High Complication Rate Associated With Arthroscopic Lysis of Adhesions Versus Manipulation Under Anesthesia for Arthrofibrosis After Total Knee Arthroplasty.

BACKGROUND: Arthrofibrosis after total knee arthroplasty (TKA) is often treated by arthroscopic lysis of adhesions (ALAs) or manipulation under anesthesia (MUA). This study compared the 2-year complication rates of ALA and MUA and range-of-motion (ROM) outcomes for ALA, early MUA (<3 months after TKA), and delayed MUA (>3 months after TKA). METHODS: This retrospective cohort study included 425 patients undergoing ALA or MUA after primary TKA from 2001 to 2018. Demographics, clinical variables, and complication rates were collected from clinical records and compared using Student t -tests and Kaplan-Meier log-rank tests. Multivariable logistic regressions were used for adjusted analysis. ROM data were analyzed using fixed and mixed-effects models. RESULTS: ALA patients were younger (55.2 versus 58.9 years, P < 0.001) and underwent surgery later from the index TKA (12 versus 1.9 months, P < 0.001). The Charlson Comorbidity Index was higher in the MUA group. Preoperative ROM was significantly worse in the MUA cohort, but did not differ between groups after the procedure (117°, P = 0.27) or at 2 years. Demographics and ROM outcomes were equivalent between early MUA and delayed MUA ( P = 0.75). The incidence of repeat arthrofibrosis (7.1%) and revision arthroplasty (2.4%) was similar between ALA and MUA cohorts while ALA patients had significantly more surgical site infections (3.8%) compared with MUA patients (0.47%, P = 0.017). DISCUSSION: Equivalent ROM outcomes were seen between ALA, early MUA, and delayed MUA for the treatment of arthrofibrosis after TKA. However, this study demonstrated a markedly higher complication rate, particularly surgical site infection, after ALA, suggesting that MUA may be the preferred option for treating arthrofibrosis at both early and late time points.

Opioid sparing effects of intravenous and oral acetaminophen in hip fracture patients: A population-based study.

STUDY OBJECTIVE: Acetaminophen (APAP) and intravenous acetaminophen (IVAPAP) has been proposed as a part of many opioid-sparing multimodal analgesic pathways. The aim of this analysis was to compare the effectiveness of IVAPAP with oral APAP on opioid utilization and opioid-related adverse effects. DESIGN: Retrospective study of population-based database. PATIENTS: The Premier Healthcare database was queried patients undergoing surgery for a primary diagnosis of hip fracture from 2011 to 2019 yielding 245,976 patients. Primary exposure was use of IVAPAP or oral APAP on the day of surgery. INTERVENTIONS: None. MEASUREMENTS: The primary outcome of interest was opioid utilization over the hospital stay, secondary outcomes included opioid-related adverse effects, length, and costs of hospital stay. Mixed effect models measured the association of IVPAP and APAP and outcomes. MAIN RESULTS: In the study population 30.67% (75,445) received at least 1 dose of IVAPAP on the day of surgery. Upon adjusting for relevant covariates, patients who received IVPAP on the day of surgery had slightly higher opioid use standardized by length of hospital stay (2.8% CI: 2%, 3.6%; p < .001), higher hospital cost (2.7% CI: 2.1%, 3.4%), and higher odds of naloxone use (1.18, CI: 1.1, 1.27; p < .001) when compared with patients who received oral APAP. CONCLUSIONS: In this population, IVAPAP use on the day of surgery failed to reduce opioid use or associated opioid related adverse effects when compared with oral APAP. IVAPAP was associated with increased overall costs, opioid requirements, and naloxone use. These results do not support the use of IV over oral APAP routinely for hip fracture surgery patients.

Correction to: Point of Care Ultrasound as Performed by the Clinician for the Enhancement of Physical Examination: A Technique Guide for Developmental Hip Dysplasia.

[This corrects the article DOI: 10.1007/s43465-021-00570-8.].

Point of Care Ultrasound as Performed by the Clinician for the Enhancement of Physical Examination: A Technique Guide for Developmental Hip Dysplasia.

Developmental dysplasia of the hip (DDH) is the most common anatomical pathology present in newborns. DDH is the most common orthopaedic disorder in newborns, with incidences cited from 4.4% to 51.8% depending on risk factors, populations and method of reporting. Traditionally, the standard physical exam for newborns includes the Barlow and Ortolani maneuvers. If either is positive by the pediatrician, the baby is then sent for evaluation by a pediatric orthopaedic surgeon. At this stage, either the pediatrician or pediatric orthopaedic surgeon obtains an ultrasound-the gold standard for DDH diagnosis. When early identification and treatment are not in place, it can lead to significant consequences on an individual's health and financial and public health implications for society at large. This is a detailed technique guide aimed to help physicians consistently perform thorough US evaluations of pediatric hips in order to successfully screen, diagnosis and manage treatment of DDH. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s43465-021-00570-8.