Orthopedics Commons^™

Who Leaves Orthopedics? Analyzing Attrition Among Texas Orthopedic Surgeons, Sean Corcoran, Anesu Karen Murambadoro, Paul Bonilla, Victoria Elizondo, Tori Sayers, Daniela Ramos, Mark Manickath

Research Symposium

Background: Nationally, attrition rates in surgical specialties have been reported to be as high as 20-26%. As of 2019, women comprised only 6.5% of the 29,613 orthopedic surgeons. Female residents showed significantly higher overall attrition rates compared to males (5.96% vs. 2.79%, p < 0.001), with unintended attrition nearly twice as high (2.09% vs. 1.01%, p < 0.001). Attrition can result from a wide array of variables, including sex, ethnicity, education, and background. The aim of this study was to evaluate the demographic and educational factors associated with career longevity beyond training among orthopedic surgeons, with a focus on identifying patterns of attrition in underrepresented groups.

Methods: Data from the Texas Medical Board Physician Database as of September 2024 was evaluated using Microsoft Excel. To determine length of practice, the date of license issuance was subtracted from the date of license expiration. Surgeons with license expirations after 2024 were excluded to maintain a focus on physicians that are no longer practicing. Entries …

Evaluating The Effectiveness Of Cryoneurolysis As A Preoperative Intervention In Total Knee Arthroplasty: A Literature Review, Paul Bonilla, Anesu K. Murambadoro, Juan Pablo Flanagan, Victoria Elizondo, Aamir Ahmad

Research Symposium

Background: Total knee arthroplasty (TKA) is a highly effective treatment for knee osteoarthritis, but significant postoperative pain often necessitates opioid use. Over 70% of patients use opioid drugs 3 weeks after TKA and up to 15% of TKA patients develop opioid dependence, increasing the risk of adverse effects, infections, and contributes to costly revision surgeries. Cryoneurolysis, a minimally invasive technique involving freezing peripheral nerves, has gained attention as a promising preoperative intervention. This study explores the potential of cryoneurolysis as a preoperative intervention to alleviate pain, reduce opioid dependence, and improve functionality.

Methods: A literature search was conducted using the …

Dual-Modality Nerve Ablation: Preoperative Radiofrequency And Cryoneurolysis For Enhanced Pain Relief In Total Knee Arthroplasty, Paul Bonilla, Juan Pablo Flanagan, Anesu Karen Murambadoro, Victoria Elizondo, Aamir Ahmad, Devin Peck

Research Symposium

Background: Total knee arthroplasty (TKA) relieves debilitating knee osteoarthritis but is associated with significant postoperative pain managed by many modalities including opioid treatment. Current pain management strategies rarely address both deep and superficial pain sources effectively. This study aims to introduce a novel dual-modality preoperative pain management technique combining radiofrequency (RF) ablation and cryoneurolysis to improve patient outcomes and reduce opioid dependence postoperatively.

Methods: A literature search was conducted using the University of Texas Rio Grande Valley (UTRGV) online database and PubMed with keywords including “cryoneurolysis” , “TKA” , “radiofrequency ablation”. Additionally, a semi-structured interview was conducted with a recognized …

The Effect Of Artificial Intelligence On High Tibial Osteotomies, Mohammad Khalil, David Rakay, Mohammad Y. Karkoutly, Zayd Ayas, Omar Karkoutly

Research Symposium

Background: High tibial osteotomy (HTO) is a surgical procedure which helps in managing lower limb deformities, provides pain relief, and arrests the progression of osteoarthritis of the knee joint. This surgical method involves cutting and realignment of the tibia and this is only as effective as the accuracy with which the tibia is cut and realigned and this success is based on the understanding of the biomechanics and the anatomical characteristics of the patient. Artificial Intelligence (AI) is becoming more widespread in the field of orthopaedic surgery, with applications in diagnostics, pre-operative planning, and predictive models of outcomes following procedures. …

Return To Sport After Anterior Shoulder Stabilization Of Ncaa Football And Nfl Athletes – A Systematic Review, Yolanda V. Gutierrez, Mohammad Khalil, Aasim Ahmad, Aamir Ahmad

Research Symposium

Background: Anterior shoulder instability is an injury prevalent in contact and non-contact athletes and can result in limited movement, increased recurrence of dislocation, and decreased quality of sports activity. Notable sports that present with frequent anterior shoulder instability include wrestling, hockey, basketball, baseball, and most commonly, football. Athletes may undergo surgical management of anterior shoulder instability via arthroscopic repair, remplissage, Laterjet, or glenoid bone grafting procedures. This review aims to evaluate the return-to-sport rates among elite football athletes in the NCAA and NFL following surgical stabilization, assess post-surgical performance, and analyze the recurrence of instability or complications.

Methods: This systematic …

Incidence Of Diabetes And Obesity In Adhesive Capsulitis Cases In The Rio Grande Valley, Mohammad Khalil, Blake Martin

Research Symposium

Background: Adhesive capsulitis, or frozen shoulder, is a condition characterized by pain and restricted motion in the shoulder joint. Previous studies implicate diabetes as one of the core risk factors for the condition, along with thyroid disease, female sex, and prolonged immobilization. This study aims to investigate the incidence of diabetes and obesity in patients diagnosed with adhesive capsulitis in the Rio Grande Valley, a region with a high prevalence of metabolic disorders.

Methods: A retrospective analysis (IRB-24-0306) was conducted on 836 patients diagnosed with adhesive capsulitis. Demographic variables, including age, sex, and ethnicity, were collected. Clinical data regarding shoulder …

Symptomatic Manifestations Of Hip Dysplasia In Young Adults: How Do Patients Present Before And After Surgery?, John M. Gaddis, Amanda Wheeler, Yossef Alsabawi, Erika Shults, Charles South, Joel E. Wells

Research Symposium

Background: Hip dysplasia is a common source of hip pain in young adults that can lead to early-onset osteoarthritis. The Bernese periacetabular osteotomy (PAO) and total hip arthroplasty (THA) have shown good results as surgical treatment options for this disorder, yet pain may persist after surgery. A previous study described the clinical features of pre-treated hip dysplasia in a traditional clinical cohort; however, to our knowledge, no previous studies have examined the symptomatic manifestations of hip dysplasia in young adults before and after various surgical treatments including the analysis of pain locations in numerous anatomical areas through a body pain …

Metallosis And An Adverse Reaction To Metal Debris Following Dislocation Of A Metal-On-Metal Hip Arthroplasty: A Case Report, John M. Gaddis, Amanda Wheeler, Bretton Laboret, Joel Wells

Research Symposium

Background: Primary total hip arthroplasties have a reported survivorship exceeding 95% at 10-year data. Metal-on-metal bearing surfaces were introduced to minimize wear rate for patients undergoing THA, however, long-term data has shown an unacceptably high failure rate requiring THA revision. The metal-on-metal implants can lead to failure with the generation of the metal ions, specifically cobalt and chromium. The rise in levels of these metal ions can result in adverse reaction to metal debris (ARMD) which can consist of macroscopic necrosis, corrosive osteolysis, sterile hip effusions, and pseudotumor. There are no specific clinical signs or symptoms indicating metallosis, rather, diagnosis …

Assessing The Accuracy And Readability Of Chatgpt 4.0’S Responses To Common Patient Questions Regarding Periacetabular Osteotomy (Pao), John M. Gaddis, Elias Arellano, Yossef Alsabawi, Pablo Castaneda, Joel Wells

Research Symposium

Aims: The study aimed to evaluate the accuracy, comprehensiveness, and readability of responses generated by ChatGPT 4.0 to 30 common patient questions about the Bernese Periacetabular Osteotomy (PAO).

Methods: Two fellowship-trained orthopaedic surgeons specializing in hip preservation selected thirty questions from a prior study identifying common PAO questions on social media. Each question was entered into ChatGPT 4.0, and the surgeons independently graded responses. Responses were evaluated using an established grading system: “excellent,” “satisfactory requiring minimal clarification,” “satisfactory requiring moderate clarification,” or “unsatisfactory.” Accuracy and comprehensiveness were assessed based on the concordance of response content with current literature. Readability was …

Staged Reconstruction And Salvage Of 5th Finger With Corticocancellous Distal Radius Autograft: A Case Report, Emmanuel Franco, Zayd Ayas, Frank Gerold

Research Symposium

Background: Finger reconstruction in the aftermath of severe trauma poses significant challenges in restorative surgery, particularly when addressing extensive soft tissue damage, comminuted fractures, and simultaneous neurovascular complications. This study presents a case of a patient with a complicated distal phalangeal fracture that pursued digit salvage.

Case Presentation: Patient is a 31-year-old woman who sustained a severe injury to her right 5th digit during an ATV rollover. The trauma resulted in an exposed and comminuted fracture of the proximal phalanx with associated loss of soft tissues, flexor tendon, radial nerve injury, and vascular compromise. She elected to pursue digit salvage …

Intraoperative Imaging In Orthopedic Settings: An Assessment Of Changes In Adherence To Imaging Guidelines, Emmanuel Franco, Tabitha Abraham, Zayd Ayas, Frank Gerold

Research Symposium

Background: High-quality intraoperative photography is vital for treatment planning, patient counseling, and surgical education. Inconsistencies in image quality are prevalent in orthopedic literature due to the absence of formalized criteria specific to orthopedic settings. In 2014, "Medical Photography: Principles for Orthopedics" introduced guidelines intending to standardize protocols for capturing clinical images. By comparing the quality of images taken both before and after these proposed guidelines, this project aims to evaluate whether this has influenced a trend toward standardization and consistency in intraoperative orthopedic photography.

Methods: To assess quality differences in orthopedic images before and after the 2014 guidelines, 60 intraoperative …

Impact Of Diabetes On Fall Related Lower Limb Fractures, Bryce M. Bellon, Daniel Salinas, Patrick De La Torre Shutz, Hunter Butler, Sean Corcoran, Kelsey Baker

Research Symposium

Background: Diabetes is a disorder that affects many Americans, characterized primarily by hyperglycemia due to either insulin resistance or lack of insulin secretion. This condition not only impacts blood sugar levels but also has significant effects on bone health. In diabetes, bone density is often decreased due to reduced osteoblast activity, which is responsible for bone formation, and increased osteoclast activity, which leads to bone resorption. This imbalance accelerates the breakdown of bone. Additionally, diabetics frequently suffer from lower extremity arterial disease (LEAD), which results in poor vascularization of the lower limbs. These factors contribute to an increased risk of …

Various Bone Disorders Affecting The Rio Grande Valley, Blake C. Martin, Justin Z. Heckman, Manoj Peiris

Research Symposium

Background: The underserved community that is the Rio Grande Valley (RGV), has a distinct demographic profile, with a high prevalence of chronic conditions such as diabetes and obesity, that warrants investigation of various health issues. The main objective of our study was to analyze the demographic disparities between osteoporosis, osteomalacia, rickets, Paget bone disease, and osteonecrosis in the RGV. We hypothesized that the frequency of osteoporosis would be the most common bone condition (of those analyzed) in the Rio Grande Valley and that the demographics between the various bone conditions would vary depending on age, sex, BMI, and ethnicity …

Joint Involvement In A Psoriasis Affected Population In A Medically Underrepresented Region, Blake C. Martin, Jared Hensley, Manoj Peiris

Research Symposium

Background: Psoriatic arthritis is an aggressive condition that may be characterized by compromised quality of life and significant morbidity. The prevalence of psoriatic arthritis in patients with psoriasis is around 1.7% at 5 years, 3.1% at 10 years, 5.1% at 20 years, and 20.5% at 30 years which shows an increase in joint involvement with increasing age, at least until the age of 30. The objective of this study was to explore joint involvement in psoriatic patients in this region and determine what are the demographic disparities in Psoriatic patients regarding joint involvement. We hypothesized that individuals with psoriasis between …

Gout Versus Pseudogout In The Medically Underserved Rio Grande Valley, Blake C. Martin, Fernando Cisneros, Kristina Vatcheva

Research Symposium

Background: Gout and pseudogout are inflammatory joint conditions, with gout being one of the most prevalent etiologies of chronic inflammatory arthritis in the United States. The patient population in the Rio Grande Valley (RGV) has a distinct demographic profile that warrants exploration of various health conditions. The primary objective of this study is to compare the frequencies of gout and pseudogout in the Rio Grande Valley to national frequencies and determine if there were demographic disparities between Gout and Pseudogout in this community. We hypothesized that the frequency gout and pseudogout would be higher in the RGV compared to the …

Demographic And Clinical Characterization Of Bone Metastases And Primary Malignant Bone Neoplasia In The Rio Grande Valley, Blake C. Martin, Neharika Penmetcha, Aun Bangash, Juan Lopez Alvarenga

Research Symposium

Background: The Rio Grande Valley (RGV) is a developing clinical research region characterized by its distinctive demographic profile that offers an opportunity to investigate diverse health issues. This pilot investigation seeks to identify the characteristics of patients diagnosed with bone metastasis and primary malignant bone neoplasia (PMBN) in the RGV. The main objective was to evaluate the demographic and clinical characteristics linked to bone metastases and PMBN in patients from the Rio Grande Valley. We hypothesized that older age and higher BMI individuals would have greater frequency of metastatic lesions compared to PMBN.

Methods: Data was gathered from the …

Demographic And Clinical Characteristics Of Patients With Benign Bone Tumors: Evidence Of Bimodal Age Distribution In A Hispanic Population, Blake C. Martin, Mohammad Khalil, Juan Lopez Alvarenga

Research Symposium

Background: As far as researchers know, there’s no way to prevent BBTs from forming. Although these tumors generally do not metastasize, they can still be dangerous as they may grow and compress healthy tissues and lead to poor outcomes. The principal objective was to evaluate the demographic and clinical characteristics linked to BBTs in individuals from the Rio Grande Valley. We hypothesized that older age, males, and higher BMI individuals would have greater frequency of BBTs.

Methods: This was a retrospective chart review and IRB approval was obtained prior to starting this study. We obtained medical charts for individuals who …

Characterizing Fracture Distribution By Sex, Age, And Body Region: Insights From A Regional Population Study, Blake C. Martin, Jared Hensley, Juan Lopez Alvarenga

Research Symposium

Background: This Rio Grande Valley (RGV) region of South Texas is a unique region that is impoverished and medically underserved. We conducted this study in order to further the knowledge of orthopedics in this unique, medically underserved community. We sought to determine if certain body regions, based on sex and age, were at increased risk for fracture in this population. We hypothesized that females would have increased fracture frequency at older ages while males would have increased fracture frequency at all other ages. We also hypothesized that femur and forearm fractures would be increased in females compared to males.

Methods …

Bone And Joint Infections: A Retrospective Chart Review Of The Medically Underserved Rio Grande Valley, Blake C. Martin, Chloe Harris, Manoj Peiris

Research Symposium

Background: The Rio Grande Valley (RGV) is a demographically unique region that is impoverished and medically underserved. Because of its unique patient population, this community may be at increased risk for bone and joint infections and the morbidity and mortality that follows. The goal of this study was to analyze individuals with osteomyelitis, septic arthritis, and periprosthetic joint infections and determine which infectious bone or joint conditions are most prevalent in the Rio Grande Valley and determine if there were any demographic disparities between the various types of bone and joint infections and healthy individuals. We hypothesized that age and …

Association Of Joint Disease With Demographic Factors In Clinical Populations Of The Rio Grande Valley, Blake C. Martin, Devian D. Baez, Juan C. Lopez-Alvarenga

Research Symposium

Background: The Rio Grande Valley (RGV) is a medically underserved, demographically unique population that warrants the exploration of various conditions, including joint conditions, such as osteoarthritis (OA), rheumatoid arthritis (RA), gout, ankylosing spondylitis (AS), psoriatic arthritis (PA), juvenile idiopathic arthritis (JIA), and septic arthritis (SA). We sought to determine the demographic disparities between the different types of common joint conditions in this community. We hypothesized that OA would follow national trends and be the most common joint condition in the Rio Grande Valley. We hypothesized that the demographics between the various joint conditions would vary depending on age, sex, BMI, …

Gut-Spine Connection: Unexplored Pathways To Improving Outcomes In Spinal Health And Disease, Anesu K. Murambadoro, Julia Saifetiarova, Priya Kale, Victor A. Bob-Yellowe, Paul Bonilla, Aun A. Bangash, Isabella Ortigoza, Anjana Ganesh, Mohammed S. Razzaque

Research Symposium

Introduction: Lumbar spinal fusion is among the most expensive procedures in the Medicare system, with costs exceeding $33 billion annually. Improving recovery outcomes for these procedures is critical, and emerging research suggests that microbiome-targeted therapies could play a key role. There is growing evidence linking spinal health with gut microbiota alterations, particularly through the gut-spine axis, which involves the gut-disc, gut-bone, and gut-immune interactions. This bidirectional relationship between gut microbiota and spinal health offers a novel approach for understanding recovery mechanisms. Additionally, magnesium deficiency, which is prevalent, may exacerbate both gut dysbiosis and poor bone health, contributing to chronic skeletal …

Evaluating Industry Relationships And Transparency: Insights From Orthopedic Surgeons In The Cms Open Payments Database, Anesu K. Murambadoro, Mario Keko, Edward Rodriguez, John J. Wixted

Research Symposium

Introduction: Industry payments to physicians may risk introducing bias into patient care. The Open Payments (OP) database, established by Physician Payments Sunshine Act, reports these payments to promote transparency. Orthopedic surgeons receive the highest industry payments especially in the category of royalties/licensing, prompting questions about conflicts of interest and whether the database accurately reflects the status across the specialty. We hypothesize that the OP database underrepresents the relationships that orthopedic surgeons have with industry. We seek to assess the validity of reported industry payments, particularly in the categories of royalties and licensing payments to determine how to improve transparency and …

Spine Surgery In South Texas: The Impact Of Rurality On Surgeon Demographics And Access To Care, Anesu K. Murambadoro, Kevin Garcia Valdez, Patrick De La Torre Schutz, Allison J. Mcadams, Anjali Rose Binoy, Kelsey Baker

Research Symposium

Introduction: Female representation in spine surgery remains low, with only 4% of orthopedic spine surgeons and 9% of neurosurgeons identifying as female. Studies have shown that factors such as societal perceptions, limited support for family planning, and a lack of mentorship deter women from pursuing surgical careers. We hypothesize that representation may be further impacted in US-Border regions. Specifically, over 90% of Texas' 32 border counties lack sufficient primary care services, including specialty care such as orthopedic surgery and neurosurgery, leading residents to seek care outside the region. Here, we sought to evaluate the demographics of spine surgeons (orthopedic and …

The Morbidity Of Greater Trochanteric Pain Syndrome Is Similar To That Of Hip Osteoarthritis Awaiting Total Hip Arthroplasty, Sonia Wadekar, Joel Wells, Avneesh Chhabra, Yin Xi, Emily Middleton

Research Symposium

Background: Greater trochanteric pain syndrome (GTPS) is characterized by chronic lateral hip pain and dysfunction. While psychosocial measures of other tendinopathies have been gaining traction, GTPS is less well studied. We sought to characterize the morbidity upon presentation of GTPS and compared it to patients with end-stage, hip osteoarthritis (OA) awaiting total hip arthroplasty (THA).

Methods: This study examined patient reported outcomes measures (PROMs) on activity limitations, quality of life (QOL), pain, and level of disability, in all patients with GTPS and end-stage, pre-THA hip OA. All patients presented at a single academic medical center between October 2016 to November …

Changes In Severity Of Pelvic Floor Dysfunction After Hip Surgery, Amisha Mehta, Joel E. Wells, Sonia Wadekar, Taylor Price, Donald Kasitinon

Research Symposium

Introduction: Despite growing evidence that suggests an association between hip pathology and pelvic floor disorder (PFD), the comprehensive effects of hip surgery on PFD symptoms are not well understood. The primary purpose of this study was to report the role of surgical hip procedures on the severity of PFD symptoms.

Methods: A prospective database of demographic and outcome data for all female patients that were operated on between 2019-2020 at a single institution was queried. The PDFI-20 was used to assess symptom severity, and cases with both pre and postoperative surveys were included (n=62). MCID was used to determine significance …

Recurrent Hemarthrosis Secondary To Erosive Patellofemoral Arthritis Treated With Arthroplasty: A Report Of 3 Cases, Rachael A. Turner, Justin N. Duke, Trevor G. Murray, Jared R.H. Foran

Research Symposium

Background: Spontaneous hemarthrosis of the knee joint in the elderly population is a rare phenomenon and is mostly seen in those with osteoarthritis. The identified causes of spontaneous hemarthrosis in this demographic include subchondral bone bleeding, meniscal tear, genicular artery bleeding, and the use of anticoagulants. Hemarthrosis caused by isolated patellofemoral bleeding, as in this case series, has been rarely documented and poorly described.

Case: Three patients presented with recurrent hemarthrosis secondary to erosive patellofemoral arthritis. Recurrent hemarthrosis from the eroded patellofemoral subchondral bone has not been well described. Each patient presented with symptoms secondary to painful effusions that …

Patients Achieving 90°/45°/0° Intraoperative Stability Do Not Require Hip Precautions Following Posterior Approach Total Hip Arthroplasty: A Prospective Randomized Study, Rachael A. Turner, Marlie R. Mounts, Nimesh B. Patel, Erin N. Snelling, Raquel E. Phillips, Dean A. Levesque, Jared R.H. Foran

Research Symposium

Background: Hip precautions are traditionally employed after posterior total hip arthroplasty (THA). The primary purpose was to investigate the necessity of hip precautions after posterior approach THA. We hypothesized that eliminating precautions in patients that achieved appropriate intraoperative stability would not increase the dislocation rate.

Methods: Randomized controlled trial of 346 consecutive eligible patients undergoing primary THA with a mean follow-up of 2.3 years (range 11 months to 3.7 years). Exclusion criteria: lumbar fusion, scoliosis, abductor insufficiency, inability to achieve intraoperative stability with combined 90° flexion and 45° internal rotation in 0° adduction. Fisher's exact test was used to compare …

Non-Syndromic Multi Focal Non-Ossifying Fibroma: A Diagnostic Challenge Of Giant-Cell Rich Lesions, Rachael A. Turner, Andres M. Burbano, Kevin J. Orellana, Duncan Ramsey

Research Symposium

Background: Diagnosing GCL can be extremely difficult due to the rarity of these lesions. Histologically many benign GCL mimic each other and can further be mistaken for a malignant GCL. Additionally confusing the diagnosis, many benign GCL have significant morphological overlap. However, it is of utmost importance to arrive at an accurate diagnosis as treatment varies significantly based on the pathology. Our patient presentation highlights that differentiating GCLs can be a diagnostic challenge as illustrated. Our review of the literature found scarce reports of multifocal non-ossifying fibroma. In this case report, we describe a non-syndromic multifocal non-ossifying fibroma successfully …

Giardia Lamblia Reactive Arthritis Mimicking Acute Periprosthetic Knee Infection: A Case Report, Rachael A. Turner, Justin N. Duke, Jared R.H. Foran

Research Symposium

Background: The difficulty in diagnosing Periprosthetic joint infection (PJI) is exacerbated by the more varied presentation of PJI and the lower synovial fluid WBC count thresholds applied when a prosthesis is present. Multiple reports have described pseudosepsis after total knee arthroplasty (TKA) due to gout or pseudogout. Further confusing the picture, periprosthetic infection also frequently coexists with crystalline arthropathy. Our review of the literature revealed no reports describing reactive arthritis (ReA) mimicking acute infection in the setting of previous TKA. In this case report, we describe a pseudo-periprosthetic infection of a well-functioning TKA secondary to ReA in the setting of …

Comparison Of The Clinical Outcomes Of Open Surgery Versus Arthroscopic Surgery For Chronic Refractory Lateral Epicondylitis Of The Elbow, Doo Sup Kim, Hoe Jeong Chung, Chang-Ho Yi, Seong-Hyeon Kim

Research Symposium

Numerous surgical options have been introduced for the treatment of chronic refractory lateral epicondylitis of the elbow, but it remains unclear which option is superior. The clinical outcomes of an open surgery group and an arthroscopic surgery group were evaluated, and the results of the 2 procedures were compared. From among patients with lateral epicondylitis refractory to 6 months of conservative treatment, 68 patients satisfying study criteria were recruited. Open surgery was performed in 34 cases (group 1), and arthroscopic surgery was performed in 34 cases (group 2). Compared with preoperatively, the 2 groups had significantly improved values for grip …