The Journal of Bone and Joint Surgery最新文献

{"title":"Early, Rather than Late, Weight-Bearing and Range-of-Motion Exercise Improved Early Function But Not Time to Return to Work After Surgical Fixation of Unstable Ankle Fractures","authors":"J. Gorczyca","doi":"10.2106/JBJS.16.01382","DOIUrl":"https://doi.org/10.2106/JBJS.16.01382","url":null,"abstract":"Dehghan N, McKee MD, Jenkinson RJ, Schemitsch EH, Stas V, Nauth A, Hall JA, Stephen DJ, Kreder HJ. Early weightbearing and range of motion versus non-weightbearing and immobilization after open reduction and internal fixation of unstable ankle fractures: a randomized controlled trial. J Orthop Trauma. 2016 Jul;30(7):345-52.\u0000\u0000### Question:\u0000\u0000In patients who had surgical fixation of unstable ankle fractures, how do early and late weight-bearing and range-of-motion exercise compare for return to work and function?\u0000\u0000### Design:\u0000\u0000Randomized (allocation concealed), unblinded, controlled trial with 12 months of follow-up.\u0000\u0000### Setting:\u0000\u00002 trauma centers in Toronto, Ontario, Canada.\u0000\u0000### Patients:\u0000\u0000110 patients (mean age, 42 years; 54% men) who had isolated, acute, unstable ankle fractures that were treated with stable internal fixation. Exclusion criteria were syndesmotic injuries, posterior malleolar fractures needing fixation, surgical fixation >14 days after injury, grade-III open fractures, tibial plafond fractures, polytrauma, skeletal immaturity, past ipsilateral ankle surgery, nonambulatory status before injury, inability to participate in the intervention or study protocol, or receipt of Workers’ Compensation. 82% of patients provided data for the primary outcome, and ≥84% provided other data at each assessment.\u0000\u0000### Intervention:\u0000\u0000Patients were allocated to early (n = 56) or late (n = 54) weight-bearing and range-of-motion exercise under the direction of physiotherapists. …","PeriodicalId":22579,"journal":{"name":"The Journal of Bone and Joint Surgery","volume":"114 1","pages":"350"},"PeriodicalIF":0.0,"publicationDate":"2017-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80798096","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}

{"title":"Twelve-Year Outcomes of an Oxinium Total Knee Replacement Compared with the Same Cobalt-Chromium Design: An Analysis of 17,577 Prostheses from the Australian Orthopaedic Association National Joint Replacement Registry","authors":"C. Vertullo, P. Lewis, S. Graves, L. Kelly, M. Lorimer, P. Myers","doi":"10.2106/JBJS.16.00092","DOIUrl":"https://doi.org/10.2106/JBJS.16.00092","url":null,"abstract":"Background: Oxidized zirconium (Oxinium) was introduced as an alternative bearing surface to cobalt-chromium (CoCr) in an attempt to reduce polyethylene wear and decrease aseptic mechanical failure of total knee replacements. While noncomparative reports have been described as promising, we were aware of no short or long-term clinical studies showing the superiority of Oxinium on polyethylene as a bearing surface. Using data from a comprehensive national joint replacement registry, we compared the long-term outcomes after cruciate-retaining total knee arthroplasty (TKA) with an Oxinium femoral component and those with the same prosthetic design but with a CoCr femoral component. Methods: The cohorts consisted of 17,577 cemented Genesis-II cruciate-retaining total knee replacements using non-cross-linked polyethylene, which included 11,608 with CoCr femoral components and 5,969 with Oxinium femoral components. The cumulative percent revision and hazard ratio (HR) for revision risk were estimated for the cemented Genesis-II Oxinium and CoCr cruciate-retaining TKAs performed in Australia from September 1, 1999, to December 31, 2013. In addition, the revision diagnoses and the effects of age and patellar resurfacing were examined. Results: No difference in the HR for revision risk was found between the Oxinium and CoCr cohorts for any age category for all causes of revision (HR = 0.92 [95% confidence interval (CI), 0.78 to 1.08]; p = 0.329), loosening or lysis, or aseptic causes, except for loosening or lysis in the group of patients who were ≥75 years old (p = 0.033). In these patients, TKA with Oxinium femoral components had a higher rate of revision. Younger patients preferentially received Oxinium femoral components. The revision risk was not affected by patellar resurfacing or nonresurfacing. At 12 years, the cumulative percent revision was 4.8% (95% CI, 4.2% to 5.4%) for the CoCr Genesis-II prosthesis compared with 7.7% (95% CI, 6.2% to 9.5%) for the Oxinium Genesis-II prosthesis. Conclusions: In this cohort study involving the same prosthetic design, Oxinium femoral components did not reduce revision rates for all causes, loosening or lysis, or when infection as a cause of revision was removed compared with the same CoCr femoral component across all age groups including patients who were <55 years old. The cumulative percent revision was greater for the Oxinium components than for the CoCr components. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22579,"journal":{"name":"The Journal of Bone and Joint Surgery","volume":"7 1","pages":"275–283"},"PeriodicalIF":0.0,"publicationDate":"2017-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90201568","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}

{"title":"Physical Activities and Lifestyle Factors Related to Adolescent Idiopathic Scoliosis","authors":"Kota Watanabe, T. Michikawa, I. Yonezawa, M. Takaso, S. Minami, S. Soshi, T. Tsuji, E. Okada, Katsumi Abe, Masamichi Takahashi, K. Asakura, Y. Nishiwaki, M. Matsumoto","doi":"10.2106/JBJS.16.00459","DOIUrl":"https://doi.org/10.2106/JBJS.16.00459","url":null,"abstract":"Background: In addition to genetic factors, environmental and lifestyle factors are thought to play an important role in the onset of adolescent idiopathic scoliosis (AIS). This cross-sectional study was conducted to explore lifestyle factors related to AIS. Methods: This study included 2,759 Japanese female junior high school students who planned a secondary screening after an initial moiré topography screening indicated possible scoliosis. The students and their mothers, or guardians, were asked to fill out a questionnaire consisting of 38 questions about demographic factors, lifestyle-related factors, social factors, household environment, participation in sports, health status, and factors related to the mother’s pregnancy and delivery. The questionnaire was completed by 2,747 students (a 99.6% response rate). After excluding students with heart disease, neurological disease, or a congenital vertebral anomaly, 2,600 students were eligible for assessment. After undergoing a secondary screening with standing radiographs of the spine, students were assigned to the normal (control) group if radiographs showed a curve of <15° or to the scoliosis group if they had a curve of ≥15°. The odds ratios (ORs) for AIS in relation to the possible risk or preventive factors were estimated by logistic regression analyses. Results: No lifestyle-related factor was significantly associated with AIS. However, AIS was associated with classical ballet training (OR, 1.38; 95% confidence interval [CI], 1.09 to 1.75); the odds of AIS developing increased as the child’s frequency of training, number of years of experience, and duration of training in ballet increased. The OR for AIS was 1.5 times higher for participants whose mothers had scoliosis. AIS was also associated with a low body mass index (BMI). These associations remained even after mutual adjustment was performed. Conclusions: No association was found between AIS and lifestyle-related factors. However, classical ballet training, a family history of scoliosis, and low BMI may be associated with AIS. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22579,"journal":{"name":"The Journal of Bone and Joint Surgery","volume":"43 1","pages":"284–294"},"PeriodicalIF":0.0,"publicationDate":"2017-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73872941","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}

{"title":"Long-Term Results After Total Knee Arthroplasty with Contemporary Rotating-Hinge Prostheses","authors":"Umberto Cottino, M. Abdel, K. Perry, K. Mara, D. Lewallen, A. Hanssen","doi":"10.2106/JBJS.16.00307","DOIUrl":"https://doi.org/10.2106/JBJS.16.00307","url":null,"abstract":"Background: Total knee arthroplasty (TKA) with a rotating-hinge prosthesis is considered a salvage procedure. While excellent immediate stability is achieved, the historically high failure rate has tempered its use. The goal of this study was to determine clinical outcomes, radiographic results, and survivorship after TKA with contemporary rotating-hinge components. Methods: We identified 408 consecutive TKAs performed with rotating-hinge components for nononcologic indications from 2002 to 2012 at a single academic institution. Two hundred and sixty-four knees (65%) had rotating-hinge TKA components implanted for aseptic etiologies, while 144 knees (35%) were managed with the components in 2-stage reimplantation following infection. Rotating-hinge TKA implants were used for complex primary procedures in 74 knees (18%) and as a revision construct in 334 knees (82%). Clinical outcomes were assessed with the Knee Society scoring system, survivorship analyses, and cumulative incidence of revision. The mean age of the patients at the time of the index arthroplasty was 69 years, and the mean duration of follow-up was 4 years (range, 2 to 12 years). Results: At the most recent follow-up, the mean Knee Society knee score had increased from 51 points preoperatively to 81 points (p < 0.0001), and the mean Knee Society functional score had increased from 26 to 36 points (p < 0.0001). At a mean of 4 years, loosening of components was observed in 13 (3.7%) of 349 knees. At the most recent follow-up, 59 revision procedures and 25 reoperations had been performed. The cumulative incidence of any revision was 9.7% at 2 years and 22.5% at 10 years. The cumulative incidence of revision for aseptic loosening was 1.7% at 2 years and 4.5% at 10 years. Metaphyseal cones were used in 114 knees (28%). Survivorship analysis revealed a trend toward a lower risk of revision (hazard ratio [HR] = 0.69; 95% confidence interval [CI] = 0.39 to 1.22; p = 0.20) and reoperation (HR = 0.51; 95% CI = 0.22 to 1.19; p = 0.12) in patients with metaphyseal cones, despite their use in the most severe of bone defects. Conclusions: Contemporary rotating-hinge TKA implants had a low 10-year cumulative incidence of revision for aseptic loosening of 4.5%. Greater use of metaphyseal fixation has aided this improvement. Patients can expect substantial improvements in clinical outcomes with this revision strategy. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22579,"journal":{"name":"The Journal of Bone and Joint Surgery","volume":"35 1","pages":"324–330"},"PeriodicalIF":0.0,"publicationDate":"2017-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81404531","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}

{"title":"Rotational Knee Instability in ACL-Deficient Knees: Role of the Anterolateral Ligament and Iliotibial Band as Defined by Tibiofemoral Compartment Translations and Rotations","authors":"F. Noyes, Lauren E Huser, M. Levy","doi":"10.2106/JBJS.16.00199","DOIUrl":"https://doi.org/10.2106/JBJS.16.00199","url":null,"abstract":"Background: The anterolateral ligament (ALL) has been proposed as a primary restraint for knee rotational stability. However, the data remain inconclusive. The purpose of this study was to determine the effect of the ALL and the iliotibial band (ITB) on knee rotational stability. Methods: A 6-degrees-of-freedom robotic simulator was used to test 14 fresh-frozen cadaveric knee specimens. There were 4 testing conditions: intact, anterior cruciate ligament (ACL)-sectioned, ACL and ALL or ITB-sectioned (determined at random), and ACL and both ALL and ITB-sectioned. Lateral, central, and medial tibiofemoral compartment translations and internal tibial rotations were measured under 100-N anterior drawer (Lachman), 5-Nm internal rotation torque, and 2 pivot-shift simulations (Pivot Shift 1 was 5 Nm of internal rotation torque, and Pivot Shift 2 was 1 Nm of internal rotation torque). Statistical equivalence within 2 mm and 2° was defined as p < 0.05. Results: Sectioning the ACL alone produced increased pivot shift and Lachman compartment translations (p > 0.05). Further sectioning of either the ALL or the ITB separately produced minor added increases in pivot-shift compartment translations and tibial internal rotations (<2 mm or <3°) in the ACL-deficient knee. Sectioning both the ALL and ITB produced increases not equivalent to the ACL-deficient knee in pivot-shift lateral compartment translations (4.4 mm; 95% confidence interval [CI], 2.7 to 6.1 mm [p = 0.99] for Pivot Shift 1 and 4.3 mm; 95% CI, 2.6 to 6.0 mm [p = 0.99] for Pivot Shift 2), with 10 of 14 knees being converted to a corresponding Grade-3 pivot-shift (>20 mm of lateral translation). Increases in internal rotation after ALL and ITB sectioning occurred at 25°, 60°, and 90° (p = 0.99 for all) and ranged from 1° to 12°, with 21% of the knees having 8° to 12° increases. Conclusions: With ACL sectioning, a positive pivot-shift anterior subluxation occurred even with intact ALL and ITB structures, which indicates that the latter are not primary restraints but function together as anterolateral secondary restraints. With ACL deficiency, concurrent loss of the ALL and ITB resulted in conversion in a majority of knees (71%) to a Grade-3 pivot-shift subluxation, along with major increases of internal rotation in select knees. Clinical Relevance: With ACL rupture, major increases in rotational instability are not adequately resisted by native ALL or ITB structures. Therefore, anatomic ALL or ITB surgical reconstruction would not block a positive pivot shift. The potential protective effects of ACL graft-unloading from these structures require further study.","PeriodicalId":22579,"journal":{"name":"The Journal of Bone and Joint Surgery","volume":"2 1","pages":"305–314"},"PeriodicalIF":0.0,"publicationDate":"2017-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85539120","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}

{"title":"Smoking Increases the Rate of Reoperation for Infection within 90 Days After Primary Total Joint Arthroplasty","authors":"E. Tischler, Laura J Matsen Ko, Antonia F. Chen, M. Maltenfort, Jacob N. Schroeder, M. Austin","doi":"10.2106/JBJS.16.00311","DOIUrl":"https://doi.org/10.2106/JBJS.16.00311","url":null,"abstract":"Background: The relationship between smoking and complications after total joint arthroplasty is unclear. Prior studies have been limited by relatively small sample sizes or investigation of select cohorts. The purpose of this study was to investigate the association between smoking and readmission and/or reoperation within 90 days of total joint arthroplasty in a large, non-select cohort of patients. Methods: Using our institutional database, we retrospectively identified patients who underwent primary total joint arthroplasty between 2000 and 2014. Patients were stratified into 1 of 3 groups: current smokers, former smokers, and nonsmokers. The association between smoking status and subsequent readmission and/or reoperation within 90 days was investigated using multivariate regression analysis. Results: We retrospectively identified 15,264 patients (6,749 male and 8,515 female) who underwent 17,394 total joint arthroplasties during the study period. Of these patients, 1,371 (9.0%) were current smokers, 5,195 (34.0%) were former smokers, and 8,698 (57.0%) were nonsmokers. Former smokers reported a median of 22.2 years (range, 0.2 to 60 years) of abstinence prior to the surgical procedure. Current smokers were significantly younger (p < 0.001) at a mean age (and standard deviation) of 57.7 ± 10.3 years than nonsmokers at 63.2 ± 11.8 years. Current smokers were significantly more likely than nonsmokers to undergo reoperation for infection (odds ratio [OR], 1.82 [95% confidence interval (CI), 1.03 to 3.23]; p = 0.04), and former smokers were at no increased risk (OR, 1.11 [95% CI, 0.73 to 1.69]; p = 0.61). Packs per decade were independently associated with an increased risk of 90-day nonoperative readmission regardless of smoking status (OR, 1.12 [95% CI, 1.03 to 1.20]). Lastly, neither smoking status nor packs per decade were associated with aseptic or total reoperations. Conclusions: This study, after controlling for confounding factors, demonstrated not only that current smokers have a significantly increased risk of reoperation for infection within 90 days of a surgical procedure compared with nonsmokers, but also that the amount that one has smoked, regardless of current smoking status, significantly contributed to increased risk of nonoperative readmission. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22579,"journal":{"name":"The Journal of Bone and Joint Surgery","volume":"36 1","pages":"295–304"},"PeriodicalIF":0.0,"publicationDate":"2017-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85568900","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}

{"title":"Same-Day Versus Next-Day Discharge Increased Pain on the Day After, But Not on the Day of or Four Weeks After, Total Hip Arthroplasty","authors":"T. Vail","doi":"10.2106/JBJS.16.01381","DOIUrl":"https://doi.org/10.2106/JBJS.16.01381","url":null,"abstract":"Goyal N, Chen AF, Padgett SE, Tan TL, Kheir MM, Hopper RH Jr, Hamilton WG, Hozack WJ. Otto Aufranc Award: a multicenter, randomized study of outpatient versus inpatient total hip arthroplasty. Clin Orthop Relat Res. 2016 Jun 10. [Epub ahead of print].\u0000\u0000### Question:\u0000\u0000In patients having total hip arthroplasty, does planned discharge on the same day versus the next day lead to different outcomes in terms of postoperative pain, complications, and health-care provider visits?\u0000\u0000### Design:\u0000\u0000Randomized (allocation concealed)*, unblinded, controlled trial with 4 weeks of follow-up and intention-to-treat analysis. ClinicalTrials.gov NCT02230657.\u0000\u0000### Setting:\u0000\u00002 high-volume, adult reconstruction centers in the United States.\u0000\u0000### Patients:\u0000\u0000220 patients <75 years of age (mean age, 60 years; 53% men) with a body mass index of <40 kg/m2 who underwent primary unilateral total hip arthroplasty through a direct anterior approach. The exclusion criteria included chronic opioid use, need for a walker or wheelchair, lack of assistance at home, or history of cardiopulmonary disease with need for acute inpatient monitoring. 100% of patients completed follow-up.\u0000\u0000### Intervention:\u0000\u0000Planned …","PeriodicalId":22579,"journal":{"name":"The Journal of Bone and Joint Surgery","volume":"54 10","pages":"352"},"PeriodicalIF":0.0,"publicationDate":"2017-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91489662","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}

{"title":"Thromboembolic Disease in Patients with Metastatic Femoral Lesions: A Comparison Between Prophylactic Fixation and Fracture Fixation","authors":"Arun Aneja, Jimmy J. Jiang, Anna Cohen-Rosenblum, Hue L. Luu, Terrance D. Peabody, S. Attar, T. David Luo, Rex C. Haydon","doi":"10.2106/JBJS.16.00023","DOIUrl":"https://doi.org/10.2106/JBJS.16.00023","url":null,"abstract":"Background: We are not aware of any previous studies that have compared the rate of venous thromboembolic events in patients who underwent prophylactic intramedullary nailing because of an impending fracture with the rate in patients who underwent intramedullary nailing after a pathological fracture. The objective of the present study was to determine if the rate of venous thromboembolic events varies between patients who are managed with prophylactic fixation and those who are managed with fixation after a pathological fracture. Methods: We performed a retrospective comparative study in which the Nationwide Inpatient Sample database was used to identify all patients who had undergone femoral stabilization, either for a pathological femoral fracture or for prophylactic fixation of femoral metastatic lesion, over a period of 10 consecutive years (between 2002 and 2011) in the United States. Demographic data, comorbidities, venous thromboembolic event rates, and other common postoperative complications were compared between the 2 groups. Results: Patients who were managed with prophylactic fixation had significantly higher rates of pulmonary embolism (p < 0.001; adjusted odds ratio, 2.1) and deep-vein thrombosis (p = 0.03; adjusted odds ratio, 1.5). Patients who were managed with fixation after a pathological fracture had a significantly greater need for blood transfusion, higher rates of postoperative urinary tract infection, and a decreased likelihood of being discharged to home (p < 0.001 for all). Conclusions: Patients with metastatic disease who undergo prophylactic intramedullary nailing have higher observed rates of venous thromboembolic events than those who undergo nailing for the treatment of a pathological fracture and should be actively and vigilantly managed in the postoperative period. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22579,"journal":{"name":"The Journal of Bone and Joint Surgery","volume":"53 1","pages":"315–323"},"PeriodicalIF":0.0,"publicationDate":"2017-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81020003","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}

{"title":"Evaluation of First-Ray Mobility in Patients with Hallux Valgus Using Weight-Bearing CT and a 3-D Analysis System: A Comparison with Normal Feet","authors":"Tadashi Kimura, M. Kubota, Tetsuya Taguchi, N. Suzuki, A. Hattori, K. Marumo","doi":"10.2106/JBJS.16.00542","DOIUrl":"https://doi.org/10.2106/JBJS.16.00542","url":null,"abstract":"Background: Some physicians report that patients with hallux valgus have hypermobility at the tarsometatarsal (TMT) joint of the first ray and 3-dimensional (3-D) deformity. With use of non-weight-bearing and weight-bearing computed tomography (CT), we evaluated the 3-D mobility of each joint of the first ray in feet with hallux valgus compared with normal feet. Methods: Ten feet of 10 patients with hallux valgus and 10 feet of 10 healthy volunteers with no foot disorders were examined. All participants were women. Weight-bearing (a load equivalent to body weight) and non-weight-bearing CT scans were made with use of a device that we developed. Orthogonal coordinate axes were set and a 3-D model was reconstructed. Each joint of the first ray was aligned with the respective proximal bone, and 3-D displacement of the distal bone relative to the proximal bone under loading was quantified. Results: At the talonavicular joint, significantly greater dorsiflexion of the navicular relative to the talus was observed in the hallux valgus group compared with the control group. At the medial cuneonavicular joint, the hallux valgus group showed significantly greater eversion and abduction of the medial cuneiform relative to the navicular. At the first TMT joint, the hallux valgus group showed significantly greater dorsiflexion, inversion, and adduction of the first metatarsal relative to the medial cuneiform. At the first metatarsophalangeal joint, the hallux valgus group showed significantly greater eversion and abduction of the first proximal phalanx relative to the first metatarsal (all p < 0.05). Conclusions: The results of this study suggest that loading of the foot causes significant 3-D displacement not only at the TMT joint but also at the other joints of the first ray. There is increased mobility in the first ray in patients who have hallux valgus.","PeriodicalId":22579,"journal":{"name":"The Journal of Bone and Joint Surgery","volume":"48 1","pages":"247–255"},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73832573","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}

{"title":"Total Knee Arthroplasty After Anterior Cruciate Ligament Reconstruction: Not Just a Routine Primary Arthroplasty","authors":"T. Watters, Y. Zhen, J. R. Martin, Dan L Levy, J. Jennings, D. Dennis","doi":"10.2106/JBJS.16.00524","DOIUrl":"https://doi.org/10.2106/JBJS.16.00524","url":null,"abstract":"Background: Despite the success of restoring joint stability and improving early functional outcomes after anterior cruciate ligament (ACL) reconstruction, the long-term risk of developing symptomatic osteoarthritis requiring total knee arthroplasty is higher than that in the uninjured population. The purpose of this study was to compare operative characteristics and early outcomes of patients undergoing total knee arthroplasty after ACL reconstruction with those of a matched cohort of control subjects with primary osteoarthritis and no history of ligament reconstruction. Methods: All patients who had undergone total knee arthroplasty from 2005 to 2013 at our institution with a history of ACL reconstruction and a minimum 2-year follow-up were identified from a prospective research database. These patients were matched by demographic and surgeon variables to patients who had not undergone prior ACL reconstruction. Outcomes included Knee Society Scores (KSS), range of motion, operative variables, complications, and reoperations. Results: A cohort of 122 patients was identified as the ACL study group and was compared with the matched control cohort. The mean age at the time of the surgical procedure was 58 years, and 55% of the patients were male. The mean follow-up was 3.3 years in the ACL group and 3.0 years in the control group. There was no significant difference in the latest KSS outcomes between groups postoperatively (p > 0.05). Although preoperative flexion was significantly lower (p = 0.01) in the ACL group (119°) than in the control group (123°), there was no difference between groups postoperatively. Fifty percent (61 of 122) of patients in the ACL group required implant removal at the time of total knee arthroplasty. The operative time was significantly longer (p < 0.001) in the ACL group (88 minutes) compared with the control group (73 minutes). There were a total of 11 reoperations in the ACL group, including 4 for periprosthetic infection, whereas there were only 2 reoperations in the control group. The risk of reoperation in the ACL group was more than 5 times higher than in the control group (relative risk, 5.5 [95% confidence interval, 1.2 to 24.3]; p = 0.01). Conclusions: The results of this retrospective matched cohort study suggest that prior ACL reconstruction results in longer operative time and increased risk of early reoperation after total knee arthroplasty. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22579,"journal":{"name":"The Journal of Bone and Joint Surgery","volume":"99 1","pages":"185–189"},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81939586","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}