bluuebunny/crossref_metadata_2025 huggingface dataset:
Ambulatory Hip and Knee Replacement Outcomes During COVID-19 Outbreak in Washington State
Authors: Jabbouri Sahir , Jones Brett , Song Christian , Dasa Vinod , McAllister Craig
Published: August 2023

Introduction

The first case of COVID-19 in the U.S. was diagnosed on January 19th, 2020 in Washington State and evidence suggested that the virus was circulating in Washington prior to this. Elective joint replacements were suspended on March 19th, 2020 with the goal of preserving resources and protecting patients and workers. This pilot study evaluates a group of patients who underwent elective joint replacement during the initial surge of COVID-19 and before the shutdown of elective surgeries to examine the patient experience of elective joint arthroplasty during a COVID-19 surge. All patients participated in an outpatient joint replacement program utilizing a dedicated patient engagement platform which enabled the investigation of Patient Reported Outcome Measures (PROMs), COVID-19 surveys, as well as patient satisfaction outcomes.

Methods

This observational study reviewed 282 patients who underwent hip and knee arthroplasty in Washington State during the COVID-19 surge between January and March 2020. Surgeries were done by surgeons experienced in outpatient techniques using a standardized protocol. Patients registered on a dedicated cloud platform (The SwiftPath Program, LLC). Patient education emphasized the benefits of early discharge and recovery at home. The patient experience included shared-decision-making and a vetted risk stratification algorithm. Homecare monitoring allowed for notifications to the care team as well as opiate tracking, recovery milestones, and PROs. Patients responded to postoperative homecare queries, satisfaction surveys, and standardized PROs surveys (HOOS JR., KOOS JR., PROMIS) at baseline and routine post-op intervals out to 6 weeks. A follow-up “COVID-19 survey” was also used to specifically evaluate exposure to and complications from potential COVID-19 infection.

Results

There were 254 patients out of 282 (90.0%) who registered and had partially completed the data collection. The average age of patients was 67.7 years old (range 30 – 91). Fifty-nine patients (23.2%) completed HOOS JR. and KOOS JR. data, and of these patients, 46 were knee replacements, and 13 were hip replacements. Every patient who responded both to the preoperative and postoperative HOOS JR. and KOOS JR. questionnaires had improved scores by six weeks postoperatively. Of the 180 patients who responded to the COVID-19 survey, none reported viral symptoms or developed COVID-19. Patients indicated limited physical therapy access, but recovery was not impacted. The average surgery satisfaction during the pandemic was 9.3/10.0.

Conclusion

An online patient engagement platform can help monitor the clinical course, PROs as well as any virus-related illnesses in patients undergoing TJA. Information from PROs can be used to evaluate outcomes during a pandemic. Additional studies should focus on larger numbers of patients and compare PROs with clinical outcomes to help document the safety of performing elective surgeries during pandemics.
Complete Traumatic Laceration of the Sciatic Nerve Secondary to Acetabular Fracture: A Case Report
Authors: John Mitchell , Taylor Shea , Ahmed Adil , Mir Hassan
Published: August 2023

BACKGROUND

Sciatic nerve injury in acetabular fractures is a rare event, with the majority of cases being transient neuropraxias. To date there are no published cases of complete traumatic sciatic nerve lacerations due to acetabular fracture with associated hip dislocation. We describe a case of such an event confirmed at the time of acetabular fracture fixation.

CASE PRESENTATION

The patient was a 37-year-old polytraumatized victim involved in a motor vehicle accident who presented with multiple injuries including left acetabular fracture with associated femoral head dislocation. The patient had absent function of both divisions of the sciatic nerve on initial evaluation. She was hemodynamically unstable on arrival requiring multidisciplinary intervention and transfer to the intensive care unit after temporization of her multiple system injuries. Following adequate resuscitation and improved hemodynamic status she was taken to the operating room for definitive orthopaedic fixation of her pelvis, acetabulum, and multiple long bones. Intraoperatively the sciatic nerve was identified, found to be completely lacerated. Direct repair was performed. Following discharge to a long term rehabilitation facility on post-trauma day 53 she was lost to follow up for 6 months when she presented to the emergency department for abdominal pain. Her pelvic and acetabular hardware was radiographically stable showing fracture union, and her lower extremity neurological examination was unchanged from her preoperative exam.

CONCLUSION

Injury to the sciatic nerve associated with pelvic and acetabular trauma is relatively rare and is most often neuropraxic. To our knowledge there is no reports in the literature on complete lacerations in this context, and there is a paucity in the literature on managing such injuries. Orthopaedic traumatologist must be aware of the possibility of this presentation in order to manage it appropriately and counsel patients accordingly.
Percutaneous Coracoclavicular Tightrope Reduction of a Displaced Distal Clavicular Fracture: A Case Report
Authors: Yang Xiuyi A. , Vermeijden Harmen D. , O'Brien Robert , Van der List Jelle P. , Difelice Gregory S.
Published: August 2023

Case

A 34-year-old male presented with a Neer type IIa clavicle fracture after a direct fall on the right shoulder following a cycling accident. The patient subsequently underwent percutaneous reduction and fixation with a coracoclavicular TightRope. The postoperative course was uncomplicated, and radiographic union was noted at 12 weeks postoperatively. The patient reported no further complaints with full range of motion of his shoulder and had a QuickDASH, SANE, ASES, and Constant Murley score of 100 at one year post-operatively.

Conclusion

Neer type II clavicle fractures can be notoriously unstable when managed non-operatively. Although multiple treatment modalities have been utilized, there remains some debate regarding the optimal surgical approach. Due to its minimally invasive nature and avoiding the risk for future hardware removal, coracoclavicular TightRope placement might be an excellent treatment option for patients with distal clavicle fractures.
Device Profile of SonoVision™ Ultrasound System: Efficacy and Safety for Lateral Approach Spinal Surgery
Authors: Singh Kern , Cha Elliot D.K. , Lynch Conor P. , Jacob Kevin C. , Patel Madhav R. , Prabhu Michael C. , Vanjani Nisheka N. , Pawlowski Hanna
Published: August 2023

Introduction

Minimally invasive spinal surgeries rely heavily on imaging for localization of key anatomical structures. Current established modalities either do not provide adequate visualization of soft-tissue structures or do so in an indirect manner. Real-time integrated soft-tissue imaging will allow surgeons to accurately differentiate nerves, muscle, vasculature, and bone while simultaneously preventing excessive dissection of tissue and risk to patients.

Areas Covered

SonoVision™ is a novel imaging device able to meet the needs of intraoperative anatomical visualization. This review explains the mechanism of the device and summarizes the empirical support for its use. Multiple animal, cadaver, and human studies have been used to compile machine-learning training data and validate the system’s accuracy and usability through actual and simulated surgical scenarios.

Expert Opinion

SonoVision™ represents a significant improvement over current intraoperative imaging technology in terms of accuracy, efficiency, and ease of use. This system provides vital anatomical information that would otherwise be unavailable in an intuitive, real-time format. SonoVision™ may play an important role in improving outcomes in lateral approach spine surgery as well as making minimally invasive techniques more accessible to a wider range of surgeons.

Article Highlights

• The direct lateral transpsoas approach for lumbar fusion has distinct advantages, but is associated with various complications, many of which are related to inadequate intraoperative imaging. • There is a significant unmet need for real-time intraoperative soft-tissue imaging in spine surgery. • The SonoVision™ ultrasound system utilizes machine-learning algorithms to provide real-time soft tissue imaging and differentiation for use during spine procedures. • Early trials are promising with regard to SonoVision’s™ ability to meet needs for intraoperative soft-tissue imaging in lateral approach spine surgery.
One Year Analysis of Financial and Clinical impacts of COVID-19 on an Orthopedic Surgery Department, Analysis of Recovery Timeline and Assessment of Implemented Telehealth Initiatives
Authors: Amato Chad , Kantzos Andrew , Matullo Kristofer
Published: August 2023

Introduction

To evaluate the effects that pandemic restrictions had on our practice, evaluate initiatives to increase care options to patients, and assess the rate of return to normal operations.

Methods

Surgical volumes, clinic volumes, telehealth utilization, RVU generation, Fee for Service Charges (FFS) during the period of COVID-19 restrictions from mid-March 2020 through May 2020, were compared to data from the preceding months of the fiscal year as well as the months following the lifting of COVID restrictions.

Results

April 2020 saw the largest impact to each area compared to preceding averages of the fiscal year. Pre-COVID office visits averaged 2,256 per week compared to the COVID period average of 1,048 or 46% from baseline. Pre-COVID surgical cases averaged 169 per week, compared to 71 or 42%. Pre-COVID work RVU generation averaged 26,130 compared to April with 9,722 or 37% of baseline average. Pre-COVID FFS charges averaged $5,214,925 per month compared to April with charges of $1,753,992 or 33% of the pre-COVID average. Office visits, surgical cases, FFS charges, and RVU generation saw overall increases of 28%, 6%, 17.6%, and 15% respectively in the period following the lifting of restrictions.

Conclusion

The COVID-19 pandemic and the associated restrictions on elective case and clinic volumes have shown significant reductions in case volumes, clinic volumes, RVU, and FFS generation. Going forward this analysis may serve as a framework to estimate the impact from possible future restrictions on an orthopedic practice should a similar event take place in the future.
Median Nerve Intraneural Lipoma as a Cause of Carpal Tunnel Syndrome: A Case Report and Review of Current Management Principles
Authors: Amato Chad , Palumbo Dante
Published: August 2023

With few cases reported on the combination of intraneural lipoma resulting in carpal tunnel syndrome, our aim is to present further case evidence of such a condition and review current literature regarding workup and management of this condition.
Interpreting the Knee Osteoarthritis Outcome Score Joint Replacement: Minimum clinically important difference values vary over time within the same patient population
Authors: Only Arthur J. , Albright Patrick , Guenthner Guy , Parikh Harsh R. , Kelly Brandon , Huyke Fernando A. , Horst Patrick K. , Cunningham Brian
Published: August 2023

Introduction

Total knee arthroplasty (TKA) is the preferred treatment for end-stage osteoarthritis.

Minimal clinical important difference (MCID) quantifies if a patient achieves a successful outcome following TKA. This study aims to determine the MCID for Knee Injury Osteoarthritis Outcome Score Joint Replacement (KOOS JR) at two designated time intervals and to compare methodologies for calculating MCID.

Methods

Patient-Reported Outcome Measures (PROM) were prospectively evaluated for 956 patients undergoing TKA between 2017 and 2018 at a single health care system. Patients who completed baseline, 3-month and 1-year post-operative PROM surveys at clinical follow-up were included in the study. MCID was calculated from baseline to 3-months and baseline to 1-year using anchoring and distribution-based methods.

Results

Average KOOS JR scores at baseline, 3-month, and 1-year follow-up were 51.7 ± 11.7, 69.2 ± 12.0, and 76.3 ± 14.5. The KOOS JR MCID determined by the PROMIS10 physical health anchoring method was 21.5 ± 14.9 and 27.9 ± 16.0 for the 3-month and 1-year intervals. The KOOS JR MCID determined by the PROMIS10 quality-of-life anchoring method was 21.2 ± 14.9 and 28.9 ± 15.8 for the 3-month and 1-year intervals. The MCID calculated by the distribution method was 7.4 and 8.2 for the 3-month and 1-year intervals.

Conclusion

KOOS JR MCID varies as a function of time and is variable within the same population depending on MCID calculation methodology. Improved strategy for calculating or standardizing MCID is required to better guide use of KOOS JR and other PROMs in clinical decision-making.
Interpreting the Hip Osteoarthritis Outcome Score Joint Replacement: Minimum clinically important difference values vary over time within the same patient population
Authors: Guenthner Guy , Albright Patrick , Only Arthur J. , Parikh Harsh R. , Kelly Brandon , Huyke Fernando , Horst Patrick K. , Cunningham Brian
Published: August 2023

Introduction

Total hip arthroplasty (THA) results in outstanding outcomes and long-term implant survivorship, but there continues to be a need for tools to identify surgical candidates and assist with shared decision-making. This study aims to determine the Hip Osteoarthritis Outcome Score Joint Replacement (HOOS JR) Minimum Clinical Important Difference (MCID) at two time intervals and to evaluate different methods for calculating the HOOS JR MCID for patients undergoing THA.

Methods

A patient reported outcome measure (PROM) database was prospectively queried at a single outpatient ambulatory surgery center for patients treated with THA between 2017 and 2018. All patients completed PROM surveys at preoperative baseline, 3-month, and 1-year follow-up. MCID was calculated at two different intervals, baseline to 3-months and baseline to 1-year, using anchoring and distribution-based methods. Anchor-based calculations were anchored to the Patient-Reported Outcomes Measure Information System (PROMIS10) quality-of-life and physical health instruments.

Results

514 patients were statistically analyzed. Average HOOS JR scores were 52.5, 79.3, and 86.1 at preoperative baseline, 3-month follow-up and 1-year follow-up, respectively. The HOOS JR MCID determined by the PROMIS10 physical health anchoring method was 30.1 and 35.5 for the 3-month and 1-year time intervals. The HOOS JR MCID determined by the PROMIS10 quality-of-life anchoring method was 31.1 and 34.8 for the 3-month and 1-year time intervals. The distribution method MCID was 8.2 for the 3-month interval and 8.4 for the 1-year interval.

Conclusions

MCID values vary by time and by calculation method. THA patients may require individualized and time-point specific MCID formulas to better guide clinical decision-making.
A Primer on Non-Clinical Opportunities for the Innovative Orthopaedic Surgeon
Authors: Mody Kush , Rahman Omar , Parekh Selene
Published: August 2023

Orthopaedic surgeons are well-positioned as experts in the diagnosis and treatment of musculoskeletal injuries and pathology. There are opportunities that exist in addition to clinical practice in which surgeons can utilize their expertise. These skillsets can be applied toward non-clinical pursuits such as entrepreneurship, consulting, ancillary service management, real estate, and medical device investing. In this article, we discuss these opportunities and how orthopaedic surgeons can apply their clinical acumen in an innovative way.
Changes Coming for Group Practices under the Stark Law Effective January 1, 2022 – Are you Ready?
Authors: Ness Allison , Kastner Elizabeth , Herschman Gary
Published: August 2023

Now is the time for all orthopedic groups to review their physician profit sharing or productivity bonus arrangements if your practice is structured as a “group practice” under the Medicare Physician Self-Referral (the so called (Stark Law)) – due to the upcoming effective date of revisions and clarifications issued by the Centers for Medicare and Medicaid Services (CMS).
Comparative Analysis of Racial and Gender Diversity in Orthopedic Surgery Applicants and Residents from 2007 and 2019
Authors: Onuoha Anointing C. , Meadows Austin M. , Faraj Majd T. , Skinner Madelyn M. , Day Charles , Ravi Karthik
Published: August 2023

Introduction

Since 1999, orthopedic surgery has noted significant gaps in racial and gender diversity. A 2007 study demonstrated that diversity in orthopedic surgery lagged behind other specialties. Our study’s purpose was to evaluate changes in orthopedic surgery applicant and resident diversity from 2007 to 2019 and to compare current levels of diversity between applicants and residents alongside 7 other specialties.

Methods

Using public demographic data, our study evaluated racial and gender demographics of medical school graduates, residency applicants, and residents from 2007 to 2019 for orthopedic surgery and 7 additional specialties. Furthermore, diversity metrics between orthopedic surgery applicants and residents were compared.

Results

From 2007 to 2019, the proportion of minority applicants increased by 26%, while the proportion of female applicants increased by 64% (p<0.001). Orthopedic surgery experienced a 10% decrease in minority resident representation, despite individual increases in some areas (p=0.004). Meanwhile, female representation increased 24% among orthopedic residents (p<0.001). When compared to other specialties in 2019, orthopedic surgery had the lowest proportions of minority and female residents (p<0.001*).

Discussion

Since 2007, orthopedic surgery experienced growths in minority and female applicant representation. However, additional efforts are needed to address the gaps in minority and female representation in orthopedic residencies compared to other specialties.
Mini-Open Carpal Tunnel Release with a Pediatric Nasal Speculum: A 10-Year Retrospective Case Series
Authors: Lung Brandon , Grossman Lauren , Kim Matthew , Komatsu David , Yang Jie , Wang Edward
Published: August 2023

Background

Nasal speculum assisted carpal tunnel release (CTR) is performed using smaller incisions than are normally achieved with open procedures. We performed a retrospective case series analysis to evaluate short and long-term symptom and functional outcomes of a single surgeon’s results with this technique.

Methods

During the period of 2005-2011, 678 cases met the inclusion criteria. Of these, 198 cases representing 152 unique individuals were contacted and consented to participate in the study. A chart review was performed to identify demographics, pre-operative questionnaire results, and post-operative characteristics. Post-operative Symptom Severity Scale and Functional Status Scale results from the Carpal Tunnel Questionnaire were then obtained via telephone interviews.

Results

The mean (StDev) time to follow up was 4.08 (2.1) years with the mean age at follow up 61.94 (14) years. More females (56%) were included than males (44%). Using linear mixed models, patients with nasal speculum assisted CTR had significant improvements in both Symptom Severity and Functional Status Scales following surgery. In addition, 97.7% of patients reported their incisions were aesthetically pleasing and only 78.7% reported their incisions were still visible. Several pre-operative factors had a significant association with good surgical outcomes, including: Positive Compression Test/Durkin’s; Severe/very severe difficulties on the Functional Status Scale; High scores on the Symptom Severity and Functional Status Scales.

Conclusions

This surgeon’s experience with nasal speculum assisted CTR shows that this technique results in not only aesthetically pleasing results, but also excellent symptomatic and functional outcomes.

Level of Evidence

Level IV Case Series
Moving From KOLs to DOLs - the changing influence of healthcare providers
Authors: Sharan Alok , Dasa Vinod , Flickinger David , Bullock Scott , Martin Justin
Published: August 2023

The increasing use of digital social media networks has changed the influence of health care providers. Key Opinion Leaders are individuals who came from academic institutions who would often maintain influence through publications or podium presentations. The Covid-19 crisis has highlighted the role of Digital Opinion Leaders as individuals who are having a tremendous amount of influence in healthcare through the posting of content or writing blogs online. This article discusses the changing role of KOLs to DOLs and defines what roles each group has in influencing behavior among healthcare providers.
How a VR Surgical Training Company Came About: Osso VR
Authors: Barad Justin , Mednick Thompson Rachel
Published: August 2023

An example of the valaue of VR Training:

““We’ve already started to see the benefits of our technology. For example, one fellowship trained orthopedic surgeon who was trying to transition from doing posterior to anterior hips did a case that took three hours and 30 minutes. He then did a 2-week Osso VR training involving 91 sessions and remote coaching. Following this, he did the same patient’s other hip, and that case only took one hour and 45 minutes!”
A Personal Journey through, and review of, the Landscape of Surgical Robotics in Knee Arthroplasty: My Transition from Mako® to NAVIO™ and finally to the ROSA® Knee System
Authors: Lonner Jess H.
Published: August 2023

The growth of robotic capabilities in arthroplasty surgery over the past few years has mirrored the slow, almost immeasurable progress and adoption of digital technologies across various industries, in general, followed by a veritable explosion. For many years, the field of robotics in orthopaedics was met with skepticism by many of our surgical colleagues who thought that the expense, learning curve, and lack of proof rendered the class of technology unnecessary. The use of robotics for total knee arthroplasty (TKA) is now growing at an exponential rate, reminiscent of the UKA experience from a decade earlier. The purpose of this review was to describe my own personal experience with robotics in knee arthroplasty which highlights an evolution over a thirteen-year period
The Differing Effects of Ethnicity on Mental Health Outcomes Among Patients Undergoing Lumbar Fusion Surgery
Authors: Jadczak Caroline N. , Mohan Shruthi , Lynch Conor P. , Cha Elliot D.K. , Jacob Kevin C. , Patel Madhav R. , Prabhu Michael C. , Vanjani Nisheka N. , Pawlowski Hanna , Singh Kern
Published: August 2023

Introduction

Few studies have explored the effect of ethnicity on postoperative mental health outcomes. This study aims to evaluate the effect of ethnicity on changes in mental health outcomes following lumbar fusion (LF).

Methods

A surgical database was retrospectively reviewed for primary, single, or multilevel, lumbar fusion with posterior instrumentation procedures. Patients were propensity score matched to account for differences in demographics. 12-Item Short Form and Veterans RAND (SF-12 and VR-12) Mental Composite Score (MCS), 9-Item Patient Health Questionnaire (PHQ-9), Visual Analogue Scale (VAS) back, VAS leg, and Oswestry Disability Index (ODI) were recorded. A minimum clinically important difference (MCID) was calculated. Patients were grouped according to ethnicity: African-American, Hispanic, Asian/Other, and Caucasian. Differences between groups in baseline characteristics and mean outcome scores were evaluated. Ethnicity was assessed as a predictor of mental health outcomes and achievement of MCID was evaluated using regression analysis.

Results

The study included 224 patients, 43 African-American, 40 Hispanic, 22 Asian/Other, and 119 Caucasian. Groups differed in age, comorbidity score, and insurance collected (p<0.05). African-Americans had the longest postoperative stay (47.3 hours; p=0.032). Groups differed in preoperative SF-12 and VR-12 MCS, but not PHQ-9 (p<0.001, both). Groups demonstrated differences in postoperative SF-12 MCS (p≤0.021), VR-12 MCS (p≤0.028), PHQ-9 (p=0.009). VAS back, VAS leg, and ODI demonstrated significantly different scores (p≤0.041, all). Ethnicity was not a predictor of mental health outcomes at any timepoint and did not demonstrate an impact on achievement of MCID. Majority of individuals achieved an MCID by 1-year for all outcomes.

Discussion

Preoperative mental health scores demonstrated significant differences based on a patient’s ethnicity but was resolved by 2-years. Ethnicity did not demonstrate significant effects on the ability to achieve an MCID for mental health outcomes. These results suggest that patients of differing backgrounds may require alternative preoperative counseling.
Surgery avoidance rates among total knee replacement candidates following a non-invasive biomechanical intervention: A retrospective cohort study
Authors: Greene Andrew , Miles Christopher
Published: August 2023

Background

Nearly twenty million people are affected by osteoarthritis (OA) across the UK. For end-stage knee OA, total knee replacement (TKR) is considered as the standard of care, but this major surgery carries high costs, long waiting lists, and risk for further revision surgeries. Health systems are therefore looking for effective alternatives to treat these cohorts, significantly delaying, and potentially avoiding joint replacement surgery altogether. The purpose of this study was to examine the 2-year surgery avoidance rate amongst TKR candidates that received a non-invasive biomechanical intervention.

Methods

A retrospective clinical audit was conducted on 365 NHS patients with end-stage knee OA patients eligible for TKR. Each patient was individually fitted with a non-invasive, shoe-like, biomechanical device, that alters the foot center of pressure, minimizes reported symptoms, and promotes neuromuscular control training using convex pods under the sole. Patients used the device for short periods during activities of daily living and were followed for two years. The primary outcome was surgery status after 2 years. Secondary outcomes were evaluated using the generalized linear mixed-models procedure and included changes in pain, function (WOMAC and Oxford Knee Score (OKS), and spatiotemporal gait measured at 3, 6, 12, and 24 months from baseline.

Results

Of the 365 candidates for TKR, 305 (84%) avoided surgery at 2 years. Patients displayed significant clinical improvements over time. Six months after starting treatment, average pain decreased by 42%, average function improved by 39%, and average OKS increased by 7.6 points. These continued to improve over the 2 years. All spatial-temporal gait measures improved over time (p<0.001).

Conclusions

The current results suggest that a non-invasive biomechanical treatment may help end-stage knee OA patients delay knee replacement surgery for at least 2 years or avoid it altogether. This treatment may provide an effective non-surgical alternative for managing these patients in the community, alleviating pain, and improving gait and function.
An innovative technique - Axial Loading and Compression Fixation (ALCF Technique) of scaphoid fracture by percutaneous K-wire
Authors: Rao M Rajeev , P K Navaneeth , Shelin Mohammed , Raj Ranju
Published: August 2023

Backgrounds

Surgical fixation techniques used for the treatment of scaphoid fracture is still a topic of discussion among hand surgeons especially in terms of approach, implants and surgical techniques.

We present an innovative technique of scaphoid fracture fixation by K-wire, which we accidentally encountered when the guide wire broke while doing a cannulated screw for the scaphoid.

This technique of axial aligning, compression loading over a bent tip of K-wire across the fracture fragments of scaphoid is innovative.

Materials

The study included 16 patients operated for Scaphoid fracture between January-2017 to January-2020 by ALCF Technique. the patient age ranged from 18 to 69 years,M:F12:4, 13 fractures on dominant hand,10 fracture presented within 2 weeks, 7 were trans-scaphoid displaced fractures sustained in RTA, 3 proximal pole fractures sustained after a fall, 6 were delayed presentation more than 3 months.

Method

The technique used to pass a K wire from dorsally in ante grade fashion to align the fracture fragments along the anatomical axis of the scaphoid then bend the K wire at the proximal end so as to hook the proximal fragment. The distal end of the K wire is then applied manual traction load with gentle rotation to achieve compression at the fracture ends with rotational alignment on the distal fragment. The distal fragment is anvil on the proximal fragment by a K-wire binder before distally binding to achieve compression & relative stable fixation.

Conclusion

It is a simple, easy to reproduce, economic method to achieve reduction, compression using axial traction and union in all types of scaphoid fractures.
Publication Rates of Podium Presentations from the Orthopedic Summit: Fellow Resident and Medical Student Annual Meeting 2019-2021
Authors: Gupta Sanchita , Cannada Lisa
Published: August 2023

Purpose

To determine the publication rate of presentations presented at the Orthopaedic Summit and Evolving Techniques (OSET) Fellow Resident and Medical Student Annual Meeting 2019-2021

Methods

All presentations from the OSET annual meeting between 2019 -2021 were identified from the OSET’s official website and confirmed through review of the OSET Official Programs. The 2019 and 2021 meeting were in person and the 2020 meeting was virtual due to the COVID pandemic. This information was then used to direct a search on PubMed and Google Scholar database to determine if the presentation was associated with a publication since the meeting. Publishing information was entered into the database.

Results

For 2019-2021 there were a total of 227 presentations with 101 associated publications (45%). The highest rate of publications was 63% of presentations published in 2019, followed by 49% rate of publications in 2020, and 27% rate of publications in 2021. The presentations were published at an average of 8.1 months after presentation.

Conclusion

Our research demonstrated a 45% publication rate over a 3-year period of presentations presented at the OSET annual meetings. Our results are comparable to other publication rates for podium presentations in other societies (e.g. American Academy of Orthopaedic Surgeons, Annual Meeting of the Pediatric Orthopedic Society of North America, Orthopedic Trauma Association Annual Meeting, American Academy for Surgery of the Hand, Annual Meetings of the North American Spine Society, and American Orthopedic Society for Sports Medicine Annual Meeting). This validates the quality of research presented in podium presentations format at the OSET Annual Meeting.
Wireless vs. Wired Arthroscopic Cameras: A Comparative OR Simulation Study of Efficiency, Cost Per Case, Setup, and Takedown
Authors: Williams James , Ustin Jeff , Calcei Jacob , Gardiner Kendra , Voos James , Polito Patrick
Published: August 2023

Arthroscopic cameras have undergone numerous incremental improvements over the last 50 years and yet continue to be tethered by light and power cables. Technological advancements in operating room (OR) equipment hold the greatest promise for improvements in value-based care. This study compares the FDA-cleared, wireless ArthroFree SystemTM to a traditional wired camera in terms of setup, takedown, and total time under simulated OR conditions by nurses and scrub technicians with varying degrees of experience with arthroscopic equipment. The data collected was then used to determine setup and takedown efficiencies and projected cost savings. The participants also completed a human factors questionnaire at the conclusion of their participation. Results demonstrated the ArthroFree System was 44% (24.5 seconds) faster to assemble, 23% (4.9 seconds) faster to disassemble, and 38% (29.4 seconds) faster overall compared to a traditional wired camera system. With OR costs per minute ranging from $20 to $239.50 per minute, the projected savings per case are $9.80 to $117.36. On a Likert Scale (1=poor to 5=excellent) evaluating the following human factors—ease of setup, efficiency, ease of use, ease of disassemble, patient safety, and stress reduction—the ArthroFree wireless camera scored between 4.4 and 4.8 reflecting OR nurses and scrub technicians’ high ratings for all parameters.
Selectively Training in a Single Sport is Not Associated with Increased Injury in High School Female Athletes
Authors: Okoruwa Ehiamen , Trojan Jeffrey , Brown Symone , Mulcahey Mary
Published: August 2023

Competing predominately in one sport instead of multiple sports has become increasingly prevalent in young athletes. However, there is a lack of data focused on female athletes who compete exclusively in one sport. We hypothesized that female athletes who selectively train in a single sport (SS) have higher rates of injury, body image concerns, and menstrual dysfunction compared to female athletes who play multiple sports (MS). Retrospective data was collected from a pre-physical questionnaire distributed among female athletes from five local high schools (n=611; 13-18 years of age). Odds ratios, 95% confidence intervals (CI), and effect size were calculated to investigate the association between SS training and injuries, irregular menses, and body image concerns (a priori p< 0.05). SS training was not associated with higher rates of injury (p=0.48) and were less likely to have a history of stress fractures compared to MS athletes (p=0.03). There was a decrease in the number of menstrual cycles within the last 12 months among SS athletes (p=0.02, d=0.34). Exclusively competing in a single sport is not associated with higher injury rates in female high school athletes but is associated with dissatisfaction with one’s weight.
The Drive for Health Equity - The Need to Use Technology to Reduce Healthcare Disparities in Orthopedics
Authors: Spira Bronwyn
Published: August 2023

Health and healthcare disparities occur across a range of dimensions—including socioeconomic status, age, geographical location, language, and gender—and are reflected in variable rates of disease, disability, and death, as well as life expectancy. Members of disadvantaged groups are more likely to have poor health status in addition to more limited means and ability to access healthcare services.

Within orthopedic care, existing literature has long identified various health and healthcare disparities, including significantly lower rates of total hip arthroplasty (THA) and total knee arthroplasty (TKA) among Black and Hispanic patients, as well as higher amputation rates among Black and Mexican American diabetic patients. While such studies have for decades identified the presence and impact of healthcare disparities among minority and disadvantaged populations, action to improve health equity in orthopedics has been scarce.

To make meaningful progress on health equity, health systems and Ambulatory Surgery Centers will first need to identify existing barriers to care that impact their own patient populations, particularly as new legislation will require organizations to document how they screen patients for social determinants of health, analyze patient data, and address healthcare disparities. Digital care management, remote monitoring, and messaging platforms can help health systems and ASCs improve the quality, consistency, and availability of the care they deliver.

As orthopedic care can potentially improve the health and well-being of so many Americans, it is crucial that we commit to resolving disparities in orthopedic care access, utilization, and outcomes for disadvantaged populations. With greater knowledge of each patient’s challenges, risks, and motivations, providers can more easily address barriers to care and support the best possible outcomes for each and every patient.
Biologic Augmentation of the Subscapularis Tendon During Anatomic Shoulder Arthroplasty: A prospective case series utilizing dynamic ultrasound
Authors: Nathani Amit
Published: August 2023

Five consecutively eligible patients with primary glenohumeral osteoarthritis underwent anatomic shoulder arthroplasty utilizing a collagen-based biointegrative implant (TAPESTRY®) to augment subscapularis tendon repairs. Evaluation of subscapularis healing was primarily assessed via dynamic ultrasound examinations at 6 months post-operatively. Subscapularis imaging was evaluated for tendon thickness, width, echotexture, and calcification. All five patients exhibited fully healed tendons at 6 months with no re-tears, representing a decrease in the 50% occurrence of subscapularis tears historically evidenced in ultrasound studies following shoulder arthroplasty. The subscapularis tendon in all patients was shown to be intact, four of which demonstrated macroscopically aligned collagen tendon architecture with anatomic size measurements, and one demonstrated mild tendinosis. Secondary clinical outcomes included validated shoulder outcome scores including the American Shoulder and Elbow Surgeons (ASES) assessment preoperatively and at 3 months and 6 months postoperatively. Improvements in ASES scores were greater than two-times (33 points at 3 months, and 35 points at 6 months) the published minimal clinically important difference (MCID) of 13.6 ± 2.3 for total shoulder arthroplasty (TSA). Additional data collected included graded belly press, lift-off, and range of motion assessments measured preoperatively and at 6 months postoperatively. Biologic augmentation of the subscapularis tendon with a collagen-based biointegrative implant in these 5 patients showed 100% healing rates assessed via dynamic ultrasound at 6 months post-operatively. All patients demonstrated tendon healing without postoperative complications or revisions. Further investigation is needed to validate the observations from this pilot study.
Increased Risk of Stiffness following Total Knee Arthroplasty with Direct Oral Anticoagulants and Avoidance of Selective COX-2 Inhibitors
Authors: Frederick Jeremy S , Weiner Travis R , Neuwirth Alexander L , Shah Roshan P , Geller Jeffrey A , Cooper H. John
Published: August 2023

Background

Database studies demonstrate a strong association between use of direct oral anticoagulant (DOAC) medications and stiffness following total knee arthroplasty (TKA). The goal of this study was to evaluate whether the risk of stiffness in patients receiving a DOAC was affected by concomitant use or avoidance of a selective COX-2 inhibitor, when compared to a control group of patients receiving aspirin.

Methods

Consecutive primary TKA’s performed at a single institution between January 2014 - September 2019 were retrospectively reviewed. During this period, a risk-stratification algorithm for prophylaxis against venous thromboembolism (VTE) was used, with DOACs selected for patients at elevated VTE risk and aspirin for the remainder. Patients who required manipulation under anesthesia (MUA) within six months of index TKA were identified. Arc of motion (AOM) data at 6-weeks, 3-months, and 1-year was collected. Patients were divided into 3 groups based on postoperative medications prescribed: (a) Aspirin, (b) DOAC alone, and (c) DOAC + NSAID. Categorical variables were analyzed using Fisher’s Exact Tests and Pearson’s Chi-Square, while continuous variables were analyzed using Student’s T-test. Multivariate logistic regression was used to assess MUA risk while controlling for demographic differences.

Results

Forty patients underwent MUA from a population of 1,358 TKAs (2.9%). There was a significantly increased risk of MUA in patients where DOACs were used and concomitant NSAIDs were avoided when compared to the control group of patients receiving aspirin (5.4% vs 2.7%, OR 3.17; p = 0.029). This increased risk was not present when DOACs were used concomitantly with NSAIDs (3.1% vs 2.7%, OR 1.30; p = 0.573). In addition, less consistent AOM was achieved at 1-year postoperatively in the DOAC alone group compared to the control group of patients receiving aspirin (p=0.034).

Conclusions

Compared to aspirin anticoagulation, patients receiving DOACs without concomitant NSAIDs were more likely to develop postoperative stiffness requiring MUA and achieved less predictable AOM. The addition of selective COX-2 inhibitors may mitigate some risk of stiffness following primary TKA when anticoagulation with DOACs is necessary.
Stemless Shoulder Arthroplasty for Glenohumeral Arthritis with Underlying Varus Malunion of the Proximal Humerus - A Case Report with Mid-Term Follow Up
Authors: Setter Kevin , Cavallaro Salvatore , Jann Derek , Setter Nicholas
Published: August 2023

We present a 65 year old right hand dominant female with a varus malunion of her right proximal humerus who went on to develop post-traumatic arthritis of her right glenohumeral joint refractory to years of conservative management. Due to inability to pass a stemmed humeral implant as well as concerns associated with a proximal humerus osteotomy, we performed a total shoulder arthroplasty using a stemless humeral implant. We present mid-term follow up at six years showing excellent range of motion, excellent functional scores, and radiographs. This is one of the only US based studies to our knowledge to report mid-term data on clinical and radiographic outcomes for the use of a stemless humeral implant during a total shoulder arthroplasty in the setting of a proximal humerus deformity
The Cost-Effectiveness of Wound Dressings for Infection Prophylaxis in Total Joint Arthroplasty: An Economic Evaluation
Authors: Kirchner Gregory , Kim Andrew , Dunleavy Mark , Webb Matthew , Kerbel Yehuda , Moretti Vincent
Published: August 2023

Background

Periprosthetic joint infection (PJI) is a medical and economical challenge. Specific post-operative wound dressings have been developed to mitigate risk of PJI following total hip arthroplasty (THA) and total knee arthroplasty (TKA), but these come with added cost and unknown benefit. The purpose of this study was to determine which dressings may be economically justifiable.

Methods

The average added cost of Xeroform with gauze (Xeroform+gauze), Mepilex Border, Aquacel Ag, and Dermabond Prineo dressings compared to standard dressing (Xeroform+gauze) only were obtained from institutional records and contemporary literature. Baseline infection rates following THA and TKA and average costs of PJI treatment were obtained from the literature. A break-even analysis was utilized to determine the absolute risk reduction (ARR) needed in infection rate to make each dressing cost-effective.

Results

At $3.00, a single Xeroform+gauze is economically justified if the initial infection rate for TKA (1.10%) and THA (1.62%) are reduced by an ARR of 0.01% and 0.009%, respectively. Two to three additional post-operative dressing changes increases the cost of Xeroform+gauze to $9.00-12.00 and increases the required ARR for TKA to 0.04-0.05% and for THA to 0.028-0.038%. Mepilex Border costs $29.00 and requires an ARR of 0.11% for TKA and 0.09% for THA. Aquacel Ag costs $40.00 and requires an ARR of 0.16% for TKA and 0.13% for THA. Dermabond Prineo costs $79.00 and requires an ARR of 0.31% for TKA and 0.25% for THA. Variations in estimation of initial infection rate did not impact ARR for any dressing type.

Conclusions

Orthopaedic surgeons have multiple options for surgical dressings following total joint replacement. With respect to infection prophylaxis, Xeroform+gauze is the most cost-effective. Other specialized dressings such as Mepilex Border, Aquacel Ag, or Dermabond Prineo, require significantly higher reductions in infection rate to be economically justifiable.
The Lateral Femoral Condyle is not Hypoplastic Relative to the Medial Condyle in 6829 Magnetic Resonance Images Irrespective of Gender, Age, or Extent of Arthritis
Authors: Shah Romil , Vail Thomas , Bini Stefano
Published: August 2023

Background

Understanding the relationship between the radii of the medial/lateral femoral condyles (MFC/LFC respectively) is important for restoring kinematics in knee arthroplasty. The objective of this study is to use a large cohort of patient magnetic resonance Images (MRIs) to investigate whether asymmetry exists between the radii of the medial/lateral femoral condyles.

Methods

Patients recruited into the Osteoarthritis Initiative (OAI) with knee MRIs were included. Using a validated machine learning algorithm, the radii of each condyle was calculated. The study sample was split into cohorts depending on medial and lateral compartment wear patterns of each knee in addition to their KL classification. The radii of each condyle in each cohort were compared using paired t-tests. Finally, a multivariable regression was run to evaluate factors that could impact differences between medial/lateral condylar size.

Results

6,829 MRIs were included in this study of which 89% were classified as varus knees. The average best fit radius of the MFC was significantly smaller than that of the LFC (15.3mm vs. 16.8mm, p<0.001) in general and in patient knees with medial wear with KL 0, 1, 2, 3 and 4 and patient knees with lateral wear with KL 0, 2, 3, and 4. After adjusting for age, BMI, and Gender, patients with lateral wear patterns and patients with increasing KL score had a statistically significant larger lateral condylar size.

Conclusion

ML was effectively used to automate the measurement of femoral condyle size suggesting that the LCF has a slightly larger radius than the MFC and is not hypoplastic.
Total Joint Arthroplasty Time-of-Day Start Time Has Minimal Effect on Intraoperative Efficiency
Authors: Hammoor Bradley T. , Kaidi Austin C , Hickernell Thomas R. , Cooper H. John
Published: August 2023

Introduction

Total hip (THA) and knee arthroplasties (TKA) are common elective procedures, and dedicated arthroplasty teams perform multiple procedures per day. Little is documented about how time-of-day scheduling affects the intraoperative efficiency of total joint arthroplasties (TJA). In this study, we analyzed the effects of surgical start time on TJA operative lengths.

Methods

A retrospective study was performed for primary TJA patients done within a four-year period at a single academic medical center. Surgical start time, operative duration, and patient demographics were collected. Based on a 12-hour operative day, surgical start times were categorized as early (7AM to 11AM), mid-day (11AM to 3PM), or late (after 3PM). A chi-squared test was performed to examine for associations between patient demographics and surgical start time. A multivariate linear regression (MLR) was performed to determine the effect of surgical start time on operative duration. P-values less than 0.05 were considered significant.

Results

This study identified 1663 TJAs – 869 total knee (TKA) and 791 total hip arthroplasties (THA) who met inclusion criteria. Among TKAs, we identified 319 (36.7%) early, 437 (50.3%) mid-day, and 113 (13.0%) late operations. Among THAs, we identified 407 (51.4%) early, 297 (37.5%) mid-day, and 87 (11.0%) late operations. MLR demonstrated that for TKA there was a 4.9 (p =0.018) and 7.3 (p=0.013) minute increase for mid-day and late cases, respectively. For THAs, a non-early start time was associated with an increased operative duration of 9.1 to 12 minutes (p<0.001).

Discussion

Surgical start time has a statistically significant, but minimal, effect on operative length for TJAs, with later cases being slightly longer than first-start cases.