ARTICLES

Purpose: The purpose of this study was to compare the clinical outcomes of patients with patellofemoral osteoarthritis (PFOA) treated non-operatively with those treated operatively with an unloading anteromedialization tibial tubercle osteotomy (TTO). Methods: A retrospective chart review was performed to identify patients with isolated PFOA who were either managed non-operatively or surgically with a TTO and who had a minimum follow-up of 2 years. Patients were surveyed with the visual analog scale (VAS) for pain, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR), Anterior Knee Pain scale (Kujala), and Tegner Activity scale. Statistical analysis included two-sample ttesting, one-way ANOVA, and bivariate analysis. Results: The clinical outcomes of 49 non-operatively managed patients (mean age: 52.7 ± 11.3 years; mean follow-up: 1.7 ± 1.0 years) and 35 operatively managed patients (mean age: 31.8 ± 9.4 years; mean follow-up: 3.5 ± 1.7 years) were assessed. The mean VAS improved significantly in both groups [6.12 to 4.22 (non-operative), p < 0.0001; 6.94 to 2.45 (TTO); p < 0.0001], with operatively treated patients having significantly lower postoperative pain than non-operatively managed patients at the time of final follow-up [2.45 (TTO) vs. 4.22 (non-operative), p < 0.001]. The mean KOOS-JR score was significantly greater in the operative group at time of final follow-up [78.7 ± 11.6 (TTO) vs. 71.7 ± 17.8 (non-operative), p = 0.035]. There was no significant difference in Kujala or Tegner scores between the treatment groups. Additionally, there was no significant relationship between the number of intra-articular injections, duration of NSAID use, and number of physical therapy sessions on clinical outcomes in the non-operatively treated group (p > 0.05). Conclusions: An unloading anteromedialization TTO provides significantly better pain relief and restoration of function compared to non-operative management in the treatment of symptomatic PFOA

Background: The surgical approach used for arthroplasty in the setting of hip fracture has traditionally been decided based on surgeon preference. This study analyzed the effect of the surgical approach on hospital quality measures, complications, and mortality in patients treated with hip arthroplasty for fracture fixation. Methods: A cohort of consecutive acute hip fracture patients who were 60 years of age or older and who underwent hemiarthroplasty (HA) or total hip arthroplasty (THA) at one academic medical center between January 2014 and January 2018 was included. Patient demographics, length of stay (LOS), surgery details, complications, ambulation at discharge, discharge location, readmission, and mortality were recorded. Two cohorts were included based on the surgical approach: the anterior-based cohort included the direct anterior and anterolateral approaches and the posterior-based cohort included direct lateral and posterior approaches. Results: Two hundred five patients were included: 146 underwent HA (81 anterior-based and 65 posterior-based) and 79 underwent THA (37 anterior-based and 42 posteriorbased). The mean age of the HA and THA cohorts was 84.1 ± 7.5 and 73.7 ± 8.0 years, respectively. There was no difference in LOS, time to surgery, or surgical time between the two cohorts for HA and THA. There were no differences in perioperative complications, including dislocation, observed based on surgical approach. No difference was found between readmission rates and mortality. Conclusion: In this cohort of hip fracture arthroplasty patients, there was no difference observed in hospital quality measures, readmission, or mortality in patients based on surgical approach. These results are in contrast with literature in elective arthroplasty patients supporting the use of an anterior approach for potential improved short-term outcomes.

Objective: The purpose of this study was to compare the short-term clinical outcomes of matrix-induced autologous chondrocyte implantation (MACI) to those seen following traditional autologous chondrocyte implantation (ACI) in the management of symptomatic cartilage lesions of the knee. Methods: This was a retrospective cohort study of patients who underwent either ACI or MACI from January 2011 to March 2018. Patients with a minimum postoperative followup of 18 months were contacted. Demographic information, intraoperative findings, and patient-reported functional outcomes scores were collected. Comparisons were made between the two cell-based cartilage repair techniques. Results: Fifty-six patients were included in the study (39 ACI, 17 MACI). Visual analog scale (VAS) for pain scores improved significantly in both groups, with MACI patients demonstrating significantly lower postoperative pain scores compared to those treated with ACI. In the ACI group, there was a decrease in the Tegner Activity score compared to the preoperative baseline, while no significant difference was seen between pre- and postoperative activity levels in the MACI group. Patients were generally satisfied with the outcome of their procedures, and there was no significant difference in satisfaction between groups. No patients required additional surgery during the follow-up period. Conclusion: Both ACI and MACI demonstrated good short-term postoperative clinical results with improved pain and activity levels compared to the preoperative baseline. Patients treated with the MACI technique demonstrated greater reductions in pain scores compared to ACI, and while ACI resulted in a decrease in levels of postoperative activity, activity levels for MACI remained stable.

Postoperative venous thromboembolism (VTE) is a common and costly complication following total joint arthroplasty (TJA). Development of a refined thrombophilic screening panel will better equip clinicians to identify patients at highest risk for developing VTEs. In this pilot study, 62 high-risk TJA recipients who had developed pulmonary emboli (PE) within 90-days of surgery were eligible to participate. Of these patients, 14 were enrolled and subsequently administered a pre-determined panel of 18 hematologic tests with the aim of identifying markers that are consistently elevated or deficient in patients developing PE. A separate cohort of seven high-risk TJA recipients who did not report a symptomatic VTE within 90-days of surgery were then enrolled and Factor VIII and lipoprotein(a) levels were assessed. The most common aberrance was noted in 10 patients (71.4%) who had elevated levels of Factor VIII followed by five patients (35.7%) who had elevated levels of lipoprotein(a). Factor VIII was significantly prevalent (p < 0.001) while lipoprotein(a) failed to achieve statistical significance (p = 0.0708). Of the patients who were within normal limits of Factor VIII, three-fourths were “high-normal” with Factor VIII levels within 5% of the upper limit of normal. This study demonstrates the potential utility of this hematologic panel as part of a perioperative screening protocol aimed at identifying patients at risk for developing VTEs. However, future larger scale studies assessing the capabilities and limitations of our findings are warranted.

Background: As volume of total hip arthroplasty (THA) continues to increase, the utilization and availability of intraoperative advanced technologies to arthroplasty surgeons continues to rise as well. Our primary goal was to determine whether the use of a mini navigation technology extended operative times and secondarily if it affected postoperative outcomes following elective THA. Methods: A single-institution total joint arthroplasty database was utilized to identify adult patients who underwent elective THA from 2017 to 2019. Baseline demographic data along with surgical operative time, length of stay (LOS) and discharge disposition were collected. The Activity Measure for Post-Acute Care (AM-PAC) was used to determine physical therapy progress. Results: A total of 1,162 THAs were performed of which 69.1% (803) used navigation while 30.9% (359) did not. Baseline demographics including age, sex, body mass index (BMI), insurance, and smoking status were not statistically different between groups. The operative time was shorter in the navigation group compared to THA without navigation (115.1 vs. 118.9 min, p < 0.0001). Mean LOS was significantly shorter in the navigation THA group as compared to THA without navigation (2.1 vs. 2.6 days, p < 0.0001). Postoperative AM-PAC scores were higher in the navigation group on postoperative day 1 as compared to patients without navigation (18.87 vs. 17.52, p < 0.0001). Additionally, a greater percentage of patients were discharged directly home after THA with navigation as compared to THA without navigation (89.54% vs. 83.57%, p < 0.0001). Conclusion: Our study demonstrates that hip navigation technology in the setting of THA is associated with reduced operative times and higher AM-PAC mobilization scores. Hip mini navigation technology shortens operative times while improving early patient outcome scores in association with shorter LOS and greater home-based discharge.

Purpose: This study aimed to evaluate implant survivorship, complications, and re-operation rates following robotic arm-assisted unicompartmental knee arthroplasty (UKA) at mid-term follow-up. Methods: Patient satisfaction, clinical outcome, and knee alignment restoration were evaluated. All patients undergoing robotic arm-assisted medial UKA during a 2-year period were prospectively enrolled. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, varusvalgus deformity, and knee range of motion were studied pre- and postoperatively. Revisions and surgery-related complications were recorded. Results: Eighty-five patients were included in the study (mean age: 71.2 years). The mean follow-up was 74.7 months. One conversion to total knee arthroplasty was performed due to periprosthetic fracture 4.5 years after initial surgery resulting in a survivorship rate of 98.8%. Overall satisfaction was excellent; 97.7% of patients were satisfied or very satisfied, while none was dissatisfied or very dissatisfied. WOMAC score in total, as well as in each component, exhibited significant improvement postoperatively. Additionally, knee alignment in the coronal plane as well as flexion contracture were significantly improved following the procedure. Conclusions: The outcomes of the present cohort revealed that precise prosthesis implantation through the robotic armassisted system in UKA provided excellent overall satisfaction rates and clinical outcomes at mid-term follow-up

Surgical management of the subscapularis tendon is critical to a successful outcome following anatomic total shoulder arthroplasty. However, the optimal surgical technique for adequate exposure of the glenohumeral joint while minimizing complications resulting from subscapularis tendon dysfunction continues to be controversial. Common surgical techniques for the management of the subscapularis tendon include tenotomy, peeling, sparing, and lesser tuberosity osteotomy. Despite a number of published studies comparing these techniques, no consensus has been reached regarding optimal management. This article reviews the extensive literature on the biomechanical, radiologic, and clinical outcomes of each technique, including recently published comparison studies

We report the treatment of two patient with humeral fractures with one or more risk factors for nonunion. The first patient was elderly with a previously diagnosed central nervous system injury. The second elderly patient previously sustained a cerebral vascular accident affecting the fractured arm. The fracture was oblique in the proximal third of the humerus. We achieved bone healing non-operatively utilizing a specialized plastic orthosis that included a deforming element made of dense foam. This device asymmetrically increases the soft tissue pressure around the fracture.

Ankle arthritis is becoming more common and can be painful and debilitating. As the disease progresses, degenerative cystic changes may be found in the distal fibula, distal tibia, and talus. After failure of non-operative modalities, arthrodesis is often considered the surgical intervention of choice, but this leaves the patient with reduced range of motion, altered gait, and can negatively impact adjacent joints of the foot. Total ankle arthroplasty has been found to be an effective surgical option for ankle arthritis but is contraindicated in patients with talar collapse. When this is the case, a more personalized approach for preserving ankle motion is necessary. We present the case of a 65-yearold male with severe right ankle arthritis and talar collapse treated with a custom three-dimensionally printed talus and concurrent total ankle replacement with 2-year follow-up.