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Resident Wellness During the COVID-19 Pandemic: A Nationwide Survey of Orthopaedic Residents
Nolte, Michael T. MD; Tornetta, Paul III MD; Mehta, Samir MD; Ponce, Brent A. MD; Grabowski, Gregory MD; Turner, Norman S. MD; Spitnale, Michael J. MD; Kogan, Monica MD
doi : 10.5435/JAAOS-D-20-01372
Journal of the American Academy of Orthopaedic Surgeons: May 15, 2021 - Volume 29 - Issue 10 - p 407-413
The COVID-19 pandemic has influenced the resident workforce to a particularly powerful and unexpected extent. Given the drastic changes to resident roles, expectations, and responsibilities, many valuable lessons regarding resident concerns and wellness can be garnered from this unique experience.
Prosthetic Bearing Surfaces in Anatomic and Reverse Total Shoulder Arthroplasty
Stone, Michael A. MD; Noorzad, Ali S. MD; Namdari, Surena MD; Abboud, Joseph MD
doi : 10.5435/JAAOS-D-20-00166
Journal of the American Academy of Orthopaedic Surgeons: May 15, 2021 - Volume 29 - Issue 10 - p 414-422
Total shoulder arthroplasty (TSA) and reverse TSA have provided an effective treatment for glenohumeral osteoarthritis; however, longevity of the procedure may be limited by osteolysis and polyethylene wear. In TSA, glenoid component failure occurs through several mechanisms, the most common being aseptic loosening and polyethylene wear. Newer bearing surfaces such as highly cross-linked ultra-high-molecular-weight polyethylene, vitamin E processing, ceramic heads, and pyrolytic carbon surfaces have shown improved wear characteristics in biomechanical and some early clinical studies. The purpose of this review is to provide a historical perspective and current state of the art of bearing surface technology in anatomic and reverse TSA.
Nonsurgical Versus Surgical Management of Femoroacetabular Impingement: What Does the Current Best Evidence Tell Us
Gao, Ian MD; Safran, Marc R. MD
doi : 10.5435/JAAOS-D-20-00571
Journal of the American Academy of Orthopaedic Surgeons: May 15, 2021 - Volume 29 - Issue 10 - p e471-e478
Controversy exists as to the management of femoroacetabular impingement (FAI). When nonsurgical management of symptomatic FAI fails, surgical management is generally indicated. However, many groups with a stake in patient care (particularly payors) have insisted on higher levels of evidence. Recently, there have been several Level I studies published, comparing physical therapy (PT) with hip arthroscopy in the management of symptomatic FAI. All of these studies have used outcomes tools developed and validated for patients with nonarthritic hip pain (the International Hip Outcome Tool). Most highest level evidence confirms that although patients with FAI do benefit from PT, patients who undergo surgical management for FAI with hip arthroscopy benefit more than those who undergo PT (mean difference in the International Hip Outcome Tool 6.8 [minimal clinically important difference 6.1], P = 0.0093). Future large prospective studies are needed to evaluate the effect on the outcomes when there is a delay in surgical management in symptomatic individuals, assess whether FAI surgery prevents or delays osteoarthritis, and determine the role of other advanced surgical techniques.
Current Concept Review: Inclusion and Analysis of Diverse Study Populations in Orthopaedic Research
Beck, Jennifer J. MD; Pandya, Nirav K. MD; Carter, Cordelia W. MD; Mulcahey, Mary K. MD
doi : 10.5435/JAAOS-D-20-01087
Journal of the American Academy of Orthopaedic Surgeons: May 15, 2021 - Volume 29 - Issue 10 - p e479-e487
As disparities in healthcare access and outcomes have been increasingly identified across medical specialties, the importance of recognizing and understanding the diversity of our patient populations and the influence of individual characteristics such as age, sex, gender, race, and ethnicity on clinical outcomes has been emphasized. Orthopaedic literature has advanced dramatically in the quality and quantity of research generated over the past 25 years, yet a consistent, sustained focus on studying musculoskeletal health in the context of these unique patient-specific variables has not been maintained. The result of this inattention may be the provision of orthopaedic care that is ill-suited for the individual patient whose biologic characteristics, life experiences, and cultural constructs differ from that of the typical research subject. The recent proliferation of meta-analyses—whose intention is to optimize statistical power—likely compounds the problem because improper, inconsistent, or absent categorization of patients in research articles precludes meaningful subgroup analysis. This article describes the current variability in demographic reporting in the orthopaedic literature, highlights the importance of complete, consistent demographic reporting and subgroup analysis, and reviews specific examples of orthopaedic conditions that illustrate how clinical outcomes may be affected by patient-specific variables such as age, sex, gender, race, and ethnicity.
Orthopaedic Manifestations of Amyloidosis
Zhang, Dafang MD; Makhni, Melvin C. MD; Kang, James D. MD; Blazar, Philip MD
doi : 10.5435/JAAOS-D-20-01146
Journal of the American Academy of Orthopaedic Surgeons: May 15, 2021 - Volume 29 - Issue 10 - p e488-e496
Amyloidosis is a disorder of misfolded proteins in human tissues, which can result in morbid cardiac and neurological disease. Historically, the utility of tissue biopsy during orthopaedic procedures to detect amyloidosis has been limited because no disease-modifying therapies were available; however, new drug therapies have recently emerged for the treatment of amyloidosis. Although these novel pharmaceuticals show promise for slowing disease progression, they are primarily effective in the early stages of amyloidosis, underscoring the importance of early diagnosis. Common orthopaedic manifestations of amyloidosis include carpal tunnel syndrome, trigger finger, spontaneous distal biceps tendon rupture, rotator cuff disease, and lumbar spinal stenosis. Carpal tunnel syndrome is frequently the earliest manifestation of amyloidosis, on average preceding a formal diagnosis of amyloidosis by over four years. By recognizing the constellation of musculoskeletal symptoms in the patient with amyloidosis, orthopaedic surgeons can play an active role in patient referral, early detection of systemic disease, and prompt initiation of disease-modifying treatment. There may be a role for selective biopsy for amyloid deposition in at-risk patients during routine orthopaedic procedures.
Diagnosis and Management of Intraoperative Fractures in Primary Total Hip Arthroplasty
Siddiqi, Ahmed DO, MBA; Springer, Bryan D. MD; Chen, Antonia F. MD, MBA; Piuzzi, Nicolas S. MD
doi : 10.5435/JAAOS-D-20-00818
Journal of the American Academy of Orthopaedic Surgeons: May 15, 2021 - Volume 29 - Issue 10 - p e497-e512
Intraoperative periprosthetic fractures are challenging complications that may affect implant stability and survivorship. Periprosthetic acetabular fractures are uncommon and infrequently are the focus of studies. Acetabular fractures are occasionally recognized after patients report unremitting groin pain weeks postoperatively. The widespread use of cementless acetabular cups might lead to higher number of fractures than is clinically detectable. Conversely, the incidence of intraoperative periprosthetic femoral fractures are more common and encompass a broad spectrum, ranging from a small cortical perforation to displaced fractures with an unstable prosthesis. Appropriate recognition, including mindfulness of preoperative patient and surgical risk factors, is critical to the successful management of acetabular and femoral complications. This comprehensive review article focuses on the incidence, patient and surgical risk factors, diagnosis, management, and clinical outcomes associated with intraoperative acetabular and femur fractures in primary total hip arthroplasty.
Performing a Safe and Effective Total Hip Arthroplasty on Patients With Inactive or Stably Active Systemic Lupus Erythematosus With Osteonecrosis
Gu, Jianming MD; Zhang, Shihong MD; Chen, Lang MD; Feng, Xiao MD; Li, Hongchao MD; Feng, Huixiong MD; Zhang, Liang MD; Zhou, Yixin MD
doi : 10.5435/JAAOS-D-20-00464
Journal of the American Academy of Orthopaedic Surgeons: May 15, 2021 - Volume 29 - Issue 10 - p 423-432
Patients with systemic lupus erythematosus (SLE) are typically treated with total hip arthroplasty (THA) because of osteonecrosis of the femoral head (ONFH). This study evaluated the outcome of THA in this patient group.
Intraoperative Indocyanine Green Fluorescence Angiography Is Sensitive for Predicting Postoperative Wound Complications in Soft-Tissue Sarcoma Surgery
Wilke, Benjamin K. MD; Schultz, Douglas S. MD; Huayllani, Maria T. MD; Boczar, Daniel MD; Spaulding, Aaron C. PhD; Sherman, Courtney E. MD; Murray, Peter M. MD; Forte, Antonio J. MD, PhD
doi : 10.5435/JAAOS-D-20-00355
Journal of the American Academy of Orthopaedic Surgeons: May 15, 2021 - Volume 29 - Issue 10 - p 433-438
Indocyanine green (ICG) angiography is a novel technology that has been predictive of postoperative wound complications. It is unknown whether this technology can successfully predict complications after sarcoma resection. In this study, we aimed to evaluate the sensitivity and specificity of ICG angiography in predicting postoperative wound complications after soft-tissue sarcoma resection.
Socioeconomic Status Is Associated With the Risk of Girdlestone Resection Arthroplasty After Periprosthetic Infection of the Hip
Kirchner, Gregory J. MD, MPH; Lieber, Alexander M. MD; Kim, Raymond Y. MD; Kerbel, Yehuda E. MD; Moretti, Vincent M. MD; Nikkel, Lucas E. MD
doi : 10.5435/JAAOS-D-20-00686
Journal of the American Academy of Orthopaedic Surgeons: May 15, 2021 - Volume 29 - Issue 10 - p 439-445
Girdlestone resection arthroplasty (GRA) is a radical but sometimes necessary treatment of periprosthetic joint infection (PJI) of the hip. The purpose of this of this study was to identify the independent risk factors for GRA after PJI of the hip.
The Missing Link: Defining the Functional Parameters of Pelvic and Acetabular Alignment
Nies, Matthew S. MD; Myrick, Karen M. DNP, APRN; Garbalosa, Juan C. PT, PhD; Halawi, Mohamad J. MD
doi : 10.5435/JAAOS-D-20-00400
Journal of the American Academy of Orthopaedic Surgeons: May 15, 2021 - Volume 29 - Issue 10 - p 446-451
This study aimed to define the three-dimensional functional alignment of the pelvis, proximal femur, and acetabulum during postural and physical activities.
Total Joint Arthroplasty and Golf Play: Analysis of Regional Golf Handicap Database
Gorbaty, Jacob D. MD; Rao, Allison J. MD; Varkey, Dax T. MD, MPH; Mu?a, Katherine MS; Saltzman, Bryan M. MD; Hamid, Nady MD
doi : 10.5435/JAAOS-D-20-00129
Journal of the American Academy of Orthopaedic Surgeons: May 15, 2021 - Volume 29 - Issue 10 - p e513-e517
As the numbers of senior golfers increase, many will consider a hip or knee joint replacement (JR) over their lifetime. The relationship of JR to the rate of return and validated level of play has not been well defined.
Utilization and Reimbursement Trends Based on Certificate of Need in Single-level Cervical Discectomy
Ziino, Chason MD; Bala, Abiram MD; Cheng, Ivan MD
doi : 10.5435/JAAOS-D-19-00224
Journal of the American Academy of Orthopaedic Surgeons: May 15, 2021 - Volume 29 - Issue 10 - p e518-e522
To compare utilization and reimbursement for cervical discectomy in certificate of need (CON) and non-CON states.
