Orthopedics Commons^™

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 …

Early Diet Liberalization After Anterior Lumbar Interbody Fusion Improves Postoperative Recovery, Tiffany Bridges, Matthew Meade, Parker L. Brush, Yunsoo Lee, Rajkishen Narayanan, Michael A. Mccurdy, Mark J. Lambrechts, Alex Charlton, Eleanor Jenkins, Robert Juniewicz, Henson Destine, I. David Kaye, Mark Kurd, Jose A. Canseco, Alan S. Hilibrand, Alex R. Vaccaro, Gregory D. Schroeder, Christopher K. Kepler

Department of Orthopaedic Surgery Faculty Papers

STUDY DESIGN: Retrospective Cohort Study.

OBJECTIVES: The objective of this study was to assess the impact of diet liberalization on short-term outcomes in patients undergoing anterior interbody lumbar fusion (ALIF).

METHODS: A retrospective review was performed for patients undergoing ALIF at our tertiary care center institution from 2010 to 2022. Electronic medical records were reviewed for demographics, surgical characteristics, and 90-day postoperative outcomes.

RESULTS: We included 515 patients in this study with 102 patients receiving a full diet on the same day as their operation. All other patients had a delay of at least 1 day (average 1.6 days) until …

Evaluating Dysphagia Duration And Severity After Acdf In Patients With Underlying Dysphagia - A Prospective, Multicenter Study, Aditya Mazmudar, Taylor Paziuk, Khoa Tran, Tyler Henry, Samuel Oh, Caroline Purtill, Daniel Habbal, Goutham Yalla, Quinlin Harrill, Brandon Sherrod, Erica Bisson, Darrel Brodke, Christopher Kepler, Gregory Schroeder, Alex Vaccaro, Alan Hilibrand, Jeffrey Rihn

Department of Orthopaedic Surgery Faculty Papers

STUDY DESIGN: Prospective Cohort Study.

OBJECTIVES: The purpose of this study was to prospectively evaluate the impact of preoperative dysphagia on the postoperative incidence and severity of dysphagia in patients undergoing ACDF at multiple institutions.

METHODS: After IRB approval, patients over 18 years of age who underwent an elective ACDF for degenerative conditions were prospectively enrolled at two academic centers from 2018 to 2021. Preoperative dysphagia was self-reported by patients through a pre-operative questionnaire on a binary basis. Patients completed dysphagia surveys (Bazaz, Dysphagia Short Questionnaire, 10-item Eating Assessment Tool) to assess dysphagia severity during their preoperative visit, and these …

An Update In Complication Rates Associated With Anterior Lumbar Surgery: A Systematic Review And Meta-Analysis, Tariq Z Issa, Teeto Ezeonu, Mason Sellig, Chester J Donnally, Rajkishen Narayanan, Brian A Karamian, Parthik D Patel, Srikanth N Divi, William A Robinson, Kartik Shenoy, Christopher K Kepler, Alexander R Vaccaro, Jose A Canseco

Department of Orthopaedic Surgery Faculty Papers

STUDY DESIGN: Systematic Review and meta-analysis.

OBJECTIVE: To conduct an updated systematic review and meta-analysis of complications associated with different anterior fusion techniques/approaches and adjuvant resources (i.e., computed tomography angiography (CTA), rhBMP-2, and access surgeons).

METHODS: A systematic review was conducted from 1/1/2014-4/1/2024 for studies evaluating the incidence of complications associated with anterior lumbar procedures. Comparisons of complications were made between surgical approach, use of CTA, rhBMP-2, and access surgeons. Meta-analyses were conducted using a generalized linear mixed model.

RESULTS: 54 studies were included in the final analysis with 8066 patients and an average follow-up of 31.2 months. The overall …

Can Oral Caffeine Decrease Postoperative Opioid Consumption Following Posterior Spinal Fusion In Adolescent Idiopathic Scoliosis? A Randomized Placebo-Controlled Trial., Anne E. Stuedemann, Richard M. Schwend, K Aaron Shaw, Nicolette Saddler, Michon Huston, Michael Benvenuti, Julia Leamon, Ashley K. Sherman, John Anderson

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Current studies have examined the efficacy of opioid-sparing analgesics primarily in adult surgical populations, while fewer guide pediatric postoperative pain treatment. Caffeine exerts most of its biological effects by binding to adenosine receptors, which are important for modifying pain and inflammation. Caffeine's ability to modulate pain following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) has not been previously assessed.

METHODS: The hospital investigational drug study (IDS) pharmacy provided either a treatment dose or placebo dose of caffeine to be given to the patient and was also in charge of randomization for the study.

RESULTS: There were 24 …

Space Flight Missions Over 6 Months Significantly Increase The Risk Of Shoulder Pathology And Rotator Cuff Tears, Benjamin Fiedler, Meghana Jami, Srikhar V Chilukuri, Abdullah Ghali, Todd Phillips, Adil Shahzad Ahmed

Faculty, Staff and Students Publications

Background: The purpose of this study was to determine risk of shoulder injury in astronauts returning from space flight and highlight the need for further exploration of risk factors and preventative strategies.

Methods: Using The Lifetime Surveillance of Astronaut Health epidemiology database at National Aeronautics and Space Administration, a retrospective cohort study was conducted to assess the effect of space flight mission duration on rate of shoulder injury among astronauts. Inclusion criteria were all astronauts who participated in space flight regardless of age or space flight mission time. Exclusion criteria were all injuries occurring greater than 5 years following return …

Which Systemic Responses Should We Evolve To Help Surgeons Navigate Their Regret Experiences?, Ryan X Lam, Ruhi Thapar, Eric J Silberfein, Lorenzo R Deveza

Faculty, Staff and Students Publications

Regret in surgical practice is typically construed as resulting from the commission or the omission of a specific action at a specific decision point, which leads to a deleterious outcome. This article suggests a need to expand this conception of surgical regret to better account for surgeons' regret experiences arising from factors beyond their control. The commentary accompanying the case investigates these external sources of regret, such as resource limitations or professional interpersonal dynamics that prevent a desired outcome from being realized. It also discusses the normative value of addressing surgeons' experiences of regret, especially as a catalyst to facilitate …

Ultrasound-Triggered Release Of Vancomycin From A Novel Spinal Device: Antibiotic Release And Efficacy In Vivo, Lauren J. Delaney, Priscilla Machado, Ji-Bin Liu, Rachel Evans, Asia Winslow, Neil Zhao, Christopher K. Kepler, Rajkishen Narayanan, Teeto Ezeonu, Viren Soni, Gagan Kaushal, Rachel Hilliard, Thomas P. Schaer, Noreen J. Hickok, Flemming Forsberg

Department of Orthopaedic Surgery Faculty Papers

Post-surgical spinal infection occurs in up to 20 % of patients, despite aggressive peri-operative antibiotic treatments. To improve prophylaxis, we have designed and evaluated an ultrasound-activated prophylactic antibiotic release system to combat post-surgical bacterial survival. Polylactic acid (PLA) clips (1 cm³) were 3D-printed with an interior reservoir (0.8 cm³) for carrying drug payload, specifically vancomycin (VAN). Under IACUC approval, clips were surgically implanted into the spines of sheep (n = 9) and swine (n = 2) by removing the spinous process at several levels of the lumbar spine. In the sheep, clips were insonated and the …

A Narrative Review Of Barriers To Utilization Of Surgical Risk Assessment Calculators, Jacob Lahti, Kaiya A. Noe, Abigail Veenstra, Sarah Gallitto, Victoria I. De Leon, Thomas C. Varkey, Nimit Agarwal

Annual Research Symposium

Over the last several decades, it has become the desire of surgical and medical teams to decrease risk levels involved for patients undergoing surgery. However, despite the advent of risk assessment calculators to help physicians obtain more accurate and objective judgements for postoperative complications, these tools are underutilized in standard clinical practices in comparison to other methods of risk assessment. This is likely due at least in part to certain barriers that decrease their functionality and ease of use. This review discusses the major barriers to the utilization of current risk calculators so as to allow for a better understanding …

Role Of Psychiatric Factors Hindering Physical Rehabilitation After Acl Reconstructive Surgery, Malak Rafik, Davian Caraballo, James Fini Jr., Nathan Barnhurst

Annual Research Symposium

No abstract provided.

A Systematic Review Of Recent Developments In Platelet-Rich Plasma Therapy In Hip Osteoarthritis: Variability In Protocols And Clinical Outcomes (2019–2024), Emily Awdish, Marlena Muszynska, Konrad Lautenschlager, Ali Hamade

Annual Research Symposium

No abstract provided.

Surgical Repair Of An Atypical Midsubstance Distal Biceps Tendon Partial Tear: A Case Report, Michael M. Valenzuela, Genoveffa R. Morway, Christopher M. Jones

Department of Orthopaedic Surgery Faculty Papers

No abstract provided.

Subtalar Dislocation With Isolated Talonavicular Dislocation – A Unique Case, Yaser J. Rahim, Naveen J. Pattisapu, Maxwell C. Alley

The Lahey Journal

Subtalar joint dislocations are infrequent injuries of the foot involving interruption of the articulations in the subtalar joint complex. These injuries involve dislocation of the talocalcaneal and talonavicular joints simultaneously with or without associated fractures. Subtalar joint dislocations are classified as medial or lateral, with medial dislocations occurring more commonly. Medial subtalar dislocations are generally not associated with other injuries whereas lateral subtalar dislocations are more frequently accompanied by fractures of talus, calcaneus or navicular. Prompt recognition of this dislocation and other injuries prevent negative sequelae associated with delayed treatment, and patients typically have a good outcome and return to …

Early Surgical Decompression For The Treatment Of Hourglass-Like Constriction Of The Posterior Interosseus Nerve, Nathan Redlich, Matan Ozery, Adam Haydel, Charles Cush, Rasheed Ahmad

School of Medicine Faculty Publications

Posterior interosseous nerve (PIN) syndrome refers to a rare compressive neuropathy of the PIN resulting in motor dysfunction of the forearm extensor compartment. Often, surgical exploration will reveal extrinsic structures that mechanically compress the nerve. Less frequently, PIN syndrome has been reported with a visible hourglass-like constriction and no identifiable causative adjacent structures. In our report, we describe an adolescent patient with PIN syndrome and associated hourglass-like constriction of the PIN. For diagnosis, we used physical examination, preoperative imaging, nerve studies, and intraoperative findings. To monitor recovery, we performed serial neurological examinations and documented patient-reported functional outcomes. The patient underwent …

Cardiovascular Disease In Adults With Osteogenesis Imperfecta: Clinical Characteristics, Care Recommendations, And Research Priorities Identified Using A Modified Delphi Technique, Lars Folkestad, Siddharth K Prakash, Sandesh C S Nagamani, Niels Holmark Andersen, Erin Carter, Jannie Dahl Hald, Riley J Johnson, Bente Langdahl, Eleanor M Perfetto, Cathleen Raggio, Stuart H Ralston, Robert A Sandhaus, Oliver Semler, Laura Tosi, Eric Orwoll

Faculty, Staff and Student Publications

Osteogenesis imperfecta (OI) is a multisystem disorder most often caused by pathogenic variants in genes that encode type I collagen. Type I collagen is abundant not only in bone but also in multiple tissues including skin, tendons, cornea, blood vessels, and heart. Thus, OI can be expected to affect cardiovascular system, and there are numerous reports of cardiovascular disease (CVD) in people with OI. However, there is no consensus on how CVD in OI should be assessed or managed. To fill this gap, a multidisciplinary group was convened to develop clinical guidance. The work included a systematic review of the …

Validation Of A Novel Landmark-Guided Intra-Articular Postero-Medial Surgeon-Administered Injection Technique, Nicolas Piuzzi, Andrew Spitzer, Jason Mussell, Ignacio Pasqualini, Stan Dysart, Jeffrey Gonzales, Michael Mont, Jess H. Lonner, Md, William Mihalko

Rothman Institute Papers

BACKGROUND: This study aimed to define an intra-articular surgeon-administered technique that may be comparable to ultrasound (US)-guided adductor canal block (ACB).

METHODS: Five cadaver lower limbs were examined. An anesthesiologist administered a US-guided ACB using 20 mL of dilute indocyanine dye. An orthopedic surgeon performed a medial parapatellar arthrotomy and introduced an 18-gauge needle 1-2 cm proximal to the palpated adductor tubercle angled posteromedially. Needle position and dye spread were fluoroscopically documented.

RESULTS: This technique consistently reached the infrapatellar branch of the saphenous nerve, nerve to the vastus medialis muscle, and posterior capsule, with minimal proximal dye spread.

CONCLUSIONS: This …

Evaluating Donor-Recipient Sex Mismatch In Anterior Cruciate Ligament Reconstruction With Allograft: Outcomes At 2 Years Postoperatively, Connor Crutchfield, Natalie Lowenstein, Chilan Leite, Christian Lattermann, Elizabeth Matzkin

SKMC Student Presentations and Publications

BACKGROUND: Female patients tend to suffer a greater risk of reinjury and worse patient-reported outcome measures (PROMs) after anterior cruciate ligament reconstruction (ACLR) than male patients, regardless of the graft type used.

PURPOSE/HYPOTHESIS: This study explored the role of donor-recipient sex mismatching to help explain these sex-based dispar- ities in outcomes after ACLR with an allograft. The hypothesis was that allograft donor-recipient sex mismatch would adversely affect surgical outcomes at a 2-year follow-up, with male-to-female graft donations yielding the lowest rates of success.

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

METHODS: Patients who underwent primary ACLR with an allograft …

Validation Of A Novel Landmark-Guided Intra-Articular Postero-Medial Surgeon-Administered Injection Technique, Nicolas S. Piuzzi, Andrew I. Spitzer, Jason Mussell, Ignacio Pasqualini, Stan Dysart, Jeffrey Gonzales, Michael A. Mont, Jess H. Lonner, William Mihalko

School of Medicine Faculty Publications

Background: This study aimed to define an intra-articular surgeon-administered technique that may be comparable to ultrasound (US)-guided adductor canal block (ACB). Methods: Five cadaver lower limbs were examined. An anesthesiologist administered a US-guided ACB using 20 mL of dilute indocyanine dye. An orthopedic surgeon performed a medial parapatellar arthrotomy and introduced an 18-gauge needle 1-2 cm proximal to the palpated adductor tubercle angled posteromedially. Needle position and dye spread were fluoroscopically documented. Results: This technique consistently reached the infrapatellar branch of the saphenous nerve, nerve to the vastus medialis muscle, and posterior capsule, with minimal proximal dye spread. Conclusions: This …

Incidence Of Heterotopic Ossification Without Additional Long-Term Nsaid Prophylaxis After Periacetabular Osteotomy And Concomitant Hip Arthroscopy, J Matthew Helm, Omar Stocks, Brian Crowley, Alexis Aboulafia, Jacob Siahaan, Alfred A Mansour

Faculty, Staff and Student Publications

Background: Periacetabular osteotomy (PAO) is an established treatment for hip dysplasia and has been increasingly combined with concomitant hip arthroscopy to address additional intra-articular hip pathology. Heterotopic ossification (HO) is a complication of arthroscopic and open hip procedures. Nonsteroidal anti-inflammatory drugs (NSAIDs) have become an established form of HO prophylaxis, but their use may delay bone healing.

Purpose: To examine the incidence of HO without NSAID prophylaxis in patients after PAO with concomitant hip arthroscopy and to evaluate the impact of other variables on the development of HO in these patients.

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

Methods: …

Stealth Navigation With Ifuse-Torq Implant For Sacroiliac Joint Fusion Technique Guide., Jia Bao Lin, Bryan L Demyan, Logan M Bushnell, Morgan T Turnow, Benjamin C Taylor

Surgery Articles

INTRODUCTION: Dysfunction of the sacroiliac (SI) joint exists in nearly one-third of patients with lower back pain. There are nuances in diagnosing SI joint dysfunction with a combination of physical exam maneuvers and intra-articular injections. The management of patients with SI joint pain can include posterior pelvic fixation, which traditionally has been described using fluoroscopy to obtain safe placement of implants.

CASE REPORT: In this technique guide, we would like to introduce a novel technique of using Stealth navigation to facilitate SI fusion with the iFuse-TORQ implant.

CONCLUSION: SI dysfunction is a common cause of low back pain that can …

The Role Of Adjunctive Medial Plating In Distal Femur Fractures And Distal Femur Fractures Nonunions., Jerrod Steimle, Jaron L Lohmeyer, Benjamin Taylor, Daniel T Degenova

Trauma and Acute Care Articles

PURPOSE: There exists controversy in the treatment of acute distal femur fractures as well as distal femur fracture nonunions. The objective of this study is to determine the clinical benefit of adjunctive medial plate application in the setting of acute distal femur fractures and distal femur fracture nonunions.

METHODS: This is a retrospective comparative study at a Level 1 academic trauma center, including 104 patients treated for acute distal femur fractures and 23 patients treated for distal femur nonunions between 2015 and 2019. The study compared dual plate fixation to other methods of fixation.

RESULTS: In the acute fracture setting, …

Understanding Hip Pain Through Social Media: An Initial Overview Of An International Web-Based Survey, John M. Gaddis, Erika Shults, Bretton Laboret, Ryan Bialaszewski, Katerina Wells, Charles South, Joel Wells

School of Medicine Publications

Background: We aimed to understand the adult experience of hip pain through a web-based REDCap platform via social media. The purpose of this study was to assess the possibility of collecting patient-reported data through social media in people with hip pain while outlining the contents of the survey and analyzing the demographics of the sample population.

Methods: The survey link was active from October 1, 2023, to May 1, 2024, and available on social media platforms. Respondents provided consent prior to survey participation. Responses were anonymous, and only unique, fully complete surveys were analyzed. The comprehensive hip survey included demographic …

Current Attitudes And Barriers Among Appalachian Patients Towards Orthopaedic Surgery, Dylan Smith Md, Justin B. West Ms, Wade Smith Md, Micah Macaskill Md, Jonathan Lash, Matthew W. Bullock Do, Mpt

Journal of Appalachian Health

Introduction: This study explores the challenges faced by residents of rural West Virginia in accessing orthopaedic care due to geographic and socioeconomic barriers.

Purpose: This study seeks to survey rural West Virginia residents about their attitudes and experiences regarding access to orthopaedic care in southern West Virginia.

Methods: A total of 132 electronic surveys were collected from rural West Virginia residents during an appointment with their primary care provider located at an affiliated outreach clinic. The survey was designed to investigate various factors influencing their access to orthopaedic care.

Results: Delays in seeking orthpaedic care are common in rural West …

Hispanic Patients Undergoing Spinal Fusion For Neuromuscular Scoliosis Sustain Health Inequalities, Armando S Martinez, David Momtaz, Travis Kotzur, Alexandra Mclennan, Abdullah Ghali, Farhan Ahmad, Ebubechi Adindu, Alan C Santiago-Rodriquez, Ali Seifi, Brian Smith

Faculty, Staff and Students Publications

INTRODUCTION: Pre- and postoperative optimization remains a complex process impacted by various demographic factors. Our study aims to identify and describe those demographic factors associated with poor outcomes after spinal fusion with instrumentation in neuromuscular scoliosis to reduce health disparities and improve postoperative outcomes.

METHODS: A retrospective analysis was conducted using Healthcare Cost and Utilization Project data from 2016 to 2020, encompassing a random sample of 20% of procedures in the United States. Data included demographic and hospital variables, including days from admission to the procedure, length of stay, recovery time, total charge, discharge disposition, and mortality rates. In addition …

Prevalence Of Flat Foot Among School-Age Girls And Its Relationship With Body Mass Index And Activity Level, Hisham Mohamed Hussein, Ehab Kamel, Walid Mohamed Kamel, Ibrahim Metwally Dewir, Ahmed Abdelmoniem Ibrahim

Internet Journal of Allied Health Sciences and Practice

Background: The foot and ankle are important structures in the skeletal system of the human body. Deviation in normal structure of the foot,such as in flat foot deformity, can lead to many health problems. Our study aimed to explore the prevalence of flexible flat foot (FFF) among school-age female students in the Ha’il region, Saudi Arabia, and to assess the association between the body mass index (BMI), activity level, and FFF in the selected samples. Materials and Methods: This cross-sectional study included 543 female students between 7 and 12 years of age. Data regarding age, height, weight, level …

Congenital Rickets, Melissa Intriago

Mako: NSU Undergraduate Student Journal

No abstract provided.

A Longer Duration Of Intravenous Antibiotic Treatment For Patients With Early Periprosthetic Joint Infections Is Not Associated With A Lower Failure Rate, Janneke Meijer, Alex Soriano, Wierd Zijlstra, Bas Ten Have, Saad Tarabichi, Paul Jutte, Javad Parvizi, Marjan Wouthuyzen-Bakker

Rothman Institute Papers

BACKGROUND: In recent years, many studies have demonstrated the efficacy of an early switch to oral antibiotics after surgical treatment in orthopedic-related infections. However, large analyses on periprosthetic joint infections (PJIs) are lacking.

MATERIAL AND METHODS: We conducted a retrospective observational multicenter study in patients diagnosed with an early post-operative PJI, defined as one occurringdebridement, antibiotics, and implant retention (DAIR). Patients from Europe and the USA were included. We took advantage of the fact that an early oral antibiotic switch is routine practice in Europe as opposed to a long duration of intravenous (IV) antibiotic treatment in the USA. Failure …