The purpose of this meta-analysis was to assess the evidence supporting the use of cementless versus cemented total knee arthroplasties (TKAs). Specifically, we evaluated (1) all-cause survivorship, (2) aseptic survivorship, and (3) functional outcomes (Knee Society Scores [KSS], Oxford Knee Scores, Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] scores, and ranges of motion [ROMs]). A literature search was performed for studies that evaluated cementless versus cemented TKAs published between 2000 and 2017. Selected studies included three randomized controlled trials, three retrospective observational studies, and one prospective observational study that met the following criteria: (1) primary TKAs, (2) compared cementless and cemented TKAs, (3) implant survivorship that described the causes of failure, and (4) at least one functional outcome. To compare the two cohorts, pooled odds ratios (OR) and 95% confidence intervals (95% CI) were used to calculate tibial and femoral implant survivorship, and pooled mean differences (MD) and 95% CI calculated the functional scores and ROMs. Based on pooled data from the few number of studies, cementless TKAs had a better all-cause survivorship (OR = 0.37; 95% CI, 0.15–0.92) and tended to have a better aseptic survivorship (OR = 0.44; 95% CI, 0.17–1.14). However, this is likely due to the 83.3% weight of the single cementless study potentially influencing the analysis. There were no differences in terms of KSS knee (MD = 1.03; 95% CI, −1.13–3.20) or function scores (MD = 5.36; 95% CI, –3.75–14.51), Oxford knee scores (MD = 0.36; 95% CI, –3.84–4.56), or WOMAC scores (MD = 0.62; 95% CI, –0.87–2.11). Moreover, there was no difference in ROMs (MD = 1.47; 95% CI, –0.11–3.05). Cementless TKA had a better all-cause survivorship when compared with cemented fixation, and similar functional outcomes were demonstrated. However, these findings are based on only a few number of studies (n = 7). Therefore, additional prospective, randomized control trials need to be performed to best compare cementless versus cemented outcomes.

Adolescent idiopathic scoliosis (AIS) is a three-dimensional, multi-faceted deformity of the vertebral column. Although screening is mandated by several states, debate exists surrounding the efficacy or utility of in-school scoliosis screenings. Detailed history and physical examination are crucial to this diagnosis of exclusion. Assessment of curves has long been limited to static radiography; however, use of MRI may permit detection of associated spinal anomalies, while three-dimensional gait analysis may permit improved understanding of functional improvement in AIS patients before and after treatment. Nonoperative management includes bracing, which is a complex, yet important, component to treatment of AIS. The Bracing in Adolescents with Idiopathic Scoliosis Trial (BrAIST) and other studies have revealed the potential for halting curve progression and a positive dose-response relationship of bracing. Surgical management has focused on the mainstay of posterior spinal fusion with pedicle screw fixation and rod instrumentation, with new techniques under development that modify fusion and fixation or focus on different approaches altogether (i.e. vertebral body tethering). This article details evaluation and treatment of AIS, supplemented by a review of the historical progression of management, to equip readers with an appreciation for the complex nature of this pathology and its treatment.

This study evaluated incidence over time, any association between race and demographics, and hospital-related parameters in pediatric patients with septic hip or knee arthritis. Methods: The Kids' Inpatient Database was used to identify all children with a diagnosis of septic hip or knee arthritis who underwent incision and drainage (1997-2012). Results: Between 1997 and 2012, overall incidence of septic arthritis of the knee (0.20-0.33 per 100,000) and hip (0.12-0.18 per 100,000) increased. Conclusion: Incidence of pediatric septic joint arthritis, an emergent orthopaedic condition, has increased over time. Patient demographics may vary with respect to both age and race.

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Objectives: Female youth ice hockey players are an overlooked population. No national study has established incidence rates for injuries in female youth ice hockey. The objective of this study was to establish incidence rates by injury location, diagnosis, and mechanism of injury using USA Hockey sanctioned age divisions. Methods: The National Electronic Injury Surveillance System (NEISS) was queried for all ice hockey injuries (product code 1279) from January 1, 2007 to December 31, 2016. Cases involving players over the age of 19 and males were excluded. Each injury’s narrative text field was reviewed to determine mechanism of injury. Data was analyzed using (IBM®, v24). Comparisons of incidence by age were made using student’s two sample t-test with 95% confidence interval. Trend analyses were performed using a linear regression. USA Hockey membership statistics were used to establish population at risk and calculate incidence rates. All incidence rates were reported per 10,000 person-years. Results: A total of 384 patients, representing an estimated 10,398 ice hockey-related injuries, presented to NEISS-participating United States emergency departments. During the study period, female youth ice hockey players increased significantly from 44,678 in 2007 to 57,792 in 2016 (p=3.9x10-5, R-squared=0.89, ß =0.94). The overall number of injuries, however, only slightly increased from 992 in 2007 to 1,042 in 2016 (p=ns). Thus, the incidence rate (IR) of injuries fell from 222.1 to 180.2 during the study period. The most commonly injured body parts were the head (n=3048, IR=554.5), trunk (n=1399, IR=256.4), knee (n=1127, IR=169), shoulder (n=704, IR=153.3) and ankle (n=591, IR=120.2). The most common diagnoses were strain/sprain (n=2002, IR=417.7), contusion (n=1877, IR= 348), internal organ injury (n=1863, IR=320), concussion (n=1112, IR=218) and fracture (n=1255, IR=202). The top mechanisms of injury were player-to-player contact (n= 3016, IR=535), falls (n=2249, IR=380.9), and contact with boards (n=942, IR=165.8). The incidence rate of injuries increased with age; The 0-8, 9-10, 11-12, 13-14, 15-16 and 17-19 age divisions had IR’s of 24, 84, 226, 381, 360, and 750, respectively. The player-to-player mechanism of injury also increased with age. The largest IR gap between ages fell between the 11-12 and 13-14 age groups, similar to what has been observed in male ice hockey studies. Player-to-player contact is the leading mechanism of injury in all age groups except the 0-8 age group. Head injuries increased with age division: 0-8 (n=15, IR=1), 9-10 (n=153, IR=17.4), 11-12 (n=598, IR=67.2), 13-14 (n=885, IR=115.1), 15-16 (n=650, IR=121.6) and 17-19 (n=746, IR=232.2). The two most common diagnoses of head injuries were concussion (36%) and internal organ injury (61%), both of these diagnoses increasing with age. In fact, concussion diagnosis increased significantly between each age group (p<0.01). Conclusion: We established the first collection of injury incidence rates for female ice hockey gleaned from a national database. Though body checking is illegal at all levels of women’s ice hockey, player-to-player contact prevailed as the leading mechanism of injury in all but the 0-8 age division. It was also the leading mechanism for the most common injury sites, including the head. This study laid bare an unspoken but long understood fact of the girl’s game that body checking is common and major contributor to the game’s injury burden.

Category: Hindfoot, Midfoot/Forefoot, Congenital Introduction/Purpose: As the most common musculoskeletal congenital anomaly, clubfoot (congenital talipes equinovarus) represents a commonly-encountered entity for pediatric orthopaedic and foot/ankle surgeons. As we have observed a shift towards more conservative, cost-conscious approaches to management, this study sought to compare short-term (30-day) perioperative and postoperative outcomes (complications and reoperations) in clubfoot patients who underwent either percutaneous Achilles tenotomy (PT) or combined open Achilles tenotomy with posterior capsulotomy (COTC). Methods: The National Surgical Quality Improvement Program (NSQIP) Pediatric Database was queried for all congenital clubfoot patients. Among those, patients who underwent percutaneous Achilles tenotomy (PT; CPT: 27606) or open Achilles tenotomy with posterior capsulotomy (COTC; CPT: 28262) were stratified into two cohorts. Cohorts were 1:1 propensity score-matched for gender, race, congenital clubfoot diagnosis, and ASA score. Demographics, peri- and 30-day postoperative data were collected for each group and compared using appropriate parametric tests. A p-value of 0.05 or lower indicated statistical significance. A binary stepwise multivariate regression model was used to assess the effects of age, gender, race, ASA score, congenital clubfoot, and surgery type on total complication and reoperation rates. Results: 690 patients were included (PT, n=345; COTC, n=345). PT patients were younger than COTC patients (1.58 vs. 4.26 years; p<0.001). However, gender and race distributions were comparable. PT patients incurred shorter operation-to-discharge intervals (0.24 vs. 1.1 days), total anesthesia (71.8 vs. 191.2 mins) and operative time (34.4 vs. 129.3 minutes) (all p<0.001). PT and COTC patients had comparable rates of postoperative complications (0.00 vs. 0.87%; p=0.082). Complications experienced by COTC patients included pneumonia (0.29%) and surgical site (0.29%), and urinary tract infections (0.29%). Both cohorts also had similar reoperation rates (0.58 vs. 1.45%; p=0.253). Multivariate regression analysis revealed that age, female sex, race, congenital clubfoot diagnosis, and type of surgery were not significantly associated with any increase in odds of incurring postoperative complications or reoperations. Conclusion: Patients who underwent PT were younger than those who underwent a COTC. In addition, COTCs were significantly longer and led to a greater length of stay than those who underwent PT. However, there was no significant difference in short-term post-operative complication and reoperation rates. Lastly, surgery type and operative time were not significant predictors for higher complication rates. Therefore, despite lengthier hospital stay and operative time for PT, COTC and PT had comparable and low short-term complication rates and appeared to be safe procedures for treatment of congenital clubfoot in pediatric patients.