This article is temporarily under embargo.
Introduction:Many patients within the orthopaedic population experience 1 or more psychosocial issues that may profoundly affect their postoperative outcomes after orthopaedic surgery. Despite the common nature of these factors, there is a paucity of literature describing their effect on orthopaedic outcomes. The purpose of this review was to describe the anecdotal 10 most-encountered psychosocial factors in our patient population, their described influence on orthopaedic outcomes, and how they may be addressed. These factors include expectations, fear of reinjury, socioeconomic status, social support, allergies, addiction, depression and anxiety, resilience, self-efficacy, and other mental health disorders.Methods:A thorough review of the PubMed-indexed literature was conducted using each one of our psychosocial factors described here combined with the key words “orthopaedic outcome.”Study Design:This was a clinical review paper.Level of Evidence:Not applicable.Results:These 10 psychosocial influences have dramatic effects on the recovery and outcomes after orthopaedic procedures. Patients benefit from early recognition and management of these issues before and after surgery.Conclusions:Each of the psychosocial factors reviewed in this paper has a significant influence on outcomes after orthopaedic surgery. A strong understanding of these factors and how to address them will aid orthopaedic surgeons in maximizing postoperative outcomes for their patients. Further research is necessary to improve our treatment strategies for this complex patient population.
Case: We describe a case of hip impingement in an 18-year-old woman in association with a large cyst at the femoral neck equal to a resection level of approximately 40%. There was great concern of femoral neck fracture. At the time of hip arthroscopy, this was prophylactically treated with cannulated screws in the femoral head and neck, and the cyst was arthroscopically bone grafted using a novel technique with instruments included in standard the arthroscopy trays. Conclusion: Prophylactic femoral neck fixation with arthroscopic bone grafting of large bone cysts is a viable treatment option with minimal added morbidity.
Objectives: High tibial osteotomy (HTO) is a well-established procedure for addressing varus deformity of the knee or offloading the medial compartment in cases of medial compartment osteoarthritis. Altering the weightbearing axis of the tibia through HTO may result in unintended changes to the posterior tibial slope (PTS) and thus the sagittal stability of the knee. In 2003, Lobenhoffer described a biplanar “L” shaped HTO with an ascending cut in the coronal plane, leaving the tibial tubercle on the distal side of the osteotomy. Since then, multiple techniques have been described, including an “Inverse L”, leaving the tibial tubercle on the proximal end of the osteotomy. We present a modified “flex” version to the plate fixation used in the “L” and “Inverse L” technique with the goal of minimizing changes in the PTS during HTO. To quantify the effect of osteotomy technique on PTS, “L” (n=5), “Inverse L” (n=5), “L with flex” (n=6), and “Inverse L with flex” (n=6) techniques were performed on cadaveric specimens following medial opening wedge HTO (Figure1). Pre- and post-osteotomy fluoroscopic images were taken and PTS measured to determine whether one technique was more effective at minimizing PTS change after medial HTO. Methods: The tibia from 22 fresh frozen cadaveric male specimen (11 pairs, mean age 46 + 14) were removed of all soft-tissue. Native anteroposterior and lateral radiographs were taken. Three independent observers measured the PTS angle using the circle method. Two 2.4mm Kirschner wires were placed through the medial cortex of the tibia at the metaphyseal-diaphyseal junction aimed towards the tip of the fibular head as a guide for the sagittal cut performed in the posterior four-fifths of the tibia. The oblique osteotomy stopped 10-15mm medial to the lateral tibial cortex and the joint line to avoid fracture. The osteotomy site was then medially opened 10mm. One specimen from each pair was randomized to receive the “L” shaped ascending HTO with the contralateral limb receiving the “Inverse L” shaped descending HTO. Vertical cuts on the coronal plane extending 3-4cm (proximally for the “L” and distally for “Inverse L”) were completed. 6 specimens from each group were subsequently fixed proximally with an anteriorly angled plate (15 degrees) which was forced posteriorly and fixed to the shaft (Figure 2). This plate “flex” technique was applied to purposefully correct PTS. All osteotomies were fixed using a standard locking AO Tomofix plate with 3 proximal screws and 4 distal screws. Pre- and post-HTO proximal tibia plateau orientations were collected using eight OptiTrack motion capture cameras as an adjunct to tibial slope measures completed through radiographic analysis. Three rigid body marker triads were used: distally along the anterior midline of tibia, medial superior articular surface, and the fixture frame. Post-HTO, the independent observers again measured PTS with the circle method. Change in tibial slope data was averaged among radiograph reviewers and compared to motion capture data. A one-way ANOVA statistical analysis was completed. Results: PTS as measured by reviewers before and after HTO using the “circle method” and the motion capture analysis of the change in orientation of the tibial plateau are reported in Table 1. For all specimens, the posterior tibial slope decreased by 1.77 degrees (+/- 3.2). There was no statistically significant difference in change of tibial slope amongst all techniques, measured by lateral radiographs or motion capture analysis. Conclusions: There was no statistical difference in the change in posterior tibial slope across treatment types. Reviewer calculations of tibial slope using the circle technique was not different from measures observed through high resolution motion capture. No difference in the change in PTS may allow surgeons to select the technique that they feel most comfortable using on their patient with less concern of causing changes in the PTS and sagittal instability during an HTO. Additionally, this may allow for versatility in the event that patient anatomical characteristics interfere or impede the use of a specific technique. Future studies incorporating pre- and post-CT data to quantify hinge fracture and further characterize slope are underway. [Figure: see text][Figure: see text][Table: see text]
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.