Superior Pain Reduction with Anteromedialization Tibial Tubercle Osteotomy Versus Non-Operative Management for Patellofemoral Osteoarthritis
Amit K. Manjunath, MD, Matthew Gotlin, MD, David A. Bloom, MD, Eoghan T. Hurley, MB,
BCh, MCh, Michael J. Alaia, MD, Laith M. Jazrawi, MD, and Eric J. Strauss, MD
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
Outcomes in Arthroplasty Procedures Performed for Femoral Neck Fractures Does Approach Affect Outcome?
Ariana Lott, MD, Roy I. Davidovitch, MD, Sanjit R. Konda, MD, and Kenneth A. Egol, MD
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.
Matrix-Induced Autologous Chondrocyte Implantation Versus Autologous Chondrocyte Implantation of the Knee A Retrospective Comparison
Amit K. Manjunath, MD, Jordan W. Fried, BM, Erin F. Alaia, MD, Charles C. Lin, MD, Eoghan T.
Hurley, MB, BCh, MCh, Robert J. Meislin, MD, Laith M. Jazrawi, MD, and Eric J. Strauss, MD
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.
Predicting Pulmonary Embolism in Total Joint Arthroplasty Patients A Pilot Study
Kevin K. Chen, MD, Afshin A. Anoushiravani, MD, John Mercuri, MD, Michael A. Nardi, MS,
Jeffrey Berger, MD, Thomas Maldonado, MD, and Richard Iorio, MD
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.
Mini-Navigation Utilization in THA Results in Shorter Length of Stay, Increased Home Discharge, and Higher Physical Therapy Mobilization Scores Compared to THA Without Navigation
Charles Wang, MD, Siddharth A. Mahure, MD, MBA, Noah Kirschner, MD, James E. Feng, MD,
Ran Schwarzkopf, MD, MSc, and William J. Long, MD
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.
Survivorship and Outcomes of Robotic ArmAssisted Medial Unicompartmental Knee Arthroplasty at a Minimum of 5-Year Follow-Up
Konstantinos Dretakis, MD, Christos Koutserimpas, MD, Konstantinos Raptis, MD, and
Vasilios G. Igoumenou, MD
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
Subscapularis Management in Anatomic Total Shoulder Arthroplasty A Review
Erel Ben-Ari, MD, Yaniv Pines, MD, Dan Gordon, MD, Ruby G. Patel, MD, Mandeep S. Virk, MD,
Joseph D. Zuckerman, MD, and Young W. Kwon, MD, PhD
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
Achieving Bone Healing Non-Operatively in Humeral Fractures in Two Patients with Risk Factors for Nonunion Utilizing a Specialized Orthosis
Ernest C. Chisena, MD, MS, and Yudell Edelstein, MD
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.
Three-Dimensional Printed Total Talus Replacement with a Concurrent Total Ankle Arthroplasty as a Personalized Approach for Advanced Ankle Osteoarthritis A Case Report
Mikhail Zusmanovich, MD, Emilie R. C. Williamson, MD, Wesley Day, and Cary B. Chapman, MD
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.