Journal of surgical orthopaedic advances最新文献

Diminished physician well-being is a serious occupational hazard in orthopaedic surgery that results from burnout and low professional fulfillment. The authors surveyed 331 members of the American Orthopaedic Association and used the Professional Fulfillment Index (PFI) to determine presence of burnout and low professional fulfillment. Thirty-three percent (110/331) of respondents were burned out. Predictors of burnout included early career stage, work hours, and specialization in arthroplasty. Forty-four percent (185/331) of respondents were not professionally fulfilled. Predictors of low professional fulfillment included early career stage, work hours, specialization in foot/ankle, female gender, and not having children. No significant relationship between PFI well-being and self-reported medical errors was found. An orthopaedic surgeon's well-being is influenced by personal and career-related factors that may be used to guide interventions that minimize burnout and maximize professional fulfillment. (Journal of Surgical Orthopaedic Advances 33(4):247-253, 2024).

Children with cerebral palsy (CP) and those with avascular necosis (AVN) after treatment of developmental hip dysplasia (DDH) are at risk of developing coxa valga. Proximal femur guided growth is a minimally invasive option to correct this deformity. A systematic review of articles that described treatment of coxa valga with proximal femur guided growth (PFGG) and reporting on primary radiographic outcomes, demographic variables, surgical variables and complications. One hundred and seventy-nine hips underwent PFGG (117 with CP and 62 with lateral overgrowth). Average age at surgery was 8.1 years; average follow-up was 52.5 months. Migration percentage improved from 11.2% (p < 0.0001). Neck-shaft angle improved by 11.9° (p < 0.0001). The most common complication was screw growth out of the physis (30% of cases). PFGG can correct coxa valga, improve radiographic parameters, and in children with CP prevent further subluxation. This technique modulates proximal femur growth, induces changes to the acetabulum and can correct valgus deformity. Evidence Level III. (Journal of Surgical Orthopaedic Advances 32(4):049-052, 2024).

Primary total knee arthroplasty (TKA) in patients under 50 is becoming more common. The goal of this study was to identify the diagnoses and predisposing factors for TKA prior to age 50. The Military Data Repository was queried for patients undergoing TKA prior to age 50. The cohort was matched to older patients. A total of 1,504 patients underwent manual record review for demographics, prior knee surgery, and indication for TKA. Primary osteoarthritis was the most common indication in both cohorts. Posttraumatic osteoarthritis was more common in patients who underwent TKA before age 50 (28%) compared with patients 50 and older (7%; p < 0.001). Patients who underwent TKA before age 50 were more likely to have previous anterior cruciate ligament injury, or any previous ipsilateral knee surgery (p < 0.001). These data suggest an association between prior knee injury and age at time of TKA. (Journal of Surgical Orthopaedic Advances 33(2):072-076, 2024).

The association between the reuse of surgical masks (SMs) for multiple procedures and rates of surgical site infections (SSIs) is unclear. Hence, the purpose of this study was to determine whether a policy mandating the reuse of SMs was associated with increased SSI incidence. It was hypothesized the rate of SSIs would be significantly greater during the postimplementation period compared with the preimplementation period. Retrospective chart review of patients who underwent orthopaedic and general surgery during the 60 days before and after policy implementation was performed. Focus was on consecutive procedures performed by the same surgeon on the same day. An assessment of SSI risk factors suggested the postimplementation group was at higher risk. However, the daily use of a single SM across multiple procedures was not associated with a clinically significant increase in SSIs. Because future pandemics and public health crises may be accompanied by similar shortages, it may be possible to reuse masks in these situations without concern for increased SSI. (Journal of Surgical Orthopaedic Advances 33(2):097-102, 2024).

There are limited data demonstrating the association of sex with different risks for complications following upper and lower total joint arthroplasty. Therefore, this study set out to determine whether biological sex is associated with different outcomes following primary total shoulder arthroplasty. The Mariner claims database was used to identify patients who underwent primary total joint arthroplasty (TSA) for the treatment of glenohumeral osteoarthritis (OA) between 2005 and 2017. Primary endpoints of the study were to compare frequency of 90-day medical complications between male and female cohorts. This study demonstrates that, within 90 days, TSA males and females do experience significantly different medical complications, specifically, the rate of transfusion of blood products and urinary tract infections (UTIs). This study can be used to evaluate sex-specific risk of medical complications following TSAs. (Journal of Surgical Orthopaedic Advances 33(4):244-246, 2024).

Adolescent back pain is a difficult problem to diagnose owing to the variability in diagnoses that can stem from this symptom. It may be due to simple myalgias or something as complex as a neoplastic or infectious process, and the consequences of missing the latter are detrimental. The authors theorize that the increased forces seen in the lower back owing to posture in conjunction with the increase in smartphone usage over the last decade and heavy backpack use have led to an increased prevalence of a phenomenon of adolescent compressive epiphysitis of the spine (ACES). In this article, the authors describe ACES as a diagnosis for nonspecific low back pain in adolescents and reiterate the red flag symptoms associated with adolescent back pain that warrant further workup. Furthermore, they describe their treatment algorithm for these patients. (Journal of Surgical Orthopaedic Advances 33(3):135-137, 2024).

Surgical scissors form an essential part of both basic and specialty surgical sets. Their prime function is to cut tissues. They are also used for blunt dissection/development of tissue planes and piercing tissues. A wide variety of scissors are available for use in practice. This review article briefly describes common surgical scissors in orthopaedic use. The basic construct, biomechanics, types, their identification, specific uses, and care aspects are also discussed. A surgeon should be aware of the different types of scissors, their biomechanical features, and specific uses, as they are an important tool in his/her armamentarium. (Journal of Surgical Orthopaedic Advances 33(1):001-004, 2024).

We investigated the effect of robotic assistance in a postoperative change in hip offset and the incidence of trochanteric bursitis among total hip arthroplasty (THA) patients. As part of a retrospective study of a consecutive series of patients over a 3-year period, 211 patients (102 traditional; 109 robotic) between 2013 and 2016 who underwent posterior-lateral THA were reviewed. Hip offset was measured on preoperative and postoperative anterior-posterior (AP) pelvis radiographs. The absolute change in total hip offset was higher in patients undergoing non-robotic THA than in patients undergoing robotic THA (5.98 ± 4.47 mm vs 4.33 ± 3.98 mm; p = 0.008). The rate of symptomatic trochanteric bursitis (p = 0.02) and cortisone injection was higher in non-robotic THA patients than in robotic THA patients (p = 0.002). Robotic arm-assisted THA is associated with a decreased postoperative change in hip offset, incidence of symptomatic trochanteric bursitis, and bursal steroid injections. (Journal of Surgical Orthopaedic Advances 32(4):112-116, 2023).

Quadriceps and patellar tendon ruptures are rare but serious injuries that can severely disrupt function and quality of life. The aim of this study was to evaluate the rates and risk factors for failed quadriceps and patellar tendon repairs. A retrospective review of 78 patients undergoing surgical repair for quadriceps or patellar tendon rupture from March 2014 to December 2020 was performed. Univariate statistics were used to evaluate differences between groups. Approximately 10.3% of cases returned to the operating room, and 6.4% required revision repair for rerupture of the quadriceps or patellar tendon. Notable trends toward increased risk for rerupture included a history of prior knee surgery (odds ratio [OR] = 6.286, p = 0.065) and quadriceps tendon rupture (OR = 6.321, p = 0.055), although statistical significance was not achieved. Although not statistically significant, previous knee surgery and quadriceps tendon rupture appear to increase the risk of rerupture after primary tendon repair. (Journal of Surgical Orthopaedic Advances 33(4):212-215, 2024).

Treatment of comminuted patella fractures is challenging. Augmentation of internal fixation has been proposed to improve stability. The authors describe an effective technique to augment internal fixation consisting of locked sutures within the quadriceps and patellar tendons. This technique functions to off-load internal fixation and restore tension to the extensor mechanism. The locked suture augmentation technique was performed for 13 patients undergoing open treatment of patella fractures by the senior author from 2016 to 2019. Patients were followed for an average of 10.2 months. No patients suffered postoperative infection or wound complication requiring intervention. There were no cases of fracture displacement, implant failure, loss of fixation, postoperative infection, or wound complication requiring intervention. Mean range of motion was 0 - 134 degrees of extension, and no patients demonstrated an extensor lag. The authors conclude that locked suture augmentation of comminuted patella fractures represents a viable technique that demonstrates excellent early clinical results. (Journal of Surgical Orthopaedic Advances 33(4):201-205, 2024).