (P<0.05). Antibiotic claims increased from 304,817 (2013) to 580,736 (2021). Claims for amoxicillin, amoxicillin/clavulanic acid, cefadroxil, cephalexin, clindamycin, doxycycline, mupirocin, penicillin V, and sulfamethoxazole/trimethoprim significantly increased, whereas use of azithromycin, ciprofloxacin, levofloxacin, and vancomycin significantly decreased (P<0.05). Claims for opioids decreased from 3,224,572 (2013) to 2,070,423 (2021). Use of hydrocodone/acetaminophen, oxycodone/acetaminophen, and tramadol/acetaminophen also significantly decreased (P<0.05). Use of oxycodone and oxycodone myristate significantly increased (P<0.05). Claims for fentanyl, methadone, and morphine all significantly decreased (P<0.05). Claims for NSAIDs increased from 1,300,279 (2013) to 1,796,419 (2021). Claims for celecoxib, diclofenac, ibuprofen, ketorolac, and meloxicam all significantly increased, whereas claims for etodolac, indomethacin, nabumetone, naproxen, piroxicam, and sulindac all significantly decreased (P<0.05).

Conclusion: In line with national guidelines, claims for NSAIDs are increasing and claims for opioid pain medications and AOMs are decreasing. Claims for outpatient antibiotics are increasing, which is of significant concern, given renewed focus on antibiotic stewardship.

Background: Obstructive sleep apnea (OSA) has shown significant effects on complication rates in total joint arthroplasty (TJA) patients. Current research lacks appropriate propensity score matching of this comorbidity as well as data surrounding treated OSA compared to untreated OSA among TJA patients. This study examined if patients with treated and untreated OSA were at higher risk for 90-day postoperative complications following TJA.

Materials and methods: 17,272 patient charts were retrospectively examined, with 3,876 having OSA and 13,396 not. Following propensity score matching of 7,014 patients, 3,507 were identified to have OSA and 3,507 not. Patients were matched based on age, sex, body mass index, American Society of Anesthesiologists (ASA) class, and type of surgery, then further divided into untreated versus treated OSA based on continuous positive airway pressure use. Chi-square analyses compared patient characteristics, and a multivariable logistic regression model assessed the effect of OSA on 90-day complication rates.

Results: OSA alone was not an indicator for 90-day postoperative complications in our propensity-matched sample. Higher ASA classes (P<0.01) and higher Charlson Comorbidity Index (CCI; P<0.01) were associated with a significant increase in 90-day complication rates compared with patients with ASA classes I-II and lower CCI, respectively. There was no significant difference in complications between patients with untreated and treated OSA (P=0.29).

Conclusion: Using propensity score matching, this study indicates that OSA alone is not associated with an increased risk of 90-day postoperative complications in primary TJA. While associated comorbidities of OSA may contribute to increased complication rates, surgeons can be reassured that OSA alone may not be a significant factor in short-term postoperative outcomes.

Background: The primary aim of this study was to quantify radiation exposure during the surgical fixation of distal radius fractures (DRF). Secondary aims included determining patient and surgeon factors associated with higher intraoperative fluoroscopic use.

Materials and methods: This retrospective study included 342 patients with DRF who underwent acute surgical fixation between January 1, 2017, and June 1, 2019. Inclusion criteria were patient age older than 18 years with acute DRF undergoing surgical fixation. Exclusion criteria were patient age younger than 18 years, additional fractures undergoing simultaneous fixation, and bilateral DRF requiring fixation. Patient demographics, surgeon factors, and fluoroscopy data were collected through chart reviews. Univariate and bivariate analyses were performed, and P<0.05 was considered significant.

Results: The median patient age was 59 years, and 77.8% were women. The median dose area product (DAP) was 9.24 cGy*cm² per case. The median number of images obtained per case was 36, and the median fluoroscopy time was 60 seconds, equating to a dose of 0.39 mGy/min. Higher radiation exposure was associated with male patients, more complex fracture morphology, type of implant chosen, junior attendings as primary surgeon, surgeon subspecialty, and surgical assistant training level.

Conclusion: Intraoperative fluoroscopic use during DRF surgical fixation is associated with both patient injury characteristics as well as surgeon factors. Male patients and fracture morphology, as well as surgeon experience and the presence of trainees, all increase fluoroscopic use and radiation exposure.

Background: Hyaluronic acid injections for knee osteoarthritis patients can result in pseudosepsis. A targeted literature review was conducted to determine the rate of pseudosepsis in patients receiving intra-articular hyaluronic acid, particularly hylan G-F 20 (SYNVISC^®).

Materials and methods: Articles were identified through Embase using predefined search strategies. Pseudosepsis event rate was calculated by dividing the number of reported events by the total number of intra-articular injections.

Results: The pseudosepsis event rate ranged from 0% to 5.6% per injection; most treatment groups had an event rate of ≤2% per injection.

Conclusion: Pseudosepsis event rates were low across studies for patients treated with hyaluronic acid, including hylan G-F 20.

Background: This study examined the association between time to surgery post-ankle fracture and perioperative, subacute, and prolonged opioid use.

Materials and methods: This was a retrospective cohort study that used the Merative MarketScan Commercial Claims and Encounters Database. It included patients aged 18 to 64 with an ankle fracture between April 1, 2016, and June 30, 2021, who underwent open reduction and internal fixation within 21 days. Time to surgery was categorized as 0 to 3 days, 4 to 7 days, and 8 to 21 days. Multivariable logistic regression models assessed associations between time to surgery and perioperative (fracture through 7 days after surgery), subacute (31 to 90 days), and prolonged (91 to 180 days) opioid use, adjusting for relevant covariates.

Results: The cohort included 20,642 patients (61.7% female, median age 48); 47.5% had surgery 0 to 3 days after fracture, 25.1% 4 to 7 days, and 27.4% 8 to 21 days. Later surgery (versus 0 to 3 days) was associated with increased perioperative opioid use (4 to 7 days: odds ratio [OR] 2.39, 95% CI 2.13-2.69, P<0.001; 8 to 21 days: OR 2.53, 95% CI 2.25-2.84, P<0.001). Having surgery at 8 to 21 (versus 0 to 3) days was significantly associated with increased prolonged use in those who filled a perioperative opioid prescription after adjusting for perioperative medications (OR 1.20, 95% CI 1.03-1.42, P=0.02).

Conclusion: The study highlights the role of surgical timing in opioid use after ankle fractures. Surgery beyond 7 days after fracture was associated with increased perioperative opioid use and slightly elevated prolonged use in those who filled perioperative opioids. Orthopedic surgeons should consider timely interventions to mitigate prolonged opioid use, thus promoting safer postoperative care in ankle fracture patients.

Metastatic peripheral nerve lymphomas are rare, often mimicking benign neurogenic tumors or neuropraxic injuries. While some report on the involvement of nerves in the upper and lower extremities, the majority of lymphomas involve the lower extremities, with the sciatic nerve being the most common. Furthermore, involvement of the ulnar nerve is exceedingly rare, with only four reported cases, each of which indicated a primary lesion. In this article, we report a unique case of recurrent B-cell lymphoma with metastatic disease of the ulnar nerve in a nonagenarian with a remote history of diffuse high-grade large B-cell lymphoma. The patient presented with 2 months of numbness, tingling, and weakness in her left ring and small fingers. Additionally, she reported a left distal forearm mass. Examination revealed sensory loss, atrophy, and clawing of the hand. Magnetic resonance imaging showed a mass involving the ulnar nerve, confirmed as lymphoma via biopsy. Treatment included radiotherapy and capsulodeses, given her desire for a functional return to her independent activities of daily living. She was satisfied with the outcome of her management. While uncommon, this case highlights the importance of considering metastatic disease as a presentation mimicking cubital tunnel syndrome for timely diagnosis and improved outcomes. By documenting this presentation, this report aims to raise awareness among orthopedic surgeons to enhance diagnostic and management strategies for similar cases of metastatic nature and advanced patient age.

Restoring knee alignment is critical to total knee arthroplasty (TKA) success. Mechanical alignment offers reliable outcomes by standardizing component positioning, but it may neglect individual anatomy. In response, personalized alignment techniques-such as kinematic, inverse kinematic, and functional alignment-aim to replicate native biomechanics using technologies like robotics and patient-specific instrumentation. While promising, these approaches raise concerns about alignment precision, long-term outcomes, and technique selection. As personalized alignment techniques gain traction, evidence is needed to determine optimal patient-specific strategies and implant compatibility. Long-term data will clarify the clinical value and durability of these individualized techniques in TKA.

Background: The Distressed Communities Index (DCI) is a metric often used in the assessment of health care disparities. The purpose of this study was to investigate whether DCI correlates with aspects of presentation, clinical course, and postoperative events among adult ankle fracture patients who undergo surgical repair.

Materials and methods: This retrospective cohort study included adult ankle fracture patients who underwent primary ankle open reduction internal fixation (ORIF) between August 2015 and June 2023 at a single academic tertiary-care center. Patients were separated into two DCI cohorts determined by ZIP Codes: more distressed (DCI≥75) and less distressed (DCI<75). Primary outcomes were time to presentation and time to definitive surgery. Secondary outcomes including location of presentation, admission rates, length of stay, postoperative complications (eg, infection, hardware failure, reoperation), physical therapy participation, and loss to follow-up were also assessed.

Results: A total of 940 patients were included. No differences were observed in time to presentation or time to definitive surgery. However, patients from more distressed communities were more likely to be lost to follow-up during the first 6 months following ankle ORIF compared to those from less distressed communities (95% CI, 1.15-2.67). No differences were found with respect to other secondary outcomes.

Conclusions: Higher DCI is associated with loss to follow-up within the 6 months following ankle fracture ORIF. Interventions focused on uncovering and addressing reasons for loss to follow-up among patients from distressed communities may help ensure follow-up completion during the postoperative recovery period.