Translational Medical Research Commons^™

Glut1 Is Redundant In Hypoxic And Glycolytic Nucleus Pulposus Cells Of The Intervertebral Disc, Shira N. Johnston, Elizabeth S. Silagi, Vedavathi Madhu, Duc H. Nguyen, Irving M. Shapiro, Makarand V. Risbud

Department of Orthopaedic Surgery Faculty Papers

Glycolysis is central to homeostasis of nucleus pulposus (NP) cells in the avascular intervertebral disc. Since the glucose transporter, GLUT1, is a highly enriched phenotypic marker of NP cells, we hypothesized that it is vital for the development and postnatal maintenance of the disc. Surprisingly, primary NP cells treated with 2 well-characterized GLUT1 inhibitors maintained normal rates of glycolysis and ATP production, indicating intrinsic compensatory mechanisms. We showed in vitro that NP cells mitigated GLUT1 loss by rewiring glucose import through GLUT3. Of note, we demonstrated that substrates, such as glutamine and palmitate, did not compensate for glucose restriction resulting …

Augmented Immunomodulation Of Endogenous Marrow-Derived Stem Cells In The Setting Of Acl Rupture, Mackenzie Fleischer, Michael Newton, Samantha Hartner, John A. Driscoll, Anthony Arveschoug, Chritopher C. Vasileff, Kevin Baker

Conference Presentation Abstracts

PURPOSE: Augmentation of MSC immunomodulation is an unexplored, potentially useful therapeutic to combat PTOA following ACLR. Lower kynurenine-to-tryptophan ratios observed in synovial fluid of ACL rupture (ACLR) rats suggests decreased activity of tryptophan metabolizing enzyme, Ido, known to be secreted by MSCs to promote T-reg expansion and Th17 suppression. This study aims to characterize the immunomodulatory capacity of pharmacologically mobilized MSCs in conjunction with exogenously delivered Ido. METHODS: Rats (N = 48) underwent ACLR to evaluate the effects of mobilized MCSs on Ido1 and inflammatory cytokine expression profiles in the synovial fluid. Additionally, rats (N = 160) underwent ACLR to …

Timing Of Preoperative Surgical Antibiotic Prophylaxis Prior To One-To-Three Level Elective Lumbar Fusion, Akash Singh, Gregory Schroeder, Md, Jose Canseco, Md, Alexander Vaccaro, Md, Parthik Patel, Md, Ariana Reyes, Md

Phase 1

Introduction: Surgical site infections (SSIs) in patients who have undergone lumbar fusion surgery can be a devastating complication. The aim of this study was to examine the relationship between timing of preoperative antibiotic prophylaxis and adverse outcomes such as SSIs with subgroup analysis stratified by antibiotic type.

Methods: This retrospective cohort included patients having undergone a 1-3 level lumbar fusion who were allocated into 5 groups based on the time from antibiotic administration to incision (Group A = 0-15 min, Group B = 16-30 min, Group C = 31-45 min, Group D = 46 – 60 min, and Group …

Total Knee Arthroplasty In Patients With Prior Meniscus Surgery: A Matched Case Control Study, Lasya Rangavajjula, Steven B. Cohen, Md, Meghan E. Bishop, Md, Shyam Brahmabhatt, Md, Michael G. Ciccotti, Md, Ashley Bassett, Md, Christopher Hadley

Phase 1

Introduction: Meniscus surgery is one of the most commonly performed orthopedic surgical procedures in the United States. However, outcomes following a Total Knee Arthroplasty (TKA) in patients with a history of prior knee arthroscopy are varied with small patient cohorts, warranting further research. The research question investigates how the clinical outcomes of TKA compare between patients with and without prior meniscectomy history. It is hypothesized that there will be no significant difference in clinical outcomes between the two cohorts.

Methods: The study design is a retrospective case-control study. The study population included patients from Rothman Institute with TKA and …

Treatment Of Distal Radius Fractures In Patients Over 80 Years Of Age: Functional Outcomes After Open Reduction And Internal Fixation Versus Nonoperative Treatment, Robert Gallivan, Lili E. Schindelar, Md, Mph, Richard Mcentee, Pedro K. Beredjiklian, Md

Phase 1

INTRODUCTION

Distal radius fractures are one of the most common fractures seen in the elderly. With the younger physiological age of patients over 60 years, the expectation of functional outcomes is changing. The management of distal radius fractures in the elderly patient, especially those over the age of 80, has not been well defined. The purpose of this study was to compare operative to nonoperative treatment of distal radius fractures in patients older than 80 years to determine if there is any difference in functional outcomes or complications.

METHODS

A retrospective review was performed to identify patients 80 years or …

Evaluation Of Arthroscopic Repair To Pan-Labral Lesions Of The Glenoid: A Retrospective Review Of Patient Outcomes Over A Ten-Year Period And Matched Cohort Analysis, Julien Aoyama, Joseph Schmitz, Christopher Hadley, Meghan Bishop, Md, Brandon Erickson, Md, Sommer Hammoud, Md

Phase 1

Introduction:

Most shoulder labral tears are partial and treated with surgery, but rarely they are “panlabral” around the entire shoulder. Due to infrequency panlabral tears aren’t well understood, and thus this study compares outcomes between panlabral and more common SLAP tears. We hypothesize no difference in outcomes based on surgeon experiences.

Methods:

This is a retrospective cohort study of shoulder labrum repairs at Rothman Institute from 2006-2016. All patients received arthroscopic repair and were categorized to compare panlabral to SLAP tears. The primary outcome is return-to-activity rate at six months post-surgery and secondary outcomes include post-operative range of motion, …

Peri-Operative Urodynamic Assessment Has Poor Predictive Value For Developing Post-Operative Urinary Retention, Baylor Wickes, Robert Pivec, Md, Mathew S. Austin, Md

Phase 1

Introduction: Post-operative urinary retention (POUR) following primary total joint arthroplasty (TJA) has a reported prevalence up to 35%. Risk factors for developing POUR have traditionally included surrogate markers such as the presence or absence of urologic disease. However, dynamic measurement of the renal system with post-void residual volumes (PVR) has not been investigated as a tool for assessing POUR risk.

Methods: All male TJA patients underwent an pre-operative screen for POUR, including PVR measurements, patient-derived subjective urinary retention scores, and assessment of urologic disease. This was combined with a post-operative monitoring and catheterization protocol developed in partnership with a …

Student-Led Surgical Research Network: Enhancing Medical Student Research Opportunities, Ronika Devi Ukrani, Muhammad Musaab Munir, Areesh Bhatti, Shahryar Noordin

Medical College Documents

The current paper was planned to describe a student-led surgical research network established by the Research Division of the Surgery Interest Group at the Aga Khan University, Karachi. The project involved the creation of a collaborative network to provide opportunities to medical students to work with faculty on research projects. Over 25 students were directly connected with faculty and research mentors to work on research projects in the surgical specialty of their choice. The initiative of establishing a student-led surgical research network was successfully implemented and provided medical students with novel research opportunities by helping bridge the gap between the …

Evaluation Of Rotator Cuff Repair With Concomitant Biceps Tenodesis, Matthew Beucherie, Daniel Nemirov, Sommer Hammoud, Md, Meghan Bishop, Md, Brandon Erickson, Md

Phase 1

Introduction: Surgical rotator cuff repair (RCR) has proven to be an effective treatment for rotator cuff tears. Commonly, rotator cuff tears are associated with concomitant biceps pathology, which are often treated by biceps tenodesis (BT). We hypothesize that patient outcomes will be similar in those that have undergone RCR with concomitant BT and isolated RCR.

Methods: This is a retrospective cohort study comparing patients who underwent arthroscopic RCR with arthroscopic or open BT to patients who underwent isolated RCR at a multisurgeon orthopaedic practice during the time period of November 2016 to December 2016. The outcome for comparison is …

Functional Outcomes After Lumbar Fusion In Opioid-Tolerant Patients, Max Detweiler, Noah Levy, Dhruv K.C. Goyal, Ariana Reyes, Alex R. Vaccaro, Md, Phd, Mba

Phase 1

Introduction: Prolonged opioid use after lumbar fusion surgery is implicated with increased hospital readmissions, higher postoperative pain scores, and longer return to work time. There are several non-modifiable risk factors for postoperative opioid use including socioeconomic status and gender. The purpose of this study was to determine the effects of opioid-tolerance on PROMs and to determine risk factors for prolonged opioid use after lumbar spine surgery.

Method: Using retrospective cohort analysis, patients who underwent lumbar spinal fusion at TJUH were identified and determined to be either opioid-naïve or opioid-tolerant using the Pennsylvania PDMP. Outcomes included number of opioid tablets consumed, …

Meta-Analysis Of Repair Techniques For Mixed Nerve Damage, Grant Jones, Zachary J. Herman, Asif Ilyas

Phase 1

BACKGROUND: Injuries to the upper extremity are common and can occur with trauma, surgery, or compression. Particularly, injuries that result in complete transection often require surgical intervention in attempt to restore function and quality of life. Classically, nerve autografts have been used as the gold standard to repair these peripheral lesions. An alternative to the autologous nerve graft is the use of the processed nerve allograft. limited research exists in comparing sensory and motor outcomes of allograft nerve repair in the upper extremity with data for autograft repair. In this systematic review and meta-analysis, we set out to cumulate results …

Dual Mobility Bearing Articulations Result In Lower Rates Of Dislocation After Revision Total Hip Arthroplasty., Zachary Kozick, William Li, Matthew Sherman, Camilo Restrepo, Md, Eric B. Smith, Md, P. Maxwell Courtney, Md

Phase 1

Introduction: The purpose of our study is to directly compare the rates of instability after revision total hip arthroplasty (THA) between a modular dual mobility (DM) and a conventional polyethylene single-bearing surface.

Methods: We retrospectively reviewed a consecutive series of patients who underwent revision THA from 2012 to 2016 at a single institution with a minimum of 2 years of follow-up. Rates of re-revision, dislocation, complications, and short-form (SF-12) scores were compared between the DM and single-bearing groups. To control for confounding variables, a multivariate logistic regression analysis was performed.

Results: Of the 267 revision THA patients, 94 patients …

Selective Serotonin Reuptake Inhibitors Are Associated With Increased Bleeding Related Complications Following Primary Total Hip And Total Knee Arthroplasty, Kyle Plusch, John Stammers, Mbbs, Frcs, Alexus M. Cooper, Chi Xu, Md, Paul Kitei, Md, Javad Parvizi, Md, Frcs, Jess H. Lonner, Md

Phase 1

Introduction: Approximately 10-22% of patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) are diagnosed with depression. Pre-operative depression is associated with poorer patient reported outcomes, costs and increased complications. Selective serotonin-reuptake inhibitors (SSRIs) are first-line treatment for depression due to their efficacy and low side effect profile. There are conflicting studies regarding SSRI-related bleeding complications. This study compares the rate of bleeding-related complications in THA and TKA patients taking SSRI’s to a control group of non-SSRI users.

Methods: A retrospective single institution study of 16,407 primary THA and TKA’s from 2008 to 2018 was performed. Patients with …

Survivorship, Complications, And Outcomes Following Distal Femoral Replacement Using Megaprosthesis, Keenan Sobol, John Strony, Timothy Tan, Md, Scot Brown, Md

Phase 1

Introduction: Distal femoral bone loss is often managed with a combination of modular prostheses, structural and non-structural allografts, and metal augmentation. However, when bone loss of the distal femur is severe, the viability of these methods can be limited.In the setting of severe bone loss, endoprosthetic reconstruction (EPR) with a megaprosthesis has become increasingly popular for both malignant and non-neoplastic indications. The primary aim of this study was to determine the short-term prosthesis survivorship, as well as complications, for patients who presented with non-neoplastic disease indications for megaprosthesis distal femoral replacement (DFR) at a single institution. The secondary aim was …

Conversion Total Knee Arthroplasty Needs Its Own Diagnosis Related Group Facility Reimbursement Code, Jonah Stein, Michael Yayac, Md, Gregory K. Deirmengian, Md, Javad Parvizi, Md, P. Maxwell Courtney, Md

Phase 1

Introduction: Conversion from a prior surgery to a total knee arthroplasty (TKA) is a more technically difficult procedure than primary TKA and is associated with worse short-term outcomes and increased complication and readmission rates, despite being undifferentiated under the current bundled payment model. The aim of this study was to determine differences in facility costs between primary TKA and conversion TKA, which we hypothesize are significant, to ensure providers are not penalized for treatment and high-risk patients have the same access to care.

Methods: We retrospectively reviewed a consecutive series of patients undergoing primary TKA at two hospitals within …

Cardiac Risk Factors Predicting 30/90-Day Readmission Rates In Lumbar Decompression Surgeries, Kevin Xiao, Blake Nourie, Joseph Bechay, Dhruv K.C. Goyal

Phase 1

Preoperative cardiopulmonary disease is known to be a risk factor for perioperative complications in deformity surgery and lumbar fusion procedures, however there is a lack of literature evaluating cardiac risk factors and their influence on readmission rates following lumbar decompression surgery. We want to determine whether preoperative cardiac risk factors influenced the 30 and 90-day readmission rates in patients undergoing lumbar decompression surgery. Patient charts from Rothman Institute between were reviewed for history of preoperative cardiac risk factors such as coronary artery disease, congestive heart failure, myocardial infarction, stroke, cardiac catheterization, stent placement, coronary artery bypass graft, aspirin and/or clopidogrel …

Static V. Expandable Tlif Cage Outcomes, Harrison Pajovich, Ryan Nachwalter, Lohit Velagapudi, Joseph Zarowin, Alexander R. Vaccaro, Md, Phd

Phase 1

Static cages were introduced in the 1990s as a solution to degenerative spondylolisthesis, recurrent disc herniation and spinal stenosis. As this procedure was popularized, a new class of expandable Transforaminal Lumbar Interbody Fusion devices was introduced to further improve outcomes that will be studied in this project. It will be explored how expandable cages compare to static cages in TLIF procedures in patient-reported outcomes, complications and restoration of appropriate lumbar lordosis. We conducted a retrospective cohort review comparing those who received expandable and static cages. Eligible patients received TLIF procedure at the Rothman Institute, were ≥18 years of age and …

Assessment Of The Composition And Biologic Activity Of Platelet Rich Plasma And Its Relationship To Clinical Outcomes In Patients With Knee Osteoarthritis, Daniel Nemirov, Bijan Dehghani, Habib Zahir, Xiaoning Yuan, Christine Kim, Reyna Bhandhari, Patrick Fava, Yurii Chinenov, Joseph Nguyen, Laura Donlin, Brian Halpern, Scott Rodeo, Miguel Otero

Phase 1

Recent studies suggest positive clinical outcomes associated with platelet-rich-plasma (PRP) administration to treat knee osteoarthritis (OA). However, the results remain inconclusive in part because of the high variability in PRP preparations and the limited information regarding the relevant biologically active components of PRP. We hypothesize that the variability in clinical response is driven by the heterogeneous composition of PRP. In this study we evaluated the composition and biological activity of PRP and further correlated our findings to clinical outcomes in patients receiving intra-articular injections for knee OA. After IRB approval and patient consent, we enrolled 51 patients (mean age: 57.9 …

Static Vs. Expandable Peek Interbody Cages: A Comparison Of One-Year Clinical And Radiographic Outcomes For One-Level Tlif, Ryan Nachwalter, Parthik Patel, Md, Alexander R. Vaccaro, Md, Phd

Phase 1

Introduction: Degenerative spine disease is a disabling condition affecting many worldwide. Transoforaminal lumbar interbody fusion (TLIF) procedures help stabilize the spine, while improving back and/or leg pain. With the introduction of new implant designs and modifications, focus has shifted to optimizing spinopelvic alignment, fusion rates, and more. This study aims to explore the effect of static versus expandable polyetheretherketone (PEEK) cages on patient-reported outcomes (PROMs) and radiographic outcomes (subsidence, disk height, and alignment parameters).

Materials/Methods: A retrospective cohort study was conducted using a database of patients in a single, high volume academic center. Patient outcomes were obtained from charts and …

Ain To Ulnar Motor Nerve Transfer Meta Analysis, Melanie Luikart, Asif M. Ilyas, Md

Phase 1

Background: There are currently few comprehensive studies of end-to-end and “supercharged” reverse end-to-side (SETS) anterior interosseous nerve (AIN) to ulnar nerve transfers for treatment of ulnar neuropathy. The authors performed a literature review existing published literature to evaluate the indications for, and utility of, AIN-ulnar nerve transfer as a treatment method and to inform future treatment decisions.

Methods: A literature review was performed based on the following inclusion criteria: inclusion of anterior interosseous nerve or AIN, ulnar nerve or ulnar motor nerve, transfer or nerve transfer, and outcome, motor, clinical, ulnar neuropathies, ulnar nerve paralysis, treatment or function. Exclusion criteria …

Opioid Tolerance Influences Outcomes After Lumbar Fusion In Patients With Degenerative Pathology, Noah Levy, Max Detweiler, Dhruv K.C. Goyal, Ariana Reyes, Alexander R. Vaccaro

Phase 1

Introduction: Extended opioid use prior to surgery has been implicated in poorer postoperative outcomes. However, it remains unclear if there is a significant difference in postoperative outcomes among preoperative opioid-naïve and opioid-tolerant patients who undergo lumbar spinal fusion. The purpose of this study was to determine the effect of preoperative opioid use on patient-reported outcome measures in patients undergoing lumbar spinal fusion.

Methods: This retrospective cohort analysis identified 260 patients who underwent lumbar spinal fusion at a high-volume, single institution. There were two cohorts: patients who were opioid-naïve (defined as total opioid consumption of ≤ 7 days in …

Outcomes In Knot Vs Knotless Surgery In Labrum Tears, Zachary Howell, Benjamin Hendy, Md

Phase 1

A Bankart lesion is a tear of the anterior and inferior glenoid labrum. The primary method of repairing this lesion is to sew the detached part back to the joint, however there is a relatively newer method of doing so that does not involve tying a knot in the joint which may cause less joint irritation. The question our research project attempted to answer was: How do the long-term outcomes associated with knotless Bankart labrum repairs compare with the knot repairs? A retrospective cohort study was done with Rothman Institute Bankart lesion patients from 2010-2016. Data was gathered over phone …

Is Facet Joint Distraction A Cause Of Postoperative Axial Neck Pain After Acdf Surgery?, Nathan Houlihan, Srikanth N. Divi, Md, Dhruv K.C. Goyal, John J. Mangan, Md, Justin D. Stull, Md, Matthew S. Galetta, Jeffrey A. Rihn, Mark F. Kurd, Md, D. Greg Anderson, Md, Alan S. Hilibrand, Md, Alexander R. Vaccaro, Md, Phd, Mba, Christopher K. Kepler, Md, Mba, Gregory D. Schroeder, Md, Joseph K. Lee, Md

Phase 1

Introduction: Intervertebral distraction in anterior cervical discectomy and fusion (ACDF) has been postulated to injure the degenerative facet joints posteriorly and increase postoperative pain and disability. This study aims to determine if there is a correlation between the amount of facet distraction and postoperative patient reported outcomes.

Methods: A retrospective cohort analysis of patients undergoing ACDF for degenerative pathologies was performed. Each patient received lateral cervical spine x-rays at the immediate postoperative time point and were split into groups based on the amount of facet distraction measured on these films: Group A: < 1.5 mm; Group B: 1.5-2.0 mm; and Group C: > 2.0 mm. Patients reported outcome measures were obtained …

The Use Of Cementless Components Does Not Significantly Increase Procedural Costs In Total Knee Arthroplasty, Samantha Harrer, Michael Yayac, Md, William J. Hozack, Md, Javad Parvizi, Md, Frcs, P. Maxwell Courtney, Md

Phase 1

Introduction: Modern cementless total knee arthroplasty (TKA) designs have shown promising early clinical success; however, concerns exist regarding the higher cost of the cementless implants. The purpose of this study is to evaluate the total facility cost of cementless vs traditional cemented TKA along with the effect of cementless fixation on short-term outcomes.

Methods: We reviewed a consecutive series of patients between 2015 and 2017 who underwent either cementless or cemented primary TKA. Itemized facility costs were calculated for every procedure using a time-driven activity-based costing algorithm. Controlling for demographic variables and medical comorbidities, we performed a multivariate analysis …

Investigation Of The Superman Stretch On Posterior Capsule Range Of Motion, Brian Gibbs, Christopher M. Aland, Md, Joshua Hornstein, Md

Phase 1

Introduction: Shoulder pain is a common clinical entity affecting all age groups and can frequently be attributed to pathological internal impingement. A primary contributing factor to labrum tears and internal impingement is posterior capsule tightness. In order to improve range of motion (R.O.M.), prior studies have demonstrated that stretching is an important tool for increasing R.O.M. at many joints. We hypothesized that the superman stretch would lead to greater increases in IR than the traditional sleeper stretch.

Methods: A level II, prospective study in collegiate-level athletes from The College of New Jersey (TCNJ) was performed. Shoulder internal rotation (IR), shoulder …

Predictors Of Functional Outcomes Following Operative Treatment Of Acute Achilles Tendon Ruptures, Andrew Fisher, Ryan Rogero, Joseph O'Neil, Md, Daniel Fuchs, Md, Steven Raikin, Md

Phase 1

Introduction: Previous studies involving operative management of Achilles tendon ruptures have attempted to determine if patient factors influence outcomes. No previous study has attempted to identify outcome predictors in patients exclusively undergoing surgical repair. The purpose of this study is to determine if any injury or patient variables were predictive of outcomes following operative management of Achilles ruptures.

Methods: Patient demographics including age, sex, body mass index (BMI), comorbidities (diabetes mellitus, depression, anxiety), mechanism of injury (sports, non-sports), and date of injury were collected. Postoperative notes were reviewed to determine compliance. Patients completed the Foot & Ankle Ability Measure (FAAM)-Activities …

Direct Crystal Formation From Micronized Bone And Lactic Acid: The Writing On The Wall For Calcium-Containing Crystal Pathogenesis In Osteoarthritis?, Anna A. Bulysheva, Nardos Sori, Michael P. Francis

Bioelectrics Publications

Introduction

Pathological calcium-containing crystals accumulating in the joints, synovial fluid, and soft tissues are noted in most elderly patients, yet arthritic crystal formation remains idiopathic. Interestingly, elevated lactic acid and bone erosion are frequently among the comorbidities and clinical features of patients with highest incidence of crystal arthropathies. This work shows that bone particulates (modeling bone erosion) dissolve in lactic acid and directly generate crystals, possibly presenting a mechanism for crystal accumulation in osteoarthritis.

Methods and results

Micronized human bone (average particle size of 160 μm x 79 μm ) completely dissolved in lactic acid in 48 hours, and in …