Building a Better Graft

Jay D. Lenn

Current surgical interventions to repair articular cartilage often result in less than optimal outcomes because the new cartilage does not sufficiently replicate both the structural and functional properties of healthy tissue. The repairs generally fail to restore the gradient composition of the osteochondral tissue. That gradient runs from the smooth surface layer of cartilage, to the transitional layer of calcified cartilage, and into the subchondral bone.

New FDA Guidances Tighten Regulation of Stem Cells

S. Raymond Golish, MD, PhD, MBA; J. Tracy Watson, MD; William M. Mihalko, MD, PhD

Legitimate stem cell research may eventually revolutionize regenerative medicine, and some innovative therapies have already been appropriately studied and commercialized. By comparison, cell and tissue therapies promoted for orthopaedic conditions have often been poorly studied and lightly regulated. Nonetheless, they have proliferated commercially in the medical device market and in so-called stem cell clinics offering autologous, point-of-care interventional procedures.

International Panelists Present the Rationale for Registries

Terry Stanton

A dozen panelists, representing both the burgeoning U.S. registry movement and the more experienced international data repositories, offered their perspectives during the symposium “What Can a Registry Do for Me?” at the AAOS 2018 Annual Meeting.

Improving Identification of Metal-on-Metal Hips at Risk of Failure

Peter Pollack

Matthew T. Houdek, MD, who presented data from Paper 853 at the AAOS 2018 Annual Meeting, said, “It’s not uncommon for patients with failed metal-on-metal (MoM) hip implants or who have a metal reaction (taper corrosion) to display soft-tissue damage that doesn’t correlate with what we see in their serum or blood metal ion levels.

What Factors Are Linked to Prolonged Opioid Use after Knee Arthroscopy?

Peter Pollack

Information from a paper presented at the AAOS 2018 Annual Meeting may help identify patients who would benefit from multimodal pain management strategies to minimize opioid use. “What are the risk factors for prolonged postoperative opioid use after knee arthroscopy?” asked Samuel R.H. Steiner, MD, who presented Paper 673, “Risk Factors for Prolonged Narcotic Use Following Knee Arthroscopy.”

ASCs and Hospitals Yield Similar Outcomes for Treatment of Supracondylar Humerus Fractures

Terry Stanton

A study of pediatric patients treated surgically for supracondylar humerus (SCH) fractures found that those who were treated in an ambulatory surgical center (ASC) received care that was as safe, faster, and more cost-effective than those treated in a children’s hospital. The study, presented at the AAOS 2018 Annual Meeting by Carson Mills Rider, MD, identified 316 patients who underwent closed reduction and percutaneous pinning (CRPP) of Gartland extension type II SCH fractures.

Nonopioid Pain Management Is Effective in Total Shoulder Arthroplasty Patients

Maureen Leahy

An opioid-free, multimodal pain management pathway is a safe and effective option in properly selected patients undergoing total shoulder arthroplasty (TSA), according to data presented by Daniel Leas, MD, at the AAOS 2018 Annual Meeting. “Overdoses are the leading cause of accidental death in our country, with opioids leading the way as the offending agent,” Dr. Leas said. “For decades, we have been comfortable with opioids as part of the routine operative course for our patients.”

ALA May Reduce Risk of Nerve Injury Compared to DAA for THA

Peter Pollack

For patients who undergo total hip arthroplasty (THA), both direct anterior approach (DAA) and anterolateral approach (ALA) in supine position can offer excellent clinical results, suggested Ryohei Takada, MD. “However, our findings suggest that ALA might be superior to DAA in terms of preventing nerve injury.”

Vitamin D Deficiency Alone Is Not Associated with Acute Fractures in Children

Maureen Leahy

Study data presented at the AAOS 2018 Annual Meeting suggest that although serum vitamin D levels are low in children, the deficiency is not associated with acute low-energy fractures. “Results of this multisite study, conducted within a large diverse population living in a seasonal climate, underscore the high prevalence of vitamin D (25-OHD) insufficiency and deficiency among pediatric patients as described in the literature,” said coauthor Alexa J.

Study Examines Readmission Risk Factors, Cost Drivers in Ankle Fractures

Terry Stanton

A study that sought to determine the independent clinical variables associated with increasing total costs in a 90-day episode of care (EOC) for the management of isolated ankle fractures requiring surgery found that patients with an American Society of Anesthesiologists (ASA) physical status classification score ≥ 3 and patients treated by the podiatry service as opposed to the orthopaedic team were at an increased risk of hospital readmission at both 30- and 90-days post discharge.

Prone Radiographs May Save Fusion Levels for AIS Patients

Peter Pollack

Saving levels is one of the biggest concerns when performing spinal fusion to correct adult idiopathic scoliosis (AIS), according to Vishal Sarwahi, MD. “Fusion corrects the spine and prevents progression, but also reduces flexibility. Our goal is to fuse no more levels than necessary to correct the scoliosis and leave the patient balanced,” he added. Dr.

Multilevel Adjacent Laminectomies Do Not Always Result in Instability

Maureen Leahy

Results of a study that investigated the reoperation rates of patients after multilevel adjacent lumbar decompressions suggested that the need for subsequent arthrodesis in decompressions of three or more consecutive levels without concomitant fusion may be less than what conventional wisdom and clinical practice dictate. The data was presented in Scientific Poster P0334 at the AAOS 2018 Annual Meeting.

Protecting the Heel with a Novel Casting Technique

According to the authors of Scientific Poster P0980, which was on display at the AAOS 2018 Annual Meeting, the short casting technique they developed to help treat tongue-type calcaneus fractures with soft-tissue compromise relieves posterior heel pressure while adequately immobilizing the foot and providing access to the heel for monitoring and wound care.

Making the Most of Protected Research Time in Residency

Jonathan D. Hughes, MD; Peter Mittwede, MD, PhD

For residents with no prior research experience, making the most of protected research time can be daunting. Residents who are not prepared for or motivated to take part in research endeavors often waste this opportunity. Our goal through this article is to provide insight and advice based on our experiences and offer tips for a successful research year or rotation. Jonathan D.