July 2007  Volume XXXVI No. 7 pISSN:1078-4519 eISSN:1934-3418

E-PUBLISHING

E-Focus on Adult Reconstruction

100	Guest Editorial—The Merits of Regional Anesthesia for Patients Undergoing Total Hip Replacement Javad Parvizi, MD Javad Parvizi, MD, is with the Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania. Abstract not available. Am J Orthop. 2007;36(7):E100
101	Comparison of Outcomes of Using Spinal Versus General Anesthesia in Total Hip Arthroplasty Stephen G. Maurer, MD, Andrew L. Chen, MD, Rudi Hiebert, MSc, Gavin Pereira, MD, and Paul E. Di Cesare, MD Paul E. Di Cesare, MD, 4860 Y Street, Suite 3800, Sacramento, CA 95817 (tel, 212-598-6567; fax, 212-598-6096; e-mail, pedicesare@aol.com). Blood loss, operative time, and rate of complications were compared in 606 patients undergoing primary unilateral total hip arthroplasty with either spinal anesthesia (SA) or general anesthesia (GA). Patients were followed for 2 years after surgery. Compared with GA, SA resulted in mean reductions of 12% in operative time, 25% in estimated intraoperative blood loss, 38% in rate of operative blood loss, and 50% in intraoperative transfusion requirements. Compared with patients receiving GA, patients receiving SA had higher hemoglobin levels on postoperative days 1 and 2 and a 20% lower total transfusion requirement. SA appears superior to GA for this procedure. Am J Orthop. 2007;36(7):E101-E106
107	Utility of Judet Oblique X-Rays in Preoperative Assessment of Acetabular Periprosthetic Osteolysis: A Preliminary Study Adrian Thomas, MD, Noah J. Epstein, MD, Kathryn Stevens, MD, and Stuart B. Goodman MD, PhD Stuart B. Goodman, MD, PhD, Department of Orthopaedic Surgery, Stanford University Medical Center, 300 Pasteur Dr, R153, Stanford, CA 94305 (tel, 650-723-7072; fax, 650-723-6396; e-mail, goodbone@stanford.edu). Anteroposterior (AP) x-rays provide limited information about size and location of acetabular osteolytic lesions after total hip arthroplasty (THA). In the study reported here, we sought to determine the utility of oblique (Judet) x-rays in preoperative assessment of acetabular lesions. AP, anterior (obturator), and posterior (iliac oblique) x-rays of 10 patients (10 hips) who underwent revision THA were evaluated retrospectively. Mean osteolytic area was 790 mm2 (SD, 520 mm2) on anterior oblique x-rays and 384 mm2 (SD, 396 mm2) on AP x-rays (P = .005). Mean osteolytic area on posterior oblique x-rays was 512 mm2 (SD, 430 mm2) (P = .34). Judet x-rays were useful in determining size and location of acetabular osteolysis. Am J Orthop. 2007;36(7):E107-E110
111	Tibial Fracture After Total Knee Arthroplasty Treated With Retrograde Intramedullary Fixation Kevin M. Doulens, MD; Atul B. Joshi, MD, MCh(Orth), FRCS; and Russell A. Wagner, MD Russell A. Wagner, MD, Department of Orthopaedics, John Peter Smith Hospital, 1500 S Main St, Fort Worth, TX 76104 (tel, 817-927-1370; fax, 817-927-3955; e-mail, Russell.Wagner@jpshealth.org). Abstract not available. Introduction provided instead. Total knee arthroplasty is a common procedure performed by orthopedic surgeons, with approximately 250,000 procedures done annually in the United States. The long-term results of knee replacements have been steadily improving, with the majority of patients reporting good to excellent levels of satisfaction. With increasing longevity of both patients and implants, the incidence of postarthroplasty complications is also rising. The various complications following knee replacements have been well documented in the literature. Of these, periprosthetic fractures, although uncommon, pose a challenging issue to orthopedic surgeons.1 We are reporting a case of a tibial fracture below a total knee arthroplasty treated with a retrograde intramedullary nail. Am J Orthop. 2007;36(7):E111-E113
114	Total Knee Arthroplasty for Degenerative Arthritis in a Patient With Femoral Trochlear Dysplasia: A Case Report Douglas D. Nowak, MD, Andrew Grose, MD, Robert H. Brophy, MD, and Thomas P. Sculco, MD Thomas P. Sculco, MD, Department of Orthopaedics, The Hospital for Special Surgery, 535 E 70th St, New York, NY 10021 (e-mail, sculcot@hss.edu). Abstract not available. Introduction provided instead. Femoral trochlear dysplasia is characterized by abnormal growth and development of the anterior knee joint.1 In this condition the lateral condyle of the distal femur is blunted, resulting in a shallow or absent femoral trochlear groove.2 This blunting is often associated with a small and hypoplastic patella with flattened articular facets.1,2 Trochlear dysplasia often leads to abnormal patellar tracking and can result in subluxation or recurrent dislocations of the patella. Multiple surgical methods of realignment have been described to treat trochlear dysplasia. However, there is scant literature regarding the late complications of untreated dysplasia and its treatment. We present a patient with patellofemoral dysplasia who required a total knee arthroplasty for severe degenerative joint disease. Am J Orthop. 2007;36(7):E114-E116

Focus on Foot and Ankle

347	Guest Editorial—The AOFAS Visitation Program at Walter Reed Donald R. Bohay, MD, and Lowell H. Gill, MD Donald R. Bohay, MD, Orthopaedic Associates of Grand Rapids, Grand Rapids, Michigan (drbohay@oagr.com). Abstract not available. Am J Orthop. 2007;36(7):347
348	Orthopedic Surgery Considerations in Post-Polio Syndrome Neil P. Sheth, MD, and Mary Ann E. Keenan, MD Mary Ann E. Keenan, MD, Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, 3400 Spruce St (2 Silverstein), Philadelphia, PA 19104 (tel, 215-349-8695; fax, 215-349-5890; e-mail, maryann.keenan@uphs.upenn.edu). Abstract not available. Am J Orthop. 2007;36(7):348-353
354	Implantable Direct-Current Bone Stimulators in High-Risk and Revision Foot and Ankle Surgery: A Retrospective Analysis With Outcome Assessment Johnny T. C. Lau, MD, Emmanouil D. Stamatis, MD, Mark S. Myerson, MD, and Lew C. Schon, MD Lew C. Schon, MD, c/o Lyn Camire, Editor, Union Memorial Orthopaedics, Johnston Professional Bldg, #400, 3333 N Calvert St, Baltimore, MD 21218 (tel, 410-554-6668;fax, 410-261-8105; e-mail, lyn.camire@medstar.net). Efficacy and morbidity of a surgically implanted direct-current bone stimulator were evaluated in 38 patients (40 feet) with fracture nonunion or at high risk for nonunion; 14 of these patients had Charcot (diabetic) neuroarthropathy. Union occurred in 26 (65%) of the 40 feet; complications other than nonunion occurred in 16 feet (40%). Two amputations (5%) were performed in cases of intractable neuritis and deep infection. Of the 6 cases of deep infection (15%), 5 resolved with device removal, and the sixth case required below-knee amputation. Use of a bone stimulator in patients with diabetes may be problematic, but the device did not have any adverse effects in other high-risk patients. Am J Orthop. 2007;36(7):354-357
361	Surgical Stabilization of Nonplantigrade Charcot Arthropathy of the Midfoot Michael S. Pinzur, MD, and James Sostak, MD Michael S. Pinzur, MD, Loyola University Medical Center, 2160 S First Ave, Maywood, IL 60153 (tel, 708-216-4993; fax, 708-216-1225; e-mail, mpinzu1@lumc.edu). Fifty-one adults (28 men, 23 women) with Charcot arthropathy of the midfoot underwent surgical correction. Mean patient age was 58 years (SD, 9.9 years). All affected feet were nonplantigrade and at high risk for ulcers. Before surgery, mean lateral talar–first metatarsal angle was 27.6° (SD, 12.8°). Corrective osteotomy was performed to achieve plantigrade alignment. At minimum 1-year follow-up, 44 of 51 patients had the desired outcome. Mean lateral talar–first metatarsal angle had decreased to 6.4° (SD, 7.7°). Despite its associated high complication rate, corrective osteotomy can help patients become ulcer- and infection-free and maintain their ability to walk with commercially available therapeutic footwear. A treatment algorithm is presented. Am J Orthop. 2007;36(7):361-365
367	Reduction of High-Grade Isthmic and Dysplastic Spondylolisthesis in 5 Adolescents Baron S. Lonner, MD, Edward W. Song, MD, Carrie L. Scharf, BA, and Jeff Yao, MD Baron S. Lonner, MD, 212 E 69th St, New York NY 10021 (tel, 212-737-5540; fax, 212-737-1369; e-mail,blonner@nyc.rr.com). Treatment of high-grade isthmic and dysplastic spondylolisthesis in children and adolescents remains a challenge. Surgical treatment of spondylolisthesis has been recommended in adolescents with pain refractory to nonoperative modalities, slippage progression, or >50% slippage on presentation. Controversy exists as to the optimal surgical approach for high-grade spondylolisthesis. In this report, we describe 5 cases of high-grade isthmic and dysplastic spondylolisthesis in adolescents and review the literature on surgical treatment for this entity. Operative records, charts, x-rays, and Scoliosis Research Society outcome questionnaires (SRS-22) were retrospectively evaluated for 5 consecutive patients diagnosed with and treated for high-grade spondylolisthesis. Each patient received treatment consisting of decompression, reduction, and circumferential fusion with transpedicular and segmental fixation from a posterior approach. Two patients had transient L5 nerve root deficit, which resolved within 3 months. Reduction benefits include a decrease in shear stresses (and resulting decreased rates of postoperative pseudarthrosis and slip progression), restoration of sagittal alignment and lumbosacral spine balance, and improvement in clinical deformity. Am J Orthop. 2007;36(7):367-373
374	A Woman With Unilateral Knee Pain in the Absence of Arthritis or Trauma Stephen S. Shinault, DO, and Paul D. Clifford, MD Paul D. Clifford, MD, Department of Radiology, Applebaum Outpatient Center, University of Miami, 1115 NW 14th St, Miami, FL 33136-2106 (tel, 305-243-5449; fax, 305-243-8422; e-mail, pclifford@med.miami.edu). Abstract not available. Am J Orthop. 2007;36(7):374-375
377	A Unique Case of Ulnar Tunnel Syndrome in a Bicyclist Requiring Operative Release LT Stacey Black, MD, MC, USN, CDR Eric Hofmeister, MD, MC, USN, and CAPT Michael Thompson, MD, MC, USN Eric Hofmeister, MD, Naval Medical Center San Diego, Department of Orthopedics, 34800 Bob Wilson Dr, San Diego, CA 92134 (tel, 619-532-8427; e-mail, ephofmeister@nmcsd.med.navy.mil). The continued growth of recreational and competitive sports is accompanied by the need for health care providers to recognize and treat conditions in athletes that have been traditionally associated with other occupational injury. This is particularly important when early diagnosis and prompt intervention for prevention and treatment may alter the outcome. We present an interesting case of ulnar tunnel syndrome in a high-performance bicyclist with compressive ulnar neuropathy refractory to nonoperative management but successfully treated with surgical release. We review evaluation, diagnosis, and historical and current treatment algorithms. Am J Orthop. 2007;36(7):377-379
380	Angled Posteroanterior Fluoroscopy for L5-S1 Discography: A Technical Note Nabil A. Ebraheim, MD, Nakul Karkare, MD, Jiayong Liu, MD, Rongming Xu, MD, and Clément M. L. Werner, MD Nabil Ebraheim, MD, Department of Orthopaedic Surgery, University of Toledo, 3000 Arlington Ave, Toledo, OH 43614 (e-mail, nebraheim@meduohio.edu). Lumbar discography, a useful modality for evaluating patients with lower back pain, is performed under fluoroscopy with posteroanterior and lateral fluoroscopic imaging. Despite use of fluoroscopy, needle placement into the L5–S1 disc may be difficult, especially in the presence of degenerative changes. We describe use of angled posteroanterior fluoroscopy with the fluoroscopy beam directed 30° to 40° caudally in a prone patient for clear visualization of the L5–S1 disc space. Use of this radiographic view aids in accurate needle placement and might decrease both procedure duration and fluoroscopic exposition. Am J Orthop. 2007;36(7):380-381

RHEUMATOID ARTHRITIS CONSULT COLLECTION

Supported by an educational grant from Bristol-Myers Squibb.

2	The New Era in the Treatment of Rheumatoid Arthritis Chaim Putterman, MD Abstract not available. Am J Orthop. 2007;36(7S):2-4
5	The Pathogenesis of Rheumatoid Arthritis Alisa Erika Koch, MD Abstract not available. Am J Orthop. 2007;36(7S):5-8
9	Early Intervention in Rheumatoid Arthritis Lisa C. Vasanth, MD, MS, and Stephen A. Paget, MD, FACP, FACR Abstract not available. Am J Orthop. 2007;36(7S):9-10, 15-17
11	Patient Handout: Maintaining Mental and Physical Health (in English and Spanish) Linda Leff, RNC, and Adena Batterman, LCSW Abstract not available. Am J Orthop. 2007;36(7S):11-14
18	New and Promising Treatments for Rheumatoid Arthritis R. John Looney, MD, and William Stohl, MD, PhD Abstract not available. Am J Orthop. 2007;36(7S):18-23

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