Spinal Anesthesia Administered in Preoperative Holding for Total Joint Arthroplasty Is Safe and Improves Operating Room Efficiency - Spencer S. Schulte, MD; Joshua E. Simson, MD; Richard L. Purcell, MD; James Esposito, MD; Sarah Rabin, MD; and Gens P. Goodman, DO
| Neuraxial anesthesia (NA) has been shown to be safe and beneficial for patients undergoing total joint arthroplasty (TJA). It has not been determined whether it is safe to perform spinal anesthesia (SA) in a location other than the operating room (OR). This is a single-institution, single-surgeon analysis of 471 consecutive primary TJAs performed from November 2016 to March 2020. Rate of complications, length of stay, and disposition were compared. Eighty-nine percent of TJAs were performed under NA. Those receiving SA were less likely to require conversion to general anesthesia (GA) than those receiving epidural anesthesia (1.8% vs. 14.4%, p < 0.001). Conversion to GA cost 12 minutes of OR time. SA room time averaged 13.4 minutes shorter than GA room time (p < 0.001). The rate of complications was similar for all groups. NA administered in the preoperative holding area for TJA is safe and improves OR time. (Journal of Surgical Orthopaedic Advances 34(1):001-005, 2025)
Key words: total joint arthroplasty, neuraxial anesthesia, practice efficiency
Sleep Disturbance in Orthopaedic Surgery: A Review of the Literature - Joshua R. Giordano, DO; Matthew J. Partan, DO; Matthew T. Geiselmann, DO; and Adam D. Bitterman, DO
Sleep disturbance within the orthopaedic patient population is gaining more headway. As more research is completed, the effects of sleep disturbance on the orthopaedic patient both preoperatively and postoperatively are evident. Overall, there is a lack of research; however, early research suggests that physicians should screen patients for sleep disturbance, as it plays a role in pain and healing. Here, the authors provide a review of the literature as well as guide further research within the topic of sleep disturbance in orthopaedic surgery and provide guidance for the orthopaedic surgeon encountering this topic within their patient population. (Journal of Surgical Orthopaedic Advances 34(1):006-010, 2025)
Key words: sleep, sleep distrubance, sleep hygiene
The Role of Preoperative Magnetic Resonance Imaging in Surgical Decision-making for Total Versus Medial Unicompartmental Knee Arthroplasty - Maddison A. McLellan, MD; Shane M. Davis, MD; and Christopher S. Lee, MD
Unicompartmental knee arthroplasty (UKA) is considered favorable over total knee arthroplasty (TKA) due to quicker recovery and high postoperative function; however, UKA failure rates remain high. The purpose of this study was to investigate the role of preoperative magnetic resonance imaging (MRI) in surgical decision-making for medial UKA versus TKA. Ninety-four knees of 85 patients who underwent knee replacement surgery were analyzed retrospectively. Patients deemed candidates for UKA based on stress-view radiographs and physical exam underwent MRIs to assess candidacy. Exclusion criteria included lateral meniscus tears, loose bodies, grade 3 – 4 chondromalacia, anterior cruciate ligament (ACL) tears, sclerosis, and osteoarthritis in more than one compartment. Based on exclusion criteria in the MRI, 47.87% of patients who were initially candidates for UKA were deemed TKA-only candidates. Therefore, although MRIs pose an additional cost, high failure rate of UKA and cost of conversion to TKA make it a beneficial solution. (Journal of Surgical Orthopaedic Advances 34(1):011-014, 2025)
Key words: magnetic resonance imaging, unicompartmental knee arthroplasty, total knee arthroplasty, osteoarthritis, surgical planning
The Prevalence of PTSD and Depression in Adults with Traumatic Brachial Plexus Palsy - Glenn Gaston, MD; Risa Reid, MD; Michael Gart, MD; Daniel Lewis, MD; Darcy Alexander, MD; and Bryan Loeffler, MD
Brachial plexus injuries (BPIs) can cause physical and psychological disability, including posttraumatic stress disorder (PTSD) and depression, though the psychological impact of BPI has received little attention. This study hypothesizes that PTSD and depression are significant in health-related quality of life. Prospectively, BPI patients completed the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, Visual Analog Pain Scale (VAS), Primary Care PTSD Screen (PC-PTSD), and Center for Epidemiologic Studies Depression Scale (CES-D) at each clinic visit. Primary endpoints included the prevalence of PTSD and depression with DASH and VAS as secondary endpoints. Eighty-five patients met inclusion criteria (average age 46.6 years; 78.8% male). Median DASH score was 56.7; median VAS score was 5/10. PTSD prevalence was 30.6% (26/85). Depression prevalence was 45.9% (35/85). Patients with PTSD were significantly more likely to exhibit depression (p < 0.0001). Concomitant PTSD and depression were seen in 23 patients (27.1%). Traumatic BPI significantly impacts physical and psychological wellbeing; thus, recognizing the high prevalence of PTSD and depression is critical. (Journal of Surgical Orthopaedic Advances 34(1):015-019, 2025)
Key words: PTSD, depression, brachial plexus
Traction Internal Rotation Radiographs Aid in the Assessment of Lateral Femoral Wall Integrity in Intertrochanteric Hip Fractures - Jonathan Yin, MD; Andrew J. Marcantonio, DO, MBA; Justin Koh, MD; and Paul Tornetta III, MD, PhD
Lateral femoral wall failure may cause catastrophic collapse after fixation of intertrochanteric (IT) fractures. Traction internal rotation (TIR) radiographs may provide a more accurate fracture assessment of the lateral wall and alter the preoperative plan and fracture implant selection. Seventy-four consecutive patients with AO Foundation/Orthopaedic Trauma Association AO/ OTA 31A1-2 fractures were evaluated. Intervention was fixation of IT fractures by sliding hip screw (SHS) or cephalomedullary nail (CMN). No patient treated with a SHS had lateral wall failure at final follow-up. TIR radiographs of IT fractures can optimize preoperative evaluation of fracture morphology, particularly if an SHS is being considered. (Journal of Surgical Orthopaedic Advances 34(1):020-022, 2025)
Key words: traction internal rotation radiograph, intertrochanteric hip fracture, sliding hip screw, cephalomedullary nail, choice of implant
Limiting Narcotic Utilization Following Ankle Fracture Surgery - Theresa Pak, DO and John Schlechter, DO
fracture surgery. A retrospective chart review of opioid-naive patients aged 18 – 65 undergoing ankle fracture surgery was performed. Patients were prescribed a multimodal pain regimen of acetaminophen, ibuprofen, gabapentin, tramadol, and two sealed envelopes each containing a prescription for 10 tablets of hydrocodone/acetaminophen 5/325 mg. Fourteen of 35 (40%) did not fi ll any hydrocodone/acetaminophen tablets, 14 (40%) fi lled 10, 7 (20%) fi lled 20, and no patients fi lled more than 20. Most patients rated their pain favorably at their fi rst postoperative visit. There was no correlation with pain control and number of fractures fi xed, obesity, or sex. Previously, the custom and practice at this study’s institution was to prescribe 30 – 50 tablets of hydrocodone/acetaminophen 5/325 mg. Patients needed much less narcotics than previously believed. This study hopes to provide a prescribing guideline that may decrease reliance on opioid analgesia. (Journal of Surgical Orthopaedic Advances 34(1):023-025, 2025)
Key words: postoperative analgesia, ankle fracture, narcotics
Infection Risk Following Contaminated Cases - Sean Baran, MD; Rishikesan Ramaesh, BMedSci, MBChB; Alexander Y. Shin, MD; andSanjeev Kakar, MD
Controversy exists whether one can perform a clean case subsequent to a dirty case in the same operating room predisposed to infection. A retrospective review of all orthopaedic surgical patients between 2003 and 2010 with a type I surgical wound whose case had been performed immediately after type a IV wound was undertaken. Six hundred seventy-four pairs of type IV wounds immediately followed by type I wounds were identified. Of the type I wounds, 3.3% subsequently developed surgical site infection. The bacterial profile of the infections in type I cases was not identical to the associated type IV cases in any instance. This finding suggests that direct cross-contamination is not a reason for infection in clean cases that are performed immediately subsequent to dirty cases. (Journal of Surgical Orthopaedic Advances 34(1):026-030, 2025)
Key words: clean case, dirty case, contaminated, infection, infection risk
Prospective, Randomized, Intra-subject Controlled Trial Comparing Ultrasound-guided Thread and Mini-open Carpal Tunnel Release - Joshua J. Meaike, MD; Ike B. Hasley, MD; Jeff rey S. Brault, DO; and Alexander Y. Shin, MD
The purpose of this study was to evaluate the efficacy and safety of a minimally invasive, ultrasound-guided, incisionless thread carpal tunnel release (TCTR) compared with mini-open carpal tunnel release (MOR) in a prospective, single-institution, randomized, intrasubject controlled study of patients with bilateral carpal tunnel syndrome (CTS). Patients underwent same-day, immediately sequential bilateral carpal tunnel surgery receiving both a TCTR and an MOR, with randomization occurring in reference to the dominant versus non-dominant extremity. Eleven patients with an average age of 49.8 years were followed for 12 months. There were no clinical or statistical differences between the two procedures at multiple postoperative time periods with respect to functional outcome scores, pain, or strength. All but one patient preferred TCTR over MOR, citing quicker recovery and decreased pain. Ultrasound-guided TCTR is safe and effective with similar functional outcomes, pain, and strength compared with a more traditional MOR. (Journal of Surgical Orthopaedic Advances 34(1):031-036, 2025)
Key words: carpal tunnel syndrome, carpal tunnel release, thread, ultrasound guided, minimally invasive, randomized controlled trial
Analysis of “Local Guide” Google Reviews for Orthopaedic Spine Surgeons - Griffin B. Harris, BS; Andrew J. Sama, BS; Nicholas C. Schiller, BS; Alina Syros, MPH; Ronald Swonger, BS; and Chester J. Donnally III
This study aimed to investigate the content and trends of online reviews of orthopaedic spine surgeons in Florida, as left by “Local Guide” reviewers on Google Maps. The data collected were categorized and analyzed to identify patterns related to physician age, academic status, gender, practice location, and the nature of comments left by reviewers. The results showed that higher ratings were associated with comments related to shorter wait times, a competent medical staff , the physician’s knowledge, and pain improvement. On the other hand, lower ratings were associated with comments related to expense of visit, poor bedside manner, worsening of pain, perceived lack of care, and unprofessional staff . This study provides unique insights into the factors that influence patients when selecting a physician online, as well as the areas that physicians can focus on to improve their online image or care delivery. (Journal of Surgical Orthopaedic Advances 34(1):037-040, 2025)
Key words: orthopaedic spine surgeons, online physician reviews, local guides, online ratings, Google reviews
Hyponatremia and Acute Kidney Injury Following Spine Surgery - Tommy Pan; William Hennrikus, MD; Matthew Bierowski; Kathryn Carlisle; Erik Lehman; Mark Knaub, MD; and Eileen Hennrikus, MD
The rates and risk factors of postoperative hyponatremia and acute kidney injury (AKI) were examined in spine surgery patients. A 2-year retrospective review of 348 patients was performed. Patients were instructed to take their routine nonsteroidal antiinflammatory drugs and antihypertensive medications the morning of surgery. Postoperative hyponatremia and AKI were studied. Statistical analysis included bivariate and multivariable logistic regression analysis with odds ratio and quantile regression model. Thirty-eight percent of patients (133/348) had postoperative hyponatremia (serum sodium < 135 mEq/L). Seven percent (24/348) had AKI (0.3 mg/dL or > 50% increase in baseline serum creatinine). On the multivariable logistic regression model, two factors remained significant for hyponatremia: preoperative sodium level and operative time. Body mass index and use of preoperative angiotensin blocking medications were significant for AKI. Patients with hyponatremia and AKI demonstrated a longer length of hospital stay. In conclusion, postoperative hyponatremia (38%) and AKI (7%) are common following spine surgery. (Journal of Surgical Orthopaedic Advances 34(1):041-045, 2025)
Key words: hyponatremia, acute kidney injury, syndrome of inappropriate antidiuretic hormone, modifiable risk factors, spine surgery
Significantly Lower Incidence of Patellar Clunk Syndrome Using a Highly Congruent Tibial Insert - Ian M. Duensing, MD; Benjamin H. Dalkin, BA; John Taliaferro, MD; Nicole Natarelli, BA; Haryoung Lee, BA; Wendy M. Novicoff , PhD; and James A. Browne, MD
Patellar crepitus and patellar clunk syndrome are potential complications seen in patients undergoing total knee arthroplasty (TKA). The etiology of this phenomenon is incompletely understood. A retrospective chart review was performed to identify a consecutive series of patients who underwent primary TKA with either a traditional posterior-stabilized implant (group 1, 728 TKAs) or a cruciate substituting implant (group 2, 393 TKAs). All surgical procedures were performed by a single surgeon at the same institution using the same surgical technique, including selective patellar resurfacing and release of the posterior cruciate ligament. The incidence of patellar clunk requiring arthroscopic debridement was recorded. Statistical analysis was performed. The incidence of patellar clunk requiring arthroscopic debridement was significantly higher in group 1 versus group 2 (6.6% vs. 0% respectively, p < 0.001) with standardization of surgeon and technique factors, suggesting implant design is a critical variable in the development of this complication. (Journal of Surgical Orthopaedic Advances 34(1):046-049, 2025)
Key Words: total knee arthroplasty, patellar clunk, posterior-stabilized, cruciate-sacrificing