Journal of surgical orthopaedic advances最新文献

Opioid-limiting legislation has been enacted in response to the opioid epidemic in the United States. However, the impact of this legislation on perioperative opioid prescribing in elective shoulder surgery is not well understood. This is an observational review of 90-day perioperative opioid-prescription filling by patients undergoing shoulder surgery using a national insurance database (n = 231,634 patients) between 2010 and 2019. Statistics evaluated the impact of the year and opioid-limiting legislation on first prescription and cumulative 90-day opioid filling. Initial and cumulative opioid-prescription volume decreased significantly from 2010 to 2019 (49 to 44.4 initial oxycodone 5-mg equivalents, 132.8 to 72.3 cumulative oxycodone 5-mg equivalents; all p < 0.001). States with opioid-limiting legislation had larger reductions in initial and cumulative opioid-prescription filling over similar time frames (p < 0.001). Perioperative opioid prescribing has decreased significantly in shoulder surgery with time and state legislation. Individual prescribers and state and national legislators should continue to seek ways to reduce opioid overprescribing. (Journal of Surgical Orthopaedic Advances 33(3):152-157, 2024).

Postoperative pain control in adolescent patients following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) requires a multimodal pain regimen involving a combination of opioids and adjuvant analgesic medications. The purpose of this study was to identify whether the use of the local anesthetic liposomal bupivacaine (LB) at time of closure following PSF reduced postoperative narcotic use in patients when compared with an alternative local anesthetic. Twenty-five patients who received LB at time of wound closure were matched with 25 AIS patients from the year prior to minimize changes in protocol and instrumentation. Charts were retrospectively reviewed, and significant difference was found in age, gender, body mass index, length of stay, visual analog scores for pain, or number of levels fused. However, the LB group had significantly less morphine equivalent totals. Based on the results, the authors would recommend the use of LB during closure of PSF for AIS. (Journal of Surgical Orthopaedic Advances 33(4):219-221, 2024).

This study compares radiographic osteoarthritis severity prior with total knee arthroplasty (TKA) by payer type. Five hundred and three primary TKAs were included. Preoperative radiographs were scored by Ahlback, Kellgren-Lawrence (KL), and International Knee Documentation Committee (IKDC) classifications. Osteoarthritis severity by age and insurance type (private, Medicare, and Medicaid) were compared using Mann Whitney U and Kruskal-Wallis testing. Three hundred and two (60%) subjects were under 65 years old, and 201 (40%) were 65 years and older. Younger subjects had no differences in radiographic severity in KL (p = 0.268), Ahlback (p = 1), or IKDC (p = 0.948) classification by insurance. Older subjects also had no differences in osteoarthritis severity for KL (p = 0.282), Ahlback (p = 0.354), or IKDC (p = 0.735) classifications by insurance. Three osteoarthritis classification systems found no difference in preoperative radiographic changes by payor type, suggesting that, in the study's population, there is no delay in appropriate surgical treatment by payer. Future studies should compare preoperative clinical symptoms. (Journal of Surgical Orthopaedic Advances 33(3):184-188, 2024).

Pulmonary embolism (PE) and deep vein thrombosis (DVT) are common postoperative complications. This study retrospectively analyzes preoperative attributes as risk factors for DVT or PE following primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). Preoperative transfusion, age 65+, dyspnea with moderate exertion, body mass index (BMI) 24.9+ were independent risk factors for PE following THA. Cardiac comorbidities were related with reduced risk. Bleeding disorder, operative time > 110 minutes, perioperative transfusion, age 65+, dyspnea at rest, and BMI < 18.5 were independent risk factors for DVT following THA. Perioperative transfusion, age 57+, dyspnea at rest and with moderate exertion, and BMI 24.9+ were independent risk factors for PE following TKA. Smoking status was related to reduced risk. Perioperative transfusion, age 65+, dyspnea with moderate exertion, and male sex were independent risk factors for DVT following TKA. Cardiac comorbidities were related with reduced risk. Identifying risk factors helps prevent DVT and PE after THA or TKA. (Journal of Surgical Orthopaedic Advances 33(3):138-142, 2024).

Guidelines provide varying recommendations for the prophylactic antimicrobial treatment of open fractures. This single-center, retrospective cohort study was conducted to determine how well an institutional prophylactic antibiotic protocol covered pathogens associated with open fractures. The authors included adult trauma patients with one or more open fractures and a positive culture from the site of the open fracture, and compared outcomes between patients who were covered by prophylactic antibiotics with patients not covered by prophylactic antibiotics. Of 957 patients evaluated, 75 were included, with 40 patients (53%) covered by the prophylactic antibiotics received. Multidrug-resistant pathogens were isolated in 23 (58%) patients covered versus 26 (74%) patients not covered (p = 0.128). The median time to positive culture was less in patients not covered by initial antibiotics compared with those who were covered (30.2 vs. 102.1 days; p = 0.003). Over half of the patients developed cultures with pathogens that were covered by their initial antibiotic prophylaxis. (Journal of Surgical Orthopaedic Advances 33(2):084-087, 2024).

Studies have shown increased risk for dislocation, loosening, and revision in patients undergoing total hip arthroplasty (THA) after hip arthroscopy (HA). The authors examined differences in presentation and outcomes between patients who underwent THA with and without prior HA from 2016 to 2021. Twenty-one HA to THA patients were matched on age, sex, race, body mass index (BMI), American Society of Anesthesiology (ASA) score, and comorbidities to 100 THA controls. Univariate analysis was used to determine differences between groups. HA patients were more likely to have Kellgren-Lawrence (KL) grades of 2 or 3, whereas those with no HA were more likely to present with 3 or 4. HA to THA patients had 1.2 mm more joint space than THA patients. Time to THA from first orthopaedic visit was 16 months longer for patients with HA. Postoperatively, there were no significant differences. This suggests THA can be an effective intervention for failed HA. (Journal of Surgical Orthopaedic Advances 33(3):168-170, 2024).

The purpose of this study was to analyze and assess students from medical schools without a home orthopaedic residency program when applying for a residency position in orthopaedic surgery in terms of metrics utilized by program directors in the Match. An anonymous survey consisting of 23 questions was distributed to graduates of six different medical schools without a home orthopaedic residency program who successfully matched into orthopaedic residency over the past 6 years. Forty-three total responses were received. The number of honors achieved in the junior clerkship phase, mean United States Medical Licensing Examination (USMLE) step 1 and step 2 clinical knowledge (CK) exam scores, number of away rotations, and number of orthopaedic research publications in surgery and total publications overall at the time of application were determined. Graduates of medical schools without a home orthopaedic residency program who successfully matched performed at a higher level across all metrics compared with national match data and the orthopaedic literature. (Journal of Surgical Orthopaedic Advances 33(3):172-177, 2024).

Periarticular injections (PAI) are a common component to multimodal regimens in total hip arthroplasty (THA), although the efficacy of adding liposomal bupivacaine (LB) remains unclear. A meta-analysis of total knee arthroplasty did not find LB superior, but a similar study has not been performed in THA. The purpose of this study was to compare opioid consumption, pain scores, and length of stay between PAIs with LB and traditional PAIs in THA. Eleven included studies showed LB to have minor decreases in opioid consumption and length of stay. No clinically significant benefits were achieved in pain control based on minimal clinically important difference thresholds. There is not adequate evidence to suggest that the increased cost of LB merits its utilization over traditional PAI in THA. The variability in the study designs, as well as results, calls for more consistent randomized clinical trials to ascertain the true efficacy of LB. (Journal of Surgical Orthopaedic Advances 33(3):143-153, 2024).

Arthrofibrosis is a multifactorial process that results in decreased knee range of motion (ROM). Manipulation under anesthesia (MUA) is commonly regarded as the preferred initial treatment of arthrofibrosis following total knee arthroplasty (TKA). There have been no well-controlled studies demonstrating that MUA effectively increases ROM in patients who develop arthrofibrosis after TKA when compared with routine care. The purpose of this study was to determine whether MUA had any advantage over routine care in the treatment of patients who developed arthrofibrosis following TKA. The authors identified patients who underwent primary TKA at the authors' institution between 2010 and 2014 and had flexion ≤ 100 degrees at early follow-up. Knees were grouped based on how the arthrofibrosis was treated: those who underwent MUA and those who received routine care. Knee flexion was captured preoperatively (prior to TKA), at early follow-up (prior to MUA or routine care), and at 1-year follow up. Flexion change from early follow-up to 1 year was calculated. The average flexion at 1-year follow-up was not significantly different between the two groups (106.1 ± 11.7 degrees in the routine care group versus 106.3 ± 12.8 degrees in the MUA group). The MUA group had a greater proportion of patients with flexion gains > 20 degrees at final follow-up when compared with patients who underwent routine care (56% vs. 8%, p < 0.0001). This study demonstrates that patients with decreased ROM at early follow-up after primary TKA can expect greater ROM increase at 1-year follow-up if they undergo MUA compared with patients who undergo routine care. (Journal of Surgical Orthopaedic Advances 33(1):033-036, 2024).

The purpose of this study is to better characterize patient- and surgery-specific parameters associated with postoperative urinary retention (POUR) and assess the impact of prophylactic Tamsulosin following posterior spinal fusion (PSF) for the management of scoliosis in pediatric and adolescent patients. All patients who underwent PSF for surgical correction of adolescent idiopathic scoliosis (AIS) and neuromuscular scoliosis (NMS) between 2015 and 2019 were retrospectively reviewed. Patients were stratified based on whether they received prophylactic Tamsulosin. Overall, POUR was reported in 3.7% (n = 10) of all patients in the study, although Tamsulosin was associated with a lower rate of POUR, and this did not reach statistical significance. Longer fusion constructs were identified as a risk factor for POUR and could help surgeons counsel families prior to surgery. This is the first study to assess the rate of POUR on AIS and NMS patients following PSF without epidural analgesia. (Journal of Surgical Orthopaedic Advances 33(1):010-013, 2024).