Purpose of Review Heterotopic ossification (HO) in hip arthroscopy is a common post-operative complication. This review was undertaken to provide an update (2014 present) on the current literature regarding HO in hip arthroscopy. Recent Findings Risk factors for HO post-hip arthroscopy include male gender, mixed impingement, picture, and the size of CAM resection. HO prophylaxis with NSAIDs has been proven to decrease the rate of HO post-hip arthroscopy; however, there is inherent risk to long-standing NSAIDs therapy. HO post-hip arthroscopy is not uncommon as a radiological finding, but symptomatic HO post-hip arthroscopy requiring revision surgery is a rare event, at < 1%. The outcomes for revision surgery for HO excision have fair outcomes. Summary The hip arthroscopist should stratify their patients based on known risk factors, and determine whether NSAIDs prophylaxis is warranted.

Background: Postoperative antibiotic prophylaxis is currently the standard of care for patients undergoing total hip and knee arthroplasty. We evaluated the evidence for this practice in the reduction of surgical-site infections. Methods:We systematically searched MEDLINE, Embase and the Cochrane Library for randomized controlled trials (RCTs) published up to Aug. 15, 2014. We included all RCTs that compared postoperative antibiotic prophylaxis with postoperative placebo or no treatment in patients undergoing primary total hip or knee arthroplasty for osteoarthritis. We combined outcomes for surgical-site infection using a random-effects model and quantified heterogeneity using the χ 2 test and the I 2 statistic. We assessed the overall quality of the evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results:We identified 4 RCTs (n = 4036) that met the inclusion criteria. Surgical-site infections occurred in 3.1% (63/2055) of patients in the prophylaxis group and 2.3% (45/1981) in the control group. Postoperative prophylaxis did not reduce the rate of surgical-site infections compared with placebo (risk difference 0.01, 95% confidence interval 0.00 to 0.02; I 2 = 26%). This result was robust to sensitivity testing for losses to follow-up. According to the GRADE approach, the overall quality of evidence was very low. Interpretation:The available evidence did not show efficacy of postoperative antibiotic prophylaxis for the prevention of surgical-site infections in patients undergoing total hip or knee arthroplasty. Multicentred RCTs are likely to have an important impact on the confidence in the effect estimate and to change the estimate itself. number of primary procedures grows, the burden of surgicalsite infections is expected to increase accordingly. 5,6 Strategies aimed at reducing the incidence and prevalence of surgical-site infections after primary total hip and knee arthroplasty are well documented. 7,8 The use of antibiotic prophylaxis (both intraoperatively and postoperatively) is accepted as the gold standard in orthopedic practice and is recommended by the most widely accepted consensusbased guidelines. [9][10][11] The duration of postoperative antibiotic prophylaxis varies somewhat across these guidelines, from no longer than 24 hours to no longer than 36 hours (Appendix 1, available at www.cmajopen.ca/content/3/3/ E338/suppl/DC1).We conducted a systematic review and meta-analysis to evaluate the evidence for postoperative antibiotic prophylaxis in the reduction of surgical-site infections among patients undergoing primary total hip or knee arthroplasty. MethodsWe followed the protocol outlined in the Cochrane Handbook for Systematic Reviews of Interventions. 12 We report our findings in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. 13Data sources and study selection We searched MEDLINE (1946 to present), Embase (1974 to present) and the Cochrane Library (no date limit) for art...

Purpose of Review We reviewed the recent literature to identify and summarize new research surrounding anterior cruciate ligament reconstruction (ACLR) with augmentation in the form of additional soft tissue procedures or biologic augmentation. Specifically, we wanted to review the failure rates of these procedures in both the primary and revision settings. Methods The databases Embase, PubMed, and Medline were searched on August 13, 2018, for English-language studies that reported on the use of anterior cruciate ligament reconstruction (primary and revision) in conjunction with either soft tissue or biologic augmentation. The studies were systematically screened and data abstracted in duplicates. Recent Findings Advancements in ACLR surgery, including soft tissue augmentation, may decrease primary and revision surgery failure rates for high-risk patients. The use of biological augmentation has shown histologic and radiographic improvements. These differences, however, have failed to be statistically significant and have not resulted in clinically significant improvements in outcome. Summary The limited body of evidence has shown that the addition of soft tissue procedures may in fact lower the risk of graft rerupture rates particularly in revision or in patients wishing to return to high-risk sports and activities. The use of biologic augmentation although promising in laboratory studies has yet to show any significant clinical results and therefore will require further studies to prove any efficacy.

Background: The purpose of this study was to determine the results of an arthrodesis technique of the first metatarsophalangeal joint (MTPJ) using a precontoured dorsal plate to correct the hallux valgus deformity. Methods: This was a retrospective analysis of outcomes for first MTPJ arthrodesis performed using 2 precontoured dorsal plates. Radiographic outcomes (intermetatarsal angle [IMA] and hallux valgus angle [HVA]) and patient-reported functional outcome measures (Short-Form 12 and Foot and Ankle Outcome Score) were recorded and compared. Results: Fifty-five patients underwent 77 first MTPJ arthrodeses for severe hallux valgus deformity with associated degenerative changes at the first MTPJ. The mean reduction of the IMA was 5.67° ( P < .05) and the mean reduction of the HVA was 33° ( P < .05). The Short-Form 12 assessment of global health demonstrated a significant improvement in both the physical and mental health composite scores by 16.4 points and 10.4 points ( P < .05), respectively. The Foot and Ankle Outcome Score demonstrated a cumulative decrease of 35% (59.28; P < .05) in all domains. Conclusions: First MTPJ arthrodesis using a precontoured dorsal plate is a successful procedure with a high union rate, low complication rate, and a high level of patient-reported satisfaction. Levels of Evidence: Level III.

Metastatic bone disease represents a significant burden of disease. Metastatic disease can seed in any bone of the body, but one of the most common long bones affected is the humerus. Although painful and often disabling, metastatic bone disease of the upper extremity often can be treated more conservatively than the lower extremity because of lower weight-bearing demands. However, the surgical management of upper extremity metastatic bone disease is an evolving field, and recent clinical studies have demonstrated several key principles. Intramedullary nailing and whole bone irradiation may be an optimal combination for prophylactic fixation. The addition of polymethyl methacrylate cement adds immediate stabilization to internal fixation and decreases postoperative pain. Plate and screw fixation can be used in lesions that cannot be treated with intramedullary nailing, but caution is necessary to avoid complications related to surgical technique. Finally, periarticular and intraarticular lesions may be managed with a hemi-or total-joint prosthesis for both the shoulder and elbow to provide the maximal functional outcome. Surgical intervention together with appropriate adjunctive therapies can decrease patient-important pain and skeletal-related events while improving quality of life in patients living with metastatic bone disease of the upper extremity. 1. Li S, Peng Y, Weinhandl ED, et al. Estimated number of prevalent cases of metastatic bone disease in the US adult population. Clin Epidemiol. 2012; 4:87--93. 2. von Moos R, Sternberg C, Body JJ, et al. Reducing the burden of bone metastases: Current concepts and treatment options.