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Thumb Carpometacarpal Instability
Rabinovich, Remy V. MD; Polatsch, Daniel B. MD; Shin, Steven S. MD; Beldner, Steven MD
doi : 10.5435/JAAOS-D-21-00310
November 15, 2021 - Volume 29 - Issue 22 - p 943-950
The basal joint complex of the thumb provides the framework necessary for function of the human hand. Although its unique saddle articulation allows for a wide range of motion necessary for routine function of the hand, it is rendered inherently unstable because of poor bony congruency and reliance on its capsuloligamentous support. Painful instability of this joint can stem from several causes including traumatic dislocation, various hypermobility conditions, and chronic overuse and microtrauma. A thorough history and examination as well adequate imaging is necessary for proper evaluation of instability. Treatment options range from nonoperative modalities to surgery, which entails closed, percutaneous, or open reduction with numerous ligament repair and reconstruction techniques. Arthroscopy can also serve to be a useful adjunct for assessment of the joint and stabilization of the critical capsuloligamentous structures. This review outlines the critical osseous and soft-tissue anatomy surrounding the thumb carpometacarpal joint, the key points in evaluating patients presenting with acute traumatic and chronic thumb carpometacarpal instability without fracture or arthritis, and reviews both nonoperative and operative treatments of this injury.
Klippel-Feil Syndrome: Pathogenesis, Diagnosis, and Management
Litrenta, Jody MD; Bi, Andrew S. MD; Dryer, Joseph W. MD
doi : 10.5435/JAAOS-D-21-00190
November 15, 2021 - Volume 29 - Issue 22 - p 951-960
Klippel-Feil syndrome (KFS), or congenital fusion of the cervical vertebrae, has been thought to be an extremely rare diagnosis. However, recent literature suggests an increased prevalence, with a high proportion of asymptomatic individuals. Occurring as a sporadic mutation or associated with several genes, the pathogenesis involves failure of cervical somite segmentation and differentiation during embryogenesis. Most commonly, the C2-C3 and C5-C6 levels are involved. KFS is associated with other orthopaedic conditions including Sprengel deformity, congenital scoliosis, and cervical spine abnormalities, as well as several visceral pathologies. There are several classification systems, some based on the anatomic levels of fusion and others on its genetic inheritance. Management of patients with KFS primarily involves observation for asymptomatic individuals. Surgical treatment may be for neurologic complaints, correction of deformity, concomitant spinal anomalies, or for associated conditions and varies significantly. Participation in sports is an important consideration. Recommendations for contact sports or activities depend on both the level and the number of vertebrae involved in the fusion. A multidisciplinary team should be involved in the treatment plan and recommendations for complex presentations.
Conforming Polyethylene Inserts in Total Knee Arthroplasty: Beyond the Posterior-Stabilized and Cruciate-Retaining Debate
Heckmann, Nathanael D. MD; Steck, Thomas MD; Sporer, Scott M. MD; Meneghini, R. Michael MD
doi : 10.5435/JAAOS-D-20-01232
November 15, 2021 - Volume 29 - Issue 22 - p e1097-e1104
Total knee arthroplasty continues to be one of the most commonly performed surgical procedures worldwide. However, considerable controversy exists regarding the optimal implant design. Total knee implants with both posterior-stabilized and cruciate-retaining designs have excellent long-term outcomes with inadequate data demonstrating superiority of either design. Recently, the popularity of total knee designs with more conforming polyethylene liners has increased. These polyethylene inserts prevent paradoxical anterior translation of the femur, without relying on a cam and post mechanism, and promote more physiologic native knee kinematics. This review summarizes the design rationale of several commercially available implants, discusses the kinematic data of several designs, and reviews the available clinical data.
Adult Distal Radius Fracture Management
Chhabra, A. Bobby MD; Yildirim, Baris MD
doi : 10.5435/JAAOS-D-20-01335
November 15, 2021 - Volume 29 - Issue 22 - p e1105-e1116
Distal radius fractures (DRFs) are some of the most commonly encountered fractures, and the incidence is increasing. Optimal treatment remains controversial. Critical evaluation of the initial imaging is necessary to recognize fracture characteristics and stability. The fracture pattern, injury mechanism, soft-tissue injury, patient characteristics, and surgeon preference are generally taken into consideration when choosing the most appropriate modality. Volar plating has become the workhorse of surgical DRF management but is not without complications. The surgeon should be comfortable using a wide variety of techniques to customize the fixation to the fracture pattern. Recognition of potential dangers and use of intraoperative imaging techniques can mitigate complications. Goals of rehabilitation after the initial treatment of DRF include regaining motion, strength, and ultimately function while managing pain.
Tranexamic Acid in Patients With Cancer Undergoing Endoprosthetic Reconstruction: A Cost Analysis
Haase, Douglas R. MD; Kimbrel, Brandon MD; Bombardier, Brenden BS; Templeton, Kimberly J. MD; Rosenthal, Howard G. MD; Sweeney, Kyle R. MD
doi : 10.5435/JAAOS-D-20-00971
November 15, 2021 - Volume 29 - Issue 22 - p 961-969
Tranexamic acid (TXA) decreases blood loss, perioperative transfusion rates, and cost in total hip and total knee arthroplasty. In a previous study, topical TXA decreased both perioperative blood loss and transfusions in patients undergoing resection of aggressive bone tumors and endoprosthetic reconstruction. The purpose of this study was to explore the cost effectiveness of TXA in patients undergoing resection of an aggressive bone tumor and endoprosthetic reconstruction, assessing transfusion cost, TXA administration cost, postoperative hospitalization cost, posthospital disposition, and 30-day readmissions.
Preoperative Hemoglobin A1c >7.5 Is Associated With Increased Bundled Payment Costs in Total Hip and Knee Arthroplasties
Kavin, Michelle PA-C; Yayac, Michael MD; Grosso, Matthew J. MD; Courtney, P. Maxwell MD
doi : 10.5435/JAAOS-D-20-00944
November 15, 2021 - Volume 29 - Issue 22 - p 970-976
Studies have shown that patients with diabetes mellitus are at an increased risk for complications and higher episode-of-care costs after total hip (THA) and total knee arthroplasties (TKA), but the effect of poor glycemic control on episode-of-care costs has yet to be addressed in the literature. The purpose of this study was to determine whether patients with a higher preoperative hemoglobin A1c have increased episode-of-care costs in diabetic patients undergoing THA and TKA.
Artificial Neural Networks Predict 30-Day Mortality After Hip Fracture: Insights From Machine Learning
DeBaun, Malcolm R. MD; Chavez, Gustavo BS; Fithian, Andrew MD; Oladeji, Kingsley MD; Van Rysselberghe, Noelle MD; Goodnough, L. Henry MD, PhD; Bishop, Julius A. MD; Gardner, Michael J. MD
doi : 10.5435/JAAOS-D-20-00429
November 15, 2021 - Volume 29 - Issue 22 - p 977-983
Accurately stratifying patients in the preoperative period according to mortality risk informs treatment considerations and guides adjustments to bundled reimbursements. We developed and compared three machine learning models to determine which best predicts 30-day mortality after hip fracture.
Trends in Practice Patterns of Conventional and Computer-assisted Knee Arthroplasty: An Analysis of 570,671 Knee Arthroplasties Between 2010 and 2017
Ahmed, Abdalrahman G.; Kang, Raymond MA; Hasan, Mohamed MD, MPH; Tian, Yao PhD, MS, MPH; Ghomrawi, Hassan M. PhD, MPH
doi : 10.5435/JAAOS-D-20-00763
November 15, 2021 - Volume 29 - Issue 22 - p e1117-e1125
Despite advances in computer-assisted knee arthroplasty (CAKA), little is known about the uptake of this technology in recent years. We aimed to explore the utilization trends and practice variation of CAKA from 2010 to 2017 and investigate the predictors of CAKA adoption.
Use of Surgical Approach Is Not Associated With Instability After Primary Total Hip Arthroplasty: A Meta-analysis Comparing Direct Anterior and Posterolateral Approaches
Huerfano, Elina MD; Bautista, Maria MD, MSc; Huerfano, Manuel MD, MSc; Nossa, Juan M. MD
doi : 10.5435/JAAOS-D-20-00861
November 15, 2021 - Volume 29 - Issue 22 - p e1126-e1140
Posterolateral approach (PA) has been historically associated with an increased risk of dislocation after primary total hip arthroplasty (THA), especially when compared with the direct anterior approach (DAA). However, current evidence is inconsistent regarding the risk of dislocation with either approach. The purpose of this study is to determine whether surgical approach influences joint stability.
Dual Mobility Cup: Does It Improve Patient's Satisfaction After Total Hip Arthroplasty? A Prospective Comparative Randomized Study
Samy, Ahmed M. MD; Mahmoud, Ashraf Atef MD; El-Tantawy, Ahmad MD
doi : 10.5435/JAAOS-D-20-00882
November 15, 2021 - Volume 29 - Issue 22 - p e1141-e1150
Despite the great success of total hip arthroplasty (THA), many patients were fairly dissatisfied after surgery. Therefore, patient-reported outcome measures have become of an utmost importance in assessing the results after joint replacement. This study was conducted to compare the postoperative patient-reported satisfactions after implantation of two commonly used THA designs.
