Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Published in
Clinical Orthopaedics and Related Research®
Volume 474 | Issue 3 | Mar, 2016

What are the Risk Factors for Cerebrovascular Accidents After Elective Orthopaedic Surgery?

Shobhit V. Minhas MD, Preeya Goyal BA, Alpesh A. Patel MD

Perioperative cerebrovascular accidents (CVAs) are one of the leading causes of patient morbidity, mortality, and medical costs. However, little is known regarding the rates of these events and risk factors for CVA after elective orthopaedic surgery.

Nicolaes Tulp: The Overshadowed Subject in The Anatomy Lesson of Dr. Nicolaes Tulp

Berardo Di Matteo MD, Vittorio Tarabella MA, Giuseppe Filardo MD, PhD, Patrizia Tomba MA, Anna Viganò MA, Maurilio Marcacci MD

CT-based Structural Rigidity Analysis Is More Accurate Than Mirels Scoring for Fracture Prediction in Metastatic Femoral Lesions

Timothy A. Damron MD, Ara Nazarian PhD, Vahid Entezari MD, Carlos Brown MD, William Grant EdD, Nathan Calderon MSc, David Zurakowski PhD, Richard M. Terek MD, Megan E. Anderson MD, Edward Y. Cheng MD, Albert J. Aboulafia MD, Mark C. Gebhardt MD, Brian D. Snyder MD, PhD

Controversy continues regarding the appropriate assessment of fracture risk in long bone lesions affected by disseminated malignancy.

Does CT-based Rigidity Analysis Influence Clinical Decision-making in Simulations of Metastatic Bone Disease?

Ara Nazarian PhD, Vahid Entezari MD, Juan C. Villa-Camacho MD, David Zurakowski PhD, Jeffrey N. Katz MD, Mary Hochman MD, Elizabeth H. Baldini MD, Vartan Vartanians MD, Max P. Rosen MD, Mark C. Gebhardt MD, Richard M. Terek MD, Timothy A. Damron MD, Michael J. Yaszemski MD, PhD, Brian D. Snyder MD, PhD

There is a need to improve the prediction of fracture risk for patients with metastatic bone disease. CT-based rigidity analysis (CTRA) is a sensitive and specific method, yet its influence on clinical decision-making has never been quantified.

What Is the Outcome of Allograft and Intramedullary Free Fibula (Capanna Technique) in Pediatric and Adolescent Patients With Bone Tumors?

Matthew T. Houdek MD, Eric R. Wagner MD, Anthony A. Stans MD, Alexander Y. Shin MD, Allen T. Bishop MD, Franklin H. Sim MD, Steven L. Moran MD

After bone tumor resection, reconstruction for limb salvage surgery can be challenging because of the resultant large segmental bony defects. Structural allografts have been used to fill these voids; however, this technique is associated with high complication rates. To circumvent the complications associated with this procedure, massive bony allografts have been supplemented with an intramedullary vascularized free fibula. However, few studies have examined the outcomes using this technique in the pediatric and adolescent populations.

What Are the Risk Factors and Management Options for Infection After Reconstruction With Massive Bone Allografts?

Luis A. Aponte-Tinao MD, Miguel A. Ayerza MD, D. Luis Muscolo MD, Germán L. Farfalli MD

Massive bone allografts have been used for limb salvage of bone tumor resections as an alternative to endoprosthesis, although they have different outcomes and risks. The use of massive bone allografts has been thought to be associated with a high risk for infection, and there is no general consensus on the management of this complication and final outcome. Because infection is such a devastating complication of limb salvage, at times leading to loss of a limb, recognizing the risk factors for infection and the results of treatment is important.

Do Surgical Margins Affect Local Recurrence and Survival in Extremity, Nonmetastatic, High-grade Osteosarcoma?

Todd E. Bertrand MD, Alex Cruz BS, Odion Binitie MD, David Cheong MD, G. Douglas Letson MD

Long-term survival for all patients with osteosarcoma using current aggressive adjuvant chemotherapy and surgical resection is between 60% and 70%. In patients who present with nonmetastatic, high-grade extremity osteosarcoma of bone, limb salvage surgery is favored, when appropriate, over amputation to preserve the limb, because limb salvage may lead to a superior quality of life compared with amputation. However, concern remains that in the attempt to preserve the limb, close or microscopically positive surgical margins may have an adverse effect on event-free survival.

How Does the Level of Sacral Resection for Primary Malignant Bone Tumors Affect Physical and Mental Health, Pain, Mobility, Incontinence, and Sexual Function?

Rishabh Phukan BA, Tyler Herzog BS, Patrick J. Boland MD, John Healey MD, Peter Rose MD, Franklin H. Sim MD, Michael Yazsemski MD, PhD, Kathryn Hess BA, Polina Osler BS, MS, Thomas F. DeLaney MD, Yen-Lin Chen MD, Francis Hornicek MD, PhD, Joseph Schwab MS, MD

En bloc resection for treatment of sacral tumors is the approach of choice for patients with resectable tumors who are well enough to undergo surgery, and studies describe patient survival, postoperative complications, and recurrence rates associated with this treatment. However, most of these studies do not provide patient-reported functional outcomes other than binary metrics for bowel and bladder function postresection.

Is MR-guided High-intensity Focused Ultrasound a Feasible Treatment Modality for Desmoid Tumors?

Raffi S. Avedian MD, Rachelle Bitton PhD, Garry Gold MD, Kim Butts-Pauly PhD, Pejman Ghanouni MD, PhD

MR-guided high-intensity focused ultrasound is a noninvasive treatment modality that uses focused ultrasound waves to thermally ablate tumors within the human body while minimizing side effects to surrounding healthy tissues. This technology is FDA-approved for certain tumors and has potential to be a noninvasive treatment option for extremity soft tissue tumors. Development of treatment modalities that achieve tumor control, decrease morbidity, or both might be of great benefit for patients. We wanted to assess the potential use of this technology in the treatment of extremity desmoid tumors.

Do Mesenchymal Stromal Cells Influence Microscopic Residual or Metastatic Osteosarcoma in a Murine Model?

Megan E. Aanstoos MS, Daniel P. Regan DVM, Ruth J. Rose DVM, Laura S. Chubb BS, Nicole P. Ehrhart VMD

Mesenchymal stromal cells (MSCs) have been shown in rodent models to promote primary and pulmonary metastatic sarcoma growth when injected in the presence of gross tumor. In theory, this would limit their use in a clinical setting after limb salvage treatment for osteosarcoma. Although concerning, these models do not translate to the clinical setting wherein MSCs could be used after primary tumor resection to aid in bone healing and incorporation of tumor endoprostheses. If we can determine whether the use of MSCs in this setting is safe, it might improve our ability to augment bone healing in patients undergoing limb salvage.

Is Radiation Necessary for Treatment of Non-Hodgkin’s Lymphoma of Bone? Clinical Results With Contemporary Therapy

Ishaq Ibrahim BS, Bryan D. Haughom MD, Yale Fillingham MD, Steven Gitelis MD

Non-Hodgkin’s lymphoma (NHL) of bone is a rare musculoskeletal malignancy accounting for fewer than 7% of bone cancers. Traditionally, we have treated patients who have NHL of bone with chemotherapy and radiation therapy, but the role of radiotherapy in disease management and patient functional outcomes after treatment have not been well studied. We investigated the survival advantage of radiotherapy in a large cohort of patients with NHL of bone and assessed associated patient complications of radiotherapy.

Custom Acetabular Cages Offer Stable Fixation and Improved Hip Scores for Revision THA With Severe Bone Defects

Huiwu Li MD, Xinhua Qu MD, Yuanqing Mao MD, Kerong Dai MD, Zhenan Zhu MD

Revision THA is particularly challenging in hips with severe acetabular bone loss. When the extent or geometry of the acetabular bone loss precludes more-straightforward techniques such as jumbo hemispheric cementless shells, reconstruction with morselized allograft protected by a custom cage may offer an alternative, but, to our knowledge, few series have reported on results with this approach.

Does Chronic Corticosteroid Use Increase Risks of Readmission, Thromboembolism, and Revision After THA?

Matthew R. Boylan ScB, Dean C. Perfetti BA, Randa K. Elmallah MD, Viktor E. Krebs MD, Carl B. Paulino MD, Michael A. Mont MD

Systemic corticosteroids are commonly used to treat autoimmune and inflammatory diseases, but they can be associated with various musculoskeletal problems and disorders. There currently is a limited amount of data describing the postoperative complications of THA associated specifically with chronic corticosteroid use.

What Factors Influence the Success of Medial Gastrocnemius Flaps in the Treatment of Infected TKAs?

Matthew W. Tetreault MD, Craig J. Della Valle MD, Daniel D. Bohl MD, MPH, Sameer J. Lodha MD, Debdut Biswas MD, Robert W. Wysocki MD

Soft tissue defects after TKA are a potentially devastating complication. Medial gastrocnemius flaps occasionally are used to provide soft tissue coverage, most commonly with a periprosthetic joint infection.

Sacral Insufficiency Fractures are Common After High-dose Radiation for Sacral Chordomas Treated With or Without Surgery

Polina Osler MS, Miriam A. Bredella MD, Kathryn A. Hess BS, Stein J. Janssen MD, Christine J. Park BS, Yen Lin Chen MD, Thomas F. DeLaney MD, Francis J. Hornicek MD, PhD, Joseph H. Schwab MD, MS

Surgery with high-dose radiation and high-dose radiation alone for sacral chordomas have shown promising local control rates. However, we have noted frequent sacral insufficiency fractures and perceived this rate to be higher than previously reported.

A Randomized Trial Among Compression Plus Nonsteroidal Antiinflammatory Drugs, Aspiration, and Aspiration With Steroid Injection for Nonseptic Olecranon Bursitis

Joon Yub Kim MD, PhD, Seok Won Chung MD, PhD, Joo Hak Kim MD, Jae Hong Jung MD, Gwang Young Sung MD, Kyung-Soo Oh MD, Jong Soo Lee MD

Olecranon bursitis might be a minor problem in the outpatient clinic but relatively be common to occur. However, there are few well-designed studies comparing approaches to treatment.

Obesity is Not Associated with Increased Short-term Complications After Primary Total Shoulder Arthroplasty

Jimmy J. Jiang MD, Jason R. Somogyi MD, Pranay B. Patel MD, Jason L. Koh MD, Douglas R. Dirschl MD, Lewis L. Shi MD

Few studies have analyzed the association between elevated BMI and complications after total shoulder arthroplasty (TSA). Previous studies have not consistently arrived at the same conclusion regarding whether obesity is associated with a greater number of postoperative complications. We used a national surgical database to compare the 30-day complication profile and hospitalization outcomes after primary TSA among patients in different BMI categories.

Open Surgical Treatment for Snapping Scapula Provides Durable Pain Relief, but so Does Nonsurgical Treatment

Martti Vastamäki MD, PhD, Heidi Vastamäki MD, PhD

Resection of the medial upper corner of the scapula is one option for treating patients with a painful chronic snapping scapula. However, the degree to which this procedure results in sustained relief of pain during long-term followup, and whether surgical treatment offers any compelling advantages over nonsurgical approaches at long-term followup, are not known.

What Is the Radiographic Prevalence of Incidental Kienböck Disease?

Wouter F. Leeuwen MD, Stein J. Janssen MD, Dirk P. Meulen MD, David Ring MD, PhD

Kienböck disease is characterized by osteonecrosis of the lunate. Not all patients with radiographic evidence of the disease experience symptoms bothersome enough to consult a doctor. Little research has been performed on the prevalence of Kienböck disease, and the prevalence in the asymptomatic population is unclear. Knowledge of the natural course of the disease and how often patients are not bothered by the symptoms is important, because it might influence the decision as to whether disease-modifying treatment would be beneficial.

Reamed Intramedullary Nailing has an Adverse Effect on Bone Regeneration During the Distraction Phase in Tibial Lengthening

Keun Jung Ryu MD, Bang Hyun Kim MD, Jin Ho Hwang MD, PhD, Hyun Woo Kim MD, PhD, Dong Hoon Lee MD, PhD

The lengthening over nail (LON) technique has gained popularity because it enables shorter periods of external fixation, prevents deformities during lengthening, and reduces the risk of refracture after removal of the frame compared with the classic Ilizarov method. However, it is not clear if the violation of endosteal blood supply by reamed intramedullary nailing in the LON technique has a negative effect on bone regeneration or a positive effect by compensatory enhancement of periosteal circulation.

Gamma Radiation Sterilization Reduces the High-cycle Fatigue Life of Allograft Bone

Anowarul Islam MS, Katherine Chapin BS, Emily Moore BS, Joel Ford MD, Clare Rimnac PhD, Ozan Akkus PhD

Sterilization by gamma radiation impairs the mechanical properties of bone allografts. Previous work related to radiation-induced embrittlement of bone tissue has been limited mostly to monotonic testing which does not necessarily predict the high-cycle fatigue life of allografts in vivo.

What Are the 30-day Readmission Rates Across Orthopaedic Subspecialties?

James T. Bernatz BS, Jonathan L. Tueting MD, Scott Hetzel MS, Paul A. Anderson MD

The Centers for Medicare & Medicaid Services (CMS) now include hip and knee replacements in the Hospital Readmission Reduction Program. The 30-day readmission rate is an important quality metric; however, the incidence has not yet been defined across the numerous orthopaedic subspecialties. Elucidating the readmission rate for each subspecialty may indicate that certain services are being disincentivized by the CMS reimbursement program. Furthermore, the “planned” and “unplanned” definitions of readmission have not been well examined to determine their clinical relevance and representation of safe patient care. Therefore, reducing the 30-day readmission rate has become a top priority in orthopaedic quality assurance.

Recurrent Hemarthroses After TKA Treated With an Intraarticular Injection of Yttrium-90

Stephen Fine MBBCh, FRACS, Alex Klestov MBBS, BSc, FRACP

Recurrent hemarthroses after a TKA are uncommon and usually respond to nonoperative treatment or intervention using angiographic embolization or synovectomy. However, in rare circumstances, the problem can be resistant to treatment.

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