Publications by authors named "Zachary Sharfman"

40 Publications

Dynamic locking plate vs. cannulated cancellous screw for displaced intracapsular hip fracture: A comparative study.

J Orthop 2021 Mar-Apr;24:15-18. Epub 2021 Feb 12.

Orthopedic Department, Tel Aviv Sourasky Medical Center, Ichilov Hospital, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Introduction: There is no consensus regarding the optimal device for displaced intracapsular hip fractures. This retrospective study compared two techniques (1) cannulated cancellous screw (CCS), and (2) Targon Femoral Neck (TFN) plate.

Materials And Methods: Data regarding gender, operational data, complications, pain, Quality of life and function scores were retrieved.

Results: 103 patients were included, 42 were treated using CCS, compared to 61 treated using TFN. Operative time shorter for CCS (p = 0.019). Complication rates were not different (p > 0.05).

Conclusion: As CCS method take shorter operating time and reduced costs, CCS should be used for the treatment of displaced ICHF.
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http://dx.doi.org/10.1016/j.jor.2021.02.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7902286PMC
February 2021

Early Medical Complications and Delayed Discharge after Spinopelvic Fusion: A Comparative Analysis of 887 NSQIP Cases from 2006 to 2016.

Spine Surg Relat Res 2020 31;4(4):314-319. Epub 2020 Mar 31.

Department of Orthopedic Surgery, Montefiore Hospital Medical Center And Albert Einstein College of Medicine, Bronx, New York, USA.

Introduction: The effect of pelvic fixation on postoperative medical complications, blood transfusion, length of hospital stay, and discharge disposition is poorly understood. Determining factors that predispose patients to increased complications after spinopelvic fusion will help surgeons to plan these complex procedures and optimize patients preoperatively.

Methods: We conducted a retrospective cohort study using data from the ACS-NSQIP database between 2006 and 2016 of patients who underwent lumbar fusion with and without spinopelvic fixation. Data regarding demographics, complications, hospital stay, and discharge disposition were collected.

Results: A total of 57,417 (98.5%) cases of lumbar fusion without spinopelvic fixation (LF) and 887 (1.5%) cases of lumbar fusion with spinopelvic fixation (SPF) were analyzed. The transfusion rate in the SPF group was 59.3% vs 13% in the LF group ( < 0.001). The mean length of stay (LOS) and discharge to skilled nursing facility (SNF) were significantly different (LOS: SPF 6.5 days vs LF 3.5 days < 0.001; SNF: SPF 21.3% vs LF 10.4% < 0.001). After controlling for demographic differences, the overall complication rates were not significantly different between the groups ( = 0.531). The odds ratio for transfusion in the SPF group was 2.9 ( < 0.001). The odds ratio for increased LOS and increased care discharge disposition were elevated in the SPF group (LOS OR: 1.3, < 0.012, Discharge disposition OR: 1.8, < 0.001).

Conclusions: Patients who underwent SPF had increased complications, transfusion rate, LOS, and discharge to SNF or subacute rehab facilities as compared with patients who underwent LF. SPF remains an effective technique for achieving lumbosacral arthrodesis. Surgeons should consider the implications of the associated complication profile for SPF and the value of preoperative optimization in a select cohort of patients.
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http://dx.doi.org/10.22603/ssrr.2019-0122DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7661021PMC
March 2020

Increased morbidity and mortality in elderly patients with lower extremity trauma and associated injuries: A review of 420,066 patients from the national trauma database.

Injury 2021 Apr 8;52(4):757-766. Epub 2020 Oct 8.

Division of Orthopaedic Surgery, NYC Health+Hospitals/Jacobi, Bronx, New York, USA.

Introduction: There is a paucity of research addressing the morbidity and mortality associated with polytrauma in elderly patients. This study aimed to compare the outcomes of elderly trauma patients with an isolated lower extremity fracture, to patients lower extremity fractures and associated musculoskeletal injuries.

Methods: This study is a retrospective review from the National Trauma Database (NTDB) between 2008 and 2014. ICD 9 codes were used to identify patients 65 years and older with lower extremity fractures. Patients were categorize patients into three sub groups: patients with isolated lower extremity fractures (ILE), patients with two or more (multiple) lower extremity fractures (MLE) and, patients with at least one upper and at least one lower extremity fracture (ULE). Groups were stratified into patients age 65-80 and patients >80 years of age.

Results: A total 420,066 patients were included in analysis with 356,120 ILE fracture patients, 27,958 MLE fracture patients, and 35,988 ULE fracture patients. The MLE group reported the highest dispatch to ACS level 1 trauma centers at 31.8% followed by the ULE group at 28.5% and the ILE group at 24.7% of patients (p<0.001). The overall rate of complications was highest in the MLE group followed by the ULE and then the ILE group (41.4%, 40.3%, 36.1%, respectively p<0.001). Motility rates in patients >80 years old in the MLE group and ULE group were similar (1.483 vs 1.4432). However, in the 65-80 year group the odds of mortality was 1.260 in the MLE group and 1.450 in the ULE group (p<0.001), such that the odds of mortality after sustaining a MLE fracture increases with age, whereas this effect was not seen in the ULE group.

Conclusion: Patients who sustained MLE and ULE fractures, had increased mortality, complications and in hospital care requirements as compared to patients with isolated lower extremity injuries. These outcomes are comparable between ULE and MLE fracture patients over the age of 80 however patients 65-80 with ULE fractures had increased mortality as compared patients 65-80 with MLE fractures. Understanding the unique considerations and requirements of elderly trauma patients is vital to providing successful outcomes.
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http://dx.doi.org/10.1016/j.injury.2020.10.037DOI Listing
April 2021

Preemptive analgesia in hip arthroscopy: intra-articular bupivacaine does not improve pain control after preoperative peri-acetabular blockade.

Hip Int 2020 Aug 31:1120700020950247. Epub 2020 Aug 31.

Department of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Introduction: Literature addressing postoperative pain management after hip arthroscopy is relatively scarce. This study aimed to assess if there was added analgesic benefit associated with postoperative intra-articular bupivacaine blockade for patients who received preoperative peri-acetabular blockade for hip arthroscopy procedures.

Methods: 52 patients were included in this comparative cohort study. Group 1 consisted of 20 patients who received preoperative peri-acetabular blockade and postoperative intra-articular blockade. The control group (Group 2), consisted of 32 patients who received only preoperative peri-acetabular blockade. Postoperative pain was recorded via visual analogue scale (VAS) pain scores, analgesic consumption, and pain diaries for 2 weeks postoperatively.

Results: Postoperative VAS pain scores were significantly lower in the experimental group at the 30-minute recovery room assessment (VAS scores Group 1: 1.1; Group 2: 3.00, = 0.034). Other than the 30-minute recovery room assessment, VAS pain scores, narcotic medication consumption, and non-narcotic analgesic consumption did not differ between the 2 groups at any time point in the study period.

Conclusions: This study did not demonstrate significant clinical benefit for patients who receive postoperative intra-articular blockade in addition to preoperative peri-acetabular blockade with bupivacaine 0.5%. We recommend the use of preoperative peri-acetabular bupivacaine blockade without intra-articular blockade postoperatively for pain control in the setting of hip arthroscopy surgery.
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http://dx.doi.org/10.1177/1120700020950247DOI Listing
August 2020

Spinal Epidural Abscess: A Review of Presentation, Management, and Medicolegal Implications.

Asian Spine J 2020 Oct 29;14(5):742-759. Epub 2020 Jul 29.

Spine Surgery Outcome Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.

Spinal epidural abscess (SEA) is a rare condition associated with significant morbidity and mortality. Despite advances in diagnostic medicine, early recognition of SEAs remains elusive. The vague presentation of the disease, coupled with its numerous risk factors, the diagnostic requirement for obtaining advanced imaging, and the necessity of specialized care constitute extraordinary challenges to both diagnosis and treatment of SEA. Once diagnosed, SEAs require urgent or emergent medical and/or surgical management. As SEAs are a relatively rare pathology, high-quality data are limited and there is no consensus on their optimal management. This paper focuses on presenting the treatment modalities that have been successful in the management of SEAs and providing a critical assessment of how specific SEA characteristics may render one infection more amenable to primary surgical or medical interventions. This paper reviews the relevant history, epidemiology, clinical presentation, radiology, microbiology, and treatment of SEAs and concludes by addressing the medicolegal implications of delayed treatment of the disease.
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http://dx.doi.org/10.31616/asj.2019.0369DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7595828PMC
October 2020

Early Experience Managing a High-volume Academic Orthopaedic Department During the Coronavirus Pandemic in New York City.

J Am Acad Orthop Surg 2020 Oct;28(19):e865-e871

From the Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, NY.

Our orthopaedic surgery department at Montefiore Medical Center and Albert Einstein College of Medicine is located within the Bronx, a borough of New York City, and serves a densely populated urban community. Since the beginning of the novel coronavirus outbreak in New York City, the medical center was forced to rapidly adapt to the projected influx of critically ill patients. The aim of this report is to outline how our large academic orthopaedic surgery department adopted changes and alternative practices in response to the most daunting challenge to public health in our region in over a century. We hope that this report provides insight for others facing similar challenges.
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http://dx.doi.org/10.5435/JAAOS-D-20-00412DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7273959PMC
October 2020

Preoperative planning and surgical technique for optimizing internal fixation of posterior malleolar fractures: CT versus standard radiographs.

J Orthop Surg Res 2020 Mar 26;15(1):119. Epub 2020 Mar 26.

Department of Orthopaedic Surgery, Assuta Medical Center affiliated with the Faculty of Health and Science, Ben Gurion University of the Negev, Menachem Begin Blvd. 126, Ashdod, Israel.

Background: A proper reduction and internal fixation of posterior malleolar fractures can be challenging, as intraoperative fluoroscopy often underestimates the extent of the fracture. Our aim was to assess the value of a modified classification system for posterior malleolar fractures, which is based on computed tomography (CT) images, optimizing screw trajectory during fluoroscopic-guided surgery, and to compare it to the Lauge-Hansen classification system to the CT-based classification.

Methods: A retrospective review of all ankle fracture operations from January 2014 to December 2016 was performed. Fractures were included if a CT scan was performed within 1 week of the surgery, and the posterior malleolar fragment occupied one third or more of the antero-posterior talar surface or jeopardize the ankle stability. Eighty-five adult ankle fractures with posterior malleolar fragments were included in this study. Fractures were categorized into one of three types, namely "postero-lateral," "postero-medial," or "postero-central," according to the location of the fracture fragment on axial CT image. An optimal trajectory angle for a single-lag screw fixation was measured on the CT cut between a central antero-posterior line and the line intersecting the posterior fragment perpendicular to the major fracture line. Mean trajectory angles were calculated for each fracture type. Fractures were also categorized according to the Lauge-Hansen system.

Results: The mean trajectory angle was 21° lateral for "postero-lateral" fragments, 7° lateral for "postero-central" fragments, and 28° medial for "postero-medial" fragments (p < 0.01 for comparisons among the groups). The range of trajectory angles within each group was about 10°, as compared to about 20° within each Lauge-Hansen type. There were no differences in trajectory angle among the Lauge-Hansen groups (p > 0.05 for all comparisons).

Conclusions: There are 3 distinct anatomic subgroups of posterior malleolar fragments, each with an ideal screw trajectory that needs to be used in order to achieve an optimal reduction and fixation.
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http://dx.doi.org/10.1186/s13018-020-01637-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7099790PMC
March 2020

Failure to extubate and delayed reintubation in elective lumbar fusion: An analysis of 57,677 cases.

Clin Neurol Neurosurg 2020 06 2;193:105771. Epub 2020 Mar 2.

Anesthesiology, Montefiore Hospital Medical Center, United States.

Objectives: There is a scarcity of literature exploring the consequences of Failure To Extubate (FTE) and Delayed Reintubation (DRI) in spine surgery. While it is reasonable to believe that patients who FTE or undergo DRI after Posterior Lumbar Fusion (PLF) and Transforaminal Lumbar Interbody Fusion (TLIF) are at risk for graver outcomes, there is minimal data to explicitly support that. The goal of this study was to investigate the morbidity and mortality associated with FTE and DRI after lumbar spine surgery in a large pool of patients.

Patients And Methods: We conducted a retrospective multicenter study of patients that underwent elective posterior lumbar fusion (PLF) and transforaminal lumbar interbody fusion (TLIF) using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2006 to 2016. We excluded patients with disseminated cancer, metastatic disease to the neural axis, patient with spinal epidural abscess, and patients with ventilator dependency prior to the operation.

Results: 57,677 patients from 2006 to 2016 were identified; 55 patients (0.1 %) had FTE and 262 patients (0.46 %) had DRI. The incidence of pneumonia was 27.2-fold greater in the FTE group and septic shock was 63.5-fold greater. All complications listed below are significance to p < 0.001. Deep vein thrombosis, pulmonary embolism, myocardial infarction and cardiac arrest were respectively, 10.4-, 12.2-, 22.8-, and 45.5- fold greater in the FTE group. Overall complication rate differed significantly between the two groups and were 9.8-fold greater in the FTE group. FTE was associated with increased, length of stay and all complications except DVT and pulmonary embolism. FTE was profoundly associated with severe complications (OR 13.0, 95 % CI 7.2-23.5) and mortality (OR = 21.5, CI = 7.5-61.0). The DRI group had a significantly higher morbidity (OR = 71.0, CI = 44.1-114.4), including overall complication (OR = 21.2, CI = 16.0-28.0) and severe complications (OR = 34.4, CI = 26.1-45.3). The DRI group had significantly higher rates of pneumonia (OR = 37.0), DVT (OR = 9.6) and pulmonary embolism (OR = 7.0), septic shock (OR = 60.5), myocardial infarction (OR = 32.1,) and cardiac arrest (OR = 236.4).

Conclusion: FTE and DRI were highly predictive of morbidity and mortality. Overall, investigations of the effects of FTE and DRI following spine procedures are lacking. This large multi-center national database review is one of the first to provide insight into the consequences of FTE and DRI in lumbar fusion cases. Future investigation into the consequences and predictors of FTE and DRI in spine surgery are required.
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http://dx.doi.org/10.1016/j.clineuro.2020.105771DOI Listing
June 2020

Does capsular closure influence patient-reported outcomes in hip arthroscopy for femoroacetabular impingement and labral tear?

J Hip Preserv Surg 2019 Aug 4;6(3):199-206. Epub 2019 Jul 4.

Department of Orthopaedic Surgery, Tel Aviv Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Weizmann St 6, Tel Aviv-Yafo, Israel.

Capsulotomy is necessary to facilitate instrument manoeuvrability within the joint capsule in many arthroscopic hip surgical procedures. In cases where a clear indication for capsular closure does not exist, surgeon's preference and experience often determines capsular management. The purpose of this study was to assess the influence of capsular closure on clinical outcome scores and satisfaction in patients who underwent hip arthroscopy surgery for femoroacetabular impingement (FAI) and labral tear. Data were prospectively collected and retrospectively analysed for hip arthroscopy surgeries with a minimum 2 years follow-up. Patients with developmental dysplasia of the hip, previous back or hip surgeries, and degenerative changes to this hip and secondary gains were excluded. Demographic data, intraoperative findings and patient-reported outcome scores were recorded, including the Modified Harris Hip Score (MHHS) and Hip Outcome Score (HOS). A total of 29 and 35 patients were included in the non-closure and closure groups, respectively. The mean follow-up time was over 3 years for both groups. The mean pre-operative and post-operative HOS scores and MHHS scores did not significantly differ between groups (pre-operative HOS: 65.6 and 66.3, = 0.898; post-operative HOS: 85.4 and 87.2, = 0.718; pre-operative MHHS: 63.2 and 58.4, = 0.223; post-operative MHHS: 85.7 and 88.7, = 0.510). Overall patient satisfaction did not differ significantly between groups (non-closure 86.3%, closure group 88.6%; = 0.672). Capsular closure did not significantly influence satisfaction or clinical outcome scores in patients who underwent arthroscopic hip surgery for FAI or labral tear.
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http://dx.doi.org/10.1093/jhps/hnz025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6874774PMC
August 2019

The anatomical properties of the indirect head of the rectus femoris tendon: a cadaveric study with clinical significance for labral reconstruction surgery.

Arch Orthop Trauma Surg 2020 Jan 16;140(1):85-92. Epub 2019 Nov 16.

Tel Aviv Medical Center, Department of Orthopaedic Surgery, Affiliated With the Sackler Faculty of Medicine and Tel Aviv University, Weizmann St 6, 6423906, Tel Aviv-Yafo, Israel.

Background: Acetabular labral tear is a common pathology. In some clinical situations, primary labral repair may not be possible and labral reconstruction is indicated.

Purpose And Clinical Relevance: Describe the anatomy of the indirect head of the rectus femoris (IHRF) tendon with clinical application in arthroscopic labral reconstruction surgery.

Methods: Twenty-six cadaver hips were dissected. Thirteen measurements, each with clinical relevance to arthroscopic labral reconstruction using an IHRF tendon graft were taken on each hip. All measurements were taken in triplicate. Mean values, standard deviations and intra-observer reliability were calculated.

Results: The mean footprint of the direct head of the rectus femoris tendon was 10.6 mm × 19.6 mm. The width and thickness at the confluence of both heads were 10.9 mm and 6.9 mm, respectively. The mean total length of the footprint and "free portion" of the IHRF was 55.3 mm, the mean cranial to caudal footprint measured at the 12 o'clock, 1 o'clock, and 2 o'clock positions were 22.3 mm. The mean length of the Indirect Head footprint alone was 38.1 mm. The mean length of IHRF tendon suitable for grafting was 46.1 mm and the mean number of clock face sectors covered by this graft was 3.3 clock face sectors. Intra-observer reliability was ≥ 0.90 for all recorded measurements. The origin of the IHRF on the acetabulum fans out posteriorly, becoming thinner and wider as the origin travels posteriorly. The tendon footprint is firmly attached on the lateral wall of the ilium and becomes a free tendon overlying the acetabular bone as it travels anteriorly and distally towards its muscular attachment.

Conclusion: The IHRF tendon is in an ideal location for harvesting and contains the appropriate thickness, length and triangular architecture to serve as a safe and local graft source for acetabular labral reconstruction surgery.
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http://dx.doi.org/10.1007/s00402-019-03293-6DOI Listing
January 2020

Does hip morphology correlate with proximal femoral fracture type?

Hip Int 2020 Sep 11;30(5):629-634. Epub 2019 Jul 11.

Department of Orthopaedic Surgery, Tel Aviv Sourasky Medical Centre, Israel.

Purpose: To determine if boney morphology influences the anatomic location of hip fractures in elderly patients.

Methods: All patients with hip fractures between 2008 and 2012 who had hip radiographs taken prior to the fracture were reviewed. Fractures were classified as intracapsular or extracapsular and hip morphology was measured on the pre-fracture x-rays. Hip morphology was determined by alpha angle, lateral central edge angle, acetabular index, neck-shaft angle, hip axis length, femoral neck diameter, Tönnis classification for hip osteoarthritis (OA) and the presence of a crossover sign.

Results: 148 subjects (78.4% female, age 83.5 years) with proximal femur fractures were included. 44 patients (29.7%) had intracapsular fractures and 104 (70.3%) had extracapsular fractures. 48% of patients had previous hip fractures on the contralateral side and 74.6% had the same type of fracture bilaterally. The rates of bilateral intracapsular and extracapsular fractures were similar (33.7% vs. 40.9% respectively, 0.39). Extracapsular fractures had a statically significant higher neck-shaft angle, a shorter hip axis length, a narrower femoral neck diameter and a higher grade of Tönnis classification of OA ( 0.04, 0.046, 0.03, 0.02 respectively). Acetabular coverage and the proximal femoral head-neck junction, which were evaluated by lateral centre-edge angle (LCEA), acetabular index and the presence of a crossover sign, did not correlate with fracture type. The alpha angle > 40° had a statistically significant higher likelihood for extracapsular fractures ( 0.013).

Conclusions: Acetabular coverage and proximal femoral head-neck junction morphology, were found to partially correlate with the location of hip fractures and do not fully elucidate fracture type susceptibility.
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http://dx.doi.org/10.1177/1120700019859275DOI Listing
September 2020

Chondral lesions in the hip: a review of relevant anatomy, imaging and treatment modalities.

J Hip Preserv Surg 2019 Jan 16;6(1):3-15. Epub 2019 Apr 16.

Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

The diagnosis and treatment of chondral lesions in the hip is an ongoing challenge in orthopedics. Chondral lesions are common and several classification systems exist to classify them based on severity, location, radiographic parameters, and potential treatment options. When working up a patient with a potential hip chondral lesion, a complete history, thorough physical exam, and ancillary imaging are necessary. The physical exam is performed with the patient in standing, supine, prone, and lateral positions. Plain film radiographs are indicated as the first line of imaging; however, magnetic resonance arthrogram is currently the gold standard modality for the diagnosis of chondral lesions outside of diagnostic arthroscopy. Multiple treatment modalities to address chondral lesions in the hip exist and new treatment modalities continue to be developed. Currently, chondroplasty, microfracture, cartilage transplants (osteochondral autograft transfer, mosaicplasty, Osteochondral allograft transplantation) and incorporation of orthobiologics (Autologous chondrocyte implantation, Autologous matrix-induced chondrogenesis, Mononuclear concentrate in platelet-rich plasma) are some techniques that have been successfully applied to address chondral pathology in the hip. Further refinement of these modalities and research in novel techniques continues to advance a surgeon's ability to address chondral lesions in the hip joint.
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http://dx.doi.org/10.1093/jhps/hnz002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6501440PMC
January 2019

Graft choices for acetabular labral reconstruction.

J Hip Preserv Surg 2018 Dec 27;5(4):329-338. Epub 2018 Sep 27.

Department of Orthopaedic Surgery, Tel Aviv Medical Center, Sackler Faculty of Medicine and Tel Aviv University, Weizmann St 6, Tel Aviv-Yafo, Israel.

The acetabular labrum plays a key role in maintaining hip function and minimizing hip degeneration. Once thought to be a rare pathology, advances in imaging have led to an increase in the number of diagnosed labral tears. While still a relatively new field, labral reconstruction surgery is an option for tears that are irreparable or require revision after primary repair. Various autograft and allograft options exist when considering labral reconstruction. The first labral reconstruction surgery was described using the ligamentum teres capitis, and has since evolved, incorporating more graft sources and reconstructive techniques. The purpose of this review is to assess and describe the different graft sources and technique currently implemented by hip surgeons. Moreover, this review attempts to determine whether a single labral reconstructive graft type is superior to the others. Techniques using the Ligamentum teres capitis autograft, ITB autograft, gracilis autograft, quadriceps tendon autograft, capsular autograft, semitendinosus allograft, indirect head of the rectus femoris autograft, peroneus brevis tendon allograft and Tensor fascia lata allograft were found. Scoring was available on 5 out of the 9 graft types. The advantages and disadvantages of each graft source is described as a comparative tool. No single graft type has shown increased benefit in acetabular labral reconstruction. The lack of uniform outcome measurements hinders comparison of reported outcomes. Surgeons should make an informed decision based on their experience as well as the patient's history and needs when choosing which graft type would be best suited for their patients.
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http://dx.doi.org/10.1093/jhps/hny033DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6328747PMC
December 2018

Cerebrovascular accidents associated with hip fractures: morbidity and mortality-5-year survival.

J Orthop Surg Res 2018 Jun 28;13(1):161. Epub 2018 Jun 28.

Department of Orthopaedic Surgery, Meir Hospital Sapir Medical Center, Affiliated with the Tel Aviv University Sackler Faculty of Medicine, Kfar Saba, Israel.

Background: Hip fractures are associated with increased cerebrovascular accidents (CVAs) in the first postoperative year. Long-term follow-up for CVA and mortality after hip fracture is lacking. The purpose of this study was to identify risk factors for CVA and follow mortality in hip fractures in a cohort with greater than 2 years follow-up.

Methods: We compared past medical history of patients with hip fractures to long-term survival and the occurrence of CVA. Past medical history, surgical intervention, CVA occurrence, and death were queried from the electronic medical recorder system. Level of significance was set at p < 0.05 with 95% confidence interval.

Results: Two thousand one hundred ninety-five patients met inclusion criteria. Mean follow-up was 5 years. One hundred ten (5.01%) patients were diagnosed with post-fracture CVA. Forty-one patients had CVA in the first year and 55 patients had CVA between 1 to 5 years after surgery. Among the potential risk factors, hypertension (HTN), atrial fibrillation (AF), and diabetes mellitus (DM) had the highest odds ratio for CVA (OR = 1.885, p value = 0.005; OR = 1.79, p value = 0.012; OR = 1.66, p value = 0.012). The median survival time in patients with CVA was 51.12 ± 3.76 months compared to 59.60 ± 0.93 months in patients without CVA (p = 0.033).

Conclusions: HTN, AF, and DM are significant risk factors for the occurrence of CVA after hip fracture. The majority of CVAs occur between the first and fifth year postoperatively, and CVA is a negative prognostic factor for postoperative survival.
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http://dx.doi.org/10.1186/s13018-018-0867-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6027793PMC
June 2018

Subspinal impingement: clinical outcomes of arthroscopic decompression with one year minimum follow up.

Knee Surg Sports Traumatol Arthrosc 2020 Sep 2;28(9):2756-2762. Epub 2018 Apr 2.

Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

Purpose: This study was designed to (1) evaluate the clinical outcomes after arthroscopic subspinal decompression in patients with hip impingement symptoms and low AIIS, and to (2) assess the presence of low anterior inferior iliac spine on the pre-operative radiographs of patients with established subspinal impingement diagnosed intra-operatively.

Methods: Retrospective analysis of patients who underwent arthroscopic subspinal decompression has been performed. The indications for surgery were femoroacetabular impingement (FAI), or subspinal impingement. Pre-operative radiographs were assessed for anterior inferior iliac spine type. Intra-operative diagnosis of low anterior inferior iliac spine was based on the level of anterior inferior iliac spine extension relative to the acetabulum and the presence of reciprocal labral and chondral lesions. In patients where low anterior inferior iliac spine was not diagnosed on pre-operative radiographs, the pre-operative radiographs were re-read retrospectively to assess missed signs of low anterior inferior iliac spine.

Results: Thirty-four patients underwent arthroscopic subspinal decompression between 2012 and 2015. The patients were followed for a median of 25 months (13-37 months). Intra-operatively, grade 2 anterior inferior iliac spine was found in 27 patients and grade 3 anterior inferior iliac spine was found in 7 patients. MHHS, HOS, and HOSS scores increased from median (range) pre-operative scores of 55 (11-90), 48 (20-91) and 20 (0-80) to 95 (27-100), 94 (30-100) and 91 (5-100), respectively (p < 0.0001, p = 0.001, p < 0.0001, respectively). Pre-operative diagnosis of low AIIS was made in 6/34 patients via AP radiographs. On retrospective analysis of pre-operative radiographs, signs of low AIIS were still not observed in 21/34 (61.8%) patients.

Conclusions: Arthroscopic subspinal decompression of low AIIS yielded significantly improved outcome measures and high patient satisfaction at a minimum of 13 months follow-up. Low AIIS is often under-diagnosed on AP pelvis and lateral frog radiographs and if left untreated, may result in unresolved symptoms and failed procedure.

Level Of Evidence: IV.
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http://dx.doi.org/10.1007/s00167-018-4923-5DOI Listing
September 2020

Functional outcomes after removal of hardware in patellar fracture: are we helping our patients?

Arch Orthop Trauma Surg 2018 Mar 28;138(3):325-330. Epub 2017 Nov 28.

Joint Arthroplasty and Sports Medicine Department, Tel Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, 6 Weitzman Street, 6423906, Tel-Aviv, Israel.

Purpose: Functional outcomes after Open Reduction Internal Fixation (ORIF) of the patella are variable. Common complications of patella ORIF include persistent anterior knee pain, limited range of motion and symptomatic hardware. The purpose of this study was to evaluate if removal of hardware is beneficial to symptomatic patients after patellar fracture fixation.

Methods: Patients who presented to our institution between December 2006 and November 2014 with patella fractures treated with ORIF were eligible for inclusion. Patella ORIF was performed using (1) K-wires (KW) with a tension band construct or (2) Cannulated Screws (CS) with a tension band construct. Radiological analyses included (1) AO classification and (2) measurements of prominent hardware length. Patient medical charts were reviewed for demographic and intraoperative data as well as peri/postoperative complications. All patients completed the SF-12 score, visual analog scale, Kujala score, Lysholm score and questionaries' regarding return to previous activity levels.

Results: Forty-seven patients met the inclusion criteria. The average time from fracture fixation to removal of hardware was 15.8 (SD ± 14.9) months. The mean follow-up was 43.1 (SD ± 27.1) months. Patella fixation was accomplished using tension band constructs with KW in 28 patients (59.5%) or with CS in 19 patients (40.5%). Patient reported quality of life and pain outcomes improved significantly after removal of hardware (p = 0.001, and p = 0.002 respectively). Functional outcome scores (Kujala and Lysholm) did not improve significantly after hardware removal in the KW or CS groups. Significantly more patients in the KW group returned to pre-injury activity (p = 0.005).

Conclusions: Hardware removal after patella ORIF significantly improves patient reported pain and quality of life outcomes but not functional outcomes. Patients should be counseled regarding the expected outcome of hardware removal following patella ORIF and diabetic patients should be given special consideration before undergoing this procedure.
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http://dx.doi.org/10.1007/s00402-017-2852-2DOI Listing
March 2018

Adult Closed Distal Radius Fracture Reduction: Does Fluoroscopy Improve Alignment and Reduce Indications for Surgery?

Hand (N Y) 2017 11 4;12(6):557-560. Epub 2016 Oct 4.

1 Hand and Elbow Unit, Orthopedic Division, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Background: This study compared the radiological outcomes of adult closed distal radius fractures (DRFs) reduction with and without fluoroscopy. We hypothesized that fluoroscopy-assisted reduction would not improve radiographic alignment or decrease the need for surgery.

Methods: Hospital medical records and radiographic images of all patients who presented with DRFs between April to June 2009 and April to June 2013 were reviewed. All patients underwent closed reduction and immobilization with or without fluoroscopic assistance. Reduction attempts were noted and pre- and postreduction posteroanterior and lateral radiographs were reviewed for fracture stability.

Results: Eighty-four patients underwent reduction without fluoroscopy (group 1), and 90 patients underwent reduction with the aid of fluoroscopy (group 2). According to accepted radiographic guidelines, nonsurgical treatment was indicated for 62% of patients in group 1 and 56% of patients in group 2 ( P = .44). In addition, no significant difference between the groups was observed in any postreduction radiographic parameters ( P > .53) or postreduction alignment of unstable fractures ( P = .47).

Conclusions: Reduction without the use of fluoroscopy demonstrated noninferiority when compared with fluoroscopy-assisted reduction in the emergency department for closed adult DRFs.
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http://dx.doi.org/10.1177/1558944716672209DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5669322PMC
November 2017

A novel non-invasive hip traction technique for hip arthroscopy in the below-knee amputation (BKA) patient.

J Hip Preserv Surg 2017 Aug 15;4(3):258-259. Epub 2017 Jun 15.

Tel Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine and Tel Aviv University, 6 Wiseman Street, Tel Aviv, Israel.

Prolonged sitting and mobilizing from a seated position are known to exacerbate the symptoms in patients with hip pathology. For patients who lack mobility and require extended periods of time in seated positions, such as amputees, the symptoms of femeroacetabular impingement can be debilitating and limit their ability to operate a wheelchair, use a prosthetic limb or complete activities of daily living. Hip arthroscopy surgery offers a minimally invasive technique to treat hip pathology but requires hip distraction to facilitate instrument maneuverability. Invasive methods of hip distraction have been previously described for use in amputees for hip arthroscopy. We herein describe a non-invasive surgical technique for hip distraction in the below-knee amputation patient.
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http://dx.doi.org/10.1093/jhps/hnx019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5604086PMC
August 2017

Acetabular labral reconstruction using the indirect head of the rectus femoris tendon significantly improves patient reported outcomes.

Knee Surg Sports Traumatol Arthrosc 2018 Aug 17;26(8):2512-2518. Epub 2017 Jul 17.

Department of Orthopedic Surgery, Tel Aviv Medical Center, Affiliated with the Sackler Faculty of Medicine and Tel Aviv University, Tel Aviv, Israel.

Purpose And Hypothesis: The aim of this study was to evaluate outcomes after acetabular labral reconstruction using the indirect head of the rectus femoris tendon. The study hypothesis stated that arthroscopic acetabular labral reconstruction may improve patient reported outcomes in patients with labral tears that were not amenable to repair.

Methods: Between 2009 and 2015, the senior author performed 31 acetabular labral reconstructions using the indirect head of the rectus femoris tendon. The graft is harvested through the same arthroscopic portals established for the procedure. The graft was gradually secured to the acetabular rim starting at its origin to the myotendinous junction, reestablishing the suction seal of the joint. Medical records and surgical reports were reviewed for demographic data, and outcome measures were assessed with pre- and postoperative modified Harris Hip Scores (mHHS).

Results: Twenty-two patients with follow-up of more than 2 years were evaluated. Fourteen procedures were revision hip arthroscopy and 8 were primary labral reconstruction in 13 males and 9 females. The median age was 43 (range 22-68 years old). The median follow-up time was 36.2 months with a range from 24 to 72 months. The median preoperative mHHS was 67.1. Postoperatively, patients improved to a median mHHS of 97.8 (range 73.7-100) (p < 0.0001).

Conclusion: Acetabular labral reconstruction using the indirect head of the rectus femoris tendon is a minimally invasive surgical procedure. The technique was applicable in all patients in this study with good outcomes. This procedure is clinically relevant for patients with large labral tears not amendable to labral repair as it offers good results using a local allograft. The local allograft is clinically advantageous as there is no additional donor-site morbidity and no risk of disease transmission.

Level Of Evidence: IV.
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http://dx.doi.org/10.1007/s00167-017-4641-4DOI Listing
August 2018

Anti-inflammatory Prophylaxis Prevents Heterotopic Ossification in Contralateral Side Hip Arthroscopy: A Case Report.

J Orthop Case Rep 2017 Jan-Feb;7(1):20-23

Department of Orthopaedics, Tel-Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Introduction: Heterotopic ossification (HO) after hip surgery is the formation of bone in non-skeletal tissue, usually between the muscle and the joint capsule. HO after hip surgery may be associated with clinical sequelae such as pain, impingement and decreased range of motion, compromising surgical outcomes.

Case Report: A 20-year-old basketball player presented with a 2-year duration of the left groin pain after a basketball-related injury. Due to continued disability and failure of conservative management the patient underwent hip arthroscopy. No HO prophylaxis was given. Follow-up radiographs at 3 months after left hip arthroscopy showed Grade 3 HO on the left side. On the 2 post-operative visit, the patient complained of contralateral (right-sided) hip pain. Due to continued symptoms on the right side and failure to respond to conservative management the patient underwent right hip arthroscopy. HO prophylaxis was initiated with non-steroidal anti-inflammatory medications (NSAIDs) treatment (Etodolac) 600 mg/day for 14 days. Follow-up radiographs at 3 months after the right hip arthroscopy showed no HO.

Conclusion: This case demonstrates the efficacy of HO prophylaxis in a single patient. Routine HO prophylaxis with NSAIDs should be considered for patients undergoing hip arthroscopy with osteoplasty. A minimum of 9 weeks post-operative follow-up is recommended to assess the radiographic presence of HO.
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http://dx.doi.org/10.13107/jocr.2250-0685.670DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5458690PMC
June 2017

Hip arthroscopy protocol: expert opinions on post-operative weight bearing and return to sports guidelines.

J Hip Preserv Surg 2017 Jan 23;4(1):60-66. Epub 2017 Feb 23.

Lyon Ortho Clinic, Clinique de la sauvegarde, 25 B avenue des sources, Lyon 69009, France.

The objectives of this study are to survey the weight-bearing limitation practices and delay for returning to running and impact sports of high volume hip arthroscopy orthopedic surgeons. The study was designed in the form of expert survey questionnaire. Evidence-based data are scares regarding hip arthroscopy post-operative weight-bearing protocols. An international cross-sectional anonymous Internet survey of 26 high-volume hip arthroscopy specialized surgeons was conducted to report their weight-bearing limitations and rehabilitation protocols after various arthroscopic hip procedures. The International Society of Hip Arthroscopy invited this study. The results were examined in the context of supporting literature to inform the studies suggestions. Four surgeons always allow immediate weight bearing and five never offer immediate weight bearing. Seventeen surgeons provide weight bearing depending on the procedures performed: 17 surgeons allowed immediate weight bearing after labral resection, 10 after labral repair and 8 after labral reconstruction. Sixteen surgeons allow immediate weight bearing after psoas tenotomy. Twenty-one respondents restrict weight bearing after microfracture procedures for 3-8 weeks post-operatively. Return to running and impact sports were shorter for labral procedures and bony procedures and longer for cartilaginous and capsular procedures. Marked variability exists in the post-operative weight-bearing practices of hip arthroscopy surgeons. This study suggests that most surgeons allow immediate weight bearing as tolerated after labral resection, acetabular osteoplasty, chondroplasty and psoas tenotomy. For cartilage defect procedures, 6 weeks or more non-weight bearing is suggested depending on the area of the defect and lateral central edge angle. Delayed return to sports activities is suggested after microfracture procedures. The level of evidence was Level V expert opinions.
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http://dx.doi.org/10.1093/jhps/hnw045DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5467404PMC
January 2017

Effects of Modification of Pain Protocol on Incidence of Post Operative Nausea and Vomiting.

Open Orthop J 2016 31;10:505-511. Epub 2016 Oct 31.

Department of Anesthesiology and Perioperative Care, University of California, Irvine Medical Center, Orange, California, USA.

Background: A Perioperative Surgical Home (PSH) care model applies a standardized multidisciplinary approach to patient care using evidence-based medicine to modify and improve protocols. Analysis of patient outcome measures, such as postoperative nausea and vomiting (PONV), allows for refinement of existing protocols to improve patient care. We aim to compare the incidence of PONV in patients who underwent primary total joint arthroplasty before and after modification of our PSH pain protocol.

Methods: All total joint replacement PSH (TJR-PSH) patients who underwent primary THA (n=149) or TKA (n=212) in the study period were included. The modified protocol added a single dose of intravenous (IV) ketorolac given in the operating room and oxycodone immediate release orally instead of IV Hydromorphone in the Post Anesthesia Care Unit (PACU). The outcomes were (1) incidence of PONV and (2) average pain score in the PACU. We also examined the effect of primary anesthetic (spinal . GA) on these outcomes. The groups were compared using chi-square tests of proportions.

Results: The incidence of post-operative nausea in the PACU decreased significantly with the modified protocol (27.4% . 38.1%, p=0.0442). There was no difference in PONV based on choice of anesthetic or procedure. Average PACU pain scores did not differ significantly between the two protocols.

Conclusion: Simple modifications to TJR-PSH multimodal pain management protocol, with decrease in IV narcotic use, resulted in a lower incidence of postoperative nausea, without compromising average PACU pain scores. This report demonstrates the need for continuous monitoring of PSH pathways and implementation of revisions as needed.
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http://dx.doi.org/10.2174/1874325001610010505DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5125376PMC
October 2016

Preemptive Analgesia in Hip Arthroscopy: A Randomized Controlled Trial of Preemptive Periacetabular or Intra-articular Bupivacaine in Addition to Postoperative Intra-articular Bupivacaine.

Arthroscopy 2017 Jan 8;33(1):118-124. Epub 2016 Oct 8.

Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Israel; Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel.

Purpose: To evaluate and compare the efficacy of intra-articular and periacetabular blocks for postoperative pain control after hip arthroscopy.

Methods: Forty-two consecutive patients scheduled for hip arthroscopy were randomized into 2 postoperative pain control groups. One group received preemptive intra-articular 20 mL of bupivacaine 0.5% injection, and the second group received preemptive periacetabular 20 mL of bupivacaine 0.5% injection. Before closure all patients received an additional dose of 20 mL of bupivacaine 0.5% intra-articularly. Data were compared with respect to postoperative pain with visual analog scale (VAS) and analgesic consumption, documented in a pain diary for 2 weeks after surgery.

Results: Twenty-one patients were treated with intra-articular injection, and 21 patients with peri-acetabular injection. There were no significant differences with regards to patient demographics or surgical procedures. VAS scores recorded during the first 30 minutes postoperatively and 18 hours after surgery were significantly lower in the periacetabular group compared with in the intra-articular group (0.667 ± 1.49 vs 2.11 ± 2.29; P < .045 and 2.62 ± 2.2 vs 4.79 ± 2.6; P < .009). There were no differences between the groups with regard to analgesic consumption.

Conclusions: Periacetabular injection of bupivacaine 0.5% was superior to intra-articular injection in pain reduction after hip arthroscopy at 30 minutes and 18 hours postoperatively. However, total analgesic consumption over the first 2 postoperative weeks and VAS pain measurements were not significantly affected.

Level Of Evidence: Level I, randomized controlled trial.
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http://dx.doi.org/10.1016/j.arthro.2016.07.026DOI Listing
January 2017

Rivaroxaban significantly inhibits the stimulatory effects of bone-modulating hormones: In vitro study of primary female osteoblasts.

Connect Tissue Res 2017 Mar 11;58(2):215-220. Epub 2016 Aug 11.

b Division of Orthopedic Surgery, Tel-Aviv Sourasky Medical Center and the Sackler Faculty of Medicine , Tel-Aviv University , Tel-Aviv , Israel.

Background: Anticoagulant therapy is a mainstay of treatment subsequent to major orthopedic surgeries. Evidence linking anticoagulant therapy, osteoporosis, and delayed fracture healing is not conclusive. We have previously reported that rivaroxaban significantly inhibited cell growth and energy metabolism in a human osteoblastic cell line. This study analyzed the response of primary female osteoblast cells to rivaroxaban in combination with various bone-modulating hormones.

Methods: Bone samples were taken from both premenopausal (pre-Ob) and postmenopausal (post-Ob) women. Cells were isolated from each sample and cultured to sub-confluence. Each sample was then treated with Rivaroxaban (10 µg/ml) in combination with the following hormones or with the hormones alone for 24 hours: 30nM estradiol-17β (E2), 390nM estrogen receptor α (ERα) agonist PPT, 420nM estrogen receptor β (ERβ) agonist DPN, 50nM parathyroid hormone (PTH), and 1nM of vitamin D analog JKF.

Results: No effects were observed after exposure to rivaroxaban alone. When pre-Ob and post-Ob cells were exposed to the bone-modulating hormones as a control experiment, DNA synthesis and creatine kinase (CK)-specific activity was significantly stimulated with a greater response in the pre-Ob cells. When the cells were exposed to rivaroxaban in combination with bone-modulating hormones, the increased DNA synthesis and CK-specific activity previously observed were completely attenuated.

Conclusions: Rivaroxaban significantly inhibited the stimulatory effects of bone-modulating hormones in both pre-Ob and post-Ob primary human cell lines. This finding may have clinical relevance for patients at high risk of osteoporosis managed with rivaroxaban or other factor Xa inhibitors.
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http://dx.doi.org/10.1080/03008207.2016.1220942DOI Listing
March 2017

Surgical Technique: Arthroscopic Osteoplasty of Anterior Inferior Iliac Spine for Femoroacetabular Impingement.

Arthrosc Tech 2016 Jun 13;5(3):e601-6. Epub 2016 Jun 13.

Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.

The anterior inferior iliac spine (AIIS) has variable morphology that correlates with hip range of motion. Subspinal impingement is an extracapsular cause for femoroacetabular impingement (FAI) and is clinically significant because it results in decreased range of motion and groin pain with flexion-based activity. In symptomatic patients with AIIS extension to or below the acetabular rim, AIIS decompression is considered part of an FAI corrective procedure. A consistent exposed bony area on the anterior and inferomedial aspect of the AIIS serves as a "safe zone" of resection allowing for decompression with preservation of the origin of the rectus femoris tendon. This surgical note describes a technique for AIIS decompression. The goal for low AIIS osteoplasty is to resect the AIIS to 2 burr widths (using a 5.5-mm burr) above the acetabular rim, achieving an 11-mm clearance, creating a type I AIIS. The resultant flat anterior acetabular surface between the most anteroinferior prominent point of the AIIS and the acetabular rim allows for free movement of the hip joint without impingement. Careful execution of AIIS decompression can alleviate clinical symptoms of FAI and restore function to the hip joint.
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http://dx.doi.org/10.1016/j.eats.2016.02.032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5021662PMC
June 2016

Biomechanical evaluation of two arthroscopic techniques for biceps tenodesis: triple loop suture versus simple suture.

J Shoulder Elbow Surg 2017 Jan 5;26(1):165-169. Epub 2016 Aug 5.

Shoulder Unit, Orthopaedic Surgery Division, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Background: Several techniques and procedures have been described to treat long head of the biceps pathology; however, tenodesis and tenotomy are the 2 most common procedures performed. This study evaluated the initial fixation strength of the biceps tenodesis triple loop suture (TLS) technique and compared it with that of the simple suture technique (SST).

Methods: Twenty fresh frozen cadaveric human shoulders (humeral head and neck with attached biceps tendons) were harvested. The biceps tendon was tenotomized proximally before reattachment to the bicipital groove of the matching humerus using suture anchors. Tenodesis was performed using the SST or the TLS technique. Specimens were tested biomechanically for load to failure, stress, and stiffness. The mechanism of failure was evaluated and compared between the 2 suture techniques.

Results: Maximal load to failure was significantly greater using the TLS technique (122.2 ± 26.73 N) than the SST (46.12 ± 14.37 N, P < .001). There was no difference in the mean stiffness (SST: 7.33 ± 4.41 N/mm, TLS: 7.46 N/mm ± 2.67, P = .94). The failure mechanism in all SST samples occurred by suture cutout through the longitudinal fibers of the tendon. In all TLS samples, the failure occurred by suture slippage.

Conclusion: This study demonstrated superior load to failure of the TLS compared with the SST technique for biceps tenodesis. Furthermore, this study provides the first description of the TLS technique as a possible application in biceps tenodesis. Clinical application of the TLS must be carefully considered, because although it achieved a superior biomechanical profile, experience with this stitch is limited.
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http://dx.doi.org/10.1016/j.jse.2016.05.019DOI Listing
January 2017

Arthroscopic Labrum Reconstruction in the Hip Using the Indirect Head of Rectus Femoris as a Local Graft: Surgical Technique.

Arthrosc Tech 2016 Apr 11;5(2):e361-4. Epub 2016 Apr 11.

Department of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.

The importance of the acetabular labrum has been well documented for the health and function of the hip joint. Labral reconstruction has proven effective but often requires the use of a cadaveric allograft or auto graft from the fascia lata or gracilis. The indirect head of the rectus femoris is in close proximity with the anterior superior acetabulum, which is the most common site of labral tears. Using the indirect head of the rectus femoris as a local graft minimizes surgical invasiveness by mitigating the need to harvest the graft from a different location, in case of an autograft, and by minimizing donor site morbidity and damage to local tissues. The graft is harvested and fixed to the acetabular rim through the same arthroscopic portals. Hip labral reconstruction using the reflected head of the rectus femoris tendon is a minimally invasive surgical procedure that restores stability to the hip joint, is applicable in all patients undergoing hip labral reconstruction, and offers decreased tissue morbidity compared with other grafting techniques.
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http://dx.doi.org/10.1016/j.eats.2016.01.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4947869PMC
April 2016

Complications of Hip Arthroscopy: Patient Perspectives.

Orthop Nurs 2016 Jul-Aug;35(4):208-13

Zachary T. Sharfman, MS, Researcher, Division of Orthopedic Surgery, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Eyal Amar, MD, Orthopedic Surgeon, Division of Orthopedic Surgery, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Oren Tsvieli, MD, Orthopedic Surgeon, Department of Orthopedic Surgery, Soroka Medical Center, Goldman Faculty of Medicine, Ben Gurion University, Beer Sheva, Israel. Nassim Alkrinawi, MD, Orthopedic Surgeon, Department of Orthopedic Surgery, Soroka Medical Center, Goldman Faculty of Medicine, Ben Gurion University, Beer Sheva, Israel. Ofer Levy, FRCS, MD, MCh(Orth), Orthopedic Surgeon, Reading Shoulder Unit, Royal Berkshire Hospital, Reading, United Kingdom. Ehud Rath, MD, Orthopedic Surgeon, Division of Orthopedic Surgery, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; and Department of Orthopedic Surgery, Soroka Medical Center, Goldman Faculty of Medicine, Ben Gurion University, Beer Sheva, Israel.

Background: In recent years, hip arthroscopy has rapidly evolved, offering patients evidence-based interventions with the merits of minimally invasive surgery and a relatively short rehabilitation period. Although considered a safe procedure, hip arthroscopy has associated complications that may be underreported depending on how patients are asked about their complications.

Purpose: The aim of this study was to evaluate hip arthroscopy complications from the patient's perspective.

Methods: Between February 2006 and April 2010, a total of 78 consecutive patients underwent arthroscopy of the hip by a single surgeon. A questionnaire was created that included questions regarding demographic data, functional data, and the patient's opinion as to the operation's indications, subjective evaluation of the success of the procedure, and the presence of specific complications. Patients were asked about the presence of specific complications rather than being asked about the presence of any complication in general.

Results: Sixty-two patients participated. The mean time postsurgery was 27.9 months (range = 5-55 months). Main indications for surgery were correction of femoroacetabular impingement in 31 (50%) patients. Mean surgery time was 1.2 hours (range = 0.5-2.43 hours), mean postoperative modified Harris hip score (MHHS) was 76.2 (range = 15-100), and mean postoperative pain score was 4 (range = 2-10). Fifteen (24%) patients reported complications after surgery, with 20 complications reported overall (32%). Eight (12.9%) patients reported transient neuropraxias. No significant differences were found between patients reporting complications and patients not reporting complications in terms of age, gender distribution, surgery time, visual analog scale score, MHHS, and time from surgery.

Conclusions: When patients are asked a general question, whether they suffer from any complications, they tend to underreport the presence of such complications. Complete and comprehensive interviews of the patient may give us a better understanding of the true incidence of complications.
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http://dx.doi.org/10.1097/NOR.0000000000000257DOI Listing
February 2018

Hip arthroscopy for intra-capsular benign tumors: a case series.

J Hip Preserv Surg 2016 Oct 15;3(4):312-317. Epub 2016 Jul 15.

Tel Aviv University Sackler Faculty of Medicine.

The purpose of this study is to demonstrate the assessment of intra-capsular femoral head and neck tumors, and to describe the arthroscopic surgical technique used to resect and fill the bone defects. Three cases of benign femoral head and neck lesions are presented. Two benign enchondromas and one benign osteochondroma were resected arthroscopically. Traction was used in one case. Modified Harris Hip Score improved in all three cases to scores of 95 or greater with an average improvement of 16 points with a minimum follow up of 15 months. Arthroscopic surgical resection of intra-capsular femoral hip lesions offers an effective alternative to open resection. This technique offered good outcomes in the limited cohort. We suggest that arthroscopic resection of intra-capsular femoral hip lesions be considered in relevant cases as an alternative to open resection.
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http://dx.doi.org/10.1093/jhps/hnw025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5883178PMC
October 2016
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