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In NYU Langone Orthopaedics Journal Watch, orthopaedic surgeons from NYU Langone Medical Center highlight significant studies in their subspecialty areas and provide commentary on the clinical relevance of this research to everyday practice.

Journal Watch is a collaboration of the International Congress for Joint Reconstruction and the Department of Orthopaedics at NYU Langone Medical Center, with content developed exclusively for ICJR.net.

Why Do Some Recreational Runners Develop Overuse Injuries?

- Posted 15 Oct 2018
Messier et al performed a 2-year, prospective longitudinal observational study to examine risk factors differentiating uninjured recreational runners from those with a diagnosed overuse running injury. They identified 300 recreational runners who were: Between 18 and 60 years old Running a minimum of 5 miles per week Injury-free for the previous 6 months, with their…

Can CAS Improve Outcomes in Knee Replacement?

- Posted 17 Sep 2018
In this article, Petursson et al present 2-year follow-up data on 167 patients who were randomly assigned to either a computer-assisted surgery (CAS) total knee replacement (TKR) or conventionally instrumented TKR. The primary outcome measured was the minimum important change difference (MICD) in the Knee Injury and Osteoarthritis Outcome Score (KOOS) 42-item, self-administered questionnaire, with…

What Is the Episode-of-Care Cost for a Distal Radius Fracture?

- Posted 13 Aug 2018
In this article, Huetteman et al examined a national dataset to understand the cost of care for surgical treatment of a distal radius fracture (DRF), with the goal of developing episode-of-care scenarios that could be used as the basis for DRF bundled payment models. To compile the cost information, they looked at insurance claims from…

Is the Radiation Level a Concern During Fixation of Pediatric SCH Fractures?

- Posted 16 Jul 2018
In the pediatric population, supracondylar humerus (SCH) fracture is one of the most common elbow fractures requiring operative intervention. Patients with displaced SCH fractures undergo closed or open reduction and percutaneous pinning in the operating room with the use of fluoroscopy. Much attention has been focused on the amount of the radiation used intraoperatively due…

Fixing the Syndesmosis: Suture Button Versus Screws

- Posted 18 Jun 2018
Syndesmotic injuries occur in 10% to 13% of ankle fractures. As one of the primary stabilizers of the tibiofibular relationship, anatomic fixation of the syndesmosis is critical for ankle mortise congruity. The surgeon has a myriad of options for stabilizing the injured syndesmosis. Historically, stabilization meant the use of screws of various permutations, including quadricortical…

Should Surgeons Debride Chondral Lesions Found During Arthroscopic Partial Meniscectomy?

- Posted 21 May 2018
When performing an arthroscopic partial meniscectomy, the surgeon may identify unstable chondral lesions. Addressing these lesions with debridement is common. However, the impact of debridement plus partial meniscectomy versus partial meniscectomy alone on the patient’s postoperative functional status has not been rigorously studied. In this randomized controlled trial by Bisson et al, 161 patients undergoing…

Comparing Costs and Complications Associated with Primary versus Conversion THA

- Posted 23 Apr 2018
Several studies have reported an increased rate of perioperative complications associated with conversion total hip arthroplasty (THA) compared with primary THA. However, the current literature lacks robust data on cost differences associated with conversion versus primary THA. In the current healthcare economic climate, close attention must be paid to patient outcomes, complications, and costs of…

Treatment Recommendations for Chondrosarcomas of the Pelvis

- Posted 26 Mar 2018
and Clinical Relevance Chondrosarcomas typically present in the fifth through eighth decades of life, with a slight male predominance. They are most commonly found in flat bones such as the pelvis or scapula. Pelvic chondrosarcomas can also involve the proximal femur. Approximately 85% of chondrosarcomas are low grade, with a risk of developing into high…

Vertebral Body Stapling: A Novel Treatment of Moderate Idiopathic Scoliosis

- Posted 19 Feb 2018
The current management of moderate adolescent idiopathic scoliosis (AIS) is conservative and includes observation and thoracolumbosacral orthosis (TLSO) bracing. However, this method is not completely efficacious and requires a less-invasive next step in management to prevent progression of the deformity to the point of requiring spinal fusion surgery. Vertebral body stapling (VBS) is a relatively…

Why Do Some RTSA Patients Have Poor Outcomes?

- Posted 22 Jan 2018
Jeon and Rhee, from the College of Medicine, Kyung Hee University, Seoul, Republic of Korea, conducted aretrospective chart review of 76 patients who underwent primary reverse total shoulder arthroplasty (RTSA) using the reverse-type Aequalis prosthesis (Tornier; Montbonnot, France) to treat the following conditions: Cuff tear arthropathy Osteoarthritis Rheumatoid arthritis Post-traumatic arthritis Posti-infectious arthritis Proximal humerus…

More Support for Non-Operative Treatment of Achilles Tendon Rupture

- Posted 09 Jan 2018
Lim et al report on 200 patients who were treated for an acute Achilles tendon rupture with an identical functional bracing protocol, regardless of whether surgical repair was performed, at their institution over a 10 year period. Although indications for surgical repair depended on multiple factors including age, activity level, comorbidities, and surgeon preference, relative…

Examining the Link Between Concussion and Abnormal Menstruation

- Posted 18 Dec 2017
In a prospective cohort study, adolescent and young female patients diagnosed with a sport-related concussion had an increased risk of developing abnormal menstrual patterns compared with those diagnosed with a non-head sport-related orthopaedic injury. The researchers enrolled patients between ages 12 and 21 who presented to a concussion or sports medicine clinic within 30 days…

Patient Selection in Outpatient Total Joint Arthroplasty

- Posted 04 Dec 2017
and Clinical Relevance Traditionally, total joint arthroplasty (TJA) patients were monitored in a hospital setting to assess for acute complications, deliver pain control, and supervise physical therapy. Recently, advances in multidisciplinary care coordination, perioperative protocols, and careful patient selection have introduced the option for outpatient TJA. [1-3] Surgeons considering this model expect to benefit from…

When Can Patients Safely Drive after Surgery for Distal Radius Fractures?

- Posted 27 Nov 2017
A major concern for patients following distal radius fracture fixation is when they can resume driving. This decision has medical, legal, and safety considerations, but there are no evidence-based guidelines to assist the surgeon. Prior publications have examined functional ability to drive on a simulated course using different types of casts, but no studies had…

Comparing Methods for Correcting LLD in Pediatric Patients

- Posted 13 Nov 2017
Orthopaedic surgeons have 2 options for epiphysiodesis when treating limb length discrepancies (LLD): permanent percutaneous epiphysiodesis or temporary use of an 8-plate construct. Few studies have compared outcomes of these methods. Using long-leg standing radiographs and scanograms as their outcome measures, Bayhan et al have now added to the scant literature on this topic with…

Orthopaedic Trauma Patients and the Opioid Epidemic

- Posted 22 Oct 2017
Opioid-based analgesics are the most commonly prescribed drugs for orthopaedic surgery patients despite their association with poor long-term postoperative outcomes and well-known risk for abuse, addiction, and overdose. In a retrospective study, Ruder et al sought to determine opioid-prescribing practices in the orthopaedic trauma population at a large Level 1 trauma center over a 1-month…

PRP Injections May Be an Effective Treatment for Early Knee OA

- Posted 06 Oct 2017
The authors of this article compared the efficacy of leukocyte-poor platelet-rich plasma (PRP) injections with that of hyaluronic acid (HA) injections for the treatment of unilateral knee osteoarthritis (OA). Their double-blinded, prospective, randomized controlled trial included 111 patients, 49 randomized to receive PRP injections and 50 randomized to receive HA injections. Outcome measures, including WOMAC…

Comparing the Risk of Early Failure in THA by Surgical Approach

- Posted 24 Sep 2017
The direct anterior approach for total hip arthroplasty (THA) has gained popularity in recent years, with proposed benefits of quicker recovery and return to activity and less postoperative pain. The current literature, however, is inconclusive on the rates of intraoperative and early postoperative complications compared with other routinely used approaches for THA. The authors of…

A Solution for Reducing Tumor Size in Giant Cell Tumor of the Bone

- Posted 11 Sep 2017
Giant cell tumor of the bone (GCTB) is a primary bone lesion that is locally aggressive and rarely metastasizes. Historically, it has been treated with surgery. This is especially true of tumors in the meta-epiphyseal region of long bones, where surgical excision and curettage with local adjuvants has proven to be successful. Depending on the…

Single-Stage Revision in Shoulder Arthroplasty Patients Positive for Propionibacterium

- Posted 20 Mar 2017
In this retrospective case review, Hsu et al sought to evaluate the differences in clinical outcomes in patients with and without 2 or more positive cultures for Propionibacterium who received antibiotic therapy immediately following single-stage revision shoulder arthroplasty. Specifically, the authors identified patients of a single surgeon who fit the following inclusion criteria: Underwent revision…

A Viable Option for Treating Multilevel Cervical Degenerative Disc Disease

- Posted 06 Mar 2017
In this prospective, multicenter, randomized controlled clinical trial, the authors followed 330 patients who had undergone 1 of 2 surgical procedures for multilevel cervical degenerative disc disease Total disc replacement (TDR), 225 patients Anterior cervical discectomy and fusion (ACDF), 105 patients Patients were treated at 2 contiguous levels from C3 to C7. At 7-year follow-up,…

Are There Gender Differences in Outcomes of Surgery for Chronic Ankle Instability?

- Posted 16 Jan 2017
Xu et al retrospectively reviewed the records of 155 patients (94 males, 61 females) who underwent a modified Brostrum procedure for chronic lateral ankle instability. The procedure involved primarily repairing the anterior talofibular and calcaneofibular ligaments with the Gould modification of reinforcing the repair with the inferior extensor retinaculum. The authors hypothesized that clinical and…

Evaluating Outcomes of Compartment Release for CECS

- Posted 19 Dec 2016
Beck et al performed a retrospective review of adolescent patients who underwent compartment release for chronic exertional compartment syndrome (CECS) in an effort to describe the characteristics and surgical outcomes of this patient population.    The researchers identified 155 patients (286 legs) with a mean age of 16.4 years at presentation in whom compartment release was…

Does Quantity Equal Quality? The Volume-Outcome Relationship in TKA in the Age of the Bundle

- Posted 21 Nov 2016
Prevailing wisdom suggests that “high-volume” total knee arthroplasty (TKA) surgeons and surgical centers achieve superior clinical outcomes for their patients with fewer complications.However, the definition of “high volume” is variable in previous literature, and has been defined as low as more than 6 cases per year to more than 70 cases per year.This study by…

Identifying Hand Surgery Patients At Risk for Prolonged Opioid Use

- Posted 24 Oct 2016
The authors studied insurance claims from the Truven MarketScan databases to identify opioid-naïve adult patients who underwent an elective or trauma-related hand surgery procedure between 2010 and 2012 (N = 77,573 patients). All patients had a single Current Procedural Terminology code for an elective or trauma-related hand surgery procedure between January 1, 2010 and December 31,…

Is VDRO Alone Appropriate Treatment for Hip Dysplasia in Cerebral Palsy?

- Posted 19 Sep 2016
Chang et al investigated acetabular remodeling after isolated proximal femoral varus derotational shortening osteotomy (VDRO) and factors predictive of remodeling in children with cerebral palsy (CP), as well as acetabular development in children without CP. This retrospective study included a cohort of 100 consecutive patients who underwent VDRO without a pelvic osteotomy procedure. Indications for…

Weight-Bearing Following ORIF of Unstable Ankle Fractures

- Posted 06 Aug 2016
Ankle fractures are  common orthopaedic injuries and account for approximately 13% of all fractures. Current dogma dictates postoperative immobilization and non-weight-bearing for 6 weeks. This has been shown to lead to joint stiffness, muscle atrophy, and inconvenience for the patient. The goal of the study by Dehghan et al was to compare 2 postoperative rehabilitation…

Are Corticosteroid Injections Too Risky for Knee Arthroscopy Patients?

- Posted 18 Jul 2016
The authors of this article investigated the safety of utilizing intraoperative corticosteroid injections during knee arthroscopy. The retrospective study examines a cohort of patients from a national Medicare insurance database who underwent knee arthroscopy, with or without a corticosteroid injection, from 2005 to 2012. The researchers identified 2,866 patients who underwent knee arthroscopic procedures and…

The Link Between Hip Injections and PJI after THA

- Posted 20 Jun 2016
Intraarticular hip injections are often done for diagnostic or therapeutic reasons in patients who are candidates for total hip arthroplasty (THA). Current literature is conflicting on the impact of these injections on infection rates following THA. In this study, Werner et al sought to investigate the rate of postoperative periprosthetic joint infections (PJI) in patients…

Evaluating Fracture Risk in Metastatic Femoral Lesions

- Posted 18 May 2016
A recently published study demonstrated that CT-based structural rigidity analysis is superior to the traditional Mirels score in predicting which patients are at greatest risk for pathologic fracture. Author Timothy B. Rapp, MD Article Damron TA, Nazarian A, Entezari V, et al. CT-based structural rigidity analysis is more accurate than Mirels scoring for fracture prediction…

Not All Lumbar Stenosis Patients Are Candidates for Surgery

- Posted 27 Apr 2016
This study was a retrospective subgroup analysis of the Spine Patient Outcomes Research Trial (SPORT) lumbar spinal stenosis arm. Baseline characteristics were analyzed for lumbar spinal stenosis patients who underwent reoperation versus those who did not undergo reoperation in an effort to elucidate risk factors for reoperation. At 8-year follow-up, the reoperation rate of the…

Wound Irrigation for Open Fractures

- Posted 13 Apr 2016
During the 2015 Annual Meeting of the Orthopaedic Trauma Association (OTA), lead author Dr. Mohit Bhandari and his colleagues released the long-awaited results of the Fluid Lavage of Open Wounds (FLOW) trial, simultaneously presenting the results during a keynote address at the meeting and launching the publication online. The goal of this prospective, randomized controlled…

Investigating a Novel Biologic to Enhance Rotator Cuff Repair

- Posted 22 Mar 2016
In this prospective, randomized, controlled study, Zumstein et al compared arthroscopic double-row rotator cuff repair with and without leucocyte- and platelet-rich fibrin (L-PRF) at a mean 14 months of follow-up (range, 12-25 months): 17 patients received arthroscopic rotator cuff repair with L-PRF locally applied to the repair site (L-PRF+ group) 18 patients received arthroscopic rotator…

Lower Risk of Death with an Ankle Fracture than with a Hip Fracture

- Posted 17 Feb 2016
The 2008 Medicare Part A database was retrospectively reviewed for patients admitted for an ankle fracture, a hip fracture, or another diagnosis. The 1-year mortality rate was analyzed, taking into account patient age and pre-exisiting comorbidity. Morbidity was measured by length of stay, discharge disposition, readmissions, and medical complications. The authors included only patients who…

The Value of Knee Injury Prevention Programs

- Posted 18 Jan 2016
In a systemic review and meta-analysis of 9 high-quality randomized controlled trials (RCT), implementation anterior cruciate ligament (ACL) and knee injury prevention programs for soccer players were found to significantly reduce the risk of knee injury overall. However, reduction of the risk of ACL injuries was not statistically significant. The researchers conducted a systemic search…

A Surgeon’s Transition from Posterior to Direct Anterior Approach

- Posted 21 Dec 2015
This study is a retrospective review from a single surgeon comparing his results with a switch from the posterior approach (PA) to the direct anterior approach (DAA) for total hip arthroplasty using a fracture table and intraoperative fluoroscopy. The surgeon compared complication rate, acetabular component position including both cup anteversion and inclination, and femoral head…

Outcomes of PIP Joint Arthroplasty

- Posted 16 Nov 2015
The authors report on the outcomes and complications associated with revision proximalinterphalangeal (PIP) joint arthroplasty. Patient evaluation was performed by uniformly examining the electronic medical records and total joints registry to collect: Patient’s demographic Comorbidities Operative indications Postoperative outcomes Complications Joint survival They analyzed outcomes of 49 patients who underwent 75 consecutive revision PIP joint…

Does Scapular Stabilization Benefit Children with Obstetric Brachial Plexus Palsy?

- Posted 19 Oct 2015
The authors of this article sought to determine whether scapular stabilization in patients with obstetric brachial plexus paralysis truly restores anatomic position and enhances shoulder function. The paper is a retrospective chart review from 1979 to 2007. Sixty-eight patients (41 female, 27 male) were included in the study. Of those patients, 38 had global paralysis,…

CT-based Classification System Has Prognostic Value for Calcaneal Fractures

- Posted 23 Sep 2015
In 1992, Sanders et al set forth a standard with the advent and use of a prognostic classification system based on computed tomography (CT). The original paper highlighted a systematic fracture reduction protocol with restoration of the posterior facet, followed by definitive fixation of the calcaneal body. While there have been those who have questioned…

Adding Epi to Irrigation Fluid May Help Visualization in Shoulder Arthroscopy

- Posted 17 Aug 2015
The authors of this article sought to determine whether the addition of epinephrine to arthroscopy fluid improved visualization during arthroscopy of the shoulder. The study is double-blinded, prospective, randomized controlled trial that included 83 shoulder arthroscopies performed with or without 1 mL of 1:1000 epinephrine added to each 3 L bag of lactated Ringers used…

Which Patients Are at Greatest Risk for Readmission after THA?

- Posted 20 Jul 2015
Much of the current literature regarding rates and risk factors for readmission following total joint arthroplasty is based on single-center studies, which limits application to larger populations. In this study, Paxton et al sought to investigate rates and risks factors for readmission in a large, multi-center health care system. Three important questions were posed: What…

Diluted Epinephrine Injection Helps Reduce Blood Loss in Primary TKA

- Posted 19 Jun 2015
In a double-blind, randomized controlled trial, tranexamic acid plus diluted-epinephrine was shown to reduce blood loss significantly more than tranexamic acid alone. The researchers randomly assigned 100 consecutive patients undergoing primary total knee replacement to receive either intra-articular tranexamic acid plus diluted-epinephrine or tranexamic acid alone. An injection was given intraoperatively after closure of the…

Study Identifies Risk Factors for 30-day Readmission in Older Hip Fracture Patients

- Posted 19 Jun 2015
A 10% readmission rate within the first 30 days was reported in a study of a national database of older hip fracture surgery patients. Three modifiable risk factors for readmission were identified: Preoperative time to surgery Anesthesia type Implant selection This study utilized the American College of Surgeons’ National Surgical Quality Improvement Program database, which…

Reducing PJI Can Have a Big Impact on Costs Associated with THA

- Posted 19 Jun 2015
Using the Markov model, researchers investigated the effect of reducing short- and long-term complications of total hip arthroplasty on net monetary benefit, which was defined as a combination of reduction in cost and improvement in quality adjusted life years (QALYs). The Markov model is a method of predicting long-term outcomes of various interventions based on…

3D Imaging and Templating May Improve Glenoid Positoning in Anatomic TSA

- Posted 19 Jun 2015
In this prospective, randomized, controlled study, Ianotti et al compared glenoid implant positioning in 3 patient cohorts: 25 patients who underwent anatomic total shoulder arthroplasty (TSA) with 3D CT imaging and templating 21 patients who underwent anatomic TSA with 3D CT imaging and templating plus patient-specific instrumentation (PSI) to assist with component positioning 17 patients…

Presoaking ACL Grafts with a Vancomycin Solution May Significantly Decrease Infection Rates

- Posted 19 Jun 2015
The authors of this article sought to determine whether the infection rate following anterior cruciate ligament (ACL) reconstruction could be decreased by soaking the graft in an antibiotic solution. The article is a retrospective, case-control study of all ACL reconstructions performed in 2 university hospitals over an 8-year period. The study included only autograft reconstructions,…

Classic Article: A Treatment Option for SCFE with Good Clinical, Radiographic Outcomes

- Posted 18 Jun 2015
The authors of this article sought to evaluate the outcomes of a gentle reduction maneuver with fixation for unstable acute slipped capital femoral epiphysis (SCFE). This retrospective, cohort study of acute unstable SCFE at a large tertiary care pediatric hospital in Stuttgart, Germany, included patients who underwent operative reduction and Kirschner wire fixation over a…

Does PJI after TJA Put Patients At Risk for Another PJI after Replacement of a Different Joint?

- Posted 18 Jun 2015
In this multi-center, retrospective cohort study, the authors found an increased rate of periprosthetic joint infection (PJI) in patients undergoing primary total joint arthroplasty after being successfully treated for PJI following replacement of a different joint. The research group from 4 academic institutions did a 1-to-1 match of patients who had no history of infection…

Immediate Weight-bearing in Achilles Rupture Treatment Does Not Harm Clinical Outcomes

- Posted 18 Jun 2015
A blinded, randomized controlled trial between immediate and delayed weight-bearing for non-operative dynamic treatment for acute Achilles tendon ruptures showed no difference in heel-rise work, health quality of life, and re-rupture rates. All patients were treated with the same protocol, except that one group began with immediate weight-bearing and the other group delayed weight-bearing until…

Octogenarians Can Benefit from Surgery for Lumbar Stenosis and Degenerative Spondylolisthesis

- Posted 18 Jun 2015
Operative treatment of lumbar stenosis and degenerative spondylolisthesis in patients more than 80 years old offered significant benefits with no increased risk of complications or mortality compared with younger patients. The authors of this study performed a sub-group analysis of the Spine Patient Outcomes Research Trial (SPORT) data, the largest randomized control trial that has…

In Advanced Kienbock Disease, SCA Improves Grip Strength at the Expense of Wrist ROM

- Posted 18 Jun 2015
The authors report on outcome measures from a retrospective review of 27 patients with at least 1 year of clinical follow-up who underwent a scaphocapitate arthrodesis (SCA) for the treatment of advanced stages of Kienböck disease (stages III-IV). Outcome measures included: Preoperative and postoperative pain Range of motion Grip strength Complications Additional surgery Radiographic changes…

A Strict Rest Period May Not Be the Right Treatment for Every Adolescent Concussion Patient

- Posted 18 Jun 2015
In a randomized controlled study of adolescents diagnosed with concussion, strict rest immediately after a concussion did not improve neurocognitive and balance tests, and conversely resulted in more reported post-concussive symptoms (PCSS) and slower symptom resolution. The researchers enrolled adolescents between 11 and 22 years old who presented to the emergency room within 24 hours…
  • SECTION EDITOR.

    CONTRIBUTORS

    ADULT RECONSTRUCTIVE SURGERY

    SPORTS MEDICINE – ORTHOPAEDIC SURGERY

    SPORTS MEDICINE – PRIMARY CARE

    SHOULDER AND ELBOW SURGERY

    TRAUMA AND FRACTURE SURGERY

    FOOT AND ANKLE SURGERY

    HAND SURGERY

    SPINE SURGERY

    ORTHOPAEDIC ONCOLOGY

    PEDIATRIC ORTHOPAEDIC SURGERY