The traumatic knee dislocation (KD) is a complex condition resulting in injury to >1 ligament or ligament complexes about the knee, termed multiligament knee injuries. Typically, KDs result in injury to both cruciate ligaments with variable injury to collateral ligament complexes. Very rarely, KD may occur with single cruciate injuries combined with collateral involvement but it is important to understand that not all multiligament knee injuries are KDs. Patients can present in a wide spectrum of severity; from frank dislocation of the tibiofemoral joint to a spontaneously reduced KD, either with or without neurovascular injury. The initial evaluation of these injuries should include a thorough patient history and physical examination, with particularly close attention to vascular status which has the most immediate treatment implications. Multiple classification systems have been developed for KDs, with the anatomic classification having the most practical application.

Minimally invasive spine surgeries (MISS) are becoming increasingly favored as alternatives to open spine procedures because of the reduced blood loss, postoperative pain, and recovery time. Studies have shown mixed results regarding the efficacy and safety of minimally invasive procedures compared to the traditional, open counterparts. The objectives of this systematic analysis are to compare clinical outcomes between the three MISS and open procedures: (1) laminectomy/discectomy, (2) transforaminal lumbar interbody fusion (TLIF), and (3) posterior lumbar interbody fusion (PLIF). The Cochrane and PubMed databases were queried according to the preferred reporting items for systematic review and meta-analyses (PRISMA) statement. The primary outcome measures included the visual analog scale (VAS), the Oswestry disability index (ODI), and blood loss. A total of 32 studies were included in the analysis. Of the three procedures investigated, only MISS TLIF showed significantly improved VAS for leg pain (p = 0.02), ODI (p = 0.05), and reduced blood loss (p = 0.005). MISS-laminectomy/discectomy, TLIF, and PLIF appear to be similar in terms of postoperative pain and perioperative blood loss. MISS TLIF is perhaps more effective in specific outcome measures and results in less intraoperative blood loss than open TLIF.

BackgroundFollowing total knee and hip arthroplasty, patient progress can be assessed with patient-reported outcome measures (PROMs) and performance-based outcome measures (PBOMs). The American Joint Replacement Registry 2016 guide recommends collecting several measures, including Patient Reported Outcome Measure Information System Global, Knee Injury and Osteoarthritis Outcome Score Jr, and Hip Injury and Osteoarthritis Outcome Score Jr. This study aimed to assess the current and anticipated use of PROMs and PBOMs by New England physical therapists.MethodsAn online survey was conducted in July and August of 2015 asking physical therapists in New England to rate their current and anticipated future use of PROMs and PBOMs in terms of clinical decision making associated with the treatment and care of patients after total hip and knee replacement.ResultsThere were 122 responses. The most often used and recommended PROMS were the Numeric Pain Rating Scale (99.2% and 97.5%, respectively) and Lower Extremity Function Scale (76.2% and 77.0%). There was significant variability in the use of different PBOMs, but the most often used and recommended were the Timed Up and Go (93.4% and 85.2%) and the Single Leg Balance Test (90.2% and 87.7%).ConclusionsThis study suggests that orthopaedic surgeons and physical therapists use different PROMs and PBOMs for postoperative assessment of total joint patients and highlights the need for more collaboration and consistency between these disciplines.

Prosthetic joint infection (PJI) and metallosis are known complications of total hip arthroplasty (THA) and are causes for revision surgeries. Articulating metal surfaces in total hip arthroplasty with corrosion at modular junctions can lead to the release of metal ions that can cause an immune-mediated biological reaction. There are few cases in the literature of both coinciding together. We describe a case of chronic Cutibacertium acnes PJI and metallosis co-occurring in a 64-year-old female after THA with a dual mobility construct. After undergoing uncomplicated left THA through a modified Hardinge approach, the patient dislocated anteriorly after four weeks and required revision of her acetabular component to a less anteverted position. Nine months later, she presented with hip pain and was found to have medial wall fragmentation and cystic changes around the greater trochanter on radiographs, elevated serum cobalt and chromium levels, and a benign noninfected hip aspiration. During her revision procedure, intraoperative histopathology showed over 20 neutrophils per high power field in multiple samples and fluid aspirates demonstrating Gram-positive rods. She was also found to have pseudotumor formation with the erosion of the anterior and posterior capsules with black debris on the femoral stem trunnion and the backside of the modular dual mobility liner. An antibiotic spacer was placed and her cultures grew into C. acnes. She completed six weeks of intravenous ceftriaxone and, during her "drug holiday," she dislocated her spacer and was found to have a lateral femoral diaphyseal stress fracture at the distal end of her spacer. She underwent stage II of her revision, and while the plan was to continue her antibiotics, she had an adverse reaction and was transitioned to oral antibiotics for six months. Due to delayed healing, she underwent additional irrigation and debridement with head and liner exchange. Her wound then healed, and at her one-year final follow-up, she was able to ambulate without pain, and her serum inflammatory and metal ion levels were within normal limits. Concurrent PJI and metallosis from articulating metal interfaces can occur, and a high index of suspicion is necessary to properly manage both conditions.

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