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

We present the case of a transgender female patient who had been undergoing feminizing hormone therapy for several years and sustained a Tillaux fracture despite being older than the expected age range for females with this injury pattern. Despite work focused on understanding physeal closure, the molecular signals governing this phenomenon remain incompletely described. This case study illustrates that physeal closure may be delayed in patients undergoing sex hormone therapy with associated transitional fractures possibly occurring later than would be expected for the transitional gender. Additional work is necessary to clarify the direct effect of sex hormonal therapy on physeal homeostasis.

Introduction: Hip resurfacing arthroplasty (HRA) is a surgical option with positive outcomes at medium-term follow-up for young, active patients with osteoarthritis. However, early failures of HRA often occur due to improper implant placement. The purpose of this study was to assess the utility of computer-assisted navigation in the effort to optimize implant positioning following HRA.

Materials and methods: A retrospective analysis of 262 consecutive HRAs at a single institution was performed. Radiographic analysis included measurements of cup inclination and anteversion, leg length restoration (LLR), and offset. Cup position was evaluated based on placement within Lewinnek parameters and the surgeon's preferred anteversion (10° to 20°). Chi-squared and unpaired Student's t-test were performed for all categorical and continuous variables, respectively.

Results: One hundred fifty-six cases were performed using conventional technique and 106 cases used computernavigation. Computer-assisted HRA (caHRA) had a longer mean surgical time (129 vs. 110 minutes; p < 0.001) but shorter average LOS (1.1 vs. 1.5 days; p < 0.001). Cup position was within the surgeon-preferred target zone in 47% of caHRA versus 22% of conventional HRA (p = 0.0001). Cup position fell within the Lewinnek safe zone in 86% of caHRA versus 60% of conventional HRA (p < 0.001). Global offset was reduced by a mean of 6.4 mm in caHRA versus 8.4 mm (p = 0.036). No differences in rates of complication (p = 0.406), reoperation (p = 1.00), or 90-day readmission (p = 0.568) were observed.

Conclusion: Computer-assisted technology in HRA allows for comparable clinical outcomes to conventional technique. Cup position accuracy and precision is improved by computer navigation in HRA.

Background: The SARS-CoV-2 (COVID-19) pandemic resulted in new, non-orthopedic roles for many members of our New York City based orthopedic department, including redeployment to medicine wards, emergency departments, and intensive care units. The purpose of this study was to determine if certain areas of redeployment predisposed individuals to higher likelihood of positive diagnostic or serologic testing for COVID-19.

Methods: In this study, attendings, residents, and phy-sician assistants within our orthopedic department were surveyed to determine their roles during the COVID-19 pandemic and whether they were tested via diagnostic or serologic methods for detecting COVID-19. Additionally, symptoms and missed days of work were reported.

Results: No significant association between redeployment site and rate of positive COVID-19 diagnostic (p = 0.91) or serologic (p = 0.38) testing was detected. Sixty individuals responded to the survey, with 88.3% of respondents rede-ployed during the pandemic. Nearly half (n = 28) of those redeployed experienced at least one COVID-19 related symptom. Two respondents had a positive diagnostic test, and 10 had a positive serologic test.

Conclusions: Area of redeployment during the COVID-19 pandemic is not associated with an increased risk of subse-quently having a positive diagnostic or serologic COVID-19 test.

Purpose: This study sought to determine the clinical outcomes of patients that underwent hip arthroscopy for femoroacetabular impingement (FAI) and concomitant arthroscopic iliotibial (IT) band lengthening with trochan- teric bursectomy (TB group) as well as a matched cohort of patients undergoing hip arthroscopy for isolated FAI symptoms (NTB group) from baseline to a minimum of 2-year follow-up.

Methods: Patients who were diagnosed with FAI and symptomatic trochanteric bursitis and who failed con- servative measures and underwent hip arthroscopy and arthroscopic IT band lengthening with trochanteric bur- sectomy were identified. These patients were matched by age, sex, and body mass index (BMI) to a group of patients who underwent surgery for FAI without trochanteric bur- sitis symptoms. Patients were separated into two groups: iliotibial band lengthening with trochanteric bursectomy (TB) and non-trochanteric bursectomy (NTB). The patient reported outcomes (PROs) recorded were the modified Har- ris Hip Score (mHHS) and Non-Arthritic Hips Score (NAHS), which were obtained with a minimum of 2-years follow-up.

Results: Each cohort was composed of 22 patients. The TB cohort was composed of 19 females (86%) with a re- ported mean age of 49.3 ± 11.6 years. The NTB cohort was composed of 19 females (86%) with a reported mean age of 49.0 ± 11.7 years. Both cohorts showed significant improve- ment from baseline in the mHHS and NAHS. There was no significant difference in the mHHS and NAHS between the two groups. There was no significant difference between TB and NTB groups with respect to achieving minimal clinically important difference (MCID), [19 (86%) vs. 20 (91%), p > 0.99] or patient acceptable symptom state (PASS), [13 (59%) vs. 14 (64%), p = 0.76].

Conclusions: There was no difference in PROs of patients with FAI and trochanteric bursitis who underwent hip ar- throscopy with concomitant arthroscopic IT band lengthen- ing with trochanteric bursectomy compared to patients with isolated FAI who underwent hip arthroscopy.

Purpose: The purpose of the current study was to system-atically review the evidence in the literature to ascertain the rate of return to play and subsequent recurrence rates after first-time anterior shoulder instability in athletes.

Methods: A literature search of MEDLINE, EMBASE, and The Cochrane Library was performed based on the PRISMA guidelines. Studies evaluating the outcomes of athletes with primary anterior shoulder dislocation were included. Return to play and subsequent recurrent instability were evaluated.

Results: Twenty-two studies with 1,310 patients were included. The mean age of included patients was 30.1 years, 83.1% were male, and the mean follow-up was 68.9 months. Overall, 76.5% were able to return to play, with 51.5% able to return to play at their pre-injury level. The pooled recurrence rate was 54.7%, with best-case and worst-case analysis revealing the recurrence rate to be between 50.7% to 67.7% in those able to return to play. Among collision athletes, 88.1% were able to return to play, with 78.7% experiencing a recurrent instability event.

Conclusion: The current study demonstrates that non-operative management of athletes with primary anterior shoulder dislocation results in a low rate of success. While the majority of athletes are able to return to play, there is a low rate of return to their pre-injury level of play, and there is a high rate of recurrent instability.

Introduction: Cement burns following arthroplasty pro-cedures are a rare but serious complication. To the authors' knowledge, this report is the first of its kind in total knee arthroplasty.

Case: A 61-year-old female underwent an otherwise rou-tine left total knee arthroplasty. On postoperative day one, a 3 cm by 3 cm cement burn was noted on the distal aspect of the popliteal fossa of the operative leg. The burn was noted to be a full-thickness (third degree) burn that required plastic surgery burn service management and limited the patient's postoperative recovery and function.

Conclusions: Cement burns of the skin following total joint arthroplasty are rare, though when they do occur, they can cause significant pain and distress. Recognizing the depth of the skin involvement is important to determine the burn classification, treatment, and ultimately the prognosis to optimize outcomes.

Background: In situ pinning is one of the primary treat-ments for slipped capital femoral epiphysis (SCFE) in pedi-atric patients, many of whom have multiple comorbidities. Despite the fact that SCFE pinning is a frequently performed procedure in the United States, little is known regarding sub-optimal postoperative outcomes in this patient population. The purpose of this study was thus to identify the incidence, perioperative predictors, and specific causes of prolonged hospital length of stay (LOS) and readmissions following fixation.

Methods: The 2016-2017 National Surgical Quality Im-provement Program database was employed to identify all patients undergoing in situ pinning of a SCFE. Significant variables, such as demographics, preoperative comor-bidities, birth history, operative characteristics (length of surgery and inpatient and outpatient procedure), and postop-erative complications were collected. The primary outcomes of interest were prolonged LOS (defined as exceeding the 90th percentile, or 2 days) and readmission within 30 days following the procedure. The specific reason for readmission was recorded for each patient. Bivariate statistics followed by binary logistic regression modeling were employed to explore the relationship between perioperative variables and prolonged LOS and readmissions.

Results: A total of 1,697 patients underwent pinning, with a mean age of 12.4 years. Of these, 110 (6.5%) experienced a prolonged LOS and 16 (0.9%) were readmitted within 30 days. The most common causes of readmission related to the initial treatment were hip pain (n = 3) followed by postop-erative fracture (n = 2). Surgery on an inpatient basis (OR = 3.64; 95% CI: 1.99-6.67; p < 0.001), history of seizure disorder (OR = 6.79; 95% CI: 1.55-29.7; p = 0.01), and longer operative time (OR = 1.03; 95% CI: 1.02-1.03; p < 0.001) were significantly associated with prolonged LOS.

Conclusions: The majority of readmissions following SCFE pinning were due to postoperative pain or fracture. Patients presenting with medical comorbidities and un-dergoing pinning as an inpatient were at increased risk of experiencing a prolonged LOS.

Introduction: We analyzed two different government joint registries for survivorship associated with one platform shoulder system and compared reasons for revision and trends in usage of anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) over a period of more than 10 years to elucidate reasons for any changes in market trends.

Methods: A review of the United Kingdom (UK) and Aus- tralian national joint registries was performed for a single platform shoulder prosthesis (Equinoxe; Exactech, Inc, Gainesville, Florida, USA) from 2011 to 2022 to investigate changes in annual usage rates of primary aTSA and primary rTSA relative to differences in survivorship and reasons for revision for each prosthesis type.

Results: Between June 2011 and July 2022, 633 primary aTSA and 4,048 primary rTSA were performed in Australia, and 1,371 primary aTSA and 3,659 primary rTSA were per- formed in the UK with the same platform shoulder prosthesis. Over this period of use, rTSA utilization increased annually at a greater rate than aTSA for this platform shoulder pros- thesis. Specifically in Australia, primary aTSA use increased annually by an average of 38.3% while primary rTSA use increased annually by an average of 148.9%. Similarly, in the UK, primary aTSA use increased annually by an aver- age of 14.0%, while primary rTSA use increased annually by an average of 32.4%. Additionally, the overall incidence of aTSA and rTSA revisions was low; 99 of 2,004 primary aTSA (4.9%) patients and 216 of 7,707 primary rTSA (2.8%) patients with this specific platform shoulder prosthesis were revised. The average 8-year cumulative revision rate for primary aTSA patients was higher than that for primary rTSA patients; 7.7% of aTSA patients were revised at 8 years (0.96% revised/year), but only 4.4% of primary rTSA patients were revised at 8 years (0.55% revised/year). No difference in hazard ratio for all-cause revisions was ob- served for the Equinoxe aTSA or rTSA as compared to all other aTSA systems in either registry. Some differences in the reasons for revision were observed between aTSA and rTSA, where most importantly, rTSA patients experienced only one case of revision due to rotator cuff tears or sub- scapularis failure as compared to the 34 cases of rotator cuff tears or subscapularis failure with aTSA, which accounted for more than one-third of all aTSA revisions. Furthermore, soft-tissue related failure modes were the most common reasons for aTSA failure and were responsible for 56.5% (34.3% rotator cuff tears or subscapularis failure and 22.2% instability or dislocation) of all aTSA revisions; in contrast, soft-tissue related failure modes were responsible for only 26.9% (26.4% instability or dislocation and 0.5% rotator cuff failure) of all rTSA revisions.

Conclusions: This multi-country registry analysis utiliz- ing independent and unbiase

Introduction: There is relatively little current literature analyzing predictive factors of postoperative complications in radical soft tissue sarcoma (STS) resection. The goal was to analyze risk factors based on STS size ( < 5 cm vs. > 5 cm) with regard to STS resection in a large up-to-date, multi- center, population-based study. Additionally, we sought to determine any independent risk factors for the development of postoperative complications.

Methods: Our study was completed through a retrospec- tive analysis of 2005-2014 American College of Surgeons National Surgical Quality Improvement Program (ACS- NSQIP). Data were queried for patients undergoing radical resection for soft tissue tumor based on CPT code. Univari- ate analysis, t-test, and multivariate logistic regressions were employed adjusting for patient demographic, preoperative, and intraoperative variables in order to identify patient- and surgery-specific predictive factors for patients who devel- oped complications.

Results: Based on the 1,845 patients who met the inclu- sion criteria, 1,709 (92.62%) had a STS smaller than 5 cm and 136 (7.37%) had tumors larger than 5 cm. Results indicate that larger tumors yield greater risk and greater po- tential for wound complications. Specifically, adult patients who had radical resection of soft tissue tumors greater than 5 cm were more likely to have inpatient status, history of smoking, hypertension, disseminated cancer, chemotherapy and radiation, and were more likely to have longer length of stay in the hospital.

Conclusion: The results indicate that larger tumors (> 5 cm) carry greater risk for complications. We hypothesize that this may be due to larger tumors being more invasive and requiring greater surgical manipulation. As such, it is important to provide appropriate counseling and proper preoperative planning for these patients.