Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Published in
Clinical Orthopaedics and Related Research®
Volume 472 | Issue 4 | Apr, 2014

How Does Accounting for Worker Productivity Affect the Measured Cost-Effectiveness of Lumbar Discectomy?

Lane Koenig PhD, Timothy M. Dall MS, Qian Gu PhD, Josh Saavoss BA, Michael F. Schafer MD

Back pain attributable to lumbar disc herniation is a substantial cause of reduced workplace productivity. Disc herniation surgery is effective in reducing pain and improving function. However, few studies have examined the effects of surgery on worker productivity.

Review of the Molecular Development of the Thumb: Digit Primera

Kerby C. Oberg MD, PhD

The thumb, or digit 1, is not a typical digit. In addition to its unusual mobility and function, its formation is also unusual. It is the last digit to form and the most commonly targeted when limb development is disrupted. The thumb domain is defined by the overlapping expression of HOXA13, TBX5, GLI3R, and HOXD13 and, importantly, by an absence of other distal HOXD transcription factors. This brief review, combining developmental biology and clinical genetics, discusses the current understanding of how the thumb domain is established.

In Vivo Pilot Study Evaluating the Thumb Carpometacarpal Joint During Circumduction

Akira Goto MD, Shuai Leng PhD, Kazuomi Sugamoto MD, William P. Cooney MD, Sanjeev Kakar MD, Kristin Zhao PhD

Analysis of arthrokinematics may have clinical use in the diagnosis of dynamic instability of the thumb and wrist. Recent technological advances allow noninvasive, high-resolution imaging of skeletal (thumb and carpal bones) structures during motion.

In Vivo Kinematics of the Thumb Carpometacarpal Joint During Three Isometric Functional Tasks

Eni Halilaj BA, Michael J. Rainbow PhD, Christopher Got MD, Joel B. Schwartz BS, Douglas C. Moore MS, Arnold-Peter C. Weiss MD, Amy L. Ladd MD, Joseph J. Crisco PhD

The thumb carpometacarpal (CMC) joint is often affected by osteoarthritis—a mechanically mediated disease. Pathomechanics of the CMC joint, however, are not thoroughly understood due to a paucity of in vivo data.

Functional Task Kinematics of the Thumb Carpometacarpal Joint

Kali R. Luker MD, Arnel Aguinaldo ATC, MA, Deborah Kenney OTR, Katelyn Cahill-Rowley MS, Amy L. Ladd MD

Abnormal biomechanical loading has been identified as an associated risk factor of osteoarthritis in the wrist and hand. Empirical data to date are insufficient to describe the role of altered biomechanics in thumb carpometacarpal (CMC) arthritis.

Relationship of Relaxin Hormone and Thumb Carpometacarpal Joint Arthritis

Jennifer Moriatis Wolf MD, Danielle L. Scher MD, Eric W. Etchill MPH, Frank Scott MD, Allison E. Williams PhD, Steven Delaronde MPH, MSW, Karen B. King PhD

The female predominance in thumb carpometacarpal (CMC) joint arthritis has led to speculation that reproductive hormones or hypermobility are responsible. Evidence shows that patients with pathologic laxity have a higher rate of thumb CMC arthritis. Relaxin hormone increases laxity in the pelvic ligaments through upregulation of matrix metalloproteases (MMPs). It is thus a hormone of interest in the development of thumb CMC arthritis.

Trapeziometacarpal Joint Stability: The Evolving Importance of the Dorsal Ligaments

James D. Lin MD, MS, John W. Karl MD, MPH, Robert J. Strauch MD

Trapeziometacarpal (TMC) arthritis of the thumb is a common source of hand pain and disability. TMC ligamentous instability may play a role in TMC degeneration. However, the relative importance of the TMC ligaments in the etiology of degeneration and the use of surgery to treat instability in early-stage arthritis are unclear.

Ultrastructure and Innervation of Thumb Carpometacarpal Ligaments in Surgical Patients With Osteoarthritis

Nathalie Mobargha MD, Cassie Ludwig BS, Amy L. Ladd MD, Elisabet Hagert MD, PhD

The complex configuration of the thumb carpometacarpal (CMC-1) joint relies on musculotendinous and ligamentous support for precise circumduction. Ligament innervation contributes to joint stability and proprioception. Evidence suggests abnormal ligament innervation is associated with osteoarthritis (OA) in large joints; however, little is known about CMC-1 ligament innervation characteristics in patients with OA. We studied the dorsal radial ligament (DRL) and the anterior oblique ligament (AOL), ligaments with a reported divergent presence of mechanoreceptors in nonosteoarthritic joints.

Intra- and Interobserver Reliability of the Eaton Classification for Trapeziometacarpal Arthritis: A Systematic Review

Aaron J. Berger MD, PhD, Arash Momeni MD, Amy L. Ladd MD

Trapeziometacarpal, or thumb carpometacarpal (CMC), arthritis is a common problem with a variety of treatment options. Although widely used, the Eaton radiographic staging system for CMC arthritis is of questionable clinical utility, as disease severity does not predictably correlate with symptoms or treatment recommendations. A possible reason for this is that the classification itself may not be reliable, but the literature on this has not, to our knowledge, been systematically reviewed.

Degenerative Change at the Pseudarthrosis After Trapeziectomy at 6-year Followup

Hatem M. Salem MRCS, Tim R. C. Davis FRCS

Simple trapeziectomy has a well-documented history of success for the management of osteoarthritis at the trapeziometacarpal joint. There is concern, however, that late-onset failure can occur as a result of the development of degenerative disease at the scaphoid-metacarpal pseudarthrosis.

Does Arthroscopic Débridement With or Without Interposition Material Address Carpometacarpal Arthritis?

Julie E. Adams MD

Thumb carpometacarpal (CMC) joint arthritis is a common problem in clinical practice with a variety of treatment options. Arthroscopic procedures can preserve all or part of the trapezium in the setting of treatment of basilar joint arthritis, and such procedures (even without stabilization or ligament reconstruction) have high reported success rates. However, little is documented about the limitations of these procedures in terms of patient selection, the optimal type of interposition, if any, and rehabilitation.

The Role of Arthroscopy in Trapeziometacarpal Arthritis

David Joseph Slutsky MD

Trapeziometacarpal (TM) arthroscopy should be viewed as a useful minimally invasive adjunctive technique rather than the operation itself since it allows one to visualize the joint surface under high-power magnification with minimal disruption of the important ligamentous complex. Relatively few articles describe the arthroscopic treatment of TM osteoarthritis (OA) and the arthroscopic anatomy of the TM joint. There is lingering confusion as to whether soft tissue interposition and K-wire fixation of the joint are needed and whether the outcomes of arthroscopic procedures compare to the more standard open techniques for TM arthroplasty.

Surgical Treatment of Trapeziometacarpal Joint Arthritis: A Historical Perspective

Vincent R. Hentz MD

The trapeziometacarpal (TMC) joint’s unique anatomy and biomechanics render it susceptible to degeneration. For 60 years, treatment of the painful joint has been surgical when nonoperative modalities have failed. Dozens of different operations have been proposed, including total or subtotal resection of the trapezium or resection and implant arthroplasty. Proponents initially report high levels of patient satisfaction, but longer-term reports sometimes fail to support initial good results. To date, no one procedure has been shown to be superior to another.

A Systematic Review of Postoperative Hand Therapy Management of Basal Joint Arthritis

Terri Wolfe ORT/LCHT, Jennifer Y. Chu MD, Tammy Woods MD, John D. Lubahn MD

There are a variety of postoperative immobilization and therapy options for patients with basal joint arthritis. Although prior systematic reviews have compared surgical procedures used to treat basal joint arthritis, none to our knowledge compares therapy protocols for this condition, which are considered an important part of the treatment.

Risk Factors for Revision Within 10 Years of Total Knee Arthroplasty

Christopher J. Dy MD, MSPH, Robert G. Marx MD, MSc, Kevin J. Bozic MD, MBA, Ting Jung Pan MPH, Douglas E. Padgett MD, Stephen Lyman PhD

An in-depth understanding of risk factors for revision TKA is needed to minimize the burden of revision surgery. Previous studies indicate that hospital and community characteristics may influence outcomes after TKA, but a detailed investigation in a diverse population is warranted to identify opportunities for quality improvement.

Are Younger Patients Undergoing TKAs Appropriately Characterized As Active?

James A. Keeney MD, Ryan M. Nunley MD, Rick W. Wright MD, Robert L. Barrack MD, John C. Clohisy MD

The use of TKAs in young patients is increasing. Demographic characteristics and activity levels among this patient group may affect implant selection, performance, and survivorship. Patient age (≤ 55 years) and preoperative diagnosis have been used to define this patient group, with the presumption that these patients are more active than older patients with similar indications for TKA.

Medial Open Wedge High Tibial Osteotomy: Can Delayed or Nonunion Be Predicted?

Albert H. Houten MD, Petra J. C. Heesterbeek PhD, Ronald J. Heerwaarden MD, PhD, Tony G. Tienen MD, PhD, Ate B. Wymenga MD, PhD

The opening wedge approach to high tibial osteotomy (HTO) is perceived to have some advantages relative to the closing wedge approach but it may be associated with delayed and nonunions. Because nonunions evolve over months, it would be advantageous to be able to identify risk factors for and early predictors of nonunion after medial opening wedge HTO.

Patients With Hip Osteoarthritis Have a Phenotype With High Bone Mass and Low Lean Body Mass

Magnus K. Karlsson MD, PhD, Håkan Magnusson MD, PhD, Maria C. Cöster MD, Tord vonSchewelov MD, PhD, Caroline Karlsson MD, PhD, Björn E. Rosengren MD, PhD

Although hip osteoarthritis (OA) is common, its etiology is poorly understood. Specifically, it is not known whether hip OA is associated with abnormal relationships among the anthropometric and musculoskeletal characteristics that are associated with OA in general.

Obesity Increases Length of Stay and Direct Medical Costs in Total Hip Arthroplasty

Hilal Maradit Kremers MD, MSc, Sue L. Visscher PhD, Walter K. Kremers PhD, James M. Naessens PhD, David G. Lewallen MD

The number of obese patients undergoing THA is increasing. Previous studies have shown that obesity is associated with an increased likelihood of complications after THA, but there is little information regarding the impact of obesity on medical resource use and direct medical costs in THA.

Modular versus Nonmodular Neck Femoral Implants in Primary Total Hip Arthroplasty: Which is Better?

Paul J. Duwelius MD, Bob Burkhart PA, Clay Carnahan PA, Grant Branam BSc, Laura Matsen Ko MD, YingXing Wu MD, Cecily Froemke MS, Lian Wang MS, Gary Grunkemeier PhD

Restoration of the hip center is considered important for a successful THA and requires achieving the right combination of offset, anteversion, and limb length. Modular femoral neck designs were introduced to make achieving this combination easier. No previous studies have compared these designs in primary THA, and there is increasing concern that modular designs may have a higher complication rate than their nonmodular counterparts.

When Do Patients With Hand Illness Seek Online Health Consultations and What Do They Ask?

Jan Paul Briet MD, Michiel G. Hageman MD, Robin Blok BSc, David Ring MD, PhD

Several websites allow people to post health questions and get answers from doctors. Knowing more about what patients seek from these websites might help in-office educational efforts, but little is known about what occurs on these sites.

Subungual Exostosis of the Toes: A Systematic Review

Mark P. DaCambra MD, MSc, Sumit K. Gupta MD, Fabio Ferri-de-Barros MD, MSc

Subungual exostosis is a relatively common benign bone tumor that occurs in the distal phalanges of the toes and can be a source of pain and nail deformity. There is controversy about the treatment of these lesions and there are few studies that have synthesized what is known and provided meaningful information on treatment.

Lateral Ankle Stabilization After Distal Fibular Resection Using a Novel Approach: A Surgical Technique

David Kevin Monson MD, Saman Vojdani BS, Thad James Dean DO, John Louis-Ugbo MD

After tumor resection involving the distal fibula, the method for recreating stability of the lateral ankle remains controversial. Many reconstructive options exist, including allograft reconstruction and arthrodesis; however, each of these approaches has significant potential disadvantages.

Is Sternocleidomastoid Muscle Release Effective in Adults With Neglected Congenital Muscular Torticollis?

Kyung Sup Lim MD, Jong Sup Shim MD, Yeong Seok Lee MD

Neglected congenital muscular torticollis is rare in adults but may be associated with pain and cosmetic problems. The efficacy of surgical correction in these patients has not been well established in the literature.

Long-term Results of Comprehensive Clubfoot Release Versus the Ponseti Method: Which Is Better?

Peter A. Smith MD, Ken N. Kuo MD, Adam N. Graf MS, Joseph Krzak PT, PhD, Ann Flanagan PT, Sahar Hassani MS, Angela K. Caudill PT, Fredrick R. Dietz MD, Jose Morcuende MD, Gerald F. Harris PE, PhD

Clubfoot can be treated nonoperatively, most commonly using a Ponseti approach, or surgically, most often with a comprehensive clubfoot release. Little is known about how these approaches compare with one another at longer term, or how patients treated with these approaches differ in terms of foot function, foot biomechanics, or quality-of-life from individuals who did not have clubfoot as a child.

Cemented versus Uncemented Hemiarthroplasty for Displaced Femoral Neck Fractures: 5-year Followup of a Randomized Trial

Ellen Langslet MD, Frede Frihagen MD, PhD, Vidar Opland MD, Jan Erik Madsen MD, PhD, Lars Nordsletten MD, PhD, Wender Figved MD, PhD

Displaced femoral neck fractures usually are treated with hemiarthroplasty. However, the degree to which the design of the implant used (cemented or uncemented) affects the outcome is not known and may be therapeutically important.

Angle Stable Nails Provide Improved Healing for a Complex Fracture Model in the Femur

Meghan R. Kubacki MS, Christopher A. Verioti DO, Savan D. Patel MD, Adam N. Garlock MS, David Fernandez MD, Patrick J. Atkinson PhD

Conventional nails are being used for an expanding range of fractures from simple to more complex. Angle stable designs are a relatively new innovation; however, it is unknown if they will improve healing for complex fractures.

Dual Plating of Humeral Shaft Fractures: Orthogonal Plates Biomechanically Outperform Side-by-Side Plates

Victor Kosmopoulos PhD, Arvind D. Nana MD, MBA

Single large-fragment plate constructs currently are the norm for internal fixation of middiaphyseal humerus fractures. In cases where humeral size is limited, however, dual small-fragment locking plate constructs may serve as an alternative. The mechanical effects of different possible plate configurations around the humeral diaphysis may be important, but to our knowledge, have yet to be investigated.

Novel Microhydroxyapatite Particles in a Collagen Scaffold: A Bioactive Bone Void Filler?

Frank G. Lyons MB, PhD, MRCS, John P. Gleeson PhD, Sonia Partap PhD, Karen Coghlan PhD, Fergal J. O’Brien PhD

Treatment of segmental bone loss remains a major challenge in orthopaedic surgery. Traditional techniques (eg, autograft) and newer techniques (eg, recombinant human bone morphogenetic protein-2 [rhBMP-2]) have well-established performance limitations and safety concerns respectively. Consequently there is an unmet need for osteoinductive bone graft substitutes that may eliminate or reduce the use of rhBMP-2.

Results of Clubfoot Management Using the Ponseti Method: Do the Details Matter? A Systematic Review

Dahang Zhao MD, Hai Li MD, PhD, Li Zhao MD, PhD, Jianlin Liu MD, Zhenkai Wu MD, Fangchun Jin MD, PhD

Although the Ponseti method is accepted as the best choice for treatment of clubfoot, the treatment protocol is labor intensive and requires strict attention to details. Deviations in strict use of this method are likely responsible for the variations among centers in reported success rates.

A 33-year-old Man With Low Back Pain

Dafang Zhang MD, Kathryn Hess BA, G. Petur Nielsen MD, Joseph H. Schwab MD
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