Publications by authors named "Craig L Israelite"

24 Publications

  • Page 1 of 1

Does the Preferred Study Source Impact Orthopedic In-Training Examination Performance?

J Surg Educ 2021 Sep 8. Epub 2021 Sep 8.

Department of Orthopedic Surgery, University of Minnesota Medical School, Minneapolis, Minnesota. Electronic address:

Objective: This study examines the role of electronic learning platforms for medical knowledge acquisition in orthopedic surgery residency training. This study hypothesizes that all methods of medical knowledge acquisition will achieve similar levels of improvement in medical knowledge as measured by change in orthopedic in-training examination (OITE) percentile scores. Our secondary hypothesis is that residents will equally value all study resources for usefulness in acquisition of medical knowledge, preparation for the OITE, and preparation for surgical practice.

Design: 9 ACGME accredited orthopedic surgery programs participated with 95% survey completion rate. Survey ranked sources of medical knowledge acquisition and study habits for OITE preparation. Survey results were compared to OITE percentile rank scores.

Participants: 386 orthopedic surgery residents SETTING: 9 ACGME accredited orthopaedic surgery residency programs RESULTS: 82% of participants were utilizing online learning resources (Orthobullets, ResStudy, or JBJS Clinical Classroom) as primary sources of learning. All primary resources showed a primary positive change in OITE score from 2018 to 2019. No specific primary source improved performance more than any other sources. JBJS clinical classroom rated highest for improved medical knowledge and becoming a better surgeon while journal reading was rated highest for OITE preparation. Orthopedic surgery residents' expectation for OITE performance on the 2019 examination was a statistically significant predictor of their change (decrease, stay the same, improve) in OITE percentile scores (p<0.001).

Conclusions: Our results showed that no specific preferred study source outperformed other sources. Significantly 82% of residents listed an online learning platform as their primary source which is a significant shift over the last decade. Further investigation into effectiveness of methodologies for electronic learning platforms in medical knowledge acquisition and in improving surgical competency is warranted.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jsurg.2021.08.021DOI Listing
September 2021

The accuracy of patient-reported weight prior to total joint arthroplasty and arthroscopy of the lower extremity.

Arch Orthop Trauma Surg 2021 Jul 31. Epub 2021 Jul 31.

Department of Orthopaedic Surgery, Center for Hip Preservation, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Mail code A41, Cleveland, OH, 44195, USA.

Purpose: The accuracy of preoperative patient-reported weight was never evaluated in patients undergoing lower extremity procedures. The purpose of this study was to: (1) compare the disparity between patient-reported and measured weights in patients undergoing lower extremity total joint arthroplasty (LE-TJA) and arthroscopy; and (2) investigate the association between patient-specific factors (patient age, BMI, zip code, and psychiatric comorbidities) and the accuracy of patient-reported weight.

Methods: Preoperative self-reported weights were retrospectively compared to measured weights in 400 LE-TJA and 85 control arthroscopy patients. The difference between reported and measured weights was calculated. Additionally, the percent of accurate reporting within 0.5, 1, and 5 kg ranges of the measured weight was calculated. Outcomes were compared between surgical modalities as well as between patient-specific factors.

Results: There was low disparity (p = 0.838) between patient-reported and measured weights among LE-TJA (mean difference 0.18 ± 3.63 kg; p = 0.446) and that of arthroscopy (0.27 ± 4.08 kg; p = 0.129) patients. Additionally, LE-TJA patients were equally likely to report weights accurately within 0.5 kg of the measured weight (74% vs. 71.76%; p = 0.908). LE-TJA and arthroscopy patients had similar reporting accuracy within 1 and 5 kg of the measured weights (p > 0.05).

Conclusion: Preoperative patient-reported weights demonstrated acceptable accuracy in both LE-TJA and lower extremity arthroscopic orthopaedic patient populations making it a potentially reliable parameter of preoperative assessment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00402-021-04095-5DOI Listing
July 2021

Preoperative risk stratification minimizes 90-day complications in morbidly obese patients undergoing primary total knee arthroplasty.

Bone Joint J 2021 Jun;103-B(6 Supple A):45-50

Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Aims: It has been shown that the preoperative modification of risk factors associated with obesity may reduce complications after total knee arthroplasty (TKA). However, the optimal method of doing so remains unclear. The aim of this study was to investigate whether a preoperative Risk Stratification Tool (RST) devised in our institution could reduce unexpected intensive care unit (ICU) transfers and 90-day emergency department (ED) visits, readmissions, and reoperations after TKA in obese patients.

Methods: We retrospectively reviewed 1,614 consecutive patients undergoing primary unilateral TKA. Their mean age was 65.1 years (17.9 to 87.7) and the mean BMI was 34.2 kg/m (SD 7.7). All patients underwent perioperative optimization and monitoring using the RST, which is a validated calculation tool that provides a recommendation for postoperative ICU care or increased nursing support. Patients were divided into three groups: non-obese (BMI < 30 kg/m, n = 512); obese (BMI 30 kg/m to 39.9 kg/m, n = 748); and morbidly obese (BMI > 40 kg/m, n = 354). Logistic regression analysis was used to evaluate the outcomes among the groups adjusted for age, sex, smoking, and diabetes.

Results: Obese patients had a significantly increased rate of discharge to a rehabilitation facility compared with non-obese patients (38.7% (426/1,102) vs 26.0% (133/512), respectively; p < 0.001). When stratified by BMI, discharge to a rehabilitation facility remained significantly higher compared with non-obese (26.0% (133)) in both obese (34.2% (256), odds ratio (OR) 1.6) and morbidly obese (48.0% (170), OR 3.1) patients (p < 0.001). However, there was no significant difference in unexpected ICU transfer (0.4% (two) non-obese vs 0.9% (seven) obese (OR 2.5) vs 1.7% (six) morbidly obese (OR 5.4); p = 0.054), visits to the ED (8.6% (44) vs 10.3% (77) (OR 1.3) vs 10.5% (37) (OR 1.2); p = 0.379), readmissions (4.5% (23) vs 4.0% (30) (OR 1.0) vs 5.1% (18) (OR 1.4); p = 0.322), or reoperations (2.5% (13) vs 3.3% (25) (OR 1.2) vs 3.1% (11) (OR 0.9); p = 0.939).

Conclusion: With the use of a preoperative RST, morbidly obese patients had similar rates of short-term postoperative adverse outcomes after primary TKA as non-obese patients. This supports the assertion that morbidly obese patients can safely undergo TKA with appropriate perioperative optimization and monitoring. Cite this article:  2021;103-B(6 Supple A):45-50.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1302/0301-620X.103B6.BJJ-2020-2409.R1DOI Listing
June 2021

Prospective Study of Central versus Peripheral Obesity in Total Knee Arthroplasty.

Knee Surg Relat Res 2018 Dec;30(4):319-325

Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, PA, USA.

Purpose: Body mass index (BMI) is often used to predict surgical difficulty in patients receiving total knee arthroplasty (TKA); however, BMI neglects variation in the central versus peripheral distribution of adipose tissue. We sought to examine whether anthropometric factors, rather than BMI alone, may serve as a more effective indication of surgical difficulty in TKA.

Materials And Methods: We prospectively enrolled 67 patients undergoing primary TKA. Correlation coefficients were used to evaluate the associations of tourniquet time, a surrogate of surgical difficulty, with BMI, pre- and intraoperative anthropometric measurements, and radiographic knee alignment. Similarly, Knee Injury and Osteoarthritis Outcome Score (KOOS) was compared to BMI.

Results: Tourniquet time was significantly associated with preoperative inferior knee circumference (p=0.025) and ankle circumference (p=0.003) as well as the intraoperative depth of incision at the quadriceps (p=0.014). BMI was not significantly associated with tourniquet time or any of the radiographic parameters or KOOS scores.

Conclusions: Inferior knee circumference, ankle circumference, and depth of incision at the quadriceps (measures of peripheral obesity) are likely better predictors of surgical difficulty than BMI. Further study of alternative surgical indicators should investigate patients that may be deterred from TKA for high BMI, despite relatively low peripheral obesity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5792/ksrr.18.025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6254871PMC
December 2018

Prophylactic Tibial Stem Fixation in the Obese: Comparative Early Results in Primary Total Knee Arthroplasty.

Knee Surg Relat Res 2018 Sep;30(3):227-233

Department of Orthopedic Surgery, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, PA, USA.

Purpose: Obesity is a risk factor for aseptic loosening after total knee arthroplasty (TKA). Prophylactic use of tibial stems may enhance tibial fixation in obese patients. The aim of this study was to determine whether a tibial stem extension decreases rates of early failure in obese patients.

Materials And Methods: This study included 178 consecutive primary TKAs (143 patients) with a body mass index ≥35 kg/m. Fifty TKAs were performed with the use of a 30 mm tibial stem extension, and 128 TKAs were performed with a standard tibial component. Patients with two-year clinical follow-up were included. The primary outcome was revision for aseptic loosening. Secondary outcomes were all-cause revision and radiolucent lines (RLLs) on radiographs.

Results: Average follow-up was 34 months (range, 24 to 46 months). No failures for aseptic loosening occurred. The occurrence of secondary procedures was not significantly different between groups. Quantification of RLLs revealed no difference between groups.

Conclusions: At early follow-up, no difference was measured in revision rates, need for subsequent procedures, or RLLs between groups.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5792/ksrr.18.022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6122940PMC
September 2018

Uncemented Tantalum Monoblock Tibial Fixation for Total Knee Arthroplasty in Patients Less Than 60 Years of Age: Mean 10-Year Follow-up.

J Bone Joint Surg Am 2018 May;100(10):865-870

Department of Orthopedic Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania.

Background: Although tibial component loosening has been considered a concern after total knee arthroplasty without cement, such implants have been used in younger patients because of the potential for ingrowth and preservation of bone stock. However, mid-term and long-term studies of modern uncemented implants are lacking. We previously reported promising prospective 5-year outcomes after using an uncemented porous tantalum tibial component in patients who underwent surgery before the age of 60 years. The purpose of this study was to determine clinical and radiographic implant survivorship at 10 years in this large series of young patients.

Methods: The original cohort included 79 patients (96 knees) who were <60 years old at the time of surgery. All procedures were performed with an uncemented, posterior-stabilized femoral component and a porous tantalum monoblock tibial component by 1 high-volume arthroplasty surgeon at a single institution. Patients were followed prospectively. The Knee Society Score (KSS), radiographic findings, and any complications or revisions were recorded.

Results: At the latest follow-up, 76% (60) of the 79 patients (74% [71] of the 96 knees) were available for evaluation or had undergone revision (n = 6); 7 patients had died with the implants in place, and 12 patients were lost to follow-up. The average follow-up for the available implants was 10 years (range, 8 to 12 years). There were no progressive radiolucencies on radiographic review. The mean functional KSS was 68 points (range, 0 to 100 points). All revisions were for reasons unrelated to tibial fixation: femoral component loosening (1), stiffness (1), pain and swelling (2), and instability (2). The all-cause revision rate was 6% (6 of 96 knees).

Conclusions: Uncemented porous tantalum monoblock tibial components provided reliable fixation, excellent radiographic findings, and satisfactory functional outcomes at a mean of 10 years postoperatively. We identified no cases of tibial component loosening. These promising clinical and radiographic results support the use of uncemented tibial components. Such implants may produce well-integrated, durable long-term constructs in young patients.

Level Of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2106/JBJS.17.00724DOI Listing
May 2018

Selecting the Best and Brightest: A Structured Approach to Orthopedic Resident Selection.

J Surg Educ 2016 Sep-Oct;73(5):879-85. Epub 2016 May 24.

Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia.

Background: Resident selection is integral to the graduate medical educational process and the future of our profession. There is no consensus among residency directors as to how to systematically and consistently screen and select applicants who would perform well as residents. The purpose of this study was to introduce and assess a high volume application screening tool and semistructured interview process.

Methods: This study took place in an academic orthopedic surgery department over 2 years (2013-2014). Overall, 1382 applications were screened in 7 categories, with a maximum score of 100. A total of 14 faculty reviewed applications; 218 interviews were offered; 165 applicants accepted the interview. Overall, 4 interview domains (cognitive, affective, activities, and theme), and an impression score were ranked from 1 (Exceptional) to 6 (Concern). Each room had an assigned "theme" (ethics, affective, cognitive, research, and "fit") with standardized questions. A summary score was generated of all scores to determine the preliminary rank list; the final rank list was determined after group discussion. Correlation between preliminary rank, final rank, and screening scores were assessed.

Results: The average screening score was 62.5 (range: 0-100, median = 64). The average interview score was 69.5 (range: 32.24-95.0). Final rank lists correlated most highly with initial rank (0.912, p < 0.001), impression (0.847, p < 0.001), and affective domain (0.834, p < 0.001). Cognitive domain (0.628, p < 0.001) and screening scores (0.264, p < 0.001) less highly correlated with final rank position.

Conclusions: A systematic approach was used to screen and evaluate a large number of orthopedic surgery applicants. Our system demonstrated excellent feasibility, reliability, and predictability for the final rank list.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jsurg.2016.04.004DOI Listing
March 2017

Surgical management of osteonecrosis of the femoral head in patients with sickle cell disease.

World J Orthop 2015 Nov 18;6(10):776-82. Epub 2015 Nov 18.

Atul F Kamath, Michael H McGraw, Craig L Israelite, Department of Orthopedic Surgery, the Center for Hip Preservation, Penn Medicine, University of Pennsylvania, Philadelphia, PA 19107, United States.

Sickle cell disease is a known risk factor for osteonecrosis of the hip. Necrosis within the femoral head may cause severe pain, functional limitations, and compromise quality of life in this patient population. Early stages of avascular necrosis of the hip may be managed surgically with core decompression with or without autologous bone grafting. Total hip arthroplasty is the mainstay of treatment of advanced stages of the disease in patients who have intractable pain and are medically fit to undergo the procedure. The management of hip pathology in sickle cell disease presents numerous medical and surgical challenges, and the careful perioperative management of patients is mandatory. Although there is an increased risk of medical and surgical complications in patients with sickle cell disease, total hip arthroplasty can provide substantial relief of pain and improvement of function in the appropriately selected patient.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5312/wjo.v6.i10.776DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4644865PMC
November 2015

Is bilateral total knee arthroplasty staged at a one-week interval safe? A matched case control study.

J Arthroplasty 2014 Oct 15;29(10):1946-9. Epub 2014 May 15.

University of Pennsylvania, Department of Orthopaedic Surgery, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania.

Controversy surrounds the safety of bilateral total knee arthroplasty (TKA) and whether staging the procedures one week apart represents a safer option. A consecutive series of 234 patients underwent either a simultaneous (103 patients) or staged bilateral TKA (131 patients) from 2007 to 2012 and were compared to a matched control group of unilateral TKA (131 patients). Staged patients had no difference in one-year complication rate when compared to simultaneous bilateral TKA and the matched unilateral TKA control group (15% vs. 19% vs. 15%, P=0.512). There was also no difference in perioperative complications (10% vs. 14% vs. 7%, P=0.231) or 90-day readmissions (8% vs. 4% vs. 4%, P=0.295). In selected patients with bilateral knee OA, TKA staged at a one-week interval is a safe alternative.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.arth.2014.05.004DOI Listing
October 2014

One-week staged bilateral total knee arthroplasty protocol: a safety comparison of intended and completed surgeries.

J Arthroplasty 2014 Jun 21;29(6):1176-80. Epub 2013 Dec 21.

Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.

The number of patients requiring bilateral total knee arthroplasty (TKA) is expected to grow rapidly. While some trials have compared staged with simultaneous TKA, no literature characterizes the subset of staged TKA patients who cancel their second surgery. In this study, we report on the safety and utility of a one-week staged TKA protocol in a series of 145 patients who registered to undergo staged bilateral total knee arthroplasty one week apart. Among these patients, we identify a significantly higher complication rate and comorbidity status among patients who do not proceed to a second TKA. This finding identifies a potential advantage of a staged protocol over simultaneous bilateral TKA in not subjecting higher-risk patients to a second physiologic insult of a contralateral TKA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.arth.2013.12.025DOI Listing
June 2014

Converting between high- and low-sensitivity C-reactive protein in the assessment of periprosthetic joint infection.

J Arthroplasty 2014 Apr 18;29(4):685-9. Epub 2013 Oct 18.

Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA.

Although low-sensitivity CRP (Ls-CRP) is an important tool for evaluating infected orthopedic prostheses, no clinical studies have evaluated whether Hs-CRP is a suitable surrogate for Ls-CRP or other traditional infection biomarkers. The laboratory data of 98 arthroplasty patients with suspected prosthetic infection were reviewed. Hs-CRP was highly correlated with Ls-CRP (R = 0.93). ROC analysis generated 100% sensitivity and 97% specificity for both Hs-CRP and Ls-CRP at optimal cutoffs of 28.6 and 2.6 mg/dL, respectively. Both CRP tests were more accurate than serum erythrocyte sedimentation rate, neutrophil differential, and white blood cell count. Hs-CRP was no different from Ls-CRP after unit conversion, and regression analyses suggested conversion factors that approximated 10. Hs-CRP and Ls-CRP have equivalent utility in the diagnosis of infected joint arthroplasty.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.arth.2013.09.015DOI Listing
April 2014

Transfer of hip arthroplasty patients leads to increased cost and resource utilization in the receiving hospital.

J Arthroplasty 2013 Oct 6;28(9):1687-92. Epub 2013 Aug 6.

Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota. Electronic address:

Factors other than complexity of care often drive the transfer of orthopedic patients to tertiary centers. We sought to compare the demographics, diagnoses, insurance data, peri-operative outcomes and institutional costs of total hip arthroplasty patients transferred from outside facilities with those of patients derived from our clinics. We analyzed 419 consecutive patients as part of a prospective risk study. Transferred patients were older (P=0.01), less likely to have private insurance (P<0.0001), and more likely to be admitted on weekends (P=0.04). Both dislocation and fracture were more prevalent in transferred patients (P=0.04; P=0.003). Across all key metrics - including length of stay, mortality scoring, peri-operative complications, and direct and total costs - transferred patients more significantly strained the resources of our arthroplasty center.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.arth.2013.07.009DOI Listing
October 2013

Unplanned hip arthroplasty imposes clinical and cost burdens on treating institutions.

Clin Orthop Relat Res 2013 Dec 9;471(12):4012-9. Epub 2013 Aug 9.

Department of Orthopedic Surgery, University of Pennsylvania, Penn Presbyterian Medical Center, Cupp 1, 39th and Market Streets, Philadelphia, PA, 19104, USA,

Background: Emergent surgery has been shown to be a risk factor for perioperative complications. Studies suggest that patient morbidity is greater with an unplanned hip arthroplasty, although it is controversial whether unplanned procedures also result in higher patient mortality. The financial impact of these procedures is not fully understood, as the costs of unplanned primary hip arthroplasties have not been studied previously.

Questions/purposes: We asked: (1) What are the institutional costs associated with unplanned hip arthroplasties (primary THA, hemiarthroplasty, revision arthroplasty, including treatment of periprosthetic fractures, dislocations, and infections)? (2) Does timing of surgery (urgent/unplanned versus elective) influence perioperative outcomes such as mortality, length of stay, or need for advanced care? (3) What diagnoses are associated with unplanned surgery and are treated urgently most often? (4) Do demographics and insurance status differ between admission types (unplanned versus elective hip arthroplasty)?

Methods: We prospectively followed all 419 patients who were admitted to our Level I trauma center in 2011 for procedures including primary THA, hemiarthroplasty, and revision arthroplasty, including the treatment of periprosthetic fractures, dislocations, and infections. Fifty-seven patients who were treated urgently on an unplanned basis were compared with 362 patients who were treated electively. Demographics, admission diagnoses, complications, and costs were recorded and analyzed statistically.

Results: Median total costs were 24% greater for patients admitted for unplanned hip arthroplasties (USD 18,206 [USD 15,261-27,491] versus USD 14,644 [USD 13,511-16,309]; p < 0.0001) for patients admitted for elective arthroplasties. Patients with unplanned admissions had a 67% longer median hospital stay (5 days [range, 4-9 days] versus 3 days [range, 3-4 days]; p < 0.0001) for patients with elective admissions. Mortality rates were equivalent between groups (p = 1.0). Femoral fracture (p < 0.0001), periprosthetic fracture (p = 0.01), prosthetic infection (p = 0.005), and prosthetic dislocation (p < 0.0001) were observed at higher rates in the patients with unplanned admissions. These patients were older (p = 0.04), less likely to have commercial insurance (p < 0.0001), more likely to be transferred from another institution (p < 0.0001), and more likely to undergo a revision procedure (p < 0.0001).

Conclusions: Unplanned arthroplasty and urgent surgery are associated with increased financial and clinical burdens, which must be accounted for when considering bundled quality and reimbursement measures for these procedures.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11999-013-3226-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3825898PMC
December 2013

Prospective study of unplanned admission to the intensive care unit after total hip arthroplasty.

J Arthroplasty 2013 Sep 16;28(8):1345-8. Epub 2013 Mar 16.

Department of Orthopaedic Surgery, Mayo Clinic, 200 First St SW, Gonda 14, Rm 130, Rochester, Minnesota 55905, USA.

The morbidity associated with elective total hip arthroplasty (THA) may result in intensive care unit (ICU) admission. A total of 175 consecutive THA patients were prospectively triaged to either an ICU bed or routine post-operative floor according to admission criteria based on a prior published study of 1259 THA patients. Primary end points were a reduction in unplanned ICU admission, as well as major complications. With our triage model, the rate of unplanned ICU admissions dropped from 7.1% to 2.2% (P=0.013). The as-treated odds of unplanned admission pre- versus post-intervention were 3.2 (1.2, 10.6). The complication rate fell from 12.5% to 2%, and the mortality index decreased from 4.77 to 1.62. Triage according to selected risk factors affects a reduction in unplanned ICU admissions and major complications after THA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.arth.2013.01.011DOI Listing
September 2013

Revision total knee arthroplasty after severe notching of the anterior femoral cortex.

J Knee Surg 2013 Feb 28;26(1):65-7. Epub 2012 Jun 28.

Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA.

Anterior femoral cortex notching is a known complication of total knee arthroplasty (TKA). In severe cases, notching may alter the mechanical properties of the distal femur. We report a patient with significant femoral notching and malpositioning of the femoral prosthesis after TKA, leading to unresolved postoperative pain, decreased range of motion, and functional disability. The severity of this lesion required the use of augments and an offset femoral stem for improved alignment during revision arthroplasty, which is described in this brief technical note.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0032-1319786DOI Listing
February 2013

Suture anchor repair of patellar tendon rupture after total knee arthroplasty.

J Knee Surg 2013 Dec 12;26 Suppl 1:S128-31. Epub 2012 Nov 12.

Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.

Extensor mechanism disruption after total knee arthroplasty (TKA) is a complex problem that often requires surgical repair for functional deficits. We present a brief technical note on suture anchor fixation of a patellar tendon rupture after TKA. A surgical technique and literature review follows. Although suture anchor fixation is well described for tendinous repairs in other areas of orthopedic surgery, no study has discussed the use of suture anchors in patellar tendon repair after TKA. The technique must be evaluated in more patients with longer follow-up before adoption.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0032-1329234DOI Listing
December 2013

Unplanned admission to the intensive care unit after total hip arthroplasty.

J Arthroplasty 2012 Jun 6;27(6):1027-32.e1-2. Epub 2012 Mar 6.

Department of Orthopaedic Surgery, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Triage to the intensive care unit (ICU) after elective total hip arthroplasty proves a complex medical and resource decision point. A total of 1259 consecutive total hip arthroplasties were reviewed; 89 patients experienced unplanned ICU admissions. Significant risk factors for ICU admission in univariate analysis were age greater than 75 years, revision surgery, obstructive sleep apnea, creatinine clearance less than 60 mL/min, prior myocardial infarction, American Society of Anesthesiologist class 3 or greater, use of vasopressors intraoperatively, and body mass index greater than 35 kg/m(2). With multiple regression, age greater than 75 years (odds ratio [OR], 2.6 [1.2-5.6]), revision surgery (OR, 5.8 [3.0-11.4]), creatinine clearance less than 60 mL/min (OR, 6.5 [2.5-16.3]), prior myocardial infarction (OR, 7.2 [2.0-25.4]), and body mass index greater than 35 kg/m(2) (OR, 2.9 [1.4-6.2]) were predictive of unplanned ICU admission. With 1 risk factor, the risk of ICU admission was 40%, 2 (75%), 3 (93.5%), 4 (98.5%), and 5 (>99%). A prospective study of these risk factors is needed to establish a threshold for planned ICU admission.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.arth.2012.01.004DOI Listing
June 2012

Prospective results of uncemented tantalum monoblock tibia in total knee arthroplasty: minimum 5-year follow-up in patients younger than 55 years.

J Arthroplasty 2011 Dec 26;26(8):1390-5. Epub 2011 Aug 26.

Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19102, USA.

A significant increase in younger patients undergoing total knee arthroplasty raises the theoretical concern for revision secondary to micromotion and fixation failure with cemented components. We prospectively studied 100 consecutive tantalum monoblock uncemented tibial components and 312 concurrent cemented controls. Patients younger than 55 years with adequate bone stock were enrolled. This cementless patient group was younger and had higher preoperative functional status. Prostheses were posterior-substituting uncemented femoral and tibial components with a cemented patellar button. Knee Society pain and function scores and radiographs were obtained, and a cost analysis was performed. Knee Society scores were excellent and equivalent beyond 6 months. There was no significant difference in perioperative blood loss, complication rates, or cost. There was a significant decrease in operative time in the uncemented group. Radiographs revealed no failures of ingrowth at last follow-up. There were 3 uncemented group failures, but none were due to failure of fixation. The use of a porous tantalum tibia at minimum 5 years has yielded promising clinical and radiographic results in a younger patient population.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.arth.2011.06.030DOI Listing
December 2011

Suture anchor repair of quadriceps tendon rupture after total knee arthroplasty.

J Arthroplasty 2011 Aug 11;26(5):817-20. Epub 2011 Mar 11.

Department of Orthopaedic Surgery, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.

Disruption of the extensor mechanism after total knee arthroplasty (TKA) is a devastating complication, usually requiring surgical repair. Although suture anchor fixation is well described for repair of the ruptured native knee quadriceps tendon, no study has discussed the use of suture anchors in quadriceps repair after TKA. We present an illustrative case of successful suture anchor fixation of the quadriceps mechanism after TKA. The procedure has been performed in a total of 3 patients. A surgical technique and brief review of the literature follows. Suture anchor fixation of the quadriceps tendon is a viable option in the setting of rupture after TKA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.arth.2011.01.006DOI Listing
August 2011

Ethnic and gender differences in the functional disparities after primary total knee arthroplasty.

Clin Orthop Relat Res 2010 Dec 15;468(12):3355-61. Epub 2010 Jul 15.

Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.

Background: The benefits of TKA have been well documented. Whether these benefits apply equally across gender and ethnic groups is unclear. Given the underuse of TKA among certain demographic groups, it is important to understand whether gender or ethnicity influence pain and function after TKA.

Questions/purposes: We determined (1) the influence of race, gender, and body mass index (BMI) on primary TKA functional scores and ROM before gender-specific implants; and (2) whether comorbidities influenced ROM and functional scores.

Patients And Methods: We reviewed all 202 patients who underwent primary TKAs in 2004. We contacted 185 of the 202 patients, including 90 African-Americans, 87 Caucasians, four Asians, and four Hispanics (55 men, 130 women). Their average age was 66 years, and average BMI was 34.4 (range, 20-55). Knee Society scores (KSS) and ROM, patient demographics, and the Charlson Comorbidity Index (CCI) were recorded. Minimum followup was 24 months (average, 29.1 months; range, 24-60.3 months).

Results: African-Americans had longer delays to presentation, higher BMI, and worse 2-year KSS. Women (all races) had higher BMI and worse preoperative flexion/arc ROM. African-American women had worse final ROM and had similar final gains in ROM (postoperative minus preoperative ROM) after controlling for confounders.

Conclusions: Gender and race affected functional KSS and ROM variables. The worse results experienced by African-American women may be attributable to a longer delay to presentation. However, the scores and motion were high for all subgroups, and underuse of TKA in women and African-Americans cannot be justified based on a perception of lesser functional gains.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11999-010-1461-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2974876PMC
December 2010

Hip arthroscopy for labral tears: review of clinical outcomes with 4.8-year mean follow-up.

Am J Sports Med 2009 Sep 22;37(9):1721-7. Epub 2009 Jul 22.

Department of Orthopaedic Surgery, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Background: Arthroscopy of the hip joint is a relatively new diagnostic and therapeutic option for labral tears.

Purpose: More data are needed to characterize the utility and effectiveness of hip arthroscopy and identify patient-related factors that might predict functional outcome.

Study Design: Case series; Level of evidence, 4.

Methods: This retrospective study with prospective follow-up examined the clinical outcomes of 52 consecutive patients undergoing hip arthroscopy for labral tears. Outcomes measures included clinical outcome and the modified Harris hip score. Any complications associated with the procedure were recorded. Exclusion criteria included age younger than 18 years or prior ipsilateral hip surgery.

Results: Mean patient age was 42 years. Mean follow-up was 4.8 years. Twenty-one patients (40.4%) had a traumatic cause of the labral tears. Eight patients (15.4%) had possible secondary gain issues. Four (7.7%) patients suffered transient nerve palsies; in 1 case, the guide wire broke during initial cannulation. Three patients (5.8%) went on to total hip arthroplasty after hip arthroscopy. On multivariate analysis, left-sided surgery, a higher preoperative activity level, and duration of symptoms greater than 18 months were found to be positive predictors of good or excellent outcomes. Smoking and secondary gain issues were significant negative predictors of good or excellent outcomes. Only prior level of activity was a significant positive predictor of return to activity after surgery. A traumatic cause of the labral tear was a significant negative predictor of return to activity. Chondromalacia and osteoarthritis were not significant predictors of negative outcome. Postoperative modified Harris hip score improved 40% from 56.8 preoperatively to 80.4 (P < .001). No cases of patients with secondary gain issues achieved good or excellent outcomes. Overall percentage of good or excellent outcomes was 56%, or 66% when those with secondary gain issues were excluded; 84% of patients were able to return to sports or equivalent level of preoperative recreational activity. Neither preoperative radiographic osteoarthritis nor grade of intraoperative chondromalacia predicted postoperative outcome.

Conclusion: This series supports the hypothesis that hip arthroscopy provides safe and reliable improvement of labral symptoms in the majority of patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0363546509333078DOI Listing
September 2009

Management of periprosthetic femur fractures with severe bone loss using impaction bone grafting technique.

J Arthroplasty 2010 Apr 13;25(3):405-9. Epub 2009 Mar 13.

Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.

We present a technique of femoral impaction grafting used for the treatment of periprosthetic femur fractures with severe bone loss after total hip arthroplasty. Seven patients with femoral fractures with compromise of the femoral isthmus were treated with femoral component revision using the impaction grafting bone technique. The average age was 64 years (range, 44-72 years), and 2 patients required mesh augmentation at the time of surgery. The average follow-up for this group of patients was 56 months (range, 39-92 months). Radiographic evaluation revealed healed fractures in all patients and no evidence of implant loosening at a mean of 56 months (range, 39-92 months). There were no cases of infections or dislocations in this series. Impaction grafting technique can be useful in the treatment of periprosthetic femur fractures when bone loss and canal geometry preclude the use of fully coated femoral components.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.arth.2009.01.024DOI Listing
April 2010

Periprosthetic supracondylar femur fractures following total knee arthroplasty.

J Arthroplasty 2004 Jun;19(4):453-8

Department of Orthopaedic Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.

Periprosthetic supracondylar femur fractures following total knee arthroplasty (TKA) are an infrequent, but devastating, complication. From 1998 to 2000, we treated 30 supracondylar femur fractures above TKAs. Eighteen fractures were managed with retrograde intramedullary rod fixation (FIMR) and the other 12 fractures with traditional open reduction with internal fixation (ORIF). Follow-up averaged 3 years, with Knee Society knee scores being 84 and 82, respectively. Complications included 1 above-knee amputation for deep sepsis and 1 nonunion with varus alignment. FIMR appears to be the treatment of choice when it is feasible. However, traditional ORIF also may yield satisfactory results in those designs that cannot accommodate retrograde FIMR fixation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.arth.2003.12.078DOI Listing
June 2004
-->