Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Published in
Clinical Orthopaedics and Related Research®
Volume 474 | Issue 9 | Sep, 2016

Physicians’ Attire Influences Patients’ Perceptions in the Urban Outpatient Orthopaedic Surgery Setting

John D. Jennings MD, Sophia G. Ciaravino BS, Frederick V. Ramsey PhD, Christopher Haydel MD

Previous work has established that physician attire influences patients’ perceptions of their physicians. However, research from different specialties has disagreed regarding what kinds of physician attire might result in increased trust and confidence on the part of patients.

The Law and Social Values: Prescription Pain Killers

Wendy Z. W. Teo BA(Cantab), BM BCh (Oxon), LLM, B. Sonny Bal MD, JD, MBA

What Provisions Do Orthopaedic Programs Make for Maternity, Paternity, and Adoption Leave?

Jennifer Weiss MD, David Teuscher MD

The process of choosing medical specialty and residency programs is multifaceted. Today’s generation of medical students may have an increased interest in work-life balance and time with their families. In considering this factor, medical students may be influenced by policy regarding maternity, paternity, and adoption leave during residency and fellowship training. Current policy among orthopaedic programs regarding maternity, paternity, and adoption leave is not well described. To understand the influence these policies may have on the choices that medical students make in choosing their specialty, the policies must first be better understood.

Where Are the Women in Orthopaedic Surgery?

Rachel S. Rohde MD, Jennifer Moriatis Wolf MD, Julie E. Adams MD

Although women account for approximately half of the medical students in the United States, they represent only 13% of orthopaedic surgery residents and 4% of members of the American Academy of Orthopaedic Surgeons (AAOS). Furthermore, a smaller relative percentage of women pursue careers in orthopaedic surgery than in any other subspecialty. Formal investigations regarding the gender discrepancy in choice of orthopaedic surgery are lacking.

Women in Orthopaedic Fellowships: What Is Their Match Rate, and What Specialties Do They Choose?

Lisa K. Cannada MD

Orthopaedic fellowship training is a common step before becoming a practicing orthopaedic surgeon. In the past, fellowship decisions in orthopaedics were made early in the residency and without a formal match. The process was disorganized, often not fair to the applicants or fellowship programs. More recently, there has been an organized match process for nine different disciplines in orthopaedics. Although the numbers of women applicants into orthopaedic residency has been reported and is the target of efforts to continue to improve gender diversity in orthopaedics, the numbers regarding women in orthopaedic fellowships have not been known. Other details including if there is a difference in match rate between male and female fellowship applicants and what discipline they choose to pursue across orthopaedic surgery has not been reported.

The Perry Initiative’s Medical Student Outreach Program Recruits Women Into Orthopaedic Residency

Lisa L. Lattanza MD, Laurie Meszaros-Dearolf PhD, Mary I. O’Connor MD, Amy Ladd MD, Amy Bucha BE, Amy Trauth-Nare PhD, Jenni M. Buckley PhD

Orthopaedic surgery lags behind other surgical specialties in terms of gender diversity. The percentage of women entering orthopaedic residency persistently remains at 14% despite near equal ratios of women to men in medical school classes. This trend has been attributed to negative perceptions among women medical students of workplace culture and lifestyle in orthopaedics as well as lack of exposure, particularly during medical school when most women decide to enter the field. Since 2012, The Perry Initiative, a nonprofit organization that is focused on recruiting and retaining women in orthopaedics, had conducted extracurricular outreach programs for first- and second-year female medical students to provide exposure and mentoring opportunities specific to orthopaedics. This program, called the Medical Student Outreach Program (MSOP), is ongoing at medical centers nationwide and has reached over 300 medical students in its first 3 program years (2012–2014).

Medical School Experiences Shape Women Students’ Interest in Orthopaedic Surgery

Mary I. O’Connor MD

Orthopaedic surgery now has the lowest percentage of women in residency programs of any surgical specialty. Understanding factors, particularly those related to the medical school experience, that contribute to the specialty’s inability to draw from the best women students is crucial to improving diversity in the profession.

Gender Differences in Pediatric Orthopaedics: What Are the Implications for the Future Workforce?

Marielle A. Amoli MD, John M. Flynn MD, Eric W. Edmonds MD, Michael P. Glotzbecker MD, Derek M. Kelly MD, Jeffrey R. Sawyer MD

Although the number of women in surgical specialties has increased dramatically over the past two decades, little research exists regarding how a surgeon’s gender impacts job selection and practice models. Because the number of women specializing in pediatric orthopaedics continues to increase, it is important to understand how one’s gender affects practice choices and how this may affect the future workforce.

Can a Strategic Pipeline Initiative Increase the Number of Women and Underrepresented Minorities in Orthopaedic Surgery?

Bonnie S. Mason MD, William Ross MD, Gezzer Ortega MD, MPH, Monique C. Chambers MD, MSL, Michael L. Parks MD

Women and minorities remain underrepresented in orthopaedic surgery. In an attempt to increase the diversity of those entering the physician workforce, Nth Dimensions implemented a targeted pipeline curriculum that includes the Orthopaedic Summer Internship Program. The program exposes medical students to the specialty of orthopaedic surgery and equips students to be competitive applicants to orthopaedic surgery residency programs. The effect of this program on women and underrepresented minority applicants to orthopaedic residencies is highlighted in this article.

Disparities in TKA Outcomes: Census Tract Data Show Interactions Between Race and Poverty

Susan M. Goodman MD, Lisa A. Mandl MD, MPH, Michael L. Parks MD, Meng Zhang PhD, Kelly R. McHugh MA, Yuo-Yu Lee MS, Joseph T. Nguyen MPH, Linda A. Russell MD, Margaret H. Bogardus BA, Mark P. Figgie MD, Anne R. Bass MD

Race is an important predictor of TKA outcomes in the United States; however, analyses of race can be confounded by socioeconomic factors, which can result in difficulty determining the root cause of disparate outcomes after TKA.

Modular to Monoblock: Difficulties of Detaching the M2 a-MagnumTM Head Are Common in Metal-on-metal Revisions

Heikki Mäntymäki, Keijo T. Mäkelä, Tero Vahlberg, Joni Hirviniemi, Tuukka Niinimäki

Modern hip implants typically feature modular heads, which allow for easy exchange and removal from the femoral stem at the time of revision. However, owing to fretting, corrosion, or cold welding, the modular head may be difficult or impossible to separate from the underlying trunnion, especially if the implant has titanium interfaces between the head and the stem. We have repeatedly encountered difficulty removing the titanium sleeve adapter in the Ma-Magnumimplant. Although the manufacturer warns about this complication and cases with these difficulties have been reported to the United States FDA, we believed this topic is important to study, because the frequency of difficulties in head removal is unknown and the complications related to this event have not been characterized.

Ultrashort versus Conventional Anatomic Cementless Femoral Stems in the Same Patients Younger Than 55 Years

Young-Hoo Kim, Jang-Won Park, Jun-Shik Kim

Because the clinical and radiographic performance of an ultrashort anatomic cementless stem has been investigated in only two randomized controlled studies, well-designed trials should aim for a thorough comparison of the outcomes of ultrashort anatomic cementless and conventional anatomic cementless stems.

The Oblique Anterolateral Approach to the Lumbar Spine Provides Access to the Lumbar Spine With Few Early Complications

Christoph Mehren MD, H. Michael Mayer MD, Christoph Zandanell MD, Christoph J. Siepe MD, Andreas Korge MD

During the last 20 years several less-invasive anterior approaches to the lumbar spine have become standard, including the extreme lateral transpsoas approach. Although it is associated with a lower risk of vascular injury compared with anterior midline approaches, neuromonitoring is considered mandatory to avoid neurologic complications. Interestingly, despite neuromonitoring, the reported risk of neurologic deficits with the extreme lateral transpsoas approach is greater than observed with other anterior approaches. An alternative lateral, oblique, psoas-sparing approach, recently named the oblique lumbar interbody fusion, uses the anatomic pathway between the abdominal vessels anteriorly and the lumbar plexus laterally to decrease the risk of neurologic and vascular injury; however, as yet, little on this new approach has been reported.

Clinician and Patient-reported Outcomes Are Associated With Psychological Factors in Patients With Chronic Shoulder Pain

Adrian Wolfensberger MSc, Philippe Vuistiner MSc, Michel Konzelmann MD, Chantal Plomb-Holmes MD, Bertrand Léger PhD, François Luthi MD

Validated clinician outcome scores are considered less associated with psychosocial factors than patient-reported outcome measurements (PROMs). This belief may lead to misconceptions if both instruments are related to similar factors.

Reliability and Validity of a Japanese-language and Culturally Adapted Version of the Musculoskeletal Tumor Society Scoring System for the Lower Extremity

Shintaro Iwata MD, Kosuke Uehara MD, Koichi Ogura MD, Toru Akiyama MD, Yusuke Shinoda MD, Tsukasa Yonemoto MD, Akira Kawai MD

The Musculoskeletal Tumor Society (MSTS) scoring system is a widely used functional evaluation tool for patients treated for musculoskeletal tumors. Although the MSTS scoring system has been validated in English and Brazilian Portuguese, a Japanese version of the MSTS scoring system has not yet been validated.

Hip, Knee, and Ankle Osteoarthritis Negatively Affects Mechanical Energy Exchange

Robin M. Queen PhD, Tawnee L. Sparling BS, Daniel Schmitt PhD

Individuals with osteoarthritis (OA) of the lower limb find normal locomotion tiring compared with individuals without OA, possibly because OA of any lower limb joint changes limb mechanics and may disrupt transfer of potential and kinetic energy of the center of mass during walking, resulting in increased locomotor costs. Although recovery has been explored in asymptomatic individuals and in some patient populations, the effect of changes in these gait parameters on center of mass movements and mechanical work in patients with OA in specific joints has not been well examined. The results can be used to inform clinical interventions and rehabilitation that focus on improving energy recovery.

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