Surgical knee arthroscopy is among the most commonly performed procedures in the United States. The decision to treat is often based on clinical examination and magnetic resonance imaging. Equivocal results frequently require patients to undergo surgical arthroscopy, exposing the patient to inherent risks and potential surgical complications. Office-based needle arthroscopy provides an alternative approach to visualizing intra-articular anatomy and pathology in real time. The purpose of this article is to provide a standardized diagnostic approach to needle arthroscopy of the knee.
Venous thromboembolic disease (VTED) is a rare complication following arthroscopic rotator cuff repair (RCR). The American Academy of Orthopaedic Surgeons and the American College of Chest Physicians have no prophylaxis guidelines specific to shoulder arthroscopy, yet many surgeons prescribe aspirin following RCR. The purpose of this study was to evaluate the effectiveness of aspirin and mechanical prophylaxis compared with mechanical prophylaxis alone in preventing VTED following RCR. A total of 914 patients underwent RCR between January 2010 and January 2015. A retrospective case-control study was performed. The control group (n=484) consisted of patients treated with compression boots and early mobilization. The study group (n=430) used compression boots, early mobilization, and 81 mg/d of aspirin. The primary outcome was symptomatic VTED, including deep venous thrombosis (DVT) and pulmonary embolism (PE). A total of 7 VTED events occurred during the study period: 6 DVTs and 1 PE; 1 patient experienced both DVT and PE. The percentage of patients with VTED, DVT, and PE was 0.66%, 0.66%, and 0.11%, respectively. There was no significant difference for DVT or PE between the 2 groups. The incidence of DVT and PE was 0.62% and 0.00%, respectively, for the control group (no aspirin) and 0.70% and 0.23%, respectively, for the study group (aspirin). Aspirin does not lead to a clinically significant reduction in either DVT or PE rate in patients undergoing RCR. The authors conclude that the use of mechanical prophylaxis and early mobilization is a sufficient method of VTED prophylaxis in this low-risk population. [ Orthopedics . 2019; 42(2):e187–e192.]
The use of swine as a model for bariatric surgery has promise, but also has associated pitfalls that must be addressed for this to be an effective model.
Failure after anatomic total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RTSA) leaves few options secondary to loss of bone stock and derangement of the soft tissues. Treatment modalities for prosthetic joint infection are as diverse as their efficacy and morbidity. Single- or two-stage revision arthroplasty is an option for treating prosthetic joint infections in patients who can be treated surgically. The use of an antibiotic cement spacer as definitive treatment also has been shown in recent literature to be a viable treatment in medically tenuous patients or in patients with infections. The utility of a hemiarthroplasty with an antibiotic-coated stem (functional spacer) has been shown to provide good pain relief in over half of patients, and conversion of a hemiarthroplasty to a reverse TSA can be performed with improvement in both motion and function. Two-stage revision methods have the highest likelihood of restoring function, with a reported 60% to 90% success rate. While arthrodesis and amputation are options in life-threatening infections or the severely ill patient, resection arthroplasty remains an option as a limb and limited motion-sparing alternative.
Objectives:Venous thromboembolic disease (VTED) is a rare complication following arthroscopic rotator cuff repair (RCR). Historical rates of symptomatic VTED after arthroscopic shoulder surgery, DVT and PE, are 0.26%, and 0.01-0.21%, respectively. At present, the American Academy of Orthopaedic Surgeons (AAOS) and American College of Chest Physicians (ACCP) have no prophylaxis guidelines specific to shoulder arthroscopy. Despite this, many surgeons prescribe Aspirin (ASA) for chemical prophylaxis following RCR. The efficacy of ASA as a thromboprophylaxis after shoulder arthroscopy is unknown, but there are risks associated with its’ use. The purpose of this study is to evaluate the effectiveness of chemical prophylaxis (ASA) and mechanical prophylaxis vs. mechanical prophylaxis alone in preventing VTED following RCR.Methods:A total of 914 patients underwent RCR between the months of January 2010 and January 2015. A retrospective case control study was performed. The control group (n=484) consisted of patients treated with perioperative mechanical VTED prophylaxis (compression boots) and early mobilization. The study group (n=430) also utilized perioperative mechanical prophylaxis and early mobilization, and added chemical prophylaxis (ASA 81 mg daily) for four weeks after surgery. The primary outcome was symptomatic VTED (DVT/PE). Chart records were collected and evaluated for six months after surgery. Patient demographics and other surgical complications were also analyzed.Results:A total of 7 VTED events occurred during the study period, 6 DVTs and 1 PE. The total rate of VTED was 0.88%, DVT was 0.77%, and PE was 0.11%. There was no significant different between DVT (p=0.88, 95% CI= -1.36% - 1.65%) or PE (p=0.45, 95% CI = -0.77% - 1.50%) between the control and study groups. The control group (no ASA) recorded an incidence of 0.62% DVT and 0.00% PE. As compared to the study group (ASA), which recorded an incidence of 0.47% DVT and 0.23% PE. The control group had significantly greater number of documented current smokers (8.68% vs 3.72%, p= 0.0003). The study group had a statistically significant higher mean age of subject (59.1 vs 57.7, p=0.0055), as well as more subjects undergoing revision RCR surgery (4.67% vs 1.86%, p= 0.021).Conclusion:Based on our study of 914 patients, ASA does not provide a clinically significant reduction in VTED rates in patients undergoing RCR. We conclude that the use of mechanical prophylaxis and early mobilization is a sufficient method of VTED prophylaxis in this low risk population.
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