Orthopaedic Surgeons Research Articles

The Relationship Between Surgeon Volume and Major Surgical Complications After Total Shoulder Arthroplasty: An Evaluation of 3177 US Orthopedic Surgeons.

Total shoulder arthroplasty (TSA), which includes anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA), is a technically demanding procedure and limited data exist on the relationship between case volume and complications. We sought to identify volume thresholds for TSA, aTSA, and rTSA at which risk of a major surgical complication decreased and to compare complications of patients treated by high-volume surgeons with those of patients treated by low-volume surgeons. Primary, elective TSAs (aTSA and rTSA) from January 1, 2016, to December 31, 2019, were identified in the Premier Healthcare Database. Multivariable logistic regression with restricted cubic splines modeled the relationship between annual TSA, aTSA, and rTSA surgeon volume and 90-day risk of major surgical complications. The 90-day complications of patients treated by high- and low-volume surgeons were compared. From 2016 to 2019, 3177 surgeons performed 78,639 TSAs. Increasing annual volume was associated with decreasing major surgical complication risk (thresholds: 50 TSAs, 25 aTSAs, and 36 rTSAs). High- and low-volume surgeons performed 24,595 and 54,044 TSAs, respectively. Patients of high-volume surgeons had lower risk of major surgical complications (adjusted odds ratio [aOR], 0.69; 95% CI, 0.56-0.84), myocardial infarction (aOR, 0.59; 95% CI, 0.36-0.97), and readmission (aOR, 0.71; 95% CI, 0.62-0.81). Importantly, 74.9% of high-volume and 93.0% of low-volume surgeon-year units had major surgical complication rates below the mean of all recorded surgeons. While most high- and low-volume surgeons had major surgical complication rates below the cohort average, increasing TSA volume was associated with a decreased risk of complications. [Orthopedics. 202x;4x(x):xx-xx.].

Characteristics of sagittal spinopelvic alignment in Thai population: a cross-sectional study.

The prevalence of spinal deformity is a significant health concern often associated with the aging process. It is primarily attributed to the thickening of spinal joints, ligament pathologies, or the narrowing of the spinal canal, leading to compression of the spinal cord and nerve roots, and subsequently causing musculoskeletal problems. When considering corrective surgery for adult spinal deformities, it is crucial for spine surgeons to take into account the standard values of sagittal spinopelvic alignment. Notably, there is currently a lack of specific data on this aspect within the Thai population. Therefore, our study was focused on evaluating the alignment in the Thai population. To analyze sagittal spinopelvic alignment parameters in the asymptomatic Thai population and compare them with other populations. This study was designed as a cross-sectional analysis involving 194 participants, wherein the sagittal spinopelvic parameters were evaluated utilizing radiographic images. The measurements of the sagittal vertical axis (SVA), pelvic incidence (PI), lumbar lordosis (LL), sacral slope (SS), and pelvic tilt (PT) were determined by averaging the assessments conducted by two orthopedic residents and a spine surgeon. In addition, participants' demographic information was obtained through questionnaires, and further analysis was performed on age, gender, and body mass index data. The study also encompassed the determination of correlations between various parameters and the comparison of these parameters with other populations. The body mass index (BMI) of the study participants demonstrated significant associations with several spinal parameters. Specifically, BMI showed significant correlations with sagittal vertical axis (SVA) (r = 0.2, p = 0.09), pelvic incidence (PI) (r = 0.4, p < 0.01), lumbar lordosis (LL) (r = 0.2, p = 0.02), sacral slope (SS) (r = -0.2, p = 0.02), and pelvic tilt (PT) (r = 0.2, p = 0.02). The SS exhibited a statistically significant decline with increasing age (p = 0.04). Furthermore, the mean SVA, PI, LL, SS, and PT differed significantly between the study participants and the Indian population. In addition, the SS was notably lower when compared to the European population. The study revealed the spinopelvic parameters in a cohort of healthy Thai population and observed a correlation between their body mass index (BMI) and pelvic incidence (PI), lumbar lordosis (LL), sacral slope (SS), and pelvic tilt (PT). Notably, the average SS among Thai adults was found to be statistically lower than that of individuals from Indian, European Caucasian, Asian, and Mexican populations. These insights hold potential value as a reference when strategizing surgical interventions for Thai patients with spinal deformities.

Three-Dimensional Fluoroscopic System to Assess Robotically Placed Pedicle Screws: Should We Confirm Robotic Pedicle Screw Placement With Advanced Imaging?

Retrospective cohort study. The purpose of this study is to determine the utility of advanced imaging to confirm the placement of robotic pedicle screws. With increasing robotic adoption, certain institutions and surgeons have developed protocols for obtaining 3D intraoperative imaging after robotic pedicle screw placement to ensure proper hardware placement. No studies have assessed the utility of these protocols relative to the potential risks of increased radiation exposure and operative time. The purpose of this study is to determine if we should be obtaining advanced imaging to confirm the placement of robotic pedicle screws. This is a single institution retrospective cohort study of patients from May 2022 to July 2023 who underwent lumbar spinal fusion by a high-volume orthopedic spine surgeon at a level 1 metropolitan hospital. All cases used combined robotics and navigation systems for pedicle screw placement and intraoperative 3D imaging for evaluation of screw position. Pedicle screw accuracy was assessed using the Gertzbein and Robbins system (GRS). Acceptable pedicle screw position was defined as GRS A or B. Seventy patients with 354 robotically placed pedicle screws were assessed with intraoperative 3D fluoroscopy. All pedicle screws were placed in either a GRS type A or type B position. Three hundred forty-seven were placed in a GRS A classification (99.2%, 351/354), and 3 were placed in a GRS B classification (0.08% 3/354). No patients had screw-related complications. The average radiation dosage of 3D imaging was 289.7±164.6mGy. The robotic system places pedicle screws accurately without 3D intraoperative imaging. Given the increased radiation and operative time associated with 3D imaging protocols 3D imaging scans should only be obtained in cases with heightened clinical concern. Level IV.

EFFICACY OF NERVE ROOT BLOCK FOR THE TREATMENT OF LUMBAR SPINAL CANAL STENOSIS IN ADULTS OLDER THAN 80 YRS OF AGE

Background: Patients with advanced lumbar spinal canal stenosis (LCS) often prefer non-operative treatment owing to decreased physiological function and comorbidities. Although the therapeutic value ofselective nerve root block (SNRB) for LCS is confirmed, there are few reports of its effectiveness in theelderly. We investigated the efficacy of SNRB for LCS in patients over 80 years of age. Methods: The subjects were 112 patients aged over 80 years (mean age: 84 years 45 men and 67 women)with medication-resistant LCS without cauda equina syndrome who underwent SNRB. Cases with acute-onset lumbar disc herniation were excluded. We retrospectively investigated and compared the presence orabsence of surgery, effect of SNRB, number of procedures, duration of disease, and magnetic resonanceimaging findings. Patients who could avoid the surgery by SNRB were defined as the effective group. Patientswhose symptoms were not relieved by SNRB and who underwent surgery and those whose symptoms werenot relieved but who continued conservative treatment were defined as the ineffective group. A total of oneto seven SNRBs were performed in both groups, and the same spine surgeon performed the entire procedurefrom SNRB to surgery. Results: There were 86 nonoperative patients (69 effective cases) and 26 operative patients the overall rateof effectiveness was 61% (69/112 patients). The area of the spinal canal at the responsible level was 108.63mm2in the effective group compared with 77.06 mm 2 in the ineffective group. This was significantlynarrower in the ineffective group (p=0.0094). There was no significant difference in the duration of illness,number of blocks, or hernia complication rate between the groups. No patient experienced severe neuralgiathat may have been caused by neuropathy during SNRB. Discussion: Our outcome showed that more than 60% of older patients with LCS showed symptomatic improvement with SNRB. SNRB can be performed relatively safely in the elderly and appears to be afavourable treatment option for older patients with various risks, such as poor general condition. Conclusions: Multiple sessions of SNRB may provide older patients with symptomaticimprovement and maybe an option for treatment.

Frequency and mechanism of injury for unintentional paediatric femoral fractures associated with consumer products over a 10-year period in the USA.

Femoral shaft fractures tend to be rare among children; however, these injuries are the most common major paediatric injuries treated by orthopaedic surgeons. The purpose of this study is to characterise the demographics and mechanisms of femoral injury associated with consumer products in the age group treated with spica casting, children 6 months to 6 years, to identify areas for injury prevention. Data from 2012 to 2021 were obtained from the National Electronic Injury Surveillance System maintained by the Consumer Products Safety Commission, documenting emergency department visits for unintentional injuries associated with consumer products. Narrative descriptions were analysed to identify common factors in the injury events such as location, products and mechanisms of action. From 2012 to 2021, the estimated incidence of femur fractures was 23.5 cases per 100 000 children with no significant difference in yearly frequency. The most common mechanism of injury was a fall with the most frequent fracture sources being bed/bunk beds (16.1%), floor (slips/falls, 9.7%) and trampolines (9.7%). Most fractures occurred at the patient's home (58.4%). The incidence of injury outside of the home and frequency of fractures involving play structures/trampolines increased with age. The incidence and demographic characteristics of paediatric femur fractures associated with consumer products have remained consistent over the past 10 years. As home was the most common location of fracture, prevention of femur fractures should focus on caregiver education around high-risk sources of fracture (bed, stairs and trampolines) and manufacturers should consider design alternatives that discourage potential misuse.

Bilateral hip ochronosis, an unsuspected diagnosis in polyarticular pain: A case report

Alkaptonuria is a rare metabolic disorder characterized by the accumulation of homogentisic acid, leading to the deposition of blackish pigment in cartilage and soft tissue, known as ochronosis. This can mimic multiple joint pathologies and is a diagnosis of exclusion. We describe the case of a 52-year-old woman who had a total hip replacement after experiencing left hip pain for which oral medications were unable to provide relief. Unexpectedly, during the procedure, a blackish tissue was noticed. This led to a histological examination and the confirmation of the ochronosis diagnosis. The patient’s medical history revealed a number of malignancies, but no previous metabolic illness diagnoses. Subsequent follow-up revealed rapid-onset pain in other joints, leading to a similar diagnosis of polyarticular ochronosis in the right hip, knees, spine, and shoulders. This highlights how difficult it is to treat this condition. This case underscores the importance of considering ochronosis as a differential diagnosis in patients with chronic polyarticular pain. Current treatment consists of initial non-surgical measures, including physical therapy and analgesics. If there is no improvement, treatment would be joint arthroplasty. Awareness among orthopedic surgeons and histopathological examination of tissues is crucial for the accurate diagnosis and management of ochronosis.

Timing of debridement: When to do it, and who should perform it?

The timely and effective management of open fractures continues to be a challenge in modern orthopaedic practice. Lower limb high energy fractures with complex soft tissue injuries require multi-disciplinary care to achieve the best results. Despite an extensive published literature on open fractures, the timing of debridement and the most appropriate personnel to perform it continue to be a source of debate. National guidelines on the topic are few but they suggest immediate debridement for open fractures with highly contaminated wounds and debridement within 12 to 24 h is considered desirable for less contaminated wounds. There is actually limited evidence linking timing of debridement to infection risk but the largest studies recently published do indicate a link between delay to debridement and increasing infection risk. Most studies on management are based on a clinical model where the initial debridement and fixation are performed by an orthopaedic surgeon and if required delayed coverage and closure is subsequently carried out by a plastic surgeon. More recently, studies have proposed an alternative approach, with initial debridement and temporary fixation followed within 48 h with a further debridement, definitive fixation and flap cover with a combined orthoplastic team. Reported results have been favourable. This is a significant change in management and there are limited data at present to determine if this approach will improve results in the most complex open fractures.

Prevalence of Non-specific Low Back Pain Among Chinese Healthcare Workers (Surgeons and Surgical Nurses): A Multi-Center Survey Study

Background: Low Back Pain (LBP) is one of the most common diseases affecting many persons including Healthcare Professionals (HCPs). LBP affects the quality of work and daily activities in HCPs. However, many factors contribute to LBP including age, Body Mass Index (BMI) and working experience. Purpose: The objective of this study was to assess the prevalence of LBP and examine the potential risk factors associated with LBP in Chinese HCPs (surgeons and surgical nurses). Method: A cross-sectional survey performed from October 2023 to January 2024. Quebec Back Pain Disability Scale (QBPDS) was used to assess the rating of LBP impairment. As well as Ovako Working Posture Assessment System (OWAS) is used to assess the working postures of HCPs. In addition to five more questions with yes/no answers. Results: A total of 250 surgeons and surgical nurses were collected from six hospitals with a mean age of 45.8 ± 11.0 years old, 47 females and 203 males. The BMI was 25.07 ± 1.49 kg, and working experience was 20.30 ± 10.0 years. Working hours in a week range from &lt; 50 to &gt; 55 hours. However, the OWAS action category was 1 in 109, 2 in 107, 3 in 30, and 4 in 4 participants. The majority of participants with mild LBP (90.4%), half of them had neck pain, and 26% with knee pain. The QBPDS scores of HCPs with LBP were 10.88 ± 4.78. Moreover, the risk factors associated with LBP include long working hours and incorrect postures of the trunk and lower extremities. As well as notice the orthopedic surgeon was the highest risk among HCPs (p = 0.046, 0.005). Conclusion: LBP is a common disorder in surgeons and surgical nurses and is associated with different factors including age, work experience, BMI, and abnormal working posture.

Reperfusion injury case following cervical fusion with OPLL: a case report and literature review

IntroductionSpinal cord ischemic reperfusion injury is characterized by an abrupt decline in neurological function and only a few cases have been published in literature. Herein, we present a white cord syndrome following anterior decompression cervical fusion.Case ReportA 54-year-old Jewish male patient was diagnosed with disc herniation among the intervertebral discs at C2, C3, C4, C6, and C7, along with ossification of the posterior longitudinal ligament, pressuring more to the right side of the spinal canal, ruling-out cervical myelopathy. Under general anesthesia and multimodal intraoperative monitoring, he underwent laminectomy surgery from C3 to C6 and cervical fixation from C3 to C7. No blood pressure fluctuations occurred during surgery, and complete pressure release was achieved on the spinal cord and the nerve roots. In addition, neuromonitoring did not indicate any nerve damage during the surgery. A neurologic exam in the post-anesthesia care unit revealed weakness in his right hand and leg. A brain computed tomography scan ruled out cerebrovascular accident, neck computed tomography revealed optimal implant position, and magnetic resonance imaging ruled out spinal cord distress or injury. We treated him with intravenous fluids, steroids, painkillers, and anticoagulants. Following surgery, we involved the occupational therapy department. After a few days, we observed a significant improvement in motor function in the right leg; however, there was no change in the right hand.ConclusionWhite cord syndrome likely arises from reperfusion injury subsequent to surgical decompression of a compressed spinal cord segment. Although infrequent, it is imperative for spine surgeons to recognize this potential complication and apprise patients of it prior to the procedure.

Prevalence of Work-Related Musculoskeletal Disorders Among Orthopedic Surgeons in Saudi Arabia: A Systematic Literature Review.

Work-related musculoskeletal disorder (WRMD) complications are common in surgeons in general, but they are much higher in orthopedic surgeons. Numerous studies have explored the prevalence of WRMD among orthopedic surgeons internationally. However, little research has been carried out in Saudi Arabia on this matter. This review aimed to investigate it. A consistent and systematic search method was carried out to establish studies reporting the prevalence of WRMD among orthopedic surgeons in Saudi Arabia. The search comprised published research from 2000 to June 2024. Nine eligible studies were incorporated for analysis, which involved 490 participants. The prevalence documented in these studies has exhibited an upward trend in recent years, with reported rates ranging from 36% to 90.3%. The most frequent anatomic site is found to be the lower back. There is a significant association between WRMD, smoking, and increasing age. The prevalence of WRMD is elevated among orthopedics based on existing information in the literature. Hospitals, along with orthopedic residency programs offering orthopedic-specialized ergonomics or occupational injury lectures as well as workshops, may help equip surgeons with the necessary knowledge and skills for addressing this issue.

Using Video-Fluoroscopy and Multibody Modelling to Unveil the Influence of a Gradually Reducing Femoral Radius on Ligament Elongation Patterns Following Posterior Cruciate-Retaining Total Knee Arthroplasty

Stability in total knee arthroplasties (TKAs) is mainly provided by soft tissue structures and the implant geometry. Paradoxical anterior translation could be decreased with a gradually reducing femoral radius compared to a dual-radii design. However, the influence of the sagittal curvature of the femoral condyles on knee ligaments remains unclear. This study quantified the length change patterns of the medial and lateral collateral ligaments (MCL and LCL) and posterior cruciate ligament (PCL) in 15 subjects with a gradually reducing radius and 15 subjects with a dual-radii TKA. Kinematics obtained from video-fluoroscopy were used to drive personalised multibody knee models. The ligament lengths were analysed throughout complete cycles of level gait, stair descent, and sit-to-stand-to-sit activity. Regardless of the implant design, our results indicated flexion-dependent elongation patterns in all ligament bundles. Importantly, however, subjects with the dual-radii implant design exhibited higher ligament strains during the mid-flexion phase compared to those with gradually reducing designs. Our findings, therefore, emphasise the importance of the impact of subtle changes in implant geometry on the loading patterns of the knee soft tissues, which need to be acknowledged by implant manufacturers and orthopaedic surgeons.

Do Children With Accidental Gunshot-related Fractures Experience Greater Risk of Mental Illness and Psychiatric Disorders? A Propensity-matched Study.

Firearm violence is the leading cause of death and is a major source of morbidity for children in the United States. While gunshot wounds (GSWs) are known to cause lasting psychological repercussions beyond physical injury, these effects are not well documented compared with the physical implications. Our study explores the association between accidental gunshot-related fractures in children and subsequent psychiatric outcomes. Relative to non-GSW-related fractures, do children sustaining an accidental GSW-related fracture experience higher risk of mental illness and psychiatric disorders? This study utilized the TriNetX US Collaborative Network as it provides comprehensive inpatient and outpatient data, longitudinal follow-up, and complete medical records across different facilities, closely reflecting real-world patient outcomes in orthopaedic practice. We retrospectively evaluated children diagnosed with an accidental GSW-related fracture and compared mental health diagnoses to children who experienced non-GSW-related fractures. Between January 1, 2003, and March 1, 2023, a total of 5071 children in the United States without preexisting anxiety, mood, psychotic, substance use, or insomnia disorders were reported to have experienced an accidental GSW-related fracture. Among these patients, 55% (2773) had a follow-up period of at least 1 year and met the inclusion criteria for the exposure cohort. In the non-GSW-related fracture cohort, a total of 61% (985,070) of children among 1,613,891 without the preexisting aforementioned conditions had a minimum follow-up period of 1 year and met the inclusion criteria. A total of 2769 children were successfully matched in each cohort using a greedy nearest neighbor propensity score-matching algorithm. Matching was based on age, gender, race, fracture location, and BMI, as these characteristics were identified through a regression analysis as potentially associated with psychiatric outcomes (p < 0.01). The mean ± SD age was 15 ± 4 years, and 16% (451) in the GSW cohort were girls. In the non-GSW cohort 17% (474) were girls. With respect to race and ethnicity, 62% (1709 in the GSW cohort; 1679 in the non-GSW cohort) were Black and 14% (384 in the GSW cohort; 386 in the non-GSW cohort) were Hispanic. Outcomes of interest were recorded for up to 3 years after the index event. The accidental GSW-related fracture cohort experienced a greater hazard of developing anxiety disorders (HR 3.8 [95% confidence interval (CI) 3.2 to 4.6]; p < 0.001), substance use disorders (HR 3.6 [95% CI 3.0 to 4.2]; p < 0.001), mood disorders (HR 2.4 [95% CI 1.9 to 3.1]; p < 0.001), non-mood psychotic disorders (HR 2.4 [95% CI 1.5 to 3.9]; p < 0.001), and insomnia (HR 1.8 [95% CI 1.4 to 2.3]; p < 0.001). Orthopaedic surgeons should implement early psychiatric screenings and integrate mental health support for children with gunshot-related fractures to address elevated risk of anxiety disorders, psychotic disorders, mood disorders, substance abuse, and insomnia. Future studies should focus on identifying effective interventions that mitigate these long-term psychological outcomes, with an emphasis on practical, targeted approaches in clinical care. Level III, prognostic study.

Enhancing Diagnostic Accuracy of Fresh Vertebral Compression Fractures with Deep Learning Models.

Retrospective study. The study aimed to develop and authenticated a deep learning model based on X-ray images to accurately diagnose fresh thoracolumbar vertebral compression fractures. In clinical practice, diagnosing fresh vertebral compression fractures often requires MRI. However, due to the scarcity of MRI resources and the high time and economic costs involved, some patients may not receive timely diagnosis and treatment. Using a deep learning model combined with X-rays for diagnostic assistance could potentially serve as an alternative to MRI. In this study, the main collection included X-ray images suspected of thoracolumbar vertebral compression fractures from the municipal shared database between December 2012 and February 2024. Deep learning models were constructed using frameworks of EfficientNet, MobileNet, and MnasNet respectively. We conducted a preliminary evaluation of the deep learning model using the validation set. The diagnostic performance of the models was evaluated using metrics such as AUC value, accuracy, sensitivity, specificity, F1 score, precision, and ROC curve. Finally, the deep learning models were compared with evaluations from two spine surgeons of different experience levels on the control set. This study included a total of 3025 lateral X-ray images from 2224 patients. The dataset was divided into a training set of 2388 cases, a validation set of 482 cases, and a control set of 155 cases. In the validation set, the three groups of DL models had accuracies of 83.0%, 82.4%, and 82.2%, respectively. The AUC values were 0.861, 0.852, and 0.865, respectively. In the control set, the accuracies of the three groups of DL models were 78.1%, 78.1%, and 80.7%, respectively, all higher than spinal surgeons and significantly higher than junior spine surgeon. This study developed deep learning models for detecting fresh vertebral compression fractures, demonstrating high accuracy.

Real-world Referral Pattern of Unplanned Excision in Patients With Soft-tissue Sarcoma: A Multicenter Study Conducted by the Bone and Soft-tissue Tumor Study Group of the Japan Clinical Oncology Group.

Despite the well-publicized clinical outcomes after unplanned excision (UE) and re-excision (re-excision) in patients with soft-tissue sarcoma (STS), there is little information about the real-life referral patterns for UE, such as patient profile, details of procedures, and subsequent management after UE. We aimed to investigate the characteristics of patients with UE who were referred to sarcoma-specific centers. Between May 2022 and June 2023, we registered 97 patients who underwent UE and were referred to sarcoma-specific centers in Japan. We excluded those with well-differentiated liposarcomas and dermatofibrosarcoma protuberances. We investigated the details of UE and additional treatment after UE. There were 49 men and 48 women, with a mean age of 62 years. A broad range of surgeons performed UE; 36 plastic surgeons, 22 orthopedic surgeons, 17 general surgeons, 17 dermatologists, and 5 others. The mean tumor size was 4.1 cm. Local anesthesia was administered to 58 patients. Forty-five patients underwent UE without prior magnetic resonance imaging. Inappropriate transverse skin incisions were performed in 42 patients. Of the 97 patients, 82 underwent re-excision after UE. The mean time between UE and date of initial presentation at the referral hospital was 46 days. The mean interval between UE and re-excision was 96 days. Of the 82 patients, 59 underwent soft-tissue reconstruction after re-excision. A broad range of surgeons performed UE. Continuous education about STS should be considered for all surgeons. UE should be avoided because residual tumors are common, and reconstructive surgery may be necessary.

A cost-effectiveness analysis of three surgical options for treating displaced femoral neck fractures in active older patients in Japan: A full economic evaluation.

For older patients with displaced femoral neck fractures, in which primary osteosynthesis is usually not indicated, there are three primary prosthetic options-bipolar hemiarthroplasty (BHA), single-bearing total hip arthroplasty (SB-THA), and dual-mobility THA (DM-THA). However, the optimal choice for managing displaced femoral neck fractures remains controversial. Accordingly, this study aimed to evaluate the cost-effectiveness of BHA, SB-THA, and DM-THA in active older patients with displaced femoral neck fractures. A decision tree combined with a Markov model was employed to analyze the cost and quality-adjusted life years (QALYs) of BHA, SB-THA, and DM-THA for the management in the Japanese healthcare system. By simulating the five-year trajectory of a 75-year-old woman treated for a displaced femoral neck fracture, the cost-effectiveness of the three surgical options was evaluated. One-way sensitivity analysis and probabilistic sensitivity analysis (PSA) were used to assess parameter uncertainty. Additionally, two scenario analyses were conducted for other settings. The treatment was considered to be cost-effective when the incremental cost-effectiveness ratio (ICER) was below the 5,000,000 yen/QALY threshold. Compared with BHA, SB-THA exhibited higher costs but greater health benefits, resulting in an ICER of 1,499,440 yen/QALY. DM-THA offered additional health benefits compared with SB-THA, with an ICER of 4,145,777 yen/QALY. One-way sensitivity analysis revealed some influential parameters. PSA indicated that the probability of DM-THA, SB-THA, and BHA being cost-effective was 40.1%, 38.5%, and 21.4%, respectively. SB-THA was more cost-effective than BHA in patients aged 65-85 years, while DM-THA was more cost-effective than SB-THA in patients aged 65-75 years. The results suggest that SB-THA is a cost-effective alternative to BHA for displaced femoral neck fractures in active older patients, whereas DM-THA is more cost-effective than SB-THA in relatively younger patients. It is, therefore, recommended that orthopedic surgeons select the most appropriate surgical option based on the individual patient's physiological age.

Gender Disparity of Orthopaedic Surgery Grand Rounds Speakers

Introduction Women are significantly underrepresented within orthopaedic surgery and academia. Limited opportunities to present at local and national conferences may impact professional advancement for women. The purpose of this study was to determine how often female orthopaedic surgeons presented at orthopaedic grand rounds between 2016-2021, if there was a difference between the types of presentations (technical vs non-technical) given by female and male speakers, and whether the COVID-19 pandemic increased the number of opportunities available for female orthopaedic surgeons to speak at orthopaedic grand rounds with the increase of online platforms. Methods A cross sectional study of 8 ACGME accredited orthopaedic residency programs, who are a part of COERG, was performed. Program directors were asked to describe the demographics of grand rounds speakers and the types of presentations given by those speakers before and after the COVID-19 pandemic from September 2016 to September 2021. Results Between September 2016-February 2020, 472 male (83.7%) and 92 (16.3%) female orthopaedic surgeons presented during grand rounds. There was no significant difference in the gender distribution of speakers from March 2020-September 2021 during which 81 men (79.4%) and 21 women (20.6%) presented (p=0.315). Men were more likely than women to present on technical topics before (p=0.006) and after the COVID-19 pandemic (p=0.023). Conclusion Male orthopaedic surgeons more frequently present at grand rounds in comparison to female orthopaedic surgeons. This was unchanged during the COVID-19 pandemic when online platforms were increasingly utilized. Male speakers were more likely to present on technical topics; whereas female speakers were more likely to present on non-technical topics. Understanding the gender disparity amongst orthopaedic grand rounds speakers is necessary for programs to re-evaluate and revise the methodology by which speakers are selected. This can allow for more balanced topic discussions and can foster female career advancement in academia.

Return to work after hip and knee arthroplasty: qualitative outcome from the Netherlands

Abstract Background Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA) are performed daily worldwide. More younger working-age patients are receiving a THA and/or TKA. Outcomes, including Quality-of-Life (QOL), patient satisfaction and Return-to-Work (RTW) are becoming more important and have implications for healthcare budget and health workforce. Clinical recovery pathways should improve patient outcomes and cost-effective care. Insight in patient experiences and expectations regarding RTW remains behind. This study aims to gain insight into influenceable factors in the recovery pathway after THA or TKA that could lead to improved care and enhanced patient participation. Methods In this single-center qualitative study, performed at Zuyderland Medical Center (Sittard-Geleen, the Netherlands), 12 patients (n = 6 THA; n = 6 TKA) aged under 65 years were approached to participate. During interviews 6-weeks after arthroplasty, this research explored their RTW experiences in both pre-, and postoperative, in- and outpatient settings. Results In total, 12 employed patients who received a THA (n = 6, mean age 56 ± 7.4 years; female: n = 4, 66%) or a TKA (n = 6, mean age 61 ± 2.6 years; female n = 3, 50%) participated. Own control regarding RTW and a minimal recovery time after the operation was necessary for all patients. During this time, focus on physical therapy and strengthening was most important. RTW was not expected to be the primary goal during the clinical recovery pathway. The RTW topic was said to belong to the occupational physician (OP) and employer. Patients however knowledge that the type of work should gain importance in the consultation room. Patients missed accessible communication between the orthopedic surgeon and OP. Conclusions Overall, patients are satisfied with the current clinical recovery pathway. Intercollegiate communication should be made more accessible. Own control and strengthening self-management in the RTW remain important for all patients. Key messages • Own control and strengthening self-management should have importance in the guidance of working-age patients after THA or TKA. • Intercollegiate communication should be made more accessible.

Investigation of Radiation Exposure of Medical Staff During Lateral Fluoroscopy for Posterior Spinal Fusion Surgery.

Background/Objectives: In spinal surgery, it is especially crucial to insert implants in the correct location. Intraoperative fluoroscopy is often necessary to safely perform spinal surgery because of serious complications that can occur if the screw deviates. However, the use of intraoperative fluoroscopy comes at the cost of radiation exposure to the surgeons and operating room staff. Therefore, it is desirable for spinal surgeons to understand the characteristics of radiation in order to minimize patient and medical staff exposure. This study aimed to create an aerial radiation dose distribution map for lateral fluoroscopy, a commonly used technique for posterior spinal fusion. Methods: A human body-equivalent phantom was placed in a prone position on the Jackson Table. The measurement method used was a lateral fluoroscopic evaluation, assuming posterior spinal fusion. Measurements were taken at three levels: 80 (gonadal), 100 (thoracoabdominal), and 150 cm (lens and thyroid). Results: The highest radiation doses were received by primary surgeons. The scrub nurse was the next most exposed. Conclusions: We developed an aerial dose distribution map for lateral fluoroscopy in posterior spinal fusion. Radiation exposure was the highest among primary surgeons.

Difference in Rotational Alignment of the Tibial Component, as Determined by the Range-of-Motion Technique and Akagi's Line, is Influenced by Tibial Varus Deformity: A Cross-Sectional Study.

Anatomical landmarks and range-of-motion (ROM) techniques are commonly used to rotationally align the tibial component in total knee arthroplasty (TKA). This study investigated; 1) the difference in tibial rotational alignment between the ROM technique and Akagi's line, 2) the influence of preoperative deformity and intraoperative gaps on this difference, and 3) intraoperative tibial rotational kinematics associated with these 2 techniques. Patients who underwent cruciate-substituting (CS) TKA (Evolution, Microport Orthopedics) for knee osteoarthritis were enrolled. Intraoperatively, the rotational alignment of the tibial component was determined with the ROM technique and recorded. The difference from the value determined using Akagi's line was evaluated. Correlations among preoperative coronal deformity, postoperative coronal alignment, and intraoperative gaps between the femur and tibia were evaluated. Differences in knee kinematics (rotational movement of the tibia against the femur) between the 2 techniques were compared. This study included 34 knees from 34 patients. The rotational alignment of the tibial component using the ROM technique was 2.5±6.4° externally rotated in relation to that determined using Akagi's line (p=0.029), which was increased in knees with a smaller preoperative medial proximal tibial angle (r=0.45). Tibial rotational kinematics did not significantly differ between the 2 techniques. The ROM technique and Akagi's line yielded significantly different values for the rotational alignment of the tibial component. Orthopedic surgeons using Evolution (CS) should be reminded that in knees with proximal tibial varus deformity, the ROM technique will result in external rotation of the tibial component in relation to Akagi's line.

Prevalence of spin reporting bias in hip labrum reconstruction: a qualitative assessment of systematic reviews and meta-analyses

Hip labral reconstruction is an evolving technique to treat labral pathology. Spin is a recent concept that is defined as a reporting bias that misrepresents research. The purpose of this study is to identify the prevalence of spin in meta-analysis and systematic review abstracts regarding acetabular labral reconstruction. Electronic libraries were queried for meta-analyses and systematic reviews regarding hip labrum reconstruction. The nine most severe types of spin found in abstracts were used as an evaluation tool. Two reviewers each performed a blinded assessment of each article for spin. A third reviewer was used to address any discrepancies between the original reviewers. Other variables evaluated include number of citations, journal impact factor, reported conflicts of interest (COI), adherence to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, and methodologic quality according to a measurement tool to assess systematic reviews (AMSTAR-2). The electronic database search resulted in 1,148 articles, of which 10 met inclusion criteria. Of these 10 articles, 70% (7/10) were found to have at least one form of spin present, 20% (2/10) contained 3 different types of spin, 30% (3/10) contained 2 different types of spin, and 20% (2/10) contained 1 type of spin. The most common type of spin found was type 5, “conclusion claims the beneficial effect of the experimental treatment despite high risk of bias in the primary studies,” which was found in 60% (6/10) of the articles. When assessing AMSTAR-2 score, 90% (9/10) of the articles were found to be ‘low quality’ or ‘critically low quality.’ Spin was present in 70% of the abstracts of meta-analyses and systematic reviews pertaining to hip labrum reconstruction. Recognition of spin is crucial for orthopaedic surgeons. Improved guidelines should be considered to reduce the prevalence of spin in orthopaedic literature.