Trends in Osteopathic Authorship in Orthopedic Publications and Its Impact on Adult Reconstruction Match Rates.

Background: Doctors of osteopathy (D.O.) have historically been underrepresented in the orthopedic literature. As adult reconstruction (AR) continues to rank among the most competitive orthopedic fellowships, participation in research likely serves a key role for successfully matching. This study sought to identify trends in D.O. orthopedic publications and assess for correlations between these trends and osteopathic AR match results. Methods: The top 10 orthopedic surgery journals based on impact factor were selected for analysis. Articles published between 2010 and 2021 were screened to assess for publications with a D.O. author, as well as authorship position. A total of 29,499 articles were available for final analysis. Data from the San Francisco Residency and Fellowship Match Services were also reviewed to evaluate the number of osteopathic applicants and their match rates during the same study period. Trends in D.O. publications and osteopathic AR match rates were then assessed for any correlations. Results: From 2010 to 2021, there was a significant increase in orthopedic and arthroplasty-related publications with a D.O. author (P < .0001), as well as D.O. first (P = .0006) and senior authorship positions (P = .009). Osteopathic match rate significantly increased during the study period (P = .003). There was a strong correlation between the increase in osteopathic match rate and arthroplasty-related publications with a D.O. author (r = 0.76). Conclusions: From 2010 to 2021, there was an upward trend of osteopathic orthopedic publications. This increase is strongly correlated with an increase in osteopathic AR match rate. Our findings suggest that authorship in publications may play a key role in successfully matching into an AR fellowship.

Robotic-Assisted Total Knee Arthroplasty: An Assessment of Content, Quality, and Readability of Available Internet Resources.

BACKGROUND: The use of robotic-assisted total knee arthroplasty (TKA) has significantly increased over the past decade. Internet content is largely unregulated and may contain inaccurate and/or misleading information about robotic TKA. Our goal was to assess the content, quality, and readability of online material regarding robotic-assisted TKA. METHODS: We conducted an internet search for the top 50 web sites from each of the 3 most popular search engines (Google, Yahoo, and Bing) using the search term robotic total knee replacement. Each web site was assessed for content, quality, and readability. Web site quality was assessed utilizing the QUality Evaluation Scoring Tool (QUEST). Readability was assessed utilizing the Simple Measure of Gobbledygook, Flesch-Kincaid Grade Level, and Flesch Reading Ease Formula scores. RESULTS: General risks of TKA were discussed in 47.2%, while benefits were discussed in 98.6% of all web sites. Inaccurate claims occurred at a significantly higher rate in physician/community hospital sources compared to university/academic web sites (59% vs 28%, P = .045). Web sites from university/academic web sites had the highest QUEST scores, while physician/community hospital sources scored the lowest (16.1 vs 10.6, P = .01). Most web sites were written at a college reading level or higher. CONCLUSION: Patients should be counseled on the largely unregulated nature of online information regarding robotic-assisted TKA. Physicians and hospitals should consider revising the readability of their online information to a more appropriate level in order to provide accurate, evidence-based information to allow the patient to make an informed consent decision.

Rotational alignment errors can occur in unicompartmental knee arthroplasty if anatomical landmarks are misused: A preoperative CT scan analysis.

BACKGROUND: Accurate implant positioning, including rotation, is essential for successful unicompartmental knee arthroplasty (UKA). This study defined the rotational error that would result in medial UKA when using the medial edge of the tibial tubercle (TT) rather than the medial tibial spine for determining tibial component rotation, and in lateral UKA when aligning the anterior edge of the sagittal tibial cut with the lateral edge of the patellar tendon. METHODS: Preoperative computed tomography (CT) scans were reviewed in 88 knees undergoing medial (n = 71) and lateral (n = 17) UKAs. In medial UKA, the angle between a line along the long axis of the medial tibial spine and a line drawn to the medial edge of the TT was measured. In lateral UKA, the angular relationship between the longitudinal axis of the lateral tibial spine and the lateral edge of the patellar tendon was measured. RESULTS: In medial UKA, an average angular error of 9.6° of external rotation could result if the medial edge of the TT is used to set tibial implant rotation. In lateral UKA, the error of the sagittal tibial cut was an average of 7.1° of excessive external rotation if it is referenced on the lateral edge of the patellar tendon. CONCLUSIONS: The preoperative CT scan analysis showed that using the medial edge of the TT and lateral edge of the patellar tendon to set tibial implant rotation may result in excessive external rotation in medial and lateral UKAs, which could result in kinematic mismatch, suboptimal contact areas and rotational malalignment.

Impact of Resident Training Level on Radiation Exposure During Fixation of Proximal Femur Fractures.

OBJECTIVE: To identify whether residents are at greater risk of radiation exposure from intraoperative fluoroscopy while earlier in their training and during more complex procedures. METHODS: We analyzed 852 extracapsular proximal femur fracture fixation cases. We compared fluoroscopy times by various levels of resident training, fracture type, and implant used. Attending-only cases were used as a control group. RESULTS: Fluoroscopy times during subtrochanteric fracture fixation (176.1 ± 11.27 seconds) were longer than intertrochanteric (111.4 ± 2.44 seconds) and basicervical fractures (91.49 ± 5.77 seconds). Long nail (150.2 ± 3.75 seconds) times were longer than short (92.3 ± 3.15 seconds) and intermediate (76.45 ± 3.01 seconds) nails. Significantly, more fluoroscopy was used in junior (115.9 ± 4.24 seconds), senior (123.0 ± 6.08 seconds), junior combo (130.6 ± 7.74 seconds), and senior combo cases (131.8 ± 6.11 seconds) compared with the control (94.91 ± 3.91). CONCLUSION: Orthopaedic surgery residents and attendings must remain aware of radiation exposure secondary to intraoperative fluoroscopy. Appropriate personal protective equipment should be worn, and more experienced surgeons should take a more active role in the complex cases to decrease exposure risk. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Daily Postoperative Complete Blood Counts After Primary Total Joint Arthroplasty May Not Always Be Necessary.

As the incidence of primary total hip and knee arthroplasties increases and reimbursement models shift toward a more quality-based model, orthopedic surgeons must focus on maintaining quality while containing costs. With current blood conservation strategies, serial laboratory testing after total joint arthroplasty (TJA) may not always be necessary. This study investigated the need for routine postoperative complete blood counts (CBCs) by determining preoperative and postoperative day 1 hemoglobin values that predict the need for a postoperative blood transfusion. Data were used to estimate potential cost savings. The medical records of all patients who underwent primary unilateral TJA performed by a single surgeon between October 2014 and September 2017 were reviewed. Patient demographic and procedural data were recorded, and statistical and cost analyses were performed. Of 108 TJAs, 9 (8.3%) patients received a blood transfusion during their postoperative inpatient stay. A preoperative hemoglobin value of 12.5 g/dL or less and a postoperative day 1 hemoglobin value of 10 g/dL or less were strong predictors of meeting the threshold transfusion trigger for a postoperative blood transfusion (area under the curve, 0.845 and 0.943, respectively). A 56% cost reduction ($845) could have been achieved by eliminating CBCs performed after postoperative day 1 in patients at low risk for transfusion. Patients with preoperative hemoglobin value levels greater than 12.5 g/dL and postoperative day 1 hemoglobin value levels greater than 10 g/dL may not require routine serial CBC monitoring after primary TJA. The cost savings in a high-volume joint center could be significant. [Orthopedics. 2020; 43(1): e31-e36.].

Patient-Reported Outcomes Following Total Hip Arthroplasty Stratified by Body Mass Index.

Obese patients undergoing total hip arthroplasty have been shown to have less functional recovery. This study prospectively compared temporal trends in patient-reported outcomes and activity levels between patients with a body mass index (BMI) of less than 30, 30 to 35, and 35 to 40 kg/m(2) after total hip arthroplasty. Patients were evaluated via the Harris Hip Score, Lower Extremity Activity Scale, and Short Form-12 physical and mental components. The results suggest that patients with BMIs of 35 to 40 kg/m(2) might have poorer functional outcomes preoperatively, with function returning more slowly or poor function being sustained and their not reaching other cohorts' levels. Surgeons must counsel these patients regarding functional expectations and the potential for slower functional returns. [Orthopedics. 2016; 39(3):e572-e577.].

Outcomes of delayed total hip arthroplasty in patients with a previous ipsilateral acetabular fracture.

Post-traumatic arthritis of the hip can develop in 12-57% of patients after an acetabular fracture. Once it develops, salvage treatment options include arthroplasty or arthrodesis. Delayed total hip arthroplasty (THA) has been shown to be a viable treatment option to decrease pain, improve stability and increase functional outcomes. Using cemented designs, earlier long-term studies reported satisfactory functional outcomes of delayed THA used to treat previously failed acetabular fractures. However, high aseptic loosening rates were also observed. Recent advances in cementless acetabular designs have shown comparable functional outcomes and loosening rates compared to those undergoing THA for non-traumatic arthritis. However, even with improvements in functional and radiographic outcomes, unique complications are commonly encountered in patients with previous acetabular fractures, including heterotopic bone around the hip, increased operative times and blood loss, aseptic loosening, sciatic nerve injury and dislocation. The outcomes and complications of delayed THA in patients with previous acetabular fracture will be reviewed.

Outcomes of post-operative periprosthetic femur fracture around total hip arthroplasty: a review.

As the number of primary total hip arthroplasties increase over the next several decades so will the incidence of periprosthetic fractures around the femoral stem. Treatment can reliably be predicted using the Vancouver classification with internal fixation being indicated in fractures involving a stable implant and revision arthroplasty indicated in those with unstable prostheses. Non-displaced fractures involving the greater and lesser trochanter can generally be treated non-operatively. Extensively porous-coated stems and the use of modular uncemented revision stems to treat Vancouver B fractures have shown encouraging results. The treatment of Vancouver C periprosthetic fractures continues to follow basic AO fixation principles with an emphasis on eliminating stress risers with adequate implant overlap and length. This review will focus on the risk factors and classification of these fractures, as well as highlight the treatment options for post-operative periprosthetic femoral fractures around a total hip arthroplasty.

Treatment of osteonecrosis in systemic lupus erythematosus: a review.

Osteonecrosis (ON) is a devastating illness that can lead to severe joint disease in young patients. The pathogenesis of ON is largely unknown; however, there have been numerous reports associating risk factors including systemic lupus erythematosus (SLE) with the disease. The risk of ON for SLE patients is believed to be a result of both the SLE disease state itself and the concomitant use of corticosteroids. The objective of osteonecrosis treatment is typically to halt progression or delay the onset of end-stage arthritis that may require a total joint arthroplasty (TJA). Joint-preserving procedures are attempted for pre-collapse and some post-collapse lesions. After severe subchondral collapse has occurred, TJA is often necessary to relieve pain. The purpose of this article is to draw attention to recent evidence regarding several treatment options for the management of SLE-associated ON, including lesion observation, medication, joint-preserving techniques, and TJA.