Academic Teaching Hospital Research Articles

Thoracic Aortic Injuries Following Intra-Aortic Balloon Pump Placement: A Retrospective Case Series.

Retrospective, single-institution study through chart review of five patients with known thoracic aortic injuries following IABP placement awaiting heart transplant. Tertiary care academic teaching hospital with all patients requiring cardiac ICU admission. All five patients were diagnosed with advanced heart failure awaiting heart transplantation. Each patient had an IABP placed while awaiting transplant. Five patients (4.6%) out of a total of 107 supported with IABP awaiting heart transplantation were identified with thoracic aortic injury. Three underwent transplantation and subsequently received thoracic endovascular aortic repair, and they are doing well with a mean follow-up of 6 months. One patient died acutely and the other did not require intervention. IABP-related aortic injuries may be more common in patients awaiting transplantation and that endovascular therapy is a suitable treatment modality with no immediate impact on transplantation outcomes. Pooled data from multiple centers may help identify patients risk profile to potentially design an algorithm that can more quickly identify these injuries.

Understanding the Underlying Causes of Tensions That Arise in ICU Care for Older Patients.

AbstractObjective: We hypothesized that the reasons behind this tension are complex and can be understood better by applying social psychology theory.Design: A qualitative methodology was drawn on for data collection and thematic analysis, with focus group discussions adopted for interviews with patient families and ICU physicians. Additionally, we used a social psychology theory, the reasoned action approach (RAA) framework, to understand these tensions.Setting: Two 15-bedded ICUs of an academic university-affiliated teaching hospital in Singapore.Subjects: A total of 72 physicians and family members of older ICU patients (>70 years old).Measurements and Main Results: The primary analysis revealed five areas of tension around prognostication in the ICU. These dealt with issues of divergent views, different role expectations, conflicting emotional responses, and issues of communication and trust. Further analysis helped to identify underlying factors leading to tensions and behaviors. Differences in prognostication and in expectation of outcomes between clinicians and family members were the main cause of tensions. When the RAA framework was applied, these tensions could be predicted early on and understood more clearly.Conclusions: Tensions revolve around losing control of the patient's care, differences between hopeful expectations and clinical prognostication, perceived biases of physicians, and underlying mistrust between families and physicians.

Microperimetry in Foveal Sparing Atrophic Late-Onset Retinal Degeneration.

To understand the baseline and longitudinal microperimetry (MP) characteristics in foveal sparing atrophic Late-Onset Retinal Degeneration (L-ORD). Prospective, cross-sectional, longitudinal study in which patients from the retina clinics of two academic teaching hospitals were included. Mesopic microperimetry was performed using a Nidek MP-1 micro-perimeter. Mean total, foveal, inner ring, and outer ring sensitivities were analyzed. A total of 20 eyes from 10 patients had baseline data. The subset of 10 eyes from 5 patients had follow-up data. The mean baseline macular sensitivity was 10.02 dB (+/- 5.26) with findings showing symmetry between both eyes. In the follow-up cohort, there was a significant loss of outer ring (0.83 dB per year, p= 0.0001), inner ring (0.67 dB per year, p=0.034), and foveal sensitivity (0.92dB loss per year, p= 0.015), while the mean sensitivity decreased significantly (0.66 dB per year, p = 0.0008) at 4-year follow-up. The drop in mean sensitivity was associated with significant increases in the number of deep scotoma points (6.20, p=0.037) and a decrease in the number of normal points (-6.30, p=0.022). Microperimetry is a useful tool for macular function follow-up to measure disease progression in L-ORD.

PREDICTORS OF MORTALITY OF COVID-19 INFECTED PATIENTS WITH ACUTE KIDNEY INJURY

Introduction: Coronavirus disease 2019 (COVID-19) is a condition brought on by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) where this virus is highly contagious. In several studies, acute kidney injury was associated with the cause of death. This study aimed to analyze what factors played a role as predictors of mortality in COVID-19 patients who experienced acute kidney injury. Method: This study used a one-center retrospective cohort method where the study was conducted at Dr. Soetomo General Academic Teaching Hospital, Surabaya, Indonesia. Statistical analysis of multivariate logistic regression was performed, and the results were presented in the form of an odds ratio (OR), with a p-value considered significant < 0.05 and a 95% confidence interval. Results: A total of 498 COVID-19 patients with acute kidney injury were included in this study. Our research found that 153 subjects (30.7%) died. The results of multivariate logistic regression analysis showed that the largest OR value was the D-dimer value variable, namely 2.102 (95% CI: 1.361-3.247), which means that COVID-19 patients with acute kidney injury who have a D-dimer value of ≥ 1.2 mg/L have the possibility of experiencing mortality within 30 days was 2.1 times greater than in patients with D-dimer values < 1.2 mg/L. The next variables were albumin value < 3.5 g/dL (OR 2.015, 95% CI: 0.992-4.091), history of hypertension (OR 2.003, 95% CI: 1.343-2.988). Conclusion: Our study found that a history of hypertension, higher than normal D-dimer levels, and hypoalbuminemia were predictors of mortality in patients with acute kidney injury who were infected with COVID-19.

The Effect of Vancomycin and Piperacillin-Tazobactam on Incidence of Acute Kidney Injury in Patients With Obesity.

Background: Increasing evidence suggests that administration of combination vancomycin and piperacillin-tazobactam (VPT) increases the incidence of acute kidney injury (AKI) beyond that of vancomycin alone. But these investigations have not evaluated AKI risk specifically in an increasingly prevalent obese population in whom VPT pharmacokinetics are altered. Objective: To evaluate AKI risk with VPT administration to patients with obesity. Methods: We conducted a multicenter retrospective study of obese patients admitted to 2 separate academic teaching hospitals from January 2010 to December 2021, who received VPT, or vancomycin plus either cefepime, meropenem, or ceftazidime. The primary outcome evaluated AKI when patients were treated with or without VPT. Results: A total of 227 patients were evaluated (114 in VPT, vs 113 in control group). Overall, body mass index (35.6 kg/m2 ± 4.8vs 36.1 kg/m2 ± 5.2; P = .44) was similar between the VPT and control groups respectively. Total vancomycin dose on day 1 of antibiotic therapy (3,432 mg ± 935 vs 2,732 mg ± 912; P < .01) and nephrotoxin administration (75.4% vs 62.8%; P = .04) were higher in the VPT group. Incidence of AKI was higher in the VPT group (37.7%vs 14.2%; P = .01) and on regression analysis VPT was predictive of developing AKI (OR = 3.9; 95% CI = 2.0-7.7; P < .01). Conclusion and Relevance: In this retrospective study, the incidence of AKI was increased in obese patients receiving therapy with VPT. Vancomycin combination therapy with ceftazidime, cefepime, and meropenem appeared to be safe and was associated with less nephrotoxicity. Cautious use of VPT and further investigation with larger studies are warranted in this area.

Laser Treatment of Pilonidal Disease — Immediate and Mid-term Results

Different forms of treatment of pilonidal disease include traditional open surgery with or without flap reconstruction, phenolization, and laser treatment. However, no significantly large series have been published about the laser method. This case series analysis consisted of 69 consecutive pilonidal disease patients, who were operated upon with a Fistula-tract laser Closure in the plastic surgery department of a single academic teaching hospital between August 2019 and December 2021. The follow-up was done by phone at 2 weeks and 4 weeks. The outpatient clinic follow-ups were at 6 weeks and 6 months postoperatively. The mean number of sick leave days was 6.2 ± 8.9 days. The mean number of outpatient clinic visits (including phone calls) was 3.4 ± 3.9. The mean secretion time was 22.1 ± 20.3 days. During the follow-up, 54 (81.8%) patients wounds healed. Eight (12.1%) patients had postoperative wound infection. There were no other complications. The mean follow-up time was 15.3 ± 7.7 months. Laser treatment for sinus pilonidal is promising and minimally invasive procedure. The procedure can be performed under local anesthesia. A re-operation comes into question if the operation area does not heal in the primary operation.

Examining the impact of racial disparities on Clostridioides difficile infection outcomes at a Southern California academic teaching hospital.

Racial differences in Clostridioides difficile infection (CDI) outcomes have been reported. In this study, minoritized patients with CDIs had prolonged hospitalizations and increased intensive care unit admissions. Chronic kidney disease was shown to partially mediate the relationship between race or ethnicity and severe CDI. Our findings suggest potential areas for equitable interventions.

Opportunity Cost to Attending Surgeons of Intraoperative Training for Residents in Cataract Surgery.

To estimate the opportunity cost to attending surgeons of teaching residents cataract surgery in the operating room. Operating room records at an academic teaching hospital from July 2016 to July 2020 were analyzed in this retrospective review of cases. Cases were identified using Current Procedural Terminology (CPT) codes 66982 and 66984 for cataract surgery. Outcomes measured include operative time and work relative value units (wRVUs). Cost analysis was performed using the generic 2021 Medicare Conversion Factor. Of 8813 cases, 2906 (33.0%) included resident involvement. For CPT 66982 cases, median (interquartile range (IQR)) operative time was 47 (22) minutes with resident involvement and 28 (18) minutes without (p<0.001). For CPT 66984 cases, median (IQR) operative time was 34 (15) minutes with resident involvement and 20 (11) minutes without (p<0.001). Median wRVUs was 78.5 (20.9) with resident involvement and 61.0 (14.4) without (p<0.001) which converted to an opportunity cost (IQR) per case of $1393.72 ($1055.63). Among cases involving residents, median operative time was significantly higher during the first and second quarters (p<0.001) and for every quarter when compared to cases performed by attendings only (p<0.001). Teaching cataract surgery in the operating room is associated with a considerable opportunity cost for attending surgeons.

AP-453071-2 SYNCHRONOUS AND ASYNCHRONOUS ATRIAL FIBRILLATION EDUCATION DIRECTED BY ALLIED PROFESSIONALS FOR IMPROVED PATIENT CARE

Patient education programs are an integral component of care, which helps promote patient engagement and improved clinical outcomes. The role and durability of virtual learning programs for patients (pts) with atrial fibrillation (AF) requires further study. To assess the utilization, acceptance, durability, and benefits of virtual learning for pts with atrial fibrillation as well as the impact on virtual care models. A comprehensive 3-hour virtual symposium on AF via an online video platform was offered to pts and family in 2021 and 2022. The program was sponsored by an academic teaching hospital free to pts and promoted through social media. Participants could watch live and the recorded presentation was also made available for future viewing. A follow up survey was sent to attendees that included questions on demographic information and opinions regarding virtual education and care. Comparisons were made between the 2022 and 2021 programs. A total of 465 participants registered for the 2022 program (48% increase from 2021) and 146 participants logged on (31% of registrants - down from 34% in 2021). A follow-up survey was sent to all registrants with 55 respondents, (89% watched the program live). Most respondents were >65 years old (58%); female (76%), Caucasian (89%), completed graduate school (40%) and lived 50+ miles away (36%). Four patients were from outside the US. Minority populations were under-represented relative to the local population demographics (black 0%, Hispanic 1.8%). The total cost of the program was $20/pt. The majority of respondents (58% - an increase of 22% from 2021) indicated they preferred a virtual program and if they had a choice, 61% preferred virtual (11% increase); and 53% indicated that program participation increased the likelihood of them performing a remote/virtual clinic visit with their provider. COVID was no longer an influence for most (57.4%). Presentations were made publicly available after the October 2022 program and have been viewed 247 times. Virtual education for pts with AF can be successfully offered, with a high enrollment rate at a fraction of the cost of an in-person program. Attendees generally prefer virtual over in person and can increase participation worldwide. This program influences future acceptance of virtual care as well as potential models of virtual care delivery. Greater efforts need to be made, however, to include under-represented populations.

Hospital Teaching Status and Patient-Reported Outcomes Following Primary Total Hip Arthroplasty: An American Joint Replacement Registry Study

IntroductionPrevious studies have shown lower morbidity and mortality rates after total hip arthroplasty (THA) at academic teaching hospitals. This study sought to determine the relationship between hospital teaching status and patient-reported outcome measures following primary THA. MethodsUsing American Joint Replacement Registry data from 2012 to 2020, 4,447 primary, elective THAs with both preoperative and one year postoperative Hip disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS, JR) scores were analyzed. The main exposure variable was hospital teaching status, with three cohorts, as follows: major teaching hospitals, minor teaching hospitals, and non-teaching hospitals. Mean preoperative and one year postoperative HOOS, JR scores were compared. ResultsPreoperative HOOS, JR scores (nonteaching: 49.69 ± 14.42 versus major teaching: 47.68 ± 15.10 versus minor teaching: 42.46 ± 19.19, P < .001) were significantly higher at non-teaching hospitals than major and minor teaching hospitals, and these differences persisted at one year postoperatively (87.40 ± 15.14 versus 83.87 ± 16.68 versus 80.37 ± 19.27, P < .001). Both preoperative and postoperative differences in HOOS, JR scores were less than the minimum clinically important difference (MCID) at both time points. In multivariate regressions, non-teaching and minor teaching hospitals had similar odds of MCID achievement in HOOS, JR scores compared to major teaching hospitals. ConclusionUsing the HOOS, JR score as a validated outcome measure, undergoing primary THA at an academic teaching hospital did not correlate with higher postoperative HOOS, JR scores or greater chances of MCID achievement in HOOS, JR scores compared to non-teaching hospitals. Further work is required to determine the most important factors that may lead to improvement in patient-reported outcomes following THA.

Using exogenous organizational and regional hospital attributes to explain differences in case-mix adjusted hospital costs.

Diagnosis-related group (DRG) hospital reimbursement systems differentiate cases into cost-homogenous groups based on patient characteristics. However, exogenous organizational and regional factors can influence hospital costs beyond case-mix differences. Therefore, most countries using DRG systems incorporate adjustments for such factors into their reimbursement structure. This study investigates structural hospital attributes that explain differences in average case-mix adjusted hospital costs in Switzerland. Using rich patient and hospital-level data containing 4 million cases from 120 hospitals across 3 years, we show that a regression model using only five variables (number of discharges, ratio of emergency/ambulance admissions, rate of DRGs to patients, expected loss potential based on DRG mix, and location in large agglomeration) can explain more than half of the variance in average case-mix adjusted hospital costs, capture all cost variations across commonly differentiated hospital types (e.g., academic teaching hospitals, children's hospitals, birth centers, etc.), and is robust in cross-validations across several years (despite differing hospital samples). Based on our findings, we propose a simple practical approach to differentiate legitimate from inefficiency-related or unexplainable cost differences across hospitals and discuss the potential of such an approach as a transparent way to incorporate structural hospital differences into cost benchmarking and payment schemes.

Safety and Feasibility Assessment of a Pharmacy-Driven AUC/MIC Vancomycin Dosing Protocol in a Multicenter Hospital System.

Vancomycin is used for Gram-positive infections, including methicillin-resistant Staphylococcus aureus. The 2020 vancomycin guidelines described by M. J. Rybak, J. Le, T. P. Lodise, D. P. Levine, et al. (Am J Health Syst Pharm 77:835-864, 2020, https://doi.org/10.1093/ajhp/zxaa036) provided an update on vancomycin dosing, which recommended an optimal area under the concentration-time curve over 24 h to MIC (AUC/MIC) target of 400 to 600. In 2021, a pharmacy-driven AUC/MIC vancomycin dosing protocol was implemented across 12 Sentara Health System hospitals. The primary objective of this study was to assess if the pharmacy-driven AUC/MIC vancomycin dosing protocol led to fewer acute kidney injury (AKI) events than trough-based dosing. Secondary objectives included vancomycin duration, hospital length of stay, administered vancomycin dose during admission, vancomycin labs drawn during standard lab times, and cost. AKI was assessed in two separate ways: (i) modified AKIN (Acute Kidney Injury Network) criteria and (ii) a modified version from the vancomycin guidelines. Inferential statistics were used to analyze the results of this retrospective study. Per the AKIN definition, the rates of AKI were 13.9% (349/2,507) in the trough-based group and 14.9% (369/2,471) in the AUC/MIC-based group (P = 0.309). Per the definition of the vancomycin guidelines, the rates of AKI were 6.7% (169/2,507) in the trough-based group and 7.6% (187/2,471) in the AUC/MIC-based group (P = 0.258). A total of 52% (2,679/5,151) of vancomycin labs were obtained during standard lab times in the AUC group and 24% (1,144/4,766) in the trough group (P < 0.05). There was no difference in AKI events between AUC and trough dosing. Use of contrast dye may confound these results. AUC/MIC dosing was associated with more lab draws during standard times, a larger number of labs drawn per person, and less total use of vancomycin. IMPORTANCE In this article, we report that there were no differences in rates of acute kidney injury between trough-based vancomycin dosing and AUC/MIC-based vancomycin dosing across 12 hospitals. AUC/MIC dosing resulted in more vancomycin lab draws during standard lab draw times compared to trough dosing, thus making it more convenient for health care personnel. This study includes all uses for vancomycin, including empirical use, and all patient severity levels. Therefore, this research reflects real-world use of vancomycin in hospitals. AUC/MIC dosing is supported by various infectious disease societies. However, the feasibility of incorporating AUC/MIC dosing in hospitals is undetermined. This study is unique in that it includes hospitals of various sizes (small community hospitals and an academic teaching hospital), and it includes a feasibility component. Therefore, this study has broad applicability to other hospitals across the United States. This original research includes the clinical application of vancomycin in a multicenter health system.

Evaluation of Antinuclear Antibody and Subserology Reflex Testing for the Diagnosis of Systemic Autoimmune Rheumatic Disorders in an Academic Teaching Hospital.

The aim of this study was to examine appropriate utilization of antinuclear antibody (ANA) screening tests with follow-up subserology tests (reflex testing) for diagnosing systemic autoimmune rheumatic disorder (SARD). We conducted a retrospective chart review of 3003 SARD-test orders at an academic teaching hospital from January to December 2019. Testing patterns were categorized as American College of Rheumatology (ACR)-recommended reflex testing, panel testing, or single subserology testing. We described testing patterns, assessed their diagnostic accuracy, and explored factors associated with reflex testing. Reflex testing accounted for 79.7% of SARD test-ordering, whereas improper testing (panel or single subserology) accounted for the other 20.3%. Reflex testing was associated with significantly more SARD diagnoses than improper testing (P = .004). Testing patterns were significantly associated with race/ethnicity (P = .008), with reflex testing being less frequent than improper testing in Hispanics and Whites. In summary, one-fifth (20.3%) of testing patterns for suspected SARD did not follow the ACR-recommended guidelines for using reflex testing. Use of reflex testing was associated with an increased frequency of SARD diagnosis.

Staples versus sutures wound closure in hip and knee arthroplasty: a prospective cohort study

This study aimed to compare two methods of wound skin closure-staples versus vertical mattress nylon sutures-in patients undergoing primary total hip (THR) and total knee replacements (TKR). The comparison was for wound complications as a primary outcome, and satisfaction of patient and nurse as secondary outcomes. A prospective cohort study was conducted at an academic teaching hospital. All the patients who were admitted for either primary THR or TKR from September 2018 to September 2019 were included. Revision surgeries, patients >85 years of age, and those who were on steroid therapy were excluded. Patients were divided into two groups (staples and sutures) to compare the two methods of wound closure. Patients in each group were assessed for characteristics such as age, sex, weight, height, comorbidities, smoking status, postoperative wound complications, reoperation and patient/nurse satisfaction. A total of 100 patients met the inclusion criteria. In the staples group (n=50), 26 patients underwent THR while 24 patients underwent TKR. In the sutures group (n=50), 23 patients underwent THR and 27 patients underwent TKR. Overall, there was no significant difference between the two groups (staples versus sutures) in terms of wound complications (p=0.401), patient satisfaction (p=0.357) and nurse satisfaction (p=0.513). Further analysis compared THR and TKR subgroups (THR staples versus THR sutures and TKR staples versus TKR sutures). The results showed no significant difference between the staples and sutures subgroups of THR and TKR in terms of wound complications, patient satisfaction and nurse satisfaction. In THR and TKR, there was no significant difference between either vertical mattress nylon sutures or staples primary skin closure in terms of wound complications and patient satisfaction in this study. The decision on wound closure method should be based on the availability of resources in the institution/country.

Advice for Early Career Clinical Stroke Researchers Applying for National Institutes of Health Funding.

Advice for Early Career Clinical Stroke Researchers Applying for National Institutes of Health Funding.

Utilizing an Informatics Engagement Strategy as an Approach to Sustain and Retain the Nursing Workforce.

The purpose of this paper is to describe a nursing informatics engagement strategy at an academic teaching hospital in Canada aimed at sustaining and retaining the nursing workforce by (1) enhancing nursing engagement and leadership in informatics decision making; (2) improving nurses' experiences using the electronic health record (EHR) by creating a process of rapid handling of technology issues; (3) leveraging data about nurses' EHR system use to identify opportunities to further streamline documentation; and (4) enhancing and optimizing informatics education/training and communication strategies. The nursing informatics strategy aims to improve engagement among nursing staff, as well as decrease the burden of using the EHR as a way of addressing possible causes of burnout.

Surgeon experience in glioblastoma surgery of the elderly—a multicenter, retrospective cohort study

PurposeTo assess the impact of individual surgeon experience on overall survival (OS), extent of resection (EOR) and surgery-related morbidity in elderly patients with glioblastoma (GBM), we performed a retrospective case-by-case analysis.MethodsGBM patients aged ≥ 65 years who underwent tumor resection at two academic centers were analyzed. The experience of each neurosurgeon was quantified in three ways: (1) total number of previously performed glioma surgeries (lifetime experience); (2) number of surgeries performed in the previous five years (medium-term experience) and (3) in the last two years (short-term experience). Surgeon experience data was correlated with survival (OS) and surrogate parameters for surgical quality (EOR, morbidity).Results198 GBM patients (median age 73.0 years, median preoperative KPS 80, IDH-wildtype status 96.5%) were included. Median OS was 10.0 months (95% CI 8.0–12.0); median EOR was 89.4%. Surgery-related morbidity affected 19.7% patients. No correlations of lifetime surgeon experience with OS (P = .693), EOR (P = .693), and surgery-related morbidity (P = .435) were identified. Adjuvant therapy was associated with improved OS (P < .001); patients with surgery-related morbidity were less likely to receive adjuvant treatment (P = .002). In multivariable testing, adjuvant therapy (P < .001; HR = 0.064, 95%CI 0.028–0.144) remained the only significant predictor for improved OS.ConclusionLess experienced neurosurgeons achieve similar surgical results and outcome in elderly GBM patients within the setting of academic teaching hospitals. Adjuvant treatment and avoidance of surgery-related morbidity are crucial for generating a treatment benefit for this cohort.

Variation in Provider Practice Patterns and the Perceived Need for a Shared Decision-making Tool for Neurogenic Lower Urinary Tract Dysfunction

To evaluate neurogenic lower urinary tract dysfunction (NLUTD) care providers' current practice patterns, their perceived need for a shared decision-making tool for NLUTD management. We developed an electronic survey to assess multiple factors surrounding NLUTD management including practice patterns, perceived need for a decision aid and willingness to use it. Prior to survey dissemination, a panel of expert NLUTD care providers reviewed and provided a critique of the survey. It was delivered via email to the members of the Genitourinary Reconstructive Surgeons, and the Society of Urodynamics, female pelvic medicine and urogenital reconstruction between March and May 2022. A total of 117 NLUTD care providers from 11 countries participated in this survey. Most participants were urologists (n: 109, 93%) working at academic teaching hospitals (n: 82, 70%). The most common treatments the providers had provided for stress urinary incontinence and detrusor overactivity were sling procedures (n: 76, 65%) and anticholinergics (n: 111, 95%). Participants believed that NLUTD management can be highly patient-specific and extensively vary from one individual to another. Most participants believed that patients performing clean intermittent catheterization have better QoL compared to those utilizing indwelling urinary catheters (n: 81, 69%). Participants believed there is a need for a NLUTD decision aid, and they expressed their willingness to use one if available. We found discordances between guideline recommendations, provider practice patterns, and patient-reported outcome measures and essential attributes that indicated the need for a decision aid to improve patient-provider communication and shared decision-making in NLUTD management.

Learn, Earn, Return

Recently, I attended the 25th anniversary celebration for the Power of Nursing Leadership event hosted by the University of Illinois at Chicago’s College of Nursing (CON). Twenty-five years ago, Dr. Joan Shaver, dean of the CON, observed that across the greater metro Chicago-land area, there were many integrated health care delivery systems, community and public health agencies, and large academic teaching hospitals with affiliated colleges of nursing (in addition to other nursing colleges and schools); however, there was little formal acknowledgment in the area about the contributions nurse scientists, leaders, faculty, and staff were making.

Accuracy of ultrasound-guided knee injections confirmed by fluoroscopy

BackgroundInjection with viscosupplements is a common treatment for knee osteoarthritis. However, there is a lack of knowledge about how the injectate spreads within the knee following an injection. ObjectiveUsing ultrasound and fluoroscopy, this study seeks to assess whether injectate introduced into the suprapatellar recess disperses into the tibiofemoral joint. DesignDescriptive case series and reliability test-retest study. SettingOutpatient rehabilitation center at an academic teaching hospital. Patients14 adults between 44 and 80 with knee osteoarthritis, defined as a grade 2–4 on the Kellgren and Lawrence scale, who were candidates for hyaluronic acid injections. InterventionsParticipants received ultrasound guided knee injections into the suprapatellar recess with hyaluronic acid and contrast. Post-injection fluoroscopic images were taken. The participants then underwent a walking protocol. Post-walking fluoroscopic images were then taken. Main outcome measurementsDetermining if an injectate introduced into suprapatellar recess localizes to the tibiofemoral joint following a walking test; and assessing interrater agreement with between 2 radiologists and 1 interventional physiatrist with regards to location of injectate. ResultsInjectate placed in the suprapatellar recess using ultrasound-guided technique will disperse to a varying extent from the suprapatellar recess into the tibiofemoral or patellofemoral joint after a brief bout of walking. Images of US-guided knee injections identified by an experienced interventionalist to represent correct needle placement and injectate location, confirmed by reference-standard fluoroscopy, can be corroborated by a blinded radiologist and are therefore reliable. ConclusionsFluoroscopic imaging confirmed that ultrasound-guided injection of hyaluronic acid into the suprapatellar recess dispersed into the tibiofemoral joint after a walking test. Future studies should examine whether the amount of injectate found in the tibiofemoral joint is correlated with patient outcomes. Level of evidenceLevel IV.