Publications by authors named "Thomas Parisi"

11 Publications

  • Page 1 of 1

Revision Total Knee Arthroplasty for Arthrofibrosis.

J Arthroplasty 2018 07 23;33(7S):S177-S181. Epub 2018 Mar 23.

Colorado Joint Replacement, Porter Adventist Hospital, Denver, Colorado; Department of Mechanical and Materials Engineering, Denver University, Denver, Colorado; Department of Biomedical Engineering, University of Tennessee, Knoxville, Tennessee; Department of Orthopaedics, University of Colorado School of Medicine, Denver, Colorado.

Background: Arthrofibrosis after TKA is a significant cause of patient dissatisfaction. There is little evidence regarding revision arthroplasty in this patient population. The purpose of this study is to evaluate outcomes after revision TKA for arthrofibrosis.

Methods: We retrospectively reviewed 46 consecutive revision TKAs for arthrofibrosis between 2007 and 2015 with minimum 2-year follow-up. Range of motion (ROM), complication rates, and Knee Society Scores (KSS) were recorded.

Results: Patients were followed for a mean of 59 months. ROM and KSS significantly improved: with flexion improving from 88° to 103° and extension improving from 11° to 3° (P < .001). There was not a relationship between patient or surgical factors and outcomes in this study. The rate of complications was 28.2% with a 17.4% reoperation rate.

Conclusion: While revision for arthrofibrosis after TKA can be associated with significant improvements in ROM and KSS, caution is advised given high rates of revisions, reoperations, and complications. Thirty percent of patients in this series had a decrease in one or more component of the KSS or a net decrease in arc of motion after revision surgery.
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http://dx.doi.org/10.1016/j.arth.2018.03.037DOI Listing
July 2018

Radiographic Changes in Nonoperative Contralateral Knee After Unilateral Total Knee Arthroplasty.

J Arthroplasty 2018 07 15;33(7S):S116-S120. Epub 2018 Feb 15.

Colorado Joint Replacement, Porter Adventist Hospital, Denver, CO; Department of Mechanical and Materials Engineering, Denver University, Denver, CO.

Background: Some patients perceive symptomatic improvement in the contralateral knee after unilateral total knee arthroplasty (TKA). This so-called "splinting effect" has been observed but has not been radiographically evaluated.

Methods: A retrospective review of patients with bilateral knee osteoarthritis treated with unilateral TKA was performed. Patients were subcategorized into 2 groups based on whether contralateral TKA was performed within the 2-year period. Contralateral radiographic measurements were performed.

Results: Forty-four of 203 patients had contralateral TKA performed within 2 years. Preoperative parameters were significantly worse in the bilateral group. By 6 weeks postoperatively, mechanical axis plumbline improved approximately 1°, with more change in those patients with preoperative varus alignment. Larger delta changes were also present in bilateral group preoperative to 1-year radiographs for tibiofemoral angle and joint space widening.

Conclusion: In patients with bilateral knee osteoarthritis who undergo unilateral TKA, a splinting effect may be present and measurable radiographically with improvement of contralateral mechanical axis plumbline. Further research is necessary to determine whether this improvement may delay contralateral TKA implantation.
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http://dx.doi.org/10.1016/j.arth.2018.02.018DOI Listing
July 2018

Quality of life and functioning of Hispanic patients with Major Depressive Disorder before and after treatment.

J Affect Disord 2018 01 14;225:117-122. Epub 2017 Aug 14.

Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States. Electronic address:

Background: Similar rates of remission from Major Depressive Disorder (MDD) have been documented between ethnic groups in response to antidepressant treatment. However, ethnic differences in functional outcomes, including patient-reported quality of life (QOL) and functioning, have not been well-characterized. We compared symptomatic and functional outcomes of antidepressant treatment in Hispanic and non-Hispanic patients with MDD.

Methods: We analyzed 2280 nonpsychotic treatment-seeking adults with MDD who received citalopram monotherapy in Level 1 of the Sequenced Treatment Alternatives to Relieve Depression study. All subjects (239 Hispanic, 2041 non-Hispanic) completed QOL, functioning, and depressive symptom severity measures at entry and exit.

Results: Hispanic participants had significantly worse QOL scores at entry and exit (p < 0.01). However, after controlling for baseline QOL, there was no difference between Hispanic and non-Hispanic patients' QOL at exit (p = 0.21). There were no significant between-group differences at entry or at exit for depressive symptom severity or functioning. Both groups had significant improvements in depressive symptom severity, QOL, and functioning from entry to exit (all p values < 0.01). Patients with private insurance had lower depressive symptom severity, greater QOL, and better functioning at exit compared to patients without private insurance.

Limitations: This study was a retrospective data analysis, and the Hispanic group was relatively small compared to the non-Hispanic group.

Conclusions: Hispanic and non-Hispanic participants with MDD had similar responses to antidepressant treatment as measured by depressive symptom severity scores, quality of life, and functioning. Nevertheless, Hispanic patients reported significantly worse quality of life at entry.
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http://dx.doi.org/10.1016/j.jad.2017.08.031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5626642PMC
January 2018

What is the Long-term Economic Societal Effect of Periprosthetic Infections After THA? A Markov Analysis.

Clin Orthop Relat Res 2017 Jul 7;475(7):1891-1900. Epub 2017 Apr 7.

Department of Orthopaedics, Massachusetts General Hospital, 55 Fruit Street, Yawkey Building 3B, Boston, MA, 02114, USA.

Background: Current estimates for the direct costs of a single episode of care for periprosthetic joint infection (PJI) after THA are approximately USD 100,000. These estimates do not account for the costs of failed treatments and do not include indirect costs such as lost wages.

Questions/purposes: The goal of this study was to estimate the long-term economic effect to society (direct and indirect costs) of a PJI after THA treated with contemporary standards of care in a hypothetical patient of working age (three scenarios, age 55, 60, and 65 years).

Methods: We created a state-transition Markov model with health states defined by surgical treatment options including irrigation and débridement with modular exchange, single-stage revision, and two-stage revision. Reoperation rates attributable to septic and aseptic failure modes and indirect and direct costs were calculated estimates garnered via multiple systematic reviews of peer-reviewed orthopaedic and infectious disease journals and Medicare reimbursement data. We conducted an analysis over a hypothetical patient's lifetime from the societal perspective with costs discounted by 3% annually. We conducted sensitivity analysis to delineate the effects of uncertainty attributable to input variables.

Results: The model found a base case cost of USD 390,806 per 65-year-old patient with an infected THA. One-way sensitivity analysis gives a range of USD 389,307 (65-year-old with a 3% reinfection rate) and USD 474,004 (55-year-old with a 12% reinfection rate). Indirect costs such as lost wages make up a considerable portion of the costs and increase considerably as age at the time of infection decreases.

Conclusions: The results of this study show that the overall treatment of a periprosthetic infection after a THA is markedly more expensive to society than previously estimated when accounting for the considerable failure rates of current treatment options and including indirect costs. These overall costs, combined with a large projected increase in THAs and a steady state of septic failures, should be taken into account when considering the total cost of THA. Further research is needed to adequately compare the clinical and economic effectiveness of alternative treatment pathways.

Level Of Evidence: Level II, economic and decision analysis.
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http://dx.doi.org/10.1007/s11999-017-5333-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5449335PMC
July 2017

The recovery index: A novel approach to measuring recovery and predicting remission in major depressive disorder.

J Affect Disord 2017 Jan 15;208:369-374. Epub 2016 Oct 15.

UCLA Graduate School of Education and Information Studies, United States.

Background: Clinicians view "recovery" as the reduction in severity of symptoms over time, whereas patients view it as the restoration of premorbid functioning level and quality of life (QOL). The main purpose of this study is to incorporate patient-reported measures of functioning and QOL into the assessment of patient outcomes in MDD and to use this data to define recovery.

Method: Using the STAR*D study of patients diagnosed with MDD, this present analysis grades patients' MDD severity, functioning level, and QOL at exit from each level of the study, as well as at follow-up. Using Item Response Theory, we combined patient data from functioning and QOL measures (WSAS, Q-LES-Q) in order to form a single latent dimension named the Recovery Index.

Results: Recovery Index - a latent measure assessing impact of illness on functioning and QOL - is able to predict remission of MDD in patients who participated in the STAR*D study.

Conclusions: By incorporating functioning and quality of life, the Recovery index creates a new dimension towards measuring restoration of health, in order to move beyond basic symptom measurement.
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http://dx.doi.org/10.1016/j.jad.2016.08.081DOI Listing
January 2017

The Basics of the Sunshine Act: How It Pertains to the Practicing Orthopaedic Surgeon.

J Am Acad Orthop Surg 2015 Aug;23(8):455-67

The Physician Payments Sunshine Act is a disclosure law requiring all drug, medical device, and biologics companies to report transfers of value to physicians and teaching hospitals. It was passed into law in 2010 as part of the Affordable Care Act. The first set of data was released via an online public database on September 30, 2014, with subsequent annual reports to come. Three categories of payments are recorded: general payments, ownership interests, and research payments. With few exceptions, any transfer of value greater than $10 is reported. The first dataset of 4.4 million payments totaling more than $3.5 billion was released amidst controversy and technical problems. Identified data constituted $1.3 billion in transfer payments; de-identified data constituted $2.2 billion in payments. Data regarding an additional $1.1 billion in payments were not published, in part because of unresolved disputes. The largest amount of funding went to research payments. The highest proportion of general payments went to licensing and royalty payments. Orthopaedic surgeons comprised 3.5% of the physicians represented, and they were responsible for more than 20% of total payments. The full impact of the Sunshine Act will not be clear until several years after its implementation.
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http://dx.doi.org/10.5435/JAAOS-D-14-00426DOI Listing
August 2015

Modular hip implant fracture at the stem-sleeve interface.

Orthopedics 2015 Mar;38(3):e234-9

The use of modular implants in femoral stem design has grown increasingly popular over the last decade because of the theoretical advantage of more flexibility and optimization of femoral anteversion, limb length, and femoral component offset. With the benefit of increased surgical flexibility, however, modularity also carries the theoretical risks of fretting at the modular surfaces, sequelae of wear debris, and possible failure and fracture of the stem at the modular junction. Indeed, there have been an increasing number of reports of modular implants failing due to fracture at modular junctions. The S-ROM prosthesis (DePuy Orthopaedics, Inc, Warsaw, Indiana), however, has a stellar clinical record and has been used with good results in both primary and revision total hip arthroplasty. Only a single case of S-ROM failure at the stem-sleeve interface has been reported in the orthopedic literature. The aim of this case report was to present a succinct history of proximal modularity in total hip arthroplasty and to describe the only known case of this type of catastrophic failure in an S-ROM prosthesis with a metal-on-metal bearing. Despite a low level of serum metal ions on presentation, scanning electron microscopy showed findings consistent with corrosive processes and pseudotumor was seen at revision surgery.
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http://dx.doi.org/10.3928/01477447-20150305-91DOI Listing
March 2015

Does the addition of a nerve wrap to a motor nerve repair affect motor outcomes?

Microsurgery 2014 Oct 14;34(7):562-7. Epub 2014 May 14.

Department of Orthopedic Surgery, St. Vincent's Hospital, The Catholic University of Korea, Seoul, Korea.

The purpose of this study was to evaluate the effect of wrapping bioabsorbable nerve conduit around primary suture repair on motor nerve regeneration in a rat model. Forty rats were randomly divided into two experimental groups according to the type of repair of the rat sciatic nerve: group I had primary suture repair; group II had primary suture repair and bioabsorbable collagen nerve conduit (NeuraGen® 1.5 mm, Integra LifeSciences Corp., Plainsboro, NJ) wrapped around the repair. At 12 weeks, no significant differences in the percentage of recovery between the two groups were observed with respect to compound muscle action potentials, isometric muscle force, and muscle weight (P = 0.816, P = 0.698, P = 0.861, respectively). Histomorphometric analysis as compared to the non-operative sites was also not significantly different between the two groups in terms of number of myelinated axons, myelinated fiber area, and nerve fiber density (P = 0.368, P = 0.968, P = 0.071, respectively). Perineural scar tissue formation was greater in primary suture repair group (0.36 ± 0.15) than in primary repair plus conduit wrapping group (0.17 ± 0.08). This difference was statistically significant (P < 0.001). Wrapping bioabsorbable nerve conduit around primary nerve repair can decrease perineural scar tissue formation. Although the scar-decreasing effect of bioabsorbable nerve wrap does not translate into better motor nerve recovery in this study, it might have an effect on the functional outcome in humans where scar formation is much more evident than in rats.
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http://dx.doi.org/10.1002/micr.22274DOI Listing
October 2014

Meralgia paresthetica: relation to obesity, advanced age, and diabetes mellitus.

Neurology 2011 Oct 5;77(16):1538-42. Epub 2011 Oct 5.

Department of Graduate Medicine, Mayo Medical School, 200 First Street SW, Rochester, MN 55905, USA.

Objective: To determine the incidence of meralgia paresthetica (MP) and its relationship to diabetes mellitus (DM) and obesity.

Methods: A population-based study was performed within Olmstead County Minnesota, from January 1, 1990, to December 31, 1999. MP incidence and its association with age, gender, body mass index (BMI), and DM were reviewed.

Results: A total of 262 patients with MP, 262 normal controls, and 262 BMI-matched normal controls with mean age of 50 years were identified (51% men). The age- and sex-adjusted incidence of MP was 32.6 per 100,000 patient years, whereas the incidence of MP in people with DM was 247 per 100,000 patient years, 7 times the occurrence of MP in the general population. Of the patients with MP, 28% had DM vs 17% of BMI-matched controls and the majority of people with MP developed DM after the diagnosis of MP. Patients with MP are 2 times more likely to develop DM (odds ratio 2, 95% confidence interval 1.3-3.0, p = 0.0027). The mean BMI of patients with MP (30.1 kg/m(2), obese class I) was significantly higher than that of age- and gender-matched controls (27.3 kg/m(2), overweight). MP incidence increased 12.9 per 100,000 patient years in the hemidecade study period with an associated increase in both BMI (2.2 kg/m(2)) and average age (3 years).

Conclusions: MP is a frequent painful neuropathy associated with obesity, advancing age, and DM. The incidence rate of MP is predicted to increase as these demographics increase in world populations. Because MP associates with DM beyond weight- and age-matched controls, more aggressive counseling of these patients in prevention of DM may be warranted.
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http://dx.doi.org/10.1212/WNL.0b013e318233b356DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3198972PMC
October 2011

Learning curve of robotic-assisted microvascular anastomosis in the rat.

J Reconstr Microsurg 2012 Sep 29;28(7):451-6. Epub 2011 Sep 29.

Department of Orthopedic Surgery, The Catholic University of Korea, Seoul, Korea.

We hypothesized that the learning plateau and learning rate of robotic-assisted microvascular anastomosis could be estimated statistically using curve-fitting method. Three surgeons with various microsurgical experiences performed 20 microsurgical anastomoses of the rat femoral artery using the da Vinci robotic system (Intuitive Surgical, Inc., Sunnyvale, CA). We evaluated the anastomosis time, patency rate, and quality of anastomosis. Objective structured assessment of technical skills (OSATS) score which is introduced to assess surgical dexterity was also measured. The average starting anastomosis time was 101 ± 30 minutes, and the estimated mean learning plateau was 33 ± 15 minutes. The estimated mean learning rate for anastomosis time was 22 ± 5 trials and the estimated mean learning rate for OSATS score was 8 ± 1 trials. Overall patency rate was 90 ± 5%. Anastomosis patency correlated with OSATS score and quality of anastomosis rather than anastomosis time. Important aspects of learning curve can be estimated by fitting inverse curves for robotic-assisted microvascular anastomosis. As anastomosis time does not necessarily correlate with the patency rate, OSATS score might be a valuable tool to evaluate surgeons during training for this complicated surgical task.
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http://dx.doi.org/10.1055/s-0031-1289166DOI Listing
September 2012

Patterns of intraneural ganglion cyst descent.

Clin Anat 2008 Apr;21(3):233-45

Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.

On the basis of the principles of the unifying articular theory, predictable patterns of proximal ascent have been described for fibular (peroneal) and tibial intraneural ganglion cysts in the knee region. The mechanism underlying distal descent into the terminal branches of the fibular and tibial nerves has not been previously elucidated. The purpose of this study was to demonstrate if and when cyst descent distal to the articular branch-joint connection occurs in intraneural ganglion cysts to understand directionality of intraneural cyst propagation. In Part I, the clinical records and MRIs of 20 consecutive patients treated at our institution for intraneural ganglion cysts (18 fibular and two tibial) arising from the superior tibiofibular joint were retrospectively analyzed. These patients underwent cyst decompression and disconnection of the articular branch. Five of these patients developed symptomatic cyst recurrence after cyst decompression without articular branch disconnection which was done elsewhere prior to our intervention. In Part II, five additional patients with intraneural ganglion cysts (three fibular and two tibial) treated at other institutions without disconnection of the articular branch were compared. These patients in Parts I and II demonstrated ascent of intraneural cyst to differing degrees (12 had evidence of sciatic nerve cross-over). In addition, all of these patients demonstrated previously unrecognized MRI evidence of intraneural cyst extending distally below the level of the articular branch to the joint of origin: cyst within the proximal most portions of the deep fibular and superficial fibular branches in fibular intraneural ganglion cysts and descending tibial branches in tibial intraneural ganglion cysts. The patients in Part I had complete resolution of their cysts at follow-up MRI examination 1 year postoperatively. The patients in Part II had intraneural recurrences postoperatively within the articular branch, the parent nerve, and the terminal branches, although in three cases they were subclinical. The authors demonstrate that cyst descent distal to the take-off of the articular branch to the joint of origin occurs regularly in patients with fibular and tibial intraneural ganglion cysts. The authors believe that parent terminal branch descent follows ascent up the articular branch from an affected joint of origin. This mechanism for bidirectional flow explains cyst within terminal branches of the fibular and tibial nerves and is dependent on pressure fluxes and resistances. This new pattern is consistent with principles previously described in a unified (articular) theory, is generalizable to other intraneural ganglion cysts arising from joints, and has important implications for pathogenesis and treatment of these intraneural cysts.
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http://dx.doi.org/10.1002/ca.20614DOI Listing
April 2008