D. Fitzpatrick, Stephanie Mueller, Ellie Jitto, M. M. Herbert, Connor M Fitzpatrick, E. Owen
To review outcomes of a consecutive, non-selected series of distal femur fractures treated with a dynamic plate construct and allowed unrestricted weight bearing immediately after surgery. Retrospective consecutive case series. Level 2 trauma center Thirty-one consecutive distal femur fractures in 29 patients with 33A and 33C fractures stabilized with a distal femur locking plate and Far Cortical Locking diaphyseal screws. All patients were allowed immediate unrestricted weight bearing with assistive devices post-surgery. Loss of reduction from immediate post-operative alignment, implant failure, nonunion, and medical complications. No loss of alignment greater than three degrees in the lateral distal femoral angle was noted at healing. Two implant failures occurred, one in the first five weeks and another in an established nonunion. Mortality at one year was 6.5%. Readmission for medical complications was noted in 6.5% of patients. Immediate, unrestricted weight bearing after fixation of 33A and 33C distal femur fractures with a dynamic plate construct may be safe, with a low risk of implant failure or loss of coronal plane alignment. Relative to historical reports, morbidity and mortality in our cohort were improved with early weight-bearing. Therapeutic Level IV, case series
{"title":"Weight-bearing as tolerated following distal femur fracture surgically treated with Far Cortical Locking screws","authors":"D. Fitzpatrick, Stephanie Mueller, Ellie Jitto, M. M. Herbert, Connor M Fitzpatrick, E. Owen","doi":"10.60118/001c.74617","DOIUrl":"https://doi.org/10.60118/001c.74617","url":null,"abstract":"To review outcomes of a consecutive, non-selected series of distal femur fractures treated with a dynamic plate construct and allowed unrestricted weight bearing immediately after surgery. Retrospective consecutive case series. Level 2 trauma center Thirty-one consecutive distal femur fractures in 29 patients with 33A and 33C fractures stabilized with a distal femur locking plate and Far Cortical Locking diaphyseal screws. All patients were allowed immediate unrestricted weight bearing with assistive devices post-surgery. Loss of reduction from immediate post-operative alignment, implant failure, nonunion, and medical complications. No loss of alignment greater than three degrees in the lateral distal femoral angle was noted at healing. Two implant failures occurred, one in the first five weeks and another in an established nonunion. Mortality at one year was 6.5%. Readmission for medical complications was noted in 6.5% of patients. Immediate, unrestricted weight bearing after fixation of 33A and 33C distal femur fractures with a dynamic plate construct may be safe, with a low risk of implant failure or loss of coronal plane alignment. Relative to historical reports, morbidity and mortality in our cohort were improved with early weight-bearing. Therapeutic Level IV, case series","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience & Innovation","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126365106","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}
Clavicle fractures are among the most common fractures. Nonunion fracture of the clavicle has traditionally been treated with autograft from the iliac crest, although it has been proposed that distal clavicle autograft would have less morbidities associated. Patient presented with a left midshaft clavicle fracture with broken hardware from previous open reduction internal fixation (ORIF). This was treated with removal of broken hardware, revision ORIF, and autograft bone from distal clavicle. Healing was augmented with bone marrow aspirate from the ipsilateral proximal humerus as well as with BioBrace (CONMED Corporation, Largo, FL) collagen strips to reestablish periosteal sleeve and retain bone graft material. Distal clavicle autograft augmented with BioBrace is presented as a novel method to treat nonunion clavicle fracture and may be associated with less morbidities.
{"title":"Revision Clavicle Fracture ORIF with Bone Graft from the Distal Clavicle Utilizing BioBrace","authors":"Gregory P. Colbath, Emily German","doi":"10.60118/001c.84085","DOIUrl":"https://doi.org/10.60118/001c.84085","url":null,"abstract":"Clavicle fractures are among the most common fractures. Nonunion fracture of the clavicle has traditionally been treated with autograft from the iliac crest, although it has been proposed that distal clavicle autograft would have less morbidities associated. Patient presented with a left midshaft clavicle fracture with broken hardware from previous open reduction internal fixation (ORIF). This was treated with removal of broken hardware, revision ORIF, and autograft bone from distal clavicle. Healing was augmented with bone marrow aspirate from the ipsilateral proximal humerus as well as with BioBrace (CONMED Corporation, Largo, FL) collagen strips to reestablish periosteal sleeve and retain bone graft material. Distal clavicle autograft augmented with BioBrace is presented as a novel method to treat nonunion clavicle fracture and may be associated with less morbidities.","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience & Innovation","volume":"68 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115952546","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}
The rate of retear after primary rotator cuff failure remains unacceptably high (up to 36% for small- to medium-sized tears). Augmentation of the repair with an interpositional scaffold has been reported to improve healing. To compare the short-term radiographic and clinical outcomes of arthroscopic rotator cuff repair with and without augmentation with an interpositional nanofiber scaffold. We prospectively enrolled patients with full thickness rotator cuff tears into a multicenter study with institutional review board approval. All patients had a minimum of one year clinical and radiographic follow-up. A single fellowship trained shoulder surgeon performed all procedures. Patients were blinded and randomized at the time of surgery into either a treatment group consisting of double row rotator cuff repair augmented with an interpositional nanofiber scaffold or a control group in which a standard double-row repair without augmentation was performed. Range of motion, muscle dynamometer strength testing (Lafayette Instruments), and clinical outcomes according to visual analog scale pain, American Shoulder and Elbow Surgeons (ASES), and Simple Shoulder Test (SST) scores were assessed preoperatively and at routine follow-up intervals. Magnetic resonance imaging (MRI) was obtained at a minimum of 4 months (range 4.5-14) on all patients and assessed according to the Sugaya classification with failure noted as grade 4 or higher. Patients without initial failure were then assessed at a minimum of one year (range 12-24 months) by ultrasound examination or MRI to assess for late failure of the repair and clinical outcomes. Thirty patients with a mean age of 64.6 years were statistically analyzed. Fourteen patients were treated with the nanofiber scaffold and 16 patients were non-augmented and made up the control. At an average of 6.8 months, all patients underwent MRI and early failure occurred in 7.1% of the nanofiber scaffold patients compared to 18.8% in the control group (p=.602). At an average time of 17 months postoperatively, all remaining patients with intact repairs underwent MRI (2) or ultrasound (28) and 9 more patients demonstrated Sugaya tear progression with five progressing to failure. All late failures and Sugaya tear progressions occurred in the control group. Cumulative treatment failure occurred significantly less often in patients who received the nanofiber scaffold (7.1%) compared to those who did not receive the bioresorbable scaffold (50%) (p=.017). The present prospective study demonstrates a statistically significant difference in rotator cuff healing with use of an interpositional nanofiber scaffold. While future studies and larger series are warranted, the current data is promising in further advancing the outcomes of rotator cuff repairs.
{"title":"Short-term radiographic and clinical outcomes of arthroscopic rotator cuff repair with and without augmentation with an interpositional nanofiber scaffold","authors":"Casey M. Beleckas, P. Minetos, B. Badman","doi":"10.60118/001c.84269","DOIUrl":"https://doi.org/10.60118/001c.84269","url":null,"abstract":"The rate of retear after primary rotator cuff failure remains unacceptably high (up to 36% for small- to medium-sized tears). Augmentation of the repair with an interpositional scaffold has been reported to improve healing. To compare the short-term radiographic and clinical outcomes of arthroscopic rotator cuff repair with and without augmentation with an interpositional nanofiber scaffold. We prospectively enrolled patients with full thickness rotator cuff tears into a multicenter study with institutional review board approval. All patients had a minimum of one year clinical and radiographic follow-up. A single fellowship trained shoulder surgeon performed all procedures. Patients were blinded and randomized at the time of surgery into either a treatment group consisting of double row rotator cuff repair augmented with an interpositional nanofiber scaffold or a control group in which a standard double-row repair without augmentation was performed. Range of motion, muscle dynamometer strength testing (Lafayette Instruments), and clinical outcomes according to visual analog scale pain, American Shoulder and Elbow Surgeons (ASES), and Simple Shoulder Test (SST) scores were assessed preoperatively and at routine follow-up intervals. Magnetic resonance imaging (MRI) was obtained at a minimum of 4 months (range 4.5-14) on all patients and assessed according to the Sugaya classification with failure noted as grade 4 or higher. Patients without initial failure were then assessed at a minimum of one year (range 12-24 months) by ultrasound examination or MRI to assess for late failure of the repair and clinical outcomes. Thirty patients with a mean age of 64.6 years were statistically analyzed. Fourteen patients were treated with the nanofiber scaffold and 16 patients were non-augmented and made up the control. At an average of 6.8 months, all patients underwent MRI and early failure occurred in 7.1% of the nanofiber scaffold patients compared to 18.8% in the control group (p=.602). At an average time of 17 months postoperatively, all remaining patients with intact repairs underwent MRI (2) or ultrasound (28) and 9 more patients demonstrated Sugaya tear progression with five progressing to failure. All late failures and Sugaya tear progressions occurred in the control group. Cumulative treatment failure occurred significantly less often in patients who received the nanofiber scaffold (7.1%) compared to those who did not receive the bioresorbable scaffold (50%) (p=.017). The present prospective study demonstrates a statistically significant difference in rotator cuff healing with use of an interpositional nanofiber scaffold. While future studies and larger series are warranted, the current data is promising in further advancing the outcomes of rotator cuff repairs.","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience & Innovation","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116981266","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}
A. Wickline, Windy E. Cole, M. Melin, S. Ehmann, Frank Aviles, Jennifer L. Bradt
Total knee arthroplasty (TKA) is a treatment option for individuals with symptomatic osteoarthritis who have failed conservative therapy. In this manuscript the authors describe the pathophysiology of post-operative edema and explore the patient dependent factors potentially contributing to lymphatic dysfunction and thus directly influencing the TKA postoperative course. A proposed multimodal perioperative protocol is presented that focuses on identifying limb edema/lymphedema preoperatively, intraoperative technique changes that may decrease swelling post-TKA.
{"title":"Mitigating the Post-operative Swelling Tsunami in Total Knee Arthroplasty: A Call to Action","authors":"A. Wickline, Windy E. Cole, M. Melin, S. Ehmann, Frank Aviles, Jennifer L. Bradt","doi":"10.60118/001c.77444","DOIUrl":"https://doi.org/10.60118/001c.77444","url":null,"abstract":"Total knee arthroplasty (TKA) is a treatment option for individuals with symptomatic osteoarthritis who have failed conservative therapy. In this manuscript the authors describe the pathophysiology of post-operative edema and explore the patient dependent factors potentially contributing to lymphatic dysfunction and thus directly influencing the TKA postoperative course. A proposed multimodal perioperative protocol is presented that focuses on identifying limb edema/lymphedema preoperatively, intraoperative technique changes that may decrease swelling post-TKA.","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience & Innovation","volume":"63 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129236215","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}
JOIE has asked ChatGPT to generate an editorial comparing mechanical vs. kinematic alignment. I was asked to write a human editorial, from my experience as one of the earliest adopters of kinematic alignment since 2007.
{"title":"The Evaluation of a ChatGPT Article","authors":"Thomas Meade, MD","doi":"10.60118/001c.83338","DOIUrl":"https://doi.org/10.60118/001c.83338","url":null,"abstract":"JOIE has asked ChatGPT to generate an editorial comparing mechanical vs. kinematic alignment. I was asked to write a human editorial, from my experience as one of the earliest adopters of kinematic alignment since 2007.","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience & Innovation","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117246027","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}
Massive rotator cuff tears (MRCT) are a challenging problem in young and active patients. Despite advances in surgical repair techniques, retear rates remain high. The long head of the biceps tendon (LHBT) can be used as an autologous tissue for anterior cable reconstruction to augment MRCT repairs. Current data suggests decreased retear rate and improved functional outcomes. The anterior cable procedure with the LHBT should be considered as an additional option within the MRCT algorithm, given its potential benefits.
{"title":"Anterior Cable Reconstruction Using Autologous Long Head of the Biceps Tendon for Massive Irreparable Rotator Cuff Tears","authors":"R. Sanchez, Spencer Williams, P. Sethi","doi":"10.60118/001c.74713","DOIUrl":"https://doi.org/10.60118/001c.74713","url":null,"abstract":"Massive rotator cuff tears (MRCT) are a challenging problem in young and active patients. Despite advances in surgical repair techniques, retear rates remain high. The long head of the biceps tendon (LHBT) can be used as an autologous tissue for anterior cable reconstruction to augment MRCT repairs. Current data suggests decreased retear rate and improved functional outcomes. The anterior cable procedure with the LHBT should be considered as an additional option within the MRCT algorithm, given its potential benefits.","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience & Innovation","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133456482","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}
Travis R Weiner, MD, Sarah Barringer, Laura Silverio, Akshay Lakra, MD, J. Geller, H. Cooper, R. Shah
Recall of auditory and physical sensations during hip and knee arthroplasty surgery is inadequately studied. We investigated rates of sensory recall, impact on satisfaction, and risk factors. We surveyed 164 consecutive patients after primary or revision arthroplasty about sensory recall and its impact on satisfaction (improved, worsened, or no effect), without exclusions. Three surgeons and 25 anesthesiologists in an academic university hospital setting provided care. Demographic data (age, gender, BMI, comorbidities, ASA class), type of anesthesia, intravenous fentanyl and midazolam doses, pre-operative diagnosis, type of surgery, anesthesia duration, and surgery time (morning vs afternoon case) were analyzed. Pearson’s correlation coefficient was calculated for each variable. A binary logistic regression model was used to identify risk factors for sensory recall. 147 patients (89.6%) received spinal anesthesia. No patients receiving general anesthesia had recall. Twenty-three patients (14.0% of the total, 15.6% of neuraxial anesthesia patients) had sensory recall after surgery: 19 (11.6%) auditory, 2 (1.2%) physical, and 2 (1.2%) both. There was a correlation between spinal anesthesia and sensory recall, r = 0.163, p = 0.037. On logistic regression, decreasing age (p=0.032, 95% CI, 0.894–0.995) and less midazolam (p = 0.009, 95% CI, 0.283–0.832) were significant risk factors for sensory recall. Seventeen (73.9%) reported no impact on satisfaction (14 auditory, 2 physical, 1 both), while two (8.7%) reported worse satisfaction (1 auditory, 1 both) and four (17.4%) reported improved satisfaction (all auditory). We found a 14.0% rate of sensory recall. Spinal anesthesia, decreasing age, and lower benzodiazepine administration were associated with sensory recall. Sensory recall has a minimal effect on patient satisfaction, although some were still affected. Although we focused on instrument sounds, our high rate of sensory recall serves as a reminder to also be mindful of conversations in the operating room. Level II
{"title":"Incidence and Impact of Sensory Recall in Patients Undergoing Total Joint Arthroplasty","authors":"Travis R Weiner, MD, Sarah Barringer, Laura Silverio, Akshay Lakra, MD, J. Geller, H. Cooper, R. Shah","doi":"10.60118/001c.77910","DOIUrl":"https://doi.org/10.60118/001c.77910","url":null,"abstract":"Recall of auditory and physical sensations during hip and knee arthroplasty surgery is inadequately studied. We investigated rates of sensory recall, impact on satisfaction, and risk factors. We surveyed 164 consecutive patients after primary or revision arthroplasty about sensory recall and its impact on satisfaction (improved, worsened, or no effect), without exclusions. Three surgeons and 25 anesthesiologists in an academic university hospital setting provided care. Demographic data (age, gender, BMI, comorbidities, ASA class), type of anesthesia, intravenous fentanyl and midazolam doses, pre-operative diagnosis, type of surgery, anesthesia duration, and surgery time (morning vs afternoon case) were analyzed. Pearson’s correlation coefficient was calculated for each variable. A binary logistic regression model was used to identify risk factors for sensory recall. 147 patients (89.6%) received spinal anesthesia. No patients receiving general anesthesia had recall. Twenty-three patients (14.0% of the total, 15.6% of neuraxial anesthesia patients) had sensory recall after surgery: 19 (11.6%) auditory, 2 (1.2%) physical, and 2 (1.2%) both. There was a correlation between spinal anesthesia and sensory recall, r = 0.163, p = 0.037. On logistic regression, decreasing age (p=0.032, 95% CI, 0.894–0.995) and less midazolam (p = 0.009, 95% CI, 0.283–0.832) were significant risk factors for sensory recall. Seventeen (73.9%) reported no impact on satisfaction (14 auditory, 2 physical, 1 both), while two (8.7%) reported worse satisfaction (1 auditory, 1 both) and four (17.4%) reported improved satisfaction (all auditory). We found a 14.0% rate of sensory recall. Spinal anesthesia, decreasing age, and lower benzodiazepine administration were associated with sensory recall. Sensory recall has a minimal effect on patient satisfaction, although some were still affected. Although we focused on instrument sounds, our high rate of sensory recall serves as a reminder to also be mindful of conversations in the operating room. Level II","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience & Innovation","volume":"58 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122885333","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}
Joseph Abboud, MD, Matt Barber, MD, Wael Barsoum, MD, Lisa Cannada, MD, William Levine, MD, Kevin Plancher, MD, Ira H. Kirschenbaum, MD
This Open Editorial is the edited transcript of an online seminar run by The Journal of Orthopaedic Experience & Innovation. If features Dr. William Levine, Dr. Joseph Abboud, Dr. Wael Barsoum, Dr. Matt Barber, Dr. Lisa Cannada, and Dr. Kevin Plancher. The session is moderated by Dr. Ira Kirschenbaum, the Editor-in-Chief of The Journal of Orthopaedic Experience & Innovation.
{"title":"Voices of Experience: Advice to Medical Students, Residents, Fellows, and Young Surgeons","authors":"Joseph Abboud, MD, Matt Barber, MD, Wael Barsoum, MD, Lisa Cannada, MD, William Levine, MD, Kevin Plancher, MD, Ira H. Kirschenbaum, MD","doi":"10.60118/001c.77401","DOIUrl":"https://doi.org/10.60118/001c.77401","url":null,"abstract":"This Open Editorial is the edited transcript of an online seminar run by The Journal of Orthopaedic Experience & Innovation. If features Dr. William Levine, Dr. Joseph Abboud, Dr. Wael Barsoum, Dr. Matt Barber, Dr. Lisa Cannada, and Dr. Kevin Plancher. The session is moderated by Dr. Ira Kirschenbaum, the Editor-in-Chief of The Journal of Orthopaedic Experience & Innovation.","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience & Innovation","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124129447","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}
Periprosthetic joint infections (PJIs) and periprosthetic femur fractures (PFFs) increase total costs of care. Retrospective registry/institutional studies with selection bias and underpowered meta-analyses have corrupted the evidence base regarding antibiotic-laden bone cement (ALBC) use in total knee arthroplasties (TKAs). Clinical practice guidelines (CPGs) recommend using cement fixation of femoral components in hip fracture patients to prevent PFFs, but have no recommendations regarding ALBC. Hip osteoarthritis CPGs have no bone cement recommendations regarding prevention of PJIs or PFFs. ALBC is potentially cost-effective by reducing PJIs, PFFs, and reducing implant costs. A systematic review was conducted to identify randomized controlled trials (RCTs), meta-analyses, and registry reports related to the efficacy of ALBC in reducing PJIs and cemented femoral fixation in reducing PFFs. Numbers needed to treat (NNT) are calculated. Cost-effectiveness margins per case are calculated. A pooled analysis of four TKA RCTs found ALBC reduces PJI by 0.94% (p=0.027), NNT 106. A total hip arthroplasty (THA) meta-analysis found ALBC reduces PJI by 0.58% (p<0.0001), NNT 172. A hip hemiarthroplasty (HH) RCT found high-dose dual-antibiotic ALBC reduces PJI by 2.35% (p=0.0474), NNT 43. A THA registry report found that cemented fixation compared to ingrowth fixation reduced PFFs by 0.44% (p<0.0001), NNT 229. A pooled analysis of three HH RCTs found that cemented femoral stem fixation reduced PFFs by 5.09% (p-0.0099), NNT 20. Mean PJI treatment costs are $80,000. Mean PFF treatment costs are $27,596. Mean HH cemented femoral stem cost reduction: $685. Using ALBC: TKA margin/case is $755; THA margin/case is $586; and HH margin/case is $3,925. Using plain bone cement: TKA margin/case is $0; THA margin/case is $121; and HH margin/case is $2,065. A broader perspective demonstrates that ALBC provides significant financial margins in TKAs, THAs, and hip hemiarthroplasties. ALBC is cost-effective when including the additional costs of using ALBC in TKAs, THAs, and hip hemiarthroplasties. Hand-mixed ALBC is more cost-effective than pre-mixed ALBC in all scenarios.
{"title":"Cost-Effectiveness of Bone Cement With and Without Antibiotics: A Broader Perspective","authors":"Oliver Sogard, Gregory A. Brown","doi":"10.60118/001c.74412","DOIUrl":"https://doi.org/10.60118/001c.74412","url":null,"abstract":"Periprosthetic joint infections (PJIs) and periprosthetic femur fractures (PFFs) increase total costs of care. Retrospective registry/institutional studies with selection bias and underpowered meta-analyses have corrupted the evidence base regarding antibiotic-laden bone cement (ALBC) use in total knee arthroplasties (TKAs). Clinical practice guidelines (CPGs) recommend using cement fixation of femoral components in hip fracture patients to prevent PFFs, but have no recommendations regarding ALBC. Hip osteoarthritis CPGs have no bone cement recommendations regarding prevention of PJIs or PFFs. ALBC is potentially cost-effective by reducing PJIs, PFFs, and reducing implant costs. A systematic review was conducted to identify randomized controlled trials (RCTs), meta-analyses, and registry reports related to the efficacy of ALBC in reducing PJIs and cemented femoral fixation in reducing PFFs. Numbers needed to treat (NNT) are calculated. Cost-effectiveness margins per case are calculated. A pooled analysis of four TKA RCTs found ALBC reduces PJI by 0.94% (p=0.027), NNT 106. A total hip arthroplasty (THA) meta-analysis found ALBC reduces PJI by 0.58% (p<0.0001), NNT 172. A hip hemiarthroplasty (HH) RCT found high-dose dual-antibiotic ALBC reduces PJI by 2.35% (p=0.0474), NNT 43. A THA registry report found that cemented fixation compared to ingrowth fixation reduced PFFs by 0.44% (p<0.0001), NNT 229. A pooled analysis of three HH RCTs found that cemented femoral stem fixation reduced PFFs by 5.09% (p-0.0099), NNT 20. Mean PJI treatment costs are $80,000. Mean PFF treatment costs are $27,596. Mean HH cemented femoral stem cost reduction: $685. Using ALBC: TKA margin/case is $755; THA margin/case is $586; and HH margin/case is $3,925. Using plain bone cement: TKA margin/case is $0; THA margin/case is $121; and HH margin/case is $2,065. A broader perspective demonstrates that ALBC provides significant financial margins in TKAs, THAs, and hip hemiarthroplasties. ALBC is cost-effective when including the additional costs of using ALBC in TKAs, THAs, and hip hemiarthroplasties. Hand-mixed ALBC is more cost-effective than pre-mixed ALBC in all scenarios.","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience & Innovation","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127921018","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}
G. Ball, S. Bishai, Bodrie Jensen, M. Maceroni, Samuel D. Howard
This case presentation highlights the ability to fix coracoid fracture nonunion arthroscopically. A right hand dominant 27 year old male with 6 months of symptomatic nonunion of a coracoid fracture. After arthroscopic internal fixation the patient went on to have union at the fracture site and resolution of pain at the coracoid.
{"title":"Case Presentation for Arthroscopic Internal Fixation of Coracoid Fracture","authors":"G. Ball, S. Bishai, Bodrie Jensen, M. Maceroni, Samuel D. Howard","doi":"10.60118/001c.71397","DOIUrl":"https://doi.org/10.60118/001c.71397","url":null,"abstract":"This case presentation highlights the ability to fix coracoid fracture nonunion arthroscopically. A right hand dominant 27 year old male with 6 months of symptomatic nonunion of a coracoid fracture. After arthroscopic internal fixation the patient went on to have union at the fracture site and resolution of pain at the coracoid.","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience & Innovation","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126518375","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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