Alon Burg

Trends in Femoroacetabular Impingement Research Over 11 Years

Femoroacetabular impingement is the abutment between the proximal femur and the rim of the acetabulum. It is a common cause of labral injury that has been identified as an early cause of hip osteoarthritis. The diagnosis of femoroacetabular impingement of the hip is currently well defined in orthopedic surgery but should attract the attention of physicians in other disciplines. Conversely, much less is known about the etiology and natural history of femoroacetabular impingement.The goal of this study was to assess the number of articles published on femoroacetabular impingement over 11 years in orthopedic vs nonorthopedic medical journals, and to evaluate the quality of available evidence. PubMed and OvidSP databases were searched for articles on femoroacetabular impingement published from 1999 to 2009. Articles were characterized by publication type and journal type per year. Regression analysis was used to determine the effect of publication year on number of publications of each type. The search yielded 206 publications on femoroacetabular impingement during the evaluation period. Seventy-two percent were published in orthopedic journals. Overall, the number of publications increased exponentially with time. There was an increase in clinical trials over the course of the study period. However, studies with high-quality evidence were scarce. The increase in data from orthopedic and nonorthopedic disciplines is welcome. Nevertheless, high-quality evidence on femoroacetabular impingement is lacking. We believe the current trend toward evidence-based orthopedic surgery will impact future research on this relatively new disorder.

Fixation of an Akin osteotomy with a tension suture: Our results

An Akin osteotomy is a closing wedge varus osteotomy of the proximal phalanx, usually performed as part of a hallux valgus correction surgery to complement the metatarsal correction. Numerous fixation techniques have been described; most provide good and stable fixation, but involve permanent and sometimes protruding hardware. A retrospective cohort study has been carried out of 115 feet in 109 patients using a technique with an absorbable suture fixation of the medial cortex of the proximal phalanx while preserving the lateral cortex. All the osteotomies united completely with no loss of position. HV angles and IM angles were within acceptable parameters. In comparison to others methods, the technique presented in this study is technically simple, provides good results, requires no specialized instrumentation, is cost effective and has a very low complication rate.

Ankle tourniquet pain control in forefoot surgery: a randomized study.

Background: Forefoot surgery is often performed under regional anesthesia in awake patients, using tourniquet or Esmarch bandage to obtain a bloodless field. The purpose of this study was to examine the value and need for local tourniquet pain control using local subcutaneous analgesic mixture in patients undergoing forefoot surgery under ankle block anesthesia. Materials and Methods: We prospectively randomized 56 patients who underwent forefoot surgery under ankle block to receive either subcutaneous local anesthetic mixture under the tourniquet or no additional anesthetic. We checked for local tourniquet pain score (VAS 0 to 100) and skin condition during and after the procedure. Results: The tourniquet was quite tolerable in both groups, with an average VAS score of 7 to 21. No difference was observed between groups throughout most of the procedure. No correlation between VAS scores and procedure length or patients age or gender was found. Conclusion: An ankle tourniquet was well-tolerated by patients without need for local anesthetic beneath the cuff. Level of Evidence: II, Prospective Comparative Study

Chondrolysis of the Hip following Septic Arthritis: A Rare Complication of Magnetic Resonance Arthrography

Magnetic resonance arthrography (MRA) is commonly used to detect labral tears of the hip. Complications of MRA are unusual and include minor reactions such as chemical synovitis and urticaria. This paper presents a rapidly progressive chondrolysis of the hip in a young patient after arthrography. The patient had suffered from acute septic arthritis and was treated by emergent arthroscopic surgery followed by appropriate antibiotics. At 18 months of followup, there were no signs of active infection but evidence of joint chondrolysis. Magnetic resonance arthrography (MRA) of the hip is an invasive procedure and should therefore be recommended judiciously. Post-MRA pain is common but often mild and temporary, while post-MRA joint infection is rare; nevertheless, severe joint pain and limitation should raise suspicion for septic hip.

THE EFFECTS OF USING A TOURNIQUET IN TOTAL KNEE ARTHROPLASTY: A STUDY OF 77 PATIENTS

Introduction: Total Knee Arthroplasty (TKA) is usually performed with a tourniquet. Previous studies investigated the relationship between tourniquet and blood loss. This study evaluated tourniquet usage regarding parameters such as blood loss, drainage, blood administration, knee flexion, and complications. Patients and Methods: A cohort of 77 patients who underwent total knee arthroplasty was reviewed. Results: No difference in 24-hours postoperative hemoglobin levels was observed. Blood collected in drains was slightly higher in the tourniquet group, yet there was more overall administration of blood for non-tourniquet group: a mean of 1.2 units of packed RBC versus a mean of 0.63 units for the tourniquet group. Complication rate was comparable, but a higher rate of local infection in tourniquet group was observed. No thromboembolic events were observed. Conclusion: With regards to direct blood loss parameters, there was no statistical difference between groups, provided that meticulous hemostasis is undertaken. Operating without a tourniquet poses a risk of increased demand for blood products. There is also some concern regarding local complication rate when tourniquets are used.

Do weight-bearing films affect decision making in hallux valgus surgery?

Hallux valgus is a complex deformity of the first ray and forefoot that can be surgically treated using different procedures and osteotomies. Preoperative planning includes anteroposterior and lateral plain films. The effect of weight-bearing on the results of the standardized measurements is still the subject of debate. We evaluated the effect of weight-bearing on the results of measurements and decision making by expert evaluators. A total of 21 foot and ankle surgeons were given weight-bearing and non-weight-bearing anteroposterior plain foot films of patients with hallux valgus. They were asked to measure 3 standard angles and then to select the most appropriate procedure from a short list. Using a paired Students t test, no difference in the angles measured nor in the procedures chosen was detected between the weight-bearing and non-weight-bearing films. Although it is generally accepted that decisions regarding the treatment of hallux valgus should be based on plain weight-bearing films, in the present study, we established that non-weight-bearing films can reliably be used to choose the surgical procedure.

The early results of minimally invasive technique for hallux valgus repair

Hallux valgus deformity is a common disorder, affecting about –4% of the population (Myerson [10]). Coughlin and Thompson stimated that more than 200,000 hallux valgus corrections are erformed in the United States each year [11]. The indication or surgical correction is pain associated with deformity. A distal steotomy of the first metatarsal can be used to achieve correcion inmild-to-moderate hallux valgus, with a first intermetatarsal ngle [8] of 10–20◦ [1,2,8]. There are many procedures described n the literature for distal osteotomies of the first metatarsus, most f which require soft tissue procedure combined with extensive edial approach and capsulotomy, thus risking blood supply to he metatarsal head. A percutaneous technique, as developed by Bosch et al. [12] and opularized by Magnan et al. [9], involves osteotomy of the subapital region through aminimal 1 cmmedial approach and sliding he capital segment laterally. The osteotomy is fixed using a robust mm Kirsches wire which is inserted extraperiostally to buttress gainst the metatarsal head, using the bunion to displace the head aterally. The Kirsches wire is driven into the metatarsal shaft to old the osteotomy in position for 6 weeks until bony union is chieved. The potential advantages of a minimally invasive percutaneous pproach are a reduction in operating time and surgical dissection, he possibility of performing the procedure bilaterally with fewer omplications, the use of distal ankle-block anesthetic techniques 5], and early weight-bearing (Magnan et al. [9]).