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Concomitant depression negatively impacts outcomes following total knee arthroplasty (TKA). Patient-Reported Outcomes Measurement Information System (PROMIS) surveys are validated measures that quantify depression, pain, and physical function. We hypothesized that higher preoperative PROMIS-depression scores would be associated with inferior outcomes following TKA. A total of 258 patients underwent primary TKA at a tertiary academic center between June 2018 and August 2020. PROMIS scores were collected preoperatively and at 6 weeks, 3 months, 1 year, and 2 years postoperatively. Patients with preoperative PROMIS depression scores of 55 or greater were considered PROMIS depressed (PD) and patients with scores less than 55 were considered not PROMIS depressed (ND). The primary outcomes were changes in PROMIS scores. Secondary outcomes included total and daily mean morphine milligram equivalents (MME) received during admission as well as 90-day hospital readmission and 2-year all-cause revision rates. There were 66 (25.58%) patients in the PD group and 192 (74.42%) in the ND group. Patients in the PD group had improved depression scores at all follow-up intervals (P<.001) and decreased pain scores at 1 year (P=.016). Both groups experienced similar changes in function scores at each follow-up interval. Patients in the PD group had higher total (P=.176) and daily (P=.433) mean MME use while admitted. Ninety-day hospital readmissions were higher in the PD group (P=.002). There were no differences in 2-year revision rates (P=.648). Preoperative PROMIS-depression scores of 55 or greater do not negatively impact postoperative function, depression, or pain, and patients with these scores have greater improvement in depression and pain at certain intervals. Patients in the PD group had higher readmission rates. [Orthopedics. 2024;47(1):40–45.] [ABSTRACT FROM AUTHOR]

»: A formal unsupervised activity program should be recommended to all patients recovering from total knee arthroplasty (TKA) and total hip arthroplasty (THA).»: In a subset of all patients undergoing TKA or THA, studies have found that an unsupervised activity program may be as efficacious as supervised physical therapy (PT) after surgery. Certain patients with inadequate independent function may continue to benefit from supervised PT.»: For TKA, supervised telerehabilitation has also been proven to be an effective modality, with studies suggesting equivalent efficacy compared with supervised in-person PT.»: Following TKA, there is no benefit to the use of continuous passive motion or cryotherapy devices, but there are promising benefits from the use of pedaling exercises, weight training, and balance and/or sensorimotor training as adjuncts to a multidisciplinary program after TKA.»: No standardized postoperative limitations exist following TKA, and the return to preoperative activities should be dictated by an individual's competency and should consist of methods to minimize high impact stress on the joint.»: Despite traditional postoperative protocols recommending range-of-motion restrictions after THA, it is reasonable to recommend that hip precautions may not be needed routinely following elective primary THA. [ABSTRACT FROM AUTHOR]

» Metallosis is a rare but significant complication that can occur after total hip arthroplasty (THA) for a variety of reasons but most commonly in patients with metal-on-metal implants.» It is characterized by the visible staining, necrosis, and fibrosis of the periprosthetic soft tissues, along with the variable presence of aseptic cysts and solid soft tissue masses called pseudotumors secondary to the corrosion and deposition of metal debris.» Metallosis can present with a spectrum of complications ranging from pain and inflammation to more severe symptoms such as osteolysis, soft tissue damage, and pseudotumor formation.» Workup of metallosis includes a clinical evaluation of the patient's symptoms, imaging studies, serum metal-ion levels, and intraoperative visualization of the staining of tissues. Inflammatory markers such as erythrocyte sedimentation rate and C-reactive protein along with intraoperative frozen slice analysis may be useful in certain cases to rule out concurrent periprosthetic joint infection.» Management depends on the severity and extent of the condition; however, revision THA is often required to prevent rapid progression of bone loss and tissue necrosis., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/B15)., (Copyright © 2023 by The Journal of Bone and Joint Surgery, Incorporated.)

Objective: The purpose of this study was to compare standard knee arthroscopic and MRI findings and measurements for visualization of the femoral condyle articular cartilage. The hypothesis was that certain posterior cartilage defects identified with MRI may not be accessible with routine arthroscopy., Materials and Methods: Six cadaveric knees were examined by routine arthroscopy through standard inferomedial and inferolateral portals. Suture anchors were inserted into the femoral condyles at 30°, 60°, 90°, and 120° of flexion as markers of the cartilage surface at the most posterior aspect of the condyle that could be accessed at each degree of flexion. Each specimen was then examined with 3-T MRI and gross dissection. Measurements were obtained and compared., Results: During arthroscopy at 90° of knee flexion, only 5.83 mm of the medial femoral condyle and 6.83 mm of the lateral femoral condyle were visualized posterior to the anchor placed at 90° of flexion. These arthroscopic measurements were statistically significant underestimates of the actual amount of cartilage identified posterior to the 90° anchor at gross dissection (medial condyle, 44.20 mm; lateral condyle, 37.50 mm) and MRI (medial, 41.33 mm; lateral, 38.87 mm). This indicates that 85.9% of the medial and 81.8% of the lateral posterior articular cartilage of the femoral condyle seen at MRI were not visualized during arthroscopy., Conclusion: More than 80% of the articular cartilage proximal to the menisci seen at MRI is not visible during routine arthroscopy. This far posterior articular cartilage should be called the hidden zone.

Incomplete release of the transverse carpal ligament (TCL) and median nerve injury are complications of carpal tunnel release (CTR). In this article, we describe a modified mini-open release using a fine nasal turbinate speculum to aid in the proximal release with direct visualization of the proximal limb of the TCL and the distal volar forearm fascia (DVFF). The technique begins with a 2.5-cm palmar longitudinal incision, and standard distal release of the TCL is completed. A fine nasal turbinate speculum is inserted into the plane above the proximal limb of the TCL and the DVFF. A long-handle scalpel is used to incise the TCL and the DVFF under direct visualization. We retrospectively analyzed a cohort of 101 consecutive CTR cases (63 right, 38 left). Carpal tunnel syndrome symptoms were relieved in all patients with a high degree of satisfaction. This modified mini-open technique provides surgeons with a reproducible and inexpensive method to ensure a safe proximal release of the TCL.

Recent literature reports an increase in the rate of shoulder arthroplasties, particularly total shoulder arthroplasties (TSAs), being performed in the United States. However, the national epidemiology of use of hemiarthroplasty (HA) and TSA as treatments for glenohumeral osteoarthritis has not been elucidated. We conducted a study to analyze trends in using HA and TSA as treatments for glenohumeral osteoarthritis from 2000 to 2010, and to compare patient characteristics and inpatient complications. US Nationwide Inpatient Sample patients with a primary inpatient diagnosis of shoulder arthritis and a principal procedure of HA or TSA were identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedural codes. From 2000 to 2010 the nationally adjusted population rate of shoulder arthroplasty performed for osteoarthritis increased 3.7-fold. Specifically, the population rate of TSA increased 5.0-fold, and that of HA increased 1.9-fold. In 2010, 80.3% of patients having shoulder arthroplasty for arthritis underwent TSA. TSA patients were older (P < .0001) and had a higher mean number of chronic illnesses (P = .034). TSA-associated discharges had a higher rate of surgical and medical care complications (P = .011) and blood transfusions (P = .041) after adjusting for comorbidities.