Study Compares General versus Spinal Anesthesia for TJA
According to a study published in the April issue of The Journal of Arthroplasty, spinal anesthesia resulted in less complications compared to general anesthesia in total joint arthroplasty (TJA) patients. The study prospectively enrolled 2,242 TJA patients treated between 2015 and 2017 at a single institution who were contacted postoperatively to report 90-day complications. Most patients (n = 1,586) underwent total knee arthroplasty, and 656 underwent total hip arthroplasty. More than half of patients (n = 1,325; 59.1 percent) received spinal anesthesia, and 40.9 percent (n = 917) received general anesthesia. General anesthesia patients had higher mean Charlson Comorbidity Index scores (0.05 versus 0.09), as well as higher average body mass index (BMI) (29.35 kg/m 2 versus 30.24 kg/m 2). The complication rate was lower in the spinal anesthesia group compared to the general anesthesia group (7.02 percent versus 10.14 percent). General anesthesia patients also had a longer length of stay (2.43 days versus 2.18 days) and were more likely to be discharged to a nursing facility (32.28 percent versus 25.06 percent).
A study published in the April issue of Arthroscopy compared demographic and radiographic findings, treatment decisions and clinical outcomes, and risk factors for poorer outcomes for patients with medial versus lateral meniscal root tears. Researchers retrospectively reviewed patients with symptomatic, medial, or lateral meniscus posterior root tears who had at least two years of follow-up. A total of 141 root tears were identified: 109 medial meniscus posterior horn root tears (MMRTs) and 30 lateral meniscus root repairs (LMRTs); two patients had both. At presentation, MMRT patients were significantly older than LMRT patients (51.4 years versus 24.6 years) and had significantly higher BMI (32.1 kg/m 2 versus 25.8 kg/m 2), Kellgren-Lawrence score (1.3 versus 0.6), and rate of major meniscal extrusion (72 percent versus 20 percent). All 30 LMRTs underwent meniscal repair. In the MMRT group, 48 percent received nonoperative treatment, 25 percent received partial meniscectomy, and 27 percent received meniscal repair. Meniscus root repair was performed in 62 patients. LMRT had significantly higher International Knee Documentation Committee (89.5 versus 80.4) and Tegner (6.5 versus 5.1) scores.
Study: SPECT/CT to Assess Periarticular Arthritis Progression
A study published in the April issue of Foot & Ankle International evaluated single photon emission CT combined with CT (SPECT/CT) activity in the ankle and periarticular joints before and after ankle fusion to assess its relationship with clinical pain and function scores. Final analysis included 31 patients (31 ankles) who underwent either arthroscopic or open ankle fusion. X-ray and SPECT/CT imaging was collected, and patients filled out the Ankle Osteoarthritis Scale (AOS) and 36-item Short Form Survey (SF-36) questionnaires preoperatively and at six months postoperatively. After six months, no significant difference in the ankle joint was observed on SPECT/CT, but periarticular joint activity significantly increased. All patients had significant improvements in AOS and SF-36 scores at six months postoperatively.
A systematic review published in the April issue of The Journal of Hand Surgery assessed the indications, outcomes, and complications of capitolunate arthrodesis (CLA). A literature review yielded 33 relevant articles, of which six were eligible for inclusion and comprised 80 patents (average age, 48 years). Median follow-up was 34 months. In 59 percent of cases, the indication was scaphoid nonunion advanced collapse. Nearly half of patients (49 percent) required a concomitant triquetrum excision. Most patients (78 percent) were pain-free; 92 percent returned to work. Improvements were observed in grip strength and visual analog scale pain score following CLA. Nearly all patients (96 percent) fused between 42 and 210 days; 11 percent of patients had complications, including loose hardware (6.3 percent) and nonunion (3.8 percent). Reoperations included wrist arthrodesis and wrist arthroplasty and occurred in 14 percent of cases.
Study: Managing Fasciotomy Incisions Following Acute Compartment Syndrome in Children
A study published in the April issue of the Journal of Pediatric Orthopaedics evaluated delayed primary closure (DPC) success in children with fasciotomy wounds secondary to acute compartment syndrome (ACS) using serial débridement. ACS patients treated with fasciotomy aged zero to 18 years (n = 82) were identified. Patients were stratified by primary closure, DPC, and flap or skin graft (F/SG). Treatment success in patients who underwent additional débridements after fasciotomy was defined as closure by DPC that did not require F/SG. Fifteen patients (18 percent) received primary closure at the time of their initial fasciotomy and were excluded from the rest of the study; 48 patients (59 percent) underwent DPC and 19 (23 percent) underwent F/SG. DPC successfully closed 72 percent of fasciotomy wounds. DPC and F/SG groups did not largely differ in terms of age or injury method or severity. F/SG patients were hospitalized for an average of 12 days versus eight days for DPC patients.
The 2020 American Board of Orthopaedic Surgery (ABOS) Web-Based Longitudinal Assessment (WLA) Program Assessment Window has been extended due to the COVID-19 pandemic. The new Assessment Window is April 1 to June 1.
Take Part in a CPG Workgroup on Performing a Transtibial Amputation
AAOS is seeking volunteers to take part in the workgroup for the development of the clinical practice guideline (CPG) for Performing a Transtibial Amputation. The deadline to submit an application is May 1.
