Hip resurfacing as an outpatient procedure: a comparison of overall cost and review of safety.

Recent advancements in arthroplasty surgical techniques and perioperative protocols have reduced the duration of hospitalization and length of recovery, allowing surgeons to perform joint replacement as an outpatient procedure. This study aims to evaluate the cost-effectiveness and safety of outpatient hip resurfacing. Two experienced surgeons performed 485 resurfacing surgeries. We retrospectively compared clinical outcomes and patient satisfaction with published outpatient total hip results. Furthermore, we compared average insurance reimbursement with that of local inpatient hip replacement. No major complications occurred within 6 weeks. Of the 39 patients with previous inpatient experience, 37 (95%) believed their outpatient experience was superior. The average reimbursement for hip arthroplasty at local hospitals was $50,000, while the average payment for outpatient resurfacing at our surgery center was $26,000. We conclude that outpatient hip resurfacing can be accomplished safely, with high patient satisfaction, and at a tremendous financial savings to the insurer/patient. LEVEL OF EVIDENCE: III.

Synovial chondromatosis of the biceps tendon sheath.

The case presented is a 22-year-old man with previously treated synovial chondromatosis of the shoulder. He subsequently presented with pain and tenderness above the biceps tendon. Magnetic resonance imaging and radiographs revealed recurrent synovial chondromatosis in the biceps tendon sheath. The patient underwent an open procedure to remove the loose bodies and partial tenosynovectomy. The patient has subsequently done well and resumed normal activities. To our knowledge there are no reported cases of synovial chondromatosis involving the biceps tendon sheath in the literature.

Bicondylar tibial plateau fractures: principles of treatment.

The management of intraarticular fractures such as tibial plateau fractures in weightbearing joints is inherently complex. Bicondylar tibial plateau fractures resulting from high energy trauma are particularly difficult to treat successfully. The objectives in managing these fractures are to obtain adequate reduction and appropriate stabilization while allowing early range of motion and limiting potential morbidity. The incidence of complications and long-term sequelae is relatively high in cases treated with traditional open reduction and internal fixation. From 1986 through 1993, 32 bicondylar tibial plateau fractures were treated at our institution. Of these, 26 were treated operatively using various methods of open reduction and internal fixation, and, more recently, indirect reduction techniques with percutaneous screw and/or external fixation. These newer techniques include arthroscopically-assisted reduction with percutaneous screw fixation or applications of a hybrid circular external fixator with or without limited internal fixation. These techniques provide adequate reduction and fixation while limiting the complications associated with traditional open methods. This retrospective study was conducted to compare these newer techniques with more traditional methods of open reduction and internal fixation (ORIF).

In-shoe plantar pressure measurement of the first metatarsophalangeal joint in asymptomatic patients.

Using an in-shoe plantar pressure sensor, the pressure under the first metatarsophalangeal (MTP) joint was measured in 20 asymptomatic control subjects during their normal gait. A 7-micron in-shoe pressure sensor recorded the pressure under the first MTP joint in the 20 volunteers while they were wearing their normal footwear (athletic footwear), a wooden postoperative shoe, a fiberglass short leg walking cast, and a postoperative shoe with a first MTP joint cutout orthotic device. The results showed both casting, and the postoperative shoe with the first MTP joint cutout orthotic device significantly reduced pressure under the first MTP joint compared with normal footwear, with an average decrease of 31% and 43%, respectively. However, the standard postoperative shoe did not significantly reduce first MTP pressure compared with normal footwear. Certain surgeries performed on the distal first metatarsal may benefit from a diminution of loading forces encountered during normal gait. The results of this study indicate that a reduction of first MTP pressures can best be accomplished with either a postoperative shoe with a cutout orthotic device or a short leg walking cast. A standard postoperative shoe showed inconsistent results and had no statistically significant effect on decreasing the pressure under the first MTP joint.

The role of arthroscopy in the assessment and treatment of tibial plateau fractures.

This retrospective study compared arthroscopic treatment of certain tibial plateau fractures to traditional open techniques. From January 1989 through August 1992, 40 patients with tibial plateau fractures were evaluated. After reviewing the records and radiologic studies, 23 patients were included in the study based on fracture patterns. Using Hohl's revised classification system, patients with either local compression or split compression fractures were included. Twelve of these patients were treated with arthroscopic reduction and percutaneous fixation (ARPF; group A). The remaining 11 underwent open reduction and internal fixation (ORIF; group B). The results of the ARPF group were superior to those of the ORIF group. In the ARPF group, all reductions were anatomic and remained fixed at least 3 months postoperatively, whereas only six (55%) of the ORIF patients had anatomic reductions initially. Furthermore, one of these patients had further loss of reduction on follow-up radiographs. Iliac crest bone graft was used in two patients in group A and 10 in group B. The use of bone graft in the arthroscopically treated group had no effect on the final outcome. The average length of postoperative hospitalization for the ARPF patients with isolated tibial plateau fractures was 5.36 days compared with 10.27 days for patients who were treated with ORIF. Average time to full weight bearing was 8.95 weeks in the ARPF group and 12.30 weeks in the ORIF group. No patients in either group had medial collateral ligament repairs. No ARPF-treated patients experienced valgus laxity after treatment. One patient in the ORIF group had residual instability and another walked with a cane.(ABSTRACT TRUNCATED AT 250 WORDS)

Arthroscopic treatment of synovial chondromatosis of the shoulder and biceps tendon sheath.

We present a case of synovial chondromatosis of the shoulder in a 22-year-old man. The patient was initially treated with arthroscopic debridement and partial synovectomy of the shoulder joint. Eighteen months later, the patient returned with similar symptoms. However, repeat radiographic studies showed involvement of both the shoulder and biceps tendon sheath. The patient was taken back to the operating room for an arthroscopic debridement of the shoulder joint and debridement of the biceps tendon sheath through an open approach. Use of the arthroscope to evaluate and treat this patient allowed him to return to normal activities much sooner than a formal open synovectomy would have allowed. Additionally, the morbidity associated with arthroscopic techniques is much lower than that of open procedures. In cases of synovial chondromatosis, the results in terms of efficacy and recurrence rates of each method appear comparable.