Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Published in
Clinical Orthopaedics and Related Research®
Volume 473 | Issue 5 | May, 2015

Surgeons’ Attitudes Are Associated With Reoperation and Readmission Rates

John Kadzielski MD, Frank McCormick MD, James H. Herndon MD, MBA, Harry Rubash MD, David Ring MD, PhD

Attitudes influence how people make decisions. In an effort to decrease pilot judgment-related accidents, the Federal Aviation Administration teaches new pilots about hazardous attitudes that are believed to be incompatible with safe flight: macho, impulsive, worry, resignation, self-confidence, and antiauthority. If these attitudes are hazardous for pilots and their passengers, they may also be incompatible with the reliable and safe delivery of surgical care.

Use of the National Surgical Quality Improvement Program in Orthopaedic Surgery

Cesar S. Molina MD, Rachel V. Thakore BS, Alexandra Blumer BS, William T. Obremskey MD, MPH, MMHC, Manish K. Sethi MD

The goal of the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) is to improve patient safety. The database has been used by hospitals across the United States to decrease the rate of adverse events and improve surgical outcomes, including dramatic decreases in 30-day mortality, morbidity, and complication rates. However, only a few orthopaedic surgical studies have employed the ACS NSQIP database, all of which have limited their analysis to either single orthopaedic procedures or reported rates of adverse events without considering the effect of patient characteristics and comorbidities.

How Prevalent Are Hazardous Attitudes Among Orthopaedic Surgeons?

Wendy E. Bruinsma MD, Stéphanie J. E. Becker MD, Thierry G. Guitton MD, PhD, John Kadzielski MD, David Ring MD, PhD

So-called “hazardous attitudes” (macho, impulsive, antiauthority, resignation, invulnerable, and confident) were identified by the Federal Aviation Administration and the Canadian Air Transport Administration as contributing to road traffic incidents among college-aged drivers and felt to be useful for the prevention of aviation accidents. The concept of hazardous attitudes may also be useful in understanding adverse events in surgery, but it has not been widely studied.

Do 360-degree Feedback Survey Results Relate to Patient Satisfaction Measures?

Michiel G. J. S. Hageman MD, David C. Ring MD, PhD, Paul J. Gregory PhD, Harry E. Rubash MD, PhD, Larry Harmon PhD

There is evidence that feedback from 360-degree surveys—combined with coaching—can improve physician team performance and quality of patient care. The Physicians Universal Leadership-Teamwork Skills Education (PULSE) 360 is one such survey tool that is used to assess work colleagues’ and coworkers’ perceptions of a physician’s leadership, teamwork, and clinical practice style. The Clinician & Group-Consumer Assessment of Healthcare Providers and System (CG-CAHPS), developed by the US Department of Health and Human Services to serve as the benchmark for quality health care, is a survey tool for patients to provide feedback that is based on their recent experiences with staff and clinicians and soon will be tied to Medicare-based compensation of participating physicians. Prior research has indicated that patients and coworkers often agree in their assessment of physicians’ behavioral patterns. The goal of the current study was to determine whether 360-degree, also called multisource, feedback provided by coworkers could predict patient satisfaction/experience ratings. A significant relationship between these two forms of feedback could enable physicians to take a more proactive approach to reinforce their strengths and identify any improvement opportunities in their patient interactions by reviewing feedback from team members. An automated 360-degree software process may be a faster, simpler, and less resource-intensive approach than telephoning and interviewing patients for survey responses, and it potentially could facilitate a more rapid credentialing or quality improvement process leading to greater fiscal and professional development gains for physicians.

What Effects Have Resident Work-hour Changes Had on Education, Quality of Life, and Safety? A Systematic Review

Joshua D. Harris MD, LT, Greg Staheli MD, MC, USN, LCDR, Lance LeClere MD, MC, USN, Diana Andersone BS, Frank McCormick MD

More than 15 years ago, the Institute of Medicine (IOM) identified medical error as a problem worthy of greater attention; in the wake of the IOM report, numerous changes were made to regulations to limit residents’ duty hours. However, the effect of resident work-hour changes remains controversial within the field of orthopaedics.

Incidence of Surgical Site Infection After Spine Surgery: What Is the Impact of the Definition of Infection?

Sjoerd P. F. T. Nota MD, Yvonne Braun MD, David Ring MD, PhD, Joseph H. Schwab MD, MS

Orthopaedic surgical site infections (SSIs) can delay recovery, add impairments, and decrease quality of life, particularly in patients undergoing spine surgery, in whom SSIs may also be more common. Efforts to prevent and treat SSIs of the spine rely on the identification and registration of these adverse events in large databases. The effective use of these databases to answer clinical questions depends on how the conditions in question, such as infection, are defined in the databases queried, but the degree to which different definitions of infection might cause different risk factors to be identified by those databases has not been evaluated.

Platelet-rich Plasma Modulates the Secretion of Inflammatory/Angiogenic Proteins by Inflamed Tenocytes

Isabel Andia PhD, Eva Rubio-Azpeitia MSc, Nicola Maffulli MD, MS, PhD, FRCS (Orth)

Platelet-rich plasma therapies for tendinopathy appear to provide moderate pain reduction. However, the biological mechanisms behind the observed clinical effects remain poorly characterized.

Platelet-rich Concentrates Differentially Release Growth Factors and Induce Cell Migration In Vitro

Michael O. Schär MD, Jose Diaz-Romero PhD, Sandro Kohl MD, Matthias A. Zumstein MD, Dobrila Nesic PhD

Platelet-rich concentrates are used as a source of growth factors to improve the healing process. The diverse preparation protocols and the gaps in knowledge of their biological properties complicate the interpretation of clinical results.

rhPDGF-BB Promotes Early Healing in a Rat Rotator Cuff Repair Model

David Kovacevic MD, Lawrence V. Gulotta MD, Liang Ying DVM, John R. Ehteshami MD, Xiang-Hua Deng MD, Scott A. Rodeo MD

Tendon-bone healing after rotator cuff repair occurs by fibrovascular scar tissue formation, which is weaker than a normal tendon-bone insertion site. Growth factors play a role in tissue formation and have the potential to augment soft tissue healing in the perioperative period.

The Effect of Granulocyte-colony Stimulating Factor on Rotator Cuff Healing After Injury and Repair

David Ross MD, Tristan Maerz MS, Michael Kurdziel MS, Joel Hein MD, Shashin Doshi MD, Asheesh Bedi MD, Kyle Anderson MD, Kevin Baker PhD

The failure rate of tendon-bone healing after repair of rotator cuff tears remains high. A variety of biologic- and cell-based therapies aimed at improving rotator cuff healing have been investigated, and stem cell-based techniques have become increasingly more common. However, most studies have focused on the implantation of exogenous cells, which introduces higher risk and cost. We aimed to improve rotator cuff healing by inducing endogenous stem cell mobilization with systemic administration of granulocyte-colony stimulating factor (G-CSF).

Platelet-rich Plasma in Meniscal Repair: Does Augmentation Improve Surgical Outcomes?

Justin W. Griffin MD, Michael M. Hadeed MD, Brian C. Werner MD, David R. Diduch MD, Eric W. Carson MD, Mark D. Miller MD

Increased contact stresses after meniscectomy have led to an increased focus on meniscal preservation strategies to prevent articular cartilage degeneration. Platelet-rich plasma (PRP) has received attention as a promising strategy to help induce healing and has been shown to do so both in vitro and in vivo. Although PRP has been used in clinical practice for some time, to date, few clinical studies support its use in meniscal repair.

What Is the Effect of Matrices on Cartilage Repair? A Systematic Review

James D. Wylie MD, Melissa K. Hartley BA, Ashley L. Kapron PhD, Stephen K. Aoki MD, Travis G. Maak MD

Articular cartilage has minimal endogenous ability to undergo repair. Multiple chondral restoration strategies have been attempted with varied results.

What Is the Utility of Biomarkers for Assessing the Pathophysiology of Hip Osteoarthritis? A Systematic Review

Jeffrey J. Nepple MD, Kayla M. Thomason BS, Tonya W. An BS, Marcie Harris-Hayes DPT, John C. Clohisy MD

Innovations in biologics offer great promise in the treatment of patients with orthopaedic conditions and in advancing our ability to monitor underlying disease pathophysiology. Our understanding of the pathophysiology of hip osteoarthritis (OA) has improved significantly in the last decade. Femoroacetabular impingement (FAI) and hip dysplasia are increasingly recognized and treated as forms of prearthritic hip disease, yet the inability of radiographic and MR imaging to identify patients before the onset of irreversible articular cartilage injury limits their use for early diagnosis and treatment of patients with these conditions. Molecular biomarkers, as objectively measureable indicators of the pathophysiology of hip OA, have the potential to improve diagnosis, disease staging, and prognosis of hip OA and prearthritic hip disease. Although research into molecular biomarkers of hip OA has been conducted, investigations in prearthritic hip disease have only recently begun.

Short-term Complications Have More Effect on Cost-effectiveness of THA than Implant Longevity

David W. Shearer MD, MPH, Jiwon Youm MD, MS, Kevin J. Bozic MD, MBA

Outcomes research in THA has focused largely on long-term implant survivorship as a primary outcome and emphasized the development of new implant technologies. In contrast, strategies to improve short-term outcomes, such as the frequencies of periprosthetic joint infections and unplanned readmissions, have received less attention.

How Are Dysplastic Hips Different? A Three-dimensional CT Study

Harold Bosse MD, John H. Wedge MD, Paul Babyn MD

Surgical correction of acetabular dysplasia can postpone or prevent joint degeneration. The specific abnormalities that make up the dysplastic hip are controversial.

Do Glycemic Markers Predict Occurrence of Complications After Total Knee Arthroplasty in Patients With Diabetes?

Ji Sup Hwang BE, Seok Jin Kim MD, Ankur B. Bamne MS (Orth), Young Gon Na MD, Tae Kyun Kim MD, PhD

Patients with diabetes have increased risk of infections and wound complications after total knee arthroplasty (TKA). Glycemic markers identifying patients at risk for complications after TKA have not yet been elucidated.

How Do Different Anterior Tibial Tendon Transfer Techniques Influence Forefoot and Hindfoot Motion?

A. R. Knutsen MS, T. Avoian MD, S. N. Sangiorgio PhD, S. L. Borkowski MS, E. Ebramzadeh PhD, L. E. Zionts MD

Idiopathic clubfoot correction is commonly performed using the Ponseti method and is widely reported to provide reliable results. However, a relapsed deformity may occur and often is treated in children older than 2.5 years with repeat casting, followed by an anterior tibial tendon transfer. Several techniques have been described, including a whole tendon transfer using a two-incision technique or a three-incision technique, and a split transfer, but little is known regarding the biomechanical effects of these transfers on forefoot and hindfoot motion.

Antegrade Intramedullary Pinning Versus Retrograde Intramedullary Pinning for Displaced Fifth Metacarpal Neck Fractures

Jae Kwang Kim MD, PhD, Dong Jin Kim MD

Severe angulation or shortening can be a surgical indication for fifth metacarpal neck fracture. In a previous meta-analysis, antegrade intramedullary pinning was shown to produce better hand function outcomes than percutaneous transverse pinning or miniplate fixation for treatment of fifth metacarpal neck fractures. However, the outcomes of retrograde intramedullary pinning, to our knowledge, have not been compared with those of antegrade intramedullary pinning.

Does Salter Innominate Osteotomy Predispose the Patient to Acetabular Retroversion in Adulthood?

Daisuke Kobayashi MD, Shinichi Satsuma MD, Maki Kinugasa MD, Ryosuke Kuroda MD, Masahiro Kurosaka MD

Salter innominate osteotomy has been identified as an effective additional surgery for the dysplastic hip. However, because in this procedure, the distal segment of the pelvis is displaced laterally and anteriorly, it may predispose the patient to acetabular retroversion. The degree to which this may be the case, however, remains incompletely characterized.

Incidence and Risk Factors of Allograft Bone Failure After Calcaneal Lengthening

In Hyeok Lee MD, Chin Youb Chung MD, Kyoung Min Lee MD, Soon-Sun Kwon PhD, Sang Young Moon MD, Ki Jin Jung MD, Myung Ki Chung MD, Moon Seok Park MD

Calcaneal lengthening with allograft is frequently used for the treatment of patients with symptomatic planovalgus deformity; however, the behavior of allograft bone after calcaneal lengthening and the risk factors for graft failure are not well documented.

Do Claims-based Comorbidities Adequately Capture Case Mix for Surgical Site Infections?

Hilal Maradit Kremers MD, Laura W. Lewallen MD, Brian D. Lahr MS, Tad M. Mabry MD, James M. Steckelberg MD, Daniel J. Berry MD, Arlen D. Hanssen MD, Elie F. Berbari MD, Douglas R. Osmon MD

There is increasing interest in using administrative claims data for surveillance of surgical site infections in THAs and TKAs, but the performance of claims-based models for case-mix adjustment has not been well studied. Performance of claims-based models can be improved with the addition of clinical risk factors for surgical site infections.

Survival, Recurrence, and Function After Epiphyseal Preservation and Allograft Reconstruction in Osteosarcoma of the Knee

Luis Aponte-Tinao MD, Miguel A. Ayerza MD, D. Luis Muscolo MD, Germán L. Farfalli MD

Bone tumor resections for limb salvage have become the standard treatment. Recently, intercalary tumor resection with epiphyseal sparing has been used as an alternative in patients with osteosarcoma. The procedure maintains normal joint function and obviates some complications associated with osteoarticular allografts or endoprostheses; however, long-term studies analyzing oncologic outcomes are scarce, and to our knowledge, the concern that a higher local recurrence rate may be an issue has not been addressed.

Negative Pressure Wound Therapy in Grade IIIB Tibial Fractures: Fewer Infections and Fewer Flap Procedures?

Daniel R. Schlatterer DO, MS, Adam G. Hirschfeld MD, Lawrence X. Webb MD

Grade IIIB open tibia fractures are devastating injuries. Some clinicians advocate wound closure or stable muscle flap coverage within 72 hours to limit complications such as infection. Negative pressure wound therapy was approved by the FDA in 1997 and has become an adjunct for many surgeons in treating these fractures. Opinions vary regarding the extent to which negative pressure wound therapy contributes to limb salvage. Evidence-based practice guidelines are limited for use of negative pressure wound therapy in Grade IIIB tibia fractures. This systematic literature review of negative pressure wound therapy in Grade IIIB tibia fractures may substantiate current use and guide future studies.

Current Status of Cost Utility Analyses in Total Joint Arthroplasty: A Systematic Review

Benedict U. Nwachukwu MD, MBA, Kevin J. Bozic MD, MBA, William W. Schairer MD, Jaime L. Bernstein BS, David S. Jevsevar MD, MBA, Robert G. Marx MD, MSc, Douglas E. Padgett MD

Total joint arthroplasty (TJA), although considered to be highly beneficial, is associated with substantial costs to the US healthcare system. Cost utility analysis has become an increasingly important means to objectively evaluate the value of a healthcare intervention from the perspective of both extending the quantity and improving the quality of life. Relatively little is known about the overall cost utility analysis evidence base in TJA.

Low-intensity Pulsed Ultrasound Enhances Bone Repair in a Rabbit Model of Steroid-associated Osteonecrosis

Hanxiao Zhu MD, Xunzi Cai MD, Tiao Lin MD, Zhongli Shi MD, Shigui Yan MD

Steroids are a leading cause of femoral head osteonecrosis. Currently there are no medications available to prevent and/or treat steroid-associated osteonecrosis. Low-intensity pulsed ultrasound (LIPUS) was approved by the FDA for treating delayed union of bone fractures. Some studies have reported that LIPUS can enhance bone formation and local blood flow in an animal model of fracture healing. However, whether the effect of osteogenesis and neovascularization by LIPUS can enhance the repair progress in steroid-associated osteonecrosis is unknown.

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