Pyrocarbon Arthroplasty Implants in the Upper Extremity: A Systematic Review of Outcomes and Pooled Analysis of Complications.

BACKGROUND: Growing use of pyrocarbon implants in upper extremity arthroplasty has culminated in a breadth of literature ascertaining outcomes and complications at long-term follow-up. However, at present, the literature remains devoid of studies synthesizing the available evidence for upper extremity surgeons to adequately assess the safety and utility of these implants relative to other available options. METHODS: A systematic search of the National Library of Medicine, MEDLINE, and Embase databases was performed to determine clinical outcomes and complication and reoperation rates following pyrocarbon arthroplasties in the upper extremity. A breakdown of complication and reoperation rates for each independent joint (shoulder, elbow, wrist, and hand joints), and according to specific causes necessitating surgery, was also compiled. RESULTS: A comprehensive summary of functional outcomes following upper extremity pyrocarbon arthroplasties is presented. Overall complication and reoperation rates in the hand and wrist were determined to be 28.2 percent and 17 percent, respectively. The proximal interphalangeal joint was associated with the highest complication rate (42.7 percent), followed by carpometacarpal joint (18.8 percent), metacarpophalangeal joint (17.6 percent), wrist (16 percent), elbow (15.7 percent), and shoulder (12.9 percent). In the hand and wrist, major complications included dislocations and subluxations (8.4 percent), stiffness and limited motion (4.4 percent), deformity (3.1 percent), hardware failure (1.9 percent), fractures (1.7 percent), persistent pain (1.7 percent), and infections (0.9 percent). CONCLUSION: In the absence of large clinical trials, systematic reviews such as these can help inform clinical guidelines and provide practitioners with an evidence-based reference to improve informed consent.

Trends and Risk Factors in Orthopedic Lawsuits: Analysis of a National Legal Database.

Orthopedic surgeons frequently encounter medical malpractice claims. The purpose of this study was to assess trends and risk factors in lawsuits brought against orthopedic surgeons using a national legal database. A legal research service was used to search publicly available settlement and verdict reports between 1988 and 2013 by terms "orthopaedic or orthopedic" and "malpractice." Temporal trends were evaluated, and logistic regression was used to identify independent risk factors for case outcomes. A total of 1562 publicly reported malpractice cases brought against orthopedic surgeons, proceeding to trial during a 26-year period, were analyzed. The plaintiffs won 462 (30%) cases, with a mean award of $1.4 million. The frequency of litigation and pay-outs for plaintiffs increased 215% and 280%, respectively, between the first and last 5-year periods. The mean payout for plaintiff-favorable verdicts was highest in pediatrics ($2.6 million), followed by spine ($1.7 million) and oncology ($1.6 million). Fracture fixation (363 cases), arthroplasty (290 cases), and spine (231 cases) were the most commonly litigated procedures, while plaintiffs were most successful for fasciotomy (48%), infection-treating procedures (43%), and carpal tunnel release (37%). When analyzing data by state and region, adjusted for population, northeastern states had a higher frequency of lawsuits. Malpractice liability has increased during the past 3 decades while orthopedic surgeons continue to win most of the cases making it to court. As patients search for medical care via publicly available information, it is important for orthopedic surgeons to understand what aspects of their own practice carry different risks of litigation. [Orthopedics. 2019; 42(2):e260-e267.].

Additive Manufacturing in Total Joint Arthroplasty.

Additive manufacturing (AM) has demonstrated the potential to revolutionize manufacturing for various applications across the medical, aerospace, automobile, and energy sectors. It is a layer-by-layer manufacturing process in which the computer-aided design model is sliced into layers and each layer is deposited successively to realize the final product. This article provides a general overview of AM and discusses current state-of-the-art AM methodologies as they apply to total joint arthroplasty. Specifically, details on their applications and current challenges are summarized to provide orthopedic surgeons with a basic understanding of current and potential applications of AM in total joint arthroplasty.

Endoprótesis articulares y el nuevo Baremo de tráfico / Endoprosthesis and the new Scale in traffic accidents

El nuevo Baremo en accidentes de tráfico modifica la actual valoración de las secuelas en los lesionados, ya que a la simple valoración numérica de las mismas se deben añadir los gastos previsibles de asistencia sanitaria futura. Este apartado adquiere una especial importancia en las lesiones relativas a la especialidad de Cirugía Ortopédica y Traumatología, especialmente en el ámbito de las endoprótesis articulares (artroplastias de cadera, rodilla, hombro y tobillo). El objetivo del presente trabajo es proporcionar datos válidos para realizar la valoración del daño corporal con el nuevo Baremo de tráfico en pacientes con artrosis postraumática que precisarán una cirugía de implante de prótesis y en pacientes a los que ya se les ha implantado la prótesis y precisarán una cirugía de recambio en el futuro (AU)

The new scale in traffic accidents modifies the current valuation of the sequels on the injured and as the simple numerical assessment of them should be added the foreseeable future healthcare costs. This section is particularly important in injuries related to the specialty of Orthopedics and Traumatology, especially in the field of joint endoprosthesis (hip replacements, knee, shoulder and ankle). The aim of this study is to provide valid data for the damage assessment with the new traffic scale in patients with posttraumatic arthritis necessitating a prosthesis implant surgery and in patients who have been implanted a prosthesis and will require revision surgery in the future (AU)

Orthopaedic malpractice claims in the VA medical system.

This study was undertaken to delineate the outcome of orthopaedic malpractice claims in the Veterans Affairs Medical Center (VAMC) system compared with the private sector. All orthopaedic administrative tort (malpractice) claims handled by the Office of Regional Counsel in Nashville, Tennessee during the 5-year period (8/93-7/98) were analyzed. Attention was directed at: 1) the number and type of claims, 2) the disposition of the claims, 3) the average award or settlement and range in size of awards (indemnity), and 4) the length of time required to process and dispose of each claim. These data were compared to those compiled in that segment of the private sector represented in the database of Physician Insurers Association of America (PIAA) for a similar five years (1/90-12/94). Twenty-six claims were filed in the 5-year study period and 22 were adjudicated by December 1999. Fourteen of 22 (64%) were defended successfully and eight (36%) resulted in an award to the claimant plaintiff. In the private sector those figures were 69% and 31%, respectively. The VAMC average indemnity was 20,404 dollars (range, 3500-100,000 dollars) versus 145,200 dollars in the private sector. Approximately 1% of all awards in the private sector were greater than 1,000,000 dollars. The length of time required by the VAMC to process and dispose of each claim ranged from 6 to 59 months and averaged 15.2 months. The settlement rate of orthopaedic medical malpractice claims involving the VAMC and the private sector is similar. It appears that the average award is greater in the private sector. This may reflect more claims and lesser awards in the VAMC. In both systems, most claims do not result in an indemnity.