Public Opinion and Expectations of Stem Cell Therapies in Orthopaedics

The 50 Most Cited Publications in Adipose-Derived "Stem Cell Therapies" with Application in Orthopaedic Surgery

Stem cell therapies have become widely popular in orthopaedic surgery, with a recent interest in adipose-derived therapeutics. Adipose-derived mesenchymal signaling cells (ADSCs) and micronized adipose tissue (MAT) are unique therapies derived from different processing methods. Characterizing the most influential studies in lipoaspirate research can help clarify controversies in definitions, identify core literature, and further collective knowledge for educational purposes. The Science Citation Index Expanded subsection of the Web of Science Core Collection was systematically searched to identify the top 50 most cited publications (based on citation/year) on orthopaedic ADSCs or MAT research. Publication and study characteristics were extracted and reported using descriptive statistics. Level of evidence was assessed for applicable studies, and Spearman correlations were calculated to assess the relationship between citation data and level of evidence. The top 50 articles were published between the years 2003 and 2020, with 78% published in the year 2010 or later. The mean number of citations was 103.1 ± 81.1. The mean citation rate was 12.4 ± 6.0 citations per year. Of the 21 studies for which level of evidence was assessed, the majority were level III (10, 47.6%). The single study design most common among the top 50 cited articles was in vitro basic science studies (17 studies, 34%). Twenty-nine articles (58%) were classified as basic science or translational. Application to treat knee osteoarthritis was the most common focus of studies (14 studies, 28%), followed by in vitro analysis of growth factor and cell signaling markers (11 studies, 22%). No correlation was found between rank, citation rate, or year of publication and level of evidence. This study provides a current landscape on the most cited articles in lipoaspirates in orthopaedic surgery. With the expansion of ADSCs and MAT in the past two decades, this study provides the first historical landmark of the literature and a launching point for future research. Studies should explicitly state their processing methodology and whether their study investigates ADSCs or MAT to avoid misinformation.

Online Crowdsourcing Survey of United States Population Preferences and Perceptions Regarding Outpatient Hip and Knee Arthroplasty

BACKGROUND

Outpatient total joint arthroplasty (TJA) has been shown to be both safe and cost-effective in appropriately selected patients and continues to expand substantially across the United States. Using online crowdsourcing, we aimed to assess population perceptions regarding outpatient TJA and to determine factors associated with preference for outpatient versus inpatient arthroplasty.

METHODS

A closed-ended survey consisting of 39 questions was administered to members of a public platform. Study participants responded to questions regarding demographic factors and outpatient TJA. Validated assessments to capture health literacy and engagement were also used. To determine factors associated with preference for outpatient TJA, multivariable logistic regression analyses were performed.

RESULTS

In total, 900 participants completed the survey. After exclusion of surveys with incomplete data, 725 responses remained for analysis (80.6%). Over half (59.9%) of the survey participants would feel comfortable going home the same day of surgery following TJA. However, two-thirds (64.6%) would prefer to stay in the hospital following TJA. The majority (68.0%) of respondents perceive a hospital setting as the safest location for TJA. The 3 major concerns regarding outpatient TJA were cost, post-operative pain control, and post-operative complication. Among the 111 respondents (15.3%) who would prefer outpatient TJA, 45% would pay more out-of-pocket, 63.1% travel further, and 55.9% would be willing to wait longer to have their surgery performed as an outpatient. On multivariable regressions, those living in a suburban setting (adjusted odds ratios, 95% confidence intervals: 4.2 [1.3-2.7], P = .02) and >60 year old adjusted odds ratios (95% confidence intervals: 8 [2-33.1], P = .004) were more likely to prefer outpatient TJA.

CONCLUSION

Despite the rise in outpatient TJA, the majority of the public appears to prefer inpatient TJA and the minority would expect to be discharged home the same day. Our data can be used to address specific patient concerns regarding outpatient TJA and set realistic expectations for hospital systems and ambulatory facilities.

Surgeon Personality, Time Spent With the Patient, and Quality of Facilities Are the Most Important Factors to Patients in Selecting an Orthopaedic Sports Medicine Surgeon

Purpose

To determine the most important factors to patients across the United States in selecting an orthopaedic sports medicine surgeon.

Methods

In this cross-sectional survey study, adult U.S. residents were surveyed using Amazon Mechanical Turk, a validated survey tool. Data included demographics and the relative importance of both pre-office and in-office factors that determine how patients select an orthopaedic sports medicine surgeon. Results were compiled, and factors were compared by patient demographics.

Results

Of 1,074 respondents, 56.3% were male, and 60.0% were 25 to 40 years old. Responses were geographically diverse. The most important factors in selecting a sports medicine surgeon (graded on a 0-10 scale) were surgeon professionalism and personality (6.6), quality of the hospital/office facilities (6.4), and how much time the surgeon spends with the patient (6.4). Each of these in-office factors were more important than pre-office factors, the most important of which were reputation of the surgeon’s hospital or group (6.3), surgeon’s reviews on medical review websites (6.2), and surgeon’s educational background (6.0). The least important factors were surgeon’s sex (3.7), marketing of the surgeon (4.2), and surgeon’s social media accounts (4.3). A social media account was taken into consideration at least “a little” by nearly two-thirds of respondents. The most preferred surgeon personality was a balance of professional and lighthearted (66.9%), with strictly professional (27.6%) or largely lighthearted (5.6%) less preferred.

Conclusions

The most important factors to patients in selecting their orthopaedic sports medicine surgeon, regardless of patient sex, race, or geography, are related to the patient’s in-office experience, including surgeon’s professionalism/personality, how much time the surgeon spends with the patient, and quality of the hospital/office facilities. Surgeons should consider prioritizing a professional office environment and taking the time to get to know patients for the benefit of their patients and their practice.

Clinical Relevance

The market for orthopaedic sports medicine surgeons is competitive. It is important to know what qualities of a surgeon and his or her practice are important to patients.