Publications by authors named "Joshua M Kolz"

15 Publications

  • Page 1 of 1

C1 and C2 Fractures Above a Previous Fusion Treated with Internal Fixation without Fusion: A Case Report.

JBJS Case Connect 2021 04 14;11(2). Epub 2021 Apr 14.

Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota.

Case: A 71-year-old woman sustained C1 lateral mass and type 2 odontoid fractures 3 years after C2-T2 anterior-posterior fusion. She was treated with C1-C4 instrumentation without fusion for 9 months followed by instrumentation removal to restore atlantoaxial motion. After instrumentation removal, she maintained clinically relevant cervical lateral bending, rotation, and flexion and extension.

Conclusion: The loss of upper cervical motion after C1-C2 instrumented fusion may be debilitating for patients in the setting of previous subaxial cervical fusion. Temporary instrumentation without fusion may allow for preservation of upper cervical motion in patients with concomitant C1 and C2 fractures above a previous cervical fusion.
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http://dx.doi.org/10.2106/JBJS.CC.20.00672DOI Listing
April 2021

The Value of Cement Augmentation in Patients With Diminished Bone Quality Undergoing Thoracolumbar Fusion Surgery: A Review.

Global Spine J 2021 Apr;11(1_suppl):37S-44S

4352Mayo Clinic, First Street SW, Rochester, MN, USA.

Study Design: Systematic review.

Objectives: Osteoporosis predisposes patients undergoing thoracolumbar (TL) fusion to complications and revision surgery. Cement augmentation (CA) improves fixation of pedicle screws to reduce these complications. The goal of this study was to determine the value and cost-effectiveness of CA in TL fusion surgery.

Methods: A systematic literature review was performed using an electronic database search to identify articles discussing the cost or value of CA. As limited information was available, the review was expanded to determine the mean cost of primary TL fusion, revision TL fusion, and the prevalence of revision TL fusion to determine the decrease of revision surgery necessary to make CA cost-effective.

Results: Two studies were identified discussing the cost and value of CA. The mean cost of CA for two vertebral levels was $10 508, while primary TL fusion was $87 346 and revision TL fusion was $76 825. Using a mean revision rate of 15.4%, the use of CA for TL fusion would need to decrease revision rates by 13.7% to be cost-effective. Comparison studies showed a decreased revision rate of 11.3% with CA, which approaches this value.

Conclusion: CA for TL fusion surgery improves biomechanical fixation of pedicle screws and decreases complications and revision surgery in patients with diminished bone quality. The costs of CA are substantial and reported decreases in revision rates approach but do not reach the calculated value to be a cost-effective technique. Future studies will need to focus on the optimal CA technique to decrease complications, revisions, and costs.
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http://dx.doi.org/10.1177/2192568220965526DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8076807PMC
April 2021

Surgical treatment of primary mobile spine chordoma.

J Surg Oncol 2021 Apr 10;123(5):1284-1291. Epub 2021 Feb 10.

Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.

Background And Objectives: Chordomas of the mobile spine (C1-L5) are rare malignant tumors. The purpose of this study was to review the outcome of surgical treatment for patients with primary mobile spine chordomas.

Methods: The oncologic outcomes and survival of 26 patients undergoing surgical resection for a primary mobile spine chordoma were assessed over a 25-year period. The mean follow-up was 12 ± 6 years.

Results: The 2-, 5-, and 10-year disease-free survivals were 95%, 61%, and 55%. The local recurrence-free survival was improved in patients receiving en bloc resection with negative margins (83% vs. 35%, p = 0.02) and similar in patients receiving adjuvant radiation therapy (43% vs. 45%, p = 0.30) at 10 years. Debulking of the tumor (hazard ratio [HR] = 6.41, p = 0.01) and a local recurrence (HR = 9.52, p = 0.005) were associated with death due to disease. Complications occurred in 19 (73%) patients, leading to reoperation in 9 (35%) patients; this rate was similar in intralesional and en bloc procedures.

Conclusion: Surgical resection of mobile spine chordomas is associated with a high rate of complications; however, en bloc resection can provide a hope for cure and appears to confer better oncologic outcomes for these tumors without an increase in complications compared to lesser resections.
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http://dx.doi.org/10.1002/jso.26423DOI Listing
April 2021

Analysis of patient characteristics and outcomes related to distance traveled to a tertiary center for primary reverse shoulder arthroplasty.

Arch Orthop Trauma Surg 2021 Jan 28. Epub 2021 Jan 28.

Department of Orthopedic Surgery, Mayo Clinic, Gonda 14, 200 First Street SW, Rochester, 55905, USA.

Introduction: The reasons for referral and travel patterns are lacking for patients undergoing reverse shoulder arthroplasty (RSA). The purpose of this study was to compare comorbidities, surgical time, cost and complications between local and distant primary RSA patients.

Methods: Between 2007 and 2015, 1,666 primary RSAs were performed at our institution. Patients were divided into two cohorts, local patients (from within Olmstead county and surrounding counties, 492 RSAs) and those from a distance (1,174 RSAs).

Results: Local patients were older (74 vs 71 years, p < .001), more likely to have RSA for fracture, had a higher Charlson comorbidity score (3.8 vs 3.2, p < .001) and longer hospital stays (2.0 vs 1.8 days, p < 0.001) compared to referred patients. Referral patients required longer operative times (95 vs 88 min, p = .002), had higher hospitalization costs ($19,101 vs $18,735, p < .001), and had a higher rate of prior surgery (32% vs 24%, p < .001). There were no differences between cohorts regarding complications or need for reoperation.

Conclusions: Patients traveling from a distance to undergo primary RSA had longer operative times and were more likely to have had prior surgery than local patients. This may demonstrate the referral bias seen at large academic centers and should be considered when reviewing RSA outcomes, hospital performance, and calculating insurance reimbursement.

Level Of Evidence: Level IV.
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http://dx.doi.org/10.1007/s00402-021-03764-9DOI Listing
January 2021

Nonsurgical Management of Combined Occipitocervical and Atlantoaxial Distraction Injuries: A Case Report.

JBJS Case Connect 2021 Jan 14;11(1):e20.00228. Epub 2021 Jan 14.

Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota.

Case: A 41-year-old man sustained occipitocervical dislocation (OCD) and atlantoaxial dislocation (AAD) injuries in a motor vehicle collision. These injuries were treated nonoperatively with a hard cervical collar and activity restrictions with an excellent result at 4-year follow-up.

Conclusion: OCD and AAD injuries require prompt diagnosis and immobilization. Standard of care for coexisting injuries is occipitocervical fusion; however, some patients have coexisting injuries which may prevent operative treatment. These polytrauma patients require a creative nonoperative approach with close follow-up to avoid neurologic decline.
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http://dx.doi.org/10.2106/JBJS.CC.20.00228DOI Listing
January 2021

In Vivo Corrosion of Sleeved Ceramic Femoral Heads: A Retrieval Study.

J Arthroplasty 2021 03 9;36(3):1133-1137. Epub 2020 Oct 9.

Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.

Background: The purpose of this study was to evaluate a series of retrieved sleeved ceramic femoral heads used in total hip arthroplasty (THA) and determine qualitative and quantitative damage and corrosion patterns.

Methods: An IRB-approved implant retrieval database was utilized to identify all sleeved ceramic femoral heads collected from 1995 to 2004. There were 16 implants with an average duration of in situ of 70 months (range, 13-241 months). The femoral stem was known in 14 cases and was titanium alloy in each of those cases. None were revised for metal-related complications. Ten implants (63%) were from primary THAs, and 6 (38%) were from revision THAs. Damage and corrosion were qualitatively graded using a modified Goldberg method. A quantitative assessment was performed with a coordinate measurement machine (CMM).

Results: Among the 16 retrieved implants, 1 (6%) demonstrated severe Grade 4 corrosion, 5 (31%) had moderate Grade 3 corrosion, 5 (31%) had mild Grade 2 corrosion, and 5 (31%) had no visible corrosion at the inner sleeve that interfaces with the stem trunnion. The only case of grade 4 corrosion occurred in the only head-sleeve in the study that was not factory assembled and was mated with a titanium molybdenum zirconium ferrous (TMZF) alloy stem. The mean maximum linear corrosion depth at the taper interface, as measured by the CMM, was 7.7 microns (range, 0.9-32.9 microns).

Conclusion: This study is the first to quantify corrosion at the titanium interface of sleeved ceramic femoral heads. Potentially clinically significant damage and corrosion patterns were observed in a few failed retrievals; however, the majority of cases demonstrated minimal or no damage.
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http://dx.doi.org/10.1016/j.arth.2020.10.005DOI Listing
March 2021

Sacral Insufficiency Fracture Following Short-Segment Lumbosacral Fusion: Case Series and Review of the Literature.

Global Spine J 2020 Aug 30:2192568220950332. Epub 2020 Aug 30.

4352Mayo Clinic, Rochester, MN, USA.

Study Design: Retrospective case series.

Objective: Sacral insufficiency fracture is a rare and serious complication following lumbar spine instrumented fusion. The purpose of this study was to describe the patient characteristics, presentation, evaluation, treatment options, and outcomes for patients with sacral insufficiency fracture after short-segment lumbosacral fusion.

Methods: Six patients from our institutional database and 16 patients from literature review were identified with a sacral insufficiency fracture after short-segment (L4-S1 or L5-S1) lumbar fusion within 1 year of surgery.

Results: Patients were 55% female with a mean age of 58 years and body mass index of 30 kg/m. Osteoporosis or osteopenia was the most common comorbidity (85%). Half of patients sustained a sacral fracture after surgery from a posterior approach, while the others had anterior or anterior-posterior surgery. Mean time to fracture was 42 days with patients clinically presenting with new sacral pain (86%), radiculopathy (60%), or neurologic deficit (5%). Ultimately, 73% of patients underwent operative fixation often involving extension of the construct (75%) and fusion to the pelvis (69%). Men ( = .02) and patients with new radicular pain or neurologic deficit ( = .01) were more likely to undergo revision surgical treatment while women over 50 years of age were more likely to be treated conservatively ( = .003).

Conclusions: Spine surgeons should monitor for sacral insufficiency fracture as a source of new-onset pain in the postoperative period in patients with a short segment fusion to the sacrum. The recognition of this complication should prompt an assessment of bone health and management of underlying bone fragility.
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http://dx.doi.org/10.1177/2192568220950332DOI Listing
August 2020

Anterior Cervical Osteophyte Resection for Treatment of Dysphagia.

Global Spine J 2021 May 20;11(4):488-499. Epub 2020 Mar 20.

Department of Orthopedic Surgery, 4352Mayo Clinic, Rochester, MN, USA.

Study Design: This was a retrospective cohort study.

Objectives: When anterior cervical osteophytes become large enough, they may cause dysphagia. There is a paucity of work examining outcomes and complications of anterior cervical osteophyte resection for dysphagia.

Methods: Retrospective review identified 19 patients who underwent anterior cervical osteophyte resection for a diagnosis of dysphagia. The mean age was 71 years and follow-up, 4.7 years. The most common level operated on was C3-C4 (13, 69%).

Results: Following anterior cervical osteophyte resection, 79% of patients had improvement in dysphagia. Five patients underwent cervical fusion; there were no episodes of delayed or iatrogenic instability requiring fusion. Fusion patients were younger (64 vs 71 years, = .05) and had longer operative times (315 vs 121 minutes, = .01). Age of 75 years or less trended toward improvement in dysphagia ( = .09; OR = 18.8; 95% CI 0.7-478.0), whereas severe dysphagia trended toward increased complications ( = .07; OR = 11.3; 95% CI = 0.8-158.5). Body mass index, use of an exposure surgeon, diffuse idiopathic skeletal hyperostosis diagnosis, surgery at 3 or more levels, prior neck surgery, and fusion were not predictive of improvement or complication.

Conclusions: Anterior cervical osteophyte resection improves swallowing function in the majority of patients with symptomatic osteophytes. Spinal fusion can be added to address stenosis and other underlying cervical disease and help prevent osteophyte recurrence, whereas intraoperative navigation can be used to ensure complete osteophyte resection without breaching the cortex or entering the disc space. Because of the relatively high complication rate, patients should undergo thorough multidisciplinary workup with swallow evaluation to confirm that anterior cervical osteophytes are the primary cause of dysphagia prior to surgery.
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http://dx.doi.org/10.1177/2192568220912706DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8119911PMC
May 2021

In Vivo Corrosion of Modular Dual-Mobility Implants: A Retrieval Study.

J Arthroplasty 2020 11 4;35(11):3326-3329. Epub 2020 Jun 4.

Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.

Background: Modular dual-mobility (MDM) total hip arthroplasty (THA) implants have an additional metal-metal interface between the metal liner and outer metal shell that poses a risk of corrosion. The purpose of this study is to evaluate retrieved MDM liners to evaluate qualitative and quantitative damage and corrosion patterns at this interface.

Methods: Twelve MDM implants of one design with a mean in situ duration of 26 months (range, 1-57 months) were evaluated. Six implants (50%) were from primary THAs and 6 (50%) from revision THAs. The taper region of the liner at risk of damage was qualitatively graded using modified Goldberg criteria while quantitative dimensional assessment was performed with a validated coordinate measurement machine.

Results: Among the retrieved implants, 2 (17%) demonstrated severe grade 4 corrosion, 5 (42%) moderate grade 3 corrosion, 4 (33%) mild grade 2 corrosion, and 1 (8%) grade 1 (no visible corrosion). Mean maximum linear corrosion depth at the taper interface measured 35.5 microns (range, 8.4-176.2 microns). All implants had a maximum linear corrosion depth >7 microns, a threshold suggestive of potentially clinically significant material loss. Three corrosion patterns were identified: generalized corrosion, a stripe of corrosion about the middle of the taper region, and focal areas of corrosion at the portion of the taper closest to the joint surface.

Conclusion: Visual and dimensional analysis of all 12 retrieved MDM implants demonstrated identifiable corrosion/wear of the cobalt-chromium metal liner taper of varying severity. These implants should be used judiciously until larger series with clinical correlation can be completed.
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http://dx.doi.org/10.1016/j.arth.2020.05.075DOI Listing
November 2020

Is Reduction and Fusion Required for High-grade Spondylolisthesis?

Clin Spine Surg 2020 Jun 16. Epub 2020 Jun 16.

Departments of Orthopedic Surgery.

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http://dx.doi.org/10.1097/BSD.0000000000001029DOI Listing
June 2020

Lymphedema: A Significant Risk Factor for Infection and Implant Failure After Total Knee Arthroplasty.

J Am Acad Orthop Surg 2020 Dec;28(23):996-1002

From the Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.

Background: Lymphedema is characterized by fluid buildup and swelling, leading to skin fibrosis and recurring soft-tissue infections. There is a paucity of data examining the impact of lymphedema in total knee arthroplasty (TKA). The purpose of this study was to review the outcomes of TKA in patients with lymphedema compared with a matched cohort with primary osteoarthritis.

Methods: One hundred forty-four knees underwent primary TKA with a preceding diagnosis of ipsilateral lymphedema. The mean follow-up was 7 years. A blinded 1:2 match of knees with lymphedema to a group of knees without lymphedema undergoing primary TKA was performed. Matching criteria included sex, age, date of surgery, and body mass index. The mean follow-up for the comparison cohort was 8 years.

Results: Lymphedema increased revision hazard ratio [HR] 7.60; P < 0.001), reoperation (HR, 2.87; P < 0.001), and infection (HR, 6.19; P < 0.001) in addition to periprosthetic fracture (P = 0.04) and tibial component loosening (P = 0.01). The mean time to infection trended toward later time points in knees with lymphedema (19 versus 2 months, P = 0.25).

Discussion: Lymphedema increased the risk of revision, reoperation, and infection. These data highlight the need for appropriate patient counseling and the need for further investigation into the effects of preoperative and postoperative optimization of lymphedema management in the TKA setting.

Level Of Evidence: Therapeutic Level III.
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http://dx.doi.org/10.5435/JAAOS-D-20-00005DOI Listing
December 2020

Total Knee Arthroplasty After Intramedullary Tibial Nail: A Matched Cohort Study.

J Arthroplasty 2020 07 28;35(7):1847-1851. Epub 2020 Feb 28.

Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.

Background: As the use of intramedullary nails (IMNs) has become more common, there are an increasing number of patients requiring total knee arthroplasty (TKA) who have an indwelling tibial IMN. The purpose of this study is to compare implant survivorship, clinical outcomes, and complications in patients undergoing primary TKA with a history of tibial IMN to those without.

Methods: We retrospectively identified 24 TKAs performed between 2000 and 2017 after ipsilateral tibial IMN. Patients were matched 1:2 to patients undergoing primary TKA without history of tibial IMN based upon age, gender, body mass index, and year of surgery. Mean follow-up was 7 years.

Results: The 10-year survivorship free of any revision was 100% for the tibial IMN cohort, and 96% for the control cohort, while the 10-year survivorship free of any reoperation was 91% and 89%, respectively (P = .72). Patients with a history of tibial IMN had similar Knee Society Scores to matched controls at 2 years (P = .77) and 5 years (P = .09). Acquired idiopathic stiffness trended toward being more common (17% vs 6%, P = .21) and operative time trended toward being longer (135 vs 118 min, P = .07) when the tibial IMN was removed, but there was no overall difference in complication rate between cohorts.

Conclusions: To our knowledge, this is the first report of primary TKA in patients with a history of ipsilateral tibial IMN. Compared to a matched cohort of patients without tibial IMN, these patients have similar outcomes in regards to implant survivorship, clinical outcomes, and risk of complications.

Level Of Evidence: Therapeutic Level III.
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http://dx.doi.org/10.1016/j.arth.2020.02.052DOI Listing
July 2020

Symptomatic Thromboembolic Complications After Shoulder Arthroplasty: An Update.

J Bone Joint Surg Am 2019 Oct;101(20):1845-1851

Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.

Background: Venous thromboembolism (VTE) complications, including deep vein thrombosis and pulmonary embolism, are dreaded complications of orthopaedic surgical procedures that can result in substantial morbidity and mortality. There is a paucity of data examining risk factors for VTE in shoulder arthroplasty. The purpose of the present study was to review the rate of symptomatic VTE, determine patient and operative risk factors for VTE, and report on complications associated with VTE following shoulder arthroplasty.

Methods: Over a 16-year period, 5,906 patients underwent primary anatomic total shoulder arthroplasty, reverse total shoulder arthroplasty, or hemiarthroplasty. Symptomatic VTE events were identified in 24 shoulders within 90 days of surgery. Patient records were reviewed for surgical indication, patient and operative risk factors, and management of VTE.

Results: The rate of symptomatic VTE following shoulder arthroplasty was 0.41%. There were no deaths resulting from VTE events. Compared with patients who did not have VTE, those with symptomatic VTE events were found to be older (74.75 versus 68.51 years; p = 0.0028) and more likely to have had arthroplasty for a traumatic indication (3.31% versus 0.33%; p < 0.001). Age of >70 years and arthroplasty for a traumatic indication were found to be independent risk factors on multivariate nominal logistic regression analysis, whereas body mass index, sex, operative time, and type of arthroplasty performed were not found to be independent risk factors. There were 11 readmissions resulting directly from the VTE events, and patients diagnosed with VTE as inpatients had longer hospital stays than outpatients (13.71 versus 1.94 days; p = 0.0002).

Conclusions: The risk of VTE following shoulder arthroplasty is low, and routine use of pharmacologic VTE prophylaxis may not be necessary. However, VTE complications can lead to substantial morbidity, longer hospital stays, readmission to the hospital, and further complications. Therefore, patients with multiple risk factors for VTE such as prior history of VTE, active malignancy, age of >70 years, or arthroplasty for traumatic indications should be considered for pharmacologic VTE prophylaxis.

Level Of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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http://dx.doi.org/10.2106/JBJS.18.01200DOI Listing
October 2019

Efficient generation of functional epithelial and epidermal cells from human pluripotent stem cells under defined conditions.

Tissue Eng Part C Methods 2013 Dec 4;19(12):949-60. Epub 2013 Jun 4.

Department of Chemical and Biological Engineering, University of Wisconsin , Madison, Wisconsin.

Human pluripotent stem cells (hPSCs) have an unparalleled potential to generate limitless quantities of any somatic cell type. However, current methods for producing populations of various somatic cell types from hPSCs are generally not standardized and typically incorporate undefined cell culture components often resulting in variable differentiation efficiencies and poor reproducibility. To address this, we have developed a defined approach for generating epithelial progenitor and epidermal cells from hPSCs. In doing so, we have identified an optimal starting cell density to maximize yield and maintain high purity of K18+/p63+ simple epithelial progenitors. In addition, we have shown that the use of synthetic, defined substrates in lieu of Matrigel and gelatin can successfully facilitate efficient epithelial differentiation, maintaining a high (>75%) purity of K14+/p63+ keratinocyte progenitor cells and at a two to threefold higher yield than a previously reported undefined differentiation method. These K14+/p63+ cells also exhibited a higher expansion potential compared to cells generated using an undefined differentiation protocol and were able to terminally differentiate and recapitulate an epidermal tissue architecture in vitro. In summary, we have demonstrated the production of populations of functional epithelial and epidermal cells from multiple hPSC lines using a new, completely defined differentiation strategy.
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http://dx.doi.org/10.1089/ten.TEC.2013.0011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3833387PMC
December 2013