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 8 | Aug, 2017
Articles

Readability of Orthopaedic Patient-reported Outcome Measures: Is There a Fundamental Failure to Communicate?

Jorge L. Perez MD, Zachary A. Mosher BS, Shawna L. Watson BA, Evan D. Sheppard MD, Eugene W. Brabston MD, Gerald McGwin MS, PhD, Brent A. Ponce MD

Patient-reported outcome measures (PROMs) are increasingly used to quantify patients’ perceptions of functional ability. The American Medical Association and NIH suggest patient materials be written at or below 6th to 8th grade reading levels, respectively, yet one recent study asserts that few PROMs comply with these recommendations, and suggests that the majority of PROMs are written at too high of a reading level for self-administered patient use. Notably, this study was limited in its use of only one readability algorithm, although there is no commonly accepted, standard readability algorithm for healthcare-related materials. Our study, using multiple readability equations and heeding equal weight to each, hopes to yield a broader, all-encompassing estimate of readability, thereby offering a more accurate assessment of the readability of orthopaedic PROMS.

Medicolegal Sidebar: Resident Physician Liability

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

Does Removal of Subchondral Cortical Bone Provide Sufficient Resection Depth for Treatment of Cam Femoroacetabular Impingement?

Penny R. Atkins BS, Stephen K. Aoki MD, Ross T. Whitaker PhD, Jeffrey A. Weiss PhD, Christopher L. Peters MD, Andrew E. Anderson PhD

Residual impingement resulting from insufficient resection of bone during the index femoroplasty is the most-common reason for revision surgery in patients with cam-type femoroacetabular impingement (FAI). Development of surgical resection guidelines therefore could reduce the number of patients with persistent pain and reduced ROM after femoroplasty.

What is the Ideal Route of Administration of Tranexamic Acid in TKA? A Randomized Controlled Trial

Sung Yup Lee MD, Suri Chong MD, Dhanasekaraprabu Balasubramanian MS (Orth), Young Gon Na MD, Tae Kyun Kim MD, PhD

TKA commonly involves substantial blood loss and tranexamic acid has been used to reduce blood loss after TKA. Numerous clinical trials have documented the efficacy and safety of intravenous (IV) or intraarticular (IA) use of tranexamic acid. Combined administration of tranexamic acid also has been suggested; however, there is no consensus regarding the ideal route of tranexamic acid administration.

What Factors Are Associated With Femoral Component Internal Rotation in TKA Using the Gap Balancing Technique?

Seung-Yup Lee MD, MSc, Hong-Chul Lim MD, PhD, Ki-Mo Jang MD, PhD, Ji-Hoon Bae MD, PhD

When using the gap-balancing technique for TKA, excessive medial release and varus proximal tibial resection can be associated with internal rotation of the femoral component. Previous studies have evaluated the causes of femoral component rotational alignment with a separate factor analysis using unadjusted statistical methods, which might result in treatment effects being attributed to confounding variables.

Epiphyseal Arterial Network and Inferior Retinacular Artery Seem Critical to Femoral Head Perfusion in Adults With Femoral Neck Fractures

Dewei Zhao MD, PhD, Xing Qiu PhD, Benjie Wang MD, Zihua Wang MD, Wei Wang PhD, Jun Ouyang PhD, Rona M. Silva PhD, Xiaotian Shi PhD, Kai Kang PhD, Dachuan Xu PhD, Chuang Li MD, Shizhen Zhong PhD, Yu Zhang PhD, Kent E. Pinkerton PhD

A better understanding of the blood supply of the femoral head is essential to guide therapeutic strategies for patients with femoral neck fractures. However, because of the limitations of conventional techniques, the precise distribution and characteristics of intraosseous arteries of the femoral head are not well displayed.

Prediction of Polyethylene Wear Rates from Gait Biomechanics and Implant Positioning in Total Hip Replacement

Marzieh M. Ardestani PhD, Pedro P. Amenábar Edwards MD, Markus A. Wimmer PhD

Patient-specific gait and surgical variables are known to play an important role in wear of total hip replacements (THR). However a rigorous model, capable of predicting wear rate based on a comprehensive set of subject-specific gait and component-positioning variables, has to our knowledge, not been reported.

Exchangeable Femoral Neck (Dual-Modular) THA Prostheses Have Poorer Survivorship Than Other Designs: A Nationwide Cohort of 324,108 Patients

Sandrine Colas MSc, MPH, Assia Allalou MSc, Antoine Poichotte MD, Philippe Piriou MD, PhD, Rosemary Dray-Spira MD, PhD, Mahmoud Zureik MD, PhD

Exchangeable neck stems, defined as those with a dual taper (that is, a modular junction between the femoral head and the femoral neck and an additional junction between the neck and the stem body), were introduced in THA to improve restoration of joint biomechanics (restoring anteversion, offset, and limb length) and reduce the risk of dislocation. However exchangeable necks have been reported to result in adverse effects such as stem fractures and acute local tissue reaction. Whether they result in a net improvement to or impairment of reconstructive survivorship remains controversial.

Single-stage Acetabular Revision During Two-stage THA Revision for Infection is Effective in Selected Patients

Bernd Fink MD, Michael Schlumberger MD, Damian Oremek MD

The treatment of periprosthetic infections of hip arthroplasties typically involves use of either a single- or two-stage (with implantation of a temporary spacer) revision surgery. In patients with severe acetabular bone deficiencies, either already present or after component removal, spacers cannot be safely implanted. In such hips where it is impossible to use spacers and yet a two-stage revision of the prosthetic stem is recommended, we have combined a two-stage revision of the stem with a single revision of the cup. To our knowledge, this approach has not been reported before.

Complete Circumferential Osseous Extension in the Acetabular Rim Occurs Regardless of Acetabular Coverage

Keisuke Watarai MD, Fumihiko Kimura MD, Yuho Kadono MD, PhD, Yoon Taek Kim MD, PhD, Mamoru Niitsu MD, PhD, Hiromi Oda MD, PhD, Hirohiko Azuma MD, PhD

Complete circumferential osseous extension in the acetabular rim has been reported to occur in the deep hip with pincer impingement. However, this phenomenon occasionally is observed in dysplastic hips without pincer impingement, and the degree to which this finding might or might not be associated with hip pain, and how often it occurs bilaterally among patients, are not well characterized.

Débridement and Reconstruction Improve Postoperative Sagittal Alignment in Kyphotic Cervical Spinal Tuberculosis

Zhimin Pan MD, Jiaquan Luo MD, PhD, Limin Yu MD, PhD, Yiwei Chen MD, Junlong Zhong MD, Zhiyun Li MD, PhD, Zhaoxun Zeng MD, Pingguo Duan MD, PhD, Yoon Ha MD, PhD, Kai Cao MD, PhD

Cervical spinal tuberculosis is relatively common in some developing countries. It erodes vertebrae and discs, which sometimes results in cervical kyphosis and myelopathy. However, to our knowledge, no studies have evaluated improvements to patient-reported outcomes among patients who undergo surgical cervical sagittal realignment after kyphotic cervical spinal tuberculosis has been treated by débridement and reconstruction.

What are the Oncologic and Functional Outcomes After Joint Salvage Resections for Juxtaarticular Osteosarcoma About the Knee?

Jing Li MD, PhD, Zhen Wang MD, Chuanlei Ji MD, Guojing Chen MD, Dong Liu MD, Haodong Zhu MD

Joint salvage surgery for patients with juxtaarticular osteosarcoma remains challenging, especially when the tumor invades the epiphysis. Because patients are surviving longer with current chemotherapy regimens, it is advantageous to retain native joints if possible, especially in young patients. However, the results using joint-preserving tumor resections in this context have not been well characterized.

Does Extracellular DNA Production Vary in Staphylococcal Biofilms Isolated From Infected Implants versus Controls?

Beata Zatorska MSc, Marion Groger PhD, Doris Moser PhD, Magda Diab-Elschahawi MD, MSc, Luigi Segagni Lusignani MD, Elisabeth Presterl MD, MBA

Prosthetic implant infections caused byandare major challenges for early diagnosis and treatment owing to biofilm formation on the implant surface. Extracellular DNA (eDNA) is actively excreted from bacterial cells in biofilms, contributing to biofilm stability, and may offer promise in the detection or treatment of such infections.

Prolotherapy Induces an Inflammatory Response in Human Tenocytes In Vitro

Emmanuel C. Ekwueme PhD, Mahir Mohiuddin BS, Jazmin A. Yarborough, P. Gunnar Brolinson DO, Denitsa Docheva PhD, Hugo A. M. Fernandes PhD, Joseph W. Freeman PhD

Proliferative therapy, or prolotherapy, is a controversial treatment method for many connective tissue injuries and disorders. It involves the injection of a proliferant, or irritant solution, into the site of injury, which causes small-scale cell death. This therapeutic trauma is theorized to initiate the body’s wound-healing cascade, perhaps leading to tissue repair. The immediate effects of many of these proliferants are poorly characterized, as are the cellular responses to them; here, we sought to evaluate the immediate effects of two common proliferants (dextrose and P2G, a combination of phenol, glucose, and glycerin) on the cellular response of human tenocytes, and begin to explicate the mechanisms with which each proliferant functions.

Increase in Total Joint Arthroplasty Projected from 2014 to 2046 in Australia: A Conservative Local Model With International Implications

Maria C. S. Inacio PhD, Stephen E. Graves MBBS, DPhil, Nicole L. Pratt PhD, Elizabeth E. Roughead PhD, Szilard Nemes PhD

The incidence of joint arthroplasty is increasing worldwide. International estimates of future demand for joint arthroplasty have used models that propose either an exponential future increase, despite obvious system constraints, or static increases, which do not account for past trends. Country-specific projection estimates that address limitations of past projections are necessary. In Australia, a high-income country with the 7th highest incidence of TKA and 15th highest incidence of THA of the Organization for Economic Cooperation and Development (OECD) countries, the volume of TKAs and THAs increased 198% between 1994 and 2014.

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