The experts at The Rothman Institute share their diagnostic and treatment insights in 3 areas of orthopaedics: adult reconstruction, shoulder surgery, and sports medicine. Rothman Institute Grand Rounds is exclusive to the International Congress for Joint Reconstruction's website, ICJR.net.
Stem Exchange in Revision TKA for Periprosthetic Fracture
After a fall at home, a 93-year-old female patient sustains a left periprosthetic tibial fracture around a well-functioning implant from a prior total knee arthroplasty. What is the best treatment option to avoid compromising bone quality and the extensor mechanism in this patient?
By P. Maxwell Courtney MD, Joseph A. Karam MD, David G. Nazarian MD - Posted 18 Jul 2019
A Case of ACL Graft Failure with Segmental Meniscal Deficiency
A 35-year old female patient with a history of two failed anterior cruciate ligament (ACL) reconstructions presents with persistent right knee instability and pain. Imaging shows a vertical femoral tunnel, significant widening of the tibial tunnel, torn ACL graft, and posterior medial meniscus deficiency without chondral damage. Nonoperative management is no longer an option. Would she benefit from a Collagen Meniscus Implant and revision ACL reconstruction?
By Ashley J. Bassett MD, Donald W. Mazur MD - Posted 12 Jun 2019
Calcific Tendinitis of the Subscapularis Tendon
A 71-year-old woman with a history of right shoulder pain of insidious onset is unable to perform activities of daily living due to the pain and functional deficits in her shoulder. Should she receive a steroid injection, or would surgery be the better treatment option?
By Richard McEntee BS, Daniel Davis MD MS - Posted 15 May 2019
Periprosthetic Tibial Shaft Fracture after Kinematically Aligned TKA
A 67-year-old female patient with a history of a primary left total knee arthroplasty presents with a periprosthetic tibial fracture that occurred while she was walking up the stairs. What is the best approach to manage this patient?
By P. Maxwell Courtney MD, Timothy L. Tan MD, Keith P. Connolly MD - Posted 20 Mar 2019
Acute Coracoid Fracture with Recurrent Traumatic Anterior Glenohumeral Instability
A police officer who fell on his shoulder during training exercises presents with significant pain, including severe night pain, and difficulty with range of motion. He has a past medical history of 2 arthroscopic procedures on that shoulder for a prior glenohumeral dislocation. What is the best option to manage him this time?
By Daniel E. Davis MD MS, Mark D. Lazarus MD - Posted 13 Feb 2019
Surgical Repair of a Proximal Hamstring Injury
A 56-year-old male patient reports that he felt a “pop” and experienced isolated pain to the posterior aspect of his left thigh after he slipped and his left leg extended into a split position. Will surgery be the best option to get him back to work and playing recreational ice hockey?
By Anant Dixit MD, Steven B. Cohen MD - Posted 16 Jan 2019
Periprosthetic Fracture Below Hip Arthrodesis: Fusion Takedown and Conversion to THA
A 51-year-old male with a history of a right hip arthrodesis fell and sustained a periprosthetic fracture below his fusion plate. What is the best approach to manage this patient: revision fixation or conversion to arthroplasty?
By P. Maxwell Courtney MD, Amy Wasterlain MD - Posted 12 Dec 2018
Latissimus Dorsi and Teres Major Tear in a Throwing Athlete
A 23-year-old male professional baseball player presents with pain in the posterior axillary fold of the right arm following 1 specific pitch. MRI demonstrates a tear of the latissimus dorsi and possibly the teres major. What is the next step?
By Anthony A. Romeo MD, Brandon J. Erickson MD - Posted 10 Oct 2018
Surgical Dislocation of the Hip for the Treatment of a Femoral Head Chondroblastoma
A 17-year-old, high-level female athlete has persistent groin pain that's limiting her performance. What is the best way to manage the lesion found in her femoral head?
By Daniel Baquet BA, Keenan Sobol BA, John A. Abraham MD - Posted 12 Sep 2018
Proximal Tibiofibular Joint Reconstruction in a Young Equestrian
A 16-year-old female patient who is a competitive equestrian presents with painful proximal tibiofibular joint instability of the left knee and numbness and paresthesia in her peroneal nerve distribution. MRI shows proximal tibiofibular ligament injury. She has failed conservative treatment – what’s the next step?
By Nimit Patel MD, Yehuda E. Kerbel MD, Sommer Hammoud MD - Posted 11 Jul 2018
Managing Extensive Femoral Bone Loss in 2-Stage Revision THA for Infection
A 57-year-old male with a history of multiple revision surgeries on his right hip presents with recurrent chronic periprosthetic joint infection. What is the best option to manage this patient at explantation and reconstruction?
Posted 14 May 2018
MPFL Reconstruction in a Young Athlete
A 14-year-old female patient presents with left knee pain and swelling after sustaining a non-contact injury to her knee while playing soccer. MRI shows an injury to the medial patellofemoral ligament with patellar subluxation, which is treated conservatively. She returns 11 months later with a recurrent injury. What is the best option to manage this patient?
By Nimit Patel MD, Neel A. Gupta MD, Shyam Brahmabhatt MD - Posted 19 Apr 2018
Total Shoulder Arthroplasty with a Glenoid Augment
A 69-year-old male patient with chronic left shoulder pain had been “just trying to live with it,” but now the pain and impaired motion are interfering with his job as truck driver.
By Cory Lebowitz DO, Luke S. Austin MD - Posted 21 Mar 2018
Polyethylene and Tibial Baseplate Wear in a TKA Patient with a PJI
A 61-year-old male presents with an acute periprosthetic infection of his left knee. Radiographs demonstrate severe polyethylene wear and likely tibial base plate damage. What is the best option to manage this patient?
By Arjun Saxena MD, John R. Schnell MD - Posted 14 Feb 2018
A Case of Anatomic Reconstruction of an ACL Tear
A 26-year-old female patient presents with a non-contact valgus injury to her left knee, which she sustained while playing soccer. She felt a pop, with immediate pain and swelling, which have persisted. The authors diagnosed a tear of the anterior cruciate ligament, a common injury in athletes.
By Nirav K. Patel MD MS FRCS, Christopher C. Dodson MD - Posted 08 Feb 2018
Chronic Extensor Mechanism Disruption Following Revision TKA
A 65-year old female presents with a severe extensor lag following 3 revision knee surgeries. She has also failed a direct repair of her patellar tendon and has undergone an irrigation and debridement for suspected periprosthetic joint infection. What is the best option to manage this patient?
By P. Maxwell Courtney MD, Scott M. Sporer MD, Anthony J. Boniello MD - Posted 06 Dec 2017
Arthroscopic Suprascapular Nerve Decompression and Posterior Labral Repair
A 55-year-old patient with chronic mild shoulder pain presents when she suddenly develops weakness and an inability to perform normal activities. Will an arthroscopic procedure alleviate her symptoms?
By Mark Ghobrial DO, Luke S. Austin MD - Posted 15 Nov 2017
Management of Recurrent Anterior Shoulder Instability with Open Bankart Labral Repair
A 20-year-old Division I college football player with recurrent anterior shoulder instability has persistent instability 2 years after arthroscopic labral repair, which involved a small bony Bankart lesion. Will open Bankart repair resolve his symptoms?
By William Emper MD, Zaira Chaudhry MPH - Posted 11 Oct 2017
Development of an Abiotrophia Defectiva Infection after TKA
A 61-year-old male patient presents with sudden onset of intense knee pain 6 years after total knee arthroplasty. A positive alpha-defensin and high synovial CRP levels raise the suspicion of an acute periprosthetic joint infection. Further cultures reveal an extremely rare cause of infection in orthopaedic implants: Abiotrophia defectiva.
By Rahul Goel BA, Asim M. Makhdom MD MSc FRCSC, Matthew Austin MD - Posted 13 Sep 2017
Management of End-Stage Patellofemoral Post-Traumatic Chondromalacia with Fresh Osteochondral Allograft
A 40-year-old with a history of recurrent patellar dislocation resulting in post-traumatic patellofemoral chondromalacia has persistent anterior knee pain and swelling 2 years after patellofemoral chondroplasty and synovectomy. Will fresh osteochondral allograft transplantation offer pain relief?
By Zaira Chaudhry MPH, Robert Frederick MD - Posted 22 Mar 2017
Complex Femoral Reconstruction in Revision Total Knee Arthroplasty
A 74-year-old total knee arthroplasty patient presents with recurrent aseptic loosening of cemented femoral component. She has already undergone 4 attempts at revision/salvage arthroplasty using fully cemented hinged prostheses, with no success. What would be the best option for achieving durable femoral reconstruction in this patient?
By R. Andrew Henderson MD MSc, Matthew S. Austin MD - Posted 01 Feb 2017
Femoral Head-Stem Dissociation Secondary to Severe Trunnion Corrosion
An 81-year-old male patient was doing well 11 years after an uncomplicated primary THA – until he felt a “pop” in the hip accompanied by pain and an inability to bear weight.
By Christopher Bechtel MD, John A. Abraham MD - Posted 21 Dec 2016
A Case of Terrible Triad Injury to the Elbow
A fall from a ladder sends a 65-year-old male patient to the emergency department with left elbow pain. Following closed reduction of an elbow dislocation, imaging shows an unusually large anteromedial coronoid fragment requiring surgical fixation.
By Alexander W. Aleem MD, Charles L. Getz MD - Posted 16 Nov 2016
Superior Capsular Reconstruction: An Alternative for a Recurrent Irreparable Supraspinatus Tendon Tear
A 61-year-old male patient is still in pain 6 months after surgery for a rotator cuff tear. Will a new type of procedure offer pain relief and restore the function of his left shoulder?
By Eric Secrist BS, Sommer Hammoud MD, Max Greenky MD - Posted 18 Oct 2016
Simultaneous Bilateral Extensor Mechanism Reconstruction for Acute Patellar Tendon Rupture
Following a fall at home, a 46-year-old male with alkaptonuria and a history of bilateral total knee arthroplasty presents with bilateral knee pain and an inability to actively extend either knee. The surgical plan calls for primary patellar tendon and retinacular repair and reconstruction of the bilateral extensor mechanisms.
By James Fraser MD MPH, Gregory K. Deirmengian MD - Posted 14 Sep 2016
Arthroscopic Transosseus Tunnel Repair for a Large Rotator Cuff Tear
A 64-year-old male patient who had previously been treated for a partial rotator cuff tear presents with significant anterior shoulder pain in the same shoulder. When an acute retracted large rotator cuff tear is diagnosed, decisions need to be made about non-operative versus operative treatment.
By John G. Horneff MD, Joseph A. Abboud MD - Posted 17 Aug 2016
Jumper’s Knee: When Conservative Treatment Fails
A college basketball player presents with a more than 1-year history of pain and disability in his knee. He was pain-free after a 6-week course of non-operative treatment – but then he began playing basketball again and the pain returned. Should surgery be the next step?
By Christopher M. Aland MD - Posted 13 Jul 2016
Rapidly Progressive Osteoarthritis of the Hip
The authors describe a uniquely aggressive case of rapidly destructive osteoarthritis of the left hip in a 91-year-old female patient. An infectious etiology was suspected but ultimately ruled out.
By Andrew Fleischman MD, Antonia F. Chen MD MBA - Posted 13 Jun 2016
A Case of Severe Systemic Cobalt Toxicity in THA
A 61-year-old female patient presents with worsening groin pain and symptoms suggesting cobalt toxicity – including vision and hearing loss – following revision of a fractured ceramic-on-ceramic bearing surface to a cobalt-chrome-on-polyethylene bearing surface.
By Lindsay McAlpine, Max Greenky MD, Michael Feldstein MD MS, Matthew S. Austin MD - Posted 23 Mar 2016
RSA for Locked Anterior Shoulder Dislocation
A 56-year-old female patient with a prior left humeral shaft fracture presents with pain and dysfunction following a fall on the same shoulder. Will a reverse shoulder arthroplasty provide pain relief and restore range of motion?
By Bradley Schoch, Surena Namdari - Posted 10 Feb 2016
ACI for Articular Cartilage Injury in the Knee
A 25-year-old male who had previously played college football is diagnosed with full-thickness articular cartilage defect of the medial femoral condyle and trochlea. Would he benefit from an autologous chondrocyte implantation procedure?
Posted 11 Jan 2016
Revision THA for Osteolysis after Failed SCFE Pinning and Primary THA
The authors describe a complex case of a young patient in need of revision total hip after a primary total hip for SCFE.
Posted 16 Dec 2015
ORIF with Intramedullary Nail for a Proximal Humerus Fracture
When a 66-year-old woman presents with a displaced 2-part proximal humerus fracture, the authors weigh the advantages and disadvantages of closed versus open reduction.
Posted 11 Nov 2015
Treating Patellofemoral Instability with Bony and Soft Tissue Procedures
A high school athlete presents with left knee patella dislocation, her first dislocation after 8 incidents of subluxation of the patella in a 1-year period.
Posted 20 Oct 2015
Arthroscopic Repair of a Full-Thickness Rotator Cuff Tear
A middle-aged male presents with persistent shoulder pain after lifting heavy boxes. MRI reveals a full-thickness supraspinatus rotator cuff tear.
Posted 16 Sep 2015
Hip Preservation vs. THA for Legg-Calve-Perthes Disease
A 22 year-old woman with history of left hip Legg-Calvé-Perthes disease treated with a femoral osteotomy during childhood presents with severe groin pain that is compromising her quality of life. Should she undergo a hip preservation procedure, or would total hip arthroplasty be the better option?
Posted 12 Aug 2015
Fracture of a Ceramic-on-Ceramic Total Hip Implant
When a 62-year-old male presents with severe squeaking 3 years after a THA with a ceramic-on-ceramic implant, the authors discover that the implant has fractured and a revision procedure is necessary.
Posted 15 Jul 2015
A Case of Multidirectional Instability of the Shoulder
When physical therapy fails to resolve a 23-year-old female patient's chronic multidirectional shoulder instability, she agrees to undergo an arthroscopic capsulorraphy.
Posted 12 Jun 2015
Recurrent Knee Contracture after Total Knee Arthroplasty
A 66-year-old female presents with severe flexion contracture following posterior-stabilized TKA at another facility. Physical therapy and MUA have been unsuccessful in restoring ROM. A complicated revision procedure is the next option.
Posted 10 Jun 2015
An Anterior-based Muscle-sparing Approach to THA
A 66-year-old female who has acetabular protrusio and end-stage osteoarthritis of the right hip undergoes total hip arthroplasty through the ABMSparing approach. According to the authors, this approach avoids the complications of wound healing that can occur with an approach that crosses the hip flexion crease, as well as avoids cutting muscle.
Posted 20 May 2015
A Case of Ulnar Collateral Ligament Instability of the Elbow
A 21-year-old elite collegiate baseball player presents with a 6-month history of mild right medial elbow pain. When non-operative treatment fails, the author recommends right elbow UCL reconstruction.
Posted 14 May 2015
Acute Avulsion of the Medial Meniscus Posterior Root Attachment
A young, active male presents with knee pain and swelling after rolling his ankle a week earlier. When an MRI reveals a meniscus tear, the author recommends arthroscopy and medial meniscus root repair.
Posted 16 Apr 2015
Total Elbow Arthroplasty for Rheumatoid Arthritis
A 77-year-old female presents with long-standing right elbow pain caused by rheumatoid arthritis. She has taken disease-modifying anti-rheumatic drugs and has had a corticosteroid injection without relief. The authors recommend total elbow arthroplasty to get her back to the gardening she loves.
By Matthew L. Ramsey MD, Brian Lee MD - Posted 11 Mar 2015
Staged Patellofemoral Arthroplasty for Bilateral Knee Pain
A 74-year-old woman presents with bilateral anterior knee pain. She has significant pain when going up or down stairs, kneeling, squatting, and standing from a seated position. Because non-operative treatment has failed to provide relief, the authors recommend patellofemoral arthroplasty.
By Jess H. Lonner MD, Julie Shaner MD - Posted 09 Mar 2015
Hip Arthroscopy for a Labral Tear with FAI
A 21-year-old collegiate hockey player presents with a 2-year history of right hip and groin pain that has increased in frequency and intensity. When an MRI arthrogram reveals a labral tear with mixed CAM and pincer FAI, the author recommends hip arthroscopy to address the issue.
By John P. Salvo - Posted 09 Feb 2015
Using the Direct Anterior Approach for THA
A 65-year-old female presents with severe pain in the right groin area that worsens with activity. When she's diagnosed with advanced degenerative joint disease of the right hip, the authors recommend a total hip arthroplasty, and they deem her a good candidate for the procedure through the direct anterior approach.
Posted 16 Jan 2015
Arthroscopic Repair of a Suspected Type II SLAP Tear
A 16-year-old high school athlete who plays football and baseball presents with pain while throwing but no specific history of injury. Six months of physical therapy has provided no relief. When an MRI arthrogram reveals a superior labral tear, the patient agrees to shoulder arthroscopy with labral repair.
By Christopher M. Aland MD - Posted 12 Jan 2015
Arthroscopic Latarjet Procedure for Shoulder Instability
A 24-year-old hockey player had undergone a Bankart repair due to recurrent instability of his left shoulder. After a fall, he’s now dislocating at rest, with significant subjective instability of the shoulder. What can be done to stabilize the joint?
By George S. Athwal MD FRCSC, Eric M. Black MD, Charles Getz MD - Posted 08 Dec 2014
Managing Osteochondritis Dessicans of the Capitellum
A young gymnast presents with 16-month history of recurrent left elbow pain, swelling, and occasional locking and catching. Conservative treatment has failed to provide relief. Is surgery the best treatment option at this point?
By Edward S. Chang MD, Christopher C. Dodson MD - Posted 08 Dec 2014
Distal Femoral Replacement with a Metaphyseal Sleeve
A 63-year-old morbidly obese male has had 11 previous knee surgeries, including a total knee arthroplasty and multiple revisions. He now has severe, intolerable pain in his leg following a distal femoral replacement. When another revision procedure fails to relieve the pain, what options are left?
Posted 08 Dec 2014
A Case of Anterior Shoulder Instability with Labral Tear
When a 17-year-old patient is diagnosed with recurrent posterior subluxation, posterior shoulder instability, and labral tear without significant capsular laxity, the author recommends arthroscopic repair.
By Steven B. Cohen - Posted 10 Nov 2014
Mini-open FAO to Manage FAI with Bilateral Calcified Labrum
A 32-year-old female presents with a history of bilateral groin and greater trochanteric pain. Conservative treatment has failed to provide relief. When she is diagnosed with bilateral pincer femoroacetabular impingement, the authors discuss the pros and cons of various surgical options with her.
Posted 10 Nov 2014
A New Option for Irreparable Rotator Cuff Tears
After a fall at work, a 51-year-old male can no longer perform his job functions, which include lifting heavy loads. He’s diagnosed with a massive rotator cuff tear, but when the surgical repair fails, what options are available? The authors offer him a lower trapezius tendon transfer with Achilles allograft reconstruction.
Posted 10 Nov 2014
Biceps Tenodesis for Biceps Tendonitis and Rotator Cuff Tear
A 55-year-old male patient presents with increasing right shoulder pain and mild weakness when performing overhead activities and lifting heavy objects. When pathology of the long head of the biceps is diagnosed, the authors propose subpectoral biceps tenodesis, the surgical technique for which is outlined in this article.
By Patrick Kane, Kevin B. Freedman - Posted 13 Oct 2014
Arthroscopic Repair of the Rotator Cuff and Subscapularis
A 65-year-old woman presents with a 2-month history of increased anterior/lateral right shoulder pain without trauma. She had previously been treated non-operatively for a small rotator cuff tear - which appears to have have progressed.
Posted 13 Oct 2014
Cementless TKA as an Option for a Younger, Active Patient
A 52-year-old healthy male presents with severe, intolerable left knee pain that has failed to respond to conservative treatment. Radiographs show severe advanced osteoarthritis in both knees. The authors recommend total knee arthroplasty, offering him the option of cemented or cementless fixation.
Posted 13 Oct 2014
Femoral Component Revision through a DAA THA
The authors describe a unique case of a total hip arthroplasty patient with failure at the modular head neck junction due to trunnion wear that was revised through a direct anterior approach.
By Snir Heller MD, William J. Hozack MD - Posted 08 Sep 2014
External Fixation for a Proximal Humerus Fracture
An older patient with serious medical comorbidities cannot undergo surgery to repair a 2-part proximal humerus fracture. The authors chose closed reduction with external fixation as a safer alternative.
Posted 08 Sep 2014
Posterior Shoulder Instability with Labral Tear
A 19-year-old college student who plays basketball and baseball presents with a history of left shoulder pain, restricted range of motion and occasional numbness. Conservative treatment provides only temporary relief. When he's diagnosed with posterior glenohumeral instability, shoulder arthroscopy is recommended.
Posted 08 Sep 2014