Orthopedics Commons^™

Loss Of Function Mutation In Ank Causes Aberrant Mineralization And Acquisition Of Osteoblast-Like-Phenotype By The Cells Of The Intervertebral Disc, Takashi Ohnishi, Victoria Tran, Kimheak Sao, Pranay Ramteke, William Querido, Ruteja A. Barve, Koen Van De Wetering, Makarand V. Risbud

Department of Orthopaedic Surgery Faculty Papers

Pathological mineralization of intervertebral disc is debilitating and painful and linked to disc degeneration in a subset of human patients. An adenosine triphosphate efflux transporter, progressive ankylosis (ANK) is a regulator of extracellular inorganic pyrophosphate levels and plays an important role in tissue mineralization. However, the function of ANK in intervertebral disc has not been fully explored. Herein we analyzed the spinal phenotype of Ank mutant mice (ank/ank) with attenuated ANK function. Micro-computed tomography and histological analysis showed that loss of ANK function results in the aberrant annulus fibrosus mineralization and peripheral disc fusions with cranial to caudal progression in …

Utility Of Seated Lateral Radiographs In The Diagnosis And Classification Of Lumbar Degenerative Spondylolisthesis, Tariq Z. Issa, Yunsoo Lee, Emily Berthiaume, Mark J. Lambrechts, Caroline Zaworski, Qudratallah S. Qadiri, Henley Spracklen, Richard Padovano, Jackson Weber, John J. Mangan, Jose A, Canseco, Barrett I. Woods, I. David Kaye, Alan S. Hilibrand, Christopher K. Kepler, Alexander R. Vaccaro, Gregory D. Schroeder, Joseph K. Lee

Rothman Institute Papers

STUDY DESIGN: Retrospective cohort study.

PURPOSE: Our goal was to determine which radiographic images are most essential for degenerative spondylolisthesis (DS) classification and instability detection.

OVERVIEW OF LITERATURE: The heterogeneity in DS requires multiple imaging views to evaluate vertebral translation, disc space, slip angle, and instability. However, there are several restrictions on frequently used imaging perspectives such as flexion-extension and upright radiography.

METHODS: We assessed baseline neutral upright, standing flexion, seated lateral radiographs, and magnetic resonance imaging (MRI) for patients identified with spondylolisthesis from January 2021 to May 2022 by a single spine surgeon. DS was classified by Meyerding and …

Enough Is Enough: Salvage Procedures In Severe Periprosthetic Joint Infection, Yves Gramlich, Javad Parvizi

Rothman Institute Papers

Background

In severe cases of periprosthetic joint infection involving negative host-dependent factors, individual-based decisions between a curative therapy vs. salvage procedure are necessary. We aimed to review salvage procedures in severe periprosthetic joint infection cases, where a gold standard of a curative two-stage exchange can no longer be achieved. The options of knee arthrodesis, amputation, persistent fistula (stable drainage), or a debridement, antibiotics, and implant retention procedure in late-onset cases are discussed, including lifelong antibiotic suppression alone.

Methods

We focused on known salvage procedures for severe periprosthetic joint infection of the hip and knee, such as amputation, arthrodesis, antibiotic …

Validation Of The Hierarchical Nature Of The Ao Spine Sacral Classification And The Development Of The Sacral Ao Spine Injury Score, Brian A. Karamian, Gregory D. Schroeder, Mark J. Lambrechts, Jose A. Canseco, Emiliano N. Vialle, Frank Kandziora, Lorin M. Benneker, Rajasekaran Shanmuganathan, F. Cumhur Öner, Klaus J. Schnake, Christopher K. Kepler, Alexander R. Vaccaro

Rothman Institute Papers

STUDY DESIGN: Global cross-sectional survey.

OBJECTIVE: The objective of this study was to validate the hierarchical nature of the AO Spine Sacral Classification System and develop an injury scoring system.

SUMMARY OF BACKGROUND DATA: Although substantial interobserver and intraobserver reliability of the AO Spine Sacral Classification System has been established, the hierarchical nature of the classification has yet to be validated.

METHODS: Respondents numerically graded each variable within the classification system for severity. Based on the results, a Sacral AO Spine Injury Score (AOSIS) was developed.

RESULTS: A total of 142 responses were received. The classification exhibited a hierarchical Injury …

Multiple Sterile Withdrawals From Iohexol Bottles Does Not Increase Contamination Risk, Caroline Purtill, Manraj Dhesi, Daniel Haber, Nicholas D'Antonio, Noreen J. Hickok, Jeremy I. Simon

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: There is a global shortage of iohexol contrast media, commonly used in epidural injections, as a result of lockdown and decreased production due to COVID-19. Iohexol bottles are designated for single use, which, depending on the vials available, often leads to wasting up to 95% of this limited resource. However, avoiding multiple withdrawals may be unnecessary if withdrawing multiple times using sterile technique does not increase the risk for contamination.

OBJECTIVES: The purpose of our study is to determine whether multiple withdrawals from iohexol injection bottles using a sterile technique poses a greater risk of introducing contaminants than a …

Impact Of Dual-Energy Computed Tomography (Dect) Postprocessing Protocols On Detection Of Monosodium Urate (Msu) Deposits In Foot Tendons Of Cadavers, Andrea Sabine Klauser, Sylvia Strobl, Christoph Schwabl, Christian Kremser, Werner Klotz, Violeta Vasilevska Nikodinovska, Hannes Stofferin, Yannick Scharll, Ethan Halpern

Department of Radiology Faculty Papers

Objective: To evaluate two different dual-energy computed tomography (DECT) post-processing protocols for the detection of MSU deposits in foot tendons of cadavers with verification by polarizing light microscopy as the gold standard. Material and Methods: A total of 40 embalmed cadavers (15 male; 25 female; median age, 82 years; mean, 80 years; range, 52–99; SD ± 10.9) underwent DECT to assess MSU deposits in foot tendons. Two postprocessing DECT protocols with different Hounsfield unit (HU) thresholds, 150/500 (=established) versus 120/500 (=modified). HU were applied to dual source acquisition with 80 kV for tube A and 140 kV for tube B. …

Postoperative Considerations Based On Graft Type After Anterior Cruciate Ligament Reconstruction A Narrative Review, Anne Leung, Bridget Desandis, Luke O'Brien, Sommer Hammoud, Ryan Zarzycki

Department of Orthopaedic Surgery Faculty Papers

Background and Objective: Graft selection for anterior cruciate ligament reconstruction (ACLR) affects rehabilitation throughout the course of postoperative care. Methods: A search of PubMed and EBSCO was performed and abstracts independently reviewed by two authors. This search was also supplemented with additional evidence relevant to each phase of ACLR rehabilitation.

Key Content and Findings: Direct implications of graft type on clinical decisions vary throughout treatment phases, transitioning from potential differences in acute postoperative pain management immediately after surgery to facilitating sufficient and appropriate lower extremity loading in subsequent weeks. Regardless of graft type, surgical limb weakness persists throughout the course …

Bibliometric Analysis Of Spinopelvic Alignment In Total Hip Arthroplasty, Samantha Harrer, Justin A. Magnuson, Gregory R. Toci, Andrew M. Star, Arjun Saxena

Rothman Institute Papers

INTRODUCTION: Postoperative dislocation of unclear etiology remains a concern after total hip arthroplasty (THA). Interest is growing in the importance of spinopelvic alignment on stability in THA. The purpose of this study was to analyze publication trends, areas of interest, and future research direction of spinopelvic alignment in THA.

METHODS: Articles on the topic of spinopelvic alignment in THA published between 1990 and 2022 were obtained through Web of Science Core Collection of Clarivate Analytics (WSCCA). Results were screened by title, abstract, and full text. The inclusion criterion was English-language peer-reviewed journal publications on the clinical topic of spinopelvic alignment …

Diagnosis Of Periprosthetic Joint Infection: The Utility Of Biomarkers In 2023, Mehmet Kursat Yilmaz, Ahmad Abbaszadeh, Saad Tarabichi, Ibrahim Azboy, Javad Parvizi

Rothman Institute Papers

Periprosthetic joint infection (PJI) is a rare yet devastating complication following total joint arthroplasty (TJA). Early and accurate diagnosis of PJI is paramount in order to maximize the chances of successful treatment. However, we are yet to identify a single “gold standard” test for the diagnosis of PJI. As a result, the diagnosis of PJI is often challenging. Currently, the 2018 ICM definition of PJI is the only validated diagnostic criteria available. This article will review the importance of serum and synovial biomarkers in the diagnosis of PJI. In addition, it will provide a brief overview of the emerging modalities …

Reasons For Transfer And Subsequent Outcomes Among Patients Undergoing Elective Spine Surgery At An Orthopedic Specialty Hospital, Tristan B. Fried, Yunsoo Lee, Jeremy C. Heard, Nicholas S. Siegel, Tariq Z. Issa, Mark J. Lambrechts, Caroline Zaworski, Jasmine Wang, Taylor D'Amore, Amit Syal, Charles Lawall, John J. Mangan, Jose A. Canseco, Barrett I. Woods, Alan S. Hilibrand, Alex R. Vaccaro, Christopher K. Kepler, Gregory D. Schroeder

Rothman Institute Papers

Objective:

To evaluate the reasons for transfer as well as the 90-day outcomes of patients who were transferred from a high-volume orthopedic specialty hospital (OSH) following elective spine surgery.

Materials and Methods:

All patients admitted to a single OSH for elective spine surgery from 2014 to 2021 were retrospectively identified. Ninety-day complications, readmissions, revisions, and mortality events were collected and a 3:1 propensity match was conducted.

Results:

Thirty-five (1.5%) of 2351 spine patients were transferred, most commonly for arrhythmia (n = 7; 20%). Thirty-three transferred patients were matched to 99 who were not transferred, and groups had similar rates …

Osteoporosis In The Setting Of Shoulder Arthroplasty: A Narrative Review, Mohammad Daher, Mohamad Fares, Peter Boufadel, Akshay Khanna, Ziad Zalaquett, Joseph A. Abboud

Rothman Institute Papers

Patients who undergo shoulder surgery are frequently affected by osteoporosis and osteopenia, and the prevalence of this association is expected to increase due to the growing number of elderly individuals undergoing these procedures. It may be advisable to conduct a preoperative DXA scan for orthopedic surgical candidates at high risk, to detect those who could benefit from early intervention and avoid any related adverse events. Some of these complications include periprosthetic fractures, infection, subsequent fragility fractures, and have an all-cause revision arthroplasty at 2 years post-op. Some studies analyzed the beneficence of antiresorptive medications pre-operatively but the latter did not …

The Dome Technique For Managing Massive Anterosuperior Medial Acetabular Bone Loss In Revision Total Hip Arthroplasty: Short-Term Outcomes, Tyler J. Humphrey, Colin M. Baker, P. M. Courtney, Wayne G. Paprosky, Hany S. Bedair, Neil P. Sheth, Christopher M. Melnic

Rothman Institute Papers

PURPOSE: The dome technique is a technique used in performance of revision total hip arthroplasty (THA) involving intraoperative joining of two porous metal acetabular augments to fill a massive anterosuperior medial acetabular bone defect. While excellent outcomes were achieved using this surgical technique in a series of three cases, short-term results have not been reported. We hypothesized that excellent short-term clinical and patient reported outcomes could be achieved with use of the dome technique.

MATERIALS AND METHODS: A multicenter case series was conducted for evaluation of patients who underwent revision THA using the dome technique for management of Paprosky 3B …

Intracept Technique At Adjacent Levels To Fusions With Pedicle Screws, David Stolzenberg, Paul Kitei, David Tran, Ryan Pfeifer

Rothman Institute Papers

No abstract provided.

A Comparison Of Radiographic Alignment Between Bilateral And Unilateral Interbody Cages In Patients Undergoing Transforaminal Lumbar Interbody Fusion, Mark J. Lambrechts, Jeremy Heard, Nicholas D. D'Antonio, John Bodnar, Gregory Schroeder, Evan Bloom, Jose Canseco, Barrett Woods, Ian David Kaye, Mark Kurd, Jeffrey Rihn, Alan Hilibrand, Gregory D. Schroeder, Alex R. Vaccaro, Christopher Kepler

Rothman Institute Papers

Study Design

Purpose:

Overview of Literature

Methods:

Incidence, Risk Factors, And Outcomes Of Incidental Durotomy During Lumbar Spine Decompression With Or Without Fusion, Gregory Toci, Mark James Lambrechts, Tariq Issa, Brian A. Karamian, Nicholas Siegel, Nicholas D'Antonio, Jose Canseco, Mark Kurd, Barrett Woods, Ian D. Kaye, Alan Hilibrand, Christopher K. Kepler, Alexander Vaccaro, Gregory Schroeder

Rothman Institute Papers

STUDY DESIGN: Retrospective cohort study.

PURPOSE: The primary objective of this study was to determine the incidence and risk factors for incidental durotomies during lumbar decompression surgeries. In addition, we aimed to determine the changes in patient-reported outcome measures (PROMs) based on incidental durotomy status.

OVERVIEW OF LITERATURE: There is limited literature investigating the affect of incidental durotomy on patient reported outcome measures. While the majority of research does not suggest differences in complications, readmission, or revision rates, many studies rely on public databases, and their sensitivity and specificity for identifying incidental durotomies is unknown.

METHODS: Patients undergoing lumbar decompression …

Treatment Of Angular Deformity And Limb Length Discrepancy With A Retrograde Femur Magnetic Intramedullary Nail: A Fixator-Assisted, Blocking Screw Technique, Erik J. Geiger, Adam D Geffner, S Robert Rozbruch, Austin T Fragomen

Rothman Institute Papers

Background: Fixator-assisted nailing techniques that incorporate magnetic internal lengthening nails (MILNs) permit acute deformity correction and then gradual limb lengthening without needing postoperative external fixators.

Purposes: We sought to investigate the safety and accuracy of a fixator-assisted, blocking screw technique using retrograde MILNs for the correction of LLD and limb malalignment.

Methods: Forty-one patients (13 patients with genu varum and 28 patients with genu valgum) with LLD treated with fixator-assisted, blocking screw retrograde MILN reconstruction were included. Preoperative LLD, mechanical axis deviation, and joint orientation angles were compared with values at the end of treatment, and bone healing indices were …

Full Issue: Volume 1, Issue 1 - May 2023

Bone Bulletin

Contents

i - Editors’ Note by Payton Boere and Ari Clements

ii - Foreword by Dr. Alan Hilibrand

7 - Injuries, Management, and Prevention in the Weekend Warrior by John Paulik

10 - A Practical Guide to Etiquette in the Orthopaedic OR for the Rotating Medical Student by Tyler Radack

13 - New Trends in Orthopaedic Surgery Residency Applications: The Role of Preference Signaling by J. Liam Gibbons

16 - First Job Considerations as an Orthopaedic Surgery Attending: Picking a Practice Setting by Purab Kothari

20 - A Day in the Life of an Orthopaedic Surgeon with Dr. Rachel Shakked …

Summary Of Early Sport Specialization In Baseball, Matthew Sabitsky

Bone Bulletin

Background/Scope of the Problem

Early sport specialization, defined as playing one sport for over eight months in a year without participation in any other sports, has gained significant popularity in recent years.^1,2 Increasing numbers of young baseball players are leaving their local leagues for travel programs where they may pay thousands to play for a team year-round.³ Youth baseball players are competing in more games than ever. During the busiest months, summer travel teams routinely schedule around 80 games over the course of just three months.⁴ Putting this in perspective, Division I college programs play about 60 …

Additional Strategies To Heal A Fracture: The Impact Of Lifestyle Modifications To Improve Bone Repair, Katie Duquette

Bone Bulletin

Suffering from a bone fracture can hinder a patient’s ability to work and greatly diminish their quality of life. Depending on fracture characteristics, treatment options consist of non-operative and operative management. Regardless of intervention needed, the process of bone healing is multi-factorial. Therefore, patients who are interested in maximizing their functional recovery can make changes within their control to optimize the healing process. Changes as simple as adding beets and probiotics could have a significant impact on returning function earlier and alleviating pain sooner.

If physicians elevate their current recovery strategy advice, it may be possible to improve a patient’s …

Exploring The Use Of Robotics In Orthopaedic Surgery, Daniel Givner

Bone Bulletin

Over the last few decades, the use of robotics has dramatically increased across all surgical specialties. While initially only utilized in a few gynecological and urological procedures, robotics are now used in a wide range of surgical procedures ranging from general surgery, cardiovascular surgery, to otolaryngology and orthopaedic surgery. One study noted in the field of general surgery, roughly 15% of all surgeries are utilizing some form of robotics.1 Surgical robotics assist in a variety of ways ranging from guiding procedures by creating 3D images of the anatomic landscape, to allowing physicians to operate through telemanipulating in a separate room. …

Biologic Augmentation In Osteochondral Lesions Of The Talus, Yashas Reddy

Bone Bulletin

Introduction

Osteochondral lesions of the talus (OLT) are injuries involving damage to the cartilage and bone associated with the talar dome. They occur in up to 50% of ankle sprains and 73% of ankle fractures, varying in stability and severity.¹ Standard weightbearing ankle radiographs may allow for visualization of the lesions if substantial bone fragmentation is involved but CT and MRI are more sensitive for subchondral bone damage and purely cartilaginous lesions, respectively (Figure 1). The majority of patients with OLT are active individuals in their 20s and 30s, and often present after sustaining an acute inversion injury.^{2 …}

A Day In The Life Of An Orthopaedic Surgeon With Dr. Rachel Shakked, Anne Cohen

Bone Bulletin

From a young age, Dr. Shakked knew she wanted to be a doctor and started medical school with an interest in pursuing medical oncology. As a third year, she did her surgery rotation with low expectations but ended up loving it and discovering the field of orthopaedics. After completing her fellowship in 2016, she is now a foot and ankle specialist at the Rothman Institute where she experiences a mix of both private and academic practice. This conversation was born from her desire to show students what life is like beyond medical school and residency, and the importance of living …

First Job Considerations As An Orthopaedic Surgery Attending: Picking A Practice Setting, Purab Kothari

Bone Bulletin

A career in medicine is a journey with many forks in the road as medical students choose specialties, then subspecialties, and finally a practice setting. Particularly with the latter, becoming familiar with the various practice options early on can lead to an easier decision when the time to join the workforce arrives. Additionally, the ability to work in a setting that aligns with one’s career goals may ultimately lead to increased job satisfaction and reduced burnout risk. The following article aims to define various practice settings, including academic, private, community, “privademics” and locum tenens, and explore key considerations orthopaedic surgery …

New Trends In Orthopaedic Surgery Residency Applications: The Role Of Preference Signaling, J. Liam Gibbons

Bone Bulletin

Introduction

Orthopaedic surgery is known to be one of the most competitive specialties for medical students to pursue. It is important for applicants to have a strong portfolio of achievements, including research, presentations, and volunteering to increase chances of matching. USMLE scores and AOA membership tend to be higher among residency applicants that match into orthopaedic surgery. Moreover, the match rate for orthopaedics is lower at 74% compared to the overall match rate of 93.8%.¹ To increase chances of matching into an orthopaedic program, it is recommended to start preparing early and stay informed about trends and strategies in …

A Practical Guide To Etiquette In The Orthopaedic Or For The Rotating Medical Student, Tyler Radack

Bone Bulletin

The Operating Room, the operating theatre, the lair of the Orthopaedic surgeon, it goes by many names. It is a place most try to avoid, but this daunting windowless room is a classroom and training ground for many. And for the medical student interested in an orthopaedic surgery career, making an impression in the operating room is vital to matching into their desired orthopaedic residency.¹

Unfortunately, making an impression in the operating room is difficult, or more precisely, making a good impression in the operating room is difficult. Furthermore, every operating room dynamic can be different, and the personalities …

Injuries, Management, And Prevention In The Weekend Warrior, John Paulik

Bone Bulletin

Introduction

Sports medicine is known for heroically returning competitors back to the big game just in the nick of time for the winning play. This storybook ending is a reality of sports medicine. However, the majority of athletes will not end up on ESPN in the newest 30 for 30. This begs the question - who is an athlete? To some, it may be defined as someone who participates in an organized sport, culminating in regular competition and requiring systematic training.¹ This definition, however, excludes those who regularly exercise with the goal of improving their health or appearance.^{2 …}

Foreword, Alan S. Hilibrand

Bone Bulletin

As the Director of Undergraduate Medical Education for the Department of Orthopedic Surgery at the Sidney Kimmel Medical College, I am thrilled to have this opportunity to introduce the inaugural issue of the Bone Bulletin. Through the activities of the DePalma Orthopaedic Society, medical students at SKMC have had an excellent venue to learn about orthopaedic surgery, and our surgeons here at Rothman Orthopaedics have enthusiastically mentored younger students interested in the field of orthopedic surgery. The DePalma leadership has worked hard on many initiatives in recent years: providing forums for orthopaedic faculty to speak about their work, assembling lists …

Editor's Note, Payton Boere, Ari Clements

Bone Bulletin

We are thrilled to introduce the inaugural issue of the Bone Bulletin, DePalma Orthopaedic Society’s student-run, non-peer reviewed journal for Sidney Kimmel Medical College (SKMC) students. The journal’s aim is to provide yet another way to be involved with orthopaedics in medical school and to promote student interest in orthopaedics by reporting on diverse aspects of the field through editorial and opinion pieces. Under the close 1-on-1 mentorship of a physician from the Rothman Orthopaedic Institute, students have a hands-on opportunity to write about and directly engage with orthopaedic research and developments.

Within the pages of this journal, you …

Observations On The Present And The Future Of Hip Surgery, Alberto Di Martino

Department of Orthopaedic Surgery Faculty Papers

No abstract provided.

Inpatient Opioid Use Varies By Construct Length Among Laminoplasty Versus Laminectomy And Fusion Patients, Harry M. Lightsey, Peter J. Georgakas, Matthew H. Lindsey, Caleb M. Yeung, Joseph H. Schwab, Harold A. Fogel, Stuart H. Hershman, Daniel G. Tobert, Kevin M. Hwang

Rothman Institute Papers

BACKGROUND: Laminoplasty (LP) and laminectomy and fusion (LF) are utilized to achieve decompression in patients with symptomatic degenerative cervical myelopathy (DCM). Comparative analyses aimed at determining outcomes and clarifying indications between these procedures represent an area of active research. Accordingly, we sought to compare inpatient opioid use between LP and LF patients and to determine if opioid use correlated with length of stay.

METHODS: Sociodemographic information, surgical and hospitalization data, and medication administration records were abstracted for patients >18 years of age who underwent LP or LF for DCM in the Mass General Brigham (MGB) health system between 2017 and …