Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Published in
Clinical Orthopaedics and Related Research®
Volume 473 | Issue 10 | Oct, 2015

Adipose-derived Mesenchymal Stem Cells Are Phenotypically Superior for Regeneration in the Setting of Osteonecrosis of the Femoral Head

Cody C. Wyles BS, Matthew T. Houdek MD, Ruben J. Crespo-Diaz PhD, German A. Norambuena MD, Paul G. Stalboerger MS, Andre Terzic MD, PhD, Atta Behfar MD, PhD, Rafael J. Sierra MD

Bone marrow-derived mesenchymal stem cells (bmMSCs) have been used as a cellular therapeutic option for treatment of osteonecrosis of the femoral head. However, use of bmMSCs as a treatment adjuvant for orthopaedic disorders in general has achieved limited success. Adipose-derived MSCs (aMSCs) may be a more-efficient regenerative cell source given their greater quantity and protection from physiologic stress.

2015 Marshall Urist Young Investigator Award: Prognostication in Patients With Long Bone Metastases: Does a Boosting Algorithm Improve Survival Estimates?

Stein J. Janssen MD, Andrea S. Heijden BSc, Maarten Dijke BSc, John E. Ready MD, Kevin A. Raskin MD, Marco L. Ferrone MD, Francis J. Hornicek MD, MS, PhD, Joseph H. Schwab MD, MS

Survival estimation guides surgical decision-making in metastatic bone disease. Traditionally, classic scoring systems, such as the Bauer score, provide survival estimates based on a summary score of prognostic factors. Identification of new factors might improve the accuracy of these models. Additionally, the use of different algorithms—nomograms or boosting algorithms—could further improve accuracy of prognostication relative to classic scoring systems. A nomogram is an extension of a classic scoring system and generates a more-individualized survival probability based on a patient’s set of characteristics using a figure. Boosting is a method that automatically trains to classify outcomes by applying classifiers (variables) in a sequential way and subsequently combines them. A boosting algorithm provides survival probabilities based on every possible combination of variables.

What is the Utility Of a Limb Lengthening and Reconstruction Service in an Academic Department of Orthopaedic Surgery?

S. Robert Rozbruch MD, Elizabeth S. Rozbruch, Samuel Zonshayn BS, Eugene W. Borst BS, Austin T. Fragomen MD

Limb lengthening and reconstruction surgery is a relatively new subspecialty of orthopaedic surgery in the United States. Despite increased awareness and practice of the specialty, it is rarely vested as a separate clinical service in an academic department of orthopaedic surgery. We have had experience growing such a dedicated service within an academic department of orthopaedic surgery over the past 9 years.

Fixator-assisted Technique Enables Less Invasive Plate Osteosynthesis in Medial Opening-wedge High Tibial Osteotomy: A Novel Technique

Dong Hoon Lee MD, PhD, Keun Jung Ryu MD, Hae Hwa Kim MD, PhD, Sahyun Soung MD, Soowan Shin BS

Opening-wedge high tibial osteotomy is a well-established procedure in the management of medial osteoarthritis of the knee and correction of proximal tibia vara. Recently, surgical approaches using less invasive plate osteosynthesis have been used with the goal of minimizing complications from more extensive soft tissue exposures. However, to our knowledge, less invasive fixator-assisted plate osteosynthesis has not been tested in the setting of opening-wedge high tibial osteotomy.

Does Integrated Fixation Provide Benefit in the Reconstruction of Posttraumatic Tibial Bone Defects?

Mitchell Bernstein MD, Austin T. Fragomen MD, Samir Sabharwal BA, Jonathan Barclay BA, S. Robert Rozbruch MD

Limb salvage in the presence of posttraumatic tibial bone loss can be accomplished using the traditional Ilizarov method of distraction osteogenesis with circular external fixation. Internal fixation placed at the beginning of the consolidation phase, so-called integrated fixation, may allow for earlier removal of the external fixator but introduces concerns about cross-contamination from the additional open procedure and maintenance of bone regenerate stability.

Clinical Implications of Psychosocial Factors on Pediatric External Fixation Treatment and Recommendations

Heather M. Richard PsyD, Dylan C. Nguyen MA, John G. Birch MD, FRCS(C), Sandy D. Roland PhD, Mikhail K. Samchukov MD, Alex M. Cherkashin MD

Pediatric limb reconstruction using circular external fixation is a prolonged treatment that interrupts patients’ daily function. Patient personality characteristics and expectations may interfere with planned treatment, making complicated medical procedures more challenging. The aims of this study are to identify factors impacting treatment outcome and recommendations for preoperative evaluation and planning.

Low Albumin Levels, More Than Morbid Obesity, Are Associated With Complications After TKA

Charles L. Nelson MD, Nabil M. Elkassabany MD, MSCE, Atul F. Kamath MD, Jiabin Liu MD, PhD

Morbid obesity and malnutrition are thought to be associated with more frequent perioperative complications after TKA. However, morbid obesity and malnutrition often are co-occurring conditions. Therefore it is important to understand whether morbid obesity, malnutrition, or both are independently associated with more frequent perioperative complications. In addition, assessing the magnitude of an increase in complications and whether these complications are major or minor is important for both conditions.

Tantalum Cones Provide Durable Mid-term Fixation in Revision TKA

Ivan Martino MD, Vincenzo Santis MD, Peter K. Sculco MD, Rocco D’Apolito MD, Joseph B. Assini MD, Giorgio Gasparini MD

Multiple studies have reported favorable short-term outcomes using tantalum cones to reconstruct massive bone defects during revision TKA. However, longer-term followup is needed to determine the durability of these reconstructions.

Posterior Soft Tissue Repair After Primary THA is Durable at Mid-term Followup: A Prospective MRI Study

Alexander S. McLawhorn MD, MBA, Hollis G. Potter MD, Michael B. Cross MD, Friedrich Boettner MD, Weiyang Lim MBBS, FRCR, MMED, Yuo-yu Lee MS, Paul M. Pellicci MD

The enhanced posterior soft tissue repair has reduced the frequency of dislocation after primary THA performed through the posterolateral approach. However, the long-term integrity of the repair is unknown and could influence surgeon choice regarding surgical technique and THA approach.

Can Normal Fracture Healing Be Achieved When the Implant Is Retained on the Basis of Infection? An Experimental Animal Model

Fuat Bilgili MD, Halil Ibrahim Balci MD, Kayahan Karaytug MD, Kerim Sariyilmaz MD, Ata Can Atalar MD, Ergun Bozdag PhD, Meral Tuna PhD, Bilge Bilgic MD, Nezahat Gurler MD

Infection after open fractures is a common complication. Treatment options for infections developed after intramedullary nailing surgery remain a topic of controversy. We therefore used a rat fracture model to evaluate the effects of infection on osseous union when the implant was maintained.

Are There Long-term Benefits to Cementing the Metaphyseal Stem in Hip Resurfacing?

Harlan C. Amstutz MD, Michel J. Duff MA, Sandeep K. Bhaurla MPH

Cementing the metaphyseal stem during hip resurfacing surgery improves the initial fixation of the femoral component. However, there may be long-term detrimental effects such as stress shielding or an increased risk of thermal necrosis associated with this technique.

Does Microwave Ablation of the Tumor Edge Allow for Joint-sparing Surgery in Patients With Osteosarcoma of the Proximal Tibia?

Jing Li MD, PhD, Zheng Guo MD, PhD, Zhen Wang MD, Hongbin Fan MD, Jun Fu MD

Joint-sparing surgery of a patient’s native joint for osteosarcoma likely affords better function and comparable survival. However, it sometimes is challenging to resect a juxtaarticular osteosarcoma in a way that preserves the affected epiphysis because wide margins are necessary to minimize the risk of local recurrence. If there was a method to resect a tumor close to the joint and treat a potentially positive margin to prevent recurrence, it might allow salvage of a joint that otherwise might be lost.

Latissimus Dorsi and Teres Major Transfer With Reverse Shoulder Arthroplasty Restores Active Motion and Reduces Pain for Posterosuperior Cuff Dysfunction

Lewis L. Shi MD, Kirk E. Cahill BA, Eugene T. Ek MBBS, PhD, Jeffrey D. Tompson MS, Laurence D. Higgins MD, Jon J. P. Warner MD

In patients with rotator cuff dysfunction, reverse shoulder arthroplasty can restore active forward flexion, but it does not provide a solution for the lack of active external rotation because of infraspinatus and the teres minor dysfunction. A modified L’Episcopo procedure can be performed in the same setting wherein the latissimus dorsi and teres major tendons are transferred to the lateral aspect of proximal humerus in an attempt to restore active external rotation.

Patients Undergoing Total Shoulder Arthroplasty on the Dominant Extremity Attain Greater Postoperative ROM

Gregory L. Cvetanovich MD, Peter N. Chalmers MD, Jonathan J. Streit MD, Anthony A. Romeo MD, Gregory P. Nicholson MD

Total shoulder arthroplasty (TSA) provides excellent functional outcomes and pain relief in appropriately selected patients. Although it is known to affect other shoulder conditions, the role of hand dominance after TSA has not been reported, to our knowledge.

What Are Risk Factors for Intraoperative Humerus Fractures During Revision Reverse Shoulder Arthroplasty and Do They Influence Outcomes?

Eric R. Wagner MD, Matthew T. Houdek MD, Bassem T. Elhassan MD, Joaquin Sanchez-Sotelo MD, PhD, Robert H. Cofield MD, John W. Sperling MD, MBA

With the increase in shoulder arthroplasty rates, the number of perioperative complications, such as periprosthetic fractures, continues to be a rise; however, the risk factors and incidence of intraoperative complications, such as fractures, during revision reverse shoulder arthroplasty are not well established.

The Minimum Clinically Important Difference of the Patient-rated Wrist Evaluation Score for Patients With Distal Radius Fractures

Monique M. J. Walenkamp MD, MSCE, Robert-Jan Muinck Keizer MD, J. Carel Goslings MD, PhD, Lara M. Vos MD, Melvin P. Rosenwasser MD, Niels W. L. Schep MD, PhD, MSCE

The Patient-rated Wrist Evaluation (PRWE) is a commonly used instrument in upper extremity surgery and in research. However, to recognize a treatment effect expressed as a change in PRWE, it is important to be aware of the minimum clinically important difference (MCID) and the minimum detectable change (MDC). The MCID of an outcome tool like the PRWE is defined as the smallest change in a score that is likely to be appreciated by a patient as an important change, while the MDC is defined as the smallest amount of change that can be detected by an outcome measure. A numerical change in score that is less than the MCID, even when statistically significant, does not represent a true clinically relevant change. To our knowledge, the MCID and MDC of the PRWE have not been determined in patients with distal radius fractures.

Immunohistochemical Mapping of Sensory Nerve Endings in the Human Triangular Fibrocartilage Complex

Susanne Rein MD, PhD, Manuel Semisch, Marc Garcia-Elias MD, PhD, Alex Lluch MD, Hans Zwipp MD, PhD, Elisabet Hagert MD, PhD

The triangular fibrocartilage complex is the main stabilizer of the distal radioulnar joint. While static joint stability is constituted by osseous and ligamentous integrity, the dynamic aspects of joint stability chiefly concern proprioceptive control of the compressive and directional muscular forces acting on the joint. Therefore, an investigation of the pattern and types of sensory nerve endings gives more insight in dynamic distal radioulnar joint stability.

Surgical Treatment of Hip Instability in Patients With Lower Lumbar Level Myelomeningocele: Is Muscle Transfer Required?

Timur Yildirim MD, Sarper Gursu MD, İlhan Avni Bayhan MD, Hakan Sofu MD, Aysegul Bursali MD

Treatment of hip instability in patients with lower lumbar level myelomeningocele is clinically challenging. Muscle transfer procedures, release of contractures, and intertrochanteric varus-rotation osteotomies have been described to restore weak or absent abductor strength as well as relocation of the hip. However, controlled trials evaluating hip instability in lower lumbar myelomeningocele are limited in the current literature.

Lengthening With External Fixation Is Effective in Congenital Femoral Deficiency

Daniel E. Prince MD, MPH, John E. Herzenberg MD, Shawn C. Standard MD, Dror Paley MD

Treatment of congenital femoral deficiency is a complex, multistage protocol and a variety of strategies have been devised to address joint instability, limb length inequality, and deformities. Despite being an important part of the algorithmic approach to the overall treatment of patients with congenital femoral deficiency, a reproducible, safe, and functional treatment for femoral length discrepancy in patients with mild and moderate congenital femoral deficiency has not been reported.

Mortality and Revision Surgery Are Increased in Patients With Parkinson’s Disease and Fractures of the Femoral Neck

Mark S. Karadsheh MD, Michael Weaver MD, Kenneth Rodriguez MD, PhD, Mitchel Harris MD, David Zurakowski PhD, Robert Lucas BA

Patients with Parkinson’s disease are at increased risk for falls and associated hip fractures as a result of tremor, bradykinesia, rigidity, and postural instability. The available literature is limited and conflicting regarding the optimal surgical treatment and risk for postoperative complications and mortality in this unique patient population.

Intraarticular Matrix Metalloproteinases and Aggrecan Degradation Are Elevated After Articular Fracture

Justin M. Haller MD, Craig A. Swearingen BS, Deveree Partridge MS, Molly McFadden MS, Kannan Thirunavukkarasu PhD, Thomas F. Higgins MD

Posttraumatic osteoarthritis (OA) is a variant of OA that can develop after articular injury. Although the mechanism(s) of posttraumatic OA are uncertain, the presence and impact of postinjury proteolytic enzymes on articular cartilage remain unknown. To our knowledge, there are no studies that evaluate the presence of matrix metalloproteinases (MMPs) or aggrecan degradation after articular fracture.

What Are the Strength of Recommendations and Methodologic Reporting in Health Economic Studies in Orthopaedic Surgery?

Eric C. Makhni MD, MBA, Michael E. Steinhaus MD, Eric Swart MD, Kevin J. Bozic MD, MBA

Cost-effectiveness research is an increasingly used tool in evaluating treatments in orthopaedic surgery. Without high-quality primary-source data, the results of a cost-effectiveness study are either unreliable or heavily dependent on sensitivity analyses of the findings from the source studies. However, to our knowledge, the strength of recommendations provided by these studies in orthopaedics has not been studied.

Orthopaedic Surgeons Receive the Most Industry Payments to Physicians but Large Disparities are Seen in Sunshine Act Data

Andre M. Samuel BBA, Matthew L. Webb AB, Adam M. Lukasiewicz MSc, Daniel D. Bohl MPH, Bryce A. Basques BS, Glenn S. Russo MD, Vinay K. Rathi BA, Jonathan N. Grauer MD

Industry payments made to physicians by drug and device manufacturers or group purchasing organizations are now reported to the Centers for Medicare and Medicaid Services (CMS) as a part of the Physician Payments Sunshine Act. Initial reports from the program show that orthopaedic surgeons lead all physician specialties in total and average industry payments. However, before further discussion of these payments and their implications can take place, it remains to be seen whether these figures are a true reflection of the field of orthopaedic surgery in general, rather than the result of a few outlier physicians in the field. In addition, the nature and sources of these funds should be determined to better inform the national dialogue surrounding these payments.

Prevalence and Risk Factors of Spine, Shoulder, Hand, Hip, and Knee Osteoarthritis in Community-dwelling Koreans Older Than Age 65 Years

Hyung Joon Cho MD, Vivek Morey MS(Ortho), Jong Yeal Kang MD, Ki Woong Kim MD, Tae Kyun Kim MD

Osteoarthritis (OA) is common and disabling among older patients around the world. Data exploring the prevalence and risk factors of OA are of paramount importance in establishing healthcare policies. However, few studies have evaluated these topics among Asian populations.

Spinal Cord Injury After Extremity Surgery in Children With Thoracic Kyphosis

Blazej Pruszczynski MD, William G Mackenzie MD, FRCS, Kenneth Rogers PhD, ATC, Klane K. White MD, MSc

Spinal cord injury is a rare complication after lower extremity surgery in children with skeletal dysplasia and thoracic kyphosis. We encountered two patients who had this complication, from among 51 (39 from Nemours/Alfred I. duPont Hospital for Children and 12 from Seattle Children’s Hospital) who underwent lower extremity surgery during an 8.5-year period (June 2004 to December 2012). Because spinal cord injury is a devastating complication likely not known to most physicians treating patients with skeletal dysplasias, we sought to examine factors that may contribute to this rare complication.

Erratum to: 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

Classifications in Brief: Lauge-Hansen Classification of Ankle Fractures

Jason P. Tartaglione MD, Andrew J. Rosenbaum MD, Mostafa Abousayed MD, John A. DiPreta MD
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