Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Published in
Clinical Orthopaedics and Related Research®
Volume 472 | Issue 6 | Jun, 2014

Nationwide Inpatient Sample and National Surgical Quality Improvement Program Give Different Results in Hip Fracture Studies

Daniel D. Bohl MPH, Bryce A. Basques BS, Nicholas S. Golinvaux BA, Michael R. Baumgaertner MD, Jonathan N. Grauer MD

National databases are being used with increasing frequency to conduct orthopaedic research. However, there are important differences in these databases, which could result in different answers to similar questions; this important potential limitation pertaining to database research in orthopaedic surgery has not been adequately explored.

Art and Science in the Renaissance: The Case of Walther Hermann Ryff

Berardo Di Matteo MD, Vittorio Tarabella MA, Giuseppe Filardo MD, Anna Viganò MA, Patrizia Tomba MA, Maurilio Marcacci MD

Orthopaedic Education in the United Kingdom

M. Gavan McAlinden MPhil, FRCS (Tr & Orth), Paul J. Dougherty MD

Complications Associated With the Initial Learning Curve of Minimally Invasive Spine Surgery: A Systematic Review

Joseph A. Sclafani MD, Choll W. Kim MD, PhD

There is an inherently difficult learning curve associated with minimally invasive surgical (MIS) approaches to spinal decompression and fusion. The association between complication rate and the learning curve remains unclear.

Does Minimally Invasive Surgery Have a Lower Risk of Surgical Site Infections Compared With Open Spinal Surgery?

Wen Wei Gerard Ee MBBS, Wen Liang Joel Lau, William Yeo (Manips), Yap Bing BSc, MSc, PhD, MBBS, M Med (Surg), FRCS (Edin & Glasg), FAMS, Wai Mun Yue MBBS, FRCS (Edin), FAMS (Orth Surg)

Surgical site infection (SSI) ranges from 1.9% to 5.5% in most large series. Minimally invasive surgery (MIS) has been postulated to reduce SSI rates.

Comparative Outcomes of Minimally Invasive Surgery for Posterior Lumbar Fusion: A Systematic Review

Christina L. Goldstein MD, FRCSC, Kevin Macwan BHSc, Kala Sundararajan BSc, MSc, Y. Raja Rampersaud MD, FRCSC

Although minimally invasive surgical (MIS) approaches to the lumbar spine for posterior fusion are increasingly being utilized, the comparative outcomes of MIS and open posterior lumbar fusion remain unclear.

Does Less Invasive Spine Surgery Result in Increased Radiation Exposure? A Systematic Review

Elizabeth Yu MD, Safdar N. Khan MD

Radiation exposure to patients and spine surgeons during spine surgery is expected. The risks of radiation exposure include thyroid cancer, cataracts, and lymphoma. Although imaging techniques facilitate less invasive approaches and improve intraoperative accuracy, they may increase radiation exposure.

Minimally Invasive Surgical Techniques in Adult Degenerative Spinal Deformity: A Systematic Review

Konrad Bach MD, Amir Ahmadian MD, Armen Deukmedjian MD, Juan S. Uribe MD

Minimally invasive surgery (MIS) approaches have the potential to reduce procedure-related morbidity when compared with traditional approaches. However, the magnitude of radiographic correction and degree of clinical improvement with MIS techniques for adult spinal deformity remain undefined.

Is Circumferential Minimally Invasive Surgery Effective in the Treatment of Moderate Adult Idiopathic Scoliosis?

Neel Anand MD, MchOrth, Eli M. Baron MD, Babak Khandehroo MD

Outcomes for minimally invasive scoliosis correction surgery have been reported for mild adult scoliosis. Larger curves historically have been treated with open surgical procedures including facet resections or posterior column osteotomies, which have been associated with high-volume blood loss. Further, minimally invasive techniques have been largely reported in the setting of degenerative scoliosis.

Does Minimally Invasive Transsacral Fixation Provide Anterior Column Support in Adult Scoliosis?

Neel Anand MD, MchOrth, Eli M. Baron MD, Babak Khandehroo MD

Spinal fusion to the sacrum, especially in the setting of deformity and long constructs, is associated with high complication and pseudarthrosis rates. Transsacral discectomy, fusion, and fixation is a minimally invasive spine surgery technique that provides very rigid fixation. To date, this has been minimally studied in the setting of spinal deformity correction.

Is the Lateral Transpsoas Approach Feasible for the Treatment of Adult Degenerative Scoliosis?

Carlos Castro MD, Leonardo Oliveira BS, Rodrigo Amaral MD, Luis Marchi MS, Luiz Pimenta MD, PhD

Lumbar degenerative scoliosis is a common condition in the elderly. Open traditional surgical approaches are associated with high-morbidity complication rates. Less invasive options may carry fewer risks in this patient population. A minimally disruptive lateral transpsoas retroperitoneal technique to accomplish interbody fusion was developed to avoid the morbidity of traditional open surgery, but this approach as an anterior stand-alone construction has not been reported yet for the treatment of adult degenerative scoliosis.

Indirect Decompression of Lumbar Stenosis With Transpsoas Interbody Cages and Percutaneous Posterior Instrumentation

Antonio E. Castellvi MD, Thomas W. Nienke MD, German A. Marulanda MD, Ryan D. Murtagh MD, Brandon G. Santoni PhD

The minimally invasive lateral transpsoas retroperitoneal approach to address lumbar stenosis offers advantages to traditional approaches, including sparing of the AP annulus and longitudinal ligament and less risk to the peritoneal contents and retroperitoneal vascular structures. Few studies have presented longitudinal measures of radiographic indirect decompression and relief of pain and restoration of function using the lateral approach to spine fusion.

Minimally Invasive versus Open Posterior Lumbar Interbody Fusion: A Systematic Review

Gursukhman S. Sidhu MBBS, Erik Henkelman BSE, Alexander R. Vaccaro MD, PhD, Todd J. Albert MD, Alan Hilibrand MD, D. Greg Anderson MD, Jeffrey A. Rihn MD

Although conventional open posterior lumbar interbody fusion (open PLIF) is efficacious in management of lumbar spinal instability, concerns exist regarding lengthy hospital stays, blood loss, and postoperative complications. Minimally invasive posterior lumbar interbody fusion (MIS PLIF) may be able to address these concerns, but the research on this topic has not been systematically reviewed.

Disc Space Preparation in Transforaminal Lumbar Interbody Fusion: A Comparison of Minimally Invasive and Open Approaches

Jeffrey A. Rihn MD, Sapan D. Gandhi BS, Patrick Sheehan BBA, Alexander R. Vaccaro MD, PhD, Alan S. Hilibrand MD, Todd J. Albert MD, David G. Anderson MD

Minimally invasive surgical (MIS) approaches to transforaminal lumbar interbody fusion (TLIF) have been developed as an alternative to the open approach. However, concerns remain regarding the adequacy of disc space preparation that can be achieved through a minimally invasive approach to TLIF.

Same-day Discharge After Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Series of 808 Cases

Walter W. Eckman MD, Lynda Hester PT, Michelle McMillen RN

The versatility of transforaminal lumbar interbody fusion (TLIF) allows fusion at any level along with any necessary canal decompression. Unilateral TLIF with a single interbody device and unilateral pedicle fixation has proven effective, and minimally invasive techniques have shortened hospital stays. Reasonable questions have been raised, though, about whether same-day discharge is feasible and safe after TLIF surgery.

Minimally Invasive Transforaminal Lumbar Interbody Fusion for Spondylolisthesis and Degenerative Spondylosis: 5-year Results

Yung Park MD, Joong Won Ha MD, Yun Tae Lee MD, Na Young Sung MS

Multiple studies have reported favorable short-term results after treatment of spondylolisthesis and other degenerative lumbar diseases with minimally invasive transforaminal lumbar interbody fusion. However, to our knowledge, results at a minimum of 5 years have not been reported.

Elderly Patients Have Similar Outcomes Compared to Younger Patients After Minimally Invasive Surgery for Spinal Stenosis

Ilyas S. Aleem MD, Y. Raja Rampersaud MD, FRCS(C)

Older patients undergo surgery for lumbar spinal stenosis in great numbers, but as a result of substantial diagnostic and surgical heterogeneity, the impact of age on results after surgery is poorly defined.

Minimally Invasive Versus Open Sacroiliac Joint Fusion: Are They Similarly Safe and Effective?

Charles G. T. Ledonio MD, David W. Polly MD, Marc F. Swiontkowski MD

The sacroiliac joint has been implicated as a source of chronic low back pain in 15% to 30% of patients. When nonsurgical approaches fail, sacroiliac joint fusion may be recommended. Advances in intraoperative image guidance have assisted minimally invasive surgical (MIS) techniques using ingrowth-coated fusion rods; however, how these techniques perform relative to open anterior fusion of the sacroiliac joint using plates and screws is not known.

What Is the Learning Curve for Robotic-assisted Pedicle Screw Placement in Spine Surgery?

Xiaobang Hu MD, PhD, Isador H. Lieberman MD, MBA, FRCSC

Some early studies with robotic-assisted pedicle screw implantation have suggested these systems increase accuracy of screw placement. However, the relationship between the success rate of screw placement and the learning curve of this new technique has not been evaluated.

Changes in the Adjacent Segment 10 Years After Anterior Lumbar Interbody Fusion for Low-Grade Isthmic Spondylolisthesis

Kyung-Chul Choi MD, PhD, Jin-Sung Kim MD, PhD, Hyeong-Ki Shim MD, Yong Ahn MD, PhD, Sang-Ho Lee MD, PhD

Adjacent segment degeneration is a long-term complication of arthrodesis. However, the incidence of adjacent segment degeneration varies widely depending on the patient’s age and underlying disease and the fusion techniques and diagnostic methods used.

Minimally Invasive Surgical Approaches in the Management of Tuberculosis of the Thoracic and Lumbar Spine

Nitin Garg MCh, MS, MRCS(Edin), Renuka Vohra DNB, DMRD

Spinal tuberculosis is the most common form of skeletal tuberculosis. Various approaches have been described for surgical management of spinal tuberculosis, but many entail wide exposures with attendant morbidity; whether minimally invasive surgical (MIS) approaches are suitable is unknown.

Education Attainment is Associated With Patient-reported Outcomes: Findings From the Swedish Hip Arthroplasty Register

Meridith E. Greene BA, Ola Rolfson MD, PhD, Szilard Nemes PhD, Max Gordon MD, Henrik Malchau MD, PhD, Göran Garellick MD, PhD

Age, sex, and medical comorbidities may be associated with differences in patient-reported outcome scores after THA. Highest level of education may be a surrogate for socioeconomic status, but the degree to which this is associated with patient-reported outcomes after THA is not known.

Does Fluoroscopy With Anterior Hip Arthoplasty Decrease Acetabular Cup Variability Compared With a Nonguided Posterior Approach?

Parthiv A. Rathod MD, Sean Bhalla BS, Ajit J. Deshmukh MD, Jose A. Rodriguez MD

The direct anterior approach for THA offers some advantages, but is associated with a significant learning curve. Some of the technical difficulties can be addressed by the use of intraoperative fluoroscopy which may improve the accuracy of acetabular component placement.

Psychologic Distress Reduces Preoperative Self-assessment Scores in Femoroacetabular Impingement Patients

Michael Q. Potter MD, James D. Wylie MD, Grant S. Sun BS, James T. Beckmann MD, Stephen K. Aoki MD

In several areas of orthopaedics, including spine and upper extremity surgery, patients with greater levels of psychologic distress report worse self-assessments of pain and function than patients who are not distressed. This effect can lead to lower than expected baseline scores on common patient-reported outcome scales, even those not traditionally considered to have a psychologic component.

Is Surgery for Brachial Plexus Schwannomas Safe and Effective?

Hyuk Jin Lee MD, Jeong Hwan Kim MD, Seung Hwan Rhee MD, Hyun Sik Gong MD, Goo Hyun Baek MD, PhD

Schwannomas rarely are found in the brachial plexus, and although they are benign, they present significant challenges to surgical treatment. To our knowledge, there are few studies investigating the surgical outcomes of patients with brachial plexus tumors.

Aneurysmal Bone Cysts: Do Simple Treatments Work?

Krishna I. A. Reddy MCh (Orth), FRCSEd (Orth), F. Sinnaeve MD, Czar Louie Gaston MD, Robert J. Grimer FRCS, Simon R. Carter FRCS

Primary aneurysmal bone cysts (ABCs) are benign, expansile bone lesions commonly treated with aggressive curettage with or without adjuvants such as cryotherapy, methacrylate cement, or phenol. It has been reported that occasionally these lesions heal spontaneously or after a pathologic fracture, and we observed that some ABCs treated at our center healed after biopsy alone. Because of this, we introduced a novel biopsy technique we call “curopsy,” which is a percutaneous limited curettage at the time of biopsy, obtaining the lining membrane from various quadrants of the cyst leading to consolidation (curopsy = biopsy with intention to cure).

Proximal Tumor Location and Fluid-fluid Levels on MRI Predict Resistance to Chemotherapy in Stage IIB Osteosarcoma

Dae-Geun Jeon MD, Won Seok Song MD, Wan Hyeong Cho MD, Chang-Bae Kong MD, Sang Hyun Cho MD

Primary tumor growth during neoadjuvant chemotherapy is believed to be a sign of resistance to chemotherapy (chemoresistance), and often is associated with poor histologic response, local recurrence, and poorer survival. Currently there are no proven indicators to predict poor response to chemotherapy at the time of diagnosis.

An Algorithmic Approach for Managing Orthopaedic Surgical Wounds of the Foot and Ankle

Eugenia H. Cho BS, Ryan Garcia MD, Irene Pien BS, Steven Thomas MS, L. Scott Levin MD, Scott T. Hollenbeck MD

Wound breakdown after orthopaedic foot and ankle surgery may necessitate secondary soft tissue coverage. The foot and ankle region is challenging to reconstruct for orthopaedic and plastic surgeons owing to its complex bony anatomy and unique functional demands. Therefore, identifying strategies for plastic surgery of these wounds may help guide surgeons in defining the best treatment plan.

Optimization of the Racking Hitch Knot: How Many Half Hitches and Which Suture Material Provide the Greatest Security?

James D. Kelly MD, Suketu Vaishnav MD, Bradley M. Saunders MD, Mark A. Schrumpf MD

Reliable methods of fixation of soft tissue and bone are of utmost importance in reconstructive shoulder surgery and in many orthopaedic applications. Current methods of securing lesser tuberosity osteotomies performed during shoulder arthroplasty and tuberosity fixation performed during repair of proximal humeral fractures often rely on alternating half hitches or surgeon’s knots regardless of the suture configuration used passing through the tissue (eg, Mason-Allen, Krackow). The racking hitch knot in contrast to half hitches allows sequential tightening, even under tension, with minimal risk of knot slippage or premature locking. These knot characteristics allow the surgeon to stepwise improve their reduction before committing and locking a construct, preventing hanging knots or under-tensioned repairs. However, little data exist to support the use the racking hitch knot to guide decision making regarding how to back up the knot or to explain the effect of suture material on security and strength.

Spontaneous Age-related Cervical Disc Degeneration in the Sand Rat

Helen E. Gruber PhD, Ryan Phillips BS, Jane A. Ingram BS, H. James Norton PhD, Edward N. Hanley MD

Disc space narrowing, osteophytes, and disc degeneration are common and increase with aging. Few animal models are appropriate for the study of spontaneous age-related cervical disc degeneration.

Migration Inhibitory Factor Enhances Inflammation via CD74 in Cartilage End Plates with Modic Type 1 Changes on MRI

Chengjie Xiong MD, PhD, Bo Huang MD, PhD, Yanping Cun MD, PhD, Bayan G. Aghdasi MD, Yue Zhou MD, PhD

Type 1 Modic changes are characterized by edema, vascularization, and inflammation, which lead to intervertebral disc degeneration. Macrophage migration inhibitory factor (MIF) is a proinflammatory cytokine closely related to the inflammatory cytokines detected in degenerative intervertebral disc tissues. However, the existence and role of MIF and its receptor CD74 in intervertebral disc degeneration have not been elucidated.

Long-term Outcome of Displaced, Transverse, Noncomminuted Olecranon Fractures

Hendrik J. A. Flinterman MD, Job N. Doornberg MD, PhD, Thierry G. Guitton MD, PhD, David Ring MD, PhD, J. Carel Goslings MD, PhD, Peter Kloen MD, PhD

Operative treatment of a displaced, transverse, noncomminuted fracture of the olecranon is associated with good to excellent elbow function in retrospective short-term followup studies. However, to our knowledge, no studies have evaluated objective and subjective outcomes using standardized outcome instruments (ie, DASH and Mayo Elbow Performance Index [MEPI]) to quantify long-term outcome of these specific fractures.

Evaluating the Affect and Reversibility of Opioid-induced Androgen Deficiency in an Orthopaedic Animal Fracture Model

Jesse Chrastil MD, Christopher Sampson BS, Kevin B. Jones MD, Thomas F. Higgins MD

Opioid pain medications are the basis for analgesia after orthopaedic injuries and procedures. However, opioids have many adverse effects, including opioid-induced androgen deficiency.

Are Patients Satisfied With a Web-based Followup after Total Joint Arthroplasty?

Jacquelyn Marsh PhD, Dianne Bryant PhD, Steven J. MacDonald MD, FRCSC, Douglas Naudie MD, FRCSC, Alliya Remtulla MSc, Richard McCalden MD, FRCSC, James Howard MD, FRCSC, Robert Bourne MD, FRCSC, James McAuley MD, FRCSC

A web-based followup assessment may be a feasible, cost-saving alternative of tracking patient outcomes after total joint arthroplasty. However, before implementing a web-based program, it is important to determine patient satisfaction levels with the new followup method. Satisfaction with the care received is becoming an increasingly important metric, and we do not know to what degree patients are satisfied with an approach to followup that does not involve an in-person visit with their surgeons.

High Methodologic Quality But Poor Applicability: Assessment of the AAOS Guidelines Using The AGREE II Instrument

Sanjeeve Sabharwal MBBS, MRCS, MSc, Nirav K. Patel MBBS, MRCS, MSc, Salman Gauher MBBS, BSc, Ian Holloway MBBS, FRCS (Orth), Thanos Athansiou MD, PhD, FRCS, FETCS

The American Academy of Orthopaedic Surgeons (AAOS) is a globally recognized leader in musculoskeletal and orthopaedic education. Clinical guidelines are one important focus of the AAOS’ educational efforts. Although their recommendations sometimes generate controversy, a critical appraisal of the overall quality of these guidelines has not, to our knowledge, been reported.

Letter to the Editor

Tomislav Smoljanovic MD, PhD, Courtney L. Pollock PT, MSc, Ivan Bojanic MD, PhD

Letter to the Editor

Daniel Rhon PT, DPT, DSc, Benjamin Hando PT, DSc

Reply to the Letter to the Editor

Daniel B. Whelan MD, MSc, Robert Litchfield MD, Katie N. Dainty PhD
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