Orthop Clin North Am
· 2024 Oct · PMID 39216954
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Reverse total shoulder arthroplasty (RSA) was historically reserved for the elderly, low-demand patient with rotator cuff arthropathy (RCA) or as a salvage procedure after failed primary arthroplasty. Surgeon expertise a...Reverse total shoulder arthroplasty (RSA) was historically reserved for the elderly, low-demand patient with rotator cuff arthropathy (RCA) or as a salvage procedure after failed primary arthroplasty. Surgeon expertise and the advancement of implant design has allowed RSA to now become commonplace not only for RCA but also for glenohumeral osteoarthritis. RSA provides a robust glenoid baseplate fixation, which allows for easier and more reliable bone grafting or augmentation when needed. For patients with severe glenoid bone loss, RSA has been shown to have superior or equivalent patient-reported outcomes and shoulder range of motion when compared with total shoulder arthroplasty.
Caudle K, Mickley JP, Moses A
… +3 more, James N, Weller WJ, Calandruccio JH
Orthop Clin North Am
· 2024 Oct · PMID 39216953
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Metacarpophalangeal joint arthritis of the index finger is a debilitating disease often caused by osteoarthritis or inflammatory arthritides such as rheumatoid arthritis. Treatment options include nonsurgical management...Metacarpophalangeal joint arthritis of the index finger is a debilitating disease often caused by osteoarthritis or inflammatory arthritides such as rheumatoid arthritis. Treatment options include nonsurgical management with nonsteroidal anti-inflammatory drugs, splinting, occupational therapy, corticosteroid injections, and disease-modifying antirheumatic drugs. Operative management options include arthrodesis and arthroplasty, which can be further broken down into silicone implants and 2 component resurfacing implants. The article summarizes the current literature for each of the treatment options for metacarpophalangeal joint arthritis of the index finger.
Orthop Clin North Am
· 2024 Oct · PMID 39216952
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Transient synovitis (TS) is a self-limiting inflammatory condition of the joints, predominantly affecting children and characterized by symptoms such as pain, swelling, warmth, and erythema. It is often triggered by an i...Transient synovitis (TS) is a self-limiting inflammatory condition of the joints, predominantly affecting children and characterized by symptoms such as pain, swelling, warmth, and erythema. It is often triggered by an immune response to a viral infection, leading to acute inflammatory arthritis. Diagnosis involves a combination of patient history, physical examinations, imaging techniques, and laboratory tests, although there are no specific laboratory tests for TS. Treatment primarily consists of symptom management through rest, analgesics, and nonsteroidal anti-inflammatory drugs. The condition underscores the importance of distinguishing TS from more serious joint diseases to prevent unnecessary interventions and to ensure appropriate management.
Orthop Clin North Am
· 2024 Oct · PMID 39216951
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Post-traumatic osteoarthritis (PTOA) occurs following injury to joints. It accounts for approximately 12% of osteoarthritis and has far-reaching effects on individual patients and social/health care systems. Present work...Post-traumatic osteoarthritis (PTOA) occurs following injury to joints. It accounts for approximately 12% of osteoarthritis and has far-reaching effects on individual patients and social/health care systems. Present work focuses on evaluating the role of the post-traumatic inflammatory response in the development and progression of the disease. As there is minimal evidence to suggest the capacity of cartilage to undergo self-healing, most of this work focuses strictly on the avoidance or prevention of PTOA as opposed to treatment solutions following its onset. Ongoing and future investigations may reveal therapeutic targets for possible intervention and ultimately the prophylaxis of PTOA development.
Orthop Clin North Am
· 2024 Oct · PMID 39216950
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This article highlights patient, radiographic, and surgical risk factors for the development of posttraumatic arthritis after acetabular fractures. Surgical treatment options including acute and staged total hip arthropl...This article highlights patient, radiographic, and surgical risk factors for the development of posttraumatic arthritis after acetabular fractures. Surgical treatment options including acute and staged total hip arthroplasty as well as outcomes after arthroplasty for fracture management are addressed.
Cardillo C, Schaffler BC, Lehane K
… +3 more, Habibi AA, Schwarzkopf R, Lajam CM
Orthop Clin North Am
· 2024 Oct · PMID 39216949
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This article addresses the challenges surrounding hip and knee osteoarthritis (OA) treatment in Jehovah's Witnesses (JWs), focusing on the complexities arising from their refusal of blood products and transfusions. Ackno...This article addresses the challenges surrounding hip and knee osteoarthritis (OA) treatment in Jehovah's Witnesses (JWs), focusing on the complexities arising from their refusal of blood products and transfusions. Acknowledging the heightened risk of blood loss anemia during joint replacement surgery, this review explores documented strategies that enable safe elective joint arthroplasty in JW patients, emphasizing comparable initial diagnostic methods and non-operative treatments up until the pre-operative stage. Special considerations should be taken in the perioperative and intraoperative stage. Despite these challenges, safe arthroplasty is feasible with satisfactory outcomes through a combination of careful preoperative optimization, blood saving protocols, and cultural sensitivity.
Parhar D, Dhatt R, Liu SH
… +6 more, Slater A, Liu L, Khan N, Badii M, Masri B, Liu DM
Orthop Clin North Am
· 2024 Oct · PMID 39216948
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Minimally invasive interventional radiology procedures play an adjunctive role in treating the symptoms of osteoarthritis (OA) with the hopes of delaying total knee arthroplasty (TKA). However, currently available intra-...Minimally invasive interventional radiology procedures play an adjunctive role in treating the symptoms of osteoarthritis (OA) with the hopes of delaying total knee arthroplasty (TKA). However, currently available intra-articular injections offer only short-term benefits. This has led to evolution of new techniques such as genicular artery embolization and genicular nerve ablation, which show benefit in pain control and quality of life, especially for mild-to-moderate OA, positioning these techniques as potential alternatives to intra-articular injections to help delay TKA.
Kirwan MJ, Johnson EP, Calkins TE
… +3 more, Holland CT, Mihalko WM, Ford MC
Orthop Clin North Am
· 2024 Oct · PMID 39216947
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Inflammatory arthritis is a family of conditions including rheumatoid arthritis, juvenile inflammatory arthritis, and spondyloarthropathies affecting both the large and small joints. Total joint arthroplasty is commonly...Inflammatory arthritis is a family of conditions including rheumatoid arthritis, juvenile inflammatory arthritis, and spondyloarthropathies affecting both the large and small joints. Total joint arthroplasty is commonly used for surgical management of end-stage disease. Preoperative and postoperative considerations as well as perioperative medical management and intraoperative treatment of patients with inflammatory arthritis undergoing total joint arthroplasty are reviewed. Although individualized, multidisciplinary approaches to treatment are necessary due to the complex nature of the disease and the varying levels of severity, patients generally have favorable outcomes with respect to pain scores and functional outcomes.
Orthop Clin North Am
· 2024 Oct · PMID 39216946
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Post-traumatic arthritis (PTA) of the knee is a complex problem, requiring foresight and careful preoperative planning. Each case of PTA is unique, requiring understanding of the altered anatomy, management of any retain...Post-traumatic arthritis (PTA) of the knee is a complex problem, requiring foresight and careful preoperative planning. Each case of PTA is unique, requiring understanding of the altered anatomy, management of any retained hardware, and also the ability to provide the appropriate stability for each affected knee. Successful treatment of PTA with total knee arthroplasty (TKA) requires the creation of stable and well-balanced joint. TKA for PTA provides comparable improvements in pain and function when compared with primary osteoarthritis, however, these patients are at increased risk of post-operative complications, including instability and infection.
Gelvez D, Dong K, Redlich N
… +3 more, Williams J, Bhandutia A, Shammassian B
Orthop Clin North Am
· 2024 Jul · PMID 38782511
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This article reviews the appropriate assessment and management of osteoporotic compression fractures and discusses the implications of osteoporosis on initial patient evaluation, medical optimization for surgery, selecti...This article reviews the appropriate assessment and management of osteoporotic compression fractures and discusses the implications of osteoporosis on initial patient evaluation, medical optimization for surgery, selection of instrumentation, and surgical technique. Adverse outcomes associated with osteoporosis are discussed. Failure to appropriately evaluate, optimize, and treat spine patients with osteoporotic bone can lead to disastrous complications. Weakened bone can lead to implant failure through cage subsidence and screw pullout, as well as, peri-implant fractures, failure of deformity correction, and proximal kyphosis. These risks must be taken into account when considering operative interventions in these patients.
Skinner WC, Pattisapu N, Yeoh J
… +4 more, Grear BJ, Richardson DR, Murphy GA, Bettin CC
Orthop Clin North Am
· 2024 Jul · PMID 38782510
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Treatment of Charcot neuroarthropathy (CN) of the foot and ankle remains challenging for both patients and surgeons. Nonoperative treatment with cast/orthosis immobilization has long been the mainstay of treatment, but s...Treatment of Charcot neuroarthropathy (CN) of the foot and ankle remains challenging for both patients and surgeons. Nonoperative treatment with cast/orthosis immobilization has long been the mainstay of treatment, but surgical intervention has gained interest to improve poor long-term outcomes. A review of existing data on the operative management of CN demonstrates the potential benefits but also the continued risks associated with treatment. Additionally, a retrospective review of cohorts managed with limited surgical interventions (wound debridements, exostectomies, and other surgical procedures) compared to reconstructive procedures provides additional insight into the surgical management of CN.
Orthop Clin North Am
· 2024 Jul · PMID 38782509
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Although the impact that vitamin D has on bone healing is uncertain in foot and ankle (F&A) surgery, there is support for vitamin D supplementation (2000 IU/day) with calcium (1 g/day) to promote bone healing. Although o...Although the impact that vitamin D has on bone healing is uncertain in foot and ankle (F&A) surgery, there is support for vitamin D supplementation (2000 IU/day) with calcium (1 g/day) to promote bone healing. Although orthopedic F&A surgeons are frequently the first provider to detect the harbingers of osteoporosis by the occurrence of fragility fractures, this should trigger referral to the appropriate specialist for assessment and treatment. There is circumstantial evidence suggesting a role of hypovitaminosis D in bone marrow edema syndrome and possibly osteochondritis dissecans. There should be a low threshold for assessing vitamin D levels in such patients.
Root KT, Hones KM, Hao KA
… +5 more, Brolin TJ, Wright JO, King JJ, Wright TW, Schoch BS
Orthop Clin North Am
· 2024 Jul · PMID 38782508
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The utilization of total shoulder arthroplasty (TSA) is increasing, driving associated annual health care costs higher. Opting for outpatient over inpatient TSA may provide a solution by reducing costs. However, there is...The utilization of total shoulder arthroplasty (TSA) is increasing, driving associated annual health care costs higher. Opting for outpatient over inpatient TSA may provide a solution by reducing costs. However, there is no single set of accepted patient selection criteria for outpatient TSA. Here, the authors identify and systematically review 14 articles to propose evidence-based criteria that merit postoperative admission. Together, the studies suggest that patients with limited ability to abmluate independently or a history of congestive heart failure may benefit from postoperative at least one night of hospital based monitoring and treatment.
Greenfield PT, Coble TJ, Bell JA
… +2 more, Calandruccio JH, Weller WJ
Orthop Clin North Am
· 2024 Jul · PMID 38782507
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Fragility fractures as a result of osteoporosis, osteopenia, or vitamin D deficiency are some of the most common injuries encountered in orthopedics and require careful consideration when determining the appropriate mana...Fragility fractures as a result of osteoporosis, osteopenia, or vitamin D deficiency are some of the most common injuries encountered in orthopedics and require careful consideration when determining the appropriate management and treatment options. A thorough perioperative evaluation can identify causes of low bone mineral density allowing for initiation of appropriate therapy. Surgical treatment of these fractures can be difficult, and techniques should be employed to ensure stable fixation. It is important to understand the potential pitfalls associated with treatment of fragility fractures to prevent avoidable complications. Postoperative management is key to preventing future injuries in this unique patient population.
Orthop Clin North Am
· 2024 Jul · PMID 38782506
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As medical and surgical treatment options for children with osteoporosis expand, multidisciplinary strategies for bone health optimization become more important. Each patient's bone mineral density and fracture history s...As medical and surgical treatment options for children with osteoporosis expand, multidisciplinary strategies for bone health optimization become more important. Each patient's bone mineral density and fracture history should be interpreted in context. Off-label bisphosphonate use is a standard pharmacologic intervention for children with osteoporosis for optimal bone accrual. It is possible to continue this therapy perioperatively under certain circumstances. The rare side effects (osteonecrosis of the jaw and atypical femur fractures) seem less common in children. Physical therapy, vitamin D supplementation, and other interventions are also important tools for optimal bone health perioperatively and for satisfactory surgical outcomes.
Orthop Clin North Am
· 2024 Jul · PMID 38782505
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There is concern for cementless total knee arthroplasty (TKA) in patients with decreased bone mineral density (BMD) due to the potential increase in complications, namely failed in-growth or future aseptic loosening. Som...There is concern for cementless total knee arthroplasty (TKA) in patients with decreased bone mineral density (BMD) due to the potential increase in complications, namely failed in-growth or future aseptic loosening. Some data suggest that advances in cementless prostheses mitigate these risks; however this is not yet born out in long-term registry data. It is crucial to expand our understanding of the prevalence and etiology of osteoporosis in TKA patients, survivorship of cementless implants in decreased BMD, role of bone-modifying agents, indications and technical considerations for cementless TKA in patients with decreased BMD. The purpose of this study is to review current literature and expert opinion on such topics.
Duggan JL, Fitz W, Lange JK
… +4 more, Shah VM, Olsen A, Iorio R, Chen AF
Orthop Clin North Am
· 2024 Jul · PMID 38782504
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This study was a retrospective cohort analysis of 20 patients who underwent 23 revision total knee arthroplasty procedures in a single geographic region of the United States from January 2015 to February 2023. We analyze...This study was a retrospective cohort analysis of 20 patients who underwent 23 revision total knee arthroplasty procedures in a single geographic region of the United States from January 2015 to February 2023. We analyzed their 25-OH vitamin D levels preoperatively and postoperatively at 1 month, 3 months, 6 months, 1 year, and 2 years. We categorized their supplementation regimens by dose: none, low dose (1000 IU and below), medium dose (1001-5000 IU), and high dose (>5000 IU). We found that there was a high incidence of vitamin D deficiency in this patient population.
Layson JT, Hameed D, Dubin JA
… +3 more, Moore MC, Mont M, Scuderi GR
Orthop Clin North Am
· 2024 Jul · PMID 38782503
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This report provides an updated analysis for patients with osteoporosis following total hip arthroplasty (THA). The comorbidities of alcohol abuse, chronic kidney disease, cerebrovascular disease, obesity, and rheumatoid...This report provides an updated analysis for patients with osteoporosis following total hip arthroplasty (THA). The comorbidities of alcohol abuse, chronic kidney disease, cerebrovascular disease, obesity, and rheumatoid arthritis continue to be significant risk factors for periprosthetic femur fracture (PPFFx) and aseptic loosening in the population with osteoporosis. Patients with dual-energy x-ray absorptiometric (DEXA) scans were at risk for PPFFx regardless of femoral fixation method, and patients with DEXA scans with cementless fixation were at risk of aseptic loosening after THA. The patient population with severe osteoporosis may have higher risks for aseptic loosening and PPFFx than previously recognized.