Fontalis A, Hansjee S, Giebaly DE
… +3 more, Mancino F, Plastow R, Haddad FS
Orthop Clin North Am
· 2024 Jan · PMID 37980102
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The introduction of new surgical technology highlights appreciable concerns; robotic arthroplasty is no exception. Acquiring comprehensive understanding of the robotic technology to avoid complications during surgery and...The introduction of new surgical technology highlights appreciable concerns; robotic arthroplasty is no exception. Acquiring comprehensive understanding of the robotic technology to avoid complications during surgery and devising troubleshooting strategies to overcome potential difficulties is of paramount importance. Troubleshooting algorithms depend on the stage of the procedure and problem encountered, such as loosening of the pins or array, registration or verification problems, or malfunctioning of the device, which is rare. This article aims to outline reproducible workflows and solutions for troubleshooting during robotic-arm assisted total hip arthroplasty and total knee arthroplasty.
Orthop Clin North Am
· 2024 Jan · PMID 37980101
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Publisher ↗
Total knee arthroplasty (TKA) is a widely accepted surgical procedure for managing end-stage knee osteoarthritis. Among the various TKA techniques, kinematic alignment has gained increasing popularity as it can potential...Total knee arthroplasty (TKA) is a widely accepted surgical procedure for managing end-stage knee osteoarthritis. Among the various TKA techniques, kinematic alignment has gained increasing popularity as it can potentially restore a more natural joint function. However, despite its theoretical advantages, kinematic total knee replacement presents several operative challenges that necessitate a thorough understanding and analysis of patient-specific anatomy during surgical planning and execution. This review article aims to critically evaluate the operative challenges associated with kinematic TKA and explore potential strategies to optimize surgical outcomes. The challenges encompass multiple aspects including patient selection, preoperative planning, bone cuts, soft tissue balancing, and component positioning.
Orthop Clin North Am
· 2024 Jan · PMID 37980100
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Intraoperative trochanteric fractures during primary and revision total hip arthroplasty typically occur during femoral canal preparation and component placement. Several fixation strategies, including wires, cables, cab...Intraoperative trochanteric fractures during primary and revision total hip arthroplasty typically occur during femoral canal preparation and component placement. Several fixation strategies, including wires, cables, cable grips, and plating, are available for fracture fixation. Surgeons should consider patient activity level preoperatively, bone mineral density, and fracture morphology when deciding on fixation strategies. Patient activity must be modified postoperatively to prevent fracture displacement and additional complications. Patients must be counseled postoperatively about the possibility of decreased clinical outcomes.
Redlich N, Gelvez D, Dong K
… +4 more, Darlow M, Williams J, Shammassian B, Bhandutia AK
Orthop Clin North Am
· 2024 Jan · PMID 37980099
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Vertebral artery injury (VAI) is a serious and potentially life-threatening injury that is encountered with trauma to the cervical spine and less frequently during surgery. VAI can occur during either anterior or posteri...Vertebral artery injury (VAI) is a serious and potentially life-threatening injury that is encountered with trauma to the cervical spine and less frequently during surgery. VAI can occur during either anterior or posterior cervical approaches or instrumentation and often involves anomalous courses of the artery. Although the incidence is rare, serious consequences including fistula formation, thrombosis, pseudoaneurysm development, cerebral ischemia, hemorrhage, and death may occur. Management of VAI can be divided into prevention, including review of preoperative imaging with knowledge of the anatomic course, utilization of surgical landmarks intraoperatively, and prompt recognition and management when injury is encountered.
Orthop Clin North Am
· 2024 Jan · PMID 37980098
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Publisher ↗
Intraoperative complications during total ankle replacement (TAR) can be devastating. As surgeons' experience with total ankles grow and surgical techniques are refined, intraoperative complications, such as fractures, c...Intraoperative complications during total ankle replacement (TAR) can be devastating. As surgeons' experience with total ankles grow and surgical techniques are refined, intraoperative complications, such as fractures, can still occur. Surgeons must be able to recognize a problem, identify the options to remediate, and then execute a solution readily. Unfortunately, given the heterogeneity of TAR outcome studies, it is difficult to garner the true incidence of complications in the peri-operative period following ankle replacements. The purpose of this review is to focus on perioperative fractures during TAR. Fractures can occur intraoperatively and postoperatively as stress fractures or post-operative trauma.
Wallace DR, Shiver AL, Whitehead J
… +2 more, Wood M, Snoddy MC
Orthop Clin North Am
· 2024 Jan · PMID 37980097
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Publisher ↗
A wide array of intraoperative issues can arise during surgery involving the hand and upper extremity. An understanding of the common pitfalls within hand surgery may help practicing hand surgeons circumvent such issues....A wide array of intraoperative issues can arise during surgery involving the hand and upper extremity. An understanding of the common pitfalls within hand surgery may help practicing hand surgeons circumvent such issues. Within this manuscript, we first identify problems with the increasingly popular technique of wide-awake local anesthesia no tourniquet (WALANT). Achieving appropriate hemostasis and anesthetic can be bothersome, especially for procedures proximal to the distal palmar crease. We discuss our local anesthetic timing and concentrations to help mitigate such issues, as well as other problems that may arise in WALANT procedures. There also lies a barrier in connecting the traumatized patient to care in the outpatient/ambulatory setting. Additionally, the polytraumatized patient increases the complexity of care coordination for not just the hand surgeon, but all surgical providers involved. The order in which multidisciplinary surgical procedures are performed is influenced by both the complexity of the patient's case as well as the institution's current protocol. All academic institutions are faced with challenges in providing optimal intraoperative education to trainees. We acknowledge that there should be a balance between the attending surgeon executing key portions of the procedure and the trainee gaining the appropriate hands-on experience. This manuscript elaborates on the issues of intraoperative education provided to residents and anecdotal methods that may help overcome such challenges. Resources within hand surgery can often be limited and become particularly problematic in the operative setting. Specific examples include but are not limited to the lack of dedicated teams, inability to obtain appropriate intraoperative imaging, access to appropriate hardware, and intraoperative complications in an ambulatory surgery center setting.
Bell JA, James NF, Mauck BM
… +2 more, Calandruccio JH, Weller WJ
Orthop Clin North Am
· 2024 Jan · PMID 37980096
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Distal radius fractures are some of the most common injuries encountered in orthopedics and require careful consideration when determining the appropriate treatment options. These fractures can be difficult injuries to t...Distal radius fractures are some of the most common injuries encountered in orthopedics and require careful consideration when determining the appropriate treatment options. These fractures can be difficult injuries to treat surgically based on a large variability of fracture patterns, bone quality, and anatomy. It is important to understand the potential pitfalls associated with the treatment of difficult distal radius fractures to prevent avoidable complications. Some of these pitfalls include but are not limited to appropriate surgical exposure and soft tissue handling, provisional reduction, fixation type, and augmentation of fracture fixation.
Orthop Clin North Am
· 2024 Jan · PMID 37980095
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Publisher ↗
As the incidence of shoulder arthroplasty continues to rise, encountering significant glenoid bone loss in the primary and revision setting is becoming a common occurrence. To effectively treat these difficult scenarios,...As the incidence of shoulder arthroplasty continues to rise, encountering significant glenoid bone loss in the primary and revision setting is becoming a common occurrence. To effectively treat these difficult scenarios, surgeons must understand the common patterns of glenoid bone loss and be aware of the various techniques available for treatment. Understanding bone loss requires careful pre-operative evaluation with appropriate imaging and pre-operative planning software. Treatment algorithms consist of primary anatomic and reverse arthroplasty as well as the use of allograft or autograft bone grafting, augmented glenoid components, specialized surgical techniques, or custom implant designs. Ultimately, good outcomes are able to be obtained with various techniques when applied to the appropriate clinical situation.
Mosher ZA, Calkins TE, Cope SR
… +2 more, Pharr ZK, Ford MC
Orthop Clin North Am
· 2024 Jan · PMID 37980094
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Publisher ↗
Studies regarding the safety of same day discharge (SDD) in patients ≥65 years of age undergoing total hip arthroplasty (THA) are lacking. A retrospective review of 69 patients undergoing SDD following primary THA in 2 f...Studies regarding the safety of same day discharge (SDD) in patients ≥65 years of age undergoing total hip arthroplasty (THA) are lacking. A retrospective review of 69 patients undergoing SDD following primary THA in 2 free-standing ambulatory surgical centers (ASCs) was performed to evaluate for safety and complications. Sixty-six patients met SDD goals, while 1 patient required transport to a hospital for transfusion, and 2 patients underwent overnight observation in the ASC. This study reveals that with appropriate preoperative evaluation, patient selection, and education, THA in a free-standing ASC can be safely performed in patients ≥65 years of age.
Bullock WM, Kumar AH, Manning E
… +1 more, Jones J
Orthop Clin North Am
· 2023 Oct · PMID 37718088
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This Clinical Research discusses the diverse nature of spine surgery procedures and the use of multimodal analgesia within enhanced recovery after surgery (ERAS) protocols to improve patient outcomes. Spine surgeries ran...This Clinical Research discusses the diverse nature of spine surgery procedures and the use of multimodal analgesia within enhanced recovery after surgery (ERAS) protocols to improve patient outcomes. Spine surgeries range from minor decompressions to extensive tumor resections, performed by neurosurgeons or orthopedic spine surgeons on adults and children. To manage perioperative pain effectively, various methods have been employed, including multimodal analgesia within ERAS protocols. Incorporating ERAS protocols into spine surgery has shown benefits such as reduced pain scores, decreased opioid use, shorter hospital stays, and improved functionality. ERAS protocols help to enhance patient outcomes, focusing on deconstructing these protocols for surgeons and anesthesiologists.
Orthop Clin North Am
· 2023 Oct · PMID 37718087
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Publisher ↗
There remains a high prevalence and substantial risks of opioid utilization amongst orthopedic patients. The goal of this review is to discuss strategies for responsible opioid use in the perioperative setting following...There remains a high prevalence and substantial risks of opioid utilization amongst orthopedic patients. The goal of this review is to discuss strategies for responsible opioid use in the perioperative setting following foot and ankle orthopedic surgeries. We will highlight 1) education interventions, 2) risk identification, and 3) non-opioid alternatives for postoperative pain management.
Orthop Clin North Am
· 2023 Oct · PMID 37718086
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Publisher ↗
Wide awake local anesthetic no tourniquet (WALANT) surgery of the foot and ankle has the potential to offer safe and effective surgeon-based anesthesia for a significant number of surgeries about the foot and ankle. This...Wide awake local anesthetic no tourniquet (WALANT) surgery of the foot and ankle has the potential to offer safe and effective surgeon-based anesthesia for a significant number of surgeries about the foot and ankle. This has been documented with significant and growing body of literature. WALANT could offer significant advantages with respect to patient experience, per case cost of procedures as well as for improving access for patients to operative resources in a setting of scarcity or restricted access.
Orthop Clin North Am
· 2023 Oct · PMID 37718085
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Publisher ↗
Distal radius fractures have a high incidence among both young and elderly patients, and in many instances require operative intervention. When operative intervention is employed, adequate pain management is essential to...Distal radius fractures have a high incidence among both young and elderly patients, and in many instances require operative intervention. When operative intervention is employed, adequate pain management is essential to decrease postoperative complications, such as chronic pain and disability, while minimizing the risk of prolonged opioid use and dependence. Strategies to optimize pain management include regional anesthesia, preoperative dosing of medication, multimodal regimens, long-acting selective opioids at the time of surgery, corticosteroids, and non-pharmacologic therapies.
Orthop Clin North Am
· 2023 Oct · PMID 37718084
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Publisher ↗
The use of opioid pain medication regimens to control perioperative pain has led to significant patient and societal consequences. There are several alternative, opioid-sparing and opioid-minimizing pain regimens that ha...The use of opioid pain medication regimens to control perioperative pain has led to significant patient and societal consequences. There are several alternative, opioid-sparing and opioid-minimizing pain regimens that have been shown to provide equal, if not superior, pain relief with fewer secondary consequences. This article provides an in-depth review of the current evidence regarding efficacy, safety, and feasibility of a perioperative opioid-sparing clinical pathway for patients undergoing shoulder arthroplasty.
Sabesan V, Lapica H, Fernandez C
… +1 more, Fomunung C
Orthop Clin North Am
· 2023 Oct · PMID 37718083
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Publisher ↗
Historically, opioids have been used as a primary conservative treatment for pain related to glenohumeral osteoarthritis (GHOA). However, this practice is concerning as it often leads to overuse, which has contributed to...Historically, opioids have been used as a primary conservative treatment for pain related to glenohumeral osteoarthritis (GHOA). However, this practice is concerning as it often leads to overuse, which has contributed to the current epidemic of addiction and overdoses in the United States. Studies have shown that preoperative opioid use is associated with higher complication rates and worse outcomes following surgery, particularly for shoulder arthroplasty. To address these concerns, perioperative pain management for shoulder arthroplasty has evolved over the years to the use of multimodal analgesia.
Orthop Clin North Am
· 2023 Oct · PMID 37718082
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Publisher ↗
Adolescent idiopathic scoliosis (AIS) is the most common form of scoliosis. Treatment depends on the degree of curvature, skeletal maturity, and age of the patient. Once the curve reaches 50 degrees, posterior spinal fus...Adolescent idiopathic scoliosis (AIS) is the most common form of scoliosis. Treatment depends on the degree of curvature, skeletal maturity, and age of the patient. Once the curve reaches 50 degrees, posterior spinal fusion (PSF) is necessary to stabilize the spine and prevent further progression of the curve. PSF causes significant trauma to the tissues and often results in significant pain postoperatively. The purpose of this article is to provide the audience with a review of preoperative, intraoperative, and postoperative pain control with an accelerated protocol in patients with AIS undergoing PSF.
Orthop Clin North Am
· 2023 Oct · PMID 37718081
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Publisher ↗
A delayed acute compartment syndrome (ACS) diagnosis often results in devastating complications; however, the sensitivity of the classic signs and symptoms is very low. All analgesic modalities have been implicated in de...A delayed acute compartment syndrome (ACS) diagnosis often results in devastating complications; however, the sensitivity of the classic signs and symptoms is very low. All analgesic modalities have been implicated in delaying the diagnosis, but there is very little evidence linking peripheral nerve blocks (PNBs) with delays in diagnosis. In fact, there is evidence that PNBs may facilitate an early diagnosis; this may be in part due to differences in how ischemic and inflammatory pain is transmitted through unique nociceptive pathways. Collaboration is required to optimize care for patients at risk for ACS.
Kayani B, Howard LC, Neufeld ME
… +2 more, Garbuz DS, Masri BA
Orthop Clin North Am
· 2023 Oct · PMID 37718080
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Publisher ↗
Cannabis use among the elderly has increased over the previous 2 decades. This has translated to a greater proportion of orthopedic procedures being undertaken on these patients. This review provides clinicians with evid...Cannabis use among the elderly has increased over the previous 2 decades. This has translated to a greater proportion of orthopedic procedures being undertaken on these patients. This review provides clinicians with evidence-based information on the effects of cannabis on pain control in THA and TKA, to help counsel these patients and facilitate their perioperative management. The review specifically focuses on the following: origins of cannabis; biochemistry of cannabis; medical versus recreational cannabis; pharmacology of cannabis; effects of cannabis on bone metabolism; preoperative pain control; preoperative systemic considerations; intraoperative considerations; postoperative pain control, postoperative systemic considerations; and scope for future work.
Purcell KF, Scarcella N, Chun D
… +4 more, Holland C, Stauffer TP, Bolognesi M, Lachiewicz P
Orthop Clin North Am
· 2023 Oct · PMID 37718079
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Publisher ↗
Disorders of sleep are common after total hip and knee arthroplasty and may contribute to patient dissatisfaction and poorer outcomes in the early postoperative period. Multiple factors contribute to sleep disorders, inc...Disorders of sleep are common after total hip and knee arthroplasty and may contribute to patient dissatisfaction and poorer outcomes in the early postoperative period. Multiple factors contribute to sleep disorders, including poorly controlled pain, opioid medication, perioperative stress, and anxiety. Both pharmacologic and nonpharmacologic methods have been used for perioperative sleep disorders, but there is no consensus on the optimal treatment.