Orthopedics Commons^™

Stemless Arthroplasty For Avascular Necrosis Of The Humerus: Implant Survival And Outcomes, Alyssa R. Henriquez, Damon V. Briggs, Eoghan T. Hurley, Samuel Lorentz, Christopher S. Klifto, Michael A. Moverman, Oke Anakwenze

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Avascular necrosis (AVN) of the humeral head often affects younger patients and may lead to progressive pain and functional deficits. While stemmed hemiarthroplasty and total shoulder arthroplasty (TSA) are established treatments for advanced-stage AVN, stemless arthroplasty offers potential advantages including bone preservation and facilitation of future revision. However, the impact of bone necrosis on stemless humerus fixation is yet to be elucidated. Therefore, the purpose of this study was to evaluate the outcomes of stemless hemiarthroplasty and TSA in treating humeral head AVN and, further, to determine if stemless humeral fixation is appropriate in this population.

METHODS: This retrospective …

Predictive Factors For Humeral And Ulnar Stem Loosening After Total Elbow Arthroplasty: A Retrospective Cohort Study, Akash Singh, James Satalich, Miguel Fiandeiro, Harrison S. Fellheimer, Matthew Ramsey, Surena Namdari

Rothman Institute Conference Posters

BACKGROUND: There has been a significant increase in the use of total elbow arthroplasty (TEA) in advanced osteoarthritis, post-traumatic arthritis, and complex distal humerus fractures. The purpose of this study is to determine the incidence of total elbow loosening and association with patient demographics, implant specifications, and cement mantle characteristics.

METHODS: A retrospective cohort study was conducted of patients who underwent primary TEA between 2013 and 2022 at a single institution. Revisions and conversions from prior open reduction and internal fixation were excluded. Pre-operative distal humeral cortical thickness and bone quality were assessed. Variables included anterior humeral flange contact with …

Comparison Of Training Background And Characteristics Between Osteopathic And Allopathic Team Physicians In Professional Sports Leagues., Brandon D Rust, Ambika Singh, Matthew T Mckinley, Joseph Imler, Mackenzie Elting, Ryan Callahan, Christopher L Rennie, Leighann C Krasney

Orthopedic Surgery Resident Research

CONTEXT: Team physicians (TPs) play a critical role in professional sports, providing medical care for athletes under high-pressure conditions. These positions are highly competitive, influenced by previous affiliations, training pedigree, and institutional connections, with fellowship training increasingly essential. Although the number of osteopathic (Doctor of Osteopathic Medicine [DO]) physicians in the United States has grown substantially, TPs in professional sports remain predominantly filled by allopathic (Doctor of Medicine [MD]) physicians, and the training pathways of DO TPs are not well characterized.

OBJECTIVES: The objective of this study is to compare the training and demographic characteristics of DO and MD TPs …

In Reply To The Letter To The Editor Regarding "The Effect Of Glp-1 Receptor Agonists On Reoperation Following Anterior Cervical Discectomy And Fusion", Nicholas C. Bank, Daniel Whittingslow, Sam Duggan, Joshua L. Morningstar, Douglas S. Weinberg

Student Papers, Posters & Projects

No abstract available

The Biological Response Of Human Np Cells To Soluble Collagen Vi, Jonathan Dalton, Srikanth N. Divi, Yasmine Eichbaum, Panya Luksanapruksa, Mitchell K. Ng, Rachel Huang, Alan S. Hilibrand, Alex R. Vaccaro, Dessislava Z. Markova, Christopher K. Kepler

Department of Orthopaedic Surgery Faculty Papers

Extracellular matrix (ECM) dysregulation plays a significant role in the development of intervertebral disc disease (IVDD). The ECM around the chondrocytes in the nucleus pulposus (NP) is unique in that it contains ColVI. While linked to chondrocyte proliferation in cartilage, ColVI's specific role in IVD degeneration is less clear. Our aim was to determine the expression of ColVI in NP cells from degenerative IVDs, along with the effects of soluble ColVI on NP cells. Thus, we compared the expression levels of ColVI in human degenerated IVD samples, along with the effect of soluble ColVI on primary human NP cells. A …

Depression And Psychotic Disorders Elevate Inpatient Burden After Posterior Cervical Decompression And Fusion: Prioritizing Screening And Targeted Discharge Planning, Leonidas E. Mastrokostas, Paul G. Mastrokostas, Daniel Yusupov, Abigail Razi, Aaron B. Lavi, Luke B. Schwartz, Sean Inzerillo, Mohamed Said, Alexander Kucherina, Pemla Jagtiani, Arie Monas, John K. Houten, Christopher K Kepler, Jad Bou Bou Monsef, Afshin E. Razi, Mitchell K. Ng

Rothman Institute Papers

CONTEXT: Psychiatric comorbidity has been associated with worse perioperative outcomes and greater healthcare utilization after spine surgery.

AIMS: This study compared complications and healthcare utilization among posterior cervical decompression and fusion (PCDF) patients with depression, psychotic disorders, or no mental-health diagnosis.

SETTINGS AND DESIGN: Retrospective cohort analysis of the National Inpatient Sample from 2016 to 2022.

MATERIALS AND METHODS: The database was queried for elective adult PCDF encounters. Mental-health exposures were defined using Elixhauser indicators for depression and psychoses. Outcomes included medical complications, non-routine discharge, inpatient mortality, length of stay (LOS), and costs.

STATISTICAL ANALYSIS USED: Chi-square and multivariate logistic …

Higher Mortality And Distinct Complications After Anterior Cervical Discectomy And Fusion In Dialysis Patients, Despite Improvements Over Prior Decade: A National Inpatient Study, Mitchell K. Ng, Leonidas E. Mastrokostas, Paul G. Mastrokostas, William A. Green, Joshua Mathew, Gregorio Baek, Yasmine Eichbaum, Yulia Lee, Morgan Hitchner, Jonathan Dalton, Adam Fano, Alec Giakas, Rajendra Singh, Brendan Reitman, Afshin E. Razi, Daniel R. Fassett, Alan S. Hilibrand, Alex R. Vaccaro, Christopher K. Kepler, Gregory D. Schroeder, Andrew P. Alvarez

Rothman Institute Papers

Introduction: Dialysis patients undergoing anterior cervical discectomy and fusion (ACDF) face elevated perioperative risk due to complex comorbidities. This study aimed to (1) identify associations between dialysis status and perioperative complications after ACDF, (2) quantify differences in length of stay (LOS), hospitalization costs, and discharge disposition, and (3) provide a contemporary national benchmark for outcomes in this high-risk population. Materials and Methods: The 2016–2022 National Inpatient Sample was queried for adult elective ACDF cases. Dialysis dependence was identified through International Classification of Diseases-10 codes for end-stage renal disease with hemodialysis or peritoneal dialysis. Demographics, comorbidities, complications, LOS, costs, and discharge …

What Factors Do Patients Consider When Choosing A Hand Surgeon?, Monik Debkowska, Jeremy Ruskin, Brian Lynch, Samuel Caradonna, David Komatsu, Edward Wang, Samantha Muhlrad

Introduction: Many patients find themselves frustrated wasting time and money when searching for the right hand specialist, only to be referred to a different one. There has been little research evaluating patient decision making when choosing a hand surgeon. Specialists would benefit from learning how to optimize their practice to reach their appropriate patient population for maximum benefit and minimum resource waste, both for the patients and physicians. We therefore conducted a survey study to evaluate which factors patients consider important when choosing a hand surgeon, and if these factors differ based on patient demographics. Our hypothesis is that patients …

Intravenous Versus Oral Tranexamic Acid In Shoulder Arthroplasty, Tarishi Parmar, Akin Adio, Mohammad Daher, Adam Khan, John Horneff, Joseph A. Abboud

Rothman Institute Papers

PURPOSE: Tranexamic acid (TXA) is used in shoulder arthroplasty to reduce blood loss. While intravenous (IV) TXA is standard, oral TXA offers advantages in cost and administration. This study compares 90-day complications and postoperative laboratory values between IV and oral TXA in total shoulder arthroplasty (TSA).

METHODS: A retrospective cohort study using TriNetX identified adults undergoing primary TSA (2005-2025) receiving TXA on the day of surgery, stratified by route (IV vs. oral). One-to-one propensity score matching was performed. Ninety-day outcomes included transfusion, thromboembolic events, cardiac and renal complications, neurologic events, infection, wound dehiscence, readmissions, emergency department visits, opioid utilization, and …

Full Issue: Volume 4, Issue 1 - 2026

Bone Bulletin

i - Editors’ Note by Elijah Hoffman and Liam Gibbons

ii - Foreword by Dr. Alan Hilibrand

7 - Clinical Uncertainty in Digital Monitoring After Shoulder Arthroplasty by Abhi Pandey

10 - The Changing Value of Joint Arthroplasty Under the RVU System by Kiley Hamou

13 - SCALPEL TO ROBOT TO ALGORITHM: Robotics, Artificial Intelligence, and the Evolution of Spine Surgery by Mateja Stefanovic

18 - Suture-Free Nerve Repair in Upper-Extremity Surgery by Adam Gaughan

20 - The Impact of Wide-Awake Local Anesthesia No Tourniquet Surgery on Distal Radius Fracture Plating by Michael Carey

23 - Unicompartmental Versus Total Knee …

Biologic Adjuncts In Hand Surgery: Current Evidence, Limitations, And Clinical Implications, Joseph Kelly

Bone Bulletin

Introduction Biologic therapies such as platelet-rich plasma (PRP) and mesenchymal stem cell (MSC) based treatments, have gained substantial attention across orthopaedics as agents that may enhance tissue healing and modulate inflammation.^1,4 Their use has expanded in the management of degenerative joint disease, tendinopathies, and fracture nonunion across multiple subspecialties within the field.^1,3,6 Despite the developing research base, prior hand-focused reviews have noted that orthobiologics in hand surgery remains an underdeveloped area, leaving limited guidance available to inform clinical decision making.^1-2

Optimizing Total Knee Arthroplasty In Young Patients: Strategies For Enhancing Durability And Function, Bridger Bell

Bone Bulletin

Introduction

The subspecialty of orthopaedics focuses on the prevention, diagnosis, and treatment of diseases and injuries impacting the musculoskeletal system.1 Within orthopaedics, surgery for arthritis and related conditions make up half of those performed.² Of the surgical interventions for arthritis, total knee arthroplasty (TKA) is one of the most frequent, with over 700,000 performed per year in the United States and an expectation that nearly one million will be performed by 2030.3 Interestingly, since the 1980s, the prevalence of surgery in younger patients has continually increased.⁴ This has been accompanied by a declining average age of primary TKA …

Hazards For The Female Athlete: Disparities In Acl Injury Risk And The Evolving Research Base, Abby Skiena

Bone Bulletin

Introduction

Sex plays a significant role in sports medicine risk factors, but historically, there has been a lack of research involving female participants and investigating physiologic factors unique to female athletes.^1–4 Male athletes face a 2.26 times higher risk of hip and groin injuries, a 2.4 times higher risk of hamstring injuries, and a 1.8-2.8 times higher risk of acute fractures, especially in competitive situations.² Alternatively, female athletes experience a 2-8 times higher rate of anterior cruciate ligament (ACL) injuries, a 3.4 times higher risk of bone stress injuries, a 1.25 times higher rate of foot and ankle …

Outcomes In Robotic Knee Surgery, Tyler West

Bone Bulletin

Introduction

Total knee arthroplasty (TKA) is one of the most common orthopedic surgeries worldwide and is the mainstay for treating severe knee arthritis. In the United States, surgeons perform over 700,000 TKAs each year, and that number is expected to climb as osteoarthritis becomes more common in an aging population.^1,2 Roughly, two TKAs are completed for every one total hip arthroplasty (THA) and yet patient satisfaction after TKA has always lagged behind the THA.³ Hip replacements routinely see satisfaction rates above 90 percent.^2,3 For knees, however, satisfaction rates historically have fallen between 80 and 89 percent.^{4 …}

Conceptual Frameworks, Evolving Technology, And Common Misconceptions: How Orthopedic Hand Surgeons Choose Fracture Fixation Technique, Sudesh Jaisi

Bone Bulletin

Fracture fixation is often taught as a binary decision between operative and nonoperative management, which fails to reflect the complexity of real-world clinical decision-making. This article analyzes fracture fixation through a conceptual, fracture personality-based framework incorporating biomechanics, fracture characteristics, patient-specific factors, and evolving implant technology. Clinical decision-making is best understood as a spectrum of interventions, where multiple fixation strategies may be technically appropriate but differ in invasiveness, stability, complication risk, and functional recovery. Across representative fracture types, including distal radius and olecranon injuries, management is driven by fracture stability, anticipated behavior under physiologic load, and patient functional demands rather than …

Unicompartmental Versus Total Knee Arthroplasty In Osteoarthritis: Indications, Outcomes, And Value-Based Care, Spencer Uggla

Bone Bulletin

Introduction

Knee osteoarthritis (OA) is a highly prevalent and disabling condition, affecting an estimated 654 million people worldwide in 2023. It is the most common diagnosis among patients over 45 years of age who present with activity-related knee pain.1 When nonoperative management fails, surgical intervention is frequently required to relieve pain and restore function. Traditionally, total knee arthroplasty (TKA) has been considered the gold standard surgical treatment for advanced OA, with approximately 700,000 procedures performed annually and projections exceeding 1 million by 2030.²

The Impact Of Wide-Awake Local Anesthesia No Tourniquet Surgery On Distal Radius Fracture Plating, Michael Carey

Bone Bulletin

Introduction

The surgical technique known as wideawake local anesthesia no tourniquet (WALANT) has been widely used in soft tissue hand procedures since 2005.1 A local surgical field block using lidocaine with epinephrine provides local anesthesia and hemostasis via alpha-1 adrenergic agonism without the need for general anesthesia with a tourniquet. In addition to reducing costs related to general anesthesia (GA), WALANT procedures are suitable for American Society of Anesthesiologists Physical Status Classification 4 (ASA 4) high-risk patients, specifically by eliminating anesthesia risks such as nausea, aspiration, pneumonia, and thromboembolism, all while maintaining or improving clinical outcomes compared with the current …

Suture-Free Nerve Repair In Upper-Extremity Surgery, Adam Gaughan

Bone Bulletin

Introduction

Peripheral nerves have a limited capacity to regenerate.¹ Treating peripheral nerve injuries and the ensuing recovery of sensory and/or motor function are challenging for surgeons due to a number of variables that impact nerve recovery; including, the mechanism of nerve transection, the level or distance of injury relative to the target organ, patient age and comorbidities, and the repair technique employed. Most factors are not modifiable, but repair techniques are modifiable and can have a meaningful impact on outcomes. Nerve repair opt ions inc lude di r e ct end- to- end r epai r (neurorrhaphy), conduit-assisted repair, …

Scalpel To Robot To Algorithm: Robotics, Artificial Intelligence, And The Evolution Of Spine Surgery, Mateja Stefanovic

Bone Bulletin

Introduction

The past five decades in spine surgery have seen innovations in pedicle screw fixation, image-guided navigation, and first-generation robotics; each change was confronted with skepticism for uprooting existing paradigms until pushback inevitably yielded progress. Artificial intelligence (AI) and machine learning (ML) feel different in kind. Beyond better instrumentation, they represent entirely new frameworks for processing clinical information at unprecedented scale and speed. A neural network trained on thousands of preoperative records can learn to detect interactions among imaging findings, laboratory indices, functional variables, and comorbidity burden that conventional statistical models are structurally unable to identify.¹˒² Simultaneously, robotic platforms outfitted …

The Changing Value Of Joint Arthroplasty Under The Rvu System, Kiley Hamou

Bone Bulletin

Background and Introduction of Total Knee Arthroplasty

Few procedures in modern medicine illustrate the value of surgical advancement more clearly than total hip and total knee arthroplasty. Over the past several decades, advances in surgical technique, pre-operative management, and postoperative rehabilitation have transformed joint replacement into one of the most successful procedures in medicine. Patient satisfaction rates routinely exceed 90% and millions of individuals regain mobility, independence and quality of life each year through these operations.¹ However, despite this clinical success and societal value, physician reimbursement for joint replacement surgery and many other successful orthopedic procedures has steadily declined. …