American journal of orthopedics (Belle Mead, N.J.)最新文献

Unicondylar Knee Arthroplasty in the U.S. Patient Population: Prevalence and Epidemiology. 美国患者人群中的单髁膝关节置换术:患病率和流行病学。

American journal of orthopedics (Belle Mead, N.J.) Pub Date : 2018-12-01 DOI: 10.12788/ajo.2018.0113

Erik N Hansen, Kevin L Ong, Edmund Lau, Steven M Kurtz, Jess H Lonner

{"title":"Unicondylar Knee Arthroplasty in the U.S. Patient Population: Prevalence and Epidemiology.","authors":"Erik N Hansen, Kevin L Ong, Edmund Lau, Steven M Kurtz, Jess H Lonner","doi":"10.12788/ajo.2018.0113","DOIUrl":"https://doi.org/10.12788/ajo.2018.0113","url":null,"abstract":"Publications on the prevalence of unicompartmental knee arthroplasty in the United States using a single database may have underestimated the \"true\" number of cases performed, given that several unicondylar knee arthroplasty (UKA) patients are <65 years and have private insurance. The prevalence of UKA in elderly (≥65 years) and younger (<65 years) populations was evaluated using the 2002 to 2011 5% sample of the Medicare data (Part B) and the 2004 to June 2012 MarketScan Commercial and Medicare Supplemental databases, respectively. The prevalence of UKA was stratified by age, gender, census region, Charlson comorbidity index, Medicare buy-in status, and diagnosis. The annual rate of change in the UKA rate was examined using Poisson regression to evaluate temporal changes considering year as a covariate. A total of 5235 and 23,310 UKA procedures were identified from the 5% Medicare and MarketScan databases, respectively. The rates of UKA generally increased until 2008, after which there was a decline. In both cohorts, gender and year of operation were found to be significantly associated with UKA rate. Analysis of data obtained over the past few years revealed that males 55 to 64 years, 65 to 69 years, and 70 to 74 years were the only age-gender groups whose UKA rates appeared to be trending upward. From 2002 to 2011, the rate of UKAs performed in the United States has increased, and a significant proportion of the surgeries were performed in younger (<65 years) patients.","PeriodicalId":79316,"journal":{"name":"American journal of orthopedics (Belle Mead, N.J.)","volume":"47 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36859658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 22

Incidental Asymptomatic Fibular Stress Fractures Presenting as Varus Knee Osteoarthritis: A Case Report. 偶发无症状腓骨应力性骨折表现为膝内翻性骨关节炎1例。

American journal of orthopedics (Belle Mead, N.J.) Pub Date : 2018-12-01 DOI: 10.12788/ajo.2018.0102

Taylor J Freetly, Yair D Kissin, Andrew Carbone, Michael A Kelly

引用次数: 1

Current Concepts: Evaluation and Treatment of Discoid Meniscus in the Pediatric Athlete. 当前概念:儿童运动员盘状半月板的评估和治疗。

American journal of orthopedics (Belle Mead, N.J.) Pub Date : 2018-12-01 DOI: 10.12788/ajo.2018.0107

Allen Nicholson, Logan Petit, Anthony Egger, Paul Saluan, Cordelia W Carter

{"title":"Current Concepts: Evaluation and Treatment of Discoid Meniscus in the Pediatric Athlete.","authors":"Allen Nicholson, Logan Petit, Anthony Egger, Paul Saluan, Cordelia W Carter","doi":"10.12788/ajo.2018.0107","DOIUrl":"https://doi.org/10.12788/ajo.2018.0107","url":null,"abstract":"Discoid meniscus is a rare anatomical variant with altered morphology and structure that can sometimes present symptomatically, typically in the pediatric population. The discoid meniscus is usually in the lateral compartment of the knee and is characterized by a partial or complete filling-in of central meniscal tissue, increased meniscal thickness, disorganization of longitudinal collagen fibers, and sometimes lack of peripheral attachments. These changes to both the macro- and micro-structure of the meniscus predispose affected patients to increased rates of both meniscal tears and mechanical symptoms. Surgical management of symptomatic discoid meniscus is directed toward symptom resolution while preserving sufficient functional meniscal tissue to delay or prevent the development of osteoarthritis. Modern surgical techniques consist of arthroscopic saucerization of the discoid meniscus with repair of associated meniscal tears and stabilization of peripheral attachments. Although long-term outcome data are lacking, short- and mid-term outcomes for patients treated with arthroscopic partial meniscectomy and meniscal repair and/or stabilization as needed are generally good.","PeriodicalId":79316,"journal":{"name":"American journal of orthopedics (Belle Mead, N.J.)","volume":"47 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36870008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 2

Massive Rotator Cuff Tears in Patients Older Than Sixty-five: Indications for Cuff Repair versus Reverse Total Shoulder Arthroplasty. 65岁以上患者大量肩袖撕裂:肩袖修复与反向全肩关节置换术的适应症。

American journal of orthopedics (Belle Mead, N.J.) Pub Date : 2018-12-01 DOI: 10.12788/ajo.2018.0109

Jesse W Allert, Thomas R Sellers, Peter Simon, Kaitlyn N Christmas, Shaan Patel, Mark A Frankle

{"title":"Massive Rotator Cuff Tears in Patients Older Than Sixty-five: Indications for Cuff Repair versus Reverse Total Shoulder Arthroplasty.","authors":"Jesse W Allert, Thomas R Sellers, Peter Simon, Kaitlyn N Christmas, Shaan Patel, Mark A Frankle","doi":"10.12788/ajo.2018.0109","DOIUrl":"https://doi.org/10.12788/ajo.2018.0109","url":null,"abstract":"The decision to perform rotator cuff repair (RCR) versus reverse total shoulder arthroplasty (rTSA) for massive rotator cuff tear (MCT) without arthritis can be difficult. Our aim was to identify preoperative variables that are influential in a surgeon's decision to choose one of the two procedures and evaluate outcomes. We retrospectively reviewed 181 patients older than 65 who underwent RCR or rTSA for MCT without arthritis. Clinical and radiographic data were collected and used to evaluate the preoperative variables in each of these two patient populations and assess outcomes. Ninety-five shoulders underwent RCR and 92 underwent rTSA with an average followup of 44 and 47 months, respectively. Patients selected for RCR had greater preoperative flexion (113 vs 57), abduction (97 vs 53), and external rotation (42 vs 32), higher SST (3.1 vs 1.9) and ASES scores (43.8 vs 38.6), and were less likely to have had previous cuff surgery (6.3% vs 35.9%). Patients selected for rTSA had a smaller acromiohumeral interval (4.8 vs 8.7) and more superior subluxation (50.6% vs 14.1%). Similar preoperative characteristics included pain, comorbidities, and BMI. Patients were satisfied in both groups and had significant improvement in motion and function postoperatively. Both RCR and rTSA can result in significant functional improvement and patient satisfaction in the setting of MCT without arthritis in patients older than 65. At our institution, patients who underwent rTSA had less pre-operative motion, lower function, more evidence of superior migration, and were more likely to have had previous rotator cuff surgery.","PeriodicalId":79316,"journal":{"name":"American journal of orthopedics (Belle Mead, N.J.)","volume":"47 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36870011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 10

Patellofemoral Instability in the Skeletally Immature Patient: A Review and Technical Description of Medial Patellofemoral Ligament Reconstruction in Patients with Open Physes. 骨未成熟患者的髌股不稳定:开放性骨骺患者髌股内侧韧带重建的回顾和技术描述。

American journal of orthopedics (Belle Mead, N.J.) Pub Date : 2018-12-01 DOI: 10.12788/ajo.2018.0110

Henry B Ellis, Garrett Dennis, Philip L Wilson

引用次数: 4

Preoperative Corticosteroid Use for Medical Conditions is Associated with Increased Postoperative Infectious Complications and Readmissions After Total Hip Arthroplasty: A Propensity-Matched Study. 术前使用皮质类固醇与全髋关节置换术后感染并发症和再入院增加相关:一项倾向匹配研究

American journal of orthopedics (Belle Mead, N.J.) Pub Date : 2018-12-01 DOI: 10.12788/ajo.2018.0104

Venkat Boddapati, Michael C Fu, Edwin P Su, Peter K Sculco, Stefano A Bini, David J Mayman

{"title":"Preoperative Corticosteroid Use for Medical Conditions is Associated with Increased Postoperative Infectious Complications and Readmissions After Total Hip Arthroplasty: A Propensity-Matched Study.","authors":"Venkat Boddapati, Michael C Fu, Edwin P Su, Peter K Sculco, Stefano A Bini, David J Mayman","doi":"10.12788/ajo.2018.0104","DOIUrl":"https://doi.org/10.12788/ajo.2018.0104","url":null,"abstract":"Systemic corticosteroids are used to treat a number of medical conditions; however, they are associated with numerous adverse effects. The impact of preoperative chronic corticosteroid use on postoperative outcomes following total hip arthroplasty (THA) is unclear. The purpose of this study was to assess the independent effect of chronic systemic preoperative steroid use on short-term perioperative complications and readmissions after THA. All patients undergoing primary THA in the American College of Surgeons National Surgical Quality Improvement Program registry from 2005 to 2015 were identified. Patients were considered chronic steroid users if they used any dosage of oral or parenteral steroids for >10 of the preceding 30 days before THA. Two equally sized propensity-matched groups based on preoperative steroid use were generated to account for differences in operative and baseline characteristics between the groups. Thirty-day complications and hospital readmissions rates were compared using bivariate analysis. Of 101,532 THA patients who underwent primary THA, 3714 (3.7%) were identified as chronic corticosteroid users. Comparison of propensity-matched cohorts identified an increased rate of any complication (odds ratio [OR] 1.30, P = .003), sepsis (OR 2.07, P = .022), urinary tract infection (OR 1.61, P = .020), superficial surgical site infection (OR 1.73, P = .038), and hospital readmission (OR 1.50, P < .001) in patients who used systemic steroids preoperatively. Readmissions in preoperative steroid users were most commonly for infectious reasons. Patients prescribed chronic corticosteroids are at a significantly increased risk of both 30-day periopative complications and hospital readmissions. This finding has important implications for pre- and postoperative patient counseling as well as preoperative risk stratification.","PeriodicalId":79316,"journal":{"name":"American journal of orthopedics (Belle Mead, N.J.)","volume":"47 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36859653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 11

The Characteristics of Surgeons Performing Total Shoulder Arthroplasty: Volume Consistency, Training, and Specialization. 实施全肩关节置换术的外科医生的特点:体积一致性、训练和专业化。

American journal of orthopedics (Belle Mead, N.J.) Pub Date : 2018-12-01 DOI: 10.12788/ajo.2018.0111

Benjamin Zmistowski, William Warrender, Michael Livesey, Alex Girden, Gerald R Williams, Surena Namdari

{"title":"The Characteristics of Surgeons Performing Total Shoulder Arthroplasty: Volume Consistency, Training, and Specialization.","authors":"Benjamin Zmistowski, William Warrender, Michael Livesey, Alex Girden, Gerald R Williams, Surena Namdari","doi":"10.12788/ajo.2018.0111","DOIUrl":"https://doi.org/10.12788/ajo.2018.0111","url":null,"abstract":"Total shoulder arthroplasty (TSA) has proved a cost-effective, reproducible procedure for multiple shoulder pathologies. As utilization of TSA continues to grow, it is important to investigate procedure diversity, training, and other characteristics of surgeons performing TSA. To identify surgeons performing TSA in the Medicare population, the Medicare Provider Utilization and Payment Databases from 2012 through 2014 were used. This dataset includes any provider who bills Medicare >10 times with a single billing code. A web-based search was performed for each physician performing >10 TSA in all years of the study to identify their surgical training characteristics. Between 2012 and 2014, 1374 surgeons (39 females [2.8%]) performed >10 TSA in Medicare patients in at least 1 year (71,973 TSA). Only 44.3% (609/1374) of surgeons met this threshold for all 3 years (55,538 TSA). Of these 609 surgeons, 191 (31.3%) were shoulder and elbow fellowship trained (21,444 TSA). Shoulder and elbow fellowship-trained surgeons were at earlier points in their careers and practiced in large referral-based centers with other surgeons performing TSA. In addition to TSA, surgeons performed other non-arthroplasty shoulder procedures (80.2% of surgeons), total knee arthroplasty (46.3%), repairs of traumatic injuries (29.8%), total hip arthroplasty (27.8%), non-arthroplasty knee surgeries (27.2%), elbow procedures (19.6%), and hand surgery (15.4%) during the study period. With less than one-third of TSA performed by shoulder and elbow fellowship-trained surgeons with consistent moderate-volume practices, the impact of consistent high-volume practices and targeted fellowship training on quality must be determined.","PeriodicalId":79316,"journal":{"name":"American journal of orthopedics (Belle Mead, N.J.)","volume":"47 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36859656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 4

A Retrospective Analysis of the Modified Intervastus Approach. 改良股间入路的回顾性分析。

American journal of orthopedics (Belle Mead, N.J.) Pub Date : 2018-12-01 DOI: 10.12788/ajo.2018.0106

Muthana Sartawi, Hafizur Rahman, James Kohlmann, Ross Leighton, Mariana E Kersh

{"title":"A Retrospective Analysis of the Modified Intervastus Approach.","authors":"Muthana Sartawi, Hafizur Rahman, James Kohlmann, Ross Leighton, Mariana E Kersh","doi":"10.12788/ajo.2018.0106","DOIUrl":"https://doi.org/10.12788/ajo.2018.0106","url":null,"abstract":"The subvastus (SV) approach is a well-known muscle- and tendon-sparing approach for total knee arthroplasty (TKA), which has been shown in some studies to provide better outcomes in the visual analog pain score (VAS), knee range of motion (ROM), straight-leg raise, as well as faster rehabilitation, compared with the standard medial parapatellar (MP) approach. We previously described a new knee replacement technique known as the modified intervastus (MIV) approach. The MIV approach is a muscle- and tendon-sparing approach that is extensile and simple to perform. It may be used in the majority of complex primary cases and revisions. Here we describe the surgical technique for performing the MIV approach and provide functional outcome measures. A total of 127 patients (mean age, 66.75 years) underwent TKA using the MIV approach with 1-year follow-up. Clinical outcomes were assessed by recording both a VAS and knee ROM preoperatively, and again at several postoperative time points when the length of time required to ambulate independently (without assistive devices) was also measured. The VAS decreased significantly from the preoperative period (3.69 ± 2.22) to postoperative day 1 (3.17 ± 1.97) (P < .05). Although knee ROM decreased 1 week after surgery, the ROM increased by 6 weeks after surgery compared with the preoperative ROM, and the trend continued over the 1-year follow-up. One-third (33%) of patients were able to walk independently (without assistive devices) at 2 weeks and 78% at 8 weeks. The MIV approach to the knee is a muscle- and tendon-sparing approach that offers advantages over the SV approach and may be used for complex primary and revision total knee cases.","PeriodicalId":79316,"journal":{"name":"American journal of orthopedics (Belle Mead, N.J.)","volume":"47 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36870555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 2

Return to Play After an Anterior Cruciate Ligament Injury: Prioritizing Neurological and Psychological Factors of the Decision-Making Algorithm. 前交叉韧带损伤后恢复:优先考虑决策算法的神经和心理因素。

American journal of orthopedics (Belle Mead, N.J.) Pub Date : 2018-12-01 DOI: 10.12788/ajo.2018.0108

Todd Furman, Holly Silvers-Granelli

{"title":"Return to Play After an Anterior Cruciate Ligament Injury: Prioritizing Neurological and Psychological Factors of the Decision-Making Algorithm.","authors":"Todd Furman, Holly Silvers-Granelli","doi":"10.12788/ajo.2018.0108","DOIUrl":"https://doi.org/10.12788/ajo.2018.0108","url":null,"abstract":"Soccer players recovering from anterior cruciate ligament (ACL) injuries have better options for treatment today than they did 25 years ago. Surgical techniques have improved, and rehabilitation protocols have evolved considerably. Although the rehabilitation community is doing a better job of treating this patient population, the evidence does demonstrate that both re-injury and return- to-play (RTP) rates are still suboptimal. Most protocols focus on normalizing strength and range of motion (ROM) and achieving limb symmetry with soccer-specific movements. While these factors are certainly prerequisites for returning to the field, their inclusion does not provide a complete picture of the athlete's presentation. An additional factor that should be prioritized with this patient population is the central nervous system (CNS). Advanced imaging has shown that peripheral deafferentation does occur with musculoskeletal injuries; this ultimately results in cortical reorganization, which makes movement planning more difficult for the player, since simpler tasks must now be processed at higher levels in the CNS. The evidence also shows that the CNS demonstrates plasticity in these cases, so that through focused neuromotor rehabilitation techniques, it is possible to bring movement planning back down to a sub-cortical level. Cognitive issues may also be a factor in preventing the player from returning. Fear of re-injury and diminished confidence can influence the way the player moves on the field, and diminish ability to demonstrate protective kinematics with all soccer-specific tasks. We believe that an approach incorporating traditional musculoskeletal rehabilitation, CNS neuro-motor training, and consideration for cognitive factors, may define an improved paradigm for treating the soccer player and assessing readiness for RTP following ACL injury.","PeriodicalId":79316,"journal":{"name":"American journal of orthopedics (Belle Mead, N.J.)","volume":"47 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36859654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 2

Review of Common Clinical Conditions of the Proximal Tibiofibular Joint. 胫腓骨近端关节常见临床情况综述。

American journal of orthopedics (Belle Mead, N.J.) Pub Date : 2018-12-01 DOI: 10.12788/ajo.2018.0105

Christian M Curatolo, Gregory Bach, Christopher E Mutty, John M Marzo

引用次数: 6