Christopher J. Fang, G. Coden, Ruijia Niu, Ryan Aghazadeh, D. Mattingly, Eric L. Smith
We review the case of a 48-year-old male with Arthrogryposis Multiplex Congenita (AMC), who presented with chronic right hip pain after a previous total hip arthroplasty (THA) in 1988 and revision THA (rTHA) in 2013. Routine radiographs demonstrated failure of his right acetabulum component with debonding of the bone implant interface and a well-fixed femoral component. The patient underwent a rTHA using a direct anterior approach (DAA) that resulted in a successful recovery without complication at one year. We report the successful result of the first case of a rTHA using a DAA in a patient with AMC.
{"title":"Revision Total Hip Arthroplasty using a Direct Anterior Approach in a Patient with Arthrogryposis Multiplex Congenita: A Case Report","authors":"Christopher J. Fang, G. Coden, Ruijia Niu, Ryan Aghazadeh, D. Mattingly, Eric L. Smith","doi":"10.60118/001c.57791","DOIUrl":"https://doi.org/10.60118/001c.57791","url":null,"abstract":"We review the case of a 48-year-old male with Arthrogryposis Multiplex Congenita (AMC), who presented with chronic right hip pain after a previous total hip arthroplasty (THA) in 1988 and revision THA (rTHA) in 2013. Routine radiographs demonstrated failure of his right acetabulum component with debonding of the bone implant interface and a well-fixed femoral component. The patient underwent a rTHA using a direct anterior approach (DAA) that resulted in a successful recovery without complication at one year. We report the successful result of the first case of a rTHA using a DAA in a patient with AMC.","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience & Innovation","volume":"139 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126915810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Patellar tendon tears are rare debilitating injuries that deeply affect patients’ ability to ambulate. Prompt repair is recommended for more optimal outcomes. Chronic tears are more diffcult to treat. There is no standard of care procedure for this matter and multiple techniques have been described. In this article, we present a case of chronic recurrent patellar tendon tear that has failed surgery twice. The technique performed is a V-Y quadriceps-plasty along with a patellar tendon reconstruction using tibialis anterior allograft in a triangular fashion around the tibial tubercle or as we call a Delta repair of the patellar tendon. A dermal allograft was used to drape our construct providing a biological scaffold. This technique is not previously described as of the time of publication of this paper.
{"title":"Delta technique reconstruction of a failed patellar tendon repair: a case report","authors":"Tarek Haj Shehadeh, Firas Kawtharani","doi":"10.60118/001c.67846","DOIUrl":"https://doi.org/10.60118/001c.67846","url":null,"abstract":"Patellar tendon tears are rare debilitating injuries that deeply affect patients’ ability to ambulate. Prompt repair is recommended for more optimal outcomes. Chronic tears are more diffcult to treat. There is no standard of care procedure for this matter and multiple techniques have been described. In this article, we present a case of chronic recurrent patellar tendon tear that has failed surgery twice. The technique performed is a V-Y quadriceps-plasty along with a patellar tendon reconstruction using tibialis anterior allograft in a triangular fashion around the tibial tubercle or as we call a Delta repair of the patellar tendon. A dermal allograft was used to drape our construct providing a biological scaffold. This technique is not previously described as of the time of publication of this paper.","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience & Innovation","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123562662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Understanding the relationship between the radii of the medial/lateral femoral condyles (MFC/LFC respectively) is important for restoring kinematics in knee arthroplasty. The objective of this study is to use a large cohort of patient magnetic resonance Images (MRIs) to investigate whether asymmetry exists between the radii of the medial/lateral femoral condyles. Patients recruited into the Osteoarthritis Initiative (OAI) with knee MRIs were included. Using a validated machine learning algorithm, the radii of each condyle was calculated. The study sample was split into cohorts depending on medial and lateral compartment wear patterns of each knee in addition to their KL classification. The radii of each condyle in each cohort were compared using paired t-tests. Finally, a multivariable regression was run to evaluate factors that could impact differences between medial/lateral condylar size. 6,829 MRIs were included in this study of which 89% were classified as varus knees. The average best fit radius of the MFC was significantly smaller than that of the LFC (15.3mm vs. 16.8mm, p<0.001) in general and in patient knees with medial wear with KL 0, 1, 2, 3 and 4 and patient knees with lateral wear with KL 0, 2, 3, and 4. After adjusting for age, BMI, and Gender, patients with lateral wear patterns and patients with increasing KL score had a statistically significant larger lateral condylar size. ML was effectively used to automate the measurement of femoral condyle size suggesting that the LCF has a slightly larger radius than the MFC and is not hypoplastic.
了解股骨内侧/外侧髁(分别为MFC/LFC)半径之间的关系对于膝关节置换术中恢复运动学非常重要。本研究的目的是使用大量患者磁共振图像(mri)来调查股骨内髁/外侧髁桡骨之间是否存在不对称。纳入骨关节炎倡议(OAI)并进行膝关节mri的患者。使用经过验证的机器学习算法，计算每个髁的半径。研究样本根据每个膝关节的内侧和外侧隔室磨损模式以及他们的KL分类被分成队列。每个队列中每个髁突的半径采用配对t检验进行比较。最后，采用多变量回归评估可能影响内外侧髁大小差异的因素。6829例mri纳入本研究，其中89%归类为膝内翻。总的来说，MFC的平均最佳配合半径明显小于LFC (15.3mm vs. 16.8mm, p<0.001)，内侧磨损为KL 0、1、2、3和4的患者和外侧磨损为KL 0、2、3和4的患者的膝关节也明显小于LFC (15.3mm vs. 16.8mm, p<0.001)。在调整年龄、BMI和性别后，有外侧磨损模式的患者和KL评分增加的患者的外侧髁尺寸有统计学意义上的较大。ML被有效地用于自动测量股骨髁的大小，这表明LCF的半径比MFC略大，并且没有发育不良。
{"title":"The Lateral Femoral Condyle is not Hypoplastic Relative to the Medial Condyle in 6829 Magnetic Resonance Images Irrespective of Gender, Age, or Extent of Arthritis","authors":"R. Shah, T. Vail, S. Bini","doi":"10.60118/001c.68135","DOIUrl":"https://doi.org/10.60118/001c.68135","url":null,"abstract":"Understanding the relationship between the radii of the medial/lateral femoral condyles (MFC/LFC respectively) is important for restoring kinematics in knee arthroplasty. The objective of this study is to use a large cohort of patient magnetic resonance Images (MRIs) to investigate whether asymmetry exists between the radii of the medial/lateral femoral condyles. Patients recruited into the Osteoarthritis Initiative (OAI) with knee MRIs were included. Using a validated machine learning algorithm, the radii of each condyle was calculated. The study sample was split into cohorts depending on medial and lateral compartment wear patterns of each knee in addition to their KL classification. The radii of each condyle in each cohort were compared using paired t-tests. Finally, a multivariable regression was run to evaluate factors that could impact differences between medial/lateral condylar size. 6,829 MRIs were included in this study of which 89% were classified as varus knees. The average best fit radius of the MFC was significantly smaller than that of the LFC (15.3mm vs. 16.8mm, p<0.001) in general and in patient knees with medial wear with KL 0, 1, 2, 3 and 4 and patient knees with lateral wear with KL 0, 2, 3, and 4. After adjusting for age, BMI, and Gender, patients with lateral wear patterns and patients with increasing KL score had a statistically significant larger lateral condylar size. ML was effectively used to automate the measurement of femoral condyle size suggesting that the LCF has a slightly larger radius than the MFC and is not hypoplastic.","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience & Innovation","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133574731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rachel A. Ranson, Herbert Mao, Christopher Saker, Kevin Lehane, Arianna L. Gianakos, M. Stamm, M. Mulcahey
The purpose of this study was to investigate differences in the demographic characteristics of orthopaedic surgery residents in 2021 in regard to sex, degree earned, and regional or medical school affiliation. The Fellowship and Residency Electronic Interactive Database was used to identify all orthopaedic surgery residency programs in the United States. Resident sex, degree, residency year, and geographic region attended for residency and medical school were collected from each program website. 199 orthopaedic surgery residencies were identified: 153 traditional Accreditation Council for Graduate Medical Education (tACGME) programs, 38 traditional American Osteopathic Association (tAOA) programs, and 8 military programs, which were excluded. 4,095 orthopaedic surgery residents were identified. Females accounted for 16.6% (N=679) of residents, 17.6% (N=620) within tACGME programs and 10.4% (N=59) in tAOA programs (p<0.001). The 573 orthopaedic residents with DO degrees accounted for 14% of the residents identified, 97.6% (N=533) of residents in tAOA programs, and 1.1% (N=40) of residents in tACGME programs. Regional data showed that 34.4% (N=1208) of MDs trained in the Northeast, while 41.9% (N=240) of DOs trained in the Midwest. There has been a slight increase in the representation of females and DOs in orthopaedic surgery residency programs since the mid-2000s; however, data following the ACGME and AOA merger still shows significant predilection for male and MD degree applicants. This study suggests that the Northeast and Midwest regions of the United States train more MDs and DOs, respectively. This finding offers potential data for interested applicants and demonstrates opportunity for more heterogeneity in applicant selection.
{"title":"The Demographic Make-up of Orthopaedic Surgery Residents in the United States Post ACGME Merger","authors":"Rachel A. Ranson, Herbert Mao, Christopher Saker, Kevin Lehane, Arianna L. Gianakos, M. Stamm, M. Mulcahey","doi":"10.60118/001c.57307","DOIUrl":"https://doi.org/10.60118/001c.57307","url":null,"abstract":"The purpose of this study was to investigate differences in the demographic characteristics of orthopaedic surgery residents in 2021 in regard to sex, degree earned, and regional or medical school affiliation. The Fellowship and Residency Electronic Interactive Database was used to identify all orthopaedic surgery residency programs in the United States. Resident sex, degree, residency year, and geographic region attended for residency and medical school were collected from each program website. 199 orthopaedic surgery residencies were identified: 153 traditional Accreditation Council for Graduate Medical Education (tACGME) programs, 38 traditional American Osteopathic Association (tAOA) programs, and 8 military programs, which were excluded. 4,095 orthopaedic surgery residents were identified. Females accounted for 16.6% (N=679) of residents, 17.6% (N=620) within tACGME programs and 10.4% (N=59) in tAOA programs (p<0.001). The 573 orthopaedic residents with DO degrees accounted for 14% of the residents identified, 97.6% (N=533) of residents in tAOA programs, and 1.1% (N=40) of residents in tACGME programs. Regional data showed that 34.4% (N=1208) of MDs trained in the Northeast, while 41.9% (N=240) of DOs trained in the Midwest. There has been a slight increase in the representation of females and DOs in orthopaedic surgery residency programs since the mid-2000s; however, data following the ACGME and AOA merger still shows significant predilection for male and MD degree applicants. This study suggests that the Northeast and Midwest regions of the United States train more MDs and DOs, respectively. This finding offers potential data for interested applicants and demonstrates opportunity for more heterogeneity in applicant selection.","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience & Innovation","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129500872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. Coden, T. Zink, Christopher J. Fang, K. Garvey, Eric Schafer, D. Mattingly, M. Gordon, Eric L. Smith
Diaphyseal engaging femoral stems are often required for revision total hip arthroplasty (THA) due to complex anatomy. However, no studies have been performed to identify the best implant or intraoperative radiographic parameters of stability. We sought to evaluate the rate of complications and radiographic parameters of an uncemented diaphyseal engaging femoral stem in revision THA. We retrospectively reviewed 54 patients who underwent revision THA using an uncemented diaphyseal engaging modular femoral stem between 2012 and 2019 with mean follow-up of 1.4 years. Mean age was 66.3 years (range 23-90), and 47.2% of patients were female. 36 (73.5%) hips were classified as a Paprosky 3a and 13 (26.5%) patients were classified as a Paprosky 3b. We calculated the radiographic subsidence, canal fill ratio, and complete cortical contact percentage, defined as the sum of anterior, posterior, medial, and lateral cortical contact. Chi-square related-samples t-test, and Pearson’s correlation coefficient were used to compare values. Significance was set at <0.05. Postoperative periprosthetic infection occurred in 4 patients (7.41%) and was the most common complication. There were no revisions for aseptic loosening or failure of the diaphyseal engaging femoral stem. Canal fill ratio (mean=85.85%, p<0.001) and complete cortical contact (mean=71.74%, p<0.001) were less than the expected, while subsidence was higher than the expected (mean=2.07mm, p<0.001). Complete cortical contact was not associated with canal fill ratio (p=0.07) or subsidence (p=0.50). This uncemented diaphyseal engaging femoral stem had a low complication rate (11.11%) when used for revision THA. While canal fill ratio and complete cortical contact was less than the expected mean of 100%, it was not correlated with subsidence. It is important for surgeons to know that this uncemented diaphyseal engaging femoral stem can be well fitting despite low canal fill ratio and cortical contact.
{"title":"Radiographic Outcomes using a Diaphyseal Engaging Femoral Stem for Revision Total Hip Arthroplasty","authors":"G. Coden, T. Zink, Christopher J. Fang, K. Garvey, Eric Schafer, D. Mattingly, M. Gordon, Eric L. Smith","doi":"10.60118/001c.68119","DOIUrl":"https://doi.org/10.60118/001c.68119","url":null,"abstract":"Diaphyseal engaging femoral stems are often required for revision total hip arthroplasty (THA) due to complex anatomy. However, no studies have been performed to identify the best implant or intraoperative radiographic parameters of stability. We sought to evaluate the rate of complications and radiographic parameters of an uncemented diaphyseal engaging femoral stem in revision THA. We retrospectively reviewed 54 patients who underwent revision THA using an uncemented diaphyseal engaging modular femoral stem between 2012 and 2019 with mean follow-up of 1.4 years. Mean age was 66.3 years (range 23-90), and 47.2% of patients were female. 36 (73.5%) hips were classified as a Paprosky 3a and 13 (26.5%) patients were classified as a Paprosky 3b. We calculated the radiographic subsidence, canal fill ratio, and complete cortical contact percentage, defined as the sum of anterior, posterior, medial, and lateral cortical contact. Chi-square related-samples t-test, and Pearson’s correlation coefficient were used to compare values. Significance was set at <0.05. Postoperative periprosthetic infection occurred in 4 patients (7.41%) and was the most common complication. There were no revisions for aseptic loosening or failure of the diaphyseal engaging femoral stem. Canal fill ratio (mean=85.85%, p<0.001) and complete cortical contact (mean=71.74%, p<0.001) were less than the expected, while subsidence was higher than the expected (mean=2.07mm, p<0.001). Complete cortical contact was not associated with canal fill ratio (p=0.07) or subsidence (p=0.50). This uncemented diaphyseal engaging femoral stem had a low complication rate (11.11%) when used for revision THA. While canal fill ratio and complete cortical contact was less than the expected mean of 100%, it was not correlated with subsidence. It is important for surgeons to know that this uncemented diaphyseal engaging femoral stem can be well fitting despite low canal fill ratio and cortical contact.","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience & Innovation","volume":"96 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134172125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Orthopedics still very much remains an attractive area of investment for private equity because the demand for orthopedic care is high, yet the supply of orthopedic surgeons in the U.S. is relatively low. This supply and demand imbalance provides for long-term sustainable growth of orthopedic services within what remains a highly fragmented clinical specialty, thus bolstering investment interest from private equity firms seeking to form strategic partnerships with best-in-class orthopedic providers. Further, data from a recent survey of orthopedic surgeons who have partnered with private equity noted that “growth and long-term success of the clinical enterprise” were the main drivers of independent orthopedic groups pursuing private equity partnerships.
{"title":"Private Equity Partnerships with Orthopedic Groups: 2022 Trends and Strategic Insights for 2023 Including Insights from Special Feature: Survey of Orthopedic Surgeons on “Life After Closing” in Private Equity Deals","authors":"G. Herschman, Dana L. Jacoby, Hector Torres","doi":"10.60118/001c.70249","DOIUrl":"https://doi.org/10.60118/001c.70249","url":null,"abstract":"Orthopedics still very much remains an attractive area of investment for private equity because the demand for orthopedic care is high, yet the supply of orthopedic surgeons in the U.S. is relatively low. This supply and demand imbalance provides for long-term sustainable growth of orthopedic services within what remains a highly fragmented clinical specialty, thus bolstering investment interest from private equity firms seeking to form strategic partnerships with best-in-class orthopedic providers. Further, data from a recent survey of orthopedic surgeons who have partnered with private equity noted that “growth and long-term success of the clinical enterprise” were the main drivers of independent orthopedic groups pursuing private equity partnerships.","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience & Innovation","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129657847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Patrick Szukics, Elizabeth Ford, Brian E. Fliegel, William Baker, S. McMillan
The risk of a periprosthetic joint infection after arthroplasty can be devastating to a patient, with the possibility of loss of limb or even death. There are multiple tools at the surgeon’s disposal to help minimize the risk of a complication occurring, and we present a novel intra-operative sterilization technique that has the potential to further minimize these unwanted outcomes. A 60-year-old right hand dominant male who had previously undergone two attempted rotator cuff spearing surgeries on his right shoulder now presents with continued right shoulder pain and evidence of rotator cuff arthropathy on imaging. He wished to proceed with a reverse total shoulder arthroplasty (rTSA). Due to his multiple surgeries on this shoulder as well as his medical comorbidities, we were concerned with his elevated risk for intra-operative complications, blood loss and hematoma formation, as well as risk for a periprosthetic joint infection. We present our technique for minimizing the risk of these undesirable outcomes, one of which is a novel intra-operative sterilization technique with sterile betadine being used in the surgical wound. Our technique to optimize the patient preoperatively, minimize periprosthetic joint infection, and maintain adequate hemostasis throughout the surgery can be utilized to help surgeons minimize the risk of sustaining these unwanted outcomes.
{"title":"Optimizing Outcomes in Shoulder Arthroplasty: Mitigating Surgical Complications in High-Risk Patients – Case Report","authors":"Patrick Szukics, Elizabeth Ford, Brian E. Fliegel, William Baker, S. McMillan","doi":"10.60118/001c.67844","DOIUrl":"https://doi.org/10.60118/001c.67844","url":null,"abstract":"The risk of a periprosthetic joint infection after arthroplasty can be devastating to a patient, with the possibility of loss of limb or even death. There are multiple tools at the surgeon’s disposal to help minimize the risk of a complication occurring, and we present a novel intra-operative sterilization technique that has the potential to further minimize these unwanted outcomes. A 60-year-old right hand dominant male who had previously undergone two attempted rotator cuff spearing surgeries on his right shoulder now presents with continued right shoulder pain and evidence of rotator cuff arthropathy on imaging. He wished to proceed with a reverse total shoulder arthroplasty (rTSA). Due to his multiple surgeries on this shoulder as well as his medical comorbidities, we were concerned with his elevated risk for intra-operative complications, blood loss and hematoma formation, as well as risk for a periprosthetic joint infection. We present our technique for minimizing the risk of these undesirable outcomes, one of which is a novel intra-operative sterilization technique with sterile betadine being used in the surgical wound. Our technique to optimize the patient preoperatively, minimize periprosthetic joint infection, and maintain adequate hemostasis throughout the surgery can be utilized to help surgeons minimize the risk of sustaining these unwanted outcomes.","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience & Innovation","volume":"63 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134594514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
An editorial concerning the value of the remplissage procedure.
一篇关于补偿程序价值的社论。
{"title":"Remplissage: is it all that?","authors":"P. Sethi","doi":"10.60118/001c.68394","DOIUrl":"https://doi.org/10.60118/001c.68394","url":null,"abstract":"An editorial concerning the value of the remplissage procedure.","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience & Innovation","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130082824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Mulcahey, Jeffrey M. Henstenburg, A. Hinkle, M. Stamm, M. Morley, Joshua Luginbuhl
Medical student clerkship evaluations are susceptible to preceptor bias. Students interested in orthopaedics may choose not to disclose their career path during clerkships to avoid bias. The purpose of this study was to identify factors that may lead to grading bias, including career choice disclosure, among medical students interested in a career in orthopaedic surgery. A cross-sectional survey was performed by distributing an anonymous electronic survey. Respondents were asked if they disclosed an interest in orthopaedic surgery during core clerkships and whether or not they believed it impacted their grade. The relationship between demographic variables including age, gender, race, ethnicity, and geographical location were also collected and compared. Multiple institutions in different geographic locations in the US. Medical students in orthopaedic interest groups or those who completed an orthopaedic surgery rotation. Of 149 responses, 90 (60.1%) of students chose to disclose an interest in orthopaedics during all clerkships. Over 50% of students were able to achieve honors in core clerkships except for OB/Gyn (41/112, 36.6% honors) and emergency medicine (17/59, 28.8% honors). On average, 7.9% of students believed disclosure had a negative impact on their grade, but in internal medicine and OB/Gyn, those that disclosed were able to achieve honors more often than those that did not. Males (38/50, 76%) were given honors more often than females (11/24, 45.8%) in their surgery clerkship and those that identified as “other” race (1/6, 16.7%) achieved fewer honors in surgery and pediatrics compared to White, Black, Asian, Indian, and Hispanic students (48/68, 70.6%). Some students believe disclosing an interest in orthopaedics may negatively impact their grade, but the opposite may be true. Other potential areas of bias include gender and race. More research is needed to improve the clerkship evaluation process given an increasingly competitive application process.
{"title":"Career Choice Disclosure and Clerkship Grades Among Orthopaedic Residency Applicants","authors":"M. Mulcahey, Jeffrey M. Henstenburg, A. Hinkle, M. Stamm, M. Morley, Joshua Luginbuhl","doi":"10.60118/001c.55753","DOIUrl":"https://doi.org/10.60118/001c.55753","url":null,"abstract":"Medical student clerkship evaluations are susceptible to preceptor bias. Students interested in orthopaedics may choose not to disclose their career path during clerkships to avoid bias. The purpose of this study was to identify factors that may lead to grading bias, including career choice disclosure, among medical students interested in a career in orthopaedic surgery. A cross-sectional survey was performed by distributing an anonymous electronic survey. Respondents were asked if they disclosed an interest in orthopaedic surgery during core clerkships and whether or not they believed it impacted their grade. The relationship between demographic variables including age, gender, race, ethnicity, and geographical location were also collected and compared. Multiple institutions in different geographic locations in the US. Medical students in orthopaedic interest groups or those who completed an orthopaedic surgery rotation. Of 149 responses, 90 (60.1%) of students chose to disclose an interest in orthopaedics during all clerkships. Over 50% of students were able to achieve honors in core clerkships except for OB/Gyn (41/112, 36.6% honors) and emergency medicine (17/59, 28.8% honors). On average, 7.9% of students believed disclosure had a negative impact on their grade, but in internal medicine and OB/Gyn, those that disclosed were able to achieve honors more often than those that did not. Males (38/50, 76%) were given honors more often than females (11/24, 45.8%) in their surgery clerkship and those that identified as “other” race (1/6, 16.7%) achieved fewer honors in surgery and pediatrics compared to White, Black, Asian, Indian, and Hispanic students (48/68, 70.6%). Some students believe disclosing an interest in orthopaedics may negatively impact their grade, but the opposite may be true. Other potential areas of bias include gender and race. More research is needed to improve the clerkship evaluation process given an increasingly competitive application process.","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience & Innovation","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115342139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gregory J. Kirchner, Andrew Kim, Mark L. Dunleavy, Matthew Webb, Yehuda E. Kerbel, V. Moretti
Periprosthetic joint infection (PJI) is a medical and economical challenge. Specific post-operative wound dressings have been developed to mitigate risk of PJI following total hip arthroplasty (THA) and total knee arthroplasty (TKA), but these come with added cost and unknown benefit. The purpose of this study was to determine which dressings may be economically justifiable. The average added cost of Xeroform with gauze (Xeroform+gauze), Mepilex Border, Aquacel Ag, and Dermabond Prineo dressings compared to standard dressing (Xeroform+gauze) only were obtained from institutional records and contemporary literature. Baseline infection rates following THA and TKA and average costs of PJI treatment were obtained from the literature. A break-even analysis was utilized to determine the absolute risk reduction (ARR) needed in infection rate to make each dressing cost-effective. At $3.00, a single Xeroform+gauze is economically justified if the initial infection rate for TKA (1.10%) and THA (1.62%) are reduced by an ARR of 0.01% and 0.009%, respectively. Two to three additional post-operative dressing changes increases the cost of Xeroform+gauze to $9.00-12.00 and increases the required ARR for TKA to 0.04-0.05% and for THA to 0.028-0.038%. Mepilex Border costs $29.00 and requires an ARR of 0.11% for TKA and 0.09% for THA. Aquacel Ag costs $40.00 and requires an ARR of 0.16% for TKA and 0.13% for THA. Dermabond Prineo costs $79.00 and requires an ARR of 0.31% for TKA and 0.25% for THA. Variations in estimation of initial infection rate did not impact ARR for any dressing type. Orthopaedic surgeons have multiple options for surgical dressings following total joint replacement. With respect to infection prophylaxis, Xeroform+gauze is the most cost-effective. Other specialized dressings such as Mepilex Border, Aquacel Ag, or Dermabond Prineo, require significantly higher reductions in infection rate to be economically justifiable.
{"title":"The Cost-Effectiveness of Wound Dressings for Infection Prophylaxis in Total Joint Arthroplasty: An Economic Evaluation","authors":"Gregory J. Kirchner, Andrew Kim, Mark L. Dunleavy, Matthew Webb, Yehuda E. Kerbel, V. Moretti","doi":"10.60118/001c.56922","DOIUrl":"https://doi.org/10.60118/001c.56922","url":null,"abstract":"Periprosthetic joint infection (PJI) is a medical and economical challenge. Specific post-operative wound dressings have been developed to mitigate risk of PJI following total hip arthroplasty (THA) and total knee arthroplasty (TKA), but these come with added cost and unknown benefit. The purpose of this study was to determine which dressings may be economically justifiable. The average added cost of Xeroform with gauze (Xeroform+gauze), Mepilex Border, Aquacel Ag, and Dermabond Prineo dressings compared to standard dressing (Xeroform+gauze) only were obtained from institutional records and contemporary literature. Baseline infection rates following THA and TKA and average costs of PJI treatment were obtained from the literature. A break-even analysis was utilized to determine the absolute risk reduction (ARR) needed in infection rate to make each dressing cost-effective. At $3.00, a single Xeroform+gauze is economically justified if the initial infection rate for TKA (1.10%) and THA (1.62%) are reduced by an ARR of 0.01% and 0.009%, respectively. Two to three additional post-operative dressing changes increases the cost of Xeroform+gauze to $9.00-12.00 and increases the required ARR for TKA to 0.04-0.05% and for THA to 0.028-0.038%. Mepilex Border costs $29.00 and requires an ARR of 0.11% for TKA and 0.09% for THA. Aquacel Ag costs $40.00 and requires an ARR of 0.16% for TKA and 0.13% for THA. Dermabond Prineo costs $79.00 and requires an ARR of 0.31% for TKA and 0.25% for THA. Variations in estimation of initial infection rate did not impact ARR for any dressing type. Orthopaedic surgeons have multiple options for surgical dressings following total joint replacement. With respect to infection prophylaxis, Xeroform+gauze is the most cost-effective. Other specialized dressings such as Mepilex Border, Aquacel Ag, or Dermabond Prineo, require significantly higher reductions in infection rate to be economically justifiable.","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience & Innovation","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129699280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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