Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Published in
Clinical Orthopaedics and Related Research®
Volume 471 | Issue 5 | May, 2013

Comparative Responsiveness and Minimal Clinically Important Differences for Idiopathic Ulnar Impaction Syndrome

Jae Kwang Kim MD, PhD, Eun Soo Park MD

Patient-reported questionnaires have been widely used to predict symptom severity and functional disability in musculoskeletal disease. Importantly, questionnaires can detect clinical changes in patients; however, this impact has not been determined for ulnar impaction syndrome.

Mid-America Orthopaedic Association Physician in Training Award: Surgical Technique: Pediatric Supracondylar Humerus Fractures: A Technique to Aid Closed Reduction

Mary A. Herzog MD, Shelley M. Oliver MD, James R. Ringler MD, Clifford B. Jones MD, FACS, Debra L. Sietsema PhD

Anatomic reduction of some displaced pediatric supracondylar humerus fractures is not attainable via closed manipulation, thus necessitating open reduction. Open reduction has been associated with increased complications, including elbow stiffness, scarring, iatrogenic neurovascular injury, and longer hospital stays. Using a Schanz pin to aid in closed reduction may decrease the need for conversion to an open procedure, possibly reducing morbidity.

Complications In Brief: Arthroscopic Partial Meniscectomy

Stuart Duncan Kinsella BA, James L. Carey MD Arthroscopic partial meniscectomy can be complicated by excessive resection, damage to articular cartilage, neurovascular injury, persistent drainage from portals, and infection; the procedure can be rendered more difficult, and the outcome less certain, if the surgeon fails to recognize concomitant injuries, malpositions the portals, or misidentifies the components of a meniscus tear. We review the problems that can occur as a result of errors made before, during, and after surgery.

Trends in Use of Total Knee Arthroplasty in Korea From 2001 to 2010

In Jun Koh MD, Tae Kyun Kim MD, Chong Bum Chang MD, Hyung Joon Cho MD, Yong In MD

The use of total knee arthroplasty (TKA) has increased substantially in most Western countries. However, the trends in TKA use and changes in demographic characteristics of patients having TKA in Korea remain unclear.

Comparative Demographics, ROM, and Function After TKA in Chinese, Malays, and Indians

Wei Ming Siow MBBS, MRCS, Pak Lin Chin MBBS, FRCS, Shi Lu Chia MBBS, FRCS, Ngai Nung Lo MBBS, MRCS, Seng Jin Yeo MBBS, FRCS

There is marked racial disparity in TKA use rates, demographics, and outcomes between white and Afro-Caribbean Americans. Comparative studies of ethnicity in patients undergoing TKAs have been mostly in American populations with an underrepresentation of Asian groups. It is unclear whether these disparities exist in Chinese, Malays, and Indians.

Distal Femur Rotation Relates to Joint Obliquity in ACL-deficient Chinese


The lower limb osteometry of Chinese differs from that of whites. The joint line of the knee in the coronal plane in Chinese is more medially inclined and the posterior condylar angle of the distal femur in the axial plane is larger. However, it is unclear whether there is any direct association between the coronal plane and axial plane osteometry.

Tibia Vara Affects the Aspect Ratio of Tibial Resected Surface in Female Japanese Patients Undergoing TKA

Shigeshi Mori MD, Masao Akagi MD, PhD, Shigeki Asada MD, Tetsunao Matsushita MD, Kazuhiko Hashimoto MD

Tibia vara seen in Japanese patients reportedly influences the tibial component alignment when performing TKA. However, it is unclear whether tibia vara affects the component position and size selection.

Femoral Lateral Bowing and Varus Condylar Orientation Are Prevalent and Affect Axial Alignment of TKA in Koreans

Marco Paolo G. Lasam MD, Kil Jae Lee MD, Chong Bum Chang MD, PhD, Yeon Gwi Kang MS, Tae Kyun Kim MD, PhD

Coronal alignment is considered key to the function and longevity of a TKA. However, most studies do not consider femoral and tibial anatomical features such as lateral femoral bowing and the effects of these features and subsequent alignment on function after TKA are unclear.

Surgical Technique: Computer-assisted Sliding Medial Condylar Osteotomy to Achieve Gap Balance in Varus Knees During TKA

Arun B. Mullaji FRCS Ed, MCh Orth, MS Orth, Gautam M. Shetty MS Orth

Extensive posteromedial release to correct severe varus deformity during TKA may result in mediolateral or flexion instability and may require a constrained implant. We describe a technique combining computer navigation and medial condylar osteotomy in severe varus deformity to achieve a primary goal of ligament balance during TKA.

Brief Followup Report: Does High-flexion Total Knee Arthroplasty Allow Deep Flexion Safely in Asian Patients?

Hyuk-Soo Han MD, PhD, Seung-Baik Kang MD, PhD

The long-term survivorship of TKA in Asian countries is comparable to that in Western countries. High-flexion TKA designs were introduced to improve flexion after TKA. However, several studies suggest high-flexion designs are at greater risk of femoral component loosening compared with conventional TKA designs. We previously reported a revision rate of 21% at 11 to 45 months; this report is intended as a followup to that study.

No Better Flexion or Function of High-flexion Designs in Asian Patients With TKA

Jong-Keun Seon MD, Ji-Hyeon Yim MD, Hyoung-Yeon Seo MD, Eun-Kyoo Song MD

Recently, high-flexion PCL-retaining (CR) and -substituting (PS) knee prostheses were designed to allow greater and safer flexion after TKA. However, the advantages of high-flexion TKA over standard design have been debated in terms of early maximal flexion. A recent study reported a high incidence of early loosening of the femoral component related to the deep flexion provided by high-flexion PS TKA.

High-flexion Prosthesis Improves Function of TKA in Asian Patients Without Decreasing Early Survivorship

Bum-Sik Lee MD, Jong-Won Chung MD, Jong-Min Kim MD, Kyung-Ah Kim PhD, Seong-Il Bin MD

Two previous studies recently raised the possibility of a high risk of early femoral components loosening with high-flexion (HF) prostheses in Asian populations and suggested that the high failure rate of HF TKAs was associated with HF ability. However, these findings are controversial given other studies reporting a low incidence of aseptic failures in HF prostheses.

Painful Patellar Clunk or Crepitation of Contemporary Knee Prostheses

Won Chul Choi MD, PhD, Keun-Jung Ryu MD, Sahnghoon Lee MD, PhD, Sang Cheol Seong MD, PhD, Myung Chul Lee MD, PhD

Painful patellar clunk or crepitation (PCC) is a resurgent complication of contemporary posterior-stabilized TKA. The incidence, time to presentation, causes, and treatment of PCC still remain controversial.

The Incidence of Pulmonary Embolism and Deep Vein Thrombosis After Knee Arthroplasty in Asians Remains Low: A Meta-analysis

Woo-Suk Lee MD, PhD, Kang-Il Kim MD, PhD, Han-Jun Lee MD, PhD, Hee-Soo Kyung MD, PhD, Seung-Suk Seo MD, PhD

While Western literature has mostly reported the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) after TKA with chemoprophylaxis, the Asian literature still has mostly reported the incidence without chemoprophylaxis. This may reflect a low incidence of DVT and PE in Asian patients, although some recent studies suggest the incidence after TKA in Asian patients is increasing. Moreover, it is unclear whether the incidence of DVT and PE after TKA is similarly low among different Asian countries.

What Are the Causes of Revision Total Knee Arthroplasty in Japan?

Yasuhiko Kasahara MD, PhD, Tokifumi Majima MD, PhD, Shoichi Kimura MD, PhD, Osamu Nishiike MD, Jun Uchida MD, PhD

There is limited information regarding the cause of revision TKA in Asia, especially Japan. Owing to differences in patient backgrounds and lifestyles, the modes of TKA failures in Asia may differ from those in Western countries.

Development and Validation of a New Evaluation System for Patients With a Floor-based Lifestyle: The Korean Knee Score

Jin Goo Kim MD, PhD, Jeong Ku Ha MD, Seung Beom Han MD, PhD, Tae Kyun Kim MD, PhD, Myung Chul Lee MD, PhD

Patients’ perspectives on functioning and health have been increasingly recognized as a crucial aspect of health care, leading to the use of patient-reported instruments for outcome assessment. However, available instruments for total knee arthroplasty do not reflect the floor-based lifestyle with high knee flexion of eastern Asia.

Endoscopic Carpal Tunnel Release Is Preferred Over Mini-open Despite Similar Outcome: A Randomized Trial

Ho Jung Kang MD, PhD, Il Hyun Koh MD, Tae Jin Lee MD, Yun Rak Choi MD, PhD

The decision to perform endoscopic versus the mini-open carpal tunnel release technique is most likely left to surgeons rather than patients with idiopathic carpal tunnel syndrome.

The Natural Course of Serratus Palsy at 2 to 31 Years

Veera Pikkarainen MD, Jyrki Kettunen PT, PhD, Martti Vastamäki MD, PhD

The natural course of isolated serratus palsy is obscure. Residual winging, muscle weakness, and fatigability reportedly occur in half of the patients. Because we believed isolated serratus palsy might have a better natural course than earlier thought, we evaluated our long-term records.

Surgical Technique: Spike Translation: A New Modification in Step-cut Osteotomy for Cubitus Varus Deformity

Ali Moradi MD, Ehsan Vahedi MD, Mohammad H. Ebrahimzadeh MD

Various methods of osteotomy have been proposed for the treatment of cubitus varus. We designed a modification of the step-cut osteotomy to achieve more correction of the deformity. We describe this new technique called spike translation step-cut osteotomy and report the clinical and radiographic outcomes (deformity correction, ROM, function, osteotomy healing, complications) in a series of patients treated for cubitus varus using this technique.

Surgical Technique: Simple Technique for Removing a Locking Recon Plate With Damaged Screw Heads

Nirmal Raj Gopinathan (MS)Ortho, Mandeep Singh Dhillon (MS)Ortho, Rajesh Kumar (MS)Ortho

The introduction of locking plates in the treatment of periarticular fractures was a major breakthrough in orthopaedic evolution. Removal of these implants is extremely difficult as a result of cold welding and stripping of screw heads.

Risk of Thromboembolism in Shoulder Arthroplasty: Effect of Implant Type and Traumatic Indication

Ronald A. Navarro MD, Maria C. S. Inacio MS, Mary F. Burke MPH, John G. Costouros MD, Edward H. Yian MD

Prior research about symptomatic venous thromboembolism (VTE) after shoulder arthroplasty has not determined whether procedure type (hemiarthroplasty, total shoulder arthroplasty, or reverse shoulder arthroplasty) or surgical indication (traumatic or elective) represent risk factors for VTE after shoulder replacement.

Heterotopic Bone Formation About the Hip Undergoes Endochondral Ossification: A Rabbit Model

Oliver Tannous MD, Alec C. Stall MD, Cullen Griffith MD, Christopher T. Donaldson MD, Rudolph J. Castellani MD, Vincent D. Pellegrini MD

Heterotopic ossification (HO) occurs most commonly after trauma and surgery about the hip and may compromise subsequent function. Currently available animal models describing the cellular progression of HO are based on exogenous osteogenic induction agents and may not reflect the processes following trauma.

Are the Left and Right Proximal Femurs Symmetric?

Ernest Y. Young MS, Jeremy Gebhart BS, Daniel Cooperman MD, Nicholas U. Ahn MD

The contralateral femur frequently is used for preoperative templating for THA or hemiarthroplasty when the proximal femur is deformed by degenerative changes or fracture. Although femoral symmetry is assumed in these situations, it is unclear to what degree the contralateral femur is symmetrical.

Impingement Adversely Affects 10-year Survivorship After Periacetabular Osteotomy for DDH

Christoph E. Albers MD, Simon D. Steppacher MD, Reinhold Ganz MD, Moritz Tannast MD, Klaus A. Siebenrock MD

Although periacetabular osteotomy (PAO) for developmental dysplasia of the hip (DDH) provides conceptual advantages compared with other osteotomies and reportedly is associated with joint survivorship of 60% at 20 years, the beneficial effect of proper acetabular reorientation with concomitant arthrotomy and creation of femoral head-neck offset on 10-year hip survivorship remains unclear.

Contact Patch to Rim Distance Predicts Metal Ion Levels in Hip Resurfacing

James P. Yoon BA, Michel J. Le Duff MA, Alicia J. Johnson BA, Karren M. Takamura BA, Edward Ebramzadeh PhD, Harlan C. Amstutz MD

Component design, size, acetabular orientation, patient gender, and activity level have been suggested as factors leading to elevated metal ion concentrations after-on-metal hip resurfacing arthroplasty (MMHRA). The calculation of the contact patch to rim (CPR) distance integrates component size, design, and acetabular orientation and may be a good predictor of elevated metal ion levels.

A Long Femoral Stem Is Not Always Required in Hip Arthroplasty for Patients With Proximal Femur Metastases

Zhiqing Xing MD, PhD, Bryan S. Moon MD, Robert L. Satcher MD, PhD, Patrick P. Lin MD, Valerae O. Lewis MD

During hip arthroplasties for treating proximal femur metastases, a long femoral stem frequently is used, presumably protecting the entire femur against progression of the existing lesions or development of new lesions. However, it is unclear whether a long stem is really required.

A Positive Hip Arthrogram May Predict Lower Function in Patients with Primary Hip Arthroplasty

Jason B. T. Lim MBChB (Hons), Lynne Horey MA, Sanjeev Patil FRCS (Tr & Orth), Robert M. D. Meek MD, FRCS (Tr & Orth)

A local anesthetic hip arthrogram is a simple test mainly used as an adjunct to define the origin of hip pain. Temporary pain relief (a positive response) following an injection may lead to a surgeon recommending hip surgery. However, it is unclear whether relief of pain corresponds to better postoperative pain relief or function.

New Radiographic Index for Evaluating Acetabular Version

Hiroshi Koyama MD, Hironobu Hoshino MD, PhD, Daisuke Suzuki MD, Shoichi Nishikino MD, Yukihiro Matsuyama MD, PhD

Several qualitative radiographic signs have been described to assess acetabular retroversion. However, quantitative assessment of acetabular version would be useful for more rigorous research purposes and perhaps to diagnose and treat hip disorders.

Does Femoral Rotation Influence Anteroposterior Alpha Angle, Lateral Center-edge Angle, and Medial Proximal Femoral Angle? A Pilot Study

Shafagh Monazzam MD, James D. Bomar MPH, Mandar Agashe MD, Harish S. Hosalkar MD

Femoral rotation on AP radiographs affects several parameters used to assess morphologic features of the proximal femur but its effect on femoroacetabular impingement parameters remains unknown.

Is There a Gold Standard for TKA Tibial Component Rotational Alignment?

Erin E. Hutter MS, Jeffrey F. Granger MD, Matthew D. Beal MD, Robert A. Siston PhD

Joint function and durability after TKA depends on many factors, but component alignment is particularly important. Although the transepicondylar axis is regarded as the gold standard for rotationally aligning the femoral component, various techniques exist for tibial component rotational alignment. The impact of this variability on joint kinematics and stability is unknown.

Patellar Tracking and Anterior Knee Pain are Similar After Medial Parapatellar and Midvastus Approaches in Minimally Invasive TKA

Boonchna Pongcharoen MD, Thanasak Yakampor MD, Keerati Charoencholvanish MD

Since the medial parapatellar (MPP) approach in conventional TKA can cause patellar maltracking and anterior knee pain, some orthopaedic surgeons use the midvastus (MV) approach instead of the MPP approach to reduce patellar maltracking. Minimally invasive surgical (MIS) TKA has been developed to limit the damage to the surrounding muscle and reduce the necessity of patellar eversion during surgery. Thus, MIS TKA might be associated with proper patellar tracking and a low incidence of anterior knee pain. However, this presumption has not been confirmed.

Proximal Tibial Bone Density Is Preserved After Unicompartmental Knee Arthroplasty

Bradley I. Richmond MBChB, Simon V. Hadlow MBChB, Tim G. Lynskey MBChB, Cameron G. Walker PhD, Jacob T. Munro MBChB

Bone mineral density (BMD) in the proximal tibia decreases after TKA and is believed to be a factor in implant migration and loosening. Unicompartmental knee arthroplasty (UKA) is a less invasive procedure preserving knee compartments unaffected by degeneration. Finite element studies have suggested UKA may preserve BMD and that implants of differing stiffnesses might differentially affect BMD but these notions have not been clinically confirmed.

Is there a Valid and Reliable Assessment of Diagnostic Knee Arthroscopy Skill?

Tyson Olson BS, Ryan Koehler BS, Aaron Butler BS, Simon Amsdell MD, Gregg Nicandri MD

The Basic Arthroscopic Knee Skill Scoring System (BAKSSS) has construct validity as an objective measure of arthroscopic proficiency when used to assess the task of performing arthroscopic meniscectomies on cadaver knees. The reliability of this instrument is unknown.

Can A Modified Robert Jones Bandage After Knee Arthroplasty Reduce Blood Loss? A Prospective Randomized Controlled Trial

Piya Pinsornsak MD, Sukanis Chumchuen MD

A bulky compression dressing (Robert Jones bandage) is commonly used after TKA to reduce blood loss, pain, and swelling. However, it is unclear whether these dressings in fact reduce blood loss.

Calcaneal Lengthening for Planovalgus Foot Deformity in Patients With Cerebral Palsy

Ki Hyuk Sung MD, Chin Youb Chung MD, Kyoung Min Lee MD, Seung Yeol Lee MD, Moon Seok Park MD

Calcaneal lengthening has been used to correct planovalgus foot deformities in patients with cerebral palsy (CP).

Distal Radius Malunion Increases Risk of Persistent Disability 2 Years After Fracture: A Prospective Cohort Study

Elisabeth Brogren MD, Philippe Wagner MSc, Michael Petranek MD, Isam Atroshi MD, PhD

Studies concerning the relationship between distal radius fracture malunion and a persistent arm-related disability have produced conflicting results.

What are the Factors Influencing Outcome Among Patients Admitted to a Hospital With a Proximal Humeral Fracture?

Valentin Neuhaus MD, Christiaan H. J. Swellengrebel MS, Jeroen K. J. Bossen MS, David Ring MD, PhD

Fracture of the proximal humerus is common in older patients during the decline of their physical health.

Adverse Events After Recombinant Human BMP2 in Nonspinal Orthopaedic Procedures

Emily Jane Woo MD, MPH

The FDA has approved recombinant human bone morphogenetic protein 2 (rhBMP-2) for treating acute, open tibial shaft fractures. However, the nature and frequency of complications after the use of rhBMP-2 in nonspinal orthopaedic surgery have not been well characterized.

Charlson Comorbidity Indices and In-hospital Deaths in Patients with Hip Fractures

Valentin Neuhaus MD, John King BA, Michiel G. Hageman MD, David C. Ring MD, PhD

The Charlson Comorbidity Index (CCI) and its modifications are comorbidity-based measures that predict mortality. It was developed for patients without trauma and inconsistently predicted mortality and adverse events in several previous studies of patients with trauma.

Orthopaedic Residency Applications Increase After Implementation of 80-hour Workweek

Oke A. Anakwenze MD, Vamsi Kancherla MD, Keith Baldwin MD, MPH, MSPT, William N. Levine MD, Samir Mehta MD

The factors that influence interest among medical students toward different medical specialties with time are important. The potential impact of changes in work-hour rules on orthopaedic applications in comparison to that of primary care medicine has not been reported. The change in number of applicants to general surgery during this period also is unknown.

Case Report: Osteoid Osteoma of the Acetabulum Treated With Arthroscopy-assisted Radiofrequency Ablation

Damiano Ricci MD, Guido Grappiolo MD, Matthew Franco BA, Federico Della Rocca MD

Osteoid osteomas consist of a nidus surrounded by reactive sclerotic bone. The diagnosis typically is based on imaging and clinical presentation involving nocturnal pain. Removal of the lesion is essential and currently is performed mainly with image-guided, minimally invasive techniques. We describe a case involving an osteoid osteoma of the acetabular fossa, treated with arthroscopy-assisted radiofrequency ablation.

Reply to Letter to the Editor: Intramedullary Nails Result in More Reoperations Than Sliding Hip Screws in Two-part Intertrochanteric Fractures

Kjell Matre MD, Leif Ivar Havelin MD, PhD, Jan-Erik Gjertsen MD, PhD, Birgitte Espehaug MSc, PhD, Jonas Meling Fevang MD, PhD

Erratum to: Validity and Reliability of the Paprosky Acetabular Defect Classification

Raymond Yu BM, BS, HB.MedSc, M.SurgSci, Jochen G. Hofstaetter MD, Thomas Sullivan BMa&CompSc(Hons), Kerry Costi BA, Donald W. Howie BM, BS, PhD, FRACS, Lucian B. Solomon MD, PhD, FRACS
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