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Heterotopic Ossification (HO) Prophylaxis in Total Hip Arthroplasty (THA): A Systematic Review of Level I and Level II Evidence Since 2000
Get PDFIntroduction: Heterotopic ossification (HO) is a somewhat common occurrence after total hip arthroplasty (THA), particularly with certain approaches. This complication can be detrimental to the success of the surgical outcome. Indomethacin and radiotherapy remain common treatment modalities; however, no true gold-standard treatment is universally agreed upon. This study aims to evaluate Level I and Level II evidence for treatment practices of HO prophylaxis since 2000.
Methods: To evaluate HO prophylaxis in total hip arthroplasty, a search was conducted across MEDLINE/Pubmed, Cochrane, and Embase databases using keywords and Medical Subject Heading (MeSH) terms. Titles and abstracts were screened for eligibility for inclusion criteria. Full texts were screened and included if they met eligibility criteria.
Results: HO chemical prophylaxis was more effective than no HO prophylaxis, except for aspirin. Multiple NSAIDs showed equivalence and better side effect profiles than indomethacin. No one superior NSAID was found, and numerous modalities showed efficacy. The most effective dosages of radiation therapy and combination therapy remain unclear. Additionally, both etidronate and salmon calcitonin showed benefit in preventing HO in one study each.
Conclusion: Radiation, NSAIDs, and combination therapy all showed efficacy as HO prophylaxis modalities. HO prophylaxis treatment and modalities should be guided upon patient and surgical factors such as surgical approach, side effects and tolerability of modalities, comorbidities, and available facility resources to optimize the prevention of HO.
Level of evidence: Level IV Therapeutic
All-Arthroscopic Segond Fracture Fixation in Association With Anterior Cruciate Ligament Repair
Get PDFAnterior cruciate ligament (ACL) reconstruction techniques for ACL injury are still the gold standard, but today primary repair has been an effective alternative in the appropriate patient population. The goal of ACL surgery is to restore the rotational stability and to control the pivot shift phenomenon. For this reason, the treatment of the associated lesions such as anterolateral ligament and capsule, Segond fracture (SF), and lateral meniscus posterior root are recommended. This Technical Note shows the pearls and pitfalls of an all-arthroscopic technique of SF fixation with ACL repair combined with external meniscus suture and SF fixation
Accuracy of Race and Ethnicity Data in the Pediatric Electronic Health Record: A Concordance and System Adequacy Study
Get PDFIntroduction: Conventional race and ethnicity categories and analysis are reductive and prone to inaccuracy. Because race and ethnicity data validity is essential to health equity efforts, we measured the accuracy of race and ethnicity data in a pediatric electronic health record (EHR) to identify areas for improvement in data collection and use. Methods: Patients and their caregivers reported patient race and ethnicity via in-person survey in four pediatric settings (inpatient, emergency room, urgent care, and primary care). Race and ethnicity data from the EHR were compared with survey data to calculate four measures of EHR data accuracy. The U.S. Census Bureau’s novel categorization scheme was used to analyze racial and ethnic identities “alone” and “in combination” with ≥1 other identity. Results: Caregivers for 561 patients completed the survey; 116 patients aged ≥12 years completed a patient version. For consolidated race and ethnicity fields, overall concordance between survey and EHR was 74.6%. Concordance differed by race and ethnicity category when alone (Black or African American 96.1%, Hispanic 90.6%, and White 92.5%) and in combination with another category (Black or African American 93.9%, Hispanic 88.6%, and White 84.4%). The EHR had low accuracy for patients with multiple racial or ethnic identities (overall sensitivity 35%). Such patients’ identities were often oversimplified due to EHR design. Using “alone” and “in combination” analysis for race and ethnicity categories allowed all patient identities to be visible across categories, unlike in conventional race and ethnicity analysis. Discussion: Identifying and eliminating health disparities depend on accurate race and ethnicity data, but current EHR design provides an unreliable data foundation for needed analyses. Conventional categorization used in race and ethnicity analysis is problematic, hiding identities in a reductive set of groupings. New approaches to validation, categorization, and analysis, as explored in this study, are urgently needed to advance health equity goals
Elbow Ulnar Collateral Ligament Repair: A Systematic Review of Trends and Outcomes
Get PDFBackground
Ulnar collateral ligament (UCL) injuries of the elbow have rapidly risen among high-level baseball players. These injuries have led to the rise of the UCL repair for partial tears. This technique has been theorized to allow for an earlier return to sport. This review aims to evaluate the current literature regarding UCL repair to help guide surgeons in managing UCL injuries.
Methods
A search was conducted across MEDLINE/PubMed, Cochrane, and Embase databases to evaluate for UCL repair. The search used a combination of keywords and Medical Subject Heading terms. Titles and abstracts were screened for eligibility for inclusion criteria. Full texts were screened and included if they met eligibility criteria. Demographics and results of the studies were extracted from the articles that met inclusion criteria.
Results
Thirteen relevant studies were found and included in this scoping review. Five studies found that the incidence of UCL repair surgery has increased in recent years. One study found that the incidence of UCL repair surgery increased at a 5.4% faster rate than UCL reconstruction surgery. Repair with suture augmentation was used as the UCL repair technique in four studies. UCL repair showed a return to sport of 86.7% or higher in studies that evaluated return to sport. Four studies reported return to sport at same level or higher, with four studies not specifying return to sport level or return to sport metrics. The most common complication reported was postoperative ulnar nerve neuropathy or paresthesias. Overall, there was a low rate of return to the operating room for complications.
Conclusion
This scoping review found that UCL repair surgery continues to rise in popularity. It also found that UCL repair is safe and effective, with patients having low complication rates and high rates of return to sport