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Case: A 19-year-old man underwent arthroscopic posterior glenoid reconstruction with a distal tibia allograft (DTA) after failing 2 posterior, soft-tissue instability surgeries. Although he experienced near-complete resolution of symptoms and return to sport, graft resorption was noted 7 months postoperatively. The patient underwent revision surgery for screw removal., Conclusion: Graft resorption has not previously been reported in the setting of arthroscopic DTA use for posterior instability. It is believed that stress shielding contributed to resorption. In such situations, screw removal may be warranted. Consideration of alternative fixation techniques and additional investigation into the causes, clinical significance, and optimal management of posterior DTA resorption are warranted., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/C318)., (Copyright © 2024 by The Journal of Bone and Joint Surgery, Incorporated.)

Study Design: Systematic review., Objective: To examine the outcomes of customized 3-dimensional (3D) printed implants for spinal reconstruction after tumor resection., Summary of Background Data: Various techniques exist for spinal reconstruction after tumor resection. Currently, there is no consensus regarding the utility of customized 3D-printed implants for spinal reconstruction after tumor resection., Materials and Methods: A systematic review was registered with PROSPERO and performed according to "Preferred Reporting Items for Systematic Reviews and Meta-analyses" guidelines. All level I-V evidence studies reporting the use of 3D-printed implants for spinal reconstruction after tumor resection were included., Results: Eleven studies (65 patients; mean age, 40.9 ± 18.1 y) were included. Eleven patients (16.9%) underwent intralesional resections with positive margins and 54 patients (83.1%) underwent en bloc spondylectomy with negative margins. All patients underwent vertebral reconstruction with 3D-printed titanium implants. Tumor involvement was in the cervical spine in 21 patients (32.3%), thoracic spine in 29 patients (44.6%), thoracolumbar junction in 2 patients (3.1%), and lumbar spine in 13 patients (20.0%). Ten studies with 62 patients reported perioperative outcomes radiologic/oncologic status at final follow-up. At the mean final follow-up of 18.5 ± 9.8 months, 47 patients (75.8%) had no evidence of disease, 9 patients (14.5%) were alive with recurrence, and 6 patients (9.7%) had died of disease. One patient who underwent C3-C5 en bloc spondylectomy had an asymptomatic subsidence of 2.7 mm at the final follow-up. Twenty patients that underwent thoracic and/or lumbar reconstruction had a mean subsidence of 3.8 ± 4.7 mm at the final follow-up; however, only 1 patient had a symptomatic subsidence that required revision surgery. Eleven patients (17.7%) had one or more major complications., Conclusion: There is some evidence to suggest that using customized 3D-printed titanium or titanium alloy implants is an effective technique for spinal reconstruction after tumor resection. There is a high incidence of asymptomatic subsidence and major complications that are similar to other methods of reconstruction., Level of Evidence: Level V, systematic review of level I-V studies., Competing Interests: T.H. was supported by a Burroughs Wellcome Fund Physician Scientist Institutional Award to the Texas A&M University Academy of Physician Scientists. C.S.: Acquisition of Vertera Inc. by NuVasive’ Shares: stock or stock options. R.A.W.M.: Globus Medical: Royalties. J.E.B.: GT Medical Technologies: paid consultant. The remaining authors declare no conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Private equity acquisition of medical specialty practices has increased in recent years. With the projected increase in the volume of elective, ambulatory orthopaedic procedures, especially in the outpatient setting, private equity firms are increasingly investing in orthopaedic practices. The purpose of this cross-sectional study was to report recent trends and variations in acquisitions of US orthopaedic practices by private equity firms and other institutional investors (venture capital firms, trusts, and large investment companies)., Methods: Acquisition data through January 1, 2020, were collected and analyzed using various financial databases, supplemented with publicly available information from financial news outlets, press releases, and financial analyst and industry reports. Disclosed financing data were also included, in addition to pertinent geographic information (state, city, and zip code) of the target practices., Results: Between 2004 and 2019, 41 orthopaedic practices and surgeon groups across 22 states were acquired by 34 private equity and other investment firms. A significant increase was observed in the number of acquisitions between 2017 and 2019, consisting of 70.7% of total transactions during the study period, with a statistically significant upward yearly trend (P = 0.002). The compound annual growth rate in acquisition volume was 29.2% during the study period. A disproportionate share of private equity acquisitions took place in the South, where more than half (51.2%) of the total transactions took place. Firms were markedly more likely to acquire or invest in practices located in major metropolitan areas (population more than 1 million) compared with those in mid-sized or rural areas (70.7%, 17.1%, 12.2%, respectively; P < 0.001)., Conclusions: Private equity acquisition of orthopaedic surgery practices has increased markedly in recent years. The effect of private equity acquisition on physician independence, practice management, and procedure reimbursement remains unclear and may be important to explore as practice management evolves., Level of Evidence: Prognostic Level III., (Copyright © 2022 by the American Academy of Orthopaedic Surgeons.)

Introduction: Orthopaedic surgeons prescribe an estimated 7.7% of all US opioid prescriptions, and understanding prescribing patterns is important to curtail the inappropriate dispensing of these drugs. The purpose of this study was to characterize recent trends in opioid prescribing patterns by orthopaedic surgeons within a Medicare population and to identify demographical characteristics associated with the highest prescribers., Methods: This study used Medicare Part D beneficiary prescription between 2013 and 2016. The number of prescriptions written per orthopaedic surgeon, prescriptions received by each beneficiary, and the length of each prescription were compared across years. Top prescribers were identified and compared with the remainder of prescribers to identify differences in sex, professional degree, and geographic regions., Results: Between 2013 and 2016, an average of 24,100 unique orthopaedic prescribers were identified. There was a decrease in the average number of prescriptions written per year from 157 to 148 and per beneficiary from 2.1 to 1.8 from 2013 to 2016, respectively. The most commonly prescribed opioids were hydrocodone/acetaminophen (47.1% of all opioids prescribed) and oxycodone/acetaminophen (17.5%). The total number of opioid prescriptions decreased by 372,045, and nonopioid pain medications increased by 269,917 between 2013 and 2016. Orthopaedic surgeons were more likely to have a high total opioid prescription count if they were male, lived in the south, and had an osteopathic degree (P < 0.001 for all)., Discussion: Orthopaedic surgeons prescribe an estimated 7.7% of all US opioid prescriptions; however, in recent years, there has been a decrease in the number of prescriptions written per surgeon, per beneficiary, total opioid prescriptions, and an increase in total nonopioid prescriptions. These changes may reflect an increase in public awareness of the opioid epidemic and subtle changes in physician behavior. Differences in opioid prescription volume by sex, professional degree, and region also illustrate a lack of consensus on opioid prescription guidelines in orthopaedic surgery., (Copyright © 2020 by the American Academy of Orthopaedic Surgeons.)

Introduction: Opioid prescriptions and abuse remain a significant national concern. Cannabinoids offer a potentially attractive nonopioid analgesic option for orthopaedic patients, and 32 US states have passed medical cannabis laws (MCLs), legalizing patient access to cannabinoids. We examine the association between implementation of state cannabis laws and prescribing patterns for opioids by orthopaedic surgeons in Medicare Part D patients between 2013 and 2017., Methods: Using the Medicare Part D Prescription Drug Event database, we measured annual aggregate daily doses of all opioid medications (excluding buprenorphine) prescribed by orthopaedic surgeons in each US state (and DC), in addition to total daily doses of opioid medications by generic name (hydrocodone, oxycodone, fentanyl, morphine, methadone, and "other opioids"). We used adjusted linear regression models to examine associations between state-specific cannabis regulations (state MCL, MCL type-dispensary or home cultivation, and recreational cannabis legalization) and annual total daily doses of opioid medications (all opioids and opioid types, separately)., Results: State MCLs were associated with a statistically significant reduction in aggregate opioid prescribing of 144,000 daily doses (19.7% reduction) annually (95% confidence interval [CI], -0.535 to -0.024 million; P < 0.01). States with MCLs allowing access to in-state dispensaries had a statistically significant reduction in total opioid prescriptions of 96,000 daily doses (13.1%) annually (95% CI, -0.165 to -0.026 million; P < 0.01). Specifically, MCLs were associated with a statistically significant reduction of 72,000 daily doses of hydrocodone annually (95% CI, -0.164 to -0.019 million; P < 0.01). No significant association between recreational marijuana legalization and opioid prescribing was found., Conclusion: Orthopaedic surgeons are among the highest prescribers of opioids, highlighting the importance of providing nonopioid analgesic alternatives in efforts to reduce opioid use in the patient cohort. This study is the first to examine the association between implementation of state cannabis laws and prescribing patterns for opioids by orthopaedic surgeons in Medicare Part D patients., Level of Evidence: Population-based ecological study., (Copyright © 2020 by the American Academy of Orthopaedic Surgeons.)

Case: A 26-year-old woman developed a painful enlarging mass in her left leg over the course of 4 years. Marginal resection and local adjuvant therapy was undertaken, and pathology confirmed the mass to be an apocrine hidrocystoma., Conclusion: Giant apocrine hidrocystomas with osseous involvement outside of the head and neck are extremely rare. Although these tumors have a low recurrence rate, this case presents a single giant apocrine hidrocystoma that recurred and was successfully treated.