Pub Date : 2023-01-01DOI: 10.2106/jbjs.jopa.22.00021
Julia L. Hale, Jacquelyn N. Valenzuela-Moss, V. Tolo
{"title":"Chemotherapy-Induced Peripheral Neuropathy Leading to Foot Deformity","authors":"Julia L. Hale, Jacquelyn N. Valenzuela-Moss, V. Tolo","doi":"10.2106/jbjs.jopa.22.00021","DOIUrl":"https://doi.org/10.2106/jbjs.jopa.22.00021","url":null,"abstract":"","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67754017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.2106/jbjs.jopa.22.00025
Sean M. Hazzard, Gary Sakryd, Larry Collins, T. Randolph, D. Cloutier
{"title":"Sports Medicine Roundtable: Trends in 2022","authors":"Sean M. Hazzard, Gary Sakryd, Larry Collins, T. Randolph, D. Cloutier","doi":"10.2106/jbjs.jopa.22.00025","DOIUrl":"https://doi.org/10.2106/jbjs.jopa.22.00025","url":null,"abstract":"","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67754073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.2106/jbjs.jopa.23.00017
Devon Patel, Addison Sparks, Dalton Blood, Jiayong Liu
Background: Prosthetic joint infections (PJIs) are significant complications of total joint arthroplasties. The incidence of this dangerous complication is expected to rise, but there is not a unanimous solution. Two-stage surgical revisions are the traditional gold standard of treatment, but recent literature suggests that 1-stage revisions can be equally effective. A comparison of the outcomes of 2-stage revisions vs. 1-stage revisions has not been thoroughly investigated. This systematic review and meta-analysis were designed to compare the outcomes of 2-stage exchanges vs. 1-stage exchanges in the treatments of hip PJI based on comparison studies. Methods: MEDLINE, Embase, and Cochrane were searched for relevant studies that compared the effectiveness and outcomes of 1-stage and 2-stage procedures from January 2000 to May 2023. Keywords relating to hip PJI were used, and comparison studies of 1-stage vs. 2-stage procedures that reported patient characteristics and outcomes including success rates, rates of reinfection, or other outcomes such as functional outcomes (e.g., mean Harris hip scores), infection-free survival, and blood loss were included. Statistical analysis for this study was conducted using Review Manager 5.4 with a standard p-value of ≤ 0.05 for statistical significance. Results: Fifteen articles and 1,017 patients were included in the meta-analysis. One-stage revision procedures (320 patients) were found to have greater success rates (i.e., lower rates of reinfection) than 2-stage revisions (697 patients) (p = 0.04). One-stage revisions (184 patients) had shorter durations of operation and less blood loss than 2-stage revisions (90 patients) (p < 0.05). Conclusion: One-stage revision procedures are associated with lower reinfection rates, blood loss, and durations of operation compared with 2-stage revisions. Level of Evidence: I.
{"title":"Outcomes of 1-Stage Versus 2-Stage Revisions After Hip Prosthetic Joint Infection","authors":"Devon Patel, Addison Sparks, Dalton Blood, Jiayong Liu","doi":"10.2106/jbjs.jopa.23.00017","DOIUrl":"https://doi.org/10.2106/jbjs.jopa.23.00017","url":null,"abstract":"Background: Prosthetic joint infections (PJIs) are significant complications of total joint arthroplasties. The incidence of this dangerous complication is expected to rise, but there is not a unanimous solution. Two-stage surgical revisions are the traditional gold standard of treatment, but recent literature suggests that 1-stage revisions can be equally effective. A comparison of the outcomes of 2-stage revisions vs. 1-stage revisions has not been thoroughly investigated. This systematic review and meta-analysis were designed to compare the outcomes of 2-stage exchanges vs. 1-stage exchanges in the treatments of hip PJI based on comparison studies. Methods: MEDLINE, Embase, and Cochrane were searched for relevant studies that compared the effectiveness and outcomes of 1-stage and 2-stage procedures from January 2000 to May 2023. Keywords relating to hip PJI were used, and comparison studies of 1-stage vs. 2-stage procedures that reported patient characteristics and outcomes including success rates, rates of reinfection, or other outcomes such as functional outcomes (e.g., mean Harris hip scores), infection-free survival, and blood loss were included. Statistical analysis for this study was conducted using Review Manager 5.4 with a standard p-value of ≤ 0.05 for statistical significance. Results: Fifteen articles and 1,017 patients were included in the meta-analysis. One-stage revision procedures (320 patients) were found to have greater success rates (i.e., lower rates of reinfection) than 2-stage revisions (697 patients) (p = 0.04). One-stage revisions (184 patients) had shorter durations of operation and less blood loss than 2-stage revisions (90 patients) (p < 0.05). Conclusion: One-stage revision procedures are associated with lower reinfection rates, blood loss, and durations of operation compared with 2-stage revisions. Level of Evidence: I.","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135213251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.2106/jbjs.jopa.23.00007
Craig Hricz
Dupuytren contracture is a contraction disorder of the hand related to an abnormal myofibroplastic process. An autoimmune response may trigger fibroblasts to proliferate along lines of tension within bands of the palmar fascia and other tissues within the hand resulting in fibrous cords and nodules of the hand. Risk factors include Scandinavian or Northern European descent, trauma, chronic use of vibrating tools, medical disorders such as diabetes, HIV, epilepsy, and vascular disease as well as a social history of smoking or alcoholism. The disorder is relatively painless, and patients tend to delay seeking care until the contracture has progressed to the point of causing some degree of disability or impacting their daily lives. Treatment options include surgical fasciectomy, collagenase injections, or needle fasciotomy followed by occupational therapy interventions such as splinting and stretching. Intervention is generally effective in improving symptoms and functionality; however, recurrence is still possible.
{"title":"Dupuytren's Contracture: A Case Review","authors":"Craig Hricz","doi":"10.2106/jbjs.jopa.23.00007","DOIUrl":"https://doi.org/10.2106/jbjs.jopa.23.00007","url":null,"abstract":"Dupuytren contracture is a contraction disorder of the hand related to an abnormal myofibroplastic process. An autoimmune response may trigger fibroblasts to proliferate along lines of tension within bands of the palmar fascia and other tissues within the hand resulting in fibrous cords and nodules of the hand. Risk factors include Scandinavian or Northern European descent, trauma, chronic use of vibrating tools, medical disorders such as diabetes, HIV, epilepsy, and vascular disease as well as a social history of smoking or alcoholism. The disorder is relatively painless, and patients tend to delay seeking care until the contracture has progressed to the point of causing some degree of disability or impacting their daily lives. Treatment options include surgical fasciectomy, collagenase injections, or needle fasciotomy followed by occupational therapy interventions such as splinting and stretching. Intervention is generally effective in improving symptoms and functionality; however, recurrence is still possible.","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67753609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.2106/jbjs.jopa.22.00019
A. Rees, J. Riehl
{"title":"Under Pressure","authors":"A. Rees, J. Riehl","doi":"10.2106/jbjs.jopa.22.00019","DOIUrl":"https://doi.org/10.2106/jbjs.jopa.22.00019","url":null,"abstract":"","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67753909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.2106/jbjs.jopa.23.00016
Margaret Sims, Kenneth L. Urish, Neel B. Shah
Total hip arthroplasty is among the most frequently performed elective surgical procedures in the United States. Infection of the implant is a rare but catastrophic complication. Generally, patients require multiple surgical procedures and intravenous antibiotics to eradicate the infection. We present the case of a patient diagnosed with a strain of rapidly growing mycobacteria not frequently encountered. He was successfully treated with retention of implants and chronic oral antibiotic therapy. A literature review was performed to identify similar cases, and the results showed that most of the patients underwent successful revision of the implant along with antibiotic therapy. We present this case to illustrate an alternative method of management for appropriate patients who may not be an adequate surgical candidate for prosthesis removal.
{"title":"Prosthetic Joint Infection Due to Mycobacterium goodii/smegmatis","authors":"Margaret Sims, Kenneth L. Urish, Neel B. Shah","doi":"10.2106/jbjs.jopa.23.00016","DOIUrl":"https://doi.org/10.2106/jbjs.jopa.23.00016","url":null,"abstract":"Total hip arthroplasty is among the most frequently performed elective surgical procedures in the United States. Infection of the implant is a rare but catastrophic complication. Generally, patients require multiple surgical procedures and intravenous antibiotics to eradicate the infection. We present the case of a patient diagnosed with a strain of rapidly growing mycobacteria not frequently encountered. He was successfully treated with retention of implants and chronic oral antibiotic therapy. A literature review was performed to identify similar cases, and the results showed that most of the patients underwent successful revision of the implant along with antibiotic therapy. We present this case to illustrate an alternative method of management for appropriate patients who may not be an adequate surgical candidate for prosthesis removal.","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135648938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.2106/jbjs.jopa.23.00011
Jennifer Joseph, Helen Salisbury
Background: Physician assistants (PAs) perform joint injections in the office setting. Although ultrasound (US) provides a safe option that increases accuracy of injections, this orthopedic specific training has not been routinely offered in PA education. The aim of this study was to examine the frequency with which orthopedic PAs performed shoulder, hip, and knee joint injections, with and without US, and how US training was obtained. Methods: In a quantitative descriptive cross-sectional study, PAs received a link to a self-designed survey by an email list provided by the physician assistants in orthopedic surgery. Results: Most PAs with access to US performed 10 or less shoulder, hip, and knee joint injections using US each month. The most common US training reported was on-the-job (n = 141; 35.30%), independent courses (n = 91; 22.80%), and self-taught (n = 70; 17.50%). Nearly one-half (n = 196; 49.00%) reported no US training, leading to 177 PAs (60.00%) perceiving they were not at all or only somewhat prepared to perform US in clinical practice. Conclusion: Overall, shoulder and knee joint injections were performed more often in the office than hip joint injections and were more commonly performed without US. Most PAs perceived they were not prepared to perform US in practice during their formal education, with many having sought further training.
{"title":"Physician Assistant Use of Ultrasound for Shoulder, Hip, and Knee Joint Injections","authors":"Jennifer Joseph, Helen Salisbury","doi":"10.2106/jbjs.jopa.23.00011","DOIUrl":"https://doi.org/10.2106/jbjs.jopa.23.00011","url":null,"abstract":"Background: Physician assistants (PAs) perform joint injections in the office setting. Although ultrasound (US) provides a safe option that increases accuracy of injections, this orthopedic specific training has not been routinely offered in PA education. The aim of this study was to examine the frequency with which orthopedic PAs performed shoulder, hip, and knee joint injections, with and without US, and how US training was obtained. Methods: In a quantitative descriptive cross-sectional study, PAs received a link to a self-designed survey by an email list provided by the physician assistants in orthopedic surgery. Results: Most PAs with access to US performed 10 or less shoulder, hip, and knee joint injections using US each month. The most common US training reported was on-the-job (n = 141; 35.30%), independent courses (n = 91; 22.80%), and self-taught (n = 70; 17.50%). Nearly one-half (n = 196; 49.00%) reported no US training, leading to 177 PAs (60.00%) perceiving they were not at all or only somewhat prepared to perform US in clinical practice. Conclusion: Overall, shoulder and knee joint injections were performed more often in the office than hip joint injections and were more commonly performed without US. Most PAs perceived they were not prepared to perform US in practice during their formal education, with many having sought further training.","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":"268 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135443069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.2106/jbjs.jopa.23.00014
Dev Raveendran, Luke A Perry, Andrew Bucknill, Zhengyang Liu
Background: The neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and red cell distribution width (RDW) are routinely available inflammatory biomarkers. Their significance in osteoarthritis (OA) is poorly understood. This is a systematic review, and meta-analysis aimed to determine the association of these biomarkers with the presence and severity of OA. Methods: We searched MEDLINE, EMBASE, and Cochrane library for studies reporting on associations between NLR, PLR, and RDW with OA from October 1, 2022, to November 18, 2022. We generated pooled effect measures using random-effects inverse-variance modeling to compare biomarker levels in patients with OA against healthy controls. We generated pooled effect measures to compare patients with severe OA against mild/moderate OA as defined by the Kellgren-Lawrence grading scale, a classification of OA severity based on radiographic findings. We performed metaregression to explore between-study heterogeneity. Results: We included 20 studies involving 5,109 patients in this review. Both NLR and PLR were significantly elevated in OA. RDW was not significantly elevated with OA presence or severity. Only NLR demonstrated a significant elevation with OA severity. Conclusions: In this systematic review and meta-analysis, both NLR and PLR were associated with the presence of OA, whereas only NLR was associated with the severity of disease.
{"title":"The Significance of Neutrophil Lymphocyte Ratio, Platelet Lymphocyte Ratio, and Red Cell Distribution Width in Osteoarthritis","authors":"Dev Raveendran, Luke A Perry, Andrew Bucknill, Zhengyang Liu","doi":"10.2106/jbjs.jopa.23.00014","DOIUrl":"https://doi.org/10.2106/jbjs.jopa.23.00014","url":null,"abstract":"Background: The neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and red cell distribution width (RDW) are routinely available inflammatory biomarkers. Their significance in osteoarthritis (OA) is poorly understood. This is a systematic review, and meta-analysis aimed to determine the association of these biomarkers with the presence and severity of OA. Methods: We searched MEDLINE, EMBASE, and Cochrane library for studies reporting on associations between NLR, PLR, and RDW with OA from October 1, 2022, to November 18, 2022. We generated pooled effect measures using random-effects inverse-variance modeling to compare biomarker levels in patients with OA against healthy controls. We generated pooled effect measures to compare patients with severe OA against mild/moderate OA as defined by the Kellgren-Lawrence grading scale, a classification of OA severity based on radiographic findings. We performed metaregression to explore between-study heterogeneity. Results: We included 20 studies involving 5,109 patients in this review. Both NLR and PLR were significantly elevated in OA. RDW was not significantly elevated with OA presence or severity. Only NLR demonstrated a significant elevation with OA severity. Conclusions: In this systematic review and meta-analysis, both NLR and PLR were associated with the presence of OA, whereas only NLR was associated with the severity of disease.","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134982029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-15DOI: 10.2106/JBJS.JOPA.22.00014
M. Lawhorne, R. Kortyna
Osteonecrosis has become the standardized term for a condition of many and varied etiologies. In this brief review, we note the evolution of the standardization of the condition and we also delve into the intraosseous versus extraosseous etiologies. Additionally, we list some of the more common medications known to cause osteonecrosis.
{"title":"Osteonecrosis","authors":"M. Lawhorne, R. Kortyna","doi":"10.2106/JBJS.JOPA.22.00014","DOIUrl":"https://doi.org/10.2106/JBJS.JOPA.22.00014","url":null,"abstract":"Osteonecrosis has become the standardized term for a condition of many and varied etiologies. In this brief review, we note the evolution of the standardization of the condition and we also delve into the intraosseous versus extraosseous etiologies. Additionally, we list some of the more common medications known to cause osteonecrosis.","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":"10 1","pages":"e22.00014"},"PeriodicalIF":0.0,"publicationDate":"2022-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46893093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-08DOI: 10.2106/JBJS.JOPA.22.00016
Gary Sakryd
Arthroscopy of the elbow can be used to treat numerous pathologies about the elbow joint. Conditions such as arthritis, osteochondritis dissecans, arthrofibrosis, and loose body removal are all amenable to arthroscopy. Elbow arthroscopy is a technically demanding procedure. Surgeon knowledge and awareness of the surrounding neurovascular structures is paramount. Neurovascular injury at the time of surgery can have catastrophic consequences.
{"title":"Elbow Arthroscopy","authors":"Gary Sakryd","doi":"10.2106/JBJS.JOPA.22.00016","DOIUrl":"https://doi.org/10.2106/JBJS.JOPA.22.00016","url":null,"abstract":"Arthroscopy of the elbow can be used to treat numerous pathologies about the elbow joint. Conditions such as arthritis, osteochondritis dissecans, arthrofibrosis, and loose body removal are all amenable to arthroscopy. Elbow arthroscopy is a technically demanding procedure. Surgeon knowledge and awareness of the surrounding neurovascular structures is paramount. Neurovascular injury at the time of surgery can have catastrophic consequences.","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":"10 1","pages":"e22.00016"},"PeriodicalIF":0.0,"publicationDate":"2022-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43830395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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