Orthopedics Commons^™

La Dolce Vita Or The American Way: A Comparative Study Into The Italian And American Healthcare Systems Through An Analysis Of Total Knee Replacements, James (Jim) Mcmurray '26

Honor Scholar Theses

This thesis presents a comparative study of the Italian and the American healthcare systems, using Total Knee Replacements (TKRs) as a standardized metric to evaluate the health policy, financing, and patient outcomes. Despite the United States spending over $10,000 more per capita on healthcare than Italy, American life expectancy is 5 years shorter than Italian life expectancy. Through a mixed-methods analysis of data from the American Joint Replacement Registry (AJRR), the Programma Nazionale Esiti (PNE), the Registri Italiani di ArtoProtesi (RIAP), and the HCUPnet (AHRQ) database, this research identifies multiple disparities throughout the system. Key findings in this thesis include …

Patient Reported Outcome Participation And Completion In Total Joint Arthropathy: A Socioeconomic Analysis, Diana Kernen Ba, Michelle Yi Mse, Kathleen Jahnke Bs, Nevil Khurana Ms, Ezra Goodrich Md, Charles Day Md, Mba

Medical Student Research Symposium

Background
Patient-reported outcome measures (PROMs) assess symptoms, function, and overall health from a patient perspective. Although PROM engagement has been studied across orthopaedics, limited work has examined both participation and completion specifically in joint replacement. This study evaluated associations between sociodemographic factors and PROM participation and completion among total joint arthroplasty patients.

Methods
We performed a retrospective review of all primary arthroplasties completed by a single surgeon in 2023 at a Midwestern tertiary health system. PROMs included PROMIS PF, PROMIS PI, and either HOOS JR or KOOS JR. Demographic data and Area Deprivation Index (ADI) were collected. Participation was defined …

A Systemic Review Of Functional Outcomes And Patient Satisfaction Across Lower-Limb Prosthetic Types In Military Personnel And Veterans, Emma Ho Harris, Amir Ghafarian, Sen Gao, Khaled Saleh, Jason Pasley

Medical Student Research Symposium

Background: Military personnel and veterans are at increased risk of lower-limb amputation, often due to combat-related trauma such as improvised explosive devices (IEDs), as well as secondary factors including tobacco use, peripheral artery disease, and diabetes. This study systematically reviews and compares lower-limb prosthetic technologies in military personnel and veterans, focusing on functional outcomes, mobility, and patient satisfaction.

Methods: A comprehensive literature search was conducted using PubMed MeSH terms to identify studies examining lower-limb prosthetic use and outcomes among military personnel and veterans. The final MeSH-based search yielded 27 results.

Results: The review included 27 studies on lower-limb prosthetic use …

Platelet Rich Plasma Injection Treatment Outcomes In Patellar Tendinopathy, Hunter M. Butler, Aamir Ahmad

School of Medicine Publications

Background: Platelet rich plasma (PRP) refers to the processed product of autologous peripheral blood with a concentration of platelets higher than baseline. This product has garnered interest for 30 years as a potential method of regenerative medicine. PRP injections have shown to be an effective treatment for patellar tendinopathy. However, some concerns remain with regards to empiric treatment of tendinopathy with PRP injections.

Objective: This article aims to investigate the outcomes of platelet rich plasma injections in patients with patellar tendonitis.

Methods: A systematic literature search was conducted using the University of Texas Rio Grande Valley (UTRGV) online database. The …

Variability In The Orthopaedic Residency Trainee Trauma Surgical Experience, Todd Phillips, Benjamin Fiedler, Joshua T Morrow, Zbigniew Gugala, Melvyn Harrington, Douglas R Dirschl

Faculty, Staff and Students Publications

Background: The aim of this study was to analyze fracture fixation case logs from residents training at a level 1 trauma center to assess variability across residents' surgical experiences within a single residency program. The authors hypothesize that notable variability exists between residents' surgical experiences in fracture care.

Methods: A retrospective case series was conducted at a single, urban residency program with a level 1 trauma center. Completed case logs were collected from program graduates from 2022 to 2024. All surgical cases involving fracture fixation at the level 1 trauma center were included for analysis. The anatomic region of the …

Utility Of Diagnostic Arthroscopy Before Medial Patellofemoral Ligament Reconstruction In Pediatric And Adolescent Patients Without Articular Findings On Magnetic Resonance Imaging, Holden Archer, Kaleb Patterson, Jonathan D Schwartzman, Scott D Mckay, Indranil Kushare

Faculty, Staff and Students Publications

BACKGROUND: Medial patellofemoral ligament (MPFL) reconstruction is frequently used to manage recurrent patellar instability. Diagnostic arthroscopy is commonly performed before MPFL reconstruction to identify, confirm, and address intra-articular pathology. However, when preoperative magnetic resonance imaging (MRI) does not demonstrate intra-articular lesions, it is unclear how often diagnostic arthroscopy in pediatric patients alters surgical management.

PURPOSE: To determine the utility of diagnostic arthroscopy in young patients undergoing MPFL reconstruction who had no intra-articular chondral or osteochondral pathology, meniscal tears, or loose bodies identified on preoperative MRI, and to characterize intra-articular pathology detected on arthroscopy but not identified on MRI.

STUDY DESIGN: …

Incidence Of Carpal Tunnel Syndrome After The Diagnosis Of Ulnar Neuropathy, Harrison S. Fellheimer, Eric Didomenico, Mahaa Ayub, Magnolia Livingston, William L. Justice, Gabriel I. Onor, Eric Tecce, Pedro K. Beredjiklian

Department of Orthopaedic Surgery Faculty Papers

PURPOSE: The purpose of this study is to determine whether patients diagnosed with ulnar nerve lesions (UNLs) have an increased risk of developing carpal tunnel syndrome (CTS).

METHODS: A retrospective cohort study was conducted using the TriNetX database, which contains data of >100 million patients. We identified 360,021 patients with UNLs and matched them 1:1 with controls. The incidence of CTS was assessed at 1, 2, 3, 4, and 5 years following the diagnosis of UNL. Statistical analyses were used to evaluate the development of CTS in the UNL cohort compared with controls.

RESULTS:  Patients with UNL demonstrated a significantly …

Pre-Operative Antiplatelet Therapy Is Associated With Increased Risk Of Periprosthetic Joint Infection Following Total Shoulder Arthroplasty, Muhammad Hamza Ilyas, Mohammad Daher, Viraj Deshpande, Adam Lindsay, Joseph A. Abboud, Hafiz F. Kassam

Rothman Institute Papers

Background Antiplatelet therapy is widely prescribed for the prevention and management of cardiovascular disease and for mitigation of thromboembolic risk. However, its impact on post-operative periprosthetic joint infection (PJI) following total shoulder arthroplasty (TSA) remains poorly defined.MethodsA retrospective cohort study was conducted using the TriNetX US Research Network. Propensity score matching was performed to balance demographics, body mass index, and Charlson Comorbidity Index variables. The primary outcome was the incidence of PJI at 90 days, 6 months, and 1 year. Secondary outcomes included post-operative medical and surgical complications. Comparative risk was quantified using risk ratios with 95% confidence intervals. Subgroup …

Influenza Infection Has Higher Risk Of Postoperative Complications Than Covid-19 In Shoulder Arthroplasty Patients, Jad J Lawand, Umar Ghilzai, Caleb Witsken, Dion Birhiray, Abdullah Ghali, Youssef M Khalafallah, Rohan G Reddy, Sameer R Khawaja, Adil Shahzad Ahmed

Faculty, Staff and Students Publications

INTRODUCTION: The COVID-19 pandemic has captured the attention of healthcare systems worldwide, and testing remains a mainstay of preoperative testing before all surgical procedures, including shoulder arthroplasty. Other viral illnesses, specifically influenza, while still having severe complications, are either overshadowed by testing for COVID-19 or not tested at all.

METHODS: A multi-institutional cohort study using the TriNetX network examined patients undergoing total or hemi shoulder arthroplasty from January 2020 to March 2024. Matched cohorts were created: one with influenza and one with COVID-19 infection, 14 days before surgery.

RESULTS: A total of 3233 and 18,209 patients were included in the …

Increasing Utilization Trends Of Robotic Assistance In Orthopaedic Surgery, Anish K. Ponna, Alec Giakas, Anthony A. Khoudary, Spencer N. Uggla, Sina Ramtin, Yousef A. Soliman, Asif M. Ilyas

Department of Orthopaedic Surgery Faculty Papers

INTRODUCTION: Robotic-assisted surgeries in orthopaedics have increased, particularly in hip and knee arthroplasty and spine surgeries. This study evaluates national utilization trends of robotic-assisted orthopaedic surgeries and demographic and geographic distribution of patients undergoing these surgeries.

METHODS: A retrospective cohort study was conducted on patients who underwent total hip arthroplasty, total and partial knee arthroplasty, or spine arthrodesis from 2017 to 2023 using the TriNetX database. Relevant International Classification of Diseases, 10th Revision, and Current Procedural Terminology codes identified patients who underwent a primary surgery with a corresponding robot-assisted code on the same day. Temporal trends in procedural volume were …

Concomitant Subacromial Decompression Remains Commonly Performed During Rotator Cuff Repair: A Trinetx Study, Madison Baldauf, Zachary Krumm, Savannah Ward, Katherine Worcester, Kevin Bonner Md

Knowledge and Creativity Expo

Introduction:

Arthroscopic rotator cuff repair (RCR) is among the most frequently performed shoulder procedures in the US and is often accompanied by concomitant subacromial decompression (SAD). In recent years some studies have called into question the benefit of SAD in this setting. The topic is controversial as many surgeons still feel SAD is indicated. This study aims to characterize the changes in proportion of SAD performed concomitantly with RCR over recent years using TriNetX.

Methods:

The TriNetX database was queried for all patients undergoing arthroscopic rotator cuff repair from 2013 to 2025. Cohorts were established using the Current Procedural Terminology …

Pre-Operative Methicillin-Resistant Staphylococcus Aureus Colonization Increases The Risk Of 90-Day Medical And 2-Year Implant-Related Complications Following Primary Total Shoulder Arthroplasty: A Propensity-Matched Analysis, Muhammad Hamza Ilyas, Tarishi Parmar, Zina Smadi, Viraj A. Deshpande, Akin A. Adio, Joseph A. Abboud, Hafiz F. Kassam

Rothman Institute Papers

BACKGROUND: Pre-operative methicillin-resistant Staphylococcus aureus (MRSA) colonization has been associated with increased risk of post-operative infection and medical complications in lower-extremity arthroplasty; however, its impact on outcomes following total shoulder arthroplasty (TSA) remains poorly understood. This study aims to evaluate the association between MRSA colonization and early medical as well as mid-term implant-related complications after primary TSA.

METHODS: The TriNetX US Research Network was queried to identify primary TSA patients. Propensity score matching (1:1) was performed using demographic characteristics and relevant comorbidities. Ninety-day medical complications, including readmission, emergency department utilization, venous thromboembolism, pneumonia, urinary tract infection, stroke, sepsis, respiratory failure, …

Depression And Psychotic Disorders Worsen Perioperative Outcomes And Increase Resource Utilization After Multilevel Lumbar Fusion: Implications For Screening And Perioperative Care, Leonidas E. Mastrokostas, Paul G. Mastrokostas, Luke B. Schwartz, Abigail Razi, Sean Inzerillo, John K. Houten, Arya Varthi, Alex R. Vaccaro, Jad Bou Monsef, Afshin E. Razi, Mitchell K. Ng

Rothman Institute Papers

CONTEXT: Multilevel lumbar fusion use has increased with an aging U.S. population. Depression and psychotic disorders are linked to poorer surgical outcomes, but their effects in this setting are unclear.

AIMS: The aims of this study were to quantify the prevalence of these disorders and evaluate associations with perioperative outcomes and resource use.

SETTINGS AND DESIGN: This was a retrospective cohort study using the National Inpatient Sample from 2016 to 2022.

SUBJECTS AND METHODS: Depression and psychotic disorders were defined using Elixhauser-derived indicators. Outcomes included medical and mechanical complications, discharge disposition, length of stay (LOS), and costs.

STATISTICAL ANALYSIS USED: …

Patient Perceptions And Knowledge Of Corticosteroid Injections: A Cross-Sectional Survey Study, Juliet Chung, Sina Ramtin, Philip Koehler, Stephen Stache, Charles Langman, Bryan Hozack, Asif M. Ilyas

Rothman Institute Papers

INTRODUCTION: Although cortisone injections are commonly used, patient understanding of cortisone is variable and often affected by misconceptions. This study explores patient perspectives, identifies misconceptions, and emphasizes the importance of improved patient education to enhance patient-centered care.

METHODS: A cross-sectional survey study was conducted from April to August 2024 among patients aged 18 and older presenting to an orthopedic physicians' office. Patients completed a novel anonymous questionnaire designed to assess their knowledge and perceptions of cortisone injections. A total of 246 patients participated, with responses collected electronically via SurveyMonkey.

RESULTS: Among 246 respondents, individuals with history of prior cortisone infections …

Cemented Femoral Fixation In A High-Risk Periprosthetic Fracture Cohort – A Case Series, John Spak, Philip C. Aurigemma, Yaser C. Rahim

The Lahey Journal

Introduction:
Periprosthetic femur fractures (PPFx) are a major cause of early revision after total hip arthroplasty (THA), accounting for nearly 20% of early failures. Cementless fixation, though widely used, has been associated with an increased risk of early PPFx, particularly in elderly or osteoporotic patients. Cemented femoral fixation may reduce this risk in high-risk populations.

Case Presentation:
We performed a retrospective review of 430 consecutive primary THAs conducted between July 2022 and July 2025 at a single institution. Cementless fixation was used in 390 patients and cemented fixation in 40 high-risk patients (mean age 81.7 vs. 65.9 years; BMI 24.5 …

Symptomatic Manifestations Of Hip Dysplasia In Young Adults: How Do Patients Present Before Or After Surgery? Results From A Social Media Cohort, John M. Gaddis, Amanda J. Wheeler, Erika Shults, Charles South, Stephen T. Duncan, Joel Wells

School of Medicine Publications

This study aimed to analyse the symptomatic differences of hip dysplasia before or after separate surgical interventions, including pain location and characteristics, severity, patient-reported outcomes, and a body pain diagram. A REDCap-based survey was distributed through social media from October 2023 to May 2024 and targeted individuals with current or past hip pain. The survey gathered data on demographics, comprehensive hip-specific history, and various patient-reported outcome measures. Of 509 completed surveys, 287 respondents reported a diagnosis of hip dysplasia and were divided into cohorts based on treatment history: no surgery (n = 65), post-periacetabular osteotomy (PAO) (n = 162), post-THA …

Association Between Bmi Z-Score And Postoperative Complications In Pediatric Neuromuscular Scoliosis Surgery, Alexander K Mihas, Dion Birhiray, Chun Wai Hung, Lorenzo R Deveza, Dallas Vanorny, Frank Gerow, Darrell Hanson, Benny Dahl

Faculty, Staff and Students Publications

Study Design

Single-center retrospective review.

Objective

To investigate the association between BMI Z-scores and postoperative complications in pediatric patients with neuromuscular scoliosis undergoing spinal instrumentation.

Methods

Pediatric patients who underwent spinal instrumentation for neuromuscular scoliosis from July 2012 to June 2016 with a minimum 2-year follow-up were included. BMI and BMI Z-scores were calculated, and patients were stratified into CDC-defined BMI-for-age percentiles: underweight (< 5th percentile), normal (5th to < 85th percentile), overweight (85th to < 95th percentile), and obese (≥95th percentile). Logistic regression assessed associations of BMI, BMI Z-score, and BMI groups with postoperative complications.

Results

In total, 147 patients were included. Average follow-up was 3.2 ± 1.4 years. The most common diagnosis was cerebral palsy (39.5%). Complications occurred in 65 (44.2%) patients: 32 (21.8%) had a surgical site infection (SSI), …

Differences In Graft Rupture And Subsequent Meniscal Tears Following Adolescent Acl Reconstruction Using Quadriceps Tendon Versus Hamstrings Autograft: A Retrospective Study With Minimum 2-Year Follow-Up., Morgan E. Swanson, Christopher Defrancesco, Kevin M. Landrum, David Kell, Richa Gandhi, Sulagna Sarkar, Theodore J. Ganley, Kathleen J. Maguire

Department of Medicine Faculty Papers

BACKGROUND: Anterior cruciate ligament (ACL) reconstruction (ACLR) using quadriceps tendon (QT) autograft is associated with lower rates of graft rupture and favorable functional outcomes compared with hamstring (HS) autograft in adolescents. The ACL-deficient knee is at increased risk of injury to secondary stabilizers of the knee, including the menisci, although studies have not reported differences in rates of subsequent meniscal tear between HS and QT groups.

PURPOSE: The goal of this study was to compare rates of graft rupture and subsequent meniscal tear after adolescent ACLR using HS or QT autograft.

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

METHODS: …

Examining The Relationship Between Academic Excellence And Clinical Productivity In Orthopedic Surgery, Mohamad Y. Fares, Xiaoran Zhang, Harry H. Liu, Ana Paula Beck Da Silva Etges, Krishna Chopra, Brian Zhou, Ira Sivaram, Chrishaun Alexander, Peter Boufadel, Porter Jones, Derek A. Haas, Adam Z. Khan, Eric Wagner, Joseph A. Abboud

Rothman Institute Papers

Background/Objectives: The relationship between clinical volume and academic performance in orthopedic surgery remains understudied. The purpose of this study is to explore the characteristics of high-achieving academic orthopedic surgeons in an attempt to extrapolate patterns and trends that govern the relationship between clinical performance and academia in orthopedic surgery. Methods: The 2023 National Plan and Provider Enumeration System and Medicare claims data (2021–2022) databases were used to include all active orthopedic surgeons of different subspecialties. A publication score, based on publication volume, journal impact, and authorship position, was calculated for each included surgeon, and surgeons who scored in the top …

Which Repair Technique, Bone Tunneling Or Suture Anchors, Is Superior When Performing Lesser Tuberosity Osteotomy At The Time Of Stemless Total Shoulder Arthroplasty?, Jared M. Mahylis, Stephaine J. Muh, Mahdi Mazeh, Emil Espinal Nunez, Daniel Oravec, Johnny Kasto, Chimdindu Obinero, Kai Zhu, Yener N. Yeni, Shariff K. Bishai

Conference Presentation Abstracts

INTRODUCTION: Total shoulder arthroplasty (TSA) has evolved as a treatment for advanced shoulder osteoarthrosis, with stemless implants gaining popularity due to reduced risks of stress shielding and complications associated with stemmed designs. However, the optimal technique for repairing the subscapularis during TSA remains under investigation. This study evaluates the biomechanical performance of two repair techniques—bone tunneling and suture anchors—used for Lesser Tuberosity Osteotomy (LTO) in the context of stemless TSA.  
METHODS: Ten shoulders from six cadaveric specimens (3 male, 3 female; aged 58–93) were prepared and allocated to bone tunneling or suture anchor repair groups. Cyclic loading tests were performed, …