Neil V. Shah

New alternate bearing surfaces in total hip arthroplasty: A review of the current literature

As indications for total hip arthroplasty (THA) have expanded, the incidence of THA has increased among younger patients, who live longer and tend to place more strain on implants via higher activity levels. This demographical shift accentuates the importance of advancing innovation to ensure implant longevity for younger and more active patients. Future innovation, as it pertains to THA components, is likely to focus on modifying implant designs and tribology in conjunction with identification and application of newer biomaterials. By reviewing the literature for development status of various materials and novel design advancements in THA component outside of the standard highly cross-linked polyethylene, this investigation provided an update on the current and future status of design initiatives as they pertain to THA. Though the highlighted alternative bearing surfaces have shown promising in vitro and limited, yet encouraging clinical data, they lack larger and longer-term clinical trial results. Further research and innovation is warranted to identify the optimal bearing surface to most effectively accommodate for the trend of younger and more active patients undergoing THA. Implant longevity is crucial if the clinical success of THA is to be maintained.

Nerve injuries associated with total hip arthroplasty

Nerve injury is a relatively rare, yet potentially devastating complication of total hip arthroplasty (THA). Incidence of this ranges from 0.6 to 3.7%, and is highest in patients with developmental hip dysplasia and previous hip surgery. Apart from patient and surgeon dissatisfaction, this complication can have medico-legal consequences. Therefore, the purpose of this study was to review the risk factors, etiology, diagnostic options, management strategies, prognosis, and prevention measures of nerve injuries associated with THA. We specifically evaluated the: 1) sciatic nerve; 2) femoral nerve; 3) obturator nerve; 4) superior gluteal nerve; and 5) the lateral femoral cutaneous nerve.

Poster 35: Epidemiology and Trends of Surfing-Related Head Injuries that Presented to United States Emergency Departments from 2001 to 2016

Disclosures: Kevin Ong: I Have No Relevant Financial Relationships To Disclose Objective: (1) Is hylan G-F 20 associated with a delay to knee arthroplasty (KA)? (2) Does the delay to KA differ with the number of HA courses? Design: Retrospective cohort study. Setting: Optum Clinformatics data (2006-Q2 2016) with claims from about 13 million lives covered by UnitedHealth Group annually. Participants: 141,305 KA patients. Interventions: Patients who did not use IA HA (No HA group), used one type of non-hylan G-F 20 HA or multiple types of HAs (Non-hylan G-F 20 group), and used only hylan G-F 20. Main Outcome Measures: Median duration from knee OA to KA, using quantile regression with adjustment confounding factors, with propensity score weighting. Results: Overall median time from knee OA diagnosis to KA was 1.2 years. Unadjusted median time to KA for the no HA group was 0.9 years versus 2.1 years and 2.0 years for the non-hylan G-F 20 and hylan G-F 20 groups, respectively. After propensity score weighting, hylan G-F 20 and nonhylan G-F 20 patients had significantly longer times by 7.3 and 7.8 months (P < .001), respectively, than the no HA patients. 25.6% of the non-hylanG-F20groupand19.7%of thehylanG-F20groupreceivedmore than oneHAcourse. After adjusting for time to firstHAuse and number of injections, hylan G-F 20 patients had 1.7 months longer time to KA than non-hylanG-F20HApatients (P<.001). Themedian time toKA increased fromabout21months (1.8years) to59months (4.9 years) as thehylanG-F 20 group increased their treatment courses from one to five or more. Conclusions: Most KA patients did not use IA HA (73.7%), but those who did were associated with a longer median time to KA by about 7-8 months. A dose response was observed in terms of a longer time to KA with more HA courses. Level of Evidence: Level II

Realignment surgery in adult spinal deformity

Although surgical techniques pertaining to adult spinal deformity (ASD) have advanced over the last decade, proximal junctional kyphosis (PJK) is still axa0complication following surgery for ASD that continues to significantly challenge clinicians. This article aimed to report on the prevalence of PJK as well as enhance understanding of surgically modifiable and non-modifiable risk factors of PJK to guide management of this postoperative complication of ASD. As the understanding of the pathogenesis as well as surgical modifications aimed at reducing the incidence of PJK have advanced, so too should clinicians’ ability to implement more patient-specific operative plans and improve outcomes following realignment surgery for ASD.ZusammenfassungObwohl sich die chirurgischen Techniken in Bezug auf die Behandlung von Wirbelsäulendeformitäten des Erwachsenen („adult spinal deformities“, ASD) in den letzten Dekaden weiterentwickelt haben, stellt die proximale junktionale Kyphose (PJK) als Komplikation nach operativer Versorgung der ASD eine große Herausforderung für den Wirbelsäulenchirurgen dar. Ziel dieser Übersichtsarbeit ist es, die Prävalenz der PJK darzustellen und das Verständnis für chirurgisch beeinflussbare sowie chirurgisch nicht beeinflussbare Risikofaktoren der PJK zu erhöhen, damit diese relevante postoperative Komplikation der ASD besser eingeordnet und behandelt werden kann. Da das Verständnis für die Pathogenese der PJK wie auch die chirurgischen Strategien mit dem Ziel, die Häufigkeit der postoperativen PJK zu reduzieren, fortgeschritten sind, muss nun auch die Fähigkeit der Kliniker gefordert werden, die patientenspezifische operative Planung in der Behandlung zu implementieren, um das postoperative Ergebnis nach der Wiederherstellung des sagittalen Profils bei ASD zu verbessern.

Comparing psychological burden of orthopaedic diseases against medical conditions: Investigation on hospital course of hip, knee, and spine surgery patients

Retrospective review of National Inpatient Sample (2000-2012) revealed that 31.28% of musculoskeletal (MSK) patients were found to have in-hospital psychological burdens (PBs). Adult spinal deformity (ASD), degenerative disc disease (DDD) and lung cancer patients had highest PB-prevalence. MSK patients with PB were more often young, white females with increased Deyo index compared to no-PB patients. Patients who underwent spinal revision procedures had higher PB rates than with primary procedures; a converse trend was observed for total hip/knee arthroplasty. Psychological disorders were identified as significant predictors of increased total-hospital charges. Augmenting counseling with psychological screening/support is recommended to complement MSK management.

Knee dislocation with popliteal artery disruption: A nationwide analysis from 2005 to 2013

ObjectivenFew have compared short-term outcomes following knee dislocations with or without concomitant popliteal artery disruption (PAD).nnnMethodsnThe Nationwide Inpatient Sample was used to identify 2175 patients admitted for knee dislocation from 2005 to 2013 (concomitant PAD: nu202f=u202f210/9.7%; without: nu202f=u202f1965/90.3%).nnnResultsnPatients with PAD were younger, more often male, Black and Hispanic, and with Medicaid (all pu202f≤u202f0.013). PADs were associated with 11.0-times higher odds of increased LOS (95%CI, 6.6-18.4) and 2.8-times higher odds of experiencing any complication (95%CI, 2.03-3.92). Female sex was a protective factor against increased LOS, (ORu202f=u202f0.65; 95%CI, 0.48-0.88).nnnConclusionnHigh suspicion index should be maintained for concomitant vascular injuries following knee dislocations.

ORIF versus arthroplasty for open proximal humerus fractures: Nationwide Inpatient Sample data between 1998 and 2013

BackgroundLimited data exists in analyzing open reduction and internal fixation (ORIF) and arthroplasty in the management of open proximal humerus fractures. We analyzed differences in hospital course between these procedures, patient demographics, complication rate, length of stay, hospital charges, and mortality rate.Materials and methodsThis is a retrospective review of the Nationwide Inpatient Sample database. ICD-9 codes identified patients hospitalized for open proximal humerus fractures from 1998 to 2013 who underwent ORIF or shoulder arthroplasty (hemi-, total, or reverse). Demographics and in-hospital complications were compared. Logistic regression controlling for age, gender, and Deyo index tested the impact of ORIF vs ARTH on any complications.ResultsSeven hundred thirty patients were included (ORIF, nu2009=u2009662 vs ARTH, nu2009=u200968). ORIF patients were younger (pu2009<u20090.001), more likely to be males (pu2009<u20090.001), and had a lower Deyo score (pu2009=u20090.012). Both groups had comparable complication rates (21.4% vs 18.0%, pu2009=u20090.535), lengths of stay (7.86xa0days vs 7.44xa0days, pu2009=u20090.833), hospital charges (

Have the Annual Trends of Total Knee Arthroplasty in Rheumatoid Arthritis Patients Changed

76,998 vs

Motion analysis in the axial plane after realignment surgery for adolescent idiopathic scoliosis

64,133, pu2009=u20090.360), and mortality rates (0.2% vs 0%, pu2009=u20090.761). Type of surgery was not a predictor of any complications (ORu2009=u20090.67 [95% CI 0.33–1.35], pu2009=u20090.266), extended length of stay (ORu2009=u20091.01 [95% CI 0.58–1.78], pu2009=u20090.967), or high hospital charges (ORu2009=u20091.39 [95% CI 0.68–2.86], pu2009=u20090.366).ConclusionWe revealed no differences in hospital course between ORIF and arthroplasty for management of open proximal humerus fractures. Although differences in demographics existed, no differences in complication rates, length of stay, hospital charges and mortality rates were noted. Future studies can evaluate the long-term outcomes of these procedures.Level of evidenceLevel III.

Wednesday, September 26, 2018 1:00 PM – 2:00 PM Spinal Trauma

Abstract As the use of disease modifying antirheumatic drugs have increased, it remains unclear whether or not this has affected the rates of total knee arthroplasty (TKA) in rheumatoid arthritis (RA) patients. Therefore, the purpose of this study was to evaluate the annual trends of RA patients who underwent TKA. Specifically, we evaluated: (1) the annual trends of TKAs due to RA in the United States population; and (2) the annual trends in the proportion of TKAs due to RA in the United States. The Nationwide Inpatient Sample was used to identify all patients who underwent TKA between 2002 and 2013 (n = 6,492,873). Then, we identified TKA patients who had a diagnosis of RA, defined by the International Classification of Diseases, Ninth Revision (ICD‐9) code 714.0. The incidence of TKAs with a diagnosis of RA in the United States was calculated using the U.S. population as the denominator. Regression models were used to analyze the annual trends of RA in patients who underwent TKA. A total of 209,332 RA patients were identified who underwent TKA. The annual prevalence of RA in patients who underwent TKA slightly increased, from 33.2 per 1,000 TKAs in 2002 to 35 per 1,000 TKAs in 2013 (R2 = 0.254, p = 0.095). The annual number of TKAs with a diagnosis of RA increased by 93.1% from 11,618 to 22,430. After normalizing for the U.S. population, the incidence of TKAs with RA increased from 5.4 to 9.2 TKAs per 1 million U.S. adults (incidence rate ratio [IRR] = 1.05; 95% confidence interval [CI], 1.05‐1.05; p < 0.001). In 2002, 11,618 (3.31%) TKAs, and in 2013, 22,430 (3.50%) TKAs were due to RA. The prevalence of RA in those who underwent TKA remained the same from 2002 to 2013 (coefficient = 0.02; 95% CI, ‐0.01 to 0.05; p = 0.095). The results of this study demonstrated that the rates of TKA performed in RA patients have remained relatively stable. Furthermore, there may have been a decline in the rate of RA patients undergoing TKA, due to an increase in the U.S. population by approximately 28.8 million during the study period.