Acromioclavicular Joint Injuries: Effective Rehabilitation.

PURPOSE: To perform a review of the literature focusing on rehabilitation protocols in patients with acromioclavicular (AC) joint injuries treated operatively and nonoperatively and to provide an updated rehabilitation treatment algorithm. METHODS: Studies were identified by searching the MEDLINE database from 01/1995 to 09/2020. Included studies contained detailed rehabilitation protocols with physiologic rationale for AC joint injuries. Biomechanical studies, technique articles, radiographic studies, systematic reviews, case studies, editorials, and studies that compared nonoperative versus operative treatment without focus on rehabilitation were excluded. Following identification of the literature, an updated treatment algorithm was created. RESULTS: The search strategy yielded 1742 studies, of which 1654 studies were excluded based on title, 60 on the abstract, and 25 on the full manuscript. One study was manually identified using article reference lists, yielding four publications presenting detailed rehabilitation protocols based on physiologic rationale. No randomized controlled trials or comparative studies were identified or cited as a basis for these rehabilitation protocols. CONCLUSION: Few detailed rehabilitation protocols in patients with AC joint injuries have been published. These protocols are limited by their standardization, arbitrary timelines, and provide minimal assessment of individual patient characteristics. The quality of patient care can be improved with more practical guidelines that are goal-oriented and allow for critical thinking among clinicians to address individual patient needs. Three common barriers preventing successful rehabilitation were identified and addressed: Pain, Apprehension, and (anterior chest wall) Stiffness to regain Scapular control, effectively termed "PASS" for AC joint rehabilitation. CLINICAL RELEVANCE: Rehabilitation protocols for AC joint injuries should be less formulaic and instead allow for critical thinking and effective communication among clinicians and therapists to address individual patient needs.

Spinal Anesthesia Using Ropivacaine Leads to Earlier Ambulation After Total Hip Arthroplasty.

Spinal anesthesia has grown in popularity for total hip arthroplasty (THA) due to its documented low complications. However, the use of a local anesthetic agent dictates the recovery of neuraxial blockade. Bupivacaine has emerged as the most popular choice, but its relatively long-acting effect limits its use with rapid recovery. Although not well studied, ropivacaine may offer a viable alternative with shorter-acting properties. Primary unilateral THA patients who received either ropivacaine or bupivacaine spinal anesthesia were retrospectively reviewed. These groups were compared for common demographics, such as age, sex, and body mass index. The primary outcomes included postoperative ambulation time and distance, post-anesthesia care unit transition time, and selective complications. Five hundred three patients were included. Of these, 227 received ropivacaine and 276 received bupivacaine. The ropivacaine group showed superior ambulation time and distance, quicker post-anesthesia care unit transition, and equivalent complications compared with the bupivacaine group. Ropivacaine shows a clear advantage over bupivacaine for spinal anesthesia during THA when considering rapid recovery. Its use should be strongly considered, especially in the ambulatory setting. [Orthopedics. 2021;44(3):e343-e346.].

Mobility Technicians: A Viable Solution to Early Ambulation of Total Joint Replacement Patients.

BACKGROUND: Early ambulation of patients with total joint replacement (TJR) has been shown to improve outcomes while reducing length of stay and postoperative complications. Limited physical therapy (PT) resources and late-in-the-day cases may challenge day-of-surgery (POD0) ambulation. At our institution, a Mobility Technician (MT) program, composed of specially trained nurse's aides, was developed to address this issue. PURPOSE: The purpose of this study was to compare the effectiveness of the MT model with a traditional PT model in the early ambulation of patients with TJR. METHODS: Patients undergoing unilateral primary TJR at a single institution between June 1, 2014, and October 31, 2018, were included. Ambulation measures were retrospectively assessed between pre- and post-MT program groups. RESULTS: This study included 11,777 patients with TJR. Following the MT program, number of POD0 ambulations, POD0 ambulation distance, and total distance ambulated all increased while time-to-first ambulation decreased. CONCLUSION: Preliminary analyses indicate that the MT program has been successful in the early ambulation of patients with TJR.