Case: The American Academy of Orthopaedic Surgeons has recently identified continuous intracompartmental pressure monitoring as 1 of the few means to assist in ruling out acute compartment syndrome (ACS). There are very few methods that allow this measurement. This manuscript describes the use of a new digital monitoring system for ACS in 3 patients. This minimally invasive device, the MY01 (NXTSENS, Montreal, Canada) is capable of continuously and precisely measuring variations in intracompartmental pressure. Conclusion: MY01 detected the occurrence of ACS at early-stage and expedited the timing of surgery for 2 patients. This tool also objectively excluded a suspected diagnosis of ACS in a medically comorbid patient, obviating the need for unnecessary fasciotomies and potential complications.

Background: Although day surgery (DS) total hip arthroplasty (THA) has good patient satisfaction and a good safety profile, accurate episode-of-care cost (EOCC) calculations for this procedure compared to standard same-day admission (SDA) THA are not well known. We determined the EOCCs for patients who underwent THA, comparing DS and SDA pathways. Methods: We evaluated the EOCCs for consecutive patients who underwent DS or SDA THA for osteoarthritis or osteonecrosis performed by a single surgeon at 1 academic centre from July 2018 to January 2020. Patient demographic and clinical data were recorded, as were preoperative diagnosis, type of anesthesia, type of implant used, surgical time and estimated blood loss. We determined direct and indirect costs from time of arrival at the presurgical unit to hospital discharge. We determined the EOCCs using an ABC method. Results: The study included 50 patients who underwent THA (25 DS, 25 SDA). The mean length of stay in the SDA group was 45.1 (standard deviation [SD] 21.4) hours. Differences were observed between the 2 groups in mean age, mean Charlson Comorbidity Index score, surgical technique and mean surgical time (p ≤ 0.001). The mean total EOCC for SDA THA was $10 911 (SD $706.12, range $9944.07–$12 871.95), compared to $9672 (SD $546.55, range $8838.30–$11 058.07) for DS THA, a difference of 11.4%, mostly attributable to hospital resources such as laboratory tests, radiologic studies and cost of the surgical admission. Conclusion: Day surgery THA is cost-effective in selected patient populations. With the savings identified in this study, every 10 additional DS THA procedures would save sufficient resources to perform an additional THA operation. Contexte: Si l’arthroplastie totale de la hanche (ATH) en chirurgie d’un jour est associée à un taux de satisfaction élevé des patients et à un bon profil d’innocuité, il existe peu de calculs précis du coût de la période de traitement (CPT) pour cette intervention par rapport au coût des interventions avec hospitalisation. Nous avons déterminé le CPT des patients ayant subi une ATH pour ensuite comparer les interventions en chirurgie d’un jour à celles avec hospitalisation. Méthodes: Nous avons évalué le CPT de patients consécutifs ayant subi une ATH en chirurgie d’un jour ou avec hospitalisation pour cause d’arthrose ou d’ostéonécrose auprès d’un même chirurgien dans un centre universitaire entre juillet 2018 et janvier 2020. Les caractéristiques démographiques et les données cliniques des patients ont été notées, de même que le diagnostic préopératoire, le type d’anesthésie, le type d’implant utilisé, le temps de chirurgie et la perte sanguine estimée. Nous avons déterminé les coûts directs et indirects, de l’admission à l’unité préopératoire jusqu’au congé de l’hôpital, et calculé le CPT avec la méthode des coûts par activités. Résultats: L’étude comprenait 50 patients ayant subi une ATH (25 en chirurgie d’un jour, 25 avec hospitalisation). La durée de séjour moyenne pour le groupe en chirurgie d’un jour était de 45,1 heures (écart type [É.T.] 21,4 heures). Des différences ont été notées entre les 2 groupes pour l’âge moyen, l’indice de comorbidités de Charlson moyen, la technique chirurgicale et le temps de chirurgie moyen (p ≤ 0,001). Le CPT total moyen était de 10 911 $ pour les interventions avec hospitalisation (É.T. 706,12 $, plage 9944,07 $–12 871,95 $), comparativement à 9672 $ pour les chirurgies d’un jour (É.T. 546,55 $, plage 8838,30 $–11 058,07 $), une différence de 11,4 % attribuable principalement aux ressources hospitalières telles que les analyses de laboratoire, les examens radiologiques et les coûts d’admission au bloc opératoire. Conclusion: L’ATH en chirurgie d’un jour est rentable lorsqu’on cible des populations de patients précises. Selon les économies quantifiées dans cette étude, les ressources économisées en réalisant 10 ATH en chirurgie d’un jour seraient suffisantes pour une intervention de plus.

Limb salvage surgeries utilizing endoprostheses and allografts are performed for a variety of oncologic conditions. These reconstructions can fail and require revision for many reasons, which are outlined and classified into mechanical failures (soft tissue failures, aseptic loosening, structural failure), non-mechanical failures (infection, tumor progression), and pediatric failures (physeal arrest, growth dysplasia). Distinct radiologic and clinical findings define specific failure subtypes but are sparsely illustrated in the radiology literature. Specifically, an understanding of the organizational structure of the failure modes can direct radiologists’ search for post-reconstruction complications, enhance an appreciation of their prognostic significance, and facilitate research by standardizing the language and conceptual framework around outcomes. The purpose of this review is to highlight the key radiologic findings and imaging studies of each failure mode in orthopedic oncologic reconstructive surgery in the context of risk factors, failure rates, prognosis and survival statistics, and clinical decision-making regarding chemotherapy, radiation, and revision surgery.

The femoral-sided anatomic footprint of the anterior cruciate ligament (ACL) has been widely studied during the past decades. Nonanatomic placement is an important cause of ACL reconstruction (ACLR) failure. To describe femoral tunnel placement in ACLR through use of a comprehensive 3-dimensional (3D) cylindrical coordinate system combining both the traditional clockface technique and the quadrant method. Our objective was to validate this technique and evaluate its reproducibility. Descriptive laboratory study. The EOS Imaging System was used to make 3D models of the knee for 37 patients who had undergone ACLR. We designed an automated cylindrical reference software program individualized to the distal femoral morphology of each patient. Cylinder parameters were collected from 2 observers’ series of 3D models. Each independent observer also manually measured the corresponding parameters using a lateral view of the 3D contours and a 2-dimensional stereoradiographic image for the corresponding patient. The average cylinder produced from the first observer’s EOS 3D models had a 30.0° orientation (95% CI, 28.4°-31.5°), 40.4 mm length (95% CI, 39.3-41.4 mm), and 19.3 mm diameter (95% CI, 18.6-20.0 mm). For the second observer, these measurements were 29.7° (95% CI, 28.1°-31.3°), 40.7 mm (95% CI, 39.7-41.8 mm), and 19.7 mm (95% CI, 18.8-20.6 mm), respectively. Our method showed moderate intertest intraclass correlation among all 3 measuring techniques for both length (r = 0.68) and diameter (r = 0.63) but poor correlation for orientation (r = 0.44). In terms of interobserver reproducibility of the automated EOS 3D method, similar results were obtained: moderate to excellent correlations for length (r = 0.95; P < .001) and diameter (r = 0.66; P < .001) but poor correlation for orientation (r = 0.29; P < .08). With this reference system, we were able to describe the placement of each individual femoral tunnel aperture, averaging a difference of less than 10 mm from the historical anatomic description by Bernard et al. This novel 3D cylindrical coordinate system using biplanar, stereoradiographic, low-irradiation imaging showed a precision comparable with standard manual measurements for ACLR femoral tunnel placement. Our results also suggest that automated cylinders issued from EOS 3D models show adequate accuracy and reproducibility. This technique will open multiple possibilities in ACLR femoral tunnel placement in terms of preoperative planning, postoperative feedback, and even intraoperative guidance with augmented reality.

Background: Periprosthetic joint infections (PJI) following joint arthroplasty are now the leading cause of reoperation and are associated with serious morbidity to the patient, often requiring several staged operations and a prolonged course of parenteral antibiotics. Prophylactic administration of intravenous antibiotics before skin incision is arguably the most important measure to prevent PJI; however, the dose effectiveness of cefazolin in target tissue is not well known. We aimed to identify parameters affecting local tissue concentration (LTC) of cefazolin. Methods: We performed a literature search using the following keywords: “orthopaedics,” “orthopedic,” “arthroplasty” and “cefazolin.” We included studies that measured LTC of cefazolin from samples obtained during either a total knee or total hip arthroplasty. Results: Of the 332 records screened, we included 10 studies that described LTC of cefazolin. The included studies evaluated dosing (n = 7), procedure type (n = 3), body mass index (n = 1) and tourniquet utilization (n = 1). Conclusion: Few studies have measured LTC levels of antibiotics (or levels of cefazolin) to validate current recommendations for antibiotic prophylaxis in orthopedic surgery. With infection as the leading reason for early reoperation or revision surgery, the parameters affecting LTC during orthopedic procedures need to be further assessed. Contexte: Les infections de prothèse articulaire (IPA) suivant une arthroplastie de la hanche sont aujourd’hui la principale cause de réopération; elles sont associées à une grave morbidité chez le patient et nécessitent souvent plusieurs interventions en séquence et une antibiothérapie prolongée administrée par voie parentérale. L’administration prophylactique d’antibiotiques intraveineux avant l’incision cutanée est sans doute la mesure la plus importante pour prévenir les IPA; la dose efficace de céfazoline dans le tissu ciblé n’est toutefois pas connue avec précision. Nous avons voulu déterminer les paramètres modulant la concentration locale tissulaire de la céfazoline. Méthodes: Nous avons effectué une recherche documentaire à l’aide des mots-clés suivants : « orthopaedics » [orthopédie], « orthopedic » [orthopédique], « arthroplasty » [arthroplastie] et « cefazolin » [céfazoline]. Nous avons aussi inclus des études ayant mesuré la concentration locale de la céfazoline dans des échantillons obtenus dans le cadre d’arthroplasties totales du genou ou de la hanche. Résultats;: Après examen de 332 articles, nous avons inclus 10 études décrivant la concentration locale tissulaire de céfazoline, qui évaluaient la dose (n = 7), le type d’intervention (n = 3), l’indice de masse corporelle (n = 1) et l’utilisation d’un garrot (n = 1). Conclusion: Peu d’études ont mesuré les concentrations locales tissulaires d’antibiotiques (ou de céfazoline) afin de valider les recommandations actuelles sur l’antibioprophylaxie en chirurgie orthopédique. Les infections étant la principale cause de réopérations ou chirurgies de révision hâtives, les paramètres modulant la concentration locale tissulaire au cours des interventions orthopédiques doivent faire l’objet d’une évaluation plus poussée.