Orthopedics Commons^™

Polyethylene Wear: An Under-Recognized Cause Of Failed Shoulder Arthroplasty, Brandon Fisher, Matthew Astolfi, Justin Taylor Deslaurier, Karen Childers, James Youngjin Lee, Marisa Samani, J Michael Wiater

Conference Presentation Abstracts

INTRODUCTION: Particle-induced osteolytic and chronic inflammatory effects of polyethylene (PE) wear are a source of failure after both anatomic total shoulder arthroplasty (ATSA) and reverse total shoulder arthroplasty (RTSA). Historically, PE wear has rarely been reported as a cause of revision in the setting of prior shoulder arthroplasty, unlike hip and knee counterparts. The goal of this study was to analyze and present the clinical, radiographic, and intra-operative findings in a consecutive series of patients who presented after shoulder arthroplasty with evidence of PE wear. METHODS: This was a retrospective review of prospectively collected data on a consecutive series of …

Uncemented Versus Cemented Humeral Fixation In Reverse Shoulder Arthroplasty For Proximal Humerus Fractures In The Elderly: A Multicenter Retrospective Cohort Study, Johnny Kasto, Thomas Ward Throckmorton, Tyler James Brolin, H Mike Kim, Curtis R. Noel, J Michael Wiater, Thomas W. Wright, Stephanie J. Muh

Conference Presentation Abstracts

INTRODUCTION: Among surgical interventions for proximal humerus fractures, RSA has been shown to have superior or noninferior outcomes to hemiarthroplasty or open reduction internal fixation. Cemented humeral fixation in RSA has been the traditional treatment method for proximal humerus fractures, however, there is a growing interest in uncemented humeral fixation. Both cemented and cementless RSA are currently used to treat proximal humerus fractures with few studies comparing postoperative outcomes of these 2 techniques. The aim of this study was to compare postoperative outcomes between cemented and uncemented humeral fixation following primary reverse total shoulder arthroplasty (RSA) for proximal humerus fractures. …

Serum Metal Ion Levels In Patients Undergoing Revision Should Arthroplasty, Rishi Chatterji, Brandon Fisher, Avianna Elizabeth Arapovic, Yuying Xing, J Michael Wiater

Conference Presentation Abstracts

INTRODUCTION: Shoulder arthroplasty systems are transitioning towards more modular prosthesis options with the goal of reducing complication profiles and increasing range of motion. Modularity may increase the potential for fretting, corrosion, and subsequent release of metal ions. These events have been associated with adverse reactions in hip and knee arthroplasty, but not in the setting of revision shoulder arthroplasty. The purpose of this study was to identify associations between implant designs, metallurgy, patient characteristics, and serum metal ion levels in patients undergoing revision shoulder arthroplasty. METHODS: 51 patients that underwent revision shoulder arthroplasty were retrospectively reviewed based on prospectively collected …

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

Research Symposium

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

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

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

Research Symposium

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

Methods: A literature search was conducted using the …

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

Research Symposium

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

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

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

Research Symposium

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

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

Research Symposium

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

Methods: This systematic …

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

Research Symposium

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

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

High Rate Of Complications With Exchange Nailing For Femoral Nonunions, Benjamin Averkamp, Ziqing Yu, Julia C. Mastracci, Matthew J. Braswell, Andrew T. Chen, Luke A. Lopas, Ishani Sharma, Hassan Farooq, Hassan Mir, Jessica Rivera, Rachel B. Seymour, Joseph R. Hsu, Evidence-Based Musculoskeletal Injury & Trauma Collaborative, Robert D. Zura, Marc Schatz, Et Al

School of Medicine Faculty Publications

Objectives: To evaluate rates of nonunion repair, osseous healing, and outcomes in femoral nonunions with contemporary healing. Design: Retrospective review. Setting: Five academic level 1 trauma centers. Patients/Participants: This study includes adult patients (age older than 18) seen at one of the participating institutions between 2012 and 2019 who sustained a femur fracture (OTA/AO 31, 32, 33) initially treated with intramedullary fixation that developed nonunion and were treated with exchange nailing for the index nonunion surgery. Seventy-nine patients with femoral nonunion met inclusion criteria. Intervention: Exchange nailing for treatment of femoral nonunion. Main Outcome Measurements: The primary outcome measure was …

Orthopedic Frailty Risk Stratification (Ofrs): A Systematic Review Of The Frailty Indices Predicting Adverse Outcomes In Orthopedics., Nithin K Gupta, Forrest Dunivin, Hikmat R Chmait, Chase Smitterberg, Azhaan Buttar, Moiz Fazal-Ur-Rehman, Taylor Manes, Morgan Turnow, Tyler K Williamson, Benjamin C Taylor, Jack W Weick, Christian Bowers

Surgery Articles

BACKGROUND: With a growing number of elderly patients requiring elective and non-elective procedures, frailty-based preoperative risk stratification is an emerging tool in orthopedic surgery to minimize adverse postoperative outcomes. This paper sought to understand the current literature regarding preoperative Orthopedic Frailty Risk Stratification (OFRS) and describe the disparate frailty indices and their capabilities for discrimination in predicting adverse postoperative outcomes.

METHODS: A literature search was conducted in Pubmed, Cochrane, and Scopus for articles published during or prior to February 2024 assessing frailty following surgery for orthopedic pathologies. Qualitative variables including study characteristics and application of frailty were collected and synthesized. …

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

Research Symposium

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

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

Research Symposium

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

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

Research Symposium

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

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

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

Research Symposium

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

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

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

Research Symposium

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

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

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

Research Symposium

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

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

Research Symposium

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

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

Research Symposium

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

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

Research Symposium

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