Articles and Chapters

Return to sports after shoulder arthroplasty: a survey of surgeons’ preferences

Shoulder arthroplasty has become more prevalent, and patients undergoing shoulder arthroplasty are becoming more active. Recommendations for return to athletic activity have not recently been updated and do not consider the newest arthroplasty options.

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Athletic participation after hip and knee arthroplasty

The issue of athletic participation after hip and knee arthroplasty has become more relevant in recent years, with an increase in the number of young and active patients receiving joint replacements. This article reviews patient-, surgery-, implant-, and sports-related factors, and discusses currently available guidelines that should be considered by the physician when counseling patients regarding a return to athletic activity after total joint arthroplasty. Current evidence regarding appropriate athletic participation after total hip arthroplasty, resurfacing hip arthroplasty, total knee arthroplasty, and unicondylar knee arthroplasty is reviewed.

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Arthroscopically Assisted Two-stage Cementation Technique for a Periarticular Knee Lesion.

Managing skeletal metastatic disease can be a challenging task for the orthopedic surgeon. In patients who have poor survival prognoses or are poor candidates for extensive reconstructive procedures, management with intralesional curettage and stabilization with bone cement with or without internal fixation to prevent development or propagation of a pathologic fracture may be the best option. The use of bone cement is preferable over the use of bone graft, as it allows for immediate postoperative weight bearing on the affected extremity.

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Can the Bio-Transfx pin fail during initial ACL graft insertion?

The Bio-Transfix pin is a biodegradable device used for femoral tunnel anterior cruciate ligament (ACL) graft fixation. Recent clinical studies have suggested the possibility of the pin's postoperative failure.

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A new surgical technique for arthroscopic repair of the meniscus root tear

Injury of the meniscal root can lead to meniscal extrusion and loss of normal hoop stress distribution by the meniscus. This has been shown to result in an excessive tibiofemoral contact pressures and has been associated with development of arthritis in the affected compartment of the knee. Repair of meniscal root avulsion has been shown to restore the normal contact stresses, and several techniques for such repair have been described. We report an all-arthroscopic technique that allows anatomic reattachment of the avulsed meniscal root, applicable to both the medial or lateral menisci.

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Cold exposure injuries to the extremities.

Cold exposure injuries comprise nonfreezing injuries that include chilblain (aka pernio) and trench, or immersion, foot, as well as freezing injuries that affect core body tissues resulting in hypothermia of peripheral tissues, causing frostnip or frostbite. Frostbite, the most serious peripheral injury, results in tissue necrosis from direct cellular damage and indirect damage secondary to vasospasm and arterial thromboses. The risk of frostbite is influenced by host factors, particularly alcohol use and smoking, and environmental factors, including ambient temperature, duration of exposure, altitude, and wind speed.

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Osgood-Schlatter Disease (subscription required to Epocrates Online)

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Complications of Arthroscopic Shoulder Surgery – Miscellaneous Shoulder Conditions (book chapter)

Overall rate of complications after arthroscopic shoulder surgery was once believed to be quite low. For instance Ellman reported no major complications, one localized hematoma at a portal site, and three transient dysesthesias in the thumb (attributed to inadequate padding on the traction device) in his review of 50 consecutive subacromial decompressions.

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Patellofemoral Instability: Diagnosis and Management

Patellofemoral articulation plays a major role in locomotion and other activities that involve knee flexion and extension. Problems of patellofemoral tracking are very common, ranging from mild lateral maltracking and tilt, to frank instability and dislocation of the patella. Patellofemoral instability can be defined as movement of the patella out of its normal position, and can be divided into dislocation and subluxation. Natural history of this condition is that of a relatively high recurrence. Even in the absence of recurrent instability, patients who sustain patella dislocation or subluxation may develop a number of significant problems, including persistent knee pain, functional limitations, decreased athletic performance, and arthritic degeneration of the patellofemoral articulation. Especially for the recurrent dislocator, surgical treatment plays an important role in management, since the natural history of this condition is that of relatively poor return to normal function.

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