Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Published in
Clinical Orthopaedics and Related Research®
Volume 470 | Issue 4 | Apr, 2012

Do Patients With Traumatic Recurrent Anterior Shoulder Instability Have Generalized Joint Laxity?

Maximiliano Ranalletta MD, Santiago Bongiovanni MD, Federico Suarez MD, Juan Manuel Lopez Ovenza MD, Gaston Maignon MD

A number of studies suggest a relationship between generalized joint laxity (GJL) and increased risk of some musculoskeletal injuries. However, there are conflicting data on the association between GJL and traumatic recurrent shoulder instability (RSI).

Arthroscopically Determined Degree of Injury After Shoulder Dislocation Relates to Recurrence Rate

Vicente Gutierrez MD, Juan Edo Monckeberg MD, PhD, Miguel Pinedo MD, Fernando Radice MD

The glenohumeral joint is the most mobile articulation in the body and the most commonly dislocated diarthrodial joint with peaks in the incidence of dislocation occurring during the second and sixth decades. Age at the time of the initial dislocation is inversely related to the recurrence rate. Traumatic anterior instability is often associated with intraarticular injuries. The frequency of injuries may increase with dislocation or subluxation episodes.

Is Selective Arthroscopic Revision Beneficial for Treating Recurrent Anterior Shoulder Instability?

Guillermo Arce MD, Francisco Arcuri MD, Diego Ferro MD, Enrique Pereira MD

Surgeons have traditionally treated recurrent shoulder dislocation by open methods. With the advent of arthroscopic repair techniques some surgeons reported higher recurrence rates than with open methods but some of those reports included patients with a variety of problems, including bone loss and those continuing in contact sports. It is unclear whether recurrence rates would be higher in patients without bone loss and those willing to forego contact sports.

Arthroscopic Scapholunate Joint Reduction. Is an Effective Treatment for Irreparable Scapholunate Ligament Tears?

Martín Caloia MD, Hugo Caloia MD, Enrique Pereira MD

Irreparable tears to the scapholunate (SL) interosseous ligament area are common causes of mechanical wrist pain and yet treatment of this condition remains challenging. The reduction association of the SL joint (RASL) technique alleviates pain while preserving wrist function by creating a fibrous pseudarthrosis stabilized by a cannulated screw placed through the SL joint. Although arthroscopic RASL (ARASL) is a minimally invasive alternative to the open procedure, its effectiveness in controlling pain and preserving wrist function has not been established.

Spontaneous Healing in Complete ACL Ruptures: A Clinical and MRI Study

Matias Costa-Paz MD, Miguel Angel Ayerza MD, Ignacio Tanoira MD, Juan Astoul MD, Domingo Luis Muscolo MD

Most authors believe the ACL does not spontaneously heal after a complete rupture. Although several studies have reported spontaneous healing of torn ACLs, it is difficult to determine its healing potential and whether patients will be able to return to sports activities.

Can Wedge Osteotomy Correct Depression of the Lateral Tibial Plateau Mimicking Posterolateral Rotatory Knee Instability?

Miguel A. Ayerza MD, Federico Suarez MD, Matias Costa-Paz MD, D. Luis Muscolo MD

The literature suggests rotatory knee instability (pseudolaxity) can be associated with depressions of the lateral tibial plateau in patients despite an intact arcuate ligament complex. Correcting this bone deformity by an open-wedge osteotomy of the lateral tibia plateau, elevating the depressed bone may restore knee stability.

Can Arthroscopically Assisted Treatment of Chronic Patellar Tendinopathy Reduce Pain and Restore Function?

Jorge Santander MD, Eduardo Zarba MD, Horacio Iraporda MD, Sebastián Puleo MD

Patellar tendinopathy is a common source of pain in athletes, especially those involved in sports with a high incidence of jumping and cutting. Changes in training programs and exercises based on eccentric quadriceps contractions often relieve patients’ symptoms. For athletes unresponsive to this treatment, some authors suggest open and arthroscopic procedures débriding either the tendon alone, or the tendon and bone.

Is Percutaneous Repair Better Than Open Repair in Acute Achilles Tendon Rupture?

Hugo Henríquez MD, Roberto Muñoz MD, Giovanni Carcuro MD, Christian Bastías MD

Open repair of Achilles tendon rupture has been associated with higher levels of wound complications than those associated with percutaneous repair. However, some studies suggest there are higher rerupture rates and sural nerve injuries with percutaneous repair.

The Use of Three Strategies to Improve Quality of Care at a National Level

Jeannette P. P. So MSc, James G. Wright MD, MPH, FRCSC

Improving the quality of care is essential and a priority for patients, surgeons, and healthcare providers. Strategies to improve quality have been proposed at the national level either through accreditation standards or through national payment schemes; however, their effectiveness in improving quality is controversial.

Public Reporting of Cost and Quality Information in Orthopaedics

Youssra Marjoua MD, MPP, Craig A. Butler MD, MBA, Kevin J. Bozic MD, MBA

Public reporting of patient health outcomes offers the potential to incentivize quality improvement by fostering increased accountability among providers. Voluntary reporting of risk-adjusted outcomes in cardiac surgery, for example, is viewed as a “watershed event” in healthcare accountability. However, public reporting of outcomes, cost, and quality information in orthopaedic surgery remains limited by comparison, attributable in part to the lack of standard assessment methods and metrics, provider fear of inadequate adjustment of health outcomes for patient characteristics (risk adjustment), and historically weak market demand for this type of information.

Using Financial Incentives to Improve Value in Orthopaedics

David Lansky PhD, Benedict U. Nwachukwu BA, Kevin J. Bozic MD, MBA

A variety of reforms to traditional approaches to provider payment and benefit design are being implemented in the United States. There is increasing interest in applying these financial incentives to orthopaedics, although it is unclear whether and to what extent they have been implemented and whether they increase quality or reduce costs.

Care Experience-based Methodologies: Performance Improvement Roadmap to Value-driven Health Care

Anthony M. DiGioia MD, Pamela K. Greenhouse MBA

The literature contains proposals for creating value by creating exceptional patient experiences rather than simply improving services. However, few articles describe replicable applications focused on the patient experience.

Shared Decision-making in Orthopaedic Surgery

James Slover MD, MS, Jennifer Shue BS, Karl Koenig MD, MS

The process of clinical decision-making and the patient-physician relationship continue to evolve. Increasing patient involvement in clinical decision-making is embodied in the concept of “shared decision-making” (SDM), in which the patient and physician share responsibility in the clinical decision-making process. Various patients’ decision aid tools have been developed to enhance this process.

Value-based Purchasing of Medical Devices

William T. Obremskey MD, MPH, Teresa Dail RN, BSN, A. Alex Jahangir MD

Health care in the United States is known for its continued innovation and production of new devices and techniques. While the intention of these devices is to improve the delivery and outcome of patient care, they do not always achieve this goal. As new technologies enter the market, hospitals and physicians must determine which of these new devices to incorporate into practice, and it is important these devices bring value to patient care. We provide a model of a physician-engaged process to decrease cost and increase review of physician preference items.

Measuring the Value of Total Hip and Knee Arthroplasty: Considering Costs Over the Continuum of Care

Deborah A. Marshall PhD, Tracy Wasylak MSc, CHE, Hoa Khong MD, Robyn D. Parker BSc, Peter D. Faris PhD, Cy Frank MD FRCSC

Controlling escalating costs of hip (THA) and knee arthroplasty (TKA) without compromising quality of care has created the need for innovative system reorganization to inform sustainable solutions.

Does Age or Bilateral Disease Influence the Value of Hip Arthroplasty?

Bryan M. Lawless MD, Meridith Greene BA, James Slover MD, MS, Young-Min Kwon MD, PhD, Henrik Malchau MD, PhD

Measuring value in medicine is an increasingly important issue as healthcare spending continues to rise and cost containment becomes even more important. However, value assessments can be affected by patient factors and comorbidities.

Is Hip Arthroscopy Cost-effective for Femoroacetabular Impingement?

David W. Shearer MD, MPH, Jonathan Kramer BS, Kevin J. Bozic MD, MBA, Brian T. Feeley MD

The impact of hip arthroscopy on health-related quality of life (HRQoL) among younger patients with symptomatic femoroacetabular impingement (FAI) is unknown, but with increasing recognition of the condition there is likely to be increasing demand for arthroscopy.

Drivers of Surgery for the Degenerative Hip, Knee, and Spine: A Systematic Review

S. Samuel Bederman MD, PhD, FRCSC, Charles D. Rosen MD, Nitin N. Bhatia MD, FACS, P. Douglas Kiester MD, Ranjan Gupta MD

Surgical treatment for degenerative conditions of the hip, knee, and spine has an impact on overall healthcare spending. Surgical rates have increased dramatically and considerable regional variation has been observed. The reasons behind these increasing rates and variation across regions have not been well elucidated.

Value-based Care in the Management of Spinal Disorders: A Systematic Review of Cost-utility Analysis

Santoshi S. Indrakanti BS, Michael H. Weber MD, Steven K. Takemoto PhD, Serena S. Hu MD, David Polly MD, Sigurd H. Berven MD

Spinal disorders are a major cause of disability and compromise in health-related quality of life. The direct and indirect costs of treating spinal disorders are estimated at more than $100 billion per year. With limited resources, the cost-utility of interventions is important for allocating resources.

Quality Indicators in Pediatric Orthopaedic Surgery: A Systematic Review

Angeliki Kennedy MSc, Christina Bakir MD, Carmen A. Brauer MD, MSc (Health Econ), FRCSC

The ability to measure health system quality has become a priority for governments, the private sector, and the public. Quality indicators (QIs) refer to clear, measurable items related to outcomes. The use of QIs can initiate local quality improvement and track changes in quality over time as interventions are implemented.

The Natural History of Idiopathic Frozen Shoulder: A 2- to 27-year Followup Study

Heidi Vastamäki MD, Jyrki Kettunen PT, PhD, Martti Vastamäki MD, PhD

The natural history of spontaneous idiopathic frozen shoulder is controversial. Many studies claim that complete resolution is not inevitable. Based on the 40-year clinical experience of the senior author, we believed most patients with idiopathic frozen shoulder might have a higher rate of resolution than earlier thought.

Convex Instrumented Hemiepiphysiodesis with Concave Distraction: A Preliminary Report

Ahmet Alanay MD, Ozgur Dede MD, Muharrem Yazici MD

The convex growth arrest (CGA) procedure has been well accepted for treatment of congenital scoliosis as it is a simpler procedure with successful results. However, unpredictability of curve behavior, slow and usually inadequate correction, and necessity of anterior surgery for completeness of the epiphysiodesis are its shortcomings.

Can a Periarticular Levobupivacaine Injection Reduce Postoperative Opiate Consumption During Primary Hip Arthroplasty?

Terence P. Murphy MCh, Damien P. Byrne PhD, Paul Curtin MCh, Joseph F. Baker MCh, Kevin J. Mulhall FRCS (Tr and Orth)

Several reports have confirmed the ability of intraoperative periarticular injections to control pain after THA. However, these studies used differing combinations of analgesic agents and the contribution of each, including the local anesthetic agent, is uncertain. Understanding the independent effects of the various agents could assist in improved pain management after surgery.

Is the Dislocation Rate Higher after Bipolar Hemiarthroplasty in Patients with Neuromuscular Diseases?

Kuen Tak Suh MD, Dae Woong Kim MD, Hong Seok Lee MD, Yoon Jae Seong MD, Jung Sub Lee MD

Patients with neuromuscular disease reportedly have a higher incidence of postoperative dislocation after bipolar hemiarthroplasty. Although the literature has focused on a high prevalence of preoperative neurologic conditions in patients who had dislocations after bipolar hemiarthroplasties, the relative incidence of dislocation in patients with neuromuscular disease and without is unclear.

Aberrant Femoral Torsion Presenting with Frog-leg Squatting Mimicking Gluteal Muscle Contracture

Chia-Ling Chiang MD, Meng-Yuan Tsai MD, Wei-Ning Chang MD, Clement Kuen-Huang Chen MD

Patients with frog-leg squatting have restricted internal rotation and adduction of the affected hips during sitting or squatting. In the surgical literature, the cause generally has been presumed to arise from and be pathognomonic for gluteal muscle contracture. However, we have encountered patients with frog-leg squatting but without gluteal muscle contracture.

Does Total Knee Arthroplasty Change Frontal Plane Knee Biomechanics During Gait?

Karl F. Orishimo MS, Ian J. Kremenic MEng, Ajit J. Deshmukh MD, Stephen J. Nicholas MD, Jose A. Rodriguez MD

Dynamic knee varus angle and adduction moments have been reported to be reduced after TKA. However, it is unclear whether this reduction is maintained long term.

Is the Medial Wall of the Intercondylar Notch Useful for Tibial Rotational Reference in Unicompartmental Knee Arthroplasty?

Shinya Kawahara MD, Shuichi Matsuda MD, PhD, Ken Okazaki MD, PhD, Yasutaka Tashiro MD, PhD, Yukihide Iwamoto MD, PhD

It is difficult to implant components in the correct rotational position in the narrow operating field in a unicompartmental knee arthroplasty. Although no rotational reference has been confirmed for unicompartmental knee arthroplasty, the AP axis of the tibia may serve as a reference for unicompartmental knee arthroplasty and TKA. However, it is difficult to identify the AP axis during unicompartmental knee arthroplasty, especially with the tibia first-cut technique.

Are African American Patients More Likely to Receive a Total Knee Arthroplasty in a Low-quality Hospital?

Xueya Cai PhD, Peter Cram MD, MBA, Mary Vaughan-Sarrazin PhD

Total joint arthroplasty is widely performed in patients of all races with severe osteoarthritis. Prior studies have reported that African American patients tend to receive total joint arthroplasties in low-volume hospitals compared with Caucasian patients, suggesting potential racial disparity in the quality of arthroplasty care.

What are Estimated Reimbursements for Lower Extremity Prostheses Capable of Surgical and Nonsurgical Lengthening?

Eric R. Henderson MD, Andrew M. Pepper BS, G. Douglas Letson MD

Growing prostheses accommodate skeletally immature patients with bone tumors undergoing limb-preserving surgery. Early devices required surgical procedures for lengthening; recent devices lengthen without surgery. Expenses for newer expandable devices that lengthen without surgery are more than for their predecessors but overall reimbursement amounts are not known.

Surgical Technique: Methods for Removing a Compress® Compliant Prestress Implant

Geoffrey D. Abrams MD, Varun K. Gajendran MD, David G. Mohler MD, Raffi S. Avedian MD

The Compress® device uses a unique design using compressive forces to achieve bone ingrowth on the prosthesis. Because of its design, removal of this device may require special techniques to preserve host bone.

Intralesional Excision versus Wide Resection for Giant Cell Tumor Involving the Acetabulum: Which is Better?

Wei Guo MD, PhD, Xin Sun MD, Jie Zang MD, Huayi Qu MD

Because of the anatomic complexity of the pelvis, there is no standard surgical treatment for giant cell tumors (GCTs) of the pelvic bones, especially in the periacetabular region. Treatment options include intralesional curettage with or without adjunctive techniques and wide resection. The best surgical treatment of a pelvic GCT remains controversial.

Femoral Lengthening with Lengthening over a Nail has Fewer Complications than Intramedullary Skeletal Kinetic Distraction

Shahab Mahboubian DO, MPH, Matthew Seah MBChB, Austin T. Fragomen MD, S. Robert Rozbruch MD

Lengthening over a nail and internal lengthening nails have been developed to minimize or eliminate patients’ time wearing a frame during femur lengthening. However it is unclear whether either of these two approaches results in faster times to union or fewer complications over the other.

Case Report: Bone Tumor of the Scapula in a Patient Undergoing Liver Transplantation

Zhen-Qi Ding MD, Hai-Fang Zhang MD, Liang-Qi Kang MD, Mo Sha MD

De novo malignancies are serious complications in the late postoperative period after liver transplantation. The most common de novo tumors are skin malignancies, posttransplantation lymphoproliferative disorder, tumors of the head and neck, and Kaposi’s sarcoma. Such posttransplant de novo malignancies are apparently rarely found in bone.

Reply to Letter to the Editor: Surgical Technique: Medial Column Arthrodesis in Rigid Spastic Planovalgus Feet

Patricia Maria Moraes Barros Fucs MD, PhD, Celso Svartman MD, Rodrigo Montezuma Cezar Assumpção MD, Helder Henzo Yamada MD, Simone Dota Simis MD

Erratum to: A More Reliable Method to Assess Acetabular Component Position

John V. Tiberi MD, Nicholas Pulos MD, Michael Kertzner BS, Thomas P. Schmalzried MD

Erratum to: Complications in Brief: Anterior Cruciate Ligament Reconstruction

Fotios Paul Tjoumakaris MD, Amy L. Herz-Brown MD, Andrea L. Bowers MD, Brian J. Sennett MD, Joseph Bernstein MD

Erratum to: Do Patient-specific Guides Improve Coronal Alignment in Total Knee Arthroplasty?

Ryan M. Nunley MD, Bradley S. Ellison MD, Jinjun Zhu MD, PhD, Erin L. Ruh MS, Stephen M. Howell MD, Robert L. Barrack MD
Back to top