Orthopedics Commons^™

24 Hours Of Postoperative Oral Antibiotics For Same-Day Discharge After Hip And Knee Arthroplasty Has Low Rate Of Prosthetic Joint Infection, Phillip Mckegg, Colton L. Clymer, Hamza Raja, Alexander Driessche, Gabriel Boudagh, W. Trevor North Md, Michael A. Charters Md

Medical Student Research Symposium

Title: 24 Hours of Postoperative Oral Antibiotics for Same-Day Discharge After Hip and Knee Arthroplasty Has Low Rate of Prosthetic Joint Infection

Authors: Phillip C. McKegg, MS, Colton Clymer, BS, Hamza Raja, BS, Alexander Driessche, MSE, Gabriel Boudagh, BS, W. Trevor North, MD, Michael A. Charters, MD

Introduction:

There is no clear consensus on postoperative antibiotic protocols for same-day discharge hip and knee arthroplasties. This study evaluates prosthetic joint infection (PJI) rates in patients discharged with 24 hours of oral antibiotics after surgery.

Methods:

A retrospective review was conducted on 1,843 patients who underwent primary hip or knee …

Canary In The Carpal Tunnel: A Pilot Study Of The Value Of The Screening For Amyloidosis In Carpal Tunnel Syndrome, Trevor Ruesch, Nevil Khurana, Logan Hansen Md, Katiya Barkho, Julia Malewicz, Charles Day Md

Medical Student Research Symposium

Introduction/Purpose:

Transthyretin amyloidosis occurs in two forms, hereditary transthyretin amyloidosis (hATTR), and wild-type ATTR (wtATTR)². Amyloidosis can result in restrictive cardiomyopathy presenting as heart failure with preserved ejection fraction (HFpEF)⁴. A growing body of evidence demonstrates that amyloidosis may be underdiagnosed and can be caught earlier in the disease course⁵. The proteins causing amyloidosis can also deposit into various tissues including the carpal tunnel leading to carpal tunnel syndrome ².

In this pilot study, we propose that early detection of amyloid via a biopsy of the transverse carpal ligament or tenosynovium in the …

Pulling The Trigger On Patient Care: A Comparison Of Asc And Hopd Settings For Trigger Finger Release, Carinne M. Jarvis, Nooraldin Kamalaldin, Hunter Cohn, Meet S. Patel, Charles S. Day

Medical Student Research Symposium

Introduction

There is an increased focus on balancing cost-effectiveness with positive patient outcomes. Trigger finger release (TFR) offers an opportunity to compare its value in a hospital outpatient department (HOPD) versus an ambulatory surgical center (ASC). We hypothesized that TFR performed in an ASC provides greater value.

Methods

Time-Driven Activity-Based Costing (TDABC) was used to collect cost data for each procedure. Steps in the patient care pathway were timed, and costs were categorized as:

• Direct Variable: Staff salaries, supplies

• Direct Fixed: Facility, utilities

• Indirect: Administration, marketing

Changes in PROMIS Pain Interference (PI) and Upper Extremity (UE) from pre-operative to three …

Synergistic Surgical Strategies: A Comparative Analysis Of Combined Carpal Tunnel And Trigger Finger Release, Diana Kernen Ba, Clayton Kramm Bs, Meet Patel Bs, Trae Hill Bs, Carter Dunaway Bs, Charles S. Day Md, Mba

Medical Student Research Symposium

Introduction:

Since 1980, U.S. healthcare spending has outpaced GDP growth, while lagging outcomes, highlighting the need to evaluate cost-effectiveness of treating Trigger Finger Release (TFR) and Carpal Tunnel Release (CTR) simultaneously or sequentially.

Methods:

36 Patients were recruited: 12 CTR and 12 TFR patients comprised the sequential cohort, while 12 patients who underwent simultaneous CTR and TFR comprised the simultaneous cohort. Costs were calculated utilizing time-dependent activity-based costing (TDABC), activity-based costing (ABC), and insurance claims data. Procedural times were tracked and multiplied by personnel per-minute salaries to determine direct variable labor costs. Direct variable costs for supplies and direct fixed …

Is There A Difference In Effectiveness Between Nonoperative Treatments For Modified Garcia-Elias Scapholunate Ligament Injuries Stages 1 And 2?, Michelle Yi, Minie Zhang, Lucas Kopp, Charles S. Day

Medical Student Research Symposium

Introduction

Scapholunate interosseous ligament (SLIL) injuries result from falling on an outstretched hand. Studies have assessed the effectiveness of non-operative treatments, but none has compared different non-operative treatments. We analyze the effectiveness of casting and bracing/splinting based on patient reported outcomes (PRO).

Methods

Chart review was conducted on 1150 possible SLIL injury patients from 5 orthopaedic hand surgeons from a Midwestern, tertiary-care academic hospital system between 2021 and 2024. Two patient cohorts were divided based on treatment. PROs obtained were PROMIS Upper Extremity (UE) and Pain Interference (PI) pre-treatment and 2-3 months after. Patient improvement was calculated as difference between …

Reevaluating Informed Consent: Integrating Shared Decision-Making Into Spinal Surgery For Better Patient Outcomes., Jeffrey N Wang, Mohamed A Elhakeem, Matthew J Mesimer, Paul G Mastrokostas, Salman Ahmad, Tim Reed, Brandon Klein, Lucas E Bartlett, Adam D Bitterman, Andrew Megas

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Study Design: Narrative review.

Objectives: The objectives of this study were to answer the following questions: (1) What is the quality of informed consent in spine surgery, including both neurosurgery and orthopaedic spine surgery? (2) What limitations impede the ability of surgeons to engage in effective shared decision-making (SDM) and obtain adequate informed consent? (3) What strategies and solutions may improve the quality of informed consent and SDM? (4) What factors decrease the incidence of litigation in spine surgery?

Methods: N/A.

Results: SDM is a collaborative process where patients are involved in their treatment choices through open communication about risks, …

Triangular Fibrocartilage Complex: An Anatomical And Medical Illustration Study., Hallie Tiburzi, Carlos A G Machado, Massimo S D'Antoni, R Shane Tubbs

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Recent advances in small-joint arthroscopy and cutting-edge magnetic resonance imaging systems have enabled orthopedic surgeons to perform more complex repairs of the wrist. Such repairs can include those of the triangular fibrocartilage complex (TFCC) of the wrist that necessitates a reappraisal of its morphometry with special emphasis on the relationship between its articular disc (AD) and surrounding tissues. The TFCC AD is a fibrocartilaginous, biconcave structure located between the ulnar styloid process and the carpal bones of the wrist. We carefully dissected and measured the ADs of 58 wrists from 34 embalmed cadavers (20 females, 14 males) and fabricated three-dimensional …

Streamlining The Journey Of Research Into Clinical Practice: Making Your Patients And Practice Flourish Evaluation And Treatment Of Pyogenic Spondylodiscitis Of The Spine: Ao Spine Knowledge Forum Trauma And Infection, Sebastian F. Bigdon, Emiliano Vialle, Charlotte Dandurand, Julian Scherer, Gaston Camino-Willhuber, Andrei F. Joaquim, Harvinder S. Chhabra, Mohammad El-Sharkawi, Richard Bransford, Charles G. Fisher, Klaus J. Schnake, Gregory D. Schroeder

Rothman Institute Papers

Study DesignLiterature Review with clinical recommendations.ObjectiveTo highlight impactful studies on pyogenic spondylodiscitis (PS), identified by the AO Spine Knowledge Forum Trauma and Infection, with recommendations for their integration into clinical practice.MethodsFive influential studies on PS that have the potential to shape current practice in spinal infections were selected and reviewed. Each study was chosen for its contribution to a critical phase in PS management: diagnosis, imaging, surgical vs conservative treatment, and antibiotic duration. Recommendations were graded as strong or conditional following the GRADE methodology.ResultsFive studies were highlighted. Article 1: Pluemer et al introduced the Spinal Infection Treatment Evaluation (SITE) Score, …

Academic Productivity At Orthopaedic Surgery Sports Medicine Fellowship Programs In The United States Has A Weak Positive Correlation With Nonresearch Lifetime Industry Earnings, Benjamin Miltenberg, William Johns, Anthony Baumann, Faheem Pottayil, Bradley Richey, Albert Anastasio, Kempland Walley, Christopher Dodson, Sommer Hammoud

Rothman Institute Papers

PURPOSE: To characterize the relationship between academic productivity, as defined by the h-index, and industry payments for fellowship-trained sports medicine surgeons in faculty positions at sports medicine fellowships.

METHODS: The American Orthopaedic Society for Sports Medicine fellowship directory was used to create a comprehensive list of all fellowship programs nationwide. Fellowship websites were then reviewed to generate a list of the teaching faculty associated with each program. Total nonresearch lifetime earnings were obtained from the Centers for Medicare & Medicaid Services website. Academic productivity of each fellowship faculty was assessed via the h-index. Frequency counts and other descriptive statistic measures …

Increased Rates Of Dysphagia, Longer Length Of Stay, Nonroutine Discharge, And Higher Hospital Costs In Patients Over 65 Undergoing Single-Level Cervical Disc Arthroplasty: A Propensity Score-Matched Analysis, Paul G. Mastrokostas, Leonidas E. Mastrokostas, Ahmed K. Emara, Ian J. Wellington, Elizabeth Ginalis, Jonathan Dalton, Amrit S. Khalsa, Jad Bou Monsef, Afshin E. Razi, Mitchell K. Ng

Rothman Institute Papers

CONTEXT: Cervical disc arthroplasty (CDA) is a safe and effective treatment for cervical spine conditions, with increasing utilization. As the population over 65 grows, understanding the suitability of CDA in older patients is critical.

AIMS: This study evaluates differences in postoperative complications, hospital course, and costs between patients aged 18 and 65 and those over 65 undergoing CDA.

SETTINGS AND DESIGN: This was a retrospective cohort study using the National Inpatient Sample, a nationally representative database of U.S. hospital discharges.

SUBJECTS AND METHODS: Patients undergoing single-level CDA from 2016 to 2020 were identified. The cohort was divided into two groups: …

Ibuprofen, Flurbiprofen Or Naproxen Sodium Minimally Influences Musculoskeletal Adaptations To Treadmill Exercise In Rats, Brandon Roberts, Alyssa Geddis, Alexandra Ciuciu, Marinaliz Reynoso, Nikhil Mehta, Alyssa Varanoske, Alyssa Kelley, Maximus Leiss, Alexander Kolb, Julie Hughes, Marshall Naimo, Ryan Tomlinson, Jeffery Staab

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) may influence musculoskeletal health. The purpose of this study was to compare the effects of three different NSAIDS: naproxen sodium, ibuprofen, flurbiprofen or a placebo on musculoskeletal adaptations in rodents with or without 6 weeks of aerobic exercise.

METHODS: Nine-week-old male Wistar rats (n = 80) were randomized to either exercise (EX) or no-exercise control (CON) conditions and treated with naproxen, ibuprofen (IBU), flurbiprofen (FLU) or placebo (PLA). For exercise, rats ran 5 days per week for 6 weeks at a 5% incline on a motorized treadmill for 30 min. Three-point bending (3 PB) and …

Nerve Transfers For Median Nerve Injury, Corinne Wee

Faculty Scholarship

Due to its role in hand function, median nerve injuries can have a significant impact on patients’ lives. Nerve transfers can be performed alone or in conjunction with tendon transfers to restore critical functions supplied by the median nerve, with a particular emphasis on restoring grasp, pinch, and sensation. Continued study into possible nerve transfers for median nerve injury has led to multiple options that can be tailored to the patient's demands, deficits, and injury pattern.

An Assessment Of The Performance Of Different Chatbots On Shoulder And Elbow Questions, Mohamad Y. Fares, Tarishi Parmar, Peter Boufadel, Mohammad Daher, Jonathan Berg, Austin Witt, Brian W. Hill, John G. Horneff, Adam Z. Khan, Joseph A. Abboud

Rothman Institute Papers

Background/Objectives: The utility of artificial intelligence (AI) in medical education has recently garnered significant interest, with several studies exploring its applications across various educational domains; however, its role in orthopedic education, particularly in shoulder and elbow surgery, remains scarcely studied. This study aims to evaluate the performance of multiple AI models in answering shoulder- and elbow-related questions from the AAOS ResStudy question bank.

Methods: A total of 50 shoulder- and elbow-related questions from the AAOS ResStudy question bank were selected for the study. Questions were categorized according to anatomical location, topic, concept, and difficulty. Each question, along with the …

Periclavicular Multifocal, Infiltrative Extraneural Soft Tissue Perineuriomas: Illustrative Case, Ankur Khanna, Matthew Darlow, Rachna Jetly Shridhar, Matthew G. Cable

School of Medicine Faculty Publications

BACKGROUND Perineuriomas are benign, typically solitary tumors with intraneural and extraneural subtypes presenting distinct clinical manifestations and symptomatology. Here, the authors report a unique case of multifocal, infiltrative extraneural soft tissue perineuriomas localized to the shoulder. OBSERVATIONS A 33-year-old female presented with 1 year of right neck and shoulder pain accompanied by a new onset of numbness and tingling down her right arm. MRI of a mass apparent over her right trapezius and scapula revealed several mixed cystic and solid neoplasms encroaching on the C5–6 nerve roots and brachial plexus. The tumors were biopsied and confirmed by immunohistochemical staining to …

Comparing Postoperative Opioid Use In Primary And Revision Lumbar Fusion: A Propensity-Matched Analysis, Jonathan Dalton, Jarod Olson, Nicholas B. Pohl, Rajkishen Narayanan, Omar Tarawneh, Yunsoo Lee, Michael V. Carter, Gokul Karthikeyan, Logan Witt, Aayush Mehta, John J. Mangan, Mark F. Kurd, Jose A. Canseco, Alan S. Hilibrand, Alex R. Vaccaro, Gregory D. Schroeder, Christopher K. Kepler

Department of Orthopaedic Surgery Faculty Papers

OBJECTIVE: This study compared postoperative opioid use for patients undergoing short segment primary versus revision lumbar fusion.

METHODS: Patients who underwent primary or revision 1-2 level lumbar fusion (2017-2021) were included in this study. The state Prescription Drug Monitoring Program was reviewed for all patients to quantify preoperative and postoperative opioid, benzodiazepine, muscle relaxant, and gabapentin use. A 1:1 propensity match was performed to match primary lumbar fusion patients with revision lumbar fusion patients. Revision lumbar fusion patients were substratified into those with or without persistent postoperative opioid use to identify demographic differences between these patient cohorts.

RESULTS: The final …

Female Patients Report Comparable Results To Males After The Implantation Of An Aragonite-Based Scaffold For The Treatment Of Knee Chondral And Osteochondral Defects: A Gender-Based Analysis Of A Rct At 4 Years' Follow-Up., Elizaveta Kon, Francesca De Caro, Vinod Dasa, Jason M Scopp, Berardo Di Matteo, David Flanigan, Nogah Shabshin, Sabrina Strickland, Nir Altschuler

School of Medicine Faculty Publications

No abstract provided.

Polymicrobial Prosthetic Joint Infection Including Mycobacterium Tuberculosis: A Case Report, Hernan Andres Yunis, Zachary J. Walker, Matthew E. Charlick, Daniel P. Mccall

Posters

• Usual culprits of PJI affecting total hip and knee arthroplasty are Staphylococcus aureus and streptococcus epidermidis in the acute phase.

• During the chronic presentation, microbes become much more diverse as they may seed due to hematogenous spread from other body sites.

• The purpose of this case study was to illustrate an instance when polymicrobial total hip arthroplasty PJI included Mycobacterium Tuberculosis.

Subclinical Presentation Of Cutibacterium Acnesinfection Following Revision Rotator Cuff Repair: A Case Report, Zachary Walker, David Shuster, David Sosnoski, Ali Hamade, Hussein Saad, Marc Milia

Posters

Cutibacterium acnesis a gram-positive anaerobic bacillus which is commonly found in the sebaceous glands of the skin generally in the axilla, chest and back regions1,2.

Shoulder infections have been reported to occur at 3.4% following arthroscopic or open shoulder surgeries, where they are most commonly due to C. acnes3,4.

This case report demonstrates a unique case and management of a subclinical presentation of confirmed C. acnes infection.

Laryngeal Tuberculosis Mimicking Laryngeal Candidiasis, Claire Walters, Maranda Saigh, Eytan Keidar

Posters

Tuberculosis (TB) from the bacterium Mycobacterium tuberculosisand candidiasis from the fungus Candida albicansare both opportunistic pathogens with the ability to instigate infections within the larynx with similar clinical features, yet vastly different diagnostic parameters and treatment regimens.

Here, we highlight a case of an Indian woman on immune-modulating drugs who presented with severe laryngeal symptoms initially presumed to be laryngeal candidiasis but was later discovered to be laryngeal tuberculosis.

Second-Site Periprosthetic Joint Infection After Subsequent Primary Hip Or Knee Arthroplasty: Risk Factor Assessment, Daniel Aris Nikolaidis, Devin Young, Robert Runner, Mark S. Karadsheh, Andrew Steffensmeier

Conference Presentation Abstracts

INTRODUCTION: The risk factors for developing a periprosthetic joint infection (PJI) are well described. However, those associated with developing a second-site or metachronous PJI (MPJI) following a subsequent primary arthroplasty are poorly understood. The purpose of our study is to determine (1) prevalence and (2) risk factors associated with developing a second-site PJI in patients with a prior history of PJI who undergo a subsequent THA or TKA. METHODS: A retrospective, single-center case-control study identified 77 patients treated for an index PJI (hip or knee) between 2013-2022, and who also underwent another primary arthroplasty after completing treatment for their first …