Orthopedics Commons^™

Retrieval Analysis Of Necropsy Total Hip Replacements: Considerations Beyond The Implant, Julie Alyse Lowell

Theses and Dissertations (ETD)

Introduction. Total hip arthroplasty (THA) surgery is one of the most commonly performed and successful orthopedic procedures in the United States. More than 300,000 primary THAs and 40,000 revision THAs performed in the United States every year. While the need for revision surgeries can stem from a variety of causes, there have been, to the author’s knowledge, no studies attempting to correlate the concentrations of certain inflammatory cytokines to metal ion concentrations found in the tissue surrounding the implant, amount of polyethylene wear, or strength of the interface of the modular taper. The purpose of this study was to begin …

Platelet-Rich Plasma Injection With Percutaneous Needling For Recalcitrant Lateral Epicondylitis: Comparison Of Tenotomy And Fenestration Techniques., Michael P. Gaspar, Michael A. Motto, Sarah Lewis, Sidney M. Jacoby, Randall W. Culp, A. Lee Osterman, Patrick M. Kane

Department of Orthopaedic Surgery Faculty Papers

Background: Recalcitrant lateral epicondylitis (LE) is a common debilitating condition, with numerous treatment options of varying success. An injection of platelet-rich plasma (PRP) has been shown to improve LE, although it is unclear whether the method of needling used in conjunction with a PRP injection is of clinical importance.

Purpose: To determine whether percutaneous needle tenotomy is superior to percutaneous needle fenestration when each is combined with a PRP injection for the treatment of recalcitrant LE.

Study Design: Cohort study; Level of evidence, 3.

Methods: A total of 93 patients with recalcitrant LE were treated with a PRP injection and …

Antibiotic Spacers In Shoulder Arthroplasty: Comparison Of Stemmed And Stemless Implants., Eric M. Padegimas, Alexia Narzikul, Cassandra Lawrence, Benjamin A. Hendy, Joseph A. Abboud, Matthew L. Ramsey, Gerald R R. Williams, Surena Namdari

Department of Orthopaedic Surgery Faculty Papers

Background: Antibiotic spacers in shoulder periprosthetic joint infection deliver antibiotics locally and provide temporary stability. The purpose of this study was to evaluate differences between stemmed and stemless spacers.

Methods: All spacers placed from 2011 to 2013 were identified. Stemless spacers were made by creating a spherical ball of cement placed in the joint space. Stemmed spacers had some portion in the humeral canal. Operative time, complications, reimplantation, reinfection, and range of motion were analyzed.

Results: There were 37 spacers placed: 22 were stemless and 15 were stemmed. The stemless spacer population was older (70.9 ± 7.8 years vs. 62.8 …

Psoas Abscess Masquerading As A Prosthetic Hip Infection: A Case Report, Muhammad Atif, Azeem Tariq Malik, Shahryar Noordin

Section of Orthopaedic Surgery

Introduction: Psoas abscess is an unusual condition and is defined as a collection of pus in the iliopsoas compartment. Due to the unique anatomy of psoas muscle it forms a conduit for spread of infection from upper part of body to hip joint in neglected cases.
Case Presentation: A 67year old lady presented with left groin pain for three weeks. She underwent an uncemented unipolar hemiarthoplasty eight years back. Currently, she developed fever and was unable to do any active left hip range of motion. Passive motion of the left hip was restricted to 30° flexion, no internal rotation, 5° …

A Murine Model For Developmental Dysplasia Of The Hip: Ablation Of Cx3cr1 Affects Acetabular Morphology And Gait., George J. Feldman, Arlene Offemaria, Hind Sawan, Javad Parvizi, Theresa A. Freeman

Rothman Institute Papers

BACKGROUND: Developmental dysplasia of the hip (DDH) is a debilitating condition whose distinguishing signs include incomplete formation of the acetabulum leading to dislocation of the femur, accelerated wear of the articular cartilage and joint laxity resulting in osteoarthritis. It is a complex disorder having environmental and genetic causes. Existing techniques fail to detect milder forms of DDH in newborns leading to hip osteoarthritis in young adults. A sensitive, specific and cost effective test would allow identification of newborns that could be non-invasively corrected by the use of a Pavlik harness. Previously, we identified a 2.5 MB candidate region on human …

Conference Proceedings: Aurora Scientific Day 2017

Journal of Patient-Centered Research and Reviews

This supplement includes select abstracts presented at the 43rd Annual Aurora Scientific Day research symposium on May 24, 2017. Aurora Scientific Day hosts a forum for original research conducted by faculty, fellows, residents, and other allied health professionals affiliated with Aurora Health Care, an integrated health system headquartered in Milwaukee, Wisconsin.

Effects Of Revision Surgery On Grade Of Adverse Local Tissue Reaction Following Recall Of A Modular Hip Implant, Joseph F. Davies, Danielle M. Greer, Susan Truchan

Journal of Patient-Centered Research and Reviews

Background: The Stryker Rejuvenate modular hip implant device allows for greater versatility in matching a patient’s anatomy than conventional implants. Device recalls and in vivo metal hypersensitivity after total hip arthroplasty (THA) are common. However, recall of the Rejuvenate implant represents one of the largest recall volumes to date, highlighting our uncertainty regarding causes of device metal fretting/corrosion and adverse local tissue reaction (ALTR). While devices with metal-on-metal bearings historically were culprits for release of metal debris, more recently developed modular-neck devices add opportunity for adjacent metal components to rub together. With the Rejuvenate device, corrosion or fretting likely occurs …

Metastatic Deaths In Retinoblastoma Patients Treated With Intraarterial Chemotherapy (Ophthalmic Artery Chemosurgery) Worldwide., David H. Abramson, Carol L. Shields, Pascal Jabbour, Luiz Fernando Teixeira, José Roberto Falco Fonseca, Marcio Chaves Pedro Marques, Francis L. Munier, Francesco Puccinelli, Theodora Hadjistilianou, Sandra Bracco, Guillermo Chantada, Alejandro Ceciliano, Y. Pierre Gobin

Department of Neurosurgery Faculty Papers

BACKGROUND: Ophthalmic artery chemosurgery [OAC, intra-arterial chemotherapy (IAC)] was introduced in 2006 as treatment modality for intraocular retinoblastoma. The purpose of this commentary is to retrospectively review the incidence of metastatic deaths in retinoblastoma patients treated with OAC worldwide over a 10 year period. Retrospective data regarding metastatic deaths was collected from six international retinoblastoma centers (New York City USA, Philadelphia USA, Sao Paulo Brazil, Siena Italy, Lausanne Switzerland and Buenos Aires Argentina). All retinoblastoma patients from these centers (naive and recurrent, unilateral and bilateral) treated with OAC/IAC since 2006 have been included in this study. Data regarding number of …

Tnf-Α Promotes Nuclear Enrichment Of The Transcription Factor Tonebp/Nfat5 To Selectively Control Inflammatory But Not Osmoregulatory Responses In Nucleus Pulposus Cells., Zariel I. Johnson, Alexandra C. Doolittle, Joseph W. Snuggs, Irving M. Shapiro, Christine L. Le Maitre, Makarand V. Risbud

Department of Orthopaedic Surgery Faculty Papers

Intervertebral disc degeneration (IDD) causes chronic back pain and is linked to production of proinflammatory molecules by nucleus pulposus (NP) and other disc cells. Activation of tonicity-responsive enhancer-binding protein (TonEBP)/NFAT5 by non-osmotic stimuli, including proinflammatory molecules, occurs in cells involved in immune response. However, whether inflammatory stimuli activate TonEBP in NP cells and whether TonEBP controls inflammation during IDD is unknown. We show that TNF-α, but not IL-1β or LPS, promoted nuclear enrichment of TonEBP protein. However, TNF-α-mediated activation of TonEBP did not cause induction of osmoregulatory genes. RNA sequencing showed that 8.5% of TNF-α transcriptional responses were TonEBP-dependent and …

Perceived Stress Levels May Impact Upper Extremity Function Among Women Treated For Breast Cancer, Mary Insana Fisher, Anne Fleischer, Lynn Hendricks, Megan Mcclure, Kim Parent, Renee Roberts

Physical Therapy Faculty Publications

Purpose/Hypothesis: Women treated for breast cancer report ongoing upper extremity disability with functional limitations; however, objective measures do not appear to explain the extent of perceived dysfunction. The purpose of this study was to investigate the relationship between perceived stress level, fear of physical activity, self-reported upper extremity function, and objective measures of upper extremity function including range of motion (ROM), strength, and muscular endurance, among women treated for breast cancer.

Number of Subjects: 25

Materials/Methods: Women diagnosed with stage I-III breast cancer in the past 12-60 months were evaluated using the Disabilities of the Arm, Shoulder and Hand (DASH), …

Sacral Fractures And Associated Injuries., Ricardo Rodrigues-Pinto, Mark F. Kurd, Gregory D. Schroeder, Christopher K. Kepler, James C. Krieg, Jörg H. Holstein, Carlo Bellabarba, Reza Firoozabadi, F Cumhur Oner, Frank Kandziora, Marcel F. Dvorak, Conor P. Kleweno, Luiz R. Vialle, S. Rajasekaran, Klause J. Schnake, Alexander R. Vaccaro

Rothman Institute Papers

STUDY DESIGN: Literature review.

OBJECTIVE: The aim of this review is to describe the injuries associated with sacral fractures and to analyze their impact on patient outcome.

METHODS: A comprehensive narrative review of the literature was performed to identify the injuries associated with sacral fractures.

RESULTS: Sacral fractures are uncommon injuries that result from high-energy trauma, and that, due to their rarity, are frequently underdiagnosed and mistreated. Only 5% of sacral fractures occur in isolation. Injuries most often associated with sacral fractures include neurologic injuries (present in up to 50% of sacral fractures), pelvic ring disruptions, hip and lumbar spine …

Inhibition Of Apoptosis Signal-Regulating Kinase 1 Alters The Wound Epidermis And Enhances Auricular Cartilage Regeneration., Qian-Shi Zhang, Deepa S. Kurpad, My G. Mahoney, Marla J. Steinbeck, Theresa A. Freeman

Department of Orthopaedic Surgery Faculty Papers

Why regeneration does not occur in mammals remains elusive. In lower vertebrates, epimorphic regeneration of the limb is directed by the wound epidermis, which controls blastema formation to promote regrowth of the appendage. Herein, we report that knockout (KO) or inhibition of Apoptosis Signal-regulated Kinase-1 (ASK1), also known as mitogen-activated protein kinase kinase kinase 5 (MAP3K5), after full thickness ear punch in mice prolongs keratinocyte activation within the wound epidermis and promotes regeneration of auricular cartilage. Histological analysis showed the ASK1 KO ears displayed enhanced protein markers associated with blastema formation, hole closure and regeneration of auricular cartilage. At seven …

Serum D-Dimer Test Is Promising For The Diagnosis Of Periprosthetic Joint Infection And Timing Of Reimplantation., Alisina Shahi, Michael M. Kheir, Majd Tarabichi, Hamid R.S. Hosseinzadeh, Timothy L. Tan, Javad Parvizi

Rothman Institute Papers

BACKGROUND: Despite the availability of a battery of tests, the diagnosis of periprosthetic joint infection (PJI) continues to be challenging. Serum D-dimer assessment is a widely available test that detects fibrinolytic activities that occur during infection. We hypothesized that patients with PJI may have a high level of circulating D-dimer and that the presence of a high level of serum D-dimer may be a sign of persistent infection in patients awaiting reimplantation.

METHODS: This prospective study was initiated to enroll patients undergoing primary and revision arthroplasty. Our cohort consisted of 245 patients undergoing primary arthroplasty (n = 23), revision for …

Varied Percutaneous And Endovascular Management Of Large Iatrogenic Profunda Femoris Artery Pseudoaneurysm, Wasey Jillani, Raza Sayani, Masood Umer, Muhammad Azeemuddin

Section of Orthopaedic Surgery

The case of an elderly male diagnosed with a large iatrogenic pseudoaneurysm arising from the profunda femoris artery on ultrasound examination is presented. The immediate postoperative period was uneventful; however later he developed leg swelling and mild oozing at the incision site. In view of deranged renal function CT angiogram was not done and decision was made to treat the pseudoaneurysm with percutaneous thrombin injection. Almost complete thrombosis was achieved however a small residual portion remained patent near the neck. Later limited contrast angiography was done which re-demonstrated a small anneurysm. Instead of embolizing the vessel completely repeat prolonged balloon …

Sustained Efficacy, Safety And Patient-Reported Outcomes Of Certolizumab Pegol In Axial Spondyloarthritis: 4-Year Outcomes From Rapid-Axspa., Désirée Van Der Heijde, Maxime Dougados, Robert Landewé, Joachim Sieper, Walter P Maksymowych, Martin Rudwaleit, Filip Van Den Bosch, Jürgen Braun, Philip Mease, Alan J Kivitz, Jessica Walsh, Owen Davies, Lars Bauer, Bengt Hoepken, Luke Peterson, Atul Deodhar

Articles, Abstracts, and Reports

Objective: The aim was to assess the long-term safety and efficacy of certolizumab pegol over 4 years of continuous treatment in patients with axial spondyloarthritis (axSpA), including both AS and non-radiographic (nr-) axSpA.

Methods: RAPID-axSpA was a phase 3 randomized trial, double blind and placebo controlled to week 24, dose blind to week 48 and open label to week 204. Patients had a clinical diagnosis of axSpA, meeting Assessment of SpondyloArthritis international Society (ASAS) criteria, and had active disease. The assessed outcomes included ASAS20, ASAS40, AS DAS (ASDAS), BASDAI, BASFI and BASMI scores, along with selected measures of remission. Further …

Efficacy And Safety Of Abatacept, A T-Cell Modulator, In A Randomised, Double-Blind, Placebo-Controlled, Phase Iii Study In Psoriatic Arthritis., Philip Mease, Alice B Gottlieb, Désirée Van Der Heijde, Oliver Fitzgerald, Alyssa Johnsen, Marleen Nys, Subhashis Banerjee, Dafna D Gladman

Articles, Abstracts, and Reports

OBJECTIVES: To assess the efficacy and safety of abatacept, a selective T-cell costimulation modulator, in a phase III study in psoriatic arthritis (PsA).

METHODS: This study randomised patients (1:1) with active PsA (~60% with prior exposure to a tumour necrosis factor inhibitor) to blinded weekly subcutaneous abatacept 125 mg (n=213) or placebo (n=211) for 24 weeks, followed by open-label subcutaneous abatacept. Patients without ≥20% improvement in joint counts at week 16 were switched to open-label abatacept. The primary end point was the proportion of patients with ≥20% improvement in the American College of Rheumatology (ACR20) criteria at week 24.

RESULTS: …

National Football League Skilled And Unskilled Positions Vary In Opportunity And Yield In Return To Play After An Anterior Cruciate Ligament Injury., Jaewon Yang, Jonathan D. Hodax, Jason T. Machan, Eric S. Secrist, Wesley M. Durand, Brett D. Owens, Adam E.M. Eltorai, Christopher C. Dodson

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Anterior cruciate ligament (ACL) injuries pose a significant risk to the careers of players in the National Football League (NFL). The relationships between draft round and position on return to play (RTP) among NFL players are not well understood, and the ability to return to preinjury performance levels remains unknown for most positions.

PURPOSE: To test for differences in RTP rates and changes in performance after an ACL injury by position and draft round. We hypothesized that skilled positions would return at a lower rate compared to unskilled positions. We further hypothesized that early draft-round status would relate to …

A Prospective Randomized Study Analyzing Preoperative Opioid Counseling In Pain Management After Carpal Tunnel Release Surgery., Todd H. Alter, Asif M Ilyas

Rothman Institute Papers

PURPOSE: Prescription opioid misuse has become increasingly prevalent in the United States. Preoperative opioid counseling has been proposed to decrease opioid consumption after surgery. This study aimed to evaluate the effect of preoperative opioid counseling on patients' pain experience and opioid consumption after carpal tunnel release (CTR) surgery.

METHODS: A prospective comparison of consecutive patients scheduled to undergo CTR surgery was conducted. Patients were randomized to receive either formal preoperative opioid counseling or no counseling. All operations were performed with the same miniopen CTR surgical technique, and the same number of opioids were prescribed after surgery. Daily opioid pill consumption, …

Proximal Femur Locking Plate For Sub-Trochanteric Femur Fractures: Factors Associated With Failure, Akbar Zubairi, Rizwan Haroon Rashid, Marij Zahid, Pervaiz Mahmood Hashmi, Shahryar Noordin

Section of Orthopaedic Surgery

Introduction: Proximal femur locking compression plates (PF-LCP) have gained popularity since their inception due to superior biomechanical stability and durability but clinical experience has shown conflicting results including implant failure.
Objective: To study the incidence of implant failure in patients with sub-trochanteric fractures managed with proximal femoral locking compression plate and identify potential risk factors associated with the failure.
Materials & Methods: Fifty patients with sub-trochanteric fractures, operated upon with titanium PF-LCP were included in the study from January 2012 to December 2014. These plates were of two designs including one five 5.0 mm proximal locking screws (implant A) and …

Incidence, Positional Distribution, Severity, And Time Missed In Medial Collateral Ligament Injuries Of The Knee In Ncaa Division I Football Athletes., Ali R Motamedi, Anirudh K Gowd, Alireza K Nazemi, Stephen T Gardner, Caleb J Behrend

Articles, Abstracts, and Reports

Introduction: We studied injury to the medial collateral ligament (MCL) in National Collegiate Athletic Association (NCAA) Division I football players, their incidence, magnitude of injury, distribution by position, and missed time, which has not previously been described in a consecutive series.

Methods: The knee injuries sustained in 163 consecutive NCAA Division I collegiate football players at our institution were evaluated over a span of 6 years.

Results: The incidence of MCL injuries with any knee injury was 29% (47 of 163). Of 47 MCL injuries, 34% occurred in defensive linemen and 29% in offensive linemen. The average days missed by …