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Split-Thickness Skin Grafting: A Primer for Orthopaedic Surgeons
Taylor, Benjamin C. MD; Triplet, Jacob J. DO; Wells, Mark MD
doi : 10.5435/JAAOS-D-20-01389
October 15, 2021 - Volume 29 - Issue 20 - p 855-861
Soft-tissue defects pose a unique challenge to the treating orthopaedic surgeon. Such defects are commonly encountered after orthopaedic injuries or infection, and the management of these wounds varies significantly. Skin grafting has gained popularity in the management of such soft-tissue defects due to its ability to provide coverage, re-epithelialize, and have a relatively high success rate. One of the most frequently used types of skin graft in orthopaedics is the split-thickness skin graft (STSG). Understanding the proper indications, technique, and management of the STSG foreshadows its success or failure. This review focuses on the indications, technique, alternatives, and complications surrounding the utilization of the STSG in the management of orthopaedic injuries.
Fundamentals of Arthroscopy Fluid Management and Strategies to Safely Improve Visualization
Walker-Santiago, Rafael MD; Maldonado, David R. MD; Domb, Benjamin G. MD; Lall, Ajay C. MD, MS
doi : 10.5435/JAAOS-D-20-01057
October 15, 2021 - Volume 29 - Issue 20 - p 862-871
Arthroscopy has become increasingly relevant to various subspecialties within the orthopaedic surgery. From a patient safety standpoint and surgical efficiency standpoint, it is critical to know the fundamental concepts of fluid management such as those related to the fluid, pressure, and flow. A satisfactory field of view during arthroscopy can be achieved with the use of gravity-dependent or automated fluid management systems. Fluid management parameters and their physiological impact on the patient should be continuously monitored to avoid morbidity or delayed recovery. Local and systemic complications can occur from careless use of techniques that improve visualization such as tourniquet, epinephrine-diluted irrigation, and controlled hypotensive anesthesia. The purpose of this article is to review the fundamental concepts of fluid management in arthroscopy and the techniques to safely improve arthroscopic visualization.
Osteosarcoma: An Evolving Understanding of a Complex Disease
Alexander, John H. MD; Binitie, Odion T. MD; Letson, G. Douglas MD; Joyce, David M. MD
doi : 10.5435/JAAOS-D-20-00838
October 15, 2021 - Volume 29 - Issue 20 - p e993-e1004
Osteosarcoma is the most common primary bone sarcoma and affects both children and adults. The cornerstone of treatment for patients with localized and oligometastatic disease remains neoadjuvant chemotherapy, surgical resection of all sites of disease, followed by adjuvant chemotherapy. This approach is associated with up to an 80% 5-year survival. However, survival of patients with metastatic disease remains poor, and overall, osteosarcoma remains a challenging disease to treat. Advances in the understanding of molecular drivers of the disease, identification of poor prognostic factors, development of risk-stratified treatment protocols, successful completion of large collaborative trials, and surgical advances have laid the ground work for progress. Advances in computer navigation, implant design, and surgical techniques have allowed surgeons to improve patients' physical functional without sacrificing oncologic outcomes. Future goals include identifying effective risk stratification algorithms which minimize patient toxicity while maximizing oncologic outcomes and continuing to improve the durability, function, and patient acceptance of oncologic reconstructions.
Private Equity and Its Emergence in Orthopaedics
Patel, Alpesh A. MD, MBA; Fernandez, Claire BBA; Mazmudar, Aditya MD, MBA
doi : 10.5435/JAAOS-D-21-00058
October 15, 2021 - Volume 29 - Issue 20 - p e1005-e1012
Private equity (PE) is increasing its role in healthcare financing and may be a source of strategic funding for orthopaedic practice groups. With acquisitions in other medical specialties such as dermatology and ophthalmology, PE works to increase operating efficiency and cut costs. Orthopaedic practices' access to revenue through ancillary services and ambulatory surgery centers, coupled with a growing, aging cohort, make them an attractive candidate for PE acquisition. However, careful consideration is warranted before surgeons enter these partnerships to ensure patient safety, and the quality of care is not compromised because PE works to increase the return on their investment.
Anxiety and Depression Impact on Inhospital Complications and Outcomes After Total Knee and Hip Arthroplasty: A Propensity Score-Weighted Retrospective Analysis
Zalikha, Abdul Kareem MD; Karabon, Patrick MSc; Hajj Hussein, Inaya PhD; El-Othmani, Mouhanad M. MD
doi : 10.5435/JAAOS-D-20-00721
October 15, 2021 - Volume 29 - Issue 20 - p 873-884
The purpose of this study was to assess the impact of anxiety and depression on immediate inhospital outcomes and complications after total joint arthroplasty of the hip (total hip arthroplasty [THA]) and knee (total knee arthroplasty [TKA]) using a large national registry.
Conversion to Total Hip Arthroplasty After Hip Arthroscopy: A Cohort-Based Survivorship Study With a Minimum of 2-Year Follow-up
Hoit, Graeme MD; Whelan, Daniel B. MD, MSc, FRCSC; Ly, Patrick BSc; Saskin, Refik MSc; Atrey, Amit MD, MSc, FRCSC; Khoshbin, Amir MD, MSc, FRCSC
doi : 10.5435/JAAOS-D-20-00748
October 15, 2021 - Volume 29 - Issue 20 - p 885-893
The purpose of this study was to determine which patient, provider, and surgical factors influence progression to total hip arthroplasty (THA) after hip arthroscopy (HA) through a large cohort-based registry.
Early Discharge After Total Hip Arthroplasty at an Urban Tertiary Care Safety Net Hospital: A 2-Year Retrospective Cohort Study
Alley, Maxwell C. MD; Shewmaker, Grant S. BA; Vaickus, Max H. MS; Niu, Ruijia MPH; Freccero, David MD; Smith, Eric L. MD
doi : 10.5435/JAAOS-D-20-01006
October 15, 2021 - Volume 29 - Issue 20 - p 894-899
Previous studies have shown that shorter inpatient stays after total hip arthroplasty (THA) are safe and effective for select patient populations with limited medical comorbidity and perioperative risk. The purpose of our study was to compare the postoperative complications because they relate to the length of hospital stay at a safety net hospital in the urban area of the United States.
Preoperative Serum C-Reactive Protein/Albumin Ratio Is a Predictor of Complications After Single-stage Revision for the Treatment of Periprosthetic Joint Infection
Fury, Matthew S. MD; Klemt, Christian PhD; Barghi, Ameen MPP; Tirumala, Venkatsaiakhil MS; van den Kieboom, Janna MD; Kwon, Young-Min MD, PhD
doi : 10.5435/JAAOS-D-20-00613
October 15, 2021 - Volume 29 - Issue 20 - p e1013-e1024
The C-reactive protein/albumin ratio (CAR) is a marker of inflammation that has been associated with negative outcomes in the general surgery. This study investigates the potential association of preoperative CAR with postoperative complications and readmission rates in the treatment of patients with single-stage revision total joint arthroplasty for periprosthetic joint infection.
MRI Characteristics of Adverse Local Tissue Reactions Associated With Intraoperative Tissue Damage and Poor Revision Surgery Outcomes: A Systematic Review
Xiong, Liang MD; Smith, Evan J. MD; Klemt, Christian PhD; Barghi, Ameen MPP; Padmanabha, Anand MD; Kwon, Young-Min PhD, MD
doi : 10.5435/JAAOS-D-20-00793
October 15, 2021 - Volume 29 - Issue 20 - p e1025-e1033
Metal artifact reductions sequence (MARS) MRI has been established as a cross-sectional imaging modality for diagnosis of adverse local tissue reaction (ALTR). This study aims to evaluate the current literature regarding the characteristics of MARS MRI associated with intraoperative tissue necrosis and postoperative complications in patients undergoing revision THA because of ALTR.
YouTube as a Source of Patient Information for Total Knee/Hip Arthroplasty: Quantitative Analysis of Video Reliability, Quality, and Content
Ng, Mitchell K. MD; Emara, Ahmed K. MD; Molloy, Robert M. MD; Krebs, Viktor E. MD; Mont, Michael MD; Piuzzi, Nicolas S. MD
doi : 10.5435/JAAOS-D-20-00910
October 15, 2021 - Volume 29 - Issue 20 - p e1034-e1044
YouTube has become a popular platform for disseminating health-related information. However, the quality of such videos has never been assessed based on video source (author). Therefore, the current investigation aimed to quantitatively analyze the (1) accuracy, (2) reliability, (3) quality, and (4) content of total knee (TKA) and hip (THA) arthroplasty videos as a platform for patient information, based on video source.
