Orthopedics Commons^™

Evaluating The Impact Of Modic Changes On Operative Treatment In The Cervical And Lumbar Spine: A Systematic Review And Meta-Analysis, Mark J Lambrechts, Parker Brush, Tariq Z Issa, Gregory R Toci, Jeremy C Heard, Amit Syal, Meghan M Schilken, Jose A Canseco, Christopher K Kepler, Alexander R Vaccaro

Rothman Institute Faculty Papers

Modic changes (MCs) are believed to be potential pain generators in the lumbar and cervical spine, but it is currently unclear if their presence affects postsurgical outcomes. We performed a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All studies evaluating cervical or lumbar spine postsurgical outcomes in patients with documented preoperative MCs were included. A total of 29 studies and 6013 patients with 2688 of those patients having preoperative MCs were included. Eight included studies evaluated cervical spine surgery, eleven evaluated lumbar discectomies, nine studied lumbar fusion surgery, and three assessed …

Total Joint Implant Alloy Oxide Layer Cell-Induced Damage, Chandler K. Sears

Longitudinal Scholar's Project

Cobalt-Chromium alloy is commonly used in total joint arthroplasty (TJA). Several studies have investigated evidence of inflammatory-cell-induced-corrosion (ICIC) causing pitting in TJA retrieved implants. Others have determined that placing orthopedic alloys into lower pH solutions will increase the rate of corrosion. We have determined that electrochemical potential and corrosion rates of human knee synovial fluid show a variation greater than an order of magnitude. This means there is going to be a significant variation between a patient’s local environment of the TJA implant and may affect how macrophages interact with alloy oxide layers. Knee disability can be quantified by using …

Risk Factors For Reoperation Following Operative Fixation Of Distal Femur Fractures: A Report Of 73 Consecutive Cases, Aditya Desai, Victoria Oakes, John Pisquiy, Christopher Dodo, Ahmed A. Toreih, Wael Azzam, Amr Abdelgawad, Ahmed M. Thabet

Western Journal of Orthopaedics

Introduction: Various factors including patient demographics, fracture types, and fixation methods can affect the outcomes of distal femur fractures. This study aimed to analyze the risk factors for reoperation after operative fixation of these fractures. Methods: This was an institional review board (IRB) approved retrospective study of extra-articuilar, partial articular, and complete articular distal femur fractures treated with operative fixation at a Level I trauma center between 2008 and 2018. The study included a consecutive series of adult patients operatively treated for a distal femur fracture. The primary outcome was reoperation rate due to infection, non-union, or implant failure. Periprosthetic …

Acute Effects Of Percussive Therapy On The Posterior Shoulder Muscles Differ Based On The Athlete's Soreness Response, Jack H Trainer, Matthew Pascarella, Ryan W. Paul, Stephen J. Thomas

Department of Exercise Science Faculty Papers

Background: Percussive therapy is hypothesized to speed recovery by delivering gentle, rhythmic pulses to soft tissue. However, patients often present with a differential soreness response after percussive therapy, which may lead to altered clinical outcomes.

Purpose: To compare the acute effects of percussion therapy on passive range of motion (ROM) and tissue-specific ultrasound measures (pennation angle [PA] and muscle thickness [MT]) between healthy individuals responding positively vs. negatively to percussive therapy performed on the dominant arm posterior rotator cuff.

Study design: Cross-sectional laboratory study.

Methods: Fifty-five healthy individuals were assessed on a subjective soreness scale before and after a five-minute …

Laboratory-Reported Normal Value Ranges Should Not Be Used To Diagnose Periprosthetic Joint Infection., Salvador A. Forte, Joseph A. D'Alonzo, Zachary Wells, Brett Levine, Stephen Sizer, Carl Deirmengian

Orthopedic Surgery Resident Research

INTRODUCTION: Clinical laboratories offer several multipurpose tests, such as the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), which are not intended to diagnose any specific disease but are used by clinicians in multiple fields. The results and laboratory interpretation (normal/abnormal) of these multipurpose tests are based on laboratory-reported normal thresholds, which vary across clinical laboratories. In 2018, the International Consensus Meeting on Musculoskeletal Infection (2018 ICM) provided a gold-standard definition to diagnose periprosthetic joint infection (PJI) which included many multipurpose laboratory tests, along with thresholds optimized to diagnose PJI. The discrepancy between laboratory-reported normal thresholds and 2018 ICM-recommended PJI-optimized …

The Number Of Shoulder And Elbow Questions On The Orthopedic In-Training Examination Is Increasing With Greater Emphasis On Critical Thinking Over Recall, Suleiman Y. Sudah, Robert D. Faccone, Christopher R. Michel, Christopher N. Dijanic, Daniel J. Kerrigan, Mariano E. Menendez, Surena Namdari, Allen D. Nicholson

Rothman Institute Faculty Papers

Background: It is critical for orthopedic surgery residents and residency programs to have a current understanding of the content and resources utilized by the Orthopedic In-Training Examination (OITE) to continuously guide study and educational efforts. This study presents an updated analysis of the shoulder and elbow section of the OITE. Methods: All OITE questions, answers, and references from 2013 to 2019 were reviewed. The number of shoulder and elbow questions per year was recorded, and questions were analyzed for topic, imaging modalities, cognitive taxonomy, and references. We compared our data to the results of a previous study that analyzed shoulder …

The Effects Of Covid-19 On Mental Health And Injury Occurrence Of Division Iii College Football Players, Evan Kennaley

Masters Theses/Capstone Projects

Objective: The aim of the study was to investigate if with the lockdown of COVID-19 and the reschedule of the Fall 2020 football season caused an increase in injury in a Division Three College football team.

Methods: A 20 question survey was given to the 2022 Spring Otterbein football team. The survey allowed for self reporting of injuries suffered in the 2019,2020, and 2021 football seasons. The survey also looked to examine if there is any anxiety the players suffered from during the lockdown using the Covid Anxiety Scale.

Results: Of the 63 surveys, it was found that the 2021 …

Systematic Review Of Prevalence, Risk Factors, And Management Of Instability Following Reverse Shoulder Arthroplasty, Jeffrey J. Olson, Michael D. Galetta, Rachel E. Keller, Luke S. Oh, Evan A. O'Donnell

Orthopedic Surgery Resident Research

Background

Since its approval for use, reverse shoulder arthroplasty (RSA) has become the primary treatment for cuff tear arthropathy, with indications expanding more recently to include revision fracture, osteoarthritis with significant glenoid bone loss, tumor, and chronic instability. Instability is a well-described postoperative complication, occurring in 1to 31% of relatively small cohorts and case series. Given the relative infrequency of instability, there remains a need for a comprehensive review of instability with a focus on risk factors and management. Our goal of this systematic review is to describe the prevalence, risk factors, and management strategies for instability …

Household Transmission Of Group A Streptococcus Necrotizing Fasciitis., Michael Markowitz, Stephanie Kwan, Jonas Matzon

Department of Orthopaedic Surgery Faculty Papers

A healthy 40-year-old woman was diagnosed with necrotizing fasciitis 2 days after her husband's death from the same infectious process. Prompt identification and immediate surgical intervention prevented a similar result in this patient. Additional investigation into both patients' medical records found the inciting organism to be group A streptococcus. Although the exact mechanism of inoculation is unknown, the spread of this infection within a household prompts the question of whether antibiotic prophylaxis should be given among close contacts in future cases of necrotizing fasciitis.

Evolution Of The Ao Spine Sacral And Pelvic Classification System: A Systematic Review, Barry Ting Sheen Kweh, Jin W. Tee, F. Cumhur Oner, Klaus J. Schnake, Emiliano N. Vialle, Frank Kanziora, Shanmuganathan Rajasekaran, Marcel Dvorak, Jens R. Chapman, Lorin M. Benneker, Gregory Schroeder, Alexander R. Vaccaro

Rothman Institute Faculty Papers

OBJECTIVE: The purpose of this study was to describe the genesis of the AO Spine Sacral and Pelvic Classification System in the context of historical sacral and pelvic grading systems.

METHODS: A systematic search of MEDLINE, EMBASE, Google Scholar, and Cochrane databases was performed consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify all existing sacral and pelvic fracture classification systems.

RESULTS: A total of 49 articles were included in this review, comprising 23 pelvic classification systems and 17 sacral grading schemes. The AO Spine Sacral and Pelvic Classification System represents both the evolutionary …

Quantitative Mri And 3d-Printing For Monitoring Periprosthetic Joint Infection, Greg Hong

Electronic Thesis and Dissertation Repository

Joint replacements are becoming increasingly commonplace with over 130,000 joint arthroplasties being performed annually in Canada. Although joint replacement surgery is highly successful, implants do occasionally fail and need to be replaced via costly and difficult revision surgery. Periprosthetic joint infection (PJI) has recently become the leading reason for revision of both hip and knee replacements, which is unfortunate because PJI is difficult to diagnose and treat effectively; diagnosis is made particularly difficult by the lack of established non-invasive (imaging) means of evaluating PJI. This thesis aims to demonstrate that magnetic resonance imaging (MRI) has potential for diagnosing and monitoring …

Implementation Of Vitamin D Screening And Planned Intervention Of Supplementation For Deficient Collegiate Athletes Of The Rio Grande Valley, Amanda J. Wheeler

MEDI 8127 Scholarly Activities Pre-Clerkship

In the past decade, studies on vitamin D levels and relationships to orthopaedic patients have increased exponentially worldwide. Journals have established risk factors, proper assessment of vitamin D levels, supplementation standards, and dependent variables that effect prevalence.¹

More specifically, many vitamin D studies in the field of orthopaedics and sports medicine have been conducted by analyzing NFL teams and NCAA Division I athletes and dividing the cohorts into player parameters such as age, BMI, race, team position, and supplement type. The results of these studies concluded that there is a large prevalence of vitamin D deficiency amongst athletes and …

The Biomechanical Effects Of Glenoid And Humeral Lateralization On The Rotator Cuff Muscles In Reverse Total Shoulder Arthroplasty, Yousif Atwan

Electronic Thesis and Dissertation Repository

The utilization of reverse total shoulder arthroplasty (RTSA) has continued to increase as its clinical indications expand. The optimization of the rotator cuff function in the setting of RTSA is poorly understood and poor outcomes are associated with lack of external and internal rotation function. The purpose of this study is to evaluate the role of implant parameters on rotator cuff tendon excursion and moment arms in the setting of RTSA.

Using a cadaveric based model, a custom designed modular RTSA system was implanted that allowed for incremental changes to glenoid and humeral lateralization. Using a shoulder simulator and optical …

Return To Work And Driving After Robotic Arm-Assisted Total Knee Arthroplasty, Manoshi Bhowmik-Stoker, Kevin K Mathew, Zhongming Chen, Antonia F Chen, William J Hozack, Ormonde Mahoney, Fabio R Orozco, Michael A Mont

Rothman Institute Faculty Papers

Background: Robotic arm-assisted total knee arthroplasty (RATKA) has demonstrated improved patient-reported outcome measures. Less evidence has been reported on how frequently patients return to complex activities of daily living. Our purposes were to investigate (1) hospital lengths of stay (LOSs) (2) discharge dispositions and (3) the rates and postoperative time intervals at which patients returned to driving and working.

Methods: A total of 50 RATKA patients who were employed prior to surgery were included. Outcomes included hospital LOS, discharge dispositions, return to driving, and return to work.

Results: A total of 48 patients (96%) were discharged home with self-care or …

Seasonal Variation Of Hip Fractures In Patients With Benign Paroxysmal Positional Vertigo, Steven D. Curry, Pooja M. Varman, Alessandro Carotenuto, Justin C. Siebler, Jonathan L. Hatch

Graduate Medical Education Research Journal

Introduction: Seasonal variation of benign paroxysmal positional vertigo (BPPV) presentation has been reported, with higher rates of presentation in months associated with times of lower serum vitamin D levels. The purpose of this study was to examine the association between the timing of hip fracture in patients with BPPV.

Methods: A retrospective review (2013 to 2019) of adult patients was performed at a tertiary care academic center to identify patients with hip fracture due to ground level fall (ICD-10 code S72) and a previously established diagnosis of vestibular disorder (ICD-10 codes H81-83, A88.1, and R42). Included patients were …

Combination Of Statistical Shape Modeling And Statistical Parametric Mapping To Quantify Cartilage Contact Mechanics In Hip Dysplasia, Penny R. Atkins Phd, Shireen Y. Elhabian Phd, Jeffrey A. Weiss Phd, Ross T. Whitaker Phd, Christopher L. Peters Md, Andrew E. Anderson Phd

PanaSoMM

Finite element models can predict subject-specific chondrolabral stresses and help to elucidate the effect of under-coverage and incongruency of the hip joint in patients with dysplasia. However, complex stress patterns are difficult to generalize and evaluate statistically. With an established correspondence across shapes from statistical shape modeling (SSM), statistical parametric mapping (SPM) allows for evaluation of local variability while preserving model subject-specificity. Herein, we evaluated the combined application of SSM and SPM to compare cartilage contact stress between control subjects and patients with dysplasia.

Previously published hip joint contact stresses were mapped onto chondrolabral surface meshes and incorporated into an …

Application Of Statistical Shape Modeling To Predict Clinical Metric Of Femoral Head Coverage In Patients With Developmental Dysplasia, Penny R. Atkins Phd, Praful Agrawal Phd, Joseph D. Mozingo Phd, Keisuke Uemura Md, Phd, Kunihiko Tokunaga Md, Christopher L. Peters Md, Shireen Y. Elhabian Phd, Ross T. Whitaker Phd, Andrew E. Anderson Phd

PanaSoMM

Developmental dysplasia of the hip (DDH) is described as under-coverage of the femoral head by the acetabulum, resulting in mechanical instability. Though DDH is often diagnosed using plain film radiographs, these images cannot adequately capture 3D joint coverage. Herein, we applied a 3D statistical shape model (SSM) to the femur and hemi-pelvis of patients with DDH to objectively measure shape variation and evaluated whether SSM outputs could predict measurements of joint coverage.

The femur and hemi-pelvis were semi-automatically segmented from CT images (83 hips from 47 females with DDH). Surfaces of each hip were reconstructed from segmentations, aligned, and input …

Screening And Assessment Of Cancer-Related Fatigue: A Clinical Practice Guideline For Health Care Providers, Mary I. Fisher, Joy C. Cohn, Shana Harrington, Jeannette Lee, Daniel Malone

Physical Therapy Faculty Publications

Cancer-related fatigue (CRF) is the most common side effect of cancer treatment. Regular surveillance is recommended, but few clinical practice guidelines transparently assess study bias, quality, and clinical utility in deriving recommendations of screening and assessment methods. The purpose of this clinical practice guideline (CPG) is to provide recommendations for the screening and assessment of CRF for health care professions treating individuals with cancer. Following best practices for development of a CPG using the Appraisal of Guidelines for Research and Evaluation (AGREE) Statement and Emergency Care Research Institute (ECRI) Guidelines Trust Scorecard, this CPG included a systematic search of the …

Trustworthiness And Quality In Research For Clinical Application, Mary I. Fisher

Physical Therapy Faculty Publications

No abstract provided.

An Evaluation Of Patients With Abdominal Pain After Lateral Lumbar Interbody Fusion, Tristan B Fried, Khoa Tran, Mark J. Lambrechts, Nicholas D D'Antonio, Brian A Karamian, Justin Chu, Jose A Canseco, Alan S. Hilibrand, Christopher K Kepler, Alexander R Vaccaro, Gregory D. Schroeder

Department of Orthopaedic Surgery Faculty Papers

Context: Abdominal pain after surgery can occur for numerous reasons. Postoperative radiographs may be indicated to evaluate for ileus or other reasons for the pain. Whether outcomes are significantly different based on whether patients get radiographs following lateral lumbar interbody fusion (LLIF) are unclear.

Aims: To investigate the postoperative outcomes of patients experiencing abdominal pain after LLIF.

Settings and design: This retrospective cohort study included patients at a tertiary academic medical center and surrounding affiliated hospitals.

Materials and methods: Patients >18 years of age who underwent elective LLIF at a single institution were retrospectively identified. Patients were stratified into two …