Editorial| Volume 53, ISSUE 4, Pxv, October 2022


      Musculoskeletal disorders are conditions that affect the muscles, bones, and joints, with a multitude of diagnoses and approaches to treatment. The reviews in this issue cover the current findings and recommendations in the literature for appropriate and efficient management for optimal patient outcomes.
      Pain management for disorders of the hip and knee is a common concern for orthopedists as well as their patients. This issue includes reviews on pharmacogenomic testing for drug-drug–gene interactions prior to initiating opioids, knee osteonecrosis diagnosis and treatment, soft-tissue structure pathologic conditions of the hip, and premature hip osteoarthritis in younger patients caused by acetabular retroversion. And, in current technology, we include a report of robotic assistance for total hip arthroplasty (THA) that can reduce both mental and physical fatigue in surgeons when compared with manual techniques.
      Sickle cell disease (SCD) frequently affects the musculoskeletal system, including periarticular osteonecrosis of major joints, most commonly the hip, and major infarcts that result in pain, limit function, and decrease quality of life. A multidisciplinary approach for providing surgical care is necessary for patients with SCD undergoing THA who are at increased risk for complications and may require surgery at a young age.
      The trauma section includes a review of management options for insufficiency fractures of the pelvis and acetabulum, which are becoming a more prevalent concern with increasing age, with the most prevalent risk factor being osteoporosis. Pelvic and acetabular fractures carry significant morbidity and mortality for the elderly population. This review presents management options for pelvic ring injuries and acetabular fractures in elderly patients.
      In pediatric and adolescent patients, osteochondritis dissecans is not completely understood. We include a review of the most current epidemiology, classification, and pathoanatomy of the disease that also discusses different treatment options. Also affecting pediatric patients is the obesity epidemic, which can lead to an increased risk of musculoskeletal injury, fracture, and lower-extremity deformities. The limited efficacy of nonoperative treatments, such as casting and bracing, due to body habitus and the increased risks of perioperative complications from surgical treatment are discussed.
      In the shoulder and elbow section, the complex issue of failed rotator cuff repairs and current management options are reviewed. Reverse shoulder arthroplasty and various modalities used during the perioperative period that maximize functional progression, reduce overt complications, and improve patient outcomes over the years are presented.
      Unsolicited patient complaints (UPCs) about surgeons correlate with surgical complications and malpractice claims. After finding limited analysis of these complaints, a large national patient complaint database was used to evaluate differences in the number and distribution of UPCs between orthopedic surgeons, other surgeons, and nonsurgeons, describe the distribution of UPCs among orthopedic subspecialties, and assess clinical characteristics that may be associated with UPCs.
      Also included in the foot and ankle section is a review of radiographic outcomes and postoperative complications after a modified Lapidus procedure for hallux valgus, noting significant improvements in intermetatarsal angle, hallux valgus angle, and tibial sesamoid position. The authors present an updated modified Lapidus technique for achieving triplanar correction of hallux valgus.
      The spine section discusses the typical presentations and operative interventions of degenerative cervical myelopathy, which is often caused by cervical spondylosis and causes spinal impairment in a predominantly elderly population. Also included is a discussion of the diagnosis of lumbar spinal stenosis and the improved mid- to long-term pain and functional outcomes with surgery when compared with conservative treatment.
      We thank the authors for their contributions to clinical knowledge that will guide orthopedists in treating patients with musculoskeletal disorders around the world.