Orthopedics Commons^™

Clinical Uncertainty In Digital Monitoring After Shoulder Arthroplasty, Abhimaneu Pandey

Bone Bulletin

Introduction

Wearable sensor technology and smartphone based care platforms have been identified as promising technologies for postoperative care after joint arthroplasties.^1,2 In fact, in lower extremity arthroplasty, these technologies have already demonstrated their effectiveness in a multitude of randomized trials.^1,2 One recent multicenter RCT with 401 patients undergoing primary total knee arthroplasty (TKA) showed that self-directed rehabilitation using a smartwatch and mobile application (mymobility with Apple Watch, Zimmer Biomet) achieved comparable range of motion and patient-reported outcomes measures (PROMs) to standard post-operative rehab without increasing adverse events.¹ Related evidence also indicates that “episode of care” smartphone applications …

Foreword, Alan S. Hilibrand, Md, Mba

Bone Bulletin

As the Director of Undergraduate medical education for the Department of Orthopedic Surgery at the Sidney Kimmel Medical College, I am happy to oversee the fourth annual issue of the Bone Bulletin. Through the activities of the DePalma Orthopaedic Society, medical students at SKMC have an excellent venue to learn about orthopaedic surgery and to receive support for their application to the specialty. The Bone Bulletin has provided a great opportunity for our orthopaedic surgery faculty members at Rothman Orthopaedics to mentor younger students interested in the field of orthopedic surgery. This is one of the many initiatives the …

Editors' Note, Elijah Hoffman, Liam Gibbons

Bone Bulletin

It is our pleasure to present the fourth edition of the Bone Bulletin, DePalma Orthopaedic Society’s student-run journal for Sidney Kimmel Medical College (SKMC) students. The journal provides a unique opportunity for medical students to be involved with scholarly work in orthopaedics, often representing their first experience with orthopedic scholarship and academic writing. Through the journal, students gain valuable experience in orthopedic research and scientific writing with close mentorship from the renowned physicians of Rothman Orthopaedics.

Each year, the journal has grown in scope and impact, addressing new topics in orthopaedics. We are thrilled to introduce our new contributors …

Clinical Outcomes After Ulnar Collateral Ligament Reconstruction With Palmaris Longus Versus Gracilis Autograft In Baseball Players: A Cohort Analysis, Michael C. Ciccotti, Brooks Martino, Frank Cautela, Nathaniel Tchangou, Daniel Kwak, Eric Didomenico, Harrison S. Fellheimer, Christopher C. Dodson, Steven B. Cohen, Michael G. Ciccotti

Rothman Institute Papers

BACKGROUND: Ulnar collateral ligament (UCL) reconstruction (UCLR) is a common procedure for overhead athletes, particularly baseball players sustaining partial or full UCL tears. Palmaris longus (PL) and gracilis (GR) autografts are the most frequently used graft sources, yet limited data compare clinical outcomes in baseball athletes.

PURPOSE: To compare patient-reported outcomes after UCLR with PL versus GR autografts in baseball players.

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

METHODS: Patients who underwent isolated UCLR with either PL or GR autograft and a minimum of 2 years of follow-up were identified. All reconstructions were performed using the Modified Jobe or …

Tranexamic Acid In High-Risk Shoulder Arthroplasty Patients: Safety Across Thromboembolic, Cardiac, Renal, And Neurologic Risk Profiles, Tarishi Parmar, Akin Adio, Asim Handy, Mohammad Daher, Alec Kellish, Adam Khan, Joseph A. Abboud

Rothman Institute Papers

INTRODUCTION: Tranexamic acid (TXA) effectively reduces blood loss and transfusion requirements in shoulder arthroplasty. However, concerns regarding thromboembolic, neurologic, cardiac, and renal complications have limited its use in medically high-risk patients. This study evaluated temporal trends and the safety of TXA in high-risk patients undergoing total shoulder arthroplasty (TSA).

METHODS: A retrospective cohort study was conducted using TriNetX, identifying patients who underwent shoulder arthroplasty (2012-2025). Patients were stratified by preexisting high-risk conditions, including prior thromboembolism, renal failure, atrial fibrillation, seizure disorders, and visual disturbances. Within each subgroup, patients receiving TXA were propensity score-matched to those who did not. Perioperative TXA …

Myelomalacia Severity On Preoperative Magnetic Resonance Imaging Does Not Predict Patient-Reported Outcomes After Anterior Cervical Discectomy And Fusion, Mitchell K. Ng, Joshua Mathew, Robert J. Oris, Yulia Lee, Jonathan Dalton, Gregorio Baek, Ashley Thommana, William A. Green, Yasmine Eichbaum, Morgan Hitchner, Brandon Martinazzi, Ali Farooqi, Alec Giakas, Paul Gunter, Vinay Bijoor, Andrew Vanchikorn, John J. Mangan, David I. Kaye, Mark F. Kurd, Thomas Cha, Jose A Canseco, Alan S. Hilibrand, Alexander R. Vaccaro, Christopher K. Kepler, Gregory D. Schroeder

Department of Orthopaedic Surgery Faculty Papers

STUDY DESIGN/SETTING: Retrospective cohort study.

BACKGROUND: Signal changes within the spinal cord on magnetic resonance imaging (MRI) or myelomalacia, are frequently seen in patients with cervical myelopathy. While often assumed to predict the outcomes, their prognostic value remains uncertain. Therefore, this study aimed to: (1) describe the clinical characteristics of patients with myelomalacia undergoing Anterior cervical discectomy and fusion (ACDF); (2) evaluate whether MRI findings correlate with patient-reported outcomes (PROMs); and (3) determine whether morphology predict recovery.

METHODS: A retrospective review at a single tertiary care center was performed (2014-2021). Patients were included if they underwent a primary elective ACDF …

Transforaminal Endoscopic Lumbar Decompression: Defining Its Scope And Limitations, Kai-Uwe Lewandrowski, Álvaro Dowling, Jun Ho Lee, Benedikt W Burkhardt, Óscar L. Alves, Avelino Parajón, Jorge Felippe Ramirez, Nicola Montemurro, Alex R. Vaccaro, Morgan P. Lorio

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Transforaminal endoscopic lumbar decompression (TELD) has emerged as a minimally invasive alternative for managing lumbar stenosis and disc herniations. While the literature consistently reports favorable outcomes, real-world adoption remains variable, with discrepancies often linked to surgeon experience and case complexity.

OBJECTIVE: To evaluate surgeon perspectives on the clinical applicability of TELD across different pathologies and compare these findings with published evidence.

METHODS: An international cross-sectional survey was conducted among spine surgeons. Responses were analyzed using Rasch modeling to assess consensus levels, with agreement categorized as strong, moderate, weak, or disagreement. Differential Item Functioning (DIF) and correlation analyses were applied …

Population-Level Eligibility For Bonemri As A Radiation-Free Alternative To Spine Ct, Niels Levy-Thiebaut, Timothy Borden Md

Summer Research Program Abstracts

No abstract provided.

Does Staff Education Increase Sequential Compression Device Utilization: A Retrospective Study, Devin Q. John, Vincent Lee, Akshay V. Daji, Hans Lapica, Connor Donley, Matthew J. Mccrosson, Nino Coutelle, Carlos Fernandez, Diego Lima

HCA Healthcare Journal of Medicine

Background

Venous thromboembolism (VTE) is a significant perioperative safety concern among orthopedic patients, with an incidence of 0.4%-1.0% and a substantial risk of chronic complications. Sequential compression devices (SCDs) are recommended for VTE prophylaxis, yet compliance remains suboptimal due to staff misconceptions. This study evaluates the impact of a resident-led educational intervention on SCD utilization among nursing staff in orthopedic postoperative care.

Methods

This retrospective study was conducted at 2 hospitals (HCA Florida JFK Hospital and HCA Florida Palms West Hospital). Nursing staff participated in a single educational session addressing SCD benefits, application techniques, and operational protocols. Data on SCD …

Program (Pdf), Department Of Orthopaedics

Dept. of Orthopaedics: Robert D. D’Ambrosia Lectureship & Research Day

Program with abstracts for the 22nd Annual Dept of Orthopaedics Annual Robert D. D’Ambrosia Lectureship & Research Day held June 20, 2026.

Non-Tobacco Nicotine Dependence Is Associated With Increased Complications Following Clavicle Open Reduction Internal Fixation, Akin A. Adio, Rahul K. Goyal, Abby Skiena, Mohammad Daher, John G. Horneff, Hafiz F. Kassam, Brian W. Hill, Joseph A. Abboud

Rothman Institute Papers

BACKGROUND: Tobacco dependence is well established to impair bone healing and increase postoperative complications. However, the independent effects of nicotine, separate from combustion-related factors, remain unclear. This study aimed to evaluate the impact of non-tobacco nicotine dependence (NTND) following open reduction and internal fixation (ORIF) of clavicle fractures, including midshaft and lateral fracture subtypes.

METHODS: A retrospective cohort study was performed using a large national database. Patients undergoing ORIF of clavicle fractures were identified using procedural and diagnostic codes. Patients with non-tobacco nicotine dependence (e.g., vaping, patches, or gum) were identified and propensity score matched to (1) patients without nicotine …

Loss Of Mct1 Mediated Lactate Uptake Causes Delayed Endplate Maturation And Intervertebral Disc Degeneration, Maria Tsingas, Konstantinos Tsingas, Mei Smyers, Wujuan Zhang, Aaron R. Goldman, Eulisa Lawrence, John A. Collins, Makarand V. Risbud

Department of Orthopaedic Surgery Faculty Papers

During skeletal growth, it is thought that the lactate secreted by the glycolytic nucleus pulposus (NP) cells exits the intervertebral disc into circulation via endplates. Our current studies challenge this long-held notion. Mice with early postnatal, endplate, and annulus fibrosus-specific deletion of lactate importer, MCT1, exhibited disc degeneration characterized by NP cell loss and pronounced endplate structural changes. Using metabolic and transcriptomic approaches, we demonstrate that MCT1 loss inhibits endplate chondrocyte differentiation and that lactate serves both as a crucial TCA metabolite and promotes protein and histone lactylation and gene expression. These findings suggest that during skeletal growth, NP-derived lactate …

Silent Bones, Visible Changes: Increasing Osteoporosis Screening At Swedish Fmr, Alissa Kummer, Devin Beecher, Tara Ahmadi, Amanda Maxwell

All Podium Presentations

No abstract provided.

A Decade Of Leadership And Impact: Celebrating 10 Years Of The Ors Spine Section, Makarand V. Risbud

College of Life Sciences Faculty Papers

No abstract provided.

Mri-Based Deep Learning Radiomics Model For Automated Classification Of Disc Degeneration In The Lumbar Spine, Shiv Patil, Om Gandhi, Mert Karabacak, Matthew Carr, Konstantinos Margetis

Student Papers, Posters & Projects

Disc degeneration in the lumbar spine is a major cause of low back pain (LBP). The accurate grading of disc degeneration on magnetic resonance imaging (MRI) is critical for clinical management and patient selection for spine surgery. This study aims to develop and evaluate machine learning (ML) models that combine features from deep learning (DL) and radiomics for the automated prediction of Pfirrmann grade (PG), a measure of disc degeneration, using multi-parametric lumbar spine MRI. Sagittal T1, T2, and T2 SPACE MRIs of 218 patients with LBP were acquired from the SPIDER dataset. For each intervertebral disc and available sequence, …

Patient-Reported Outcomes Following Operative And Nonoperative Management Of A3 Versus A4 Thoracolumbar Burst Fractures, Barry T. S. Kweh, Charlotte Dandurand, Alex R. Vaccaro, Klaus J. Schnake, Mohammad El-Sharkawi, Richard J J. Bransford, Andrei Fernandes Joaquim, Harvinder Singh Chhabra, Ulrich J. A. Spiegl, Dimitri Hauri, F. Cumhur Öner, Gregory D. Schroeder, Jin Wee Tee

Department of Orthopaedic Surgery Faculty Papers

OBJECTIVE: The aim of this study was to compare patient-report outcome measures in patients with thoracolumbar burst fractures managed either operatively or nonoperatively.

METHODS: A prospective multicenter observational study was conducted of neurologically intact patients who sustained traumatic thoracolumbar burst fractures managed operatively or nonoperatively. Outcome measures included scores on the EQ-5D index, EQ-5D visual analog scale (VAS), pain numerical rating scale (NRS), and AO Spine Patient Reported Outcome Spine Trauma (PROST) tool and patient satisfaction with follow-up up to 2 years. The Wilcoxon rank-sum test and Cochran-Armitage test were used to evaluate differences between continuous and ordinal variables, respectively. …

Joint Disease And Demographic Factors In Clinical Populations Of Medically Underserved Communities, Blake C. Martin, Juan Lopez-Alvarenga, Michael Sander

School of Medicine Publications

Background: The Rio Grande Valley is a medically underserved, demographically unique population that warrants the exploration of various conditions.

Objectives: We sought to analyze the demographic disparities between the different types of common joint conditions in this community. We hypothesized that osteoarthritis would be the most common joint condition and that the demographics between the various joint conditions would vary depending on age, sex, BMI, and ethnicity.

Methods: This was a retrospective cohort, from January 1, 2018, to September 4, 2024. Patients’ charts were obtained using the ICD-10 diagnosis codes M15-M19 for osteoarthritis, M05-M06 for rheumatoid arthritis, M10 or M1A …

Comparative Effectiveness Of Liposomal Bupivacaine And Regional Nerve Blocks For Analgesia After Total Knee Arthroplasty, Ahmed Makled, Amir Ghafarian, Jawad Saad, Muhammed Zahriyeh, Muaaz Wajahath, Khaled Saleh

Medical Student Research Symposium

Title: Comparative Effectiveness of Liposomal Bupivacaine and Regional Nerve Blocks for Analgesia After Total Knee Arthroplasty

Introduction: Liposomal bupivacaine (Exparel) has been adopted in total knee arthroplasty (TKA) as a long-acting local anesthetic. However, its comparative effectiveness against standard regional anesthesia techniques, such as femoral or adductor canal block, remains insufficiently defined. This study evaluates postoperative analgesic utilization following TKA among patients receiving Exparel, regional blocks, or no regional intervention, using matched cohorts from a large national dataset.

Methods: Patients who underwent primary TKA between January 1, 2005 and January 1, 2025 were retrospectively identified from a multi-institutional electronic medical …

Real-World Clinical Outcomes Of Robotic-Assisted Total Knee Arthroplasty: A Propensity-Matched Comparative Study, Hassan Yassine, Amir Ghafarian, Jawad Saad, Abdel Kareem Hilo, Muaaz Wajahath, Khaled Saleh

Medical Student Research Symposium

Background:

Robotic-assisted total knee arthroplasty (RA-TKA) is increasingly utilized to improve component alignment and soft-tissue balance, yet its impact on clinically meaningful outcomes in large real-world populations remains uncertain. Although prior studies demonstrate improved radiographic accuracy, whether robotic assistance reduces postoperative complications, opioid utilization, or midterm mechanical failure has not been established at scale.

Methods:

We conducted a retrospective, propensity-matched cohort study using the TriNetX US Collaborative Network to identify adults undergoing primary TKA from 2018–2023. Robotic-assisted procedures were defined by CPT 27447 with concurrent robotic navigation codes. Propensity score matching (1:1) was performed to balance demographics and comorbidities, yielding …

Investigating Racial Differences In The Receipt Of Antenatal Interventions Prior To Periviable Delivery, Niurka Monteserin, Whitney Bender

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: The Society for Maternal Fetal Medicine (SMFM) provides guidance on the use of antenatal corticosteroids, antibiotics, and cesarean delivery in the periviable period. Although racial differences exist in postnatal active management of periviable neonates have been described, less is known about racial differences in antenatal interventions preceding delivery.

OBJECTIVE: To evaluate differences in the receipt of antenatal interventions before periviable delivery by birthing parent race.

METHODS:  We conducted a population-based cohort study using the National Center for Health Statistics database including periviable deliveries (20w0d-25w6d) from 2016-2021. Individuals delivering a non-anomalous live singleton gestation in a hospital were included. Births …