The Orthopedic Specialty Hospital

Murray, UT, United States

The Orthopedic Specialty Hospital

Murray, UT, United States
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Popp K.L.,University of Minnesota | McDermott W.,The Orthopedic Specialty Hospital | Hughes J.M.,U.S. Army | Baxter S.A.,The Orthopedic Specialty Hospital | And 2 more authors.
Bone | Year: 2017

Purpose To determine differences in bone geometry, estimates of bone strength, muscle size and bone strength relative to load, in women runners with and without a history of stress fracture. Methods We recruited 32 competitive distance runners aged 18–35, with (SFX, n = 16) or without (NSFX, n = 16) a history of stress fracture for this case-control study. Peripheral quantitative computed tomography (pQCT) was used to assess volumetric bone mineral density (vBMD, mg/mm3), total (ToA) and cortical (CtA) bone areas (mm2), and estimated compressive bone strength (bone strength index; BSI, mg/mm4) at the distal tibia. ToA, CtA, cortical vBMD, and estimated strength (section modulus; Zp, mm3 and strength strain index; SSIp, mm3) were measured at six cortical sites along the tibia. Mean active peak vertical (pkZ) ground reaction forces (GRFs), assessed from a fatigue run on an instrumented treadmill, were used in conjunction with pQCT measurements to estimate bone strength relative to load (mm2/N ∗ kg− 1) at all cortical sites. Results SSIp and Zp were 9–11% lower in the SFX group at mid-shaft of the tibia, while ToA and vBMD did not differ between groups at any measurement site. The SFX group had 11–17% lower bone strength relative to mean pkZ GRFs (p < 0.05). Conclusion These findings indicate that estimated bone strength at the mid-tibia and mean pkZ GRFs are lower in runners with a history of stress fracture. Bone strength relative to load is also lower in this same region suggesting that strength deficits in the middle 1/3 of the tibia and altered gait biomechanics may predispose an individual to stress fracture. © 2016

Barker T.,The Orthopedic Specialty Hospital | Henriksen V.T.,The Orthopedic Specialty Hospital | Martins T.B.,Arup | Hill H.R.,Arup | And 8 more authors.
Nutrients | Year: 2013

The primary purpose of this study was to identify if serum 25-hydroxyvitamin D (25(OH)D) concentrations predict muscular weakness after intense exercise. We hypothesized that pre-exercise serum 25(OH)D concentrations inversely predict exercise-induced muscular weakness. Fourteen recreationally active adults participated in this study. Each subject had one leg randomly assigned as a control. The other leg performed an intense exercise protocol. Single-leg peak isometric force and blood 25(OH)D, aspartate and alanine aminotransferases, albumin, interferon (IFN)-γ, and interleukin-4 were measured prior to and following intense exercise. Following exercise, serum 25(OH)D concentrations increased (p < 0.05) immediately, but within minutes, subsequently decreased (p < 0.05). Circulating albumin increases predicted (p < 0.005) serum 25(OH)D increases, while IFN-γ increases predicted (p < 0.001) serum 25(OH)D decreases. Muscular weakness persisted within the exercise leg (p < 0.05) and compared to the control leg (p < 0.05) after the exercise protocol. Serum 25(OH)D concentrations inversely predicted (p < 0.05) muscular weakness (i.e., control leg vs. exercise leg peak isometric force) immediately and days (i.e., 48-h and 72-h) after exercise, suggesting the attenuation of exercise-induced muscular weakness with increasing serum 25(OH)D prior to exercise. Based on these data, we conclude that pre-exercise serum 25(OH)D concentrations could influence the recovery of skeletal muscle strength after an acute bout of intense exercise. © 2013 by the authors; licensee MDPI, Basel, Switzerland.

Barker T.,The Orthopedic Specialty Hospital | Henriksen V.T.,The Orthopedic Specialty Hospital | Rogers V.E.,The Orthopedic Specialty Hospital | Trawick R.H.,The Orthopedic Specialty Hospital
Cytokine | Year: 2015

The purpose of this communication was to identify if a decrease in serum cytokine concentrations associates with an improvement in muscle strength after an anterior cruciate ligament (ACL) injury. To establish groups with contrasting serum cytokine concentrations, subjects scheduled for ACL reconstructive surgery were separated into one of two groups (gender matched) based on their time from injury occurrence: (1) Early (<21-d from injury occurrence; n=. 22) or (2) Late (≥21-d from injury occurrence; n=. 22). Before surgery, each subject provided a fasting blood sample and performed single-leg peak isometric force testing on the injured (INJ) and non-injured (NI) limbs. Compared to the NI limb, peak isometric force in the INJ limb was decreased (. p<. 0.05) in both groups (Early, ~35%; Late, ~18%). The deficit in peak isometric force, however, was increased (. p<. 0.05) in the Early compared to Late group. Similarly, serum granulocyte macrophage colony-stimulating factor (GM-CSF), interleukin (IL)-6, and IL-13 were increased (all p<. 0.05) in the Early group. These unique findings show a concurrent increase in muscular weakness and serum cytokine concentrations shortly after (<21-d) an ACL injury. Importantly, muscular weakness persisted thereafter (≥21-d) but at an attenuated level and parallel to a decrease in circulating cytokine concentrations. We conclude that a decrease in serum cytokines associates with a reduction in muscular weakness after an ACL injury. © 2015 Elsevier Ltd.

Christensen J.C.,The Orthopedic Specialty Hospital | Goldfine L.R.,The Orthopedic Specialty Hospital | West H.S.,The Orthopedic Specialty Hospital
Journal of Sport Rehabilitation | Year: 2013

Study Design: Prospective randomized clinical trial. Methods and Measures: Thirty-six patients who had a primary anterior cruciate ligament reconstruction (ACL-R) with a semitendinosus-gracilis (STG) autograft from a single orthopedic surgeon were prospectively randomized into 2 groups. Nineteen patients were randomized to the aggressive group (53% male, mean age 30.1 + 10.5 y) and 17 to the nonaggressive group (88% male, mean age 33.1 + 10.9 y). Impairment measures of anteroposterior (A-P) knee laxity, range of motion (ROM), and peak isometric force (PIF) values were obtained 12 wk postoperatively. Subjective response to the International Knee Documentation Committee knee form (IKDC) was collected 1, 12, and 24 wk postoperatively. One-way ANOVA was used to analyze differences between groups at 12 wk for A-P knee laxity, ROM, and PIF. Differences between the groups for the IKDC scores were determined using 1-way ANOVA with repeated measures 1, 12, and 24 wk postoperatively. Bonferroni adjustment was used for multiple comparisons. Results: There were no differences between the groups for the baseline characteristics (P > .05). There was no difference found between the groups in respect to A-P knee laxity, ROM, or PIF at 12 wk (P > .05). Further analysis also showed no significant differences in the IKDC scores between groups at 12 or 24 wk (P > .05). Conclusions: No differences were found between early aggressive and nonaggressive rehabilitation after an isolated ACL-R using STG autografts for the primary outcomes of A-P knee laxity and subjective IKDC score. In addition, no differences were observed for secondary outcomes between groups for differences in ROM and PIF values. © 2013 Human Kinetics, Inc.

Murphy C.A.,The Orthopedic Specialty Hospital | McDermott W.J.,The Orthopedic Specialty Hospital | Petersen R.K.,The Orthopedic Specialty Hospital | Johnson S.E.,UNITED ORTHOPEDIC GROUP | Baxter S.A.,The Orthopedic Specialty Hospital
Journal of Shoulder and Elbow Surgery | Year: 2013

Background: Numerous rehabilitation protocols exist for postoperative rotator cuff repairs. Because the goal of early rehabilitation is to prevent postoperative adhesions while protecting the repaired tendons, it would be advantageous to know which range-of-motion exercises allow the rotator cuff to remain the most passive in a painful, guarded, postsurgical shoulder. Methods: Twenty-six subjects who had undergone subacromial decompression, distal clavicle resection, or a combination of both procedures volunteered to participate within the first 4 days after surgery. Fine-wire electrodes were inserted into the subject's supraspinatus (SS) and infraspinatus (IS). Muscle activity was recorded at resting baseline (BL) and during 14 exercises that have been found in the passive phase of rotator cuff protocols and tested in healthy subjects. Each exercise was compared with BL activity as well as with other exercises in the same movement group. Results: The SS remained as passive as BL during therapist- and self-assisted external rotation, therapist-assisted elevation, pendulums, and isometric internal rotation and adduction. The IS was activated greater than BL for all 14 exercises studied. Conclusion: Of the 14 exercises studied, 6 allowed the SS and 0 allowed the IS to remain as passive as quiet-stance BL in postsurgical subacromial decompression/distal clavicle resection patients. © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees.

Barker T.,The Orthopedic Specialty Hospital | Traber M.G.,Oregon State University
Journal of Evidence-Based Complementary and Alternative Medicine | Year: 2011

Muscular (quadriceps) weakness is a predominant impairment that follows anterior cruciate ligament injury and surgery. This continued weakness impairs activities of daily living and could predispose patients to adverse conditions later in life, such as knee osteoarthritis. Vitamins E and C have potent antioxidant and anti-inflammatory activity. Herein, the authors summarize the state-of-the science and suggest directions for future research endeavors regarding the therapeutic influence of vitamins E and C, or other antioxidants, on the recovery from anterior cruciate ligament injury and surgery. © The Author(s) 2011.

Henriksen V.T.,The Orthopedic Specialty Hospital | Rogers V.E.,The Orthopedic Specialty Hospital | Rasmussen G.L.,The Orthopedic Specialty Hospital | Trawick R.H.,The Orthopedic Specialty Hospital | And 3 more authors.
Medical Hypotheses | Year: 2014

Vitamin D is a fat-soluble micronutrient that regulates inflammation and skeletal muscle size and function. Inflammation and skeletal muscle dysfunction (i.e., atrophy and weakness) are predominant impairments that continue to challenge the rehabilitation from total knee arthroplasty (TKA). Data suggest a decrease in serum 25-hydroxyvitamin D (25(OH)D) concentrations after TKA. Despite the decrease being attributed to a systemic inflammatory response, it is unclear what inflammatory mediator(s) is contributing to the decrease in serum 25(OH)D concentrations after TKA. In immune cells, pro-inflammatory cytokines mediate the enzymatic conversion of 25(OH)D to 1,25-dihydroxyvitamin D, implying that pro-inflammatory cytokines contribute to the decrease in substrate availability (i.e., 25(OH)D). We propose the hypothesis that pro-inflammatory cytokines mediate the decrease in serum 25(OH)D concentrations after TKA. To complement the supporting literature for the proposed hypothesis, we analyzed serum 25(OH)D and pro-inflammatory cytokine concentrations prior to and serially after TKA in a case subject (female; age, 62year; height, 160cm; body mass, 63kg; body mass index, 26.5kg/m2). The subtle decrease (12%) from pre-surgery to 2-d post-surgery and the more pronounced decrease (74%) from 3-week to 8-week post-surgery in serum 25(OH)D concentrations corresponded with the increase in serum pro-inflammatory cytokine (i.e., TNF-α, IFN-γ, IL-1β, GM-CSF, and IL-6) concentrations. This observation lends credence to the proposed hypothesis that pro-inflammatory cytokines could contribute to the decrease in serum 25(OH)D concentrations after TKA. Clearly, future research is needed to confirm the proposed hypothesis and to identify if attenuating the decrease in serum 25(OH)D concentrations improves patient outcomes after TKA. © 2013 Elsevier Ltd.

Look N.,University of Colorado at Boulder | Arellano C.J.,University of Colorado at Boulder | Grabowski A.M.,University of Colorado at Boulder | McDermott W.J.,The Orthopedic Specialty Hospital | And 3 more authors.
Chaos | Year: 2013

In this paper, we study dynamic stability during running, focusing on the effects of speed, and the use of a leg prosthesis. We compute and compare the maximal Lyapunov exponents of kinematic time-series data from subjects with and without unilateral transtibial amputations running at a wide range of speeds. We find that the dynamics of the affected leg with the running-specific prosthesis are less stable than the dynamics of the unaffected leg and also less stable than the biological legs of the non-amputee runners. Surprisingly, we find that the center-of-mass dynamics of runners with two intact biological legs are slightly less stable than those of runners with amputations. Our results suggest that while leg asymmetries may be associated with instability, runners may compensate for this effect by increased control of their center-of-mass dynamics. © 2013 AIP Publishing LLC.

Barker T.,The Orthopedic Specialty Hospital | Rogers V.E.,The Orthopedic Specialty Hospital | Henriksen V.T.,The Orthopedic Specialty Hospital | Aguirre D.,The Orthopedic Specialty Hospital | And 3 more authors.
Cytokine | Year: 2014

Knee osteoarthritis (OA) is a leading cause of physical disability. At the early stage of knee OA, the increase in synovial fluid cytokine concentrations could contribute to the pathogenesis of OA by degrading articular cartilage. It is unknown, however, if inflammatory cytokines increase systemically at the early or advanced stage of knee OA. The systemic increase of inflammatory cytokines could be detrimental to the endogenous status of micronutrients that protect against excessive inflammation and cytokine-mediated events. The purpose of this study was to test the hypothesis that an increase in serum cytokines associate with a decrease in circulating micronutrients in subjects with early compared to advanced knee OA. Advanced knee OA subjects (n= 14) displayed radiographic, pain, and muscular weakness symptoms of knee OA. Early knee OA subjects (n= 14) were matched (age, gender, and body mass index) to the advanced OA group and displayed one or two of the aforementioned symptoms of knee OA. Inflammatory cytokines, vitamins C (ascorbic acid), D (25-hydroxyvitamin D), and E (α- and γ-tocopherols), and β-carotene were measured in fasting blood samples. In the early OA group, serum tumor necrosis factor (TNF)-α, interleukin (IL)-5, IL-6, IL-12, and IL-13 concentrations were significantly (all p<. 0.05) increased. Circulating ascorbic acid, 25-hydroxyvitamin D, α- and γ-tocopherol's, and β-carotene concentrations were not significantly different between groups. Based on these preliminary results, we conclude that the systemic increase of inflammatory cytokines is not associated with a decrease in circulating micronutrients in subjects with early compared to advanced knee OA. © 2014 Elsevier Ltd.

News Article | November 6, 2016

In October 2016, Mercy Medical Center became the first hospital in Maryland to utilize the new Cartiva Synthetic Cartilage Implant (SCI) in a surgical procedure, the first synthetic cartilage device approved by the FDA. The Cartiva SCI was developed for the treatment of painful arthritis at the base of the big toe, the most common arthritic condition in the foot. The current standard of care involves fusing the bones in the arthritic joint with plates and screws. While fusion is an effective procedure for eliminating pain, it permanently prevents movement of the joint. “The advent of synthetic cartilage offers surgeons a new option to treat patients dealing with the pain caused by degenerative arthritis of the big toe joint. The implant replaces part of the damaged cartilage surface in the joint, provides improved mobility versus traditional fusion surgery, and patients can begin walking on the foot much sooner,” said Dr. Clifford Jeng, Medical Director, The Institute for Foot and Ankle Reconstruction at Mercy. The Cartiva SCI is a molded, cylindrical device made of biocompatible, biomedical polymer designed to have physical properties similar to those of actual cartilage. Cartilage damaged by degenerative or post-traumatic arthritis is replaced with a small implant that provides a compressible, low-friction and durable bearing surface. The implant provides pain relief and improves both function and motion. The Cartiva SCI is meant for use in patients with arthritis in the first metatarsophalangeal (MTP) joint (e.g. loss of big toe joint motion due to arthritic conditions). "SCI implantation is a minimally invasive treatment that takes about 40% less time than a traditional fusion surgery, so less time in the operating room for the patient. Patients have been found to return to their pre-operative activities much faster than with fusion. There’s no cast to wear and patients can begin bearing full weight almost immediately,” Dr. Jeng said. The Institute for Foot and Ankle Reconstruction is a division of The Orthopedic Specialty Hospital at Mercy Medical Center, named a Best National Hospital in Orthopedics by U.S. News & World Report. Dr. Clifford Jeng, renowned foot and ankle surgeon in Baltimore, leads a team of experts, including, Dr. John Campbell, Dr. Rebecca Cerrato and Dr. Gary Pichney. Mercy Medical Center is a 142-year-old, university affiliated medical facility with a national reputation for women’s health care. For more information, visit Mercy online at; MDMercyMedia on Facebook and Twitter; or call 1-800-MD-MERCY.

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