The Effect of Sensory Deficit After Total Knee Arthroplasty on Patient Satisfaction and Kneeling Ability.

BACKGROUND: Skin numbness after total knee arthroplasty is a common complication. The incidence in the literature is variable from 27% to 100%. However, there is conflicting evidence about the consequences of this complication. The purpose of this study was to evaluate if postoperative numbness influenced patient satisfaction or kneeling ability. METHODS: We recruited patients who underwent a total knee arthroplasty for osteoarthritis one to 5 years before the study. Sensation was measured using a Semmes-Weinstein, 10-gram monofilament. Measurements were taken in several zones around the incision, and overall sensory status was classified as full numbness, partial numbness, and no numbness. Patients completed a questionnaire evaluating their subjective numbness, overall satisfaction, and kneeling ability. We evaluated the effect of numbness on satisfaction and function. RESULTS: A total of 96 patients were enrolled. Thirty-four patients were classified as no sensory deficit, 29 as partial deficit, and 33 as full deficit. There were no differences in demographics. Out of all the patients that were found to have a sensory deficit, 54.8% of them did not report any subjective numbness. Average patient-reported satisfaction scores were 8.76/10, 8.97/10, and 8.48/10 for no numbness, partial numbness, and full numbness, respectively. Eleven out of 96 patients noted an inability to kneel. There was no statistical difference for satisfaction scores or kneeling ability between the groups. CONCLUSION: Sensory deficit after total knee arthroplasty is a frequently reported complication. However, the majority of the patients do not report subjective sensory deficits. Postoperative numbness does not appear to affect patient satisfaction or kneeling ability.

TEAM: A Low-Cost Alternative to ATLS for Providing Trauma Care Teaching in Haiti.

OBJECTIVE: Trauma resuscitation protocols have unified the care of trauma patients and significantly improved outcomes. However, the success of the Advanced Trauma Life Support course is difficult to reproduce in developing countries due to set-up costs, limitations of resources, and variations of practice. The objective of this study is to assess the Trauma Evaluation and Management (TEAM) course as a low-cost alternative for trauma resuscitation teaching in Low and Middle Income Countries (LMIC). DESIGN: As part of the Team Broken Earth initiative, TEAM course was provided to the health care professionals in Haiti. At its conclusion, participants were asked to complete a survey evaluating the course. Qualitative and quantitative data were analyzed to evaluate the perception of the course. SETTING: The course was provided in Port-au-Prince, Haiti. PARTICIPANTS: A total of 80 health care professionals participated in the course. Response was obtained from 69 participants, which comprised of 32 physicians, 10 Emergency Medical Technicians (EMT), 22 nurses, and 5 medical trainees. RESULTS: The course was well received by physicians, nurses, and EMT with an average score of 90.6%. Question analysis revealed a lower satisfaction of physicians for the course manual and teaching materials, and information related to decisions for transfer of patients. EMT consistently felt that the course was not tailored to their learning and practice needs. Written feedback demonstrated several areas of weaknesses including need for improvements in translations, hands-on practice, and educational materials. CONCLUSIONS: Overall, the TEAM course was well received. Analysis demonstrated a need for adjustments specific to LMIC including a focus on prehospital assessment, increased nursing responsibilities, and unavailability of specialist's referrals. Team Broken Earth intends to take these findings into consideration and continue to provide the TEAM course to other LMIC.

Operative Versus Nonoperative Management of Acute High-Grade Acromioclavicular Dislocations: A Systematic Review and Meta-Analysis.

OBJECTIVES: Management of high-grade acromioclavicular (AC) joint dislocations has been controversial. Recent studies suggest no difference in outcomes between operative and nonoperative management of Rockwood types III-V injuries. The objective of this meta-analysis is to compare outcomes between operative and nonoperative management of high-grade AC joint dislocations. DATA SOURCES: Search was conducted using PubMed, Embase, and Cochrane databases through October 2016. A broad search strategy was used to identify English, comparative studies of AC joint dislocations. STUDY SELECTION: Inclusion criteria included comparative studies of AC joint dislocations in adult patients with acute, high-grade AC dislocations. DATA EXTRACTION: Two authors independently reviewed and assessed for bias according to the U.S. Preventative Task Force Quality Rating Criteria. Data were extracted for validated functional scores, clinical and radiographic outcomes, and complications. DATA SYNTHESIS: Nineteen studies (n = 954) were included in the meta-analysis. Operative group had better cosmetic outcome (odds ratio [OR] = 0.05; P < 0.00001) and radiographic reduction (OR = 24.94; P < 0.0001). Constant scores favored the operative group, although the difference may not be clinically significant (MD = 3.14; P = 0.03). Nonoperative treatment was associated with faster return to work (MD = 4.17, P < 0.0001), lower implant complications (OR = 7.19, P < 0.0001), and reduced infection rate (OR = 3.65, P = 0.007). No difference was found for DASH Score, return to sport, radiologic evidence of osteoarthritis, and need for surgery after failed management. CONCLUSIONS: No clinical difference in functional outcome scores was detected between operative and nonoperative management of high-grade AC joint dislocations. Patients in the nonoperative cohort had a more rapid return to work, but were associated with a poorer cosmetic outcome. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Initial stability of press-fit acetabular components under rotational forces.

The primary goal of this study was to determine the initial press-fit stability in acetabular components without screw fixation. Mechanical testing was performed with the implantation of press-fit acetabular components in cadaveric specimens. No significant difference was found in load to failure testing between 1 and 2 mm of under-reaming. However, there was significant variability in bending forces required to create 150 µm of micromotion ranging from 49.3 N to 214.4 N. This study shows that cups implanted in a press-fit fashion, which are felt to be clinically stable, have high degrees of variability in resisting load and may be at risk for loosening. There is a need for more objective intra-operative techniques to test cup stability.

Evaluation of appropriateness of patient transfers for hand and microsurgery to a level I trauma center.

BACKGROUND: The transfer of patients for hand and microsurgical emergencies to level I trauma centers is a common practice. Many of these transfers do not actually require a hand specialist and could be taken care of at most regional hospitals. In this study, we will evaluate the appropriateness of patient transfers for hand trauma and determine if there is a correlation between inappropriate transfers and undesirable factors, such as insurance status and off-hour's presentation. METHODS: A retrospective chart review was performed in all patients transferred to a level I trauma center for hand and microsurgical trauma over a 22-month period. Collected data included indication for transfer, mode of transfer, time and day of the week, patient demographics, insurance status, and whether the transferring facilities had surgical coverage available. A synopsis, including treatment details, of each transfer was created, and a survey was sent to a review committee who rated the appropriateness of the transfers. Statistical analysis was performed to determine whether appropriateness of transfers was influenced by nonmedical variables. RESULTS: Over a 22-month period, a total of 95 hand or microsurgical patients were transferred to a single tertiary referral center. Of these, 66 % of the transfers were considered inappropriate by the surveyed physicians. Inappropriate transfers were statistically more likely to be under insured or transferred during nonbusiness hours. CONCLUSION: A large percentage of patients are being transferred to tertiary care centers for reasons other than medical necessity, generating a large burden on already strained medical resources.