Orthopedic Reviews 2019-04-18T09:44:29+02:00 Emanuela Fusinato Open Journal Systems <p><strong>Orthopedic Reviews</strong> is an Open Access, online-only, peer-reviewed journal that considers articles concerned with any aspect of orthopedics, as well as diagnosis and treatment, trauma, surgical procedures, arthroscopy, sports medicine, rehabilitation, pediatric and geriatric orthopedics. All bone-related molecular and cell biology, genetics, pathophysiology and epidemiology papers are also welcome.&nbsp;The journal publishes original articles, brief reports, reviews and case reports of general interest.</p> Does surgeon experience influence the amount of radiation exposure during orthopedic procedures? A systematic review 2019-04-18T09:44:24+02:00 Azeem Tariq Malik Hamid Hussain Rai Riaz Hussain Lakdawala Shahryar Noordin <p>With an increasing use of intraoperative fluoroscopy in operating rooms worldwide, the topic of radiation exposure has become a major concern among hospital staff, doctors and patients alike. Since fluoroscopy has become an integral part in orthopedic intraoperative management, we sought to identify whether surgeon grade or experience plays a role in the amount of radiation used and consequently exposed. We performed a systematic review examining the association between surgeon experience and radiation exposure using primary outcome measures (radiation dose and total screening time/fluoroscopy time). To be included in the review, the study population had to compare varying surgeon experience levels and their effect on the primary outcomes. A total of eighteen studies were included in the review. The studies were a mix of prospective and retrospective studies with low to moderate quality as evaluated by the MINORs criteria. Studies were variable in defining surgeon experience levels and in the type of operations being performed. Majority of the studies showed that inexperienced surgeons/trainees had a higher total fluoroscopy time and a higher mean radiation exposure as compared to experienced surgeons. We conclude that higher surgeon experience significantly reduces usage of fluoroscopy and the consequent radiation exposure in orthopedic procedures. Introduction of strict radiation guidelines involving limited usage of fluoroscopy and supervision of trainees may be beneficial in controlling radiation exposure in the future.</p> 2019-03-12T10:13:55+01:00 ##submission.copyrightStatement## Outcome of total hip and knee arthroplasty in HIV-infected patients: A systematic review 2019-04-18T09:44:18+02:00 Shane C. O'Neill Joseph M. Queally Anne Hickey Kevin J. Mulhall <p>Significant advances in the treatment of Human Immunodeficiency Virus (HIV) have occurred in recent times, with life expectancy now approaching the normal population. Therefore, patients with HIV will increasingly be undergoing joint replacement in the future, however concerns remain regarding the complications and outcome in this patient cohort. The aim was to assess the outcome of total hip and knee arthroplasty in HIV-infected patients. A systematic search of the literature using MOOSE reporting guidelines was performed to assess the outcome of hip and knee arthroplasty in HIV-infected patients. The primary outcome was infection. Secondary outcome was all-cause revision. The search yielded 552 results, of which 19 met the inclusion criteria, comprising 5.819.412 joint replacements. The overall quality of the studies was poor with significant heterogeneity between the studies. Infection and revision appeared to be more likely to occur in HIV positive patients compared to HIV negative patients. A subgroup analysis of four studies revealed a risk ratio of 3.31 and 2.25 for increase in infection and revision respectively in HIV positive patients. This systematic review and meta-analysis demonstrates an increased risk of infection and revision in HIV infected patients undergoing total hip and knee arthroplasty. However, these findings are based on poor quality evidence in a limited number of studies and need to be interpreted with caution. Further research should concentrate on large, well-designed, prospective studies, that control for co-morbidities and employ standardised outcome measures to allow for direct comparison.</p> 2019-03-22T08:52:20+01:00 ##submission.copyrightStatement## Intra-articular soft-tissue sarcoma of the knee: Is extra-articular resection and tumor endoprosthetic reconstruction the solution? A retrospective report on eight cases 2019-04-18T09:44:29+02:00 Markus Nottrott Arne Streitbürger Georg Gosheger Wiebke Guder Gregor Hauschild Jendrik Hardes <p>Intra-articular sarcoma of the knee joint is a very rare condition. Extra-articular resection and reconstruction with a tumor prosthesis is usually performed. This report describes the results with this rare surgical procedure. This retrospective study evaluated the clinical and functional results after extra-articular resection of the knee joint in eight patients with soft-tissue sarcomas of the knee that were reconstructed using a tumor endoprosthesis. Five of the eight patients (62.5%) ultimately had to undergo amputation, mainly due to periprosthetic infection. In addition, two patients experienced periprosthetic fractures. The mean Musculoskeletal Tumor Society score was 18 (range 10-22), as function was impaired due to a weak extensor mechanism. These results suggest that in patients with intraarticular soft-tissue sarcomas, limb salvage procedures with tumor prostheses after extra-articular resection are associated with very high complication rates. In most cases, long-term limb salvage was not possible. When limb salvage is successful, function is also poor due to a weak extensor mechanism in the knee joint. The indication for this procedure should therefore be considered critically.</p> 2019-02-26T10:22:05+01:00 ##submission.copyrightStatement## Transcranial motor-evoked potentials for prediction of postoperative neurologic and motor deficit following surgery for thoracolumbar scoliosis 2019-04-18T09:44:27+02:00 Samuel M. Miller Sean W. Donegan Niesha Voigt Adam E.M. Eltorai Joseph Nguyen Jason T. Machan Alan H. Daniels Teena Shetty <p>Transcranial motor-evoked potentials (TcMEPs) are used to monitor the descending motor pathway during scoliosis surgery. By comparing potentials before and after correction, surgeons may prevent postoperative functional loss in distal muscles. There is currently no consensus as to which muscles should be monitored. The purpose of this study is to determine the least invasive monitoring protocol with the best localization of potential neurologic deficit. A retrospective review of 125 patients with TcMEP monitoring during surgery for thoracolumbar scoliosis between 2008 and 2015 was conducted. 18 patients had postoperative neurologic consult due to deficit. The remaining 107 patients were a consecutive cohort without postoperative neurologic consult. TcMEPs were recorded from vastus lateralis (VL), tibialis anterior (TA), peroneus longus (PL), adductor hallucis (AH) and abductor pollicis brevis (APB) bilaterally. The effectiveness of each muscle combination was evaluated independently and then compared to other combinations using Akaike Information Criterion (AIC). Monitoring of VL, TA, PL, and AH yielded sensitivity of 77.8% and specificity of 92.5% (AIC=66.7). Monitoring of TA, PL and AH yielded sensitivity of 77.8% and specificity of 94.4% (AIC=62.4). Monitoring of VL, TA and PL yielded sensitivity of 72.2% and specificity of 93.5% (AIC=70.1). Monitoring of TA and PL yielded sensitivity of 72.2% and specificity of 96.3% (AIC=63.9). TcMEP monitoring of TA, PL, and AH provided the highest sensitivity and specificity and best predictive power for postoperative lower extremity weakness.</p> 2019-03-12T09:55:24+01:00 ##submission.copyrightStatement## Computed-tomography-guided biopsy in suspected spondylodiscitis: Single-center experience including 201 biopsy procedures 2019-04-18T09:44:21+02:00 Derya Özmen Neriman Özkan Nika Guberina Klaus Fliessbach Saravanabavaan Suntharalingam Jens Theysohn Matthias Büchter Michael Forsting Jan Buer Marcel Dudda Marcus Jäger Axel Wetter <p>Our propose is to evaluate CT-guided biopsies in suspected spondylodiscitis with respect to puncture site, microbiology findings, histopathology findings and impact on antibiotic therapy. 86 CT-guided spine interventions in suspected spondylodiscitis comprising 201 biopsy procedures were analyzed. Medical records of all patients were screened for microbiology and histopathology reports as well as date, duration and kind of antibiotic therapy. Statistical analyses included calculation of Chi2-tests and logistic regression analyses. Locations of biopsies were intervertebral disc (48.3%), paravertebral soft-tissue (38.3%) and vertebral body (10.9%). Positive microbiological findings were found altogether in 33.8% of cases, positive histopathological findings in 53.6%. Significant associations between positive microbiological findings, positive histopathological findings and antibiotic therapy, respectively, were found. Location of biopsies did not significantly influence rate of positive findings. From the variables age, white blood cell count, serum creatinine and puncture site, none were found to be an independent predictor for a positive microbiological result. We concluded that CT-guided biopsy of intervertebral disc and paravertebral soft tissue yields positive microbiologic findings in a significant proportion of cases. Puncture site is not associated with positive results of microbiology or histopathology.</p> 2019-03-22T08:36:53+01:00 ##submission.copyrightStatement## Radiation safety education as a component of orthopedic training 2019-04-18T09:44:16+02:00 Devin F. Walsh Andrew P. Thome Kush S. Mody Adam E.M. Eltorai Alan H. Daniels Mary K. Mulcahey <p>Fluoroscopy poses an occupational hazard to orthopedic surgeons. The purpose of this study was to examine resident and faculty understanding of radiation safety and to determine whether or not a radiation safety intervention would improve radiation safety knowledge. An anonymous survey was developed to assess attitudes and knowledge regarding radiation safety and exposure. It was distributed to faculty and residents at an academic orthopedic program before and after a radiation safety lecture. Pre- and post-lecture survey results were compared. 19 residents and 22 faculty members completed the pre-lecture survey while 11 residents and 17 faculty members completed the post-lecture survey. Pre-lecture survey scores were 48.3% for residents and 49.5% for faculty; post-lecture survey scores were 52.7% and 46.1% respectively. Differences between pre and post-survey scores were not significant. This study revealed low baseline radiation safety knowledge scores for both orthopedic residents and faculty. As evidence by our results, a single radiation safety information lecture did not significantly impact radiation knowledge. Radiation safety training should have a formal role in orthopedic surgery academic curricula.</p> 2019-03-27T00:00:00+01:00 ##submission.copyrightStatement## Blood supply in the bicipital groove: A histological analysis 2019-04-18T09:44:10+02:00 Martin Hufeland Glyn Hamed Hannes Kubo Hakan Pilge Rüdiger Krauspe Timm Filler Thilo Patzer <p>The vascular anatomy in the closed bicipital groove with the long head of the biceps brachii muscle tendon (LHBT), its mesotenon and the transverse ligament intact has not been analyzed on a histological level yet. An anatomic dissection and histologic study was conducted by using 24 cadaveric formaldehyde fixated shoulders. The bicipital groove including the LHBT and its intact sheath was cut <em>en-bloc, f</em>ixated, sliced in 7 μm sections, Azan stained and the vascular anatomy analyzed under light microscopy. Each sideward branch deriving from the main ascending branches of the anterior humeral circumflex artery (ACHA) in the mesotenon of the LHBT was identified and followed through multiple sections to identify its direction and area of supply. Per specimen, a mean of 2.71±1.85 branches could be identified running through the soft tissue of the mesotenon towards the osseous walls of the groove. Of the total 65 arterial branches in all specimens, 22 (33.8%) were running into the medial wall of the groove and 40 (61.5%) into the lateral wall (P&lt;0.01). The results indicate that branches of the ACHA in the mesotenon of the LHBT provide blood supply not only to the tendon but to the osseous bicipital groove as well and here significantly more to the lateral than to the medial osseous wall. In addition, Pacini-like mechanoreceptors could be identified in the mesotenon in 9 (37.5%) of the specimens which has not been described up to now.</p> 2019-03-29T15:52:42+01:00 ##submission.copyrightStatement## First presentation of a Nora-lesion of the talus in a paraossal fasciitis 2019-04-18T09:44:13+02:00 Philipp Rottler Axel Wilke Hans Udo Kasper Felix Hütter <p>Nora-Lesion is a proliferation that normally develops out of an intact corticalis. The entity of this fibroostotic pseudotumor, as discussed in literature, is triggered from repeating trauma or reactive periosteitis. In the literature, there are more than 200 cases defined as Nora lesion. In the daily routine of medical offices or ambulances, the Nora- Lesion should be established as a differential diagnosis for a swelling of the foot. Our case report of a 49-year-old patient is the worldwide first description of a Nora lesion of the talus, as well as secondary of the calcaneus. In the immense differential diagnosis discussion for bony pathologies of the hindfoot the Nora-lesion should be now added.</p> 2019-03-27T16:04:18+01:00 ##submission.copyrightStatement##