Obturator Anterior Dislocation After Direct Anterior Total Hip Arthroplasty in a Patient with Ehlers-Danlos Syndrome: A Case Report.

CASE: A 71-year-old woman with Ehlers-Danlos syndrome suffered an atraumatic obturator dislocation status post direct anterior total hip arthroplasty. A closed reduction under conscious sedation was attempted, but was unsuccessful. Repeat closed reduction under full general anesthesia with paralysis and fluoroscopic guidance was successful at reducing the femoral prosthesis out of the pelvis and back into an appropriate position. CONCLUSION: Atraumatic obturator dislocations after total hip arthroplasty are exceedingly rare. General anesthesia with full paralysis is helpful for a successful closed reduction, and open reduction may be necessary to remove the femoral prosthesis from the pelvis.

Impact of prior anterior instability on shoulder arthroplasty outcomes: a systematic review.

Background: Anterior shoulder instability (ASI) is a frequently encountered pathology. Patients with a history of ASI have an increased rate of developing glenohumeral osteoarthritis and becoming candidates for shoulder arthroplasty. This systematic review aims to synthesize outcomes for patients undergoing shoulder arthroplasty with a history of ASI. Methods: A comprehensive literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) using PubMed, Embase, OVID Medline, Scopus, CINAHL, Web of Science, and Cochrane databases for studies evaluating the impact of prior ASI on total shoulder arthroplasty (TSA), reverse TSA, and/or hemiarthroplasty outcomes, with a minimum follow-up of 12 months. Studies were graded by level of evidence and data concerning patient demographics and outcomes were extracted. Results: Sixteen articles met the inclusion criteria, including 596 patients (413 male, 181 female). The average age of the control and prior ASI groups were 57.5 and 57.0 years, respectively. Overall, 251 patients were treated operatively, 132 nonoperatively, and 213 were controls without a history of prior ASI. Shoulder arthroplasty techniques included TSA (436 shoulders), reverse TSA (130 shoulders), and hemiarthroplasty (14 shoulders). Prior anterior stabilization management included soft tissue repair, bony augmentation, and nonoperative treatment. Almost all studies reported no significant difference in subjective and functional arthroplasty outcomes between control and prior ASI groups, or between patients with prior ASI treated nonoperatively vs. surgically. Conclusion: Shoulder arthroplasty in the setting of prior ASI results in improved subjective and functional outcome scores that are comparable to patients without a history of instability.

Treatment of Malalignment and Cartilage Injury: High Tibial Osteotomy With a Concomitant Osteochondral Allograft to the Medial Femoral Condyle and Lateral and Medial Partial Meniscectomy.

In patients with full-thickness focal cartilage defects, osteochondral allograft is a technique for restoration of hyaline cartilage; however, in patients with genu varum, the diseased compartment of the knee is generally offloaded as well. A high tibial osteotomy presents a biomechanical solution to malalignment of the knee and offloading of the diseased compartment of the knee. The purpose of this Technical Note is to present our preferred technique to treat focal cartilage damage in a varus misaligned knee coupling a high tibial osteotomy with an osteochondral allograft to the medial femoral condyle, along with partial medial and lateral meniscectomy.

Evolution and Trends in Male Versus Female Authorship of Articles in Flagship Orthopaedic Journals From 1995 to 2020.

INTRODUCTION: The gender disparity in orthopaedic surgery has been recognized for many years. Because research affects promotions, this study investigates trends in female authorship in three journals over the past 25 years for both first and senior authors. METHODS: All articles from Journal of Bone and Joint Surgery, Journal of the American Academy of Orthopaedic Surgeons, and Clinical Orthopaedics and Related Research from 1995 to 2020 in 5-year intervals were downloaded, and the data for first and senior authors were extracted. The sex of the first and senior authors was determined using the validated Genderize algorithm. The demographics of the first and senior author cohorts were analyzed using chi square tests. The trends in female authorship controlling for year and journal were assessed with logistic regression models. RESULTS: Within the studied journals, 5,636 individuals were identified as first authors and 4,572 as senior authors. Sex was determined for 82.59% of the authors. Female first authorship increased significantly from 1995 to 2020 (6.70% to 15.37%, P < 0.001). Similarly, female senior authorship increased significantly from 1995 to 2020 (8.22% to 13.65%, P < 0.001). Overall, there was no significant difference in gender composition of authors between journals (P = 0.700 first author and P = 0.098 senior author). Women were much more likely to publish as first or senior author in later years, regardless of the journal (P < 0.001 first author and P < 0.001 senior author). DISCUSSION: Female authorship in prominent orthopaedic journals has increased markedly from 1995 to 2020 with interjournal differences in senior author gender disparity. Although female orthopaedic surgeons publish at rates equal to or greater than their representation in the specialty, additional research is needed into the persistence of gender disparities in orthopaedics.

What is the deviation in 3D preoperative planning software? A systematic review of concordance between plan and actual implant in reverse total shoulder arthroplasty.

BACKGROUND: Three-dimensional (3D) preoperative planning software for reverse total shoulder arthroplasty (rTSA) has been implemented in recent years in order to increase accuracy, improve efficiency, and add value to the outcome. A comprehensive literature review is required to determine the utility of preoperative 3D planning software in guiding orthopedic surgeons for implant placement in rTSA. We hypothesize that implementation of 3D preoperative planning software in the setting of rTSA leads to high concordance with minimal deviation from the preoperative plan. METHODS: A comprehensive and iterative literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) using the PubMed, Embase, OVID Medline, Scopus, Cinahl, Web of Science, and Cochrane databases for original English-language studies evaluating the impact of preoperative planning software usage on rTSA outcomes published from January 1, 2000, to present. Blinded reviewers conducted multiple screens. All included studies were graded based on level of evidence, and data concerning patient demographics and postoperative outcomes were extracted. RESULTS: Nine articles met inclusion criteria (1 level II, 3 level III, and 5 level IV articles), including 415 patients and 422 shoulders. Of the patients who underwent rTSA, 235 were female and 140 were male, although 3 studies (n = 40) did not report sex breakdowns for rTSA patients. The average age was 72.7 years. Four studies (79 shoulders) reported implant final position as mean deviation from planned version and planned inclination. Six studies (n = 236) reported screw angle deviation, fixation, length, and concordance. Concordance with the preoperative plan was measured in 3 studies (n = 178), resulting in complete concordance of 90% (n = 100), arthroplasty type concordance (rTSA vs. TSA) of 100% (n = 100), and glenosphere size concordance between 93% (n = 100) and 88% (n = 76). For screw length concordance, baseplate screw matched by 81% (n = 76) and 100% (n = 2), and upper (n = 35) and lower (n = 35) screw length concordance was observed as 74% and 69%, respectively. The use of preoperative planning (n = 178) was associated with low deviation from preoperative plan, more 2-screw fixations, and longer average screw length in comparison with an unplanned cohort. CONCLUSION: The use of preoperative planning software in the setting of rTSA results in minimal deviation from preoperative plan. High levels of concordance in screw angle, screw length, and glenosphere size were observed. Further prospective studies should be conducted to further substantiate these results.

Impact of fatty infiltration of the rotator cuff on reverse total shoulder arthroplasty outcomes: a systematic review.

Background and hypothesis: The impact of preoperative fatty infiltration of specific rotator cuff muscles on the outcomes of reverse total shoulder arthroplasty (rTSA) has not been well defined. Preoperative fatty infiltration of the shoulder musculature will negatively affect rTSA outcomes. Methods: A comprehensive literature review was conducted as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses using PubMed, Embase, OVID Medline, Scopus, Cinahl, Web of Science, and Cochrane databases for original, English-language studies evaluating effect of fatty infiltration of shoulder musculature on rTSA outcomes published from January 1, 2000 to present. Blinded reviewers conducted multiple screens. All included studies were graded based on the level of evidence, and data concerning patient demographics and postoperative outcomes were extracted. Results: A total of 11 articles were included, including one level I article, three level III articles, and seven level IV articles. The review consisted of 720 patients and 731 shoulders (320 women and 157 men), with a mean age of 72.4 years. A single deltopectoral approach was performed for a majority of studies (627/731 shoulders), followed by a superolateral approach (70/731 shoulders) and a single transdeltoid approach (4/731 patients). Eleven studies reported data specifically about preoperative fatty infiltration of the rotator cuff musculature; the teres minor was studied most widely (298/731 shoulders), followed by the subscapularis (256/731 shoulders) and infraspinatus (232/731 shoulders). The Constant score (562/731 shoulders) and American Shoulder and Elbow Surgeons score (284/731 shoulders) were the most common recorded outcome scores. Fatty infiltration of the teres minor, supraspinatus, and infraspinatus was associated with worse range of motion after rTSA. Conclusion: Preoperative fatty infiltration of the rotator cuff, particularly of the teres minor and infraspinatus, has a negative impact on subjective patient outcomes and restoration of range of motion, especially external rotation, after rTSA. The impact of fatty infiltration of the other rotator cuff muscles remains unclear, which may be due to intersurgeon differences in the handling of the remaining rotator cuff muscles or differences in implant design. The evaluated literature provides information on which patients can be educated about probable outcomes and restoration of function after rTSA.

Postoperative Rehabilitation of Multiligament Knee Reconstruction: A Systematic Review.

BACKGROUND: Multiligamentous knee injuries (MLKIs) are rare, and heterogeneous in presentation and treatment options. Consequently, optimal postoperative rehabilitation of MLKI remains unclear. OBJECTIVE: To summarize the latest evidence for postoperative rehabilitation protocols following multiligamentous knee reconstruction (MLKR). PATIENTS AND METHODS: A multidatabase search was conducted with the aid of a health sciences librarian. Blinded reviewers conducted multiple screenings of studies evaluating postoperative rehabilitation protocols following MLKR. All included studies were then graded based on level of evidence, and data concerning patient demographics and rehabilitation protocols were extracted. RESULTS: MLKR rehabilitation protocols differ widely in terms of weightbearing, bracing, initiation, and types of physical therapy, yet several established protocols were referenced frequently throughout the literature. Such protocols resulted in good outcomes, with patients returning to running in 6 to 12 months and returning to sport in 8 to 12 months. CONCLUSION: The rare nature of MLKI hinders the ability to create a standardized rehabilitation protocol. However, early postoperative physical therapy and range of motion consistently lead to improved outcomes. Randomized studies are needed to determine optimal postoperative rehabilitation following MLKR.

Epidemiological investigation of tattoo-like skin lesions among bottlenose dolphins in Shark Bay, Australia.

Bottlenose dolphins are excellent bioindicators of ocean ecosystem health for three reasons: (a) as long-lived apex predators they accumulate biotoxins and contaminants; (b) they are visible, routinely appearing at the water's surface in coastal areas, often coming into close contact with humans; and, (c) they exhibit a range of pathogenic lesions attributable to environmental degradation. In this study, we analyzed tattoo-like skin lesions in a population of Tursiops aduncus studied for 30+years in Shark Bay, Australia, a UNESCO World Heritage Site. We provide important baseline data by documenting epidemiological patterns of tattoo-like skin lesions in a healthy, free-ranging population that builds on the previous data of tattoo skin disease (TSD) derived from free ranging, stranded, and dead dolphins. Individual dolphins were classified as symptomatic with tattoo-like skin disease if at least one photograph showed a lesion similar to TSD. The average age of infection was 26.6months (±34.8months) with the symptomatic period lasting 137±29.8days. Overall prevalence of tattoo-like skin disease in the population was 19.4%. Age, but not sex, was significant, with yearlings (1-2years) exhibiting tattoo-like lesions more than younger and older calves. Tattoo-like lesions were rare among juvenile and adult dolphins (N=68 calves, 4 juveniles, and 3 adults). We hypothesize that the lower prevalence in youngest calves (<1year) is due to maternal immunity, while older individuals (>2years) have infection-acquired immunity, as reported for other small cetaceans. The low prevalence of tattoo-like lesions in Shark Bay compared to other populations with poxvirus is consistent with reproductive and demographic viability analyses. Furthermore, by documenting the demography of the disease, we can monitor changes in the prevalence of tattoo-like lesions as a sentinel indicator of ecosystem health.