Purpose:The purpose of this study was to analyze national trends in knee and shoulder arthroscopy to identify seasonal and annual variability using the Healthcare Cost and Utilization Project-Nationwide Ambulatory Surgery Sample (HCUP-NASS) dataset.Methods:Estimated national rates of ambulatory knee and shoulder arthroscopy were analyzed using HCUP-NASS data from 2016 to 2021. Time trend plots were generated to identify potential seasonal trends in these procedures.Results:There was a decreasing trend in the number of procedures (shoulder arthroscopy, rotator cuff repair [RCR], knee arthroscopy, meniscal repair [MR]/meniscectomy, and anterior cruciate ligament reconstruction [ACLR]) done from 2016 to 2021. There were an estimated 264,987 (95% confidence interval [CI] = 251,205 to 276,770) patients who underwent shoulder arthroscopy and 381,125 (95% CI = 362,555 to 399,696) patients who underwent knee arthroscopy in 2021, as compared with 345,892 (95% CI = 326,224 to 365,559) patients who underwent shoulder arthroscopy and 521,912 (95% CI = 496,905 to 546,919) patients who underwent knee arthroscopy in 2016. Male patients showed markedly higher rates of shoulder arthroscopy, RCR, knee arthroscopy, MR, and ACLR procedures as compared with female patients, whereas female patients showed markedly higher rates of knee arthroscopy done without MR and ACLR. Shoulder and knee arthroscopy rates peaked in the 55 to 75-year-old age group. In addition, both procedures were most frequently done in December and had the lowest utilization in the month of July.Conclusion:There was a nonlinear decrease in the estimates of shoulder arthroscopy, RCR, MR/meniscectomy, knee arthroscopy, and anterior cruciate ligament reconstruction procedures from 2016 to 2021, with peaks in 2016 and 2019, and a low point in 2020. There are notable variations in rates of knee and shoulder arthroscopy procedures by age and sex.Clinical relevance:Recent data on commonly done ambulatory orthopaedic arthroscopies are important for policy makers and for understanding utilization trends.

Introduction:Patients undergoing total shoulder arthroplasty (TSA) may experience postoperative new-onset depression (NOD), which is gaining attention because of its detrimental effect on patient outcomes.Methods:The PearlDiver Mariner database from 2010 through October 2022 was queried for adult patients undergoing first-time TSA. Exclusion criteria included patients with diagnoses of tumors, trauma, and infections within 30 days before surgery and patients with previous depression or psychiatric risk factors for depression. The incidence of NOD diagnoses within 1 year after surgery was identified. Those with and without NOD were exact matched 1:4 based on age, sex, and Elixhauser Comorbidity Index and compared on multivariate logistic regression to determine whether various 90-day postoperative complications were associated with the development of NOD. After Bonferroni correction, significance was established at P < 0.003. Five-year revision rates were also compared with the log-rank test.Results:Overall, 144,773 TSA patients meeting inclusion criteria were identified. NOD diagnoses in the year after surgery were identified for 4,321 (3.0%). Those with NOD were more likely to be female and have greater comorbidity burden (P < 0.003 for both). Among matched comparisons, those with NOD had higher odds of experiencing various 90-day complications, visits to the emergency department, hospital readmission, and were more likely to undergo revision TSA within 5 years (P < 0.003).Conclusions:Postoperative NOD was diagnosed in 3% of patients after TSA. Having NOD was associated with various postoperative complications and higher revision rates. Recognizing predisposing factors for NOD may help target risk mitigation strategies.

Introduction:Total hip arthroplasty (THA) is a widely performed procedure. Despite its overall success, adverse outcomes have been associated with defined comorbidities. Hypertension (HTN), which affects a notable portion of the adult population, may be one such factor but has not been independently studied in this regard.Methods:THA patients were abstracted from the 2010 to 2022 M165 Ortho PearlDiver Mariner Database. Adult patients with versus without HTN were matched 1:1 based on age, sex, and Elixhauser Comorbidity Index. Ninety-day adverse outcomes and 5-year implant survival rates were compared for the matched cohorts with multivariable analysis, adjusting for multiple comparisons.Results:Of 851,605 THA patients identified, HTN was noted for 601,475 (70.6%). After matching, there were 148,946 patients with and the same number without HTN. Patients with HTN were at independently greater odds of most individual adverse outcomes assessed, any adverse events (odds ratio [OR] 2.18), serious adverse events (OR 2.19), minor adverse events (OR 2.26), and readmissions (OR 1.52) (P < 0.001 for each). Furthermore, the 5-year implant survival rate was mildly lower in HTN group (96.5% versus 97.5%, P < 0.001).Discussion:The current, large-cohort study identified HTN to be diagnosed for more than half of patients undergoing THA. The clear correlation of HTN with many adverse outcomes and mildly (but statistically) lower 5-year implant survival highlights the need for further consideration of this variable. Although there could be other confounding factors that may not have been fully controlled, those with HTN are clearly an “at-risk” group.

Dysplasia epiphysealis hemimelica, also known as Trevor disease, is a rare and intriguing developmental disorder characterized by asymmetric cartilage overgrowth at the epiphyses, predominantly affecting long bones. We present a case of an 8-year-old girl with dysplasia epiphysealis hemimelica involving the carpal bones which is a highly unusual site in the upper limb. The patient underwent successful surgical excision of the symptomatic wrist mass, leading to notable functional improvement, albeit with mild residual extension limitation. This case highlights the critical role of advanced imaging in accurate diagnosis and surgical planning. Although conservative management remains the standard, timely surgical intervention may be necessary to alleviate symptoms and restore function in cases with notable impairment.

Introduction:Total hip arthroplasty (THA) is a commonly performed orthopaedic procedure, yet the correlation of patient sex with outcomes has been inadequately explored. Previous studies have been limited by population/database constraints. Thus, 90-day adverse event and 5-year outcome differences were assessed in a large national database.Methods:Patients undergoing THA from the 2010 to 2022 M165 Ortho PearlDiver Mariner Database were identified. Male and female patients were matched 1:1 based on age and Elixhauser Comorbidity Index. Ninety-day adverse events were assessed and compared with multivariable analysis adjusting for multiple comparisons. Five-year survival to revision, dislocation, and periprosthetic fracture was assessed by Kaplan-Meier analysis.Results:Of 780,745 THA patients, 333,974 (42.7%) were male and 446,771 (57.3%) were female. After matching, there were 327,978 male and 327,978 female patients. At 90 days, female patients had greater odds of any adverse events (odds ratio [OR], 1.36), serious adverse events (OR, 1.76), minor adverse events (OR, 1.43), and readmissions (OR, 1.25; P < 0.001). Female patients had higher rates of surgical site infection, deep vein thrombosis, urinary tract infection, and wound dehiscence but lower rates of cardiac events, pneumonia, and acute kidney injury. At 5 years, female patients had higher rates of revision (1.8% vs. 1.4%, P < 0.001), fracture (1.2% vs. 0.7%, P < 0.001), and dislocation (1.8% vs. 1.2%, P < 0.001).Conclusion:This study identified notable sex-based differences in THA outcomes. Female patients had greater odds of perioperative complications and 5-year adverse events. These findings may inform patient counseling, surgical planning, and care pathways.

Management of acute blood loss anemia in patients who are Jehovah's witness with orthopaedic trauma injuries remains a moral dilemma and medical challenge. There are varying patient beliefs as to what is considered acceptable in the setting of acute blood loss anemia within the Jehovah's Witness community. Advancements have been made in pharmacologic options (iron replacement, erythropoiesis-stimulating agents, tranexamic acid, clotting factors, artificial oxygen carriers) since the time of the religion's blood ban, as well as procedural interventions (interventional radiology, red blood cell salvage). There is minimal published evidence of the acute management of orthopaedic trauma injuries with acute blood loss anemia requiring ongoing orthopaedic surgeries in the Jehovah's Witness population. Management options can be extrapolated from other surgical fields and orthopaedic case reports to create a systematic approach to treatment. Management of patients who refuse blood products with acute blood loss anemia requires a multidisciplinary approach and strict clarification of the patient's beliefs. The goals of this article are to clarify Jehovah's Witness beliefs regarding blood transfusions, review management options available in the orthopaedic trauma setting, and propose a treatment algorithm.

Introduction:This study aimed to determine the effect of preoperative variables and three-dimensional acetabular correction on patient-reported outcome measures after transposition osteotomy of the acetabulum (TOA), a spherical periacetabular osteotomy.Methods:We retrospectively reviewed 442 patients (582 hips) with hip dysplasia who underwent TOA between 1998 and 2019 and completed validated questionnaires, including the visual analog scale (VAS) for pain and satisfaction and the Hip disability and Osteoarthritis Outcome Score (HOOS). The median follow-up was 12 years. Associations between patient-reported outcome measures and preoperative variables and postoperative acetabular coverage (lateral center-edge angle, anterior wall index, and posterior wall index) were analyzed.Results:Older age was negatively correlated with HOOS-ADL (r = −0.26, P < 0.001) and HOOS-sports/recreation (r = −0.25, P < 0.001). Male patients reported lower median HOOS-QOL than female patients (P = 0.038). Patients with Tönnis grade 0 had higher median satisfaction-VAS than those with grade 2 (P = 0.031), and higher median HOOS-ADL, sports/recreation, and QOL subscales than those with grade 1 or 2. For postoperative anterior wall index, the deficient group had higher VAS-pain (P = 0.045) and lower HOOS-pain (P = 0.047) than the normal group. For postoperative posterior wall index, the excessive group had lower HOOS-pain than the normal group (P = 0.029).Conclusion:Even in preserved hips after TOA, sagittal plane acetabular correction influenced postoperative pain, whereas age, sex, and Tönnis grade affected satisfaction, functional capacity, and QOL. These insights have implications for refining surgical indications and acetabular reorientation strategies, improving postoperative patient experience.

Background:Pediatric diaphyseal both-bone forearm fractures are increasingly treated with elastic stable intramedullary nailing (ESIN) using titanium nails. However, clear guidelines on the type and duration of splint immobilization are lacking. This study aims to assess the necessity of splint immobilization after ESIN for diaphyseal forearm fractures in children.Methods:A prospective study was conducted on 38 patients with isolated radial and ulnar shaft fractures from 2018 to 2020. Patients were divided into two groups: 14 with splint immobilization for a mean of 3.93 weeks and 24 with only a sling allowing early postoperative movement. The mean ages were 10.3 years (group I) and 10.0 years (group II). Patients were evaluated at 2, 6, 12, and 24 weeks postsurgery. Final range of motion, recovery pace, bone healing, pain, complications, and treatment outcomes were compared.Results:No notable differences were found between splint immobilization and nonsplint groups regarding bone healing time (3.79 vs. 3.13 months), complications (28.6% vs. 29.2%), and final outcomes. Movement recovery was faster in the nonsplint group, but range of motion was similar at the final follow-up. Pain-free rates at 2 weeks postsurgery were higher in the splint group (85.8% vs. 50%). Pain intensity was similarly low in both groups (mean 2.5 vs. 2.67 on the visual analog scale scale).Conclusion:Splint immobilization improves pain control in the first 2 weeks postsurgery, but it offers no additional benefits in terms of healing time and functional outcome. Meanwhile, ESIN is a safe, effective treatment for pediatric forearm shaft fractures.

Introduction:To solve barriers to simulation-based training of residents, we have developed a three-dimensional (3D) printed anatomic shoulder simulator that is low cost and deployable worldwide. The purpose of our study was to evaluate the educational and construct validity of a novel 3D-printed shoulder simulator (3DP) for arthroscopy of the shoulder and compare it to a commercially available shoulder simulator (control).Methods:In this institutional review board–approved randomized controlled trial, 20 participants were divided into four groups: five senior medical students and five expert surgeons for each simulator. Participants completed four arthroscopic tasks, which were videorecorded and assessed using the Arthroscopic Surgery Skill Evaluation Tool (ASSET) and time to task completion. Pre- and posttask anatomy tests were also administered.Results:The expert surgeon group was faster to complete arthroscopic tasks than the medical student group for both the control (P = 0.003) and 3DP (P = 0.046). The ASSET scores were markedly higher for expert surgeons versus medical students on the 3DP (P = 0.017), with no difference on the control (P = 0.533). After task completion, medical students improved scores on an anatomy test from an average of 52% to a 76% on the control and from 52% to 84% on the 3DP.Conclusion:The 3D printed arthroscopic shoulder simulator demonstrated construct validity based on time and ASSET scores, while also demonstrating educational value. The commercially available shoulder simulator demonstrated construct validity based on time; however, it was not able to differentiate skill level based on arthroscopic skills assessment.

Background:Joint-preserving surgery of a patient's native knee joint for juxtaarticular osteosarcoma may enhance function but poses resection and reconstruction challenges.Methods:We included 15 patients with nonmetastatic distal femoral osteosarcoma who underwent in situ microwave ablation with intralesional resection and subsequent mechanical reinforcement. Knee function was assessed at 1 and 3 years postoperatively using Musculoskeletal Tumor Society scores, six degrees of freedom kinematic analysis. The 1-year and 3-year construct and overall survival rates were recorded. A control group of 20 healthy individuals was used for comparison.Result:At the 3-year follow-up, two patients had died. The final Musculoskeletal Tumor Society score was 29.0 ± 1.2 (range, 26 to 30). No major complication was recorded. At 1 year, notable gait differences were observed compared with healthy control subjects, including reduced knee flexion at 12%, 52%, 62%, 75%, and 85% of the gait cycle; increased adduction at 12%, 52%, 62%, and 75%; and increased external rotation at 52%, 62%, 75%, and 85%. The range of motion (ROM) in flexion/extension, internal/external rotation, proximal/distal translation, and medial/lateral translation (P < 0.05) were significantly reduced. At 3 years, most kinematic differences had diminished and ROM differences had largely resolved, with only an increase in internal/external and abduction-adduction ROM.Conclusion:The surgical procedure of in situ microwave ablation with intralesional resection and subsequent mechanical reinforcement shows restricted mobility at 1 year postoperatively, but knee kinematic performance is nearly indistinguishable from that of healthy individuals at the 3-year follow-up. With adequate resection and adjuvant treatment insured, mechanical reinforcement reconstruction effectively preserves knee function.