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Parel PM, Bervell J, Agarwal AR, Haft M, Stadecker M, Nelson S, Rudzki JR, McFarland EG, Srikumaran U. Reverse Total Shoulder Arthroplasty Within 6 Weeks of Proximal Humerus Fracture is Associated with the Lowest Risk of Revision. J Shoulder Elbow Surg 2024:S1058-2746(24)00307-0. [PMID: 38685379 DOI: 10.1016/j.jse.2024.03.027] [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: 09/16/2023] [Revised: 02/24/2024] [Accepted: 03/05/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Reverse total shoulder arthroplasty (RTSA) has become an increasingly popular treatment strategy in the management of complex proximal humeral fractures (PHF). However, no definitive consensus has been reached regarding the optimal surgical timing of RTSA following PHF, particularly considering nonoperative management is often a viable option. Therefore, the aim of this study was (1) to identify optimal timing intervals that maximize the likelihood of revision following RTSA and (2) to determine differences in revision etiologies using the identified timing intervals. METHODS A retrospective cohort analysis of patients undergoing PHF-indicated RTSA from 2010 to 2021 was conducted using a national administrative claims database. Stratum specific likelihood ratio (SSLR) analysis was conducted to determine data-driven timing strata between PHF and RTSA that maximized the likelihood of revision surgery within 2-years of RTSA. To control for confounders, multivariable regression analysis was conducted to confirm the identified data-driven strata's association with 2-year revision rates as well as compare the likelihood of various indications for revision including mechanical loosening, dislocation, periprosthetic joint infection (PJI), and periprosthetic fracture (PPF). RESULTS In total, 11,707 patients undergoing TSA following PHF were included in this study. SSLR analysis identified two timing categories: 0-6 weeks and 7-52 weeks from the time of PHF to TSA surgery. Relative to the 0-6 week cohort, the 7-52 week cohort was more likely to undergo revision surgery within 2-years (OR: 1.93, P < 0.001). Moreover, the 7-52 week cohort had significantly higher odds of revision indicated for dislocation (OR: 2.24, P < 0.001), mechanical loosening (OR: 1.71, P < 0.001), PJI (OR: 1.74, P < 0.001), and PPF (OR: 1.96, P < 0.001). CONCLUSIONS Using SSLR, we were successful in identifying two data-driven timing strata between PHF and RTSA that maximized the likelihood of 2-year revision surgery. As it can be difficult to determine whether RTSA or nonoperative management is initially more appropriate, considering the results of this study, an early trial of 4 to 6 weeks of nonoperative management may be appropriate without altering the risks associated with RTSA.
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Affiliation(s)
- Philip M Parel
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
| | - Joel Bervell
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amil R Agarwal
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA; Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mark Haft
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Monica Stadecker
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Sarah Nelson
- Department of Orthopaedic Surgery, Walter Reed National Medical Center, Bethesda, MD, USA
| | - Jonas R Rudzki
- Washington Orthopaedics and Sports Medicine, Washington, DC, USA
| | - Edward G McFarland
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Uma Srikumaran
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Sharma S, Miller AS, Pearson Z, Tran A, Bahoravitch TJ, Stadecker M, Ahmed AF, Best MJ, Srikumaran U. Social determinants of health disparities impact postoperative complications in patients undergoing total shoulder arthroplasty. J Shoulder Elbow Surg 2024; 33:640-647. [PMID: 37572748 DOI: 10.1016/j.jse.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/30/2023] [Accepted: 07/02/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND Understanding the role of social determinants of health disparities (SDHDs) in surgical outcomes can better prepare providers to improve postoperative care. In this study, we use International Classification of Diseases (ICD) codes to identify SDHDs and investigate the risk of postoperative complication rates among patients undergoing total shoulder arthroplasty (TSA). METHODS A retrospective cohort analysis was conducted using a national insurance claims database. Using ICD and Current Procedural Terminology (CPT) codes, patients who underwent primary TSA with at least 2 years of follow-up in the database were identified. Patients with a history of SDHDs were identified using appropriate ICD-9 and ICD-10 codes. Patients were grouped in one of 2 cohorts: (1) patients with no history of SDHDs (control) and (2) patients with a history of SDHDs (SDHD group) prior to TSA. The SDHD and control groups were matched 1:1 for comorbidities and demographics prior to conducting multivariable analysis for 90-day medical complications and 2-year surgical complications. RESULTS After matching, there were 8023 patients in the SDHD group and 8023 patients in the control group. The SDHD group had significantly higher odds for 90-day medical complications including heart failure, cerebrovascular accident, renal failure, deep vein thrombosis, pneumonia, sepsis, and urinary tract infection. Additionally, the SDHD group had significantly higher odds for revision surgery within 2 years following TSA. Patients in the SDHD group also had a significantly longer length of hospital stay following TSA. DISCUSSION This study highlights the association between SDHDs and postoperative complications following TSA. Quantifying the risk of complications and differences in length of stay for TSA patients with a history of SDHDs is important in determining value-based payment models and risk stratifying to optimize patient care.
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Affiliation(s)
- Sribava Sharma
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew S Miller
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zachary Pearson
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew Tran
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tyler J Bahoravitch
- Department of Orthopaedic Surgery, George Washington University School of Medicine, Washington, DC, USA
| | - Monica Stadecker
- Department of Orthopaedic Surgery, George Washington University School of Medicine, Washington, DC, USA
| | - Abdulaziz F Ahmed
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew J Best
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Uma Srikumaran
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Agarwal AR, Cuero KJ, Stadecker M, Meshram P, Sharma S, Zimmer ZR, Best MJ. Impact of preoperative urinary tract infection on postoperative outcomes following total shoulder arthroplasty for osteoarthritis. Shoulder Elbow 2023; 15:100-110. [PMID: 37692880 PMCID: PMC10492532 DOI: 10.1177/17585732221127590] [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: 06/22/2022] [Revised: 08/13/2022] [Accepted: 09/01/2022] [Indexed: 09/12/2023]
Abstract
Introduction As the utilization of total shoulder arthroplasty (TSA) increases, it is essential to identify risk factors associated with postoperative complications. Urinary tract infection (UTI) is one such example. Our objective is to identify whether UTI is associated with increased rates of prosthetic joint infection (PJI) and determine whether its treatment reduces PJI rates. Methods Patients who underwent primary TSA for glenohumeral osteoarthritis between 2010 and 2019 with minimum two-year follow-up were identified in a national database (PearlDiver Technologies) using Current Procedural Terminology and International Classification of Diseases codes. These patients were stratified into two cohorts: those with preoperative UTI within two weeks of TSA and those without. The preoperative UTI cohort was stratified into those treated and those untreated prior to TSA. Univariate and multivariable analyses were performed. Results Following multivariable analysis, there were significantly higher odds of postoperative anemia, pulmonary embolism, and death in the UTI cohort. Comparing treated to untreated UTI, there were no significant differences in multivariable analysis for any 90-day medical or two-year surgical complications. Discussion This study showed that UTI was not associated with increased rates of PJI. UTI was, however, associated with postoperative medical complications that surgeons should be aware of.
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Affiliation(s)
- Amil R. Agarwal
- Department of Orthopedic Surgery, George Washington Hospital, Washington, DC, USA
| | - Kendrick J. Cuero
- Department of Orthopedic Surgery, George Washington Hospital, Washington, DC, USA
| | - Monica Stadecker
- Department of Orthopedic Surgery, George Washington Hospital, Washington, DC, USA
| | - Prashant Meshram
- Department of Orthopaedic Surgery, Adult Reconstruction Division, Johns Hopkins University, Columbia, MD, USA
| | - Sribava Sharma
- Department of Orthopaedic Surgery, Adult Reconstruction Division, Johns Hopkins University, Columbia, MD, USA
| | - Zachary R. Zimmer
- Department of Orthopedic Surgery, George Washington Hospital, Washington, DC, USA
| | - Matthew J. Best
- Department of Orthopaedic Surgery, Adult Reconstruction Division, Johns Hopkins University, Columbia, MD, USA
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Agarwal AR, Ahmed AF, Stadecker M, Miller AS, Best MJ, Srikumaran U. Trends in Venous Thromboembolism After Shoulder Arthroplasty in the United States: Analysis Following the 2009 American Academy of Orthopaedic Surgeons Clinical Practical Guidelines. J Am Acad Orthop Surg 2023; 31:364-372. [PMID: 36727919 DOI: 10.5435/jaaos-d-22-00825] [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: 09/13/2022] [Accepted: 12/16/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND In 2009, the American Academy of Orthopaedic Surgeons released a consensus recommending venous thromboembolism (VTE) prophylaxis after total shoulder arthroplasty (TSA). The purpose of this study was to examine the (1) change in incidence of 90-day VTE, deep vein thrombosis (DVT), and pulmonary embolism; (2) change in utilization of chemoprophylaxis; and (3) change in the economic burden associated with VTE after TSA from 2010 to 2019. METHODS Using the PearlDiver database, national data from 2010 to 2019 were used to identify patients who underwent primary TSA for osteoarthritis and/or rotator cuff arthropathy. Exclusions entailed liver pathology, coagulopathy, or those on prior prescribed blood thinners before TSA. Multivariable regression was used controlling for age and Charlson Comorbidity Index for all years with 2010 as the reference year. RESULTS From 2010 to 2019, there was a reduction in VTE rates from 0.89% in 2010 to 0.78% in 2019. Regarding implant type, there was no notable change in incidence of VTE, DVT, and pulmonary embolism within 90 days after anatomic TSA. Notable reductions were observed in both VTE and DVT after reverse TSA from 2010 to 2019. Prescribed chemical VTE prophylaxis utilization after TSA markedly increased from 4.41% in 2010 to 11.70% utilization in 2019. The utilization of aspirin markedly increased from 17.27% in 2010 to 65.17% in 2019. Among anticoagulants, the utilization of direct factor Xa inhibitors increased from 0.0% utilization in 2010 to 66.09% utilization in 2019. The added reimbursements associated with VTE after TSA markedly decreased from $14,122 in 2010 to $4,348 in 2019. CONCLUSION The incidence and economic burden associated with VTE after TSA have markedly declined following the 2010 American Academy of Orthopaedic Surgeons clinical practice guidelines. This reduction can be attributed to both an increase in VTE prevention through increased utilization of prescribed chemoprophylaxis and improvement in VTE treatment strategies. LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Amil R Agarwal
- From the Department of Orthopedic Surgery, George Washington Hospital, Washington DC (Agarwal and Stadecker), and the Johns Hopkins Department of Orthopaedic Surgery, Columbia, MD (Agarwal, Ahmed, Miller, Best, and Srikumaran)
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Fassihi SC, Lee D, Tran AA, Lee R, Pollard T, Stadecker M, Stake S, Hughes AJ, Thakkar S. Erratum to ‘Total Hip Arthroplasty in An Adult Patient With Pelvic Dysmorphism, Unilateral Sacroiliac Joint Autofusion, and Developmental Hip Dysplasia’ [Arthroplasty Today 6 (2020) 41-47]. Arthroplast Today 2022; 15:235. [PMID: 35774882 PMCID: PMC9237268 DOI: 10.1016/j.artd.2022.01.018] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Safa C. Fassihi
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC, USA
| | - Danny Lee
- School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Andrew A. Tran
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC, USA
- Corresponding author. 2300 M St NW, 5th Floor, Washington, DC 20037, USA. Tel.: +1 408 476 2609.
| | - Ryan Lee
- School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Tom Pollard
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC, USA
| | - Monica Stadecker
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC, USA
| | - Seth Stake
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC, USA
| | - Alice J. Hughes
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC, USA
| | - Savyasachi Thakkar
- Department of Orthopaedic Surgery, MedStar Washington Hospital Center, Washington, DC, USA
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Lee D, Lee R, Fassihi SC, Stadecker M, Heyer JH, Stake S, Rakoczy K, Rodenhouse T, Pandarinath R. Risk Factors for Blood Transfusions in Primary Anatomic and Reverse Total Shoulder Arthroplasty for Osteoarthritis. Iowa Orthop J 2022; 42:217-225. [PMID: 35821928 PMCID: PMC9210430] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND The purpose of this study was to determine risk factors for blood transfusion in primary anatomic and reverse total shoulder arthroplasty (TSA) performed for osteoarthritis. METHODS Patients who underwent anatomic or reverse TSA for a diagnosis of primary osteoarthritis were identified in a national surgical database from 2005 to 2018 by utilizing both CPT and ICD-9/ICD-10 codes. Univariate analysis was performed on the two transfused versus non-transfused cohorts to compare for differences in comorbidities and demographics. Independent risk factors for perioperative blood transfusions were identified via multivariate regression models. RESULTS 305 transfused and 18,124 nontransfused patients were identified. Female sex (p<0.001), age >85 years (p=0.001), insulin-dependent diabetes mellitus (p=0.001), dialysis dependence (p=0.001), acute renal failure (p=0.012), hematologic disorders (p=0.010), disseminated cancer (p<0.001), ASA ≥ 3 (p<0.001), and functional dependence (p=0.001) were shown to be independent risk factors for blood transfusions on multivariate logistic regression analysis. CONCLUSION Several independent risk factors for blood transfusion following anatomic/reverse TSA for osteoarthritis were identified. Awareness of these risk factors can help surgeons and perioperative care teams to both identify and optimize high-risk patients to decrease both transfusion requirements and its associated complications in this patient population. Level of Evidence: III.
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Affiliation(s)
- Danny Lee
- Department of Orthopaedic Surgery, University of Miami-Jackson Memorial Health System, Miami, Florida, USA
| | - Ryan Lee
- The George Washington University School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Safa C. Fassihi
- Department of Orthopaedic Surgery, The George Washington University Hospital, Washington, DC, USA
| | - Monica Stadecker
- Department of Orthopaedic Surgery, The George Washington University Hospital, Washington, DC, USA
| | - Jessica H. Heyer
- Department of Orthopaedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Seth Stake
- Department of Orthopaedic Surgery, The George Washington University Hospital, Washington, DC, USA
| | - Kyla Rakoczy
- University of Miami Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Thomas Rodenhouse
- Department of Orthopaedic Surgery, University of Rochester, Rochester, New York, USA
| | - Rajeev Pandarinath
- Department of Orthopaedic Surgery, The George Washington University Hospital, Washington, DC, USA
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7
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Stadecker M, Gu A, Ramamurti P, Fassihi SC, Wei C, Agarwal AR, Bovonratwet P, Srikumaran U. Risk of revision based on timing of corticosteroid injection prior to shoulder arthroplasty. Bone Joint J 2022; 104-B:620-626. [PMID: 35491573 DOI: 10.1302/0301-620x.104b5.bjj-2021-0024.r3] [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: 11/05/2022]
Abstract
AIMS Corticosteroid injections are often used to manage glenohumeral arthritis in patients who may be candidates for future total shoulder arthroplasty (TSA) or reverse shoulder arthroplasty (rTSA). In the conservative management of these patients, corticosteroid injections are often provided for symptomatic relief. The purpose of this study was to determine if the timing of corticosteroid injections prior to TSA or rTSA is associated with changes in rates of revision and periprosthetic joint infection (PJI) following these procedures. METHODS Data were collected from a national insurance database from January 2006 to December 2017. Patients who underwent shoulder corticosteroid injection within one year prior to ipsilateral TSA or rTSA were identified and stratified into the following cohorts: < three months, three to six months, six to nine months, and nine to 12 months from time of corticosteroid injection to TSA or rTSA. A control cohort with no corticosteroid injection within one year prior to TSA or rTSA was used for comparison. Univariate and multivariate analyses were conducted to determine the association between specific time intervals and outcomes. RESULTS In total, 4,252 patients were included in this study. Among those, 1,632 patients (38.4%) received corticosteroid injection(s) within one year prior to TSA or rTSA and 2,620 patients (61.6%) did not. On multivariate analysis, patients who received corticosteroid injection < three months prior to TSA or rTSA were at significantly increased risk for revision (odds ratio (OR) 2.61 (95% confidence interval (CI) 1.77 to 3.28); p < 0.001) when compared with the control cohort. However, there was no significant increase in revision risk for all other timing interval cohorts. Notably, Charlson Comorbidity Index ≥ 3 was a significant independent risk factor for all-cause revision (OR 4.00 (95% CI 1.40 to 8.92); p = 0.036). CONCLUSION There is a time-dependent relationship between the preoperative timing of corticosteroid injection and the incidence of all-cause revision surgery following TSA or rTSA. This analysis suggests that an interval of at least three months should be maintained between corticosteroid injection and TSA or rTSA to minimize risks of subsequent revision surgery. Cite this article: Bone Joint J 2022;104-B(5):620-626.
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Affiliation(s)
- Monica Stadecker
- Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington D.C., USA
| | - Alex Gu
- Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington D.C., USA
| | - Pradip Ramamurti
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Safa C Fassihi
- Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington D.C., USA
| | - Chapman Wei
- Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington D.C., USA
| | - Amil Raj Agarwal
- Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington D.C., USA
| | - Patawut Bovonratwet
- Department of Orthopedics, Hospital for Special Surgery, New York, New York, USA
| | - Uma Srikumaran
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland, USA
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Abstract
» Conversion total knee arthroplasty (TKA) represents a heterogeneous group of procedures and most commonly includes TKA performed after ligamentous reconstruction, periarticular open reduction and internal fixation (ORIF), high tibial osteotomy (HTO), and unicompartmental knee arthroplasty (UKA). » Relative to patients undergoing primary TKA, patients undergoing conversion TKA often have longer operative times and higher surgical complexity, which may translate into higher postoperative complication rates. » There is mixed evidence on implant survivorship and patient-reported outcome measures when comparing conversion TKA and primary TKA, with some studies noting no differences between the procedures and others finding decreased survivorship and outcome scores for conversion TKA. » By gaining an improved understanding of the unique challenges facing patients undergoing conversion TKA, clinicians may better set patient expectations, make intraoperative adjustments, and guide postoperative care.
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Affiliation(s)
- Pradip Ramamurti
- Department of Orthopaedic Surgery, George Washington University, Washington, DC
| | - Safa C Fassihi
- Department of Orthopaedic Surgery, George Washington University, Washington, DC
| | - Seth Stake
- Department of Orthopaedic Surgery, George Washington University, Washington, DC
| | - Monica Stadecker
- Department of Orthopaedic Surgery, George Washington University, Washington, DC
| | - Zachariah Whiting
- Department of Orthopaedic Surgery, George Washington University, Washington, DC
| | - Savyasachi C Thakkar
- Adult Reconstruction Division, Department of Orthopaedic Surgery, Johns Hopkins University, Columbia, Maryland
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Sheppard ED, Ramamurti P, Stake S, Stadecker M, Rana MS, Oetgen ME, Young ML, Martin BD. Posterior Tibial Slope is Increased in Patients With Tibial Tubercle Fractures and Osgood-Schlatter Disease. J Pediatr Orthop 2021; 41:e411-e416. [PMID: 33782370 DOI: 10.1097/bpo.0000000000001818] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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] [Indexed: 02/07/2023]
Abstract
BACKGROUND Osgood-Schlatter disease (OSD) and tibial tubercle fractures are pathologies that affect the tibial tubercle apophysis in preadolescents and adolescents. Anatomic alignment of the proximal tibia may explain why some children develop OSD or sustain tibial tubercle fractures and some do not. Recent data has shown an association between posterior tibial slope angle (PTSA) and both OSD and proximal tibia physeal fractures. In this study, we compare radiographic parameters between patients with non-OSD knee pain, knees with OSD, and knees with tibial tubercle fracture to elucidate a difference between these groups. METHODS Patients treated for OSD, tibial tubercle fractures, and knee pain, from 2012 to 2018, were retrospectively reviewed. Radiographic parameters for each study group included PTSA, anatomic lateral distal femoral angle, anatomic medial proximal tibial angle, patellar articular height, and the distance from the inferior aspect of the patellar articular surface. Caton-Deschamps index was then calculated. Demographic data was collected including age, sex, and body mass index. Demographic and radiographic data was compared using analysis of variance tests, χ2 tests, 2-sample t tests, and multiple linear regression. RESULTS Two hundred fifty-one knees in 229 patients met inclusion criteria for the study. In all, 76% were male and the average age of the overall cohort was 14 years old. In patients with tibial tubercle fractures, the majority of fractures were Ogden type 3b (65%). After controlling for demographic variability, average PTSA in the fracture cohort was significantly greater than that in the control cohort (β=3.49, P<0.001). The OSD cohort had a significantly greater posterior slope (β=3.14) than the control cohort (P<0.001). There was no statistically significant difference between the fracture and OSD cohorts. There was also no difference in Caton-Deschamps index between the 2 study groups when compared with the control group. CONCLUSION This study demonstrates that patients with tibial tubercle fractures and patients with OSD have an increased PTSA when compared with the control group. This information adds to the body of evidence that increased tibial slope places the proximal tibial physis under abnormal stress which may contribute to the development of pathologic conditions of proximal tibia such as OSD and tibial tubercle fractures. LEVEL OF EVIDENCE Level III; retrospective comparative study.
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Affiliation(s)
| | - Pradip Ramamurti
- The George Washington University School of Medicine and Health Sciences
| | - Seth Stake
- Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Monica Stadecker
- Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC
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Abstract
Previous studies from our laboratory have suggested that aging leads to an accumulation of cells expressing high levels of CD44, thought to be a marker for memory lymphocytes, and that positively selected CD44hi T cells, from mice of any age, respond poorly to concanavalin A (Con A) in limiting dilution estimates of interleukin (IL)-2-producing cells. We now report the results of a more comprehensive analysis of memory T cell function, in old and young mice, to non-cognate activators (Con A and the staphylococcal enterotoxin SEB). We report that memory T cells, isolated by removing cells bearing the CD45RB determinant, contain very few cells able to respond to either Con A or SEB under limiting dilution culture conditions, whether the responses are measured by IL-2 or by IL-3 accumulation. As a control, we show that memory T cells do respond strongly, at limiting dilution, to recently encountered priming antigens, i.e. Schistosoma mansoni egg antigen; the limiting dilution culture protocol thus does not preclude activation of memory T cells when cognate stimuli are presented to antigen-specific cells. These data suggest that virgin and memory T cells may differ fundamentally in their activation requirements, and suggest further that the accumulation, with age, of memory T cells accounts for the low responsiveness of old mice to non-cognate mitogens.
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Affiliation(s)
- K Flurkey
- Department of Pathology, University of Michigan, Ann Arbor
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Koh HK, Clapp RW, Barnett JM, Nannery WM, Tahan SR, Geller AC, Bhawan J, Harrist TJ, Kwan T, Stadecker M. Systematic underreporting of cutaneous malignant melanoma in Massachusetts. Possible implications for national incidence figures. J Am Acad Dermatol 1991; 24:545-50. [PMID: 2033127 DOI: 10.1016/0190-9622(91)70079-h] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
An independent tabulation of incidence of cutaneous malignant melanoma in Massachusetts indicates that 12% and perhaps as many as 19% of new cases of cutaneous malignant melanoma in Massachusetts are not recorded in the Massachusetts Cancer Registry, significantly more than the expected 5% (p = 0.0001). The increasing number of nonhospital medical settings in which melanomas can be diagnosed and/or treated appears to account for this discrepancy. We suspect that these findings in Massachusetts also apply to cancer reporting systems in other regions of the United States. We suggest that the true incidence of cutaneous malignant melanoma in Massachusetts, and perhaps in the United States, may be significantly higher than reported.
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Affiliation(s)
- H K Koh
- Department of Dermatology, Boston University School of Medicine, MA 02118-2394
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Abstract
Fifteen cases of palisading granulomas of the prostate occurring in patients with a history of previous prostate surgery are described and illustrated. This distinctive histologic lesion strongly resembles a rheumatoid nodule, but is not associated with connective tissue disease or infection and is probably related to prior transurethral prostatectomy or needle biopsy.
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Abstract
CBH to DNP-GL could be elicited only in responder guinea pigs which possess the genetic ability to develop classic delayed type hypersensitivity to DNP-PLL, the response to which is governed by the same gene. Since the defect in nonresponder animals seems to reside at the level of their T cells and not B cells, these results lend support to the contention that CBH, as well as DH, is dependent on and probably mediated by T cells.
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