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Jalali O, Smith JS, Bess S, Hostin R, Lafage R, Lafage V, Shaffrey CI, Ames CP, Lenke LG, Kelly MP. Validation of the Oswestry Disability Index in Adult Spinal Deformity. Spine (Phila Pa 1976) 2024; 49:682-688. [PMID: 38356276 DOI: 10.1097/brs.0000000000004960] [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: 12/22/2023] [Accepted: 02/03/2024] [Indexed: 02/16/2024]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE To examine the validity of the Oswestry Disability Index (ODI) in patients with adult spinal deformity (ASD) treated with surgery. BACKGROUND The ODI is a patient-reported outcome measure of low back pain and disability. Although nearly ubiquitous in ASD research, the measure has not been validated in this patient population. PATIENTS AND METHODS A registry of patients with ASD was queried for baseline and 1-year PROM data, including the ODI, the Scoliosis Research Society-22r (SRS-22r), and the Patient Reported Outcomes Measurement Information System-Pain Interference (PI) and Physical Function (PF) CATs. Internal reliability was assessed with Cronbach alpha, where values ≥0.7 are considered reliable. Validity was assessed with Spearman correlation coefficients calculated for the ODI against validated Patient-Reported Outcomes Measurement Information System (PROMIS)-PI and PF, and legacy measures SRS-Pain and SRS-Activity. Responsiveness to change was measured with the adjusted effect size. RESULTS A total of 325 patients were enrolled, with 208 completing baseline and 1-year patient-reported outcome measures. The majority (149, 72%) were females and White (193, 93%), median Charlson Comorbidity Index 0 (interquartile range: 0-2). The majority of cases included sagittal plane deformity [mean T1PA: 24.2° (13.9)]. Cronbach alpha showed excellent internal reliability (baseline = 0.89, 1 yr = 0.90). ODI was valid, with strong correlations between PROMIS-PI, PROMIS-PF, SRS-Pain, and SRS-Activity at baseline and 1-year follow-up. All measures were responsive to change, with the ODI showing greater responsiveness than PROMIS-PI, PROMIS-PF, and SRS-Activity. CONCLUSIONS The ODI is a valid measure of disability as measured by pain and function in patients with ASD. It is responsive to change in a manner not different from validated PROMIS-CAT or the SRS-22r legacy measure. It is multidimensional, however, as it assesses both pain and function simultaneously. It does not measure disability related to self-image and may not account for all disease-related disability in patients with ASD.
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Affiliation(s)
- Omid Jalali
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia, Charlottesville, VA
| | - Shay Bess
- Denver International Spine Center, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, CO
| | - Richard Hostin
- Department of Orthopaedic Surgery, Baylor Scoliosis Center, Plano, TX
| | - Renaud Lafage
- Department of Orthopedic Surgery, Lennox Hill Hospital, New York, NY
| | - Virginie Lafage
- Department of Orthopedic Surgery, Lennox Hill Hospital, New York, NY
| | | | - Christopher P Ames
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA
| | | | - Michael P Kelly
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA
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2
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Jalali O, Fiske J, DeJardin MG, Scudday TS, Barnett SL, Gorab RS. Wear of Third-Generation Cross-Linked Polyethylene in Primary Total Hip Arthroplasty: A 10-Year Analysis. J Arthroplasty 2024; 39:1335-1340. [PMID: 37977306 DOI: 10.1016/j.arth.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 11/08/2023] [Accepted: 11/10/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Sequential modifications to the manufacturing process of highly cross-linked polyethylene (HXLPE) have improved the wear resistance and implant survival of these liners in total hip arthroplasty (THA). However, no study has examined the long-term (mean 10 year) wear rates and clinical outcomes of third-generation HXLPE in THA. The aim of our study was to report the longest-to-date analysis of wear rates and clinical outcomes of a third-generation HXLPE liner. METHODS A series of 133 THAs using a specific HXLPE acetabular liner were retrospectively evaluated. Linear and volumetric wear rates were determined using a validated radiographic technique and clinical outcomes were analyzed. Multivariate analyses were performed to determine risk factors for accelerated wear. RESULTS At a mean follow-up of 10.4 years (range, 8 to 13.4), the mean linear wear rate was 0.0172 mm/year and the mean volumetric wear rate was 16.99 mm3/year. There were no instances of osteolysis or mechanical failures at any time point and there was a 100% acetabular component survival rate. Younger age and use of offset liners were independent risk factors for increased wear (P < .01 for both). CONCLUSIONS Our series of a third-generation HXLPE demonstrated very low wear rates and excellent implant survival at a mean of 10.4 years following primary THA. Future comparative studies at the 15- and 20-year follow-up timepoints are necessary to determine if such findings translate to true improvements in the tribological properties and longevity of these liners when compared to previous generations of HXLPE liners.
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Affiliation(s)
- Omid Jalali
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, California
| | - Joseph Fiske
- College of Osteopathic Medicine, Touro University California, Vallejo, California
| | | | - Travis S Scudday
- Department of Orthopaedic Surgery, Hoag Orthopedic Institute, Irvine, California
| | - Steven L Barnett
- Department of Orthopaedic Surgery, Hoag Orthopedic Institute, Irvine, California
| | - Robert S Gorab
- Department of Orthopaedic Surgery, Hoag Orthopedic Institute, Irvine, California
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3
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Shaw V, Patel J, Siatecka H, Jalali O. Cutaneous Dermal Metastasis of Inflammatory Breast Carcinoma Mimicking Granuloma Annulare. Cureus 2023; 15:e47544. [PMID: 38021832 PMCID: PMC10665136 DOI: 10.7759/cureus.47544] [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] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Breast cancer can present as a wide range of cutaneous lesions at the time of diagnosis or months to years after a known diagnosis of breast cancer. Cutaneous sequela of breast cancer, including metastasis, have a diverse range of clinical appearances. Here, we describe the case of a 59-year-old female with stage IV metastatic inflammatory breast carcinoma presenting with a chronic worsening rash on her anterior chest wall. Biopsy results demonstrated metastatic carcinoma cells within the dermal lymphatics, consistent with primary breast cancer. To our knowledge, based on a thorough review of the literature, no previous case reports detailing cutaneous metastasis of breast cancer have identified a rash mimicking granuloma annulare. The present case highlights the importance of early dermatologic referral if any abnormal or persistent lesions appear in a patient with a history of or current treatment for breast cancer.
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Affiliation(s)
- Vikram Shaw
- College of Medicine, Baylor College of Medicine, Houston, USA
| | - Jay Patel
- Department of Dermatology, Baylor College of Medicine, Houston, USA
| | - Hanna Siatecka
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, USA
| | - Omid Jalali
- Department of Dermatology, Baylor College of Medicine, Houston, USA
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Hopkins C, Jalali O, Guffey D, Dao H. A survey of dermatology residents and program directors assessing the transition to dermatology residency. Proc (Bayl Univ Med Cent) 2020; 34:59-62. [PMID: 33456147 DOI: 10.1080/08998280.2020.1799289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
The transition from internship to residency is a critical period for trainees. This study investigated factors that influence the transition of residents from postgraduate year 1 (PGY-1) to dermatology residency. In June 2019, a program director-specific survey and a resident-oriented survey were administered via Survey Monkey. An email containing survey hyperlinks was sent via the Association of Professors of Dermatology Listserv to program directors, who were asked to forward the email to their current trainees. A total of 44 dermatology residents and 33 program directors responded. More than 58% of program directors identified a preliminary year in internal medicine as most beneficial. Both residents and program directors indicated rheumatology, infectious disease, and allergy and immunology as the most relevant PGY-1 electives. Eighty-two percent of program directors expected <1 h/week or no independent preparation for dermatology residency during PGY-1. The stress of incoming residents as perceived by program directors was significantly less than the self-reported stress of residents during their transition to dermatology residency (Mann-Whitney U, two-sided, P = 0.011).
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Affiliation(s)
| | - Omid Jalali
- Department of Dermatology, Baylor College of Medicine, Houston, Texas
| | - Danielle Guffey
- Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas
| | - Harry Dao
- Department of Dermatology, Baylor College of Medicine, Houston, Texas.,Department of Medical Dermatology, Loma Linda University Health, Loma Linda, California
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Jalali O, Best M, Wong A, Schaeffer B, Bauer B, Johnson L. Reduced Bacterial Burden of the Skin Surrounding the Shoulder Joint Following Topical Protocatechuic Acid Application: Results of a Pilot Study. JB JS Open Access 2020; 5:JBJSOA-D-19-00078. [PMID: 32803100 PMCID: PMC7386540 DOI: 10.2106/jbjs.oa.19.00078] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Reducing the rising health-care burden associated with shoulder surgical site infection (SSI) is of paramount importance. The purpose of this study was to investigate the antimicrobial efficacy of protocatechuic acid (PCA) as a topical reagent for surgical skin antisepsis surrounding the shoulder joint.
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Affiliation(s)
- Omid Jalali
- Keck School of Medicine of USC, Los Angeles, California
| | - Molly Best
- Loma Linda Department of Orthopedics (M.B.) and Loma Linda University School of Medicine (A.W., B.S., and B.B.), Loma Linda, California
| | - Alison Wong
- Loma Linda Department of Orthopedics (M.B.) and Loma Linda University School of Medicine (A.W., B.S., and B.B.), Loma Linda, California
| | - Brett Schaeffer
- Loma Linda Department of Orthopedics (M.B.) and Loma Linda University School of Medicine (A.W., B.S., and B.B.), Loma Linda, California
| | - Brendon Bauer
- Loma Linda Department of Orthopedics (M.B.) and Loma Linda University School of Medicine (A.W., B.S., and B.B.), Loma Linda, California
| | - Lanny Johnson
- Keck School of Medicine of USC, Los Angeles, California.,Loma Linda Department of Orthopedics (M.B.) and Loma Linda University School of Medicine (A.W., B.S., and B.B.), Loma Linda, California
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6
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Burgmeier R, Bolia IK, Gipsman A, Jalali O, Weber AE. Plate fixation versus intramedullary nailing of proximal humerus fractures: an ACS NSQIP-based comparative analysis over 8 years. Eur J Orthop Surg Traumatol 2020; 31:33-41. [PMID: 32642807 DOI: 10.1007/s00590-020-02734-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/01/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The primary goal of this study was to compare the utilization of plate versus intramedullary nail (IMN) in the treatment of humerus fractures. Secondarily, we sought to examine whether any differences in demographics and clinical course of patients who receive a nail versus plate affect the procedure selection process. METHODS The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database was queried for patients surgically treated for a humeral shaft fracture from the years 2007-2015, using current procedural terminology (CPT) code. Patients with overlapping procedures, nonunion, polytrauma, and malignancy were excluded. The Charlson Comorbidity Index (CCI) was calculated to compare preoperative comorbidities. A two-sample Wilcoxon rank-sum (Mann-Whitney U) test was used to compare numerical values, whereas the Fisher exact and Chi-squared analyses were performed to compare categorical variables. A p value < 0.05 was considered significant. Preoperative variables with a p value < 0.05 and a clinical prevalence > 1%, indicating statistical and clinical significance, were included in a logistic regression for multivariate analysis to identify any independent predictors for procedure selection (IMN versus PF) based on preoperative patient characteristics. RESULTS During the study period plate fixation increased from 7 cases per year to 272 cases per year, while IMN increased from 8 cases per year to 80 cases per year. IMNs were mostly in older patients (63.85 vs 56.19 years, p < 0.001), and patients with a higher Charlson Comorbidity Index (CCI) (4.64 vs 2.79, p < 0.001). IMN was associated with shorter operation times (104 min vs 128 min, p < 0.001) and longer lengths of hospital stay (3.43d vs 2.78d, p < 0.001). No significant differences in overall complication rates were seen between patients who received IMN versus PF. However, the postoperative mortality rate was higher in patients who received IMN compared to PF (2.19% vs 0.40%, p < 0.01). Based on the regression analysis, patient age was the only independent patient factor demonstrated to predict the utilization of IMN over PF in older patients with humeral shaft fractures p = 0.043). CONCLUSION According to this NSQIP-based analysis, the rate of PF and IMN utilization increased in the treatment of humeral shaft fractures over a period of 8 years, but PF was performed at an overall a higher rate than IMN. Intramedullary nailing was preferred over PF in older patients with more comorbidities. The last possibly contributed to the higher 30-day mortality rate observed in patients who received IMN compared to PF. LEVEL OF EVIDENCE III Retrospective comparative study.
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Affiliation(s)
- Robert Burgmeier
- Orthopaedic Surgery Section of Sports Medicine, USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, 1520 San Pablo st#2000, Los Angeles, CA, 90033, USA
| | - Ioanna K Bolia
- Orthopaedic Surgery Section of Sports Medicine, USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, 1520 San Pablo st#2000, Los Angeles, CA, 90033, USA
| | - Aaron Gipsman
- Orthopaedic Surgery Section of Sports Medicine, USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, 1520 San Pablo st#2000, Los Angeles, CA, 90033, USA
| | - Omid Jalali
- Orthopaedic Surgery Section of Sports Medicine, USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, 1520 San Pablo st#2000, Los Angeles, CA, 90033, USA
| | - Alexander E Weber
- Orthopaedic Surgery Section of Sports Medicine, USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, 1520 San Pablo st#2000, Los Angeles, CA, 90033, USA.
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Abstract
CONTEXT Malnutrition is well-studied in various aspects of the orthopaedic literature, most commonly in relation to arthroplasty, spine surgery, and trauma. However, the management of nutritional deficiencies is commonly overlooked among orthopaedic sports medicine providers. The purpose of this article is to analyze the available sports medicine literature to review the associations between malnutrition and the management of orthopaedic sports medicine patients from a treatment and performance standpoint. EVIDENCE ACQUISITION PubMed was searched for relevant articles published from 1979 to 2019. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 4. RESULTS Few studies exist on the implications of macronutrient deficiencies specific to orthopaedic sports medicine procedures. Interestingly, micronutrient disorders-namely, hypovitaminosis D and iron deficiency-have been well studied and may lead to worse postoperative outcomes, injury rates, and athletic performance. Nutritional supplementation to correct such deficiencies has been shown to mitigate these effects, though further study is required. CONCLUSION Nutritional deficiencies are highly prevalent in orthopaedic sports medicine patients, and practitioners should be aware of their potential effects on treatment and performance outcomes. Management of such deficiencies and their effect on surgical patients remain an area of potential future research. Future studies are warranted in order to explore the potential therapeutic role of nutritional supplementation to prevent complications after common orthopaedic sports medicine procedures, improve athletic performance, and reduce injury rates.
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Affiliation(s)
- Jihoon T Choi
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Brandon Yoshida
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Omid Jalali
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - George F Hatch
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
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8
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Jalali O, Best M, Wong A, Schaeffer B, Bauer B, Johnson L. Protocatechuic Acid as a Topical Antimicrobial for Surgical Skin Antisepsis: Preclinical Investigations. JB JS Open Access 2020; 5:JBJSOA-D-19-00079. [PMID: 32803102 PMCID: PMC7386545 DOI: 10.2106/jbjs.oa.19.00079] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background There is a need for novel skin antiseptic agents to combat the health-care burdens associated with surgical site infection (SSI) and bacterial resistance. The purpose of this proof-of-principle pilot study was to investigate the potential of the phenolic compound protocatechuic acid (PCA) as a topical antimicrobial for surgical skin antisepsis. Methods The Kirby-Bauer method of disc diffusion was used to investigate the in vitro antimicrobial activity and comparative effectiveness of PCA and 7 related compounds against SSI pathogens. To explore the in vivo efficacy of topical PCA for providing deep, penetrating skin antisepsis, living Cutibacterium acnes was intradermally injected into the skin of female BALB/c mice. Mice were assigned to treatment with daily applications of topical PCA at 3 doses (78, 39, and 19.5 mM) or no treatment (n = 2 mice per group). After 96 hours, infected skin samples were harvested to compare mean C. acnes counts by treatment. Results Compared with other polyphenols, PCA demonstrated the broadest spectrum of antimicrobial activity against tested SSI pathogens, including drug-resistant organisms. At 96 hours following infection, the mean C. acnes burden in untreated mice was 6.65 log colony-forming units (CFUs) per gram of skin. Compared with the untreated group, daily topical application of 78 mM of PCA was associated with a significantly lower C. acnes CFU burden in mice skin (mean, 5.51 log CFUs per gram of skin; p = 0.0295). Both lower dosages of topical PCA failed to show an effect. Conclusions PCA demonstrated laboratory efficacy against pathogens implicated in SSI, including drug-resistant organisms. In vivo, topical PCA demonstrated dose-dependent skin penetration and antimicrobial activity against mouse skin C. acnes loads. Human clinical studies exploring the antimicrobial efficacy of topical PCA for preoperative shoulder skin antisepsis are warranted. Clinical Relevance Topical PCA may have the potential to improve current shoulder SSI treatment and prevention protocols.
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Affiliation(s)
- Omid Jalali
- Keck School of Medicine of USC, Los Angeles, California
| | - Molly Best
- Loma Linda Department of Orthopedics (M.B.) and Loma Linda University School of Medicine (A.W., B.S., and B.B.), Loma Linda, California
| | - Alison Wong
- Loma Linda Department of Orthopedics (M.B.) and Loma Linda University School of Medicine (A.W., B.S., and B.B.), Loma Linda, California
| | - Brett Schaeffer
- Loma Linda Department of Orthopedics (M.B.) and Loma Linda University School of Medicine (A.W., B.S., and B.B.), Loma Linda, California
| | - Brendon Bauer
- Loma Linda Department of Orthopedics (M.B.) and Loma Linda University School of Medicine (A.W., B.S., and B.B.), Loma Linda, California
| | - Lanny Johnson
- Keck School of Medicine of USC, Los Angeles, California.,Loma Linda Department of Orthopedics (M.B.) and Loma Linda University School of Medicine (A.W., B.S., and B.B.), Loma Linda, California
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9
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Jalali O, Scudday T, Fickenscher MC, Barnett S, Gorab R. Third-Generation Medium Cross-Linked Polyethylene Demonstrates Very Low Wear in Total Hip Arthroplasty. Arthroplast Today 2020; 6:316-321. [PMID: 32514421 PMCID: PMC7267711 DOI: 10.1016/j.artd.2020.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/21/2020] [Accepted: 04/07/2020] [Indexed: 02/08/2023] Open
Abstract
Background Cross-linked polyethylene (XLPE) liners have shown lower wear rates than conventional polyethylene liners in total hip arthroplasty. The primary aim of our study was to report our most recent analysis of wear rates and clinical outcomes of a third-generation XLPE liner. Secondary aims were to investigate the rate of adverse events related to mechanical failure or oxidation of this liner. Methods A series of 266 total hip arthroplasties using a specific XLPE liner were retrospectively reviewed. Radiographs were examined to determine linear and volumetric wear rates and presence of osteolysis. Clinical outcomes, revision rates, mechanical failures, and risk factors for accelerated polyethylene wear were additionally investigated. Results The mean age at the time of surgery was 65.8 years and the mean follow-up was 5.5 years. The mean linear wear rate was 0.003 mm/year and the mean volumetric wear rate was 0.42 mm3/year, and there was no evidence of osteolysis. Harris hip scores increased from 50.9 preoperatively to 96.0 at the latest follow-up. The revision rate was 0.4%, with no liner rim fractures and no liner dissociations/loosenings. Femoral head material, head size, age, body mass index, and time since implantation had no effect on wear rates. Conclusion Wear rates for this third-generation XLPE liner were low at mid-term follow-up, and no adverse sequelae of oxidation or deleterious mechanical properties were observed. This remained true regardless of femoral head size and material or patient age and body mass index. Further analysis will be necessary to ensure continued wear resistance, oxidative stability, and mechanical strength at long-term follow-up.
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Affiliation(s)
- Omid Jalali
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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10
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Weber AE, Jalali O, Limfat S, Shkhyan R, Van Der Horst R, Lee S, Lin Y, Li L, Mayer EN, Wang L, Liu NQ, Petrigliano FA, Lieberman JR, Evseenko D. Modulation of Hedgehog Signaling by Kappa Opioids to Attenuate Osteoarthritis. Arthritis Rheumatol 2020; 72:1278-1288. [PMID: 32249508 DOI: 10.1002/art.41250] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 03/03/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Inhibition of hedgehog (HH) signaling prevents cartilage degeneration and promotes repair in animal models of osteoarthritis (OA). This study, undertaken in OA models and in human OA articular cartilage, was designed to explore whether kappa opioid receptor (KOR) modulation via the inhibition of HH signaling may have therapeutic potential for achieving disease-modifying activity in OA. METHODS Primary human articular cartilage and synovial tissue samples from patients with knee OA undergoing total joint replacement and from healthy human subjects were obtained from the National Disease Research Interchange. For in vivo animal studies, a partial medial meniscectomy (PMM) model of knee OA in rats was used. A novel automated 3-dimensional indentation tester (Mach-1) was used to quantify the thickness and stiffness properties of the articular cartilage. RESULTS Inhibition of HH signaling through KOR activation was achieved with a selective peptide agonist, JT09, which reduced HH signaling via the cAMP/CREB pathway in OA human articular chondrocytes (P = 0.002 for treated versus untreated OA chondrocytes). Moreover, JT09 markedly decreased matrix degeneration induced by an HH agonist, SAG, in pig articular chondrocytes and cartilage explants (P = 0.026 versus untreated controls). In vivo application of JT09 via intraarticular injection into the rat knee joint after PMM surgery significantly attenuated articular cartilage degeneration (60% improvement in the tibial plateau; P = 0.021 versus vehicle-treated controls). In JT09-treated rats, cartilage content, structure, and functional properties were largely maintained, and osteophyte formation was reduced by 70% (P = 0.005 versus vehicle-treated controls). CONCLUSION The results of this study define a novel mechanism for the role of KOR in articular cartilage homeostasis and disease, providing a potential unifying mechanistic basis for the overlap in disease processes and features involving opioid and HH signaling. Moreover, this study identifies a potential novel therapeutic strategy in which KOR modulation can improve outcomes in patients with OA.
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Affiliation(s)
| | - Omid Jalali
- University of Southern California, Los Angeles
| | - Sean Limfat
- University of Southern California, Los Angeles
| | | | | | - Siyoung Lee
- University of Southern California, Los Angeles
| | - Yucheng Lin
- University of Southern California, Los Angeles, Nanjing First Hospital, Nanjing Medical University, Zhongda Hospital, and Southeast University, Nanjing, China
| | - Liangliang Li
- University of Southern California, Los Angeles, Nanjing First Hospital, and Nanjing Medical University, Nanjing, China
| | | | - Liming Wang
- Nanjing Medical University and Nanjing First Hospital, Nanjing, China
| | - Nancy Q Liu
- University of Southern California, Los Angeles
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11
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Gallo MC, Bolia IK, Jalali O, Rosario S, Rounds A, Heidari KS, Trasolini NA, Prodromo JP, Hatch GF, Weber AE. Risk Factors for Early Subsequent (Revision or Contralateral) ACL Reconstruction: A Retrospective Database Study. Orthop J Sports Med 2020; 8:2325967119901173. [PMID: 32118083 PMCID: PMC7029539 DOI: 10.1177/2325967119901173] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 10/30/2019] [Accepted: 11/06/2019] [Indexed: 12/23/2022] Open
Abstract
Background: Many factors contribute to the risk for subsequent anterior cruciate ligament reconstruction (ACLR) within 2 years from the index procedure. Purpose/Hypothesis: The purpose of this study was 2-fold: (1) to evaluate the incidence of subsequent (revision or contralateral) ACLR at 2 years in a large cohort and (2) to explore the association between patient-specific factors and early subsequent ACLR risk by age group. We hypothesize that 2-year subsequent (revision or contralateral) ACLR rates will be low and that risk factors for subsequent (revision or contralateral) ACLR will vary depending on a patient’s age group. Study Design: Case-control study; Level of evidence, 3. Methods: The California Office of Statewide Health Planning and Development Ambulatory Surgery Database was retrospectively reviewed to assess the incidence of 2-year subsequent (revision or contralateral) ACLR and to identify patient-specific risk factors for early subsequent (revision or contralateral) ACLR by age group between 2005 and 2014. Results: Of 94,108 patients included, the rate of subsequent (revision or contralateral) ACLR was highest in patients younger than 21 years (2.4 per 100 person-years; 95% CI, 2.3-2.6) and lowest in those older than 40 years (1.3 per 100 person-years; 95% CI, 1.2-1.4). Younger age, white race (compared with Hispanic in all age groups and Asian in age <21 or >40 years), private insurance if age younger than 21 years, public insurance or worker's compensation claims if age older than 30 years were significantly associated with an increased risk of subsequent (revision or contralateral) ACLR at 2 years. Conclusion: Results of the present study provide insight into subsequent (revision or contralateral) ACL reconstruction, which can be used to assess and modify treatment for at-risk patients and highlight the need for data mining to generate clinically applicable research using national and international databases.
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Affiliation(s)
- Matthew C Gallo
- University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Ioanna K Bolia
- Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Omid Jalali
- University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Santano Rosario
- University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Alexis Rounds
- University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Keemia Soraya Heidari
- University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Nicholas A Trasolini
- Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - John P Prodromo
- Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - George Frederick Hatch
- Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Alexander Evan Weber
- Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
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12
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Heckmann N, Heidari KS, Jalali O, Weber AE, She R, Omid R, Vangsness CT, Rick Hatch GF. Cutibacterium acnes persists despite topical clindamycin and benzoyl peroxide. J Shoulder Elbow Surg 2019; 28:2279-2283. [PMID: 31471244 DOI: 10.1016/j.jse.2019.06.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 01/04/2019] [Revised: 04/26/2019] [Accepted: 06/03/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Cutibacterium (formerly Propionibacterium) acnes persists in the dermis despite standard skin antiseptic agents, prompting some surgeons to use topical antimicrobials such as benzoyl peroxide and clindamycin prior to shoulder arthroplasty surgery. However, the efficacy of these topical agents has not been established. METHODS The upper backs of 12 volunteers were randomized into 4 treatment quadrants: topical benzoyl peroxide, topical clindamycin, combination topical benzoyl peroxide and clindamycin, and a negative control. The corresponding topical agents were applied to each site twice daily for 3 days. A 3-mm dermal punch biopsy specimen was obtained from each site and cultured for 14 days to assess for C acnes growth. Positive cultures were assessed for the hemolytic phenotype. The McNemar test was used to compare the proportion of positive cultures in each group. RESULTS C acnes grew in 4 of 12 control sites (33.3%), 1 of 12 benzoyl peroxide sites (8.3%), 2 of 12 clindamycin sites (16.7%), and 2 of 12 combination benzoyl peroxide-clindamycin sites (16.7%). The C acnes hemolytic phenotype was present in 2 of 12 control specimens (16.7%) compared with 0 (0.0%) in the benzoyl peroxide group, 2 of 12 (16.7%) in the clindamycin group, and 2 of 12 (16.7%) in the combination benzoyl peroxide-clindamycin group. There were no statistically significant differences between treatment arms. CONCLUSION The topical application of benzoyl peroxide and clindamycin did not eradicate C acnes in all subjects. The clinical implications of these findings are yet to be determined.
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Affiliation(s)
- Nathanael Heckmann
- Keck Hospital Department of Orthopaedics, University of Southern California, Los Angeles, CA, USA.
| | - K Soraya Heidari
- Keck Hospital Department of Orthopaedics, University of Southern California, Los Angeles, CA, USA
| | - Omid Jalali
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Alexander E Weber
- Keck Hospital Department of Orthopaedics, University of Southern California, Los Angeles, CA, USA
| | - Rosemary She
- Department of Medical Microbiology, University of Southern California, Los Angeles, CA, USA
| | - Reza Omid
- Keck Hospital Department of Orthopaedics, University of Southern California, Los Angeles, CA, USA
| | - C Thomas Vangsness
- Keck Hospital Department of Orthopaedics, University of Southern California, Los Angeles, CA, USA
| | - George F Rick Hatch
- Keck Hospital Department of Orthopaedics, University of Southern California, Los Angeles, CA, USA
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13
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Jalali O, Vredenburgh Z, Prodromo J, Benvegnu N, Hatch GF“R. Bipolar Fresh Osteochondral Allograft Transplantation and Joint Reconstruction for Patellar and Trochlear Cartilage Defects. Arthrosc Tech 2019; 8:e1533-e1541. [PMID: 31890534 PMCID: PMC6928370 DOI: 10.1016/j.eats.2019.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 08/12/2019] [Indexed: 02/03/2023] Open
Abstract
Patellar instability is a debilitating condition, and trauma due to the dislocations may severely damage the articular cartilage of the patellofemoral joint. The lack of healing capacity of cartilage makes treatment of such lesions challenging. In young patients, preservation of native bone and cartilage is a priority, and therefore arthroplasty procedures should be avoided even in relatively larger lesions. Fresh osteochondral allografting has been described for these difficult and complex cases, with recent studies showing promising results. In this surgical technique, we describe the use of bipolar osteochondral allografts of the patella and trochlea and patellofemoral joint reconstruction for large bipolar full-thickness cartilage defects due to recurrent dislocation events.
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Affiliation(s)
- Omid Jalali
- Address correspondence to Omid Jalali, 765 Kendall Dr., Laguna Beach, CA 92651.
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14
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Juhan T, Stone M, Jalali O, Curtis W, Prodromo J, Weber AE, Hatch GF, Omid R. Irreparable rotator cuff tears: Current treatment options. Orthop Rev (Pavia) 2019; 11:8146. [PMID: 31616552 PMCID: PMC6784596 DOI: 10.4081/or.2019.8146] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 04/11/2019] [Accepted: 06/07/2019] [Indexed: 01/07/2023] Open
Abstract
Rotator cuff disease is one of the most common causes of shoulder pain, yet controversy still exists regarding treatment of "irreparable" tears. Nonoperative management, including physical therapy and steroid injections, should be reserved for those without significant pain or functional impairment. Debridement may be used for low-demand patients, and should be performed with partial cuff repair, subacromial decompression, and/or acromioplasty to maximize outcomes. Biceps tenotomy and/or tenodesis have been shown to reduce postoperative pain and improve satisfaction when performed in conjunction with rotator cuff repairs, with no difference in functional outcome comparatively. Tendon transfers have been advocated with the potential benefit to improve function and decrease pain. More recently, extracellular matrix and human-derived dermal allografts have been used off-label as patch grafts in irreparable tears. Superior capsular reconstructive techniques and subacromial balloon spacers serve a similar function by acting to depress the humeral head in a cuff-deficient shoulder, however long-term data is needed before widespread adoption of these procedures. Finally, reverse shoulder arthroplasty serves as a salvage option for low demand elderly patients.
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Affiliation(s)
- Tristan Juhan
- Epstein Center for Sports Medicine, Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Michael Stone
- Epstein Center for Sports Medicine, Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Omid Jalali
- Epstein Center for Sports Medicine, Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Will Curtis
- Epstein Center for Sports Medicine, Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - John Prodromo
- Epstein Center for Sports Medicine, Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Alexander E Weber
- Epstein Center for Sports Medicine, Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - George Frederick Hatch
- Epstein Center for Sports Medicine, Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Reza Omid
- Epstein Center for Sports Medicine, Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
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15
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Stone MA, Jalali O, Alluri RK, Diaz PR, Omid R, Gamradt SC, Tibone JE, Mayer EN, Weber A. NONOPERATIVE TREATMENT FOR INJURIES TO THE IN-SEASON THROWING SHOULDER: A CURRENT CONCEPTS REVIEW WITH CLINICAL COMMENTARY. Int J Sports Phys Ther 2018; 13:306-320. [PMID: 30090688 PMCID: PMC6063065] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
Repetitive overhead throwing generates tremendous demands on the shoulder joint of the overhead athlete. Clinicians, therapists, and medical staff are charged with optimizing a throwing athlete's shoulder mobility and stability to maximize performance and prevent injury. Modifiable risk factors such as strength asymmetry, glenohumeral range of motion deficits, and scapulothoracic joint abnormalities contribute to the overhead athlete's predisposition to shoulder injury. Most shoulder injuries in the overhead thrower can be successfully treated nonoperatively to allow in-season return to sport. The optimal rehabilitation program must be based on an accurate evaluation of historical and physical information as well as diagnostic imaging. Return to play decisions should be individualized and should weigh subjective assessments along with objective measurements of range of motion, strength, and function. The purpose of this clinical commentary is to summarize the current literature regarding the nonoperative treatment options for these common injuries, and to present a treatment plan to safely return these athletes to the field of play. Level of evidence 5.
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Affiliation(s)
- Michael A. Stone
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southen California, Los Angeles, CA, USA
| | - Omid Jalali
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southen California, Los Angeles, CA, USA
| | - Ram K. Alluri
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southen California, Los Angeles, CA, USA
| | - Paul R. Diaz
- Department of Athletic Medicine, University of Southern California, Los Angeles, CA, USA
| | - Reza Omid
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southen California, Los Angeles, CA, USA
| | - Seth C. Gamradt
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southen California, Los Angeles, CA, USA
| | - James E. Tibone
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southen California, Los Angeles, CA, USA
| | - Erik N. Mayer
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southen California, Los Angeles, CA, USA
| | - Alexander Weber
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southen California, Los Angeles, CA, USA
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Zinn Z, Ellison S, Leight H, Meeker J, Jalali O. Aging Skin: Skin Care and Differential Diagnoses for the Elder Mountaineer. W V Med J 2016; 112:48-53. [PMID: 27301155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Abstract
Here, we report a case of a middle-aged woman presenting with severe, long-standing, hyperkeratotic plaques of the lower extremities unrelieved by over-the-counter medications. Initial history and clinical findings were suggestive of an inherited ichthyosis. Ichthyoses are genetic disorders characterized by dry scaly skin and altered skin-barrier function. A diagnosis of ichthyosis vulgaris was confirmed by histopathology. Etiology, prevalence, and treatment options are discussed.
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Affiliation(s)
- Hayley Leight
- Department of Dermatology, West Virginia University, Morgantown, WV, USA
| | - Zachary Zinn
- Department of Dermatology, West Virginia University, Morgantown, WV, USA
| | - Omid Jalali
- Department of Dermatology, West Virginia University, Morgantown, WV, USA
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