Intraoperative Comparison of Measured Resection and Gap Balancing Using a Force Sensor: A Prospective, Randomized Controlled Trial.

BACKGROUND: For establishing femoral component position, gap-balancing (GB) and measured resection (MR) techniques were compared using a force sensor. METHODS: Ninety-one patients were randomized to undergo primary total knee arthroplasty using either MR (n = 43) or GB (n = 48) technique using a single total knee arthroplasty design. GB was performed with an instrumented tensioner. Force sensor data were obtained before the final implantation. RESULTS: GB resulted in greater range of femoral component rotation vs MR (1.5° ± 2.9° vs 3.1° ± 0.5°, P \u3c .05) and posterior condylar cut thickness medially (10.2 ± 2.0 mm vs 9.0 ± 1.3 mm) and laterally (8.5 ± 1.9 mm vs 6.4 ± 1.0 mm). Force sensor data showed a decreased intercompartmental force difference at full flexion in GB (.8 ± 2.3 vs 2.0 ± 3.3u, 1u ≈ 15 N, P \u3c .05). CONCLUSION: GB resulted in a greater range of femoral component rotation and thicker posterior condylar cuts resulting in an increased flexion space relative to MR. Intercompartmental force difference trended toward a more uniform distribution between full extension and full flexion in the GB vs MR group

Osseous Remodeling After Femoral Head-neck Junction Osteochondroplasty

Femoral head-neck junction osteochondroplasty is commonly used to treat femoroacetabular impingement, yet remodeling of the osteochondroplasty site is not well described. We therefore describe bony remodeling at the osteochondroplasty site and analyze clinical outcomes and complications associated with femoral osteochondroplasty. We retrospectively reviewed 135 patients (150 hips) who underwent femoral head-neck osteochondroplasty combined with hip arthroscopy, surgical hip dislocation, periacetabular osteotomy, or proximal femoral osteotomy. The minimum clinical followup was 10 months (mean, 22.3 months; range, 10–65 months). We assessed the femoral-head neck offset, head-neck offset ratio, alpha angle, and cortical remodeling. We used the Harris hip score to determine hip function. We observed an increase in the head-neck offset, offset ratio, and decrease in the alpha angle postoperatively and at latest followup. Ninety-eight of 113 (87%) hips had partial or complete recorticalization at the osteochondroplasty site. The mean Harris hip score improved from 64 to 85. We excised heterotopic bone in one hip. There were no femoral neck fractures. The deformity correction achieved with femoral head-neck osteochondroplasty is maintained and recorticalization occurs in the majority of cases during the first two years

Use of Tetrahydrocannabinol and Cannabidiol Products in the Perioperative Period Around Primary Unilateral Total Hip and Knee Arthroplasty.

BACKGROUND: Given the opioid crisis in America, patients are trying alternative medications including tetrahydrocannabinol (THC) and other cannabidiol (CBD) containing products in the perioperative period, especially in states where these products are legal. This study sought to analyze usage rates of CBD/THC products in the perioperative period for primary unilateral total hip and knee arthroplasty (THA/TKA) patients and identify a possible association with post-operative opioid use. METHODS: A prospective cohort of primary unilateral THA/TKA patients were enrolled at a single institution. Patients who completed detailed pain journals were retrospectively surveyed for CBD/THC product usage. Pain medications were converted to morphine milligram equivalents (MME). RESULTS: Data from 195 of the 210 patients (92.9% response rate) following primary arthroplasty were analyzed. Overall, 16.4% of arthroplasty-22.6% (n = 19) of TKA and 11.7% (n = 13) of THA-patients used CBD/THC products in the perioperative period. There was a wide variety of usage patterns among those using CBD/THC products. In comparing CBD/THC users and non-users, there was no significant difference in the length of narcotic use, total morphine milligram equivalents taken, narcotic pills taken, average post-op pain scores, the percentage of patients requiring a refill of narcotics, or length of stay. CONCLUSION: Understanding that CBD/THC usage was not consistent for patients who used these products, 22.6% of TKA and 11.7% of THA patients tried CBD/THC products in the perioperative period. In this small sample, CBD/THC use was not associated with a major effect on narcotic requirements. Further studies on the effects of CBD/THC are needed as these therapies become more widely available

Opioid Use After Discharge Following Primary Unilateral Total Knee Arthroplasty: How Much Are We Over-Prescribing?

BACKGROUND: The opioid crisis pressures orthopedic surgeons to reduce the amount of narcotics prescribed for post-operative pain management. This study sought to quantify post-operative opioid use after hospital discharge for primary unilateral total knee arthroplasty (TKA) patients. METHODS: A prospective cohort of primary unilateral TKA patients performed by one of 5 senior fellowship-trained arthroplasty surgeons were enrolled at a single institution. Detailed pain journals tracked all prescriptions and over-the-counter pain medications, quantities, frequencies, and visual analog scale pain scores. Narcotic and narcotic-like pain medications were converted to morphine milligram equivalents (MME). Statistical analysis was performed using Student\u27s t-test with α \u3c 0.05. RESULTS: Data from 89 subjects were analyzed; the average visual analog scale pain score was 6.92 while taking narcotics. The average number of days taking narcotics was 16.8 days. The distribution of days taking narcotics was right shifted with 52.8% of patients off narcotics after 2 week, and 74.2% off by 3 weeks post-op. The average MME prescribed was significantly greater than MME taken (866.6 vs 428.2, P \u3c .0001). The average number of narcotic pills prescribed was significantly greater than narcotic pills taken (105.1 vs 52.0, P \u3c .0001). The average excess narcotic pills prescribed per patient was 53.1 pills. About 48.3% took fewer than 40 narcotic pills; 75.3% took fewer than 75 narcotic pills. About 3.4% did not require any narcotics; 40.5% required a refill of narcotics. Also, 9.0% went home the day of surgery. CONCLUSION: Significantly more narcotics were prescribed than were taken in the post-operative period following TKA with an average 53.1 excess narcotic pills per patient. Adjusting prescribing patterns to match patient narcotic usage could reduce the excess narcotic pills following TKA

Opioid Use After Discharge Following Primary Unilateral Total Hip Arthroplasty: How Much Are We Overprescribing?

BACKGROUND: The opioid crisis pressures orthopedic surgeons to reduce the amount of narcotics prescribed for postoperative pain management. This study sought to quantify postoperative opioid use after hospital discharge for primary unilateral total hip arthroplasty (THA) patients. METHODS: A prospective cohort of primary unilateral THA patients were enrolled at a single institution. Detailed pain journals tracked all prescription and over-the-counter pain medication, quantity, frequency, and visual analog scale pain scores. Pain medications were converted to morphine milligram equivalents (MME). RESULTS: Data from 121 subjects were analyzed; the average visual analog scale pain score was 3.44 while taking narcotics. The average number of days taking narcotics was 8.46 days. The distribution of days taking narcotics was right shifted with 50.5% of patients off narcotics after 1 week, and 82.6% off by 2 weeks postoperatively. The average number of narcotic pills prescribed was significantly greater than narcotic pills taken (72.5 vs 28.8, P \u3c .0001). The average MME prescribed was significantly greater than MME taken (452.1 vs 133.8, P \u3c .0001). The average excess narcotic pills prescribed per patient was 51.7 pills. And 71.9% took fewer than 30 narcotic pills; 90.9% patients took fewer than 50 narcotic pills. Also, 10.7% did not require any narcotics; 9.9% required a refill of narcotics; and 33.1% went home the day of surgery. CONCLUSION: Significantly more narcotics were prescribed than were taken in the postoperative period following THA with an average 51.7 excess narcotic pills per patient. Adjusting prescribing patterns to match patient narcotic usage could reduce the excess narcotic pills following THA

Vascularized Fibular Epiphyseal Transfer for Pediatric Limb Salvage: Review of Applications and Outcomes

Summary:. Vascularized fibular epiphyseal transfer (VFET) offers a functional advantage in pediatric limb salvage due to the preservation of growth potential and an articular surface for remodeling. This review summarizes the available evidence on the clinical characteristics and outcomes of pediatric reconstruction applying VFET at different recipient sites and with varying techniques. VFET was used to reconstruct the proximal humerus, distal radius or ulna, proximal femur, distal fibula, calcaneus, and mandible. Although most often harvested on the anterior tibial artery, VFET has also been performed using the peroneal artery, the inferior lateral genicular artery, and a dual pedicle. Recipient site flap inset most often involved fixation with plates and/or screws as well as soft tissue reconstruction using a retained slip of biceps femoris tendon. Outcomes included limb growth, range of motion, and strength. The most common reported complications were bone flap fracture and peroneal nerve palsy. The anterior tibial artery was the most applied pedicle with reliable limb growth, but with the added risk of postoperative peroneal palsy. Bone flap fracture most often occurred at the proximal humerus and femur recipient sites. Plate fixation and the combined use of allograft had lower instances of bone flap fracture. This review highlights how the anticipated dynamic growth and remodeling this free flap offers in the long term must be weighed against its complexity and potential complications

Ultrahigh-resolution high-speed retinal imaging using spectral-domain optical coherence tomography

The performance of spectral-domain optical coherance tomography (SD-OCT) was determined by measuring the signal-to-noise ratio (SNR), and the coherence length on a mirror and in the eye. It was found that SD-OCT gained preference for ultrahigh-resolution opthalmic imaging, as source bandwidth did not affect the SNR performance of the SD-OCT configuration. The new system enabled the view of two layers at the location of retinal pigmented epithelium and showed small features in the inner and outer plexiform layers, believed to be blood vessels