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What’s New in Shoulder and Elbow Surgery
Kim, H. Mike MD1,a; Hsu, Jason E. MD2; Ricchetti, Eric T. MD3
doi : 10.2106/JBJS.21.00698
October 20, 2021 - Volume 103 - Issue 20 - p 1865-1871
Is Gastrocnemius Tightness a Normal Finding in Children?
Liyanarachi, Suki MD1,a; Hulleberg, Gunn MD1; Foss, Olav A. MD, PhD1,2
doi : 10.2106/JBJS.20.01273
October 20, 2021 - Volume 103 - Issue 20 - p 1872-1879
Isolated gastrocnemius tightness has been associated with chronic foot symptoms and conditions such as plantar fasciitis, calf pain, metatarsalgia, Achilles tendinopathy, and pes planus1-6. Studies regarding gastrocnemius tightness in healthy children are limited, but there is evidence that ankle dorsiflexion decreases with increasing age in children7-9. The normal range of ankle dorsiflexion with a flexed and extended knee has not been sufficiently mapped. We do not know whether gastrocnemius tightness is a normal finding in children. More knowledge of gastrocnemius tightness is of interest as recurrent leg pain is not uncommon in children10.
Tranexamic Acid Was Not Associated with Increased Complications in High-Risk Patients with Hip Fracture Undergoing Arthroplasty
Porter, Steven B. MD1,a; Spaulding, Aaron C. PhD2; Duncan, Christopher M. MD3; Wilke, Benjamin K. MD4; Pagnano, Mark W. MD5; Abdel, Matthew P. MD5
doi : 10.2106/JBJS.21.00172
October 20, 2021 - Volume 103 - Issue 20 - p 1880-1889
Tranexamic acid (TXA) is considered safe and efficacious for elective total joint arthroplasty. However, evidence of TXA’s safety in high-risk patients with hip fracture requiring nonelective arthroplasty has been lacking. This study aimed to assess whether TXA administration to high-risk patients with a hip fracture requiring arthroplasty increased the risk of thrombotic complications or mortality.
Use of a Tourniquet and Spinal Anesthesia Increases Satisfactory Outcomes After Total Knee Arthroplasty
Rantasalo, Mikko MD1,a; Palanne, Riku MD2,3; Vakkuri, Anne MD, PhD2; Olkkola, Klaus T. MD, PhD4; Madanat, Rami MD, PhD5; Skants, Noora MD, PhD2
doi : 10.2106/JBJS.20.02080
October 20, 2021 - Volume 103 - Issue 20 - p 1890-1899
Total knee arthroplasty (TKA) is usually performed successfully with or without a tourniquet and under spinal anesthesia (SA) or general anesthesia (GA). However, 10% to 34% of patients experience dissatisfaction and pain after TKA. We aimed to compare the effects of tourniquet use and SA or GA on TKA outcomes.
The Use of Computer Navigation in Total Hip Arthroplasty Is Associated with a Reduced Rate of Revision for Dislocation
Agarwal, Sujit MBBS, MS, FRCS(T&Orth)1,2,*; Eckhard, Lukas MD1,3,a,*; Walter, William L. MBBS, PhD, FRACS(Orth)4; Peng, Andrea MMed(Epi&Stats)5; Hatton, Alesha BMedMath(Hons)5; Donnelly, Bill MBBS, BMedSci, FRACS(Orth)6; de Steiger, Richard MBBS, PhD, FRACS(Orth)6,7
doi : 10.2106/JBJS.20.00950
October 20, 2021 - Volume 103 - Issue 20 - p 1900-1905
The use of computer navigation has been shown to produce more accurate cup positioning when compared with non-navigated total hip arthroplasty (THA), but so far there is only limited evidence to show its effect on clinical outcomes. The present study analyzed data from the Australian Orthopaedic Association National Joint Replacement Registry to assess the impact of computer navigation on the rates of all-cause revision and revision for dislocation following THA.
Outcomes of Management of Proximal Humeral Fractures with Patient-Specific, Evidence-Based Treatment Algorithms
Spross, Christian MD1,a; Zdravkovic, Vilijam MD1; Manser, Melanie PT1; Farei-Campagna, Jan Marino MD1; Jacxsens, Matthijs MD1; Jost, Bernhard MD1
doi : 10.2106/JBJS.20.01309
October 20, 2021 - Volume 103 - Issue 20 - p 1906-1916
Previous studies have identified risk factors for different types of treatment of proximal humeral fracture (PHF) and allowed the development of a patient-specific, evidence-based treatment algorithm with the potential of improving overall outcomes and reducing complications. The purpose of this study was to evaluate the results and complications of treating PHF using this algorithmic approach.
Detecting Periprosthetic Joint Infection by Using Mass Spectrometry
Li, Rui MD1,2,*; Song, Lei PhD3,*; Quan, Qi MD2; Liu, Ming-Wei PhD3; Chai, Wei MD1,2; Lu, Qiang MD1; Li, Xiang MD1,2; Qin, Jun PhD3,b; Chen, Ji-Ying MD1,a
doi : 10.2106/JBJS.20.01944
October 20, 2021 - Volume 103 - Issue 20 - p 1917-1926
Novel methods for diagnosing periprosthetic joint infection (PJI) are currently being explored. Mass spectrometry (MS) is an approach that can detect whole-protein changes in synovial fluid and may represent a promising method.
Syndesmosis Repair Affects in Vivo Distal Interosseous Tibiofibular Ligament Elongation Under Static Loads and During Dynamic Activities
Canton, Stephen P. MS, MS1,2,a; Gale, Tom MS2; Onyeukwu, Chukwudi BS1,2; Hogan, MaCalus V. MD, MBA1,2,3; Anderst, William PhD1,2
doi : 10.2106/JBJS.20.01787
October 20, 2021 - Volume 103 - Issue 20 - p 1927-1936
Ligamentous ankle injuries are the most common injuries sustained by athletes and by the general population, with an incidence of approximately 2 million per year in the U.S. Injuries to the ankle syndesmosis (i.e., “high ankle sprains”) are generally treated operatively. Although cadaveric studies can evaluate syndesmosis fixation strength, they cannot predict how healing, neuromuscular adaptation, or dynamic loading will affect in vivo biomechanics. Using dynamic biplane radiography (DBR), we tested the hypothesis that syndesmosis repair would restore ankle kinematics and ligament elongation during static and dynamic loading.
Brief Electrical Stimulation Accelerates Axon Regeneration and Promotes Recovery Following Nerve Transection and Repair in Mice
Sayanagi, Junichi MD1; Acevedo-Cintrón, Jesús A. BS1; Pan, Deng BS1; Schellhardt, Lauren BA1; Hunter, Daniel A.1; Snyder-Warwick, Alison K. MD1; Mackinnon, Susan E. MD1; Wood, Matthew D. PhD1,a
doi : 10.2106/JBJS.20.01965
October 20, 2021 - Volume 103 - Issue 20 - p e80
Clinical outcomes following nerve injury repair can be inadequate. Pulsed-current electrical stimulation (ES) is a therapeutic method that facilitates functional recovery by accelerating axon regeneration. However, current clinical ES protocols involve the application of ES for 60 minutes during surgery, which can increase operative complexity and time. Shorter ES protocols could be a strategy to facilitate broader clinical adoption. The purpose of the present study was to determine if a 10-minute ES protocol could improve outcomes.
Enhanced Recovery After Primary Total Hip and Knee Arthroplasty
Morrell, Aidan T. BS1,a; Layon, Daniel R. MD2; Scott, Michael J. MB, ChB, FRCP, FRCA, FFICM3; Kates, Stephen L. MD2; Golladay, Gregory J. MD2; Patel, Nirav K. MD, FRCS2
doi : 10.2106/JBJS.20.02169
October 20, 2021 - Volume 103 - Issue 20 - p 1938-1947
Enhanced Recovery After Surgery (ERAS) has become increasingly implemented to reduce costs, to increase efficiency, and to optimize patient outcomes after a surgical procedure. This study aimed to systematically review the effect of ERAS after primary elective total hip arthroplasty (THA) or total knee arthroplasty (TKA) on hospital length of stay, total procedure-related morbidity, and readmission.
Early Sport Specialization
Agel, Julie MA, ATC1; Post, Eric PhD, ATC2
doi : 10.2106/JBJS.21.00018
October 20, 2021 - Volume 103 - Issue 20 - p 1948-1957
Early sport specialization has been recognized as a potential factor in the relationship between physical activity and health since the early 1970s.
Surgeon Suicide Remains a Critical Issue for the Orthopaedic Profession
Zaid, Musa MD1,a; Diab, Mohammad MD1
doi : 10.2106/JBJS.20.01125
October 20, 2021 - Volume 103 - Issue 20 - p e81
Own the Fall
Anderson, Paul A. MD1,a; Magaziner, Jay S. PhD2; Mendelson, Daniel Ari MS, MD3; Switzer, Julie A. MD4,5
doi : 10.2106/JBJS.20.02254
October 20, 2021 - Volume 103 - Issue 20 - p e82
Falls are the most common cause of injury to older patients, resulting in >3 million emergency room visits per year and 290,000 hip fractures annually in the United States. Orthopaedic surgeons care for the majority of these patients; however, they are rarely involved in the assessment of fall risk and providing prevention strategies. Falls also occur perioperatively (e.g., in patients with arthritis and those undergoing arthroplasty). Preoperatively, up to 40% of patients awaiting joint arthroplasty sustain a fall, and 20% to 40% have a fall postoperatively. Risk factors for falls include intrinsic factors such as age and comorbidities that are not modifiable as well as extrinsic factors, including medication reconciliation, improvement in the environment, and the management of modifiable comorbidities that can be optimized. Simple in-office fall assessment tools are available that can be adapted for the orthopaedic practice and be used to identify patients who would benefit from rehabilitation. Orthopaedic surgeons should incorporate these strategies to improve care and to reduce fall risk and associated adverse events.
Measuring Ankle Dorsiflexion: Not as Simple as You Might Think
Sussman, Michael D. MD1,a
doi : 10.2106/JBJS.21.00742
October 20, 2021 - Volume 103 - Issue 20 - p e83
Blood Loss Prophylaxis: Tranexamic Acid Is Safe Even in High-Risk Patients
Azboy, Ibrahim MD1,a
doi : 10.2106/JBJS.21.00757
October 20, 2021 - Volume 103 - Issue 20 - p e84
