Bulletin of the Hospital for Joint Disease (2013)最新文献

Purpose: The purpose of this study was to evaluate changes in perioperative tranexamic acid (TXA) utilization among patients undergoing primary total hip arthroplasty (THA) and total knee arthroplasty (TKA), based on patient demographics and comorbidities, including those at higher and lower risk of venous thromboembolism (VTE).

Methods: Patients who underwent THA or TKA between 2012 and 2021 were identified using the TriNetX electronic health record database. Perioperative TXA use was evaluated among patients stratified according to risk of VTE. Utilization rates were analyzed using compound annual growth rates (CAGRs) and linear regression analysis.

Results: From 2012 to 2021, TXA use increased by 406% (CAGR: +17.66%; P < 0.001) for THA and 459% for TKA (CAGR: +18.86%; P < 0.001). Among patients with at least 1 factor placing them at high risk of VTE, TXA use increased by 1277% for THA (CAGR: +30.0%; P < 0.001) and by 966% for TKA (CAGR: +26.7%; P < 0.001). During the final study year (2021), surgeons overall used TXA in 67.8% of THA cases and 62.5% of TKA cases. In the high-risk group, TXA use was lowest among patients with a history of myocardial infarction (THA, 48.7%; TKA, 51.4%), cerebrovascular accident (THA, 51.0% and TKA, 50.6%), bleeding or clotting disorder (THA, 57.4% and TKA, 57.1%), or previous VTE (THA, 57.3%; TKA, 53.6%).

Conclusion: Despite the rapid growth in TXA utilization over the past decade in THA and TKA, patients at high risk of VTE and ischemia are still less likely to receive perioperative TXA.

Background: Acute blood loss anemia is a common complication of hip fractures. Due to this complication, the rate of allogenic blood transfusions remains high in this patient population. More recently, surgeons have utilized intraoperative tranexamic acid as a strategy to minimize blood loss.

Purpose: The purpose of this study was to identify risk factors and associated outcomes of blood transfusions in hip fracture patients.

Study design: Retrospective cohort study.

Methods: A trauma database from one academic medical center was queried for hip fracture patients (OTA/AO 31A or 31B). Demographic, clinical, quality, and cost data were obtained for each patient. A Score for Trauma Triage in Geriatric and Middle Aged (STTGMA), a validated risk predictive and matching tool, was calculated for each patient. Patients receiving blood transfusions during their hospitalization were identified. Multivariate logistic regression analysis identified independent risk factors for transfusion during admission. Patients receiving transfusions were matched to patients not receiving a transfusion based on STTGMA. Comparative analyses of matched cohorts were performed.

Results: In total, 1,344 hip fracture patients (29.8% male and 70.2% female) with mean age 81.04 ± 10.18 were identified. Four hundred ninety-nine (37.1%) patients received a transfusion during their admission. Risk factors for transfusion included higher STTGMA scores (P = .006), lower hemoglobin levels on admission (P < .001), anticoagulation or antiplatelet use on admission (P = .019), and fracture repair with a long cephalomedullary nail (P = .005). Trauma risk score-matched cohort outcomes show transfusions correlated with increased mortality, complications, readmission, and longer, more costly hospital stays.

Conclusion: Surgeons should be cognizant of transfusion risk factors such as repair with long cephalomedullary nail and poorer matched outcomes correlated with patients receiving transfusions.

Level of evidence: Level 3.

Abstract: Lower limb deformities encompass a wide range of problems, and the work-up and management of these patients is quite complex. The purpose of this review was to define the essential considerations of preoperative planning for lower limb deformity correction. This can be somewhat simplified into the who, what, where, how, and why, which includes the patient evaluation, defining the deformity, finding the center of rotation of angulation, the osteotomy, the technique of distraction osteogenesis, and the goals of surgery, respectively. The goal of this review was to establish a framework of the fundamentals for preoperative planning of lower limb deformity corrections.

Background: The coronavirus disease (COVID)-19 pandemic led to shutdowns of organized sporting activity. Prolonged periods of inactivity lead to deconditioning and may increase one's risk for injury. The purpose of this study was to quantify the incidence of anterior cruciate ligament (ACL) injuries requiring reconstruction during the peripandemic period.

Methods: The electronic medical record of a single university teaching hospital was queried for current procedural terminology codes for ACL reconstructions (ACLR; 29,888) from January 2017 to December 2022. Date of injury was collected from clinic notes if it could be estimated within 2 weeks. The years 2017-2019 were used as a proxy for "pre-COVID," the year 2020 for "COVID," and the years 2021-2022 for "post-COVID."

Results: In total, 2178 patients had an ACL injury and underwent reconstruction from 2017 to 2022. Date of injury could be estimated for 1,617 patients (51.3% male, average age 30.9 ± 11.0 years). There was a decrease in the number of ACL surgeries observed during the COVID era, followed by a post-COVID rebound. The proportion of female patients who underwent ACLR increased from the pre-COVID to the post-COVID period (42.7% vs. 49.4%, P < .001). The proportion of patients with American Society of Anesthesiologists (ASA) score 2 increased from the COVID to the post-COVID period in relation to the proportion of patients with ASA score 1 (P = .007).

Conclusion: ACLRs decreased at our institution during the COVID-19 pandemic, followed by an increase in ACLRs from 2021 to 2022. The proportion of female patients and patients with higher ASA scores increased in the post-COVID era.

Abstract: The need to perform revision anterior cruciate ligament reconstruction (ACLR) has several etiologies such as infection, arthrofibrosis, cyclops lesions, and graft failure, which should be distinguished before revision ACLR. Even the definition of graft failure varies within the literature. ACLR graft failure falls into modifiable, surgeon-controlled factors, such as tunnel position, graft choice, and alignment, and nonmodifiable factors, such as patient age, tissue quality, or secondary traumatic reruptures. In this review, we describe a facile framework for the workup of modifiable ACLR graft failure.

Purpose: To determine the clinical outcomes of hip arthroscopy for anterior inferior iliac spine subspine impingement (SSI).

Level of evidence: Case Series; level IV.

Methods: Patients who underwent unilateral, primary hip arthroscopy for SSI from February 2015 to December 2017 with minimum 3-year follow-up data were identified (SSI). Analysis of variance, Kaplan-Meier analysis, and regression modeling were used to analyze outcomes.

Results: Of 23 eligible, 19 (83% inclusion) patients (mean [standard error of the mean]: age: 45.9 [3.1]; body mass index, 26.3 [0.9]; 79% female, 53% right side) had a minimum of 3-year follow-up (48.3 [2.2] months). The estimated mean survival time of index procedure across the whole cohort was 64.9 ± 3.1 months. One patient underwent total hip arthroplasty. Patients improved from baseline modified Harris Hip Score (62.7 [5.1]) to follow-up (75.1 [4.3]; P = .014). Twelve patients (63%) met minimal clinically importance difference criteria while 7 (37%) met patient acceptable symptomatic state criteria. Linear regression modeling demonstrated lower postoperative lateral center edge angle (beta = -2.1, 95% confidence interval: -0.5 to -2.9, P = .035) and presence of labral repairs (beta = 46.1, 95% confidence interval: 24.8-67.4, P = .003) were associated with higher follow-up modified Harris Hip Score.

Conclusion: In conclusion, patients undergoing anterior inferior iliac spine decompression during hip arthroscopy for SSI in the setting of femoroacetabular impingement syndrome have acceptable, improved clinical outcomes at minimum 3-year follow-up. Labral repair and decreasing postoperative lateral center edge angle were predictive of improved patient-reported outcomes. Hip arthroscopy remains a viable successful treatment options in the treatment of concomitant SSI during femoroacetabular impingement syndrome surgery.

Abstract: Needle arthroscopy is a minimally invasive technique available for the management of common foot and ankle pathologies. Owing to the limitations associated with first-generation needle arthroscopic models, specifically visualization and fluid management, needle arthroscopy has undergone revitalization over the past decade. Newer systems are now using chip on tip visualization capability as well as improved fluid pumps allowing for direct intervention under improved visualization. The smaller diameter of the needle arthroscope permits procedures to be conducted in both the operating room and office setting under wide-awake conditions. We present this review to detail the history of needle arthroscopy and highlight how needle arthroscopy has improved care for patients with foot and ankle disorders.

Background: The objective of this study was to survey a cross-section of US female orthopaedic surgeons evaluating their education and attitudes on radiation safety and adherence to safety recommendations.

Methods: An online survey was distributed to female orthopaedic surgery faculty through the Forum, a society for women in orthopaedic surgery, and through internal institutional education networks (residency and fellowship programs). The first component of the survey gathered demographic information including practice setting, US state, and years in practice. The second component was a 10-question knowledge assessment. The third component captured personal experiences among respondents including satisfaction with radiation safety training, radiation safety practices, and level of concern regarding exposure risk. Responses from 66 participants from differing geographic locations were collected using Research Electronic Data Capture.

Results: Sixty-six female orthopaedic surgeons from 21 states completed the survey. Regular dosimeter usage was reported by 24.2% of respondents, and 36.4% of respondents reported always having well-fitted radiation protective equipment provided. The majority (56.1%) stated that they worry about the risks of radiation to their health. Regarding their radiation safety training, 60.6% of respondents rated their training as unsatisfactory or extremely unsatisfactory, and 90.9% of respondents stated that they think training efforts for radiation safety can improve.

Conclusions: Female orthopaedic surgeons demonstrated an inadequate knowledge of adherence to radiation safety protocols and the majority expressed concern with long-term radiation exposure, particularly regarding health and pregnancy risk. To enhance radiation safety awareness and adherence among female orthopaedic surgeons, strategies should be tailored to this demographic, fostering confidence in their knowledge of radiation exposure and bolstering safety measures.

Abstract: Since the beginning of documented medical history, amputation procedures, limb loss, and the myriad creative solutions attempted to care for these individuals have been reported. With the coalescence of multiple World Wars resulting in an ever-increasing number of individuals with limb loss and advancing medical technology, a need to innovate in this field has always been present. The complexity of the hand and upper extremity in self-care, communication, vocation, and exercise results in more demands of prostheses to mimic or replace these functions as opposed to the lower extremity, which is focused mostly on weight bearing and ambulation. As such, this need has pushed technological advances past the simpler passive or body-powered prostheses alone, now with externally powered and hybrid devices revolutionizing the way these appliances were implemented in everyday life. Despite the ever-advancing field of prosthetic technology, upper and lower extremity amputees alike still battle common challenges of pain, phantom limb sensation, and lack of prosthetic control and sensation. Targeted muscle reinnervation and regenerative peripheral nerve interface offer new surgical solutions to some of these challenges and are proving invaluable. As technology and surgical options continue to advance at an ever-rapid pace, a more thoughtful and individualized approach to the care of upper extremity limb loss is available. In this study, we review the history and evolution of upper extremity prostheses and discuss considerations in making optimal surgical and prosthetic decisions for upper extremity amputees.