1
|
Heiman E, Menken LG, Tang A, Vialonga M, Jankowski JM, Liporace FA, Yoon RS. Early versus Standard Weight Bearing Following Operative Treatment of Tibial Plateau Fractures: Do We Really Have to Wait So Long? J Knee Surg 2024; 37:402-408. [PMID: 37586405 DOI: 10.1055/s-0043-1772232] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Postoperative management of tibial plateau fractures classically involves a prolonged period between 10 and 12 weeks of nonweight bearing or partial weight bearing. In recent years, there has been some support for earlier weight-bearing protocols although this remains controversial. The goal of this study was to investigate the difference in outcomes between early weight-bearing (EWB) and traditional weight-bearing (TWB) protocols. This investigation is a retrospective review of 92 patients treated with open reduction and internal fixation of tibial plateau fractures at a single institution, from August 2018 to September 2020. Subjects were divided into EWB (< 10 weeks) and traditional nonweight bearing groups (≥ 10 weeks). Key outcome measures collected include injury classification, mechanism of injury, surgical fixation method, bone grafting, time to full weight bearing, radiographic time to union, range-of-motion, all-cause complications, and subsidence at an average follow-up time of 1 year. The EWB group had an earlier average time to weight bearing versus the TWB group (6.5 ± 1.4 vs. 11.8 ± 2.3 weeks, p < 0.0001). There was no difference in the classification of fractures treated between the two groups, with Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association B3 fractures the most common in the EWB group, and C3 fractures the most common in the TWB group. Radiographic time to union was no different between the two groups (93.5 ± 53.7 days for EWB vs. 103.7 ± 77.6 days for TWB, p = 0.49). There was no significant difference in complication rates or subsidence. Following operative treatment of tibial plateau fractures, patients who underwent a weight-bearing protocol earlier than 10 weeks were able to recover faster with similar outcomes and complications compared with patients who started weight bearing after 10 weeks or more. LEVEL OF EVIDENCE: III.
Collapse
Affiliation(s)
- Erick Heiman
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center - RWJBarnabas Health, Jersey City, New Jersey
| | - Luke G Menken
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center - RWJBarnabas Health, Jersey City, New Jersey
| | - Alex Tang
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center - RWJBarnabas Health, Jersey City, New Jersey
| | - Mason Vialonga
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center - RWJBarnabas Health, Jersey City, New Jersey
| | - Jaclyn M Jankowski
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center - RWJBarnabas Health, Jersey City, New Jersey
| | - Frank A Liporace
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center - RWJBarnabas Health, Jersey City, New Jersey
| | - Richard S Yoon
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center - RWJBarnabas Health, Jersey City, New Jersey
| |
Collapse
|
2
|
Shah JK, Abwini LZ, Tang A, Yang JI, Keller DM, Menken LG, Liporace FA, Yoon RS. Comparative outcomes after treatment of peri-implant, periprosthetic, and interprosthetic femur fractures: which factors increase mortality risk? OTA Int 2024; 7:e322. [PMID: 38425489 PMCID: PMC10904097 DOI: 10.1097/oi9.0000000000000322] [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] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/01/2023] [Accepted: 12/23/2023] [Indexed: 03/02/2024]
Abstract
Objectives To compare mortality rates between patients treated surgically for periprosthetic fractures (PPF) after total hip arthroplasty (THA), total knee arthroplasty (TKA), peri-implant (PI), and interprosthetic (IP) fractures while identifying risk factors associated with mortality following PPF. Design Retrospective. Setting Single, Level II Trauma Center. Patients/Participants A retrospective review was conducted of 129 consecutive patients treated surgically for fractures around a pre-existing prosthesis or implant from 2013 to 2020. Patients were separated into 4 comparison groups: THA, TKA, PI, and IP fractures. Intervention Revision implant or arthroplasty, open reduction and internal fixation (ORIF), intramedullary nailing (IMN), percutaneous screws, or a combination of techniques. Main Outcome Measurements Primary outcome measures include mortality rates of different types of PPF, PI, and IP fractures at 1-month, 3-month, 6-month, 1-year, and 2-year postoperative. We analyzed risk factors associated with mortality aimed to determine whether treatment type affects mortality. Results One hundred twenty-nine patients were included for final analysis. Average follow-up was similar between all groups. The overall 1-year mortality rate was 1 month (5%), 3 months (12%), 6 months (13%), 1 year (15%), and 2 years (22%). There were no differences in mortality rates between each group at 30 days, 90 days, 6 months, 1 year, and 2 years (P-value = 0.86). A Kaplan-Meier survival curve demonstrated no difference in survivorship up to 2 years. Older than 65 years, history of hypothyroidism and dementia, and discharge to a skilled nursing facility (SNF) led to increased mortality. There was no survival benefit in treating patients with PPFs with either revision, ORIF, IMN, or a combination of techniques. Conclusion The overall mortality rates observed were 1 month (5%), 3 months (12%), 6 months (13%), 1 year (15%), and 2 years (22%), and no differences were found between each group at all follow-up time points. Patients aged 65 and older with a history of hypothyroidism and/or dementia discharged to an SNF are at increased risk for mortality. From a mortality perspective, surgeons should not hesitate to choose the surgical treatment they feel most comfortable performing. Level of Evidence Level III.
Collapse
Affiliation(s)
- Jay K. Shah
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center–RWJBarnabas Health, Jersey City, NJ
| | - Laith Z. Abwini
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center–RWJBarnabas Health, Jersey City, NJ
| | - Alex Tang
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center–RWJBarnabas Health, Jersey City, NJ
| | - Jason I. Yang
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center–RWJBarnabas Health, Jersey City, NJ
| | - David M. Keller
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center–RWJBarnabas Health, Jersey City, NJ
| | - Luke G. Menken
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center–RWJBarnabas Health, Jersey City, NJ
| | - Frank A. Liporace
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center–RWJBarnabas Health, Jersey City, NJ
| | - Richard S. Yoon
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center–RWJBarnabas Health, Jersey City, NJ
| |
Collapse
|
3
|
Vijayakumar G, Tang A, Vance D, Yoon RS, Sweeney K, Blank AT. Does Perioperative Radiation Affect Implant Survivorship of Primary Total Hip Arthroplasty in the Setting of Metastatic Bone Disease? Arthroplast Today 2024; 25:101296. [PMID: 38292148 PMCID: PMC10826139 DOI: 10.1016/j.artd.2023.101296] [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: 03/03/2023] [Revised: 09/30/2023] [Accepted: 11/05/2023] [Indexed: 02/01/2024] Open
Abstract
Background Metastatic bone disease (MBD) commonly affects the hip and surgical intervention including total hip arthroplasty (THA) is often indicated to treat the joint and improve function. Patients with metastatic cancer often receive radiotherapy, and orthopaedic oncologists must consider surgical risks with operating on irradiated bone and soft tissue. We evaluated surgical outcomes and implant survival (IS) of titanium acetabular components and femoral components in patients treated for MBD in the setting of perioperative radiation. Methods This was a retrospective review of patients who underwent THA for MBD at 3 institutions between 2017 and 2021. Outcomes included rates of reoperation, complications, IS, and overall survival. Results Forty-six patients who received primary THA for MBD were included in the study. Twenty patients (43.5%) received perioperative radiation for MBD. Six postoperative complications including one superficial wound infection, 2 dislocations, 2 pathologic fractures, and one aseptic acetabular component loosening led to 5 reoperations. There were no significant differences in postoperative outcomes, reoperation after THA, and IS based on radiotherapy status. Conclusions To our knowledge, this is the first paper evaluating primary THA outcomes and IS between patients who receive perioperative radiation for MBD to the hip and those who do not. As surgical management is a crucial part of the treatment in alleviating pain and disability in patients with MBD, we continue to recommend THA for patients who received radiation at the operative site.
Collapse
Affiliation(s)
- Gayathri Vijayakumar
- Department of Orthopedic Surgery, Section of Orthopedic Oncology, Rush University Medical Center, Chicago, IL, USA
| | - Alex Tang
- Divison of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center - RWJBarnabas Health, Livingston, Jersey City, NJ, USA
| | - Dylan Vance
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Richard S. Yoon
- Divison of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center - RWJBarnabas Health, Livingston, Jersey City, NJ, USA
| | - Kyle Sweeney
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Alan T. Blank
- Department of Orthopedic Surgery, Section of Orthopedic Oncology, Rush University Medical Center, Chicago, IL, USA
| |
Collapse
|
4
|
Bouchard A, Mun J, Vazquez F, Tang A, Delsole E, Strom R, Chen T. Radiographic Robustness of Lumbar Interbody Fusion Techniques. Global Spine J 2024:21925682241226659. [PMID: 38197369 DOI: 10.1177/21925682241226659] [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] [Indexed: 01/11/2024] Open
Abstract
STUDY DESIGN Retrospective chart review. OBJECTIVES Lumbar interbody fusion (LIF) can be achieved with various techniques. Evidence supporting the long-term clinical advantages of one technique over another are inconclusive. The purpose of this study was to (1) determine the changes in sagittal parameters in the preoperative, intraoperative, and post-operative phase, (2) evaluate the radiographic maintenance of these parameters over time, and (3) compare the demographics and patient reported outcomes of patients undergoing various LIF techniques. METHODS We performed a retrospective chart review of patients with degenerative spine disease undergoing single level anterior (ALIF), lateral (LLIF), posterior (PLIF), or transforaminal (TLIF) lumbar interbody fusion. Data collected included patient demographics and diagnosis at time of surgery. Upright lumbar radiographs taken pre-operatively, intra-operatively, and post-operatively were measured for lumbar lordosis (LL), segmental lordosis (SL), posterior disc height (PDH), and foraminal height (FH). RESULTS 194 patients in a single center were included. PDH and FH increased intra-operatively following ALIF (P < .0001), PLIF (P < .0001), LLIF (P < .0001), and TLIF (P < .0001). SL also increased intra-operatively for ALIF (P = .002) and LLIF (P = .0007). Compared to intra-operative radiographs, PDH and FH decreased at latest post-operative phase for ALIF (P < .03), LLIF (P < .003), TLIF (P < .001), and PLIF (P < .005). SL decreased for ALIF (P = .0008), and TLIF (P = .02). LL did not change postoperatively across techniques. Patient reported outcomes improved post-surgically and disability index decreased, but neither differed between techniques. CONCLUSION LIF, regardless of technique, was shown to provide significant radiographic changes in PDH and FH. Techniques utilizing larger intervertebral cage sizes (ALIF/LLIF) improved SL. Single level LIF did not affect overall LL. No single technique displayed superior radiographic robustness over time.
Collapse
Affiliation(s)
- Alice Bouchard
- Department of Orthopedic Surgery, Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Jeffrey Mun
- Department of Orthopedic Surgery, Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Frank Vazquez
- Department of Orthopedic Surgery, Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Alex Tang
- Northeast Orthopaedic Surgery Residency, Geisinger, Wilkes-Barren, PA, USA
| | - Edward Delsole
- Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, PA, USA
| | - Russell Strom
- Department of Neurosurgery, Geisinger Medical Center, Danville, PA, USA
| | - Tan Chen
- Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, PA, USA
| |
Collapse
|
5
|
Zhang W, Zhang Y, Xia Y, Feng G, Wang Y, Wei C, Tang A, Song K, Qiu R, Wu Y, Jin S. Choline induced cardiac dysfunction by inhibiting the production of endogenous hydrogen sulfide in spontaneously hypertensive rats. Physiol Res 2023; 72:719-730. [PMID: 38215059 PMCID: PMC10805251] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 09/07/2023] [Indexed: 01/14/2024] Open
Abstract
To investigate the exact effects of dietary choline on hypertensive heart disease (HHD) and explore the potential mechanisms, male spontaneously hypertensive rats (SHR) and Wistar Kyoto rats (WKY) were randomly divided into five groups as follows: WKY group, WKY + Choline group, SHR group, SHR + Choline group, and SHR + Choline + NaHS group. In choline treatment groups, rats were fed with 1.3% (w/v) choline in the drinking water for 3 months. The rats in the SHR + Choline + NaHS group were intraperitoneally injected with NaHS (100 micromol/kg/day, a hydrogen sulfide (H2S) donor) for 3 months. After 3 months, left ventricular ejection fraction (LVEF) and fractional shortening (LVFS), the indicators of cardiac function measured by echocardiography, were increased significantly in SHR as compared to WKY, although there was no significant difference in collagen volumes and Bax/Bcl-2 ratio between the two groups, indicating the early stage of cardiac hypertrophy. There was a significant decrease in LVEF and LVFS and an increase in collagen volumes and Bax/Bcl-2 ratio in SHR fed with choline, meanwhile, plasma H2S levels were significantly decreased significantly in SHR fed with choline accompanying by the decrease of cystathionine-gamma-lyase (CSE) activity. Three months of NaHS significantly increased plasma H2S levels, ameliorated cardiac dysfunction and inhibited cardiac fibrosis and apoptosis in SHR fed with choline. In conclusion, choline aggravated cardiac dysfunction in HHD through inhibiting the production of endogenous H2S, which was reversed by supplementation of exogenous H2S donor.
Collapse
Affiliation(s)
- W Zhang
- Department of Physiology, Hebei Medical University, Hebei, China
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Mun JS, Parry MW, Tang A, Manikowski JJ, Crinella C, Mercuri JJ. Patient "No-Show" Increases the Risk of 90-Day Complications Following Primary Total Knee Arthroplasty: A Retrospective Cohort Study of 6,776 Patients. J Arthroplasty 2023; 38:2587-2591.e2. [PMID: 37295624 DOI: 10.1016/j.arth.2023.05.089] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Patients who "no-show" (NS) clinical appointments are at a high risk of adverse health outcomes. The objective of this study was to evaluate and characterize the relationship between NS visits prior to primary total knee arthroplasty (TKA) and 90-day complications after TKA. METHODS We retrospectively reviewed 6,776 consecutive patients undergoing primary TKA. Study groups were separated based on whether patients who NS versus always attended their appointment. A NS was defined as an intended appointment that was not canceled or rescheduled ≤2 hours before the appointment in which the patient did not show. Data collected included total number of follow-up appointments prior to surgery, patient demographics, comorbidities, and 90-day postoperative complications. RESULTS Patients who have ≥3 NS appointments had 1.5 times increased odds of a surgical site infection (odds ratio (OR) 1.54, P = .002) compared to always attended patients. Patients who were ≤65 years old (OR: 1.41, P < .001), smokers (OR: 2.01, P < .001), and had a Charlson comorbidity index ≥3 (OR: 4.48, P < .001) were more likely to miss clinical appointments. CONCLUSION Patients who have ≥3 NS appointments prior to TKA had an increased risk for surgical site infection. Sociodemographic factors were associated with higher odds of missing a scheduled clinical appointment. These data suggest that orthopaedic surgeons should consider NS data as an important clinical decision-making tool to assess risk for postoperative complications to minimize complications following TKA.
Collapse
Affiliation(s)
- Jeffrey S Mun
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania
| | - Matthew W Parry
- Geisinger Musculoskeletal Institute, Division of Adult Reconstruction, Scranton, Pennsylvania
| | - Alex Tang
- Geisinger Musculoskeletal Institute, Division of Adult Reconstruction, Scranton, Pennsylvania
| | - Jesse J Manikowski
- Geisinger Cancer Institute - Center for Oncology Research and Innovation, Danville, Pennsylvania
| | - Cory Crinella
- Geisinger Musculoskeletal Institute, Division of Adult Reconstruction, Scranton, Pennsylvania
| | - John J Mercuri
- Geisinger Musculoskeletal Institute, Division of Adult Reconstruction, Scranton, Pennsylvania
| |
Collapse
|
7
|
Fiedler B, Singh V, Tang A, Marwin S, Meftah M, Schwarzkopf R. Impact of a Novel Navigational Technology on Short-Term Patient Outcomes Following Total Knee Arthroplasty A Propensity Matched Cohort Study. Bull Hosp Jt Dis (2013) 2023; 81:273-278. [PMID: 37979145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
PURPOSE The use of intraoperative technology is increasing among orthopedic surgeons in the United States. However, there is continued debate as to whether intraoperative technologies provide clinical benefits in patients undergoing total knee arthroplasty (TKA). This study sought to determine whether the use of a novel intraoperative navigation technology produces equivalent or superior short-term outcomes compared to conventional technique. METHODS Fifty-nine consecutive patients underwent primary TKA with a novel imageless intraoperative navigational technology between October 2019 and January 2020 at a single, urban, orthopedic specialty hospital. A 1:1 cohort propensity matching was performed with patients with similar demographics who underwent primary TKA without the use of technology. Demographics, clinical data, as well as preoperative and 3-month Knee Injury and Osteoarthritis Outcome Score, Joint Replacement (KOOS, JR) scores were collected. Demographic differences, clinical data, and mean KOOS, JR scores were assessed using chi-squared analysis for categorical variables and independent sample t-test for continuous variables. RESULTS Upon 1:1 cohort matching, patients in both the navigational cohorts and non-navigational cohorts were statistically similar demographically. Length of stay (2.11 vs. 1.71 days; p = 0.108), surgical time (108.89 vs. 101.19 minutes, p = 0.066), discharge disposition (p = 0.675), 90- day readmissions (4 vs. 4, p = 0.999), and 90-day reoperations (2 vs. 2, p = 0.999) did not statistically differ between the two matched cohorts. Additionally, KOOS, JR scores evaluated between the two cohorts preoperatively (46.06 vs. 45.17, p = 0.836) and at 3-month follow-up (57.63 vs. 55.06, p = 0.580) were similar. CONCLUSION This study demonstrates that the use of this novel intraoperative navigational technology yields similar short-term TKA results when compared to conventionally performed TKA. Further studies are required to validate new technologies and determine their effect on long-term clinical and patient-reported outcomes.
Collapse
|
8
|
Keller DM, Saad BN, Hong IS, Gencarelli P, Tang A, Jankowski JM, Liporace FA, Yoon RS. Comparison of Outcomes After Reverse Total Shoulder Arthroplasty in Patients With Proximal Humerus Fractures Versus Rotator Cuff Arthropathy. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202310000-00006. [PMID: 37856701 PMCID: PMC10589608 DOI: 10.5435/jaaosglobal-d-23-00160] [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] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 09/01/2023] [Indexed: 10/21/2023]
Abstract
INTRODUCTION Indications for reverse total shoulder arthroplasty (rTSA) has expanded to encompass complex proximal humerus fractures (PHFs) in recent years. The purpose of this study was to report and assess whether PHF patients treated with rTSA could achieve similar functional outcomes and short-term survivorship to patients who underwent rTSA for rotator cuff arthropathy (RTCA). METHODS All consecutive patients with a preoperative diagnosis of PHF or RTCA, 18 years or older, treated with rTSA at a single academic institution between 2018 and 2020 with a minimum 2-year follow-up were retrospectively reviewed. Primary outcomes were survivorship defined as revision surgery or implant failure analyzed using the Kaplan-Meier survival curve, and functional outcomes, which included Quick Disabilities of the Arm, Shoulder, and Hand, and range of motion (ROM) were compared at multiple follow-up time points up to 2 years. Secondary outcomes were patient demographics, comorbidities, surgical data, length of hospital stay, and discharge disposition. RESULTS A total of 48 patients were included: 21 patients (44%) were diagnosed with PHF and 27 patients (56%) had RTCA. The Kaplan-Meier survival rate estimates at 3 years were 90.5% in the PHF group and 85.2% in the RTCA group. No differences in revision surgery rates between the two groups (P = 0.68) or survivorship (P = 0.63) were found. ROM was significantly lower at subsequent follow-up time points in multiple planes (P < 0.05). A greater proportion of patients in the PHF group received cement for humeral implant fixation compared with the RTCA group (48% versus 7%, P = 0.002). The mean length of hospital stay was longer in PHF patients compared with RTCA patients (2.9 ± 3.8 days versus 1.6 ± 1.8 days, P = 0.13), and a significantly lower proportion of PHF patients were discharged home (67% versus 96%, P = 0.015). CONCLUSION The rTSA implant survivorship at 3 years for both PHF and RTCA patients show comparable results. At the 2-year follow-up, RTCA patients treated with rTSA were found to have better ROM compared with PHF patients.
Collapse
Affiliation(s)
- David M. Keller
- From the Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center–RWJBarnabas Health, Livingston, NJ/Jersey City, NJ
| | - Bishoy N. Saad
- From the Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center–RWJBarnabas Health, Livingston, NJ/Jersey City, NJ
| | - Ian S. Hong
- From the Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center–RWJBarnabas Health, Livingston, NJ/Jersey City, NJ
| | - Pasquale Gencarelli
- From the Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center–RWJBarnabas Health, Livingston, NJ/Jersey City, NJ
| | - Alex Tang
- From the Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center–RWJBarnabas Health, Livingston, NJ/Jersey City, NJ
| | - Jaclyn M. Jankowski
- From the Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center–RWJBarnabas Health, Livingston, NJ/Jersey City, NJ
| | - Frank A. Liporace
- From the Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center–RWJBarnabas Health, Livingston, NJ/Jersey City, NJ
| | - Richard S. Yoon
- From the Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center–RWJBarnabas Health, Livingston, NJ/Jersey City, NJ
| |
Collapse
|
9
|
Green CC, Stelzer JW, Kerr MS, Tang A, Menken LG, Romanelli F, Miller JM, Liporace FA, Haidukewych GJ, Yoon RS. Risk Factors for Revision Surgery Following Revision Total Knee Arthroplasty Using a Hinged Knee Prosthesis for Septic and Aseptic Indications. J Am Acad Orthop Surg 2023; 31:e798-e814. [PMID: 37235694 DOI: 10.5435/jaaos-d-22-00746] [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: 08/11/2022] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION The use of hinged knee replacements (HKRs) for limb salvage is a popular option for revision total knee arthroplasty (RTKA). Although recent literature focuses on the outcomes of HKR for septic and aseptic RTKAs, little is reported on the risk factors of returning to the operating room. The purpose of this study was to evaluate risk factors of revision surgery and revision after receiving HKR for septic versus aseptic etiology. METHODS A multicenter, retrospective review was conducted on consecutive patients who received HKR from January 2010 to February 2020 with a minimum follow-up of 2 years. Patients were separated into two groups: septic and aseptic RTKAs. Demographic, comorbidity, perioperative, postoperative, and survivorship data were collected and compared between groups. Cox hazard regression was used to identify risk factors associated with revision surgery and revision. RESULTS One-hundred fifty patients were included. Eighty-five patients received HKR because of prior infection, and 65 received HKR for aseptic revision. A larger proportion of septic RTKA returned to the OR versus aseptic RTKA (46% vs 25%, P = 0.01). Survival curves revealed superior revision surgery-free survival favoring the aseptic group ( P = 0.002). Regression analysis revealed that HKR with concomitant flap reconstruction was associated with a three-fold increased risk of revision surgery ( P < 0.0001). DISCUSSION HKR implantation for aseptic revision is more reliable with a lower revision surgery rate. Concomitant flap reconstruction increased the risk of revision surgery, regardless of indication for RTKA using HKR. Although surgeons must educate patients about these risk factors, HKR remains a successful treatment option for RTKA when indicated. LEVEL OF EVIDENCE prognostic, level III evidence.
Collapse
Affiliation(s)
- Cody C Green
- From the Department of Orthopaedic Surgery, Division of Orthopaedic Trauma and Adult Reconstruction, Orlando Regional Medical Center, Orlando, FL (Dr. Green, Dr. Kerr, and Dr. Haidukewych); Department of Orthopaedic Surgery, Division of Orthopaedic Trauma and Adult Reconstruction, Jersey City Medical Center, Jersey City, NJ (Dr. Tang, Dr. Menken, Dr. Romanelli, Dr. Miller, Dr. Liporace, and Dr. Yoon); and Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT (Dr. Stelzer)
| | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Yurek JW, Doerr NA, Tang A, Kohring AS, Liporace FA, Yoon RS. Assessing the Necessity of Extra Reduction Aides in Intramedullary Nailing of Intertrochanteric Hip Fractures. Hip Pelvis 2023; 35:183-192. [PMID: 37727297 PMCID: PMC10505845 DOI: 10.5371/hp.2023.35.3.183] [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: 03/26/2023] [Revised: 07/21/2023] [Accepted: 07/21/2023] [Indexed: 09/21/2023] Open
Abstract
Purpose This study aims to determine which intertrochanteric (IT) hip fracture and patient characteristics predict the necessity for adjunct reduction aides prior to prep and drape aiming for a more efficient surgery. Materials and Methods Institutional fracture registries from two academic medical centers from 2017-2022 were analyzed. Data on patient demographics, comorbidities, fracture patterns identified on radiographs including displacement of the lesser trochanter (LT), thin lateral wall (LW), reverse obliquity (RO), subtrochanteric extension (STE), and number of fracture parts were collected, and the need for additional aides following traction on fracture table were collected. Fractures were classified using the AO/OTA classification. Regression analyses identified significant risk factors for needing extra reduction aides. Results Of the 166 patients included, the average age was 80.84±12.7 years and BMI was 24.37±5.3 kg/m2. Univariate regression revealed increased irreducibility risk associated with RO (odds ratio [OR] 27.917, P≤0.001), LW (OR 24.882, P<0.001), and STE (OR 5.255, P=0.005). Multivariate analysis significantly correlated RO (OR 120.74, P<0.001) and thin LW (OR 131.14, P<0.001) with increased risk. However, STE (P=0.36) and LT displacement (P=0.77) weren't significant. Fracture types 2.2, 3.2, and 3.3 displayed elevated risk (P<0.001), while no other factors increased risk. Conclusion Elderly patients with IT fractures with RO and/or thin LW are at higher risk of irreducibility, necessitating adjunct reduction aides. Other parameters showed no significant association, suggesting most fracture patterns can be achieved with traction manipulation alone.
Collapse
Affiliation(s)
- John W. Yurek
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center – RWJBarnabas Health, Jersey City, NJ, USA
| | - Nikki A. Doerr
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center – RWJBarnabas Health, Jersey City, NJ, USA
| | - Alex Tang
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center – RWJBarnabas Health, Jersey City, NJ, USA
| | - Adam S. Kohring
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center – RWJBarnabas Health, Jersey City, NJ, USA
| | - Frank A. Liporace
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center – RWJBarnabas Health, Jersey City, NJ, USA
| | - Richard S. Yoon
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center – RWJBarnabas Health, Jersey City, NJ, USA
| |
Collapse
|
11
|
Tang A, Chandler S, Torkington J, Harris DA, Dhruva Rao PK. Adapting the investigation of patients on urgent suspected cancer pathway with lower gastrointestinal symptoms across Wales during COVID-19. Ann R Coll Surg Engl 2023; 105:S35-S41. [PMID: 35616545 PMCID: PMC10390240 DOI: 10.1308/rcsann.2021.0366] [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] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic necessitated the introduction of revised diagnostic pathways for assessing urgent suspected cancer (USC) referrals. Combinations of faecal immunochemical testing (FIT) and minimal preparation computed tomography (CT) scans (MPCT) were used to manage referrals and prioritise access to clinical services or invasive tests. The effectiveness of these pathways across Wales is evaluated in this study. METHODS All consecutive patients referred from primary care on the USC pathway between 15 March and 15 June 2020 were included to reflect the effect of full lockdown measures. Data collected included demographics, presenting symptom(s), investigations and timelines and patient outcomes up to 90 days following initial referral. RESULTS A total of 1,050 patients across eight sites in Wales were included. Of these 1,050 patients, 52.6% were female with median age 68 (21-97) years; 50.5% had first-line clinical review, of which 61.1% were virtual consultations; 49.5% had primary investigations; 26.7% of patients had FIT and 13.1% had MPCT. COVID-response pathways achieved a 29.9% reduction in use of colonoscopy as first-line investigation and 79% of patients avoided face-to-face consultations altogether during this first wave of the pandemic. Overall, 6.8% of USC referrals were diagnosed with colorectal cancer (CRC). Median timescale from diagnosis to treatment for CRC was 65 (4-175) days. The negative predictive value (NPV) for FIT in this cohort was 99.6%. MPCT as the first modality had a NPV of 99.2%. CONCLUSION A modified investigation pathway helped maintain cancer diagnosis rates during the pandemic with improved resource utilisation to that used prepandemic.
Collapse
Affiliation(s)
- A Tang
- Singleton Hospital, Swansea Bay University Health Board, UK
| | - S Chandler
- Singleton Hospital, Swansea Bay University Health Board, UK
| | | | - D A Harris
- Singleton Hospital, Swansea Bay University Health Board, UK
| | | |
Collapse
|
12
|
Jiancaro T, Bayoumi AM, Ibáñez-Carrasco F, Torres B, McDuff K, Brown DA, Chan Carusone S, Tang A, Loutfy M, Cobbing S, O’Brien KK. Factors influencing initial implementation of an online community-based exercise intervention with adults living with HIV: a systems approach. Front Rehabil Sci 2023; 4:1176960. [PMID: 37546578 PMCID: PMC10399961 DOI: 10.3389/fresc.2023.1176960] [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] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/05/2023] [Indexed: 08/08/2023]
Abstract
Introduction Online community-based exercise (CBE) is a digital health intervention and rehabilitation strategy that promotes health among people living with HIV. Our aim was to describe the factors influencing initial implementation of a pilot online CBE intervention with adults living with HIV using a systems approach, as recommended by implementation science specialists. Methods We piloted the implementation of a 6-month online CBE intervention and 6-month independent exercise follow up, in partnership with the YMCA in Toronto, Canada. We recruited adults living with HIV who identified themselves as safe to engage in exercise. The intervention phase included personalized exercise sessions online with a personal trainer; exercise equipment; access to online exercise classes; and a wireless physical activity monitor. Two researchers documented implementation factors articulated by participants and the implementation team during early implementation, defined as recruitment, screening, equipment distribution, technology orientation, and baseline assessments. Data sources included communication with participants; daily team communication; weekly team discussions; and in-person meetings. We documented implementation factors in meeting minutes, recruitment screening notes, and email communication; and analyzed the data using a qualitative descriptive approach using a systems engineering method called Cognitive Work Analysis. Results Thirty-three adults living with HIV enrolled in the study (n = 33; median age: 52 years; cis-men: 22, cis-women: 10, non-binary: 1). Fifty-five factors influencing implementation, spanned five layers: (i) Natural, including weather and the COVID-19 virus; (ii) Societal, including COVID-19 impacts (e.g. public transit health risks impacting equipment pick-ups); (iii) Organizational, including information dissemination (e.g. tech support) and logistics (e.g. scheduling); (iv) Personal, including physical setting (e.g. space) and digital setting (e.g. device access); and (v) Human, including health (e.g. episodic illness) and disposition (e.g. motivation). The implementation team experienced heightened needs to respond rapidly; sustain engagement; and provide training and support. Additional organizational factors included a committed fitness training and research team with skills spanning administration and logistics, participant engagement, technology training, physical therapy, and research ethics. Conclusion Fifty-five factors spanning multiple layers illustrate the complexities of online CBE with adults living with HIV. Initial implementation required a dedicated, rehabilitation-centred, multi-skilled, multi-stakeholder team to address a diverse set of factors.
Collapse
Affiliation(s)
- T. Jiancaro
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - A. M. Bayoumi
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- MAP Centre, St. Michael’s Hospital, Toronto, ON, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - F. Ibáñez-Carrasco
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - B. Torres
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - K. McDuff
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - D. A. Brown
- Therapies Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - S. Chan Carusone
- McMasterCollaborative Centre for Health and Aging, McMaster University, Hamilton, ON, Canada
| | - A. Tang
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - M. Loutfy
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Maple Leaf Medical Clinic, Toronto, ON, Canada
| | - S. Cobbing
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- The Institute of Education Research, University Health Network, Toronto, ON, Canada
- Department of Physiotherapy, University of KwaZulu-Natal, Durban, South Africa
| | - K. K. O’Brien
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, ON, Canada
| |
Collapse
|
13
|
Deliso M, Baskar S, Gencarelli P, Tang A, Jankowski JM, Liporace FA, Yoon RS. Reverse Total Shoulder Arthroplasty for Younger Patients: A Comparable Analysis of Patients Older and Younger Than 65 Years. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202306000-00012. [PMID: 37339241 DOI: 10.5435/jaaosglobal-d-22-00264] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 04/24/2023] [Indexed: 06/22/2023]
Abstract
INTRODUCTION Reverse total shoulder arthroplasty (rTSA) has become a popular option for the surgical management of rotator cuff arthropathy and complex fractures of the proximal humerus. However, there is a paucity of studies evaluating outcomes, especially between patients of different age groups. The purpose of this study was to compare functional outcomes and survivorship between patients older than 65 years (o65) and those 65 years and younger (y65). METHODS A retrospective review was conducted at a single academic medical center identifying a consecutive cohort of patients undergoing rTSA between 2018 and 2020. The minimum follow-up time was 2 years. Patients were stratified into two groups for comparative analyses (y65 and o65). Patient demographics, perioperative and postoperative data, and functional outcomes were collected. A Kaplan-Meier survival analysis was conducted to determine survivorship, defined as revision surgery or implant failure. RESULTS Forty-eight patients were included for final analysis. Nineteen patients comprised the y65 group while 29 patients comprised the o65 group. No difference was observed in Quick Disabilities of the Arm, Shoulder, and Hand scores at baseline nor at the latest follow-up between the two groups. Patients in the y65 group had significantly greater internal and external rotation (IR/ER) from 3 months to 2 years compared with patients in the o65 group (P ≤ 0.05). Finally, there were no differences in revision surgery rates between the y65 group and the o65 group (11% vs. 14%, P = 1.0). A KM survival analysis revealed no difference in implant failure, necessitating revision surgery between the two groups at the latest follow-up (P = 0.69). DISCUSSION Despite a notable difference in the number of baseline comorbidities, there were no notable differences in functional outcomes, survivorship, and revision surgery rates between each cohort. Although both groups had a similar function initially, by 3 months postoperatively, the y65 group had markedly greater range of motion in IR and ER. Longer term survivorship is needed; however, rTSA may offer a reliable option for shoulder reconstruction even in the y65 patient group.
Collapse
Affiliation(s)
- Marisa Deliso
- From the Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center - RWJBarnabas Health Jersey City, NJ
| | | | | | | | | | | | | |
Collapse
|
14
|
Chan VWS, Rahman L, Ng HHL, Tang KP, Mok A, Tang A, Liu JPH, Ho KSC, Chan SM, Wong S, Teoh AYB, Chan A, Wong MCS, Yuan Y, Teoh JYC. Mitigation of COVID-19 transmission in endoscopic and surgical aerosol-generating procedures: a narrative review of early-pandemic literature. Hong Kong Med J 2023. [PMID: 37217445 DOI: 10.12809/hkmj209089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Affiliation(s)
- V W S Chan
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - L Rahman
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - H H L Ng
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - K P Tang
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - A Mok
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - A Tang
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - J P H Liu
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - K S C Ho
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - S M Chan
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - S Wong
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - A Y B Teoh
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - A Chan
- Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, Hong Kong SAR, China
| | - M C S Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Y Yuan
- Department of Medicine, McMaster University, Hamilton, Canada
| | - J Y C Teoh
- SH Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| |
Collapse
|
15
|
Zak SG, Cieremans D, Tang A, Schwarzkopf R, Rozell JC. Intraoperative technology increases operating room times in primary total knee arthroplasty. Arch Orthop Trauma Surg 2023; 143:2113-2119. [PMID: 35551447 DOI: 10.1007/s00402-022-04468-4] [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: 11/26/2021] [Accepted: 04/24/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Optimization of patient outcomes and identification of factors to improve the surgical workflow are increasingly important. Operating room time is one modifiable factor that leads to greater hospital efficiency as well as improved outcomes such as shorter length of stay and fewer infections and readmissions. The aim of this study was to identify factors associated with operative time disparities in total knee arthroplasty (TKA). METHODS A retrospective review of 7659 consecutive primary TKA cases was conducted. Patient demographic data, discrete operating room (OR) times, use of technology (i.e. robotic-assisted surgery, computer navigation), surgeon experience and the level of training of the first assistant were collected. Multivariate regression analysis was used to determine the effect of hospital characteristics on operative times. Operative times of five minutes or greater were considered to be clinically significant. RESULTS While the use of technology (182.64 ± 39.85 vs 158.70 ± 37.45 min; B = 26.09; p < 0.0001) and greater surgeon experience (162.14 ± 39.87 vs 158.69 ± 33.18 min, B = 3.15, p = 0.002) were found to increase OR times, level of training of the first assist (161.65 vs 156.4 min; Β = - 0.264; p = 0.487) did not. Of the discrete OR times examined, incision time and total time under anesthesia were negatively impacted by the use of technology. CONCLUSION Use of technology was the only study variable found to significantly increase OR times. With increased operative times and limited evidence that technology improves long-term patient outcomes, surgeons should carefully consider the benefits and cost of technology in TKA.
Collapse
Affiliation(s)
- Stephen G Zak
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA
| | - David Cieremans
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA
| | - Alex Tang
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA
| | - Joshua C Rozell
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA.
| |
Collapse
|
16
|
Postill G, Benchimol EI, Im J, Tang A, Kuenzig E. A16 UNMET HEALTHCARE NEEDS AMONG PEOPLE WITH INFLAMMATORY BOWEL DISEASE: A NATIONAL CROSS-SECTIONAL POPULATION-REPRESENTATIVE STUDY. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991203 DOI: 10.1093/jcag/gwac036.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Inflammatory bowel disease (IBD) is a chronic inflammatory disease primarily affecting the gastrointestinal tract. Despite treatment with the current standards of care, many IBD patients experience relapsing, remitting, and disabling bowel symptoms and significant disease complications. Ensuring patients have adequate access to high quality multidisciplinary healthcare is vital for the short- and long-term wellbeing of IBD patients. Purpose (1) Compare unmet healthcare needs of people with and without IBD. (2) Determine whether accessing regular medical care mediates the association between IBD and unmet healthcare needs. (3) Describe the reasons for unmet healthcare needs among people with and without IBD. Method We used the 2014 Canadian Community Health Survey, a population-representative national cross-sectional survey conducted by Statistics Canada. Respondents with a non-IBD bowel disorder or aged 18 or younger were excluded. Survey weights were used for descriptive statistics. We used multilevel logistic regression to compare perceived unmet healthcare needs among individuals with and without IBD, clustering by health region and controlling for age, immigration status, race, home ownership, marital status, annual household income, education level, and number of chronic conditions (0, 1, 2+). In a second model, we additionally controlled for having a regular family doctor, having consulted a specialist, and having consulted a psychologist to assess if regularly accessing medical care mediated the association between IBD and unmet healthcare needs. Individuals reporting unmet healthcare needs were asked about the reasons for their unmet healthcare needs. Responses are summarized with weighted percentages, plotted in a bar graph. Result(s) Among the 690 IBD and 62,832 non-IBD eligible survey respondents, 16.7% of people with IBD had an unmet healthcare need within the past 12 months, compared with 10.3% of those without IBD (OR 1.39, 95% CI 1.12 to 1.74). Additionally adjusting for regular access to medical care slightly attenuated the association between IBD and unmet healthcare needs (OR 1.29, 95% CI 1.03 to 1.62). Reasons for unmet healthcare needs differed among those with and without IBD (Figure). Specifically, doctors believing that care was unnecessary and the cost of care were more likely to be the reason people with IBD had an unmet healthcare need. Image ![]()
Conclusion(s) People with IBD are more likely to have an unmet healthcare need that was partially mediated by access to healthcare professionals. Our work highlights the need for further research into the types of unmet healthcare needs experienced by people living with IBD. This underscores the need for multidisciplinary healthcare teams to address the increased burden of unmet healthcare needs in the IBD population. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest G. Postill: None Declared, E. Benchimol Consultant of: Hoffman La-Roche Limited and Peabody & Arnold LLP for matters unrelated to medications used to treat inflammatory bowel disease. Dr. Benchimol has also acted as a consultant for McKesson Canada and the Dairy Farmers of Ontario for matters unrelated to medications used to treat inflammatory bowel disease., J. Im: None Declared, A. Tang: None Declared, E. Kuenzig: None Declared
Collapse
Affiliation(s)
- G Postill
- Temerty Faculty of Medicine, University of Toronto
| | - E I Benchimol
- Temerty Faculty of Medicine, University of Toronto,SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Hospital for Sick Children,Child Health Evaluative Sciences, SickKids Research Institute,Institute of Health Policy, Management and Evaluation, University of Toronto,Institute for Clinical and Evaluative Sciences, Toronto, Canada
| | - J Im
- Child Health Evaluative Sciences, SickKids Research Institute
| | - A Tang
- Child Health Evaluative Sciences, SickKids Research Institute
| | - E Kuenzig
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Hospital for Sick Children,Child Health Evaluative Sciences, SickKids Research Institute
| |
Collapse
|
17
|
Khan R, Kuenzig E, Tang A, Im J, Widdifield J, McCurdy J, Kaplan G, Benchimol E. A177 RISK OF VENOUS THROMBOEMBOLISM IN COVID-19 PATIENTS WITH INFLAMMATORY BOWEL DISEASE: A POPULATION-BASED MATCHED COHORT STUDY. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991269 DOI: 10.1093/jcag/gwac036.177] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Venous thromboembolism (VTE), is associated with significant morbidity and mortality. Inflammation increases the risk of VTE, and it is a well-recognised complication of both inflammatory bowel disease (IBD) and COVID-19. Purpose To compare the risk of VTE among individuals with and without IBD following a positive COVID-19 test. Method Using health administrative data from Ontario, Canada we conducted a retrospective matched cohort study.All Ontario residents with a positive SARS-CoV-2 PCR test between January 1,2020 and December 30,2021 who had been diagnosed with IBD prior to their COVID-19 infection (identified using a validated algorithm) were matched to 5 individuals without IBD based on year of birth, sex, mean neighbourhood income quintile, date of positive COVID-19 test, and rural/urban residence. Individuals with a cancer diagnosis in the 5 years prior to their first COVID-19 positive test were excluded. Individuals were followed from positive COVID-19 PCR test until VTE event, death, migration out of Ontario or March 31, 2022.VTEs were identified from emergency department or hospitalization data using ICD-10 codes. Incidence rate of VTEs among individuals with IBD were assessed at 1, 6 and 12 months. Proportional cause-specific hazards models compared the risk of VTEs in people with and without IBD, treating death as a competing risk and controlling for vaccination status (2nd dose ≥14 days prior to positive COVID-19 test) and a history of VTE (VTE in the 5 years prior to infection). Result(s) There were 4293 people with IBD (44% Crohn’s disease, mean age ±SD 46.1±17.2 y) matched to 20,207 with out IBD (mean age 45.3±16.8 y) with a positive SARS-CoV-2 PCR test. Within 1 month of a positive COVID-19 test, the crude incidence rate of VTE in individuals with IBD was 4.77(95%CI, 4.75-4.80) per 100,000 person-days compared to 8.25(95%CI, 8.20-8.30) per 100,000 among people without IBD.Within 6 months, these rates were 1.86(95%CI, 1.86-1.87) and 2.12(95%CI, 2.11-2.12) per 100,000 person-days among people with and without IBD, respectivley. Within 12 months, these rates were 1.59(95% CI, 1.58-1.59) and 1.42(95% CI, 1.42-1.42) per 100,000 person-days among people with and without IBD, respectively.After adjusting for vaccination status and history of VTE there was no difference in the risk of VTE for people with and without IBD (HR 1.08, 95%CI, 0.64 to 1.83). Conclusion(s) IBD patients with COVID-19 were not more likely to experience a VTE infection compared with the general popluation. The risk of VTE was highest soon after COVID-19 and declined thereafter. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared
Collapse
Affiliation(s)
- R Khan
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Hospital for Sick Children, University of Toronto,ICES
| | - E Kuenzig
- Child Health Evaluative Sciences, SickKids Research Institute
| | - A Tang
- Child Health Evaluative Sciences, SickKids Research Institute
| | - J Im
- Child Health Evaluative Sciences, SickKids Research Institute
| | - J Widdifield
- ICES,Institute of Health Policy, Management and Evaluation, University of Toronto
| | - J McCurdy
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - G Kaplan
- Department of Medicine and Community Health Sciences, University of Calgary, Toronto, Canada
| | - E Benchimol
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Hospital for Sick Children, University of Toronto,ICES,Child Health Evaluative Sciences, SickKids Research Institute,Institute of Health Policy, Management and Evaluation, University of Toronto
| |
Collapse
|
18
|
Zak SG, Yeroushalmi D, Tang A, Meftah M, Schnaser E, Schwarzkopf R. The Use of Navigation or Robotic-Assisted Technology in Total Knee Arthroplasty Does Not Reduce Postoperative Pain. J Knee Surg 2023; 36:439-444. [PMID: 34530477 DOI: 10.1055/s-0041-1735313] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The use of intraoperative technology (IT), such as computer-assisted navigation (CAN) and robot-assisted surgery (RA), in total knee arthroplasty (TKA) is increasingly popular due to its ability to enhance surgical precision and reduce radiographic outliers. There is disputing evidence as to whether IT leads to better clinical outcomes and reduced postoperative pain. The purpose of this study was to determine if use of CAN or RA in TKA improves pain outcomes. This is a retrospective review of a multicenter randomized control trial of 327 primary TKAs. Demographics, surgical time, IT use (CAN/RA), length of stay (LOS), and opioid consumption (in morphine milligram equivalents) were collected. Analysis was done by comparing IT (n = 110) to a conventional TKA cohort (n = 217). When accounting for demographic differences and the use of a tourniquet, the IT cohort had shorter surgical time (88.77 ± 18.57 vs. 98.12 ± 22.53 minutes; p = 0.005). While postoperative day 1 pain scores were similar (p = 0.316), the IT cohort has less opioid consumption at 2 weeks (p = 0.006) and 1 month (p = 0.005) postoperatively, but not at 3 months (p = 0.058). When comparing different types of IT, CAN, and RA, we found that they had similar surgical times (p = 0.610) and pain scores (p = 0.813). Both cohorts had similar opioid consumption at 2 weeks (p = 0.092), 1 month (p = 0.058), and 3 months (p = 0.064) postoperatively. The use of IT in TKA does not yield a clinically significant reduction in pain outcomes. There was also no difference in pain or perioperative outcomes between CAN and RA technology used in TKA.
Collapse
Affiliation(s)
| | | | - Alex Tang
- Department of Orthopedic Surgery, NYU Langone Health, New York
| | - Morteza Meftah
- Department of Orthopedic Surgery, NYU Langone Health, New York
| | - Erik Schnaser
- Desert Orthopedic Center, Eisenhower Medical Center, Rancho Mirage, California
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York
| |
Collapse
|
19
|
Huang Y, Wei WI, Correia DF, Ma BHM, Tang A, Yeoh EK, Wong SYS, Ip M, Kwok KO. Antibiotic use for respiratory tract infections among older adults living in long-term care facilities: a systematic review and meta-analysis. J Hosp Infect 2023; 131:107-121. [PMID: 36202187 DOI: 10.1016/j.jhin.2022.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 08/29/2022] [Accepted: 09/22/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Antibiotics are commonly prescribed for respiratory tract infections (RTIs) among older adults in long-term care facilities (LTCFs), and this contributes to the emergence of antimicrobial resistance. The objective of this study was to determine the antibiotic prescribing rate for RTIs among LTCF residents, and to analyse the antibiotic consumption patterns with the AwaRe monitoring tool, developed by the World Health Organization. METHODS MEDLINE, EMBASE and CINAHL were searched from inception to March 2022. Original articles reporting antibiotic use for RTIs in LTCFs were included in this review. Study quality was assessed using the Joanna Briggs Institute's Critical Appraisal Checklist for Prevalence Data. A random-effects meta-analysis was employed to calculate the pooled estimates. Subgroup analysis was conducted by type of RTI, country, and study start year. RESULTS In total, 47 articles consisting of 50 studies were included. The antibiotic prescribing rate ranged from 21.5% to 100% (pooled estimate 69.8%, 95% confidence interval 55.2-82.6%). The antibiotic prescribing rate for lower respiratory tract infections (LRTIs) was higher than the rates for viral and general RTIs. Compared with Italy, France and the USA, the Netherlands had lower antibiotic use for LRTIs. A proportion of viral RTIs were treated with antibiotics, and all the antibiotics were from the Watch group. Use of antibiotics in the Access group was higher in the Netherlands, Norway, Switzerland and Slovenia compared with the USA and Australia. CONCLUSION The antibiotic prescribing rate for RTIs in LTCFs was high, and AWaRe antibiotic use patterns varied by type of RTI and country. Improving antibiotic use may require coordination efforts.
Collapse
Affiliation(s)
- Y Huang
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - W I Wei
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - D F Correia
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - B H M Ma
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - A Tang
- College of Computing and Informatics, Sungkyunkwan University, Seoul, Republic of Korea
| | - E K Yeoh
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - S Y S Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - M Ip
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - K O Kwok
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Shenzhen Research Institute of the Chinese University of Hong Kong, Shenzhen, China; Hong Kong Institute of Asia-Pacific Studies, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
| |
Collapse
|
20
|
Yap DYH, Lie D, Lau T, Tang A, Chan G, Chan TSY, Sim J, Lie AKW, Chan TM. Clinico-pathological correlations and outcomes of de novo glomerular diseases in patients after haematopoietic stem cell transplantation. Clin Kidney J 2022. [DOI: 10.1093/ckj/sfac264] [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: 12/14/2022] Open
Abstract
Abstract
Introduction
Various glomerular pathologies have been reported in patients who have undergone haematopoietic stem cell transplantation (HSCT), but the data on clinico-pathological correlations and clinical outcome remain limited.
Methods
We analysed the clinical and histopathological data of patients who had biopsy-proven de novo glomerular diseases after HSCT since 1999.
Results
A total of 2204 patients underwent HSCT during the period 1999–2021, and 31 patients (1.4%) developed de novo glomerular diseases after a mean duration of 2.8 ± 2.7 years after HSCT. Fifteen patients (48.4%) had graft-versus-host-disease (GVHD) prior to or concomitant with renal abnormalities. Proteinuria and eGFR at the time of kidney biopsy were 4.1 ± 5.3 g/D and 50.8 ± 25.4 ml/min/1.73m2 respectively. Kidney histopathologic diagnoses included thrombotic microangiopathy (TMA) (38.7%), membranous nephropathy (MN) (25.8%), mesangial proliferative glomerulonephritis (MesPGN) (12.9%), minimal change disease (9.7%), focal segmental glomerulosclerosis (9.7%) and membranoproliferative glomerulonephritis (3.2%)Immunosuppressive treatment was given to patients who presented with nephrotic-range proteinuria and/or acute kidney injury, while renin-angiotensin-aldosterone blockade was given to all patients with proteinuria ≥ 1 g/D, with complete and partial response rates of 54.8% and 19.4% respectively. One patient with TMA progressed to end-stage kidney disease after 24 weeks, and 2 patients, 1 with TMA and 1 with MN, (6.4%) progressed to CKD Stage ≥ 3. Kidney and patient survival rates were 96.6% and 83.5% at 5-year.
Conclusion
De novo glomerular diseases with diverse histopathologic manifestations affect 1.4% of patients after HSCT, and approximately 10% develop progressive CKD.
Collapse
Affiliation(s)
- Desmond Y H Yap
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong , Hong Kong
| | - Davina Lie
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong , Hong Kong
| | - Tiffany Lau
- Department of Pathology, Queen Mary Hospital, The University of Hong Kong , Hong Kong
| | - Alex Tang
- Department of Pathology, Queen Mary Hospital, The University of Hong Kong , Hong Kong
| | - Gavin Chan
- Department of Pathology, Queen Mary Hospital, The University of Hong Kong , Hong Kong
| | - Thomas S Y Chan
- Division of Haematology, Medical Oncology and Haematopoietic Stem Cell Transplantation, Queen Mary Hospital, The University of Hong Kong , Hong Kong
| | - Joycelyn Sim
- Division of Haematology, Medical Oncology and Haematopoietic Stem Cell Transplantation, Queen Mary Hospital, The University of Hong Kong , Hong Kong
| | - Albert K W Lie
- Division of Haematology, Medical Oncology and Haematopoietic Stem Cell Transplantation, Queen Mary Hospital, The University of Hong Kong , Hong Kong
| | - Tak Mao Chan
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong , Hong Kong
| |
Collapse
|
21
|
Bin X, Zhu C, Tang Y, Li R, Ding Q, Xia W, Tang Y, Tang X, Yao D, Tang A. Nomogram Based on Clinical and Radiomics Data for Predicting Radiation-induced Temporal Lobe Injury in Patients with Non-metastatic Stage T4 Nasopharyngeal Carcinoma. Clin Oncol (R Coll Radiol) 2022; 34:e482-e492. [PMID: 36008245 DOI: 10.1016/j.clon.2022.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/19/2022] [Accepted: 07/21/2022] [Indexed: 01/31/2023]
Abstract
AIMS To use pre-treatment magnetic resonance imaging-based radiomics data with clinical data to predict radiation-induced temporal lobe injury (RTLI) in nasopharyngeal carcinoma (NPC) patients with stage T4/N0-3/M0 within 5 years after radiotherapy. MATERIALS AND METHODS This study retrospectively examined 98 patients (198 temporal lobes) with stage T4/N0-3/M0 NPC. Participants were enrolled into a training cohort or a validation cohort in a ratio of 7:3. Radiomics features were extracted from pre-treatment magnetic resonance imaging that were T1-and T2-weighted. Spearman rank correlation, the t-test and the least absolute shrinkage and selection operator (LASSO) algorithm were used to select significant radiomics features; machine-learning models were used to generate radiomics signatures (Rad-Scores). Rad-Scores and clinical factors were integrated into a nomogram for prediction of RTLI. Nomogram discrimination was evaluated using receiver operating characteristic analysis and clinical benefits were evaluated using decision curve analysis. RESULTS Participants were enrolled into a training cohort (n = 139) or a validation cohort (n = 59). In total, 3568 radiomics features were initially extracted from T1-and T2-weighted images. Age, Dmax, D1cc and 16 stable radiomics features (six from T1-weighted and 10 from T2-weighted images) were identified as independent predictive factors. A greater Rad-Score was associated with a greater risk of RTLI. The nomogram showed good discrimination, with a C-index of 0.85 (95% confidence interval 0.79-0.92) in the training cohort and 0.82 (95% confidence interval 0.71-0.92) in the validation cohort. CONCLUSION We developed models for the prediction of RTLI in patients with stage T4/N0-3/M0 NPC using pre-treatment radiomics data and clinical data. Nomograms from these pre-treatment data improved the prediction of RTLI. These results may allow the selection of patients for earlier clinical interventions.
Collapse
Affiliation(s)
- X Bin
- Department of Otolaryngology-Head and Neck Surgery, First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - C Zhu
- Department of Radiation Oncology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Y Tang
- Department of Neurology, First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - R Li
- Interdisciplinary Institute of Neuroscience and Technology, Zhejiang University Hangzhou, Zhejiang Province, China; Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Q Ding
- Institute of Natural Sciences, Shanghai Jiao Tong University, Shanghai, China
| | - W Xia
- Department of Otolaryngology-Head and Neck Surgery, First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Y Tang
- Department of Radiology, First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - X Tang
- Department of Otolaryngology-Head and Neck Surgery, First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - D Yao
- Department of Otolaryngology-Head and Neck Surgery, First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - A Tang
- Department of Otolaryngology-Head and Neck Surgery, First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China.
| |
Collapse
|
22
|
Chandra AA, Romanelli F, Tang A, Menken L, Zhang M, Feintisch A, Liporace FA, Yoon RS. A comparison of healing and complication rates between common flaps utilized in total knee arthroplasty: a review of the literature. Knee Surg Relat Res 2022; 34:15. [PMID: 35346398 PMCID: PMC8961959 DOI: 10.1186/s43019-022-00145-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/11/2022] [Indexed: 11/12/2022] Open
Abstract
Background Flap reconstruction with perforator, fasciocutaneous, muscular, and/or free microvascular flaps is utilized to cover wound defects and improve vascularization and antibiotic/nutrient delivery. Flap use in revision procedures for total knee arthroplasty has been explored previously; however, current data are limited and studies comparing healing and complication rates between different flap types are lacking. Methods A literature review was performed using PubMed on 13 January 2022. Studies were included if they reported healing and complication rates for either gastrocnemius, rectus abdominis, latissimus dorsi, fasciocutaneous, chimeric, or gracilis flaps in the setting of revision total knee arthroplasty (TKA). Results The final cohort included gastrocnemius (n = 421, healing rate 73.8%, complication rate 59.9%), gracilis (n = 9, healing rate 93%, complication rate 55.6%), latissimus dorsi (n = 41, healing rate 67%, complication rate 46.3%), rectus abdominis (n = 3, healing rate 100%, complication rate 0%), fasciocutaneous (n = 78, healing rate 70%, complication rate 19.2%), and chimeric flaps (n = 4, healing rate 100%, complication rate 25%). There was no significant difference when comparing healing rates across flap types (p = 0.39). There was a significant difference when comparing complication rates across flap types (p < 0.0001), with a significant difference being noted between gastrocnemius and fasciocutaneous complication rates (p < 0.0001). All other comparisons between flap types by complication rate were not significantly different. Conclusions Gastrocnemius flaps are the workhorse flap in the setting of revision TKA, as evidenced by this review. Healing rates did not vary significantly across flap types, which suggests that determining the appropriate flap for coverage of soft-tissue defects in revision TKA should be driven by defect size and location as well as physician experience and patient tolerance.
Collapse
|
23
|
D'Ambrosio M, Tang A, Menken L, Thabet AM, Liporace FA, Yoon RS. Adjunct neutralization plating in patella fracture fixation: a technical trick. OTA Int 2022; 5:e217. [PMID: 36569111 PMCID: PMC9782314 DOI: 10.1097/oi9.0000000000000217] [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] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 06/30/2022] [Indexed: 11/07/2022]
Abstract
Patella fracture outcomes are positive overall; however, in some cases, traditional fixation methods result in complications, including loss of fixation and irritable hardware requiring removal. We present a technique of plate fixation that we believe has the potential to improve stability and is less offensive in more comminuted fracture patterns. Improved stability should allow unfettered advancement of rehabilitation without concern for loss of fixation. Lower profile fixation offers a potential for diminishing the presence of irritating hardware requiring removal. We present our technique for using plate fixation to augment more complex patella fracture patterns.
Collapse
Affiliation(s)
- Matthew D'Ambrosio
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Saint Barnabas Medical Center—RWJBarnabas Health, Livingston, NJ
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center—RWJBarnabas Health, Jersey City, NJ; and
| | - Alex Tang
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Saint Barnabas Medical Center—RWJBarnabas Health, Livingston, NJ
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center—RWJBarnabas Health, Jersey City, NJ; and
| | - Luke Menken
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Saint Barnabas Medical Center—RWJBarnabas Health, Livingston, NJ
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center—RWJBarnabas Health, Jersey City, NJ; and
| | - Ahmed M. Thabet
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center—El Paso, El Paso, TX
| | - Frank A. Liporace
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Saint Barnabas Medical Center—RWJBarnabas Health, Livingston, NJ
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center—RWJBarnabas Health, Jersey City, NJ; and
| | - Richard S. Yoon
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Saint Barnabas Medical Center—RWJBarnabas Health, Livingston, NJ
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center—RWJBarnabas Health, Jersey City, NJ; and
| |
Collapse
|
24
|
Tang A, Shieh MS, Pekow P, Prentiss K, Lindenauer P, Westafer L. 175 National Trends in Chemical Restraint for Pediatric Behavioral Health Patients in the Emergency Department. Ann Emerg Med 2022. [DOI: 10.1016/j.annemergmed.2022.08.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
25
|
Tang A, Singh V, Sharan M, Roof MA, Mercuri JJ, Meftah M, Schwarzkopf R. The accuracy of component positioning during revision total hip arthroplasty using 3D optical computer-assisted navigation. Eur J Orthop Surg Traumatol 2022:10.1007/s00590-022-03383-z. [PMID: 36074304 DOI: 10.1007/s00590-022-03383-z] [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] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/28/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Despite the excellent outcomes associated with primary total hip arthroplasty (THA), implant failure and revision continue to burden the healthcare system. The use of computer-assisted navigation (CAN) offers the potential for more accurate placement of hip components during surgery. While intraoperative CAN systems have been shown to improve outcomes in primary THA, their use in the context of revision total hip arthroplasty (rTHA) has not been elucidated. We sought to investigate the validity of using CAN during rTHA. METHODS A retrospective analysis was performed at an academic medical institution identifying all patients who underwent rTHA using CAN from 2016-2019. Patients were 1:1 matched with patients undergoing rTHA without CAN (control) based on demographic data. Cup anteversion, inclination, change in leg length discrepancy (ΔLLD) and change in femoral offset between pre- and post-operative plain weight-bearing radiographic images were measured and compared between both groups. A safety target zone of 15-25° for anteversion and 30-50° for inclination was used as a reference for precision analysis of cup position. RESULTS Eighty-four patients were included: 42 CAN cases and 42 control cases. CAN cases displayed a lower ΔLLD (5.74 ± 7.0 mm vs 9.13 ± 7.9 mm, p = 0.04) and greater anteversion (23.4 ± 8.53° vs 19.76 ± 8.36°, p = 0.0468). There was no statistical difference between the proportion of CAN or control cases that fell within the target safe zone (40% vs 20.9%, p = 0.06). Femoral offset was similar in CAN and control cases (7.63 ± 5.84 mm vs 7.14 ± 4.8 mm, p = 0.68). CONCLUSION Our findings suggest that the use of CAN may improve accuracy in cup placement compared to conventional methodology, but our numbers are underpowered to show a statistical difference. However, with a ΔLLD of ~ 3.4 mm, CAN may be useful in facilitating the successful restoration of pre-operative leg length following rTHA. Therefore, CAN may be a helpful tool for orthopedic surgeons to assist in cup placement and LLD during complex revision cases.
Collapse
Affiliation(s)
- Alex Tang
- Department of Orthopedic Surgery, NYU Langone Orthopedic Health, 301 East 17th Street, New York, NY, 10003, USA
- Department of Orthopaedic Surgery, Geisinger Health, Scranton, PA, USA
| | - Vivek Singh
- Department of Orthopedic Surgery, NYU Langone Orthopedic Health, 301 East 17th Street, New York, NY, 10003, USA
- Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Mohamad Sharan
- Department of Orthopedic Surgery, NYU Langone Orthopedic Health, 301 East 17th Street, New York, NY, 10003, USA
| | - Mackenzie A Roof
- Department of Orthopedic Surgery, NYU Langone Orthopedic Health, 301 East 17th Street, New York, NY, 10003, USA
| | - John J Mercuri
- Department of Orthopaedic Surgery, Geisinger Health, Scranton, PA, USA
| | - Morteza Meftah
- Department of Orthopedic Surgery, NYU Langone Orthopedic Health, 301 East 17th Street, New York, NY, 10003, USA
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Orthopedic Health, 301 East 17th Street, New York, NY, 10003, USA.
| |
Collapse
|
26
|
Liporace FA, Tang A, Jankowski JM, Yoon RS. Distal femur: nail plate combination and the linked construct. OTA Int 2022; 5:e172. [PMID: 37781482 PMCID: PMC10538551 DOI: 10.1097/oi9.0000000000000172] [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] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/06/2021] [Indexed: 10/03/2023]
Abstract
Operative fixation of distal femur fractures in patients with osteoporotic bone can be challenging. Treatment with either lateral locking plate or retrograde intramedullary nail alone may not provide adequate fixation to allow for early mobilization. Rather, fixation using the nail plate combination (NPC) to treat distal femur fractures in the elderly may offer improved biomechanical stability to achieve immediate weight-bearing, especially in the setting of complex fracture patterns and osteoporosis. Here, we describe the rationale, step-by-step technique, and outcome following 2 cases: 1 patient treated with a true NPC procedure using retrograde intramedullary nail and standard locking plate, as well as a NPC procedure using a novel locking attaching washer plate.
Collapse
Affiliation(s)
- Frank A Liporace
- Division of Orthopaedic Trauma and Complex Adult Reconstruction, Department of Orthopaedic Surgery, Saint Barnabas Medical Center/Jersey City Medical Center - RWJBarnabas Health, Livingston, New Jersey
| | - Alex Tang
- Division of Orthopaedic Trauma and Complex Adult Reconstruction, Department of Orthopaedic Surgery, Saint Barnabas Medical Center/Jersey City Medical Center - RWJBarnabas Health, Livingston, New Jersey
| | - Jaclyn M Jankowski
- Division of Orthopaedic Trauma and Complex Adult Reconstruction, Department of Orthopaedic Surgery, Saint Barnabas Medical Center/Jersey City Medical Center - RWJBarnabas Health, Livingston, New Jersey
| | - Richard S Yoon
- Division of Orthopaedic Trauma and Complex Adult Reconstruction, Department of Orthopaedic Surgery, Saint Barnabas Medical Center/Jersey City Medical Center - RWJBarnabas Health, Livingston, New Jersey
| |
Collapse
|
27
|
Singh V, Tang A, Aggarwal VK, Schwarzkopf R, Rozell JC. The number of stairs into home do not impact discharge disposition and patient reported outcomes after total joint arthroplasty. Arch Orthop Trauma Surg 2022; 142:2165-2171. [PMID: 33646356 DOI: 10.1007/s00402-021-03842-y] [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: 10/21/2020] [Accepted: 02/16/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The purpose of this study is to report on the association between the number of stairs to enter home and length of stay (LOS), discharge disposition, and patient reported outcome measures (PROMs) among patients who underwent primary total joint arthroplasty (TJA). MATERIALS AND METHODS We retrospectively reviewed patients who underwent primary total hip or knee arthroplasty between January 2016 and March 2020. Only patients with documentation of the number of stairs to enter their homes were included in the study. The two cohorts were separated into four groups: none, 1-10, 11-20, and > 20 stairs. Collected variables included demographic data, LOS, discharge disposition, and PROMs. Chi-square and ANOVA were utilized to determine significance. RESULTS Of the 1116 patients included, 510 underwent THA, and 606 underwent TKA. There was no statistical difference in LOS (THA: p = 0.308; TKA: p = 0.701) and discharge disposition (THA: p = 0.371; TKA: p = 0.484) in both cohorts regardless the number of stairs. There was no statistical difference in FJS-12 scores at 3 months (THA: p = 0.590; TKA: p = 0.206), 12 months (THA: p = 0.217; TKA: p = 0.845), and 21 months (THA: p = 0.782; TKA: p = 0.296) postoperatively for both cohorts. There was no statistical difference in HOOS, JR scores preoperatively (p = 0.278) and at 3 months postoperatively (p = 0.527) for the THA cohort, as well as KOOS, JR scores preoperatively and at 3 and 12 months postoperatively (p = 0.557; p = 0.522; p = 0.747) for the TKA cohort. CONCLUSION We found no statistical differences in LOS, discharge disposition, and PROMs in patients who underwent TJA, irrespective of the number of stairs negotiated to enter their home. These findings can aid surgeons to provide preoperative education and reassurance to patients who have concerns with their discharge planning due to the walk-up stairway at their residence.
Collapse
Affiliation(s)
- Vivek Singh
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA
| | - Alex Tang
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA
| | - Vinay K Aggarwal
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA
| | - Joshua C Rozell
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA.
| |
Collapse
|
28
|
Singh V, Tang A, Bieganowski T, Anil U, Macaulay W, Schwarzkopf R, Davidovitch RI. Fluctuation of visual analog scale pain scores and opioid consumption before and after total hip arthroplasty. World J Orthop 2022; 13:703-713. [PMID: 36159616 PMCID: PMC9453274 DOI: 10.5312/wjo.v13.i8.703] [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: 10/01/2021] [Revised: 01/28/2022] [Accepted: 07/22/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients who undergo orthopedic procedures are often given excess opioid medication. Understanding the relationship between pain and opioid consumption following total hip arthroplasty (THA) is key to creating safe and effective opioid prescribing guidelines.
AIM To evaluate the association between the quantity of opioid consumption in relation to pain scores both pre-and postoperatively in patients undergoing primary THA.
METHODS We retrospectively reviewed patients who underwent primary THA from November 2018-May 2019 and answered both the visual analog scale (VAS) pain and opioid medication questionnaires pre-and postoperatively. Both surveys were delivered daily for 7-days before surgery through the first 30 postoperative days. Survey results were divided into preoperative, postoperative days 1-7, postoperative days 8-14, and postoperative days 15-30 for analysis. Mean opioid pill consumption and VAS pain scores in each time period were determined and compared to patients’ preoperative status using hierarchical Poisson and linear regressions, respectively.
RESULTS There were 105 patients included. Mean VAS pain scores were the highest preoperatively 7.41 ± 1.72. However, VAS pain scores significantly declined in each successive postoperative category compared to preoperative scores: postoperative day 1-7 (5.07 ± 1.79; P < 0.001), postoperative day 8-14 (3.60 ± 1.64; P < 0.001), and postoperative day 15-30 (3.15 ± 1.63; P < 0.001). Mean opioid pill consumption preoperatively was 0.68 ± 1.29 pills. Compared to preoperative opioid consumption, opioid use was significantly greater between postoperative days 1-7 (1.51 ± 1.58; P = 0.001) and postoperative days 8-14 (1.00 ± 1.27; P = 0.043). Opioid consumption declined below preoperative levels between postoperative days 15-30 (0.35 ± 0.72; P = 0.160) which correlates with a VAS pain score of 3.15.
CONCLUSION All patients experienced significant benefit and pain relief from having undergone THA. Average postoperative opioid consumption decreased below preoperative consumption between postoperative days 15-30, which was associated with a VAS pain score of 3.15. These results can be used to appropriately guide opioid prescribing practices and set patient expectations regarding pain management following THA.
Collapse
Affiliation(s)
- Vivek Singh
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY 10010, United States
| | - Alex Tang
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY 10010, United States
| | - Thomas Bieganowski
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY 10010, United States
| | - Utkarsh Anil
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY 10010, United States
| | - William Macaulay
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY 10010, United States
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY 10010, United States
| | - Roy I Davidovitch
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY 10010, United States
| |
Collapse
|
29
|
Yeroushalmi D, Laarhoven SV, Tang A, Heesterbeek PJC, Hellemondt GV, Schwarzkopf R. Short- to Midterm Outcomes of a Novel Guided-Motion Rotational Hinged Total Knee Arthroplasty. J Knee Surg 2022; 35:1153-1158. [PMID: 33485277 DOI: 10.1055/s-0040-1722349] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hinged prostheses have been increasingly utilized in complex and revision total knee arthroplasty (TKA) cases requiring additional mechanical support and global stability. However, there is limited data detailing the outcomes of modern hinge designs in these procedures. The aim of this study is to report a minimum 2-year functional outcomes and survivorship of a novel-guided motion-hinged knee TKA system. A multicenter, retrospective cohort study was conducted on consecutive TKA patients between March 2013 and August 2017 with a novel-guided motion-hinged knee system. Demographics, change in range of motion (ΔROM), quality metrics, and implant survivorship were collected with a minimum of 2-year follow-up. Implant survival was analyzed by using the Kaplan-Meier method. Overall, 147 hinged knee cases (18 complex primaries and 129 revisions) were identified with an average follow-up duration of 3.8 ± 1.2 years. Patients presented with an average of 2.4 ± 1.6 prior knee surgeries, and 51 (34.7%) had a history of knee infections. The ROM improved postoperatively: Δ extension = 2 ± 1 degrees, Δflexion = 7 ± 3 degrees, Δtotal ROM = 9 ± 4 degrees. Kaplan-Meier survivorship analysis for implant revision at 2- and 5-year follow-up showed a survival rate of 100 and 98.5% (95% confidence interval: 94.3-99.6%), respectively, with one patient undergoing two-stage revision for infection and another undergoing femoral revision for aseptic loosening. Survivorship for aseptic all-cause reoperation at 2- and 5-year follow-up was 93.2% (87.7-96.3%) and 88.2% (80.0-93.2%), respectively. Fourteen patients underwent aseptic reoperation (patellar complications: n = 7 [4.8%]; instability: n = 5 [3.4%]; tuberosity fixation: n = 1 [0.7%]; extensor mechanism failure: n = 1 [1.1%]). Survivorship for all-cause reoperation at 2- and 5-year follow-up were 85% (78.2-90.0%) and 77.7% (68.8-84.3%), respectively. Fifteen patients underwent reoperation for infection (DAIR: n = 14 (9.5%); two-stage revision: n = 1 [0.7%]). Despite some reoperations, this guided-motion hinged-knee TKA system demonstrates excellent survivorship for component revision compared to other modern hinged knee implants reported in the literature. Patients also displayed an improvement in knee ROM at their latest follow-up.
Collapse
Affiliation(s)
| | - Simon Van Laarhoven
- Departments of Research, Development and Education and Orthopaedics, Sint Maartenskliniek, Nijmegen, the Netherlands - Orthopedic, Nijmegen, Netherlands
| | - Alex Tang
- NYU Langone Health, Orthopedic Surgery, New York City, New York
| | - Petra J C Heesterbeek
- Departments of Research, Development and Education and Orthopaedics, Sint Maartenskliniek, Nijmegen, the Netherlands - Orthopedic, Nijmegen, Netherlands
| | - Gijs Van Hellemondt
- Departments of Research, Development and Education and Orthopaedics, Sint Maartenskliniek, Nijmegen, the Netherlands - Orthopedic, Nijmegen, Netherlands
| | - Ran Schwarzkopf
- NYU Langone Health, Orthopedic Surgery, New York City, New York
| |
Collapse
|
30
|
Tang A, Zak S, Lygrisse K, Slover J, Meftah M, Lajam C, Schwarzkopf R, Macaulay W. Discontinued Use of Outpatient Portable Intermittent Pneumatic Compression Devices May Be Safe for Venous Thromboembolism Prophylaxis in Primary Total Knee Arthroplasty Using Low-Dose Aspirin. J Knee Surg 2022; 35:909-915. [PMID: 33241544 DOI: 10.1055/s-0040-1721092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Venous thromboembolism (VTE) is a rare, but serious complication following total knee arthroplasty (TKA). Current VTE guidelines recommend pharmacologic agents with or without intermittent pneumatic compression devices (IPCDs). At our institution, both 81-mg aspirin (ASA) twice a day (BID) and portable IPCDs were previously prescribed to TKA patients at standard risk for VTE, but the IPCDs were discontinued and patients were treated with ASA alone going forward. The aim of this study is to determine if discontinued use of outpatient IPCDs is safe and does not increase the rate of VTE or any other related complications in patients following TKA. A retrospective review of 2,219 consecutive TKA cases was conducted, identifying patients with VTE, bleeding complications, infection, and mortality within 90 days postoperatively. Patients were divided into two cohorts. Patients in cohort one received outpatient IPCDs for a period of 14 days (control), while those in cohort two did not (ASA alone). All study patients received inpatient IPCDs and were maintained on 81-mg ASA BID for 28 days. A posthoc power analysis was performed using a noninferiority margin of 0.25 (α = 0.05; power = 80%), which showed that our sample size was fully powered for noninferiority for our reported deep vein thrombosis (DVT) rates, but not for pulmonary embolism (PE) rates. A total of 867 controls and 1,352 patients treated with ASA alone were identified. Only two control patients were diagnosed with a PE (0.23%), while one patient in the ASA alone group had DVT (0.07%). There was no statistical difference between these rates (p = 0.33). Furthermore, no differences were found in bleeding complications (p = 0.12), infection (p = 0.97), or 90-day mortality rates (p = 0.42) between both groups. The discontinued use of outpatient portable IPCDs is noninferior to outpatient IPCD use for DVT prophylaxis. Our findings suggest that this protocol change may be safe and does not increase the rate of VTE in standard risk patients undergoing TKA while using 81-mg ASA BID.
Collapse
Affiliation(s)
- Alex Tang
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Stephen Zak
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Katherine Lygrisse
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - James Slover
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Morteza Meftah
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Claudette Lajam
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - William Macaulay
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| |
Collapse
|
31
|
Zak SG, Tang A, Pivec R, Meftah M, Austin MS, Schnaser E, Schwarzkopf R. The effects of tourniquet on cement penetration in total knee arthroplasty. Arch Orthop Trauma Surg 2022; 143:2877-2884. [PMID: 35552801 DOI: 10.1007/s00402-022-04470-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 02/01/2022] [Accepted: 04/24/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Aseptic loosening is a common cause of implant failure following total knee arthroplasty (TKA). Cement penetration depth is a known factor that determines an implant's "strength" and plays an important role in preventing aseptic loosening. Tourniquet use is thought to facilitate cement penetration, but its use has mixed reviews. The aim of this study was to compare cement penetration depth between tourniquet and tourniquet-less TKA patients. METHODS A multicenter retrospective review was conducted. Patients were randomized preoperatively to undergo TKA with or without the use of an intraoperative tourniquet. The variables collected were cement penetration measurements in millimeters (mm) within a 1-month post-operative period, length of stay (LOS), and baseline demographics. Measurements were taken by two independent raters and made in accordance to the zones described by the Knee Society Radiographic Evaluation System and methodology used in previous studies. RESULTS A total of 357 TKA patients were studied. No demographic differences were found between tourniquet (n = 189) and tourniquet-less (n = 168) cohorts. However, the tourniquet cohort had statistically, but not clinically, greater average cement penetration depth [2.4 ± 0.6 mm (range 1.2-4.1 mm) vs. 2.2 ± 0.5 mm (range 1.0-4.3 mm, p = 0.01)]. Moreover, the tourniquet cohort had a significantly greater proportion of patients with an average penetration depth within the accepted zone of 2 mm or greater (78.9% vs. 67.3%, p = 0.02). CONCLUSION Tourniquet use does not affect average penetration depth but increases the likelihood of achieving optimal cement penetration depth. Further study is warranted to determine whether this increased likelihood of optimal cement penetration depth yields lower revision rates.
Collapse
Affiliation(s)
- Stephen G Zak
- Division of Adult Reconstruction, NYU Langone Orthopedic Hospital, Hospital for Joint Diseases, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA
| | - Alex Tang
- Division of Adult Reconstruction, NYU Langone Orthopedic Hospital, Hospital for Joint Diseases, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA
| | - Robert Pivec
- Department of Orthopaedic Surgery, The Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Morteza Meftah
- Division of Adult Reconstruction, NYU Langone Orthopedic Hospital, Hospital for Joint Diseases, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA
| | - Matthew S Austin
- Department of Orthopaedic Surgery, The Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Erik Schnaser
- Desert Orthopedic Center, Eisenhower Medical Center, Rancho Mirage, CA, USA
| | - Ran Schwarzkopf
- Division of Adult Reconstruction, NYU Langone Orthopedic Hospital, Hospital for Joint Diseases, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA.
| |
Collapse
|
32
|
Tang A, Zak SG, Waren D, Iorio R, Slover JD, Bosco JA, Schwarzkopf R. Low-Dose Aspirin is Safe and Effective for Venous Thromboembolism Prevention in Patients Undergoing Revision Total Knee Arthroplasty: A Retrospective Cohort Study. J Knee Surg 2022; 35:553-559. [PMID: 32898907 DOI: 10.1055/s-0040-1716377] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Venous thromboembolism (VTE) events are rare, but serious complications of total joint replacement affect patients and health care systems due to the morbidity, mortality, and associated cost of its complications. There is currently no established universal standard of care for prophylaxis against VTE in patients undergoing revision total knee arthroplasty (rTKA). The aim of this study was to determine whether a protocol of 81-mg aspirin (ASA) bis in die (BID) is safe and/or sufficient in preventing VTE in patients undergoing rTKAs versus 325-mg ASA BID. In 2017, our institution adopted a new protocol for VTE prophylaxis for arthroplasty patients. Patients initially received 325-mg ASA BID for 1 month and then changed to a lower dose of 81-mg BID. A retrospective review from 2011 to 2019 was conducted identifying 1,438 consecutive rTKA patients and 90-day postoperative outcomes including VTE, gastrointestinal, and wound bleeding complications, acute periprosthetic joint infection, and mortality. In the 74 months prior to protocol implementation, 1,003 rTKAs were performed and nine VTE cases were diagnosed (0.90%). After 26 months of the protocol change, 435 rTKAs were performed with one VTE case identified (0.23%). There was no significant difference in rates or odds in postoperative pulmonary embolism (PE; p = 0.27), DVT (p = 0.35), and total VTE rates (p = 0.16) among patients using either protocol. There were also no differences in bleeding complications (p = 0.15) or infection rate (p = 0.36). No mortalities were observed. In the conclusion, 81-mg ASA BID is noninferior to 325-mg ASA BID in maintaining low rates of VTE and may be safe for use in patients undergoing rTKA.
Collapse
Affiliation(s)
- Alex Tang
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Stephen G Zak
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Daniel Waren
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Richard Iorio
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - James D Slover
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Joseph A Bosco
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| |
Collapse
|
33
|
Ghanem A, Maahs L, Gutta R, Tang A, Gilbert M, Arya S, Saheli Z, Tam S, Sheqwara J, Siddiqui F. Does Cetuximab Reduce the Risk of Anemia in Patients Undergoing Radiation Therapy for Head and Neck Cancers? Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2021.12.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
34
|
Vialonga MD, Menken LG, Tang A, Yurek JW, Sun L, Feldman JJ, Liporace FA, Yoon RS. Survivorship Analysis in Asymptomatic COVID-19+ Hip Fracture Patients: Is There an Increase in Mortality? Hip Pelvis 2022; 34:25-34. [PMID: 35355631 PMCID: PMC8931945 DOI: 10.5371/hp.2022.34.1.25] [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: 09/20/2021] [Revised: 01/14/2022] [Accepted: 01/14/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose Mortality rates following hip fracture surgery have been well-studied. This study was conducted to examine mortality rates in asymptomatic patients presenting for treatment of acute hip fractures with concurrent positive COVID-19(+) tests compared to those with negative COVID-19(–) tests. Materials and Methods A total of 149 consecutive patients undergoing hip fracture surgery during the COVID-19 pandemic at two academic medical centers were reviewed retrospectively. Patients were divided into two groups for comparative analysis: one group included asymptomatic patients with COVID-19+ tests versus COVID-19– tests. The primary outcome was mortality at 30-days and 90-days. Results COVID-19+ patients had a higher mortality rate than COVID-19– patients at 30-days (26.7% vs 6.0%, P=0.005) and 90-days (41.7% vs 17.2%, P=0.046) and trended towards an increased length of hospital stay (10.1±6.2 vs 6.8±3.8 days, P=0.06). COVID-19+ patients had more pre-existing respiratory disease (46.7% vs 11.2%, P=0.0002). Results of a Cox regression analysis showed an increased risk of mortality at 30-days and 90-days from COVID-19+ status alone without an increased risk of death in patients with pre-existing chronic respiratory disease. Conclusion Factors including time to surgery, age, preexisting comorbidities, and postoperative ambulatory status have been proven to affect mortality and complications in hip fracture patients; however, a positive COVID-19 test result adds another variable to this process. Implementation of protocols that will promote prompt orthogeriatric assessments, expedite patient transfer, limit operating room traffic, and optimize anesthesia time can preserve the standard of care in this unique patient population.
Collapse
Affiliation(s)
- Mason D Vialonga
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ, USA
| | - Luke G Menken
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ, USA
| | - Alex Tang
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ, USA
| | - John W Yurek
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ, USA
| | - Li Sun
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ, USA
| | - John J Feldman
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ, USA
| | - Frank A Liporace
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ, USA
| | - Richard S Yoon
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ, USA
| |
Collapse
|
35
|
Tang A, Gambhir N, Menken LG, Shah JK, D'Ambrosio M, Ramakrishnan V, Liporace FA, Yoon RS. Identification of concomitant injuries associated with specific spine level fractures in polytrauma patients. Injury 2022; 53:1068-1072. [PMID: 34920875 DOI: 10.1016/j.injury.2021.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/06/2021] [Accepted: 12/04/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Spine fractures are associated with high energy mechanisms and can lead to substantial morbidity and mortality in the trauma setting. Rapid identification and treatment of these fractures and their associated injuries are paramount in preventing adverse outcomes. The purpose of this study is to identify concomitant skeletal and non-skeletal injuries related to cervical, thoracic, and lumbar fractures. METHODS A retrospective review of institutional American College of Surgeons (ACS) registry was conducted on 3,399 consecutive trauma patients identifying those with spine fractures from 1/2016-12/2019. Two-hundred ninety patients were included(8.5%) and separated into three groups based on fracture location: eighty-eight cervical(C)-spine, 129thoracic(T)-spine, and 143lumbar(L)-spine. Logistic regression analyses were performed to identify associated injuries, presenting injury severity score(ISS) and Glasgow coma scale(GCS), mechanism of injury, demographic data, substance use, and paralysis for each group. Cox hazard regression was utilized to identify factors associated with inpatient mortality. RESULTS C-spine fractures were associated with head trauma(OR2.18,p = 0.003),intracranial bleeding (OR2.64,p = 0.001),facial(OR2.25,p = 0.02) and skull fractures(OR3.92,p = 0.001),and cervical cord injuries(OR4.78,p = 0.012). T-spine fractures were associated with rib fractures(OR2.31,p = 0.003). L-spine fractures were associated with rib(OR1.77, p = 0.04), pelvic(OR5.11,p<0.001), tibia/fibula (OR2.31,p = 0.05), and foot/ankle fractures(OR3.32,p = 0.04), thoracic(OR2.43,p = 0.008) and retroperitoneal cavity visceral injuries(OR27.3,p = 0.001). Falls≤6meters were also significantly associated with C-spine fractures(OR1.70,p = 0.04) while falls>6meters were associated with L-spine fractures(OR4.30,p = 0.001). Inpatient mortality risk increased in patients with C-spine fractures(HR4.41,p = 0.002), higher ISS(HR1.05, p<0.001), and lower GCS(HR0.85,p<0.001). Last, patients≥65-years-old were more likely to experience C-spine fractures(OR1.88,p = 0.03). CONCLUSION Patients who experience fractures of the cervical, thoracic, or lumbar spine are at risk for additional fractures, visceral injury, and/or death. Awareness of the associations between spinal fractures and other injuries can increase diagnostic efficacy, improve patient care, and provide valuable prognostic information. These associations highlight the importance of effective and timely communication and multidisciplinary collaboration.
Collapse
Affiliation(s)
- Alex Tang
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJ Barnabas Health, 355 Grand Street, Jersey City, NJ 07302, United States of America
| | - Neil Gambhir
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJ Barnabas Health, 355 Grand Street, Jersey City, NJ 07302, United States of America
| | - Luke G Menken
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJ Barnabas Health, 355 Grand Street, Jersey City, NJ 07302, United States of America
| | - Jay K Shah
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJ Barnabas Health, 355 Grand Street, Jersey City, NJ 07302, United States of America
| | - Matthew D'Ambrosio
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJ Barnabas Health, 355 Grand Street, Jersey City, NJ 07302, United States of America
| | - Vivek Ramakrishnan
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJ Barnabas Health, 355 Grand Street, Jersey City, NJ 07302, United States of America
| | - Frank A Liporace
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJ Barnabas Health, 355 Grand Street, Jersey City, NJ 07302, United States of America
| | - Richard S Yoon
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJ Barnabas Health, 355 Grand Street, Jersey City, NJ 07302, United States of America.
| |
Collapse
|
36
|
Ong J, Tang A, Rozell JC, Babb JS, Schwarzkopf R, Lin D. Factors predicting hip joint aspiration yield or “dry taps” in patients with total hip arthroplasty. J Orthop Surg Res 2022; 17:42. [PMID: 35065660 PMCID: PMC8783512 DOI: 10.1186/s13018-022-02942-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/24/2021] [Indexed: 11/29/2022] Open
Abstract
Background Image-guided joint aspirations used to assist the diagnosis of periprosthetic joint infection (PJI) may commonly result in a dry tap–or insufficient fluid for culture and cell count analysis. Dry tap aspirations are painful and invasive for patients and often utilize a subsequent saline lavage to obtain a microbiology sample. Currently, there is a paucity of the literature addressing predictors that could suggest whether a dry tap will occur. The purpose of this study was to examine the effects of various factors on “dry tap” occurrence in patients with suspected PJI following total hip arthroplasty (THA). Methods A retrospective review was performed among THA patients suspected for PJI who received image-guided joint aspiration procedures at our institution from May 2016 to February 2020. The procedural factors included the imaging modality used for aspiration, anatomic approach, needle gauge size used, and the presence of a trainee. The patient-specific factors included number of prior ipsilateral hip surgeries, femoral head size, ESR/CRP values, and BMI. Results In total, 336 patients met our inclusion criteria. One hundred and twenty hip aspirations resulted in a dry tap (35.7%) where the patients underwent a saline lavage. Among the procedural and patient-specific factors, none of the factors were found to be statistically different between the two cohorts nor conferred any greater odds of a dry tap occurring. Conclusion No associations with dry tap occurrence were found among the procedural and patient-specific factors studied. Further research is needed to identify additional factors that may be more predictive of dry taps.
Collapse
|
37
|
Ye X, Fan W, Wang Z, Wang J, Wang H, Niu L, Fang Y, Gu S, Liu L, Liu B, Zhuang Y, Wei Z, Li X, Li X, Li Y, Li C, Yang X, Yang W, Yang P, Lin Z, Meng Z, Hu K, Liu C, Huang Y, Huang G, Huang K, Peng Z, Han Y, Jin Y, Lei G, Zhai B, Li H, Pan J, Filippiadis D, Kelekis A, Pua U, Futacsi B, Yumchinserchin N, Iezzi R, Tang A, Roy S. Clinical practice guidelines on image-guided thermal ablation of primary and metastatic lung tumors (2022 edition). J Cancer Res Ther 2022; 18:1213-1230. [PMID: 36204866 DOI: 10.4103/jcrt.jcrt_880_22] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
|
38
|
Heiman E, Gencarelli P, Tang A, Yingling JM, Liporace FA, Yoon RS. Fragility Fractures of the Pelvis and Sacrum: Current Trends in Literature. Hip Pelvis 2022; 34:69-78. [PMID: 35800130 PMCID: PMC9204239 DOI: 10.5371/hp.2022.34.2.69] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/20/2022] [Accepted: 03/02/2022] [Indexed: 11/24/2022] Open
Abstract
Fragility fractures of the pelvis (FFP) and fragility fractures of the sacrum (FFS), which are emerging in the geriatric population, exhibit characteristics that differ from those of pelvic ring disruptions occurring in the younger population. Treatment of FFP/FFS by a multidisciplinary team can be helpful in reducing morbidity and mortality with the goal of reducing pain, regaining early mobility, and restoring independence for activities of daily living. Conservative treatment, including bed rest, pain therapy, and mobilization as tolerated, is indicated for treatment of FFP type I and type II as loss of stability is limited with these fractures. Operative treatment is indicated for FFP type II when conservative treatment has failed and for FFP type III and type IV, which are displaced fractures associated with intense pain and increased instability. Minimally invasive stabilization techniques, such as percutaneous fixation, are favored over open reduction internal fixation. There is little evidence regarding outcomes of patients with FFP/FFS and more literature is needed for determination of optimal management. The aim of this article is to provide a concise review of the current literature and a discussion of the latest recommendations for orthopedic treatment and management of FFP/FFS.
Collapse
Affiliation(s)
- Erick Heiman
- Division of Orthopedic Trauma and Adult Reconstruction, Department of Orthopedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ, USA
| | - Pasquale Gencarelli
- Division of Orthopedic Trauma and Adult Reconstruction, Department of Orthopedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ, USA
| | - Alex Tang
- Division of Orthopedic Trauma and Adult Reconstruction, Department of Orthopedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ, USA
| | - John M. Yingling
- Division of Orthopedic Trauma and Adult Reconstruction, Department of Orthopedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ, USA
| | - Frank A. Liporace
- Division of Orthopedic Trauma and Adult Reconstruction, Department of Orthopedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ, USA
| | - Richard S. Yoon
- Division of Orthopedic Trauma and Adult Reconstruction, Department of Orthopedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ, USA
| |
Collapse
|
39
|
Sims BM, Patel AD, Garnica BG, Faraj MT, Tang A, Parsons T, Hoegler JJ, Day CS. Effect of elective surgery cancellations during the COVID-19 pandemic on patients' activity, anxiety and pain. Br J Surg 2021; 108:e392-e393. [PMID: 34611698 PMCID: PMC8500095 DOI: 10.1093/bjs/znab318] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 08/20/2021] [Indexed: 11/12/2022]
Affiliation(s)
- B M Sims
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - A D Patel
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - B G Garnica
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - M T Faraj
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - A Tang
- Department of Orthopedic Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - T Parsons
- Department of Orthopedic Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - J J Hoegler
- Department of Orthopedic Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - C S Day
- Wayne State University School of Medicine, Detroit, Michigan, USA.,Department of Orthopedic Surgery, Henry Ford Health System, Detroit, Michigan, USA
| |
Collapse
|
40
|
Li C, Yu Y, Fang A, Feng D, Du M, Tang A, Chen S, Li A. Insight into biosorption of heavy metals by extracellular polymer substances and the improvement of the efficacy: a review. Lett Appl Microbiol 2021; 75:1064-1073. [PMID: 34562275 DOI: 10.1111/lam.13563] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 08/26/2021] [Accepted: 09/01/2021] [Indexed: 01/21/2023]
Abstract
Heavy metals are continuously released into aquatic environments in which they accumulate. This phenomenon endangers public health because heavy metals accumulate along the food chain. However, conventional remediation methods are inefficient, expensive and yield toxic intermediate products, which adversely affect the environment. The discovery of green bio-adsorbents such as microbial extracellular polymer substance (EPS) has quickly attracted considerable worldwide attention because of their low cost, high removal efficiency of heavy metals and industrial availability. Hence, this review considers the sources, hazards and treatment methods of heavy metals pollution, particularly the biosorption mechanism of EPS to heavy metals and the influencing factors of the bio-adsorption process, which are significant in the efficient removal of heavy metals-containing wastewater treatment. This review also focuses on strengthening the process of EPS adsorption of heavy metals, which can further contribute to heavy metals removal. Finally, it has been proposed that improving the yield, stability, selectivity and recoverability of EPS is the key direction of further research.
Collapse
Affiliation(s)
- C Li
- State Key Laboratory of Urban Water Resource and Environment, School of Environment, Harbin Institute of Technology, Harbin, People's Republic of China
| | - Y Yu
- State Key Laboratory of Urban Water Resource and Environment, School of Environment, Harbin Institute of Technology, Harbin, People's Republic of China
| | - A Fang
- State Key Laboratory of Urban Water Resource and Environment, School of Environment, Harbin Institute of Technology, Harbin, People's Republic of China
| | - D Feng
- State Key Laboratory of Urban Water Resource and Environment, School of Environment, Harbin Institute of Technology, Harbin, People's Republic of China
| | - M Du
- State Key Laboratory of Urban Water Resource and Environment, School of Environment, Harbin Institute of Technology, Harbin, People's Republic of China
| | - A Tang
- State Key Laboratory of Urban Water Resource and Environment, School of Environment, Harbin Institute of Technology, Harbin, People's Republic of China
| | - S Chen
- School of Municipal and Environmental Engineering, Jilin University of Architecture and Technology, Changchun, People's Republic of China
| | - A Li
- State Key Laboratory of Urban Water Resource and Environment, School of Environment, Harbin Institute of Technology, Harbin, People's Republic of China.,School of Municipal and Environmental Engineering, Jilin University of Architecture and Technology, Changchun, People's Republic of China
| |
Collapse
|
41
|
Yuan Y, Lee J, Yost SE, Frankel PH, Ruel C, Egelston CA, Guo W, Padam S, Tang A, Martinez N, Schmolze D, Presant C, Ebrahimi B, Yeon C, Sedrak M, Patel N, Portnow J, Lee P, Mortimer J. Phase I/II trial of palbociclib, pembrolizumab and letrozole in patients with hormone receptor-positive metastatic breast cancer. Eur J Cancer 2021; 154:11-20. [PMID: 34217908 PMCID: PMC8691850 DOI: 10.1016/j.ejca.2021.05.035] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/11/2021] [Accepted: 05/24/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND CDK4/6 inhibitors modulate immune response in breast cancer. This phase I/II trial was designed to test the safety and efficacy of palbociclib, pembrolizumab and letrozole in women with hormone receptor positive (HR+) human epidermal growth factor receptor 2 negative (HER2-) metastatic breast cancer (MBC). PATIENTS AND METHODS Women with stage IV HR+ HER2- MBC were enrolled and treated with palbociclib, pembrolizumab and letrozole. Primary end-points were safety, tolerability and efficacy. RESULTS Between November 2016 and July 2020, 23 patients were enrolled with 20 evaluable for response, including 4 patients in cohort 1 and 16 patients in cohort 2. Cohort 1 median age was 48 years (33-70) and cohort 2 median age was 55 (37-75). Cohort 1 closed early due to limited accrual. Grade III-IV adverse events were neutropenia (83%), leucopaenia (65%), thrombocytopenia (17%) and elevated liver enzymes (17%). In cohort 1, 50% achieved a partial response (PR) and 50% had stable disease (SD). In cohort 2, 31% achieved complete response (CR), 25% had PR and 31% had SD by Response Evaluation Criteria in Solid Tumours version 1.1. Median progression-free survival was 25.2 months (95% confidence interval [CI] 5.3, not reached) and median overall survival was 36.9 months (95% CI 36.9, not reached) in cohort 2 with a median follow-up of 24.8 months (95% CI 17.1, not reached). A correlative immune biomarker analysis was published separately. CONCLUSION The combination of palbociclib, pembrolizumab and letrozole is well tolerated, and a complete response rate of 31% was identified in HR+ MBC patients who received this combination as front-line therapy. Confirmatory trials are required to better understand the immune-priming effects of CDK4/6 inhibitors.
Collapse
Affiliation(s)
- Y. Yuan
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA,Corresponding author: Dr. Yuan Yuan, Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, 1500 E. Duarte Road, Duarte, CA 91010 USA, Phone: 626-256-4673, Fax: 626-301-8233,
| | - J. Lee
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - S. E. Yost
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - P. H. Frankel
- Department of Biostatistics, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - C. Ruel
- Department of Biostatistics, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - C. A. Egelston
- Department of Immune-Oncology, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - W. Guo
- Department of Immune-Oncology, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - S. Padam
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - A. Tang
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - N. Martinez
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - D. Schmolze
- Department of Pathology, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - C. Presant
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - B. Ebrahimi
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - C. Yeon
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - M. Sedrak
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - N. Patel
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - J. Portnow
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - P. Lee
- Department of Immune-Oncology, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - J. Mortimer
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| |
Collapse
|
42
|
Abstract
Aims As our population ages, the number of octogenarians who will require a total hip arthroplasty (THA) rises. In a value-based system where operative outcomes are linked to hospital payments, it is necessary to assess the outcomes in this population. The purpose of this study was to compare outcomes of elective, primary THA in patients ≥ 80 years old to those aged < 80. Methods A retrospective review of 10,251 consecutive THA cases from 2011 to 2019 was conducted. Patient-reported outcome (PRO) scores (Hip disability and Osteoarthritis Outcome Score (HOOS)), as well as demographic, readmission, and complication data, were collected. Results On average, the younger cohort (YC, n = 10,251) was a mean 61.60 years old (SD 10.71), while the older cohort (OC, n = 609) was 84.25 years old (SD 3.02) (p < 0.001). The OC had greater surgical risk based on their higher mean American Society of Anesthesiologists (ASA) scores (2.74 (SD 0.63) vs 2.30 (SD 0.63); p < 0.001) and Charlson Comorbidity Index (CCI) scores (6.26 (SD 1.71) vs 3.87 (SD 1.98); p < 0.001). While the OC stayed in the hospital longer than the YC (mean 3.5 vs 2.5 days; p < 0.001), there were no differences in 90-day emergency visits (p = 0.083), myocardial infarctions (p = 0.993), periprosthetic joint infections (p = 0.214), dislocations (p = 0.993), or aseptic failure (p = 0.993). The YC was more likely to be readmitted within 90 days (3.88% vs 2.18%, Β = 0.57; p = 0.048). There were no observed differences in 12-week (p = 0.518) or one-year (p = 0.511) HOOS scores. Conclusion Although patients ≥ 80 years old have a greater number of comorbidities than younger patients, they had equivalent perioperative complication rates and PRO scores. This study demonstrates the safety and success of elective THA in octogenarians. Cite this article: Bone Jt Open 2021;2(7):535–539.
Collapse
Affiliation(s)
- Stephen Gerard Zak
- Orthopedic Surgery, NYU Langone Orthopedic Center, New York, New York, USA
| | - Katherine Lygrisse
- Orthopedic Surgery, NYU Langone Orthopedic Center, New York, New York, USA
| | - Alex Tang
- Orthopedic Surgery, NYU Langone Orthopedic Center, New York, New York, USA
| | - Morteza Meftah
- Orthopedic Surgery, NYU Langone Orthopedic Center, New York, New York, USA
| | - William J Long
- Orthopedic Surgery, NYU Langone Orthopedic Center, New York, New York, USA
| | - Ran Schwarzkopf
- Orthopedic Surgery, NYU Langone Orthopedic Center, New York, New York, USA
| |
Collapse
|
43
|
Zak SG, Lygrisse KA, Tang A, Bosco JA, Schwarzkopf R, Long WJ. In a Bundled Payment Model, the Costs Associated With Total Joint Replacement in Those Aged Older Than 80 Years Are Significantly Greater. J Arthroplasty 2021; 36:2263-2267. [PMID: 33358513 DOI: 10.1016/j.arth.2020.11.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/22/2020] [Revised: 10/27/2020] [Accepted: 11/24/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The number of octogenarians requiring a total hip arthroplasty (THA) and/or total knee arthroplasty (TKA) will rise disproportionally in the coming decade. Although outcomes are comparable with younger patients, management of these older patients involves higher medical complexity at a greater expense to the hospital system. The purpose of this study was to compare the cost of care for primary THA and TKA in our bundled care patients aged ≥80 years to those aged 65-80 years. METHODS A retrospective review of primary TKA (n = 641) and THA (n = 1225) cases from 2013 to 2017 was performed. Patient demographic and admission cost data were collected. Patients were grouped based on surgery type (ie, elective or nonelective THA/TKA) and age group (ie, older [≥80 years old] or younger [65-80 years old]). Multivariate regression analyses were used to account for demographic differences. RESULTS Elective primary THA in the older cohort (n = 157) cost 24.5% more than the younger cohort (n = 1025) (P < .0001). Elective primary TKA cases in the older cohort (n = 87) cost 17.0% more than the younger cohort's (n = 554) (P < .0001). For nonelective THA cases, the older cohort's (n = 29) episodes cost 39.1% more than the younger cohort (n = 14) (P < .0001). When comparing the <80 elective THA cohort (n = 1025) to the ≥90 cohort (n = 10), the cost difference swelled to 58.7% (P < .0001). CONCLUSION Although primary THA and TKA in ≥80-year-old patients yield similar outcomes, this study demonstrates that the additional measures required to care for older patients and ensure successful outcomes cost significantly more. Consideration should be given to age as a factor in determining reimbursement in a bundled payment system to reduce the incentive to restrict care to elderly patients.
Collapse
Affiliation(s)
- Stephen G Zak
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | | | - Alex Tang
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - Joseph A Bosco
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - William J Long
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| |
Collapse
|
44
|
Zak SG, Tang A, Sharan M, Waren D, Rozell JC, Schwarzkopf R. Tranexamic Acid Is Safe in Patients with a History of Coronary Artery Disease Undergoing Total Joint Arthroplasty. J Bone Joint Surg Am 2021; 103:900-904. [PMID: 33983147 DOI: 10.2106/jbjs.20.01226] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Tranexamic acid (TXA) is increasingly used to minimize blood loss during total joint arthroplasty (TJA). Although TXA has been shown to be highly effective in reducing operative blood loss, many surgeons believe that it places patients with coronary artery disease (CAD) or a history of coronary stents at an increased risk for myocardial infarction. The purpose of this study was to determine if TXA is safe to use in patients with a history of CAD or coronary stents. METHODS We performed a retrospective analysis at a single, tertiary academic medical center identifying consecutive total hip and knee arthroplasty cases over an 8-year period. From this cohort who received TXA intraoperatively, we identified patients with a history of CAD or coronary stents and determined the total myocardial infarction and venous thromboembolism (VTE) rates within a 90-day postoperative period. Chi-square analyses were used to identify differences in VTE rates between cohorts. A post hoc power analysis was also performed to determine whether our results were powered to detect a difference in VTE rates. RESULTS In the 26,808 identified at-risk patients, there were no postoperative myocardial infarctions. No significant differences were observed for VTE rates compared with the control cohort using either topical or intravenous TXA, with regard to CAD (0.29% compared with 0.76%; p = 0.09) or coronary stents (0% compared with 0.76%; p = 0.14). Moreover, there was no significant difference observed in VTE rates when administration was subcategorized into intravenous and topical methods with regard to CAD (0.13% compared with 0.72%; p = 0.12) or coronary stents (0% compared with 0%; p = 1.0). CONCLUSIONS In our series, topical and intravenous TXA were equally safe when used in patients with a history of CAD and coronary stents in comparison with the control cohort. With equal efficacy and risk of adverse events, we recommend intravenous TXA, which may enable easier institutional implementation. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Stephen G Zak
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | | | | | | | | | | |
Collapse
|
45
|
Tang A, Massey I, Bosanquet DC. Gastrocnemius suture myodesis for skew flap amputations. Ann R Coll Surg Engl 2021; 103:1-2. [PMID: 33645275 DOI: 10.1308/rcsann.2020.7056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- A Tang
- Royal Gwent Hospital, Newport, UK
| | | | | |
Collapse
|
46
|
Merkow DB, Tang A, Iorio R, Slover JD, Bosco JA, Schwarzkopf R. Low dose aspirin is effective in preventing venous thromboembolism in patients undergoing primary total knee arthroplasty. J Orthop 2021; 24:26-28. [PMID: 33679024 DOI: 10.1016/j.jor.2021.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 11/19/2020] [Accepted: 02/03/2021] [Indexed: 10/22/2022] Open
Abstract
Introduction Venous thromboembolism (VTE) is a known complication after total knee arthroplasty (TKA) with well-established morbidity, mortality, and significant healthcare expenditure. However, no standard form of prophylaxis against VTE currently exists. Methods A retrospective review was performed identifying 12,866 TKA cases and post-operative VTE events using either 325 mg aspirin or 81 mg aspirin twice daily (BID). Results 133 VTE cases were diagnosed of the 9413 TKA on 325 mg aspirin BID compared to 8 VTE cases out of 3453 TKA on 81 mg aspirin BID (1.41% vs. 0.23%, p < 0.001). Conclusion 81 mg aspirin BID significantly improved post-operative VTE rates over 325 mg aspirin BID.
Collapse
Affiliation(s)
- David B Merkow
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Alex Tang
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | | | - James D Slover
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Joseph A Bosco
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| |
Collapse
|
47
|
Lorbergs A, Prorok J, Holroyd-Leduc J, Bouchard D, Giguere A, Gramlich L, Keller H, Tang A, Racey M, Ali M, Fitzpatrick-Lewis D, Sherifali D, Kim P, Muscedere J. Nutrition and Physical Activity Clinical Practice Guidelines for Older Adults Living with Frailty. J Frailty Aging 2021; 11:3-11. [DOI: 10.14283/jfa.2021.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: We developed clinical practice guidelines to provide health care providers with evidence-based recommendations for decisions related to the effective management of frailty and pre-frailty using nutrition and physical activity interventions. Methods: We based the recommendations on two systematic reviews with meta-analyses. Nutrition, physical activity, and combined nutrition and physical activity interventions for adults ≥65y were considered if study populations were identified as frail using a frailty tool or assessment. Risk of bias and certainty of evidence were evaluated. We included physical outcomes, mobility, frailty, cognitive function, activities of daily living, falls, quality of life, diet quality, energy/fatigue levels, health services use, and caregiver outcomes. Results: Overall, mobility improvements were moderate with nutritional strategies that optimize dietary intake, various types of physical activity interventions, and interventions that combine nutrition and physical activity. Physical outcomes, such as body mass and muscle strength, improved moderately with nutritional strategies and interventions that combined nutrition with physical activity. Frailty status improved with multi-component physical activity interventions. Strong recommendations include optimizing dietary intake, performing physical activity, and adopting interventions that combine nutrition and physical activity. We strongly recommend various types of physical activity including muscle strengthening activities, mobilization or rehabilitation exercises, and multi-component physical activity interventions. Interpretation: Tailored nutrition and physical activity interventions based on individual goals and health status are associated with improved clinical and physical outcomes. While the recommendations facilitate shared decision-making, we identified sparse application of validated frailty assessments and lack of standardized research outcomes as critical gaps in knowledge.
Collapse
|
48
|
Sharan M, Tang A, Schoof L, Gaukhman A, Meftah M, Sculco P, Schwarzkopf R. Obesity does not influence acetabular component accuracy when using a 3D optical computer navigation system. J Clin Orthop Trauma 2020; 14:40-44. [PMID: 33717895 PMCID: PMC7919980 DOI: 10.1016/j.jcot.2020.09.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/14/2020] [Accepted: 09/22/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Improper cup positioning and leg length discrepancy (LLD) are two of the most common errors following total hip arthroplasty (THA) and are associated with potentially significant consequences. Obesity is associated with increased risk of mechanical complications, including dislocations, which may be secondary to cup malposition and failure to restore leg length and offset. 3D Optical Camera computerassisted navigation (CAN) system may reduce the risk of component malposition and LLD with real time intraoperative feedback. The aim of this study was to investigate whether the use of CAN influences acetabular component placement (CP) accuracy and leg length restoration in obese (body mass index(BMI)≥35kg/m 2 ) patients undergoing primary THA. METHODS A multi-center retrospective review was conducted identifying consecutive THA cases with BMI > 35kg/m 2 using CAN (Intellijoint Hip, Waterloo, CA) from 2015-2019. These patients were then matched with patients undergoing conventional THA (control) at a 1:1 ratio according to BMI, American Society of Anesthesiologists score, and gender. TraumaCad™ software (Brainlab, Chicago, IL) was used to measure cup anteversion, inclination, and change (Δ) in LLD between pre- and postoperative radiographic images. The safety target zones used as reference for precision analysis of CP were 15°-30° for anteversion and 30°-50° for inclination. RESULTS 176 patients were included: 88 CAN and 88 control cases. CAN cases were found to have a lower ΔLLD than controls (3.53±2.12mm vs. 5.00±4.05mm; p=0.003). Additionally, more CAN cases fell within the target safe zone than controls (83% vs.60%, p=0.00083). CONCLUSION Our findings suggest that the use of a CAN system may be more precise in component placement, and useful in facilitating the successful restoration of preoperative leg length following THA than conventional methodology.
Collapse
Affiliation(s)
- Mohamad Sharan
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA,Corresponding author.
| | - Alex Tang
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Lauren Schoof
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | | | - Morteza Meftah
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Peter Sculco
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA,Corresponding author. Department of Orthopedic Surgery NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA.
| |
Collapse
|
49
|
Khan H, Deif B, So A, Lee T, Tang A. APPROACH TO THE LEFT SIDED PURKINJE SYSTEM AND LEFT VENTRICLE ENDOCARDIUM DIRECTLY FROM THE RIGHT ATRIUM - POTENTIAL NEW APPROACH TO LBBAP. Can J Cardiol 2020. [DOI: 10.1016/j.cjca.2020.07.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
50
|
Herrero C, Tang A, Wasterlain A, Sherman S, Bosco J, Lajam C, Schwarzkopf R, Slover J. Smoking cessation correlates with a decrease in infection rates following total joint arthroplasty. J Orthop 2020; 21:390-394. [PMID: 32921947 DOI: 10.1016/j.jor.2020.08.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 05/25/2020] [Accepted: 08/19/2020] [Indexed: 10/23/2022] Open
Abstract
Background The impact of tobacco use on perioperative complications, hospital costs, and survivorship in total joint arthroplasty (TJA) is well established. The aim of this study is to report the impact of tobacco cessation on outcomes after TJA and to measure the impact of a voluntary smoking cessation program (SCP) on self-reported smoking quit rates in a premier academic medical center. Methods A seven-year (2013-2019) SCP database was provided by the Integrative Health Promotion Department and Infection Prevention and Control Department. We evaluated program and smoking status, patient demographics, length of stay (LOS), and 90-day post-operative infection rates and readmission rates. The primary outcome was quit rates based on SCP enrollment status. The secondary outcomes measured infection rates, readmission rates, and LOS based on enrollment status and/or quit rate. Results A total of 201 eligible patients were identified: 137 patients in the SCP (intervention) group and 64 in the self-treatment (control) group. SCP patients trended towards higher quit rates (43% vs 33%, p = 0.17), shorter LOS (2.47 vs 2.62 days, p = 0.52), lower infection rates (7.3% vs 12.5%, p = 0.27) and slightly higher readmission rates (5.8% vs 4.7%, p = 0.73). In a sub-analysis, self-reported smokers demonstrated statistically significant decrease in infection (3.7% vs 12.5%, p = 0.03). Conclusion There was a statistically significant decrease in infection rates in patients who self-reported quitting tobacco prior to TJA. Additionally, quit rates for patients who participated in a voluntary SCP trended towards increased pre-operative cessation. Further efforts to increase tobacco cessation prior to TJA and examine the impact on patient outcomes are needed.
Collapse
Affiliation(s)
- Christina Herrero
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Alex Tang
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Amy Wasterlain
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Scott Sherman
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Joseph Bosco
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Claudette Lajam
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - James Slover
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| |
Collapse
|