196 results on '"Susan M Odum"'
Search Results
2. Perception of Residency Program Diversity Is Associated With Vulnerability to Race and Gender Stereotype Threat Among Minority and Female Orthopaedic Trainees
- Author
-
Risa T. Reid, MD, Susan M. Odum, PhD, Patrick J. Rosopa, PhD, Jaysson T. Brooks, MD, FAOA, Brian P. Scannell, MD, FAOA, Selina Poon, MD, FAOA, Tyler Williams, BA, Joshua C. Patt, MD, MPH, FAOA, Gabriella E. Ode, MD, FAOA, the Collaborative Orthopaedic Educational Research Group (COERG), Brian Scannell, Craig Eberson, Carol Lin, Bill Levine, Michelle Coleman, Charles Day, Brent Ponce, Dawn LaPorte, Afshin Razi, Adam Gordon, Deb Bohn, Harris Slone, Randy Cohn, Eric Strauss, Stephanie Tanner, Rishi Balkisoon, Monica Kogan, Raffi Avedian, Joseph Sewards, Tessa Balach, Brandi Hartley, Ben Jackson, Ginger Holt, Elise Ames, and Alex Aleem
- Subjects
Orthopedic surgery ,RD701-811 - Abstract
Introduction:. Stereotype threat (ST) is a psychological phenomenon in which perceived fear of confirming negative stereotypes about one's identity group leads to impaired performance. Gender and racial ST has been described in various academic settings. However, it is prevalence in orthopaedic surgery, where women and minorities are underrepresented, has not been examined. This study analyzes the prevalence of ST among orthopaedic surgery residents and fellows. Methods:. US orthopaedic trainees completed a voluntary anonymous survey, which included demographics, perceived program diversity based on percentage of racial-ethnic and gender-diverse faculty and trainees, and a validated, modified version of the Stereotype Vulnerability Scale (SVS). Higher scores indicate greater ST vulnerability. ST prevalence was analyzed with descriptive statistics, and associations between program diversity, resident demographics, and ST vulnerability were compared using nonparametric tests. Results:. Of 1,127 orthopaedic trainees at 40 programs, 322 responded (response rate 28.6%). Twenty-five percent identified as female, and 26% identified as an underrepresented minority in medicine (i.e., Asian, Black, or Hispanic). Asian (12 points), Black (12.5 points), and Hispanic (13.5 points) trainees had significantly higher SVS scores than White trainees (9 points) (p = 0.0003; p < 0.0001; p = 0.0028, respectively). Black trainees at perceived racially nondiverse residencies had the highest mean SVS scores (16.4 ± 1.03 points), while White trainees at perceived racially nondiverse residencies had the lowest SVS scores (9.3 ± 0.3 points), p = 0.011. Women had significantly higher gender stereotype vulnerability than men (p < 0.0001) in both gender-diverse (17.9 ± 0.2 vs. 9.0 ± 0.3 points) and gender nondiverse residencies (16.4 ± 0.4 vs. 9.6 ± 0.2 points). Conclusion:. Minority and female orthopaedic trainees had higher ST vulnerability, especially in programs perceived as lacking racial or gender diversity. While perceived program diversity may offer some protection for minority and women trainees, women trainees still met the threshold for high vulnerability regardless of program gender diversity. Future strategies to mitigate ST should be explored in orthopaedic training.
- Published
- 2025
- Full Text
- View/download PDF
3. Size and morphology of the coracoid and glenoid in pediatric and adolescent patients: implications for Latarjet procedure
- Author
-
Samuel L. Posey, MD, Josef E. Jolissaint, MD, Matthew Boylan, MD, Daniel Hurwit, MD, Julian Sonnenfeld, MD, Ziqing Yu, PhD, Susan M. Odum, PhD, Shadley Schiffern, MD, Nady Hamid, MD, and Jonathan Riboh, MD
- Subjects
Coracoid ,Shoulder instability ,Pediatric ,Adolescent ,Latarjet ,Glenoid ,Orthopedic surgery ,RD701-811 ,Diseases of the musculoskeletal system ,RC925-935 - Abstract
Background: Glenohumeral instability is a challenging problem in children and adolescents. For patients with anterior glenoid bone loss, the Latarjet procedure is an effective treatment option. However, concerns about coracoid size and morphology may limit its utilization within this patient population. The purpose of this study was to establish normative data on coracoid and glenoid size and morphology among a large cohort of adolescent patients and describe the anatomic relationships with demographic factors. Methods: This is a retrospective cross-sectional study of a consecutive series of 584 patients aged 12-21 years after a chest computed tomography scan for non-shoulder related trauma at a single level I trauma center. Demographic characteristics were collected from the electronic medical record, and the following coracoid anatomic measurements were obtained from computed tomography scans: coracoid length, coracoid thickness, coracoid width, glenoid height, and glenoid width. The ratio of coracoid thickness to glenoid width was calculated to estimate the percent bone loss that could be addressed with a traditional Latarjet coracoid transfer. To ensure reliability among 3 reviewers, all measured the same 25 scans and inter-rater reliability was excellent with all Kappa coefficients >0.81. The remaining scans were divided equally and assessed separately by these reviewers. Correlation coefficients were used to quantify the relationships between all anatomic measures and the age, weight, and height of individuals. Growth curves for each measurement were modeled using quantile regression with height and height∗height as predictors. Additionally, we stratified the growth curves by sex, when significant. Of the 584 subjects, 55% were male, and average age was 19 years (range 12, 21). Results: All growth curves illustrated increase anatomic size across the height range of 145-190 cm. The growth curve including all patients (Fig. 1) illustrated that the 50% percentile of median coracoid length increased from approximately 28 to 32 mm. In addition to height, sex was a significant predictor for coracoid width and glenoid width. The median coracoid width increased from approximately 9.5 to 10.2 mm for females compared to an increased width from approximately 10 to 11 mm for males. The median glenoid width for females increased from approximately 21 to 25 mm and for males the median glenoid width increased from just under 22 to 25.5 mm. Conclusions: Among children and adolescents, coracoid and glenoid size are correlated with patient height. These data can help guide patient selection for the Latarjet procedure.
- Published
- 2023
- Full Text
- View/download PDF
4. Nitinol Staple vs Traditional Plate Osteosynthesis for Primary Arthrodesis of Lisfranc Injuries: A Retrospective Analysis
- Author
-
Carson D. Strickland MD, Alex R. Dombrowsky, Matthew S. Conti MD, Todd A. Irwin MD, W. Hodges Davis MD, Bruce E. Cohen MD, Carroll P. Jones, J. Kent Ellington MD, MS, Scott B. Shawen MD, Susan M. Odum PhD, and Samuel E. Ford MD
- Subjects
Orthopedic surgery ,RD701-811 - Abstract
Category: Trauma; Midfoot/Forefoot Introduction/Purpose: Primary arthrodesis of Lisfranc and midfoot fracture-dislocations is a reliable treatment option, yet concerns remain about nonunion and dorsiflexion malunion. The use of a new generation of nitinol staples has proliferated in midfoot arthrodesis. The purpose of this study is to examine the use of nitinol staples in primary arthrodesis of acute Lisfranc fracture-dislocations, comparing outcomes to traditional plate and screw fixation. The primary hypothesis is that nonunion rates are lower with constructs that include nitinol staples than those with plates and screws alone. Secondary hypotheses are: 1. Total operative and tourniquet time are shorter using nitinol staples. 2. Reoperation rates are lower using nitinol staples. 3. Dorsiflexion malunion rates are lower using nitinol staples. 4. Functional outcome scores will indicate comparable post-arthrodesis disability. Methods: Midfoot fracture-dislocations treated with primary arthrodesis by seven foot and ankle orthopaedic surgeons at a tertiary referral center from 1/1/2012 to 8/1/2021 were reviewed. Patients with open fractures, fractures managed with external fixation, Charcot arthropathy, neuropathy, previous midfoot surgery, or concomitant hindfoot/ankle fractures were excluded. Of the 160 eligible patients, 121 met the required 4-month minimum radiographic follow-up. Preoperative imaging and operative records were reviewed, evaluating for associated metatarsal and cuneiform fractures, operative and tourniquet time, joints included, and fixation construct. Patients and individual joints (303 total) were categorized as either staples alone (47 patients), staples plus plates and screws (hybrid) (47), or plates and screws alone (35). Postoperative radiographs at last follow-up were then analyzed for union and malunion at each joint fused. CT scans were used, when available (41 patients), to assess for union. Medical records were reviewed for postoperative complications. FAAM, VR-12, and NPRS were collected. Results: When assessed at the individual joint level, the nonunion rate was higher (8%, 9/101) among joints fixed with plate and screw constructs than with hybrid (2.4%, 1/41) or staple only constructs (1.3%, 2/152) (P = 0.015). Of the 12 nonunions in the study, 6 had either a metatarsal or cuneiform fracture. Median OR and tourniquet time were both shorter for hybrid (92 & 83 minutes) and staple only (67 & 63 minutes) constructs than plate and screw only fixation (107 & 96 minutes) (P = 0.0002 & 0.0009). There were 17 (14%) reoperations including 10 hardware removals, 3 nonunion revisions, and 1 malunion revision. There was no difference in reoperation, malunion (14 total, 12%), or patient reported outcome measure between fixation types. Conclusion: Nitinol staples are effective in achieving bony fusion when used alone or in combination with plates and screws. With lower rates of nonunion and shorter tourniquet and operative time compared to traditional plate and screw fixation, their use should be considered for primary arthrodesis of Lisfranc and midfoot fracture-dislocations. Further studies are needed to determine if staples decrease the risk for dorsiflexion malunion and improve patient reported outcomes.
- Published
- 2022
- Full Text
- View/download PDF
5. Failure to Medically Optimize Before Total Hip Arthroplasty: Which Modifiable Risk Factor Is the Most Dangerous?
- Author
-
Joseph M. Statz, MD, Susan M. Odum, PhD, Nicholas R. Johnson, MD, and Jesse E. Otero, MD, PhD
- Subjects
Hip ,Arthroplasty ,Total hip arthroplasty ,Modifiable risk ,Orthopedic surgery ,RD701-811 - Abstract
Background: There is mounting evidence that smoking, abnormal body mass index (BMI), uncontrolled diabetes, and poor nutritional status are associated with complications after total hip arthroplasty (THA). The goal of the present study was to evaluate the consequences of failure to medically optimize Medicare-eligible patients with respect to these key modifiable health targets by assessing complications in the early postoperative period after THA. Methods: The National Surgical Quality Improvement Program database was queried for all primary THAs performed in 2018. Data were collected on preoperative serum albumin, BMI, diabetes, and tobacco use as well as postoperative infections, readmissions, complications, and mortality. We identified 47,924 THA patients with a median BMI of 29 kg/m2 and age of 72 years, and 60% of whom were female. Results: We found that preoperative albumin
- Published
- 2021
- Full Text
- View/download PDF
6. Valgus Drift after Total Ankle Arthroplasty
- Author
-
David Vier MD, Rasikh N. Hamid, Susan M. Odum PhD, Carroll P. Jones MD, Bruce E. Cohen MD, Todd A. Irwin MD, and W. Hodges. Davis MD
- Subjects
Orthopedic surgery ,RD701-811 - Abstract
Category: Ankle; Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) is a common treatment for ankle arthritis, but many challenges exist when attempting to correct and balance coronal plane deformity. Varus ankle arthritis tends to be stiffer and often leads to a more stable TAA, but valgus ankle arthritis tends to have more laxity especially in the setting of a progressive collapsing foot deformity. Failure to achieve appropriate deformity correction and soft tissue balance can result in recurrence of the deformity with valgus drift. The purpose of this study was to evaluate the longitudinal coronal plane alignment as well as outcomes in patients treated with TAA with resultant valgus drift. Methods: 98 patients who underwent TAA for valgus ankle arthritis were identified through a prospectively collected database. All patients had a minimum of 2 year follow-up. The tibiotalar angle was measured on preoperative radiographs to include patients with valgus ankle arthritis five degrees or greater. Radiographic alignment in the postoperative period was compared to the alignment at final follow-up. Complications, failures, revisions, and reoperations were recorded. Patients were categorized by severity of preoperative valgus deformity into 3 groups: 5-10 degrees, 11-20 degrees, and greater than 20 degrees. Valgus drift was defined as greater than 5 degrees of valgus shift at final follow-up when compared to the postoperative alignment. Median follow- up was 49.2 (37.2-68.3 inner quartile) months. Results: Patients with greater than 20 degrees of preoperative valgus deformity had an initial postoperative alignment of 2 degrees of valgus and ended with an average of 5.5 degrees of valgus at final follow-up. The groups of patients with 5-10 degrees as well as 11-20 degrees of valgus were corrected to neutral (0 degrees) in the initial post-op period and ended with a final postoperative valgus alignment of 2.5 degrees and 2 degrees, respectively. Overall, 16 patients (18%) had greater than 5 degrees of valgus drift after their surgery, of which 2 failed and were revised (13%) and 5 had reoperations (31%). Conclusion: All groups of preoperative valgus deformity severity had some valgus shift overall at final follow-up. The most severe preoperative valgus deformities were least likely to be corrected to neutral with the index procedure and also on average drifted back to over 5 degrees of valgus. Patients with valgus drift after TAA can still have a good result but should be monitored closely. Overall, they did not have a high failure rate. This study emphasizes the necessity of correcting both the ankle and foot deformity when performing TAA for valgus ankle arthritis in order to maintain deformity correction.
- Published
- 2022
- Full Text
- View/download PDF
7. Does Preoperative Valgus Deformity Severity Predict Outcomes in Total Ankle Arthroplasty vs Ankle Arthrodesis?
- Author
-
David Vier MD, Rasikh N. Hamid, Susan M. Odum PhD, Carroll P. Jones MD, Bruce E. Cohen MD, Todd A. Irwin MD, and W. Hodges Davis MD
- Subjects
Orthopedic surgery ,RD701-811 - Abstract
Category: Ankle; Ankle Arthritis Introduction/Purpose: Coronal plane deformity is an important consideration in the treatment of ankle arthritis, and valgus alignment presents its own unique challenges. Ankle fusions were previously considered the gold standard, but advancements in total ankle arthroplasty (TAA) implant design and surgical technique have increased its popularity in the treatment of even large coronal plane deformities. Although many studies have compared fusion to arthroplasty, no studies have directly compared these two treatments in the treatment of valgus ankle arthritis. The purpose of this study was to evaluate and compare clinical and radiographic outcomes of TAA to ankle fusion in the treatment of valgus ankle arthritis. Methods: 137 patients with valgus ankle arthritis who underwent either TAA or ankle fusion were identified through a prospectively collected database. Minimum clinic follow-up was two years. Preoperative radiographs were measured for tibiotalar angle to include patients with valgus ankle arthritis five degrees or greater. Axial alignment views were also analyzed for preoperative hindfoot alignment. Patients who underwent tibiotalocalcaneal fusion or had previous ankle corrective osteotomy were excluded. Complications, failures, revisions, and reoperations were recorded. Failures were defined by explant of a metal component. Reoperations included any additional related ankle/hindfoot surgery including subtalar fusion. Patients were categorized by severity of preoperative valgus deformity into 4 groups: 5-10 degrees, 11-15 degrees, 16-20 degrees, and greater than 20 degrees. Outcomes were compared across these groups between TAA and ankle fusion. There were 98 patients who underwent TAA and 39 patients who underwent ankle fusion. Median follow-up was 50.4 months (inner quartile 37.4-74.1). Results: Patients who underwent TAA with greater than 15 degrees of preoperative valgus deformity had higher rates of failures, revisions, and reoperations compared to those who underwent fusion with the same deformity severity. Overall, 44% of patients (60/137) had major or minor complications. There were 6 failures (6%) in the TAA cohort and 5 failures (13%) in the fusion cohort. 36% of fusions (14/39) underwent reoperation which was a higher rate compared to 18% of TAAs (18/98) (p=0.03). Combined fusion and TAR cohorts had less complications, failures/revisions, and reoperation rates as the severity of deformity increased (p
- Published
- 2022
- Full Text
- View/download PDF
8. Prevalence of Prescription Opioids for Nonoperative Treatment of Rotator Cuff Disease Is High
- Author
-
Jacob Gorbaty, M.D., Susan M. Odum, Ph.D., Meghan K. Wally, M.S.P.H., Rachel B. Seymour, Ph.D., Nady Hamid, M.D., Joseph R. Hsu, M.D., Michael Beuhler, M.D., Michael J. Bosse, M.D., Michael Gibbs, M.D., Christopher Griggs, M.D., Steven Jarrett, Pharm.D., Daniel Leas, M.D., Tamar Roomian, M.S., M.P.H., Michael Runyon, M.D., Animita Saha, M.D., Bradley Watling, M.D., Stephen Wyatt, D.O., and Ziqing Yu, M.S.
- Subjects
Sports medicine ,RC1200-1245 - Abstract
Purpose: To quantify the prevalence of opioid and benzodiazepine prescriptions for patients with rotator cuff disease across a large health care system and to describe evidence-based risk factors for opioid use within this population. Methods: We conducted a retrospective cohort study at a major health care system of all patients with qualifying diagnostic codes. Emergency department, urgent care, and outpatient encounters between January and December 2016 for an acute rotator cuff tear, listed as the primary diagnosis, were included. Encounters with prescriptions for opioids or benzodiazepines were identified using the Prescription Reporting With Immediate Medication Utilization Mapping (PRIMUM) system. Descriptive statistics and the rate of controlled-substance prescribing were calculated for the population as a whole and among subgroups. Results: We identified 9,376 encounters meeting the inclusion criteria. Of these encounters, 1,559 (16.6%) resulted in 1 or more prescriptions for an opioid or benzodiazepine that were issued during the visit. A total of 2,007 opioid and/or benzodiazepine prescriptions were issued for the 1,559 encounters (rate of 1.29 prescriptions per prescribing encounter). This represented 5,310 patients, of whom 1,096 (20.6%) received a prescription for an opioid or benzodiazepine during at least 1 of their encounters. Of patients who received a prescription, 20.9% had at least 1 risk factor for prescription misuse; 3.6% of patients had more than 1 risk factor. There were no demographic differences between patients with risk factors and patients without them. Conclusions: The prescribing of opioids for the treatment of pain in patients with rotator cuff disease remains high across multiple locations and specialties within a large health care system. Using alternative pain management pathways as primary prevention for opioid misuse and abuse in high opioid-prescribing locations—and especially for patients identified as having a high risk of opioid misuse—is an important practice to continue in our shift away from opioid use as a health care system. Level of Evidence: Level IV, case series.
- Published
- 2021
- Full Text
- View/download PDF
9. Mortality and Conversion Rate to Below Knee or Above Knee Amputation Following Transmetatarsal Amputation
- Author
-
D. Anthony Barcel MD, Susan M. Odum PhD, Taylor Rowe, Jefferson B. Sabatini MD, Samuel E. Ford MD, J. Kent Ellington MD, MS, Carroll P. Jones MD, W. Hodges Davis MD, and Todd A. Irwin MD
- Subjects
Orthopedic surgery ,RD701-811 - Abstract
Category: Midfoot/Forefoot; Diabetes; Other Introduction/Purpose: Non-traumatic lower extremity amputations (LEA), especially those performed in dysvascular and diabetic patients, are known to have poor long-term prognosis. Perioperative mortality has been reported at between 4 and 10%, and the 1 and 5 year mortality rates range between 22-33% and 39-69%, respectively. While poor outcomes in these patients have been described, there is no consensus as to the predictors of mortality. The purpose of the study is to determine the percentage of patients who had a complication following transmetatarsal amputation (TMA) and identify associated risk factors for complications and mortality. Methods: We queried our institution’s administrative database to identify 247 TMA procedures performed in 229 patients between January, 2002 and December, 2016. Electronic health records were reviewed to document complications defined as reoperation, amputation and mortality. Mortality was also verified using the National Death Index. Additionally, we recorded risk factors including diabetes, A1c level, end stage renal disease (ESRD), cardiovascular disease (CVD), peripheral vascular disease (PVD), history of revascularization, contralateral amputation, and neuropathy. The majority of the study patients were males (157, 69%) and the average age was 57 years (range 24-91). The median BMI was 28 (range 16-58) and 29% of the study patients were obese with a BMI ≥ 30. Fishers Exact tests were used to compare categorical variables. Kruskal-Wallis and Independent T-tests were used to compare numeric data. All data were analyzed using SAS/STAT software version 9.4 (Carey, NC) and a 0.05 level of significance was defined apriori. Results: The conversion rate to below (BKA) or above knee amputation (AKA) was 26% (64 of 247). Males (p=.0274), diabetics (p=.0139), patients in ESRD (p=.019), and patients with a history of CVD (p=.0247) or perioperative revascularization (p=.022) were more likely to undergo further amputation following an index TMA. BMI was significantly higher in patients requiring BKA/AKA (p=.0305). There were no significant differences in age (p=.2723) or A1c levels (p=.4219). The overall mortality rate was 35% (84 of 229). Diabetes (p=.0272), ESRD (p=.0031), history of CVD (p
- Published
- 2020
- Full Text
- View/download PDF
10. Cheilectomy with or without Cryopreserved Amniotic Membrane-Umbilical Cord Allograft for Hallux Rigidus: A Prospective Randomized Controlled Trial
- Author
-
Sara H. Galli MD, Chad M. Ferguson MD, W. Hodges Davis MD, Robert B. Anderson MD, Bruce E. Cohen MD, Carroll P. Jones MD, Susan M. Odum PhD, and J. Kent Ellington MD, MS
- Subjects
Orthopedic surgery ,RD701-811 - Abstract
Category: Basic Sciences/Biologics; Other Introduction/Purpose: Arthritis of the first MTP joint (hallux rigidus) is the most common form of osteoarthritis affecting the foot. Even with advances in interpositional techniques and devices, dorsal cheilectomy remains part of the treatment algorithm after failed conservative treatment of hallux rigidus. Cheilectomy aims to alleviate dorsal impingement and improve pain and function as well as range of motion. However, prospective data on outcomes following this procedure is lacking.Cryopreserved amniotic membrane-umbilical cord (AM-UC) allograft has been shown to mitigate inflammation and decrease scar formation. This has theoretical benefit for improving outcomes following cheilectomy. In the first prospective randomized and blinded cheilectomy study reported, we aimed to compare outcomes between patients undergoing cheilectomy alone and cheilectomy with cryopreserved amniotic membrane-umbilical cord allograft. Methods: After obtaining institutional board review approval, patients were randomized to cheilectomy alone (CA) or cheilectomy with cryopreserved amniotic membrane-umbilical cord (AM-UC). Surgeries were performed by fellowship trained surgeons. Cheilectomy was performed utilizing fluoroscopy to remove ˜25% dorsal articular surface. Cryopreserved AM-UC was applied to cheilectomy site and secured inside capsule with absorbable ‘stay-stitch.’Patients were followed with AOFAS MTP- IP, Foot Function Index (FFI), and VAS-pain (walking, waking, and end of day) outcomes collected preoperatively and at 6 months and 1 year postoperatively. In addition, radiographic range of motion data was collected (maximal dorsiflexion and plantarflexion) utilizing stress radiographs. Power analysis determined 27 patients per group was needed to detect a difference between AOFAS scores of 95 (AM-UC) and 85 (CA). Data was analyzed utilizing statistical analysis software (SAS v9.4). AOFAS, FFI, and VAS scores were analyzed using Wilcoxon signed-rank test. Range of motion data was analyzed using two-way ANOVA with Tukey adjusted least square means test. Results: 51 patients (26 AM-UC, 25 CA) completed the study. There were 5 bilateral surgeries in AM-UC group and 2 in CA group, totaling 31 and 27 feet respectively. Postoperatively, the AM-UC group had improved AOFAS and FFI scores at 1 year compared to CA group but there was no difference at 6 months. There was no difference between groups for VAS-pain scores (walking, waking, or end of day) at any time point, but overall VAS-pain improved in both groups from preoperative values. There was no difference seen in range of motion (total arc) between groups. In addition, changes in range of motion (total arc) in both groups from preoperative to 1 year postoperative were small. Conclusion: We present the results of the first randomized and blinded prospective study of cheilectomy surgery patients. There was improvement in pain, AOFAS MTP-IP, and FFI scores in all patients with statistically significant improvement at 1 year in AOFAS and FFI scores in the cryopreserved amniotic membrane-umbilical cord group compared to cheilectomy alone group. This was despite minimal change in range of motion in both groups. When appropriately selected, cheilectomy remains a good option for patients with symptomatic hallux rigidus. Cryopreserved amniotic membrane-umbilical cord is a potential adjuvant to cheilectomy to modulate inflammation and scarring with 1 year results showing improvements in functional outcome scores.
- Published
- 2020
- Full Text
- View/download PDF
11. Are reinfusion drains safe to use with periarticular liposomal bupivacaine? An analysis of systemic bupivacaine toxicity
- Author
-
Marc R. Angerame, MD, Gavin P. Hart, MD, Susan M. Odum, PhD, and Bryan D. Springer, MD
- Subjects
Total knee arthroplasty ,Pain control ,Periarticular injection ,Liposomal bupivacaine ,Reinfusion drain ,Bupivacaine toxicity ,Orthopedic surgery ,RD701-811 - Abstract
Background: Intraoperative periarticular injection (PAI) with local anesthetic is an important component of multimodal pain control in total joint arthroplasty (TJA). A potential risk of this practice is serum anesthetic toxicity resulting from the autotransfusion of blood collected from a reinfusion drain. The purpose of this study is to evaluate the levels of bupivacaine in blood collected in an autotransfusion system after use of a PAI in TJA. Methods: In this prospective study, each TJA patient had an identical PAI consisting of 20 cc of liposomal bupivacaine, 30 cc of 0.25% bupivacaine with epinephrine, and 10 cc of normal saline. An autologous reinfusion drain was utilized in all patients. At 2 and 5 hours postoperatively, blood was collected from the autotransfusion canister and sent to the laboratory to quantify bupivacaine levels. The sums of these levels were compared to the lowest reported serum bupivacaine dose associated with toxicity (1.1 mg/kg). Results: Eleven unilateral TJA patients were enrolled (6 total knee arthroplasties, 5 total hip arthroplasties). The average 2-hour serum bupivacaine level was 2.9 μg (range 0.8-5.6) while the average 5-hour serum bupivacaine level was 4.5 μg (range 0.4-10.0). The average sum of the 2-hour and 5-hour serum bupivacaine level was 5.6 μg (range 0.8-13.6). Each of the 11 patient samples were well below their minimum serum bupivacaine dose toxicity. Conclusions: Use of a reinfusion drain after PAI with liposomal bupivacaine in TJA appears safe, as bupivacaine levels in the autotransfused blood remains well below the reported minimum serum toxic dose. Level of Evidence: IV.
- Published
- 2018
- Full Text
- View/download PDF
12. Early femoral condyle insufficiency fractures after total knee arthroplasty: treatment with delayed surgery and femoral component revision
- Author
-
George L. Vestermark, MD, Susan M. Odum, PhD, and Bryan D. Springer, MD
- Subjects
Total knee arthroplasty ,Periprosthetic fracture ,Insufficiency fracture ,Delayed treatment ,Orthopedic surgery ,RD701-811 - Abstract
Background: Periprosthetic fracture following total knee arthroplasty (TKA) is usually associated with a traumatic event and typically treated with fracture fixation techniques. However, we report on a series of patients with early atraumatic condyle fractures that occurred as a result of insufficiency of the unloaded preoperative femoral condyle treated with delayed reconstruction. Methods: We retrospectively reviewed a series of 7 patients who sustained femoral condyle fractures following TKA and evaluated risk factors for insufficiency. Results: There were 6 females and 1 male with an average age of 65.5 (range, 63-75) years and an average body mass index of 29.4 (range, 27-32). Fracture occurred on average 24.9 days from the index surgery and secondary to a low energy mechanism. Five patients had valgus alignment (mean, 15.2°) preoperatively and sustained fracture of the unloaded medial femoral condyle. Two patients had varus alignment (mean, 7.0°) preoperatively and both fractured the unloaded lateral condyle. One patient underwent early intervention requiring distal femoral replacement secondary to femoral bone loss. The remaining 6 patients underwent delayed surgery for an average of 6 weeks to allow for fracture healing followed by femoral component revision. At last follow-up (average, 48.5 months), 1 patient required a tibial component revision; however, no revision of the femoral component was required. Conclusions: Early femoral condyle insufficiency fractures following TKA may be a risk in females with poor bone quality and preoperative valgus alignment. Delayed surgery and femoral component revision is a treatment strategy that prevented the need for other tertiary reconstruction.
- Published
- 2018
- Full Text
- View/download PDF
13. Cheilectomy With or Without Cryopreserved Umbilical Cord for Hallux Rigidus: A Prospective Randomized Controlled Trial
- Author
-
Sara Heintzman MD, Chad Ferguson MD, W. Hodges Davis MD, Robert B. Anderson MD, Bruce E. Cohen MD, Carroll P. Jones MD, Susan M. Odum PhD, and J. Kent Ellington MD
- Subjects
Orthopedic surgery ,RD701-811 - Abstract
Category: Midfoot/Forefoot Introduction/Purpose: Arthritis of the first MTP joint (hallux rigidus) is the most common form of osteoarthritis affecting the foot. Despite advances in interpositional techniques and devices, dorsal cheilectomy remains part of the treatment algorithm after failed conservative treatment of hallux rigidus. Dorsal cheilectomy aims to surgically remove dorsal impingement and improve pain and function as well as range of motion. However, prospective data on outcomes following this procedure is lacking. Cryopreserved umbilical cord (UC) allografts have been shown to mitigate inflammation and decrease scar formation. This has theoretical benefit for recovery and disease progression following dorsal cheilectomy. In the first prospective randomized and blinded cheilectomy trial reported, we aimed to compare outcomes of patients undergoing dorsal cheilectomy alone and dorsal cheilectomy with cryopreserved umbilical cord. Methods: After obtaining institutional board review approval, patients were randomized to cheilectomy alone(CA) or cheilectomy with cryopreserved UC. Surgeries were performed by fellowship trained surgeons. Dorsal cheilectomy was performed utilizing fluoroscopy to remove ˜25% articular surface. UC was applied to cheilectomy site and secured inside capsule with absorbable “stay-stitch.” Patients were followed for 1 year with AOFAS MTP-IP, Foot Function Index (FFI), and VAS-pain (walking, waking, and end of day) outcomes collected preoperatively and at 6 months and 1 year. In addition, radiographic range of motion data was collected (maximal dorsiflexion and plantarflexion). Power analysis determined 27 patients per group was needed to detect a significant difference between AOFAS scores of 95(UC) and 85(control). Data was analyzed utilizing statistical analysis software(SAS v9.4). AOFAS MTP-IP, FFI, and VAS scores were analyzed using Wilcoxon signed-rank test. Range of motion data was analyzed using two-way ANOVA with Tukey adjusted least square means test. Results: 51 patients (26 UC, 25 CA) completed the study. There were 5 bilateral surgeries in UC group and 2 in CA group, totaling 31 and 27 feet respectively. Post-operatively, UC group had significantly improved AOFAS and FFI scores at 1 year compared to CA group. There was no difference between groups for VAS-pain scores (walking, waking, or end of day at any time point), but overall VAS-pain improved in both groups from preoperative values. There was no difference seen in range of motion between groups. However, there was an overall improvement in maximal plantarflexion at 6 months and 1 year and maximal dorsiflexion at 6 months in both groups. Conclusion: We present the results of the first randomized and blinded prospective study of cheilectomy surgery patients. There was improvement in range of motion, pain, AOFAS, and FFI scores in all patients with statistically significant improvement at 1 year in AOFAS and FFI scores in the UC group compared to CA group. When appropriately selected, cheilectomy remains a good option for patients with symptomatic hallux rigidus. Cryopreserved umbilical cord is a potential adjuvant to cheilectomy to modulate inflammation and scarring with early 1 year results showing improvements in functional outcome scores.
- Published
- 2019
- Full Text
- View/download PDF
14. Opioid-free shoulder arthroplasty is safe, effective, and predictable compared with a traditional perioperative opiate regimen: a randomized controlled trial of a new clinical care pathway
- Author
-
Josef E. Jolissaint, Gregory T. Scarola, Susan M. Odum, Daniel Leas, Nady Hamid, Todd M. Chapman, Patrick M. Connor, Brian M. Curtin, R. Glenn Gaston, Todd A. Irwin, Bryan J. Loeffler, Caleb Michalek, R. Alden Milam, Bryan M. Saltzman, Shadley C. Schiffern, and Meghan K. Wally
- Subjects
Analgesics, Opioid ,Pain, Postoperative ,Morphine ,Arthroplasty, Replacement, Shoulder ,Opiate Alkaloids ,Critical Pathways ,Humans ,Orthopedics and Sports Medicine ,Surgery ,General Medicine ,Pain Measurement - Abstract
Opiate-based regimens have been used as a foundation of postoperative analgesia in orthopedic surgery for decades, and the vast majority of orthopedic patients in the United States receive postoperative opioid prescriptions. Both the safety and efficacy of opioid use in orthopedic patients have been questioned because of mounting evidence that postoperative opioid use can be detrimental to outcomes and patient satisfaction. The purpose of this study is to compare a new, opioid-free pain management pathway with a traditional opioid-containing, multimodal pathway in patients undergoing shoulder arthroplasty.This is a single-center randomized clinical trial in which 67 patients who underwent shoulder arthroplasty were allocated into 2 treatment arms: either a completely opioid-free, multimodal perioperative pain management pathway (OF), or a traditional opioid-containing perioperative pain management pathway (OC). Pain was measured on a numeric rating scale from 0 to 10 at 6-, 12-, 24-hour, 2-week, and 6-week time points. Deviations from the OF pathway, morphine milligram equivalents, readmissions, and opioid-related side effects were analyzed.Pain levels were significantly lower in the OF group at 12 hours, 24 hours, and 2 weeks. At 12 hours, the median pain rating was 0 compared with a median pain rating of 3 in the OC group (P = .003). At 24 hours, the OF group reported a median pain rating of 1 and the OC group reported a median pain rating of 4 (P .001). The median pain rating at the 2-week time point in the OF group was 2 compared with 4 in the OC group (P = .006). Median pain ratings were similar between the OF group and the OC group at the 6-week time point. The median pain rating in the OF group at 6 weeks was 1, compared with 1.5 in the OC group. Of the 35 patients in the OF pathway, 1 required a rescue opioid medication for left cervical radiculopathy that ultimately necessitated cervical spine fusion after recovery from right shoulder arthroplasty, and 1 was noted to have taken an opioid medication, diverted from a prior prescription, at the 2-week visit. The morphine milliequivalents received in the OF group was 20 compared with 4936.25 in the OC group. There were no readmissions in the OF pathway, and no differences between the groups with regard to constipation, falls, or delirium.A multimodal, opioid-free perioperative pain management pathway is safe and effective in patients undergoing total shoulder arthroplasty and offers superior pain relief to that of a traditional opioid-containing pain management pathway at 12 hours, 24 hours, and 2 weeks postoperatively.
- Published
- 2022
- Full Text
- View/download PDF
15. The Effect of Femoral Fixation on Revision and Mortality Following Elective Total Hip Arthroplasty in Patients Over the Age of 65 years. An Analysis of the American Joint Replacement Registry
- Author
-
Alejandro Gonzalez Della Valle, Susan M. Odum, Ayushmita De, John W. Barrington, James I. Huddleston, Richard L. Illgen, and Bryan D. Springer
- Subjects
Reoperation ,Risk Factors ,Arthroplasty, Replacement, Hip ,Bone Cements ,Humans ,Orthopedics and Sports Medicine ,Hip Prosthesis ,Registries ,Periprosthetic Fractures ,Prosthesis Design ,United States ,Aged - Abstract
With the overwhelming use of cementless femoral fixation for primary total hip arthroplasty in the United States, the associations of stem fixation on the risk of revision and mortality are poorly understood. We evaluated the relationship between femoral fixation and risk of revision and mortality in patients included in the American Joint Replacement Registry.Elective, primary, unilateral total hip arthroplasties in the American Joint Replacement Registry, in patients over the age of 65 years were considered. In total, 9,612 patients with a cemented stem were exact matched 1:1 with patients who received a cementless stem based on age, gender, and the Charlson Comorbidity Index. Outcomes compared between the groups included need and reason for revision at 90 days and 1 year; in-hospital, 90-day, and 1-year mortality; and mortality after early revision. Covariates were used in linear regression analyses.Cemented fixation was associated with a 37% reduction in the risk of 90-day revision, and a reduction in the risk of revision for periprosthetic fracture of 87% at 90 days and 81% at 1 year. Cemented fixation was associated with increased 90-day and 1-year mortality (odds ratio [OR] 3.15, confidence interval [CI] 2.24-4.43 and OR 2.36, CI 1.86-3.01, respectively). Patients who underwent subsequent revision surgery within the first year exhibited the highest mortality risk (OR 3.23, CI 1.05-9.97).In this representative sample of the United States, 90-day revision for any reason and for periprosthetic fracture was significantly reduced in patients with a cemented stem. This benefit must be weighed against the association with increased mortality and with the high risk of mortality associated with early revision, which was more prevalent with cementless fixation.
- Published
- 2022
- Full Text
- View/download PDF
16. Dual Mobility Articulation in Revision Total Hip Arthroplasty: An American Joint Replacement Registry Analysis of Patients Aged 65 years and Older
- Author
-
Jesse E. Otero, Nathanael D. Heckman, Heena Jaffri, Kyle Mullen, Susan M. Odum, Jay R. Lieberman, and Bryan D. Springer
- Subjects
Orthopedics and Sports Medicine - Published
- 2023
- Full Text
- View/download PDF
17. Central Slip Reconstruction With a Distally Based Flexor Digitorum Superficialis Slip: A Biomechanical Study
- Author
-
Samuel Louis Posey, Jed Ian Maslow, R. Glenn Gaston, Susan M. Odum, Nahir A. Habet, and Marc Duemmler
- Subjects
Orthodontics ,Primary suture ,Sutures ,business.industry ,Strain (injury) ,Slip (materials science) ,medicine.disease ,Numerical digit ,Biomechanical Phenomena ,Cadaver ,Hand Deformities, Acquired ,Direct repair ,Load to failure ,medicine ,Humans ,Orthopedics and Sports Medicine ,Surgery ,business ,Boutonniere deformity - Abstract
Purpose The ideal method of central slip reconstruction is difficult to determine due to the multitude of techniques, nonstandardized outcome reporting, and small patient series in the literature. Although most boutonniere deformities may be treated with nonsurgical measures, chronic, subacute, or open injuries may require operative intervention. To aid surgeons in the choice of the ideal central slip reconstruction method, this biomechanical study compared the 3 most common methods performed at our institution: direct repair, lateral band centralization, and distally-based flexor digitorum superficialis (FDS) slip repair. Methods A boutonniere deformity was induced in 35 fresh-frozen cadaver digits. The central slip was repaired in 9 digits using a primary suture repair, in 9 digits using a lateral band centralization technique, and in 9 digits using a distally-based FDS slip reconstruction. A control group without injury was tested in 8 digits. Following repair or reconstruction, each digit was tested for load to failure, strain, and stiffness at the repair. Results The average load to failure after central slip reconstruction was significantly greater for a distally based FDS slip method at 82.1 ± 14.6 N (95% CI, 62.2–101.9 N) than all other repair types. Although the FDS slip reconstruction was not as strong as the intact state (82.1 N vs 156.2 N, respectively), it was 2.6 times stronger than the lateral band centralization (82.1 N vs 31.6 N, respectively) and 3 times stronger than a primary repair (82.1 N vs 27.6 N, respectively). Conclusions Reconstruction of the central slip using a distally-based FDS slip provided the greatest biomechanical strength compared with the direct repair or lateral band centralization. Clinical relevance The use of a distally based reconstruction using FDS may allow for safer early motion.
- Published
- 2022
- Full Text
- View/download PDF
18. Hypoalbuminemia Predicts Failure of Two-Stage Exchange for Chronic Periprosthetic Joint Infection of the Hip and Knee
- Author
-
Cody C. Green, Michael M. Valenzuela, Susan M. Odum, Taylor M. Rowe, Bryan D. Springer, Thomas K. Fehring, and Jesse E. Otero
- Subjects
Orthopedics and Sports Medicine - Published
- 2023
- Full Text
- View/download PDF
19. Complications of Early Versus Delayed Total Elbow Arthroplasty for the Treatment of Distal Humerus Fractures
- Author
-
David M. Macknet, Patrick G. Marinello, Peter M. Casey, Bryan J. Loeffler, Marc J. Richard, Bradley C. Carofino, Susan M. Odum, and Raymond Glenn Gaston
- Subjects
Orthopedics and Sports Medicine ,Surgery - Published
- 2023
- Full Text
- View/download PDF
20. Total Knee Arthroplasty following Knee Arthroscopy in Patients over 50
- Author
-
J Stewart, Buck, Susan M, Odum, Jonathan K, Salava, David M, Macknet, Thomas K, Fehring, and Bryan D, Springer
- Subjects
musculoskeletal diseases ,Orthopedics and Sports Medicine ,Surgery ,musculoskeletal system - Abstract
The purpose of this study was to evaluate the conversion rate of knee arthroscopy to ipsilateral total knee arthroplasty (TKA) within 2 years in patients aged 50 or older at the time of arthroscopy. The administrative database from a large, physician-owned orthopaedic practice (>100 surgeons) was queried to identify patients over the age of 50 who had undergone arthroscopic knee surgery between January 1, 2006 and January 2, 2015. The subset of patients who converted to TKA within 2 years after knee arthroscopy was identified and matched by age and sex to a control population that did not convert to TKA. Rates of conversion to TKA were calculated. Prearthroscopic digital radiographs were reviewed and Kellgren–Lawrence (KL) grades were compared among case and control populations. Univariable analyses and multivariable regression analysis were performed. Eight hundred seven of 16,061 (5.02%) patients aged 50 or older were converted to TKA within 2 years following ipsilateral knee arthroscopy. In univariable analysis, the rate of conversion to TKA in patients aged between 50 and 54 was 2.94%, compared with 4.44% in patients aged between 55 and 64, and 8.32% in patients 65 or older (p
- Published
- 2021
- Full Text
- View/download PDF
21. Outcomes and reoperation rates after tibial tubercle transfer and medial patellofemoral ligament reconstruction: higher revision stabilization in patients with trochlear dysplasia and patella alta
- Author
-
Dana P. Piasecki, Jacob D. Gorbaty, Dax T. Varkey, Susan M. Odum, Ian S. Hong, Bryan M. Saltzman, David P. Trofa, and James E. Fleischli
- Subjects
medicine.medical_specialty ,Trochlear dysplasia ,Sports medicine ,Tubercle ,business.industry ,Radiography ,Medial patellofemoral ligament ,Surgery ,medicine.anatomical_structure ,Orthopedic surgery ,medicine ,Orthopedics and Sports Medicine ,In patient ,Patella ,business - Abstract
To determine the reoperation rate, risk factors for reoperation, and patient-reported outcomes after isolated or combined tibial tubercle transfer and medial patellofemoral ligament reconstruction, for patellofemoral instability surgery. Patient’s records who underwent medial patellofemoral ligament reconstruction and/or tibial tubercle transfer for patellar instability by 35 surgeons from 2002 to 2018 at a single academic institution were retrospectively reviewed using CPT codes. Four-hundred-and-eighty-six patients were identified. Radiographic measurements, demographic parameters, and subsequent revision procedures and their indications were identified. A modified anterior knee pain survey was conducted by mail and with follow-up phone survey. The overall rate of reoperation was 120/486 (24.7%). The most common cause for reoperation was removal of hardware 42/486 (8.6%). The rate of reoperation for isolated medial patellofemoral ligament reconstruction 43/226 (19%) was lower than that of isolated tibial tubercle transfer 45/133 (33.8%) or a combined procedure 32/127 (25.2%) (P = 0.007). Woman had a higher rate of reoperation (29.4%) compared to men (15.9%) (P = 0.002). Patients at risk for a revision stabilization procedure included those with severe trochlear morphology (C or D) (6.1%) and those with Caton–Deschamps index > 1.3 (7.3%). Patients who underwent reoperation of any kind had poorer patient-reported outcomes. The overall reoperation rate after patellofemoral instability surgery remains high, and any reoperation portends worse patient-reported outcomes. Re-operations for instability are more likely in patients with trochlear dysplasia and patella alta and may benefit from more aggressive initial treatment, such as medial patellofemoral ligament reconstruction and tibial tubercle transfer in combination. Using the results of this study, surgeons will be able to engage in meaningful discussion with patients to counsel patients on expectations postoperatively. IV.
- Published
- 2021
- Full Text
- View/download PDF
22. Opioid-Free Forefoot Surgery vs Traditional Perioperative Opiate Regimen: A Randomized Controlled Trial
- Author
-
Edward M. Rooney, Susan M. Odum, Nady Hamid, Todd A. Irwin, Todd M. Chapman, Bruce E. Cohen, Patrick M. Connor, Brian M. Curtin, W. Hodges Davis, J. Kent Ellington, James E. Fleischli, Samuel E. Ford, R. Glenn Gaston, Kayla T. Hietpas, Carroll P. Jones, Bryan J. Loeffler, Caleb J. Michalek, R.Alden Milam, Bryan M. Saltzman, Shadley C. Schiffern, and Scott B. Shawen
- Subjects
Orthopedics and Sports Medicine ,Surgery - Abstract
Background: In response to the opioid epidemic, the use of multimodal pain management in orthopaedic surgery is increasing. Efforts to decrease opioid prescribing and opioid consumption among foot and ankle surgical patients are needed. The purpose of this study was to compare the efficacy and adverse events between 2 multimodal pain management pathways for forefoot surgical patients: standard opioid-containing (OC) and opioid-free (OF). Methods: This is a single-center noninferior randomized controlled trial of 51 patients undergoing forefoot surgery allocated to one of 2 perioperative pain management treatments: opioid-free, multimodal (OF, n=27 patients), or traditional opioid-containing (OC, n=24 patients). Patient characteristics, creatine markers, pain (numeric rating scale [NRS]), general health (Veterans Rand 12-Item Health Survey [VR-12]), and depression were measured preoperatively. Postoperatively, pain was measured at 24-hour, 2-week, and 6-week time points. Satisfaction with pain control, complications, and general health were measured at 2 and 6 weeks. Results: The OF group is statistically noninferior to the OC group and reported lower median pain scores at 24 hours (2 [IQR 0, 3] vs 6 [IQR 3.5, 7]; p90% at 6 weeks. The VR-12 scores were similar between groups across all time points. At 2 weeks, 8 patients in each group reported constipation. By 6 weeks, all but 2 OC patients reported resolution. No other adverse events of postoperative wound complications, readmissions, medication reactions, thrombosis, or persistent pain were documented. Conclusion: In forefoot surgery, the opioid-free pain management protocol was statistically noninferior to the opioid-containing protocol in reducing postoperative pain. Level of Evidence: Level II, prospective cohort study.
- Published
- 2022
23. Pain and Anxiety due to the COVID-19 Pandemic: A Survey of Patients With Delayed Elective Hip and Knee Arthroplasty
- Author
-
Nick R. Johnson, Bryan D. Springer, Keith A. Fehring, James D. Lastra, Jesse E. Otero, and Susan M. Odum
- Subjects
medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,medicine.medical_treatment ,MEDLINE ,Pain ,Elective arthroplasty ,03 medical and health sciences ,0302 clinical medicine ,Patient experience ,Pandemic ,Medicine ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,Patient reported outcomes ,Original Research ,Orthopedic surgery ,Delay ,030222 orthopedics ,Hip fracture ,business.industry ,COVID-19 ,Evidence-based medicine ,medicine.disease ,Arthroplasty ,Physical therapy ,Anxiety ,Surgery ,medicine.symptom ,business ,RD701-811 - Abstract
Background The COVID-19 pandemic led to cancelation of all elective surgeries for a time period in the vast majority of the United States. We compiled a questionnaire to determine the physical and mental toll of this delay on elective total joint arthroplasty patients. Methods All patients whose primary or revision total hip or knee arthroplasty was canceled because of the COVID-19 pandemic at a large academic-private practice were identified. An 11-question survey was administered to these patients via email. All data were deidentified and stored in a REDCAP database. Results Of 367 total patients identified, 113 responded to the survey. Seventy-seven percent of patients had their surgery postponed at least 5 weeks, and 20% were delayed longer than 12 weeks. Forty-one percent of patients reported an average visual analog scale pain score greater than 7.5. Forty percent of respondents experienced increased anxiety during the delay. Thirty-four percent of patients felt their surgery was not elective. Sixteen percent experienced a fall during the delay, and 1 patient sustained a hip fracture. Level of pain reported was significantly associated with negative emotions, negative effects of delay, and whether patients felt their surgery was indeed elective. Seventy-six percent reported trust in their surgeon's judgment regarding appropriate timing of surgery. Communication was listed as the number one way in which patients felt their surgeon could have improved during this time. Conclusion Surgical delay due to the COVID-19 pandemic resulted in increased pain and anxiety for many total joint arthroplasty patients. While most patients maintained trust in their surgeon during the delay, methods to improve communication may benefit the patient experience in future delays. Level of Evidence Level II.
- Published
- 2021
- Full Text
- View/download PDF
24. Retrospective Comparison of Capitolunate Arthrodesis Using Headless Compression Screws Versus Nitinol Memory Staples for SLAC and SNAC Wrist: Radiographic, Functional, and Patient-Reported Outcomes
- Author
-
John W. Bracey, Susan M Odum, Daniel R. Lewis, Mark A. Tait, R. Randall McKnight, and R. Glenn Gaston
- Subjects
Joint Instability ,musculoskeletal diseases ,Radiography ,Arthrodesis ,medicine.medical_treatment ,Scaphoid nonunion ,030230 surgery ,Wrist ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Orthopedics and Sports Medicine ,Patient Reported Outcome Measures ,Retrospective Studies ,Orthodontics ,030222 orthopedics ,business.industry ,SLAC Wrist ,Middle Aged ,medicine.disease ,Compression (physics) ,medicine.anatomical_structure ,Surgery ,business - Abstract
Background Nitinol memory compression staples have been proposed as an effective alternative to compression screws for capitolunate arthrodesis (CLA) for scaphoid nonunion advanced collapse (SNAC) and scapholunate advanced collapse (SLAC) wrist. The purpose of this study was to compare the clinical outcomes of CLA for SNAC or SLAC wrist treatment using either compression screws or nitinol staples. Methods In all, 47 patients with CLA for SLAC or SNAC wrist with screws or nitinol staples were retrospectively identified. Primary outcome was fusion on radiographs and/or computed tomography. Secondary outcomes were hardware-related complications (HWCs) and other complications, range of motion, grip strength, and patient-reported outcome measures (PROMs), including Visual Analogue Pain scale; Disabilities of the Arm, Shoulder, and Hand score; and patient-rated wrist evaluation. Results Of the 47 eligible patients, 40 (85%) were included: 31 patients in the staple group and 9 patients in the screw group. The average age was 49 (17-80) years. There was an 89% union rate for the screw group and a 97% union rate for the staple group. Two patients had screw backout: one who went onto union after screw removal and the other who went onto nonunion after hardware removal. There were 2 (6.5%) HWCs in the staple group. One patient had staple loosening requiring revision and the other dorsal impingement requiring staple removal after radiographic union. In all subsequent cases, the staples were countersunk with no impingement. No significant differences existed between any additional outcomes. Conclusions We found no differences between nitinol staples and screws for CLA regarding HWCs or PROMs. Nitinol staples may offer additional benefits as a safe and effective alternative to compression screws for wrist fusions.
- Published
- 2021
- Full Text
- View/download PDF
25. Higher In-Hospital Complications in Ankle Fusion Than Ankle Arthroplasty
- Author
-
Robert B. Anderson MD, W. Hodges Davis MD, Susan M. Odum PhD, and Bryce Van Doren
- Subjects
Orthopedic surgery ,RD701-811 - Abstract
Category: Ankle Introduction/Purpose: Ankle fusion and total ankle arthroplasty (TAA) are common surgical procedures used to treat ankle morbidity. Little is known about the comparative rates of in-hospital complications between patients treated with ankle fusion and TAA. Methods: Data from the 2002-2013 Nationwide Inpatient Sample releases were analyzed. 4,451 TAA patients and 16,277 ankle fusion patients were identified using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) 81.11 and 81.56 procedure codes, respectively. ICD-9-CM diagnosis codes were utilized to classify major or minor in-hospital complications. Fusion and TAA patients were exact matched on age, gender, race, hospital type, geographical region, comorbidities, and diabetes status. Minor and major in-hospital complications, including mortality were compared using chi-square and multivariate logistic regression. Results: Exact matches were identified for 4,174 (93.8%) TAA patients, with a mean age of 62.2 years. The major in-hospital complication rate for ankle fusion patients was 14.7% (615 of 4,174) versus 6.4% (269 of 4,174) for TAA patients (p< .01). The minor complication rate for ankle fusion was 3.9% (169 of 4,174) compared to 4.6% (167 of 4,174) for TAA (p=0.91). Fewer than 10 patients in either group died (p=0.59). After adjusting for case-mix, ankle fusion patients were 2.46 times more likely to experience major complications (OR: 2.46, 95% CI 2.11-2.88) than TAA patients. Conclusion: Compared to a matched cohort of ankle fusion patients, TAA patients are less likely to experience major in-hospital complications. These findings suggest that TAA may be a safer surgery than ankle fusion.
- Published
- 2016
- Full Text
- View/download PDF
26. No difference in patient compliance between full-strength versus low-dose aspirin for VTE prophylaxis following total hip and total knee replacement
- Author
-
Brandon Hood, Susan M. Odum, Brian M. Curtin, and Bryan D. Springer
- Subjects
030222 orthopedics ,Aspirin ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Vte prophylaxis ,Arthroplasty ,Compliance (physiology) ,03 medical and health sciences ,Regimen ,0302 clinical medicine ,Internal medicine ,Statistical significance ,Medicine ,Orthopedics and Sports Medicine ,Surgery ,030212 general & internal medicine ,Medical prescription ,business ,Adverse effect ,medicine.drug - Abstract
The utilization of aspirin for VTE prophylaxis following TJA has increased due to updated clinical practice guidelines. Aspirin is the only approved VTE prophylaxis medication that does not require a prescription, but adherence and tolerance remain unknown. We hypothesized decreased patient compliance utilizing full-strength 325 mg aspirin twice daily following TJA when compared to low-dose 81 mg twice daily. We also investigated the reasons why patients may elect to stop the medication earlier than 28 days. A consecutive series of patients undergoing primary total hip or knee arthroplasty utilizing 325 or 81 mg of EC aspirin twice daily for 4 weeks were surveyed to determine compliance with use and any adverse events related to the medication. Fisher's exact test was used to determine statistical significance. 404 patients were enrolled with 199 patients prescribed the 325 mg regimen. Fifty-two patients who were prescribed 325 mg missed a dose versus 51 patients who were prescribed 81 mg (p = 0.082). No significant difference in the frequency of missed doses (missing 10 doses) between the treatment regimens (p = 0.78, 0.39 and 0.83, respectively). Most commonly cited reason for stopping aspirin in both treatment groups was gastrointestinal issues (10.5% and 7%, respectively). By surveying patients on their use of aspirin we find no difference in adherence between full-strength and low-dose treatment regimens. Additionally, we have a better understanding of the reasons for noncompliance as GI upset was a relatively common complaint with both doses.
- Published
- 2020
- Full Text
- View/download PDF
27. Rate of radiographic hip OA in spine patients: utility of including femoral heads on plain film A/P lumbar radiographs
- Author
-
Brian M. Curtin, Susan M. Odum, Casey Davidson, and Leo R. Spector
- Subjects
musculoskeletal diseases ,030222 orthopedics ,medicine.medical_specialty ,business.industry ,Radiography ,Plain film ,musculoskeletal system ,Spine (zoology) ,03 medical and health sciences ,0302 clinical medicine ,Lumbar ,Concomitant ,medicine ,Orthopedics and Sports Medicine ,Surgery ,Lumbar spine ,Radiology ,business ,Hip arthritis ,030217 neurology & neurosurgery - Abstract
The incidence of concomitant lumbar spine and hip pathology is common in referral patients to spine clinics. Differentiating between the two pathologies is a key component to the clinical practitioner's role. At our institution, it has become routine protocol to obtain radiographs including the femoroacetabular joints on the AP and lateral views of the lumbar spine as part of the initial workup. The purpose of this study was to determine the rates of radiographic hip pathology seen on lumbar spine imaging. We report just over 25% concomitant spine and hip pathology with 25% of patients requiring further management from a hip surgeon. The studied protocol will assist in the workup of spine patients to further differentiate the intricacies of hip- and spine-related pathology.
- Published
- 2020
- Full Text
- View/download PDF
28. An update on graft-tunnel mismatch in anterior cruciate ligament reconstruction: A survey of the experts in the field of orthopedic sports medicine demonstrates no clear consensus in management
- Author
-
Dax T. Varkey, Patrick M. Connor, Dana P. Piasecki, Claude T. Moorman, David P. Trofa, James E. Fleischli, Susan M. Odum, Bryan M. Saltzman, and Nicholas C. Yeatts
- Subjects
medicine.medical_specialty ,Anterior cruciate ligament reconstruction ,Demographics ,Sports medicine ,medicine.medical_treatment ,Anterior cruciate ligament ,Sports Medicine ,03 medical and health sciences ,0302 clinical medicine ,Surveys and Questionnaires ,medicine ,Humans ,Orthopedics and Sports Medicine ,Practice Patterns, Physicians' ,030222 orthopedics ,Anterior Cruciate Ligament Reconstruction ,business.industry ,Tibial tunnel ,Anterior Cruciate Ligament Injuries ,General surgery ,Treatment method ,Orthopedic Surgeons ,030229 sport sciences ,United States ,medicine.anatomical_structure ,Orthopedic surgery ,Femoral bone ,business - Abstract
Background The purpose of this study was to identify and report on the rate at which leaders in orthopaedic surgery are encountering GTM, their treatment methods and to identify whether these clinicians’ demographics or techniques correlate with their GTM incidence and/or treatment algorithms. Methods A survey was sent to identify the rate at which member orthopaedic surgeons of the American Orthopaedic Society for Sports Medicine (AOSSM), the National Football League Physicians Society (NFLPS), and the Herodicus Society are encountering GTM in ACL reconstruction with BTB graft and to establish what methods are most commonly utilized. Results In total, 260 orthopaedic surgeons completed the survey. Respondents most frequently reported GTM in 1–5% of cases, with GTM most often between 5 and 10 mm. For lower levels of GTM, surgeons are most frequently recessing the femoral bone plug and adding a cortical suspensory device or outside–in fixation. Higher degrees of GTM are most commonly supplemented with a screw/post on the tibia. Those with > 15 years of experience were more commonly using a transtibial femoral drilling with lower tibial tunnel angulation, and lower incidences of GTM than their less experienced counterparts. Conclusion There is tremendous variability in the incidence and management of GTM in ACL reconstruction with BTB graft with no clear consensus among experts. Differences are seen in ACL reconstruction techniques and means of correcting GTM when evaluating based on years of surgical experience and Sports Medicine Fellowship completion.
- Published
- 2020
- Full Text
- View/download PDF
29. In the Era of Tranexamic Acid, are Type and Screens for Primary Total Joint Arthroplasty Obsolete?
- Author
-
George L. Vestermark, Susan M. Odum, Bryan D. Springer, Taylor M. Rowe, John R. Martin, and Thomas K. Fehring
- Subjects
musculoskeletal diseases ,030222 orthopedics ,medicine.medical_specialty ,Joint arthroplasty ,Blood management ,Intraoperative Complication ,Blood transfusion ,Anemia ,business.industry ,medicine.medical_treatment ,Perioperative ,medicine.disease ,Surgery ,03 medical and health sciences ,surgical procedures, operative ,0302 clinical medicine ,medicine ,Orthopedics and Sports Medicine ,business ,Body mass index ,Tranexamic acid ,medicine.drug - Abstract
Background Advances in technique and perioperative blood management have improved transfusion rates following unilateral primary total joint arthroplasty and led some centers to change their preoperative blood ordering protocols. The purpose of this study is to determine whether deleting type and screens (T&S) from preoperative order sets was safe for patients undergoing primary total knee (TKA) and total hip arthroplasty (THA) and to identify patients who required allogenic blood transfusion. Methods Prospectively collected data were reviewed to identify any patient with a hemoglobin (Hgb) drawn within 30 days of surgery who received a transfusion following a unilateral primary TKA or THA. Results A total of 1255 patients met inclusion criteria. Of the total, 682 (54%) were TKAs and 573 (46%) were THAs. The mean preoperative Hgb was 11.5 g/dL with an average delta Hgb of 3.6 g/dL on postoperative day 1. No patient required an intraoperative transfusion. Fourteen patients (mean age and body mass index, 67.9 and 29.0) required a transfusion (1.1%) for postoperative blood loss anemia. Of those transfused, 13 (93%) of the patients underwent THA with the mean estimated blood loss of 378.6 mL. The total cost for a patient obtaining a T&S is $191.27. Conclusion In our series, the risk of blood transfusion was rare (1.1%) and occurred only secondary to postoperative blood loss anemia. There were no cases of intraoperative complication requiring urgent or emergent blood transfusion. Removing T&S from standard order sets for patients undergoing primary TKA or THA appears to be a safe and cost-effective practice.
- Published
- 2020
- Full Text
- View/download PDF
30. Clinical and Radiographic Outcomes of Revision Total Ankle Arthroplasty Using an Intramedullary-Referencing Implant
- Author
-
W. Hodges Davis, Thomas B. Bemenderfer, Steve B. Behrens, Robert B. Anderson, Oliver N. Schipper, Susan M. Odum, and Todd A. Irwin
- Subjects
Adult ,Male ,Reoperation ,medicine.medical_specialty ,Joint Prosthesis ,Radiography ,Aseptic loosening ,Ankle arthritis ,Prosthesis Design ,law.invention ,Intramedullary rod ,Arthroplasty, Replacement, Ankle ,Disability Evaluation ,03 medical and health sciences ,0302 clinical medicine ,law ,Osteoarthritis ,medicine ,Humans ,Orthopedics and Sports Medicine ,Patient Reported Outcome Measures ,Aged ,Retrospective Studies ,030222 orthopedics ,Revision arthroplasty ,business.industry ,030229 sport sciences ,Middle Aged ,Prosthesis Failure ,Surgery ,Total ankle arthroplasty ,Female ,Implant ,business - Abstract
Background: Treatment of failed total ankle arthroplasty (TAA) is challenging. Limited literature is available on options and outcomes of revision arthroplasty despite failure rates ranging from 10% to 23% within 10 years after primary TAA. This study reports the clinical and radiographic outcomes of revision TAA using a fixed-bearing, intramedullary-referencing implant. Methods: A retrospective review was performed of 18 consecutive revision TAA cases between 2008-2015 using an intramedullary-referencing, fixed-bearing, 2-component total ankle system. Demographic and radiographic data were collected preoperatively, immediately postoperatively, and at the most recent follow-up. Functional outcome data were collected immediately postoperatively and at mean follow-up 47.5 months. Results: Eighteen patients underwent revision TAA, with 77.8% (14/18) implant survival. Index revision was performed most commonly for aseptic talar subsidence (55.6%) or implant loosening (tibia, 29.4%; talus, 58.9%). Following revision, 22.2% (4/18) patients required reoperation at a mean 57.3 (39-86) months. Osteolysis of the tibia, talus, and fibula was present preoperatively in 66.7% (12/18), 38.9% (7/18), and 38.9% (7/18) of patients, respectively, with progression of osteolysis in 27.8% (5/18), 11.1% (2/18) and 11.1% (2/18) of patients, respectively. Subsidence of the tibial and talar revision components was observed in 38.9% (7/18) and 55.6% (10/18) of patients, respectively. The median American Orthopaedic Foot & Ankle Society (AOFAS) score was 74.5 (26-100) and Foot Function Index (FFI) score 10.2 (0-50.4). Conclusion: Early results of intramedullary-referencing revision TAA demonstrated good patient-reported outcomes with maintenance of radiographic parameters at mean follow-up of 47.5 months. Aseptic talar subsidence or loosening were the main postoperative causes of reoperation. Revision arthroplasty utilizing an intramedullary-referencing implant was a viable option for the failed TAA. Level of Evidence: Level IV, case series.
- Published
- 2020
- Full Text
- View/download PDF
31. Complications in the treatment of prosthetic joint infection
- Author
-
Katherine Li, Molly A Hartzler, Michael B Geary, Bryan D. Springer, and Susan M. Odum
- Subjects
030222 orthopedics ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Prosthetic joint infection ,Arthroplasty ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,business - Abstract
Aims Two-stage exchange arthroplasty is the most common definitive treatment for prosthetic joint infection (PJI) in the USA. Complications that occur during treatment are often not considered. The purpose of this study was to analyze complications in patients undergoing two-stage exchange for infected total knee arthroplasty (TKA) and determine when they occur. Methods We analyzed all patients that underwent two-stage exchange arthroplasty for treatment of PJI of the knee from January 2010 to December 2018 at a single institution. We categorized complications as medical versus surgical. The intervals for complications were divided into: interstage; early post-reimplantation (three months); and late post-reimplantation (three months to minimum one year). Minimum follow-up was one year. In total, 134 patients underwent a first stage of a two-stage exchange. There were 69 males and 65 females with an mean age at first stage surgery of 67 years (37 to 89). Success was based on the new Musculoskeletal Infection Society (MSIS) definition of success reporting. Results Overall, 70 (52%) patients experienced a complication during the planned two-stage treatment, 36 patients (27%) experienced a medical complication and 47 (41%) patients experienced a surgical complication. There was an 18% mortality rate (24/134) at a mean of 3.7 years (0.09 to 8.3). During the inter-stage period, 28% (37/134) of patients experienced a total of 50 complications at a median of 47 days (interquartile range (IQR) 18 to 139). Of these 50 complications, 22 were medical and 28 required surgery. During this inter-stage period, four patients died (3%) and an additional five patients (4%) failed to progress to the second stage. While 93% of patients (125/134) were reimplanted, only 56% (77/134) of the patients were successfully treated without antibiotic suppression (36%, 28/77) or with antibiotic suppression (19%, 15/77) at one year. Conclusion Reported rates of success of two stage exchanges for PJI have not traditionally considered complications in the definition of success. In our series, significant numbers of patients experienced complications, more often after reimplantation, highlighting the morbidity of this method of treatment. Cite this article: Bone Joint J 2020;102-B(6 Supple A):145–150.
- Published
- 2020
- Full Text
- View/download PDF
32. Radiographic and Clinical Outcomes of Modular Tapered Fluted Stems for Femoral Revision for Paprosky III and IV Femoral Defects or Vancouver B2 and B3 Femoral Fractures
- Author
-
Susan M. Odum, John B. Mason, Jesse E. Otero, John R. Martin, and Taylor M. Rowe
- Subjects
Reoperation ,medicine.medical_specialty ,Joint replacement ,Arthroplasty, Replacement, Hip ,medicine.medical_treatment ,Population ,Periprosthetic ,Bone grafting ,Prosthesis Design ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Orthopedics and Sports Medicine ,Femur ,education ,Retrospective Studies ,Fixation (histology) ,030222 orthopedics ,education.field_of_study ,Femur fracture ,Impaction ,business.industry ,Surgery ,Treatment Outcome ,Hip Prosthesis ,Periprosthetic Fractures ,business ,Femoral Fractures - Abstract
Background Extensive femoral bone loss poses a challenge in revision total hip arthroplasty (rTHA). Many techniques have been developed to address this problem including fully porous cylindrical stems, impaction bone grafting, and cementation of long stems, which have had varied success. Modular tapered fluted femoral stems (MTFS) show favorable results. We sought to determine the minimum 2-year radiographic and clinical performance of MTFS in rTHA in a population with extensive proximal femoral bone loss. Methods Our clinical database was queried retrospectively for all patients who underwent rTHA with an MTFS. We included patients with Paprosky 3 and 4 femoral bone loss and patients with Vancouver B2 and B3 periprosthetic femur fractures. Patients without 2-year follow-up were invited to return to clinic for X-ray evaluation and to complete clinical questionnaires. We assessed distance of stem subsidence and presence of stem fixation on final X-ray. We recorded all-cause revision and survival of the stem at final follow-up. Results One hundred twenty-nine patients were available for follow-up. Average follow-up time was 3.75 years. One hundred twenty-two stems (95%) remained in place at final follow-up. Median subsidence was 1.4 mm (range 0-21). All-cause revision rate was 16.3% (21 patients). Of the hips revised, 10 were for instability, 6 for infection, 1 for aseptic loosening, and 1 for periprosthetic femur fracture. Three were revised for other reasons. The stem was revised in 7 patients (5.4%), and the most common reason for stem revision was infection (5 patients). The other 2 stems were revised for aseptic loosening in a Paprosky 4 femur and periprosthetic femur fracture. Survival of tapered modular fluted stems with aseptic failure as an endpoint was 98.4%. The mean Hip disability and Osteoarthritis Outcome Score, Joint Replacement score at final follow-up was 73, and mean Veterans Rand 12 item health survey physical and mental scores were 32.8 and 52.2, respectively. Conclusion In patients with Paprosky 3, 4 femoral defects or Vancouver type B2, B3 fractures, modular tapered fluted stems for femoral revision show excellent outcomes at minimum 2-year follow-up.
- Published
- 2020
- Full Text
- View/download PDF
33. New Beginnings and Revealing Invisible Identities
- Author
-
Jaime L. Bellamy, David Fralinger, Mark Schultzel, Qusai Hammouri, Joseph Letzelter, Carla M. Bridges, Susan M. Odum, and Julie Samora
- Subjects
Orthopedics and Sports Medicine ,Surgery ,General Medicine - Published
- 2022
34. Isolated Osteochondral Autograft Versus Allograft Transplantation for the Treatment of Symptomatic Cartilage Lesions of the Knee: A Systematic Review and Meta-analysis
- Author
-
David P. Trofa, Ian S. Hong, Cesar D. Lopez, Allison J. Rao, Ziqing Yu, Susan M. Odum, Claude T. Moorman, Dana P. Piasecki, James E. Fleischli, and Bryan M. Saltzman
- Subjects
surgical procedures, operative ,Physical Therapy, Sports Therapy and Rehabilitation ,Orthopedics and Sports Medicine - Abstract
Background: Focal cartilage lesions of the knee remain a difficult entity to treat. Current treatment options include arthroscopic debridement, microfracture, autograft or allograft osteochondral transplantation, and cell-based therapies such as autologous chondrocyte transplantation. Osteochondral transplantation techniques restore the normal topography of the condyles and provide mature hyaline cartilage in a single-stage procedure. However, clinical outcomes comparing autograft versus allograft techniques are scarce. Purpose: To perform a comprehensive systematic review and meta-analysis of high-quality studies to evaluate the results of osteochondral autograft and allograft transplantation for the treatment of symptomatic cartilage defects of the knee. Study Design: Systematic review and meta-analysis; Level of evidence, 2. Methods: A comprehensive search of the literature was conducted using various databases. Inclusion criteria were level 1 or 2 original studies, studies with patients reporting knee cartilage injuries and chondral defects, mean follow-up ≥2 years, and studies focusing on osteochondral transplant techniques. Exclusion criteria were studies with nonknee chondral defects, studies reporting clinical outcomes of osteochondral autograft or allograft combined with other procedures, animal studies, cadaveric studies, non–English language studies, case reports, and reviews or editorials. Primary outcomes included patient-reported outcomes and failure rates associated with both techniques, and factors such as lesion size, age, sex, and the number of plugs transplanted were assessed. Metaregression using a mixed-effects model was utilized for meta-analyses. Results: The search resulted in 20 included studies with 364 cases of osteochondral autograft and 272 cases of osteochondral allograft. Mean postoperative survival was 88.2% in the osteochondral autograft cohort as compared with 87.2% in the osteochondral allograft cohort at 5.4 and 5.2 years, respectively ( P = .6605). Patient-reported outcomes improved by an average of 65.1% and 81.1% after osteochondral autograft and allograft, respectively ( P = .0001). However, meta-analysis revealed no significant difference in patient-reported outcome percentage change between osteochondral autograft and allograft ( P = .97) and a coefficient of 0.033 (95% CI, –1.91 to 1.98). Meta-analysis of the relative risk of graft failure after osteochondral autograft versus allograft showed no significant differences ( P = .66) and a coefficient of 0.114 (95% CI, –0.46 to 0.69). Furthermore, the regression did not find other predictors (mean age, percentage of female patients, lesion size, number of plugs/grafts used, and treatment location) that may have significantly affected patient-reported outcome percentage change or postoperative failure between osteochondral autograft versus allograft. Conclusion: Osteochondral autograft and allograft result in favorable patient-reported outcomes and graft survival rates at medium-term follow-up. While predictors for outcomes such as mean age, percentage of female patients, lesion size, number of plugs/grafts used, and treatment location did not affect the comparison of the 2 cohorts, proper patient selection for either procedure remains paramount to the success and potentially long-term viability of the graft.
- Published
- 2022
35. Polymicrobial Colonization of Prosthetic Joint Infections Treated With Open Wound Management
- Author
-
Michael M. Valenzuela, Benjamin J. Averkamp, Susan M. Odum, Taylor M. Rowe, and Thomas K. Fehring
- Subjects
Reoperation ,Arthritis, Infectious ,Prosthesis-Related Infections ,Coinfection ,Humans ,Orthopedics and Sports Medicine ,Retrospective Studies - Abstract
Open wound management in prosthetic joint infection (PJI) patients has been used in problematic dehisced wounds hoping to stimulate granulation tissue and closure. However, infections that start as a monomicrobial PJI can become polymicrobial with resultant worse outcomes following open wound management. This study assessed the relationship between open wound management and the development of polymicrobial periprosthetic joint infections.We reviewed patients referred with a synovial cutaneous fistula. Patients with an open wound measuring less than 2 cm and less than two weeks of open wound management were excluded. Variables included original organisms cultured, type and length of open wound management, and organisms cultured at the time of revision infection surgery.Of the 65 patients with a previous monomicrobial infection treated with open wound management, 22/65 (34%) progressed to a polymicrobial infection. Thirty (46%) wounds were packed open with gauze, 20 (31%) were managed with negative pressure wound therapy, and 15 (23%) had surface dressings only. Of the 22 patients who converted to a polymicrobial infection, only 10 (45%) were infection free at follow-up. In contrast, 30 of 43 patients (70%) whose infections remained monomicrobial were infection free at follow-up.Open wound management can lead to conversion from a monomicrobial to a polymicrobial PJI, a rate of 34% in this series. Open prosthetic wound management should be discontinued for a fear of converting a monomicrobial infection to a difficult to treat polymicrobial infection. Surgeons must be prudent in the use of open wound management.Level IV, Retrospective Case Series.
- Published
- 2021
36. Ambulatory versus inpatient shoulder arthroplasty: a population-based analysis of trends, outcomes, and charges
- Author
-
Patrick M. Connor, Nady Hamid, Susan M. Odum, and Gabriella E. Ode
- Subjects
medicine.medical_specialty ,lcsh:Diseases of the musculoskeletal system ,medicine.medical_treatment ,charges ,risk stratification ,Logistic regression ,inpatient ,Article ,lcsh:Orthopedic surgery ,Health care ,Outpatient clinic ,Medicine ,Orthopedics and Sports Medicine ,ambulatory surgery ,database ,Cardiopulmonary disease ,readmission ,business.industry ,Outpatient ,Emergency department ,Arthroplasty ,lcsh:RD701-811 ,Cohort ,Ambulatory ,Emergency medicine ,shoulder arthroplasty ,Surgery ,lcsh:RC925-935 ,business - Abstract
Background: The purpose of this study was to evaluate the clinical outcomes and cost of shoulder arthroplasty (SA) performed in ambulatory surgery centers (ASCs) compared with SA performed in hospital-based surgery settings. Methods: The State Inpatient Databases and the State Ambulatory Surgery Databases were queried for patients undergoing primary or reverse SA between 2010 and 2014 in 5 states in either the inpatient (IP), hospital outpatient department (HOPD), or ASC setting. Outcomes included all-cause readmissions, emergency department visits within the 90-day postoperative period, and charges. Covariates included patient demographic data and procedure details. Risk factors for readmission were calculated using logistic regression analysis. Results: We identified 795 ASC (2%), 183 HOPD (0.5%), 38,114 (97.5%) SA procedures. The outpatient cohort was overall younger and healthier with a lower percentage of diabetes (14.1% vs. 20.2%), cardiopulmonary disease (11.4% vs. 20.4%), and obesity (10.7% vs. 15.6%). The US state and obesity were factors significantly (P < .0001) associated with readmission. The median IP charge was $62,905 (range, $41,327-$87,881) vs. $37,395 (range, $21,976-$61,775) for combined outpatient cases. When outpatient SA was stratified into ASC and HOPD cases, the median charges were $31,790 for ASC cases vs. $55,990 for HOPD cases (P < .0001). After adjustment for multiple covariates, the charges for combined outpatient SA surgery were 40% lower than those for IP SA surgery (P < .0001). Conclusion: As the current health care climate shifts toward lower-cost and higher-quality care, this study demonstrates that SAs performed in ASCs have a comparable safety profile to and significant financial advantage over SAs performed in the hospital-based setting.
- Published
- 2020
- Full Text
- View/download PDF
37. Initial metal ion levels predict risk of elevation in metal on metal total hip arthroplasty
- Author
-
William L. Griffin, Bryan D. Springer, Susan M. Odum, and J. Ryan Martin
- Subjects
Adult ,Chromium ,Male ,medicine.medical_specialty ,Arthroplasty, Replacement, Hip ,Total hip replacement ,Prosthesis Design ,Asymptomatic ,Osteoarthritis, Hip ,Postoperative Complications ,medicine ,Humans ,Orthopedics and Sports Medicine ,Aged ,Retrospective Studies ,Ions ,business.industry ,Cobalt ,Middle Aged ,Surgery ,Metal-on-Metal Joint Prostheses ,Female ,Hip Prosthesis ,medicine.symptom ,business ,Total hip arthroplasty - Abstract
Introduction: Screening protocols for asymptomatic patients with metal on metal (MoM) total hip arthroplasty (THA) are evolving. Most surgeons began screening patients around 2010 by obtaining cobalt (Co) and chromium (Cr) metal ion levels. There is currently no data available to guide repeat screening in this familiar clinical scenario. Therefore, the following study evaluated how metal ion levels change after an initial metal ion level in patients with MoM THAs. Materials and methods: 171 consecutive patients (265 hips) underwent primary MoM THA. All patients had at least one Co and Cr ion level draw. 84 patients (136 hips) had 2 ion level draws. Ion levels were divided into elevated levels (⩾4.5 ppb) and normal levels (Results: 12 metal ion levels were ⩾4.5 ppb on the first lab draw. On the second draw, all 12 remained ⩾4.5 ppb. Of the 121 hips with initial metal ion levels Discussion: Initial metal ion levels reliably predicted those that would remain elevated or remain normal with a subsequent metal ion level. An initial metal ion level above 3.0 ppb may represent a cutoff at which further workup is necessary.
- Published
- 2019
- Full Text
- View/download PDF
38. Are Ceramic Bearings Becoming Cost-Effective for All Patients Within a 90-Day Bundled Payment Period?
- Author
-
Steven M. Kurtz, Bryan D. Springer, Thomas K. Fehring, Edmund Lau, Susan M. Odum, and Doruk Baykal
- Subjects
Male ,Reoperation ,Ceramic bearing ,Ceramics ,medicine.medical_specialty ,Databases, Factual ,Total cost ,Arthroplasty, Replacement, Hip ,Cost-Benefit Analysis ,Medicare ,Prosthesis Design ,Reimbursement Mechanisms ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Orthopedics and Sports Medicine ,Claims database ,health care economics and organizations ,030222 orthopedics ,business.industry ,Bundled payments ,Inpatient cost ,After discharge ,United States ,Metals ,Polyethylene ,Medicare population ,Emergency medicine ,Female ,Hip Prosthesis ,business ,Total hip arthroplasty - Abstract
BACKGROUND We analyzed whether the total hospital cost in a 90-day bundled payment period for ceramic-on-polyethylene (C-PE) and ceramic-on-ceramic (COC) total hip arthroplasty (THA) bearings was changing over time, and whether the cost differential between ceramic bearings and metal-on-polyethylene (M-PE) bearings was approaching the previously published tipping point for cost-effectiveness of US$325. METHODS A total of 245,077 elderly Medicare patients (65+) who underwent primary THA between 2010 and 2015 were identified from the United States Medicare 100% national administrative hospital claims database. The total inpatient cost, calculated up to 90 days after index discharge, was computed using cost-to-charge ratios, and hospital payment was analyzed. The differential total inpatient cost of C-PE and COC bearings, compared to metal-on-polyethylene (M-PE), was evaluated using parametric and nonparametric models. RESULTS After adjustment for patient and clinical factors, and the year of surgery, the mean hospital cost up to 90 days for primary THA with C-PE or COC was within ±1% of the cost for primary THA with M-PE bearings (P < .001). From the nonparametric analysis, the median total hospital cost was US$296-US$353 more for C-PE and COC than M-PE. Cost differentials were found to decrease significantly over time (P < .001). CONCLUSION Patient and clinical factors had a far greater impact on the total cost of inpatient THA surgery than bearing selection, even when including readmission costs up to 90 days after discharge. Our findings indicate that the cost-effectiveness thresholds for ceramic bearings relative to M-PE are changing over time and increasingly achievable for the Medicare population.
- Published
- 2019
- Full Text
- View/download PDF
39. Outcomes and reoperation rates after tibial tubercle transfer and medial patellofemoral ligament reconstruction: higher revision stabilization in patients with trochlear dysplasia and patella alta
- Author
-
Jacob D, Gorbaty, Dax T, Varkey, Ian S, Hong, David P, Trofa, Susan M, Odum, Dana P, Piasecki, Bryan M, Saltzman, and James E, Fleischli
- Subjects
Joint Instability ,Male ,Reoperation ,Patellofemoral Joint ,Patellar Dislocation ,Ligaments, Articular ,Humans ,Female ,Patella ,Retrospective Studies - Abstract
To determine the reoperation rate, risk factors for reoperation, and patient-reported outcomes after isolated or combined tibial tubercle transfer and medial patellofemoral ligament reconstruction, for patellofemoral instability surgery.Patient's records who underwent medial patellofemoral ligament reconstruction and/or tibial tubercle transfer for patellar instability by 35 surgeons from 2002 to 2018 at a single academic institution were retrospectively reviewed using CPT codes. Four-hundred-and-eighty-six patients were identified. Radiographic measurements, demographic parameters, and subsequent revision procedures and their indications were identified. A modified anterior knee pain survey was conducted by mail and with follow-up phone survey.The overall rate of reoperation was 120/486 (24.7%). The most common cause for reoperation was removal of hardware 42/486 (8.6%). The rate of reoperation for isolated medial patellofemoral ligament reconstruction 43/226 (19%) was lower than that of isolated tibial tubercle transfer 45/133 (33.8%) or a combined procedure 32/127 (25.2%) (P = 0.007). Woman had a higher rate of reoperation (29.4%) compared to men (15.9%) (P = 0.002). Patients at risk for a revision stabilization procedure included those with severe trochlear morphology (C or D) (6.1%) and those with Caton-Deschamps index 1.3 (7.3%). Patients who underwent reoperation of any kind had poorer patient-reported outcomes.The overall reoperation rate after patellofemoral instability surgery remains high, and any reoperation portends worse patient-reported outcomes. Re-operations for instability are more likely in patients with trochlear dysplasia and patella alta and may benefit from more aggressive initial treatment, such as medial patellofemoral ligament reconstruction and tibial tubercle transfer in combination. Using the results of this study, surgeons will be able to engage in meaningful discussion with patients to counsel patients on expectations postoperatively.IV.
- Published
- 2021
40. Opioid Prescribing Risk Factors in Nonoperative Ankle Fractures: The Impact of a Prospective Clinical Decision Support Intervention
- Author
-
Meghan K. Wally, Michael A. Gibbs, Stephen H. Sims, Animita Saha, Madhav A. Karunakar, Joseph R. Hsu, Tamar Roomian, Daniel Leas, Michael S. Runyon, Stephen Wyatt, Andrew D. Wohler, Bradley Watling, Kevin D. Phelps, David M. Macknet, Michael C. Beuhler, Michael J. Bosse, Steven Jarrett, Laurence B. Kempton, Rachel B. Seymour, Todd A. Irwin, Susan M. Odum, Ziqing Yu, and Christopher Griggs
- Subjects
Adult ,medicine.medical_specialty ,Adolescent ,Ankle Fractures ,Young Adult ,Risk Factors ,Intervention (counseling) ,medicine ,Outpatient clinic ,Humans ,Orthopedics and Sports Medicine ,Prospective Studies ,Medical prescription ,Risk factor ,Practice Patterns, Physicians' ,Retrospective Studies ,business.industry ,Retrospective cohort study ,Emergency department ,Middle Aged ,Decision Support Systems, Clinical ,Surgery ,Analgesics, Opioid ,Opioid ,Ambulatory ,Emergency medicine ,business ,medicine.drug - Abstract
Opioids are frequently used for acute pain management of musculoskeletal injuries, which can lead to misuse and abuse. This study aimed to identify the opioid prescribing rate for ankle fractures treated nonoperatively in the ambulatory and emergency department setting across a single healthcare system and to identify patients considered at high risk for abuse, misuse, or diversion of prescription opioids that received an opioid. A retrospective cohort study was performed at a large healthcare system. The case list included nonoperatively treated emergency department, urgent care and outpatient clinic visits for ankle fracture and was merged with the Prescription Reporting With Immediate Medication Mapping (PRIMUM) database to identify encounters with prescription for opioids. Descriptive statistics characterize patient demographics, treatment location and prescriber type. Rates of prescribing among subgroups were calculated. There were 1,324 patient encounters identified, of which, 630 (47.6%) received a prescription opioid. The majority of patients were 18-64 years old (60.3%). Patients within this age range were more likely to receive an opioid prescription compared to other age groups (p < .0001). Patients treated in the emergency department were significantly more likely to receive an opioid medication (68.3%) compared to patients treated at urgent care (33.7%) or in the ambulatory setting (16.4%) (p < .0001). Utilizing the PRIMUM tool, 14.2% of prescriptions were provided to patients with at least one risk factor. Despite the recent emphasis on opioid stewardship, 14.2% of patients with risk factors for misuse, abuse, or diversion received opioid analgesics in this study, identifying an area of improvement for prescribers.
- Published
- 2021
41. Response to Letter to the Editor on 'In the Era of Tranexamic Acid, Are Type and Screens for Primary Total Joint Arthroplasty Obsolete?'
- Author
-
Taylor M. Rowe, John R. Martin, Bryan D. Springer, Susan M. Odum, Thomas K. Fehring, and George L. Vestermark
- Subjects
medicine.medical_specialty ,Letter to the editor ,Joint arthroplasty ,business.industry ,medicine.medical_treatment ,MEDLINE ,Blood Loss, Surgical ,Arthroplasty ,Antifibrinolytic Agents ,Surgery ,Tranexamic Acid ,Antifibrinolytic agent ,medicine ,Humans ,Orthopedics and Sports Medicine ,business ,Tranexamic acid ,medicine.drug - Published
- 2021
42. Failure to Optimize Before Total Knee Arthroplasty: Which Modifiable Risk Factor is the Most Dangerous?
- Author
-
Susan M. Odum, Joseph M. Statz, Jesse E. Otero, and Nick R. Johnson
- Subjects
Reoperation ,medicine.medical_specialty ,Databases, Factual ,medicine.medical_treatment ,Total knee arthroplasty ,Patient Readmission ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Risk Factors ,medicine ,Humans ,Orthopedics and Sports Medicine ,Hypoalbuminemia ,Risk factor ,Arthroplasty, Replacement, Knee ,Retrospective Studies ,030222 orthopedics ,business.industry ,Retrospective cohort study ,Evidence-based medicine ,medicine.disease ,Arthroplasty ,Emergency medicine ,Cohort ,business ,Body mass index - Abstract
Background Complications after total knee arthroplasty (TKA) are devastating for patients, and surgeons are held accountable in alternative payment models. Optimization of modifiable risk factors has become a mainstay in the preoperative period. We sought to evaluate the consequence of failure to optimize key risk factors in a modern cohort of patients who underwent TKA. Methods The American College of Surgeons National Surgical Quality Improvement Program database was searched to identify patients who underwent TKA in 2017-2018. Patients were considered optimized if they had a body mass index 3.5g/dL, were nonsmokers, and were nondiabetic. Patients were then grouped based on the previous 4 risk factors. Thirty-day readmission, infection, general complications, and mortality were analyzed and compared between the groups. Results Overall, 84,315 patients were included in the study. A total of 31.6% of patients were not considered optimized. Body mass index >40kg/m2, albumin Conclusion Despite knowledge that modifiable risk factors significantly influence postoperative outcomes, surgeons continue to operate on patients who are not optimized. Among the modifiable risk factors analyzed, hypoalbuminemia appears to be the strongest risk factor for all complications evaluated. Special attention should be paid to preoperative nutritional optimization. Level of Evidence Retrospective cohort study, level IV.
- Published
- 2020
43. Lower Extremity Girth Does Not Predict Complications in TKA
- Author
-
Jonathon K. Salava, Michael D. Baratz, Susan M. Odum, Jacob M. Drew, Thomas K. Fehring, Jeffrey M. Goldstein, and Eric S. Secrist
- Subjects
030222 orthopedics ,medicine.medical_specialty ,Bone width ,business.industry ,Radiography ,Total knee arthroplasty ,Soft tissue ,Girth (geometry) ,Surgery ,Body Mass Index ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Lower Extremity ,medicine ,Cutoff ,Humans ,Orthopedics and Sports Medicine ,business ,Complication ,Arthroplasty, Replacement, Knee ,Body mass index ,Retrospective Studies - Abstract
Obese patients have increased complications after total knee arthroplasty (TKA). A body mass index (BMI) cutoff of 40 is frequently used to determine eligibility for TKA. Patients with a BMI40 and extremely large legs which may predispose them to complications are approved for surgery because they fall below this cutoff. Alternatively, patients with truncal obesity and a BMI40 are accepted because they have thin legs. We sought to determine whether BMI or girth should be used to determine eligibility.453 patients who underwent TKA were included. A lower extremity girth (LEG) ratio was calculated dividing the width of the soft tissue envelope by bone width on lateral radiographs. Receiver operator curves were generated to predict 90-day complications.There was no difference in median LEG ratio between patients with or without a complication (P = .08). Receiver operator curves indicated that size of the soft tissue envelope had no utility in predicting complications. There was no correlation between LEG ratio and specific complications such as infection, malalignment, or wound complications. Using a LEG ratio threshold of 4.834, the sensitivity and specificity for predicting complications were 48% and 64%, respectively. The median BMI for patients with no complication was 32.3 and 35 for patients with a complication (P = .07).Complications are not necessarily associated with size of the soft tissue envelope in TKA.Decisions concerning TKA should not be made solely on the size of a patient's leg.Level III (retrospective comparative study).
- Published
- 2020
44. Irrigation and Debridement with Chronic Antibiotic Suppression Is as Effective as 2-Stage Exchange in Revision Total Knee Arthroplasty with Extensive Instrumentation
- Author
-
Michael B Geary, Susan M. Odum, Bryan D. Springer, Aldo M. Riesgo, Jeffrey J. Barry, and Thomas K. Fehring
- Subjects
Male ,Reoperation ,medicine.medical_specialty ,Prosthesis-Related Infections ,Knee Joint ,medicine.drug_class ,medicine.medical_treatment ,Arthrodesis ,Antibiotics ,Periprosthetic ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,Stage (cooking) ,Arthroplasty, Replacement, Knee ,Therapeutic Irrigation ,Device Removal ,Aged ,Retrospective Studies ,Aged, 80 and over ,030222 orthopedics ,Debridement ,business.industry ,General Medicine ,Recovery of Function ,Middle Aged ,Surgery ,Anti-Bacterial Agents ,Treatment Outcome ,Female ,Level iii ,business ,Knee Prosthesis ,Revision total knee arthroplasty - Abstract
Extraction of implants because of periprosthetic infection (PJI) following complex revision total knee arthroplasty (rTKA) with extensive instrumentation is a daunting undertaking for surgeon and patient alike. The purpose of the present study was to evaluate whether infections following complex rTKA are better treated with 2-stage exchange or irrigation and debridement (ID) with modular component exchange and antibiotic suppression in terms of infection control, reoperation, and function.We reviewed rTKAs that had been performed for the treatment of PJI from 2005 to 2016. Extensive instrumentation was defined as the presence ≥1 of the following: metaphyseal cones/sleeves, distal femoral replacement, periprosthetic fracture instrumentation, or fully cemented stems measuring75 mm. Cases were categorized according to the initial treatment (ID with antibiotic suppression or initiation of 2-stage exchange).Eighty-seven patients with PJI and extensive instrumentation were identified: 56 patients who were managed with ID with suppression and 31 who were managed with the initiation of 2-stage exchange. The rate of success (defined as no reoperation for infection) was similar for the 2 groups (62.5% the ID group compared with 67.7% for the 2-stage group; p = 0.62). The rate of mortality was also similar (39.3% for the ID group compared with 38.7% for the 2-stage group; p = 0.96). Of the 31 patients in the 2-stage group, 18 (58.1%) underwent reimplantation with a revision replacement. Of those 18 patients, 13 were still infection-free at the time of the most recent follow-up; however, when the analysis was expanded to all 31 patients in the 2-stage group, only 13 (41.9%) both had a successful reimplantation and did not require additional surgery for infection. Nine (29.0%) of the 31 patients in the 2-stage group never underwent the second stage, and 4 (12.9%) of the 31 required arthrodesis at the second stage. In contrast, 35 (62.5%) of the 56 patients in the ID group were successfully managed, without additional surgery for the treatment of infection. At the time of the latest follow-up (mean, 3.2 years; range, 2 to 13 years), more patients in the ID group were ambulatory (76.8% in the ID group compared with 54.8% in the 2-stage group; p = 0.05) and maintained a functional bending knee joint (85.7% in the ID group compared with 45.2% in the 2-stage group; p0.001).In the treatment of periprosthetic infection of rTKA with extensive instrumentation, ID with chronic antibiotic suppression was as effective as 2-stage exchange in terms of preventing reoperation for infection and was more effective in terms of maintaining function. These data apply to rTKA with extensive periarticular instrumentation and should not be extrapolated to primary or simple revision implants.Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
- Published
- 2020
45. Practice Makes Perfect: Bundled Payment Models for 90-Day Total Knee Arthroplasty Episodes: Commentary on an article by Peter L. Schilling, MD, MSc, et al.: 'Risk-Adjusted Cost Performance for 90-Day Total Knee Arthroplasty Episodes. Data and Methods for Comparing U.S. Hospitals Nationwide'
- Author
-
Susan M. Odum
- Subjects
medicine.medical_specialty ,business.industry ,Arthroplasty, Replacement, Hip ,Bundled payments ,Total knee arthroplasty ,General Medicine ,Hospitals ,Physical therapy ,Medicine ,Orthopedics and Sports Medicine ,Surgery ,business ,Arthroplasty, Replacement, Knee ,Cost performance ,Risk adjusted - Published
- 2020
46. Hip and Knee Section, Diagnosis, Laboratory Tests: Proceedings of International Consensus on Orthopedic Infections
- Author
-
Montri D. Wongworawat, Stergios Lazarinis, Alisina Shahi, Thomas W. Bauer, Jay Shah, Jonathan D. Creech, Noam Shohat, Susan M. Odum, Noreen J. Hickok, Carl Deirmengian, Annette W-Dahl, Hannah K. Eriksson, Lars Lidgren, Majd Tarabichi, Veit Krenn, V. Krenn, Jess H. Lonner, Yale A. Fillingham, Grigor Grigoryan, and Hany Bedair
- Subjects
medicine.medical_specialty ,business.industry ,Diagnosis laboratory ,Orthopedic surgery ,Physical therapy ,Medicine ,Diagnostic test ,Orthopedics and Sports Medicine ,Diagnostic accuracy ,α defensin ,business ,Diagnostic tools ,Serum markers - Published
- 2019
- Full Text
- View/download PDF
47. Reoperation Rates Following Open-Door Cervical Laminoplasty
- Author
-
John A. Rodriguez-Feo, Daniel Leas, Susan M. Odum, R. Alden Milam, Marc R. Angerame, Mark F. Kurd, and Bruce V. Darden
- Subjects
030222 orthopedics ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Incidence (epidemiology) ,Cervical Spine ,Laminectomy ,Laminoplasty ,medicine.disease ,Surgery ,03 medical and health sciences ,Myelopathy ,Stenosis ,0302 clinical medicine ,Cervical laminoplasty ,Concomitant ,medicine ,Orthopedics and Sports Medicine ,business ,030217 neurology & neurosurgery ,Cohort study - Abstract
Background: Laminoplasty is a safe and effective procedure for multilevel degenerative cervical stenosis causing myelopathy, that allows for motion preservation. The purpose of this study was to determine the reoperation rate and associated risk factors after cervical laminoplasty. Methods: We present a retrospective consecutive series of patients who underwent a laminoplasty procedure between January 1, 2005, and October 31, 2012, and had a minimum 2-year follow-up. Demographic data were collected and operative records were reviewed to determine the cervical levels involved in the laminoplasty procedure, any concomitant procedures, and estimated blood loss. Clinical records were reviewed and telephone interviews were conducted on those patients with less than 2-year in-person follow-up. Patients requiring reoperations and the reason for the reoperations were determined, as well as the incidence of postoperative C5 palsy. Results: A total of 222 of 266 patients (83%) with a minimum 2-year follow-up had an average follow-up of 4.97 years. Overall, 26 patients underwent 30 reoperations (13.5%). A total of 15 patients underwent 16 reoperations (7.2%) in the acute postoperative period for infection requiring at least 1 irrigation and debridement, hardware-related issues, or posterior cervical wound issues. A total of 13 patients had 14 reoperations (6.3%) outside of the acute postoperative period for the development of a new radiculopathy, recurrent myelopathy, neurologic symptoms with a kyphotic deformity, or a posttraumatic focal kyphotic deformity. Patients who had a concomitant laminectomy demonstrated a significantly (P = .03) higher reoperation rate than those who did not. There were no other statistically significant associations. The C5 palsy rate was 8.1% (18 of 222). Conclusions: Although the preserved motion following laminoplasty may allow for the development of new neurologic symptoms, the reoperation rate continues to compare favorably with laminectomy and fusion and remains a reasonable option for the surgical management of multilevel cervical stenosis causing myelopathy. Level of Evidence: 4.
- Published
- 2018
- Full Text
- View/download PDF
48. Variability of Pelvic Orientation in the Lateral Decubitus Position: Are External Alignment Guides Trustworthy?
- Author
-
Susan M. Odum, Keith A. Fehring, Jesse E. Otero, Thomas K. Fehring, and John R. Martin
- Subjects
Adult ,Male ,Pelvic tilt ,Rotation ,Arthroplasty, Replacement, Hip ,Posture ,Patient Positioning ,Pelvis ,03 medical and health sciences ,0302 clinical medicine ,Orientation (geometry) ,medicine ,Lateral Decubitus Position ,Humans ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,Pelvic Bones ,Aged ,Aged, 80 and over ,030222 orthopedics ,business.industry ,Acetabulum ,Middle Aged ,Radiography ,body regions ,Position (obstetrics) ,Trustworthiness ,Tilt (optics) ,medicine.anatomical_structure ,Female ,business ,Nuclear medicine ,Pelvic rotation - Abstract
Background The position of the acetabular component in total hip arthroplasty (THA) is critical for success. However, this remains the most variable aspect of the surgery. We hypothesized that there is wide variation in pelvic orientation in the lateral decubitus position. We sought to determine the variability in pelvic positioning and the frequency of pelvic malposition during THA in lateral decubitus with regard to pelvic tilt and pelvic rotation. Methods We analyzed preoperative standing and intraoperative anteroposterior pelvis X-rays in 248 consecutive THAs performed in lateral decubitus by one surgeon. Pelvic tilt and rotation were determined for preoperative and intraoperative X-rays. Proper intraoperative positioning was defined as less than 10° change in tilt or rotation between preoperative and intraoperative X-rays. Results With regard to pelvic tilt, the intraoperative position was proper in 188 (76%) cases. There was a pelvic tilt discrepancy of 10°-20° in 43 (17.5%) cases and greater than 20° in 16 (6.5%) patients. With regard to pelvic rotation, the intraoperative position was proper in 202 (81%) cases. There was a pelvic rotation discrepancy of 10°-20° in 38 (15.4%) cases and greater than 20° in 7 (2.8%) cases. In 248 cases, only 154 (62.1%) had intraoperative positioning within 10° of preoperative tilt and axial rotation. Pelvic malposition occurred in 38% of cases overall. Conclusion There is wide variation in pelvic orientation in lateral decubitus and frequent discrepancy in pelvic tilt and rotation between preoperative and intraoperative anteroposterior X-rays. Anatomic landmarks should be used to guide acetabular component positioning. Level of Evidence III Diagnostic.
- Published
- 2018
- Full Text
- View/download PDF
49. Should Depression Be Treated Before Lower Extremity Arthroplasty?
- Author
-
Bryan D. Springer, John B. Mason, Thomas K. Fehring, Susan M. Odum, Keith A. Fehring, and Brian M. Curtin
- Subjects
Male ,medicine.medical_specialty ,Arthroplasty, Replacement, Hip ,medicine.medical_treatment ,Psychological intervention ,Arthritis ,Osteoarthritis ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Preoperative Care ,Prevalence ,medicine ,Health Status Indicators ,Humans ,Orthopedics and Sports Medicine ,Risk factor ,Arthroplasty, Replacement, Knee ,Depression (differential diagnoses) ,Aged ,030203 arthritis & rheumatology ,030222 orthopedics ,Depression ,business.industry ,Recovery of Function ,Evidence-based medicine ,Middle Aged ,medicine.disease ,Arthralgia ,Arthroplasty ,United States ,Patient Health Questionnaire ,Treatment Outcome ,Female ,business - Abstract
Background Patient optimization is becoming increasingly important before arthroplasty to ensure outcomes. It has been suggested that depression is a modifiable risk factor that should be corrected preoperatively. It remains to be determined whether psychological intervention before surgery will improve outcomes. We theorized that the use of preoperative depression scales to predict postoperative outcomes may be influenced by the pain and functional disability of arthritis. To determine whether depression is a modifiable risk factor that should be corrected preoperatively we asked the following questions: (1) What is the prevalence of depression in arthroplasty patients preoperatively? (2) Do depressive symptoms improve after surgery? (3) Is preoperative depression associated with outcome? Methods Patients scheduled for surgery completed a patient health questionnaire (PHQ-9) to assess the presence and severity of depression pre-operatively and one year post-operatively. Results Sixty-five of the 282 patients had a PHQ-9 score >10 indicating moderate depression and 57 (88%) improved to P = .0012). Ten patients had a PHQ-9 score >20 indicating severe depression and 9 (90%) improved to P = .10). Of the 65 patients who had a PHQ-9 score >10 preoperatively, the median postoperative Hip Disability and Osteoarthritis Outcome Score (N = 40) was 92.3, while the median postoperative Knee Injury and Osteoarthritis Outcome Score (N = 25) was 84.6. The median postoperative Hip Disability and Osteoarthritis Outcome Score and Knee Injury and Osteoarthritis Outcome Score in nondepressed patients were 96.2 and 84.6, respectively ( P = .9041). Conclusion By diminishing pain and improving function through arthroplasty, depression symptoms improve significantly. Patients with depressive symptoms preoperatively had similar postoperative outcome scores compared to non-depressed patients. Patients should not be denied surgical intervention through optimization programs that include a depression scale threshold. Level of Evidence III.
- Published
- 2018
- Full Text
- View/download PDF
50. Perioperative Complication Rates in Pediatric Total Joint Arthroplasty Patients Compared With Adults: Results of a Matched Cohort Study
- Author
-
Virginia F. Casey, Bryce A Van Doren, and Susan M. Odum
- Subjects
Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Adolescent ,Databases, Factual ,Cohort Studies ,03 medical and health sciences ,symbols.namesake ,Postoperative Complications ,0302 clinical medicine ,Statistical significance ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Poisson regression ,Arthroplasty, Replacement ,Child ,Aged ,030203 arthritis & rheumatology ,030222 orthopedics ,business.industry ,Age Factors ,Case-control study ,General Medicine ,Perioperative ,Middle Aged ,Case-Control Studies ,Relative risk ,Pediatrics, Perinatology and Child Health ,Orthopedic surgery ,symbols ,Female ,business ,Complication ,Cohort study - Abstract
BACKGROUND One of the least studied areas in orthopaedics is total joint arthroplasty (TJA) in pediatric patients. Recent studies have confirmed that these procedures are being performed on pediatric patients, making it critical to understand the rates of surgical complications in this patient population. We sought to examine the frequency in which surgical complications occur in pediatric patients, aged 20 and younger, undergoing TJA compared with adults. METHODS Data from the 2003 to 2012 Kids' Inpatient Database (ages 20 and younger) and 2002 to 2013 National Inpatient Sample (ages 21 and over) were analyzed. Pediatric patients were matched to 3 adult controls (1 per age group: 21 to 50, 51 to 65, and over 65 y) using patient characteristics including sex, race, orthopaedic diagnosis, and preoperative loss of function. Comparisons were then made between the rates and relative risks (RRs) of surgical complications between pediatric and adult patients. Finally, we examined patient factors associated with surgical complications, utilizing modified Poisson regression models with robust SEs. RESULTS Three adult controls (ie, 1 control from each age group) were identified for 1385 pediatric patients, for a total sample of 5540 TJA patients. Approximately 10% of pediatric patients experienced either major or minor surgical complications. The overall rate of major complications in pediatric patients was 5.05%, compared with 4.79% in adult controls [RR: 1.06 (0.81 to 1.38), P=0.69]. The overall rate of minor complications in pediatric patients was 5.78%, compared with 5.68% in adult controls [RR: 1.02 (0.80 to 1.30), P=0.78]. When adjusted for patient demographics, the RR of major complications was 49% higher in pediatric patients compared with ages 21 to 50 [RR: 1.49 (1.03 to 2.16), P=0.03] with no statistically significant differences noted for other age groups. For minor complications, the adjusted RR in pediatric patients, compared with any other age group, did not approach statistical significance. CONCLUSIONS Pediatric patients undergoing TJA experience major and minor surgical complications at rates comparable with their adult counterparts. Our findings offer important insight on the rates of surgical complications in pediatric TJA patients, which is valuable for preoperative education and consultation with patients and families. LEVEL OF EVIDENCE Level III-therapeutic.
- Published
- 2018
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.