Orthopedics Commons^™

Comprehensive Guidance For The Prevention Of Periprosthetic Joint Infection After Total Joint Arthroplasty And Pitfalls In The Prevention, Javad Parvizi, Yonghan Cha, Emanuele Chisari, Kangbaek Kim, Kyung-Hoi Koo

Rothman Institute Papers

Total joint arthroplasty (TJA) is a surgical procedure, in which parts of damaged joints are removed and replaced with a prosthesis. The main indication of TJA is osteoarthritis, and the volume of TJA is rising annually along with the increase of aged population. Hip and knee are the most common joints, in which TJAs are performed. The TJA prosthesis is composed of metal, plastic, or ceramic device. Even though TJA is the most successful treatment for end-stage osteoarthritis, it is associated with various complications, and periprosthetic joint infection (PJI) is the most serious complication after TJA. With the increasing volume …

Adding Ofirmev: The Effectiveness Of Multimodal Treatment, Kimberly R. Bilal-Williams

MSN Capstone Projects

This project is on enhancing pain management in total knee arthroplasty (TKA) clients via the intravenous (IV) administration of acetaminophen (Ofirmev) by multimodal regimen. The patient, intervention, comparison, outcome, and time (PICOT) question shaping this initiative looks at frequency and intensity of patients’ pain scores as well as practical outcome measures such as healing and physical therapy during the recovery period ending with discharge. After a thorough literature synopsis, it is evident that multimodal pain management strategies including IV acetaminophen provide a better prospectus in comparison to the ones that solely employ opioids. Research repeatedly demonstrates the use of IV …

Relating Preoperative Mcs-12 To Microdiscectomy Outcomes, Jeremy C. Heard, Yunsoo Lee, Teeto Ezeonu, Mark J. Lambrechts, Rajkishen Narayanan, Caleb Yeung, Justin Wright, John Paulik, Caroline Purtill, John J. Mangan, Mark F. Kurd, Ian D. Kaye, Jose A. Canseco, Alan S. Hilibrand, Alex R. Vaccaro, Gregory D. Schroeder, Christopher K. Kepler

Rothman Institute Papers

PURPOSE: To determine the impact of poor mental health on patient-reported and surgical outcomes after microdiscectomy.

METHODS: Patients ≥ 18 years who underwent a single-level lumbar microdiscectomy from 2014 to 2021 at a single academic institution were retrospectively identified. Patient-reported outcomes (PROMs) were collected at preoperative, three-month, and one-year postoperative time points. PROMs included the Oswestry Disability Index (ODI), Visual Analog Scale Back and Leg (VAS Back and VAS Leg, respectively), and the mental and physical component of the short form-12 survey (MCS and PCS). The minimum clinically important differences (MCID) were employed to compare scores for each PROM. Patients …

Neuraxial Vs. General Anesthesia In Total Hip Arthroplasty For Femoral Neck Fracture: A Comparison Of Postoperative Complications, Kevin X. Farley, Hassan Mouzailhem, Robert S. Dean, Mark Karadsheh, Leonardo Cavinatto, Jacob Wilson, Drew Moore

Conference Presentation Abstracts

OBJECTIVE: Rates of complications with differing anesthetic choices has not been directly compared for patients undergoing total hip arthroplasty (THA) for femoral neck fractures. This study sought to directly compare neuraxial vs. general anesthetic use and compare postoperative outcomes for patients undergoing THA for a femoral neck fracture. METHODS: From 2012-2021, the National Surgical Quality Improvement Project (NSQIP) database was used to identify all patients undergoing THA for a femoral neck fracture. Anesthetic type was identified and categorized as neuraxial (spinal, epidural) or general. Demographic and comorbid variables were collected. Days from admission to surgery was also identified. Postoperative complications …

Non-Traumatic Osteonecrosis Of The Femoral Head Induced By Steroid And Alcohol Exposure Is Associated With Intestinal Flora Alterations And Metabolomic Profiles, Qing-Yuan Zheng, Ye Tao, Lei Geng, Peng Ren, Ming Ni, Guo-Qiang Zhang

Faculty, Staff and Student Publications

OBJECTIVE: Osteonecrosis of the femoral head (ONFH) is a severe disease that primarily affects the middle-aged population, imposing a significant economic and social burden. Recent research has linked the progression of non-traumatic osteonecrosis of the femoral head (NONFH) to the composition of the gut microbiota. Steroids and alcohol are considered major contributing factors. However, the relationship between NONFH caused by two etiologies and the microbiota remains unclear. In this study, we examined the gut microbiota and fecal metabolic phenotypes of two groups of patients, and analyzed potential differences in the pathogenic mechanisms from both the microbial and metabolic perspectives.

METHODS: …

New-Onset Depression Following Total Shoulder Arthroplasty: The Impact Of Preoperative Patient Factors And Postoperative Complications, Kevin X. Farley, Robert S. Dean, Eric R. Wagner, Michael B. Gottschalk, J Michael Wiater

Conference Presentation Abstracts

OBJECTIVE: Depression has been well studied as a risk factor for postoperative complications following total shoulder arthroplasty (TSA). However, little is known about new-onset depression (NOD) following TSA. The purpose of this study is to determine the incidence of NOD following TSA and identify risk factors for its occurrence. METHODS: This was a retrospective review of patients undergoing TSA in the Truven Health MarketScan database. NOD was identified. Patients with preoperative depression were excluded from analysis. Postoperative complications were identified, including the development of a prosthetic joint infection (PJI), need for revision surgery, and postoperative dislocation. If a complication occurred …

Trends And Outcomes Of Same-Day Discharge Total Ankle Arthroplasty In The United States: A National Analysis From 2012-2021, Kevin X. Farley, Robert S. Dean, Ricky Sareini, Elijah Auch, Zachary Vaupel, Paul T. Fortin

Conference Presentation Abstracts

OBJECTIVE: Same-day discharge Total Ankle Arthroplasty (TAA) is becoming more common. This study sought to report the percentage of patients within a national database that had a same-day discharge following TAA, and to compare the complication rates for patients that had same-day discharge to those that had a short hospital stay. METHODS: From 2012-2021, the National Surgical Quality Improvement Project (NSQIP) database was used to identify all patients undergoing TAA. All patients discharged to their home on the day of surgery were identified. A comparison cohort of patients with a hospital stay of 1 to 2 days who were then …

Risk Factors For Failure Of Same-Day Discharge Total Knee Arthroplasty, Kevin X. Farley, Robert S. Dean, Eli Auch, Mark Karadsheh, Drew Moore

Conference Presentation Abstracts

OBJECTIVE: Cemented total knee arthroplasty (TKA) is the gold standard treatment for osteoarthritis, but uncemented TKA offers benefits like improved osseointegration and reduced complications from cement debris. This study aimed to investigate (1) if there has been a rise in uncemented TKA and (2) if there are differences in early complications between cemented and uncemented TKA. METHODS: We retrospectively reviewed data from the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) database of primary TKA patients from 2017 to 2021 at a single health system (six hospitals). Uncemented TKA (uncemented fixation for femur and tibia) patients were analyzed for demographics and …

National Incidence And Economic Burden Of Revision Shoulder Arthroplasty In The United States: Projections Through 2030, Kevin X. Farley, Robert S. Dean, Eric R. Wagner, Michael B. Gottschalk, J Michael Wiater

Conference Presentation Abstracts

PURPOSE: This study sought to use an all-payor inpatient claims database to investigate the incidence and national cumulative costs of revision shoulder arthroplasty in the United States, including those being performed for PJI. In addition, we also aimed to project the incidence and national economic impact of revision shoulder arthroplasty in the US through 2030. METHODS: The National Inpatient Sample (NIS) was used to estimate the annual number of revision shoulder arthroplasties performed between 2008 and 2019 using ICD procedure codes. Cumulative national costs were estimated. Septic revision shoulder arthroplasties were identified (i.e., cases being done for a prosthetic joint …

Positive Predictor Factors Of Hip Mosaicplasty And Cartilage Repair: A Meta-Analysis Is It Comparable To Predictor Factors Of Mosaicplasty In The Knee?, Caroline E. Quindlen, Gene Shaffer Md, James Raphael Md, S. Ali Ghasemi Md

Tower Health Research Day

No abstract provided.

Do Nsaids' Decrease Union Rates Following Joint Arthrodesis? A Meta-Analysis, Emerson Rowe, Julian Takagi-Stewart, Asif Ilyas, Sina Ramtin

Tower Health Research Day

No abstract provided.

Lower Extremity Trauma Is Associated With An Increased Rate Of New Mental Health Disorder Diagnosis And Suicide Attempt, Bela P. Delvadia, Julianna E. Holzer, Jacob S. Budin, Arjun Verma, Onyebuchi A. Imonugo, Olivia C. Lee, William F. Sherman

Tower Health Research Day

No abstract provided.

The Incidence And Impact Of Bisphosphonates On Multiple Myeloma, Bela P. Delvadia, Lacee Collins, Julianna E. Winter, Matthew W. Cole, Olivia C. Lee, William F. Sherman

Tower Health Research Day

No abstract provided.

Sixty-Two Percent Of Abstracts From The American Association Of Hand Surgery Annual Meeting 2017-2020 Are Later Published, Tyson Stoker, Benjamin Millar, Lilah Fones, Asif Ilyas

Tower Health Research Day

No abstract provided.

Adductor Canal Regional Anesthetic Placement In Pediatric Patients For Knee Arthroscopy: Defining The Optimal Location And Analysis Of Other Trends, Isaac Jin, Christine Song, Sujay Deshpande, Andrew Yang, Ethan Schollaert, Neha Divi, Aysha Hasan Md

Tower Health Research Day

No abstract provided.

Biocomposite Anchors Have Greater Yield Load And Energy Compared With All-Suture Anchors In An In Vitro Ovine Infraspinatus Tendon Repair Model, Robert A. Walton, Lindsey Liuzza, Catherine Takawira, Claudia Leonardi, Mandi J. Lopez

School of Public Health Faculty Publications

Purpose: To compare tensile fatigue and strength measures of biocomposite and all-suture anchors in an ovine humerus-infraspinatus tendon model of rotator cuff repair. Methods: Infraspinatus tendons on adult ovine humeri were sharply transected at the insertion. One of each pair was assigned randomly for fixation with 2 biocomposite or all-suture anchors. Constructs were tested with 200 cycles of 20 to 70 N tensile load, and gap formation was measured at the incised tendon end every 50 cycles. They were subsequently tested to failure. Outcome measures including fatigue stiffness, hysteresis, creep, and gap formation and tensile stiffness, and yield and failure …

Parosteal Lipoma Of The Left Femur: A Case Report., James P Waters, Sydney Horenstein, Austin Egger, Parker Johnsen, Tae Won Kim

Orthopedic Surgery Resident Research

Multidisciplinary team collaboration in the diagnosis of rare tumors such as parosteal lipoma is highly important, especially when suspicious of malignancy. The use of radiological and physical examinations is imperative to monitor recurrence and quality of life.

Anterior Hip Pain In Adolescent Female Wrestler, Melanie Kennedy

Posters

No abstract provided.

Toward Electrical Impedance Sensing Surgical Drill For Tissue Boundary Detection, Harshavardhan Devaraj

Dartmouth College Ph.D Dissertations

Dental implantation is an increasingly common procedure used to treat missing teeth. However, surgical drilling to place the implant poses a high risk of injury to critical anatomy, such as inferior alveolar nerve injury or maxillary sinus perforation. A real-time surgical feedback system sensing proximity of these critical anatomy could reduce injury risks. This dissertation investigates the development of such a system that incorporates an electrical impedance sensor into the tip of a surgical drill.

A simulation framework based on finite element method (FEM) was developed to optimize the sensor as it approached a high impedance boundary. The accuracy of …

Uncemented Total Knee Arthroplasty Is On The Rise. A Retrospective Review From The Michigan Arthroplasty Registry Collaborative Quality Initiative (Marcqi), Michael E. Sacchetti, Sarah Fried, Madeleine Declercq, Jacob H. Keeley, Robert Runner

Conference Presentation Abstracts

OBJECTIVE: Cemented total knee arthroplasty (TKA) is the gold standard treatment for osteoarthritis, but uncemented TKA offers benefits like improved osseointegration and reduced complications from cement debris. This study aimed to investigate (1) if there has been a rise in uncemented TKA and (2) if there are differences in early complications between cemented and uncemented TKA. METHODS: We retrospectively reviewed data from the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) database of primary TKA patients from 2017 to 2021 at a single health system (six hospitals). Uncemented TKA (uncemented fixation for femur and tibia) patients were analyzed for demographics and …

Proteoglycan Dysfunction: A Common Link Between Intervertebral Disc Degeneration And Skeletal Dysplasia, Kimheak Sao, Makarand V. Risbud

Department of Orthopaedic Surgery Faculty Papers

Proteoglycans through their sulfated glycosaminoglycans regulate cell-matrix signaling during tissue development, regeneration, and degeneration processes. Large extracellular proteoglycans such as aggrecan, versican, and perlecan are especially important for the structural integrity of the intervertebral disc and cartilage during development. In these tissues, proteoglycans are responsible for hydration, joint flexibility, and the absorption of mechanical loads. Loss or reduction of these molecules can lead to disc degeneration and skeletal dysplasia, evident from loss of disc height or defects in skeletal development respectively. In this review, we discuss the common proteoglycans found in the disc and cartilage and elaborate on various murine …

A Perfect Storm?: The Association Of Vitamin D With Injury Incidence Among Acrobatics And Tumbling Athletes, Katherine M. Lee, Andrew R. Gallucci, Jeff S. Forsse, Leticia Cherpe De Souza, Laura R. Irvin, Emily J. Boyer, Kristin H. Fant, Jeffery Heileson, Leslee Funderburk

Internet Journal of Allied Health Sciences and Practice

Purpose: Acrobatics and Tumbling (A&T) is an emerging NCAA sport. Due to the novelty of the sport, limited research on injury incidence and correlates exists. Anecdotal evidence suggests that A&T presents with high injury rates. A relationship between vitamin D and bony injuries exists among athletes, but little is known about soft tissue injuries. Understanding the causes and incidence of injuries, including vitamin D, may assist athletic trainers. Methods: Forty-two A&T athletes (19.69 ± 1.199 years) completed 2 blood draws as part of routine medical care prior to and following fall training period. Results: Average vitamin D at T1 was …

Tumor Treating Fields Suppress Tumor Cell Growth And Neurologic Decline In Models Of Spinal Metastases, Daniel Ledbetter, Romulo Augusto Andrade De Almeida, Xizi Wu, Ariel Naveh, Chirag B Patel, Queena Gonzalez, Thomas H Beckham, Robert North, Laurence Rhines, Jing Li, Amol Ghia, David Aten, Claudio Tatsui, Christopher Alvarez-Breckenridge

Faculty, Staff and Student Publications

Spinal metastases can result in severe neurologic compromise and decreased overall survival. Despite treatment advances, local disease progression is frequent, highlighting the need for novel therapies. Tumor treating fields (TTFields) impair tumor cell replication and are influenced by properties of surrounding tissue. We hypothesized that bone's dielectric properties will enhance TTFields-mediated suppression of tumor growth in spinal metastasis models. Computational modeling of TTFields intensity was performed following surgical resection of a spinal metastasis and demonstrated enhanced TTFields intensity within the resected vertebral body. Additionally, luciferase-tagged human KRIB osteosarcoma and A549 lung adenocarcinoma cell lines were cultured in demineralized bone grafts …

Lowest Instrumented Vertebrae In Early Onset Scoliosis: Is There A Role For A More Selective Approach?, Michael J. Heffernan, Claudia Leonardi, Lindsay M. Andras, Bailli Fontenot, Luke Drake, Joshua M. Pahys, John T. Smith, Peter F. Sturm, George H. Thompson, Michael P. Glotzbecker, Tyler A. Tetreault, Benjamin D. Roye, Ying Li

School of Public Health Faculty Publications

Purpose: This purpose of this study was to assess the impact of patient and implant characteristics on LIV selection in ambulatory children with EOS and to assess the relationship between the touched vertebrae (TV), the last substantially touched vertebrae (LSTV), the stable vertebrae (SV), the sagittal stable vertebrae (SSV), and the LIV. Methods: A multicenter pediatric spine database was queried for patients ages 2–10 years treated by growth friendly instrumentation with at least 2-year follow up. The relationship between the LIV and preoperative spinal height, curve magnitude, and implant type were assessed. The relationships between the TV, LSTV, SV, SSV, …

Delayed Diagnosis Of Mycobacterium Bovis Bacillus Calmette-Guérin Periprosthetic Joint Infection Following Total Knee Arthroplasty, Christopher E. Pelt, Salika Shakir, Michael J. Cahill, Jakrapun Pupaibool, Barbara C. Cahill

SKMC Student Presentations and Publications

Periprosthetic joint infection (PJI) can present challenges in diagnosis and treatment, particularly in the setting of atypical causative organisms such as fungi and mycobacteria. Herein, we present a case and provide a review of the diagnosis and treatment of an unusual PJI caused by bacillus Calmette-Guérin, administered during the treatment of bladder cancer 3 years prior to total knee arthroplasty and subsequent PJI. Although the patient's history of bladder cancer was known, neither his Bacillus Calmette-Guérin treatment nor its potential for distant site spread that could lead to PJI were appreciated, leading to a prolonged diagnostic evaluation and treatment course.

The Impact Of Robotic Assistance For Lumbar Fusion Surgery On 90-Day Surgical Outcomes And 1-Year Revisions, Jeremy Heard, Yunsoo Lee, Nicholas D D'Antonio, Rajkishen Narayanan, Mark Lambrechts, John Bodnar, Caroline Purtill, Joshua Pezzulo, Dominic Farronato, Pat Fitzgerald, Jose Canseco, Ian Kaye, Alan Hilibrand, Alex Vaccaro, Christopher Kepler, Gregory Schroeder

Department of Orthopaedic Surgery Faculty Papers

Objectives: To evaluate the (1) 90-day surgical outcomes and (2) 1-year revision rate of robotic versus nonrobotic lumbar fusion surgery. Methods: Patients >18 years of age who underwent primary lumbar fusion surgery at our institution were identified and propensity-matched in a 1:1 fashion based on robotic assistance during surgery. Patient demographics, surgical characteristics, and surgical outcomes, including 90-day surgical complications and 1-year revisions, were collected. Multivariable regression analysis was performed. Significance was set to P < 0.05. Results: Four hundred and fifteen patients were identified as having robotic lumbar fusion and were matched to a control group. Bivariant analysis revealed no significant difference in total 90-day surgical complications (P = 0.193) or 1-year revisions (P = 0.178). The operative duration was longer in robotic surgery (287 + 123 vs. 205 + 88.3, P ≤ 0.001). Multivariable analysis revealed that robotic fusion was not a significant predictor of 90-day surgical complications (odds ratio [OR] = 0.76 [0.32-1.67], P = 0.499) or 1-year revisions (OR = 0.58 [0.28-1.18], P = 0.142). Other variables identified as the positive predictors of 1-year revisions included levels fused (OR = 1.26 [1.08-1.48], P = 0.004) and current smokers (OR = 3.51 [1.46-8.15], P = 0.004). Conclusion: Our study suggests that robotic-assisted and nonrobotic-assisted lumbar fusions are associated with a similar risk of 90-day surgical complications and 1-year revision rates; however, robotic surgery does increase time under anesthesia.

Evaluation Of Perioperative Care And Drivers Of Cost In Geriatric Thoracolumbar Trauma, Omar Tarawneh, Rajkishen Narayanan, Michael Mccurdy, Tariq Issa, Yunsoo Lee, Olivia Opara, Nicholas Pohl, Alexa Tomlak, Matthew Sherman, Jose Canseco, Alan Hilibrand, Alex Vaccaro, Gregory Schroeder, Christopher Kepler

Department of Orthopaedic Surgery Faculty Papers

INTRODUCTION: As the population of elderly patients continues to rise, the number of these individuals presenting with thoracolumbar trauma is expected to increase.

RESEARCH QUESTION: To investigate thoracolumbar fusion outcomes for patients with vertebral fractures as stratified by decade. Secondarily, we examined the variability of cost across age groups by identifying drivers of cost of care.

MATERIALS AND METHODS: We queried the United States Nationwide Inpatient Sample(NIS) for adult patients undergoing spinal fusion for thoracolumbar fractures between 2012 and 2017. Patients were stratified by decade 60-69(sexagenarians), 70-79(septuagenarians) and 80-89(octogenarians). Bivariable analysis followed by multivariable regression was performed to assess independent …

Increased Hif-2Α Activity In The Nucleus Pulposus Causes Intervertebral Disc Degeneration In The Aging Mouse Spine, Shira N Johnston, Maria Tsingas, Rahatul Ain, Ruteja A Barve, Makarand Risbud

Department of Orthopaedic Surgery Faculty Papers

Hypoxia-inducible factors (HIFs) are essential to the homeostasis of hypoxic tissues. Although HIF-2α, is expressed in nucleus pulposus (NP) cells, consequences of elevated HIF-2 activity on disc health remains unknown. We expressed HIF-2α with proline to alanine substitutions (P405A; P531A) in the Oxygen-dependent degradation domain (HIF-2αdPA) in the NP tissue using an inducible, nucleus pulposus-specific K19^CreERT allele to study HIF-2α function in the adult intervertebral disc. Expression of HIF-2α in NP impacted disc morphology, as evident from small but significantly higher scores of degeneration in NP of 24-month-old K19^CreERT; HIF-2α^dPA (K19-dPA) mice. Noteworthy, comparisons of grades …

Anterior Cruciate Ligament Hybrid Remnant Preservation Reconstruction Demonstrates Similar Outcomes As Traditional Reconstruction After 6 Months: A Randomized Control Trial, Joshua P. Castle, Eleftherios L. Halkias, Brittaney Pratt, Ashley Frei, Matthew A. Gasparro, Vasilios Moutzouros

Medical Student Research Symposium

Background

The anterior cruciate ligament (ACL) is often debrided during reconstruction (ACLR) to improve visualization. However, remnant ACL tissue contains nerve fibers and including remnant tissue in ACLR could provide benefit. Therefore, a technique was developed that preserves the tibial remnant and incorporates it into ACLR: Hybrid Remnant Preservation Reconstruction (HRPR) ACLR. This study compares HRPR-ACLR to traditional reconstruction by comparing patient reported outcomes and complications.

Methods

Patients presenting to one surgeon's clinic with an ACL injury are screened. Exclusion criteria are patient age<14 years, multi-ligament injury, chronic tears, and revision ACLR. Patients are consented and randomized to HRPR or traditional ACLR. Demographics, patient-reported outcomes, range of motion (ROM) and complications were collected.

Results

Thirty-three patients were included, 20 HRPR and 13 controls. No demographic differences were noted. PROMIS-PF, …

Tendon Rupture And Tendonitis In Low-Profile Dorsal Versus Volar Plating For Distal Radius Fractures: A Systematic Review And Meta-Analysis, Matthew Myhand, Shreya Balusu, Alex Lindahl Bs, Hardy Evans Md, Charles Day Dr., Eric Jiang Dr.

Medical Student Research Symposium

Tendon Rupture and Tendonitis in Low-Profile Dorsal versus Volar Plating for Distal Radius Fractures: A Systematic Review and Meta-Analysis

Background: Dorsal plating of distal radius fractures has historically been associated with high rates of hardware removal, tendonitis, and tendon rupture. Newer generation low-profile dorsal plates are thinner (<1.6mm thick) with improved characteristics. We examine whether low-profile dorsal plates still have higher rates of tendon complications than volar locking plates.

Methods: We searched Ovid MEDLINE, Web of Science, and EMBASE for published literature describing tendon complications in association with plating of distal radius fractures. Inclusion criteria encompasses any primary study of low-profile dorsal plates that included data on tendon complications. Studies that included both low-profile dorsal and volar plating arms were included …