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New Knee Content from JBJS

knee-spotlight-image.pngThe recently launched JBJS Knee Spotlight offers highly relevant and potentially practice-changing knee content from the most trusted source of orthopaedic information.

Here are the five JBJS articles to which you will have full-text access through the Knee Spotlight during the month of March 2017:

  • Improved Accuracy of Component Positioning with Robotic-Assisted Unicompartmental Knee Arthroplasty: Data from a Prospective, Randomized Controlled Study
  • The Effect of Timing of Manipulation Under Anesthesia to Improve Range of Motion and Functional Outcomes Following Total Knee Arthroplasty
  • Anatomic Single-Bundle ACL Reconstruction Is Possible with Use of the Modified Transtibial Technique: A Comparison with the Anteromedial Transportal Technique
  • Autologous Chondrocyte Implantation in the Knee: Mid-Term to Long-Term Results
  • Outcomes of Unicompartmental Knee Arthroplasty After Aseptic Revision to Total Knee Arthroplasty: A Comparative Study of 768 TKAs and 578 UKAs Revised to TKAs from the Norwegian Arthroplasty Register (1994 to 2011)

Knee studies offered on the JBJS Knee Spotlight will be updated monthly, so check the site often.

Visit the JBJS Knee Spotlight website today.

Smoking Boosts Rate of Reoperation for Infection after TJA

Smoking Image from Nick.jpegHere’s one thing about which medical studies have been nearly unanimous:  Smoking is a health hazard by any measure. In the February 15, 2017 edition of The Journal of Bone & Joint Surgery, Tischler et al. put some hard numbers on the risk of smoking for those undergoing total joint arthroplasty (TJA).

After controlling for confounding factors, the authors of the Level III prognostic study found that:

  • Current smokers have a significantly increased risk of reoperation for infection within 90 days of TJA compared with nonsmokers.
  • The amount one has smoked, regardless of current smoking status, significantly contributed to increased risk of unplanned nonoperative readmission.

In a commentary on the Tischler et al. study, William, G. Hamilton, MD says, “…as physicians, we should work cooperatively with our patients to enhance outcomes by attempting to reduce these modifiable risk factors. We can educate patients and can suggest smoking cessation programs and weight loss regimens that may not only improve the risk profile during the surgical episode, but also improve the patients’ overall health.”

JBJS Case Connections—Preventing and Managing Post-THA Hip Dislocations

CCX OBuzz Image.gifHip dislocation is one of the most common perioperative complications of total hip arthroplasty (THA). The latest “Case Connections” article examines an often-overlooked spinal basis for THA dislocations, 2 cases of dual-mobility hip-bearing dissociations during attempted closed reduction for post-THA dislocations, and a unique application of Ilizarov distraction to treat a chronic post-THA dislocation.

The springboard case report, from the February 22, 2017, edition of JBJS Case Connector, describes the case of a 63-year-old woman who had experienced 4 anterior dislocations in less than 3 years after having her left hip replaced. Each dislocation was accompanied by lower back pain, and the patient also reported substantial pain in the contralateral hip. The authors emphasize the importance of recognizing pelvic retroversion and sagittal spinal imbalance before performing total hip arthroplasty.

Two additional JBJS Case Connector case reports summarized in the article focus on:

While closed reduction with the patient under sedation is a frequently employed first-line tactic that is often successful for dislocated THAs, these 3 cases show that creative surgical interventions may be necessary for optimal outcomes in patients with “complicated” hips and/or recurrent dislocations.

Own the Bone Webinar: Atypical Fractures and Osteo Medications

ownbone_logo-r.pngOn Thursday, February 23, 2017, at 6:00 pm EST, the Own the Bone initiative will offer a webinar titled “Atypical Fractures and Osteoporosis Medication Considerations”

James Goulet, MD, from the University of Michigan, will discuss atypical fractures and other rare outcomes of the use of osteoporosis medication, including what to look for and how to treat these occurrences.  He will also address drug holidays, and how and when to continue treatment on these complex cases.

The American Orthopaedic Association (AOA) developed Own the Bone as a quality improvement program to address the osteoporosis treatment gap and prevent subsequent fragility fractures.

0.75 hour of CME credit is available.

During Deployment, Military Orthopaedist Discovers What’s Important

WI_Krueger.pngThe February 1, 2017 issue of JBJS contains the fourth of a series of personal essays in which orthopaedic clinicians tell a story about a high-impact lesson they learned that has altered their worldview, enhanced them personally, and positively affected the care they provide as orthopaedic
physicians.

This “What’s Important” piece comes from Dr. Chad Krueger of the Womack Army Medical Center. In his essay titled “Being Present,” Dr. Krueger emphasizes that family and friends are too easily taken for granted amid clinical and research demands.

If you would like JBJS to consider your “What’s Important” story for publication, please submit a manuscript via Editorial Manager. When asked to select an article type, please choose Orthopaedic Forum and include “What’s Important:” at the beginning of the title.

Because they are personal in nature, “What’s Important” submissions will not be subject to the usual stringent JBJS peer-review process. Instead, they will be reviewed by the Editor-in-Chief, who will correspond with the author if revisions are necessary and make the final decision regarding acceptance.

For Perthes Disease, Are Two Osteotomies Better than One?

LCP_Osteotomies.pngIt is well accepted that kids with Legg-Calve-Perthes (LCP) disease do best when their condition is diagnosed and managed before 6 years of age. Surgical treatment is often recommended for children 6 years and older who have more severe femoral-head involvement, and orthopaedists perform combined pelvic and femoral varus osteotomies on some of those children.

In the February 1, 2107 edition of The Journal, Mosow et al. compare 10-year outcomes in 52 LCP patients who underwent combined osteotomies (mean age at surgery of 7.9 years) with results reported in the literature for single pelvic or femoral osteotomies. Although the postoperative radiographic and functional results after combined osteotomy were good, they were overall no better than those reported in the literature for either osteotomy alone.

The authors admit that in the absence of a randomized study design, these findings should be interpreted with caution, but they conclude that “it is not recommended that combined osteotomies for this age group routinely be used.”

New Knee Content from JBJS

knee-spotlight-image.pngThe recently launched JBJS Knee Spotlight offers highly relevant and potentially practice-changing knee content from the most trusted source of orthopaedic information.

Here are the five JBJS articles to which you will have full-text access through the Knee Spotlight during the month of February 2017:

  • Comparison of Highly Cross-Linked and Conventional Polyethylene in Posterior Cruciate-Substituting Total Knee Arthroplasty in the Same Patients

  • What’s New in Adult Reconstructive Knee Surgery

  • Hinged External Fixation in the Treatment of Knee Dislocations: A Prospective Randomized Study

  • A Randomized, Controlled, Prospective Study Evaluating the Effect of Patellar Eversion on Functional Outcomes in Primary Total Knee Arthroplasty

  • Comparison of Functional Outcome Measures After ACL Reconstruction in Competitive Soccer Players: A Randomized Trial

Knee studies offered on the JBJS Knee Spotlight will be updated monthly, so check the site often.

Visit the JBJS Knee Spotlight website today.

New RCT Data on Midshaft Clavicular Fractures

Clavicle_Fracture_for_OBuzz.pngThe debate continues as to whether midshaft clavicular fractures are optimally treated surgically or nonoperatively. More data about this clinical dilemma is delivered in the January 18, 2017 issue of JBJS, where Woltz et al. report findings from a multicenter controlled trial that randomized 160 clavicular-fracture patients to receive ORIF with a plate or nonoperative treatment with a sling and physical therapy.

The rate of radiographic nonunion was significantly higher in the nonoperatively treated group after 1 year, but no difference was found between the groups with respect to Constant and DASH scores at any time point—6 weeks, three months, and 1 year. Pain scores and general physical health were marginally better after operative treatment, but only at 6 weeks. However, the rate of second operations for adverse events in the ORIF group was considerable, and after 1 year, implant removal was performed in or scheduled for 16.7% of the operatively treated patients.

Based on these findings and other recent data, the authors “do not advocate routine operative treatment for displaced midshaft clavicular fractures,” although they say early plate fixation may offer advantages for patients who have high demands, high pain scores, or a strong preference for surgery. Based on the fact that “neither treatment option is clearly superior for all patients,” the authors conclude that “the clavicular fracture is preemninently suitable for shared treatment decision-making.”

JBJS JOPA Image Quiz: Incomplete Spinal Cord Injury

Lateral_Spine.pngThis month’s Image Quiz from the JBJS Journal of Orthopaedics for Physician Assistants (JOPA) presents the case of a 55-year-old woman with neck pain and upper-extremity weakness after a motor vehicle accident that occurred 1 week prior, during which she sustained a whiplash injury.  She notes severe bilateral arm weakness, “clumsy hands,” and mild lower-extremity weakness with walking. The bilateral upper-extremity muscle groups have a strength of 3 of 5, and the lower-extremity muscle groups have a strength of 5 of 5. Sensation remains intact throughout the upper and lower extremities.

Select from among four choices as the most likely diagnosis:

  1. Central cord syndrome
  2. Brown-Séquard syndrome
  3. Anterior cord syndrome
  4. Posterior cord syndrome

JBJS On-Demand Webinar–Clubfoot: Predicting and Treating Ponseti Method Failures

jan. webinar speakers.JPG

The Ponseti method is a proven treatment for idiopathic clubfoot, yielding excellent outcomes with minimal pain or disability. However, as many as 40% of patients fail to respond to initial treatment or develop recurrent deformities.

On Wednesday, January 25, 2017 at 8:00 PM EST, The Journal of Bone & Joint Surgery hosted a webinar that delved into two recent JBJS studies investigating how to predict which patients are most likely to get subpar results from the Ponseti method, and how best to manage clubfoot relapses if they occur.

  • Matthew Dobbs, MD, describes in detail various soft-tissue abnormalities present in patients with treatment-resistant clubfoot that are not present in treatment-responsive patients. These parameters could be used to predict which clubfoot patients are at greater risk of relapse.
  • Jose Morcuende, MD, will spotlight findings from a study that followed treated clubfoot patients for 50 years to determine whether relapses managed with repeat casting and tibialis tendon transfer during early childhood prevented future relapses.

This webinar was moderated by James Kasser, MD, surgeon-in-chief at Boston Children’s hospital and a member of the JBJS Board of Trustees. The webinar offered additional perspectives on the authors’ presentations from two clubfoot-management experts—Steven Frick, MD and Gregory Mencio, MD. The last 15 minutes was devoted to a live Q&A session, during which the audience asked questions of all four panelists.

Register now to watch the webinar on-demand!