April 8, 2020 | Today’s News

Study Evaluates Midterm Outcomes of One-stage Knee Exchange for PJI Using Tantalum Cones

A retrospective study published in the April issue of The Journal of Arthroplasty assessed midterm outcomes after tantalum cones in one-stage knee exchange for periprosthetic joint infection (PJI). Between 2011 and 2016, 72 patients (mean age, 70 years) underwent one-stage exchange for infected total knee arthroplasty using either rotating or pure hinge system in combination with femoral and/or tibial cones. Overall, 15 patients (21 percent) were rerevised for either infection (n = 8) or aseptic loosening (n = 7); 12 patients required cone exchange. Revision-free cone-related survival was 83 percent; infection-free survival was 89 percent. The types of prosthesis used or implanted cones were not largely correlated with failure. Patients with a prior septic revision were more likely to require cone revision. Hospital for Specialty Surgery knee score improved from 47 preoperatively to 60 at final follow-up.

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Study Measures Long-term Wrist Arthroplasty Survival in Four Implants

A study published online in The Journal of Hand Surgery compared 10-year survival outcomes for total wrist arthroplasty (TWA) performed with four different implants A total of 136 TWAs (124 patients) were assessed five and 10 years postoperatively. The main outcome measure was implant survival, with revision and radiographic loosening as the final endpoint. Other outcomes included range of motion (ROM); hand grip strength; visual analog scale (VAS) pain scores; and patient-related outcome measures (PROMs), including Disabilities of the Arm, Shoulder, and Hand; Patient-rated Wrist Evaluation; and Canadian Occupational Performance Measure. With revision as the primary endpoint, total cumulative implant survival was 92 percent; when nonrevised radiographic loose implant was included as failure, survival was 75 percent. Radiographic loosening was significantly different among the implants (range, 0.0 percent to 37.5 percent). After 10 years, ROM in nonrevised TWAs remained preserved compared to preoperatively, and hand grip strength, VAS pain scores, and PROMs were still significantly improved compared to preoperative values

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A retrospective study published online in Foot & Ankle International assessed the diagnostic value of single-photon emission CT combined with conventional CT (SPECT-CT) in painful total ankle replacement (TAR). Between January 2014 and November 2018, 37 patients had painful TAR at a single institution; 28 underwent revision surgery, and 19 had an MRI during the same timeframe. Of the total cohort, 33 patients (89.2 percent) had SPECT-CT results consistent with their ultimate diagnosis; the most common diagnoses were aseptic loosening (n = 12) and impingement (n = 11). Of the 28 patients who required revision surgery, SPECT-CT results correlated with intraoperative findings in 26 cases (92.9 percent). Of the 19 patients who received MRI, their findings matched clinical findings in seven cases (36.8 percent).

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A study published online in The American Journal of Sports Medicine evaluated the clinical evidence regarding the use of superior capsule reconstruction (SCR) for irreparable massive rotator cuff tears. PubMed, Medline, Cochrane, and Google Scholar were queried for relevant English-language articles evaluating SCR outcomes. Final analysis included seven studies consisting of 352 total patients (358 shoulders), 14 of whom were lost to follow-up, leaving clinical outcome data for 338 patients (344 shoulders). Three studies each assessed dermal allografts and fascia lata autografts; one study evaluated both graft types. The most common technique used for humeral graft fixation was a double-row technique. The most common complication was graft tears (13 percent of patients); 15 SCR revisions and seven reverse shoulder arthroplasties were subsequently required. Postoperative improvements were observed in VAS (25 to 5.9), American Shoulder and Elbow Surgeons (20 to 56), Japanese Orthopaedic Association (38.0), Subjective Shoulder Value (37.0 to 41.3), and Constant-Murley (11.6 to 47.4) scores. Three studies reported patient satisfaction and found rates of 72.9 percent, 85.7 percent, and 90.0 percent.

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A study published in the April issue of the Journal of Pediatric Orthopaedics evaluated the past five years of literature on four major upper-extremity fractures in pediatric patients. PubMed and Embase databases were searched for relevant articles on supracondylar humerus (SCH) fractures, lateral condyle humerus fractures, medial epicondyle humerus fractures, and clavicle fractures published in English from Jan. 1, 2013, through Nov. 1, 2018. Final analysis included 30 papers (SCH fractures, n = 12; lateral condyle humerus fractures, n = 10; medial epicondyle humerus fractures, n = 3; and clavicle fractures, n = 5). All papers had either level III or IV evidence. An increase was observed in SCH fractures being treated at trauma centers or pediatric hospitals; open reductions in SCH fractures appeared to decrease overall, but flexion type SCH fractures still have a higher risk of requiring open reduction. The treatment of lateral condyle humerus fractures is changing and is successfully being managed with closed reduction and percutaneous pinning when an adjunct arthrogram is performed, demonstrating articular congruity. Additional research is warranted for treating displaced medial epicondyle humerus fractures and clavicle fractures in adolescents.

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Survey Assesses Compensation Trends for Physicians and Practice Administrators

The annual American Alliance of Orthopaedic Executives Benchmarking Survey collects data from orthopaedic practices across the country to give practice professionals the data they need to make strategic decisions. The results from the latest survey, the Benchmarking Results for Data Year 2018, include five years of trend data from more than 300 orthopaedic practices and represent a full range of practice sizes, specialties, population sizes, and regions. This article provides a high-level look at compensation trends affecting physicians and practice administrators.

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Submissions are Open for Kappa Delta and OREF Awards

AAOS is soliciting manuscripts for the 2021 Kappa Delta Orthopaedic Research Awards and the Orthopaedic Research and Education Foundation (OREF) Clinical Research Award. Up to two $20,000 Kappa Delta awards (Elizabeth Winston Lanier Award and Ann Doner Vaughan Award), one $20,000 Kappa Delta Young Investigator award, and one $20,000 OREF award will be bestowed, provided manuscripts of requisite quality are submitted. Manuscripts should represent a large body of cohesive scientific work generally reflecting years of investigation. Manuscripts must be submitted by members (or candidate members) of AAOS, Orthopaedic Research Society (ORS), Canadian Orthopaedic Association, or Canadian Orthopaedic Research Society. The awards will be presented at the AAOS 2021 Annual Meeting, and recipients will be invited to speak at the ORS 2021 Annual Meeting. Submissions are due no later than 11:59 p.m. C.D.T. on July 1.

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