Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Published in
Clinical Orthopaedics and Related Research®
Volume 475 | Issue 5 | May, 2017
Articles

Patients With Limited Health Literacy Ask Fewer Questions During Office Visits With Hand Surgeons

Mariano E. Menendez MD, Bastiaan T. Hoorn BS, Michael Mackert PhD, Erin E. Donovan PhD, Neal C. Chen MD, David Ring MD, PhD

In the midst of rapid expansion of medical knowledge and decision-support tools intended to benefit diverse patients, patients with limited health literacy (the ability to obtain, process, and understand information and services to make health decisions) will benefit from asking questions and engaging actively in their own care. But little is known regarding the relationship between health literacy and question-asking behavior during outpatient office visits.

Medicolegal Sidebar: Expanding Hospital Liability—The Concept of Willful Blindness

Lawrence H. Brenner JD, Wendy Z. W. Teo BA (Cantab), BM, BCh (Oxon), B. Sonny Bal MD, JD, MBA, PhD

Is There Benefit to Free Over Pedicled Vascularized Grafts in Augmenting Tibial Intercalary Allograft Constructs?

Marco Manfrini MD, Srimanth Bindiganavile MD, Ferhat Say MD, Marco Colangeli MD, Laura Campanacci MD, Massimiliano Depaolis MD, Massimo Ceruso MD, Davide Donati MD

Intercalary reconstruction of tibial sarcomas with vascularized fibula autografts and massive bone allografts is reliable with predictable long-term results. However, inadequate data exist comparing free and pedicled vascularized fibula autografts in combination with a massive bone allograft in patients undergoing intercalary tibia reconstructions.

Is There a Difference in Revision Risk Between Metal and Ceramic Heads on Highly Crosslinked Polyethylene Liners?

Guy Cafri PhD, MStat, Elizabeth W. Paxton MA, Rebecca Love MPH, RN, Stefano A. Bini MD, Steven M. Kurtz PhD

The most common bearing surface used among primary THAs worldwide is a metal or ceramic femoral head that articulates against a highly crosslinked ultrahigh-molecular-weight polyethylene (HXLPE) acetabular liner. Despite their widespread use, relatively little is known about the comparative effectiveness of ceramic versus metal femoral heads with respect to risk of revision and dislocation as well as the role of head size in this relationship.

A Novel Technique for Assessing Antioxidant Concentration in Retrieved UHMWPE

Barbara H. Currier MChE, Douglas W. Van Citters PhD

Antioxidants added to UHMWPE to prevent in vivo oxidation are important to the long-term performance of hip and knee arthroplasty. Diffused vitamin E antioxidant polyethylene raised questions about potential in vivo elution that could cause inflammatory reactions in periprosthetic tissues and also potentially leave the implant once again prone to oxidation. Currently, there is no information on the elution, if any, of antioxidants from implant polyethylene materials in vivo.

Periprosthetic UHMWPE Wear Debris Induces Inflammation, Vascularization, and Innervation After Total Disc Replacement in the Lumbar Spine

Sai Y. Veruva PhD, Todd H. Lanman MD, Jorge E. Isaza MD, Theresa A. Freeman PhD, Steven M. Kurtz PhD, Marla J. Steinbeck MT(ASCP), PhD

The pathophysiology and mechanisms driving the generation of unintended pain after total disc replacement (TDR) remain unexplored. Ultrahigh-molecular-weight polyethylene (UHMWPE) wear debris from TDRs is known to induce inflammation, which may result in pain.

Lateral-compartment Osteophytes are not Associated With Lateral-compartment Cartilage Degeneration in Arthritic Varus Knees

Wenzel Waldstein MD, Maximilian F. Kasparek MD, Martin Faschingbauer MD, Reinhard Windhager MD, PhD, Friedrich Boettner MD

Progression of arthritis in the lateral compartment is one of the main failure modes of unicompartmental knee arthroplasty (UKA). The decision regarding whether to perform a medial UKA sometimes is made based on whether lateral-compartment osteophytes are visible on plain radiographs obtained before surgery, but it is not clear whether the presence of lateral-compartment osteophytes signifies that the cartilage in the lateral compartment is arthritic.

What is the Accuracy of Nuclear Imaging in the Assessment of Periprosthetic Knee Infection? A Meta-analysis

Steven J. Verberne MD, Remko J. A. Sonnega MD, Olivier P. P. Temmerman MD, PhD, Pieter G. Raijmakers MD, PhD

In the assessment of possible periprosthetic knee infection, various imaging modalities are used without consensus regarding the most accurate technique.

Are Readmissions After THA Preventable?

Douglas S. Weinberg MD, Matthew J. Kraay MD, Steven J. Fitzgerald MD, Vasu Sidagam MD, Glenn D. Wera MD

Readmissions after total joint arthroplasty have become a key quality measure in elective surgery in the United States. The Affordable Care Act includes the Hospital Readmission Reduction Program, which calls for reduced payments to hospitals with excessive readmissions. This policy uses a method to determine excess readmission ratios and calculate readmission payment adjustments to hospitals, however, it is unclear whether readmission rates are an effective quality metric. The reasons or conditions associated with readmission after elective THA have been well established but the extent to which readmissions can be prevented after THA remains unclear.

Can Multistate Modeling of Local Recurrence, Distant Metastasis, and Death Improve the Prediction of Outcome in Patients With Soft Tissue Sarcomas?

Florian Posch MD, MSc, Lukas Leitner MD, PhD, Marko Bergovec MD, Angelika Bezan MD, Michael Stotz MD, Armin Gerger MD, MBA, Martin Pichler MD, MSc, Herbert Stöger MD, Bernadette Liegl-Atzwanger MD, Andreas Leithner MD, Joanna Szkandera MD

Exploration of the complex relationship between prognostic indicators such as tumor grade and size and clinical outcomes such as local recurrence and distant metastasis in patients with cancer is crucial to guide treatment decisions. However, in patients with soft tissue sarcoma, there are many gaps in our understanding of this relationship. Multistate analysis may help us in gaining a comprehensive understanding of risk factor-outcome relationships in soft tissue sarcoma, because this methodology can integrate multiple risk factors and clinical endpoints into a single statistical model. To our knowledge, no study of this kind has been performed before in patients with soft tissue sarcoma.

What is the Incidence of Suicide in Patients with Bone and Soft Tissue Cancer?

Brianna L. Siracuse BS, George Gorgy BA, Jeremy Ruskin MD, Kathleen S. Beebe MD

Patients with cancer in the United States are estimated to have a suicide incidence that is approximately twice that of the general population. Patients with bone and soft tissue cancer often have physical impairments and activity limitations develop that reduce their quality of life, which may put them at high risk for depression, anxiety, and suicidal ideation. To our knowledge, there have been no large studies determining incidence of suicide among patients with bone and soft tissue cancer; this information might allow screening of certain high-risk groups.

Preventing Fusion Mass Shift Avoids Postoperative Distal Curve Adding-on in Adolescent Idiopathic Scoliosis

Hideki Shigematsu MD, PhD, Jason Pui Yin Cheung MBBS (HK), MMedSc, FRCS (Edin), FHKCOS, FHKAM (Orth), Mauro Bruzzone MD, Hiroaki Matsumori MD PhD, Kin-Cheung Mak MBBS, FRCSEd, FHKCOS, FHKAM (Orth), Dino Samartzis DSc, Keith Dip Kei Luk MCh (Orth), FRCSE, FRCSG, FRACS, FHKAM (Orth)

Surgery for adolescent idiopathic scoliosis (AIS) is only complete after achieving fusion to maintain the correction obtained intraoperatively. The instrumented or fused segments can be referred to as the “fusion mass”. In patients with AIS, the ideal fusion mass strategy has been established based on fulcrum-bending radiographs for main thoracic curves. Ideally, the fusion mass should achieve parallel endplates of the upper and lower instrumented vertebra and correct any “shift” for truncal balance. Distal adding-on is an important element to consider in AIS surgery. This phenomenon represents a progressive increase in the number of vertebrae included distally in the primary curvature and it should be avoided as it is associated with unsatisfactory cosmesis and an increased risk of revision surgery. However, it remains unknown whether any fusion mass shift, or shift in the fusion mass or instrumented segments, affects global spinal balance and distal adding-on after curve correction surgery in patients with AIS.

Is Pes Cavus Alignment Associated With Lisfranc Injuries of the Foot?

Jeremy D. Podolnick MD, Daniel S. Donovan MD, Nicholas DeBellis MD, Alejandro Pino MD

Lisfranc (tarsometatarsal joint) injuries are relatively rare, accounting for less than 1% of all fractures, and as many as 20% of subtle Lisfranc injuries are missed at the initial patient presentation. An undiagnosed Lisfranc injury can have devastating consequences to the patient. Therefore, any factor that can raise a clinician’s index of suspicion to make this diagnosis is potentially important. The cavus foot has been associated with various maladies of the lower extremity, but to our knowledge, it has not been reported to be associated with Lisfranc injury.

What Are the Biomechanical Properties of the Taylor Spatial Frame™?

Daniel J. Henderson FRCS (Orth), Jeremy L. Rushbrook FRCS (Orth), Paul J. Harwood FRCS (Orth), Todd D. Stewart PhD

The Taylor Spatial Frame™ (TSF) is a versatile variant of the traditional Ilizarov circular fixator. Although in widespread use, little comparative data exist to quantify the biomechanical effect of substituting the tried-and-tested Ilizarov construct for the TSF hexapod system.

Can Spatiotemporal Fluoride (18 F− ) Uptake be Used to Assess Bone Formation in the Tibia? A Longitudinal Study Using PET/CT

Henrik Lundblad MD, PhD, Charlotte Karlsson-Thur MD, PhD, Gerald Q. Maguire PhD, Cathrine Jonsson PhD, Marilyn E. Noz PhD, Michael P. Zeleznik PhD, Lars Weidenhielm MD, PhD

When a bone is broken for any reason, it is important for the orthopaedic surgeon to know how bone healing is progressing. There has been resurgence in the use of the fluoride (F) ion to evaluate various bone conditions. This has been made possible by availability of positron emission tomography (PET)/CT hybrid scanners together with cyclotrons. Absorbed on the bone surface from blood flow,Fattaches to the osteoblasts in cancellous bone and acts as a pharmacokinetic agent, which reflects the local physiologic activity of bone. This is important because it shows bone formation indicating that the bone is healing or no bone formation indicating no healing. AsFis extracted from blood in proportion to blood flow and bone formation, it thus enables determination of bone healing progress.

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