Does Midcarpal Joint Structure Affect Development of Arthritis in the Wrist.

Background Degenerative wrist arthritis develops in specific patterns because of forces acting on existing structural configurations. The most common pattern of wrist osteoarthritis is scapholunate advanced collapse (SLAC). Other patterns include isolated scaphotrapezial trapezoid (STT) joint and isolated midcarpal or radiolunate joint arthritis. One predictor of degeneration pattern is the structure of the wrist. Questions/Purposes Our purpose was to evaluate the relationship between midcarpal joint structure and the pattern of degenerative arthritis. We hypothesized that a wrist type 2 will preferentially develop SLAC degeneration. Patients and Methods We retrospectively evaluated 195 degenerative wrist radiographs. Radiographs were reviewed for lunate/wrist type, degeneration pattern, ulnar variance, radial and volar tilt, inclination, carpal height, scapholunate angle, gap, and presence of thumb carpometacarpal (CMC) joint, STT joint, and midcarpal joint arthritis. Results We had 158 radiographs with SLAC degeneration and 37 with atypical patterns, 154 type 2 and 41 type 1 wrists. There was a significant correlation between wrist type and the pattern of wrist degeneration ( p = 0.02). SLAC degeneration developed in wrists with type 2 lunate while isolated midcarpal arthritis was associated with type 1 wrist. Isolated midcarpal joint arthritis was associated with STT arthritis, p < 0.01. Radial height, inclination, volar tilt, and ulnar variance, and scapholunate gap and angle were not associated with wrist type. Ulnar variance was associated with thumb CMC and STT joint arthritis while radial height was associated with isolated midcarpal joint arthritis. Conclusion This study found significant relationships between midcarpal joint structure and pattern of degeneration. This contributes to understanding the development of degeneration and can aid in future prevention of arthritis. Level of Evidence This is a Level IV, diagnostic study.

Indications for Conversion of Spinal into General Anesthesia During Total Joint Arthroplasty.

INTRODUCTION: Spinal anesthesia (SA) is the preferred method of anesthesia at many centers for total joint arthro- plasty (TJA). However, a small subset of patients fails SA, necessitating a conversion to general anesthesia (GA). This report assesses the patient characteristics associated with failed SA. METHODS: A retrospective study was conducted on patients who underwent SA during their primary TJA between Janu- ary 2015 and December 2016 at our institution. A subset of this group required a conversion from SA to GA. Anesthesia reports were reviewed for the number of attempts at SA and the documented reason for failure. The SA failure cohort was then subdivided into failure categories based on the reasons that had been provided. RESULTS: A total of 5,706 patients were included in this study, 78 of which experienced SA failure. The number of attempts was most strongly associated with SA failure, with three attempts resulting in a five times increased failure rate (OR = 4.73, p = 0.010) and four attempts resulting in 12 times increased failure rate compared to the no failure cohort (OR = 12.3, p < 0.001). Greater than two attempts occurred in 87.5% of the "technical failure" sub-group of the SA failure cohort (p < 0.001). No difference was demon- strated among the other patient characteristics, such as age, sex, body mass index, race, American Society of Anesthesia (ASA) score, and surgical time. CONCLUSIONS: The results suggest that the major predic- tor influencing spinal to general anesthesia conversion was the number of attempts at SA, especially among technical failure cases. Based on the results, it may be appropriate for anesthesiologists to convert to GA after two failed spi- nal attempts. Further studies are warranted to assess this relationship for firm clinical recommendations.

The Use of Ultrasound to Differentiate Between Gout and Infection in the Wrist.

BACKGROUND: Gout is a common condition and its prevalence is increasing. In the wrist, acute gouty arthritis is difficult to distinguish from infection and may occur concomitantly. Though aspiration is helpful, it is not always technically feasible or definitive. Imaging may assist in the differential diagnosis. CASE PRESENTATION: Two cases are described in which the use of ultrasound evaluation assisted in the diagnosis and ultimate treatment Conclusion: Ultrasound can be a helpful adjunct in the diagnosis of arthritis of the wrist, helping to tailor treatment in complex cases.

A Single-Center Randomized Prospective Study Investigating the Efficacy of Various Wound Closure Devices in Reducing Postoperative Wound Complications.

BACKGROUND: Sutures and staples are the mainstay wound closure techniques in total joint arthroplasty. Newer techniques such as zipper devices and novel skin adhesives have emerged because of their potential to decrease operative time and possibly minimize complications. The aim of this study is to compare these newer techniques against conventional sutures with respect to wound complications, closure time, and costs. METHODS: A single-center randomized control trial was conducted on 160 patients (52 zipper, 55 suture, 53 mesh) who underwent primary total hip or knee arthroplasty between February 2017 and May 2018. Patients were divided into 3 closure groups: zipper device, monofilament suture plus adhesive, and monofilament plus polyester mesh with adhesive. The primary endpoint was closure time (superficial skin layer). Secondarily we collected perioperative complication rates, including infection, persistent (14-day) wound drainage, 90-day readmission, and emergency room visit rates as well as compared material costs. RESULTS: There were no differences in baseline characteristics between groups for age, body mass index, and American Society of Anesthesiologists classification. There was a trend toward decreased time to closure for the suture group. There were no significant differences between groups for our secondary endpoint, complications. CONCLUSIONS: Our study shows that the suture group trended toward shorter closure time but suggests that each of the closure methods after total joint arthroplasty has equivalent complication rates. With small differences in closure time and no significant differences in complications, the decision to use one wound closure device or technique over another should be driven by institutional costs and provider familiarity.

Diagnosis of Guillain-Barré Syndrome After Total Hip Arthroplasty: A Case Report.

CASE REPORT: A 67-year-old man presented with signs of acute periprosthetic infection after total hip arthroplasty (THA). Surgical debridement, antibiotics, and a head and liner exchange were performed. After showing no improvement, a single-stage revision was conducted. Postoperatively, he developed back pain and lower extremity weakness. Electrodiagnostic studies showed a Guillain-Barré syndrome (GBS) variant. Intravenous immunoglobulin was administered to halt disease progression. After 1 year, he still demonstrated neuromuscular deficits and required a cane for ambulation. CONCLUSION: This case highlights GBS after THA. A high degree of clinical suspicion is essential to prevent misinterpretation as a postsurgical complication. LEVEL OF EVIDENCE: V, case report.

Transcription Error Rates in Retrospective Chart Reviews.

Electronic health record (EHR) technologies have improved the ease of access to structured clinical data. The standard means by which data are collected continues to be manual chart review. The authors compared the accuracy of manual chart review against modern electronic data warehouse queries. A manual chart review of the EHR was performed with medical record numbers and surgical admission dates for the 100 most recent inpatient venous thromboembolic events after total joint arthroplasty. A separate data query was performed with the authors' electronic data warehouse. Data sets were then algorithmically compared to check for matches. Discrepancies between data sets were evaluated to categorize errors as random vs systematic. From 100 unique patient encounters, 27 variables were retrieved. The average transcription error rate was 9.19% (SD, ±5.74%) per patient encounter and 11.04% (SD, ±21.40%) per data variable. The systematic error rate was 7.41% (2 of 27). When systematic errors were excluded, the random error rate was 5.79% (SD, ±7.04%) per patient encounter and 5.44% (SD, ±5.63%) per data variable. Total time and average time for manual data collection per patient were 915 minutes and 10.3±3.89 minutes, respectively. Data collection time for the entire electronic query was 58 seconds. With an error rate of 10%, manual chart review studies may be more prone to type I and II errors. Computer-based data queries can improve the speed, reliability, reproducibility, and scalability of data retrieval and allow hospitals to make more data-driven decisions. [Orthopedics. 2020;43(5):e404-e408.].