Orthopaedic Center

Background: Hip abductor pathology is increasingly recognized as a contributor to impaired mobility and suboptimal outcomes following total hip arthroplasty (THA) and hemiarthroplasty. However, the prevalence and clinical significance of abductor disruption across fracture-related and elective indications remain unknown. Methods: We conducted a retrospective cohort study of 67 patients who underwent total hip arthroplasty, hemiarthroplasty, or hip abductor repair between 2017 and 2023, identified using CPT codes from the AthenaOne healthcare system and Alpine Ortho Spine Clinic database. Results: Fracture patients were significantly older than elective total hip arthroplasty patients (76.8±8.2 versus 66.4±7.9 years, p<0.001) and demonstrated a higher proportion of Dorr type C femora (p=0.02). Both iliopsoas and quadriceps strength improved postoperatively across the cohort (iliopsoas: 2.7±0.9 to 3.4±0.8, p<0.01; quadriceps: 3.0±0.8 to 3.6±0.7, p<0.01). Elective patients showed greater strength gains than fracture patients (iliopsoas Δ0.9 versus Δ0.5, p=0.03; quadriceps Δ0.8 versus Δ0.4, p=0.04). Trendelenburg gait was more prevalent preoperatively in fracture patients (38% versus 19%, p=0.04) and remained higher at follow-up (24% versus 12%, p=0.05). Conclusions: Pre-existing hip abductor disruption is common in both fracture and elective arthroplasty populations. These findings highlight the importance of recognizing abductor pathology as a modifiable factor influencing recovery and support the role of targeted perioperative management and rehabilitation strategies.

Introduction: Transforaminal epidural injection (EI) is an effective treatment for lumbar disorders. We used a novel ultrasound (US) -guided approach to identify the lumbar transforaminal epidural space without radiation or electrical stimulation. This technique shows a characteristic "Lambda sign over Horizontal Line (LHL) " view focused on the pars interarticularis. Therefore, we aimed to determine the anatomical background of the intervertebral foramen and clinical outcomes of this technique.

Introduction: Patient-facing websites operated by medical societies are crucial for disseminating reliable health information; however, their real-world usage and effectiveness are often unquantified. This study investigated the user engagement and demographics of "Scoliosis Town," a patient education website developed by the Japanese Scoliosis Society, to evaluate its performance.

Platelet-rich plasma (PRP) is a promising orthobiologic therapy for musculoskeletal pathologies. However, its clinical application is influenced by varying legal and regulatory frameworks across regions. This narrative review aims to discuss the regulatory and legal framework for PRP therapy in musculoskeletal pathologies in South America. The authors searched and reviewed contemporary literature on laws and regulations governing platelet-rich plasma use for musculoskeletal pathologies in South America in electronic databases, summarising the findings in a narrative review. PRP regulation in South America falls into three categories: (1) countries with clear regulatory frameworks (Argentina, Bolivia, Colombia, Peru), where PRP is legally recognised and governed by specific provisions; (2) countries with emerging or developing regulations (Chile, Ecuador, Paraguay, Suriname, Uruguay, Venezuela, Guyana), where PRP is indirectly regulated under broader blood or tissue laws; and (3) countries permitting PRP only for experimental or research purposes (Brazil). Despite regional efforts to align with international standards, significant disparities exist in legal clarity, safety protocols, and clinical guidelines. These inconsistencies pose risks such as unregulated medical tourism and hinder scientific progress. PRP in South America presents three distinct regulatory scenarios: clear, established regulations; emerging or developing frameworks; and use restricted to experimental or research contexts. While most countries align with international safety standards, significant variation persists in how orthobiologics are clinically governed. The future challenge is to unify these regulations and build an international consensus on processing standards that guarantee patient safety and quality, while enabling innovation and legal clarity for clinicians.

Background: Distal tibial allograft (DTA) is the most widely used allograft for glenoid reconstruction, but distal radius allograft (DRA) has been proposed as a novel graft option with the advantage of providing a more acute radius of curvature in the anterior-posterior plane that is closer to the native glenoid. Purpose: To utilize a biomechanical testing model to investigate the glenohumeral contact pressure and kinematics of DRA versus DTA reconstructions of anterior glenoid bone loss. Study Design: Controlled laboratory study. Methods: A total of 11 human cadaveric upper extremities and 11 ankle specimens were utilized. A 30% defect of the anterior glenoid was created and reconstructed with DRA or DTA. A robotic testing system was used to test native joint, DRA, and DTA reconstructions at 60° and 90° of abduction from 0° to 90° of external rotation. Measurements of the center of rotation and humeral head translation were captured using a motion tracking camera. Load and torque data were recorded using a 6-axis load cell. Pressure and contact area were recorded with a pressure mapping sensor pad between the humeral head and the glenoid. Results: No significant differences were observed in contact pressure, contact area, translation, load, or torque between the native and allograft reconstruction conditions at 60° or 90° of abduction. No significant differences were found in contact pressure, contact area, translation, load, or torque between the DRA and DTA reconstruction conditions at 60° or 90° of abduction. Conclusion: The biomechanical data showed comparable compressive forces and glenohumeral joint kinematics between the native joint, DRA, and DTA reconstructions for large anterior glenoid bone loss defects. Clinical Relevance: These biomechanical data suggest that DRA represents a promising option for reconstruction of large anterior glenoid bone loss defects. The findings warrant further investigation into the variability of distal radius morphology and future clinical evaluation of DRA reconstruction in the setting of critical glenoid bone loss.

Background and objectivesSocial determinants of health (SDOH) impact healthcare access and outcomes for children, including those with neuromuscular disorders (NMD). This study examines the extent to which the Area Deprivation Index (ADI) and Child Opportunity Index (COI) provide similar evaluations of SDOH in children with NMD.Methods463 children with NMD <18 years treated at a tertiary children's hospital met inclusion criteria. COI, calculated using ZIP codes, includes education, health and environment, and social and economic domains. ADI, based on census block, measures income, education, employment, and housing quality. Lower COI and higher ADI are thought to represent more adverse SDOH. Analyses included Pearson's correlations, t-tests, ANOVAs, and multivariable regressions.ResultsADI and COI were negatively correlated (r = −0.71, P < .001). Furthermore, similar correlations were observed across COI's three subdomains: education (r = −0.71), social and economic (r = −0.67), and health and environment (r = −0.68) (all P < .001). However, ADI scores varied greatly within each COI quintile. ADI was lower and COI was higher for patients with private versus public insurance (P < .001) and for White and Asian versus Black and Hispanic children (P < .001). While COI did not differ among diagnoses (P = .73), ADI was higher for children with myelomeningocele (P = .003) and cerebral palsy (P = .03) compared with those with Charcot-Marie-Tooth disease. Lastly, there was no difference in ADI (P = .44) or COI (P = .71) based on sex.ConclusionsWhile ADI and COI are related, they assess SDOH differently. Using multiple SDOH indices may better capture SDOH's impacts on healthcare access and outcomes.Key Concepts(1)The health of children with neuromuscular conditions is affected by social determinants of health.(2)Lower levels of social determinants of health have been shown to delay access to care and negatively impact children's health.(3)The Area Deprivation Index and Child Opportunity Index are two indices often used to quantify social determinants of health and have not yet been directly compared to evaluate their congruence.(4)This study identifies and explores gaps between these two measurements so that clinicians and researchers can more accurately evaluate the impacts of social determinants of health on children's health.Levels of EvidenceLevel III as this is a retrospective cohort study