Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jun 2024
Pre-milling technique improves the accuracy of posterior femoral condyle cut and reduces the tibial recut in Oxford unicompartmental knee arthroplasty.
Recuts are sometimes needed in UKA because of inadequate posterior tibial cut thickness. We investigated the efficacy of a pre-milling technique (the first milling is done prior to the posterior condylar cut) in Oxford unicompartmental knee arthroplasty to enhance bone cut thickness and to minimize tibial recuts. ⋯ The pre-milling technique was found to increase the bone cut thickness in small and medium femoral components, reducing the need for tibial recuts. Further research is warranted to optimize the pre-milling technique and to investigate its long-term impact on patient outcomes.
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Arch Orthop Trauma Surg · Jun 2024
The use of preoperative continuous positive airway pressure in patients with obstructive sleep apnea following total knee arthroplasty: a propensity score matched analysis.
Patients with sleep apnea, affecting up to 1 in 4 older men in the United States, may be at increased risk of postoperative complications after total knee arthroplasty (TKA), including increased thromboembolic and cerebrovascular events, as well as respiratory, cardiac, and digestive complications. However, the extent to which the use of CPAP in patients with sleep apnea has been studied in TKA is limited. ⋯ Patients with sleep apnea have increased postoperative complications after undergoing TKA in comparison to patients without sleep apnea. More severe sleep apnea, represented by CPAP usage in this study led to worse postoperative outcomes but further analysis is required signify the role of CPAP in this patient population. Patients with sleep apnea should be treated as a high-risk group.
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Arch Orthop Trauma Surg · Jun 2024
Incidence and management of secondary deformities after megaendoprosthetic proximal femur replacement in skeletally immature bone sarcoma patients.
Megaendoprosthetic reconstruction of bone defects in skeletally immature patients has led to the development of unique complications and secondary deformities not observed in adult patient cohorts. With an increasing number of megaendoprosthetic replacements performed, orthopedic oncologists still gain experience in the incidence and type of secondary deformities caused. In this study, we report the incidence, probable cause and management outcome of two secondary deformities after megaendoprosthetic reconstruction of the proximal femur: hip dysplasia and genu valgum. ⋯ Patients aged < 10 years were prone to develop secondary hip dysplasia and genu valgum following proximal femur replacement in this study. Management of secondary deformities should depend on remaining skeletal growth. Stress shielding was observed in almost all skeletally immature patients.
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Arch Orthop Trauma Surg · Jun 2024
A novel surgical technique for revision anterior cruciate ligament reconstruction using an isolated rectus femoris tendon autograft.
Only a few anatomic studies have described an isolated rectus femoris tendon autograft for anterior cruciate ligament (ACL) reconstruction. This study aims to demonstrate a new surgical technique utilising the rectus femoris tendon for ACL reconstruction. This study hypothesises that the rectus tendon autograft will yield satisfying postoperative outcomes in terms of stability, with minimal complications at the harvest site. ⋯ Case series; Level of evidence, IV.
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Arch Orthop Trauma Surg · Jun 2024
Managing an epidemic within a pandemic: orthopedic opioid prescribing trends during COVID-19.
In response to the opioid epidemic, a multitude of policy and clinical-guideline based interventions were launched to combat physician overprescribing. However, the sudden rise of the Covid-19 pandemic disrupted all aspects of healthcare delivery. The purpose of this study was to evaluate how opioid prescribing patterns changed during the Covid-19 pandemic within a large multispecialty orthopedic practice. ⋯ During the Covid-19 pandemic opioid prescribing levels remained below historical averages. While continued efforts are needed to minimize opioid overprescribing, it appears that the significant progress made toward this goal was not lost during the pandemic era.