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

Hidradenitis suppurativa (HS) is a disorder of the terminal follicular epithelium in the apocrine sweat glands. Chronic relapsing inflammation, mucopurulent discharge, and progressive scarring frequently involving the axillary and inguinoperineal area characterize HS. Reactive arthritis is associated with chronic infections, such as HS, although joint involvement is uncommon. Treatment is based on the eradication of the underling infection. Whereas skin lesions may improve with antibiotic therapy, the arthritis of HS is often unresponsive to therapy. Various therapies have been tried in HS, including nonsteroidal antiinflammatory drugs, colchicine, mesalamine, dapsone, and TNF inhibitors. A case of severe, debilitating arthritis associated with HS that responded to dapsone is reported. This case demonstrates the difficulty of successful treatment of HS as well as of the associated arthritis.

Background: The shift to value based total joint arthroplasty (TJA) reimbursement strategies has led to an increased focus on quality and the avoidance of poor outcomes. As a result, there has been greater encouragement for patients to undergo joint replacements in high volume centers of excellence. In this study, we examined the potential complications avoided if TJA procedure volume was shifted from poor quality (high incidence) facilities to high quality (low incidence) facilities within Hospital Referral Regions (HRRs).

Methods: Using Medicare 100% claims data linked to the Dartmouth Atlas of Health Care, we examined the clinical and cost benefits of shifting TJA procedures from low performing hospital to high performing hospitals within HRRs.

Results: Across all HRRs, we identified 1,878 cases of deep infection and 3,393 annual readmissions in the Medicare population that could have potentially been avoided, resulting in a mean cost savings of $41 million and $62 million, respectively, solely due to shifting procedure location from lower third performing hospitals to the upper third performing hospitals.

Conclusions: Our study demonstrates that the incidence of deep infection and all-cause readmission varies widely among and within HRRs. Further, the potential reallocation of joint procedures from low quality facilities to high quality Centers of Excellence within an HRR could result in over $103 million in annual savings related to mitigated deep infections and readmissions.

Background: To measure functional outcome, patient reported outcome measures (PROMs) are most often used but biomechanical tests can provide valuable supplementary data. The objective of this study was to investigate instrumented insoles for measuring ground-to-foot forces during basic activities.

Methods: Three groups were evaluated: normal controls, preoperative, and postoperative total knees. The Knee Society Scoring System (KSS) Short Form was used, and with foot pressure sensor insoles, a timed-up-and-go (TUG) test and a sit-to-stand (STS) test was used.

Results: Comparing preoperative to postoperative and control groups, there were significant differences in most parameters. There were no significant differences between controls and postoperative knees. Of the 33 correlation coefficients between three PROM parameters and six biomechanical parameters for the three groups, only five coefficients were greater than 0.5.

Conclusions: The biomechanical data was substantially independent of the PROM data and provided additional functional evaluation. The most useful parameters were the left-right force ratios during sit-to stand (STS) and the timed-up-and-go (TUG) time.

Background: Graft failure following anterior cruciate ligament reconstruction (ACLR) is a devastating complication. Risk factors such as patient characteristics and tunnel positions are well described. The relationship between graft dimension and failure rates has been investigated mainly in soft tissue grafts. Less studied are the effects of patella tendon (PT) dimensions on the risk of graft failure following patella tendon autograft (PTA) reconstructions.

Purpose: The purpose of the current study was to investigate if patellar tendon thickness measured on preoperative magnetic resonance imaging (MRI) predicts failure after ACLR using PTA.

Methods: This was an institutional review board approved, single-center, retrospective case-control study comparing patients' preoperative patellar tendon thickness between July 2005 and January 2017. Sixteen patients (mean age 21.2 ± 5.0 years) with PTA failure requiring revision surgery were identified and compared to 34 control patients who had undergone primary ACLR with PTA without failure with a minimum of 2-years follow-up. Patients with failure were matched at approximately 1:2 based on age, sex, height, weight, associated meniscus injury, and associated meniscal surgery. Patellar tendon dimensions were measured at the inferior pole of the patella (IPP), tibial tubercle insertion (TT), and longitudinal midpoint (MP) on preoperative axial and sagittal cut MRIs. Interclass correlation coefficeint (ICC) and Bland-Altman analyses were evaluated to determine inter-observer reliability. The two cohorts were compared using independent samples t-tests and analysis of variance.

Results: All ACLR failures occurred after a non-contact, pivot type injury. There were no significant differences in age, sex, height, weight, meniscal injury, or meniscal surgery between the two groups. Mean time between primary ACLR and revision was 2.6 ± 2.6 years and mean follow-up time was 3.1 ± 1.0 years in the control group. Patellar tendon length and width were not significantly different between the two groups. The average thickness at both the inferior pole and longitudinal midpoint was significantly higher in the failure group compared to controls (IPP: 5.04 ± 1.1 mm versus 4.33 ± 0.7 mm, p = 0.01; MP: 4.60 ± 0.7 mm versus 4.22 ± 0.5 mm, p = 0.03). Additionally, ICC was high across all measurements, with all values > 0.978. Similarly, all values demonstrated bias of less than ± 0.05.

Conclusion: Patella tendon autograft anterior cruciate ligament reconstruction failures had significantly thicker patellar tendons at the inferior pole and longitudinal midpoint of the patella tendon.

Background: The results of treatment for neglected developmental dysplasia of the hips (DDH) in children remains controversial. We sought to determine the clinical and radiographic result of patients with neglected DDH with special emphasis on the functional outcome as determined by the Pediatric Outcomes Data Collection Instrument (PODCI) and determine which preoperative variables were related to the result. We also sought to determine if the functional results remain the same over time and if there is there a preoperative variable that can predict a poor outcome.

Methods: This was a retrospective review of 15 patients (19 hips, 11 unilateral and 4 bilateral) treated after the age of 6 years (mean: 7.6 years) with one stage open reduction, femoral shortening, and innominate osteotomy with a minimum follow-up of 15 years. Clinical and radiographic evaluations were performed at 10 years and 15 years after the index procedure. Functional outcome was determined using the PODCI scale and the Iowa Hip Score; the radiographic result was evaluated with the Severin classification, the center-edge angle, and the Tönnis grade of osteoarthritis. Linear regression analysis was used to determine the influence of preoperative variables on the result.

Results: The patients were evaluated at two points in time: the first evaluation was performed at a mean 10.7 years after surgery (range: 10.0 to 12.2 years); at that time, the patients mean age was 17.8 years; 11 had pain and 14 had a limp, the mean Iowa hip score was 73.5 and the mean PODCI score was 88.05. The mean CE angle was 26.9°, one hip was considered a Severin type I, six as type II, eight as type III, and four as type IV; eight hips were considered Tönnis grade I, seven grade II, and four grade III. The second evaluation was performed at a mean 15.8 years after surgery (range: 15.1 to 17.3 years); at that time, the patients mean age was 22.9 years; 14 had pain and 14 had a limp, the mean Iowa hip score was 67.8, and the mean PODCI score was 85.73. The mean CE angle was 29.7°, one hip was considered a Severin type I, four as type II, 10 as type III, and four as type IV; two hips were considered Tönnis grade I, five grade II, nine grade III, and three grade IV. The results were significantly worse than those seen at the first evaluation. Linear regression analysis showed a tendency toward worse functional and radiographic results with increasing age at the time of treatment as well as with time of follow-up.

Conclusions: The results demonstrate a directly inverse relationship between age at the time of treatment and functional and radiographic results for patients with neglected DDH. A progressive deterioration of the results with further follow-up was also found.

This retrospective case report describes an extended anterior surgical approach for treating oncologic patients with proximal femur resection and hip reconstruction. Three consecutive women (mean age: 57.3; range: 33 to 81 years) with non-Hodgkins lymphoma (one case) or breast cancer (two cases) that had metastasized to the proximal femur underwent this procedure. Outcome measurements included timed-up-and-go, visual analog scale (VAS) for pain, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. Independent walking distance was also recorded. At a mean of 14 months postoperatively, all three patients had returned to independent flat surface and stair ambulation with minimal hip pain. Normal active hip flexion and extension range of motion were also restored. All patients had ≥ 4/5 involved hip manual muscle test strength. The surgical approach we described enabled effective return to independent flat surface and stair ambulation.

Before the 1900s, distal radius fractures were misdiagnosed as radiocarpal dislocations and most were treated nonoperatively. Between the 1900s and 1920s there were several anesthesia and antiseptic advancements that led to the advancement of surgical interventions. Then after the continued use and implementation of radiographs in orthopedics, radiographic parameters allowed for a critical analysis of treatment and patient outcomes that led to the further advancement of distal radius fracture treatment. This review will detail the historical content that led us to current practices. Additionally, current methods are critiqued, and common complications are reviewed in order to allow orthopedic surgeons to avoid these complications today.

Lewis Albert Sayre (1820-1900) is one of the key figures in the history of American orthopedic surgery who left an indelible mark on the field. Sayre dedicated much of his career to teaching and practicing orthopedics in New York City and is considered to be one of the "fathers" of orthopedics in America. Sayre's career was defined by his development of novel, innovative treatments to attempt to improve the lives of his patients. Two of the treatments he is most well-known for developing are "exsection of the hip" for treating "Morbus Coxarius" and the plaster of Paris jacket used for treating spinal deformities caused by Pott's disease or scoliosis. Although Sayre's developments are no longer used today, examining them can help us to reflect on the orthopedic principles he sought to apply in the 19th Century as well as how Sayre's treatments have shaped the interventions that we use to care for patients today.

Endoscopic spine surgery (ESS) is growing in popularity as a minimally invasive approach to a variety of spinal conditions. Similar to other types of minimally invasive spine surgery (MISS), ESS aims to address the underlying pathology while minimizing surrounding tissue disruption. Its use in the lumbar spine has progressed over the past 50 years and is now routinely used in cases of lumbar disc herniations and stenosis. This review defines common terminology, highlights important developments in the history of ESS, and discusses its current and future application in the lumbar spine.