Addition of a Distal Femur Locking Plate to Augment Total Hip Arthroplasty in Osteogenesis Imperfecta: A Case Report.

CASE: We present a 55-year-old woman with osteogenesis imperfecta (OI) who underwent total hip arthroplasty (THA). She developed aseptic loosening of the femoral stem and was revised to a longer stem necessitating 2 osteotomies because of the proximal femur varus deformity. This was complicated by implant subsidence. She ultimately required another revision adding a distal femur locking plate to augment construct stability. CONCLUSION: The abnormal anatomy and suboptimal bone properties in patients with OI present unique challenges when performing THA. More aggressive prophylactic fixation to improve construct stability and prevent fracture may be necessary in this patient population.

Examining the Association of Knee Pain With Modifiable Cardiometabolic Risk Factors.

OBJECTIVE: A well-established link exists between obesity and knee osteoarthritis, and recent research has implicated diabetes mellitus as a potential cause of cartilage degeneration. The objective of this study was to use the National Health and Nutrition Examination Survey (NHANES) database to examine the association between knee pain and various metabolic factors. METHODS: A retrospective cross-sectional study of the NHANES database from 1999 to 2004 was performed. The main outcome was any knee pain and bilateral knee pain. The main effects of interest were body mass index (BMI) and glycohemoglobin A1c . We additionally assessed various patient factors, including age, race, poverty, sex, and smoking status. Multivariable logistic regression models and interaction terms were analyzed. RESULTS: Data on 12,900 patients were included. In the main adjusted analysis, the modifiable risk factors associated with any knee pain were overweight (odds ratio [OR] 0.91 [95% confidence interval (95% CI) 0.85-0.97), obesity (OR 1.54 [95% CI 1.42-1.66]), glycemic control (OR 1.20 [95% CI 1.03-1.38]), and current smoking (OR 1.15 [95% CI 1.05-1.27]) (all P < 0.05). These same factors remain significant for bilateral knee pain. Subgroup analysis showed that patients age <65 years have a 5% increase in the risk of any knee pain as their BMI increases, but patients age ≥65 years have a 10% increase in risk. CONCLUSION: This study confirms the association of knee pain with increased weight, glycemic control, current smoking, and age. Most of these risk factors can be modified in patients with knee pain and should be discussed when providing conservative treatment options.

Males and females exhibit distinct relationships between intervertebral disc degeneration and pain in a rat model.

Back pain is linked to intervertebral disc (IVD) degeneration, but clinical studies show the relationship is complex. This study assessed whether males and females have distinct relationships between IVD degeneration and pain using an in vivo rat model. Forty-eight male and female Sprague-Dawley rats had lumbar IVD puncture or sham surgery. Six weeks after surgery, IVDs were evaluated by radiologic IVD height, histological grading, and biomechanical testing. Pain was assessed by von Frey assay and dorsal root ganglia (DRG) expression of Calca and Tac1 genes. Network analysis visualized which measures of IVD degeneration most related to pain by sex. In both females and males, annular puncture induced structural IVD degeneration, but functional biomechanical properties were similar to sham. Females and males had distinct differences in mechanical allodynia and DRG gene expression, even though sex differences in IVD measurements were limited. Network analysis also differed by sex, with more associations between annular puncture injury and pain in the male network. Sex differences exist in the interactions between IVD degeneration and pain. Limited correlation between measures of pain and IVD degeneration highlights the need to evaluate pain or nociception in IVD degeneration models to better understand nervous system involvement in discogenic pain.

Retrospective review of open and arthroscopic repair of anterosuperior rotator cuff tears with subscapularis involvement: a single surgeon's experience.

BACKGROUND: There have been conflicting results when comparing outcomes of open vs. arthroscopic anterosuperior rotator cuff repairs with subscapularis involvement. The purpose of this study was to evaluate midterm outcome differences and complications following open vs. arthroscopic repair of rotator cuff tears involving the subscapularis by a single surgeon. METHODS: This was a retrospective review of 57 rotator cuff repairs involving the subscapularis performed by a single surgeon over a 10-year period. During this time, the surgeon transitioned from open to arthroscopic repair. Preoperative and postoperative range of motion, lift-off test, belly press test, and American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment form scores were measured. RESULTS: Eighteen patients had open procedures and 39 had arthroscopic repair. The mean preoperative ASES score for the open group was 39 and postoperatively was 79. The mean preoperative ASES score for the arthroscopic group was 44 and improved to 80 postoperatively. There was no significant difference in score or change in score between the 2 groups (P > .05). There was only 1 complication. It occurred in the open group and was a superficial wound dehiscence. CONCLUSIONS: This study demonstrated no outcome differences between open and arthroscopic rotator cuff repair involving the subscapularis, even with large subscapularis tears. Both techniques significantly improved shoulder function. Arthroscopic and open rotator cuff repairs including the subscapularis are relatively safe procedures, and either technique is an acceptable option.

Overview of Metatarsalgia.

Metatarsalgia can be viewed as more of a symptom rather than a distinct diagnosis. Timing of forefoot pain during the gait cycle and evaluation of whether the pain is from anatomic abnormalities, indirect overloading, or iatrogenic causes can suggest a specific metatarsalgia etiology. A thorough physical examination of the lower extremity, especially evaluation of the plantar foot, and weight-bearing radiographs are critical for diagnosis and treatment. Nonoperative treatment consists of physical therapy, orthotics, shoe wear modification, and injections. If conservative treatment fails, surgical options may be considered. [Orthopedics. 2019; 42(1):e138-e143.].

Risk Factors for Postoperative Venous Thromboembolism in Orthopaedic Spine Surgery, Hip Arthroplasty, and Knee Arthroplasty Patients.

BACKGROUND: Orthopaedic surgery is a major risk factor for venous thromboembolism (VTE) manifesting as deep vein thrombosis (DVT) or pulmonary embolism (PE). Various patient characteristics alter the likelihood of a postoperative VTE, and there is substantial ambiguity in current VTE prophylaxis guidelines. PURPOSE: To determine if particular patient characteristics are risk factors for VTE following major orthopaedic surgery. METHODS: Data was reviewed from 201 patients presenting with either a PE or DVT following spine surgery or joint replacement from October 2009 through June 2013. The following characteristics were reviewed for each patient: VTE event date, surgery date and type, comorbidities and pre-existing conditions, calculated comorbidity level, body mass index, prophylaxis type, time to initiation of chemoprophylaxis, time to epidural removal, and VTE event type. The control patients were randomly selected from a group of 13,782 patients during the same period. RESULTS: A history of VTE (p < 0.0001), Factor V Leiden disorder (p = 0.04) and the use of general anesthesia (p =0.05) were significant risk factors for postoperative VTE. The frequency of VTE decreased following hip and knee arthroplasty during the study period and remained constant for spine surgery. DVTs occurred 14.2 days later than PEs (p < 0.0001). Over 90% of PEs and 33.3% to 75% of DVTs were diagnosed in the first week following surgery. CONCLUSIONS: A prior history of VTE, Factor V Leiden disorder and general anesthesia increases the risk of VTE postoperatively. The probability of PE beyond the second postoperative week is low.