Comparison of Self-reported Versus Actual Height and Weight in the Orthopaedic Population.

The purpose of our study was to determine the accuracy of orthopaedic patient's reported height, weight, and body mass index (BMI). We hypothesized that patient's age, sex and/or BMI may affect their accuracy. We performed a prospective, observational study in the setting of our orthopaedic clinic. Differences between self-reported and actual values were calculated. Patients were categorized based on their age (< 65 vs. ≥ 65), sex, and actual BMI (<30 vs. >30). Student t-test and chi-square test were used to compare groups. Our study included 329 patients. Patients were more likely to underestimate weight (p < 0.001) and overestimate height (p = 0.007). Comparing patients with a BMI < 30 and > 30, height overestimation (0cm vs. 1.14cm, p = 0.004) and weight underestimation (0.09kg vs. 1.29kg, p = 0.02) discrepancies were greater in the BMI > 30 group. Patients, particularly with a BMI >30 kg/m2, over-estimate their height and under-estimate their weight. (Journal of Surgical Orthopaedic Advances 30(3):176-180, 2021).

Effects of Preoperative Antiplatelet Agents and Anticoagulants on Total Joint Arthroplasty Outcomes.

Background: Postoperative total joint arthroplasty complications place a tremendous burden on the health care system. The purpose of this study was to compare 30-day postoperative complication rates for surgeries in patients who received preoperative antiplatelet agents and/or anticoagulants to surgeries in a control group that did not receive antiplatelet agents and/or anticoagulants in the 90 days prior to undergoing a total joint arthroplasty. Methods: We retrospectively reviewed total hip or knee arthroplasties from November 2012 to March 2016. Surgeries were categorized into 4 groups depending on their preoperative antiplatelet and anticoagulant status. Complications between the groups were compared using chi-square analysis and Fisher exact test. Results: In this study, 1,726 arthroplasties in 1,544 patients were included. Superficial wound complications were the most common complication in all 4 groups (3.8% of surgeries), with no significant difference between the groups. A statistically significant difference was found in the number of prosthetic joint infections in the group of surgeries with no antiplatelets or anticoagulants compared to surgeries with both medications administered during the 90 days preoperatively (0.82% vs 5.13%, P=0.0003). No significant difference was found between the groups with regard to stroke, myocardial infarction, pulmonary embolism, or deep venous thrombosis. Conclusion: Surgeries for which both antiplatelets and anticoagulants were administered in the 90 days preoperatively had a statistically significantly higher rate of prosthetic joint infections compared to surgeries with neither medication administered preoperatively. Surgeons can use this information to better inform and risk-stratify patients prior to surgery.

Effect of Obesity on Component Alignment in Total Knee Arthroplasty.

BACKGROUND: Obesity is routinely cited as a negative predictive factor for outcomes after total knee arthroplasty (TKA), but the direct mechanism responsible for this relationship has not been described. One possible explanation is a propensity for component malalignment in obese patients that is attributable to difficulty with surgical exposure. METHODS: This study evaluated the effect of obesity on TKA component alignment in 251 primary TKAs during a 12-month period at a single center in 2009. Postoperative component alignment was retrospectively measured and compared between patients defined as obese (body mass index [BMI] ≥30 kg/m2) and patients defined as nonobese (BMI <30 kg/m2). Alignment was determined by measuring the coronal tibiofemoral angle, coronal femoral component angle, coronal tibial component angle, sagittal femoral component angle, and sagittal tibial component angle in all of the study patients. RESULTS: Statistical analysis failed to demonstrate a statistically significant relationship between obesity and component alignment in any of the measured parameters. CONCLUSION: The results of this study support that obesity does not negatively affect TKA component alignment; another factor must be associated with the worse outcomes in obese patients undergoing TKA.

Peroneus Quartus Muscle.

The peroneus quartus (PQ) muscle is a rare but sometimes missed potential etiology of ankle pain and tendon subluxation. We report the case of a 16-year-old boy who presented with lateral right ankle pain and subluxation of peroneal tendons. He had a history of non-Hodgkin lymphoma and palpable distal fibular osteochondroma. Seven months after excision of the exostosis and repair of the peroneal tendon retinaculum, the pain recurred. Imaging showed a split peroneus brevis (PB) tendon. During surgery, a PQ muscle was found and excised, and the PB tendon was repaired. One year after surgery, the patient's symptoms were resolved.

Neurectomy Outcomes in Patients With Morton Neuroma: Comparison of Plantar vs Dorsal Approaches.

BACKGROUND: Morton neuroma is a compressive neuropathy of the plantar digital nerve. Several surgical approaches have been used to treat painful Morton neuroma, with each approach having distinct advantages and disadvantages. For this study, we used validated outcome assessment tools to retrospectively compare patient satisfaction with 2 approaches. METHODS: The medical records and survey responses of 37 patients with 42 neuromas were evaluated with respect to outcomes and patient satisfaction after neurectomies performed through either a plantar or dorsal surgical approach by one Ochsner Clinic Foundation attending physician. Outcomes were evaluated using the 36-Item Short Form Health Survey (SF-36) and the Foot Function Index (FFI) self-assessments. RESULTS: Twenty patients underwent neurectomy through a dorsal approach, and 17 patients underwent neurectomy through a plantar approach. We found no statistically significant differences between the dorsal and plantar approach groups with respect to outcomes and patient satisfaction as measured by the SF-36 or the FFI. CONCLUSION: This study supports the use of either the plantar or dorsal approach for the resection of Morton neuroma and suggests that a plantar approach for neurectomy can produce satisfactory results.

Estimation of bone mineral density in children from diagnostic CT images: a comparison of methods with and without an internal calibration standard.

We investigated the feasibility and potential limitations of estimating bone mineral density (BMD) from standard diagnostic computed tomography (dCT). We analyzed three sets of BMD measurements for L1 and L2, each performed by a novice and an expert, for intra- and interobserver variance (n=43 studies from 38 patients; median age, 13.2 years) using one BMD quantification system with (conventional quantitative computed tomography (QCT)) and two without (QCT and dCT) an external calibration phantom. Using ANOVA model, means of three sets of BMD measurements analyzed by the expert differed by 2.5mg/cm(2); for the novice, by less than 1mg/cm(2). Variation of measurement differences was less for the expert. Mean intra- and interobserver absolute standardized differences (ASD) were 1.77% and 1.8%, respectively. The mean ASD between phantom and phantom-less methods of QCT studies were 3.3%; mean ASD of phantom QCT versus phantom-less dCT was 14.3%. Regression modeling suggested compensation for sources of dCT BMD measurement bias can reduce the mean ASD of phantom QCT versus phantom-less dCT to 6.5%. Thus, phantom-less QCT of dCT adds clinically useful BMD information not typically attained from dCT, thereby augmenting patient care and presenting important possibilities for research without need for additional study.