Orthopaedic Hardware, Total Joint Replacements, and Their Complications
Harry Griffiths in Musculoskeletal Radiology, 2008
However, the most important complication is infection. Drez et al. (2) reviewed the incidence of infections following arthroscopy. In 1985, 120,000 arthroscopies were performed with 105 complications and a 1% incidence of infection. Similarly, in 1986, although a lot more arthroscopies were performed, the rate of infection remained between 1% and 2%. However, in obese patients this increased to 18%, in diabetic patients to 10%, in patients on steroids to 16%, and in debilitated patients to 23%. There was also a relationship between the incidence of infection and the length of stay in the hospital: 1% incidence of infections at one day, 2% at seven days, and 3.5% at two weeks. The average cost of managing infections per patient ranges between $10,000 and $100,000. The Centers for Disease Control (CDC) estimates that there are 80,000 plus deaths from hospital-acquired infections per year. In another article, Maurer, et al. (3) reviewed their findings in 24 patients with open tibial fractures. They all underwent external fixation from 7 to 230 days. Seven patients developed one or more infected pin sites. All 24 patients went on to IM nailing and five went on to develop infection around the nail.
Surgery of the Hip
Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou in Operative Orthopaedics, 2020
Hip arthroscopy is indicated in a variety of painful conditions of the hip. The most frequent are Femeroacetabular impingementSeptic arthritis of the hip jointOsteoarthritisLabral pathologyOsteochondral defectRemoval of loose bodiesSynovectomy or synovial biopsy
Animal Models of Meniscal Repair
Yuehuei H. An, Richard J. Friedman in Animal Models in Orthopaedic Research, 2020
Arthroscopy can be a useful tool for the gross evaluation of an allograft or a graft.47,76,77 It can provide data like synovial irritation, shrinkage, tearing, fraying and gross degenerative changes within the knee joint. In humans repeat arthroscopy after an operation is only done when new problems arise, whereas in animals it can be done at regular intervals. The big advantage of this procedure is that more follow-up data can be collected without the need to sacrifice the animal. However, minor changes and especially the processes going on inside the meniscus remain obscured. We have tried arthroscopy in the dog and think that technically, the procedure is easy to perform. Most likely, arthroscopy can be performed in other large animals too.
Factors associated with RVU generation in common sports medicine procedures
Published in The Physician and Sportsmedicine, 2022
R. Timothy Kreulen, Micheal Raad, Farah N. Musharbash, Suresh K. Nayar, Matthew J. Best, Varun Puvanesarajah, Majd Marrache, Uma Srikumaran, John H. Wilckens
The NSQIP dataset enabled direct comparison between open and closed procedures in the shoulder, where both approaches are commonly used. For each procedure, the arthroscopic technique generated higher wRVUs/hour than the open technique. Arthroscopic surgery requires more surgical expertise and has a higher equipment cost but is associated with lower infection rates compared with open procedures [27]. Interestingly, patients also perceive many benefits to arthroscopic surgery compared with open surgery [28]. However, no long-term functional difference has been shown [29]. Although patient perceptions are not part of the RVU calculation algorithm, it is interesting that they correlate with wRVU generation in this case. It should also be noted that surgeons may choose an open approach for more difficult cases.
Acute pulmonary embolism after arthroscopic glenoid labral repair and subacromial decompression: case report and review of the literature
Published in The Physician and Sportsmedicine, 2018
Michelle Yagnatovsky, Amos Z Dai, Michael Zacchilli, Laith M Jazrawi
There have been several cases of upper extremity DVT after arthroscopic shoulder surgery reported in the literature [2,5–8,10–14]. Takahashi examined the incidence of DVT in 175 patients following arthroscopic shoulder surgery. Ten patients (5.7%) developed DVT, and one patient developed an upper extremity DVT [2,15]. DVTs rarely develop in the upper extremities. They mainly occur in the legs, attributed to the sedentary postoperative phase during which patients recover. Between 1% and 4% of all DVTs occur in the upper extremities [16–18]. Although less common than lower extremity DVT, upper extremity DVTs are twice as likely to progress to PE and is associated with a mortality rate as high as 16% [16,19–21]. Although it is rare for DVTs to occur in the upper extremities after arthroscopy, several cases have been reported, and complications may be fatal. Thus, it is important for surgeons to be aware and take necessary precautions.
The Effect of Pre-emptive Dexketoprofen Administration on Postoperative Pain Management in Patients with Ultrasound Guided Interscalene Block in Arthroscopic Shoulder Surgery
Published in Journal of Investigative Surgery, 2021
U. Demir, I. Ince, M. Aksoy, A. Dostbil, M. A. Arı, M. M. Sulak, M. Kose, M. Tanios, O. Ozmen
Analgesia commonly used following shoulder surgery are NSAIDs, opioids, local injection of local anesthetics to the operative field, and brachial plexus blocks. Powerful opioids may be required since pain associated with shoulder surgery can be very severe, and these may be used for days or weeks [7]. Arthroscopy can reduce postoperative pain in shoulder surgery, however, this benefit is not generally seen in the first few days since analgesic requirements in the absence of local or regional anesthesia may be equal to those of open shoulder surgery [7]. As a result, with the reduction of early postoperative pain, arthroscopic shoulder surgery has entitled to “same-day surgery” [1]. The available options to improve postoperative pain include intra-articular (IA) local anesthetic (alone or in addition to opioids), suprascapular nerve block (alone or in addition to axillary nerve block), single-shot ISB, and continuous (catheterized) ISB [8].
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