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Thalody HS, Post ZD, Bridges TN, Qadiri QS, Scaramella A, Ong AC, Ponzio DY. Does Automated Impaction Improve Femoral Component Sizing and Alignment in Total Hip Arthroplasty? J Arthroplasty 2023; 38:2154-2158. [PMID: 37146701 DOI: 10.1016/j.arth.2023.04.054] [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: 12/20/2022] [Revised: 04/22/2023] [Accepted: 04/25/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND While automated impaction can provide a more standardized process for femoral canal preparation, little is known regarding its effect on femoral component sizing and position. The purpose of our study was to directly compare femoral component canal fill ratio (CFR) and coronal alignment between primary total hip arthroplasty (THA) procedures performed with automated impaction versus manual mallet impaction. METHODS A retrospective analysis was performed on 184 patients who underwent primary THA by a single arthroplasty surgeon between 2017 and 2021 with a modern cementless femoral component using either the direct anterior or posterolateral approach. The final cohort was divided into 2 groups based on impaction technique during broaching: automated (N = 122) or manual (N = 62). A propensity score match was used to match for age, body mass index, sex, high versus standard offset stem, and preoperative femoral bone quality. Radiographic review was performed to measure intramedullary prosthetic CFR and coronal alignment. RESULTS The automated cohort trended toward the use of a larger stem (5.67 versus 4.82, P = .006) and had a larger CFR at all 4 levels within the proximal femur (P = .004). The automated cohort had a more valgus and reliable coronal alignment (-0.57 (SD 1.50) versus -0.03 (SD 2.17) degrees, P = .03) and significantly shorter operative time (mean 78 versus 90 minutes, P < .001). There were no intraoperative or postoperative periprosthetic fractures in either cohort. CONCLUSION Automated impaction in primary THA is a safe technique for femoral preparation, which resulted in improved stem coronal alignment, optimized canal fill within the proximal femur, and reduced operative times.
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Affiliation(s)
| | - Zachary D Post
- Rothman Orthopaedic Institute, Egg Harbor Township, New Jersey
| | | | | | | | - Alvin C Ong
- Rothman Orthopaedic Institute, Egg Harbor Township, New Jersey
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Lee Y, Issa TZ, Lambrechts MJ, Carey P, Becsey A, Qadiri QS, Khanna A, Canseco JA, Schroeder GD, Kepler CK, Hilibrand AS, Vaccaro AR. Gender disparities among speakers at major spine conferences. Spine J 2023:S1529-9430(23)03372-7. [PMID: 37690480 DOI: 10.1016/j.spinee.2023.08.024] [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: 03/06/2023] [Revised: 08/07/2023] [Accepted: 08/30/2023] [Indexed: 09/12/2023]
Abstract
PURPOSE To examine ten-year trends in gender representation in speaking roles at major spine conferences. BACKGROUND CONTEXT Medical conferences play an important role in career opportunities. There is little analysis on gender representation of major spine conferences despite several studies demonstrating gender disparities within spine surgery. STUDY DESIGN Observational study. SAMPLE A total of 20,181 abstract speakers across 10 years of academic conferences for six spine societies. OUTCOME MEASURES Percent of female abstract presenters. MATERIALS AND METHODS We collated the annual meeting programs of six major spine conferences (North American Spine Society (NASS), Scoliosis Research Society (SRS), International Meeting on Advanced Spine Techniques (IMAST), Global Spine Congress (GSC), American Association of Neurological Surgeons/Congress of Neurological Surgeons (AANS/CNS) Spine Summit, and the Cervical Spine Research Society (CSRS)) dating from 2013 to 2022. Departmental websites, society webpages, or personal social media were identified for images or the use of gendered pronouns in order to determine speaker gender for each speaker type. All categorical variables were compared using Pearson chi-square analysis. RESULTS Women constituted 1,816 (9.0%) of all 20,181 identified conference speakers. Female representation was highest at NASS (N=680, 12.2%) but lowest at CSRS (6.6%) and GSC (7.1%). Spine Summit (7.4%), IMAST (9.92%), and GSC (9.87%) demonstrated the largest annual percent increases in female representation. Institutions in Middle East and Africa (1.4%), and Central and South America (1.8%) supported the lowest percent of female speakers. Women were significantly less likely to be speakers or moderators/course faculty than to be podium abstract presenters (p<.001). The percent of women as invited speakers (10.4% vs. 5.5%, p=.001) and moderators (11.4% vs. 3.7%, p<.001) increased significantly over the study period, with annual increases of 8.8% and 20.8%, respectively, from 2013 to 2022 (p<.001). CONCLUSIONS While academic spine societies have made significant progress in promoting gender representation, especially among invited speakers and session moderators, women continue to be underrepresented compared to the percent of women in orthopedic surgery and neurosurgery.
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Affiliation(s)
- Yunsoo Lee
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA
| | - Tariq Z Issa
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA.
| | - Mark J Lambrechts
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA
| | - Preston Carey
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA
| | - Alexander Becsey
- College of Medicine, Drexel University, Philadelphia, PA 19129, USA
| | - Qudratullah S Qadiri
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA
| | - Akshay Khanna
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA
| | - Alan S Hilibrand
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA
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Qadiri QS, Ponzio DY, Thalody HS, Clark SC, Post ZD, Orozco FR, Ong AC. Incidental findings on CT scans for robot-assisted total joint arthroplasty. ANZ J Surg 2023; 93:1203-1206. [PMID: 36974354 DOI: 10.1111/ans.18393] [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] [Received: 08/29/2022] [Accepted: 03/01/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION This study documented the incidence of incidental findings from preoperative computerized-tomography (CT) scans obtained for robotic-arm-assisted total joint arthroplasty (TJA) and its effect on patient management. METHODS A retrospective review was conducted for patients who underwent robotic-arm assisted primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) from 2016 to 2020. All patients obtained preoperative CT scans which were formally read by fellowship-trained musculoskeletal radiologists. CT's were flagged with incidental findings and those requiring physician follow-up were identified as significant. RESULTS A total of 1519 patients (mean age, 66 years ±9; 849 females) were evaluated. Seventy-three (4.81%) patients had incidental CT scan findings, and 25 (1.65%) patients had significant incidental findings. Four patients required additional imaging and two patients required intervention. CONCLUSION This study found a 4.81% incidence of incidental findings from preoperative CT scans for robotic-arm-assisted THA and TKA. Of these findings, less than 2% required physician follow-up and less than 1% required intervention. With the increasing popularity of robotic-arm assisted total joint arthroplasty, it is important to consider the necessity of detection and management of associated incidental findings from preoperative CT scans.
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Affiliation(s)
- Qudratullah S Qadiri
- Rothman Orthopaedic Institute, 2500 English Creek Ave bldg. 1300, Egg Harbor Township, New Jersey, 08234, USA
| | - Danielle Y Ponzio
- Rothman Orthopaedic Institute, 2500 English Creek Ave bldg. 1300, Egg Harbor Township, New Jersey, 08234, USA
| | - Hope S Thalody
- Rothman Orthopaedic Institute, 2500 English Creek Ave bldg. 1300, Egg Harbor Township, New Jersey, 08234, USA
| | - Sean C Clark
- Rothman Orthopaedic Institute, 2500 English Creek Ave bldg. 1300, Egg Harbor Township, New Jersey, 08234, USA
| | - Zachary D Post
- Rothman Orthopaedic Institute, 2500 English Creek Ave bldg. 1300, Egg Harbor Township, New Jersey, 08234, USA
| | - Fabio R Orozco
- Orozco Orthopaedics, 1999 New Rd. Suite B, Linwood, New Jersey, 08221, USA
| | - Alvin C Ong
- Rothman Orthopaedic Institute, 2500 English Creek Ave bldg. 1300, Egg Harbor Township, New Jersey, 08234, USA
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Goh GS, Tarabichi S, Baker CM, Qadiri QS, Austin MS. Should We Aim to Help Patients "Feel Better" or "Feel Good" After Total Hip Arthroplasty? Determining Factors Affecting the Achievement of the Minimal Clinically Important Difference and Patient Acceptable Symptom State. J Arthroplasty 2023; 38:293-299. [PMID: 35964857 DOI: 10.1016/j.arth.2022.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/04/2022] [Accepted: 08/07/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Recent attempts have been made to use preoperative patient-reported outcome measure (PROM) thresholds as prior authorization criteria based on the assumption that patients who have higher baseline scores are less likely to achieve the minimal clinically important difference (MCID). This study aimed to identify factors affecting the achievement of MCID and patient acceptable symptom state (PASS) after total hip arthroplasty (THA), and to determine the overlap between the two outcomes. METHODS We identified 3,581 primary, unilateral THAs performed at a single practice in 2015-2019. PROMs including Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS-JR) and 12-item Short Form Health Survey were collected preoperatively and 1-year postoperatively. The likelihood of attaining PASS according to attainment of MCID was assessed. Multivariable regression was used to identify independent predictors of MCID and PASS. RESULTS In total, 79.8% achieved MCID and 73.6% achieved PASS for HOOS-JR. Approximately 1 in 7 patients who achieved MCID did not eventually achieve PASS. Worse preoperative HOOS-JR (odd ratio 0.933) was associated with MCID attainment. Better preoperative HOOS-JR (odd ratio 1.015) was associated with PASS attainment. Men, lower body mass index, better American Society of Anesthesiologists score, and better preoperative 12-item Short Form Health Survey mental score were predictors of MCID and PASS. Age, race, ethnicity, Charlson Comorbidity Index, and smoking status were not significant predictors. CONCLUSION Preoperative PROMs were associated with achieving MCID and PASS after THA, albeit in opposite directions. Clinicians should strive to help patients "feel better" and "feel good" after surgery. Preoperative PROMs should not solely be used to prioritize access to care.
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Affiliation(s)
- Graham S Goh
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Saad Tarabichi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Colin M Baker
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Qudratullah S Qadiri
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Matthew S Austin
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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Tarabichi S, Goh GS, Zanna L, Qadiri QS, Baker CM, Gehrke T, Citak M, Parvizi J. Time to Positivity of Cultures Obtained for Periprosthetic Joint Infection. J Bone Joint Surg Am 2023; 105:107-112. [PMID: 36574630 DOI: 10.2106/jbjs.22.00766] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 12/28/2022]
Abstract
BACKGROUND Despite its well-established limitations, culture remains the gold standard for microbial identification in periprosthetic joint infection (PJI). However, there are no benchmarks for the time to positivity (TTP) on culture for specific microorganisms. This study aimed to determine the TTP for pathogens commonly encountered in PJI. METHODS This retrospective, multicenter study reviewed prospectively maintained institutional PJI databases to identify patients who underwent hip or knee revision arthroplasty from 2017 to 2021 at 2 tertiary centers in the United States and Germany. Only patients who met the 2018 International Consensus Meeting (ICM) criteria for PJI and had a positive intraoperative culture were included. TTP on culture media was recorded for each sample taken intraoperatively. The median TTP was compared among different microbial species and different specimen types. Data are presented either as the mean and the standard deviation or as the median and the interquartile range (IQR). RESULTS A total of 536 ICM-positive patients with positive cultures were included. The mean number of positive cultures per patient was 3.9 ± 2.6. The median TTP, in days, for all positive cultures was 3.3 (IQR, 1.9 to 5.4). Overall, gram-negative organisms (TTP, 1.99 [1.1 to 4.1]; n = 225) grew significantly faster on culture compared with gram-positive organisms (TTP, 3.33 [1.9 to 5.8]; n = 1,774). Methicillin-resistant Staphylococcus aureus (TTP, 1.42 [1.0 to 2.8]; n = 85) had the fastest TTP, followed by gram-negative rods (TTP, 1.92 [1.0 to 3.9]; n = 163), methicillin-sensitive Staphylococcus aureus (TTP, 1.95 [1.1 to 3.3] n = 393), Streptococcus species (TTP, 2.92 [1.2 to 4.3]; n = 230), Staphylococcus epidermidis (TTP, 4.20 [2.4 to 5.5]; n = 555), Candida species (TTP, 5.30 [3.1 to 10]; n = 63), and Cutibacterium acnes (TTP, 6.97 [5.9 to 8.2]; n = 197). When evaluating the median TTP according to specimen type, synovial fluid (TTP, 1.97 [1.1 to 3.1]; n = 112) exhibited the shortest TTP, followed by soft tissue (TTP, 3.17 [1.4 to 5.3]; n = 1,199) and bone (TTP, 4.16 [2.3 to 5.9]; n = 782). CONCLUSIONS To our knowledge, this is the first study to examine the TTP of common microorganisms that are known to cause PJI. Increased awareness of these data may help to guide the selection of appropriate antimicrobial therapy and to predict treatment outcomes in the future. Nonetheless, additional studies with larger cohorts are needed to validate these benchmarks. LEVEL OF EVIDENCE Diagnostic Level IV . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Saad Tarabichi
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Graham S Goh
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Luigi Zanna
- Traumatology and General Orthopedics Department, Careggi University Hospital, Florence, Italy.,Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
| | - Qudratullah S Qadiri
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Colin M Baker
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Thorsten Gehrke
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
| | - Mustafa Citak
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
| | - Javad Parvizi
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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