Pub Date : 2023-02-01Epub Date: 2022-05-13DOI: 10.1177/15563316221091798
Pramod N Kamalapathy, Jon Raso, Rana Rahman, Sanjana Harihar, Santiago Lozano-Calderon, Hamid Hassanzadeh
Background: Fellowship directors are assumed to be distinguished in orthopedics, but the traits and training that have enabled them to achieve their leadership positions have not been assessed. Purpose: We sought to identify common demographics, research output, and educational trends of fellowship directors in orthopedics, with an emphasis on racial, ethnic, and gender diversity. Methods: We conducted a literature review to identify published studies on fellowship directors in orthopedic surgery and found 4 cross-sectional studies of fellowship directors in spine, arthroplasty, pediatrics, and sports medicine subspecialties. Another 4 accredited orthopedic subspecialties and their fellowship directors were identified using the American College of Graduate Medical Education Public Accreditation Data System for 2020-2021 and national fellowship directories. Data endpoints included race/ethnicity, age, sex, residency and fellowship training institutions, year of fellowship completion, year of hire at current institution, year of fellowship directors appointment, and h-index. The demographics and educational backgrounds for listed fellowship directors were collected from curricula vitae (CVs). Results: Of the 537 fellowship directors identified among 8 orthopedic subspecialties, the average age was 52.9 ± 2.2 years, 5.6% (N = 30) were women, 79.1% (N = 406) were white, 12.5% (N = 64) were Asian American, 3.7% (N = 19) were African American, 2.9% (N = 15) were Middle Eastern, and 1.7% (N = 9) were Hispanic/Latino. Oncology 20% (N = 4) had the highest percentage of female fellowship directors; 37.6% (N = 202) of fellowship directors were at the same institution they trained at for residency or fellowship. Their average h-index was 18.6 ± 3.7. Conclusion: This study of fellowship directors in orthopedics found that they have a high research output and a high level of institutional familiarity. We identified a need for greater diversity in these leadership positions in both gender and race/ethnicity.
{"title":"Orthopedic Surgery Fellowship Directors: Trends in Demographics, Education, Employment, and Institutional Familiarity.","authors":"Pramod N Kamalapathy, Jon Raso, Rana Rahman, Sanjana Harihar, Santiago Lozano-Calderon, Hamid Hassanzadeh","doi":"10.1177/15563316221091798","DOIUrl":"10.1177/15563316221091798","url":null,"abstract":"<p><p><i>Background:</i> Fellowship directors are assumed to be distinguished in orthopedics, but the traits and training that have enabled them to achieve their leadership positions have not been assessed. <i>Purpose</i>: We sought to identify common demographics, research output, and educational trends of fellowship directors in orthopedics, with an emphasis on racial, ethnic, and gender diversity. <i>Methods</i>: We conducted a literature review to identify published studies on fellowship directors in orthopedic surgery and found 4 cross-sectional studies of fellowship directors in spine, arthroplasty, pediatrics, and sports medicine subspecialties. Another 4 accredited orthopedic subspecialties and their fellowship directors were identified using the American College of Graduate Medical Education Public Accreditation Data System for 2020-2021 and national fellowship directories. Data endpoints included race/ethnicity, age, sex, residency and fellowship training institutions, year of fellowship completion, year of hire at current institution, year of fellowship directors appointment, and h-index. The demographics and educational backgrounds for listed fellowship directors were collected from curricula vitae (CVs). <i>Results</i>: Of the 537 fellowship directors identified among 8 orthopedic subspecialties, the average age was 52.9 ± 2.2 years, 5.6% (N = 30) were women, 79.1% (N = 406) were white, 12.5% (N = 64) were Asian American, 3.7% (N = 19) were African American, 2.9% (N = 15) were Middle Eastern, and 1.7% (N = 9) were Hispanic/Latino. Oncology 20% (N = 4) had the highest percentage of female fellowship directors; 37.6% (N = 202) of fellowship directors were at the same institution they trained at for residency or fellowship. Their average h-index was 18.6 ± 3.7. <i>Conclusion</i>: This study of fellowship directors in orthopedics found that they have a high research output and a high level of institutional familiarity. We identified a need for greater diversity in these leadership positions in both gender and race/ethnicity.</p>","PeriodicalId":35357,"journal":{"name":"Hss Journal","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9837408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10696407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-01Epub Date: 2022-08-09DOI: 10.1177/15563316221115723
Kyle N Kunze, Amar S Vadhera, Evan M Polce, Carlos A Higuera, Ahmed Siddiqi, Jorge Chahla, Nicolas S Piuzzi
Background: Given the increasing interest and potential use of social media for the promotion of orthopedic literature, there is a need to better understand Altmetrics. Purposes: We sought to determine the relationship between the Altmetric Attention Score (AAS) and the number of citations for articles on total joint arthroplasty (TJA) published in orthopedics journals. We also sought to determine the predictors of greater social media attention for these articles. Methods: Articles on TJA published in Bone and Joint Journal (BJJ), Journal of Bone and Joint Surgery (JBJS), Clinical Orthopedics and Related Research (CORR), Journal of Arthroplasty, Journal of Knee Surgery, Hip International, and Acta Orthopaedica in 2016 were extracted (n = 498). One-way analysis of variance with Bonferroni corrections was used to compare AAS and citations across journals. Multivariate regressions were used to determine predictors of social media attention and number of citations. Results: The mean AAS and number of citations were 7.5 (range: 0-289) and 16.7 (range: 0-156), respectively. Significant between-group effects were observed according to journal for AAS and number of citations. Publishing an article in JBJS was the strongest predictor of higher number of citations. Publishing an article in BJJ was the only independent predictor of higher AAS, while publishing an article in JBJS or CORR trended toward statistical significance. A higher AAS was a significant predictor of a higher number of citations. Number of citations and number of study references were positive predictors of greater social media attention on Twitter and Facebook. Conclusions: In articles on TJA published in 7 journals in 2016, a higher AAS was a associated with a higher number of citations. Various bibliometric characteristics were found to be significantly associated with greater social media attention; the most common influences were number of citations and number of references. Researchers in orthopedics can use this information when considering how to assess the impact of their work.
背景:鉴于人们对社交媒体在推广骨科文献方面的兴趣与日俱增,而且社交媒体也有可能被用来推广骨科文献,因此有必要更好地了解 Altmetrics。目的: 我们试图确定 Altmetric 关注度得分(Altmetric Attention Score)与读者关注度之间的关系:我们试图确定 Altmetric Attention Score (AAS) 与骨科期刊上发表的有关全关节成形术 (TJA) 文章的引用次数之间的关系。我们还试图确定这些文章获得更多社交媒体关注的预测因素。研究方法提取2016年发表在《骨与关节杂志》(Bone and Joint Journal,BJJ)、《骨与关节外科杂志》(Journal of Bone and Joint Surgery,JBJS)、《临床骨科及相关研究》(Clinical Orthopedics and Related Research,CORR)、《关节成形术杂志》(Journal of Arthroplasty)、《膝关节外科杂志》(Journal of Knee Surgery)、《国际髋关节》(Hip International)和《骨科学》(Acta Orthopaedica)上的有关TJA的文章(n = 498)。采用单因素方差分析和Bonferroni校正比较不同期刊的AAS和引文。多变量回归用于确定社交媒体关注度和引用次数的预测因素。结果平均AAS和引用次数分别为7.5(范围:0-289)和16.7(范围:0-156)。根据期刊不同,AAS和引用次数在组间存在显著影响。在 JBJS 上发表文章是被引用次数较高的最强预测因素。在《BJJ》上发表文章是唯一能预测较高AAS的独立因素,而在《JBJS》或《CORR》上发表文章则有统计学意义。较高的AAS可显著预测较高的引用次数。引用次数和研究参考文献的数量是 Twitter 和 Facebook 上更多社交媒体关注的积极预测因素。结论:2016年在7种期刊上发表的有关TJA的文章中,AAS越高,引用次数越多。研究发现,各种文献计量学特征与更高的社交媒体关注度显著相关;最常见的影响因素是引用次数和参考文献数量。骨科研究人员在考虑如何评估其工作的影响力时,可以利用这些信息。
{"title":"The Altmetric Attention Score Is Associated With Citation Rates and May Reflect Academic Impact in the Total Joint Arthroplasty Literature.","authors":"Kyle N Kunze, Amar S Vadhera, Evan M Polce, Carlos A Higuera, Ahmed Siddiqi, Jorge Chahla, Nicolas S Piuzzi","doi":"10.1177/15563316221115723","DOIUrl":"10.1177/15563316221115723","url":null,"abstract":"<p><p><i>Background:</i> Given the increasing interest and potential use of social media for the promotion of orthopedic literature, there is a need to better understand Altmetrics. <i>Purposes</i>: We sought to determine the relationship between the Altmetric Attention Score (AAS) and the number of citations for articles on total joint arthroplasty (TJA) published in orthopedics journals. We also sought to determine the predictors of greater social media attention for these articles. <i>Methods</i>: Articles on TJA published in <i>Bone and Joint Journal (BJJ)</i>, <i>Journal of Bone and Joint Surgery (JBJS)</i>, <i>Clinical Orthopedics and Related Research (CORR)</i>, <i>Journal of Arthroplasty</i>, <i>Journal of Knee Surgery</i>, <i>Hip International</i>, and <i>Acta Orthopaedica</i> in 2016 were extracted (<i>n =</i> 498). One-way analysis of variance with Bonferroni corrections was used to compare AAS and citations across journals. Multivariate regressions were used to determine predictors of social media attention and number of citations. <i>Results</i>: The mean AAS and number of citations were 7.5 (range: 0-289) and 16.7 (range: 0-156), respectively. Significant between-group effects were observed according to journal for AAS and number of citations. Publishing an article in <i>JBJS</i> was the strongest predictor of higher number of citations. Publishing an article in <i>BJJ</i> was the only independent predictor of higher AAS, while publishing an article in <i>JBJS</i> or <i>CORR</i> trended toward statistical significance. A higher AAS was a significant predictor of a higher number of citations. Number of citations and number of study references were positive predictors of greater social media attention on Twitter and Facebook. <i>Conclusions</i>: In articles on TJA published in 7 journals in 2016, a higher AAS was a associated with a higher number of citations. Various bibliometric characteristics were found to be significantly associated with greater social media attention; the most common influences were number of citations and number of references. Researchers in orthopedics can use this information when considering how to assess the impact of their work.</p>","PeriodicalId":35357,"journal":{"name":"Hss Journal","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9837400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10707832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-01Epub Date: 2022-05-03DOI: 10.1177/15563316221092320
Daniel W Green, Sofia Hidalgo Perea, Anne M Kelly, Hollis G Potter
Background: Symptomatic pediatric patients referred for magnetic resonance imaging (MRI) commonly present with traumatic bone marrow edema (BME) patterns.
Purpose: We sought to associate discrete MRI patterns of BME with specific injury mechanisms in pediatric knee injuries to classify injury patterns by anatomical location of the BME. We aimed to group these into 6 patterns: patellar dislocation, extensor mechanism overload, hyperextension, single compartment impaction, ligament avulsion/translation, and direct contusion.
Methods: We retrospectively reviewed 314 MRIs performed with a standard protocol on symptomatic patients aged 3 to 18 years at 1 institution. Our analysis included images, reports, and traumatic BME patterns. A musculoskeletal radiologist and orthopedic surgeon independently assigned 1 of the 6 injury patterns to each scan.
Results: After exclusion criteria were applied to the 314 MRIs, 62 (19.7%) remained, 40 boys and 22 girls. The average age was of 12.2 years. The most frequent injury patterns were patellar dislocation (n = 22, 35%) and extensor mechanism overload (n = 14, 22%). κ value associated with pattern determination was .766, indicating substantial concordance. Bone marrow edema signal intensity on fat-suppressed sequences was classified as severe in 92% of cases.
Conclusions: The strength of pediatric knee ligaments and tendons relative to epiphyseal bone may contribute to a high rate of BME injury patterns seen on MRI in symptomatic pediatric patients. We found that pediatric BME could be classified into 6 specific injury patterns, which might be useful to clinicians in recognizing mechanisms of injury. Further clinical studies are needed to assess the clinical differences in both short-term and long-term outcomes of the BME patterns described.
{"title":"Bone Marrow Edema Injury Patterns in the Pediatric Knee: An MRI Study.","authors":"Daniel W Green, Sofia Hidalgo Perea, Anne M Kelly, Hollis G Potter","doi":"10.1177/15563316221092320","DOIUrl":"10.1177/15563316221092320","url":null,"abstract":"<p><strong>Background: </strong>Symptomatic pediatric patients referred for magnetic resonance imaging (MRI) commonly present with traumatic bone marrow edema (BME) patterns.</p><p><strong>Purpose: </strong>We sought to associate discrete MRI patterns of BME with specific injury mechanisms in pediatric knee injuries to classify injury patterns by anatomical location of the BME. We aimed to group these into 6 patterns: patellar dislocation, extensor mechanism overload, hyperextension, single compartment impaction, ligament avulsion/translation, and direct contusion.</p><p><strong>Methods: </strong>We retrospectively reviewed 314 MRIs performed with a standard protocol on symptomatic patients aged 3 to 18 years at 1 institution. Our analysis included images, reports, and traumatic BME patterns. A musculoskeletal radiologist and orthopedic surgeon independently assigned 1 of the 6 injury patterns to each scan.</p><p><strong>Results: </strong>After exclusion criteria were applied to the 314 MRIs, 62 (19.7%) remained, 40 boys and 22 girls. The average age was of 12.2 years. The most frequent injury patterns were patellar dislocation (n = 22, 35%) and extensor mechanism overload (n = 14, 22%). κ value associated with pattern determination was .766, indicating substantial concordance. Bone marrow edema signal intensity on fat-suppressed sequences was classified as severe in 92% of cases.</p><p><strong>Conclusions: </strong>The strength of pediatric knee ligaments and tendons relative to epiphyseal bone may contribute to a high rate of BME injury patterns seen on MRI in symptomatic pediatric patients. We found that pediatric BME could be classified into 6 specific injury patterns, which might be useful to clinicians in recognizing mechanisms of injury. Further clinical studies are needed to assess the clinical differences in both short-term and long-term outcomes of the BME patterns described.</p>","PeriodicalId":35357,"journal":{"name":"Hss Journal","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9837404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10696916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-01Epub Date: 2022-06-30DOI: 10.1177/15563316221104765
Kyle N Kunze, Jennifer A Estrada, John Apostolakos, Michael C Fu, Samuel A Taylor, Lawrence V Gulotta, David M Dines, Joshua S Dines
Background: Limited English language proficiency in patients undergoing total shoulder arthroplasty (TSA) may make treatment more challenging. Purpose: We sought to investigate the potential association between TSA patients' use of a language interpreter and 2 outcomes: hospital length of stay (LOS) and discharge disposition. Methods: We conducted a retrospective cohort study comparing LOS and discharge disposition after TSA for patients who required interpreter services and patients who did not at a single institution in an urban setting between 2016 and 2020. Consecutive patients requiring interpreter services who underwent TSA were matched 1:1 to patients who did not require an interpreter by age, body mass index (BMI), sex, and procedure. Multivariate regression models controlling for age, BMI, sex, smoking, opioid use, white or non-white race, procedure, and diagnosis were constructed to determine associations between interpreter use, LOS, and discharge disposition. Results: Forty-one patients were included in each cohort, exceeding the minimum number required per an a priori power analysis. Mean hospital LOS was longer in the interpreter cohort than in the non-interpreter cohort (2.8 ± 2.4 vs 1.8 ± 1.0 days, respectively). Multivariate linear regression demonstrated interpreter use was the strongest predictor of LOS, with the effect estimate indicating an additional 0.88-day LOS per patient. A greater proportion of patients from the interpreter cohort were discharged to an acute/subacute rehabilitation facility than patients from the non-interpreter cohort (n = 8 [19.5%] vs n = 2 [4.9%], respectively). Patients from the interpreter cohort were 454% more likely to be discharged to acute/subacute rehabilitation facilities. Conclusions: Our retrospective analysis of patients undergoing TSA suggests that the need for interpreter services may be associated with increased LOS and discharge to a facility. More rigorous study is needed to identify the factors that influence these outcomes and to avoid disparities in hospital stay and discharge.
{"title":"Association Between Limited English Language Proficiency and Disparities in Length of Stay and Discharge Disposition After Total Shoulder Arthroplasty: A Retrospective Cohort Study.","authors":"Kyle N Kunze, Jennifer A Estrada, John Apostolakos, Michael C Fu, Samuel A Taylor, Lawrence V Gulotta, David M Dines, Joshua S Dines","doi":"10.1177/15563316221104765","DOIUrl":"10.1177/15563316221104765","url":null,"abstract":"<p><p><i>Background:</i> Limited English language proficiency in patients undergoing total shoulder arthroplasty (TSA) may make treatment more challenging. <i>Purpose</i>: We sought to investigate the potential association between TSA patients' use of a language interpreter and 2 outcomes: hospital length of stay (LOS) and discharge disposition. <i>Methods</i>: We conducted a retrospective cohort study comparing LOS and discharge disposition after TSA for patients who required interpreter services and patients who did not at a single institution in an urban setting between 2016 and 2020. Consecutive patients requiring interpreter services who underwent TSA were matched 1:1 to patients who did not require an interpreter by age, body mass index (BMI), sex, and procedure. Multivariate regression models controlling for age, BMI, sex, smoking, opioid use, white or non-white race, procedure, and diagnosis were constructed to determine associations between interpreter use, LOS, and discharge disposition. <i>Results</i>: Forty-one patients were included in each cohort, exceeding the minimum number required per an <i>a priori</i> power analysis. Mean hospital LOS was longer in the interpreter cohort than in the non-interpreter cohort (2.8 ± 2.4 vs 1.8 ± 1.0 days, respectively). Multivariate linear regression demonstrated interpreter use was the strongest predictor of LOS, with the effect estimate indicating an additional 0.88-day LOS per patient. A greater proportion of patients from the interpreter cohort were discharged to an acute/subacute rehabilitation facility than patients from the non-interpreter cohort (<i>n</i> = 8 [19.5%] vs <i>n</i> = 2 [4.9%], respectively). Patients from the interpreter cohort were 454% more likely to be discharged to acute/subacute rehabilitation facilities. <i>Conclusions</i>: Our retrospective analysis of patients undergoing TSA suggests that the need for interpreter services may be associated with increased LOS and discharge to a facility. More rigorous study is needed to identify the factors that influence these outcomes and to avoid disparities in hospital stay and discharge.</p>","PeriodicalId":35357,"journal":{"name":"Hss Journal","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9837403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10707838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-01Epub Date: 2022-11-14DOI: 10.1177/15563316221135578
Charles N Cornell
{"title":"Peer Review: An Evolving Discipline.","authors":"Charles N Cornell","doi":"10.1177/15563316221135578","DOIUrl":"10.1177/15563316221135578","url":null,"abstract":"","PeriodicalId":35357,"journal":{"name":"Hss Journal","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9837411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10695764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-01Epub Date: 2022-07-15DOI: 10.1177/15563316221110536
Amanda Lans, John R Bales, Mitchell S Fourman, Pranati P Borkhetaria, Jorrit-Jan Verlaan, Joseph H Schwab
Background: Limited health literacy has been associated with adverse health outcomes. Undergoing orthopedic surgery often requires patients to make complex decisions and adhere to complicated instructions, suggesting that health literacy skills might have a profound impact on orthopedic surgery outcomes. Purpose: We sought to review the literature for studies investigating the level of health literacy in patients undergoing orthopedic surgery and also to assess how those studies report factors affecting health equity. Methods: We conducted a systematic search of PubMed, Embase, and Cochrane Library for all health literacy studies published in the orthopedic surgery literature up to February 8, 2022. Search terms included synonyms for health literacy and for all orthopedic surgery subspecialties. Two reviewers independently extracted study data in addition to indicators of equity reporting using the PROGRESS+ checklist (Place of Residence, Race/Ethnicity, Occupation, Gender/sex, Religion, Education, Social capital, Socioeconomic status, plus age, disability, and sexual orientation). Results: The search resulted in 616 studies; 9 studies remained after exclusion criteria were applied. Most studies were of arthroplasty (4/9; 44%) or trauma (3/9; 33%) patients. Validated health literacy assessments were used in 4 of the included studies, and only 3 studies reported the rate of limited health literacy in the patients studied, which ranged between 34% and 38.5%. At least one PROGRESS+ item was reported in 88% (8/9) of the studies. Conclusions: We found a paucity of appropriately designed studies that used validated measures of health literacy in the field of orthopedic surgery. The potential impact of health literacy on orthopedic patients and their outcomes has yet to be elucidated. Thoughtful, high-quality trials across diverse demographics and geographies are warranted.
{"title":"Health Literacy in Orthopedic Surgery: A Systematic Review.","authors":"Amanda Lans, John R Bales, Mitchell S Fourman, Pranati P Borkhetaria, Jorrit-Jan Verlaan, Joseph H Schwab","doi":"10.1177/15563316221110536","DOIUrl":"10.1177/15563316221110536","url":null,"abstract":"<p><p><i>Background:</i> Limited health literacy has been associated with adverse health outcomes. Undergoing orthopedic surgery often requires patients to make complex decisions and adhere to complicated instructions, suggesting that health literacy skills might have a profound impact on orthopedic surgery outcomes. <i>Purpose</i>: We sought to review the literature for studies investigating the level of health literacy in patients undergoing orthopedic surgery and also to assess how those studies report factors affecting health equity. <i>Methods</i>: We conducted a systematic search of PubMed, Embase, and Cochrane Library for all health literacy studies published in the orthopedic surgery literature up to February 8, 2022. Search terms included synonyms for health literacy and for all orthopedic surgery subspecialties. Two reviewers independently extracted study data in addition to indicators of equity reporting using the PROGRESS+ checklist (Place of Residence, Race/Ethnicity, Occupation, Gender/sex, Religion, Education, Social capital, Socioeconomic status, plus age, disability, and sexual orientation). <i>Results</i>: The search resulted in 616 studies; 9 studies remained after exclusion criteria were applied. Most studies were of arthroplasty (4/9; 44%) or trauma (3/9; 33%) patients. Validated health literacy assessments were used in 4 of the included studies, and only 3 studies reported the rate of limited health literacy in the patients studied, which ranged between 34% and 38.5%. At least one PROGRESS+ item was reported in 88% (8/9) of the studies. <i>Conclusions</i>: We found a paucity of appropriately designed studies that used validated measures of health literacy in the field of orthopedic surgery. The potential impact of health literacy on orthopedic patients and their outcomes has yet to be elucidated. Thoughtful, high-quality trials across diverse demographics and geographies are warranted.</p>","PeriodicalId":35357,"journal":{"name":"Hss Journal","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9837407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10696406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-01Epub Date: 2022-07-12DOI: 10.1177/15563316221109549
Anthony J Ignozzi, Thomas E Moran, Brian C Werner
Background: There are few studies examining the clinical outcomes of 5-strand autografts in anterior cruciate ligament reconstruction (ACL-R). Purpose: We aimed to compare the clinical outcomes of ACL-R using 5-strand (5HS) and 4-strand (4HS) hamstring autografts of similar graft diameter to study the potential effects of autograft strand number on clinical outcomes. Methods: Patients who underwent ACL-R from 2013 to 2018 at a single academic institution and received a 4HS or 5HS autograft were included. Exclusion criteria were less than 2-year follow-up and any additional ligamentous reconstruction. Revision ACL-R and cyclops lesions were assessed at a minimum 2 years of postoperative follow-up. Objective measures of ability to return to sport were assessed at 6 months. Results: The mean graft diameters for 4HS (n = 51) and 5HS (n = 23) autografts were 8.3 ± 0.7 mm and 8.4 ± 0.7 mm, respectively. The mean follow-up for the 4HS and 5HS cohorts was 3.0 ± 1.5 years and 3.3 ± 1.3 years, respectively. The 4HS and 5HS cohorts had revision ACL-R rates of 15.7% (8/51) and 8.7% (2/23), respectively. Cyclops lesions occurred in 5.9% of 4HS patients and 13.0% of 5HS patients. We found no statistically significant differences between groups on objective measures of ability to return to sport. Conclusion: This retrospective cohort study detected no difference in revision ACL-R rates, frequency of cyclops lesions, or objective measures of ability to return to sport in patients who received 4HS or 5HS autografts of similar diameter for ACL-R. Further comparative study with larger sample sizes is warranted.
{"title":"No Difference Could Be Detected in Clinical Outcomes of 5-Strand and Quadruple Hamstring Autografts of Similar Diameter in Anterior Cruciate Ligament Reconstruction: A Retrospective Cohort Study.","authors":"Anthony J Ignozzi, Thomas E Moran, Brian C Werner","doi":"10.1177/15563316221109549","DOIUrl":"10.1177/15563316221109549","url":null,"abstract":"<p><p><i>Background:</i> There are few studies examining the clinical outcomes of 5-strand autografts in anterior cruciate ligament reconstruction (ACL-R). <i>Purpose</i>: We aimed to compare the clinical outcomes of ACL-R using 5-strand (5HS) and 4-strand (4HS) hamstring autografts of similar graft diameter to study the potential effects of autograft strand number on clinical outcomes. <i>Methods</i>: Patients who underwent ACL-R from 2013 to 2018 at a single academic institution and received a 4HS or 5HS autograft were included. Exclusion criteria were less than 2-year follow-up and any additional ligamentous reconstruction. Revision ACL-R and cyclops lesions were assessed at a minimum 2 years of postoperative follow-up. Objective measures of ability to return to sport were assessed at 6 months. <i>Results</i>: The mean graft diameters for 4HS (n = 51) and 5HS (n = 23) autografts were 8.3 ± 0.7 mm and 8.4 ± 0.7 mm, respectively. The mean follow-up for the 4HS and 5HS cohorts was 3.0 ± 1.5 years and 3.3 ± 1.3 years, respectively. The 4HS and 5HS cohorts had revision ACL-R rates of 15.7% (8/51) and 8.7% (2/23), respectively. Cyclops lesions occurred in 5.9% of 4HS patients and 13.0% of 5HS patients. We found no statistically significant differences between groups on objective measures of ability to return to sport. <i>Conclusion</i>: This retrospective cohort study detected no difference in revision ACL-R rates, frequency of cyclops lesions, or objective measures of ability to return to sport in patients who received 4HS or 5HS autografts of similar diameter for ACL-R. Further comparative study with larger sample sizes is warranted.</p>","PeriodicalId":35357,"journal":{"name":"Hss Journal","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9837399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10696408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-01Epub Date: 2022-05-25DOI: 10.1177/15563316221093614
Maxwell A Konnaris, Lucas M Junginger, Elizabeth R Sibilsky Enselman, Richard D Bell, Tristan Maerz, Asheesh Bedi
Background: Patients with symptomatic femoroacetabular impingement (FAI) have hip strength deficits, instability, and increased risk for concomitant injury. While surgical intervention is an effective method of treatment for FAI, more information is needed about the recovery process. Purposes: We sought to understand how patients with FAI recover from surgical correction in the short term. Do patients' perceptions of improvement correspond with measured improvements in hip strength? Methods: We conducted a prospective cohort study of 17 patients (11 male, age range: 16-38 years) who were diagnosed with symptomatic FAI at a single surgeon's practice. Hip strength (flexion, extension, and abduction) was measured preoperatively and at 14, 26, and 52 weeks postoperatively. Patient-reported outcomes using the modified Harris Hip Score (mHHS) and Hip Outcome Osteoarthritis Score (HOOS) subscales were measured at the same time points and at 2 weeks postoperatively. Results: Compared with preoperative values, there was a significant increase in postoperative values at 26 and 52 weeks in normalized isokinetic hip extension (29% and 38%, respectively) and normalized hip abduction (48% and 55%, respectively). No differences in strength were observed at 14 weeks. Modified Harris Hip Score and all HOOS subscales were decreased by 2 weeks postoperatively, and by 14 weeks mHHS improved by 21%, and HOOS subscales improved as well (activities of daily living by 18%, pain by 34%, quality of life by 69%, sport and recreation by 36%, and symptoms by 28%). Conclusion: We observed that patient-reported outcomes including symptoms, function, and satisfaction improved at 14 weeks, while objective measures of hip strength improved at 26 weeks following surgical correction of FAI. More rigorous study is indicated.
{"title":"Patient-Perceived Outcomes Improve Faster Than Hip Strength in Recovery After Surgical Correction for Symptomatic Femoroacetabular Impingement.","authors":"Maxwell A Konnaris, Lucas M Junginger, Elizabeth R Sibilsky Enselman, Richard D Bell, Tristan Maerz, Asheesh Bedi","doi":"10.1177/15563316221093614","DOIUrl":"10.1177/15563316221093614","url":null,"abstract":"<p><p><i>Background:</i> Patients with symptomatic femoroacetabular impingement (FAI) have hip strength deficits, instability, and increased risk for concomitant injury. While surgical intervention is an effective method of treatment for FAI, more information is needed about the recovery process. <i>Purposes</i>: We sought to understand how patients with FAI recover from surgical correction in the short term. Do patients' perceptions of improvement correspond with measured improvements in hip strength? <i>Methods</i>: We conducted a prospective cohort study of 17 patients (11 male, age range: 16-38 years) who were diagnosed with symptomatic FAI at a single surgeon's practice. Hip strength (flexion, extension, and abduction) was measured preoperatively and at 14, 26, and 52 weeks postoperatively. Patient-reported outcomes using the modified Harris Hip Score (mHHS) and Hip Outcome Osteoarthritis Score (HOOS) subscales were measured at the same time points and at 2 weeks postoperatively. <i>Results</i>: Compared with preoperative values, there was a significant increase in postoperative values at 26 and 52 weeks in normalized isokinetic hip extension (29% and 38%, respectively) and normalized hip abduction (48% and 55%, respectively). No differences in strength were observed at 14 weeks. Modified Harris Hip Score and all HOOS subscales were decreased by 2 weeks postoperatively, and by 14 weeks mHHS improved by 21%, and HOOS subscales improved as well (activities of daily living by 18%, pain by 34%, quality of life by 69%, sport and recreation by 36%, and symptoms by 28%). <i>Conclusion</i>: We observed that patient-reported outcomes including symptoms, function, and satisfaction improved at 14 weeks, while objective measures of hip strength improved at 26 weeks following surgical correction of FAI. More rigorous study is indicated.</p>","PeriodicalId":35357,"journal":{"name":"Hss Journal","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9837412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10696913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-01Epub Date: 2022-06-22DOI: 10.1177/15563316221100989
Bruce S Miller, Adam M Olszewski, Asheesh Bedi
Background: Cutibacterium acnes infections in the shoulder remain a significant concern in the setting of shoulder arthroplasty. Purpose: We sought to evaluate the efficacy of a microcurrent dressing in reducing C. acnes skin colonization and thereby reducing the risk of periprosthetic joint infection of the shoulder. Methods: This study was designed as a prospective case series. From October 2017 to February 2019, patients undergoing elective shoulder arthroplasty or arthroscopic shoulder surgery at a major academic medical center were offered enrollment; they signed an informed consent to participate. Patients under the age of 18, scheduled for revision shoulder arthroplasty, or with sensitivity or allergy to silver, zinc, or latex were excluded. Subjects underwent skin culture swab of the shoulder in the mid-point of the planned deltopectoral incision. The JumpStart (Arthrex; Naples, FL) microcurrent dressing was then placed over the area of the planned incision, and a full-thickness skin biopsy was harvested from the incision at the initiation of the surgical procedure. All specimens were cultured for C. acnes by the hospital's clinical microbiology laboratory with standard anaerobic technique. Results: Thirty-one subjects were enrolled in the study. Those who demonstrated no growth at baseline for the control specimen were excluded from further analysis (N = 11), given the absence of preoperative C. acnes colonization. Culture results from the 20 remaining subjects revealed significantly diminished C. acnes skin growth at the time of surgery compared to baseline. Sixty percent (12 of 20) of the subjects with positive skin swabs at baseline demonstrated no growth in the skin biopsy specimens at the time of surgery. There were no adverse events associated with the application of the microcurrent dressing. Conclusion: This prospective case series found that preoperative application of a microcurrent dressing resulted in significantly diminished C. acnes skin burden at the time of surgery in patients undergoing elective shoulder arthroplasty or arthroscopic shoulder surgery. Further study is warranted to investigate whether this preoperative intervention may contribute to a reduction in perioperative infections, including prosthetic joint infection.
{"title":"A Microcurrent Dressing Reduces <i>Cutibacterium Acnes</i> Colonization in Patients Undergoing Shoulder Arthroplasty or Arthroscopy: A Prospective Case Series.","authors":"Bruce S Miller, Adam M Olszewski, Asheesh Bedi","doi":"10.1177/15563316221100989","DOIUrl":"10.1177/15563316221100989","url":null,"abstract":"<p><p><i>Background: Cutibacterium acnes</i> infections in the shoulder remain a significant concern in the setting of shoulder arthroplasty. <i>Purpose</i>: We sought to evaluate the efficacy of a microcurrent dressing in reducing <i>C. acnes</i> skin colonization and thereby reducing the risk of periprosthetic joint infection of the shoulder. <i>Methods</i>: This study was designed as a prospective case series. From October 2017 to February 2019, patients undergoing elective shoulder arthroplasty or arthroscopic shoulder surgery at a major academic medical center were offered enrollment; they signed an informed consent to participate. Patients under the age of 18, scheduled for revision shoulder arthroplasty, or with sensitivity or allergy to silver, zinc, or latex were excluded. Subjects underwent skin culture swab of the shoulder in the mid-point of the planned deltopectoral incision. The JumpStart (Arthrex; Naples, FL) microcurrent dressing was then placed over the area of the planned incision, and a full-thickness skin biopsy was harvested from the incision at the initiation of the surgical procedure. All specimens were cultured for <i>C. acnes</i> by the hospital's clinical microbiology laboratory with standard anaerobic technique. <i>Results</i>: Thirty-one subjects were enrolled in the study. Those who demonstrated no growth at baseline for the control specimen were excluded from further analysis (N = 11), given the absence of preoperative <i>C. acnes</i> colonization. Culture results from the 20 remaining subjects revealed significantly diminished <i>C. acnes</i> skin growth at the time of surgery compared to baseline. Sixty percent (12 of 20) of the subjects with positive skin swabs at baseline demonstrated no growth in the skin biopsy specimens at the time of surgery. There were no adverse events associated with the application of the microcurrent dressing. <i>Conclusion</i>: This prospective case series found that preoperative application of a microcurrent dressing resulted in significantly diminished <i>C. acnes</i> skin burden at the time of surgery in patients undergoing elective shoulder arthroplasty or arthroscopic shoulder surgery. Further study is warranted to investigate whether this preoperative intervention may contribute to a reduction in perioperative infections, including prosthetic joint infection.</p>","PeriodicalId":35357,"journal":{"name":"Hss Journal","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9837413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10707837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-01DOI: 10.1177/15563316221134244
Sara N Kiani, Samuel Z Maron, Manasa G Rao, Nicole Zubizarreta, Madhu Mazumdar, Leesa M Galatz, Jashvant Poeran, Paul J Cagle
Background: Increasing demand for shoulder arthroplasty and an aging population may increase the rate of complications associated with advanced age such as postoperative delirium, but little is known on its burden in this cohort. Purpose: We sought to answer the following questions: (1) What is the epidemiology of postoperative delirium after shoulder arthroplasty? (2) What modifiable risk factors can be identified for postoperative delirium after shoulder arthroplasty? (3) Do risk factors differ in those younger than and in those older than 70 years of age? Methods: In a retrospective nationwide cohort study, we extracted data from the Premier Healthcare database on inpatient total and reverse shoulder arthroplasties from 2006 to 2016. The primary outcome was postoperative delirium; modifiable risk factors of interest were perioperative opioid use (high, medium, or low), peripheral nerve block use, and perioperative prescription medications. Mixed-effects models assessed associations between risk factors and postoperative delirium. Odds ratios and confidence intervals are reported. We applied a cutoff of 70 years of age because it was the median age of the cohort, as well as the age at which we observed that delirium prevalence increased. Results: A total of 92,429 total and reverse shoulder arthroplasties were identified (age range: 14-89 years). Overall delirium prevalence was 3.1% (n = 2909). Age-specific prevalence of postoperative delirium was lower in patients aged 50 to 70 years and higher in those aged 70 years and older, up to 8% among those older than 88 years. After adjusting for relevant covariates, only long-acting and combined short-acting and long-acting benzodiazepines (compared with no benzodiazepines) were associated with increased odds of postoperative delirium. Corticosteroids were associated with decreased odds of postoperative delirium. Conclusion: Our retrospective cohort study demonstrated that benzodiazepine use and older patient age were significantly associated with postoperative delirium in shoulder arthroplasty patients. The relationship between benzodiazepine use and delirium was particularly notable among those 70 years of age and older. Further investigation is indicated, given the known adverse effects of benzodiazepines in older adults and our findings of higher than expected use of these medications in this surgical cohort.
{"title":"The Burden of Postoperative Delirium After Shoulder Arthroplasty and Modifiable Pharmacological Perioperative Risk Factors: A Retrospective Nationwide Cohort Study.","authors":"Sara N Kiani, Samuel Z Maron, Manasa G Rao, Nicole Zubizarreta, Madhu Mazumdar, Leesa M Galatz, Jashvant Poeran, Paul J Cagle","doi":"10.1177/15563316221134244","DOIUrl":"https://doi.org/10.1177/15563316221134244","url":null,"abstract":"<p><p><i>Background:</i> Increasing demand for shoulder arthroplasty and an aging population may increase the rate of complications associated with advanced age such as postoperative delirium, but little is known on its burden in this cohort. <i>Purpose</i>: We sought to answer the following questions: (1) What is the epidemiology of postoperative delirium after shoulder arthroplasty? (2) What modifiable risk factors can be identified for postoperative delirium after shoulder arthroplasty? (3) Do risk factors differ in those younger than and in those older than 70 years of age? <i>Methods</i>: In a retrospective nationwide cohort study, we extracted data from the Premier Healthcare database on inpatient total and reverse shoulder arthroplasties from 2006 to 2016. The primary outcome was postoperative delirium; modifiable risk factors of interest were perioperative opioid use (high, medium, or low), peripheral nerve block use, and perioperative prescription medications. Mixed-effects models assessed associations between risk factors and postoperative delirium. Odds ratios and confidence intervals are reported. We applied a cutoff of 70 years of age because it was the median age of the cohort, as well as the age at which we observed that delirium prevalence increased. <i>Results</i>: A total of 92,429 total and reverse shoulder arthroplasties were identified (age range: 14-89 years). Overall delirium prevalence was 3.1% (<i>n</i> = 2909). Age-specific prevalence of postoperative delirium was lower in patients aged 50 to 70 years and higher in those aged 70 years and older, up to 8% among those older than 88 years. After adjusting for relevant covariates, only long-acting and combined short-acting and long-acting benzodiazepines (compared with no benzodiazepines) were associated with increased odds of postoperative delirium. Corticosteroids were associated with decreased odds of postoperative delirium. <i>Conclusion</i>: Our retrospective cohort study demonstrated that benzodiazepine use and older patient age were significantly associated with postoperative delirium in shoulder arthroplasty patients. The relationship between benzodiazepine use and delirium was particularly notable among those 70 years of age and older. Further investigation is indicated, given the known adverse effects of benzodiazepines in older adults and our findings of higher than expected use of these medications in this surgical cohort.</p>","PeriodicalId":35357,"journal":{"name":"Hss Journal","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e8/fd/10.1177_15563316221134244.PMC9837409.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10746544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}