Running Following Hip Arthroplasty: A Systematic Review - Colin J. Harrington, MD; Andrew D. Lachance; Nicholas M. Panarello, MD; Sean E. Slaven, MD; John P. Cody, MD; and Robert W. Tracey, MD

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With improved implants and younger patients undergoing total hip arthroplasty (THA) and hip resurfacing arthroplasty (HRA), there are increased expectations to return to high-impact activities. Recommendations regarding return to running following hip arthroplasty remain unclear. A search of the PubMed database was conducted, and all publications referencing running following THA or HRA published between January 1, 2000, and September 1, 2020, were included in the systematic review. Patient demographics, surgical variables, activity measures, and revision rates were recorded for each study. A total of 225 unique citations were identified, of which four manuscripts met the eligibility criteria. Eighty-nine of 121 (73.6%) preoperative runners returned to running postoperatively. All four studies reported mean postoperative UCLA activity scores of at least nine. More patients returned to running following HRA than THA with lower rates of revision. Further research with longer postoperative follow-up is necessary to provide definitive recommendations for running following arthroplasty procedures. (Journal of Surgical Orthopaedic Advances 32(1):001–004, 2023)

Key words: total hip arthroplasty, running, hip resurfacing arthroplasty, adult reconstruction

A Regional Analysis of Hospital Readmissions Following Total Hip and Knee Arthroplasty and the Impact of Medicaid Expansion - Ethan L. Plotsker, BA; Lara L. Cohen, MPH; Michael G. Rizzo, MD; William Cade, MPH; and Seth Dodds, MD

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The Hospital Readmissions Reduction Program (HRRP) works to temper nationally rising readmission rates. Total knee arthroplasty (TKA) and total hip arthroplasty (THA) have a 30-day readmission cost burden of $889,300 and $689,400, respectively. No research has compared TKA and THA readmission rates by region and Medicaid expansion status. This study compares THA and TKA readmission rates in the United States by region, Medicaid status, and performance. One-way ANOVAs were conducted to determine the regions with the highest and lowest mean excess readmission ratios (ERRs). An independent t-test compared Medicaid versus non-Medicaid expansion states. Southern hospitals have the highest mean ERR, followed by northeastern, midwestern, and then western hospitals. Although Medicaid expansion states have significantly lower ERRs compared to non-expansion states, Medicaid status alone does not account for regional differences in ERRs after THA and TKA. Regional factors likely confound Medicaid status’s effect on readmission rates. (Journal of Surgical Orthopaedic Advances 32(1):005–008, 2023)

Key Words: readmission, total hip arthroplasty, total knee arthroplasty, Medicaid

Rare, Atypical Mycobacterium Infection of the Hand in Immunocompetent Individuals - Jersey Burns, MD; Linda Chao, MD; Elizabeth Palavecino, MD; Shadi Qasem, MD; and Zhongyu Li, MD, PhD

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We present two cases of immunocompetent individuals diagnosed with nontuberculous infections of the hand caused by organisms rarely seen in the clinical setting: Mycobacterium heckeshornense and Mycobacterium chelonae. In the first case, a 50-year-old male presented with tenosynovitis of left long finger. He was subsequently found to have a Mycobacterium heckeshornense infection that was resolved with multiple surgeries and a long-term regimen of several antibiotics. The second case was a 29-year-old female with a history of a trivial hand injury infected with Mycobacterium chelonae. She was successfully treated with surgical debridement and antibiotics over the course of eight months. It is important to recognize the increasing prevalence of these two species of bacteria as human pathogens that can result in infections of the extremities even in immunocompetent individuals. (Journal of Surgical Orthopaedic Advances 32(1):055–058, 2023)

Key words: Mycobacterium chelonae, Mycobacterium heckeshornense, tenosynovitis, hand infection

Operative Versus Non-operative Treatment of Medial Epicondyle Fractures in Pediatric Athletes: A Systematic Review - Joshua C. Tadlock, MD; Michael D. Eckhoff, MD; Reuben A. Macias, MD; Tyler C. Nicholson, MD; Hunter R. Graver MD; and EStephan Garcia, MD

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Treatment of medial epicondyle fractures is controversial in pediatric orthopaedics with a recent trend towards operative fixation in overhead athletes. We performed a systematic review to compare outcomes in operative and non-operatively overhead athletes. A systematic review of the literature was performed. Articles investing pediatric athletes with medial epicondyle fractures treated operatively and non-operatively that reported functional and radiographic outcomes were compiled. We identified 6 studies with a total of 99 patients (52 treated operatively and 47 treated non-operatively). We found a significantly higher union rate with operative treatment (100%) compared to non-operative treatment (76%, p = 0.0025), with equivalent return to sport time and rate. Non-operative treatment had a lower complication and repeat surgery rates (p = 0.009). This study demonstrates lower complication rates and equivalent functional outcomes between operative and non-operatively treated medial epicondyle fractures in athletes. Non-operative treatment is a valid option in these patients. (Journal of Surgical Orthopaedic Advances 32(1):009–013, 2023)

Key words: trauma, pediatric elbow, athletes, medial epicondyle

Shoulder Surgery Google Search Trends during the COVID-19 Pandemic - Daniel Gittings, MD; Kurt Mohty, MD; John Kelpin, MD; Nassim Lashkari, PharmD; Milan Stevanovic, MD; and Luke Nicholson, MD

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The Coronavirus Disease 2019 (COVID-19) pandemic has strained many healthcare systems. Google Trends is a tool that provides information on online interest in selected keywords and topics over time. The purpose of this study is to describe the effect of the COVID-19 pandemic on online interest in elective shoulder pathology. Online search pattern data were obtained via Google Trends from November 2019 to November 2020 using the search terms ‘orthopedic surgery’ and ‘shoulder pathology’ search terms. Relative search volume index (SVI) graphs were generated from this data and the 7-day average of new COVID-19 cases in the United States. Orthopaedic surgery and shoulder pathology search trends decreased during March 2020 with a sudden rise in the 7-day average of new COVID-19 cases. After March 2020, orthopaedic surgery and shoulder pathology search terms approached pre-COVID-19 pandemic values despite continued increases in the 7-day average of new COVID-19 cases. (Journal of Surgical Orthopaedic Advances 32(1):014–016, 2023)

Key words: Google trends, COVID-19, shoulder surgery, rotator cuff, glenohumeral arthritis, labral tear

Distal Humerus Fractures in Adults: Comorbidity Patterns and Demographic Trends in Treatment - Andrew J. Mitchelson, MD; James S. Lieber, MD; Jianjun Ma, MD; Steven L. Scaife, MS; and Youssef El Bitar, MD

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The purpose of the study was to (1) assess the prevalence of comorbidities and (2) compare demographics of surgically and non-surgically treated distal humerus fracture patients. Retrospective review of data from a national database was performed. The primary outcome was comorbidities; the secondary outcome was demographic trends between treatment groups. Distal humerus fractures are associated with cerebrovascular disease, dementia, diabetes mellitus, heart disease, hyperlipidemia, hypertension, hypothyroidism, kidney disease, liver disease, and lung disease. Those undergoing surgery are more likely to be obese, under the age of 40 years, female, Medicare recipients with fewer comorbidities, who reside in a rural setting, and who seek care at urban/teaching hospitals within the Southern United States. They are also more likely to have a shorter hospital stay, to be discharged to home, and to have improved survival. (Journal of Surgical Orthopaedic Advances 32(1):017–022, 2023)

Key words: distal humerus fracture, supracondylar, elbow, adult, comorbidities, demographics

Decision Making and Cost in Healthcare: The Patient Perspective - Sarah E. Lindsay, MD; Aaron Alokozai, MD; Sara L. Eppler, MPH; Jeffrey Yao, MD; Arden Morris, MD, MPH; and Robin N. Kamal, MD, MBA, MS

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Unsustainable spending and unsatisfactory outcomes have prompted a reanalysis of healthcare policy towards value. Several strategies have been proposed as part of this effort including cost sharing plans to shift costs to patients and gain-sharing models to shift risk to health systems. The patient perspective is rarely elicited in policy formation despite efforts to increase patient-centered care. We conducted a prospective study of 118 patients presenting to hand clinic to assess patient perspective of who should constrain treatment options (patient, physician, insurance company, hospital) and be responsible for costs in scenarios of clinical equipoise. We found that patients believed that insurance companies and hospitals should not constrain which treatment options are available to a patient and that physicians and patients should together influence the availability of treatment options. Patients were willing to cost share with insurance companies when choosing more expensive treatments or in the setting of non-life-threatening diseases. In addressing rising healthcare costs, patient perspectives can inform policies designed to increase value. Asking patients to cost share when choosing a more expensive treatment option in the setting of clinical equipoise could be a strategy for health systems to increase value. Level of Evidence: III (Journal of Surgical Orthopaedic Advances 32(1):023–027, 2023)

Key words: hand surgery, quality, value, variation in healthcare

Determining Radiographic Reliability of Pelvic Landmarks in Assessing Limb Length Discrepancy Following Total Hip Arthroplasty - Walaa Abdelfadeel, BA; Mahamud A. Ahmed; Arjun Saxena, MD; and Andrew M. Star, MD

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Limb length discrepancy (LLD) is a frequent complication following total hip arthroplasty (THA) often associated with patient dissatisfaction. Radiographic landmarks are commonly used to determine limb length, but their reliability and accuracy remain to be validated. One-hundred and sixty-two preoperative standing pelvic radiographs from patients undergoing THA were measured using four common landmarks (teardrop, ischial tuberosity, obturator foramen, and iliac crest.) LLD and angular differences between measurements were obtained. Comparison of these landmarks for measuring leg lengths showed weak correlation and wide ranges of LLD for each method – in some cases differing by 30 mm. Angular comparisons showed similar results. Surgeons should be cautioned that there is no standard and reliable method for radiographic measurement of leg length in association with hip replacement surgery and use of these techniques in clinical and research settings should be approached cautiously. (Journal of Surgical Orthopaedic Advances 32(1):028–031, 2023)

Key words: total hip, arthroplasty, limb length discrepancy, radiographic landmarks

Is an Orthopaedic Surgery Resident’s Previous Case Experience Associated with Success of Initial Treatment of Pediatric Forearm Fractures? - Brett A. Shannon, MD; Brian T. Sullivan, MD; Dawn M. LaPorte, MD; and Paul D. Sponseller, MD, MBA

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Redisplacement and subsequent intervention are common for pediatric forearm fractures. We investigated associations between the success of closed reduction and the treating provider’s experience. We identified patients aged 4–16 years with forearm fractures treated by closed reduction and cast immobilization. Clinical data and radiographs of 130 patients treated by 30 residents were reviewed to determine the treating resident’s pediatric forearm fracture reduction experience and the incidence of initial treatment failure (ITF). ITF was defined as subsequent intervention before union or malunion. ITF occurred in 32 of 130 patients (25%), comprising 12 of 23 patients (52%) treated by residents with no previous experience and 20 of 107 patients (19%) treated by residents who had logged ≥ 1 previous reduction (odds ratio, 4.7). ITF was more likely to occur in pediatric forearm fractures treated by residents with no previous forearm reduction experience compared with those performed by residents who had such experience. Level of Evidence: Level III, therapeutic. (Journal of Surgical Orthopaedic Advances 32(1):032–035, 2023)

Key words: forearm fracture, fracture reduction, malunion, orthopaedic surgery resident, treatment failure

A Barbed Proximal Femoral Nailing System for Isolated Intertrochanteric Femur Fractures: Operative Outcomes - Benjamin W. Hoyt, MD; Sarah A. Walsh, PhD; Scott M. Tintle, MD; and Romney C. Andersen, MD

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Intertrochanteric femur fractures are associated with high morbidity/mortality, necessitating strategies to limit time under anesthesia, blood loss, and additional trauma while achieving maximal fixation in osteopenic bone. The Orthopedic Designs North America, Inc. Talon DistalFix Femoral Nail System uses deployable barbs to maximize axial and rotational control without distal interlock screws. The purpose of this study was to evaluate perioperative features and postoperative outcomes in patients treated with the DistalFix Femoral Nailing System for isolated intertrochanteric femur fractures. Seventy-one consecutive patients underwent intramedullary fixation for isolated intertrochanteric fractures with the DistalFix system between January 2019–July 2020. Median operative time was 35 (33 – 40) minutes. Median estimated blood loss was 125 (75 – 150) cc. Median fluoroscopy time was 2.4 (2.2 – 2.9) minutes and dosage was 27.1 (18.0 – 35.2) mGy. Union occurred in 98% of patients; none experienced implant cutout, and 81.1% returned to previous mobility. The DistalFix system achieves a high rate of union and return to function while limiting operative risk factors. (Journal of Surgical Orthopaedic Advances 32(1):036–040, 2023)

Key words: hip fracture, intertrochanteric fracture, intramedullary nail, osteoporosis, cost containment, safety

Critical Risk Factors for Opioid Demand after Pelvic and Acetabular Fracture Surgery - Daniel Cunningham, MD, MHSc; Micaela LaRose, BS; Patton Robinette, MD; Michael A. Maceroli, MD; Steven A. Olson, MD; and Mark J. Gage, MD

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The characteristics that contribute to opioid demand in pelvic and acetabular fracture surgery are not well understood. We hypothesize that fracture pattern and psychiatric comorbidities will be associated with increased opioid demand. This study evaluated perioperative opioid prescription filling in 743 patients undergoing operative fixation of pelvic and acetabular injuries. Multivariable linear and logistic regression models were used to evaluate associations between baseline factors and opioid outcomes. Patients filled prescriptions for 111.2, 89.3, and 200.3 oxycodone 5-mg pills at the 1-month preop to 90-days postop, 3-months postop to 1-year postop, and 1-month preop to 1-year postop timeframes. Operatively treated wall, transverse and two-column acetabular fractures were associated with the highest opioid demand. Drug abuse and pre-injury opioid use were the primary non-surgical drivers of opioid demand. Acetabular fractures, pre-injury opioid filling, and drug abuse were the main risk factors for increased perioperative opioid prescription filling. Level of Evidence: Level III, retrospective, prognostic cohort study. (Journal of Surgical Orthopaedic Advances 32(1):041–046, 2023)

Key words: pelvic fracture, acetabular fracture, opioid, mental health, substance use

A Sonography-based Decision Model for Use in Treatment of Developmental Dysplasia of the Hip - Brian Po-Jung Chen, PT, MD; H. Theodore Harcke, MD; Kenneth J. Rogers, PhD; and J. Richard Bowen, MD

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The objective of this study was to delineate a model for management of developmental dysplasia of the hip (DDH) treatment that incorporates hip ultrasound with objective/predicative parameters at key decision-making times. Hip sonograms of 74 infants (59 females, 15 males; 141 hips) with DDH were retrospectively reviewed. Hip sonographic score (HSS; ranges 0–10) was developed to reflect hip status based on sonographic position, stability, and morphology. Analysis on different management groups (i.e., no treatment, successful treatment, and failed treatment) showed that the trend of HSS is helpful in predicting course of the disease and determining effectiveness of treatment. A model for the management of DDH that utilizes an HSS and frequency schedule for hip sonography that is aligned with times of critical treatment decisions is proposed. This model illustrates how hip sonography can bring added value when timed to guide critical treatment decisions. (Journal of Surgical Orthopaedic Advances 32(1):047–054, 2023)

Key words: dynamic sonography, musculoskeletal imaging, treatment decision protocols

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