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Huebschmann NA, Lawrence KW, Robin JX, Rozell JC, Hepinstall MS, Schwarzkopf R, Aggarwal VK. Does Surgical Approach Affect Dislocation Rate After Total Hip Arthroplasty in Patients Who Have Prior Lumbar Spinal Fusion? A Retrospective Analysis of 16,223 Cases. J Arthroplasty 2024:S0883-5403(24)00312-7. [PMID: 38604275 DOI: 10.1016/j.arth.2024.03.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Lumbar spinal fusion (LSF) is a risk factor for dislocation following total hip arthroplasty (THA). The effect of the surgical approach on this association has not been investigated. This study examined the association between the surgical approach and dislocation following THA in patients who had prior LSF. METHODS We retrospectively reviewed 16,223 primary elective THAs at our institution from June 2011 to September 2022. Patients who had LSF prior to THA were identified using International Classification of Diseases (ICD) codes. Patients were stratified by LSF history, surgical approach, and intraoperative robot or navigation use to compare dislocation rates. There were 8,962 (55.2%) posterior, 5,971 (36.8%) anterior, and 1,290 (8.0%) laterally based THAs. Prior LSF was identified in 323 patients (2.0%). Binary logistic regressions were used to assess the association of patient factors with dislocation risk. RESULTS There were 177 dislocations identified in total (1.1%). In nonadjusted analyses, the dislocation rate was significantly higher following the posterior approach among all patients (P = .003). Prior LSF was associated with a significantly higher dislocation rate in all patients (P < .001) and within the posterior (P < .001), but not the anterior approach (P = .514) subgroups. Multivariate regressions demonstrated anterior (OR [odds ratio] = 0.64, 95% CI [confidence interval] 0.45 to 0.91, P = .013), and laterally based (OR = 0.42, 95% CI 0.18 to 0.96, P = .039) approaches were associated with decreased dislocation risk, whereas prior LSF (OR = 4.28, 95% CI 2.38 to 7.69, P < .001) was associated with increased dislocation risk. Intraoperative technology utilization was not significantly associated with dislocation in the multivariate regressions (OR = 0.72, 95% CI 0.49 to 1.06, P = .095). CONCLUSIONS The current study confirmed that LSF is a significant risk factor for dislocation following THA; however, anterior and laterally based approaches may mitigate dislocation risk in this population. In multivariate analyses, including surgical approach, LSF, and several perioperative variables, intraoperative technology utilization was not found to be significantly associated with dislocation risk.
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Affiliation(s)
- Nathan A Huebschmann
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, 301 East 17th Street, 15th Fl Suite 1518, New York, New York 10003
| | - Kyle W Lawrence
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, 301 East 17th Street, 15th Fl Suite 1518, New York, New York 10003
| | - Joseph X Robin
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, 301 East 17th Street, 15th Fl Suite 1518, New York, New York 10003
| | - Joshua C Rozell
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, 301 East 17th Street, 15th Fl Suite 1518, New York, New York 10003
| | - Matthew S Hepinstall
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, 301 East 17th Street, 15th Fl Suite 1518, New York, New York 10003
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, 301 East 17th Street, 15th Fl Suite 1518, New York, New York 10003
| | - Vinay K Aggarwal
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, 301 East 17th Street, 15th Fl Suite 1518, New York, New York 10003
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Rozell JC, Owusu-Sarpong S, Robin JX, Karamitopoulos M. Giving and Receiving Meaningful Feedback in Orthopaedic Surgery Training. J Am Acad Orthop Surg 2023; 31:1143-1148. [PMID: 37506320 DOI: 10.5435/jaaos-d-23-00354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/21/2023] [Indexed: 07/30/2023] Open
Abstract
The process of giving and receiving feedback in orthopaedic surgery training programs is distinctly unique from any other job. Trainees are required to meet certain milestones, and faculty are responsible for the caliber of surgical skills of their graduating trainees, yet there are rarely standardized practices and guidance for providing real-time feedback. Furthermore, institutional educational programs for faculty on giving meaningful feedback are lacking. The purpose of this article was to understand how feedback is defined, how to appropriately involve the learner in the process to foster active engagement rather than destructive thinking, and to characterize important principles that can elevate one's learning and self-reflection to the fullest potential.
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Ronan EM, Bieganowski T, Christensen TH, Robin JX, Schwarzkopf R, Rozell JC. The Impact of Hospital Exposures Prior to Total Knee Arthroplasty on Postoperative Outcomes. Arthroplast Today 2023; 23:101179. [PMID: 37712072 PMCID: PMC10498397 DOI: 10.1016/j.artd.2023.101179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/07/2023] [Accepted: 07/02/2023] [Indexed: 09/16/2023] Open
Abstract
Background Total knee arthroplasty (TKA) procedures are expected to grow exponentially in the upcoming years, highlighting the importance of identifying preoperative risk factors that predispose patients to poor outcomes. The present study sought to determine if preoperative healthcare events (PHEs) influenced outcomes following TKA. Methods This was a retrospective review of all patients who underwent TKA at a single institution from June 2011 to April 2022. Patients who had a PHE within 90 days of surgery, defined as an emergency department visit or hospital admission, were compared to patients with no history of PHE. Patients who underwent revision, nonelective, and/or bilateral TKA were excluded. Chi-squared analysis and independent sample t-tests were used to determine significant differences between demographic variables. All significant covariates were included in binary logistic regressions used to predict discharge disposition, 90-day readmission, and 1-year revision. Results Of the 10,869 patients who underwent TKA, 265 had ≥1 PHE. Patients who had a PHE were significantly more likely to require facility discharge (odds ratio [OR]: 1.662; P = .001) than patients who did not have a PHE. Any PHE predisposed patients to significantly higher 90-day readmission rates (OR: 2.173; P = .002). Patients with ≥2 PHEs were at a significantly higher risk of 1-year revision (OR: 5.870; P = .004) compared to patients without a PHE. Conclusions Our results demonstrate that PHEs put patients at significantly greater risk of facility discharge, 90-day readmission, and 1-year revision. Moving forward, consideration of elective surgery scheduling in the context of a recent PHE may lead to improved postoperative outcomes. Level III Evidence Retrospective Cohort Study.
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Affiliation(s)
- Emily M. Ronan
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | | | | | - Joseph X. Robin
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Joshua C. Rozell
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
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Shichman I, Habibi AA, Robin JX, Gemayel AC, Lowe DT, Schwarzkopf R. Cementing a Monoblock Dual-Mobility Implant into a Fully Porous Cup in Revision Total Hip Arthroplasty to Address Hip Instability: Surgical Technique. JBJS Essent Surg Tech 2023; 13:e22.00058. [PMID: 38357466 PMCID: PMC10863941 DOI: 10.2106/jbjs.st.22.00058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Background The use of a cemented monoblock dual-mobility implant into a fully porous cup is indicated for patients with acetabular bone loss who have a high risk of postoperative hip instability. Patients undergoing lumbar fusion for sagittal spinal deformities have an increased risk of hip dislocation (7.1%) and should be assessed on sitting and standing radiographs1. Gabor et al. conducted a multicenter, retrospective study assessing the use of a cemented monoblock dual-mobility bearing in a porous acetabular shell in patients with acetabular bone loss and a high risk of hip instability2. Of the 38 patients, 1 (2.6%) experienced a postoperative dislocation that was subsequently treated with closed reduction without further dislocation. This surgical technique represents a favorable surgical option for patients with acetabular bone loss who are at risk for hip instability. In the example case described in the present video article, the patients had a history of dislocations, lumbar fusion, and evidence of Paprosky 3B acetabular defect; as such, the decision was made to revise to a porous shell and cement a monoblock dual-mobility implant. Description With use of the surgeon's preferred approach, the soft tissue is dissected and the hip is aspirated. The hip is dislocated and a subgluteal pocket is made with use of electrocautery to mobilize the trunnion of the femoral stem to aid in acetabular exposure. The femoral component is assessed to ensure appropriate positioning with adequate anteversion. The acetabular component and any acetabular screws are removed. A "ream to fit" technique is performed in the acetabulum until bleeding bone is encountered, with minimal reaming performed in healthy bone from the posterior column. A trial prosthesis is placed within the acetabulum to evaluate if there is satisfactory fixation and if any augment is necessary. Care must be taken during reaming to ensure that enough bone is reamed to accommodate a porous shell that can fit the monoblock dual-mobility implant with a 2-mm cement mantle. Smaller porous shells measuring 56 mm are available for smaller defects but are often not utilized in cases of substantial acetabular bone loss. Fresh-frozen cancellous allograft is utilized to fill any contained defects. The revision porous shell with circumferential screw holes is utilized to allow for screw fixation posterosuperior and anterior toward the pubis. The implants are dried prior to placement of the cement. The cement is applied to the shell and the monoblock dual-mobility implant to ensure adequate coverage. Antibiotic-loaded cement can be utilized according to surgeon preference. Excess cement is removed under direct visualization while the cement is drying, and the position of the dual-mobility implant is adjusted in approximately 20° anteversion and 40° inclination. Stability is assessed after the cement cures, and intraoperative radiography can be performed to confirm cup positioning prior to closure. Any remaining capsule is closed, followed by closure of the remaining soft tissue in a layered fashion. Alternatives A fully porous multi-hole jumbo cup with conventional polyethylene liner and femoral head can be utilized to increase the jump distance of the femoral head. Constrained, lipped, or offset polyethylene liners can be utilized if the shell is well fixed and a dual-mobility implant cannot be inserted. A cemented dual-mobility implant can be utilized in a well-fixed acetabular shell without evidence of loosening or osteolysis. Rationale Dual-mobility implants have become increasingly utilized because of their advantages: (1) ability to decrease dislocation rate without increasing constraint and (2) increasing range of motion with reduced impingement risk2-8. These implants are particularly useful in the setting of revision cases with large acetabular bone defects. In a study of 76 patients with dual-mobility implants cemented into porous acetabular shells, Muthusamy et al. found that only 3.3% of patients experienced postoperative dislocations9. Moreover, acetabular cup survival was excellent, with 100% survival at 1 year and 96.2% at 2 years. Expected Outcomes The use of a dual-mobility implant is a viable treatment option in cases of revision total hip arthroplasty, particularly those in which postoperative stability is a concern; monoblock dual-mobility implants cemented into porous shells are particularly useful in this setting2-8. These trends are similarly seen in patients treated with monoblock dual-mobility implants cemented into porous shells. Muthusamy et al. evaluated the use of this construct to treat instability or risk of hip dislocation in 76 hips, reporting a dislocation rate of 3.3% at 2 years. Additionally, the authors reported rates of all-cause acetabular survival from re-revision of 96.7% at 6 months, 93.3% at 1 year, and 89.7% at 2 years9. Physicians should be aware of the possibility for intra-prosthetic dislocations, as although this complication is rare, it has been reported in the literature7,10. Important Tips In order to allow for circumferential coverage for fixation and ingrowth potential in cases with acetabular defects, the shell is typically impacted slightly vertical (45° to 50° of inclination) and in neutral version (0° to 5° of anteversion). Positioning can be adjusted to improve osseous contact and ingrowth as determined by the size and shape of the defect.The use of a drill guide for the locking screws allows limited degrees of variable screw angulation. In the revision setting, longer screws may be placed posterosuperior toward the sciatic notch or anteroinferior into the pubis. Surgeons should be aware of the anatomy and should predrill holes to reduce the risk of injury to surrounding neurovascular structures such as the obturator artery anteriorly.Any screw holes that are not filled should be covered with plastic hole covers in order to prevent cement from migrating behind the cup. Implants should be dried prior to the placement of the cement, and the cement should be applied to the shell and the dual-mobility implant to ensure adequate coverage.Utilize a monoblock dual-mobility implant that is designed for cementation in order to avoid implant dissociation from the acetabular shell.Remove all fibrous tissue that may hinder bony integration.Assess for pelvis discontinuity; pelvis discontinuity and acetabular bone loss are risk factors in the setting of any revision and should be properly assessed preoperatively and intraoperatively and managed accordingly.Avoid over-reaming and damage of the posterior column.Utilize a reamer or trial to assess defect size and need for augments.Place a compression screw where the cup is in contact with the bone in order to avoid tilting.Cover unused screw holes. Acronyms and Abbreviations THA = total hip arthroplastyS/P = status postTKA = total knee arthroplastyCT = computed tomographyKM = Kaplan MeierDMC = dual-mobility cupPE = polyethylene.
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Affiliation(s)
- Ittai Shichman
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
- Division of Orthopedic Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv, Israel
| | - Akram A. Habibi
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - Joseph X. Robin
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | | | - Dylan T. Lowe
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
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Robin JX, Huebschmann N, Villa JC, Schwarzkopf R. Staged Bilateral Total Hip Arthroplasty in a Patient With Larsen Syndrome. Arthroplast Today 2023; 21:101147. [PMID: 37274834 PMCID: PMC10238462 DOI: 10.1016/j.artd.2023.101147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/14/2023] [Accepted: 04/16/2023] [Indexed: 06/07/2023] Open
Abstract
Larsen syndrome is a rare genetic disorder characterized by weak connective tissues and various musculoskeletal abnormalities. This is a case report of a 39-year-old patient with Larsen syndrome who presented with over a decade of bilateral hip pain and difficulty ambulating. This patient has a prior history of bilateral congenital hip dislocations that were treated with open reduction and spica casting as a child with good result. Years later, she went on to develop bilateral hip osteoarthritis with significant remodeling of the proximal femur. The goal of this case presentation is to demonstrate the utility of total hip arthroplasty for this patient and discuss surgical challenges and considerations.
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Affiliation(s)
- Joseph X. Robin
- Division of Adult Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, 10003, USA
| | - Nathan Huebschmann
- Division of Adult Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, 10003, USA
| | - Jordan C. Villa
- Division of Adult Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, 10003, USA
| | - Ran Schwarzkopf
- Division of Adult Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, 10003, USA
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Arshi A, Hughes AJ, Robin JX, Parvizi J, Fillingham YA. Return to Sport After Hip and Knee Arthroplasty: Counseling the Patient on Resuming an Active Lifestyle. Curr Rev Musculoskelet Med 2023:10.1007/s12178-023-09839-x. [PMID: 37160556 PMCID: PMC10382373 DOI: 10.1007/s12178-023-09839-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/01/2023] [Indexed: 05/11/2023]
Abstract
PURPOSEOF REVIEW The purpose of this review is to summarize the available literature on the epidemiology, biomechanics, clinical outcomes, and complications of return to sport after TJA, as well as provide guidelines for patients' safe return to athletic activity. RECENT FINDINGS As volume and indications for total joint arthroplasty (TJA) expand, arthroplasty candidates today are demographically younger, more physically active, and have higher expectations for postoperative function. Many TJA patients wish to resume sports activity that may theoretically place their reconstruction under more biomechanical stress and risk for early wear or failure. Recommendations for postoperative patient activity following TJA have historically largely been surgeon-dependent and in the context of evolving prosthetic design and surgical techniques. We endorse a three-tiered framework for return to sporting activities: (1) low-impact sports are generally recommended, (2) intermediate-impact sports are generally recommended with experience, and (3) high-impact sports are generally not recommended though activity-specific joint decisions between patient and surgeon can be made.
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Affiliation(s)
- Armin Arshi
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17Th Street, 14Th Floor, Suite 14-02, New York, NY, 10003, USA.
| | - Andrew J Hughes
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17Th Street, 14Th Floor, Suite 14-02, New York, NY, 10003, USA
| | - Joseph X Robin
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17Th Street, 14Th Floor, Suite 14-02, New York, NY, 10003, USA
| | - Javad Parvizi
- Rothman Orthopaedic Institute, Philadelphia, PA, USA
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Robin JX, Brash AI, Schwarzkopf R. Staged Bilateral Total Hip Arthroplasty in a 17-Year-Old With Type VI Mucopolysaccharidosis. Arthroplast Today 2022; 19:101058. [PMID: 36507284 PMCID: PMC9729915 DOI: 10.1016/j.artd.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 10/20/2022] [Indexed: 12/12/2022] Open
Abstract
Mucopolysaccharidosis encompasses multiple lysosomal storage disorders that are relevant to the orthopedic surgeon as they lead to disruption in bone and cartilage development. These patients may present with early-onset joint pain, including end-stage hip arthritis warranting total hip replacement. The altered hip anatomy in this disorder is of specific importance to the arthroplasty surgeon as it presents challenges when reconstructing the proximal femur and acetabulum and informs implant choice. We present a 17-year-old patient with end-stage bilateral hip arthritis who underwent staged bilateral total hip arthroplasty. We discuss technical considerations in surgical technique and the consequences of acetabular and femoral deformity on implant selection.
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Affiliation(s)
- Joseph X. Robin
- Corresponding author. Division of Adult Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY 10003 USA. Tel.: +1 205 908 6889.
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Singh V, Anil U, Kurapatti M, Robin JX, Schwarzkopf R, Rozell JC. Emergency department visits following total joint arthroplasty: do revisions present a higher burden? Bone Jt Open 2022; 3:543-548. [PMID: 35801582 PMCID: PMC9350702 DOI: 10.1302/2633-1462.37.bjo-2022-0026.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aims Although readmission has historically been of primary interest, emergency department (ED) visits are increasingly a point of focus and can serve as a potentially unnecessary gateway to readmission. This study aims to analyze the difference between primary and revision total joint arthroplasty (TJA) cases in terms of the rate and reasons associated with 90-day ED visits. Methods We retrospectively reviewed all patients who underwent TJA from 2011 to 2021 at a single, large, tertiary urban institution. Patients were separated into two cohorts based on whether they underwent primary or revision TJA (rTJA). Outcomes of interest included ED visit within 90-days of surgery, as well as reasons for ED visit and readmission rate. Multivariable logistic regressions were performed to compare the two groups while accounting for all statistically significant demographic variables. Results Overall, 28,033 patients were included, of whom 24,930 (89%) underwent primary and 3,103 (11%) underwent rTJA. The overall rate of 90-day ED visits was significantly lower for patients who underwent primary TJA in comparison to those who underwent rTJA (3.9% vs 7.0%; p < 0.001). Among those who presented to the ED, the readmission rate was statistically lower for patients who underwent primary TJA compared to rTJA (23.5% vs 32.1%; p < 0.001). Conclusion ED visits present a significant burden to the healthcare system. Patients who undergo rTJA are more likely to present to the ED within 90 days following surgery compared to primary TJA patients. However, among patients in both cohorts who visited the ED, three-quarters did not require readmission. Future efforts should aim to develop cost-effective and patient-centred interventions that can aid in reducing preventable ED visits following TJA. Cite this article: Bone Jt Open 2022;3(7):543–548.
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Affiliation(s)
- Vivek Singh
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Utkarsh Anil
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Mark Kurapatti
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Joseph X. Robin
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Joshua C. Rozell
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
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Robin JX, Murali S, Paul KD, Kofskey AM, Wilson AL, Almaguer AM, Wills BW, McGwin G, Momaya AM, Brabston EW, Ponce BA. Disparities Among Industry's Highly Compensated Orthopaedic Surgeons. JB JS Open Access 2021; 6:JBJSOA-D-21-00015. [PMID: 34901691 PMCID: PMC8654451 DOI: 10.2106/jbjs.oa.21.00015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
The prosperous financial relationship between physicians and industry remains a highly scrutinized topic. Recently, a publicly available website was developed in conjunction with the U.S. Affordable Care Act to shed light on payments from industry to physicians with the goal of increasing transparency. The purpose of this study was to assess possible relationships between industry payments and orthopaedic surgeon gender, subspecialty training, and practice settings.
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Affiliation(s)
- Joseph X Robin
- Department of Orthopaedic Surgery, New York University, New York, NY
| | - Sudarsan Murali
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kyle D Paul
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Alexander M Kofskey
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Anthony L Wilson
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Adam M Almaguer
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Bradley W Wills
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gerald McGwin
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Amit M Momaya
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Eugene W Brabston
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Brent A Ponce
- Hughston Clinic/Hughston Foundation, Columbus, Georgia
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Liu IZ, Wang KY, Robin JX, McGeary I, Hemal K, Boyd CJ. Chronicling the effect of COVID-19 on orthopedic literature. J Orthop 2021; 26:107-110. [PMID: 34312577 PMCID: PMC8294776 DOI: 10.1016/j.jor.2021.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 07/20/2021] [Indexed: 11/05/2022] Open
Abstract
Background The novel coronavirus disease (COVID-19) has had a significant impact on orthopedic surgery practice, but there has been little investigation of the effects of COVID-19 on the orthopedic surgery literature. Additionally, because orthopedic research plays a vital role in physician education, changes to the characteristics and content of published literature can have lasting impacts on future teaching and learning. This paper represents the first known analysis of the COVID-19 pandemic's impact on peer-reviewed articles published in orthopedic surgery journals. Methods The 20 orthopedic journals with the highest impact factors in 2019, according to the Journal Citation Reports, were included in this study. Using PubMed and COVID-19 related keywords as well as manual screening, a final count of 199 articles were assessed for this study and subsequently sorted by country of origin, orthopedic subspecialty, article type, and general theme. Kruskal Wallis and Pearson's Chi-squared tests were used to analyze continuous and categorical variables, respectively. Results Fourteen journals published articles relating to COVID-19, representing 26 countries with the United States (37%) and United Kingdom (13%) publishing the greatest proportion of all COVID-19 articles. Sixty percent of publications discussed COVID-19's impact on the overall field of orthopedic surgery, with the remainder focusing on specific subspecialties. Forty-seven percent of publications were original research articles while 46% were editorials or commentaries. The median time to publication for all COVID-19 related articles was 24.5 days, compared to the 129 days reported for orthopedic journals prior to the COVID-19 pandemic (p < 0.001). In the first 100 articles published, 49% (n = 49) originated exclusively from United States institutions, whereas only 25% (n = 25) of the next ninety-nine articles had US-only institutions (p < 0.001). Conclusions The COVID-19 pandemic has significantly impacted the characteristics, content, and time to publication of the orthopedic surgery literature. The data and ideas presented in this paper should help streamline future, formal analysis on the lasting implications of COVID-19 on orthopedic surgery practice, teaching, and learning.
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Affiliation(s)
- Ivan Z Liu
- The Medical College of Georgia, Augusta University, 1120 15th St, Augusta, GA, 30912, United States
| | - Kevin Y Wang
- Wake Forest School of Medicine, 475 Vine St, Winston-Salem, NC, 27101, United States
| | - Joseph X Robin
- Department of Orthopedic Surgery, NYU Langone, 301 East 17th Street, Suite 1402, New York, NY, 10003, United States
| | - Ian McGeary
- Hackensack Meridian School of Medicine, 340 Kingsland St, Nutley, NJ, 07110, United States
| | - Kshipra Hemal
- Wake Forest School of Medicine, 475 Vine St, Winston-Salem, NC, 27101, United States
| | - Carter J Boyd
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone, 222 East 41 Street, New York, NY, 10017, United States
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Affiliation(s)
- Joseph X Robin
- Department of Orthopedic Surgery, 5894New York University, Langone Orthopaedic Hospital, New York, NY, USA
| | - Carter J Boyd
- Hansjörg Wyss Department of Plastic Surgery, 5894New York University, New York, NY, USA
| | - Soroush Rais-Bahrami
- Department of Urology, 9968University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Radiology, 9968University of Alabama at Birmingham, Birmingham, AL, USA.,O'Neal Comprehensive Cancer Center at UAB, 9968University of Alabama at Birmingham, Birmingham, AL,USA
| | - Brent A Ponce
- Department of Orthopaedic Surgery, 9968University of Alabama at Birmingham, Birmingham, AL, USA.,School of Medicine, 9968University of Alabama at Birmingham, Birmingham, AL, USA
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Almaguer AM, Wills BW, Robin JX, Chodaba Y, Arguello AM, McMichael BJ, McGwin G, Ponce BA. Open Payments Reporting of Industry Compensation for Orthopedic Residents. J Surg Educ 2020; 77:1632-1637. [PMID: 32546385 DOI: 10.1016/j.jsurg.2020.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/19/2020] [Accepted: 05/08/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Residents receiving industry payments are not legally required to be reported on the Centers for Medicare & Medicaid Services (CMS) Open Payments Database. The purpose of this study is to review reporting of orthopedic surgery residents and identify the trends for which payments or transfers in value were received. DESIGN The CMS Open Payments Database was used to search for all available orthopedic residents from 2014 to 2016. All data available on the CMS Open Payments Database was recorded. SETTING/PARTICIPANTS This is a database study. Participants are residents reported in the CMS Open Payments Database. RESULTS Over the 3-year period, 6832 resident "entities" were identified from 151 programs. A total of 3217 entities (47%) were reported as receiving payments from industry during this time period. This totaled $3,786,754 over the 3 year study period. The largest itemized categories for payment were education (32.5%) and grants (30.9%) totaling more than $2.4 million. Other areas of payment included travel (17.0%), food (16.0%), consultation fee (1.7%), research (0.8%), speaker fee (0.7%), gift (0.1%), honoraria (0.1%), and other (0.02%). CONCLUSION Overall, 47% of orthopedic resident entities were reported on the CMS Open Payments Database. The vast majority of payments were related to education and grants. Residents should become familiar with how to navigate the Open Payments Database and be educated on maintaining appropriate relationships with industry.
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Affiliation(s)
- Adam M Almaguer
- Department of Orthopedic Surgery, University of Alabama at Birmingham Hospital, Birmingham, Alabama
| | - Bradley W Wills
- Department of Orthopedic Surgery, University of Alabama at Birmingham Hospital, Birmingham, Alabama
| | - Joseph X Robin
- University of Alabama School of Medicine, Birmingham, Alabama
| | - Yvonne Chodaba
- Department of Orthopedic Surgery, University of Alabama at Birmingham Hospital, Birmingham, Alabama
| | - Alexandra M Arguello
- Department of Orthopedic Surgery, University of Alabama at Birmingham Hospital, Birmingham, Alabama
| | | | - Gerald McGwin
- University of Alabama School of Public Health, Birmingham, Alabama
| | - Brent A Ponce
- Department of Orthopedic Surgery, University of Alabama at Birmingham Hospital, Birmingham, Alabama.
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Salib CG, Reina N, Trousdale WH, Limberg AK, Tibbo ME, Jay AG, Robin JX, Turner TW, Jones CR, Paradise CR, Lewallen EA, Bolon B, Carter JM, Berry DJ, Morrey ME, Sanchez-Sotelo J, van Wijnen AJ, Abdel MP. Inhibition of COX-2 Pathway as a Potential Prophylaxis Against Arthrofibrogenesis in a Rabbit Model of Joint Contracture. J Orthop Res 2019; 37:2609-2620. [PMID: 31410880 PMCID: PMC6848758 DOI: 10.1002/jor.24441] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 07/25/2019] [Indexed: 02/04/2023]
Abstract
Arthrofibrosis is a common complication following total knee arthroplasty caused by pathologic fibroblast activation and excessive collagen deposition around a synovial joint leading to debilitating loss of motion. Treatment options are limited because the pathologic mechanisms remain to be characterized. Dysregulation of the inflammatory cascade may lead to communication between myofibroblasts and immune cells triggering tissue metaplasia, and excessive collagen deposition described clinically as arthrofibrosis. We explored the novel use of celecoxib (selective cyclooxygenase-2 [COX-2] inhibitor) to disrupt the downstream effects of the post-traumatic inflammatory cascade and inhibit scar tissue formation in a validated rabbit model of arthrofibrosis combined with new parameters for quantifying the stiffness of the posterior capsule. Biomechanical and molecular analyses, of contracted rabbit knee posterior capsule tissue after COX-2 inhibition revealed increased maximal passive extension and down-regulation of collagen messenger RNA compared with controls. Histopathologic examination suggested a trend of decreased quantities of dense fibrous connective tissue with COX-2 inhibition. These data may suggest that inhibiting the inflammatory cascade could potentially reduce pathologic myofibroblast activation, thereby reducing scar tissue formation and increasing the range of motion in arthrofibrotic joints. Implementing a multi-modal pharmacologic approach may simultaneously target numerous cellular components contributing to the complex process of arthrofibrogenesis. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2609-2620, 2019.
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Affiliation(s)
- Christopher G. Salib
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Nicolas Reina
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - William H. Trousdale
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Afton K. Limberg
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Megan E. Tibbo
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Anthony G. Jay
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Joseph X. Robin
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Travis W. Turner
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Carter R. Jones
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | | | - Eric A. Lewallen
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Brad Bolon
- GEMpath, Inc., 1610 Pace Street, Unit 900-343, Longmont, CO 80504
| | - Jodi M. Carter
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Daniel J. Berry
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Mark E. Morrey
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | | | - Andre J. van Wijnen
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905,Department of Biochemistry & Molecular Biology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Matthew P. Abdel
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
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Abstract
Leiomyomas are benign tumors of smooth muscle origin. They are most commonly found in the uterus, but cutaneous leiomyomas may be occasionally present in the extremities and cause pain secondary to mass effect. Few studies have reported leiomyoma of the foot, and leiomyoma of the heel is particularly rare. We present a case of a 41-year-old female who presented to our clinic for a tender nodule on the posterior aspect of her right heel. The tumor was surgically excised and biopsied revealing cutaneous leiomyoma.
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Affiliation(s)
| | | | - Chason Farnell
- Miscellaneous, University of Alabama at Birmingham, Birmingham, USA
| | - Joseph X Robin
- Orthopaedics, University of Alabama at Birmingham, Birmingham, USA
| | - Morad Qarmali
- Pathology, University of Alabama at Birmingham, Birmingham, USA
| | | | - Perry Washburn
- Miscellaneous, University of Alabama at Birmingham, Birmingham, USA
| | - Leonardo V Moraes
- Orthopedics, Instituto De Assistência Médica Ao Servidor Público Estadual, São Paulo, BRA
| | - Ashish Shah
- Orthopaedics, University of Alabama at Birmingham, Birmingham, USA
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Lewallen EA, Salib CG, Trousdale WH, Berry CE, Hanssen GM, Robin JX, Tibbo ME, Viste A, Reina N, Morrey ME, Sanchez-Sotelo J, Hanssen AD, Berry DJ, van Wijnen AJ, Abdel MP. Molecular pathology of total knee arthroplasty instability defined by RNA-seq. Genomics 2017; 110:247-256. [PMID: 29174847 DOI: 10.1016/j.ygeno.2017.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 11/03/2017] [Accepted: 11/04/2017] [Indexed: 11/15/2022]
Abstract
Total knee arthroplasty (TKA) is a durable and reliable procedure to alleviate pain and improve joint function. However, failures related to flexion instability sometimes occur. The goal of this study was to define biological differences between tissues from patients with and without flexion instability of the knee after TKA. Human knee joint capsule tissues were collected at the time of primary or revision TKAs and analyzed by RT-qPCR and RNA-seq, revealing novel patterns of differential gene expression between the two groups. Interestingly, genes related to collagen production and extracellular matrix (ECM) degradation were higher in samples from patients with flexion instability. Partitioned clustering analyses further emphasized differential gene expression patterns between sample types that may help guide clinical interpretations of this complication. Future efforts to disentangle the effects of physical and biological (e.g., transcriptomic modifications) risk factors will aid in further characterizing and avoiding flexion instability after TKA.
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Affiliation(s)
- Eric A Lewallen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States; Department of Biological Sciences, Hampton University, Hampton, VA, United States.
| | - Christopher G Salib
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States.
| | - William H Trousdale
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States.
| | - Charlotte E Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
| | | | - Joseph X Robin
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Meagan E Tibbo
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States.
| | - Anthony Viste
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Nicolas Reina
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Mark E Morrey
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States.
| | | | - Arlen D Hanssen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States.
| | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States.
| | - Andre J van Wijnen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States; Department of Biochemistry & Molecular Biology, Mayo Clinic, Rochester, MN, United States.
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States.
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