Transitions—New Deputy Editor Oncology and New Host for JAAOS Unplugged®

Levine, William N. MD, FAAOS; Editor-in-Chief

doi : 10.5435/JAAOS-D-21-00545

Journal of the American Academy of Orthopaedic Surgeons: July 15, 2021 - Volume 29 - Issue 14 - p 589-590

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Cemented Revision Hip Arthroplasty With Femoral Impaction Bone Grafting

Chimutengwende-Gordon, Mukai MBChB, PhD, FRCS Tr & Orth; Baker, Markus P. MBBS, FRCS Tr & Orth; Jagiello, Jakub MBBS, FRCS Tr & Orth; Stamenkov, Roumen MD, MS; Callary, Stuart A. PhD; Smitham, Peter MBChB, PhD, FRCS Tr & Orth, FRACS; Howie, Donald W. MBBS, PhD, FRACS; Solomon, Lucian B. MD, PhD, FRACS

doi : 10.5435/JAAOS-D-20-00481

Journal of the American Academy of Orthopaedic Surgeons: July 15, 2021 - Volume 29 - Issue 14 - p 591-595

Long-stemmed uncemented implants are commonly used during revision hip arthroplasty but may be difficult to re-revise. Impaction bone grafting allows for the use of a shorter cemented stem during revision hip arthroplasty and may restore bone stock in patients with substantial femoral defects. Femoral impaction bone grafting is particularly beneficial in younger patients, who are more likely to require additional revision procedures in the future. The surgical technique used at our institution includes improvements to previous methods including the use of modular tamps and nonirradiated, size-profiled bone graft.

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Meniscal Salvage: Where We Are Today

Anderson, Ashley B. MD; Gaston, Joel PhD; LeClere, Lance E. MD; Dickens, Jonathan F. MD

doi : 10.5435/JAAOS-D-20-00915

Journal of the American Academy of Orthopaedic Surgeons: July 15, 2021 - Volume 29 - Issue 14 - p 596-603

The menisci are fibrocartilaginous semilunar structures in the knee that provide load support. Injury to the meniscus alters its load sharing and biomechanical profile. Knee arthroscopy with meniscus débridement is the most common orthopaedic surgical procedure done in the United States. The current goals of meniscal surgery are to preserve native meniscal tissue and maintain structural integrity. Meniscal preservation is critical to maintain the normal mechanics and homeostasis of the knee; however, it is not always feasible because of the structure's poor blood supply and often requires removal of irreparable tissue with meniscectomy. Efforts have increasingly focused on the promotion of meniscal healing and the replacement of damaged menisci with allografts, scaffolds, meniscal implants, or substitutes. The purpose of this article was to review current and future meniscal salvage treatments such as meniscus transplant, synthetic arthroplasty, and possible bioprinted meniscus to allow patients to maintain quality of life, limit pain, and delay osteoarthritis.

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Role of Subscapularis Tendon Repair in Reverse Total Shoulder Arthroplasty

Jawa, Andrew MD; Colliton, Eileen M. MD

doi : 10.5435/JAAOS-D-20-01151

Journal of the American Academy of Orthopaedic Surgeons: July 15, 2021 - Volume 29 - Issue 14 - p 604-608

In anatomic total shoulder arthroplasty (TSA), subscapularis repair is essential for shoulder stability and function postoperatively; however, the role of subscapularis repair in reverse TSA remains unclear. Some evidence suggests that subscapularis repair is associated with improved postoperative stability and range of motion, whereas other evidence indicates that repair is unnecessary and has no effect on clinical outcomes. In this review, we will analyze the existing literature addressing subscapularis repair during reverse TSA and discuss the effect of medialized and lateralized prosthesis designs on the utility of tendon repair.

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Percutaneous Spine Biopsy: A Review of the Current Literature

Nourbakhsh, Ali MD; Hanson, Zachary C. MD

doi : 10.5435/JAAOS-D-20-00100

Journal of the American Academy of Orthopaedic Surgeons: July 15, 2021 - Volume 29 - Issue 14 - p e681-e692

Spine lesions are often the result of pathologic processes elsewhere in the body; prompt and accurate diagnosis are crucial to optimize treatment. Despite modern advances in imaging modalities, definitive diagnosis ultimately requires biopsy and histologic analysis. Although open surgical biopsy has traditionally been considered the benchmark, percutaneous image-guided needle biopsy of the spine has proven to be a safe and highly effective method in making a diagnosis. Choosing the optimal biopsy approach, instrumentation and modality of image guidance may depend on a number of factors including lesion type, location, and level within the spine. Knowledge of relevant anatomy, indications, contraindications, and potential complications are critical to a successful biopsy procedure.

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Bridging the Gap: The Influence of Foot and Ankle Pathomechanics in Total Knee Arthroplasty

Naylor, Brandon H. DO; Seidman, Daniel MD; Scuderi, Giles R. MD

doi : 10.5435/JAAOS-D-20-00786

Journal of the American Academy of Orthopaedic Surgeons: July 15, 2021 - Volume 29 - Issue 14 - p e693-e701

Altered spinopelvic mechanics can have dramatic influences on the success of hip arthroplasty as seen with concomitant hip and spine disease. Interestingly, limited focus has been directed toward a similar codependent relationship between concurrent knee and foot deformities. By bridging this interdisciplinary gap, we attempt to explore the current understanding and clinical implications of concomitant knee and foot pathology while reviewing management options for addressing this unique yet ubiquitous patient population. Multiple authors have demonstrated an inverse relationship between progressive coronal plane deformities concerning the knee and hindfoot. The utility of a conventional mechanical axis during total knee arthroplasty may be limited in the presence of foot deformity where ground reactive forces often markedly deviate with the hindfoot, potentially leading to eccentric knee loading. The use of alternative indices, such as ground mechanical axis deviation, may offer a more reliable metric for achieving an accurate neutral mechanical axis. In addition, although foot deformity and compensation can often improve to a limited degree after total knee arthroplasty, residual deformity may have deleterious effects on the success of the procedure. A comprehensive understanding of the functional relationship between the foot and the knee can allow surgeons to better guide appropriate treatment sequence, often beginning with the more symptomatic deformity. Future research is needed to further elucidate the implications and appropriate management of concomitant knee and foot deformity.

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Principles of Amputation Surgery, Prosthetics, and Rehabilitation in Children

Louer, Craig Ray Jr MD; Scott-Wyard, Phoebe DO; Hernandez, Rebecca CPO, LPO; Vergun, Anna Dimitriovna MD

doi : 10.5435/JAAOS-D-20-01283

Journal of the American Academy of Orthopaedic Surgeons: July 15, 2021 - Volume 29 - Issue 14 - p e702-e713

Pediatric patients may benefit from extremity amputations with potential prosthetic fitting when addressing limb deficiencies, trauma, infection, limb ischemia, or other pathologies. The performance of a quality amputation is a fundamental skill to an orthopaedic surgeon, yet avoidance of pitfalls can be elusive in children. The need for surgical precision and sound decision-making is amplified in pediatric amputations, where the skeleton is dynamic and growing, anatomy can be miniscule and (in the case of congenital anomalies) variable. The principles that guide amputation level and technical approach are unique in children. Despite this, descriptions of these procedures as they should be applied to a growing or congenitally deficient skeleton are lacking. Furthermore, surgeons must also understand the unique prosthetic and psychosocial considerations for children. A collaborative approach between the surgeons, rehabilitation physicians, prosthetists, therapists, and families is essential to ensuring optimal results.

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The Cost of Robot-assisted Total Hip Arthroplasty: Comparing Safety and Hospital Charges to Conventional Total Hip Arthroplasty

Kirchner, Gregory J. MD, MPH; Lieber, Alexander M. MD; Haislup, Brett MD; Kerbel, Yehuda E. MD; Moretti, Vincent M. MD

doi : 10.5435/JAAOS-D-20-00715

Journal of the American Academy of Orthopaedic Surgeons: July 15, 2021 - Volume 29 - Issue 14 - p 609-615

Utilization of robotic assistance is increasing for total hip arthroplasty (THA). However, few studies have directly examined the efficacy of this technique at reducing complications. This research aims to compare the rates of perioperative complications of robotic-assisted THA (RA-THA) with conventional THA (C-THA).

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Online Information and Mentorship: Perspectives From Orthopaedic Surgery Residency Applicants

Yong, Taylor M. MD, MS; Austin, Daniel C. MD, MS; Molloy, Ilda B. MD, MS; Torchia, Michael T. MD, MS; Coe, Marcus P. MD, MS

doi : 10.5435/JAAOS-D-20-00512

Journal of the American Academy of Orthopaedic Surgeons: July 15, 2021 - Volume 29 - Issue 14 - p 616-623

Applying to orthopaedic surgery residency is competitive. Online information and mentorship are important tools applicants use to learn about programs and navigate the process. We aimed to identify which resources applicants use and their perspectives on those resources.

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Cognitive Biases in Orthopaedic Surgery

Janssen, Stein J. MD, PhD; Teunis, Teun MD, PhD; Ring, David MD, PhD; Parisien, Robert C. MD

doi : 10.5435/JAAOS-D-20-00620

Journal of the American Academy of Orthopaedic Surgeons: July 15, 2021 - Volume 29 - Issue 14 - p 624-633

Cognitive biases are known to affect all aspects of human decision-making and reasoning. Examples include misjudgment of probability, preferential attention to evidence that confirms one's beliefs, and preference for certainty. It is not known whether cognitive biases influence orthopaedic surgeon decision-making. This study measured the influence of a few cognitive biases on orthopaedic decision-making in hypothetical vignettes. The questions we addressed were as follows: Do orthopaedic surgeons display the cognitive biases of base rate neglect and confirmation bias in hypothetical vignettes? Can anchoring and framing biases be demonstrated?

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Do We Need to Wait 3 Months After Corticosteroid Injections to Reduce the Risk of Infection After Total Knee Arthroplasty?

Bhattacharjee, Sarah BS; Wallace, Sara MD; Luu, Hue H. MD; Shi, Lewis L. MD; Lee, Michael J. MD; Chen, Antonia F. MD, MBA

doi : 10.5435/JAAOS-D-20-00850

Journal of the American Academy of Orthopaedic Surgeons: July 15, 2021 - Volume 29 - Issue 14 - p e714-e721

Corticosteroid injections administered within 3 months before total knee arthroplasty (TKA) have been linked to increased risk of postoperative infection. However, it would be beneficial to further delineate the timing of injections to determine whether a narrower window exists for safe administration of corticosteroid injections. The purposes of our study were to (1) determine whether there were a different time frame between corticosteroid injection and primary TKA that increased infection risk and (2) determine risk factors associated with infection after TKA.

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Obesity Is Preferentially Associated With Patellofemoral Compartment Wear: A Magnetic Resonance Imaging Assessment

Du, Jerry Y. MD; Sivasundaram, Lakshmanan MD; Trivedi, Nikunj N. MD; Voos, James E. MD; Victoroff, Brian N. MD

doi : 10.5435/JAAOS-D-20-00596

Journal of the American Academy of Orthopaedic Surgeons: July 15, 2021 - Volume 29 - Issue 14 - p e722-e731

A well-known association exists between obesity and knee osteoarthritis (OA) for both incidence and progression of the disease. However, the cartilage wear patterns in OA associated with obesity are less well studied.

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