Aim. Prospectively assess the degree of finger swelling after shoulder arthroscopy, to determine whether rings should be routinely removed prior to surgery. Method and Results. Patients undergoing shoulder arthroscopic procedures had finger diameters measured prior and post surgery, over a three month period. The study was approved by our Research and Development department. Measurements were taken using a finger circumference gauge (Southpointe, Florida, USA) and were all performed by one researcher in a standard technique, to eliminate inter observer variability. Control measurement, using the contralateral hand, were taken. Statistical analysis was performed, using the Mann Whitney U test. 31 patients undergoing shoulder arthroscopy were included in the study and had finger diameters assessed. The median amount of finger swelling on the operated side was 2.8 mm (IQR 4.6) per digit, compared to 0 mm on the contralateral side (IQR 1.6), which was significantly greater (p=0.0003). There was no statistical difference in the amount of finger swelling when patients undergoing short procedures (less than 30 minutes operating time) were compared to patients undergoing long procedures (greater than 60 minutes). Conclusions. These results suggest that patients undergoing shoulder arthroscopy have a significant degree of finger swelling post-operatively and that the amount of swelling cannot be accurately predicted based on the length of procedure alone. This indicates that rings should be routinely removed, prior to shoulder arthroscopy, even if this necessitates cutting of rings for removal

The standard of reference by which many imaging studies and clinical tests are often measured is arthroscopy. However, the inter-rater reliability of a surgeon’s arthroscopic diagnosis a relatively unexplored area of investigation. The purpose of the study was to determine the inter-rater reliability among a group of experienced orthopaedic shoulder surgeons in evaluating the intra-articular structures involved in a real-time diagnostic shoulder arthroscopy using a videotape model. Given the conditions of this study, the agreement among experienced shoulder surgeons was structure dependent ranging from poor to very good and was influenced by the prevalence of pathology. To determine the inter-rater reliability among a group of experienced orthopaedic shoulder surgeons in evaluating the intra-articular structures involved in a real-time diagnostic shoulder arthroscopy using a videotape model. In this patient population, the agreement among experienced shoulder surgeons was structure dependent ranging from poor to very good and was influenced by the prevalence of pathology. For educational, research and legal reasons, it is important to objectively demonstrate that intra-operative findings can be reproduced. To date, this is a relatively unexplored area of investigation within shoulder arthroscopy. The video-review surgeon median overall agreements were as follows: anterior labrum=90%, inferior labrum=45%, superior labrum=60%, posterior labrum=65%, superior glenohumeral ligament(GHL)=50%, middleGHL=50%, anterior-inferiorGHL=25%, glenoid surface=35%, detection of Hill Sachs lesion=85%, biceps tendon=70%, supraspinatus tendon=85%, infraspinatus tendon=70%, subscapularis tendon=80%. Twenty patients (nineteen males, one female) diagnosed with recurrent anterior shoulder instability with an average age of 27.9 years (15–44years) consented to participate. One experienced surgeon performed a standardized diagnostic shoulder arthroscopy following a modified Snyder 15-point protocol. All surgeries were videotaped. The operative protocol, clarity of videotape information and data collection forms were pre-tested to ensure accuracy. The patients’ clinical information, x-rays and videotaped arthroscopy were sent to six experienced shoulder surgeons. The surgeons reviewed the clinical information, assessed the intra-articular structures shown on the videotape and recorded their diagnoses on a standardized data collection form. The primary outcome was the median overall percent agreement for the video-review surgeons. This was calculated for each structure evaluated

To evaluate the incidence of early complications and operative events during shoulder arthroscopy. A prospective study of 134 consecutive shoulder arthroscopies, performed using lateral decubitus position, by the same team, with 6 months minimum follow up. During 11 months period we performed 80 shoulder arthroscopies in male and 54 in female patients with mean age 48.6 years (15–82 years). Shoulder pathology that we treated was: 74 rotator cuff repair, 37 shoulder instability, 11 frozen shoulder, 9 calcifying tendonitis, 2 SLAP lesion and 1 debridement. We have well-placed 476 anchors and 63 side to side sutures. We experience 4 early complications in total (2.98%): 1 anterior interosseous nerve paresis, that fully recovered 6 weeks post op, 1 motor and sensor ulnar nerve paresis that has not fully recovered 4 months post op, 1 sensor ulnar nerve paresis that has not fully recovered 5 months post op and 1 septic shoulder arthritis that was treated with arthroscopic lavage and intravenous antibiotics and has not shown recurrence 11 months post op. Operative events: 5 (1.05%) anchor slippage, 3 (0.63%) anchor breakage, 5 (0.53%) suture slippage from anchors, 5 (3.73%) instrument breakage, 5 (0.53%) knot loosening or suture breakage. Shoulder arthroscopy is a quite safe but technically demanding operation. Early complications occur in low rate, but due to technical difficulties operative events occur more frequently, without affecting the final outcome of the operation. Although axillary nerve is believed to be prone to injury during shoulder arthroscopy, in this series other neurological lesion occurred more frequently

Purpose of the study:. The purpose of the study was to evaluate the possible causes or risk factors for the occurrence of venous thrombotic events (VTE) after shoulder arthroscopy. Methods:. Two cases that occurred in the practice were evaluated for the study. Evaluation of their medical history, procedures and post-operative care was made. The information was evaluated for possible risk factors that could have led to the VTE. Literature reports were also evaluated. All the relevant data (personal and literature) was used to determine risk factors that could help identify high risk patients undergoing arthroscopic shoulder surgery. Results:. Results revealed no intra operative risk factors for the VTE to occur. An underlying genetic predisposition in the one case and a previous history of VTE in the other were indentified as the major risk factors/causes. Literature review revealed that underlying mechanical causes should also be considered as possible risk factors. The rate of VTE occurring after a shoulder arthroscopy (0.6/1000 procedures) is much lower than when compared to knee, hip or spinal surgery. It should be noted however that upper limb VTE's have the highest risk of a pulmonary embolus developing as compared to a lower limb VTE. Conclusion:. Surgeons performing arthroscopic shoulder surgery also run the risk of their patients developing a VTE (upper or lower limb). The attending surgeon should assess and examine their patients preoperatively with as much scrutiny as they would their patients with upcoming knee, hip or spine surgery. Surgeons should have protocols in place to identify high risk patients. These should assess extrinsic as well as intrinsic risk factors. A high index of suspicion should also be maintained in the post-operative period

Introduction: Postoperative pain management following shoulder arthroscopy procedures is important, especially if they are to be performed as a day case surgeries. A variety of techniques are currently used to reduce postoperative pain such as patient controlled infusion pump and Interscalene block. Aim: In this study we evaluate the effect of Baxter elastomeric continuous infusion pump in managing pain following shoulder arthroscopy procedures. Methods & Materials: We prospectively reviewed thirty four patients who had shoulder arthroscopy procedures between January and July 2007. All patients had arthroscopic subacromial decompression. Baxter elastomeric infusion pump was used in all patients to provide postoperative pain relief. All patients had 10ml of 0.5% Marcaine as a bolus followed by 5ml/hr for 10 hours through the infusion pump. Visual analogue scale (VAS) was assessed at 4, 6,8 and 24 hours postoperatively. Discharge time and patients’ satisfaction were also assessed. Results: The Baxter elastomer pump provided effective pain relief postoperatively with median VAS(IQR) of 2.5(1.5–4.5), 2.5(1–5), 3(2–6), 6 (2–8) at 4, 6, 8 and 24 hours respectively. Our cohort had short hospital stay postoperatively with median (IQR) discharge time of 4.6 hours (3.5–5.3).Majority of patients reported that they are either very satisfied or satisfied with the pump. Conclusion: We conclude that Baxter Infusion Elastomer pump is effective in managing pain postoperatively following shoulder arthroscopy with a high patients’ satisfaction which resulted in a short hospital stay. It is simple to insert under direct visualisation ensuring adequate placement, simple to use and doesn’t require skilled nursing care. Also it has got less morbidity compared to other means which are used to provide postoperative pain relief such as interscalene block

It is not often that the patient, surgeon and hospital management are happy about the same service. However, day-case surgery is an exception, as it has well recognised cost-effectiveness. The new day-surgical shoulder arthroscopy service was audited from its commencement in August 2008 until April 2010. The objectives were to see if patients were going home the same day. All data was gathered retrospectively via the hospital's online database and the patients' notes were collected. An Excel database was created. From August 2008 to April 2010, a total of 41 arthroscopies were performed on 41 patients. Consultant K.A. was the operator in each case. In all cases, an interscalene nerve block was attempted by a consultant anaesthetist. All patients received endotracheal intubation and they were placed in a ‘beach-chair’ position. 49% of patients were male and 51% female. Age range was from 17-70 and the average age was 51 years. 66% underwent a sub-acromial decompression and the remainder had a cuff repair. There were two unplanned admissions due to an ineffective interscalene nerve block and the other patient suffered from paranoid schizophrenia and his carer was unavailable. All patients that went home did not re-attend as an emergency. There were no adverse events documented. After discussion with senior staff, we conclude that this service is working well. Key facets of this service are that it should be consultant led with a familiar team, adhere to the standard day-surgical criteria and use interscalene nerve analgesia. The use of continuous regional anaesthetic infusion pumps may improve patient comfort, as reports suggest that they have some advantages. This service shall be re-audited in 2 years time

Orthopaedic surgeons prescribe more opioids than any other surgical speciality. Opioids remain the analgesic of choice following arthroscopic knee and shoulder surgery. There is growing evidence that opioid-sparing protocols may reduce postoperative opioid consumption while adequately addressing patients’ pain. However, there are a lack of prospective, comparative trials evaluating their effectiveness. The objective of the current randomized controlled trial (RCT) was to evaluate the efficacy of a multi-modal, opioid-sparing approach to postoperative pain management in patients undergoing arthroscopic shoulder and knee surgery.

The NO PAin trial is a pragmatic, definitive RCT (NCT04566250) enrolling 200 adult patients undergoing outpatient shoulder or knee arthroscopy. Patients are randomly assigned in a 1:1 ratio to an opioid-sparing group or standard of care. The opioid-sparing group receives a three-pronged prescription package consisting of 1) a non-opioid prescription: naproxen, acetaminophen and pantoprazole, 2) a limited opioid “rescue prescription” of hydromorphone, and 3) a patient education infographic. The control group is the current standard of care as per the treating surgeon, which consists of an opioid analgesic. The primary outcome of interest is oral morphine equivalent (OME) consumption up to 6 weeks postoperatively. The secondary outcomes are postoperative pain scores, patient satisfaction, quantity of OMEs prescribed and number of opioid refills. Patients are followed at both 2 and 6 weeks postoperatively. Data analysts and outcome assessors are blinded to the treatment groups.

As of December 1, 2021 we have enrolled 166 patients, reaching 83% of target enrolment. Based on the current recruitment rate, we anticipate that enrolment will be completed by the end of January 2022 with final follow-up and study close out completed by March of 2022. The final results will be released at the Canadian Orthopaedic Association Meeting in June 2022 and be presented as follows. The mean difference in OME consumption was XX (95%CI: YY-YY, p=X). The mean difference in OMEs prescribed was XX (95%CI: YY-YY, p=X). The mean difference in Visual Analogue Pain Scores (VAS) and patient satisfaction are XX (95%CI: YY-YY, p=X). The absolute difference in opioid refills was XX (95%CI: YY-YY, p=X).

The results of the current study will demonstrate whether an opioid sparing approach to postoperative outpatient pain management is effective at reducing opioid consumption while adequately addressing postoperative pain in patients undergoing outpatient shoulder and knee arthroscopy. This study is novel in the field of arthroscopic surgery, and its results will help to guide appropriate postoperative analgesic management following these widely performed procedures.

Since 2004, hospitals and other providers are paid based on the work they do. This in turn is largely based on the “Office of Population Censuses and Surveys” codes (OPCS) and the “Health Care Resource Group” (HRG) codes.

Audits have proven that inaccurate coding can lead to significant clinical and financial implication. Through our clinical audit works, we have assessed the current coding practices and examined potential financial shortfalls.

Fifty five arthroscopic shoulder procedures were performed over a five-month period. All case notes were retrieved and the clinical correct OPCS and HRG codes were recorded. Those were then compared with the OPCS and HRG code which were documented independently by the clinical coding office. The difference between the predicted costs and the hospital’s actual costs was evaluated.

The result was as follows: 81% of the arthroscopic shoulder surgery was inappropriately coded. Due to the fact that the HRG code is largely based on the OPCS code, a significant proportion was wrongly recorded. Secondary to the OPCS code, the HRG was inaccurately coded in 85% of the cases. If all procedures were coded accurately, the revenue generated would be £124,519. Due to inaccuracy of our coding practices, over £50,000 was unaccounted.

The real difficulty in the coding practice lies in the ability of choosing the most appropriate code for a particular surgery, and in many cases it requires the user to use multiple codes to correctly categorize the operation. Our current coding practice is extremely poor and as a result the hospital is losing a significant amount of money. A more accurate coding can generate additionally £50,000 in revenue for arthroscopic shoulder surgery alone. The significance of coding errors across all specialties must not be underestimated.

The majority of studies reporting sensitivity and specificity data for imaging modalities and physical examination tests for long head of biceps (LHB) tendon pathology use arthroscopy as the gold standard. However, there is little published data to validate this as an appropriate benchmark. The aim of this study was to determine the maximum length of the LHB tendon that can be seen at glenohumeral arthroscopy and whether it allows adequate visualisation of common sites of pathology.

Seven female cadaveric specimens were studied. Mean age was 74 years (range 44–96 years). Each specimen underwent arthroscopy in lateral decubitus (LD) and beach chair (BC) positions. The LBH-tendon was tagged with a suture placed with a spinal needle marking the intra-articular length and the maximum excursions achieved using a hook and a grasper in both LD and BC positions. T-tests were used to compare data.

The mean intra-articular and extra-articular lengths of the tendon were 23.9 mm and 82.3 mm respectively. The mean length of tendon that could be visualised by pulling it into the joint with a hook was significantly less than with a grasper (LD: hook 29.9 mm, grasper 33.9 mm, mean difference 4 mm, p=0.0032. BC: hook 32.7 mm, grasper 37.6 mm, mean difference 4.9 mm, p=0.0001). Using the BC position allowed visualisation of a significantly greater length than the LD position when using either a hook (mean difference 2.86 mm, p=0.0327) or a grasper (mean difference 3.7 mm, p=0.0077). The mean length of the extra-articular part of the tendon visualised using a hook was 6 mm in LD and 8.9 mm in BC. The maximum length of the extra-articular portion visualised using this technique was 14 mm (17%).

Pulling the tendon into the joint with a hook does not allow adequate visualisation of common distal sites of pathology in either LD or BC. Although the BC position allows a significantly greater proportion of the tendon to be visualised this represents a numerically small value and is not likely to be clinically significant. The use of a grasper also allowed greater excursion but results in iatrogenic tendon injury which precludes its use. The reported incidence of pathology in Denard zone C (distal to subscapularis) is 80% and in our study it was not possible to evaluate this zone even by using a grasper or maximum manual force to increase excursion. This is consistent with the extremely high rate of missed diagnoses reported in the literature. Surgeons should be aware that the technique of pulling the LHB-tendon into the joint is inadequate for visualising distal pathology and results in a high rate of missed diagnoses. Furthermore, efforts to achieve greater excursion by “optimum” limb positioning intra-operatively do not confer an important clinical advantage and are probably unnecessary.

Purpose: To review the results of simple arthroscopic subacromial decompression in patiens with impingement syndrome and rotator cuff tears without repairing the tears.

Type of Study: prospective study.

Material and Methods: From 1998 to 2003, 160 patients (168 shoulders) had arthroscopic subacromial decompression for impingement syndrome with a torn rotator cuff without repairing the tear of the cuff (120 males and 40 females). The average patient age was 64 years and the average follow up was 24 months.

With increasing use of arthroscopy in the treatment of shoulder disorders, tears of the rotator cuff have been well described. Management of rotator cuff tears should include consideration of tear size, patient age and activity level, and tear etiology.

Operative treatment of impingement syndrome in elderly less active lower demand patients with small and moderate tears involves decompression with and without repairing the cuff.

We evaluated the clinical outcome of arthroscopic subacromial decompression and debridement in 160 patients ( 168 shoulders ) with impingement syndrome with small and moderate tears of the rotator cuff without repairing the cuff.

Rotator cuff tears are graded arthroscopically as small (< 1 cm), moderate (> 1 cm < 3 cm ), large (> 3 cm < 5 cm ), and massive rotator cuff tears (> 5 cm ).

Results: At follow up 96 patients (60%) were rated excellent or good , 56 patients (35%) were rated fair and 8 patients (5%) were rated poor. The average “Constant” score was 62 preoperative compared with 82 postoperative in the improved group (152 patients) . The 8 patients who showed no improvement had average postoperative “Constant” score of 64.

Conclusions: Arthroscopic subacromial decompression without suture of the cuff in elderly less active lower demand patients with impingement syndrome with small and moderate tears of the cuff is a legitimate method of treatment for their shoulder pain and limitation of function.

The main advantages were: immediate physiotherapy and return of function since there is no need for immobilization.

Introduction

Superior Labral Anterior Posterior Tears are being treated surgically in increasing numbers. Stiffness is the most common complication. We reviewed 115 cases of SLAP repairs to try and identify preoperative risk factors if any for stiffness.

The laterjet procedure is an important option in both primary and revision surgeries, especially in anterior shoulder instabilities that progress with glenoid bone loss. 12 patients who had a history of unsuccessful arthroscopic bankart repair and who underwent laterjet procedure in Ankara Atatürk Research and Training Hospital between 2013 and 2017 were included in the study and the patients were evaluated retrospectively. The mean age of the patients was calculated as 27.7 (range 21 to 38 years). Rowe and Walch-Duplay scores and operated shoulder (OS)-healthy shoulder (HS) range of motion (ROM) measurements were used to evaluate patients clinically and functionally. The mean follow-up time of the patients was calculated as 5.5±1.8 years.

Firstly, no dislocation history was recorded in any patient afer the laterjet procedure. The mean Rowe score was calculated as 82.5 (range 60–100). Accordingly, 8 patients had excellent result, 3 patients had good result and 1 patient had fair result. The mean Walch-Duplay score was 81.4 (range 55–100). It was determined as excellent result in 6 patients, good result in 4 patients and fair result in 2 patients. Another data, joint ROM of the OS-HS of patients are shown in the table. There was some limitation in OS compared to the HS. p<0.05 value was accepted as statistically significant. While there was a statistically significant difference in external rotation (OS:35.2º, HS:56.4º)(p=0.003), internal rotation (OS:65.7º, HS:68.1º)(p=0.008) and flexion (OS:171.2º, HS:175.9º)(p=0.012) degrees but there was no statistically significant difference in abduction degrees (OS:164.3º, HS:170.4º) (p=0.089). In radiological evaluation, partial graft resorption was detected in 1 patient, but it was asymptomatic. The osteoarthritis which is one of the complications of laterjet procedure, was not detected radiologically. There are some limitations of the study. Firstly, it is a retrospective study. Secondly, the demographic features of the patients such as age, gender, profession and dominant hand are excluded. Thirdly, the mean follow-up time is not too long. Finally, some of the scales filled in are based on the patient's declaration, which may not yield sufficient objective results.

In conclusion, the laterjet procedure is a suitable and reliable technique even for revision surgery in the treatment of anterior shoulder instability. It gives positive results in terms of shoulder stability and function. The major disadvantage was found to be the limitation of external rotation. Longer follow-up is needed for another outcomes and late complications, such as osteoarthritis.

For any figures or tables, please contact the authors directly.

Aims

The factors that predispose to recurrent instability and revision stabilization procedures after arthroscopic Bankart repair for anterior glenohumeral instability remain unclear. We sought to determine the rate and risk factors associated with ongoing instability in patients undergoing arthroscopic Bankart repair for instability of the shoulder.

Frozen shoulder is a recognised complication following simple arthroscopic shoulder procedures, but its exact incidence has not been reported. Our aim was to analyse a single-surgeon series of patients undergoing arthroscopic subacromial decompression (ASD; group 1) or ASD in combination with arthroscopic acromioclavicular joint (ACJ) excision (group 2), to establish the incidence of frozen shoulder post-operatively. Our secondary aim was to identify associated risk factors and to compare this cohort with a group of patients with primary frozen shoulder.

We undertook a retrospective analysis of 200 consecutive procedures performed between August 2011 and November 2013. Group 1 included 96 procedures and group 2 104 procedures. Frozen shoulder was diagnosed post-operatively using the British Elbow and Shoulder Society criteria. A comparative group from the same institution involved 136 patients undergoing arthroscopic capsular release for primary idiopathic frozen shoulder.

The incidence of frozen shoulder was 5.21% in group 1 and 5.71% in group 2. Age between 46 and 60 years (p = 0.002) and a previous idiopathic contralateral frozen shoulder (p < 0.001) were statistically significant risk factors for the development of secondary frozen shoulder. Comparison of baseline characteristics against the comparator groups showed no statistically significant differences for age, gender, diabetes and previous contralateral frozen shoulder.

These results suggest that the risk of frozen shoulder following simple arthroscopic procedures is just over 5%, with no increased risk if the ACJ is also excised. Patients aged between 46 and 60 years and a previous history of frozen shoulder increase the relative risk of secondary frozen shoulder by 7.8 (95% confidence interval (CI) 2.1 to 28.3)and 18.5 (95% CI 7.4 to 46.3) respectively.

Cite this article: Bone Joint J 2015; 97-B:963–6.

The August 2024 Shoulder & Elbow Roundup. 360. looks at: Comparing augmented and nonaugmented locking-plate fixation for proximal humeral fractures in the elderly; Elevated five-year mortality following shoulder arthroplasty for fracture; Total intravenous anaesthesia with propofol reduces discharge times compared with inhaled general anaesthesia in shoulder arthroscopy: a randomized controlled trial; The influence of obesity on outcomes following arthroscopic rotator cuff repair; Humeral component version has no effect on outcomes following reverse total shoulder arthroplasty: a prospective, double-blinded, randomized controlled trial; What is a meaningful improvement after total shoulder arthroplasty by implant type, preoperative diagnosis, and sex?; The safety of corticosteroid injection prior to shoulder arthroplasty: a systematic review; Mortality and subsequent fractures of patients with olecranon fractures compared to other upper limb osteoporotic fractures

The February 2023 Shoulder & Elbow Roundup. 360. looks at: Arthroscopic capsular release or manipulation under anaesthesia for frozen shoulder?; Distal biceps repair through a single incision?; Distal biceps tendon ruptures: diagnostic strategy through physical examination; Postoperative multimodal opioid-sparing protocol vs standard opioid prescribing after knee or shoulder arthroscopy: a randomized clinical trial; Graft healing is more important than graft technique in massive rotator cuff tear; Subscapularis tenotomy versus peel after anatomic shoulder arthroplasty; Previous rotator cuff repair increases the risk of revision surgery for periprosthetic joint infection after reverse shoulder arthroplasty; Conservative versus operative treatment of acromial and scapular spine fractures following reverse total shoulder arthroplasty

The use of cannabis is increasingly medically relevant as it is legalized and gains acceptance more broadly. However, the effects of marijuana use on postoperative outcomes following orthopedic surgery have not been well-characterized. This study seeks to illuminate the relationship between marijuana use and the incidence postoperative complications including: DVT, PE, nonunion, and infection following common orthopedic procedures. This study was conducted using a national orthopaedic claims insurance database. We identified all patients undergoing knee arthroscopy, shoulder arthroscopy, operatively managed long bone fractures (humerus, femur, tibia and/or fibula, and radius and/or ulna), and single-level lumbar fusion. The proportion of patients within each surgery cohort who had a diagnostic code for marijuana dependence was assessed. The rates of DVT, PE, and infection within 90 days were assessed for all patients. The rate of nonunion was assessed for the long bone fracture and lumbar fusion cohorts. Univariate analyses of marijuana dependence on all outcomes were performed, followed by a multivariate logistic regression analysis controlling for known patient comorbidities. We identified 1,113,944 knee arthroscopy, 747,938 shoulder arthroscopy, 88,891 lumbar fusion, and 37,163 long bone fracture patients. Out of the 1,987,936 patients, 24,404 patients had a diagnostic code for marijuana dependence. Within all four surgical subgroups, the marijuana dependence cohort experienced increased rates of infection, PE, and DVT, as well as increased rates of nonunion in the lumbar fusion and long bone fracture populations. In the multivariate analyses controlling for a variety of patient risk factors including tobacco use, marijuana dependence was identified as an independent risk factor for infection within all four surgical subgroups (Knee: OR 1.85, p < 0.001; Shoulder: OR 1.65, p < 0.001; Spine: OR 1.45, p < 0.001; Long bone: OR 1.28, p < 0.001), and for nonunion in the lumbar fusion (OR 1.38, p < 0.001) and long bone fracture (OR 1.31, p < 0.001) subgroups. Our data suggests that marijuana dependence may be associated with increased rates of infection and nonunion following a variety of orthopaedic procedures. During preoperative evaluation, surgeons may consider marijuana use as a potential risk factor for postoperative complications, especially within the context of marijuana legalization. Future research into this relationship is necessary