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Hot Topics in Orthopedics

      Orthopedic surgeons have always been great innovators and inventors, witness the plethora of techniques and devices for fracture fixation, joint replacement, and deformity correction. Never satisfied with the status quo and convinced that better outcomes can be obtained, orthopedic surgeons continue to develop techniques for improving patient function and decreasing adverse events. This issue of Orthopedic Clinics of North America contains many excellent introductions to some of the recent developments in orthopedic surgery.
      Dr Han and colleagues explain the advantages of robotic systems for total knee replacement and discuss contemporary robotic total knee arthroplasty (TKA) systems that have gained or are pending Food and Drug Administration approval. They review the features of the individual robotic platforms, their accuracy in achieving the surgeon’s preoperative plan, and the resulting clinical outcome in terms of patient function and satisfaction. Periprosthetic infection is a dreaded complication of total joint replacement surgery, and investigations continue to identify methods to decrease its frequency. Drs Zlontnicki and colleagues discuss the addition of hydrogen peroxide, povidone-iodine, and chlorhexidine to irrigants to prevent and treat infection and note that a large body of evidence supports their use as prophylaxis to prevent infection as compared with treating infection. After finding that over half of TKA patients received controlled substances from both the surgery site provider and a nonsurgery site provider in the year following surgery, Dr Derefinko and colleagues caution that orthopedic surgeons should consider the possibility of outside prescribing when prescribing opioid analgesic.
      Treatment of fractures has been the focus of many and varied devices and techniques. Drs Wasky and Beltran describe the use of “extreme” intramedullary nailing and less-invasive plating of lower-extremity periarticular fractures, noting that the indications for the use of extreme nailing is multifactorial and is based on fracture pattern, condition of the soft tissues, the medical condition of the patient, and the importance of earlier or immediate weight-bearing. Nontraditional methods of fibular fixation, such as minimally invasive methods, are described and discussed by Drs Beleckas and Szatkowski. They note the effectiveness of these techniques for ensuring a superior prognosis for ankle fractures.
      Drs Hosseinzadeh and Shlykov discuss the growing practice of dual fellowships for pediatric sports medicine specialists and its impact on patient care and training patterns. Drs Baker, Milbrandt, and Larson review the translational science foundation, early to mid-term clinical reports, and future directions for the nonfusion technique of anterior vertebral body tethering for adolescent idiopathic scoliosis.
      Advances in diagnosis and management for common complaints and complex injuries of the hand and wrist, including volar locked plating of distal radial fractures, WALANT (wide awake local anesthesia no tourniquet) for outpatient procedures, and techniques for tendon and nerve repair and reconstruction, are described and discussed by Dr Doering. The review article by Dr Callegari and colleagues summarizes the effects of modern reverse shoulder prostheses on outcomes. In a detailed review of the literature, Dr Adeyemo and colleagues found that no definitive answers are available regarding best practice for proximal humeral fractures, but there is literature to guide operative decision making and implant selection based on both patient- and surgeon-specific factors.
      Dr Allen and colleagues noted that, with growing demand for foot and ankle services, the roles of podiatrists and orthopedic surgeons are increasingly overlapping and need to be defined. They examined the overlapping scope of practice of each of the groups and compared the relative costs and outcomes associated with each. The conversion of an ankle arthrodesis to a total ankle arthroplasty was long thought to be extremely difficult if not impossible, but Drs Coetzee, Raduan, and McGaver determined that in well-selected cases conversion to a total ankle replacement not only is possible but also significantly improves quality of life and reduces pain.
      The contributors and I hope this information will assist you in making the treatment choices for your patients that will obtain optimal outcomes.