Pub Date : 2024-07-28DOI: 10.1177/15563316241260717
Carolena Rojas Marcos, Nicholas Schiller, Sebastian Braun, Daniel Knauer, Jacques Yadeau, A. Nocon, Bridget Jivanelli, D. Flevas, Thomas Sculco
Background: Total knee arthroplasty (TKA) is a common surgical remedy for patients with end-stage osteoarthritis. Although TKA is generally effective, a significant number of patients experience chronic post-surgical pain. Psychosocial interventions have increasingly become an area of interest in pain management following surgical procedures. Purpose: We aimed to evaluate the impact of pre-operative, peri-operative, and post-operative psychosocial interventions on reducing the likelihood of developing chronic pain after TKA. Methods: We performed a systematic review following the Cochrane guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. A comprehensive search strategy was employed using PubMed, Embase, and Cochrane Central Register of Controlled Trials. Inclusion criteria were (1) patients undergoing; (2) pain outcome assessed ≥1 month post-operatively; (3) prospective and longitudinal study design (eg, randomized controlled trial, experimental non-randomized trial, cohort, case-control studies with measurement of exposure prior to outcome); (4) English language; and (5) psychosocial intervention (cognitive-behavioral, biopsychosocial, dialectical behavioral, psychoeducation, mindfulness, meditation, psychotherapy, relaxation, mind-body therapies, hypnosis). Exclusion criteria were non-primary literature (eg, review articles), non–peer-reviewed studies, and conference proceedings. The methodological quality of included studies was assessed using Cochrane’s tool for Risk of Bias 2 (RoB 2), the methodological index for non-randomized studies (MINORS), and the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I). Results: Of 4297 studies reviewed with title and abstract, 4160 were excluded. Of the remaining 137 studies that underwent full-text review, 122 were excluded using the same inclusion and exclusion criteria, and 15 studies were included. Our review indicates a variable but positive impact of psychosocial interventions, such as pre-operative education, relaxation techniques, and cognitive-behavioral therapy, on post-TKA pain. Of the 15 included studies, 9 studies found that psychosocial interventions reduced post-TKA pain. Our review also suggests that cognitive-behavioral therapy may aid in reducing kinesiophobia, pain catastrophizing, and knee pain intensity. For the 12 randomized studies, the risk of bias was deemed “high” concerns for 3 studies, “some” concerns for 5 studies, and “low” concerns for 4 studies. For the 3 non-randomized studies, the risk of bias was deemed “moderate” due to confounding bias. Conclusions: This systematic review of level-I and level-II studies found that the integration of psychosocial interventions into care protocols for TKA offers benefits including improved patient satisfaction and quality of life and reduced health care costs. Limitations include heterogeneity in intervention types and outcomes measured and the varying levels of risk
{"title":"Psychosocial Interventions to Reduce Post operative Pain in Total Knee Arthroplasty: A Systematic Review","authors":"Carolena Rojas Marcos, Nicholas Schiller, Sebastian Braun, Daniel Knauer, Jacques Yadeau, A. Nocon, Bridget Jivanelli, D. Flevas, Thomas Sculco","doi":"10.1177/15563316241260717","DOIUrl":"https://doi.org/10.1177/15563316241260717","url":null,"abstract":"Background: Total knee arthroplasty (TKA) is a common surgical remedy for patients with end-stage osteoarthritis. Although TKA is generally effective, a significant number of patients experience chronic post-surgical pain. Psychosocial interventions have increasingly become an area of interest in pain management following surgical procedures. Purpose: We aimed to evaluate the impact of pre-operative, peri-operative, and post-operative psychosocial interventions on reducing the likelihood of developing chronic pain after TKA. Methods: We performed a systematic review following the Cochrane guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. A comprehensive search strategy was employed using PubMed, Embase, and Cochrane Central Register of Controlled Trials. Inclusion criteria were (1) patients undergoing; (2) pain outcome assessed ≥1 month post-operatively; (3) prospective and longitudinal study design (eg, randomized controlled trial, experimental non-randomized trial, cohort, case-control studies with measurement of exposure prior to outcome); (4) English language; and (5) psychosocial intervention (cognitive-behavioral, biopsychosocial, dialectical behavioral, psychoeducation, mindfulness, meditation, psychotherapy, relaxation, mind-body therapies, hypnosis). Exclusion criteria were non-primary literature (eg, review articles), non–peer-reviewed studies, and conference proceedings. The methodological quality of included studies was assessed using Cochrane’s tool for Risk of Bias 2 (RoB 2), the methodological index for non-randomized studies (MINORS), and the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I). Results: Of 4297 studies reviewed with title and abstract, 4160 were excluded. Of the remaining 137 studies that underwent full-text review, 122 were excluded using the same inclusion and exclusion criteria, and 15 studies were included. Our review indicates a variable but positive impact of psychosocial interventions, such as pre-operative education, relaxation techniques, and cognitive-behavioral therapy, on post-TKA pain. Of the 15 included studies, 9 studies found that psychosocial interventions reduced post-TKA pain. Our review also suggests that cognitive-behavioral therapy may aid in reducing kinesiophobia, pain catastrophizing, and knee pain intensity. For the 12 randomized studies, the risk of bias was deemed “high” concerns for 3 studies, “some” concerns for 5 studies, and “low” concerns for 4 studies. For the 3 non-randomized studies, the risk of bias was deemed “moderate” due to confounding bias. Conclusions: This systematic review of level-I and level-II studies found that the integration of psychosocial interventions into care protocols for TKA offers benefits including improved patient satisfaction and quality of life and reduced health care costs. Limitations include heterogeneity in intervention types and outcomes measured and the varying levels of risk ","PeriodicalId":253125,"journal":{"name":"HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery","volume":"21 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141796600","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 : 2024-06-07DOI: 10.1177/15563316241259035
Olivia F. Perez, Christopher Warburton, Marc C. Philippon, Marc J. Philippon, Thomas M. Best
Hip osteoarthritis (HOA) is a prevalent degenerative joint disease with various treatment approaches. Biological agents, such as bone-marrow derived stem cells (BM-MSC) therapy, have recently been proposed as a treatment option in the management of HOA. We sought to further analyze the use of BM-MSC therapy by investigating the following questions. What is the standard preparation and practice? Does a dose response exist between stem cell therapy and clinical outcome? Does BM-MSC therapy alone produce effective clinical outcomes? We conducted a scoping review using the Methodological Expectations of Cochrane Intervention Reviews Manual and the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines for scoping reviews. A comprehensive search of PubMed, Embase, Cochrane CENTRAL, Scopus, SPORTDiscus, Cumulative Index to Nursing and Allied Health Literature, and Web of Science Core Collection was performed in June 2023 of studies using exclusively BM-MSC injections for the treatment of HOA. Study characteristic, injection preparation and dosage, clinical outcome measures, and adverse effect data were extracted and interpreted by 3 reviewers. Seven studies with a total of 72 patients met the inclusion criteria. Clinical outcome following intra-articular injection of BM-MSCs was measured using the numerical pain scale, the Western Ontario and McMaster Universities Osteoarthritis Index, the visual analogue scale, and other scores, all of which showed reduction in pain and increase in functional ability across studies. This scoping review found that the efficacy of BM-MSC therapy alone in the treatment of HOA appeared beneficial, improving clinical outcomes in each study. All 7 studies used “low-dose” injections with variable follow-up times; thus, a clear dose–response relationship cannot be drawn. Future studies using high doses and analyzing long-term effects of BM-MSC injections in HOA are needed.
髋关节骨关节炎（HOA）是一种常见的退行性关节疾病，治疗方法多种多样。生物制剂，如骨髓干细胞（BM-MSC）疗法，最近被提议作为治疗髋关节炎的一种治疗方法。我们试图通过研究以下问题来进一步分析骨髓干细胞疗法的使用情况。标准的准备和实践是什么？干细胞疗法与临床结果之间是否存在剂量反应？单用干细胞间充质干细胞疗法能否产生有效的临床疗效？我们采用《Cochrane干预综述方法学期望手册》（Methodological Expectations of Cochrane Intervention Reviews Manual）和《系统综述和元分析首选报告项目》（Preferred Reporting Items for Systematic Review and Meta-Analysis，PRISMA）指南进行了范围界定综述。2023年6月，我们在PubMed、Embase、Cochrane CENTRAL、Scopus、SPORTDiscus、《护理与专职医疗文献累积索引》和Web of Science Core Collection中全面检索了完全使用BM-间充质干细胞注射治疗HOA的研究。3名审稿人对研究特点、注射制剂和剂量、临床结果测量和不良反应数据进行了提取和解释。7项研究共72名患者符合纳入标准。采用数字疼痛量表、西安大略和麦克马斯特大学骨关节炎指数、视觉模拟量表和其他评分方法测量了关节内注射 BM-MSCs 后的临床疗效。这项范围界定综述发现，单用BM-间充质干细胞疗法治疗HOA似乎是有益的，每项研究的临床结果都有所改善。所有 7 项研究均采用 "低剂量 "注射，随访时间各不相同，因此无法得出明确的剂量-反应关系。未来还需要进行使用高剂量的研究，并分析注射干细胞治疗HOA的长期效果。
{"title":"The Efficacy of Bone Marrow Stem Cell Therapy in Hip Osteoarthritis: A Scoping Review","authors":"Olivia F. Perez, Christopher Warburton, Marc C. Philippon, Marc J. Philippon, Thomas M. Best","doi":"10.1177/15563316241259035","DOIUrl":"https://doi.org/10.1177/15563316241259035","url":null,"abstract":"Hip osteoarthritis (HOA) is a prevalent degenerative joint disease with various treatment approaches. Biological agents, such as bone-marrow derived stem cells (BM-MSC) therapy, have recently been proposed as a treatment option in the management of HOA. We sought to further analyze the use of BM-MSC therapy by investigating the following questions. What is the standard preparation and practice? Does a dose response exist between stem cell therapy and clinical outcome? Does BM-MSC therapy alone produce effective clinical outcomes? We conducted a scoping review using the Methodological Expectations of Cochrane Intervention Reviews Manual and the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines for scoping reviews. A comprehensive search of PubMed, Embase, Cochrane CENTRAL, Scopus, SPORTDiscus, Cumulative Index to Nursing and Allied Health Literature, and Web of Science Core Collection was performed in June 2023 of studies using exclusively BM-MSC injections for the treatment of HOA. Study characteristic, injection preparation and dosage, clinical outcome measures, and adverse effect data were extracted and interpreted by 3 reviewers. Seven studies with a total of 72 patients met the inclusion criteria. Clinical outcome following intra-articular injection of BM-MSCs was measured using the numerical pain scale, the Western Ontario and McMaster Universities Osteoarthritis Index, the visual analogue scale, and other scores, all of which showed reduction in pain and increase in functional ability across studies. This scoping review found that the efficacy of BM-MSC therapy alone in the treatment of HOA appeared beneficial, improving clinical outcomes in each study. All 7 studies used “low-dose” injections with variable follow-up times; thus, a clear dose–response relationship cannot be drawn. Future studies using high doses and analyzing long-term effects of BM-MSC injections in HOA are needed.","PeriodicalId":253125,"journal":{"name":"HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery","volume":" 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141371989","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 : 2024-06-07DOI: 10.1177/15563316241254352
Stephanie A. Kwan, Alvin C. Ong, Rex W. Lutz, Vincent W. Lau, A. Santoro, Gregory K. Deirmengian
The risk of noise-induced hearing loss (NIHL) to orthopedic surgeons due to occupational exposures is unknown. A level of 85 decibels (dB) over an 8-hour time-weighted average (TWA) is considered hazardous. We sought to identify whether manual and/or robotic arthroplasty procedures increase surgeons’ risk of developing NIHL. At our institution, we prospectively collected intraoperative recordings with a microphone attached to the surgeon during manual total knee arthroplasty (TKA), manual total hip arthroplasty (THA), and robotic-assisted total knee arthroplasty (RTKA). Recordings taken in the operating room without operating room staff present served as baseline controls. The 172 recordings consisted of 46 baseline, 42 THA, 40 TKA, and 44 RTKA recordings. Decibel levels were reported as “maximum dB level” (the highest sound pressure level using an A-weighted dB scale), “LAeq” (the equivalent continuous sound level), “LCpeak” (the peak sound pressure level using a C-weighted dB scale), and “TWA” (the average dB level projected over an 8-hour period). The percentage of allowable daily noise dose was reported as “dose” and the measured dose projected over 8 hours as “projected dose.” The recordings of surgeries had average maximum dB levels ranging from 106.0 to 108.0 dB, all significantly greater than controls. Robotic-assisted total knee arthroplasties had the highest average dose (18.7%) and average projected dose (252.0%). Our review of recordings at a single institution found that noise levels of RTKAs surpassed projected doses of 100%. Orthopedic surgeons performing more than 2 RTKAs per day may be at increased risk of NIHL. Further research is needed to assess the effectiveness of measures such as ear protection to minimize surgeons’ exposure.
整形外科医生因职业暴露而导致噪声性听力损失 (NIHL) 的风险尚不清楚。8小时时间加权平均值（TWA）达到85分贝（dB）被认为是有害的。我们试图确定人工和/或机器人关节成形术是否会增加外科医生患 NIHL 的风险。在我院，我们在人工全膝关节置换术 (TKA)、人工全髋关节置换术 (THA) 和机器人辅助全膝关节置换术 (RTKA) 中，通过连接在外科医生身上的麦克风前瞻性地收集了术中录音。在没有手术室工作人员在场的情况下进行的记录作为基线对照。172 份记录包括 46 份基线记录、42 份 THA 记录、40 份 TKA 记录和 44 份 RTKA 记录。分贝水平以 "最大 dB 级"（使用 A 加权 dB 标度的最高声压级）、"LAeq"（等效连续声级）、"LCpeak"（使用 C 加权 dB 标度的峰值声压级）和 "TWA"（8 小时内预测的平均 dB 级）的形式报告。每日允许噪声剂量的百分比报告为 "剂量"，8 小时的测量剂量预测为 "预测剂量"。手术记录的平均最大分贝水平从 106.0 到 108.0 分贝不等，均明显高于对照组。机器人辅助全膝关节置换术的平均剂量（18.7%）和平均预测剂量（252.0%）最高。我们对一家机构的记录进行审查后发现，RTKA 的噪音水平超过了 100% 的预计剂量。每天进行 2 次以上 RTKA 的骨科医生患 NIHL 的风险可能会增加。需要进一步研究评估护耳等措施的效果，以尽量减少外科医生的暴露量。
{"title":"Noise-Induced Hearing Loss: Should Surgeons Be Wearing Ear Protection During Primary Total Joint Arthroplasty?","authors":"Stephanie A. Kwan, Alvin C. Ong, Rex W. Lutz, Vincent W. Lau, A. Santoro, Gregory K. Deirmengian","doi":"10.1177/15563316241254352","DOIUrl":"https://doi.org/10.1177/15563316241254352","url":null,"abstract":"The risk of noise-induced hearing loss (NIHL) to orthopedic surgeons due to occupational exposures is unknown. A level of 85 decibels (dB) over an 8-hour time-weighted average (TWA) is considered hazardous. We sought to identify whether manual and/or robotic arthroplasty procedures increase surgeons’ risk of developing NIHL. At our institution, we prospectively collected intraoperative recordings with a microphone attached to the surgeon during manual total knee arthroplasty (TKA), manual total hip arthroplasty (THA), and robotic-assisted total knee arthroplasty (RTKA). Recordings taken in the operating room without operating room staff present served as baseline controls. The 172 recordings consisted of 46 baseline, 42 THA, 40 TKA, and 44 RTKA recordings. Decibel levels were reported as “maximum dB level” (the highest sound pressure level using an A-weighted dB scale), “LAeq” (the equivalent continuous sound level), “LCpeak” (the peak sound pressure level using a C-weighted dB scale), and “TWA” (the average dB level projected over an 8-hour period). The percentage of allowable daily noise dose was reported as “dose” and the measured dose projected over 8 hours as “projected dose.” The recordings of surgeries had average maximum dB levels ranging from 106.0 to 108.0 dB, all significantly greater than controls. Robotic-assisted total knee arthroplasties had the highest average dose (18.7%) and average projected dose (252.0%). Our review of recordings at a single institution found that noise levels of RTKAs surpassed projected doses of 100%. Orthopedic surgeons performing more than 2 RTKAs per day may be at increased risk of NIHL. Further research is needed to assess the effectiveness of measures such as ear protection to minimize surgeons’ exposure.","PeriodicalId":253125,"journal":{"name":"HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery","volume":" 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141373949","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 : 2024-06-04DOI: 10.1177/15563316241257233
Jack Mangan, Adam Shafritz
{"title":"Symptomatic Early Rupture of the InSpace Subacromial Balloon Spacer: A Case Report","authors":"Jack Mangan, Adam Shafritz","doi":"10.1177/15563316241257233","DOIUrl":"https://doi.org/10.1177/15563316241257233","url":null,"abstract":"","PeriodicalId":253125,"journal":{"name":"HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery","volume":"25 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141266281","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 : 2024-05-21DOI: 10.1177/15563316241253604
A. Illescas, J. Poeran, Haoyan Zhong, C. Cozowicz, Federico P. Girardi, S. Memtsoudis, Jiabin Liu
Background: Although the coexistence of cervical and lumbar spinal conditions is fairly common, surgical treatments are usually staged, even though simultaneous fusion of the cervical and lumbar spine may be a viable option for appropriate candidates. Purpose: We sought to investigate the outcomes of staged vs simultaneous cervical and lumbar fusions in terms of differences in postoperative complications and resource use. Methods: We performed a retrospective cohort study using claims data from the 2006 to 2020 all-payer Premier Health Database. Data were extracted for patients who underwent both a cervical and a lumbar fusion procedure either simultaneously (same hospitalization) or staged (within 1 year). Multivariable regression models measured the association between simultaneous or staged procedures and combined complications (including venous thromboembolism, infection, acute renal failure, or vascular/pulmonary/gastrointestinal complications), intensive care unit (ICU) admission, and prolonged length of stay. We report odds ratios (ORs) and 95% confidence intervals (CI). Results: Overall, 560 (5.2%) and 10 187 (94.8%) of total 10 747 cervical and lumbar fusion procedures were performed simultaneously and staged, respectively. When comparing outcomes after simultaneous procedures to those after staged procedures (for which outcomes from the cervical and lumbar procedures were pooled), simultaneous procedures were associated with higher rates of ICU admission and longer hospital stays, but there were no differences in rates of combined complications. Conclusion: Our retrospective, nationwide database study found that simultaneous cervical and lumbar fusion is relatively rare and its rates of complications do not differ meaningfully from those of staged procedures. However, we found an association between simultaneous cervical and lumbar fusion and higher rates of ICU admission and prolonged length of stay. Further study is warranted.
背景：尽管颈椎和腰椎疾病并存的情况相当常见，但手术治疗通常都是分期进行的，尽管对于合适的患者来说，同时进行颈椎和腰椎融合术可能是一种可行的选择。目的：我们试图从术后并发症和资源使用的差异方面，研究分期与同时进行颈椎和腰椎融合术的结果。方法：我们进行了一项回顾性队列研究：我们使用 2006 年至 2020 年所有付费方 Premier Health 数据库的索赔数据进行了一项回顾性队列研究。我们提取了同时接受颈椎和腰椎融合术（同一住院时间）或分阶段接受颈椎和腰椎融合术（1 年内）的患者的数据。多变量回归模型测量了同时或分期手术与合并并发症（包括静脉血栓栓塞、感染、急性肾功能衰竭或血管/肺/胃肠道并发症）、入住重症监护室（ICU）和住院时间延长之间的关系。我们报告了几率比（OR）和 95% 置信区间（CI）。结果：在总共 10 747 例颈椎和腰椎融合手术中，分别有 560 例（5.2%）和 10 187 例（94.8%）是同时进行和分期进行的。在比较同时手术和分期手术的结果时（颈椎和腰椎手术的结果被汇总在一起），同时手术与更高的重症监护室入院率和更长的住院时间有关，但在合并并发症的发生率方面没有差异。结论我们的回顾性全国数据库研究发现，同时进行颈椎和腰椎融合术的情况较为罕见，其并发症发生率与分期手术并无明显差异。然而，我们发现同时进行颈椎和腰椎融合术与更高的重症监护室入院率和住院时间延长之间存在关联。有必要进行进一步研究。
{"title":"A Nationwide Comparison of Outcomes and Resource Use in Staged vs Simultaneous Cervical and Lumbar Fusions: A Retrospective Database Study","authors":"A. Illescas, J. Poeran, Haoyan Zhong, C. Cozowicz, Federico P. Girardi, S. Memtsoudis, Jiabin Liu","doi":"10.1177/15563316241253604","DOIUrl":"https://doi.org/10.1177/15563316241253604","url":null,"abstract":"Background: Although the coexistence of cervical and lumbar spinal conditions is fairly common, surgical treatments are usually staged, even though simultaneous fusion of the cervical and lumbar spine may be a viable option for appropriate candidates. Purpose: We sought to investigate the outcomes of staged vs simultaneous cervical and lumbar fusions in terms of differences in postoperative complications and resource use. Methods: We performed a retrospective cohort study using claims data from the 2006 to 2020 all-payer Premier Health Database. Data were extracted for patients who underwent both a cervical and a lumbar fusion procedure either simultaneously (same hospitalization) or staged (within 1 year). Multivariable regression models measured the association between simultaneous or staged procedures and combined complications (including venous thromboembolism, infection, acute renal failure, or vascular/pulmonary/gastrointestinal complications), intensive care unit (ICU) admission, and prolonged length of stay. We report odds ratios (ORs) and 95% confidence intervals (CI). Results: Overall, 560 (5.2%) and 10 187 (94.8%) of total 10 747 cervical and lumbar fusion procedures were performed simultaneously and staged, respectively. When comparing outcomes after simultaneous procedures to those after staged procedures (for which outcomes from the cervical and lumbar procedures were pooled), simultaneous procedures were associated with higher rates of ICU admission and longer hospital stays, but there were no differences in rates of combined complications. Conclusion: Our retrospective, nationwide database study found that simultaneous cervical and lumbar fusion is relatively rare and its rates of complications do not differ meaningfully from those of staged procedures. However, we found an association between simultaneous cervical and lumbar fusion and higher rates of ICU admission and prolonged length of stay. Further study is warranted.","PeriodicalId":253125,"journal":{"name":"HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery","volume":"47 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141114710","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 : 2024-05-14DOI: 10.1177/15563316241254086
E. Debbi, Sonia K. Chandi, Agnes D. Cororaton, Joseph T. Nguyen, G. Westrich, P. K. Sculco, Brian P. Chalmers
Manipulation under anesthesia (MUA) is a first-line treatment for stiffness after total knee arthroplasty (TKA), but predicting outcomes after MUA can be difficult. We sought to determine the association between pre-MUA range-of-motion (ROM) and the risk of repeat MUA and revision in patients who underwent primary TKA. We conducted a retrospective review of 543 MUAs for stiffness at a single institution. Mean age was 62.5 years, and 64% were female. Second MUA or revision TKA were considered failures of treatment. Penalized logistic regression models were used to assess risk factors for failures. The Kaplan-Meier survivorship was used to examine survivorship free from second MUA or revision. Before and after MUA, there was significant improvement in knee flexion (78.0° vs 112.8°, respectively) and extension (4.1° vs 0.8°, respectively); 6.4% of patients required repeat MUA and 5.3% required revision TKA. Survivorship free of second MUA was 90.9%, revision for stiffness was 92.4%, and all-cause revision was 88.2% at 2 years post-MUA. Patients with pre-MUA flexion contracture of ≥5° were more likely to undergo second MUA revision for stiffness and any revision. There were significant improvements in patient-reported outcomes postoperatively. This retrospective chart review suggests that MUA is an effective treatment for post-TKA stiffness, with good early survivorship, and that worse pre-MUA ROM is associated with MUA failure and need for repeat MUA or revision. This information may have implications for patient counseling and management.
麻醉下手法复位（MUA）是治疗全膝关节置换术（TKA）术后僵硬的一线疗法，但要预测麻醉下手法复位后的效果却很困难。我们试图确定在接受初级 TKA 的患者中，MUA 前的活动范围 (ROM) 与重复 MUA 和翻修风险之间的关系。我们对一家机构的 543 例 MUA 的僵硬程度进行了回顾性分析。平均年龄为 62.5 岁，64% 为女性。第二次MUA或翻修TKA被视为治疗失败。采用惩罚性逻辑回归模型评估失败的风险因素。Kaplan-Meier生存率被用来检测无二次MUA或翻修的生存率。MUA前后，膝关节屈曲（分别为78.0° vs 112.8°）和伸展（分别为4.1° vs 0.8°）均有显著改善；6.4%的患者需要重复MUA，5.3%的患者需要翻修TKA。在MUA术后2年，无二次MUA的存活率为90.9%，因僵硬而进行翻修的存活率为92.4%，因各种原因进行翻修的存活率为88.2%。MUA前屈曲挛缩≥5°的患者更有可能因僵硬而进行第二次MUA翻修或任何翻修。术后患者报告的结果有明显改善。这项回顾性病历审查表明，MUA是治疗TKA术后僵硬的有效方法，早期存活率高，而MUA术前ROM较差与MUA失败和需要重复MUA或翻修有关。这些信息可能会对患者咨询和管理产生影响。
{"title":"Range-of-Motion Predictors for Repeat Manipulation Under Anesthesia and Revision Surgery for Stiffness After Total Knee Arthroplasty","authors":"E. Debbi, Sonia K. Chandi, Agnes D. Cororaton, Joseph T. Nguyen, G. Westrich, P. K. Sculco, Brian P. Chalmers","doi":"10.1177/15563316241254086","DOIUrl":"https://doi.org/10.1177/15563316241254086","url":null,"abstract":"Manipulation under anesthesia (MUA) is a first-line treatment for stiffness after total knee arthroplasty (TKA), but predicting outcomes after MUA can be difficult. We sought to determine the association between pre-MUA range-of-motion (ROM) and the risk of repeat MUA and revision in patients who underwent primary TKA. We conducted a retrospective review of 543 MUAs for stiffness at a single institution. Mean age was 62.5 years, and 64% were female. Second MUA or revision TKA were considered failures of treatment. Penalized logistic regression models were used to assess risk factors for failures. The Kaplan-Meier survivorship was used to examine survivorship free from second MUA or revision. Before and after MUA, there was significant improvement in knee flexion (78.0° vs 112.8°, respectively) and extension (4.1° vs 0.8°, respectively); 6.4% of patients required repeat MUA and 5.3% required revision TKA. Survivorship free of second MUA was 90.9%, revision for stiffness was 92.4%, and all-cause revision was 88.2% at 2 years post-MUA. Patients with pre-MUA flexion contracture of ≥5° were more likely to undergo second MUA revision for stiffness and any revision. There were significant improvements in patient-reported outcomes postoperatively. This retrospective chart review suggests that MUA is an effective treatment for post-TKA stiffness, with good early survivorship, and that worse pre-MUA ROM is associated with MUA failure and need for repeat MUA or revision. This information may have implications for patient counseling and management.","PeriodicalId":253125,"journal":{"name":"HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery","volume":"95 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140978557","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 : 2024-05-11DOI: 10.1177/15563316241248614
Raymond P. Robinson
{"title":"Commentary on: “A Consensus Approach on How to Evaluate and Treat Patients With a Recalled Exactech Knee Replacement”","authors":"Raymond P. Robinson","doi":"10.1177/15563316241248614","DOIUrl":"https://doi.org/10.1177/15563316241248614","url":null,"abstract":"","PeriodicalId":253125,"journal":{"name":"HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery","volume":"122 45","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140987539","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 : 2024-05-11DOI: 10.1177/15563316241248616
F. Boettner, Geoffrey Westrich, P. K. Sculco, T. Sculco, Elizabeth B. Gausden, Brian P. Chalmers, Timothy Wright, Lyubomir Haralambiev
{"title":"Evaluating and Treating Patients With a Recalled Exactech Knee Replacement: A Consensus Approach","authors":"F. Boettner, Geoffrey Westrich, P. K. Sculco, T. Sculco, Elizabeth B. Gausden, Brian P. Chalmers, Timothy Wright, Lyubomir Haralambiev","doi":"10.1177/15563316241248616","DOIUrl":"https://doi.org/10.1177/15563316241248616","url":null,"abstract":"","PeriodicalId":253125,"journal":{"name":"HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery","volume":" 764","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140989343","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 : 2024-05-07DOI: 10.1177/15563316241249912
G. Weinstock-Zlotnick, Aviva Wolff, Gillian Potter, Laura Robbins
Interest in adaptive sports for children with cerebral palsy (CP) is growing, but current evidence on the benefits and indications for one sport, adaptive climbing, is limited. We sought to describe perceived changes observed by parents of children with CP who participated in adaptive climbing. Parents whose children with CP participated in 5 or more adaptive climbing sessions were eligible to participate and were emailed a recruitment letter and flyer. Data were collected through semi-structured interviews, using a moderator guide. Interviews were transcribed and content analyzed, with data grouped into concepts, categories, and themes until data saturation. Ten parents (9 mothers, 1 father) of 10 children with CP (5 girls, 5 boys; ages 7 to 19 years) were interviewed for 15 to 45 minutes each, yielding 4 themes. First, parents perceived that adaptive climbing challenged the children physically (in reach, balance, strength, and head/neck and lower limb motion); second, that it sharpened children’s cognitive skills (in focus, problem-solving, and strategic thinking); third, that it raised children’s confidence (socially, physically, and emotionally); and fourth, that it expanded children’s sense of what they could do (in mastering a challenge, claiming an athletic identity, and participating in a sport like their peers). In this qualitative study, parents described physical, cognitive, and psychosocial benefits of adaptive climbing for their children with CP. These descriptions can be used to inform future studies of children with CP who participate in adaptive climbing.
{"title":"Children With Cerebral Palsy’s Experiences With Adaptive Climbing: A Qualitative Study on Parents’ Perspectives","authors":"G. Weinstock-Zlotnick, Aviva Wolff, Gillian Potter, Laura Robbins","doi":"10.1177/15563316241249912","DOIUrl":"https://doi.org/10.1177/15563316241249912","url":null,"abstract":"Interest in adaptive sports for children with cerebral palsy (CP) is growing, but current evidence on the benefits and indications for one sport, adaptive climbing, is limited. We sought to describe perceived changes observed by parents of children with CP who participated in adaptive climbing. Parents whose children with CP participated in 5 or more adaptive climbing sessions were eligible to participate and were emailed a recruitment letter and flyer. Data were collected through semi-structured interviews, using a moderator guide. Interviews were transcribed and content analyzed, with data grouped into concepts, categories, and themes until data saturation. Ten parents (9 mothers, 1 father) of 10 children with CP (5 girls, 5 boys; ages 7 to 19 years) were interviewed for 15 to 45 minutes each, yielding 4 themes. First, parents perceived that adaptive climbing challenged the children physically (in reach, balance, strength, and head/neck and lower limb motion); second, that it sharpened children’s cognitive skills (in focus, problem-solving, and strategic thinking); third, that it raised children’s confidence (socially, physically, and emotionally); and fourth, that it expanded children’s sense of what they could do (in mastering a challenge, claiming an athletic identity, and participating in a sport like their peers). In this qualitative study, parents described physical, cognitive, and psychosocial benefits of adaptive climbing for their children with CP. These descriptions can be used to inform future studies of children with CP who participate in adaptive climbing.","PeriodicalId":253125,"journal":{"name":"HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery","volume":"13 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141003994","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 : 2024-05-07DOI: 10.1177/15563316241249139
Terrance A. Sgroi, Debi Jones, Robert Andrews, Jorge Giral
The prevalence and severity of baseball-related injuries in the youth athlete population continue to escalate, despite efforts by health care professionals and sports organizations to quell this trend. This article reviews current research that has investigated the risk factors and possible prevention strategies for the most common injuries in young baseball players, including strengthening programs, pitch count guidelines, and throwing analysis.
{"title":"Throwing Injuries and Prevention Strategies in Youth Baseball","authors":"Terrance A. Sgroi, Debi Jones, Robert Andrews, Jorge Giral","doi":"10.1177/15563316241249139","DOIUrl":"https://doi.org/10.1177/15563316241249139","url":null,"abstract":"The prevalence and severity of baseball-related injuries in the youth athlete population continue to escalate, despite efforts by health care professionals and sports organizations to quell this trend. This article reviews current research that has investigated the risk factors and possible prevention strategies for the most common injuries in young baseball players, including strengthening programs, pitch count guidelines, and throwing analysis.","PeriodicalId":253125,"journal":{"name":"HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery","volume":"94 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141004067","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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