Reverse and Anatomic Shoulder Arthroplasty Regional Usage and Open Payment Analysis Using the Centers for Medicare and Medicaid Services Database.

Background: This retrospective review aimed to assess if open payments made by industry arthroplasty companies to physicians and hospital systems were significantly affected by implant type and geographic variation. Methods: Data was obtained from the Centers for Medicare and Medicaid Services (CMS) publicly available open payment datasets (2016-2019). Geographic locations were identified using regions as defined by the US Census Bureau. A linear regression was calculated to predict the open payment made based on the created variable region, the most used implant type (reverse vs anatomic, n > 30 to be included), and their hypothesized interaction. Results: A significant regression equation was found for the hypothesized interaction between implant and region, F(13,11 186) = 3.446, P < .0001, with an R2 of 0.005. Within the regression, the implant type alone was not significantly related to the open payment (P = .070) but only became significant when paired with the region in the South (US$5807; P < .0001) and West (US$5638; P = .0012) compared to the Northeast. Discussion: Our multivariate linear regression model revealed that reverse total shoulder implants were associated with higher open payments, but only within the South and West regions. This indicates that the contributions made by industry arthroplasty companies are a function of both implant and region.

Orthopedic surgery residents reported increased shoulder procedure volumes during the COVID-19 pandemic.

Background: The purpose of this study is to evaluate the impact of the COVID-19 pandemic on shoulder procedure volumes reported to the Accreditation Council for Graduate Medical Education by orthopedic surgery residents. Methods: We performed a retrospective review of Accreditation Council for Graduate Medical Education case logs reporting data from graduating orthopedic surgery residents during the academic years of 2006-2022. Data were queried for all patients for the following shoulder Current Procedural Terminology codes: incision, excision, intro or removal, repair/revision/reconstruction, fracture and/or dislocation, manipulation, arthroscopy, trauma, and total procedures performed. Individual t-tests were used to compare case log trends of graduating academic years before (classes of 2018 and 2019) and during (classes of 2020, 2021, and 2022) the COVID-19 pandemic. Statistical significance was established to be P <.05 for total procedure types, but at P <.005 during category comparisons to protect against alpha errors. Results: Reported mean total shoulder procedures per resident steadily increased each year from 2017 to 2022, but the only significant increase was seen when comparing the graduating classes of 2020 to 2021 (157.9 vs. 165.7, P =.02). Stratification of these procedures by subgroup revealed a significant increase in manipulation procedures from 2021 to 2022 (7.3 vs. 8.8, P =.001). Discussion/Conclusion: COVID-19 did not have a negative impact on logged shoulder procedure volume. Orthopedic surgery residents graduating during the COVID-19 pandemic reported more shoulder procedures than those graduating prepandemic. However, shoulder procedure log trends should be longitudinally investigated, as preceding years of procedural opportunities may underestimate the pandemic's impact.

The Geographic Movement Patterns and Career and Personal Interests of Orthopaedic Surgery Residents in the United States.

BACKGROUND: Orthopaedic surgery continues to be a highly desired residency specialty for graduating medical students in the United States. The geographic preferences and trajectories of orthopaedic surgery applicants are not well understood. OBJECTIVE: The primary objective of this study was to determine the geographic movement patterns of orthopaedic residents from university through residency. A secondary objective was to trend the career and personal interests of orthopaedic residents. METHODS: One hundred eighty-seven orthopaedic surgery programs and 3672 residents were identified through the Electronic Residency Application Service website and Google searches and included for study. Program provided information, including the residents' medical school, undergraduate institution, career interests, and personal interests was then gathered. All data were recorded between the dates of March 25, 2020, and April 2, 2020. RESULTS: A minority of orthopaedic residents (46.2%; n = 1,569/3,398) were training in the same geographic region of their medical school; however, analysis revealed a statistically significant strength of association for home region over a different US census bureau region (χ2 = 127.4, df = 8, Cramer's V = 0.2, P < 0.001). The average distance between orthopaedic residents' medical school and residency program was 666 miles. Male residents were more interested in arthroplasty, spine, and sports, whereas female residents were more interested in hand and pediatrics. The residents leading interests were in arthroplasty (24.4%), sports (21.7%), and trauma (21.3%). CONCLUSION: Orthopaedic surgery residents are more likely to train in a geographical region that is different from their medical school or undergraduate institution. The reported career interests of male and female orthopaedic residents showed significant differences, but personal interests seem to be similar between genders.

Effects of nonselective internal iliac artery angioembolization on pelvic venous flow in the swine model.

BACKGROUND: Pelvic angioembolization (AE) is a mainstay in the treatment algorithm for pelvic hemorrhage from pelvic fractures. Nonselective AE refers to embolization of the bilateral internal iliac arteries (IIAs) proximally rather than embolization of their tributaries distally. The aim of this study was to quantify the effect of nonselective pelvic AE on pelvic venous flow in a swine model. We hypothesized that internal iliac vein (IIV) flow following IIA AE is reduced by half. METHODS: Nine Yorkshire swine underwent nonselective right IIA gelfoam AE, followed by left. Pelvic arterial and venous diameter, velocity, and flow were recorded at baseline, after right IIA AE and after left IIA AE. Linear mixed-effect model and signed rank test were used to evaluate significant changes between the three time points. RESULTS: Eight swine (77.8 ± 7.1 kg) underwent successful nonselective IIA AE based on achieving arterial resistive index of 1.0. One case was aborted because of technical difficulties. Compared with baseline, right IIV flow rate dropped by 36% ± 29% (p < 0.05) and 54% ± 29% (p < 0.01) following right and left IIA AE, respectively. Right IIA AE had no initial effect on left IIV flow (0.37% ± 99%, p = 0.95). However, after left IIA AE, left IIV flow reduced by 54% ± 27% (p < 0.01). Internal iliac artery AE had no effect on the external iliac arterial or venous flow rates and no effect on inferior vena cava flow rate. CONCLUSION: The effect of unilateral and bilateral IIA AE on IIV flow appears to be additive. Despite bilateral IIA AE, pelvic venous flow is diminished but not absent. There is abundant collateral circulation between the external and internal iliac vascular systems. Arterial embolization may reduce venous flow and improve on resuscitation efforts in those with unstable pelvic fractures. LEVEL OF EVIDENCE: Prognostic, level IV.

The Content and Accessibility of Orthopaedic Residency Program Websites.

BACKGROUND: Applicants to orthopaedic surgery residency programs face a competitive match. Internet resources such as program websites allow prospective applicants to gauge interest in particular programs. This study evaluated the content and accessibility of orthopaedic surgery residency program websites. METHODS: Existing orthopaedic surgery residency programs for the 2020 application cycle were identified on the Electronic Residency Application Service (ERAS) website. Individual program websites were accessed through links directly from the ERAS website, and a Google search for each program was performed to corroborate accessibility. Programs websites were then reviewed and evaluated on the presence of 20 criteria selected for their potential to influence resident recruitment (10) and education (10), respectively. The results were compared with the lone 2001 study and with orthopaedic fellowship website analyses. RESULTS: One hundred eighty-nine orthopaedic surgery residency programs were accredited at the time of the study. Only 6 programs (3.2%) did not have a website identifiable through ERAS or Google searches, leaving a final sample size of 183 websites. Approximately 73.3% of all recruitment content and 44.9% of education content were present on the websites available. There was a significant increase in all available recruitment and education content (p < 0.05) when compared with the lone 2001 study. Orthopaedic residency program websites provide comparable recruitment content at a higher rate (71.1%) than orthopaedic fellowship websites (59.6%) but fall slightly below average in presentation of education content (44.9% vs 45.9%). CONCLUSION: This is the first study in nearly 20 years to assess the content and accessibility of orthopaedic residency program websites. There is noticeable variability in the presentation of website content, but approximately 73.3% of recruitment content and 44.9% of the educational content were easily accessible through internet search. Orthopaedic surgery residency programs and their applicants may benefit from standardization of program websites and an increase in recruitment and education content.

Early Clinical Outcomes of a New Cementless Total Knee Arthroplasty Design.

Cementless fixation design failures led to low use of this alternative technology. A cementless total knee arthroplasty addressed these design flaws. The single radius knee design incorporated additive manufacturing to produce the tibial and patellar implants. Both implants have enhanced porous substrates, optimizing initial bony ingrowth. A nonrandomized prospective review was conducted of 72 cementless knees followed for a minimum of 2 years (mean, 37 months). Surgical time, estimated blood loss, and range of motion at 6 weeks were compared with those of a matched cohort of 70 cemented knees performed by the same surgeon. Knee Society Score and Oxford Knee Score were recorded for the cementless group. Radiographs were evaluated for change in implant position, subsidence, and radiolucent and sclerotic lines. Operative time was statistically shorter in the cementless group (40 vs 45 minutes), but there was no significant difference in postoperative estimated blood loss (557 vs 355 mL). Range of motion at 6 weeks averaged 118° in the cementless group vs 114° in the cemented group. Knee Society Score improved from 53.9 preoperatively to 85.0 at 6 weeks and 91.6 at most recent follow-up. Oxford Knee Score improved from 23.9 preoperatively to 31.7 at 6 weeks and 43.4 at most recent follow-up. No implants aseptically loosened or migrated. There were 2 early infections in the cemented group requiring revision. This cementless total knee arthroplasty revealed excellent clinical results at 3-year follow-up and resulted in shortened operative times. Biologic fixation was achieved in 100% of patients with improved functional and objective scores. Early results are encouraging, and this cementless total knee arthroplasty appears to provide an excellent alternative to cemented total knee arthroplasty. [Orthopedics. 2018; 41(6):e765-e771.].

Cigar Box Arthroscopy: A Randomized Controlled Trial Validates Nonanatomic Simulation Training of Novice Arthroscopy Skills.

PURPOSE: The goal of this study was to validate the cigar box arthroscopy trainer (CBAT) as a training tool and then compare its effectiveness to didactic training and to another previously validated low-fidelity but anatomic model, the anatomic knee arthroscopy trainer (AKAT). METHODS: A nonanatomic knee arthroscopy training module was developed at our institution. Twenty-four medical students with no prior arthroscopic or laparoscopic experience were enrolled as subjects. Eight subjects served as controls. The remaining 16 subjects were randomized to participate in 4 hours of either the CBAT or a previously validated AKAT. Subjects' skills were assessed by 1 of 2 faculty members through repeated attempts at performing a diagnostic knee arthroscopy on a cadaveric specimen. Objective scores were given using a minimally adapted version of the Basic Arthroscopic Knee Skill Scoring System. Total cost differences were calculated. RESULTS: Seventy-five percent of subjects in the CBAT and AKAT groups succeeded in reaching minimum proficiency in the allotted time compared with 25% in the control group (P < .05). There was no significant difference in the number of attempts to reach proficiency between the CBAT and AKAT groups. The cost to build the CBAT was $44.12, whereas the cost was $324.33 for the AKAT. CONCLUSIONS: This pilot study suggests the CBAT is an effective knee arthroscopy trainer that may decrease the learning curve of residents without significant cost to a residency program. This study demonstrates the need for an agreed-upon objective scoring system to properly evaluate residents and compare the effectiveness of different training tools.