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AlShehri Y, McConkey M, Lodhia P. ChatGPT has Educational Potential: Assessing ChatGPT Responses to Common Patient Hip Arthroscopy Questions. Arthroscopy 2024:S0749-8063(24)00452-3. [PMID: 38914299 DOI: 10.1016/j.arthro.2024.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/24/2024] [Accepted: 06/09/2024] [Indexed: 06/26/2024]
Abstract
PURPOSE To assess the ability of ChatGPT to answer common patient questions regarding hip arthroscopy, and to analyze the accuracy and appropriateness of its responses. METHODS Ten questions were selected from well-known patient education websites, and ChatGPT (version 3.5) responses to these questions were graded by two fellowship-trained hip preservation surgeons. Responses were analyzed, compared to the current literature, and graded from A to D (A being the highest, and D being the lowest) in a grading scale based on the accuracy and completeness of the response. If the grading differed between the two surgeons, a consensus was reached. Inter-rater agreement was calculated. The readability of responses was also assessed using the Flesch-Kincaid Reading Ease Score (FRES) and Flesch-Kincaid Grade Level (FKGL). RESULTS Responses received the following consensus grades: A (50%, n=5), B (30%, n=3), C (10%, n=1), D (10%, n=1) (Table 2). Inter-rater agreement based on initial individual grading was 30%. The mean FRES was 28.2 (SD± 9.2), corresponding to a college graduate level, ranging from 11.7 to 42.5. The mean FKGL was 14.4 (SD±1.8), ranging from 12.1 to 18, indicating a college student reading level. CONCLUSION ChatGPT can answer common patient questions regarding hip arthroscopy with satisfactory accuracy graded by two high-volume hip arthroscopists, however, incorrect information was identified in more than one instance. Caution must be observed when using ChatGPT for patient education related to hip arthroscopy. CLINICAL RELEVANCE Given the increasing number of hip arthroscopies being performed annually, ChatGPT has the potential to aid physicians in educating their patients about this procedure and address any questions they may have.
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Affiliation(s)
- Yasir AlShehri
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada; Department of Orthopedics, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mark McConkey
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Parth Lodhia
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada.
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2
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Oladeji LO, Stoker AM, Kuroki K, Stannard JP, Cook JL. Making the Case for Hyperosmolar Saline Arthroscopic Irrigation Fluids: A Systematic Review of Basic Science, Translational, and Clinical Evidence. J Knee Surg 2024; 37:512-522. [PMID: 37879356 DOI: 10.1055/a-2198-8131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
Commonly used isotonic arthroscopic irrigation fluids, such as normal saline or lactated Ringer's, were initially formulated for intravenous administration so they do not replicate the physiologic properties of healthy synovial fluid. Synovial fluid plays an important role in regulating joint homeostasis such that even transient disruptions in its composition and physiology can be detrimental. Previous studies suggest that hyperosmolar solutions may be a promising alternative to traditional isotonic fluids. This manuscript sought to systematically review and synthesize previously published basic science, translational, and clinical studies on the use of hyperosmolar arthroscopic irrigation fluids to delineate the optimal fluid for clinical use. A systematic literature search of MEDLINE/PubMed and Embase databases was performed in accordance with Preferred Reporting Items for Systemic Reviews and Meta-analyses (PRISMA) guidelines. The search phrases were: ("cartilage" AND "hyperosmolar"); ("arthroscopy" OR "arthroscopic" AND "hyperosmolar"). The titles, abstracts, and full texts were screened for studies on hyperosmolar solutions and articular cartilage. Study quality was assessed, and relevant data were collected. A meta-analysis was not performed due to study heterogeneity. A risk of bias assessment was performed on the included translational and clinical studies. There were 10 basic science studies, 2 studies performed in translational animal models, and 2 clinical studies included in this review. Of the basic science studies, 7 utilized a mechanical injury model. The translational studies were carried out in the canine shoulder and equine stifle (knee) joint. Clinical studies were performed in the shoulder and knee. Multiple basic science, translational, and clinical studies highlight the short-term safety, cost-effectiveness, and potential benefits associated with use of hyperosmolar solutions for arthroscopic irrigation. Further work is needed to develop and validate the ideal formulation for a hyperosmolar irrigation solution with proven long-term benefits for patients undergoing arthroscopic surgeries.
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Affiliation(s)
- Lasun O Oladeji
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
| | - Aaron M Stoker
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
| | - Keiichi Kuroki
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
| | - James P Stannard
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
| | - James L Cook
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
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3
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Budin JS, Ramos T, Segel K, Rumps MV, Mulcahey MK. Venous Thromboembolism Chemical Prophylaxis in Patients Undergoing Shoulder Arthroscopy. JBJS Rev 2024; 12:01874474-202403000-00007. [PMID: 38466802 DOI: 10.2106/jbjs.rvw.23.00228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
» Venous thromboembolism (VTE) after shoulder arthroscopy is rare (0.01%-0.38%) but impacts a significant number of patients because of the high procedure volume.» Studies found no significant benefit in reducing VTE risk with aspirin or low-molecular-weight heparins.» Current guidelines for thromboprophylaxis in shoulder arthroscopy lack consensus and need patient-specific considerations.» Further research is required to develop evidence-based thromboprophylaxis guidelines for shoulder arthroscopy.
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Affiliation(s)
- Jacob S Budin
- Tulane University School of Medicine, New Orleans, Louisiana
| | - Tolulope Ramos
- Department of Orthopaedic Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona
| | - Kalli Segel
- Tulane University School of Medicine, New Orleans, Louisiana
| | - Mia V Rumps
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois
| | - Mary K Mulcahey
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois
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Chapman R, Horner N, Ziauddin L, Hevesi M, Nho SJ. Patients Undergoing Revision Hip Arthroscopy Demonstrate Comparable Survivability and Improvement but Worse Postoperative Outcomes Compared to Patients Undergoing Primary Hip Arthroscopy: A Propensity Matched Study at Five-Year Follow-Up. Arthroscopy 2024; 40:802-809. [PMID: 37567488 DOI: 10.1016/j.arthro.2023.07.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/02/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023]
Abstract
PURPOSE To compare mid-term clinical outcomes between patients undergoing primary hip arthroscopy (HA) versus revision hip arthroscopy (RHA) for femoroacetabular impingement syndrome (FAIS). METHODS A retrospective cohort study was conducted on 1,862 patients who underwent hip arthroscopy for FAIS from January 2012 to April 2017. Patients who underwent RHA were propensity matched in a 1:4 ratio by age, sex, body mass index (BMI), and exercise status to patients who underwent primary HA. Preoperative and postoperative radiographs were assessed. Patient-reported outcomes before and at 5 years after surgery, including the Hip Outcome Score Activities of Daily Living subscale (HOS-ADL) and Sports subscale (HOS-SS), modified Harris Hip Score (mHHS), international Hip Outcome Tool (iHOT-12), and Visual Analog Scale (VAS) for Pain and Satisfaction, were compared between groups. Minimally clinically important difference and patient-acceptable symptomatic state (PASS) achievement rates were compared using previously published thresholds. RESULTS Fifty-one patients who underwent RHA (35 female, 16 male; age 36.2 ± 10.2 years; BMI 26.5 ± 5.9) were followed up for 63.9 ± 9.2 months and then propensity matched in a 1:4 ratio by sex, age, and BMI to 204 control patients who underwent primary HA. At midterm follow-up, patients in the RHA cohort had significantly lower scores for HOS-SS (RHA 64.9 ± 32.5 vs HA 75.3 ± 26.2, P = .044), mHHS (RHA 72.2 ± 22.4 vs HA 80.1 ± 18.1, P = .039), and iHOT-12 (RHA 61.4 ± 29.3 vs HA 71 ± 27.6, P = .043) compared to primary HA patients. Rates of achieving PASS were significantly decreased for HOS-SS (RHA 38.3% vs HA 55.4%, P = .039) and iHOT-12 (RHA 41.9% vs HA 59.9%, P = .035) in the RHA cohort. There were no significant differences in rates of conversion to THA or subsequent reoperation on the index hip between groups. CONCLUSIONS Patients undergoing revision hip arthroscopy demonstrate comparable survivability and magnitude of improvement but may experience worse overall outcome scores and meet thresholds for clinically significant outcomes less often when compared to primary hip arthroscopy patients. LEVEL OF EVIDENCE Level III; retrospective comparative study.
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Affiliation(s)
- Reagan Chapman
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nolan Horner
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Lubna Ziauddin
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Mario Hevesi
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
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Perry M, LeDuc R, Stakenas S, Wozniak A, Francois A, Evans D. Adductor Canal Nerve Block versus Intra-articular Anesthetic in Knee Arthroscopy: A Single-Blinded Prospective Randomized Trial. J Knee Surg 2024; 37:220-226. [PMID: 36807102 DOI: 10.1055/a-2037-6418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Effective perioperative pain control following knee arthroscopy allows patients to reduce narcotic intake, avoid side effects of these medications, and recover more quickly. Adductor canal nerve blockade (ACB) and intra-articular injection of local anesthetic have been described as adjuvant treatments for postoperative pain control following surgery of the knee. This study directly compares the effect of each of these treatment modalities. Patients undergoing knee arthroscopy were blinded and randomized to receive either an ACB (n = 60) or intra-articular injection of local anesthetic (IAB, n = 64). Outcome measures included patient reported visual analog scale (VAS) scores at 1, 2, 4, 8, 16, 24, 36, 48 hours and 1 week and total narcotic consumption at 12, 24, and 48 hours postoperatively. Student's t-tests were used to compare unadjusted VAS scores at each time point and use of postoperative pain medication between treatment groups. Adjusted VAS scores were estimated in a multivariable general linear model with interaction of time and treatment group and other relevant covariates. There were no statistically significant differences between the two groups in terms of gender, age, body mass index, and insurance type. ACB patients had significantly higher pain scores than IAB patients at hours 1 and 2 (hour 1: 4.02 [2.99] vs. 2.59 [3.00], p = 0.009; hour 2: 3.12 [2.44] vs. 2.17 [2.62], p = 0.040). ACB patients had higher pain scores than IAB patients up to hour 16, though hours 4 to 16 were not significantly different. Adjusted covariate analyses demonstrate an additional statistically significant reduction in pain score in the IAB group at hour 4. There were no differences in narcotic consumption. Intraoperative local anesthetic and regional ACB each provides adequate pain control following knee arthroscopy, and intraoperative local anesthetic may provide enhanced pain control for up to 4 hours postoperatively. LEVEL OF EVIDENCE: : Level 1 evidence, randomized control trial.
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Affiliation(s)
- Michael Perry
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois
| | - Ryan LeDuc
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois
| | - Steven Stakenas
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois
| | - Amy Wozniak
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois
| | - Audrice Francois
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois
| | - Douglas Evans
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois
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Suarez-Ahedo C, Camacho-Galindo J, López-Reyes A, Martinez-Gómez LE, Pineda C, Domb BG. A comprehensive review of hip arthroscopy techniques and outcomes. SAGE Open Med 2024; 12:20503121231222212. [PMID: 38249944 PMCID: PMC10798066 DOI: 10.1177/20503121231222212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 12/04/2023] [Indexed: 01/23/2024] Open
Abstract
Transforming the orthopedic landscape, hip arthroscopy pioneers a minimally invasive surgical approach for diagnosing and addressing hip pathologies. With its origins dating back to Burman's 1931 cadaveric study, this groundbreaking technique gained clinical relevance in 1939 through Takagi's report. However, the 1980s marked the actual emergence of hip arthroscopy for treating a wide range of hip disorders. Now, a staple in modern orthopedics, hip arthroscopy empowers patients with previously undiagnosed and untreated hip conditions, enabling them to obtain relief and reclaim their lives. By employing a compact camera and specialized tools, surgeons expertly navigate the hip joint, performing procedures from excising loose bodies and mending labral tears to addressing femoroacetabular impingement and tackling other intricate issues. This innovative approach has dramatically elevated patients' quality of life, allowing them to embrace targeted treatments and resume daily activities without resorting to lifestyle alterations.
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Affiliation(s)
- Carlos Suarez-Ahedo
- Adult Hip and Knee Reconstruction Department, National Rehabilitation Institute of Mexico, Mexico City, Mexico
- Geriatric Science Laboratory, National Rehabilitation Institute of Mexico, Mexico City, Mexico
- American Hip Institute, Chicago, IL, USA
| | | | - Alberto López-Reyes
- Geriatric Science Laboratory, National Rehabilitation Institute of Mexico, Mexico City, Mexico
| | - Laura E Martinez-Gómez
- Geriatric Science Laboratory, National Rehabilitation Institute of Mexico, Mexico City, Mexico
| | - Carlos Pineda
- National Rehabilitation Institute of Mexico, Mexico City, Mexico
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7
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Ganglions in the Hand and Wrist: Advances in 2 Decades. J Am Acad Orthop Surg 2023; 31:e58-e67. [PMID: 36580047 DOI: 10.5435/jaaos-d-22-00105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 10/12/2022] [Indexed: 12/30/2022] Open
Abstract
Ganglion cysts represent the most common soft-tissue mass in the hand and wrist. Ganglion cysts are most commonly encountered at the dorsal or volar aspects of the wrist, although cysts may arise from the flexor tendon sheath, interphalangeal joint, and extensor tendons. Intraosseous and intraneural ganglion cysts have also been described. Diagnosis of ganglion cysts relies primarily on history and physical examination. Transillumination and aspiration of masses may be useful adjuncts to diagnosis. Imaging such as radiography and ultrasonography may be indicated to evaluate for associated conditions, such as degenerative joint disease, or to rule out a solid or heterogeneous mass. Advanced imaging such as MRI is generally reserved for patients in whom occult ganglions, intraosseous ganglions, or solid tumors, including sarcoma, remain a concern. Treatment of ganglion cysts includes observation, aspiration or puncture with possible corticosteroid injection, and surgical excision. Nonsurgical management may result in cyst resolution in over 50% of patients. Surgical excision is associated with recurrence rates of 7% to 39%. Advances in surgical techniques have allowed surgeons to conduct arthroscopic ganglion excision, with recurrence rates similar to those of open management. This study highlights the advances in diagnosis, treatment, and outcomes that have taken place over the past 2 decades for this common condition affecting the hand and wrist in the adult population.
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8
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Lateral femoral cutaneous nerve neuroma treatment after hip arthroscopy: a case report and review of the literature. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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9
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Amato PE, Coleman JR, Dobrzanski TP, Elmer DA, Gwathmey FW, Slee AE, Hanson NA. Pericapsular nerve group (PENG) block for hip arthroscopy: a randomized, double-blinded, placebo-controlled trial. Reg Anesth Pain Med 2022; 47:rapm-2022-103907. [PMID: 35998937 DOI: 10.1136/rapm-2022-103907] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 08/16/2022] [Indexed: 12/04/2022]
Abstract
INTRODUCTION Arthroscopic hip surgery is associated with significant postoperative pain. Femoral nerve blocks have been shown to improve postoperative analgesia at the expense of quadriceps weakness. The pericapsular nerve group (PENG) block could be an alternative that may improve postoperative analgesia while preserving quadriceps strength. Our hypothesis was that a PENG block would provide superior postoperative analgesia compared with a sham block following arthroscopic hip surgery. METHODS Subjects presenting for arthroscopic hip surgery were randomized in a 1:1 ratio to either an ultrasound-guided unilateral, single-injection PENG block (PENG group) with 20 mL of 0.5% ropivacaine or a sham injection with 5 mL of 0.9% normal saline (Sham group) prior to receiving general anesthesia. The primary outcome of this study was worst pain score within 30 min of emergence from anesthesia. Secondary outcomes included opioid consumption, patient satisfaction with analgesia, opioid-related adverse events, and persistent opioid use at 1 week. RESULTS Sixty-eight subjects, 34 from the PENG group and 34 from the Sham group, completed the study per protocol. Analysis of the primary outcome demonstrated a mean difference in pain scores of -0.79 (95% CI -1.96 to 0.37; p=0.17) between the PENG and Sham groups immediately following surgery. No secondary outcomes showed statistically significant differences between groups. DISCUSSION This study demonstrates that a preoperative PENG block does not improve analgesia following arthroscopic hip surgery. TRIAL REIGSTRATION NUMBER NCT04508504.
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Affiliation(s)
- Peter E Amato
- Anesthesiology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - John R Coleman
- Anesthesiology, Virginia Commonwealth University, Richmond, VA, USA
| | - Tomasz P Dobrzanski
- Anesthesiology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Donald A Elmer
- Anesthesiology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Frank W Gwathmey
- Orthopedic Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - April E Slee
- Comprehensive Clinical Trials Unit, University College London, London, UK
| | - Neil A Hanson
- Anesthesiology, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
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Rochlin DH, Perrault D, Sheckter CC, Fox P, Yao J. Prevalence of Ganglion Cyst Formation After Wrist Arthroscopy: A Retrospective Longitudinal Analysis of 2420 Patients. Hand (N Y) 2022; 17:477-482. [PMID: 32935572 PMCID: PMC9112726 DOI: 10.1177/1558944720939203] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Dorsal wrist ganglion cysts arise from the leakage of synovial fluid through tears in the scapholunate ligament and/or dorsal wrist capsule. An analogous disruption of the dorsal capsule is created with routine portal placement during wrist arthroscopy. We hypothesized that wrist arthroscopy would predispose to wrist ganglions. METHODS Using the Truven MarketScan Outpatient Services Database from 2015 to 2016, patients who underwent wrist arthroscopy and developed an ipsilateral wrist ganglion were identified. Exclusion criteria included ganglion diagnosis preceding arthroscopy and bilateral pathology. Postoperative ganglion diagnosis was modeled with logistic regression. Predictor variables included age, gender, comorbidities, and arthroscopic procedure. RESULTS In all, 2420 patients underwent wrist arthroscopy. Thirty (1.24%) were diagnosed with an ipsilateral wrist ganglion at a mean time of 4.0 months (standard deviation: 2.4, range: 0.2-9.0). Significant predictors of ganglion diagnosis included female gender (odds ratio [OR]: 4.0, P < .01) and triangular fibrocartilage complex and/or joint debridement (OR: 0.13, P < .01). By comparison, among all 24,718,751 outpatients who had not undergone wrist arthroscopy, 39,832 patients had a diagnosis of a wrist ganglion cyst (0.16%). CONCLUSIONS Wrist arthroscopy is associated with a postoperative rate of ganglion cyst formation that is nearly 8 times the rate in the general population. Additional studies are needed to investigate techniques that minimize the risk of this complication.
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Affiliation(s)
| | | | | | - Paige Fox
- Stanford University, Palo Alto, CA, USA,Veterans Affairs Palo Alto Health Care System, CA, USA
| | - Jeffrey Yao
- Stanford University, Redwood City, CA, USA,Jeffrey Yao, Department of Orthopedic Surgery, Stanford University, 450 Broadway Street, Redwood City, CA 94063, USA.
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11
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Failure of Orthopaedic Residents to Voluntarily Participate in a Laboratory Skills Training. J Am Acad Orthop Surg 2022; 30:161-167. [PMID: 34910714 DOI: 10.5435/jaaos-d-21-00680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 11/08/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Arthroscopy simulation is increasingly used in orthopaedic residency training. The implementation of a curriculum to accommodate these new training tools is a point of interest. We assessed the use of a high-fidelity arthroscopy simulator in a strictly voluntary curriculum to gauge resident interest and educational return. METHODS Fifty-eight months of simulator use data were collected from a single institution to analyze trends in resident use. Comparable data from two additional residency programs were analyzed as well, for comparison. Orthopaedic residents were surveyed to gauge interest in continued simulation training. RESULTS Average annual simulator use at the study institution was 27.7 hours (standard deviation = 26.8 hours). Orthopaedic residents spent an average of 1.7 hours practicing on the simulation trainer during the observation period. A total of 21% of residents met or exceeded a minimum of 3 hours of simulation time required for skill improvement defined by literature. Most (86%) of the residents agreed that the simulator in use should become a mandated component of a junior resident training. CONCLUSION Although surgical simulation has a role in orthopaedic training, voluntary simulator use is sporadic, resulting in many residents not receiving the full educational benefits of such training. Implementation of a mandated simulation training curriculum is desired by residents and could improve the educational return of surgical simulators in residency training.
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12
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Zhou L, Gee SM, Hansen JA, Posner MA. Heterotopic Ossification After Arthroscopic Procedures: A Scoping Review of the Literature. Orthop J Sports Med 2022; 10:23259671211060040. [PMID: 35071654 PMCID: PMC8777353 DOI: 10.1177/23259671211060040] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 08/24/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Heterotopic ossification (HO) is the formation of bone in soft tissue
resultant from inflammatory processes. Lesion formation after arthroscopic
procedures is an uncommon but challenging complication. Optimal prophylaxis
and management strategies have not been clearly defined. Purpose: To present a scoping review of the pathophysiology, risk factors, diagnostic
modalities, prophylaxis recommendations, and current treatment practices
concerning HO after arthroscopic management of orthopaedic injuries. Study Design: Scoping review; Level of evidence, 4. Methods: A scoping review via a PubMed search was performed according to the PRISMA
(Preferred Reporting Items for Systematic Reviews and Meta-analyses)
guidelines. The search strategy was based on the terms “heterotopic
ossification” AND “arthroscopy.” The clinical outcomes review included
studies on the arthroscopic management of orthopaedic injuries in which the
primary subject matter or a secondary outcome was the development of HO. An
analysis of the pathophysiology, diagnostic modalities, and management
options was reported. Results: A total of 43 studies (33,065 patients) reported on HO after hip arthroscopy,
while 21 (83 patients) collectively reported on HO after arthroscopic
procedures to the shoulder, elbow, knee, or ankle; however, management
techniques were not standardized. Identified risk factors for HO included
male sex and mixed impingement pathology, while intraoperative capsular
management was not suggested as a contributing factor. Diagnosis of
ossification foci was performed using radiography and computed tomography.
The rate of HO after hip arthroscopy procedures approached 46% without
prophylaxis, and administration of nonsteroidal anti-inflammatory drugs
(NSAIDs) decreased occurrence rates to 4% but carries associated risks.
External beam radiation has not been exclusively studied for use after
arthroscopic procedures. Conclusion: HO is a known complication after arthroscopic management of orthopaedic
injuries. NSAID prophylaxis has been demonstrated to be effective after hip
arthroscopy procedures. Patients with persistent symptoms and mature lesions
may be indicated for surgical excision, although variability is present in
patient-reported outcome scores postoperatively.
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Affiliation(s)
- Liang Zhou
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Shawn M. Gee
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Department of Orthopaedic Surgery, Fort Belvoir Community Hospital, Fort Belvoir, Virginia, USA
| | - Joshua A. Hansen
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Matthew A. Posner
- Department of Orthopaedic Surgery, Keller Army Hospital, West Point, New York, USA
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13
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Shah NV, Gold R, Dar QA, Diebo BG, Paulino CB, Naziri Q. Smart Technology and Orthopaedic Surgery: Current Concepts Regarding the Impact of Smartphones and Wearable Technology on Our Patients and Practice. Curr Rev Musculoskelet Med 2021; 14:378-391. [PMID: 34729710 PMCID: PMC8733100 DOI: 10.1007/s12178-021-09723-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW While limited to case reports or small case series, emerging evidence advocates the inclusion of smartphone-interfacing mobile platforms and wearable technologies, consisting of internet-powered mobile and wearable devices that interface with smartphones, in the orthopaedic surgery practice. The purpose of this review is to investigate the relevance and impact of this technology in orthopaedic surgery. RECENT FINDINGS Smartphone-interfacing mobile platforms and wearable technologies are capable of improving the patients' quality of life as well as the extent of their therapeutic engagement, while promoting the orthopaedic surgeons' abilities and level of care. Offered advantages include improvements in diagnosis and examination, preoperative templating and planning, and intraoperative assistance, as well as postoperative monitoring and rehabilitation. Supplemental surgical exposure, through haptic feedback and realism of audio and video, may add another perspective to these innovations by simulating the operative environment and potentially adding a virtual tactile feature to the operator's visual experience. Although encouraging in the field of orthopaedic surgery, surgeons should be cautious when using smartphone-interfacing mobile platforms and wearable technologies, given the lack of a current academic governing board certification and clinical practice validation processes.
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Affiliation(s)
- Neil V Shah
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA.
| | - Richard Gold
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
- School of Medicine, Saint George's University, True Blue, West Indies, Grenada
| | - Qurratul-Ain Dar
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - Bassel G Diebo
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - Carl B Paulino
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
- Department of Orthopaedic Surgery, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Qais Naziri
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
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14
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Pantekidis I, Malahias MA, Kokkineli S, Brilakis E, Antonogiannakis E. Comparison between all-suture and biocomposite anchors in the arthroscopic treatment of traumatic anterior shoulder instability: A retrospective cohort study. J Orthop 2021; 24:264-270. [PMID: 33867751 DOI: 10.1016/j.jor.2021.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 02/01/2021] [Accepted: 03/23/2021] [Indexed: 10/21/2022] Open
Abstract
Purpose Suture anchors have revolutionized arthroscopic surgery, enabling direct soft tissue-to-bone repair. There are many types of anchors still used in arthroscopic shoulder operations. We sought to compare the clinical outcome of all-suture and biocomposite anchors when used in arthroscopic Bankart repair for patients suffering from anterior shoulder instability. Methods A single-center retrospective cohort study of 30 patients (mean age: 26.6 years, SD: 8.8 years, male/female ratio: 5/1, mean follow up: 28 months, SD: 23.8, range: 12-92) with anterior shoulder instability was conducted. Patients were divided into 2 groups based upon the type of suture anchors used for the Bankart repair: group A (14 patients) used only all-suture anchors and group B (16 patients) used only biocomposite anchors. Outcomes reported were postoperative dislocations, positive shoulder apprehension test, self-reported sense of shoulder instability, return to activities of daily living, return to sports, patient satisfaction and complications. Patient reported outcome measures (PROMs) used were the Rowe Score for Instability, Constant Shoulder Score, Walch Duplay Score, The American Shoulder and Elbow Surgeons (ASES) Shoulder Score, Oxford Shoulder Instability Score and external rotation at 90° of arm abduction, external rotation at 0° of arm abduction, forward flexion, abduction, adduction and internal rotation. Results Rates of postoperative shoulder dislocation demonstrated no significant difference between the 2 groups (p > .05). Four postoperative dislocations happened, two in each group (14.3% and 12.5% for all suture only and biocomposite only groups, respectively), with three of them being traumatic. In addition, no significant differences were observed amongst groups regarding shoulder apprehension test (group A: 85.7% vs. group B: 93.8%), sense of shoulder instability (7.1% vs. 6.3%), return to activities of daily living (group A: 85.7% vs. group B: 93.8%), return to sports (group A: 85.7% vs. group B: 87.5%), patient satisfaction (moderate level: group A 21.4% vs. group B 12.5%), and PROMs. Conclusion The short-term failure rate and clinical/functional outcomes of arthroscopic Bankart repair using all-suture anchors is similar to the use of biocompatible anchors. Level of evidence Level III, retrospective cohort study.
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Affiliation(s)
- Ioannis Pantekidis
- 3rd Orthopaedic Department, HYGEIA Hospital, Erythrou Stavrou 4, Marousi, 15123, Athens, Greece
| | | | - Stefania Kokkineli
- 3rd Orthopaedic Department, HYGEIA Hospital, Erythrou Stavrou 4, Marousi, 15123, Athens, Greece
| | - Emmanouil Brilakis
- 3rd Orthopaedic Department, HYGEIA Hospital, Erythrou Stavrou 4, Marousi, 15123, Athens, Greece
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15
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Lubbe RJ, Miller J, Roehr CA, Allenback G, Nelson KE, Bear J, Kubiak EN. Effect of Statewide Social Distancing and Stay-At-Home Directives on Orthopaedic Trauma at a Southwestern Level 1 Trauma Center During the COVID-19 Pandemic. J Orthop Trauma 2020; 34:e343-e348. [PMID: 32815849 PMCID: PMC7446999 DOI: 10.1097/bot.0000000000001890] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To compare orthopaedic trauma volume and mechanism of injury before and during statewide social distancing and stay-at-home directives. DESIGN Retrospective. SETTING Level 1 trauma center. PATIENTS/PARTICIPANTS One thousand one hundred thirteen patients sustaining orthopaedic trauma injuries between March 17 and April 30 of years 2018, 2019, and 2020. INTERVENTION Statewide social distancing and stay-at-home directives. MAIN OUTCOME MEASUREMENTS Number of consults, mechanism of injury frequency, and type of injury frequency. RESULTS During the COVID-19 pandemic, orthopaedic trauma consult number decreased. Injuries due to gunshot wounds increased and those due to automobile versus pedestrian accidents decreased. Time-to-presentation increased and length of stay decreased. Operative consults remained unchanged. CONCLUSIONS Orthopaedic trauma injuries continued to occur during the COVID-19 pandemic at an overall decreased rate, however, with a different distribution in mechanism and type of injury. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ryan J. Lubbe
- Department of Orthopaedic Surgery, University of Nevada Las Vegas School of Medicine, Las Vegas, NV; and
| | - Jordan Miller
- Department of Orthopaedic Surgery, University of Nevada Las Vegas School of Medicine, Las Vegas, NV; and
| | - Casey A. Roehr
- Department of Orthopaedic Surgery, University of Nevada Las Vegas School of Medicine, Las Vegas, NV; and
| | - Gayle Allenback
- Department of Orthopaedic Surgery, University of Nevada Las Vegas School of Medicine, Las Vegas, NV; and
- OptumCare Orthopaedics and Spine, OptumCare, Las Vegas, NV
| | - Karen E. Nelson
- Department of Orthopaedic Surgery, University of Nevada Las Vegas School of Medicine, Las Vegas, NV; and
- OptumCare Orthopaedics and Spine, OptumCare, Las Vegas, NV
| | - Jessica Bear
- Department of Orthopaedic Surgery, University of Nevada Las Vegas School of Medicine, Las Vegas, NV; and
- OptumCare Orthopaedics and Spine, OptumCare, Las Vegas, NV
| | - Erik N. Kubiak
- Department of Orthopaedic Surgery, University of Nevada Las Vegas School of Medicine, Las Vegas, NV; and
- OptumCare Orthopaedics and Spine, OptumCare, Las Vegas, NV
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16
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Shah NV, Kelly JJ, Newman JM, Dua K, Avoricani A, Diebo BG, Koehler SM. The 100 Most Impactful Papers in Hand and Upper Extremity Surgery over the Last 25 Years: A Bibliometric Analysis of the Orthopaedic Literature. J Hand Microsurg 2020; 14:47-57. [DOI: 10.1055/s-0040-1710171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Abstract
Introduction Despite growth in hand/upper extremity investigation, impactful studies have not been thoroughly identified. Previous studies have been limited in scope. This study sought to identify and characterize the most impactful orthopaedic papers in hand/upper extremity over the past 25 years.
Materials and Methods The top 1,000 hand/upper extremity orthopaedic studies published from 1992 to 2017 were identified with Web of Science. After screening for relevance in order of decreasing citation number, the top 100 articles were identified for bibliometric analysis.
Results The mean number of authors and citations were 4.51 (range, 1–21) and 169.4 (range, 105–863). Common study types included, case series (n = 52), randomized controlled trial (n = 17), and prospective cohort (n = 16), which predominantly covered topics related to shoulder (n = 34), wrist/forearm (n = 21), and hand (n = 17). Among wrist/forearm and hand studies, distal radius fractures (n = 12) and nerve-related topics (n = 10) were most frequently analyzed. Most studies were of level IV (n = 51) and level II (n = 16) evidence. Recent studies had greater impact (mean citations/year: 2011, 82.7/year vs. 1992, 16.1/year).
Conclusion Most of the 100 top orthopaedic articles in hand/upper extremity were of level IV or II evidence, retrospective, and nonrandomized. Despite an observed recent increase in level I studies, a lack of prospective, randomized trials is apparent.
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Affiliation(s)
- Neil V. Shah
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York, United States
| | - John J. Kelly
- School of Medicine, State University of New York (SUNY) Upstate Medical University, Syracuse, New York, United States
| | - Jared M. Newman
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York, United States
| | - Karan Dua
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York, United States
| | - Alba Avoricani
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York, United States
| | - Bassel G. Diebo
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York, United States
| | - Steven M. Koehler
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York, United States
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17
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Reynolds C, Johnson DB, Triplet JJ, Comisar BR. Well-Leg Rhabdomyolysis After Prolonged Knee Arthroscopy: A Case Report. JBJS Case Connect 2019; 9:e0386. [PMID: 31770116 DOI: 10.2106/jbjs.cc.18.00386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We present the case of an obese patient who underwent combined arthroscopic and open multiligamentous knee reconstruction who, 3 months later, required revision arthroscopic anterior cruciate ligament and posterior cruciate ligament reconstruction with open lateral collateral ligament and posterolateral corner reconstruction lasting 6 hours 30 minutes. The patient developed rhabdomyolysis of the nonoperative leg after the revision procedure. Both procedures were performed in a hemilithotomy position with a commonly used leg positioner. CONCLUSIONS Complications secondary to patient positioning are a source of unnecessary patient morbidity. Surgeons should be mindful of the nonoperative extremity, particularly during prolonged cases in obese patients. Prompt diagnosis and multidisciplinary treatment can lead to the resolution of symptoms without long-term sequelae.
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