Knee Arthroscopy Prior to Revision TKA linked with Increased Revision for Stiffness
The study aimed to evaluate the impact of knee arthroscopy on outcomes of subsequent TKA revision surgery. This cohort matched analysis found patients who had prior knee arthroscopy were likely to need revision TKA than individuals who received revision TKA without prior knee arthroscopy. Patients who had prior knee arthroscopy within 6 months had a higher risk of needing revision.
Continuous Passive Motion vs. Physical Therapy after Arthroscopic Release of Elbow Contracture
Following surgical contracture release, CPM was faster & better than PT in postoperative elbow rehabilitation. This was reflected in improved 6-week & 3-month ROM, as well as a reduced median time to attain their primary post-operative goal & improved 1-year ROM. These findings suggest more contractures benefit with CPM as they regained maximal recovery at 1 year.
Long Cervical Fusions: Are Multiple Segmental Plates Less Likely to Fail than a Single Long Plate?
Multilevel anterior cervical discectomy & fusion (ACDF) is commonly used for neuro-compressive pathology. Separated segmental anterior fixation maintains its stiffness effectively at caudal aspect of the construct than long single plate fixation.The validated model of biochemical performances of cervical spine fixation will enhance ability to optimize constructs & reduce risk of fractures.
Non-Narcotic Total Joint Arthroplasty Using an Alternative to Opioids Multimodal Pain Protocol
An opioid-free, multimodal pain management pathway is safe and effective for TJA patients and does not affect length of stay, 90-day complication rates, ED visits, or readmission rates. To properly understand how to adopt an opioid-free approach in total joint arthroplasty, future research will need to include randomised trials.
Arthroscopic Latarjet: In Vitro Evidence to Avoid Complications with the Trans-Pec Medial Portal
To avoid difficulties in the arthroscopic Bankart-Bristow-Latarjet surgery, the medial trans-pec major (East) portal can be used safely. To palpable tip of coracoid process, portal placement should be 45-50 mm distal and 30-35 mm medial. The portal medial to the coracoid gives excellent surgical access without compromising critical neurovascular pathways.
Safety Profile of Recombinant Human Bone Morphogenetic Protein 2 in Spinal Fusion Surgery
The session described use of recombinant human bone morphogenetic protein (rhBMP) in spinal fusion but remained controversial. The prior observational studies have shown conflicting conclusions regarding rhBMP safety and effectivenes. This large observational study states that rhBMP is found to be safe and effective as compared to non-BMP usage in spinal fusion with low infections.
Scoliosis Team & Standardized Surgery Improve Adolescent Idiopathic Scoliosis Surgery Outcomes
A retrospective review showed that standardization of the perioperative approach for AIS correction with a dedicated team significantly reduced blood loss, surgical time, and length of stay. These results were seen as the team continued to refine the protocol and its reproducibility is demonstrated by its capacity to enhance perioperative outcomes across multiple institutions.
Arthroplasty vs. Internal Fixation for the Treatment of Minimally Displaced Femoral Neck Fractures
Arthroplasty be the optimal treatment for displaced femoral neck fracture management. For minimally displaced femoral neck fractures, internal fixation remains the preferred approach.The study suggests arthroplasty may reduce the risk of mortality & reoperation compared to internal fixation. This finding is counter to many surgical practices, but consistent with a mounting body of evidence.
Failure of Conservative Management in the Treatment of Calcific Tendinitis of the Shoulder
Shoulder calcific tendinitis results in 7% of shoulder discomfort and is caused by calcium deposits in the rotator cuff tendons. Physical therapy and corticosteroid injections are the first line treatments. If that doesn't work, arthroscopy is considered. The size of the lesion may influence the efficacy of conservative treatment. Preoperative planning and discussion should be included.
Optimal Fixation of the Capitellar Fragment in Distal Humerus Fractures
The study determined if orthogonal or parallel plate position provides superior fixation of the separate capitellar fragment often present in intraarticular distal humerus fractures. It was found that orthogonal plating would provide stiffer fixation as well as screw trajectories perpendicular to the fracture plane by a posterolateral plate compared to a parallel plate construct.
Reduced Fluoroscopy, Radiation Dose, and Surgical Time with Dedicated Spine Radiology Technologist
The purpose of this study was to investigate the fluoroscopy time and radiation exposure during pediatric spine surgery using a DRT with extensive experience in spine operating rooms compared to all other radiology technologists. It was found that the use of DRT was independently associated with a significant reduction in total fluoroscopy time, radiation exposure, total surgical time, and EBL.
Latissimus Dorsi, Pectoralis Major, and Pectoralis Minor Transfers in SCC Deficient Shoulders
Pma and Pmi transfers are less successful in generating internal rotational moment arms than LD. The transplanted LD can also generate internal rotational moment arms and mimics the subscapularis biomechanical features. Both the Pma and LD transfers had significantly reduced adducting moment arms, which clinically may result in decreased adduction.
Weightbearing CT to Diagnose Syndesmotic Instability in Weber B Lateral Malleolar Fractures
Early diagnosis of syndesmotic instability is critical for optimizing clinical outcomes, but more subtle instability can be difficult to identify. WBCT affords a unique opportunity to evaluate such injuries in 3D compared to more traditional 2D syndesmosis measurement. WBCT can be used for assessment of the wide range of syndesmotic injuries and their 3D character.
Rotating platform: High conformity, low wear
Early failures were often due to aseptic loosening, malalignment, instability, 7 severe prosthetic restraint. New problems like increased contact stresses, abnormal kinematics, & increased polyethylene shear stresses were observed due to improve surgical technique. Current TKA Design include protecting the fixation interface by limiting prosthetic loosening and reducing polyethylene wear
Medial Pivot: More Predictable, Physiologic Kinematics
Total knee arthroplasty is a reliable treatment for end stage arthritis with ten-year survivorship. However, patient dissatisfaction can be 15-20% despite of good long-term survivorship. Medical pivot designs do not lead to loosening but they promote normal knee kinematics & enhance AP stability. They might lead to better patient satisfaction and better patient activity.
Why would you leave Cement - You can’t beat it
Cement fixation has been the gold standard when performing a total knee arthroplasty (TKA). However, cemented TKAs were associated with less predictable outcomes survivorship with those early generation implants. In today’s time, cemented TKA’s are enjoying the phase of resurgence. Cement less implants have higher costs but 10 times quicker in operative time than cemented.
Should We Use Vancomycin Powder Topically?
Surgical site infection is an vital issue. In spine surgery, the use of vancomycin has become routine to inhibit surgical site infections. Vancomycin powder reduces rate of hip and knee prosthetic joint infection without local and systemic adverse reactions. It should also be contemplated in primary & revision joint arthroplasty.
Advanced Clinical Practice for IgG4-related dacryoadenitis/sialadenitis and autoimmune pancreatitis
IgG4-related illness is a new systemic disorder affecting multiple organs. In IgG4-RD, the lacrimal, salivary, and pancreatic glands are affected. Lip and core needle biopsies are useful for IgG4-DS diagnosis. Early treatment is required to protect gland function. The use of glucocorticoids and steroid-sparing medicines may help manage IgG4-DS.
JAK Inhibitors in Rheumatoid Arthritis
JAK inhibitors have changed the way RA is managed. This is because the JAK pathway is linked to numerous cytokines that are linked to RA pathogenesis. JAK inhibitors offer quick action, role in reducing central pain processing, effect on structural damage and radiographic progression, and safety.
Autoinflammatory Vasculitis Syndromes: An Emerging Diseases
AIDs should be considered in children with inflammatory episodes that recur or persist over months or years in the absence of other causes. Vasculitis is most common in FMF. Try to identify clinical pattern consistent with one of the known AIDs but may need to thing outside those boxes. Genetic testing remains the mainstay of diagnosis & functional analysis assists with precision medicine.
