36 results on '"James R. Roberson"'
Search Results
2. Prosthetic Joint Infection Trends at a Dedicated Orthopaedics Specialty Hospital
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Robert P. Runner, Amanda Mener, James R. Roberson, Thomas L. Bradbury, George N. Guild, Scott D. Boden, and Greg A. Erens
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Orthopedic surgery ,RD701-811 - Abstract
Introduction. Historically, a majority of prosthetic joint infections (PJIs) grew Gram-positive bacteria. While previous studies stratified PJI risk with specific organisms by patient comorbidities, we compared infection rates and microbiologic characteristics of PJIs by hospital setting: a dedicated orthopaedic hospital versus a general hospital serving multiple surgical specialties. Methods. A retrospective review of prospectively collected data on 11,842 consecutive primary hip and knee arthroplasty patients was performed. Arthroplasty cases performed between April 2006 and August 2008 at the general university hospital serving multiple surgical specialties were compared to cases at a single orthopaedic specialty hospital from September 2008 to August 2016. Results. The general university hospital PJI incidence rate was 1.43%, with 5.3% of infections from Gram-negative species. In comparison, at the dedicated orthopaedic hospital, the overall PJI incidence rate was substantially reduced to 0.75% over the 8-year timeframe. Comparing the final two years of practice at the general university facility to the most recent two years at the dedicated orthopaedics hospital, the PJI incidence was significantly reduced (1.43% vs 0.61%). Though the overall number of infections was reduced, there was a significantly higher proportion of Gram-negative infections over the 8-year timeframe at 25.3%. Conclusion. In transitioning from a multispecialty university hospital to a dedicated orthopaedic hospital, the PJI incidence has been significantly reduced despite a greater Gram-negative proportion (25.3% versus 5.3%). These results suggest a change in the microbiologic profile of PJI when transitioning to a dedicated orthopaedic facility and that greater Gram-negative antibiotic coverage could be considered.
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- 2019
- Full Text
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3. Outcomes Following Revision for Mechanically Assisted Crevice Corrosion in a Single Femoral Design
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James R. Roberson, Mattew S. Broggi, Rahul Goel, Philip O. Oladeji, and Jacob M. Wilson
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Reoperation ,medicine.medical_specialty ,Joint replacement ,Arthroplasty, Replacement, Hip ,medicine.medical_treatment ,Osteoarthritis ,Prosthesis Design ,Femoral head ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Retrospective Studies ,business.industry ,Incidence (epidemiology) ,Retrospective cohort study ,medicine.disease ,Prosthesis Failure ,Surgery ,Corrosion ,medicine.anatomical_structure ,Polyethylene ,Trunnion ,Hip Prosthesis ,Implant ,business ,Complication - Abstract
Background Mechanically assisted crevice corrosion (MACC) is a described complication following metal-on-polyethylene (MoP) total hip arthroplasty (THA). The literature regarding outcomes following revision for MACC suggests that complication rates are high. The purpose of this investigation is to add to this literature with the largest reported series to date. Methods This is a retrospective cohort study of 552 consecutive patients who underwent 621 MoP primary THAs. We identified patients who subsequently underwent revision THA for a diagnosis of MACC. All patients were implanted with the same implant combination (Accolade I stem/cobalt-chromium low friction ion treatment femoral head). Patient demographic, surgical, and laboratory data were collected. Follow-up was calculated from the revision surgery and Hip Disability and Osteoarthritis Outcome Score Joint Replacement and hip subjective values (HSV) were examined at final follow-up. Descriptive statistics were performed. Results The revision rate for MACC was 11.6% and mean time to revision was 6.6 (±2.4) years. Revised patients (n = 69) had a mean preoperative serum cobalt-chromium ratio of 3.5 (±2.4). There were 8 cases of gross trunnion failure. At mean 3.2 (±1.9) years following revision, the overall major complication rate was 11.6% with a 5.8% reoperation rate. At final follow-up, mean Hip Disability and Osteoarthritis Outcome Score Joint Replacement scores were 83.2 (±15.6) and mean hip subjective value was 77.6 (±17.4). Revision resulted in significant increases in both parameters (P Conclusion The incidence of MACC in MoP THA is likely higher than previously reported, particularly for certain implant combinations. Revision surgery for MACC can achieve good outcomes but a high clinical suspicion with early detection and revision is likely key to success.
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- 2021
4. Utilization Patterns, Efficacy, and Complications of Venous Thromboembolism Prophylaxis Strategies in Revision Hip and Knee Arthroplasty as Reported by American Board of Orthopaedic Surgery Part II Candidates
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Aidin Eslam Pour, Michael B. Gottschalk, Robert P. Runner, Christopher A. Staley, and James R. Roberson
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medicine.medical_specialty ,Arthroplasty, Replacement, Hip ,medicine.medical_treatment ,Deep vein ,Fondaparinux ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Orthopedic Procedures ,Orthopedics and Sports Medicine ,Enoxaparin ,Arthroplasty, Replacement, Knee ,030222 orthopedics ,Rivaroxaban ,business.industry ,Warfarin ,Anticoagulants ,Venous Thromboembolism ,medicine.disease ,Thrombosis ,Arthroplasty ,United States ,medicine.anatomical_structure ,Orthopedic surgery ,Current Procedural Terminology ,business ,medicine.drug - Abstract
Background Many strategies for venous thromboembolism (VTE) prophylaxis following hip and knee arthroplasty exist, with extensive controversy regarding the optimum strategy to minimize risk of VTE and bleeding complications. Data from the American Board of Orthopedic Surgery Part II (oral) Examination case list database was analyzed to determine efficacy, complication rates, and prescribing patterns for different prophylactic strategies. Methods The American Board of Orthopedic Surgery case database was queried utilizing Current Procedural Terminology codes 27447 and 27130 for primary total knee and hip arthroplasty, respectively. Geographic region, patient age, gender, deep vein thrombosis prophylaxis strategy, and complications were obtained. Less aggressive prophylaxis patterns were considered if only aspirin and/or sequential compression devises were utilized. More aggressive VTE prophylaxis patterns were considered if any of low-molecular-weight heparin (enoxaparin), warfarin, rivaroxaban, fondaparinux, or other strategies was used. Results In total, 22,072 cases of primary joint arthroplasty were analyzed from 2014 to 2016. The national rate of less aggressive VTE prophylaxis strategies was 45.4%, while more aggressive strategies were used in 54.6% of patients. Significant regional differences in prophylactic strategy patterns exist between the 6 regions. The predominant less aggressive prophylaxis pattern was aspirin with sequential compression devises at 84.8% with 14.8% receiving aspirin alone. Use of less aggressive prophylaxis strategy was significantly associated with patients having no complications (95.5% vs 93.0%). Use of more aggressive prophylaxis patterns was associated with higher likelihood of mild thrombotic (0.9% vs 0.2%), mild bleeding (1.3% vs 0.4%), moderate thrombotic (1.2% vs 0.4%), moderate bleeding (2.7% vs 2.1%), severe thrombotic (0.1% vs 0.0%), severe bleeding events (1.2% vs 0.9%), infections (1.9% vs 1.3%), and death within 90 days (0.7% vs 0.3%). Similar results were found in subgroup analysis of total hip and knee arthroplasty patients. Conclusion It was not possible to ascertain the individual rationale for use of more aggressive VTE prophylaxis strategies; however, more aggressive strategies were associated with higher rates of bleeding and thrombotic complications. Less aggressive strategies were not associated with a higher rate of thrombosis. Level of Evidence Therapeutic Level III. Disclaimer All views expressed in the study are the sole views of the authors and do not represent the views of the American Board of Orthopedic Surgery.
- Published
- 2021
5. Preoperative Analgesia, Complications, and Resource Utilization After Total Hip Arthroplasty: Tramadol Is Associated With Less Risk Than Other Preoperative Opioid Medications
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James R. Roberson, Andrew M. Schwartz, Kevin X. Farley, George N. Guild, Jacob M. Wilson, and Thomas L. Bradbury
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Adult ,medicine.medical_specialty ,Narcotic ,Arthroplasty, Replacement, Hip ,medicine.medical_treatment ,Analgesic ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,Orthopedics and Sports Medicine ,Tramadol ,Retrospective Studies ,Pain, Postoperative ,030222 orthopedics ,business.industry ,Retrospective cohort study ,Emergency department ,Odds ratio ,Arthroplasty ,Confidence interval ,Analgesics, Opioid ,Analgesia ,business ,medicine.drug - Abstract
Preoperative opioid use is known to be detrimental to outcomes after total hip arthroplasty (THA). This is concerning as multiple societies recommend tramadol for the management of arthritis. The purpose of this study was to determine if tramadol is associated with postoperative complications, increased resource utilization, and revision when compared with patients receiving nontramadol opioids (NTOs) and those who are opioid naive (ON).This is a retrospective cohort study using the Truven MarketScan databases (Truven Health, Ann Arbor, MI). Adult patients undergoing primary THA were identified and divided into 4 cohorts based on preoperative opioid medications (ie, ON, tramadol-only [TO], or NTOs; ±tramadol). Demographics, comorbidities, and 90-day complications were collected and compared between cohorts. Revision rates were compared at 3 years. Univariate and multivariate analyses were performed. Finally, preoperative prescription patterns were trended during the study period.About 198,357 patients, including 18,694 TO and 106,768 ON, were identified. Compared with ON, TO patients had similar rates of complications and revision surgery (P.05) but had slightly higher emergency department visits (odds ratio [OR], 1.06; 95% confidence interval [95% CI], 1.01-1.12; P = .027), readmissions (OR, 1.16; 95% CI, 1.09-1.22; P.001), and nonhome discharges (OR, 1.07; 95% CI, 1.02-1.12; P = .010). TO patients had significantly lower odds of incurring most examined complications, including revision surgery, when compared with NTO (P.05). From 2009 to 2018, the proportion of patients prescribed preoperative opioids decreased.Preoperative TO is associated with less postoperative risk than NTO use and is similar to opioid naivety. Fortunately, the number of patients receiving preoperative NTOs appears to be decreasing. Our results support tramadol as an appropriate pre-THA analgesic.
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- 2021
6. The American Board of Orthopaedic Surgery Response to COVID-19
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Scott E Porter, Jack B. Evans, John M. Flynn, Michael S. Bednar, David F. Martin, Douglas W. Lundy, Peter M. Murray, Lisa A. Taitsman, James E. Carpenter, Wayne J. Sebastianelli, Frederick M. Azar, Charles L. Saltzman, James R. Roberson, Kevin L. Garvin, Gregory A. Mencio, James D. Kang, Rick W. Wright, Terrance D. Peabody, Ann E. Van Heest, Joshua J. Jacobs, April D. Armstrong, and Charles L. Nelson
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Male ,Safety Management ,2019-20 coronavirus outbreak ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Pneumonia, Viral ,Review Article ,Certification ,Occupational safety and health ,03 medical and health sciences ,Patient safety ,0302 clinical medicine ,Specialty Boards ,medicine ,Humans ,Orthopedic Procedures ,Orthopedics and Sports Medicine ,Pandemics ,Occupational Health ,030222 orthopedics ,Medical education ,business.industry ,COVID-19 ,Flexibility (personality) ,030229 sport sciences ,United States ,Education, Medical, Graduate ,Communicable Disease Control ,Orthopedic surgery ,Education, Medical, Continuing ,Female ,Surgery ,Clinical Competence ,Patient Safety ,Board certification ,Coronavirus Infections ,business - Abstract
The COVID-19 pandemic has disrupted every aspect of society in a way never previously experienced by our nation's orthopaedic surgeons. In response to the challenges the American Board of Orthopaedic Surgery has taken steps to adapt our Board Certification and Continuous Certification processes. These changes were made to provide flexibility for as many Candidates and Diplomates as possible to participate while maintaining our high standards. The American Board of Orthopaedic Surgery is first and foremost committed to the safety and well-being of our patients, physicians, and families while striving to remain responsive to the changing circumstances affecting our Candidates and Diplomates.
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- 2020
7. Utilization Patterns, Efficacy, and Complications of Venous Thromboembolism Prophylaxis Strategies in Primary Hip and Knee Arthroplasty as Reported by American Board of Orthopedic Surgery Part II Candidates
- Author
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Robert P. Runner, Michael B. Gottschalk, Christopher A. Staley, Aidin E. Pour, and James R. Roberson
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Male ,Venous Thrombosis ,Aspirin ,Databases, Factual ,Arthroplasty, Replacement, Hip ,Anticoagulants ,Hemorrhage ,Venous Thromboembolism ,Heparin, Low-Molecular-Weight ,Middle Aged ,United States ,Orthopedics ,Fondaparinux ,Rivaroxaban ,Risk Factors ,Humans ,Female ,Orthopedic Procedures ,Orthopedics and Sports Medicine ,Warfarin ,Enoxaparin ,Practice Patterns, Physicians' ,Arthroplasty, Replacement, Knee ,Aged - Abstract
Many strategies for venous thromboembolism (VTE) prophylaxis following hip and knee arthroplasty exist, with extensive controversy regarding the optimum strategy to minimize risk of VTE and bleeding complications. Data from the American Board of Orthopedic Surgery Part II (oral) Examination case list database was analyzed to determine efficacy, complication rates, and prescribing patterns for different prophylactic strategies.The American Board of Orthopedic Surgery case database was queried utilizing Current Procedural Terminology codes 27447 and 27130 for primary total knee and hip arthroplasty, respectively. Geographic region, patient age, gender, deep vein thrombosis prophylaxis strategy, and complications were obtained. Less aggressive prophylaxis patterns were considered if only aspirin and/or sequential compression devises were utilized. More aggressive VTE prophylaxis patterns were considered if any of low-molecular-weight heparin (enoxaparin), warfarin, rivaroxaban, fondaparinux, or other strategies was used.In total, 22,072 cases of primary joint arthroplasty were analyzed from 2014 to 2016. The national rate of less aggressive VTE prophylaxis strategies was 45.4%, while more aggressive strategies were used in 54.6% of patients. Significant regional differences in prophylactic strategy patterns exist between the 6 regions. The predominant less aggressive prophylaxis pattern was aspirin with sequential compression devises at 84.8% with 14.8% receiving aspirin alone. Use of less aggressive prophylaxis strategy was significantly associated with patients having no complications (95.5% vs 93.0%). Use of more aggressive prophylaxis patterns was associated with higher likelihood of mild thrombotic (0.9% vs 0.2%), mild bleeding (1.3% vs 0.4%), moderate thrombotic (1.2% vs 0.4%), moderate bleeding (2.7% vs 2.1%), severe thrombotic (0.1% vs 0.0%), severe bleeding events (1.2% vs 0.9%), infections (1.9% vs 1.3%), and death within 90 days (0.7% vs 0.3%). Similar results were found in subgroup analysis of total hip and knee arthroplasty patients.It was not possible to ascertain the individual rationale for use of more aggressive VTE prophylaxis strategies; however, more aggressive strategies were associated with higher rates of bleeding and thrombotic complications. Less aggressive strategies were not associated with a higher rate of thrombosis.Therapeutic Level III.All views expressed in the study are the sole views of the authors and do not represent the views of the American Board of Orthopedic Surgery.
- Published
- 2019
8. Knee MRI Primary Care Ordering Practices for Nontraumatic Knee Pain: Compliance With ACR Appropriateness Criteria and Its Effect on Clinical Management
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Yara Younan, Richard Duszak, J. Matthew Kerchberger, Douglas D. Robertson, Adam D. Singer, Monica Umpierrez, Felix M. Gonzalez, Walter A. Carpenter, and James R. Roberson
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Adult ,Male ,musculoskeletal diseases ,medicine.medical_specialty ,Georgia ,Osteoarthritis ,Primary care ,030218 nuclear medicine & medical imaging ,Diagnosis, Differential ,03 medical and health sciences ,Hospitals, Urban ,0302 clinical medicine ,Knee mri ,Humans ,Medicine ,Knee ,Radiology, Nuclear Medicine and imaging ,Practice Patterns, Physicians' ,Aged ,Retrospective Studies ,Aged, 80 and over ,Primary Health Care ,business.industry ,Medical record ,Middle Aged ,medicine.disease ,Arthralgia ,Magnetic Resonance Imaging ,Appropriateness criteria ,Knee pain ,030220 oncology & carcinogenesis ,Physical therapy ,Female ,Guideline Adherence ,medicine.symptom ,business ,Body mass index ,Urban hospital - Abstract
To evaluate the appropriateness of MRI ordering practices and their effect on clinical management for nontraumatic knee pain at the primary care clinics of a large public urban hospital.In all, 196 consecutive MRIs for nontraumatic knee pain ordered from primary care clinics in a large public urban hospital over an 18-month period were studied. ACR Appropriateness Criteria (AC) scores for nontraumatic knee pain were retrospectively calculated from medical record reviews. The record was also reviewed to assess whether knee MRI changed clinical management. Knee osteoarthritis grading was performed. Tests were performed for differences in age, body mass index (BMI), gender, and ethnicity among appropriate and inappropriate MRIs.Of the MRIs, 57% (108 knees) had "usually appropriate" (ie, 7-9) and 43% (8 knees) had "usually not appropriate" (ie, 1-3) AC scores (P.1). Clinical management was changed in 26% of knees with "usually appropriate" and 20% of knees with "usually inappropriate" scores (P.05), and 70% of the knees with "usually appropriate" and 61% of the knee with "usually not appropriate" scores had moderate to severe osteoarthritis. Age, BMI, gender, and ethnicity had no significant effect on AC scores.In patients referred from primary care for MRI for nontraumatic knee pain, adherence to AC was low. Additional focus on reducing "appropriate" studies that do not impact clinical management (eg, cases with radiographically evident moderate to severe osteoarthritis) is also warranted.
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- 2019
9. Synthetic Mesh Reconstruction of Chronic, Native Quadriceps Tendon Disruptions following Failed Primary Repair
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Andrew M. Schwartz, George N. Guild, James R. Roberson, Braden E. Hartline, and Jacob M. Wilson
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Knee function ,Orthopedic surgery ,medicine.medical_specialty ,Knee extensors ,business.industry ,medicine.medical_treatment ,Extensor mechanism ,Case Report ,General Medicine ,musculoskeletal system ,Arthroplasty ,Surgery ,Primary repair ,medicine.anatomical_structure ,Ambulatory ,medicine ,Quadriceps tendon ,Range of motion ,business ,RD701-811 - Abstract
Case. Two patients presented with chronic knee extensor mechanism disruption after failed primary repairs. Both patients had minimal ambulatory knee function prior to surgical intervention and were treated with a synthetic mesh reconstruction of their extensor mechanism. Our technique has been modified from previously described techniques used in revision knee arthroplasty. At the one-year follow-up, both patients had improvement in their active range of motion and had returned to their previous activity. Conclusion. Synthetic mesh reconstruction of chronic extensor mechanism disruption is a viable technique that can be utilized as salvage for the persistently dysfunctional native knee.
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- 2021
10. Quantifying the Backlog of Total Hip and Knee Arthroplasty Cases: Predicting the Impact of COVID-19
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Thomas L. Bradbury, James R. Roberson, Jacob M. Wilson, Andrew M. Schwartz, Kevin X. Farley, and George N. Guild
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musculoskeletal diseases ,medicine.medical_specialty ,total knee arthroplasty ,total hip arthroplasty ,Coronavirus disease 2019 (COVID-19) ,Sports medicine ,medicine.medical_treatment ,Total hip replacement ,Total knee arthroplasty ,coronavirus ,03 medical and health sciences ,Response to COVID-19/Original Article ,0302 clinical medicine ,Medicine ,Orthopedics and Sports Medicine ,030222 orthopedics ,volume ,business.industry ,COVID-19 ,030229 sport sciences ,musculoskeletal system ,Arthroplasty ,Surgery ,Hip arthroplasty ,surgical procedures, operative ,Orthopedic surgery ,business ,Total hip arthroplasty - Abstract
Background Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are two high-volume procedures that were delayed due to COVID-19. Questions/Purposes To help strategize an effective return to elective orthopedic surgery, we aimed to quantify the volume of THA and TKA cases delayed across the USA and estimate the time required to care for these patients when non-urgent surgery resumes. Methods Population-level data was used to estimate monthly THA and TKA procedural volume from 2011 to 2017. Using linear regression, we used this data to project monthly procedural volumes for 2020 to 2023. Nine different permutations were modeled to account for variations in case delay rates (50%, 75%, 100%) and in resumption of non-urgent procedure timing. Two recovery pathways using the highest volume month as a surrogate for maximum operative capacity, and a second using the highest month + 20% were used to simulate a theoretical expansion of current capacity. Results The projected national volume of delayed cases was 155,293 (mid-March through April; 95% CI 142,004 to 168,580), 260,806 (through May; 95% CI 238,658 to 282,952), and 372,706 (through June; 95% CI 341,699 to 403,709). The best- and worst-case scenarios for delayed cases were 77,646 (95% CI 71,002 to 84,290) and 372,706 (95% CI 341,699 to 403,709), respectively. The projected catch-up time varied between 9 and nearly 35 months for the best- and worst-case scenarios. The addition of 20% increased productivity decreased this time to between 3.21 and 11.59 months. Conclusion The COVID-19 pandemic has generated a significant backlog of THA and TKA procedures. Surgeons, administrators, and policymakers should account for these modeled estimates of case volume delays and projected demands. Electronic supplementary material The online version of this article (10.1007/s11420-020-09806-z) contains supplementary material, which is available to authorized users.
- Published
- 2020
- Full Text
- View/download PDF
11. Modifiability of Depression's Impact on Early Revision, Narcotic Usage, and Outcomes After Total Hip Arthroplasty: The Impact of Psychotherapy
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Kevin X. Farley, Andrew M. Schwartz, Thomas L. Bradbury, James R. Roberson, George N. Guild, and Jacob M. Wilson
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Narcotics ,Reoperation ,Multivariate analysis ,Psychotherapist ,Narcotic ,medicine.medical_treatment ,Arthroplasty, Replacement, Hip ,03 medical and health sciences ,0302 clinical medicine ,Patient satisfaction ,Postoperative Complications ,Risk Factors ,Survivorship curve ,Medicine ,Humans ,Orthopedics and Sports Medicine ,Depression (differential diagnoses) ,Retrospective Studies ,030222 orthopedics ,business.industry ,Depression ,Odds ratio ,Perioperative ,Cognitive behavioral therapy ,Psychotherapy ,business - Abstract
Depression is known to negatively influence functional recovery, patient satisfaction, narcotic requirements, implant survivorship, and perioperative resource utilization after total hip arthroplasty (THA). The degree to which this effect is modifiable is largely unknown, with mixed results on preoperative pharmacological intervention, and concomitant concerns over side effects. We aim to investigate the influence of psychotherapy before THA on surgical outcomes, medical complications, and resource utilization.A retrospective chart review of Truven MarketScan Databases was performed to generate 3 cohorts: patients without depression, patients with depression who did not receive preoperative psychotherapy, and patients with depression who received psychotherapy before surgery. Outcomes of interest were resource utilization, surgical and medical complications, narcotic requirements, and 1-year and 3-year revision rates.On multivariate analysis, depressed patients who did not receive psychotherapy were more likely to be discharged to inpatient rehabilitation facility (odds ratio [OR] 1.28, 95% confidence interval [CI] 1.10-1.48, P.001) and require 2 or more postoperative narcotic prescriptions (OR 1.20, 95% CI 1.06-1.37, P = .004) than depressed patients who received psychotherapy. Patients who did not receive psychotherapy were more likely to have continued narcotic requirements within 1 year after surgery (OR 1.23, 95% CI 1.08-1.39, P.001) and undergo revision at 1 year (OR 1.74, 95% CI 1.17-2.58, P = .006) and 3 years (OR 1.92, 95% CI 1.10-3.34, P = .021) than depressed patients who received psychotherapy.The negative influence of depression on narcotic requirements, resource utilization, and implant survivorship after THA appears to be modifiable with preoperative psychotherapy.
- Published
- 2020
12. Author Correction: Factors of the bone marrow microniche that support human plasma cell survival and immunoglobulin secretion
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Greg Gibson, Igor Albizua, Ronghu Wu, Troy D. Randall, Jacques Galipeau, Shuya Kyu, Swetha Garimalla, Kuang-Yueh Chiang, Edmund K. Waller, Iñaki Sanz, James R. Roberson, F. Eun-Hyung Lee, Frances E. Lund, Doan C. Nguyen, and Haopeng Xiao
- Subjects
Adult ,Male ,Statement (logic) ,Cell Survival ,Science ,Tumor Necrosis Factor Ligand Superfamily Member 13 ,Declaration ,General Physics and Astronomy ,ComputingMilieux_LEGALASPECTSOFCOMPUTING ,Bioinformatics ,Immunoglobulin secretion ,General Biochemistry, Genetics and Molecular Biology ,Patent application ,Young Adult ,Bone Marrow ,Medicine ,Humans ,lcsh:Science ,Author Correction ,Antibody-Producing Cells ,Cell survival ,Cells, Cultured ,Multidisciplinary ,Competing interests ,business.industry ,Mesenchymal Stem Cells ,General Chemistry ,Middle Aged ,Fibronectins ,medicine.anatomical_structure ,14-3-3 Proteins ,Human plasma ,lcsh:Q ,Female ,Bone marrow ,business ,Protein Binding - Abstract
Human antibody-secreting cells (ASC) in peripheral blood are found after vaccination or infection but rapidly apoptose unless they migrate to the bone marrow (BM). Yet, elements of the BM microenvironment required to sustain long-lived plasma cells (LLPC) remain elusive. Here, we identify BM factors that maintain human ASC 50 days in vitro. The critical components of the cell-free in vitro BM mimic consist of products from primary BM mesenchymal stromal cells (MSC), a proliferation-inducing ligand (APRIL), and hypoxic conditions. Comparative analysis of protein-protein interactions between BM-MSC proteomics with differential RNA transcriptomics of blood ASC and BM LLPC identify two major survival factors, fibronectin and YWHAZ. The MSC secretome proteins and hypoxic conditions play a role in LLPC survival utilizing mechanisms that downregulate mTORC1 signaling and upregulate hypoxia signatures. In summary, we identify elements of the BM survival niche critical for maturation of blood ASC to BM LLPC.
- Published
- 2019
13. Total Wrist Arthroplasty Versus Wrist Fusion: Utilization and Complication Rates as Reported by ABOS Part II Candidates
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Richard M. Hinds, Marco Rizzo, John T. Capo, Michael B. Gottschalk, and James R. Roberson
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Male ,Wrist Joint ,medicine.medical_specialty ,Databases, Factual ,medicine.medical_treatment ,Arthrodesis ,Osteoarthritis ,Wrist ,03 medical and health sciences ,Postoperative Complications ,Sex Factors ,0302 clinical medicine ,Total wrist arthroplasty ,Specialty Boards ,Humans ,Medicine ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,National trends ,Arthroplasty, Replacement ,Surgery Articles ,030222 orthopedics ,business.industry ,Age Factors ,Middle Aged ,medicine.disease ,Arthroplasty ,United States ,Surgery ,Orthopedics ,medicine.anatomical_structure ,Orthopedic surgery ,Female ,business ,Complication - Abstract
Background: The aim of this study was to assess national trends in the utilization and complication rates of total wrist arthroplasty (TWA) and total wrist fusion (WF) as identified via review of the American Board of Orthopedic Surgery (ABOS) Part II candidate database. Methods: The ABOS Part II candidate database is a collection of cases reported by candidates of the ABOS Part II board certification oral exam. The ABOS database was queried for all TWA and WF cases performed from 2005 to 2014. Linear regression analyses were used to assess trends in procedure utilization. Treatment diagnoses, patient characteristics, and reported complications were also compared between the 2 treatment cohorts. Results: No significant increases in the proportion of candidates performing TWA or WF, number of TWA or WF cases, nor the number of TWA or WF cases performed per candidate performing those procedures were noted during the study period. Significantly less TWA cases were performed when compared with WF cases (68 vs 327; P = .006). Patients undergoing TWA were significantly older ( P = .005), more likely female ( P < .001), and more likely to have a diagnosis of osteoarthritis ( P = .003) than patients undergoing WF. There were no significant differences in complication rates, including postoperative infection, nerve palsy, or rate of secondary surgery, between the TWA and WF cohorts. Conclusions: Utilization of both TWA and WF has remained unchanged among emerging career orthopedic surgeons. Although WF is performed nearly 5 times more frequently than TWA, our short-term findings suggest that TWA compares favorably with WF.
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- 2016
14. Factors of the bone marrow microniche that support human plasma cell survival and immunoglobulin secretion
- Author
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Iñaki Sanz, Ronghu Wu, Doan C. Nguyen, Igor Albizua, Troy D. Randall, Swetha Garimalla, Kuang-Yueh Chiang, Jacques Galipeau, Greg Gibson, F. Eun-Hyung Lee, Haopeng Xiao, Frances E. Lund, James R. Roberson, Edmund K. Waller, and Shuya Kyu
- Subjects
0301 basic medicine ,Science ,General Physics and Astronomy ,Immunoglobulin secretion ,General Biochemistry, Genetics and Molecular Biology ,Article ,Transcriptome ,03 medical and health sciences ,0302 clinical medicine ,Downregulation and upregulation ,medicine ,lcsh:Science ,Multidisciplinary ,biology ,Mesenchymal stem cell ,General Chemistry ,In vitro ,3. Good health ,Cell biology ,Fibronectin ,030104 developmental biology ,medicine.anatomical_structure ,YWHAZ ,biology.protein ,lcsh:Q ,Bone marrow ,030215 immunology - Abstract
Human antibody-secreting cells (ASC) in peripheral blood are found after vaccination or infection but rapidly apoptose unless they migrate to the bone marrow (BM). Yet, elements of the BM microenvironment required to sustain long-lived plasma cells (LLPC) remain elusive. Here, we identify BM factors that maintain human ASC > 50 days in vitro. The critical components of the cell-free in vitro BM mimic consist of products from primary BM mesenchymal stromal cells (MSC), a proliferation-inducing ligand (APRIL), and hypoxic conditions. Comparative analysis of protein–protein interactions between BM-MSC proteomics with differential RNA transcriptomics of blood ASC and BM LLPC identify two major survival factors, fibronectin and YWHAZ. The MSC secretome proteins and hypoxic conditions play a role in LLPC survival utilizing mechanisms that downregulate mTORC1 signaling and upregulate hypoxia signatures. In summary, we identify elements of the BM survival niche critical for maturation of blood ASC to BM LLPC., Antibody-secreting cells (ASC) such as plasma cells must migrate to the bone marrow to survive, but microniche elements that promote survival are unknown. Here the authors define specific factors from the microniche that can maintain ASC in vitro for over 50 days, involving MSC secretome proteins, APRIL, and hypoxic conditions.
- Published
- 2018
15. Gross Trunnion Failure of a Cobalt-Chromium Femoral Head on a Titanium Stem at Midterm Follow-up: A Report of 3 Cases
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Robert P. Runner, James R. Roberson, and Jaime L. Bellamy
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inorganic chemicals ,Male ,medicine.medical_specialty ,Arthroplasty, Replacement, Hip ,Femoral stem ,03 medical and health sciences ,Femoral head ,0302 clinical medicine ,medicine ,Humans ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,Early failure ,Neck diameter ,Aged ,030222 orthopedics ,business.industry ,Middle Aged ,Serum chromium ,Surgery ,Prosthesis Failure ,Corrosion ,medicine.anatomical_structure ,Metals ,Trunnion ,Cobalt ions ,Hip Prosthesis ,business ,A titanium - Abstract
Case: Three patients underwent uncomplicated primary total hip arthroplasty with cobalt-chromium femoral heads (36+5 mm) on titanium V40 tapers. At 6 to 9 years of follow-up, severe effects of corrosion at the trunnion were noted in all 3 patients, along with elevated levels of serum cobalt ions and normal levels of serum chromium ions. Gross trunnion failure, apparently caused by corrosion, required femoral stem revision in all of the patients. Conclusion: Decreased neck diameter, longer trunnion length, and large-sized cobalt-chromium heads are possible contributors to early failure after primary total hip arthroplasty due to trunnionosis. Surgeons should be mindful of trunnionosis as a cause of pain and a mechanism of failure following total hip arthroplasty, and serum metal ions should be monitored in these patients.
- Published
- 2017
16. Epiphysiolysis of the femoral neck due to closed reduction of an adolescent hip dislocation with a 4-year follow-up
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Rajiv Rajani, Tim Oswald, Brent T Wise, and James R. Roberson
- Subjects
medicine.medical_specialty ,Adolescent ,business.industry ,medicine.medical_treatment ,Radiography ,Musculoskeletal Manipulations ,Femoral Neck Fractures ,Running ,Surgery ,Femoral head ,medicine.anatomical_structure ,Femoral epiphysis ,Epiphysiolysis ,Pediatrics, Perinatology and Child Health ,medicine ,Hip Dislocation ,Humans ,Female ,Orthopedics and Sports Medicine ,Salter harris ,business ,Epiphyses ,Reduction (orthopedic surgery) ,Femoral neck - Abstract
This case study discusses a 13-year-old girl diagnosed with a displaced Salter Harris II fracture of the proximal femoral epiphysis post reduction of a dislocated hip. Radiographs before reduction revealed a small fracture of the inferomedial femoral head. This, however, did not induce concern before reduction. The patient underwent reparative surgery of the epiphysis only to develop a collapsed femoral head, which was remedied through total hip arthroplasty. A decrease in blood flow, the delicacy in reduction, and unknown predispositions might have been contributing factors toward the unique development in this case.
- Published
- 2015
17. Long-term results of extensor mechanism reconstruction using Achilles tendon allograft after total knee arthroplasty
- Author
-
Aidin Eslam Pour, Brent T Wise, Greg A. Erens, James R. Roberson, and Thomas L. Bradbury
- Subjects
musculoskeletal diseases ,Male ,medicine.medical_specialty ,Knee Joint ,Total knee arthroplasty ,Achilles Tendon ,Quadriceps Muscle ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Patellar Ligament ,Tendon Injuries ,Medicine ,Humans ,Transplantation, Homologous ,Orthopedics and Sports Medicine ,Range of Motion, Articular ,Arthroplasty, Replacement, Knee ,Aged ,Retrospective Studies ,Aged, 80 and over ,Rupture ,030222 orthopedics ,Achilles tendon ,business.industry ,Extensor mechanism ,030229 sport sciences ,Long term results ,Middle Aged ,Plastic Surgery Procedures ,musculoskeletal system ,Patellar tendon ,Surgery ,medicine.anatomical_structure ,Treatment Outcome ,Orthopedic surgery ,Female ,Quadriceps tendon ,business ,Complication ,Follow-Up Studies - Abstract
Disruption of the extensor mechanism after total knee arthroplasty (TKA) is an infrequent but devastating complication. Presently, limited data exists regarding the optimal treatment and long-term outcomes. Patients who underwent reconstruction of their knee extensor mechanism using Achilles tendon allograft following TKA between January 2003 and January 2012 were identified. Sixteen patients with 17 reconstructions (10 patellar tendons, 7 quadriceps tendons) were studied. All patients underwent evaluation at an average of 45.7 months. Ten of the patients were followed to an average of 65.4 months. After reconstruction, the average extensor lag was 6.6° and average knee flexion was 105.1°. Of the patients with a minimum follow-up of two years and an average follow-up of 65.4 months, the average extensor lag and knee flexion was 8.4° and 107.9°, respectively, with quadriceps strength maintained at an average of 4/5. The quadriceps tendon reconstructions had an average extensor lag and flexion of 2.9° and 103°, respectively. The patellar tendon reconstructions, excluding one re-rupture, had an average extensor lag and flexion of 9.6° and 105.1°, respectively. Four patients died during the follow-up period. All but one of the patients were below the mean for age-matched controls on the SF-36. Achilles tendon allograft reconstruction is a reliable and durable treatment for patients who sustain not only patellar tendon ruptures, but also quadriceps tendon ruptures following TKA. Despite the success of this technique, the injury and procedure have a profound impact on overall function.
- Published
- 2017
18. Early Complications Following Osteosynthesis of Distal Radius Fractures: A Comparison of Geriatric and Nongeriatric Cohorts
- Author
-
Sanjeev Kakar, Richard M. Hinds, Michael B. Gottschalk, James R. Roberson, and John T. Capo
- Subjects
complications ,medicine.medical_treatment ,Population ,Dentistry ,distal radius ,geriatric ,03 medical and health sciences ,0302 clinical medicine ,internal fixation ,Medicine ,Internal fixation ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,education ,030222 orthopedics ,education.field_of_study ,Osteosynthesis ,treatment ,business.industry ,Incidence (epidemiology) ,Rehabilitation ,Radius ,Articles ,fracture ,Surgery ,Geriatrics and Gerontology ,business ,osteosynthesis - Abstract
Background: Distal radius fractures (DRFs) are common geriatric fractures with the overall incidence expected to increase as the population continues to age. The purpose of this investigation was to compare the short-term complication rates in geriatric versus nongeriatric cohorts following osteosynthesis of DRFs. Methods: The American Board of Orthopaedic Surgery (ABOS) part II database was queried for adult DRF cases performed from 2007 to 2013. Current Procedural Terminology codes were used to identify cases treated via osteosynthesis. Patient demographic information and reported complication data were analyzed. Comparisons between geriatric (age ≥65 years) and nongeriatric (age Results: From 2007 to 2013, a total of 9867 adult DRFs were treated via osteosynthesis by ABOS part II candidates. Geriatric patients comprised 28% of the study cohort. Mean age of the geriatric and nongeriatric cohorts was 74 ± 7 and 46 ± 13 years, respectively. There was a greater proportion of female patients ( P < .001) in the geriatric cohort as compared with the nongeriatric cohort. The geriatric cohort demonstrated higher rates of anesthetic complications ( P = .021), iatrogenic bone fracture ( P = .021), implant failure ( P = .031), loss of reduction ( P = .001), unspecified medical complications ( P = .007), and death ( P = .017) than the nongeriatric cohort. The geriatric cohort also showed lower rates of nerve palsy ( P = .028) when compared with the nongeriatric cohort, though no differences in rates of secondary surgery were noted between the two cohorts. Conclusion: Increased rates of complications related to poor bone quality and poor health status may be expected among geriatric patients following osteosynthesis of DRFs. However, geriatric and nongeriatric patients have similarly low rates of secondary surgery. Future studies are needed to delineate the economic, functional, and societal impact of geriatric DRFs treated via osteosynthesis.
- Published
- 2016
19. Trends in primary and revision knee arthroplasty among orthopaedic surgeons who take the American Board of Orthopaedics part II exam
- Author
-
Patrick K. Horst, John J. Harrast, Aidin Eslam Pour, Greg A. Erens, Thomas L. Bradbury, and James R. Roberson
- Subjects
Adult ,Reoperation ,medicine.medical_specialty ,Certification ,Databases, Factual ,medicine.medical_treatment ,education ,Knee Joint ,Total knee ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Humans ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,Fellowships and Scholarships ,Arthroplasty, Replacement, Knee ,Fellowship training ,030222 orthopedics ,business.industry ,Orthopedic Surgeons ,Arthroplasty ,Early complication ,United States ,Surgery ,Orthopedics ,Orthopedic surgery ,Board certification ,business ,Complication - Abstract
A certified list of all operative cases performed within a six month period is required of surgeons by the American Board of Orthopaedic Surgery (ABOS) as a prerequisite to taking the Part II Oral Examination. Using the data on these cases collected and maintained by ABOS, this study assessed the influence of prior fellowship training in adult reconstruction on the volume and surgeon-reported complication rate of knee joint arthroplasty cases over time. All data were self reported to a secure Internet database (SCRIBE) by candidates who applied to take Part II of the ABOS Examination for the first time. This database was searched for all procedures done between 2003 and 2013 with CPT codes for total and revision knee arthroplasty and removal of knee implant (static or dynamic spacer) to determine procedural volumes and early complication rates among Board-eligible orthopaedic surgeons with and without adult reconstructive fellowship training. More than 43,000 knee arthroplasty surgeries were identified. Surgeons who had completed adult reconstruction fellowship training after residency performed 55 % of total knee arthroplasties, averaging 33.5 knee arthroplasties during the six month case-collection period compared to 7.4 procedures by non-fellowship-trained surgeons (p
- Published
- 2015
20. Porous Tantalum Implant in Early Osteonecrosis of the Hip
- Author
-
James R. Roberson, Michael S. Shuler, and Michael D. Rooks
- Subjects
medicine.medical_specialty ,education.field_of_study ,business.industry ,Porous tantalum ,Population ,Surgery ,Femoral head ,DEVICE EVALUATION ,medicine.anatomical_structure ,Blood loss ,Preliminary report ,Medicine ,Operative time ,Orthopedics and Sports Medicine ,Implant ,business ,education - Abstract
Porous tantalum implants are used in early osteonecrosis of the hip. Device evaluation included surgical time, blood loss, hospitalization, patient-controlled analgesia use, transfusions, implant survival, and outcomes. Mean blood loss was 70 mL. Mean operative time was 36 minutes. Average hospitalization was less than 1 day. No patient required patient-controlled analgesia use or transfusions. Results were compared to a historical vascularized fibular graft population. All parameters were less than the fibular graft groups (P < .00001). All surviving implants (86%) resulted in good to excellent outcomes. Kaplan-Meier analysis at 39 months was 86% and 67% for the implant and fibular graft, respectively (P = .21). Early outcomes demonstrate that porous tantalum implants are a safe option for femoral head salvage. Continued follow-up is necessary to determine the long-term success.
- Published
- 2007
21. Trends in Primary and Revision Hip Arthroplasty Among Orthopedic Surgeons Who Take the American Board of Orthopedics Part II Examination
- Author
-
John J. Harrast, Thomas L. Bradbury, Greg A. Erens, James R. Roberson, Patrick K. Horst, and Aidin Eslam Pour
- Subjects
Reoperation ,medicine.medical_specialty ,Databases, Factual ,Joint replacement ,medicine.medical_treatment ,Arthroplasty, Replacement, Hip ,education ,Prosthesis Design ,Patient Readmission ,03 medical and health sciences ,Hip implant ,0302 clinical medicine ,Postoperative Complications ,medicine ,Humans ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,Fellowships and Scholarships ,Fellowship training ,Revision hip arthroplasty ,Societies, Medical ,030222 orthopedics ,business.industry ,Internship and Residency ,Orthopedic Surgeons ,Hip resurfacing ,United States ,Surgery ,Hip arthroplasty ,Orthopedics ,Orthopedic surgery ,Workforce ,Current Procedural Terminology ,Hemiarthroplasty ,business - Abstract
A certified list of all operative cases performed within a 6-month period is a required prerequisite for surgeons taking the American Board of Orthopaedic Surgery Part II oral examination. Using the American Board of Orthopaedic Surgery secure Internet database database containing these cases, this study (1) assessed changing trends for primary and revision total hip arthroplasty (THA) and (2) compared practices and early postoperative complications between 2 groups of examinees, those with and without adult reconstruction fellowship training.Secure Internet database was searched for all 2003-2013 procedures with a Current Procedural Terminology code for THA, hip resurfacing, hemiarthroplasty, revision hip arthroplasty, conversion to THA, or removal of hip implant (Girdlestone, static, or dynamic spacer).Adult reconstruction fellowship-trained surgeons performed 60% of the more than 33,000 surgeries identified (average 28.1) and nonfellowship-trained surgeons performed 40% (average 5.2) (P.001). Fellowship-trained surgeons performed significantly more revision surgeries for infection (71% vs 29%)(P.001). High-volume surgeons had significantly fewer complications in both primary (11.1% vs 19.6%) and revision surgeries (29% vs 35.5%) (P.001). Those who passed the Part II examination reported higher rates of complications (21.5% vs 19.9%).In early practice, primary and revision hip arthroplasties are often performed by surgeons without adult reconstruction fellowship training. Complications are less frequently reported by surgeons with larger volumes of joint replacement surgery who perform either primary or more complex cases. Primary hip arthroplasty is increasingly performed by surgeons early in practice who have completed an adult reconstructive fellowship after residency training. This trend is even more pronounced for more complex cases such as revision or management of infection.
- Published
- 2015
22. Surgical Trends in the Treatment of Superior Labrum Anterior and Posterior Lesions of the Shoulder: Analysis of Data From the American Board of Orthopaedic Surgery Certification Examination Database
- Author
-
Brendan M. Patterson, R. Alexander Creighton, Jeffrey T. Spang, James R. Roberson, and Ganesh V. Kamath
- Subjects
Adult ,Male ,medicine.medical_specialty ,Shoulder ,Databases, Factual ,medicine.medical_treatment ,Tenotomy ,Tenodesis ,Physical Therapy, Sports Therapy and Rehabilitation ,computer.software_genre ,Biceps ,Arthroplasty ,Cohort Studies ,Arthroscopy ,medicine ,Humans ,Orthopedics and Sports Medicine ,In patient ,Rotator cuff ,Muscle, Skeletal ,Labrum ,Database ,business.industry ,Fibrocartilage ,Middle Aged ,United States ,Nonoperative treatment ,Surgery ,medicine.anatomical_structure ,Orthopedics ,Treatment Outcome ,Concomitant ,Orthopedic surgery ,Female ,Shoulder Injuries ,business ,computer - Abstract
Background: After failure of nonoperative treatment, repair has long been the primary treatment option for symptomatic superior labrum anterior and posterior (SLAP) lesions of the shoulder. There is growing evidence to support both biceps tenotomy and tenodesis as effective alternative treatments for SLAP lesions. Hypotheses: For patients with isolated SLAP lesions, the frequency of SLAP repair has decreased, while treatment with biceps tenodesis and tenotomy has increased. Similar trends are expected in patients with SLAP lesions undergoing concomitant rotator cuff repair. Study Design: Cohort study; Level of evidence, 3. Methods: A query of the American Board of Orthopaedic Surgery part II database was performed from 2002 to 2011. The database was searched for patients with isolated SLAP lesions undergoing SLAP repair, open biceps tenodesis, arthroscopic biceps tenodesis, or biceps tenotomy. The database was then queried a second time for patients undergoing arthroscopic rotator cuff repair with concomitant SLAP repair, biceps tenodesis, or biceps tenotomy. Results: From 2002 to 2011, there were 8963 cases reported for the treatment of an isolated SLAP lesion and 1540 cases reported for the treatment of SLAP lesions with concomitant rotator cuff repair. For patients with isolated SLAP lesions, the proportion of SLAP repairs decreased from 69.3% to 44.8% ( P < .0001), while biceps tenodesis increased from 1.9% to 18.8% ( P < .0001), and biceps tenotomy increased from 0.4% to 1.7% ( P = .018). For patients undergoing concomitant rotator cuff repair, SLAP repair decreased from 60.2% to 15.3% ( P < .0001), while biceps tenodesis or tenotomy increased from 6.0% to 28.0% ( P < .0001). There was a significant difference in the mean age of patients undergoing SLAP repair (37.1 years) versus biceps tenodesis (47.2 years) versus biceps tenotomy (55.7 years) ( P < .0001). Conclusion: Practice trends for orthopaedic board candidates indicate that the proportion of SLAP repairs has decreased over time, with an increase in biceps tenodesis and tenotomy. Increased patient age correlates with the likelihood of treatment with biceps tenodesis or tenotomy versus SLAP repair.
- Published
- 2014
23. Fat embolism syndrome after bilateral total knee replacement
- Author
-
James R. Roberson and Richard S Bryan
- Subjects
medicine.medical_specialty ,business.industry ,Total knee replacement ,Fat embolism syndrome ,Total knee arthroplasty ,Medicine ,Orthopedics and Sports Medicine ,Surgery ,business ,Elderly patient ,Complication - Abstract
An elderly patient who underwent bilateral total knee arthroplasty suffered the relatively uncommon complication of the fat embolism syndrome; treatment was successful.
- Published
- 2014
24. Humeral Shaft Fracture Fixation
- Author
-
William M. Reisman, Elise A. Hiza, Michael B. Gottschalk, William E. Carpenter, and James R. Roberson
- Subjects
Male ,Humeral Fractures ,medicine.medical_specialty ,Databases, Factual ,medicine.medical_treatment ,Nonunion ,law.invention ,Intramedullary rod ,03 medical and health sciences ,Fixation (surgical) ,Postoperative Complications ,0302 clinical medicine ,Fracture Fixation ,law ,Fracture fixation ,medicine ,Humans ,Internal fixation ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,030222 orthopedics ,business.industry ,Incidence ,General Medicine ,medicine.disease ,Surgery ,Cohort ,Orthopedic surgery ,Current Procedural Terminology ,Female ,business - Abstract
Background: Despite extensive research regarding patient outcomes after operative fixation of humeral shaft fractures by means of open reduction and internal fixation (ORIF) or intramedullary nailing (IMN), no current consensus exists regarding the optimal surgical treatment. The objective of this study was to compare IMN and plate fixation (ORIF) of humeral shaft fractures by using the American Board of Orthopaedic Surgery (ABOS) Part II operative database to analyze incidence rates, changes in management trends over time, early complications, and factors affecting the management choice. Methods: The ABOS database is a collection of surgical cases that are self-reported by orthopaedic candidates approved for admission to the ABOS oral examination. The database was searched for records from 2004 to 2013 for humeral shaft surgical cases as indicated by Current Procedural Terminology (CPT) codes 24515 (open reduction internal fixation) and 24516 (insertion of intramedullary nail) pertaining to humeral shaft fractures. The geographic region and fellowship training of the candidates; the year of surgery, diagnosis code, age, and sex of the patients; and the surgeon-reported complications were analyzed. Results: The search identified 3,430 surgically treated humeral shaft fractures that were reported to the ABOS database from 2004 to 2013. A significant decline in IMN use was seen from 2004 (42.9%) to 2013 (21.2%, p < 0.001). The IMN cohort had lower complication rates pertaining to both infections (1.5% compared with 3.0% for ORIF, p = 0.007) and nerve palsies (3.1% compared with 7.8%, p < 0.001). No significant difference was seen in the rate of nonunion (1.3% for IMN compared with 1.6% for ORIF, p = 0.63), although follow-up may be too short to demonstrate a difference. The IMN cohort did have significantly higher mortality (4.9% compared with 0.7% for ORIF, p < 0.001). Subset analysis demonstrated that the IMN cohort had significantly more pathologic fractures (26.8% compared with 1.5% of the fractures treated with ORIF, p < 0.001). Conclusions: Although the overall incidence of fixation of humeral shaft fractures was unchanged from 2004 to 2013, there was a significant shift from IMN to ORIF using plate fixation during this time period. Possible reasons for this shift in treatment to ORIF include the potential impact of recent publications highlighting complications of IMN and increased surgeon attention to cost containment. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
- Published
- 2016
25. Inpatient enoxaparin and outpatient aspirin chemoprophylaxis regimen after primary hip and knee arthroplasty: a preliminary study
- Author
-
Blake John Anderson, James R. Roberson, Greg A. Erens, Thomas L. Bradbury, Stephen C. Hamilton, and William Whang
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Arthroplasty, Replacement, Hip ,Body Mass Index ,Postoperative Complications ,Outpatients ,medicine ,Humans ,Orthopedics and Sports Medicine ,Enoxaparin ,Arthroplasty, Replacement, Knee ,Retrospective Studies ,Venous Thrombosis ,Aspirin ,Inpatients ,business.industry ,Anticoagulants ,Length of Stay ,Middle Aged ,medicine.disease ,Thrombosis ,Arthroplasty ,Surgery ,Pulmonary embolism ,Venous thrombosis ,Regimen ,Anesthesia ,Chemoprophylaxis ,Female ,business ,Packed red blood cells ,Pulmonary Embolism ,medicine.drug - Abstract
Our institution has used a thromboprophylaxis regimen consisting of inpatient enoxaparin and outpatient aspirin for patients at standard risk for venous thrombosis after hip and knee arthroplasty. We reviewed 500 cases using this protocol. Inpatient treatment with enoxaparin averaged 2.75 days, followed by a 28-day course of aspirin. The overall thrombosis rate was 0.6% (1 deep venous thrombosis and 2 pulmonary emboli). Bleeding requiring transfusion of 3 or more units of packed red blood cells occurred in 1.8% of the cases. Fifteen infections were noted, 14 superficial and 1 deep. This compared favorably with a control group of 500 patients using a 14-day course of enoxaparin followed by 14 days of aspirin. We believe that a brief course of inpatient enoxaparin and outpatient aspirin is a safe and effective form of thromboprophylaxis.
- Published
- 2011
26. Deep Venous Thrombosis in Total Hip Arthroplasty
- Author
-
Orrin S. Swayze, Sam Nasser, and James R. Roberson
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Treatment options ,medicine.disease ,Prosthesis ,Surgery ,Venous thrombosis ,Medicine ,Orthopedics and Sports Medicine ,cardiovascular diseases ,Complication ,business ,Total hip arthroplasty - Abstract
Deep venous thrombosis (DVT) is the most common complication of total hip arthroplasty. This article discusses the pathogenesis and diagnosis of DVT and recommends prophylaxis and treatment options.
- Published
- 1992
27. Proximal Femoral Bone Loss after Total Hip Arthroplasty
- Author
-
James R. Roberson
- Subjects
medicine.medical_specialty ,Proximal femur ,business.industry ,medicine.medical_treatment ,Mechanical integrity ,Treatment options ,Bone grafting ,Surgery ,medicine ,Femoral bone ,Orthopedics and Sports Medicine ,Femur ,Femoral component ,business ,Total hip arthroplasty - Abstract
The cause of bone loss from the proximal femur after total hip arthroplasty is multifactorial and may progress to a degree at which loss of support for the femoral component occurs. The most durable means of reconstructing the deficient proximal femur involves bone grafting techniques designed to restore mechanical integrity. Because there is seldom an adequate quantity of autogenous bone available, allograft bone is frequently used. The indications and limitations of this procedure are described as are other treatment options.
- Published
- 1992
28. Preface
- Author
-
James R. Roberson and Sam Nasser
- Subjects
Orthopedics and Sports Medicine - Published
- 1992
29. TOTAL HIP ARTHROPLASTY USING THE MECRON RING
- Author
-
Scott D. Sagerman and James R. Roberson
- Subjects
General Medicine - Published
- 1991
30. Bipolar Components for Severe Periacetabular Bone Loss Around the Failed Total Hip Arthroplasty
- Author
-
Debra Cohen and James R. Roberson
- Subjects
medicine.medical_specialty ,business.industry ,Component Migration ,General Medicine ,Recurrent dislocation ,Acetabulum ,Bone resorption ,Stable fixation ,Surgery ,medicine.anatomical_structure ,Medicine ,Orthopedics and Sports Medicine ,In patient ,business ,Pelvis ,Total hip arthroplasty - Abstract
Twenty-seven patients had revision of a failed total hip arthroplasty using a bipolar component to replace the acetabulum. The procedure was done when periacetabular bone loss precluded stable fixation of the revision component to bone. In addition, three of the operations were done for recurrent dislocation in patients with severe medical problems. Significant component migration occurred in one case, and one patient required reoperation for dislocation in the early postoperative period. Functional results in these 27 patients were quite satisfactory; bone grafts reliably became consolidated to the host pelvis.
- Published
- 1990
31. Late hemarthrosis from a threaded acetabular component
- Author
-
James R. Roberson
- Subjects
Adult ,Male ,musculoskeletal diseases ,medicine.medical_specialty ,Time Factors ,Dentistry ,Prosthesis Design ,Postoperative Complications ,Hemarthrosis ,medicine ,Humans ,Orthopedics and Sports Medicine ,business.industry ,Acetabulum ,musculoskeletal system ,equipment and supplies ,medicine.disease ,Surgery ,Tendon ,Radiography ,Hip arthroplasty ,medicine.anatomical_structure ,Acetabular component ,Hip Prosthesis ,Complication ,business ,Total hip arthroplasty - Abstract
Painful hemarthrosis 6 months after total hip arthroplasty resulted from erosion of the anterior hip capsule over exposed threads of a threaded acetabular component. The capsular laceration occurred in an area of bone deficiency at the anterior acetabular lip underlying the psoas tendon. The diagnosis was made at the time of surgical exploration. Threaded sockets should be contained by bone in the area of these structures to prevent this previously undescribed complication.
- Published
- 1988
32. Accessory Nerve Palsy Following Thoracotomy
- Author
-
Michael D. Rooks, James R. Roberson, and Scott Morrell
- Subjects
musculoskeletal diseases ,medicine.medical_specialty ,Palsy ,medicine.diagnostic_test ,Accessory nerve ,business.industry ,medicine.medical_treatment ,General Medicine ,Electromyography ,musculoskeletal system ,Surgery ,body regions ,medicine.anatomical_structure ,Median sternotomy ,Anesthesia ,medicine ,Paralysis ,Shoulder girdle ,Orthopedics and Sports Medicine ,Thoracotomy ,medicine.symptom ,business ,Trapezius muscle - Abstract
A previously unreported cause of 11th cranial nerve palsy is described in a 53-year-old man. Dysfunction of the trapezius branch of the spinal accessory nerve occurred following median sternotomy and was documented by electromyography. This injury resulted in dysfunction of the trapezius muscle with loss of support of the shoulder girdle and pain. The injury may have been due to stretching from sternal retraction or injury secondary to internal jugular venous cannulation.
- Published
- 1989
33. Total hip arthroplasty in patients who have sickle-cell hemoglobinopathy
- Author
-
A R Bishop, J R Eckman, James R. Roberson, and L L Fleming
- Subjects
musculoskeletal diseases ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Avascular necrosis ,General Medicine ,Serious infection ,medicine.disease ,Arthroplasty ,Surgery ,Increased risk ,Hemoglobinopathy ,Resection arthroplasty ,medicine ,Orthopedics and Sports Medicine ,In patient ,business ,Total hip arthroplasty - Abstract
Eleven patients who had a form of sickle-cell hemoglobinopathy had a total hip arthroplasty for avascular necrosis of the hip. Four patients had a revision and three had a resection arthroplasty. Four had a serious infection postoperatively. Both acute and late complications were numerous. We concluded that patients who have a sickle-cell hemoglobinopathy are at markedly increased risk for complications after total hip replacement arthroplasty, yet that over-all the results are favorable.
- Published
- 1988
34. Staged versus simultaneous bilateral total knee replacement
- Author
-
J. Robin de Andrade, Lamar L. Fleming, James R. Roberson, and Stephen L. Brotherton
- Subjects
Hospital days ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Total knee replacement ,Total knee arthroplasty ,Perioperative ,Length of Stay ,Middle Aged ,Hemophilia A ,Arthroplasty ,Surgery ,Arthritis, Rheumatoid ,Hospitalization ,Blood loss ,Evaluation Studies as Topic ,Anesthetic ,Medicine ,Operative time ,Humans ,Orthopedics and Sports Medicine ,business ,Knee Prosthesis ,medicine.drug ,Anesthetics - Abstract
Bilateral total knee replacements were reviewed to determine whether any difference exists in the perioperative course between procedures done under one anesthetic (simultaneous) and those done under two anesthetics (staged). There were 29 staged and 18 simultaneous cases, therefore 76 separate procedures and 94 knees done. The total operative time, blood loss, and complications were similar between the two groups. However, the staged replacements had more than twice the hospital days (34.6 +/- 7.7 vs. 16.8 +/- 5.6, P less than .001) and 18% greater hospital bills. In fact, for a given patient, the hospital bill may be greater than 50% higher if a staged rather than simultaneous replacement is done. Therefore, simultaneous replacement is recommended for appropriate patients.
- Published
- 1986
35. The Mauch hydraulic knee unit for above knee amputation
- Author
-
Thomas B. Volatile, James R. Roberson, and Thomas E. Whitesides
- Subjects
musculoskeletal diseases ,Adult ,medicine.medical_specialty ,medicine.medical_treatment ,Acceptance rate ,Artificial Limbs ,Prosthesis Design ,Prosthesis ,Physical medicine and rehabilitation ,medicine ,Humans ,Orthopedics and Sports Medicine ,Above knee amputation ,Gait ,Aged ,Leg ,business.industry ,Stance phase ,Middle Aged ,musculoskeletal system ,Surgery ,Normal gait ,Amputation ,business ,Cadence ,human activities - Abstract
Hydraulic knee units provide a mechanical means of simulating normal gait in the above knee amputee. Sixty-one above the knee amputees were fitted with 70 Mauch SNS hydraulic knee units. Four of 60 patients rejected or were unable to use the hydraulic knee. Only one patient rejected the hydraulic knee unit for another design. Therefore, the rate of acceptance of the prosthesis was 93%. If inappropriate prescriptions for two triple amputees are omitted, the acceptance rate rises to 97%. A significant majority of patients stated that the hydraulic knee unit gave them a smoother gait, ability to change cadence, Increased activity level, increased stability in stance phase, fewer falls, and less fatigue.
- Published
- 1985
36. Surgical reconstruction of late post-traumatic thoracolumbar kyphosis
- Author
-
Thomas E. Whitesides and James R. Roberson
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Adolescent ,Decompression ,medicine.medical_treatment ,Thoracic Vertebrae ,Resection ,Postoperative Complications ,Deformity ,Medicine ,Humans ,Orthopedics and Sports Medicine ,Kyphosis ,Aged ,Lumbar Vertebrae ,business.industry ,Middle Aged ,Spinal cord ,Kyphotic deformity ,Surgery ,Vertebral body ,medicine.anatomical_structure ,Spinal Fusion ,Spinal Injuries ,Spinal fusion ,Thoracolumbar kyphosis ,Female ,Neurology (clinical) ,medicine.symptom ,business - Abstract
Thirty-four patients underwent surgery for late post-traumatic thoracolumbar kyphosis. Indications for surgery included increasing kyphotic deformity, pain, or increasing neurologic deficit. Procedures included anterior spinal fusion only, posterior spinal fusion only, anterior and posterior fusions as staged procedures, and anterior and posterior fusions under the same anesthetic. Eighteen of the patients with anterior fusions also underwent decompression of the spinal cord by resection of the vertebral body. Stable fusion with halt in progression of deformity was obtained in 33 of the 34 patients by following basic biomechanical principles.
- Published
- 1985
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