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Lavernia C.J.,Orthopaedic Institute | Alcerro J.C.,Arthritis Surgery and Research Foundation Inc | Rossi M.D.,Florida International University
Clinical Orthopaedics and Related Research | Year: 2010

Understanding the difference in perceived functional outcomes between whites and blacks and the influence of anxiety and pain on functional outcomes after joint arthroplasty may help surgeons develop ways to eliminate the racial and ethnic disparities in outcome. We determined the difference in functional outcomes between whites and blacks and assessed the influence of fear and anxiety in total joint arthroplasty outcomes in 331 patients undergoing primary hip and knee arthroplasty. WOMAC, Quality of Well Being, SF-36, and Pain and Anxiety Symptoms Scale (PASS) were administered pre- and postoperatively (average 5-year followup). For the SF-36 General Health Score, blacks reported having worse perceived general health than whites before surgery. Regardless of time, blacks scored worse than whites for all measures except for the SF-36 physical function and general health scores. Blacks had a greater fear score (ie, that associated with the procedure) and total PASS score. For both races, there was a low association between the fear dimensions and dependent measures before and after surgery. Black patients undergoing hip and knee arthroplasty had lower scores than whites in most outcome measures regardless of time of assessment. We found higher fear levels before joint arthroplasty in blacks compared with whites. After surgery, blacks had much higher associations of the fear subscale, cognitive subscale, and total PASS score with the WOMAC physical function, pain, and total scores. Level of Evidence: Level II, prospective controlled cohort study. See Guidelines for Authors for a complete description of levels of evidence. © 2009 The Association of Bone and Joint Surgeons®. Source

Khazzam M.,Southwestern Medical Center at Dallas | Kuhn J.E.,Vanderbilt University | Mulligan E.,Southwestern Medical Center at Dallas | Abboud J.A.,Thomas Jefferson University | And 6 more authors.
American Journal of Sports Medicine | Year: 2012

Background: Magnetic resonance imaging (MRI) is the most commonly used imaging modality to assess the rotator cuff. Currently, there are a limited number of studies assessing the interobserver and intraobserver reliability of MRI after rotator cuff repair. Hypothesis: Fellowship-trained orthopaedic shoulder surgeons will have good inter- and intraobserver agreement with regard to features of the repaired rotator cuff (repair integrity, fat content, muscle volume, number of tendons involved, tear size, and retract) on MRI. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Seven fellowship-trained orthopaedic shoulder surgeons reviewed 31 MRI scans from 31 shoulders from patients who had previous rotator cuff repair. The scans were evaluated for the following characteristics: rotator cuff repair status (fullthickness retear vs intact repair), tear location, tendon thickness, fatty infiltration, atrophy, number of tendons involved in retear, tendon retraction, status of the long head of the biceps tendon, and bone marrow edema in the humeral head. Surgeons were asked to review images at 2 separate time points approximately 9 months apart and complete an evaluation form for each scan at each time point. Multirater kappa (k) statistics were used to assess inter- and intraobserver reliability. Results: The interobserver agreement was highest (80%, k = 0.60) for identifying full-thickness retears, tendon retear retraction (64%, k = 0.45), and cysts in the greater tuberosity (72%, k = 0.43). All other variables were found to have fair to poor agreement. The worst interobserver agreement was associated with identifying rotator cuff footprint coverage (47%, k = 0.21) and tendon signal intensity (29%, k = 0.01). The mean intraobserver reproducibility was also highest (77%-90%, k = 0.71) for full-thickness retears, quality of the supraspinatus (47%-83%, k = 0.52), tears of the long head of the biceps tendon (58%-94%, k = 0.49), presence of bone marrow edema in the humeral head (63%-87%, k = 0.48), cysts in the greater tuberosity (70%-83%, k = 0.47), signal in the long head of the biceps tendon (60%-80%, k = 0.43), and quality of the infraspinatus (37-90%, k = 0.43). The worst intraobserver reproducibility was found in identification of the location of bone marrow edema (22%-83%, k = 0.03). Conclusion: The results of this study indicate that there is substantial variability when evaluating MRI scans after rotator cuff repair. Intact rotator cuff repairs or full-thickness retears can be identified with moderate reliability. These findings indicate that additional imaging modalities may be needed for accurate assessment of the repaired rotator cuff. © 2012 The Author(s). Source

Yan D.,Baoan Peoples Hospital | Wang Z.,Medical College | Deng S.,Baoan Peoples Hospital | Li J.,Guangzhou Medical College | Soo C.,Orthopaedic Institute
Archives of Orthopaedic and Trauma Surgery | Year: 2011

Objective This retrospective study was to evaluate the relationship between osteoporosis and dynamic cervical plates in screw-plate or screw-bone interface of elderly cervical spondylotic myelopathy (CSM) patients. Methods Retrospective study was conducted on elderly CSM patients, treated by anterior corpectomy and reconstruction with titanium mesh cages (TMC) and dynamic cervical plate between July 2004 and June 2007. All patients underwent bone mineral density (BMD) assessment in preoperation, and according to the osteoporosis degree they have been divided into two groups: moderate osteoporosis degree group and severe osteoporosis degree group. The clinical outcome [Japanese Orthopaedic Association score (JOA) and Visual Analogue Scale (VAS)], bone fusion assessment (CT mielogram), the change of titanium mesh cages and plate of cephalic screw-plate-angle (SPA) and cephalic endplate-plate-angle (EPA) of plain X-ray Wlms were measured. Results The mean JOA score and recovery rate were not different between the two groups (P > 0.05). There was no loss of sagittal alignment after surgery in any patient, and no significant difference between both groups on lordosis measurements (P > 0.05). Although there was a significant difference of the cage subsidence rate between the two groups (P < 0.001), all patients had favorable bone union and none required additional treatment. The average changes of SPA were greater in A group patients than in B group patients, while the variation of EPA was higher in B group patients than in A group patients (P < 0.001). Conclusions Despite the fact that there is a significant difference of the cage subsidence rate between the two groups no clinical outcome, nor sagittal alignment or fusion rate differences among groups was observed in elderly CSM patients. © Springer-Verlag 2011. Source

Gandhi M.J.,Orthopaedic Institute | Anderton M.J.,Royal Blackburn HospitalBlackburn | Funk L.,Upper Limb Unit
Arthroscopy - Journal of Arthroscopic and Related Surgery | Year: 2015

Purpose To evaluate correlations between objective performances measured by a new online arthroscopic skills acquisition tool (ASAT, in which "shape match" with inverted controls requires lifting shapes and releasing them into their corresponding silhouettes) and a validated virtual reality (VR) shoulder arthroscopy simulator (Insight Arthro VR; GMV, Madrid, Spain). Methods Forty-nine medical students familiarized themselves with 5 ASATs. They were then assessed using a sixth ASAT (shape match with inverted controls) and 4 VR tasks (operating room, visualize, locate and palpate, and pendulum) on the VR simulator. Correlations were assessed between 11 ASAT measures and 15 VR measures using Pearson correlation coefficients. Results Time taken and delta distance (actual distance minus minimum distance traveled) were the most frequent and correlated ASAT measures. Time taken correlated with the VR locate-and-palpate time (r = 0.596, P <.001), visualize time (r = 0.381, P =.007), and pendulum time (r = 0.646, P <.001), whereas delta distance correlated with the locate-and-palpate camera distance (r = 0.667, P <.001), instrument distance (r = 0.664, P <.001), visualize distance (r = 0.4, P =.004), pendulum camera distance (r = 0.538, P <.001), and instrument distance (r = 0.539, P <.001). Conclusions There were significant correlations between performance measures on the ASAT and a validated arthroscopic VR simulator. Clinical Relevance Arthroscopic simulators are available but are limited by their high cost and availability. ASATs may overcome these limitations by using widely available Internet-based software and basic input devices. © 2015 Arthroscopy Association of North America. Source

Roche M.,Orthopaedic Institute | Elson L.,OrthoSensor | Anderson C.,OrthoSensor
Orthopedic Clinics of North America | Year: 2014

Achieving optimal soft tissue balance intraoperatively is a critical element for a successful outcome after total knee arthroplasty. Although advances in navigation have improved the incidence of angular outliers, spatial distance measurements do not quantify soft tissue stability or degrees of ligament tension. Revisions caused by instability, malrotation, and malalignment still constitute up to one-third of early knee revisions. The development of integrated microelectronics and sensors into the knee trials during surgery allows surgeons to evaluate and act on real-time data regarding implant position, rotation, alignment, and soft tissue balance through a full range of motion. © 2014 Elsevier Inc. Source

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