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Marchand R, Shul C, Hameed D, Dubin J, Roche M, Bowes M, Scholl L, Gutowski T, Mont A M. Three-dimensional-based native alignment phenotype classification system: Description for use in planning for deformities during total knee arthroplasty. J Orthop 2024; 54:163-167. [PMID: 38605902 PMCID: PMC11004059 DOI: 10.1016/j.jor.2024.03.018] [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] [Received: 03/02/2024] [Accepted: 03/12/2024] [Indexed: 04/13/2024] Open
Abstract
Introduction Total knee arthroplasty (TKA) is a complex surgical procedure that traditionally relies on two-dimensional radiographs for pre-operative planning. These radiographs may not capture the intricate details of individual knee anatomy, potentially limiting the precision of surgical interventions. With advancements in imaging technology, there is an opportunity to refine TKA outcomes. This study introduces the Native Alignment Phenotype classification system that is based on pre-operative 3-dimensional computed tomography (CT) scans, aiming to provide a more detailed understanding of knee deformities and their influence on characterizing knee osteoarthritis and planning for TKA procedures. Methods There were 1406 pre-operative non-weight-bearing CT scans analyzed by a single surgeon experienced with robotically-assisted total knee arthroplasties. These scans were converted into three-dimensional models, focusing on the coronal and sagittal planes. Intraoperatively, the robotic system was used to capture native coronal and sagittal deformities for each patient. These values were captured with the patient's leg held in a non-stress, extension pose. A new classification system, 'The Native Alignment Phenotype', was developed to categorize the specific differences between individual knees. Results There were four primary knee malalignments identified: varus deformity; valgus deformity; and two deformities in the sagittal plane. These malalignments were further categorized based on the degrees of deviation, creating groups with 5° coronal and sagittal ranges. A total of 77 phenotypic alignment patterns were found based on the analyzed cohort. In the coronal plane, varus HKA deformity between 6 and 10° was the most common, with 36.9% of the cases, followed by varus HKA alignment, which was between 0 and 5°, representing 34.3% of the cases. In the sagittal plane, neutral and flexion contracture deformities between 0 and 5° were the most common, with 32.6% of the cases, followed by a fixed flexion contracture alignment, which was between 6 and 10°, representing 28.7% of the cases. When combining coronal and sagittal planes, the most common alignment was the varus between 0 and 5° with a flexion contracture between 0 and 5° (12.5% of cases), closely followed by the varus between 6 and 10° with a flexion contracture between 6 and 10° (12.4% of cases). Conclusion The Native Alignment Phenotype classification system offers a nuanced understanding of knee deformities based on three-dimensional (CT scan) assessments, potentially leading to improved surgical outcomes in TKA. By leveraging the detailed data from the CT scans, this system provides a more comprehensive view of the knee's anatomy, emphasizing the importance of individualized, data-driven approaches in knee surgery.
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Affiliation(s)
| | - Craig Shul
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Daniel Hameed
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Jeremy Dubin
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Martin Roche
- Department of Arthroplasty, Hospital for Special Surgery Florida, West Palm Beach, FL, USA
| | | | | | | | - Michael Mont A
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
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Albana MF, Hameed D, Bains SS, Dubin J, Mont MA, Nace J, Scuderi GR, Delanois RE. Antibiotic prophylaxis prior to colonoscopy with biopsy does not decrease risk of prosthetic joint infection in total knee arthroplasty recipients. J Orthop 2024; 53:82-86. [PMID: 38495578 PMCID: PMC10937191 DOI: 10.1016/j.jor.2024.02.037] [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: 02/02/2024] [Accepted: 02/24/2024] [Indexed: 03/19/2024] Open
Abstract
Introduction Prosthetic joint infection (PJI) risk continues to receive much attention given its associated morbidity and costs to patients and healthcare systems. It has been hypothesized that invasive colonoscopies may increase the risk of PJI. However, the decision to administer antibiotic prophylaxis lacks clinical guidance. In this study we aimed to compare PJI rates in patients undergoing colonoscopies with and without antibiotic prophylaxis against a control group, analyzing PJI occurrences at 90 days, 6 months, 9 months, and 1-year post-procedure and (2) assess the impact of antibiotic prophylaxis on PJI rates to inform clinical guidelines. Methods We queried a national, all-payer database to identify all primary total knee arthroplasty procedures without prior history of PJI between January 2010 and October 2020 (n = 1.9 million). All patients who had a diagnosis of PJI within one year of index procedure were excluded. There were three cohorts identified: colonoscopy with biopsy without antibiotic prophylaxis; colonoscopy with biopsy with antibiotic prophylaxis; and a control of no prior colonoscopy. Both colonoscopy cohorts were slightly younger and had higher comorbidities than the controls. The PJI diagnoses were identified at four separate time intervals within one-year after colonoscopy: 90-days; 6-months; 9-months; and 1-year. Chi-square analyses with odds ratios (ORs) and 95% confidence intervals were conducted for PJI rates between groups at all time-points. Results Among all cohorts, no significant differences in PJI rates were found at 90-days (P = 0.459), 6-months (P = 0.608), 9-months (P = 0.598), and 1-year (P = 0.330). Similarly, direct comparison of both colonoscopy groups, with and without antibiotic prophylaxis, demonstrated no PJI rate differences at 90-day (P = 0.540), 6-months (P = 0.812), 9-months (P = 0.958), and 1-year (P = 0.207). Ranges of ORs between the colonoscopy cohorts were 1.07-1.43. Conclusion Invasive colonoscopy does not increase the risk of PJI in patients who have pre-existing knee implants. Furthermore, antibiotic prophylaxis may not be warranted in patients undergoing colonoscopy who have a planned biopsy.
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Affiliation(s)
| | - Daniel Hameed
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Sandeep S. Bains
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Jeremy Dubin
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Michael A. Mont
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - James Nace
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | | | - Ronald E. Delanois
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
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Hlukha LP, Sax OC, Kowalewski KA, Bains SS, Dubin J, Herzenberg JE, Assayag MJ, McClure PK. Chronic knee pain following infrapatellar/suprapatellar magnetic intramedullary lengthening nails versus external fixators in limb length discrepancy: A retrospective review. J Orthop 2024; 51:7-11. [PMID: 38299066 PMCID: PMC10825912 DOI: 10.1016/j.jor.2023.11.071] [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: 11/21/2023] [Accepted: 11/26/2023] [Indexed: 02/02/2024] Open
Abstract
Aims & objectives Prior to the popularization of magnetic intramedullary nails (MILNs), gradual deformity correction using external fixation was the norm in limb lengthening. Trauma literature has shown MILN via a suprapatellar approach (SP) to be associated with less knee pain than either an infrapatellar entry (IP) or external fixation. Yet, no research has investigated chronic knee pain and MILNs. We assessed differences in chronic knee pain following lengthening via an IP or SP approach with an MILN versus external fixation. Materials & methods We reviewed 147 limbs (55 MILN/IP, 22 MILN/SP, 71 external fixator) in 124 patients who underwent tibial lengthening with ≥12 months follow-up between February 2012 and July 2020. Knee pain was assessed pre- and postoperatively at 6 and 12 months, with the Lysholm Knee Scoring Scale (LKSS) and numeric pain scale (0-10). Differences in knee pain outcomes were compared across methods, with subgroup analysis of MILN/SP and MILN/IP. Results Mean LKSS was 96.3 for external fixation and 88.5 for MILN (P = .011). In the MILN subgroups, mean LKSS was 91.7 for IP and 85.3 for SP. The IP group reported a lesser mean pain score (0.6 versus 2.1) at 12 months. Bilateral nail recipients demonstrated no knee pain differences versus unilateral. At 12 months postoperative, external fixation had better knee outcomes. Conclusion Tibial lengthening with external fixation was associated with less chronic anterior knee pain and better functional outcomes than MILN overall. In terms of MILN approach, IP surpassed SP on subjective pain scores. Larger tibial lengthening and knee pain studies are warranted.
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Affiliation(s)
- Larysa P. Hlukha
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 W. Belvedere Ave., Baltimore, MD, 21215, USA
| | - Oliver C. Sax
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 W. Belvedere Ave., Baltimore, MD, 21215, USA
| | - Kyle A. Kowalewski
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 W. Belvedere Ave., Baltimore, MD, 21215, USA
| | - Sandeep S. Bains
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 W. Belvedere Ave., Baltimore, MD, 21215, USA
| | - Jeremy Dubin
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 W. Belvedere Ave., Baltimore, MD, 21215, USA
| | - John E. Herzenberg
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 W. Belvedere Ave., Baltimore, MD, 21215, USA
| | - Michael J. Assayag
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 W. Belvedere Ave., Baltimore, MD, 21215, USA
| | - Philip K. McClure
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 W. Belvedere Ave., Baltimore, MD, 21215, USA
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Dubin J, Bains S, LaGreca M, Gilmor RJ, Hameed D, Nace J, Mont M, Lundy DW, Delanois RE. Assessing social disparities in inpatient vs. outpatient arthroplasty: a in-state database analysis. Eur J Orthop Surg Traumatol 2024:10.1007/s00590-024-03922-w. [PMID: 38625425 DOI: 10.1007/s00590-024-03922-w] [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: 02/08/2024] [Accepted: 03/15/2024] [Indexed: 04/17/2024]
Abstract
INTRODUCTION Given the growing emphasis on patient outcomes, including postoperative complications, in total joint arthroplasty (TJA), investigating the rise of outpatient arthroplasty is warranted. Concerns exist over the safety of discharging patients home on the same day due to increased readmission and complication rates. However, psychological benefits and lower costs provide an incentive for outpatient arthroplasty. The influence of social determinants of health disparities on outpatient arthroplasty remains unexplored. One metric that assesses social disparities, including the following individual components: socioeconomic status, household composition, minority status, and housing and transportation, is the Social Vulnerability Index (SVI). As such, we aimed to compare: (1) mean overall SVI and mean SVI for each component and (2) risk factors for total complications between patients undergoing inpatient and outpatient arthroplasty. METHODS Patients who underwent TJA between January 1, 2022 and December 31, 2022 were identified. Data were drawn from the Maryland State Inpatient Database (SID). A total of 7817 patients had TJA within this time period. Patients were divided into inpatient arthroplasty (n = 1429) and outpatient arthroplasty (n = 6338). The mean SVI was compared between inpatient and outpatient procedures for each themed score. The SVI identifies communities that may need support cause by external stresses on human health based on four themed scores: socioeconomic status; household composition and disability; minority status and language; and housing and transportation. The SVI uses the United States Census data to rank census tracts for each individual theme, as well as an overall social vulnerability score. The higher the SVI, the more social vulnerability, or resources needed to thrive in that area. Multivariate logistic regression analyses were performed to identify independent risk factors for total complications following TJA after controlling for risk factors and patient comorbidities. Total complications included: infection, aseptic loosening, dislocation, arthrofibrosis, mechanical complication, pain, and periprosthetic fracture. RESULTS Patients who had inpatient arthroplasty had higher overall SVI scores (0.45 vs. 0.42, P < 0.001). The SVI scores were higher for patients who had inpatient arthroplasty for socioeconomic status (0.36 vs. 0.32, P < 0.001), minority status and language (0.76 vs. 0.74, P < 0.001), and housing and transportation (0.53 vs. 0.50, P < 0.001) compared to outpatient arthroplasty, respectively. There was no difference between inpatient and outpatient arthroplasty for household composition and disability (0.41 vs. 0.41, P = 0.99). When controlling for comorbidities, inpatient arthroplasty [Odds Ratio (OR) 1.91, 95% Confidence Interval (CI) 1.23-2.95, P = 0.004], hypertension (OR 2.11, 95% CI 1.23-3.62, P = 0.007), and housing and transportation (OR 2.00, 95% CI 1.17-3.42, P = 0.012) were independent risk factors for total complications. CONCLUSION Inpatient arthroplasty was associated with increased social disparities across several components of deprivation as well as an independent risk factor total complications following TJA. To the best of our knowledge, this study is the first to examine the negative repercussions of inpatient arthroplasty through the lens of social disparities and can target specific areas for intervention.
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Affiliation(s)
- Jeremy Dubin
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Sandeep Bains
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Mark LaGreca
- Department of Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Ruby J Gilmor
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Daniel Hameed
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - James Nace
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Michael Mont
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Douglas W Lundy
- Department of Orthopaedic Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Ronald E Delanois
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA.
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Sarrel K, Hameed D, Dubin J, Mont MA, Jacofsky DJ, Coppolecchia AB. Understanding economic analysis and cost-effectiveness of CT scan-guided, 3-dimensional, robotic-arm assisted lower extremity arthroplasty: a systematic review. J Comp Eff Res 2024; 13:e230040. [PMID: 38488048 PMCID: PMC11044952 DOI: 10.57264/cer-2023-0040] [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] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 12/21/2023] [Indexed: 03/23/2024] Open
Abstract
Aim: The overall goal of this review was to examine the cost-utility of robotic-arm assisted surgery versus manual surgery. Methods: We performed a systematic review of all health economic studies that compared CT-based robotic-arm assisted unicompartmental knee arthroplasty, total knee arthroplasty and total hip arthroplasty with manual techniques. The papers selected focused on various cost-utility measures. In addition, where appropriate, secondary aims encompassed various clinical outcomes (e.g., readmissions, discharges to subacute care, etc.). Only articles directly comparing CT-based robotic-arm assisted joint arthroplasty with manual joint arthroplasty were included, for a resulting total of 21 reports. Results: Almost all twenty-one studies demonstrated a positive effect of CT scan-guided robotic-assisted joint arthroplasty on health economic outcomes. For studies reporting on 90-day episodes of costs, 10 out of 12 found lower costs in the robotic-arm assisted groups. Conclusion: Robotic-arm assisted joint arthroplasty patients had shorter lengths of stay and cost savings based on their 90-day episodes of care, among other metrics. Payors would likely benefit from encouraging the use of this CT-based robotic technology.
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Affiliation(s)
- Kara Sarrel
- Department of Orthopaedic Surgery, Northwell Hospital Lenox Hill, New York City, NY 10075, USA
| | - Daniel Hameed
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD 21215, USA
| | - Jeremy Dubin
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD 21215, USA
| | - Michael A Mont
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD 21215, USA
| | - David J Jacofsky
- The CORE Institute, Phoenix, AZ 85023, USA
- HOPCo, Phoenix, AZ 85023, USA
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Remily EA, Bains SS, Dubin J, Hameed D, Reich J, Livesey MG, Chen Z, Moore MC, Ingari JV. Elevated risk of prosthetic infections in cannabis users after shoulder arthroplasty. Eur J Orthop Surg Traumatol 2024; 34:1381-1387. [PMID: 38183443 DOI: 10.1007/s00590-023-03802-9] [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] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/25/2023] [Indexed: 01/08/2024]
Abstract
INTRODUCTION An increasing number of states are beginning to legalize recreational cannabis use, and as such, more patients using cannabis are undergoing shoulder arthroplasty procedures. The present study sought to examine the impact of cannabis use on post-operative outcomes. The primary outcomes of interest were postoperative complications, which included infection, periprosthetic fractures, periprosthetic joint infections (PJI), dislocations, and aseptic loosening as well as medical complications. Secondary outcomes were risk factors for PJI and aseptic loosening at two-years. METHODS A private, nationwide, all-payer database (Pearldiver Technologies) was queried to identify shoulder arthroplasty patients from 2010 to 2020. Those not using tobacco or cannabis ("control", n = 10,000), tobacco users (n = 10,000), cannabis users (n = 155), and concurrent tobacco and cannabis users (n = 9,842) were identified. Risk factors for PJI and aseptic loosening at two-years were further quantified utilizing multivariable logistic regression analysis. RESULTS Compared to non-users, cannabis users experienced the highest odds for PJI and aseptic revisions, which were followed by concurrent cannabis and tobacco users and tobacco-only users. Concurrent users, as well as tobacco users were at higher risk for dislocation. Cannabis use was the most significant risk factor for PJI, followed by concurrent use and male sex. CONCLUSIONS Our study found cannabis use to cause greater risk for superficial and deep infection. More research involving randomized trials are needed to fully elucidate the impact of cannabis use on shoulder arthroplasty procedures. Clinically, these findings can appropriately guide surgeons and patients alike regarding expectations prior to undergoing TSA.
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Affiliation(s)
- Ethan A Remily
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Sandeep S Bains
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Jeremy Dubin
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Daniel Hameed
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Jeremy Reich
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Michael G Livesey
- Department of Orthopaedic Surgery, University of Maryland, Baltimore, MD, USA
| | - Zhongming Chen
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Mallory C Moore
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - John V Ingari
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA.
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Dubin J, Bains S, Ihekweazu UN, Mont MA, Delanois R. Social Determinants of Health in Total Joint Arthroplasty: Income. J Arthroplasty 2024:S0883-5403(24)00236-5. [PMID: 38492822 DOI: 10.1016/j.arth.2024.03.020] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 03/09/2024] [Indexed: 03/18/2024] Open
Affiliation(s)
- Jeremy Dubin
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Sandeep Bains
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | | | - Michael A Mont
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Ronald Delanois
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
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Dubin J, Bains S, Ihekweazu UN, Mont MA, Delanois R. Social Determinants of Health in Total Joint Arthroplasty: Education. J Arthroplasty 2024:S0883-5403(24)00235-3. [PMID: 38490570 DOI: 10.1016/j.arth.2024.03.018] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 03/07/2024] [Indexed: 03/17/2024] Open
Affiliation(s)
- Jeremy Dubin
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Sandeep Bains
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | | | - Michael A Mont
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Ronald Delanois
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
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Hameed D, Dubin J, Chen Z, Sodhi N, Mont MA, Harwin SF. Are Metal Ion Levels Elevated After Dual Mobility Acetabular Systems: Minimum Five-Year Analyses. Surg Technol Int 2024; 44:sti44/1767. [PMID: 38547433 DOI: 10.52198/24.sti.44.os1767] [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: 04/11/2024]
Abstract
INTRODUCTION While dual mobility systems in total hip replacements have demonstrated reduced dislocation and revision occurrences, concerns persist about the potential elevation of metal ions in the bloodstream, leading to negative tissue reactions. Notably, there's a scarcity of research spanning over five years post-surgery that examines cobalt and chromium levels after such implants. This study aimed to delve into these metal ion concentrations after a five-year period, building on previous metal-ion findings. We focused on: (1) cobalt concentrations in blood and urine; (2) chromium concentrations in blood and urine; (3) cobalt variations based on follow-up duration and specific implant metrics (e.g., offset, cup dimension, stem, and neck inclination); and (4) chromium variations based on the same parameters. MATERIALS AND METHODS We tracked 57 individuals who received THA using modular dual mobility systems from January 1, 2011, to December 31, 2016, for an average span of six years (ranging from five to 10 years). At the final check-up, we measured cobalt and chromium levels in serum, plasma, blood, and urine. We also evaluated parameters like head composition and dimension, stem offset, cup dimension, and stem-neck inclination. RESULTS Cobalt concentrations remained minimal, with average blood and urine values being 0.8+0.6mcg/L (standard <1.8mcg/L) and 1.2+1.0mcg/L (standard <2.8mcg/L), respectively. Two individuals exhibited a slight increase in blood cobalt concentration by 0.1 and 0.2mcg/L. Chromium averages in blood and urine were also minimal, with readings of 0.9+0.2mcg/L (standard <1.2mcg/L) and 1.3 + 0.5mcg/L (standard <2mcg/L), respectively. One individual had a marginally increased blood chromium concentration of 1.3mcg/L. Evaluations considering ceramic or cobalt-chrome heads, up to a decade of follow up, or varying implant metrics showed negligible variations in metal ion concentrations. CONCLUSION The findings reveal that over a minimum of five years (average = six years; span, five to 10 years), cobalt and chromium concentrations in patients' systems remained within normal limits and were clinically insignificant, irrespective of the follow-up duration, head material, or implant specifications. This underscores the efficacy of dual mobility systems in ensuring minimal metal ion presence.
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Affiliation(s)
- Daniel Hameed
- LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Jeremy Dubin
- LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Zhongming Chen
- LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Nipun Sodhi
- Department of Orthopaedic Surgery, Long Island Jewish Medical Center, New York, New York
| | - Michael A Mont
- LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Steven F Harwin
- Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, New York
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Lutz AB, Patel DV, Bibbo C, Hong IS, Hameed D, Dubin J, Mont MA. Total Hip Arthroplasty in Human Immunodeficiency Virus Positive Patients: A Systematic Review of Outcomes. J Arthroplasty 2024:S0883-5403(24)00143-8. [PMID: 38452861 DOI: 10.1016/j.arth.2024.02.043] [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] [Received: 11/28/2023] [Revised: 02/04/2024] [Accepted: 02/11/2024] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION Total hip arthroplasty (THA) has become a common intervention for Human Immunodeficiency Virus (HIV)-positive patients who have osteonecrosis of the femoral head. This paper provides a systematic review to assess survivorships, patient-reported outcomes (PROMs), infection rates, other complications, and immune competence for patients who had THAs who did and did not have HIV. METHODS A comprehensive and systematic review of published studies investigating the outcomes of THA in HIV-positive patients (osteonecrosis and non-osteonecrosis patients) was performed adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 10 studies with 9,534 HIV-positive patients fulfilled the inclusion and exclusion criteria. Manuscript quality was assessed on two scales: the Coleman Methodology Score and the level of evidence derived from Centre for Evidence-Based Medicine criteria. Data was extracted from studies in the five key areas of interest: survivorships; PROMs; infection rates; complications; as well as clusters of differention-4 (CD4+) counts and viral loads (VL). RESULTS Implant survivorship was between 95 and 100%. Postoperative Harris Hip Scores were significantly improved from preoperative values in HIV-positive patients. Postoperative PROMs and infections did not appear to be different between HIV-positive and HIV-negative patients. Many of the cohort studies demonstrate comparable complication rates to matched controls. Where described (7 reports), mean CD4+ counts ranged from 425 to 646 cells/mm3, with low VL (3 reports) and variations not found to influence outcomes. CONCLUSION Total hip arthroplasty (THA) is an effective treatment for HIV-positive patients, many of whom suffer from osteonecrosis of the femoral head. The results demonstrate excellent implant survivorship, improved quality of life, and a low risk of infections and complications.
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Affiliation(s)
- Alexandra Baker Lutz
- University of Maryland Medical Center, Department of Orthopaedic Surgery, Baltimore, MD, U.S.A
| | - Deepak V Patel
- Seton Hall University School of Graduate Medical Education, South Orange, New Jersey, USA
| | - Christopher Bibbo
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, U.S.A.; Seton Hall University School of Graduate Medical Education, South Orange, New Jersey, USA.
| | - Ian S Hong
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center - RWJ Barnabas Health, 377 Jersey Ave, Suite 550, Jersey City, New Jersey 07302, U.S.A
| | - Daniel Hameed
- Rubin Institute for Advanced Orthopedics at LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland 21215, U.S.A
| | - Jeremy Dubin
- Rubin Institute for Advanced Orthopedics at LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland 21215, U.S.A
| | - Michael A Mont
- Rubin Institute for Advanced Orthopedics at LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland 21215, U.S.A
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Scholl LY, Hampp EL, Caba M, Azhar A, Hameed D, Dubin J, Crutcher JP, Mont MA, Mahoney OM. Robotic-assisted Total Knee Arthroplasty Technology Provides a Repeatable and Reproducible Method of Assessing Soft Tissue Balance. J Knee Surg 2024. [PMID: 38113912 DOI: 10.1055/a-2232-7511] [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: 12/21/2023]
Abstract
Soft-tissue balancing is an important factor in primary total knee arthroplasty (TKA), with 30 to 50% of TKA revisions attributed to technical operative factors including soft-tissue balancing. Robotic-assisted TKA (RATKA) offers opportunities for improved soft-tissue balancing methods. This study aimed to evaluate the repeatability and reproducibility of ligamentous laxity assessments during RATKA using a digital tensioner.Three experienced RATKA surgeons assessed preresection and trialing phases of 12 human cadaveric knees with varying degrees of arthritis. Ligamentous laxity was assessed with manual varus and valgus stresses in extension and flexion, with a digital tensioner providing feedback on the change of laxity displacement. Intraclass correlation coefficient (ICC) analyses were used to determine the repeatability within a single surgeon and reproducibility between the three surgeons.The results showed excellent repeatability and reproducibility in ligamentous laxity assessment during RATKA. Surgeons had excellent repeatability for preresection and trialing assessments, with median ICC values representing excellent reproducibility between surgeons. Surgeons were repeatable within 1 or 1.5 mm for preresection and trialing assessments. On average, the variation within a surgeon was 0.33 ± 0.26 mm during preresection and 0.29 ± 0.28 mm during trialing. When comparing surgeons to each other, they were reproducible within an average of 0.69 ± 0.33 mm for preresection and 0.65 ± 0.31 mm for trialing.This study demonstrated the reliability of robotic-assisted soft-tissue balancing techniques, providing control over ligamentous laxity assessments, and potentially leading to better patient outcomes. The digital tensioner used in this study provided excellent repeatability and reproducibility in ligamentous laxity assessment during RATKA, highlighting the potential benefits of incorporating robotics in TKA procedures.
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Affiliation(s)
| | | | | | | | - Daniel Hameed
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Jeremy Dubin
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | | | - Michael A Mont
- Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
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12
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Monarrez R, Dubin J, Bains SS, Hameed D, Moore MC, Chen Z, Mont MA, Delanois RE, Nace J. Cemented is not superior to cementless total knee arthroplasty for complications: a propensity score matched analysis. Eur J Orthop Surg Traumatol 2024:10.1007/s00590-024-03847-4. [PMID: 38429555 DOI: 10.1007/s00590-024-03847-4] [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] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/25/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION There is continued debate regarding the survivorship and revision rate of cementless versus cemented total knee arthroplasty (TKA) prostheses. This includes the assessment of early revision surgery due to aseptic loosenings and periprosthetic joint infections (PJIs). Studies have not always taken into account the impact of comorbidities, such as diabetes, obesity, and tobacco. Therefore, we compared revisions in a large population of patients undergoing cemented or cementless TKAs at 90 days, 1 year, and 2 years. METHODS A review of an administrative claims database was used to identify patients undergoing primary TKA, either cementless (n = 8,890) or cemented (n = 215,460), from October 1, 2015 to October 31, 2020. Revision surgery for PJI and aseptic loosening were identified with diagnosis and associated procedural codes at 90 days, 1 year, and 2 years and then compared between groups. A propensity matched-analysis was performed for age, sex, Charles Comorbidity Index (CCI) > 3, alcohol abuse, tobacco use, obesity, and diabetes. Chi square tests assessed statistical significance of differences in the matched cohorts using odds ratios (ORs) with 95% confidence intervals (CIs). A P < 0.05 was defined as statistically significant. RESULTS Cementless TKA was associated with similar revisions rates due to PJIs at 90 days (OR, 1.04, 95% CI 0.79-1.38, p = 0.83), 1 year (OR, 0.93, 95% CI 0.75-1.14, p = 0.53, and 2 years (OR, 0.87, 95% CI 0.73-1.05, p = 0.17) in comparison to the cemented TKA cohort. The odds ratio of revision due to aseptic loosening was similar as well at 90 days (OR, 0.67, 95% CI 0.34-1.31, 0.31), 1 year (OR, 1.09, 95% CI 0.73-1.61, p = 0.76), and 2 years (OR, 1.00, 95% CI 0.73-1.61, p = 0.99). CONCLUSIONS This study found a comparable risk of PJI and aseptic loosening in cementless and cemented TKA when controlling for several comorbidities, such as tobacco, diabetes, and alcohol. Therefore, with proper patient selection, cementless TKAs can be performed with expectation of low risks of infections and aseptic loosenings.
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Affiliation(s)
- Ruben Monarrez
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Jeremy Dubin
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Sandeep S Bains
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Daniel Hameed
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Mallory C Moore
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Zhongming Chen
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Michael A Mont
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Ronald E Delanois
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA.
| | - James Nace
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
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13
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Remily EA, Bains SS, Dubin J, Chen Z, Hameed D, Livesey MG, Weir TB, Gilotra MN, Ingari JV, Hasan SA. Open versus arthroscopic treatment of the rheumatoid elbow arthritis: a comparison of complications at two years utilizing a nationally representative database. Eur J Orthop Surg Traumatol 2024:10.1007/s00590-024-03842-9. [PMID: 38421494 DOI: 10.1007/s00590-024-03842-9] [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: 11/14/2023] [Accepted: 01/18/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE Symptomatic rheumatoid arthritis (RA) can be addressed surgically with open procedures or elbow arthroscopy. Previous studies comparing outcomes of open to arthroscopic arthrolysis for the management of RA did not utilize a large database study. The aim was to compare demographics and two-year complications, in RA patients undergoing open or arthroscopic elbow arthrolysis. METHODS A retrospective, cohort study was performed utilizing a private, nationwide, all-payer database. We queried the database to identify patients undergoing open (n = 578) or arthroscopic (n = 379) arthrolysis for elbow RA. The primary goal of the study was to compare complications at two-years. Categorical variables were assessed utilizing the chi-squared test; while, continuous variables were analyzed using the Student's t-test. Multivariable logistic regression was performed to assess risk factors for infection following open or arthroscopic arthrolysis. RESULTS RA patients undergoing open elbow arthrolysis were older (55 vs. 49 years, p < 0.001), predominately female (61.6% vs 60.9%, p = 0.895), and likely to have chronic kidney disease (20.4 vs. 12.9%), and DM (45.2 vs. 32.2%) (both p < 0.005). Open elbow arthrolysis was also associated with higher rates of infection (31.7 vs. 4.7%) and wound complications (26.8 vs. 3.4%) (both p = 0.001). Nerve injury rates were found to be similar (8.3 vs. 9.0%, p = 0.81). On multivariable logistic regression, open elbow procedures were associated with the highest risk for infection (OR: 8.43). CONCLUSIONS Patients undergoing open arthrolysis for RA were at a higher risk of infection and wound complications compared to arthroscopic arthrolysis utilizing a nationally representative database. While there appears to be a difference in outcomes following these two procedures, higher level evidence is needed to draw more definitive conclusions. LEVEL OF EVIDENCE Retrospective, Level III.
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Affiliation(s)
- Ethan A Remily
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Sandeep S Bains
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Jeremy Dubin
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Zhongming Chen
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Daniel Hameed
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Michael G Livesey
- Department of Orthopaedic Surgery, University of Maryland, Baltimore, MD, USA
| | - Tristan B Weir
- Department of Orthopaedic Surgery, University of Maryland, Baltimore, MD, USA
| | - Mohit N Gilotra
- Department of Orthopaedic Surgery, University of Maryland, Baltimore, MD, USA
| | - John V Ingari
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA.
| | - S Ashfaq Hasan
- Department of Orthopaedic Surgery, University of Maryland, Baltimore, MD, USA
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14
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Hameed D, Sodhi N, Dubin J, Schneider A, Barrack RL, Mont MA. Integrating Smartphone Applications and Wearable Devices for Post-Operative Rehabilitation in Total Knee Arthroplasty: A Critical Review. J Arthroplasty 2024:S0883-5403(24)00091-3. [PMID: 38403080 DOI: 10.1016/j.arth.2024.02.003] [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] [Received: 11/06/2023] [Revised: 01/18/2024] [Accepted: 02/02/2024] [Indexed: 02/27/2024] Open
Abstract
INTRODUCTION Smartphone and wearable technologies offer innovative methods for monitoring postoperative recovery in total knee arthroplasty (TKA) patients. This review assessed the benefits of these technologies in postoperative care, focusing on: 1) smartphone applications; 2) wearable devices; and 3) their combination. METHODS A systematic search identified studies on smartphone apps and wearables for post-TKA monitoring. The review analyzed 2,119 studies, with 58 meeting criteria: 25 on apps, 25 on wearables, and 8 on both. Studies were rated with a methodology index as well as by levels of evidence. They were then analyzed by categorizing them by: adherence and patient satisfaction; functional outcomes and pain scores; gait analyses and ranges of motion; and measurement and comparison tools. RESULTS A review of 24 of 25 publications related to smart phone apps used for postoperative recovery in total knee arthroplasty showed the potential for improved patient's satisfaction, gait recovery, pain medication scheduling guidance with improved pain management, cost savings, and functional outcomes. Wearable technologies utilized in postoperative recovery demonstrated monitoring accuracy in 25 studies. These devices also showed effectiveness in gait and motion analysis. Other demonstrated benefits of the wearables were improved outcomes, return to function, cost reduction, and again, better management of pain due to patient interaction and guidance. Studies that combined applications and wearables demonstrated the individual findings with the addition of adherence, patient's satisfaction, and overall mobility improvement at 3 months. DISCUSSION Smartphone apps and wearables can enhance postoperative rehabilitation for TKA patients. Smartphone applications and wearables have been shown in randomized trials to be accurate, effective, and useful in the postoperative rehabilitation of total knee arthroplasty patients. A recurring theme in the review was improved adherence to care plans and medication schedules that ultimately result in improved functional outcomes. These technologies and the data that they generate offer direct patient benefits and the potential for future cost savings.
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Affiliation(s)
- Daniel Hameed
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Nipun Sodhi
- Department of Orthopaedic Surgery, North Shore University Hospital, Northwell Health, New York, NY, USA
| | - Jeremy Dubin
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Andrew Schneider
- Department of Orthopedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Robert L Barrack
- Department of Orthopedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Michael A Mont
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland.
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Dubin J, Bains SS, Hameed D, Moore MC, Delanois RE. Preoperative Glycemic Markers and the Risk of Periprosthetic Joint Infection After Total Hip Arthroplasty: Commentary on an article by Julian Wier, MD, et al.: "Higher Blood Glucose Levels on the Day of Surgery Are Associated with an Increased Risk of Periprosthetic Joint Infection After Total Hip Arthroplasty". J Bone Joint Surg Am 2024; 106:e9. [PMID: 38381137 DOI: 10.2106/jbjs.23.01238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Affiliation(s)
- Jeremy Dubin
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
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Dubin J, Bains S, Ihekweazu UN, Mont MA, Delanois R. Social Determinants of Health in Total Joint Arthroplasty: Insurance. J Arthroplasty 2024:S0883-5403(24)00123-2. [PMID: 38360281 DOI: 10.1016/j.arth.2024.02.024] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/17/2024] Open
Affiliation(s)
- Jeremy Dubin
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Sandeep Bains
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | | | - Michael A Mont
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Ronald Delanois
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
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17
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Dubin J, Bains S, Ihekweazu UN, Mont MA, Delanois R. Social Determinants of Health in Total Joint Arthroplasty: Race. J Arthroplasty 2024:S0883-5403(24)00072-X. [PMID: 38311298 DOI: 10.1016/j.arth.2024.01.048] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 02/10/2024] Open
Affiliation(s)
- Jeremy Dubin
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Sandeep Bains
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | | | - Michael A Mont
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Ronald Delanois
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
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18
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Douglas S, Sax OC, Dubin J, Remily E, Bains SS, Hameed D, Chen Z, Ingari JV. Comparative analysis of open versus endoscopic carpal tunnel release in a comprehensive national database. Hand Surg Rehabil 2024; 43:101615. [PMID: 37939918 DOI: 10.1016/j.hansur.2023.10.009] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/10/2023]
Abstract
PURPOSE Carpal tunnel syndrome is the most common compressive neuropathy. There is limited evidence to support endoscopic compared to open carpal tunnel release according to the 2016 American Academy of Orthopaedic Surgeons Clinical Practice Guideline on carpal tunnel syndrome. The purpose of the present study was to assess differences between the two procedures by comparing 30- and 90-day complications and mean hospital costs in a large patient population. METHODS Using the national Mariner15 Database by PearlDiver Technologies, we retrospectively studied 27,192 carpal tunnel syndrome patients who received carpal tunnel release using an endoscopic or open surgical approach from 2010 to 2019. Patients who met the inclusion criteria were grouped and case-matched at a 1:1 ratio through the corresponding International Classification of Diseases codes (n = 13,596) and assessed for 30- and 90-day complications such as median nerve injury, superficial palmar arch injury, and revision carpal tunnel release surgery. Univariate analysis was used to compare outcomes and a multivariate regression was performed to identify risk factors associated with each outcome. RESULTS Endoscopic carpal tunnel release was associated with a higher rate of median nerve injury than open release at 30 days (0.3% vs. 0.1% odds ratio, 2.21; 95% confidence interval, 1.29-3.81; p < 0.05) and 90 days (0.4% vs. 0.3%; odds ratio, 1.77; 95% confidence interval, 1.16-2.70; p < 0.05). Endoscopic release was also associated with a higher rate of superficial palmar arch injury (0.1% vs. 0%; odds ratio, 25.02; 95% confidence interval, 1.48-423.0; p < 0.05). CONCLUSIONS In the present study, risk of median nerve injury and vascular injury was higher after endoscopic than open carpal tunnel release. At 90 days, all-cause revision rates were similar between techniques. Surgeons should understand these differences, to optimize surgical decision-making. LEVEL OF EVIDENCE Therapeutic, IIIa.
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Affiliation(s)
- Scott Douglas
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA
| | - Oliver C Sax
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA
| | - Jeremy Dubin
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA
| | - Ethan Remily
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA
| | - Sandeep S Bains
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA
| | - Daniel Hameed
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA
| | - Zhongming Chen
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA
| | - John V Ingari
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA.
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19
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Remily E, Dubin J, Bains SS, Monarrez R, Livesey MG, Weir TB, Hameed D, Ingari JV, Gilotra MN, Hasan SA. Preoperative Corticosteroid Injections Within 4 Weeks of Arthroscopic Shoulder Procedures Are Associated With Increased Postoperative Infection Rates. Arthroscopy 2024; 40:277-283.e1. [PMID: 37689159 DOI: 10.1016/j.arthro.2023.08.073] [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: 05/15/2023] [Revised: 08/10/2023] [Accepted: 08/15/2023] [Indexed: 09/11/2023]
Abstract
PURPOSE To refine the understanding of the effect of timing of corticosteroid injections (CSIs) and shoulder arthroscopy on postoperative infection. METHODS An insurance database was used to determine all patients who underwent shoulder arthroscopy for a 5-year period with an associated preoperative ipsilateral corticosteroid injection. Patients were stratified into cohorts based on timing of preoperative CSI: (1) 0-<2 weeks, (2) 2-<4 weeks, (3) 4-<6 weeks, and (4) 6-<8 weeks. Patients were pooled to include all patients who had a CSI less than 4 weeks and those longer than 4 weeks. A cohort of patients who never had a corticosteroid injection before undergoing arthroscopy were used as a control. All patients had a follow-up of 2 years. Multivariable regression analyses were performed using R Studio with significance defined as P < .05. RESULTS Multivariate logistic regression showed a greater odds ratio (OR) for postoperative infection in patients who received CSI 0-<2 weeks before shoulder arthroscopy at 90 days (3.10, 95% confidence interval [CI] 1.62-5.57, P < .001), 1 year (2.51, 95% CI 1.46-4.12, P < .001), and 2 years (2.08, 95% CI 1.27-3.28, P = .002) compared with the control group. Patients who received CSI 2-<4 weeks before shoulder arthroscopy had greater OR for infection at 90 days (2.26, 95% CI 1.28-3.83, P = .03), 1 year (1.82, 95% CI 1.13-2,82, P = .01), and 2 years (1.62, 95% CI 1.10-2.47, P = .012). Patients who received CSI after 4 weeks had similar ORs of infection at 90 days (OR 1.15, 95% CI 0.78-1.69, P = .48) 1 year (OR 1.18, 95% CI 0.85-1.63 P = .33), and 2 years (OR 1.09, 95% CI 0.83-1.42, P = .54), compared with the control cohort. CONCLUSIONS The present study shows the postoperative infection risk is greatest when CSIs are given within 2 weeks of shoulder arthroscopy, whereas CSIs given within 2-<4 weeks also portend increased risk, albeit to a lesser degree. The risk of postoperative infection is not significantly increased when CSIs are given more than 1 month before surgery. LEVEL OF EVIDENCE Level III, retrospective comparative, prognosis study.
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Affiliation(s)
- Ethan Remily
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, U.S.A
| | - Jeremy Dubin
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, U.S.A
| | - Sandeep S Bains
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, U.S.A
| | - Ruben Monarrez
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, U.S.A
| | - Michael G Livesey
- Department of Orthopaedic Surgery, University of Maryland, Baltimore, Maryland, U.S.A
| | - Tristan B Weir
- Department of Orthopaedic Surgery, University of Maryland, Baltimore, Maryland, U.S.A
| | - Daniel Hameed
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, U.S.A
| | - John V Ingari
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, U.S.A
| | - Mohit N Gilotra
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, U.S.A
| | - S Ashfaq Hasan
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, U.S.A..
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20
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Crutcher JP, Hameed D, Dubin J, Mont MA, Mont M. Comparison of three-versus two-dimensional pre-operative planning for total hip arthroplasty. J Orthop 2024; 47:100-105. [PMID: 38046454 PMCID: PMC10686848 DOI: 10.1016/j.jor.2023.11.001] [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] [Received: 08/23/2023] [Revised: 10/29/2023] [Accepted: 11/01/2023] [Indexed: 12/05/2023] Open
Abstract
Background A successful clinical outcome for total hip arthroplasty (THA) depends on accurate sizing and positioning of the implants. Using three-dimensional (3-D) pre-operative planning with a computerized tomography (CT) scan has many potential advantages over conventional 2-D planning using radiographs, including potentially more accurate assessments of the size and anteversion of the acetabulum, as well as lateral femoral offset. The purpose of this study was to compare the accuracy of 3-D to 2-D templating with respect to acetabular and femoral size, as well as lateral femoral offset. Methods Pre-operative templating data was collected prospectively from a consecutive series of 290 primary THAs (acetabulum on all, femoral component on 255 of the cases using one specific stem). All cases were initially templated on a digital imaging picture archiving and communication (PACS) system with calibrated images to estimate the acetabular size, femoral size, and lateral femoral offset. The 3-D templating was then performed with software based on a CT scan, and the results were compared to what was surgically implanted. Results The 3-D templating for the acetabulum was accurate 99.7% of the time based on the final implanted component. The 2-D templating for the acetabulum was accurate 39% of the time, with 46% of cases templating smaller and 15% templating larger. The 3-D templating of the femoral component was accurate 63% of the time, and within one size of final implant in 96% of cases. The 2-D templating of the femoral component was accurate 53% of the time and within one size of final implant in 94% of cases. The 2-D templated femoral offset was accurate 87% of the time and was changed in 13% of cases after 3-D templating. Conclusion The CT-based 3-D preoperative planning was superior to 2-D planning for THA with respect to acetabular size, femoral size, and lateral femoral offset. Precise acetabular component sizing conserves bone and allows for a more predictable press fit, while facilitating efficient inventory management. Lateral femoral offset is often difficult to measure on 2-D images, and 3-D templating consistently allows for accurate offset restoration, which is important for normal hip function and stability.
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Affiliation(s)
- James P. Crutcher
- Department of Orthopaedics, Proliance Surgeons Inc., Seattle, WA, USA
| | - Daniel Hameed
- Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopaedics, Baltimore, MD, USA
| | - Jeremy Dubin
- Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopaedics, Baltimore, MD, USA
| | - Michael A. Mont
- Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopaedics, Baltimore, MD, USA
| | - Michael Mont
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
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21
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Dubin J, Hameed D, Moore MC, Bains SS, Patel S, Nace J, Mont MA, Delanois RE. Methodological Assessment of the 100 Most-Cited Articles in Total Knee Arthroplasty in the Last Decade Compared to the All-Time List. J Arthroplasty 2023:S0883-5403(23)01246-9. [PMID: 38135168 DOI: 10.1016/j.arth.2023.12.030] [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: 11/09/2023] [Revised: 12/04/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Recent advances in total knee arthroplasty (TKA) have been driven by a growing focus on evidence-based medicine. This transition is reflected in the critical appraisal of both, the quality of work and the potential impact on the orthopedic community. The purpose of our study was to (1) identify the top 100 most-cited articles in TKA in the last decade and from all-time, and (2) compare methodological rigor of the most-cited articles in TKA in the last decade to articles all-time by level of evidence. METHODS The top 100 cited articles were recorded for manuscripts from the last decade, January 1, 2012 to December 31, 2022, and manuscripts from all-time for TKA. We collected authors, year of publication, journal of the article, country of origin of authors, article type (basic science article, clinical research article), level of evidence, methodological index for non-randomized studies score, physiotherapy evidence database scale, and citation density (total citations/years published). RESULTS The largest number of studies for all-time TKA (53.0%) and decade TKA (42.0%) were Level III. The average methodological index for non-randomized studies score for comparative studies was 18.7 for all-time TKA and 20.7 for decade TKA (P < .001). The average physiotherapy evidence database score was 6.1 for all-time TKA and 8.1 for decade TKA (P > .05). The highest citation density for all-time TKA was 111 and for past decade was 63. The number of level II studies in TKA increased from 19.0% from all time to 38.0% from the last decade (P < .05). CONCLUSIONS Our findings of improved methodologies over time reflect positive steps toward evidence-based practice in TKA. A continued focus on producing methodologically sound studies may guide evidence-based clinical decision-making.
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Affiliation(s)
- Jeremy Dubin
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Daniel Hameed
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Mallory C Moore
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Sandeep S Bains
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Saarang Patel
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - James Nace
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Michael A Mont
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Ronald E Delanois
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
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22
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Hameed D, Shear B, Dubin J, Remily E, Bains SS, Chen Z, Mont MA, Hasan SA, Gilotra MN. Curtailing infection risks in hepatitis C patients: the effect of antiviral treatment in revision shoulder arthroplasty. J Shoulder Elbow Surg 2023:S1058-2746(23)00857-1. [PMID: 38104720 DOI: 10.1016/j.jse.2023.10.030] [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: 06/26/2023] [Revised: 10/19/2023] [Accepted: 10/30/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Revision shoulder arthroplasty (RevSA) is a complex procedure that can result in various postoperative complications. However, the impact of hepatitis C virus (HCV) on postoperative complications after RevSA remains unclear because of limited and inconsistent evidence. This study aims (1) to investigate the incidence of postoperative complications in patients with HCV undergoing RevSA and (2) to evaluate the impact of HCV treatment on complication rates at different time points after the revision procedure, specifically at 90 days, 1 year, and 2 years. METHODS We queried a national, all-payer database to investigate recent trends in the use of RevSA among HCV patients to assess postoperative complication rates, including venous thromboembolism (VTE), wound complication, transfusion, and periprosthetic joint infection (PJI). Statistical analyses involved propensity score matching to create balanced cohorts and logistic regression to determine the relative risk of postoperative complications. Data were analyzed with SPSS software (version 24.0 for Windows). The study included patients who underwent partial or total RevSA procedures between January 1, 2010, and December 31, 2020. Patients were identified based on medical claims that included procedural codes for RevSA and associated diagnosis codes for PJI or insertion/removal of an antibiotic spacer. A Bonferroni correction was used because many tests were performed and statistical significance was set at P = .0125. RESULTS The HCV cohort demonstrated higher PJI rates at 1-year (5.5% vs. 3.9%, P = .006) and 2-year follow-ups (6.7% vs. 4.6%, P = .006). However, no significant differences emerged in VTE and wound complication rates between the HCV and non-HCV cohorts. Comparing untreated and treated HCV patients, the former showed significantly higher PJI rates at 2 years (P = .010), whereas the treated group had significantly lower odds ratios for PJI. When comparing treated HCV patients with the non-HCV cohort, minimal differences were found in postoperative outcomes, indicating no significant difference in the risk of complications between the groups. CONCLUSION Our study observed an association between HCV patients who received antiviral treatment prior to RevSA and a reduced incidence of PJI compared to untreated HCV patients. When comparing this group to the non-HCV controls, there was no significant difference in the incidence of PJI, suggesting a potential association between antiviral treatment and the observed risk patterns in HCV patients. Proper management of HCV-positive patients during RevSA is crucial for improving outcomes and reducing complications.
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Affiliation(s)
- Daniel Hameed
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Brian Shear
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jeremy Dubin
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Ethan Remily
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Sandeep S Bains
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Zhongming Chen
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Michael A Mont
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - S Ashfaq Hasan
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mohit N Gilotra
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.
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23
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Atzmon R, Iohanes E, Dubin J, Rosenthal A, Drexler M, Sherman SL. Bifocal avulsion fracture and fixation of the patellar tendon: a case report. J ISAKOS 2023; 8:497-501. [PMID: 37487912 DOI: 10.1016/j.jisako.2023.07.001] [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] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 04/21/2023] [Accepted: 07/04/2023] [Indexed: 07/26/2023]
Abstract
Acute distal patella tendon avulsion from the tibial tubercle (TT) is a relatively rare injury that is usually described in the adolescents or elderly population in their 7th or 8th decades. Bifocal avulsion fractures of the patella tendon from the TT and the distal pole of the patella are exceptionally rare in adults. In this case report, we present a 52-year-old healthy old male who was treated for bifocal avulsion of the patellar tendon with open reduction and internal fixation augmented with two ULTRATAPE sutures. To our knowledge, this is the first case report to describe this injury in a healthy middle-aged patient.
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Affiliation(s)
- Ran Atzmon
- Stanford University, Department of Orthopaedic Surgery, Stanford, CA, 94305, USA.
| | - Eitan Iohanes
- Assuta Medical Center, Department of Orthopaedic Surgery, Affiliated with the Faculty of Health and Science and Ben Gurion University, HaBarzel St 20, Tel Aviv-Yafo, Israel.
| | - Jeremy Dubin
- Tel Aviv Medical Center, Department of Orthopaedic Surgery, Affiliated with the Sackler Faculty of Medicine and Tel Aviv University, Kaufmann St 6, Tel Aviv-Yafo, 6801298, Israel.
| | - Alex Rosenthal
- Assuta Medical Center, Department of Orthopaedic Surgery, Affiliated with the Faculty of Health and Science and Ben Gurion University, HaBarzel St 20, Tel Aviv-Yafo, Israel.
| | - Michael Drexler
- Assuta Medical Center, Department of Orthopaedic Surgery, Affiliated with the Faculty of Health and Science and Ben Gurion University, HaBarzel St 20, Tel Aviv-Yafo, Israel.
| | - Seth L Sherman
- Stanford University, Department of Orthopaedic Surgery, Stanford, CA, 94305, USA.
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24
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Lilova R, Dubin J, Hameed D, Pettijohn WA, Bains SS, Reich J, Moore MC, Delanois RE. Assessment of the AAOS guidelines using the AGREE II instrument: An update. J Orthop 2023; 46:83-89. [PMID: 37969226 PMCID: PMC10643090 DOI: 10.1016/j.jor.2023.10.033] [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] [Received: 08/24/2023] [Accepted: 10/29/2023] [Indexed: 11/17/2023] Open
Abstract
Background The American Academy of Orthopaedic Surgeons (AAOS) provides clinical guidelines and frequently updates and expands on the recommendations. High quality, up-to-date, and applicable clinical guidelines are increasingly important tools for physicians to have. Assessing these continuously updating guidelines' overall quality has most recently been done in 2013 when there were 14 guidelines. Since then, nearly all guidelines have been updated and now 28 guidelines are provided. Our goal was to evaluate the updated 2023 AAOS guidelines using the well-established Advancing Guideline Development, Reporting and Evaluation in Health Care (AGREE II) tool. Methods On April 23, 2023, all 28 guidelines set forth by AAOS were compiled. Using the AGREE II tool, a well-recognized and established tool for evaluation of guideline quality used across all disciplines, three independent reviewers appraised the current guidelines. These data were used to run descriptive statistics and assessed accordingly. Results Across the 28 guidelines, the average AGREE II domain scores were as follows: Scope and Purpose (median score, 85%), Stakeholder Involvement (median score, 87%), Rigor of Development (median score, 87%), Clarity of Presentation (median score, 87%), Applicability (median score, 48%), Editorial Independence (median score, 87%), and Overall Assessment (median score, 80s%). Conclusions Five of the six AGREE II domains, including the overall assessment, tested achieved a median score above the 50% mark. These results indicate that the AAOS guidelines met many criteria for high quality based on a critical appraisal.
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Affiliation(s)
- Radina Lilova
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Jeremy Dubin
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Daniel Hameed
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Whitney A. Pettijohn
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Sandeep S. Bains
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Jeremy Reich
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Mallory C. Moore
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Ronald E. Delanois
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
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25
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Baksh N, Dubin J, Douglas S, Bains SS, Hameed D, Moore MC, Naziri Q, Mont MA, Ingari JV. Postoperative Opioid Dependence in Patients Undergoing Either Total or Reverse Shoulder Arthroplasty for Proximal Humerus Fracture Fixation. Surg Technol Int 2023; 43:sti43/1729. [PMID: 37972546 DOI: 10.52198/23.sti.43.os1729] [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: 01/27/2024]
Abstract
INTRODUCTION In elderly patients who have proximal humerus fractures, treatment commonly involves total shoulder arthroplasty (TSA) or reverse shoulder arthroplasty (RSA). Following these procedures, patients often require opioids for postoperative analgesia. This common scenario is of clinical and societal importance, as increased postoperative opioid usage has been shown to worsen outcomes and increase the likelihood for dependence. We aimed to compare postoperative opioid use in patients undergoing either TSA or RSA for fixation of their proximal humerus fracture. Specifically, we assessed: (1) postoperative opioid use at two, four, six, eight, and greater than eight weeks postoperatively; (2) aseptic revision rates at 90-days, one year, and two years postoperatively; and (3) periprosthetic joint infection (PJI) rates at 90-days, one year, and two years postoperatively between patients undergoing TSA or RSA for the surgical management of their proximal humerus fractures. MATERIALS AND METHODS For this review, we queried a national all-payer database from October 1, 2015 to October 31, 2020 (n=1.5 million) for all patients who had a "proximal humerus fracture" diagnosis who underwent either TSA or RSA. There were two cohorts: patients undergoing TSA (n=731) and patients undergoing RSA (n=731). Bivariate Chi-square analyses. RESULTS We found no differences (p>0.05) in opioid use postoperatively in patients undergoing RSA for proximal humerus management compared to patients undergoing TSA after two weeks. There was not a significant difference in aseptic revision or PJI rates between the two cohorts (all p>0.05). CONCLUSION The evidence comparing opioid use in patients undergoing either TSA or RSA for proximal humerus fracture fixation is lacking. Our study specifically showed no differences in opioid use postoperatively in patients undergoing RSA for proximal humerus management compared to patients undergoing TSA.
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Affiliation(s)
- Nayeem Baksh
- Downstate Medical Center (SUNY), Department of Orthopaedic Surgery, Brooklyn, New York
| | - Jeremy Dubin
- LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Scott Douglas
- LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Sandeep S Bains
- LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Daniel Hameed
- LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Mallory C Moore
- LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Qais Naziri
- Downstate Medical Center (SUNY), Department of Orthopaedic Surgery, Brooklyn, New York
| | - Michael A Mont
- LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - John V Ingari
- LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
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26
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Caba M, Scholl L, Valentino-Pfeil A, Hampp E, Sodhi N, Dubin J, Hameed D, Mont MA. Using Software to Implant Orthopaedic Hardware: Surgeon Intraoperative Confidence Increased with Latest Technological Updates. Surg Technol Int 2023; 43:sti43/1716. [PMID: 37781883 DOI: 10.52198/23.sti.43.os1716] [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: 01/27/2024]
Abstract
BACKGROUND Robotic-assisted total knee arthroplasty (TKA) has been associated with improved accuracy and precision of implant placement, protection of soft tissue, and improved patient-reported postoperative outcomes when compared to manual TKA techniques. Previous studies have highlighted the importance of surgical confidence throughout the learning curve when adopting robotic-assisted platforms. The purpose of this study was to evaluate the confidence and efficiencies of surgeons when utilizing computed tomography (CT)-based robotic TKA technology. MATERIALS AND METHODS A cross-sectional, questionnaire-based study was conducted with 20 arthroplasty-trained surgeons with prior experience in both manual TKA and robotic-assisted TKA techniques. The surgeons completed an initial learning period, with new software, during various stages of their experience. The new TKA software upgrade builds on the prior software version with new features. A Net Promoter Score (NPS), the measurement of a respondent's likelihood to recommend a product or service to others, was used during the analysis of survey questions. A NPS over 50 indicates a positive score. RESULTS When compared to manual TKA techniques, 95% of surgeons reported that their overall intraoperative confidence increased with the new software upgrade for CT-based robotic technology and had an average rating of 8.9 out of 10 for their intraoperative confidence with the new software upgrade. Additionally, 100% of surgeons reported that they were more confident when performing intraoperative implant adjustments with the new software upgrade when compared to manual TKA. Surgeons determined that the overall use of the new software upgrade was intuitive (8.4 of 10 average rating) and were satisfied with the overall use of the new software upgrade (9 of 10 average rating). Also, surgeons reported that they would recommend the new software upgrade for CT-based robotic technology to colleagues (NPS of 85), as well as being used as a research tool (NPS of 85) or for a training and education tool in a fellowship program (NPS of 90). CONCLUSION As new technology continues to enter the field of orthopedics, it is important to ensure upgrades and advancements continue to serve surgeons and provide efficiencies in the operating room. For established robotic surgeons, the new robotic technology assessed in this study provided increased confidence when compared to manual TKA. Based on these results, the new software upgrade demonstrated value during various stages of a TKA procedure and is highly recommended for use by others in the field of orthopedics.
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Affiliation(s)
| | | | | | | | - Nipun Sodhi
- Department of Orthopaedic Surgery, Long Island Jewish Medical Center, New York, New York
| | - Jeremy Dubin
- Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Daniel Hameed
- Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Michael A Mont
- Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
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27
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Dubin J, Sudah SY, Moverman MA, Pagani NR, Puzzitiello RN, Menendez ME, Guss MS. Google Search Analytics for Lateral Epicondylitis. Hand (N Y) 2023:15589447231199799. [PMID: 37746689 DOI: 10.1177/15589447231199799] [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: 09/26/2023]
Abstract
BACKGROUND The use of online search engines for health information is becoming common practice. We analyzed Google search queries to identify the most frequently asked topics and questions related to lateral epicondylitis ("tennis elbow") and the Web sites provided to address these questions. METHODS Four search terms for lateral epicondylitis were entered into Google Web Search. A list of the most frequently asked questions along with their associated Web sites was extracted and categorized by 2 independent reviewers. RESULTS A total of 400 questions were extracted with 168 associated Web sites. The most popular question topics were related to indications/management (39.0%), risks/complications (19.5%), and the ability to perform specific activities (18.8%). Frequently asked questions had to do with the duration of symptoms, self-management strategies (eg, brace use and self-massage), and the indications for surgery. The most common Web sites provided to address these questions were social media (27.5%), commercial (24.5%), academic (16.5%), and medical practice (16.3%). CONCLUSION The most frequently asked questions about lateral epicondylitis on Google centered around symptom duration and management, with most information originating from social media and commercial Web sites. Our data can be used to anticipate patient concerns and set expectations regarding the prognosis and management of lateral epicondylitis.
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Affiliation(s)
| | - Suleiman Y Sudah
- Department of Orthopedic Surgery, Monmouth Medical Center, Long Branch, NJ, USA
| | - Michael A Moverman
- Department of Orthopedic Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Nicholas R Pagani
- Department of Orthopedic Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Richard N Puzzitiello
- Department of Orthopedic Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | | | - Michael S Guss
- Department of Orthopaedic Surgery, Hand Surgery, Newton-Wellesley Hospital, Tufts University School of Medicine, Newton, MA, USA
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28
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Edmond T, Hameed D, Olsen D, Dubin J, Piuzzi NS, Mont MA. Surgical Technique: Core Decompression of Femoral Head Osteonecrosis with Bone Marrow Aspirate Concentrate. Surg Technol Int 2023; 42:sti42/1673. [PMID: 36994659 DOI: 10.52198/23.sti.42.os1673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Osteonecrosis of the femoral head is a progressive and potentially debilitating disorder that is responsive to core decompression, especially in early-stage disease. This is typically accomplished through use of an 8 to 10mm trephine or multiple, small-diameter percutaneous drilling. Use of the large diameter trephine is associated with risk of fracture and may not allow healing across large gaps. Here, we present a technique for core decompression using percutaneous drilling that allows bone marrow aspiration concentrate to be introduced. We used the aspirate needle to decompress the femoral head osteonecrotic lesion, followed by the administration of bone marrow aspirate concentrate. This is a straightforward procedure that can be used with low risk for patient morbidity.
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Affiliation(s)
- Tyler Edmond
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Daniel Hameed
- Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Devin Olsen
- Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Jeremy Dubin
- Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Michael A Mont
- 2Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
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29
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Atzmon R, Drexler M, Dolkart O, Goldstein Y, Dubin J, Sternheim A, Gortzak Y, Bickels J. Less is better than more with resection of periacetabular tumors - A retrospective 16 years study and literature review. Front Surg 2022; 9:1036640. [PMID: 36570805 PMCID: PMC9772449 DOI: 10.3389/fsurg.2022.1036640] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 11/21/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction Wide resections of periacetabular tumors create a sizeable bony defect that inevitably results in severe loss of function. Reconstruction of such defects usually requires using large metal implants, a feature associated with considerable surgery extension and complications. The aim of this study is to report resection with no reconstruction of the bony defect. In this retrospective study, we reviewed a consecutive series of 16 patients diagnosed with malignant periacetabular tumors and underwent en-bloc resection without reconstructing their remaining bone defect. Methods Records were reviewed of 16 consecutive patients diagnosed with malignant periacetabular tumors and underwent en-bloc resection without reconstructing their remaining bony defect. Measurements included: the duration of surgery, blood loss, hemoglobin levels and the need for blood transfusions, data on other hospitalization characteristics, and intraoperative and postoperative complications. Results Sixteen patients with malignant periacetabular bone tumors and extensive bone destruction underwent wide periacetabular tumor resection with a mean follow-up of 75 months and a mean age of 53 years. The average HOOS score was 46 (range: 20 to 76), and the mean MSTS score was 13% (range: 0 to 15). The mean operative time was 4.1 h, and the mean blood loss was 1200 ml. At their most recent follow-up, patients had a mean shortening of their operated extremity of 4.8 cm, and all could ambulate with assisting devices. Conclusion Wide resection of periacetabular tumors without reconstruction provides acceptable levels of function and was associated with shorter surgical time, less blood loss and fewer postoperative complications compared to resection with reconstruction. Therefore, this approach may be considered a viable surgical option in patients with an extensive malignant periacetabular. Level III Retrospective study.
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Affiliation(s)
- Ran Atzmon
- Orthopedic Department, Assuta Ashdod Medical Center, Ashdod, Israel, affiliated to Beer Sheva Faculty of Medicine, Beer Sheva University, Israel
| | - Michael Drexler
- Orthopedic Department, Assuta Ashdod Medical Center, Ashdod, Israel, affiliated to Beer Sheva Faculty of Medicine, Beer Sheva University, Israel,Correspondence: Michael Drexler
| | - Oleg Dolkart
- Orthopedic Department, Assuta Ashdod Medical Center, Ashdod, Israel, affiliated to Beer Sheva Faculty of Medicine, Beer Sheva University, Israel
| | - Yariv Goldstein
- Orthopedic Department, Assuta Ashdod Medical Center, Ashdod, Israel, affiliated to Beer Sheva Faculty of Medicine, Beer Sheva University, Israel
| | - Jeremy Dubin
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Sternheim
- The National Unit of Orthopedic Oncology, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Gortzak
- The National Unit of Orthopedic Oncology, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Bickels
- Hillel-Yaffe Medical Center, Orthopedic Oncology Unit, Department of Orthopaedic Surgery, Affiliated with the Technion - Israel Institute of Technology, Hadera, Israel
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30
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Atzmon R, Eilig D, Dubin J, Vidra M, Marom O, Tavdi A, Drexler M, Palmanovich E. Comparison of Platelet-Rich Plasma Treatment and Partial Plantar Fasciotomy Surgery in Patients with Chronic Plantar Fasciitis: A Randomized, Prospective Study. J Clin Med 2022; 11:jcm11236986. [PMID: 36498561 PMCID: PMC9739448 DOI: 10.3390/jcm11236986] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 11/15/2022] [Accepted: 11/21/2022] [Indexed: 11/29/2022] Open
Abstract
Platelet-Rich Plasma (PRP) injection has become a desirable alternative to Partial Plantar Fasciotomy (PPF) surgery and steroid injection for patients with chronic plantar fasciitis (CPF) due to its potential for shorter recovery times, reduced complications, and similar activity scores. As such, we compared PRP treatment to PPF surgery in patients with CPF. Between January 2015 and January 2017, patients were randomly divided into two groups, a PRP treatment group, and a PPF group. All procedures were performed by a single foot and ankle fellowship-trained specialist surgeon. Visual Analog Score (VAS) and Roles-Maudsley Scale (RM) were collected during the preoperative visit and 3, 6, and 12 months postoperatively. The patients were also closely followed by a physiotherapist. There were 16 patients in each group after four patients refused to participate. Patients in the PPF had low Roles-Maudsley Scale (RM) scores compared to the PRP group one-year after treatment (3.77 vs. 2.72, p < 0.0001). Both procedures showed a reduction in RM scores during the follow-up year (9 to 1.62 for PPF and 8.7 to 2.4 for PRP). There was no significant change in VAS pain between the two groups (p = 0.366). Patients treated with PRP injection reported a significant increase in their activity scores, shorter recovery time, and lower complication rates compared to PPF treatment. Moreover, with respect to existing literature, PRP may be as efficient as steroid injection with lower complication rates, including response to physical therapy. Therefore, PRP treatment may be a viable option before surgery as an earlier line treatment for CPF. Level of Clinical Evidence: II.
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Affiliation(s)
- Ran Atzmon
- Assuta Medical Center, Department of Orthopaedic Surgery, Affiliated with the Faculty of Health and Science and Ben Gurion University, Ha-Refu’a St. 7, Ashdod 7747629, Israel; (R.A.); (D.E.); (M.D.); (E.P.)
| | - Dynai Eilig
- Assuta Medical Center, Department of Orthopaedic Surgery, Affiliated with the Faculty of Health and Science and Ben Gurion University, Ha-Refu’a St. 7, Ashdod 7747629, Israel; (R.A.); (D.E.); (M.D.); (E.P.)
| | - Jeremy Dubin
- Tel Aviv Medical Center, Department of Orthopaedic Surgery, Affiliated with the Sackler Faculty of Medicine and Tel Aviv University, Weizmann St. 6, Tel Aviv 6423906, Israel;
- Correspondence:
| | - Matias Vidra
- Tel Aviv Medical Center, Department of Orthopaedic Surgery, Affiliated with the Sackler Faculty of Medicine and Tel Aviv University, Weizmann St. 6, Tel Aviv 6423906, Israel;
| | - Omer Marom
- Orthopaedic Department, Meir Medical Center, Kfar Saba, Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 6423906, Israel; (O.M.); (A.T.)
| | - Alex Tavdi
- Orthopaedic Department, Meir Medical Center, Kfar Saba, Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 6423906, Israel; (O.M.); (A.T.)
| | - Michael Drexler
- Assuta Medical Center, Department of Orthopaedic Surgery, Affiliated with the Faculty of Health and Science and Ben Gurion University, Ha-Refu’a St. 7, Ashdod 7747629, Israel; (R.A.); (D.E.); (M.D.); (E.P.)
| | - Esequiel Palmanovich
- Orthopaedic Department, Meir Medical Center, Kfar Saba, Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 6423906, Israel; (O.M.); (A.T.)
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Feldman V, Atzmon R, Dubin J, Bein O, Palmanovich E, Ohana N, Farkash U. Thousand shades of gray - The role of imaging display in diagnosis of occult scaphoid fractures - A pilot study. J Orthop 2022; 34:327-330. [PMID: 36204514 PMCID: PMC9531045 DOI: 10.1016/j.jor.2022.09.012] [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] [Received: 08/06/2022] [Revised: 09/13/2022] [Accepted: 09/18/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Most hospitals and clinics utilize commercial grade displays for viewing wrist radiographs. There is no evidence regarding the role of the imaging display used to evaluate the radiographs. The aim of this study was to compare the rates of scaphoid fracture diagnosis by commercial grade and medical grade displays. Methods Wrist radiographs of patients that had clinical signs of scaphoid fracture without findings on plain radiography (suspected scaphoid fractures) were retrospectively collected from ER department and interpreted for radiographic signs of fracture by four orthopedics seniors commercial grade and medical grade displays. The difference in fracture diagnosis rates were studied. Inter- and intra-observer variability were also studied. Results Study population comprised of 175 high quality wrist radiographs were interpreted. Mean 48.25 (27%) scaphoid fractures were observed on commercial grade display compared to 66 (38.2%) on medical grade display (p = 0.076). The total inter-observer agreement could be defined as a moderate agreement (κ = 0.527, Accuracy = 0.77). Total agreement between all observers were observed in 86 (49.1%) cases compared to 89 (50.9%) cases when reviewing X-rays on commercial and medical displays, respectively. Discussion The scaphoid fracture detection rate on medical grade display was not statistically higher compared to non-medical grade displays, but we did find a tendency toward medical grade display. We found that in a substantial number of cases, our observers recognize signs of fracture that were initially evaluated as "suspected fracture" by the ER physicians. As a pilot study, we found evidence that support the need for a prospective study designed to compare the observations to a gold standard modality, such as MRI. We believe utilizing medical grade displays can increase the rate of diagnosis in cases of clinically suspected scaphoid fractures and better manage the clinical scenario of a suspected scaphoid fracture.
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Affiliation(s)
- Viktor Feldman
- Meir Hospital, Orthopedic Department, Sapir Medical Center, Tchernichovsky St 59, Kefar Sava, 4428164, Kfar Saba, Israel
- Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tchernichovsky St 59, Kefar Sava, 4428164, Tel Aviv, Israel
| | - Ran Atzmon
- Assuta Medical Center, Department of Orthopaedic Surgery, Affiliated with the Faculty of Health and Science and Ben Gurion University, Ha-Refu'a St 7, Ashdod, 7747629, Israel
| | - Jeremy Dubin
- Tel Aviv Medical Center, Department of Orthopaedic Surgery, Affiliated with the Sackler Faculty of Medicine and Tel Aviv University, Weizmann St 6, Tel Aviv-Yafo, 6423906, Tel Aviv, Israel
| | - Orit Bein
- Meir Hospital, Orthopedic Department, Sapir Medical Center, Tchernichovsky St 59, Kefar Sava, 4428164, Kfar Saba, Israel
- Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tchernichovsky St 59, Kefar Sava, 4428164, Tel Aviv, Israel
| | - Ezequiel Palmanovich
- Meir Hospital, Orthopedic Department, Sapir Medical Center, Tchernichovsky St 59, Kefar Sava, 4428164, Kfar Saba, Israel
- Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tchernichovsky St 59, Kefar Sava, 4428164, Tel Aviv, Israel
| | - Nissim Ohana
- Meir Hospital, Orthopedic Department, Sapir Medical Center, Tchernichovsky St 59, Kefar Sava, 4428164, Kfar Saba, Israel
- Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tchernichovsky St 59, Kefar Sava, 4428164, Tel Aviv, Israel
| | - Uri Farkash
- Assuta Medical Center, Department of Orthopaedic Surgery, Affiliated with the Faculty of Health and Science and Ben Gurion University, Ha-Refu'a St 7, Ashdod, 7747629, Israel
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Dubin J, Westrich G. Differences in Patient-Reported Outcome Measures Between Primary and Revision Total Hip Arthroplasty: Realistic Patient Expectations for Patients With Low Baseline Activity. Orthopedics 2022; 45:251-255. [PMID: 35245136 DOI: 10.3928/01477447-20220225-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Primary total hip arthroplasty (pTHA) and revision total hip arthroplasty (rTHA) are not often compared in terms of patient-reported outcome measures (PROMs). However, surgeons and patients need to better understand the differences in PROMs between primary and revision surgery to set realistic patient expectations and recovery milestones. A matched cohort study of pTHA to rTHA was performed with our arthroplasty database of a single surgeon's experience from 2012 to 2018. There was a significant difference in both pre-operative assessment and change from preoperative to postoperative assessment of the PROMs. Patients undergoing pTHA had higher visual analog scale (VAS) pain scores (67.9 vs 57.9, P=.004). Those undergoing rTHA had higher Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (57.1 vs 50.1, P=.008) and Veterans RAND 12 Item Health Survey (VR-12) (33.5 vs 33.1, P=.01) scores. However, a significant change was noted in the difference from preoperative to postoperative scores between the pTHA and rTHA groups: Harris Hip Score (HHS) total score (pTHA 30.7 vs rTHA 4.4, P<.001), WOMAC score (pTHA 29.3 vs rTHA 12.2, P<.001), and VAS pain score (pTHA -48.3 vs rTHA -26.5, P<.001) as well as groin pain (pTHA 1.4% vs rTHA 7.1%, P=.02). Further, PROMs after rTHA were inferior to those after pTHA with several outcome instruments, including HHS, WOMAC score, and VAS pain score. In addition, groin pain was significantly greater in the rTHA cohort compared with the pTHA cohort at the latest follow-up. This study allows surgeons and patients to better understand the differences in PROMs to set realistic patient expectations and recovery milestones. [Orthopedics. 2022;45(4):251-255.].
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Kolin DA, Moverman MA, Pagani NR, Puzzitiello RN, Dubin J, Menendez ME, Jawa A, Kirsch JM. Substantial Inconsistency and Variability Exists Among Minimum Clinically Important Differences for Shoulder Arthroplasty Outcomes: A Systematic Review. Clin Orthop Relat Res 2022; 480:1371-1383. [PMID: 35302970 PMCID: PMC9191322 DOI: 10.1097/corr.0000000000002164] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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: 08/05/2021] [Accepted: 02/11/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND As the value of patient-reported outcomes becomes increasingly recognized, minimum clinically important difference (MCID) thresholds have seen greater use in shoulder arthroplasty. However, MCIDs are unique to certain populations, and variation in the modes of calculation in this field may be of concern. With the growing utilization of MCIDs within the field and value-based care models, a detailed appraisal of the appropriateness of MCID use in the literature is necessary and has not been systematically reviewed. QUESTIONS/PURPOSES We performed a systematic review of MCID quantification in existing studies on shoulder arthroplasty to answer the following questions: (1) What is the range of values reported for the MCID in commonly used shoulder arthroplasty patient-reported outcome measures (PROMs)? (2) What percentage of studies use previously existing MCIDs versus calculating a new MCID? (3) What techniques for calculating the MCID were used in studies where a new MCID was calculated? METHODS The Embase, PubMed, and Ovid/MEDLINE databases were queried from December 2008 through December 2020 for total shoulder arthroplasty and reverse total shoulder arthroplasty articles reporting an MCID value for various PROMs. Two reviewers (DAK, MAM) independently screened articles for eligibility, specifically identifying articles that reported MCID values for PROMs after shoulder arthroplasty, and extracted data for analysis. Each study was classified into two categories: those referencing a previously defined MCID and those using a newly calculated MCID. Methods for determining the MCID for each study and the variability of reported MCIDs for each PROM were recorded. The number of patients, age, gender, BMI, length of follow-up, surgical indications, and surgical type were extracted for each article. Forty-three articles (16,408 patients) with a mean (range) follow-up of 20 months (0.75 to 68) met the inclusion criteria. The median (range) BMI of patients was 29.3 kg/m2 (28.0 to 32.2 kg/m2), and the median (range) age was 68 years (53 to 84). There were 17 unique PROMs with MCID values. Of the 112 MCIDs reported, the most common PROMs with MCIDs were the American Shoulder and Elbow Surgeons (ASES) (23% [26 of 112]), the Simple Shoulder Test (SST) (17% [19 of 112]), and the Constant (15% [17 of 112]). RESULTS The ranges of MCID values for each PROM varied widely (ASES: 6.3 to 29.5; SST: 1.4 to 4.0; Constant: -0.3 to 12.8). Fifty-six percent (24 of 43) of studies used previously established MCIDs, with 46% (11 of 24) citing one study. Forty-four percent (19 of 43) of studies established new MCIDs, and the most common technique was anchor-based (37% [7 of 19]), followed by distribution (21% [4 of 19]). CONCLUSION There is substantial inconsistency and variability in the quantification and reporting of MCID values in shoulder arthroplasty studies. Many shoulder arthroplasty studies apply previously published MCID values with variable ranges of follow-up rather than calculating population-specific thresholds. The use of previously calculated MCIDs may be acceptable in specific situations; however, investigators should select an anchor-based MCID calculated from a patient population as similar as possible to their own. This practice is preferable to the use of distribution-approach MCID methods. Alternatively, authors may consider using substantial clinical benefit or patient-acceptable symptom state to assess outcomes after shoulder arthroplasty. CLINICAL RELEVANCE Although MCIDs may provide a useful effect-size based alternative to the traditional p value, care must be taken to use an MCID that is appropriate for the particular patient population being studied.
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Affiliation(s)
| | - Michael A. Moverman
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA, USA
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
| | - Nicholas R. Pagani
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA, USA
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
| | - Richard N. Puzzitiello
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA, USA
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
| | - Jeremy Dubin
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Mariano E. Menendez
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA, USA
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
| | - Andrew Jawa
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
| | - Jacob M. Kirsch
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
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Dubin J, Atzmon R, Feldman V, Farkash U, Nyska M, Rath E, Palmanovich E. Bipolar hemiarthroplasty may reduce cerebrovascular accidents and improve early weight-bearing in the elderly after femoral neck fracture. Medicine (Baltimore) 2022; 101:e28635. [PMID: 35089201 PMCID: PMC8797593 DOI: 10.1097/md.0000000000028635] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/04/2022] [Indexed: 01/05/2023] Open
Abstract
Cerebrovascular accidents (CVA) in the elderly population after femoral neck fracture remain great concern for physicians. Specifically, surgical fixation techniques, such as bipolar hemiarthroplasty (HA) and internal fixation play a significant role in influencing the occurrence of postoperative CVA in the elderly population.In order to identify 2 cohorts, we used a rigid selection process based on our institution's database. The cohorts were comprised of a HA cohort and a cannulated screw cohort, of which underwent femoral neck surgery, performed by 3 fellowship trained surgeons from 2003 to 2014. Risk factors were documented and measured, including Coumadin use and hypertension, and postoperative complications such as CVA and death rate were also recorded. A P-value of <.05 was determined to be statistically significant.A power analysis was performed and achieved a power of 0.95. We found a non-significant reduction in CVA for bipolar HA (3.6% CVA vs 0.0% in the non-CVA group, P = .48) and a non-significant increase in CVA for cannulated screw use (7.6% CVA vs 14.4% in the non-CVA group, P = .11). In addition, we found a significant difference in terms of weight-bearing status at 6-weeks postoperatively (0.95 vs 2.0, P < .0001), favoring the bipolar HA group.Among the advantages of bipolar HA surgery, surgeons should consider its value in reducing the occurrence of postoperative CVA. Furthermore, patients who underwent bipolar HA had improved weight-bearing status postoperatively compared with cannulated screw fixation.
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Affiliation(s)
- Jeremy Dubin
- Tel Aviv Medical Center, Department of Orthopaedic Surgery, Affiliated with the Sackler Faculty of Medicine and Tel Aviv University, Tel Aviv, Israel
| | - Ran Atzmon
- Assuta Medical Center, Department of Orthopaedic Surgery, Affiliated with the Faculty of Health and Science and Ben Gurion University, Ashdod, Israel
| | - Viktor Feldman
- Meir Hospital, Orthopedic Department, Sapir Medical Center, Kfar Saba, Israel. Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Farkash
- Meir Hospital, Orthopedic Department, Sapir Medical Center, Kfar Saba, Israel. Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Meir Nyska
- Meir Hospital, Orthopedic Department, Sapir Medical Center, Kfar Saba, Israel. Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Rath
- Tel Aviv Medical Center, Department of Orthopaedic Surgery, Affiliated with the Sackler Faculty of Medicine and Tel Aviv University, Tel Aviv, Israel
| | - Esequiel Palmanovich
- Meir Hospital, Orthopedic Department, Sapir Medical Center, Kfar Saba, Israel. Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Puzzitiello RN, Dubin J, Menendez ME, Moverman MA, Pagani NR, Drager J, Salzler MJ. Public Opinion and Expectations of Stem Cell Therapies in Orthopaedics. Arthroscopy 2021; 37:3510-3517.e2. [PMID: 34126222 DOI: 10.1016/j.arthro.2021.05.058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 03/14/2021] [Revised: 05/03/2021] [Accepted: 05/28/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To explore public opinion, understanding, and preferences regarding the use of stem cell therapies for the treatment of joint and tendon pathologies using online crowdsourcing. METHODS A 30-question survey was completed by 931 members of the public using Amazon Mechanical Turk, a validated crowdsourcing method. Outcomes included perceptions and preferences regarding the use of stem cells therapies for the nonsurgical treatment of orthopaedic conditions. Sociodemographic factors and a validated assessment of health literacy were collected. Inclusion criteria were adult participants 18 years or older, residence within the United States, and a valid Social Security number. Multivariable logistic regression modeling was used to determine population characteristics associated with the belief that stem cells represent the most effective treatment for long-standing joint or tendon disorders. RESULTS Most respondents reported that stem cell therapies have convincing evidence to support their use for orthopaedic conditions (84.5%) and are approved and regulated by the Food and Drug Administration (65%). About three-quarters of respondents reported that stem cells can stop the progression of and alleviate pain from arthritis or damaged tendons, and over half (53.5%) reported that stem cells can cure arthritis. Factors with the greatest influence on respondents' decision to receive stem cell therapies are research supporting their safety and effectiveness and doctor recommendation. However, 63.3% of respondents stated that they would consider stem cells if their doctor recommended it, regardless of evidence supporting their effectiveness, and over half would seek another doctor if their orthopaedic surgeon did not offer this treatment option. CONCLUSIONS The public's limited understanding regarding the current evidence associated with stem cell therapies for osteoarthritis and tendinous pathologies may contribute to unrealistic expectations and misinformed decisions. This study highlights the importance of patient education and expectation setting, as well as evidence transparency, as stem cell therapies become increasingly accessible. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Richard N Puzzitiello
- Department of Orthopaedic Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, U.S.A.; New England Baptist Hospital, Boston, Massachusetts, U.S.A
| | | | - Mariano E Menendez
- Department of Orthopaedic Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, U.S.A.; New England Baptist Hospital, Boston, Massachusetts, U.S.A
| | - Michael A Moverman
- Department of Orthopaedic Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, U.S.A.; New England Baptist Hospital, Boston, Massachusetts, U.S.A
| | - Nicholas R Pagani
- Department of Orthopaedic Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, U.S.A.; New England Baptist Hospital, Boston, Massachusetts, U.S.A
| | - Justin Drager
- Department of Orthopaedic Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, U.S.A
| | - Matthew J Salzler
- Department of Orthopaedic Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, U.S.A..
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Dubin J, Patel S, Seldon C, Yechieli R, Ramasamy R, Kava B. Survey of Oncology Providers' Attitudes and Practices in Evaluating Sexual Health in Cancer Care. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.627] [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: 11/24/2022]
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Dubin J, Rainer Q, Balaji N, Shoag J, Greer A, Paz L, Kava B, Troesch V, Monga V, Clifford L, Terry W, Alperstein W, Pearlman A, Ramasamy R. 019 Sexual Health Among Adolescent Young Adult Males with Cancer: An Update. J Sex Med 2021. [DOI: 10.1016/j.jsxm.2021.01.089] [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: 12/01/2022]
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Dubin J, Balaji N, Rainer Q, Wyant W, Efimenko I, Mora B, Guevara A, Paz L, Winter A, Ramasamy R. 131 Sexual Health Influences in Women: A Cross-Sectional Survey. J Sex Med 2021. [DOI: 10.1016/j.jsxm.2021.01.150] [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: 10/21/2022]
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Dubin J, Balaji N, Rainer Q, Efimenko I, Wyant W, Mora B, Paz L, Winter A, Ramasamy R. 132 Female Perceptions of Erectile Dysfunction and the Role of Male Blame on Female Sexual Health: A Cross-Sectional Survey. J Sex Med 2021. [DOI: 10.1016/j.jsxm.2021.01.151] [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: 11/16/2022]
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Chalmers BP, Dubin J, Westrich GH. Modular Dual-Mobility Liner Malseating: A Radiographic Analysis. Arthroplast Today 2020; 6:699-703. [PMID: 32923553 PMCID: PMC7475050 DOI: 10.1016/j.artd.2020.07.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 04/17/2020] [Revised: 07/22/2020] [Accepted: 07/22/2020] [Indexed: 01/23/2023] Open
Abstract
Background With dislocation as a leading cause for revision after total hip arthroplasty (THA), modular dual-mobility (MDM) constructs are more commonly used at present in an attempt to decrease postoperative instability. With modularity, there is potential for additional complications, including malseating of the liner. The goal of this study was to perform a radiographic analysis on the incidence of MDM liner malseating. Methods We retrospectively identified 305 patients (305 THAs) who underwent primary THA with an MDM liner from a single manufacturer inserted by a single surgeon. One hundred fifty-six (51%) patients were male. The mean age was 68 years, and the mean body mass index was 31 kg/m2. Only patients with both anteroposterior and cross-table lateral radiographs at a minimum of 6 weeks postoperatively were included. Dislocations and reoperations were determined at 1 year after the procedure. All MDM liners were routinely tested intraoperatively with a "4-quadrant test" to assess for proper seating. Results Four (4/305, 1.3%) MDM liners were noted to be radiographically malseated at early follow-up with three (3/147, 2.0%) occurring in a thinner two dimentional (2D) ongrowth shell and only one (1/158, 0.6%) observed in a thicker three dimentional (3D) additively manufactured shell. They were inferiorly prominent by a median of 1.2 mm, best seen on the cross-table lateral radiograph. In patients with at least 1-year follow-up, no MDM liners dissociated and no patients sustained a dislocation. Five (1.6%) patients required reoperation unrelated to the acetabular or MDM construct. Conclusions Surgeons should be aware that malseating of dual-mobility liners may occur. However, with utilization of a consistent surgical technique to test for seating of the liner, the radiographic incidence of MDM liner malseating was low at 1%. Although there were no short-term clinical implications of liner malseating, long-term follow-up is needed.
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Affiliation(s)
- Brian P Chalmers
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Jeremy Dubin
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Geoffrey H Westrich
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
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Dubin J, Huang RC, Muskat A, Sharpe K, Malkani AL, Mont M, Westrich G. Five-Year Follow-Up of Clinical Outcomes with an Anatomic Dual-Mobility Acetabular System: A Multicenter Study. Arthroplast Today 2020; 6:543-547. [PMID: 32760774 PMCID: PMC7393448 DOI: 10.1016/j.artd.2020.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 01/04/2020] [Revised: 06/02/2020] [Accepted: 06/22/2020] [Indexed: 01/19/2023] Open
Abstract
Background The dual-mobility implant system has been shown to increase impingement-free range of motion and decrease dislocation risk by increasing the effective head size. In addition, the anatomic dual-mobility (ADM) cup offers relief between the acetabular shell rim and the iliopsoas tendon. This study was designed to review a series of hips implanted with the ADM acetabular cup to examine clinical outcomes after 5 years of implantation at multiple orthopaedic centers. Methods We retrospectively queried our prospectively collected total joint arthroplasty registry for patients who underwent total hip arthroplasty with an ADM cup from January 2008 to December 2012 at 4 different orthopaedic institutions and who had minimum 5-year follow-up. Harris Hip Scores and visual analog scale scores were evaluated. Postoperative complications, dislocations, and revisions for any reason were recorded. Results A total of 142 patients had a mean follow-up of 5.7 years (range: 5.0 to 8.0 years). Radiographic analysis showed no radiolucent lines, osteolysis, or acetabular loosening. There were no dislocations in this patient series. Two (1.2%) hips required a revision because of adverse local tissue reactions related to corrosion from a recalled modular neck stem, but this was unrelated to the ADM cup. The mean Harris Hip pain scores increased from 17 points preoperatively to 39 points at the most recent follow-up (P < .001). The mean Harris Hip function score increased from an average of 29 points preoperatively to 38 points at the most recent follow-up (P < .001). The mean visual analog scale score showed patient improvement from 6.5 preoperatively to 1.2 postoperatively (P < .001). Conclusions ADM prostheses were designed to reduce the risk of dislocation by increasing the size of the effective femoral head. In this multicenter study of ADM cups used in primary total hip arthroplasty, we demonstrated good clinical and radiographic outcomes, no dislocations, and no revisions at midterm 5-year minimum follow-up. Patient-reported outcome measures were also improved, supporting the use of this implant.
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Affiliation(s)
- Jeremy Dubin
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, New York, NY, USA
| | - Ronald C. Huang
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, New York, NY, USA
- BronxCare Health Systems, Department of Orthopedic Surgery, Bronx, NY, USA
| | - Ahava Muskat
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, New York, NY, USA
| | | | | | - Michael Mont
- Cleveland Clinic, Department of Orthopedics, Cleveland, Ohio, USA
- Lenox Hill at Northwell, New York, NY, USA
| | - Geoffrey Westrich
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, New York, NY, USA
- Corresponding author. Hospital for Special Surgery, Adult Reconstruction and Joint Replacement Division, 535 East 70th Street, New York, NY 10021, USA. Tel.: +1 212 606-1510.
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Dubin J, Rainer Q, Shoag J, Greer A, Nackeeran S, Rodriguez A, Patel P, Kava B, Alperstein W, Ramasamy R. 167 Barriers to Evaluate Sexual Health Among Adolescent Young Adult Males with Cancer. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2019.11.113] [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: 10/25/2022]
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43
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Greer A, Ramos L, Dubin J, Ramasamy R. 118 Effect of Limiting Narcotic Prescription on Pain Control Following Ambulatory Scrotal Surgery. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2019.11.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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44
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Dubin J, Greer A, Ramasamy R, Kava B. 166 Attitudes, Practices, and Barriers to Sexual Health Assessments of Patients Amongst Practicing Oncologists: Survey Data from a Group of Local Oncology Healthcare Providers. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2019.11.112] [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]
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45
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Ratay M, Dubin J, Wilson M, Davis-Allen P, Gillam M, Izzo J, Maloy K, Davis J, Goyal M. 50 Multi-Center Implementation of Automated Age-Adjusted D-Dimer Cutoffs Reduces Unnecessary CTPE Imaging. Ann Emerg Med 2019. [DOI: 10.1016/j.annemergmed.2019.08.053] [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: 10/25/2022]
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46
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Dubin J, Rawal H, Ipaye O, Kalaria A, Vij R, Camire L, Weisman D. 29 Effects of Practice Site, Physician Experience, and Number of Tests Ordered Per Physician on the Diagnostic Yield of Computed Tomography Pulmonary Angiogram Ordered in the Emergency Department. Ann Emerg Med 2019. [DOI: 10.1016/j.annemergmed.2019.08.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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47
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Dubin J, Greer A, Valentine C, O'Brien I, Leue E, Paz L, Winter A, Ramasamy R. 148 Evaluation of Female Sexual Dysfunction in Adult Entertainers. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.01.156] [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: 10/27/2022]
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48
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Dubin J, Greer A, Carrasquillo R, O'Brien I, Leue E, Ramasamy R. 018 Erectile Dysfunction Among Male Adult Entertainers: A Survey. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.01.030] [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: 10/27/2022]
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49
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Woo S, Brenner N, Chong S, Benz P, Dubin J, Wilson M, Thorne J, Goyal M. 239 Advance Care Planning Among Patients With In-Hospital Cardiac Arrest. Ann Emerg Med 2018. [DOI: 10.1016/j.annemergmed.2018.08.244] [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: 11/16/2022]
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50
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Keller H, Mcnicholl T, Valaitis R, Laur C, Xu Y, Dubin J. SUN-P193: Assessing and Preventing Barriers to Food Intake in Acute Care Medical Patients: Findings of the More-2-Eat Study. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)30435-1] [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: 10/18/2022]
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