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 8 | Aug, 2014

Hospital Readmissions After Surgical Treatment of Proximal Humerus Fractures: Is Arthroplasty Safer Than Open Reduction Internal Fixation?

Alan L. Zhang MD, William W. Schairer MD, Brian T. Feeley MD

With technologic advances such as locked periarticular plating, hemiarthroplasty of the humeral head, and more recently reverse total shoulder replacement, surgical treatment of proximal humerus fractures has become more commonplace. However, there is insufficient information regarding patient outcomes after surgery, such as the frequency of unplanned hospital readmissions and factors contributing to readmission.

The Open Latarjet Procedure Is More Reliable in Terms of Shoulder Stability Than Arthroscopic Bankart Repair

Charles Bessière MD, Christophe Trojani MD, PhD, Michel Carles MD, PhD, Saurabh S. Mehta MS, FRCS (Ed) (Tr & Orth), Pascal Boileau MD

Arthroscopic Bankart repair and open Latarjet bone block procedure are widely considered mainstays for surgical treatment of recurrent anterior shoulder instability. The choice between these procedures depends mainly on surgeon preference or training rather than published evidence.

Shoulder Instability in the Setting of Bipolar (Glenoid and Humeral Head) Bone Loss: The Glenoid Track Concept

Suraj Trivedi MD, Michael L. Pomerantz MD, Daniel Gross MD, Petar Golijanan BS, Matthew T. Provencher MD

An assortment of variables has been used in predicting anterior shoulder instability resulting from pathologic engagement of Hill-Sachs lesions on the glenoid. The glenoid track is a unique biomechanical model that relates both Hill–Sachs and bony Bankart lesions to predict shoulder engagement. We examined the glenoid track concept to determine if it provides a model that unifies glenoid rim and humeral head bone loss in predicting engagement.

Remplissage Versus Latarjet for Engaging Hill-Sachs Defects Without Substantial Glenoid Bone Loss: A Biomechanical Comparison

Ryan M. Degen MD, Joshua W. Giles BESc, James A. Johnson PhD, George S. Athwal MD, FRCSC

Recurrent shoulder instability is commonly associated with Hill-Sachs defects. These defects may engage the glenoid rim, contributing to glenohumeral dislocation. Two treatment options to manage engaging Hill-Sachs defects are the remplissage procedure, which fills the defect with soft tissue, and the Latarjet procedure, which increases glenoid arc length. Little evidence exists to support one over the other.

A Large Humeral Avulsion of the Glenohumeral Ligaments Decreases Stability That Can Be Restored With Repair

Kyoung Jin Park MD, PhD, Mallika Tamboli, Lauren Y. Nguyen, Michelle H. McGarry MS, Thay Q. Lee PhD

Humeral avulsion of the glenohumeral ligaments (HAGL) has become a recognized cause of recurrent shoulder instability; however, it is unknown whether small and large HAGL lesions have similarly destabilizing effects and if large lesion repair results in restoration of stability.

External Rotation Immobilization for Primary Shoulder Dislocation: A Randomized Controlled Trial

Daniel B. Whelan MD, MSc, Robert Litchfield MD, Elizabeth Wambolt BSc(HK), CCRP, Katie N. Dainty PhD

The traditional treatment for primary anterior shoulder dislocations has been immobilization in a sling with the arm in a position of adduction and internal rotation. However, recent basic science and clinical data have suggested recurrent instability may be reduced with immobilization in external rotation after primary shoulder dislocation.

How Does External Rotation Bracing Influence Motion and Functional Scores After Arthroscopic Shoulder Stabilization?

Bob Yin MD, David Levy MD, Molly Meadows MD, Todd Moen MD, Prakash Gorroochurn PhD, Edwin R. Cadet MD, William N. Levine MD, Christopher S. Ahmad MD

After arthroscopic shoulder stabilization, the loss of motion or delayed recovery of motion remains a clinical problem and may lead to poor patient satisfaction. There remains no consensus regarding the optimal position for postoperative immobilization and it is not known whether the position for shoulder immobilization has an effect on motion and functional recovery.

Effects of External Rotation on Anteroposterior Translations in the Shoulder: A Pilot Study

Andrew J. Brown BS, Richard E. Debski PhD, Carrie A. Voycheck PhD, Patrick J. McMahon MD

Using physical examination to make the diagnosis of shoulder instability can be difficult, because typical examination maneuvers are qualitative, difficult to standardize, and not reproducible. Measuring shoulder translation is especially difficult, which is a particular problem, because measuring it inaccurately may result in improper treatment of instability.

Biceps Detachment Decreases Joint Damage in a Rotator Cuff Tear Rat Model

Stephen J. Thomas PhD, ATC, Katherine E. Reuther BS, Jennica J. Tucker BS, Joseph J. Sarver PhD, Sarah M. Yannascoli MD, Adam C. Caro DVM, Pramod B. Voleti MD, Sarah I. Rooney MSE, David L. Glaser MD, Louis J. Soslowsky PhD

Pathology in the long head of the biceps tendon often occurs in patients with rotator cuff tears. Arthroscopic tenotomy is the most common treatment. However, the role of the long head of the biceps at the shoulder and the consequences of surgical detachment on the remaining shoulder structures remain unknown.

Arthroscopic Bristow-Latarjet Combined With Bankart Repair Restores Shoulder Stability in Patients With Glenoid Bone Loss

Pascal Boileau MD, Charles-Édouard Thélu MD, Numa Mercier MD, Xavier Ohl MD, Robert Houghton-Clemmey FRCS, Michel Carles MD, PhD, Christophe Trojani MD, PhD

Arthroscopic Bankart repair alone cannot restore shoulder stability in patients with glenoid bone loss involving more than 20% of the glenoid surface. Coracoid transposition to prevent recurrent shoulder dislocation according to Bristow-Latarjet is an efficient but controversial procedure.

What Is the Prevalence of Senior-athlete Rotator Cuff Injuries and Are They Associated With Pain and Dysfunction?

Patrick J. McMahon MD, Amitesh Prasad MD, Kimberly A. Francis MS, MPA

Older individuals with rotator cuff injuries may have difficulties not only with activities of daily living, but also with sports activities.

The Detrimental Effects of Systemic Ibuprofen Delivery on Tendon Healing Are Time-Dependent

Brianne K. Connizzo BS, Sarah M. Yannascoli MD, Jennica J. Tucker BS, Adam C. Caro DVM, Corinne N. Riggin BS, Robert L. Mauck PhD, Louis J. Soslowsky PhD, David R. Steinberg MD, Joseph Bernstein MD

Current clinical treatment after tendon repairs often includes prescribing NSAIDs to limit pain and inflammation. The negative influence of NSAIDs on bone repair is well documented, but their effects on tendon healing are less clear. While NSAIDs may be detrimental to early tendon healing, some evidence suggests that they may improve healing if administered later in the repair process.

Relative Fixation Strength of Rabbit Subscapularis Repair Is Comparable to Human Supraspinatus Repair at Time 0

Karimdad Otarodifard MD, Jeffrey Wong MD, Charles F. Preston MD, James E. Tibone MD, Thay Q. Lee PhD

Recent evidence suggests that the rabbit subscapularis tendon may be anatomically, biomechanically, and histologically suitable to study rotator cuff pathology and repair. However, biomechanical comparisons of rotator cuff repairs in this model have not been evaluated and compared to those in human cadaveric specimens.

Rotator Cuff Tear and Glenohumeral Instability

M. Mustafa Gomberawalla MD, Jon K. Sekiya MD

The rotator cuff plays a significant role in the static and dynamic stability of the glenohumeral joint. Rotator cuff tears may occur after shoulder dislocations, whether in younger athletes or older patients with age-related tendon degeneration. Untreated tears may cause persistent pain, dysfunction, instability, and degenerative changes. A thorough understanding of when to look for rotator cuff tears after shoulder dislocations and how best to manage them may decrease patients’ pain and improve function.

Does Preoperative Psychologic Distress Influence Pain, Function, and Quality of Life After TKA?

Alfonso Utrillas-Compaired MD, PhD, Basilio J. Torre-Escuredo MD, PhD, Ana J. Tebar-Martínez MD, MPH, Ángel Asúnsolo-Del Barco MD, PhD

Preoperative psychologic distress is considered to be a risk factor for clinical dissatisfaction stemming from persistent pain and physical limitations after elective orthopaedic procedures such as lower-extremity arthroplasty. However, the degree to which psychologic distress, specifically in the form of anxiety and depression, influences surgical results has been poorly characterized.

No Benefit of Patient-specific Instrumentation in TKA on Functional and Gait Outcomes: A Randomized Clinical Trial

Matthew P. Abdel MD, Sébastien Parratte MD, PhD, Guillaume Blanc MD, Matthieu Ollivier MD, Vincent Pomero PhD, Elke Viehweger MD, PhD, MHA, Jean-Noël A. Argenson MD, PhD

Although some clinical reports suggest patient-specific instrumentation in TKA may improve alignment, reduce surgical time, and lower hospital costs, it is unknown whether it improves pain- and function-related outcomes and gait.

Polished Trays Reduce Backside Wear Independent of Post Location in Posterior-stabilized TKAs

Matthew P. Abdel MD, Mark W. Gesell MD, Christen W. Hoedt BS, Kathleen N. Meyers MS, Timothy M. Wright PhD, Steven B. Haas MD

Backside damage of the polyethylene in TKA is a potential source of debris. The location of the tibial post in posterior-stabilized implants may influence micromotion, and thus affect backside damage, as may surface roughness.

Increased Rates of Periprosthetic Joint Infection in Patients With Cirrhosis Undergoing Total Joint Arthroplasty

Shirley L. Jiang MD, William W. Schairer MD, Kevin J. Bozic MD, MBA

Total joint arthroplasty (TJA) is becoming more prevalent, with additional increases in procedure rates expected as the US population ages. Small series have suggested increased risk of periprosthetic joint infections in patients with liver cirrhosis after TJA. However, the rates of periprosthetic joint infections and use of TJA for patients with cirrhosis have not been evaluated on a larger scale.

Is Tip Apex Distance As Important As We Think? A Biomechanical Study Examining Optimal Lag Screw Placement

Patrick Kane MD, Bryan Vopat MD, Wendell Heard MD, Nikhil Thakur MD, David Paller MD, Sarath Koruprolu BS, Christopher Born MD

Intertrochanteric hip fractures pose a significant challenge for the orthopaedic community as optimal surgical treatment continues to be debated. Currently, varus collapse with lag screw cutout is the most common mode of failure. Multiple factors contribute to cutout. From a surgical technique perspective, a tip apex distance less than 25 mm has been suggested to decrease the risk of cutout. We hypothesized that a low-center lag screw position in the femoral head, with a tip apex distance greater than 25 mm will provide equal, if not superior, biomechanical stability compared with a center-center position with a tip apex distance less than 25 mm in an unstable intertrochanteric hip fracture stabilized with a long cephalomedullary nail.

Erratum to: Is Tip Apex Distance As Important As We Think? A Biomechanical Study Examining Optimal Lag Screw Placement

Patrick Kane MD, Bryan Vopat MD, Wendell Heard MD, Nikhil Thakur MD, David Paller MS, Sarath Koruprolu MS, Christopher Born MD

Screening for Deep Vein Thrombosis After Periacetabular Osteotomy in Adult Patients: Is It Necessary?

Gregory G. Polkowski MD, MSc, Stephen T. Duncan MD, Adam D. Bloemke MD, Perry L. Schoenecker MD, John C. Clohisy MD

The periacetabular osteotomy has become a common procedure for treating symptomatic acetabular dysplasia. Like other major hip procedures, there is concern regarding the risk of associated venous thromboembolic disease. Nevertheless, there is limited information regarding the need for screening, and optimal prophylactic measures have not been established.

Paley’s Multiplier Method Does Not Accurately Predict Adult Height in Children with Bone Sarcoma

Magdalena Maria Gilg MD, Christine Wibmer MD, Dimosthenis Andreou MD, Alexander Avian PhD, Petra Sovinz MD, Werner Maurer-Ertl MD, Per-Ulf Tunn MD, Andreas Leithner MD

The majority of patients with osteosarcoma and Ewing’s sarcoma are diagnosed before skeletal maturity. Paley’s multiplier is used for height prediction in healthy children, and has been suggested as a method to make growth predictions for children with osteosarcoma and Ewing’s sarcoma when considering limb salvage options. To our knowledge, no evaluation of this method in this particular patient group has been performed, but a temporary growth deficit has been observed in children undergoing chemotherapy.

Estimated Cause-specific Survival Continues to Improve Over Time in Patients With Chondrosarcoma

Kyle R. Duchman MD, Charles F. Lynch MD, MS, PhD, Joseph A. Buckwalter MD, MS, Benjamin J. Miller MD, MS

Conditional survival measures change in the risk of mortality given that a patient has survived a defined period of time. This has yet to be reported for chondrosarcoma of bone. This information should be of interest to the clinician and helpful in counseling patients with chondrosarcoma.

Carpal Tunnel Syndrome Impairs Thumb Opposition and Circumduction Motion

Tamara L. Marquardt BS, Raviraj Nataraj PhD, Peter J. Evans MD, PhD, William H. Seitz MD, Zong-Ming Li PhD

Carpal tunnel syndrome is associated with sensory and motor impairments resulting from the compressed and malfunctioning median nerve. The thumb is critical to hand function, yet the pathokinematics of the thumb associated with carpal tunnel syndrome are not well understood.

What is the Minimum Clinically Important Difference in Grip Strength?

Jae Kwang Kim MD, PhD, Min Gyue Park MD, Sung Joon Shin MD

Grip strength reflects functional status of the upper extremity and has been used in many of the clinical studies regarding upper extremity disease or fracture. However, the smallest difference in grip strength that a patient would notice as an improvement resulting from treatment (defined as the minimum clinically important difference [MCID]), to our knowledge has not been determined.

Opioid Use After Fracture Surgery Correlates With Pain Intensity and Satisfaction With Pain Relief

Arjan G. J. Bot MD, PhD, Stijn Bekkers BSc, Paul M. Arnstein PhD, R. Malcolm Smith MD, David Ring MD, PhD

In 2012, Medicare began to tie reimbursements to inpatient complications, unplanned readmissions, and patient satisfaction, including satisfaction with pain management.

Reply to the Letter to the Editor: Symptomatic Pulmonary Embolus After Joint Arthroplasty: Stratification of Risk Factors

Javad Parvizi MD, FRCS, Ronald Huang MD, Ibrahim J. Raphael MD, William V. Arnold MD, PhD, Richard H. Rothman MD, PhD

Aggressive Tibial Lesion in a 70-year-old Man

Jacob M. Kirsch MD, Andrew E. Rosenberg MD, Brian J. O’Hara MD, John A. Abraham MD
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