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 5 | May, 2014

Mesenchymal Stem Cells in Synovial Fluid Increase After Meniscus Injury

Yu Matsukura MD, Takeshi Muneta MD, PhD, Kunikazu Tsuji PhD, Hideyuki Koga MD, PhD, Ichiro Sekiya MD, PhD

Although relatively uncommon, spontaneous healing from a meniscus injury has been observed even within the avascular area. This may be the result of the existence of mesenchymal stem cells in synovial fluid.

Continuous Adductor Canal Blocks Are Superior to Continuous Femoral Nerve Blocks in Promoting Early Ambulation After TKA

Seshadri C. Mudumbai MD, MS, T. Edward Kim MD, Steven K. Howard MD, J. Justin Workman MD, Nicholas Giori MD, Steven Woolson MD, Toni Ganaway BA, Robert King BS, Edward R. Mariano MD, MAS (Clinical Research)

Femoral continuous peripheral nerve blocks (CPNBs) provide effective analgesia after TKA but have been associated with quadriceps weakness and delayed ambulation. A promising alternative is adductor canal CPNB that delivers a primarily sensory blockade; however, the differential effects of these two techniques on functional outcomes after TKA are not well established.

Single-injection or Continuous Femoral Nerve Block for Total Knee Arthroplasty?

Eric Albrecht MD, DESA (Fellow), Dorothea Morfey BSc, MBBS, Vincent Chan MD, Rajiv Gandhi MD, Arkadiy Koshkin MD, Ki Jinn Chin MD, MBBS, Sylvie Robinson BSc, Philippe Frascarolo PhD, Richard Brull MD

The ideal local anesthetic regime for femoral nerve block that balances analgesia with mobility after total knee arthroplasty (TKA) remains undefined.

Continuous Femoral Nerve Block Using 0.125% Bupivacaine Does Not Prevent Early Ambulation After Total Knee Arthroplasty

Michael J. Beebe MD, Rachel Allen MD, Mike B. Anderson MS, ATC, Jeffrey D. Swenson MD, Christopher L. Peters MD

Continuous femoral nerve block has been shown to decrease opioid use, improve postoperative pain scores, and decrease length of stay. However, several studies have raised the concern that continuous femoral nerve block may delay patient ambulation and increase the risk of falls during the postoperative period.

Intraarticular Analgesia Versus Epidural Plus Femoral Nerve Block After TKA: A Randomized, Double-blind Trial

Keith R. Reinhardt MD, Shivi Duggal BS, MBA, Ben-Paul Umunna BA, Gregory A. Reinhardt MSPT, Denis Nam MD, Michael Alexiades MD, Charles N. Cornell MD

Pain management after TKA remains challenging and the efficacy of continuously infused intraarticular anesthetics remains a controversial topic.

Pain Trajectories Identify Patients at Risk of Persistent Pain After Knee Arthroplasty: An Observational Study

Patricia M. Lavand’homme MD, PhD, Irina Grosu MD, Marie-Noëlle France RN, Emmanuel Thienpont MD, MBA

Persistent postsurgical pain is a major source of dissatisfaction after knee arthroplasty. Postoperative pain trajectories allow a dynamic view of pain resolution after surgery and might help to identify patients at risk for persistent pain.

Burden Incurred by Patients and Their Caregivers After Outpatient Surgery: A Prospective Observational Study

Asha Manohar MD, Kristin Cheung MD, Christopher L. Wu MD, Tracey S. Stierer MD

The burden of patients and their caregivers after outpatient surgery has not been fully examined. The number of outpatient surgeries has dramatically increased in the last several years, particularly in the orthopaedic sector. Patients undergoing outpatient orthopaedic procedures may be expected to have more postdischarge pain than those undergoing nonorthopaedic outpatient procedures. In light of this, assessment of patient and caregiver expectations and actual burden after discharge is of importance.

Is Regional Anesthesia Associated With Reduced PACU Length of Stay?

John M. Corey MD, Catherine M. Bulka MPH, Jesse M. Ehrenfeld MD, MPH

Postanesthesia care is a costly component of overall surgical care. In the ambulatory setting, regional anesthesia has been shown for multiple surgical procedures to either decrease postanesthesia care unit (PACU) length of stay (LOS) or completely bypass it altogether. This has not been demonstrated in a large hospital setting with a complex surgical case mix.

Can Regional Anesthesia and Analgesia Prolong Cancer Survival After Orthopaedic Oncologic Surgery?

Juan P. Cata MD, Mike Hernandez MS, Valerae O. Lewis MD, Andrea Kurz MD

The perioperative period of major oncologic surgery is characterized by immunosuppression, angiogenesis, and an increased load of circulating malignant cells. It is a window period in which cancer cells may seed, invade, and proliferate. Thus, it has been hypothesized that the use of regional anesthesia with the goal of reducing surgical stress and opioid and volatile anesthetic consumption would avoid perioperative immune suppression and angiogenesis and ultimately cancer recurrence.

Association of Obesity With Inflammation and Pain After Total Hip Arthroplasty

Roja Motaghedi MD, James J. Bae MSc, Stavros G. Memtsoudis MD, PhD, David H. Kim MD, Jonathan C. Beathe MD, Leonardo Paroli MD, PhD, Jacques T. YaDeau MD, PhD, Michael A. Gordon MD, Daniel B. Maalouf MD, MPH, Yi Lin MD, PhD, Yan Ma PhD, Susanna Cunningham-Rundles PhD, Spencer S. Liu MD

The prevalence of obesity is increasing, and obesity often leads to degenerative joint disease requiring total hip arthroplasty (THA). Obesity is a proinflammatory state associated with an increase in chronic, low-grade inflammatory response. As such, it may augment the postoperative inflammatory response, which has been associated with postoperative pain and complications.

Lateralizing Epidural Catheter Placement as Evidenced by Electrical Stimulation

Nigel E. Sharrock BMedSci, MB, ChB, George Go BS

Epidural steroids are more effective if administered in the anterolateral epidural space. It follows that the ability to administer local anesthetics in the ipsilateral anterolateral epidural space should likewise improve their efficacy for postoperative epidural analgesia.

The Influence of Anesthesia and Pain Management on Cognitive Dysfunction After Joint Arthroplasty: A Systematic Review

Michael G. Zywiel MD, Atul Prabhu MD, Anthony V. Perruccio PhD, Rajiv Gandhi MSc, MD

Despite the overall success of total joint arthroplasty, patients undergoing this procedure remain susceptible to cognitive decline and/or delirium, collectively termed postoperative cognitive dysfunction. However, no consensus exists as to whether general or regional anesthesia results in a lower likelihood that a patient may experience this complication, and controversy surrounds the role of pain management strategies to minimize the incidence of postoperative cognitive dysfunction.

Does Limb Preconditioning Reduce Pain After Total Knee Arthroplasty? A Randomized, Double-blind Study

Stavros G. Memtsoudis MD, PhD, Ottokar Stundner MD, Daniel Yoo MS, Alejandro Gonzalez Della Valle MD, Friedrich Boettner MD, Anna Maria Bombardieri MD, PhD, Kethy Jules-Elysee MD, Lazaros Poultsides MD, MS, PhD, Yan Ma PhD, Thomas P. Sculco MD

Total knee arthroplasty (TKA) can be associated with considerable postoperative pain. Ischemic preconditioning of tissue before inducing procedure-related underperfusion may reduce the postoperative inflammatory response, which further may reduce associated pain.

Is L2 Paravertebral Block Comparable to Lumbar Plexus Block for Postoperative Analgesia After Total Hip Arthroplasty?

Richa Wardhan MD, Anne-Sophie M. Auroux PharmD, Bruce Ben-David MD, Jacques E. Chelly MD, PhD, MBA

Continuous lumbar plexus block (LPB) is a well-accepted technique for regional analgesia after THA. However, many patients experience considerable quadriceps motor weakness with this technique, thus impairing their ability to achieve their physical therapy goals.

Peripheral Nerve Blocks in Shoulder Arthroplasty: How Do They Influence Complications and Length of Stay?

Ottokar Stundner MD, Rehana Rasul MA, MPH, Ya-Lin Chiu MS, Xuming Sun MS, Madhu Mazumdar MA, MS, PhD, Chad M. Brummett MD, Reinhold Ortmaier MD, Stavros G. Memtsoudis MD, PhD, FCCP

Regional anesthesia has proven to be a highly effective technique for pain control after total shoulder arthroplasty. However, concerns have been raised about the safety of upper-extremity nerve blocks, particularly with respect to the incidence of perioperative respiratory and neurologic complications, and little is known about their influence, if any, on length of stay after surgery.

Fewer Postoperative Fevers: An Unexpected Benefit of Multimodal Pain Management?

Joseph A. Karam MD, Benjamin Zmistowski BS, Camilo Restrepo MD, William J. Hozack MD, Javad Parvizi MD

Elevated temperatures after total joint arthroplasty (TJA) are common and can be a source of anxiety both for the patient and the surgical team. Although such fevers rarely are caused by acute infection, many patients are subjected to extensive testing for elevated body temperature after surgery. We recently implemented a multimodal pain management regimen for TJA, which includes acetaminophen, pregabalin, and celecoxib or toradol, and because some of these medications have antipyrexic properties, it was speculated that this protocol might influence the frequency of postoperative pyrexia.

Unicompartmental Knee Arthroplasty Survivorship is Lower Than TKA Survivorship: A 27-year Finnish Registry Study

Tuukka Niinimäki MD, Antti Eskelinen MD, PhD, Keijo Mäkelä MD, PhD, Pasi Ohtonen MSc, Ari-Pekka Puhto MD, Ville Remes MD, PhD

Balancing the relative advantages and disadvantages of unicompartmental knee arthroplasties (UKAs) against those for TKAs can be challenging. Survivorship is one important end point; arthroplasty registers repeatedly report inferior midterm survival rates, but longer-term data are sparse. Comparing survival directly by using arthroplasty register survival reports also may be inadequate because of differences in indications, implant designs, and patient demographics in patients having UKAs and TKAs.

Do Activity Levels Increase After Total Hip and Knee Arthroplasty?

Paula Harding D Clin Physio, Anne E. Holland PhD, Clare Delany PhD, Rana S. Hinman PhD

People with osteoarthritis (OA) often are physically inactive. Surgical treatment including total hip arthroplasty or total knee arthroplasty can substantially improve pain, physical function, and quality of life. However, their impact on physical activity levels is less clear.

Does Chondrocalcinosis Affect Knee Society Scores and Range of Motion After TKA?

Gwo-Chin Lee MD, Paul A. Lotke MD

Chondrocalcinosis is manifested by crystalline deposits of calcium commonly found during primary TKA for osteoarthritis. Its frequency among patients undergoing TKA is poorly defined, as is its influence on pain or function after TKA.

What is the Prognosis of Revision Total Hip Arthroplasty in Patients 55 Years and Younger?

Muyibat A. Adelani MD, Karla Crook BS, Robert L. Barrack MD, William J. Maloney MD, John C. Clohisy MD

Revision THAs are expected to increase; however, few studies have characterized the prognosis of revision THAs in younger patients.

Acetabular Component Thickness Does Not Affect Mid-term Clinical Results in Hip Resurfacing

Mariam Al-Hamad BS, Michel J. Duff MA, Karren M. Takamura BA, Harlan C. Amstutz MD

The benefits of using thin acetabular components for hip resurfacing have been shown in terms of bone conservation, but there currently are little data available in the literature addressing the mid-term clinical results of these devices.

Does Dual-mobility Cup Geometry Affect Posterior Horizontal Dislocation Distance?

Christopher Heffernan BME, Samik Banerjee MD, Jim Nevelos PhD, James Macintyre, Kimona Issa MD, David C. Markel MD, Michael A. Mont MD

Dual-mobility acetabular cups have been marketed with the purported advantages of reduced dislocation rates and improvements in ROM; however, the relative efficacies of these designs in terms of changing joint stability via ROM and dislocation distance have not been thoroughly evaluated.

Development of a Valid Simplified Chinese Version of the Oxford Hip Score in Patients With Hip Osteoarthritis

Wei Zheng MD, Jia Li MD, Jinzhu Zhao MD, Denghui Liu MD, Weidong Xu MD

Although the Oxford Hip Score has been translated and validated in several languages, there is currently no Chinese version of the outcomes measurement. Our study aims to crossculturally adapt and validate the Oxford Hip Score into a simplified Chinese version.

Topical Tranexamic Acid Reduces Blood Loss and Transfusion Rates Associated With Primary Total Hip Arthroplasty

Chih-Hsiang Chang MD, Yuhan Chang MD, PhD, Dave W. Chen MD, PhD, Steve W. N. Ueng MD, Mel S. Lee MD, PhD

Systemic tranexamic acid can decrease blood loss and rates of transfusion in patients undergoing total hip arthroplasty (THA). However, the efficacy of topical tranexamic acid in THA has only recently been characterized in a small number of studies.

Radiographic Classification of Coronal Plane Femoral Deformities in Polyostotic Fibrous Dysplasia

Ernesto Ippolito MD, Pasquale Farsetti MD, Alison M. Boyce MD, Alessandro Corsi MD, Fernando Maio MD, Michael T. Collins MD

Fibrous dysplasia of bone is a skeletal dysplasia with a propensity to affect the femur in its polyostotic form, leading to deformity, fracture, and pain. The proximal femur is most commonly involved with a tendency to distal progression, thereby producing the typical shepherd’s crook deformity. However, there are few data on the spectrum and progression of femoral deformities in polyostotic fibrous dysplasia.

Does Intensity of Surveillance Affect Survival After Surgery for Sarcomas? Results of a Randomized Noninferiority Trial

Ajay Puri MS, Ashish Gulia MS, Rohini Hawaldar PhD, Priya Ranganathan MD, Rajendra A. Badwe MS

Whether current postoperative surveillance regimes result in improved overall survival (OS) of patients with extremity sarcomas is unknown.

Deltoid-split or Deltopectoral Approaches for the Treatment of Displaced Proximal Humeral Fractures?

Benjamin Buecking MD, Juliane Mohr MD, Benjamin Bockmann, Ralph Zettl MD, Steffen Ruchholtz MD

Proximal humeral fractures are mainly associated with osteoporosis and are becoming more common with the aging of our society. The best surgical approach for internal fixation of displaced proximal humeral fractures is still being debated.

Does Preoperative American Society of Anesthesiologists Score Relate to Complications After Total Shoulder Arthroplasty?

Christine C. Johnson BA, Sonal Sodha MEng, Juan Garzon-Muvdi MD, Steve A. Petersen MD, Edward G. McFarland MD

For hip and knee arthroplasties, an American Society of Anesthesiologists (ASA) score greater than 2 is associated with an increased risk of medical and surgical complications. No study, to our knowledge, has evaluated this relationship for total shoulder arthroplasty (TSA) or reverse total shoulder arthroplasty (reverse TSA).

Can Internet Information on Vertebroplasty be a Reliable Means of Patient Self-education?

T. Barrett Sullivan BSE, Joshua T. Anderson BS, Uri M. Ahn MD, Nicholas U. Ahn MD

Studies of the quality and accuracy of health and medical information available on the Internet have shown that many sources provide inadequate information. However, to our knowledge, there are no published studies analyzing the quality of information available online regarding vertebroplasty. Because this has been a high-volume procedure with highly debated efficacy, it is critical that patients receive complete, accurate, and well-balanced information before deciding a treatment course. Additionally, few studies have evaluated the merit of academic site authorship or site certification on information quality, but some studies have used measurements of quality that are based primarily on subjective criteria or information accuracy rather than information completeness.

CT Provides Precise Size Assessment of Implanted Titanium Alloy Pedicle Screws

Michael J. Elliott MD, Joseph B. Slakey MD, CAPT, MC, USN

After performing instrumented spinal fusion with pedicle screws, postoperative imaging using CT to assess screw position may be necessary. Stainless steel implants produce significant metal artifact on CT, and the degree of distortion is at least partially dependent on the cross-sectional area of the implanted device. If the same effect occurs with titanium alloy implants, ability to precisely measure proximity of screws to adjacent structures may be adversely affected as screw size increases.

Hospital for Special Surgery Pediatric Functional Activity Brief Scale Predicts Physical Fitness Testing Performance

Peter D. Fabricant MD, MPH, Alex Robles BS, Son H. McLaren MD, Robert G. Marx MD, MSc, Roger F. Widmann MD, Daniel W. Green MD, MS

An eight-item activity scale was recently developed and validated for use as a prognostic tool in clinical research in children and adolescents. It is unclear, however, if this brief questionnaire is predictive of quantitative metrics of physical activity and fitness.

Developing a Pathway for High-value, Patient-centered Total Joint Arthroplasty

Aricca D. Van Citters MS, Cheryl Fahlman PhD, Donald A. Goldmann MD, Jay R. Lieberman MD, Karl M. Koenig MD, MS, Anthony M. DiGioia MD, Beth O’Donnell MPH, John Martin MPH, Frank A. Federico RPh, Richard A. Bankowitz MD, Eugene C. Nelson DSc, MPH, Kevin J. Bozic MD, MBA

Total joint arthroplasty (TJA) is one of the most widely performed elective procedures; however, there are wide variations in cost and quality among facilities where the procedure is performed.

Higher Charlson Comorbidity Index Scores are Associated With Readmission After Orthopaedic Surgery

Timothy Voskuijl MD, Michiel Hageman MD, David Ring MD, PhD

The Charlson Comorbidity Index (CCI) originally was developed to predict mortality within 1 year of hospital admission in patients without trauma. As it includes factors associated with medical and surgical complexities, it also may be useful as a predictive tool for hospital readmission after orthopaedic surgery, but to our knowledge, this has not been studied.

Another Look: Is There a Flaw to Current Hip Septic Arthritis Diagnostic Algorithms?

Chika Edward Uzoigwe MRCS

Septic arthritis is an emergency. In 1999 Kocher et al. identified four clinical criteria to distinguish hip septic arthritis from transient synovitis in children (nonweightbearing, erythrocyte sedimentation rate ≥ 40 mm/L, white blood cell count > 12 × 10/L, temperature > 38.5°C). Subsequent authors evaluating the same criteria produced conflicting results. This calls into question the use of such diagnostic algorithms. The reasons for the differences remain unclear.

Pulmonary Cement Embolization After Vertebroplasty Requiring Pulmonary Wedge Resection

Marcus A. Rothermich MD, Jacob M. Buchowski MD, MS, David B. Bumpass MD, G. Alexander Patterson MD

Pulmonary cement embolization after vertebroplasty is a well-known complication but typically presents with minimal respiratory symptoms. Although this rare complication has been reported, the current literature does not address the need for awareness of symptoms of potentially devastating respiratory compromise.

Letter to the Editor

Ankur B. Bamne MS(Orth), Anjali A. Bamne DNB(Anest), Sang Hwa Eom MD
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