Orthop Clin North Am
· 2025 Oct · PMID 41101919
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Femoroacetabular impingement is a structural mismatch between the femoral head and acetabulum that can lead to labral tear, cartilage damage, and early-onset osteoarthritis. The etiology is likely multifactorial, involvi...Femoroacetabular impingement is a structural mismatch between the femoral head and acetabulum that can lead to labral tear, cartilage damage, and early-onset osteoarthritis. The etiology is likely multifactorial, involving both genetic and environmental risk factors, particularly engagement in high-impact lower extremity activities beginning at a young age. Diagnosis requires a triad of painful symptoms, positive clinical signs, and corroborative radiographic parameters. First-line treatment is typically conservative management with dedicated physical therapy focusing on core and hip strengthening. If conservative management is unsuccessful in providing durable symptomatic improvement, then surgery with conventional hip arthroscopy consisting of CAM/pincer resection, labral repair, and cartilage procedures as indicated can result in excellent patient reported outcomes and high rates of return to sport.
Orthop Clin North Am
· 2025 Oct · PMID 41101918
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Acute management of a knee dislocation requires prompt recognition. A high index of suspicion should exist in any trauma patient with knee pain or an effusion. A thorough clinical examination to identify vascular or neur...Acute management of a knee dislocation requires prompt recognition. A high index of suspicion should exist in any trauma patient with knee pain or an effusion. A thorough clinical examination to identify vascular or neurologic injury is critical. Reduction must be performed if the knee presents dislocated and open reduction is warranted if the knee is irreducible. Stabilization can occur with a splint or knee immobilizer, but if reduction is unable to be maintained, an external fixator should be placed. Patients should be monitored postreduction for 24 to 48 hours with serial examinations to detect delayed vascular compromise and/or compartment syndrome.
Orthop Clin North Am
· 2025 Oct · PMID 41101917
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This review synthesizes current knwledge. regarding posterior cruciate ligament (PCL) injuries in athletes, encompassing anatomical structure, biomechanical function, injury mechanisms, and diagnostic evaluation. We pres...This review synthesizes current knwledge. regarding posterior cruciate ligament (PCL) injuries in athletes, encompassing anatomical structure, biomechanical function, injury mechanisms, and diagnostic evaluation. We present an analaysis of both non-operative and operative management options, with particular attention to contemporary reconstruction techniques and recovery protocols. The review provides clinicians with an evidence-based framework for PCL injury management in athletic populations.
Graham GD, Preuss FR, Mueller JD
… +4 more, Delman CM, Riboh JC, Weeks KD, Haffner MR
Orthop Clin North Am
· 2025 Oct · PMID 41101916
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Femoroacetabular impingement syndrome significantly impacts athletic performance across various sports. Recent literature shows high overall return-to-sport rates (87%-93%) following surgical treatment, particularly with...Femoroacetabular impingement syndrome significantly impacts athletic performance across various sports. Recent literature shows high overall return-to-sport rates (87%-93%) following surgical treatment, particularly with arthroscopic approaches, though return to preinjury performance levels varies (55%-83%). Athletes typically resume sport within 4 to 8 months postsurgery, with outcomes influenced by factors like symptom duration, rehabilitation adherence, and sport-specific demands. Professional athletes generally show better outcomes than recreational athletes, though many experience temporary performance declines in their first season back. Early intervention and sport-specific rehabilitation protocols appear crucial for optimal outcomes.
Barnhill S, Rubenstein W, Lange J
… +4 more, Mihalko WM, Kain MS, Jamison M, Iorio R
Orthop Clin North Am
· 2025 Jul · PMID 40484480
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Hospital margins are falling and the need to control costs has become increasingly important for hospital and ambulatory surgery centers financial survival. The Braun CoreHip System allows reconstruction of the femoral o...Hospital margins are falling and the need to control costs has become increasingly important for hospital and ambulatory surgery centers financial survival. The Braun CoreHip System allows reconstruction of the femoral offset independent of stem size. There are a maximum of 4 to 6 instrument trays thus minimizing sterilization costs and instrumentation. This study aimed to investigate the potential for cost-savings by utilizing the CoreHip stem versus legacy hip systems at a large academic institution. The use of a multi-offset, one rasp system with minimal instrumentation and low cost is attractive for institutions and practices planning to reduce cost.
Orthop Clin North Am
· 2025 Jul · PMID 40484479
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Due to the ongoing opioid epidemic in the United States, increasing attention has been placed on examining and altering opioid prescribing practices, especially within orthopedic surgery, one of the highest prescribing s...Due to the ongoing opioid epidemic in the United States, increasing attention has been placed on examining and altering opioid prescribing practices, especially within orthopedic surgery, one of the highest prescribing specialties. In recent years, there has been a growing body of literature within orthopedics, and specifically hand surgery, regarding opioids and alternative anesthesia/analgesia options to improve patient care and safety. In this review, we look at the current literature as it pertains to narcotic use in hand surgery, with an aim to alter prescribing habits to improve the quality of patient care and patient safety.
Orthop Clin North Am
· 2025 Jul · PMID 40484478
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Aspirin is increasingly being used for venous thromboembolism (VTE) prophylaxis in patients undergoing total joint arthroplasty (TJA). It is considered a safer and more cost-effective alternative to other anticoagulants,...Aspirin is increasingly being used for venous thromboembolism (VTE) prophylaxis in patients undergoing total joint arthroplasty (TJA). It is considered a safer and more cost-effective alternative to other anticoagulants, with the added benefit of not requiring blood-level titration. Studies have shown that aspirin is effective in preventing VTE, with a lower risk of major bleeding and reduced mortality compared to other options. Additionally, aspirin provides indirect benefits such as a reduced risk of periprosthetic joint infections (PJIs), heterotopic ossification (HO), and joint stiffness, with no significant difference in aseptic loosening rates when compared to stronger anticoagulants.
Orthop Clin North Am
· 2025 Jul · PMID 40484477
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Total hip and knee arthroplasty surgery are among the most successful orthopedic surgical interventions. However, there remains a cohort of patients who are dissatisfied with the outcome of their surgery despite measurab...Total hip and knee arthroplasty surgery are among the most successful orthopedic surgical interventions. However, there remains a cohort of patients who are dissatisfied with the outcome of their surgery despite measurable improvement in functional outcomes. Validated patient outcome measurement systems have depicted that patient mental health may influence a patient's interpretation of surgical outcome despite improvement in functional capability. Furthermore, patients who suffer from poor mental health may have a higher likelihood of postoperative complication that result in large socioeconomic burden. The ability of a surgeon to utilize patient health questionnaires to screen for and identify patients with mental health issues is important.
Diltz ZR, Zalewski JT, Mosher ZA
… +5 more, Gailey AD, Eason RR, Holland CT, Mihalko WM, Ford MC
Orthop Clin North Am
· 2025 Jul · PMID 40484476
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Total joint arthroplasty (TJA) is increasingly performed in ambulatory settings with equivalent safety as inpatient procedures, and obesity is a risk factor for osteoarthritis. Patient selection is critical to avoid pote...Total joint arthroplasty (TJA) is increasingly performed in ambulatory settings with equivalent safety as inpatient procedures, and obesity is a risk factor for osteoarthritis. Patient selection is critical to avoid potential complications in those with comorbidities. This study aims to review the current body of literature and evaluate the safety of ambulatory TJA with planned same-day discharge in patients with a body mass index greater than 35. Multiple studies have reported increased complication rates with TJA in patients with obesity; however, obesity alone should not prevent patients from being considered for outpatient TJA in the ambulatory setting.
Dong K, Gelvez D, Redlich N
… +2 more, Abraham J, Bhandutia A
Orthop Clin North Am
· 2025 Jul · PMID 40484475
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This article reviews the assessment and management of degenerative spondylolisthesis and lumbar stenosis. It discusses nonoperative management modalities and operative management and indications. It also discusses compli...This article reviews the assessment and management of degenerative spondylolisthesis and lumbar stenosis. It discusses nonoperative management modalities and operative management and indications. It also discusses complications and reviews the current body of literature for clinical outcomes with surgical management. There remains conflicting evidence on whether isolated decompression versus decompression and fusion is superior,. Minimally invasive techniques show early promise at reducing some of the potential complications with open decompression. As health care costs increase, cost considerations become more important and should be included as a factor in decision making.
Orthop Clin North Am
· 2025 Jul · PMID 40484474
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To achieve excellence in patient care in today's health care environment, physicians must have an eye on maximizing outcomes and safety while balancing resource utilization. Evidence is mounting to support the expanded u...To achieve excellence in patient care in today's health care environment, physicians must have an eye on maximizing outcomes and safety while balancing resource utilization. Evidence is mounting to support the expanded use of ambulatory surgery centers (ASC) as safe and effective locations for performing pediatric orthopedic surgery for various conditions. Patient selection is crucial to patient diagnosis and comorbid factors to allow ambulatory surgery to be performed safely and may require consultation with the ASC anesthesiologist. In so doing, providers are best positioned to use an ASC to deliver excellent clinical outcomes, maintain patient safety, and secure value.
Orthop Clin North Am
· 2025 Jul · PMID 40484473
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Patient reported outcome measures are a valuable tool in orthopedic trauma surgery, offering insights into patient's perspective on their functional recovery, pain, and quality of life. Among these, are the patient repor...Patient reported outcome measures are a valuable tool in orthopedic trauma surgery, offering insights into patient's perspective on their functional recovery, pain, and quality of life. Among these, are the patient reported outcome measurement information system (PROMIS) scores that are robust, efficient, and provide a validated assessment of health-related outcomes. PROMIS uses item-response theory to provide precise, adaptable, and patient-centered measures across various domains. This article highlights the potential role of PROMIS scores in orthopedic trauma and compares its advantages to legacy outcome scores. PROMIS holds the ability to improve patient-centered care and enhance evidence-based practice in orthopedic trauma surgery.
Kiwinda LV, Kocher SD, Bethell MA
… +3 more, Taylor ED, DeBaun MR, Péan CA
Orthop Clin North Am
· 2025 Jul · PMID 40484472
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Orthopedic trauma care is impacted by social determinants of health (SDOH) like socioeconomic status, education, and health care access. Disparities in these areas lead to worse outcomes, particularly in rural and low-in...Orthopedic trauma care is impacted by social determinants of health (SDOH) like socioeconomic status, education, and health care access. Disparities in these areas lead to worse outcomes, particularly in rural and low-income urban populations, who face higher mortality and delayed care. Despite their importance, routine SDOH screenings are underused in trauma settings. This review emphasizes the need to integrate SDOH into orthopedic trauma care, enabling targeted interventions, timely access to resources, and equitable recovery. By addressing systemic barriers, orthopedic surgeons can play a vital role in reducing disparities and improving holistic patient outcomes.
Orthop Clin North Am
· 2025 Jul · PMID 40484471
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Value-based health care is a commonly used term that merits a strong understanding from the orthopedic surgeon given its importance in orthopedic patient care. In this review article, we provide an overview of the concep...Value-based health care is a commonly used term that merits a strong understanding from the orthopedic surgeon given its importance in orthopedic patient care. In this review article, we provide an overview of the concept, discussing the value equation and its components. We represent payment models along a spectrum of value to emphasize the importance of considering the relative strengths and tradeoffs of each model separately. In the latter half of the article, we discuss several themes within value improvement that will be relevant for the foreseeable future and of which the orthopedic surgeon should be aware.
Orthop Clin North Am
· 2025 Jul · PMID 40484470
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As health care continues to shift to value-based reimbursement and away from volume-based reimbursement, there will be increasing emphasis on demonstrating improvement of patient health to justify reimbursement. Orthoped...As health care continues to shift to value-based reimbursement and away from volume-based reimbursement, there will be increasing emphasis on demonstrating improvement of patient health to justify reimbursement. Orthopedic surgeons that can demonstrate superior quality of care delivered will be in position to improve financial compensation as these 2 metrics become increasingly tightly correlated. In order to deliver high-value care, orthopedic surgeons must be aware of the core tenets of such delivery, including quality, value, and safety. Understanding these core tenets will be critical to providing high-value care and subsequently succeeding in the evolving value-based market.
Orthop Clin North Am
· 2025 Apr · PMID 40044352
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Infection after open fracture is much less common in children than in adults, but it still requires special attention to help prevent, diagnose, and treat when it does occur. In this review, we examine strategies for pre...Infection after open fracture is much less common in children than in adults, but it still requires special attention to help prevent, diagnose, and treat when it does occur. In this review, we examine strategies for preventing infection once open fracture is recognized, diagnostic criteria for infection, and treatment approaches for infection after open fracture in children. We highlight differences in pediatric care from adult care and discuss practice variabilities based on the lack of available data to guide certain treatment patterns.
Gonzalez MR, Mendez-Guerra C, Inchaustegui ML
… +2 more, de la Blanca JCG, Pretell-Mazzini JA
Orthop Clin North Am
· 2025 Apr · PMID 40044351
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External fixation is used in acute and elective cases in both adult and pediatric patients. Adequate selection of patients for external fixation is critical, especially in patients with polytrauma where the application o...External fixation is used in acute and elective cases in both adult and pediatric patients. Adequate selection of patients for external fixation is critical, especially in patients with polytrauma where the application of damage control orthopedics is considered. Deterioration of the bone-pin interface is the most common source of local postoperative complications. Pin loosening and pin track infection are the 2 most common complications. Treatment of pin loosening without infections consists of pin removal and reinsertion outside the affected area. Pin track infections are managed according to the infection severity, which is assessed using the Checketts-Otterburn classification.
Jones J, Eskin L, Barron M
… +5 more, Yoshida R, Tsai EY, Chen E, Shin J, Mendelson B
Orthop Clin North Am
· 2025 Apr · PMID 40044350
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Anesthesia has become very safe. Numerous anesthetic options for hand and wrist surgery exist. Optimizing patient outcomes can be achieved more reliably when anesthesiologists and surgeons collaborate to better understan...Anesthesia has become very safe. Numerous anesthetic options for hand and wrist surgery exist. Optimizing patient outcomes can be achieved more reliably when anesthesiologists and surgeons collaborate to better understand the surgical and patient-related needs for anesthesia. Examples include planning for the anticipated degree of tourniquet-related pain for longer surgeries, determining if patient can tolerate deep sedation without secured airway, and determining the best way to obtain optimal surgical field visualization. Understanding the risks and benefits of various anesthetic options from surgical and anesthetic perspectives will help in making informed decisions about anesthetic options.