In NYU Langone Orthopedics Journal Watch, orthopaedic surgeons from NYU Langone Health 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 Orthopedics at NYU Langone Health, with content developed exclusively for ICJR.net.
A prospective randomized controlled trial from Canada provides insight into postoperative ulnar nerve function when the ulnar nerve is returned to its in situ position in the cubital tunnel after fixation of a distal humerus fracture versus anterior transposition of the ulnar nerve after fracture fixation.
A prospective study from Ireland reviews the operation, referral reasons, treatment outcomes, cost efficiency, and adverse events associated with a virtual clinic for developmental dysplasia of the hip. This study includes 1002 patients referred to the virtual clinic over the course of 3.5 years.
Excellent long-term outcomes have been reported in patients over age 18 who underwent hip arthroscopy to treat femoroacetabular impingment. What about in patients under age 18? What are the long-term outcomes in active adolescents diagnosed with FAI?
Using data from the Australian Orthopaedic Association National Joint Replacement Registry, researchers evaluated whether implant choice in revision total hip arthroplasty for dislocation can reduce the risk of recurrent dislocations and, subsequently, the need for a second revision surgery.
A recently published study from a single institution evaluates whether this increasingly popular infection prevention strategy reduces periprosthetic joint infections in primary total joint arthroplasty patients without worsening the infectious organism profile.
A cost comparative analysis found that laminectomy and fusion has a significantly higher short-term cost than laminoplasty in patients with spondylotic myelopathy. Should laminoplasty, therefore, be the procedure of choice in appropriately indicated patients?
A recently published review article outlines the various types of viscoelastic cervical disc replacement implants that are intended to better mimic the native anatomy of the cervical spine than first-generation, ball-and-socket implants.
The classification system was developed at Mayo Clinic to improve communication among care team members, facilitate prediction of outcomes based on tumor type, and assist with planning for reconstruction.
In a multicenter randomized controlled trial, researchers reported equivalent outcomes with the use of a stemless and a traditional stemmed humeral implant, both from the same manufacturer.
Early weight-bearing at 2 weeks versus 6 weeks after open reduction and internal fixation of ankle fractures shows significant improvement in general health outcomes without increased complications.
Cast immobilization with prolonged non-weight-bearing has traditionally been used to manage patients with a first-time acute Achilles tendon rupture. Could functional rehab and early weight-bearing in a walking boot provide comparable – or even better – outcomes while allowing patients greater mobility?
Using data from the Australian Orthopaedic Association National Joint Replacement Registry, researchers evaluated whether the surgical approach was associated with differences in early revision rates in primary total hip arthroplasty patients.
Is the vascular anatomy of the proximal femoral epiphysis different in patients with healed slipped upper femoral epiphysis than in patient without this deformity? A recently published paper seeks to answer this question.
In a multicenter study from the UK, researchers compared deep surgical site infections in patients who had incisional negative pressure wound therapy versus patients with a standard dressing following surgery for lower limb fracture due to major trauma.
Medial meniscus root repair leads to significantly less osteoarthritis progression and subsequent total knee arthroplasty compared with non-operative management and partial meniscectomy, according to a recently published study.
A recent study from New Zealand evaluated outcomes of total knee arthroplasty from the standpoint of whether surgeons routinely used computer-assisted surgery or conventional instrumentation for more than 90% of cases.
In a recently published study, researchers identified factors associated with higher amounts of intraoperative blood loss during surgery for metastatic spine tumors and then used the data to develop a model to predict this blood loss.
A recently published study outlines an alternative multimodal pain management pathway that eliminates the need for opioids in patients undergoing elective reverse and anatomic total shoulder arthroplasty.
A recently published retrospective study evaluated early outcomes and complications of the CARTIVA hydrogel synthetic cartilage implant in the treatment of hallux rigidus for patients in the US.
Allowing athletes to participate in a sub-threshold level of aerobic exercise soon after sustaining a sports-related concussion can help reduce the time to recovery, according to a recently published study.
A recently published, award-winning study compared rates of periprosthetic joint infection among patients whose surgeons used the direct anterior approach versus those whose surgeons used other approaches.
A large cohort study supports the recommendation that patients with open tibia fractures should undergo definitive flap coverage within 7 days to reduce the risk of surgical and medical complications.
A study from the UK indicates that the incidence of late-detected developmental dysplasia of the hip hasn’t changed in 50 years. Is it time to implement universal ultrasound in newborns to improve early detection and intervention?
A corticosteroid injection within 6 months of rotator cuff repair puts patients at a significantly increased risk for revision repair, according to a recently published study.
Acetabular cup placement in the functional safe zone, as defined by the combined sagittal index, may be a better indicator of hip stability in total hip arthroplasty patients, according to a recently published study.
A recently published study highlights the growing need for a reproducible, accurate, and broadly applicable method of identifying patients with spinal metastases who are appropriate candidates for surgical intervention.
In a recently published study, Neck Disability Index scores and short-term clinical outcomes were found to be similar among the 3 anterior cervical procedures typically used to manage patients with single-level radiculopathy.
Dr. Timothy Reish and Dr. Hunter Hamilton comment on a recently published study on revision of failed hemiarthroplasty to anatomic total shoulder arthroplasty, making the case that hemiarthroplasty may actually be more beneficial than shoulder replacement as the first surgery in a younger patient population.
A recently published study suggests that many factors long believed to put runners at risk for overuse injury – such as flexibility, lower extremity strength, and weekly mileage – may not actually have anything to do with injury.
A recently published study found statistically significant improvement in some patient-reported outcome measures for computer-assisted versus conventionally instrumented total knee replacement. But is that enough reason for cautious optimism?
Dr. Anthony Sapienza discusses the implications of a recently published study showing wide variation in cost across 4 episode-of-care scenarios, noting that bundled payment models would help to decrease the discrepancies.
A recently published study suggests that in the operating room, the radiation level children are exposed to during surgery for supracondylar humerus fractures is about the same as normal daily background radiation. Dr. Rivka Ihejirika and Dr. Alice Chu review the study.
Dr. Nicole Stevens and Dr. Philipp Leucht comment on the results of a randomized controlled trial comparing anatomic reduction of the syndesmosis with these 2 methods of fixation.
A recently published study suggests that surgery with wide resection margins is the preferred option for managing conventional primary central chondrosarcoma of the pelvis, regardless of lesion grade.
Maybe not, according to a recently published study that reported no benefit at 1 year for partial meniscecomy plus debridement versus partial meniscectomy alone. And, debridement may even hamper recovery in the short term.
In a study accepted for publication, conversion total hip arthroplasty (THA) was found to be associated with increased costs and more perioperative complications than primary THA. These findings suggest that the MS-DRG for THA should be reclassified to prevent the expense disparity from becoming a barrier to patient care.
Vertebral body stapling is a safe and effective method for treating moderate adolescent idiopathic scoliosis. A recent retrospective study has identified variables that could potentially determine appropriate candidates for this procedure.
A recently published study examines potential risk factors for poor recovery of active anterior elevation after reverse total shoulder arthroplasty. But the most valuable pearls for surgeons may be the identification of specific surgical techniques that were used in the poorly performing patient population.
A recently published study found no significant differences in functional outcome in operative versus non-operative treatment of patients with acute Achilles tendon rupture when surgeons used the same functional bracing protocol for both groups of patients.
A recently published study showed menstrual abnormalities in adolescent and young female patients who had sustained a sport-related concussion – which could have implications for future bone health. But with the study’s strict inclusion criteria, the findings may have limited applicability.
A recently published study recommends a risk stratification scoring system to determine if patients are appropriate candidates for outpatient surgery. What are the pros and cons of this scoring system?
A recently published study sought to answer this question, with researchers putting patients through a series of tests on a closed driving course.
In the right patients, either percutaneous physeal epiphysiodesis or 8-plate epiphysiodesis can effectively treat limb length discrepancy. But according to a recent study, in some cases, percutaneous treatment is preferred.
Dr. Alexander Crespo and Dr. Philipp Leucht comment on a recently published study that quantified discharge prescriptions for opioids in an orthopaedic trauma population and defined which patients were at risk for opioid abuse months after discharge.
A recently published study compared outcomes of platelet-rich plasma injections with those of hyaluronic acid injections. Dr. Mehul Shah reviews the study’s key findings.
A recently published study suggests that the direct anterior approach is overall associated with more early revisions, in particular for early femoral loosening, compared with the lateral or posterior approach. Larger studies are needed to substantiate this study’s conclusions.
A recently published paper asserts that medical therapy with the monoclonal antibody denosumab should be part of a multimodal treatment strategy for complicated giant cell tumor of the bone.
The results of a recently published study suggest that a more-invasive 2-stage revision may not be necessary for patients with a failed shoulder arthroplasty and multiple positive cultures for a Propionibacterium infection.
A recently published randomized controlled trial demonstrates improved neurologic outcomes in patients treated with total disc replacement versus the gold standard of anterior cervical discectomy and fusion.
The authors of a recently published study hypothesized that clinical and radiographic outcomes would be significantly different in male and female patients undergoing a modified Brostrum procedure. Were they right?
A recent study of adolescents who had surgery for chronic exertional compartment syndrome provides insight into the important differences between adolescent and adult patients - including the timing of surgery following presentation - that could improve outcomes in the younger population.
A recent study examined the effect of surgical volume on 90-day complication rates, 90-day mortality rates, and 2-year revision rates among total knee arthroplasty patients operated on in New York state – valuable information to have in the era of bundled payments.
Dr. Anthony Sapienza reviews the findings of a study of more than 77,000 opioid-naïve adult patients who underwent an elective or trauma-related hand surgery procedure. Which patient factors and which procedures were associated with filling an opioid prescription months after surgery?
A new study shows that patient age and level of gross motor function are important factors in the effectiveness of varus derotational shortening osteotomy alone or with concomitant acetabular osteotomy.
The results of a recently published study challenge the status quo on the timing of return to weight-bearing following open reduction and internal fixation of this common orthopaedic injury.
A recently published study of Medicare patients undergoing knee arthroscopy found that those who received an intraoperative corticosteroid injection were at higher risk for infection. Can this finding be generalized to the typical younger, healthier knee arthroscopy patients?
A recently published study suggests that the time period between intraarticular hip injection and total hip arthroplasty influences the possibility that the patient will develop a periprosthetic joint infection after the joint replacement procedure.
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.
A subgroup analysis of the SPORT trial identifies patients who are more likely to have a poor outcome and require reoperation following surgical intervention for a diagnosis of lumbar spinal stenosis.
Results of the elegantly designed, well-powered, multi-national FLOW trial provide insights into the type of irrigant and the pressure that should be used when irrigating and debriding an open fracture wound.
A randomized controlled trial compared healing rates in arthroscopic double-row rotator cuff repair with and without the use of leucocyte- and platelet-rich fibrin.
A newly published study shows that compared with hip fracture, an ankle fracture does not appear to be a sentinel event for older patients.
A systematic review and meta-analysis of RCTs adds to the literature on the usefulness of programs to prevent knee injuries in soccer players, showing that these programs most likely aid in preventing ACL injuries.
This single-surgeon study suggests that when adopting the direct anterior approach, the use of this intraoperative imaging may help diminish errors that can occur during the learning curve.
With advances in implant design and materials, more patients can now undergo proximal interphalangeal arthroplasty for arthritis. But more primary procedures means more revisions.
A retrospective review suggests scapular stabilization procedures can improve range of motion and scapular dimensions. However, the clinical significance of improved scapular dimensions is yet to be determined.
A long-term follow-up study by Sanders et al demonstrates that their classification system can reliably predict outcomes of displaced, intraarticular calcaneal fractures. It also raises important issues to address with further research.
But it is not known if this improved visualization is clinically significant. And the use of epinephrine carries the risk of cardiac events.
A recently published multi-center study provides guidance on modifiable risk factors orthopaedic surgeons can address prior to surgery to reduce the chances of patients being readmitted following total hip arthroplasty.
In this study, patients who received topical tranexamic acid plus diluted epinephrine had a significantly lower total blood loss, hidden blood loss, and transfusion rate than patients who received topical tranexamic acid alone.
And unfortunately, many factors associated with readmission and increased length of stay are outside the healthcare provider’s control.
With the advent of bundled payment models, the importance of finding ways to maximize outcomes while decreasing overall cost is more important than ever before.
This study serves as an encouraging step toward improving results and longevity of anatomic total shoulder arthroplasty in patients with osteoarthritis.
The researchers theorized that the graft would act as a reservoir of the antibiotic, which would elute into the knee over a period of time.
The treatment focuses on a gentle reduction maneuver with the aid of the surgeon’s finger tip plus Kirschner wire fixation in situ crossing the physis.
Surgeons should use caution and thoroughly counsel patients who had a previous infected total joint arthroplasty when considering a subsequent joint replacement procedure.
In addition, patients who were allowed immediate weight-bearing in the first 8 weeks reported a significant health-related quality of life versus those who were on the delayed weight-bearing protocol.
This analysis of data from the SPORT study shows surgery has the potential to significantly improve quality of life for older patients without increased surgical risk.
The results of this study will allow hand surgeons to appropriately counsel patients and guide expectations when a scaphocapitate limited wrist fusion is being considered.