Publications by authors named "Daniel M George"

8 Publications

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The Top 100 Most Cited Articles on Anterior Cruciate Ligament Reconstruction: A Bibliometric Analysis.

Orthop J Sports Med 2021 Feb 8;9(2):2325967120976372. Epub 2021 Feb 8.

Department of Orthopaedic Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.

Background: The concept of anterior cruciate ligament (ACL) reconstruction (ACLR) has become widely accepted, gaining increased attention in recent years and resulting in many research achievements in this field.

Purpose: The aim of this study was to determine which original articles on ACLR have been most influential in this field by identifying and analyzing the characteristics of the 100 most cited articles.

Study Design: Cross-sectional study.

Methods: Articles on ACLR were identified via the Thomson ISI Web of Science database on November 30, 2019. The 100 most cited articles were identified based on inclusion and exclusion criteria. The data extracted from each article for the subsequent analysis included title, date of publication, total citations, average citations per year (ACY), journal name, first author, institutions, themes, level of evidence, and keywords.

Results: The total number of citations was 29,629. The date of publication ranged from 1975 to 2015. A majority of the articles originated from the United States (58%) and were published in the 1990s (32%) and 2000s (48%). The mean ACY was 18.43 ± 9.51. Of the selected articles, nearly one-half were published in the (42%). The most prolific co-author and first author were Freddie H. Fu (n = 13) and K. Donald Shelbourne (n = 5), respectively. The most productive institution was the University of Pittsburgh (14%). Material comparison (19%) and technique comparison (16%) were the 2 most popular themes. More than one-quarter of articles were level 4 evidence (37%). Moreover, the keywords , , , , , and showed the highest degree of centrality.

Conclusion: By analyzing the characteristics of articles, this study demonstrated that ACLR is a growing and popular area of research, with the focus of research varying through timeline trends. Studies on anatomic reconstruction and biomechanics might be areas of future trends.
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http://dx.doi.org/10.1177/2325967120976372DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7876772PMC
February 2021

The Top 100 Most-Cited Articles on Arthroscopy: Most Popular Topic Is Rotator Cuff Rather Than Cartilage in the Last 5 Years.

Arthroscopy 2021 Feb 2. Epub 2021 Feb 2.

Orthopaedic Department, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China. Electronic address:

Purpose: To highlight the characteristics of the 100 most-cited articles on arthroscopy and provide the variation trend of citation rate among the top 25 articles in the past 9 years. We further analyzed the topics of interest in the past or currently.

Methods: The Thomson ISI Web of Science database was used to identify arthroscopy-related articles that were published from 1950 to March 31, 2020. The 100 most-cited articles were selected for further analysis. In addition, author key words of the articles that published in the recent 5 years were further analyzed.

Results: Mean of citations was 433.59 ± 400.73. The publication year ranged from 1980 to 2013. Most articles were focused on cartilage lesions and treatments (26%). A large proportion of articles were published in the 2000s (61%). Arthroscopy-the Journal of Arthroscopic and Related Surgery (23%) was the most popular journal. One half of the articles originated from the United States. The most prolific institution and first author were the Steadman Philippon Research Institute (5%) and Marc J. Philippon (4%), respectively. Most of the articles were Level IV evidence (33%). The citation rate increased by 131% from the previous top 25 articles published in 2011. A growth trend can be seen in the citation density over time. "Shoulder" (occurrences = 535) was the most used joint key word and "rotator cuff" (342) was the most used key word of research objective in the last 5 years, whereas "cartilage" only occurred 262 times.

Conclusions: Based on bibliometric analysis of the 100 most-cited articles on arthroscopy combined with network analysis of the whole articles that published in the recent 5 years, the topic of most interest in the recent 5 years was rotator cuff rather than cartilage. The number of citations among the 25 most-cited articles is growing rapidly and has at least doubled in size on average in the past 9 years. Citation density among the 100 most-cited articles on arthroscopy has seen a growth trend.

Clinical Relevance: This article clarifies the characteristics of the 100 most-cited papers and provides guidance on the topics of interest in the past or currently as a roadmap for future research on arthroscopy.
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http://dx.doi.org/10.1016/j.arthro.2021.01.039DOI Listing
February 2021

The differences of clinical characteristics and outcomes between imported and local patients of COVID-19 in Hunan: a two-center retrospective study.

Respir Res 2020 Nov 26;21(1):313. Epub 2020 Nov 26.

Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.

Background: The clinical characteristics and outcomes of the 2019 novel coronavirus (COVID-19) pneumonia are different in Hubei compared to other regions in China. But there are few comparative studies on the differences between imported and local patients which may provide information of the different courses of the virus after transmission.

Methods: We investigated 169 cases of COVID-19 pneumonia in two centers in Hunan Province, and divided them into two groups according to epidemiological history, "imported patients" refers to patient with a clear history of travel in Wuhan within 14 days before onset, and " local patients" refers to local resident without a recent history of travel in Wuhan, aiming to analyze the difference in clinical characteristics and outcomes between the two groups. All the epidemiological, clinical, imaging, and laboratory data were analyzed and contrasted.

Results: The incidence of fever on admission in imported patients was significantly higher than local patients. There was a significantly higher proportion of abnormal pulmonary signs, hypokalemia, hyponatremia, prolonged PT, elevated D-dimer and elevated blood glucose in imported patients. Compared with local patients, the proportion using antibiotics, glucocorticoids and gamma globulin were significantly higher in imported patients. The moderate type was more common in local patients, and the severe type were more frequent in imported patients. In addition, the median duration of viral clearance was longer in imported patients.

Conclusions: In summary, we found that imported cases were more likely to develop into severe cases, compared with local patients and required more powerful treatments. Trial registration Registered 21st March 2020, and this study has been approved by the Medical Ethics Committee (Approved Number. 2020017).
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http://dx.doi.org/10.1186/s12931-020-01551-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7689384PMC
November 2020

Fixed- versus mobile-bearing unicompartmental knee arthroplasty: a meta-analysis.

Sci Rep 2020 11 5;10(1):19075. Epub 2020 Nov 5.

Department of Orthopaedics, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan, 410011, People's Republic of China.

Unicompartmental knee arthroplasty (UKA) can be either a fixed bearing (FB) or a mobile bearing (MB) construct with controversy as to which design is superior. This question is addressed with a systematic review and meta-analysis. A literature search was performed using PubMed, Embase and the Cochrane Library. Studies were reviewed according to the inclusion and exclusion criteria developed in advance. We compared the differences in clinical and radiological outcomes between the FB and MB UKAs. Analyses were performed with the Review Manager and STATA software. A total of 17 studies involving 2612 knees were included. No significant differences were presented between the FB and MB prostheses in clinical and radiological outcomes. However, it was evident that there were differences in the modes and timing of the failures, bearing dislocation led to earlier failures in the MB prosthesis, while the FB prosthesis failed later due to polyethylene wear. There was no evidence of publication bias using the incidence of revisions. There is no significant difference between the FB and MB UKAs; however, there are differences in the modes and timing of failures.
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http://dx.doi.org/10.1038/s41598-020-76124-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7645610PMC
November 2020

Oxygen embolism after hydrogen peroxide irrigation during hip arthroscopy: a case report.

BMC Musculoskelet Disord 2020 Jan 30;21(1):58. Epub 2020 Jan 30.

Department of Orthopaedics, the Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, 410011, Hunan, China.

Background: Hydrogen peroxide has been widely used in Orthopaedics including Orthopaedic oncology, trauma and joint surgeries. However, we encountered an oxygen embolism and myoglobinuria after hydrogen peroxide was used to irrigate a septic hip arthroscopically.

Case Presentation: A 61-year-old male patient with right hip septic arthritis underwent an arthroscopic hip washout and debridement. During the operation, the surgeon used 100 ml of 3% hydrogen peroxide to irrigate the joint cavity. Two minutes after irrigation, there was a transient decrease in oxygen saturation, heart rate and blood pressure, with significant subcutaneous emphysema around the wound. Concentrated urine was drained out 8 h after operation which resolved the following day. Post-operatively, the patient was managed in the intensive care unit for a pulmonary embolism and discharged without further complications.

Conclusion: Medical staff should be aware of the risk of oxygen embolism and be extremely careful when using hydrogen peroxide in patient care. Oxygen embolism following hydrogen peroxide use is rare, however, once encountered, it may bring serious consequences. Therefore, the use of hydrogen peroxide in closed spaces or arthroscopic procedures should be discontinued.
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http://dx.doi.org/10.1186/s12891-020-3081-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6993368PMC
January 2020

The top 100 most cited articles on total hip arthroplasty: a bibliometric analysis.

J Orthop Surg Res 2019 Dec 4;14(1):412. Epub 2019 Dec 4.

Orthopaedic department, The Second Xiangya hospital of Central South University, Changsha, Hunan Province, China.

Background: Over the past few decades, more and more articles about total hip arthroplasty have been published. We noticed, however, little is known about the characteristics and qualities of these studies.

Methods: The databases of Web of Science Core Collection, BIOSIS Citation Index, MEDLINE, etc. were utilized for the identification of articles published from 1990 to May 2019. Total hip arthroplasty-related articles were identified, and the 100 most cited articles were selected for subsequent analysis of citation count, citation density (citations/article age), authorship, theme, geographic distribution, time-related flux, level of evidence, and network analysis.

Results: The selected 100 articles were published mainly in the 1990s (46%) and 2000s (47%) with almost equal amount. Citations per article ranged from 994 to 191. Leading countries were the USA followed by Canada, England, and Sweden, all located in North America and Western Europe. The most highlighted study themes were postoperative thrombosis and surgical methods and materials. The most common level of evidence was level III (35%). The network analysis connoted that radiography, acetabulum, reoperation, and bone cement had a high degree of centrality in the 1990s, while cement had a high degree of centrality in the 2000s and 2010s.

Conclusions: The time, area, and theme distribution of the top 100 most cited articles in the total hip arthroplasty have been thoroughly analyzed. It is noticeable that postoperative thromboembolism currently plays a major role in the field of total hip arthroplasty researches. However, most of them focus on the effectiveness of different treatments and drugs; little is known about its underlying mechanisms and influencing factors.
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http://dx.doi.org/10.1186/s13018-019-1476-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6894193PMC
December 2019

Metabolic syndrome and components exacerbate osteoarthritis symptoms of pain, depression and reduced knee function.

Ann Transl Med 2016 Apr;4(7):133

1 Department of Orthopaedic Surgery, Central Hospital of Shaoyang, Shaoyang 422000, China ; 2 Department of Orthopaedics, School of Medicine, Flinders University, Adelaide, Australia ; 3 Department of Orthopaedics and Trauma, Flinders Medical Centre, Adelaide, Australia ; 4 Department of Orthopaedic Surgery, 2nd Xiangya Hospital, Changsha 410011, China.

Background: The purpose of this study was to investigate the prevalence of metabolic syndrome and its co-morbidities in patients with primary knee osteoarthritis and to assess if the severity of metabolic syndrome, and components, correlates with the severity of osteoarthritis symptoms.

Methods: A case controlled analysis of 70 patients with osteoarthritis compared to a control group of 81 patients. Each patient underwent clinical review including history, examination, and pathology tests. The case-group all had stage IV osteoarthritis as determined by radiographs and intra-operative assessment. In addition a visual analogue scale (VAS), Hospital for Special Surgery knee score (HSS), and Hamilton Depression scores were completed.

Results: The prevalence of hypertension, obesity, dyslipidemia and metabolic syndrome was significantly higher in the patients with osteoarthritis compared to the control group. There is a significant correlation between the degree of hypertension, the presence of dyslipidemia or hyperglycemia and the severity of osteoarthritis symptoms. Variables hypertension, low HDL-C levels, and the number of co-morbidities were all identified as risk factors for increased osteoarthritis symptoms.

Conclusions: There is a correlation between the number of metabolic disorders, the severity of hypertension and severity of osteoarthritis symptoms. Hypertension and decreased HDL-cholesterol were positive risk factors for increased osteoarthritis symptomatology.
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http://dx.doi.org/10.21037/atm.2016.03.48DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4842398PMC
April 2016

The long-term outcome of displaced mid-third clavicle fractures on scapular and shoulder function: variations between immediate surgery, delayed surgery, and nonsurgical management.

J Shoulder Elbow Surg 2015 May 18;24(5):669-76. Epub 2014 Nov 18.

Department of Orthopaedics, Flinders Medical Centre, Bedford Park, SA, Australia. Electronic address:

Background: Conservative management for uncomplicated displaced clavicle fractures is common practice. Delay of surgical fixation may result in less favorable outcomes.

Methods: A retrospective cohort study was conducted of 60 patients with a closed mid-third clavicle fracture that did not meet current operative or nonoperative guidelines; 20 primary (plate fixation <6 weeks), 20 delayed (plate fixation >6 weeks), and 20 matched conservative patients were included. Each patient completed 2 questionnaires, the Disabilities of the Arm, Shoulder, and Hand and the American Shoulder and Elbow Surgeons, as well as visual analog scales for pain, cosmetic satisfaction, and overall satisfaction. In addition, 10 patients from each group underwent clinical review of scapular rotation by the lateral scapular slide test, clinical impingement, range of motion assessment, and radiologic review of clavicle union and length.

Results: The American Shoulder and Elbow Surgeons patient self-reported questionnaire demonstrated a median score of 5.5 for the delayed group, 2 for the primary group, and 1 for the conservative group (P = .032). The median Disabilities of the Arm, Shoulder, and Hand score was 7.92 for the delayed group, 3.32 for the primary group, and 1.67 for the conservative group (P = .212). Six patients in the delayed group had scapular malrotation compared with 2 in the primary group and none in the conservative group (P = .008). Flexion and external rotation in 90° abduction were decreased in the conservative group (P = .049 and .041, respectively).

Conclusion: We support the conservative management of uncomplicated displaced clavicle fractures but recognize that a lower threshold for early surgery should be considered where optimal shoulder function is required.
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http://dx.doi.org/10.1016/j.jse.2014.09.037DOI Listing
May 2015