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Transgenic Mice Overexpressing Human Tnf-Α Experience Early Onset Spontaneous Intervertebral Disc Herniation In The Absence Of Overt Degeneration., Deborah J. Gorth, Irving M. Shapiro, Makarand V. Risbud 2018 Thomas Jefferson University

Transgenic Mice Overexpressing Human Tnf-Α Experience Early Onset Spontaneous Intervertebral Disc Herniation In The Absence Of Overt Degeneration., Deborah J. Gorth, Irving M. Shapiro, Makarand V. Risbud

Department of Orthopaedic Surgery Faculty Papers

There is a well-established link between cytokine expression and the progression of intervertebral disc degeneration. Among these cytokines, interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) are the most commonly studied. To investigate whether systemic hTNF-α overexpression affects intervertebral disc health, we studied the spine phenotype of Tg197 mice, a widely used hTNF-α transgenic line. These mice were studied at 12-16 weeks of age using comprehensive histochemical and immunohistological analysis of the spinal motion segment. Micro-CT analysis was performed to quantify vertebral trabecular bone architecture. The Tg197 mice evidenced spontaneous annular tears and herniation with increased vascularity in subchondral bone and ...


Trends And Costs Of External Electrical Bone Stimulators And Grafting Materials In Anterior Lumbar Interbody Fusion., Anthony D'Oro, Zorica Buser, Darrel Scott Brodke, Jong-Beom Park, Sangwook Tim Yoon, Jim Aimen Youssef, Hans-Joerg Meisel, Kristen Radcliff, Patrick Hsieh, Jeffrey Chun Wang 2018 University of Southern California, Los Angeles

Trends And Costs Of External Electrical Bone Stimulators And Grafting Materials In Anterior Lumbar Interbody Fusion., Anthony D'Oro, Zorica Buser, Darrel Scott Brodke, Jong-Beom Park, Sangwook Tim Yoon, Jim Aimen Youssef, Hans-Joerg Meisel, Kristen Radcliff, Patrick Hsieh, Jeffrey Chun Wang

Rothman Institute

STUDY DESIGN: Retrospective review.

PURPOSE: To identify the trends in stimulator use, pair those trends with various grafting materials, and determine the influence of stimulators on the risk of revision surgery.

OVERVIEW OF LITERATURE: A large number of studies has reported beneficial effects of electromagnetic energy in healing long bone fractures. However, there are few clinical studies regarding the use of electrical stimulators in spinal fusion.

METHODS: We used insurance billing codes to identify patients with lumbar disc degeneration who underwent anterior lumbar interbody fusion (ALIF). Comparisons between patients who did and did not receive electrical stimulators following surgery were ...


Clinical Outcomes After Four-Level Anterior Cervical Discectomy And Fusion., Tyler M Kreitz, Douglas A Hollern, Eric M. Padegimas, Gregory D. Schroeder, Christopher K Kepler, Alexander Vaccaro, MD, PhD, Alan S Hilibrand 2018 Thomas Jefferson University, Philadelphia, PA

Clinical Outcomes After Four-Level Anterior Cervical Discectomy And Fusion., Tyler M Kreitz, Douglas A Hollern, Eric M. Padegimas, Gregory D. Schroeder, Christopher K Kepler, Alexander Vaccaro, Md, Phd, Alan S Hilibrand

Rothman Institute

Study Design: Retrospective cohort study.

Objectives: Anterior cervical discectomy and fusion (ACDF) demonstrates reliable improvement in neurologic symptoms associated with anterior compression of the cervical spine. There is a paucity of data on outcomes following 4-level ACDFs. The purpose of this study was to evaluate clinical outcomes for patients undergoing 4-level ACDF.

Methods: All 4-level ACDFs with at least 1-year clinical follow-up were identified. Clinical outcomes, including fusion rates, neurologic outcomes, and reoperation rates were determined.

Results: Retrospective review of our institutional database revealed 25 patients who underwent 4-level ACDF with at least 1-year clinical follow-up. Average age was 57 ...


Etiology And Surgical Management Of Cervical Spinal Epidural Abscess (Sea):: A Systematic Review., Justin Iorio, Yusef Mosley, MD, Srinivas Prasad, Joshua Pelta-Heller, Jack Jallo, Soroush Shahrokh, James Harrop 2018 Thomas Jefferson University, Philadelphia, PA

Etiology And Surgical Management Of Cervical Spinal Epidural Abscess (Sea):: A Systematic Review., Justin Iorio, Yusef Mosley, Md, Srinivas Prasad, Joshua Pelta-Heller, Jack Jallo, Soroush Shahrokh, James Harrop

Department of Medicine Faculty Papers

Study Design: Systematic analysis and review.

Objective: Evaluation of the presentation, etiology, management strategies (including both surgical and nonsurgical options), and neurological functional outcomes in patients with cervical spinal epidural abscess (SEA).

Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria were used to create a framework based on which articles pertaining to cervical SEA were chosen for review following a search of the Ovid and PubMed databases using the search terms "epidural abscess" and "cervical." Included studies needed to have at least 4 patients aged 18 years or older, and to have been published within the ...


The Ratio Of Observed To Expected: How Much Of It Is Unexpected?, Jens R Chapman, Karsten Wiechert, Jeffrey C Wang 2018 Swedish Medical Center, Seattle, WA, USA.

The Ratio Of Observed To Expected: How Much Of It Is Unexpected?, Jens R Chapman, Karsten Wiechert, Jeffrey C Wang

Journal Articles and Abstracts

No abstract provided.


Tibiotalar Arthrodesis: Development Of A Novel Jig And Alignment Guide, Adam Mathew Ropchan 2018 The University of Western Ontario

Tibiotalar Arthrodesis: Development Of A Novel Jig And Alignment Guide, Adam Mathew Ropchan

Electronic Thesis and Dissertation Repository

Tibiotalar arthrodesis is a surgical procedure, used for the treatment of end-stage ankle arthrosis and instability. There are dozens of described procedures in the literature, all with varying rates of success. Two of the most common reasons for reoperation in tibiotalar arthrodesis are nonunion and infection; few studies have established any associations between patient/surgical factors and reoperation for nonunion and infection.

The first part of this thesis focuses on determining the rate of reoperation to the ipsilateral lower limb and if any patient/surgical factors are associated with reoperation for nonunion and infection. The second part of this thesis ...


Pigmented Villonodular Synovitis Does Not Influence The Outcome Following Cementless Total Hip Arthroplasty Using Ceramic-On-Ceramic Articulation: A Case-Control Study With Middle-Term Follow-Up., Chi Xu, Heng Guo, Kerri L. Bell, Feng-Chih Kuo, Ji-Ying Chen 2018 General Hospital of People's Liberation Army

Pigmented Villonodular Synovitis Does Not Influence The Outcome Following Cementless Total Hip Arthroplasty Using Ceramic-On-Ceramic Articulation: A Case-Control Study With Middle-Term Follow-Up., Chi Xu, Heng Guo, Kerri L. Bell, Feng-Chih Kuo, Ji-Ying Chen

Rothman Institute

BACKGROUND: Pigmented villonodular synovitis (PVNS) is a relatively rare, locally aggressive, and potentially recurrent synovial disease of large joints. The purpose of this study was to investigate (1) the disease recurrence rate and (2) the treatment outcomes including Harris hip scores, complications, and revision following cementless total hip arthroplasty (THA) with ceramic-on-ceramic (CoC) articulation in patients with PVNS.

METHODS: Twenty-two patients (14 females and 8 males) with histologically confirmed PVNS underwent cementless THA using CoC bearings between 2000 and 2013. Three patients with less than 5-year follow-up were excluded. The mean age was 35.2 years (range, 22-58 years) with ...


Collared Vs. Collarless Total Hip Arthroplasty In Both Direct Anterior And Direct Lateral Approach Surgery: A Prospective Cohort Comparison Study, Seb Heaven 2018 The University of Western Ontario

Collared Vs. Collarless Total Hip Arthroplasty In Both Direct Anterior And Direct Lateral Approach Surgery: A Prospective Cohort Comparison Study, Seb Heaven

Electronic Thesis and Dissertation Repository

Total hip arthroplasty (THA) is one of the most successful surgical procedures performed worldwide. Recent advances in implant technology and popularization of the muscle-sparing Direct Anterior (DA) approach to the hip has led to younger patients becoming candidates for hip arthroplasty surgery. Among the many considerations necessary for success in this patient population, implant design plays an important role in determining outcomes.

In this thesis, we prospectively evaluated patients who received a collared or collarless fully hydroxyapatite-coated femoral stem during THA with a standard RSA protocol to assess stem migration patterns following surgery.

Preliminary results indicate that collarless stems subside ...


The Perioperative Patient Experience Of Hand And Wrist Surgical Patients: An Exploratory Study Using Patient Journey Mapping, Else F. de Ridder, Tessa Dekkers, Jarry T. Porsius, Gerald Kraan, Marijke Melles 2018 Delft University of Technology, Delft

The Perioperative Patient Experience Of Hand And Wrist Surgical Patients: An Exploratory Study Using Patient Journey Mapping, Else F. De Ridder, Tessa Dekkers, Jarry T. Porsius, Gerald Kraan, Marijke Melles

Patient Experience Journal

Patient-centred care is becoming more important in healthcare. The success of patient-centred care can be assessed by exploring the patient experience through a patient journey map. As the number of outpatient surgeries is increasing, it is important to reveal the specific characteristics of this type of surgery. The perioperative patient experience is considered very important for outpatient surgery, because all perioperative activities are condensed in one day. To investigate this experience, we performed a case study of hand and wrist surgery. Six teams of two industrial design engineering students interviewed 40 patients in total in two private and two public ...


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 2018 Old Dominion University

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 synovial ...


The Impact Of Depression On Patient Outcomes In Hip Arthroscopic Surgery., RobRoy L. Martin, John J. Christoforetti, Ryan McGovern, Benjamin R. Kivlan, Andrew B. Wolff, Shane J. Nho, John P. Salvo, Thomas J. Ellis, Geoff Van Thiel, Dean Matsuda, Dominic S. Carreira 2018 Duquesne University; University of Pittsburgh Medical Center

The Impact Of Depression On Patient Outcomes In Hip Arthroscopic Surgery., Robroy L. Martin, John J. Christoforetti, Ryan Mcgovern, Benjamin R. Kivlan, Andrew B. Wolff, Shane J. Nho, John P. Salvo, Thomas J. Ellis, Geoff Van Thiel, Dean Matsuda, Dominic S. Carreira

Department of Medicine Faculty Papers

Background: Mental health impairments have been shown to negatively affect preoperative self-reported function in patients with various musculoskeletal disorders, including those with femoroacetabular impingement.

Hypothesis: Those with symptoms of depression will have lower self-reported function, more pain, and less satisfaction on initial assessment and at 2-year follow-up than those without symptoms of depression.

Study Design: Cohort study; Level of evidence, 3.

Methods: Patients who were enrolled in a multicenter hip arthroscopic surgery registry and had 2-year outcome data available were included in the study. Patients completed the 12-item International Hip Outcome Tool (iHOT-12), visual analog scale (VAS) for pain, and ...


Optimizing Quality Of Care By Patient Satisfaction For The Department Of Orthopaedics - A Survey Study, Milad Modarresi, Ammar Qureshi, Rodrigo Aguilar, Meghan Anderson, Felix Cheung 2018 Marshall University

Optimizing Quality Of Care By Patient Satisfaction For The Department Of Orthopaedics - A Survey Study, Milad Modarresi, Ammar Qureshi, Rodrigo Aguilar, Meghan Anderson, Felix Cheung

Marshall Journal of Medicine

Introduction: Hospital Consumer Assessment of Healthcare Providers and System (HCAHPS) has provided a standardized survey method in order to evaluate the patient’s satisfaction on the care they are provided. While overall patient satisfaction is clearly a multidimensional concept, the HCAHPS survey covers 8 domains of health care. This study tries to identify and establish the main determinants to patient’s level of satisfaction during their visit to Cabell Huntington Hospital Orthopaedics department.

Methods: Data was collected from surveys handed in 3 consecutive months; June, July and August of 2013. Sixteen questions were selected from HCAHPS that were appraised to ...


The Impact Of Free Radical Stabilization Techniques On In Vivo Property Changes In Highly Cross-Linked Polyethylene Acetabular Liners, Michael M. Decker . 2018 The University of Western Ontario

The Impact Of Free Radical Stabilization Techniques On In Vivo Property Changes In Highly Cross-Linked Polyethylene Acetabular Liners, Michael M. Decker .

Electronic Thesis and Dissertation Repository

Highly cross-linked polyethylene (HXLPE) was introduced into total hip arthroplasty (THA) to reduce long-term wear-related complications. However, HXLPE production and in vivo oxidation can alter mechanical behavior. Mechanical failure of HXLPE liners at the implant rim have been reported. The purpose of this thesis is to determine if thermal free radical stabilization techniques used in HXLPE production alter the mechanical properties, physical properties and oxidative stability of liner rims after extended in vivo time.

Retrieved remelted, single annealed and sequentially annealed HXLPE liner rims were mechanically tested using a validated microindentation technique. Oxidation and crystalline phase composition were measured. Results ...


Reconstruction Of Heel Soft Tissue Defects Using Sensate Medial Plantar Flap, Mihaela Pertea, Natalia Velenciuc, Oxana Grosu, Bogdan Veliceasa, Vladimir Poroch, Sorinel Lunca 2018 Grigore T. Popa University of Medicine and Pharmacy of Iasi, St. Spiridon Emergency County Hospital, Department of Plastic Surgery and Reconstructive Microsurgery, Iasi, Romania

Reconstruction Of Heel Soft Tissue Defects Using Sensate Medial Plantar Flap, Mihaela Pertea, Natalia Velenciuc, Oxana Grosu, Bogdan Veliceasa, Vladimir Poroch, Sorinel Lunca

Journal of Mind and Medical Sciences

Introduction. Reconstruction of heel soft tissue defects represents a true challenge for any surgeon due to the particularities of this anatomical region. The tissue used to reconstruct the heel area must be resistant, innervated, and adapted to take over the body weight. Innervated medial plantar fasciocutaneous flap is one of the best solutions to cover defects at the heel level.

Materials and Methods. We studied 5 patients, 4 males and one female, aged 42 to 67 years, who presented heel soft tissue defects of various etiologies. In all cases, the used reconstructive method was an insular innervated medial plantar fasciocutaneous ...


Severe Lumbar Disability Is Associated With Decreased Psoas Cross-Sectional Area In Degenerative Spondylolisthesis, Scott C. Wagner, Arjun S. Sebastian, James C. McKenzie, Joseph S. Butler, Ian D. Kaye, Patrick B. Morrissey, Alexander R. Vaccaro, Christopher K. Kepler 2018 Thomas Jefferson University

Severe Lumbar Disability Is Associated With Decreased Psoas Cross-Sectional Area In Degenerative Spondylolisthesis, Scott C. Wagner, Arjun S. Sebastian, James C. Mckenzie, Joseph S. Butler, Ian D. Kaye, Patrick B. Morrissey, Alexander R. Vaccaro, Christopher K. Kepler

Rothman Institute

Study Design: Retrospective cohort. Objectives: Alterations in lumbar paraspinal muscle cross-sectional area (CSA) may correlate with lumbar pathology. The purpose of this study was to compare paraspinal CSA in patients with degenerative spondylolisthesis and severe lumbar disability to those with mild or moderate lumbar disability, as determined by the Oswestry Disability Index (ODI). Methods: We retrospectively reviewed the medical records of 101 patients undergoing lumbar fusion for degenerative spondylolisthesis. Patients were divided into ODI score ≤40 (mild/moderate disability, MMD) and ODI score >40 (severe disability, SD) groups. The total CSA of the psoas and paraspinal muscles were measured on ...


Strategies To Increase Early Discharges To Decrease Hospital Length Of Stay And Avoidable Patient Days For Neuro-Spine Patients, Corey Fravert, R6, Trauma Team, Rehab Medicine, Neurosurgery, Joy Moody, Mark Parker, Suneela Nayak, Stephen Tyzik, Ruth Hanselman, Amy Sparks 2018 Maine Medical Center

Strategies To Increase Early Discharges To Decrease Hospital Length Of Stay And Avoidable Patient Days For Neuro-Spine Patients, Corey Fravert, R6, Trauma Team, Rehab Medicine, Neurosurgery, Joy Moody, Mark Parker, Suneela Nayak, Stephen Tyzik, Ruth Hanselman, Amy Sparks

Operational Excellence

STRATEGIES TO INCREASE MORNING DISCHARGES IN AN ACADEMIC TERTIARY HOSPITAL

Delays in patient discharge result in numerous negative impacts on the health care system. Amongst those are a reduced patient flow and satisfaction, long wait times, and physician/ staff frustration.

An inpatient neurotrauma unit initiated a performance improvement project that utilized a multidisciplinary approach to identify barriers to discharge and coordinate a discharge plan focused on neurospine patients.

A root cause analysis was conducted to collect reasons that these patients were not discharged by 11:00am. As a result of the findings, 4 performance improvement plans were created. Subsequent data ...


Outcomes Of Shoulder Arthroplasty Performed For Postinfectious Arthritis., Eric M. Padegimas, Thema A. Nicholson, Stephen Silva, Matthew L. Ramsey, Gerald R. Williams, Mark D. Lazarus, Surena Namdari 2018 Thomas Jefferson University

Outcomes Of Shoulder Arthroplasty Performed For Postinfectious Arthritis., Eric M. Padegimas, Thema A. Nicholson, Stephen Silva, Matthew L. Ramsey, Gerald R. Williams, Mark D. Lazarus, Surena Namdari

Rothman Institute

Background: The purpose of this study was to evaluate the functional outcomes, infection rate, and complications associated with shoulder arthroplasty for sequelae of prior septic arthritis.

Methods: This is a retrospective cohort study of 17 patients who underwent shoulder arthroplasty for sequelae of septic arthritis. Patients were analyzed for patient-reported outcomes, complications, and reoperations.

Results: The 17 patients in this cohort were an average age of 65.4 ± 12.2 years old, were 58.8% male, and had an average body mass index of 27.9 ± 4.1 kg/m

Conclusions: Shoulder arthroplasty after septic arthritis had inconsistent functional outcomes ...


Quantitative Assessment Of The Anatomical Footprint Of The C1 Pedicle Relative To The Lateral Mass: A Guide For C1 Lateral Mass Fixation, Brian W. Su, Alexander A. Theologis, Robert H. Byers, Adam L. Shimer, Gregory D. Schroeder, Alexander R. Vaccaro, Bobby Tay 2018 Mt Tam Orthopedics and Spine Center

Quantitative Assessment Of The Anatomical Footprint Of The C1 Pedicle Relative To The Lateral Mass: A Guide For C1 Lateral Mass Fixation, Brian W. Su, Alexander A. Theologis, Robert H. Byers, Adam L. Shimer, Gregory D. Schroeder, Alexander R. Vaccaro, Bobby Tay

Rothman Institute

Study Design: Anatomic study. Objectives: To determine the relationship of the anatomical footprint of the C1 pedicle relative to the lateral mass (LM). Methods: Anatomic measurements were made on fresh frozen human cadaveric C1 specimens: pedicle width/height, LM width/height (minimum/maximum), LM depth, distance between LM’s medial aspect and pedicle’s medial border, distance between LM’s lateral aspect to pedicle’s lateral border, distance between pedicle’s inferior aspect and LM’s inferior border, distance between arch’s midline and pedicle’s medial border. The percentage of LM medial to the pedicle and the distance from ...


Select Biomarkers On The Day Of Anterior Cruciate Ligament Reconstruction Predict Poor Patient-Reported Outcomes At 2-Year Follow-Up: A Pilot Study, Christian Lattermann, Caitlin E. -W. Conley, Darren L. Johnson, Emily K. Reinke, Laura J. Huston, Janet L. Huebner, Ching-Heng Chou, Virginia B. Kraus, Kurt P. Spindler, Cale A. Jacobs 2018 Harvard University

Select Biomarkers On The Day Of Anterior Cruciate Ligament Reconstruction Predict Poor Patient-Reported Outcomes At 2-Year Follow-Up: A Pilot Study, Christian Lattermann, Caitlin E. -W. Conley, Darren L. Johnson, Emily K. Reinke, Laura J. Huston, Janet L. Huebner, Ching-Heng Chou, Virginia B. Kraus, Kurt P. Spindler, Cale A. Jacobs

Orthopaedic Surgery and Sports Medicine Faculty Publications

Background. The majority of patients develop posttraumatic osteoarthritis within 15 years of anterior cruciate ligament (ACL) injury. Inflammatory and chondrodegenerative biomarkers have been associated with both pain and the progression of osteoarthritis; however, it remains unclear if preoperative biomarkers differ for patients with inferior postoperative outcomes. Hypothesis/Purpose. The purpose of this pilot study was to compare biomarkers collected on the day of ACL reconstruction between patients with "good" or "poor" 2-year postoperative outcomes. We hypothesized that inflammatory cytokines and chondrodegenerative biomarker concentrations would be significantly greater in patients with poorer outcomes. Study Design. Prospective cohort design. Methods. 22 patients ...


Comparison Of Osteoporosis Pharmacotherapy Fracture Rates: Analysis Of A Marketscan® Claims Database Cohort, Alan W. Reynolds, Guodong Liu, Paul T. Kocis, Jenna N. Skowronski, Douglas L. Leslie, Edward J. Fox 2018 Pennsylvania State College of Medicine

Comparison Of Osteoporosis Pharmacotherapy Fracture Rates: Analysis Of A Marketscan® Claims Database Cohort, Alan W. Reynolds, Guodong Liu, Paul T. Kocis, Jenna N. Skowronski, Douglas L. Leslie, Edward J. Fox

Student Papers & Posters

Background: Several different classes of medications have been shown to be efficacious at preventing fractures in patients with osteoporosis. No study has compared real world efficacy at preventing fractures between all currently approved medications.

Objectives: To directly compare the efficacy of all currently available osteoporosis medications by using a large population claims database.

Methods: The Truven Health Analytics MarketScan® database from 2008 - 2012 was used to identify all patients who started a new osteoporosis medication. Patients who experienced a fracture after at least 12 months of treatment were identified and risk factors for fracture for all patients were recorded. Logistic ...


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