Orthopedics Commons^™

Direct Anterior Versus Direct Lateral Hip Approach In Total Hip Arthroplasty With The Same Perioperative Protocols One Year Post Fellowship Training, Asim M. Makhdom, William J. Hozack

Rothman Institute Papers

BACKGROUND: Variable results have been reported regarding the clinical outcomes in Total hip arthroplasty (THA) based on the surgical approach. The aim of this study is to compare the clinical outcomes between Direct anterior (DA) and direct lateral (DL) approaches in THA when performed immediately after fellowship training.

METHODS: During the 1st year of practice, all consecutive patients who underwent THA via DA and DL hip approaches were retrospectively investigated. Patients' demographics, diagnosis, American society of Anesthesiology (ASA) score, route of anesthesia, length of hospital stay (LOS), leg length discrepancy (LLD), radiographic parameters, operative time, number of opioids refills postoperatively, …

Minimalistic Approach To Enhanced Recovery After Pediatric Scoliosis Surgery, Scott A. Barnett, Bryant M. Song, Matthew Bauer, Matthew E. Nungesser, Claudia Leonardi, Michael J. Heffernan

School of Medicine Faculty Publications

Purpose: Prior studies of enhanced recovery protocols (ERP) have been conducted at large institutions with abundant resources. These results may not apply at institutions with less resources directed to quality improvement efforts. The purpose of this study was to assess the value of a minimalistic enhanced recovery protocol in reducing length of stay (LOS) following PSF for adolescent idiopathic scoliosis. We hypothesized that accelerated transition to oral pain medications and mobilization alone could shorten hospital length of stay in the absence of a formal multimodal pain regimen. Methods: AIS patients aged 10–18 who underwent PSF at a tertiary pediatric hospital …

Nationwide Results Of Microorganism Antigen Testing As A Component Of Preoperative Synovial Fluid Analysis., Krista O'Shaughnessey Toler, Pearl Ravindra Paranjape, Alex Mclaren, Brett Levine, Alvin Ong, Carl Deirmengian

Rothman Institute Papers

BACKGROUND: Antigen immunoassays to detect synovial fluid (SF) microorganisms have recently been made available for clinical use. The purpose of this study was to determine the sensitivity and specificity of an SF microorganism antigen immunoassay detection (MID) panel, evaluate the panel's capability to detect microorganisms in the setting of culture-negative periprosthetic joint infection (PJI), and determine diagnostic predictive values of the MID panel for PJI.

METHODS: This study included 67,441 SF samples obtained from a hip or knee arthroplasty, from 2,365 institutions across the United States, submitted to 1 laboratory for diagnostic testing. All data were prospectively compiled and then …

Magnetized Chitosan Hydrogel And Silk Fibroin, Reinforced With Pva: A Novel Nanobiocomposite For Biomedical And Hyperthermia Applications, Reza Eivazzadeh-Keihan, Zeinab Pajoum, Hooman Aghamirza Moghim Aliabadi, Adibeh Mohammadi, Amir Kashtiaray, Milad Salimi Bani, Banafshe Pishva, Ali Maleki, Majid M Heravi, Mohammad Mahdavi, Elaheh Ziaei Ziabari

Department of Orthopaedic Surgery Faculty Papers

Herein, a multifunctional nanobiocomposite was designed for biological application, amongst which hyperthermia cancer therapy application was specifically investigated. This nanobiocomposite was fabricated based on chitosan hydrogel (CS), silk fibroin (SF), water-soluble polymer polyvinyl alcohol (PVA) and iron oxide magnetic nanoparticles (Fe₃O₄ MNPs). CS and SF as natural compounds were used to improve the biocompatibility, biodegradability, adhesion and cell growth properties of the nanobiocomposite that can prepare this nanocomposite for the other biological applications such as wound healing and tissue engineering. Since the mechanical properties are very important in biological applications, PVA polymer was used to increase the …

Glut1 Is Redundant In Hypoxic And Glycolytic Nucleus Pulposus Cells Of The Intervertebral Disc, Shira N. Johnston, Elizabeth S. Silagi, Vedavathi Madhu, Duc H. Nguyen, Irving M. Shapiro, Makarand V. Risbud

Department of Orthopaedic Surgery Faculty Papers

Glycolysis is central to homeostasis of nucleus pulposus (NP) cells in the avascular intervertebral disc. Since the glucose transporter, GLUT1, is a highly enriched phenotypic marker of NP cells, we hypothesized that it is vital for the development and postnatal maintenance of the disc. Surprisingly, primary NP cells treated with 2 well-characterized GLUT1 inhibitors maintained normal rates of glycolysis and ATP production, indicating intrinsic compensatory mechanisms. We showed in vitro that NP cells mitigated GLUT1 loss by rewiring glucose import through GLUT3. Of note, we demonstrated that substrates, such as glutamine and palmitate, did not compensate for glucose restriction resulting …

Comparing Five Equations To Calculate Estimated Glomerular Filtration Rate To Predict Acute Kidney Injury Following Total Joint Arthroplasty., Kevin L Mekkawy, Yash P Chaudhry, Sandesh S Rao, Micheal Raad, Raj M Amin, Harpal S Khanuja

Orthopedic Surgery Resident Research

BACKGROUND: Acute kidney injury (AKI) following total joint arthroplasty (TJA) is associated with increased morbidity and mortality. Estimated glomerular filtration rate (eGFR) is used as an indicator of renal function. The purpose of this study was (1) to assess each of the five equations that are used in calculating eGFR, and (2) to evaluate which equation may best predict AKI in patients following TJA.

METHODS: The National Surgical Quality Improvement Program (NSQIP) was queried for all 497,261 cases of TJA performed from 2012 to 2019 with complete data. The Modification of Diet in Renal Disease (MDRD) II, re-expressed MDRD II, …

Pedicle Screw-Associated Violation Of The Adjacent Unfused Facet Joint: Clinical Outcomes And Fusion Rates, Nathan J. Sinz, David Hanwuk Kim, Raymond W. Hwang, Gyu-Ho Lee, Kevin Charles Baker, Rick C. Sasso, Daniel K. Park, Jeffrey S. Fischgrund, Ruijia Niu

Conference Presentation Abstracts

INTRODUCTION: Lumbar spine pedicle screws are the most commonly utilized implants for providing immediate spinal stability during fusion surgery. Ideal pedicle screw positioning includes avoiding violation of any adjacent unfused facet joints. Nevertheless, inadvertent screw malposition and screw-associated violation of adjacent facet joints (FJV) remains a potential complication of the procedure regardless of whether surgery is performed in open fashion or with minimally invasive techniques and despite the use of intraoperative imaging or surgical navigation. Given the proximity of the lumbar vertebral pedicle to the proximal facet joint, FJV occurs almost exclusively at the level of the proximal as opposed …

Analysis Of The Effects Of Intraoperative Neurophysiological Monitoring On Anterior Cervical Surgery: A Michigan Spine Surgery Improvement Collaborative (Mssic) Study, Conner D. Ahlgren, Philip Zakko, Andrew Zachary Blankenship, Daniel K. Park

Conference Presentation Abstracts

INTRODUCTION: The utility of intraoperative neurophysiological monitoring (IOM) for anterior cervical surgery remains controversial. Despite insufficient evidence demonstrating a clear benefit, IOM continues to be utilized and in some areas is considered standard of care. The aim of this study was to evaluate the effects of IOM on anterior cervical surgery outcomes by utilizing data from the Michigan Spine Surgery Improvement collaborative. METHODS: Anterior cervical surgeries from February 2014 to November 2019 were included for analysis. IOM (EMG, MMG, SSEPs, or MEP) was the primary variable examined. Primary outcome measures were: new weakness after surgery, new radicular symptoms, return to …

Assessing General Vs. Spinal Anesthesia As A Risk Factor For 90-Day Emergency Department Visits Status-Post Index Total Knee Arthroplasty: A Retrospective Case Control Study, Ian Penvose, Helen E. Huetteman, James Feng, Robert Runner, Drew Douglas Moore, Mark S. Karadsheh

Conference Presentation Abstracts

INTRODUCTION: As bundle payment care initiatives become ever prevalent in total knee arthroplasty (TKA), institutions have increasingly focused on cost-saving measures which maintain or improve upon the standard of care. One area of interest is identifying potential modifiable and non-modifiable risk factors. Here we evaluate the correlations of general versus spinal anesthesia in TKAs in perioperative outcomes. METHODS: All primary TKAs between 7/1/2013 to 12/31/2017 were obtained retrospectively from a prospective institutional database utilized for contribution to a state-wide joint arthroplasty database. Prospective data includes baseline demographics, select medical comorbidities, intraoperative variables and postoperative course/complications. Patients were separated into two …

Shorter Length Of Stay And Increased Return To Work With Cervical Disc Arthroplasty Versus Anterior Cervical Discectomy And Fusion, Philip Zakko, Alex Miller, Daniel K. Park, Jad Khalil

Conference Presentation Abstracts

INTRODUCTION: Anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) are established surgical options for the treatment of cervical radiculopathy, myelopathy, and cervical degenerative disc disease. However, current literature does not demonstrate a clear benefit between ACDF or CDA. The primary objective of this study is to compare the outcomes of ACDF and CDA for patients enrolled in the Michigan Spine Surgery Improvement Collaborative (MSSIC) database. Secondary objectives include assessment of early complications, procedural/perioperative outcomes, and patient-reported outcome measures after both ACDF and CDA. METHODS: Patients undergoing 1 or 2 level ACDF or CDA surgery were included. A …

Assessing Public Reported Perceptions Of Hand Surgery Provided In The Office Vs. An Ambulatory Surgery Center, Trevor Tooley, James Feng, Jannat Khan, Paul Scott Shapiro

Conference Presentation Abstracts

INTRODUCTION: There is a growing body of literature supporting the efficacy, safety, and benefits of wide awake office-based low risk hand surgery. Procedures such as a carpal tunnel release are now, under the right clinical circumstances, being performed in the office-setting as opposed to a traditional operating room. While there is growing evidence supporting technique, procedure room setup, and cost analyses of office-based surgery, there is little investigation into the public perceptions of having surgery done in the office. Here we sought to evaluate public perceptions of undergoing low risk hand surgery in the office setting. METHODS: A prospective survey …

Assessing Risk Factors For 90-Day Emergency Department Visits Status-Post Index Total Knee Arthroplasty: A Retrospective Case Control Study, Ian Penvose, Helen E. Huetteman, Phil Vartanyan, James Feng, Robert Runner, Drew Douglas Moore, Mark S. Karadsheh

Conference Presentation Abstracts

INTRODUCTION: With the increasing adoption of value-based healthcare initiatives in total knee arthroplasty (TKA), a greater emphasis has been placed on implementing cost-saving measures while maintaining or improving quality of care. One area of interest has been postoperative ED visits. Here we evaluate potential risk factors for 90-day ED visits. METHODS: This is a case control study from a large, tertiary, private, academic institution. All primary TKAs between 7/1/2013 to 12/31/2017 were obtained retrospectively from a prospective institutional database utilized for contribution to a state-wide joint arthroplasty database. All patient charts were subsequently verified and reviewed for all-cause 90-day ED …

Surgeon Estimations Of Acetabular Cup Orientation Using Intraoperative Fluoroscopic Imagining Are Unreliable., Parker L Brush, Adrian Santana, Gregory R Toci, Eric Slotkin, Michael Solomon, Tristan Jones, Arjun Saxena

Rothman Institute Papers

BACKGROUND: Accurate acetabular cup orientation is associated with decreased revision rates and improved outcomes of primary total hip arthroplasty. This study assesses surgeon's ability to estimate both the acetabular component inclination and anteversion angles via intraoperative fluoroscopy (IF) images.

METHODS: We surveyed orthopedic surgeons to estimate acetabular component inclination and anteversion based on 20 IF images of total hip arthroplasty through a direct anterior approach. Postoperative computed-tomography scans were used to calculate the true inclination and anteversion component angles. The absolute difference between the true and estimated values was calculated to determine the mean and standard deviation of the survey …

Open Posterior Reduction And Stabilization Of Ao Spine C3 Sacral Fractures, Philipp Kobbe, Gregory D. Schroeder, Klaus J. Schnake, Lorin M. Benneker, Mark Lambrechts, Frank Hildebrand, Richard M. Sellei

Rothman Institute Papers

AO Spine C3 sacral fractures are defined by separation of the spine including S1 from the pelvic ring and are usually result of a high-energy injury. Besides their high biomechanical instability and high rate of associated neurological impairment, these fractures are often extremely difficult to reduce due to severe bony impaction and dislocation. Additional difficulties in management of these fractures arise from only a thin-layer of soft-tissue coverage overlying the injured area.

Analysis Of Orthopaedic In-Training Examination Trauma Questions: 2017 To 2021, Lilah Fones, Daryl C. Osbahr, Daniel E. Davis, Andrew M. Star, Atif K. Ahmed, Arjun Saxena

Rothman Institute Papers

INTRODUCTION: The Orthopaedic In-Training Examination (OITE) is a multiple-choice examination developed by the American Academy of Orthopaedic Surgeons annually since 1963 to assess orthopaedic residents' knowledge. This study's purpose is to analyze the 2017 to 2021 OITE trauma questions to aid orthopaedic residents preparing for the examination.

METHODS: The 2017 to 2021 OITEs on American Academy of Orthopaedic Surgeons' ResStudy were retrospectively reviewed to identify trauma questions. Question topic, references, and images were analyzed. Two independent reviewers classified each question by taxonomy.

RESULTS: Trauma represented 16.6% (204/1,229) of OITE questions. Forty-nine percent of trauma questions included images (100/204), 87.0% (87/100) …

Carbon Fiber-Reinforced Polyetheretherketone Spinal Implants For Treatment Of Spinal Tumors: Perceived Advantages And Limitations, Christopher Alvarez-Breckenridge, Romulo De Almeida, Ali Haider, Matthew Muir, Justin Bird, Robert North, Laurence Rhines, Claudio Tatsui

Faculty, Staff and Student Publications

PURPOSE: Carbon-fiber reinforced polyetheretherketone (CFRP)-based spinal implants are an alternative to titanium, offering less image artifact as their metallic counterparts while maintaining similar biomechanical and biocompatibility properties. Its use in the management of spinal tumors has been reported, however the perceived advantages related to improved imaging quality, radiation treatment planning, and detection of tumor recurrence have not been fully assessed.

METHODS: We performed a retrospective review of medical records amongst oncologic patients treated at MD Anderson Cancer Center with CFRP implants. Histology, tumor location, construct features, time of follow-up, adjuvant radiation, recurrences, overall survival, and hardware-related complications were recorded.

RESULTS: …

Peri-Implant Proximal Humerus Fracture Stabilized With Stacked Plating: A Case Report., Daniel T Degenova, Matthew T Glazier, John B Schrock, Brian W Skura, Taylor N Hockman, Benjamin C Taylor

Surgery Articles

INTRODUCTION: A peri-implant proximal humerus fracture is a rare complication after open reduction and internal fixation (ORIF) and poses a surgical dilemma.

CASE REPORT: A 56-year-old male sustained a peri-implant proximal humerus fracture after undergoing ORIF. We present a stacked plating method for fixation of this injury. This construct allows for decreased operative time, less soft-tissue dissection, and the ability to leave previous intact hardware in place.

CONCLUSION: We describe the rare case of a peri-implant proximal humerus treated with stacked plating.

Differences Between Patients With Diabetes Mellitus And Those Without In Cases Of Necrotizing Fasciitis., Daniel T Degenova, Scott S Hyland, Tucker Peabody, Nolan P Schmitz, Devon Myers, Robert Patterson, Jignesh Patel

Surgery Articles

Purposes This study aims to evaluate further differences between patients with diabetes and those without who have been diagnosed with necrotizing fasciitis (NF) to assist clinicians in improving morbidity and mortality. Methods All patients diagnosed with NF of an extremity were retrospectively reviewed and divided into two groups based on a diagnosis of diabetes. Patient charts were reviewed to obtain multiple variables, which were compared between groups. Results From 2015 to 2021, 115 patients underwent surgical intervention due to concern for NF of an extremity with 92 patients included for data computation. Patients with diabetes had an average Laboratory Risk …

Approximating Scaffold Printability Utilizing Computational Methods, Ashkan Sedigh, Pejman Ghelich, Jacob Quint, Evelyn C Mollocana-Lara, Mohamadmahdi Samandari, Ali Tamayol, Ryan E. Tomlinson

Department of Orthopaedic Surgery Faculty Papers

Bioprinting facilitates the generation of complex, three-dimensional (3D), cell-based constructs for various applications. Although multiple bioprinting technologies have been developed, extrusion-based systems have become the dominant technology due to the diversity of materials (bioinks) that can be utilized, either individually or in combination. However, each bioink has unique material properties and extrusion characteristics that affect bioprinting utility, accuracy, and precision. Here, we have extended our previous work to achieve high precision (i.e. repeatability) and printability across samples by optimizing bioink-specific printing parameters. Specifically, we hypothesized that a fuzzy inference system (FIS) could be used as a computational method to address …

Toll-Like Receptor 4 Signaling In Osteoblasts Is Required For Load-Induced Bone Formation In Mice, Ibtesam Rajpar, Gaurav Kumar, Paolo Fortina, Ryan E. Tomlinson

Department of Orthopaedic Surgery Faculty Papers

In mature bone, NGF is produced by osteoblasts following mechanical loading and signals through resident sensory nerves expressing its high affinity receptor, neurotrophic tyrosine kinase receptor type 1 (TrkA), to support bone formation. Here, we investigated whether osteoblastic expression of Toll-like receptor 4 (TLR4), a key receptor in the NF-κB signaling pathway, is required to initiate NGF-TrkA signaling required for load-induced bone formation. Although Tlr4 conditional knockout mice have normal skeletal mass and strength in adulthood, the loss of TLR4 signaling significantly reduced lamellar bone formation following loading. Inhibition of TLR4 signaling reduced Ngf expression in primary osteoblasts and RNA …