Predicting successful outpatient total shoulder arthroplasty.

BACKGROUND: Total shoulder arthroplasty (TSA) is increasingly performed safely and efficiently as an outpatient procedure in certain patients. Patient selection is often based on surgeon choice, surgeon expertise, or institutional guidelines. One orthopedic research group released a publicly available shoulder arthroplasty outpatient appropriateness risk calculator that considers patient demographic characteristics and comorbidities with the aim of helping surgeons to predict successful outpatient TSA. This study aimed to retrospectively assess the utility of this risk calculator at our institution. METHODS: Records were obtained for patients undergoing procedure code 23472 at our institution between January 1, 2018, and March 31, 2021. Patients undergoing anatomic TSA in the hospital setting were included. Records were reviewed for demographic characteristics, comorbidities, American Society of Anesthesiologists classification, and surgery duration. These data were entered into the risk calculator to calculate the likelihood of discharge by postoperative day 1. Charlson Comorbidity Index, complications, reoperations, and readmissions were also collected from patient records. Statistical analyses assessed the model's fit with our patient cohort and compared outcome measures between inpatient and outpatient groups. RESULTS: Of the 792 patients whose records were initially obtained, 289 met the inclusion criteria of anatomic TSA performed in the hospital setting. Of these patients, 7 were excluded because of missing data, leaving 282 patients: 166 (58.9%) in the inpatient group and 116 (41.1%) in the outpatient group. We found no significant differences in mean age (66.4 years in inpatient group vs. 65.1 years in outpatient group, P = .28), Charlson Comorbidity Index (3.48 vs. 3.06, P = .080), or American Society of Anesthesiologists class (2.58 vs. 2.66, P = .19). Surgery time was longer in the inpatient group than the outpatient group (85 minutes vs. 77 minutes, P = .001). Overall complication rates were low (4.2% in inpatient group vs. 2.6% in outpatient group, P = .07). Readmissions and reoperations did not differ between groups. There was no difference in the average percentage likelihood of same-day discharge (55.4% in inpatient group vs. 52.4% in outpatient group, P = .24), and a receiver operating characteristic curve to assess fit with the risk calculator demonstrated an area under the curve of 0.55. DISCUSSION: The shoulder arthroplasty risk calculator performed similarly to chance when retrospectively predicting discharge within 1 day after TSA in our patients. Complications, readmissions, and reoperations were not higher after outpatient procedures. Risk calculators for determining whether a patient should be admitted after TSA should be used cautiously because they may not provide measurable benefit over the use of surgeon experience and expertise in discharge decision making, and other factors may be relevant in the decision to perform outpatient TSA.

Proximal Hamstring Ruptures: Treatment, Rehabilitation, and Return to Play.

PURPOSE OF REVIEW: To assess the current literature surrounding the treatment and rehabilitation strategies surrounding proximal hamstring rupture injuries, along with comparative return to sport and patient-reported outcomes. RECENT FINDINGS: A high degree of variability exists in protective and rehabilitation strategies after both operative and non-operative proximal hamstring rupture management. Acceptable outcomes after both operative and non-operative management have been observed but may vary greatly with injury chronicity, severity, and surgical technique. The high complication rates observed after surgical treatment, along with poor functional outcomes that may occur in the setting of non-operative treatment or delayed surgery, highlight the importance of early injury evaluation and careful patient selection. Further high-quality research elucidating clearer indications for early operative management and an optimized and standardized rehabilitation protocols may improve outcomes and return to sport experience and metrics for individuals sustaining proximal hamstring ruptures.

Trends in Medical Training and Leadership at Academic Orthopedic Programs.

INTRODUCTION: When deciding on which programs to rank or fellowships to enter, medical students and residents may assess the program's prestige and specialty training opportunities. This report aimed to analyze the demographics of orthopedic department chairs and program directors (PDs), focusing on the prestige of their orthopedic training and medical school. Secondary data included fellowship, higher-level education, sex, professorship, years of practice, and total published research. METHODS: We used U.S. News and Doximity to rank 192 medical schools and 200 orthopedic residency programs based on prestige rankings, respectively. We searched for the department chair, vice-chair, and PD via program websites, Council of Orthopaedic Residency Directors (CORD), Orthopedic Residency Information Network (ORIN), personal websites, LinkedIn, and Doximity. Subsequently, we searched for each individual's demographic information, education and research history, employment history, and medical school attended. RESULTS: We gathered data on 268 orthopedic surgeons with leadership positions at academic hospitals. Of the 268, 115 were department chairs, 15 were vice-chairs, 126 were PDs, 11 were both the chair and PD, and one was vice-chair and PD. Of the 268 physicians, 244 physicians were male (91.0%), while 22 were female (9.0%). The average residency reputation ranking overall was 59.7 ± 5.7. More specifically, for chairs, the average was 57.0 ± 8.3 (p < 0.005), and for PDs, the average was 63.6 ± 8.0 (p <0.005). There was no significant difference between chairs and PDs (p = 0.26). CONCLUSION: Orthopedic leaders were found to have trained at more prestigious programs. This trend could be explained by increased research opportunities at more prestigious programs or programs attempting to increase their own reputation. 9.0% of the leaders identify as female, which is comparable to the 6.5% of practicing female orthopedic surgeons. However, this further demonstrates a need for gender equity in orthopedic surgery. Assessing trends in the training of orthopedic surgeons with leadership positions will allow a better understanding of what programs look for in the hiring process.

Postoperative Patellar Height After Undergoing Total Knee Arthroplasty: Mechanical Axis Versus Kinematic Axis.

Introduction When performing total knee arthroplasty (TKA), surgeons may use either the mechanical alignment (MA) or the kinematic alignment (KA) to guide implant placement and joint balancing. By measuring preoperative and postoperative patellar height (PH), surgeons can predict knee stability after TKA. Improper PH is associated with knee instability which may complicate the postoperative course and lead to patient dissatisfaction or need for revision. The purpose of this study is to measure patellar height using the Insall-Salvati Index (ISI), Caton-Deschamps Index (CDI), and Blackburne-Peel Index (BPI) preoperatively and postoperatively in patients who underwent TKA with either MA or KA to assess for changes in patellar height. Methods We performed a retrospective eight-year review of 256 patients who underwent TKA with either MA or KA by a single surgeon at a single hospital site. We obtained demographic data, including gender, age, and BMI, via the electronic health record. Furthermore, we calculated the ISI, CDI, and BPI using necessary parameters from preoperative and postoperative radiographs. We used these measurements to assess any statistically significant difference in postoperative PH. Results The MA cohort consisted of 104 patients with an average age of 63 years and an average BMI of 34.1 kg/m2. The KA cohort included 152 patients with an average age of 64 years and an average BMI of 34.9 kg/m2.  For the MA population, the average postoperative score with ISI was 1.10 [1.05 to 1.16] (p < 0.001), with CDI was 1.05 [0.98 to 1.11] (p < 0.001), and with BPI was was 0.94 [0.89 to 0.99] (p < 0.001). While for the KA population, the average postoperative score with ISI was 1.03 [0.99 to 1.06] (p = 0.17), with CDI was 0.87 [0.82 to 0.91] (p = 0.15), and with BPI was 0.82 [0.78 to 0.86] (p = 0.34). Conclusion TKA with a KA has a statistically significant improvement in postoperative PH and better postoperative maintenance of preoperative PH. Improved PH may lead to increased patellofemoral stability and superior postoperative outcomes in patients undergoing TKA. Future studies should focus on whether differences in preoperative and postoperative PH measurements result in changes in clinical outcomes in patients with MA versus KA TKA.

Influence of Fatty Infiltration on Hip Abductor Repair Outcomes: A Systematic Review and Meta-analysis.

BACKGROUND: Increasing evidence supports surgical intervention for hip abductor tears; however, the influence of fatty infiltration (FI) on outcomes after repair remains uncertain and has been addressed only in small case series. PURPOSE: To clarify the relationship between FI and surgical outcomes for hip abductor tears. STUDY DESIGN: Meta-analysis; Level of evidence, 4. METHODS: A systematic review and meta-analysis was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. FI severity was assessed by Goutallier-Fuchs (G-F) grade. The relationship between FI and improvement in Harris Hip Score (HHS)/modified Harris Hip Score (mHHS) and visual analog scale (VAS) score for pain was examined with mixed-effects metaregression. Outcomes with open and endoscopic techniques were also compared. RESULTS: A total of 4 studies (206 repairs in 201 patients) were eligible. High-grade FI was associated with significantly less improvement in HHS/mHHS than both no FI (6.761 less; 95% CI, 3.983-11.570; P = .002) and low-grade FI (7.776 less; 95% CI, 2.460-11.062; P < .001) but did not significantly influence VAS score (P > .05). Controlling for FI severity, we found no significant difference in HHS/mHHS improvement between open versus endoscopic repair (P > .05 at each level), but open repair resulted in significantly greater improvement in VAS score for every G-F grade (all P < .005). CONCLUSION: Surgical intervention for symptomatic hip abductor tendon tears improved outcomes as reflected by change in HHS/mHHS; however, the presence of high-grade FI resulted in less improvement. FI severity did not influence VAS scores for pain. Although no differences were found between open and endoscopic repairs in terms of FI-adjusted improvement in HHS/mHHS, open repairs resulted in significantly greater pain relief at each FI level.