Orthopedics Commons^™

A Modern Multimodal Pain Protocol Eliminates The Need For Opioids For Most Patients Following Total Knee Arthroplasty: Results From A Retrospective Comparative Cohort Study, Leland Van Deventer, Amy Bronstone, Claudia Leonardi, Matthew Bennett, Peter Yager, Vinod Dasa

School of Medicine Faculty Publications

Purpose: Modern multimodal analgesia has been shown to significantly reduce opioid use following total knee arthroplasty (TKA). This study was conducted to determine if changing TKA discharge opioid prescriptions from automatic to upon request resulted in more opioid free recoveries without compromising pain control. Methods: Between December 2019 and August 2021, an orthopedic surgeon performed 144 primary unilateral TKAs; patients received the same multimodal analgesia protocol except for postoperative opioid prescribing. The first consecutively-treated cohort automatically received an opioid prescription following discharge (automatic group) and the second cohort received opioid prescriptions only upon request (upon request group). Opioid prescription data …

Development Of An Affordable, Manual Method Of Dna Extraction From Bones And Teeth ​, Varos Victer Manukyan, Lara Laughrey, Ryan V. Powers, Amar Paul, Davis Johnston, Dashon Eure, Todeh Toomians, John A. Kriak, Kyle B. Bills, David W. Sant

Annual Research Symposium

No abstract provided.

Profibrotic Behavior Of Fibroblasts Derived From Patients That Develop Posttraumatic Shoulder Stiffness, Benjamin A. Hendy, Jolanta Fertala, Thema Nicholson, Joseph A. Abboud, Surena Namdari, Andrzej Fertala

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND AND AIMS: Arthrofibrosis is a severe scarring condition characterized by joint stiffness and pain. Fundamental to developing arthrofibrotic scars is the accelerated production of procollagen I, a precursor of collagen I molecules that form fibrotic deposits in affected joints. The procollagen I production mechanism comprises numerous elements, including enzymes, protein chaperones, and growth factors. This study aimed to elucidate the differences in the production of vital elements of this mechanism in surgical patients who developed significant posttraumatic arthrofibrosis and those who did not.

METHODS: We studied a group of patients who underwent shoulder arthroscopic repair of the rotator cuff. …

Hemoglobinopathy Is Associated With Total Hip Arthroplasty Indication Even Beyond Sickle Cell Anemia, Maxwell J. Rakutt, Daniel N. Bracey, Anna Cohen-Rosenblum, Peter K. Sculco, Franco M. Sabatini, Cale A. Jacobs, Stephen T. Duncan, David C. Landy

School of Medicine Faculty Publications

Background: The extent to which hemoglobinopathies other than sickle anemia (HbSS) are associated with hip osteonecrosis is unknown. Sickle cell trait (HbS), hemoglobin SC (HbSC), and sickle/β-thalassemia (HbSβTh) may also predispose to osteonecrosis of the femoral head (ONFH). We sought to compare the distributions of indications for a total hip arthroplasty (THA) in patients with and without specific hemoglobinopathies. Methods: PearlDiver, an administrative claims database, was used to identify 384,401 patients aged 18 years or older undergoing a THA not for fracture from 2010 to 2020, with patients grouped by diagnosis code (HbSS N = 210, HbSC N = 196, …

Opioid Prescriptions In A Veteran Population Undergoing Lumbar Spine Surgery: What Are The Current Knowledge Gaps?, Mark J. Lambrechts, Hernan Roca, Brian A. Karamian

Department of Orthopaedic Surgery Faculty Papers

No abstract provided.

One-Stage Synovectomies Result In Improved Short-Term Outcomes Compared To Two-Stage Synovectomies Of Diffuse-Type Tenosynovial Giant Cell Tumor (D-Tgct) Of The Knee: A Multicenter, Retrospective, Cohort Study, Geert Spierenburg, Floortje G M Verspoor, Jay S Wunder, Anthony M Griffin, Peter C Ferguson, Matthew T Houdek, David M King, Richard Boyle, Robert Lor Randall, Steven W Thorpe, Jacob I Priester, Erik J Geiger, Lizz Van Der Heijden, Nicholas M Bernthal, Bart H W B Schreuder, Hans Gelderblom, Michiel A J Van De Sande

Rothman Institute Papers

Diffuse-type tenosynovial giant cell tumors' (D-TGCTs) intra- and extra-articular expansion about the knee often necessitates an anterior and posterior surgical approach to facilitate an extensive synovectomy. There is no consensus on whether two-sided synovectomies should be performed in one or two stages. This retrospective study included 191 D-TGCT patients from nine sarcoma centers worldwide to compare the postoperative short-term outcomes between both treatments. Secondary outcomes were rates of radiological progression and subsequent treatments. Between 2000 and 2020, 117 patients underwent one-stage and 74 patients underwent two-stage synovectomies. The maximum range of motion achieved within one year postoperatively was similar (flexion …

One And A Half-Stage Revision With Prosthetic Articulating Spacer For Definitive Management Of Knee Periprosthetic Joint Infection., Ahmed Siddiqi, Yusuf Mahmoud, Salvador A. Forte, Thomas A Novack, James Nace

Orthopedic Surgery Resident Research

This paper is a comprehensive review that describes indications, contraindications, clinical outcomes, and pearls and pitfalls of 1.5-stage revision total knee arthroplasty (TKA) utilizing a primary TKA femoral component, all-polyethylene tibial component, and hand-crafted antibiotic cement for the management of chronic periprosthetic joint infection. The 1.5-stage exchange TKA details placement of an articulating spacer for an indefinite period, prolonging revision until reinfection, deterioration of functional status, or construct failure. A 1.5-stage revision TKA technique is a viable option for treatment of chronic periprosthetic knee infections. The inherent advantages of decreased health-care costs, decreased morbidity and mortality, and improved emotional ease …

Not All Patients Need Supervised Physical Therapy After Primary Total Knee Arthroplasty: A Systematic Review And Meta-Analysis., Yash P Chaudhry, Hunter Hayes, Zachary Wells, Efstratios Papadelis, Harpal S Khanuja, Carl Deirmengian

Orthopedic Surgery Resident Research

Although postoperative physical therapy (PT) has long been considered essential to successful total knee arthroplasty (TKA) recovery, recent literature has suggested that unsupervised home exercise regimens may offer similar benefits to formal supervised sessions. We aimed to compare objectively measured physical function and subjective patient-reported outcomes (PROs) between primary TKA patients who received formal supervised physical therapy sessions and those who received unsupervised home exercise regimens after discharge. Six electronic databases were queried to identify randomized controlled trials comparing supervised physical therapy to unsupervised home exercise regimens in primary TKA patients after discharge. Outcomes of interest included change from baseline …

Inflation-Adjusted Medicare Reimbursement For Hip Arthroscopy Fell By 211% On Average Between 2011 And 2022, Allison Y Kufta, David R Maldonado, Cammille C Go, Andrew J Curley, Paulo Padilla, Benjamin G Domb

Faculty, Staff and Student Publications

Purpose: To examine Medicare reimbursement for hip arthroscopy from 2011 to 2022.

Methods: The seven most common procedures performed with hip arthroscopy by a single surgeon were gathered. The Physician Fee Schedule Look-Up Tool was utilized to access financial data of the associated Current Procedural Terminology (CPT) codes. The reimbursement data for each CPT were gathered from the Physician Fee Schedule Look-Up Tool. With the consumer price index database and inflation calculator, reimbursement values were adjusted for inflation to 2022 U.S. dollars.

Results: Following an adjustment for inflation, it was found that reimbursement rate for hip arthroscopy procedures on average …

Relationship Between Bone Bruise Volume And Patient Outcomes After Acl Reconstruction, Connor Galloway, Hallie Ward, Steven Higbie, Jacquelyn Kleihege, Manickam Kumaravel, Walter R Lowe, Lane Bailey

Faculty, Staff and Student Publications

BACKGROUND: Subchondral bone injuries, or bone bruises, are commonly observed on magnetic resonance imaging (MRI) after anterior cruciate ligament (ACL) injury. The current relationship between bone bruise volume and postsurgical outcomes remains poorly understood.

PURPOSE: To examine the influence of bone bruise volume on self-reported and objective functional outcomes at the time of return to play and 2 years following ACL reconstruction.

STUDY DESIGN: Cohort study; Level of evidence, 3.

METHODS: Clinical, surgical, and demographic data were obtained for a sample of convenience utilizing a single-surgeon ACL database (n = 1396). For 60 participants, femoral and tibial bone bruise volumes …

Inflation-Adjusted Medicare Reimbursement For Hip Arthroscopy Fell By 211% On Average Between 2011 And 2022, Allison Y Kufta, David R Maldonado, Cammille C Go, Andrew J Curley, Paulo Padilla, Benjamin G Domb

Faculty, Staff and Student Publications

PURPOSE: To examine Medicare reimbursement for hip arthroscopy from 2011 to 2022.

METHODS: The seven most common procedures performed with hip arthroscopy by a single surgeon were gathered. The Physician Fee Schedule Look-Up Tool was utilized to access financial data of the associated Current Procedural Terminology (CPT) codes. The reimbursement data for each CPT were gathered from the Physician Fee Schedule Look-Up Tool. With the consumer price index database and inflation calculator, reimbursement values were adjusted for inflation to 2022 U.S. dollars.

RESULTS: Following an adjustment for inflation, it was found that reimbursement rate for hip arthroscopy procedures on average …

Retrospective Review Of 80 Patients With Chronic Recurrent Multifocal Osteomyelitis Evaluated By Pediatric Orthopaedic Surgeons, Tristen Noble Taylor, Callie Shawhan Bridges, Ekene Uchenna Ezeokoli, Tyler Scott Smith, Nicole Irene Montgomery

Faculty, Staff and Students Publications

Background: Chronic Recurrent Multifocal Osteomyelitis (CRMO) is a rare aseptic autoinflammatory disease with a wide and vague clinical presentation that often mimics infection, malignancy, or benign conditions, leading to a delayed diagnosis. We aimed to evaluate the clinical characteristics, differential diagnoses from evaluating pediatric orthopaedic surgeons, and compared the number of patients that could have avoided a biopsy in 80 patients with CRMO.

Methods: Children diagnosed with CRMO at a single tertiary pediatric hospital in the United States between 2012 and 2022 who were evaluated by a pediatric orthopaedic surgeon were retrospectively reviewed. The differential diagnoses from the surgeons were …

Minimally Invasive Surgery Using A Shannon Burr For The Treatment Of Hallux Valgus Deformity: A Systematic Review, Tyler Gonzalez, Rodrigo Encinas, William Johns, J Benjamin Jackson

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Recently there has been an increase in minimally invasive surgery (MIS) for the correction of hallux valgus deformity. This systematic review aims to evaluate and present the current literature on MIS hallux valgus correction in studies reporting the use of the Shannon burr with distal metatarsal osteotomies to help establish evidence-based guidelines for surgeons using this technique.

METHODS: Two independent authors performed a systematic literature search using the following databases: PubMed, Embase, and the Cochrane library. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) protocol and the Cochrane Handbook guidelines were followed. All studies included were published …

Puncture Capsulotomy Technique For Hip Arthroscopy: Midterm Functional Outcomes, Christopher T Eberlin, Michael P Kucharik, Paul F Abraham, Mark R Nazal, William Conaway, Nathan H Varady, Scott D Martin

Department of Orthopaedic Surgery Faculty Papers

Background: The most common surgical approaches in hip arthroscopy are interportal and T-capsulotomy. However, these methods may introduce capsular instability. Puncture capsulotomy preserves capsuloligamentous integrity by avoiding iatrogenic transection of the iliofemoral capsular ligament.

Purpose: To present minimum 2-year functional outcomes for patients who underwent arthroscopic treatment for acetabular labral tears and concomitant femoroacetabular impingement using the puncture capsulotomy technique.

Study design: Case series; Level of evidence, 4.

Methods: The authors conducted a retrospective review of prospectively collected data on patients who underwent arthroscopic acetabular labral tear treatment between December 2013 and May 2019. Included were patients aged ≥18 years …

Analyses Of Orthopaedic Surgery Residency Interviews, Alexander J Adams, Matthew Sherman, James J. Purtill

Rothman Institute Papers

Interviews are a critical component of orthopaedic surgery residency selection for both the applicant and the program. Some institutions no longer report Alpha Omega Alpha (AOA) designation or class rank, and US Medical Licensing Examination (USMLE) Step 1 recently switched to pass/fail scoring. During the coronavirus disease 2019 (COVID-19) pandemic, all Accreditation Council for Graduate Medical Education programs conducted virtual interviews and subinternship rotations were restricted. These changes offer significant challenges to the residency match process. The purpose of this study was to examine the residency applicant interview and ranking process at a large urban academic university setting. We hypothesized …

Impact Of Perioperative Dexamethasone On Hospital Length Of Stay And Glycemic Control In Patients With Type 2 Diabetes Undergoing Total Hip Arthroplasty, Vanessa Williams, Mohammad J. Uddin Ansari, Amruta Jaju, Stacey Ward, Daniel O'Keefe, Jumana Abdelkarim, Nicole Montes, Ula Tarabichi, Albert Botchway, Michael G. Jakoby Iv

Journal of Patient-Centered Research and Reviews

Purpose: This study aimed to evaluate effects of perioperative dexamethasone on hospital length of stay (LOS) and glycemic control for patients with type 2 diabetes mellitus undergoing total hip arthroplasty (THA).

Methods: We performed retrospective case review of THA performed in adults (≥ 18 years old) with type 2 diabetes at Springfield Memorial Hospital (Springfield, IL) immediately before (2013), during (2014), and after (2015) publication of consensus guidelines for use of perioperative dexamethasone. Hospital LOS was the primary endpoint. Capillary blood glucose by hospital day, proportion of patients treated with insulin, and median insulin dose by hospital day …

Total Hip Arthroplasty In The Setting Of Post-Traumatic Arthritis Following Acetabular Fracture: A Systematic Review, Conor S O'Driscoll, Martin S Davey, Andrew J Hughes, John M O'Byrne, Michael Leonard, Brendan J O'Daly

Rothman Institute Papers

Background: Acetabular fractures are frequently associated with post-traumatic arthritis (PTA), for which total hip arthroplasty (THA) has emerged as the established procedure. The purpose of this systematic review is to report the patient outcomes, complications, and implant survival of delayed THA for patients with PTA following acetabular fracture.

Methods: A systematic review was performed in December 2021 as per Preferred Reporting Items for Systematic Review and Meta-Analysis Guidelines to identify all studies reporting outcomes of delayed THA performed for PTA with a history of acetabular fracture. From an initial screen of 893 studies, 29 studies which met defined inclusion criteria …

Routine Pathologic Examination Of The Femoral Head In Total Hip Arthroplasty: A Survey Study Of The American Association Of Hip And Knee Surgeons, Sumon Nandi, Javad Parvizi, Aahks Research Committee

Rothman Institute Papers

Background: Current literature does not provide conclusive evidence on whether routine pathologic examination of femoral heads from total hip arthroplasty is indicated or cost-effective. As a result, there is substantial variation in opinion among surgeons related to this issue. Our study aim was to determine factors that impact surgeon propensity to order pathologic examination of femoral heads.

Methods: A 12-question survey was created to evaluate surgeon practices, indications, and patient care implications surrounding routine pathologic examination of femoral heads. The email survey was distributed to all members of the American Association of Hip and Knee Surgeons (n = 2598).

Results: …

Increasing Cefazolin Use For Surgical Prophylaxis In Penicillin-Allergy-Labeled Patients., Kathryn A. Vandervelde, Sarah Suppes, Kate Gibbs, Kevin Latz, Angela C. Vanderpool, Rana El Feghaly, Jennifer Goldman

Manuscripts, Articles, Book Chapters and Other Papers

Objective: Penicillin (PCN) allergy labels affect antimicrobial selection for surgical prophylaxis. We aimed to increase the percentage of cefazolin usage in patients with PCN allergy labels undergoing orthopedic surgery from 50% to 80%.

Design: Quality improvement initiative.

Setting: Children's Mercy Kansas City (CMKC), a freestanding children's hospital.

Patients: Children scheduled for an orthopedic surgery (excluding spinal surgery) at CMKC who had a PCN allergy label and received a perioperative antibiotic.

Methods: No standardized process existed to identify and clarify PCN-allergic-labeled patients preoperatively. We developed a process for patient identification combined with a pharmacist phone interview for PCN allergy clarification. In …

Peripheral Nerve Stimulation Improves Knee Pain Following Total Knee Arthroplasty: A Retrospective Study, David Gallacher, Paul Gastelum-Tapia, Napatkamon Ayutyanont, Upinder Singh, Sungkook Park

Far West Division GME Research Day 2023

No abstract provided.

Resection Arthroplasty For Recurrent Hip Septic Arthritis And Osteomyelitis, Benjamin Koerner, Mark W. Gendi, J Kesl, T Presley

Continental, MidAmerica, & Mountain Divisions GME Research Day 2023

No abstract provided.

Technique For Osteochondral Allograft Transplant For 1st Metatarsal Head Cartilage Damage, Bren Koerner, Angela Walker, Kyle Barner, Yale Williams

Continental, MidAmerica, & Mountain Divisions GME Research Day 2023

No abstract provided.

Mesenchymal Stem Cell Use In The Treatment Of Osteoarthritis: A Literature Review, Samantha Arrizon, Nolan Barnes, Teresa Del Toro, Lei Wena Herme, Vanessa Mendoza, Thi Tran, Reeta Zamro

Physician Assistant Studies | Student Literature Reviews

Mesenchymal stem cell (MSC) therapies have been growing in popularity in research due to their anti-inflammatory, immunomodulatory, and regenerative properties. Many ongoing clinical trials are investigating the safety and efficacy of MSC therapies to treat osteoarthritis, also known as “wear and tear” arthritis. As the average life expectancy increases, with age people are more prone to developing this disease, therefore, increasing its prevalence. This condition is progressive and will lead to functional decline, decreased quality of life, and increased medical costs. Our focus is to discuss the efficacy of mesenchymal stem cell injections in alleviating pain, improving functionality, and slowing …

Persistent Lack Of Female Orthopaedic Sports Medicine Fellows, Tessa R. Lavorgna, Sanchita Gupta, Connor Maginnis, Shreya M. Saraf, Michaela A. Stamm, Stephanie E. Wong, Mary K. Mulcahey

School of Medicine Faculty Publications

Purpose: To evaluate the gender composition of fellows, faculty, and leaders within orthopaedic sports medicine fellowship programs to provide a more complete description of gender diversity within this subspecialty. Methods: Official program websites of orthopaedic sports medicine fellowships listed on the Arthroscopy Association of North America fellowship directory were examined. Data collected for analysis included the gender of program directors, fellowship faculty, orthopaedic surgery department faculty, current sports medicine fellows, and fellows who graduated within the last 5 years. Results: Of the 132 orthopaedic sports medicine fellows in training in the United States in the 2021 to 2022 academic year, …

Small Finger Reverse Ulnar Digital Artery Hypothenar Perforator Flap For Small Finger Proximal Interphalangeal Joint Reconstruction, Nicholas Kunda, Alexander Dagum

Stony Brook Orthopaedic and Musculoskeletal Journal

Purpose: Local flaps are commonly used for digital reconstruction for soft tissue defects. There remains a paucity of options available for small finger volar proximal interphalangeal joint coverage. The purpose of this study was to analyze perforators along the hypothenar eminence arising from the artery of the ulnar side of the small finger as it comes off the superficial palmer arch for consistency and potential to be used for perforator-based flap reconstruction of the small finger proximal interphalangeal joint.

Methods: Four cadaveric upper extremities were injected with Microfil® silicone injection compound. Dissection was performed from the superficial palmer arch to …

Extracellular Vesicle Distribution And Localization In Skeletal Muscle At Rest And Following Disuse Atrophy, Ahmed Ismaeel, Douglas W. Van Pelt, Zachary Hettinger, Xu Fu, Christopher I. Richards, Timothy A. Butterfield, Jonathan J. Petrocelli, Ivan J. Vechetti Jr., Amy L. Confides, Micah J. Drummond, Esther E. Dupont-Versteegden

Markey Cancer Center Faculty Publications

Background Skeletal muscle (SkM) is a large, secretory organ that produces and releases myokines that can have autocrine, paracrine, and endocrine effects. Whether extracellular vesicles (EVs) also play a role in the SkM adaptive response and ability to communicate with other tissues is not well understood. The purpose of this study was to investigate EV biogenesis factors, marker expression, and localization across cell types in the skeletal muscle. We also aimed to investigate whether EV concentrations are altered by disuse atrophy.

Methods To identify the potential markers of SkM‑derived EVs, EVs were isolated from rat serum using density gradient ultracentrifugation, …

Clinical And Radiographic Outcomes For Femoral Neck Fracture Fixation With Femoral Neck System Versus Multiple Cannulated Screws, Samer M. Al-Humadi, D’Arcy Marsh, Michael Doany, David Swanson, David E. Komatsu, Stephen A. Kottmeier, Nicholas Divaris

Stony Brook Orthopaedic and Musculoskeletal Journal

Background: The There are few studies in the orthopaedic surgery literature that examine clinical outcomes for femoral neck system (FNS) fixation of femoral neck fractures. The purpose of this study was to compare primary outcome of non-union for femoral neck fracture fixation using FNS versus multiple cannulated screws (MCS).

Methods: Retrospective electronic medical record search for patients 18 years or older who underwent surgery between March 01, 2018 and September 01, 2021 for femoral neck fracture fixation. Two reviewers examined radiographic and clinical data reaching consensus. Patients were called via telephone to complete Short Form 12-item (SF-12) surveys with consent. …

Alcohol And Opiate Abuse Are Risk Factors For Dislocation After Primary Reverse Shoulder Arthroplasty, Ryan P. Tantone, Kenny Ling, Michael E. Doany, Rosen Jeong, Emma Smolev, Edward D. Wang

Stony Brook Orthopaedic and Musculoskeletal Journal

Background: As indications for reverse total shoulder arthroplasty (RTSA) expand and patients present with increasing comorbidities, complications have become more frequent. Dislocation and instability are devastating complications and have become one of the leading causes of revision surgery. Current literature suggests multifactorial causes for dislocation, but studies are limited to physiologic and mechanical risk factors. The purpose of this study was to investigate social risk factors, including alcohol and drug abuse, and their association with dislocation after RTSA.

Methods: A retrospective cohort of all RTSA performed at a single center by the senior author between January 2012 and March 2021 …

Diagnostic Dilemma: Schwannoma Or Ganglion Cyst, Karthik Ks, Prakash M, Gurumurthy B, Sujanatheja Js, Pramod Bm, Punith N

Digital Journal of Clinical Medicine

Schwannomas are rare, slow growing benign tumors of peripheral nerve sheath originating from Schwann cells surrounding the nerve associated with delayed presentation of pain and paresthesia. Their incidence being 5% of all upper extremity tumors. They may be a part of neurofibromatosis called schwannomatosis with multiple peripheral schwannomas. We present a case of solitary schwannomas from the peripheral nerves probably superficial branch of median nerve mistaken initially for ganglion cyst.

Core Muscle Injuries: Functional Outcomes And Return To Sport In A Consecutive Series Of Twenty Athletes, Nicholas Tsouris, Jack Tesoriero, James A. Vosswinkel, James Penna

Stony Brook Orthopaedic and Musculoskeletal Journal

Background: Core muscle injury can cause significant dysfunction in athletes. A variety of surgical procedures have been described. This study examines an orthopaedic and general surgeon’s technique and patient reported outcomes of adductor tenotomy and rectus abdominus imbrication with ilioinguinal nerve neurolysis.

Hypothesis: Surgical treatment of core muscle injuries with adductor tenotomy and rectus abdominus imbrication with ilioinguinal nerve neurolysis will result in decreased symptoms and high rates of return to play.

Study Design: Operative technique; retrospective case series.

Methods: Our electronic medical record system was searched for patients who underwent core muscle injury surgery by the treating surgeons. The …