Orthopedics Commons^™

Review: Discogenic Back Pain: Update On Treatment, Edgar Remotti, Chinoso Nduaguba, Parker A Woolley, Ryan Ricciardelli, Anh Phung, Rosa Kim, Ivan Urits, Alan David Kaye, Jamal Hasoon, Thomas Simopoulos, Cyrus Yazdi, Christopher L Robinson

Faculty, Staff and Student Publications

Purpose of review: Lower back pain (LBP) has a lifetime prevalence of 80% in the United States population. Discogenic back pain (DBP), a subcategory of LBP, occurs as a result of the interverbal disc degeneration without disc herniation. Diagnosis relies on history, physical exam, and imaging such as MRI, provocative discography, or CT discography.

Recent findings: Treatment of DBP involves a multifaceted approach with an emphasis on conservative measures including behavioral modification, pharmacologic management, and other non-pharmacologic interventions with invasive therapy reserved for select patients. Due to the paucity of data on the treatment of DBP, treatment also relies on …

Fast Multiscale Functional Estimation In Optimal Emg Placement For Robotic Prosthesis Controllers, Jin Ren, Guohui Song, Lucia Tabacu, Yuesheng Xu

Mathematics & Statistics Faculty Publications

Electromyogram (EMG) signals play a significant role in decoding muscle contraction information for robotic hand prosthesis controllers. Widely applied decoders require a large amount of EMG signals sensors, resulting in complicated calculations and unsatisfactory predictions. By the biomechanical process of single degree-of-freedom human hand movements, only several EMG signals are essential for accurate predictions. Recently, a novel predictor of hand movements adopted a multistage sequential adaptive functional estimation (SAFE) method based on the historical functional linear model (FLM) to select important EMG signals and provide precise projections.

However, SAFE repeatedly performs matrix-vector multiplications with a dense representation matrix of the …

Native Bk Polyomavirus Nephropathy In An Orthotopic Heart Transplant Patient, Zachary M Thompson, George Ajene, Prathit A Kulkarni, Nidhi Aggarwal, Savitri Fedson, Maulin K Shah

Faculty, Staff and Students Publications

BK polyomavirus nephropathy (BKVN) is a common cause of nephropathy in kidney transplant patients and is typically seen within the first year after transplantation. BK polyomavirus nephropathy can occur in the native kidneys of patients with nonrenal solid-organ transplants (NRSOT). However, this is rare, especially outside the early post-transplant period, and BKVN is not usually considered in the differential diagnosis for acute kidney injury in NRSOT patients. We present a case of a 75-year-old man who had undergone orthotopic heart transplant 13 years prior with stable allograft function who developed progressive renal dysfunction in the setting of recent unilateral obstructive …

Return To Recreational Sports Participation Following Rotator Cuff Repair In Adults Over 40 Years Of Age: Outcomes And Return To Play Analysis, John Hayden Sonnier, Gregory Connors, Michael P. Campbell, Matthew Sabitsky, Ryan W. Paul, Hayden E. Sando, William D. Emper, Steven B. Cohen, Michael G. Ciccotti, Fotios P. Tjoumakaris, Kevin B. Freedman

Rothman Institute Papers

Background: Despite the high prevalence of rotator cuff (RTC) tears in older adults, there is limited literature evaluating the return to recreational sport after repair. The purpose of this study was (1) to assess the patient-reported outcomes and return to sport rates following rotator cuff repair in patients aged more than 40 years with minimum 2-year follow-up; (2) to compare baseline, preoperative and postoperative outcomes, and level of play following repair of self-reported athletes with nonathletes; and (3) to compare return to sport rates in overhead athletes compared to nonoverhead athletes. Methods: Patients undergoing arthroscopic rotator cuff repair between January …

Effect Of Mesenchymal Stem Cells On Osteoarthritis Of The Knee, Brendan Avery, Jessica Gray

Physician Assistant Capstones, 2020-current

Osteoarthritis of the knee is one the most common sources of chronic pain due to altered joint function.¹ Current treatment modalities offer short term relief of symptoms but lack long term aid and regenerative properties.¹ Mesenchymal stem cells (MSC) offer regenerative and anti-inflammatory properties and can be collected from umbilical cord blood, adipose tissue, or bone marrow.⁴ The three studies included were all randomized controlled trials within the past 10 years that each utilized more than 30 participants who had a diagnosis of osteoarthritis and a mean age above 50 years old. MSCs were compared to corticosteroid …

A Computational Method For Estimating Trunk Muscle Activations During Gait Using Lower Extremity Muscle Synergies, Geng Li, Di Ao, Marleny M Vega, Mohammad S Shourijeh, Payam Zandiyeh, Shuo-Hsiu Chang, Valerae O Lewis, Nicholas J Dunbar, Ata Babazadeh-Naseri, Andrew J Baines, Benjamin J Fregly

Faculty, Staff and Student Publications

One of the surgical treatments for pelvic sarcoma is the restoration of hip function with a custom pelvic prosthesis after cancerous tumor removal. The orthopedic oncologist and orthopedic implant company must make numerous often subjective decisions regarding the design of the pelvic surgery and custom pelvic prosthesis. Using personalized musculoskeletal computer models to predict post-surgery walking function and custom pelvic prosthesis loading is an emerging method for making surgical and custom prosthesis design decisions in a more objective manner. Such predictions would necessitate the estimation of forces generated by muscles spanning the lower trunk and all joints of the lower …

Total Hip Arthroplasty In Patients With Neurological Conditions: A Systematic Review, Conor S O'Driscoll, Andrew J Hughes, Martin S Davey, Joseph M Queally, Brendan J O'Daly

Rothman Institute Papers

Background: As operative techniques and implant design have evolved over time, total hip arthroplasty (THA) is increasingly being carried out for patients with neurological impairment. This patient group places unique surgical challenges to the arthroplasty surgeon, which may include contractures, instability, and altered muscular tone. The purpose of this systematic review is to report the patient outcomes, complications, and implant survival following THA for patients with neurological conditions affecting the hip. Thus, we aim to support orthopaedic surgeon decision-making when considering and planning THA for these patients.

Methods: A systematic review was performed as per Preferred Reporting Items for Systematic …

Development Of A Crosslinked Osteochondral Xenograft And A Collagen Stabilizing Intra-Articular Injection To Remediate Cartilage Focal Lesions To Prevent Osteoarthritis, Mark Lewis Mosher

Theses and Dissertations

Osteoarthritis is one of the most common causes of disability in adults in America. It is a progressive and degenerative disease where the articular cartilage is broken down and lost from the surfaces of bones causing chronic pain and swelling in the joints, and currently has no cure. The most commonly osteoarthritis starts from a focal lesion on the cartilage surface, which will expand on the surface and downwards through the thickness of the tissue. The current gold standard for correcting cartilage focal lesions is the osteochondral autograft/allograft transplantation (OAT), which replaces the defect with a fresh osteochondral graft. The …

Ex Vivo Biomechanical Comparison Of Four Center Of Rotation Angulation Based Leveling Osteotomy Fixation Methods, Melody E. Whitney

Theses and Dissertations

Thirty-two canine tibiae with patellae and patellar tendons were harvested from 17 skeletally mature cadavers. Each tibia was randomly allocated to a construct group: plate and pin (Plate), plate with countersink compression screw (HCS), plate with tension band (TB), or plate with HCS and TB (HCSTB). Samples were loaded by distraction until failure. The stiffness, yield load, and ultimate load were compared between each fixation method. No difference in stiffness of the constructs was detected between groups. Yield load and ultimate load for the HCSTB group was greater than the TB group, the HCS group, and the Plate group. CBLO …

Sagittal Alignment Differences On The Operating Room Table Compared To Preoperative And Postoperative Imaging In Anterior Cervical Discectomy And Fusion, Mark J. Lambrechts, Gregory R. Toci, Brian A. Karamian, Zachary Kozick, John Prodoeh, David Reiter, Rahul Muchintala, Eric Tecce, Alexander Vaccaro Jr., Patrick O’Connor, Amit Syal, Dominic Lambo, Jose A. Canseco, I. David Kay, Barrett I. Woods, Alan S. Hilibrand, Christopher K. Kepler, Alexander R. Vaccaro, Gregory D. Schroeder

Rothman Institute Papers

Study Design: The study design used was a retrospective cohort. Objective: The objective of this study is to determine if intraoperative improvements in sagittal alignment on the operating table persisted on postoperative standing radiographs. Summary of Background Data: Cervical sagittal alignment may be correlated to postoperative outcomes. Since anterior cervical discectomy and fusions (ACDFs) can restore some cervical lordosis through intervertebral grafts/cages, it is important to understand if intraoperative radiographic measurements correlate with persistent postoperative radiographic changes. Materials and Methods: Patients undergoing elective primary ACDF were screened for the presence of lateral cervical radiographs preoperatively, intraoperatively, and postoperatively. Patients were …

The Importance Of Stigma Theory For Clinical Decisions Related To Diabetic Foot Amputations, Rachael Garcia, Callie Bartkowiak, Alison Nesbitt Do

Clinical Research in Practice: The Journal of Team Hippocrates

The authors examine the unconsidered impact of social stigma theory on the shared clinical decision-making process for a patient with foot osteomyelitis and MRSA bacteremia facing the prospect of an amputation.

Comparison Of A Dynamic Ankle Orthosis To A Walking Boot For Preserving Ankle Joint Motion And Reducing Tibial Bone Load And Strain, Perri Johnson Jr.

Theses and Dissertations (ETD)

Tibial stress fractures are a common overuse injury accounting for 21.9 – 69% of stress fractures among runners and 24 – 51.2% of stress fractures in military cadets. Current treatment involves wearing a walking boot for 3 – 12 weeks, which limits ankle motion and causes lower limb muscle atrophy. A Dynamic Ankle Orthosis (DAO) provided a distractive force that offloaded the ankle and retained sagittal ankle excursion during walking. It remains unclear how tibial loading is affected by a walking boot or the DAO. This thesis presents a feasibility study confirming the offloading effects of the DAO on tibial …

It’S Not Arthritis! Resolution Of The Illusion Of Joint Space Narrowing With Acetabuloplasty And Labral Reconstruction For The Calcified Labrum, Jade S Owens, Benjamin R Saks, Kara B Miecznikowski, David R Maldonado, Andrew E Jimenez, Ajay C Lall, Benjamin G Domb

Faculty, Staff and Student Publications

Labral calcification may be part of the natural history of untreated femoroacetabular impingement syndrome (FAIS) in certain patients, making it a potential target for intervention with the goal of preserving the hip joint. The purpose of this study was to investigate if calcified labra create the appearance of lateral joint space narrowing and report minimum 2-year patient-reported outcome measures (PROMs) after treating patients with arthroscopic acetabuloplasty and labral reconstruction. Prospectively collected data on patients who underwent primary hip arthroscopy for FAIS and labral tearing from February 2015 to April 2021 were reviewed. Patients treated with primary labral reconstruction for an …

Dnp Final Report: Multimodal Pain Management To Improve Patient Satisfaction In Total Joint Replacement Patients, Dana A. Carns

DNP Final Reports

Pain is a costly result of total joint replacement (TJR) surgery. The effect of pain can extend not only to chronic medical problems for patients but also to the hospital’s bottom line by decreasing patient satisfaction. A systematic literature search was performed, and evidence was appraised that supported the efficacy of a standardized multimodal pain management protocol to decrease pain and improve satisfaction in TJR patients. The evidence-based multimodal pain management protocol was implemented during a one-month period in patients undergoing total knee or total hip replacements. Key outcomes were examined and compared to the body of evidence and to …

Perceived Efficacy, Reduced Prescription Drug Use, And Minimal Side Effects Of Cannabis In Patients With Chronic Orthopedic Pain, Ari Greis, Eric Larsen, Conan Liu, Bryan Renslo, Anjithaa Radakrishnan, Adrianne R Wilson-Poe

Rothman Institute Papers

Introduction: Although cannabis is widely used for the treatment of chronic pain, most research relies on patient self-report and few studies have objectively quantified its efficacy and side effects. Extant inventories for measuring cannabis use were not designed to capture the medically relevant features of cannabis use, but rather were designed to detect problematic use or cannabis use disorder. Thus, we sought to capture the medically relevant features of cannabis use in a population of patients with orthopedic pain and pair these data with objective measures of pain and prescription drug use. Materials and Methods: In this prospective observational study, …

Perceptions Of Orthopaedic Medicine Students And Their Supervisors About Practice-Based Learning: An Exploratory Qualitative Study, Muhamed Nsubuga, Robert Opoka, Moses Galukande, Ian G. Munabi, Aloysius . Mubuuke, Sarah Kiguli

Paediatrics and Child Health, East Africa

Background: Practice-based learning is crucial in forming appropriate strategies for improving learning among the medical students that support the country’s understaffed health sector. Unsatisfactory learning consequently results in poor performance of students and poor quality of health care workforce in the long run. Exploring the perceptions about the current practice-based learning system and how to improve is thus vital. This study set out to explore the perceptions of Orthopaedic medicine students and their supervisors about practice-based learning at a tertiary training hospital.

Methods: This was an exploratory phenomenological qualitative study that involved in-depth interviews among 10 Orthopedic students during their …

Perioperative Chanage In Cervical Lordosis And Health-Related Quality-Of-Life Outcomes, Jose A Canseco, Brian A Karamian, Parthik D Patel, Michael Markowitz, Joseph K Lee, Mark F Kurd, D Greg Anderson, Jeffrey A Rihn, Alan S Hilibrand, Christopher K Kepler, Alexander R Vaccaro, Gregory D Schroeder

Rothman Institute Papers

BACKGROUND: Surgeons have scrutinized spinal alignment and its impact on improving clinical outcomes following anterior cervical discectomy and fusion (ACDF). The primary analysis of this study examines the relationship between change in perioperative cervical lordosis (CL) and health-related quality-of-life (HRQOL) outcomes after ACDF. Secondary analysis evaluates the effects of fusion construct length on outcomes in patients grouped by preoperative cervical alignment.

METHODS: A retrospective cohort study was performed on an institutional database including patients who underwent 1- to 3-level ACDF. C2-C7 CL was measured preoperatively and at final follow-up. For primary analysis, patients were classified based on their perioperative cervical …

Quantification Of Manipulation Forces Needed For Robot-Assisted Reduction Of The Ankle Syndesmosis: An Initial Cadaveric Study, Mikias Gebremeskel, Babar Shafiq, Ali Uneri, Niral Sheth, Corey Simmerer, Wojciech Zbijewski, Jeffrey H Siewerdsen, Kevin Cleary, Gang Li

Faculty, Staff and Student Publications

PURPOSE: Manual surgical manipulation of the tibia and fibula is necessary to properly align and reduce the space in ankle fractures involving sprain of the distal tibiofibular syndesmosis. However, manual reduction is highly variable and can result in malreduction in about half of the cases. Therefore, we are developing an image-guided robotic assistant to improve reduction accuracy. The purpose of this study is to quantify the forces associated with reduction of the ankle syndesmosis to define the requirements for our robot design.

METHODS: Using a cadaveric specimen, we designed a fixture jig to fix the tibia securely on the operating …

Cross-Sectional Area Of The Longus Colli And Cervical Degenerative Spondylolisthesis: A Retrospective Review Evaluating This Anatomic Consideration, Khoa Tran, Aditya Mazmudar, Taylor Paziuk, Mark J. Lambrechts, Eric Tecce, Olivia Blaber, Kamil Okroj, Brian A Karamian, Jose A Canseco, Jeffrey A Rihn, Alan Hilibrand, Christopher Kepler, Alexander R. Vaccaro, Gregory D. Schroeder

Department of Orthopaedic Surgery Faculty Papers

Background: Limited literature is available to define the impact of the longus colli muscle, a deep flexor of the spine, on cervical spine stability despite its close proximity to the vertebrae. Aims and Objectives: The purpose of this study was to determine if longus colli cross-sectional area (CSA) is associated with the severity preoperative cervical degenerative spondylolisthesis. Materials and Methods: Patients undergoing elective anterior cervical discectomy and fusion (ACDF) for cervical spondylolisthesis between 2010-2021 were retrospectively identified. Longus colli cross-sectional areas (CSA) were measured from preoperative MRI images at the C5 level. Preoperative spondylolisthesis measurements were recorded with cervical radiographs. …

Low-Dose Aspirin For Venous Thromboembolism Prophylaxis Is Associated With Lower Rates Of Periprosthetic Joint Infection After Total Joint Arthroplasty, Farideh Najafi, Joseph K. Kendal, Nicholas V. Peterson, Kerri-Anne Ciesielka, Camilo Restrepo, Javad Parvizi, Nicholas M. Bernthal

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Aspirin as a venous thromboembolism (VTE) prophylactic agent has been shown to have antistaphylococcal and antibiofilm roles. Optimal acetylsalicylic acid (ASA) dosage would facilitate antimicrobial effects while avoiding over-aggressive inhibition of platelet antimicrobial function. Our purpose was to determine the periprosthetic joint infection (PJI) rate after total joint arthroplasty in patients receiving low-dose ASA (81 mg twice a day), in comparison to high-dose ASA (325 mg twice a day).

METHODS: We conducted a retrospective cohort study between 2008 and 2020. Eligible patients were older than 18 years, underwent primary total joint arthroplasty, both total knee arthroplasty and total hip …