Omar Khatib

The rising incidence of arthroscopic superior labrum anterior and posterior (SLAP) repairs

BACKGROUND Superior labrum anterior-posterior (SLAP) lesions of the shoulder that require surgical repair are relatively uncommon. However, recent observations suggest that there may be a rise in the incidence of SLAP lesion repair. MATERIALS AND METHODS The Statewide Planning and Research Cooperative Systems (SPARCS) database from the New York State Department of Health was used to acquire data for all outpatient ambulatory surgery procedures that were performed in New York State from 2002 to 2010. The data were reviewed and analyzed to compare the incidence of arthroscopic SLAP lesion repairs relative to other outpatient surgical procedures. RESULTS Within New York State, from 2002 to 2010, the number of all ambulatory surgical procedures increased 55%, from 1,411,633 to 2,189,991. Correspondingly, the number of ambulatory orthopedic procedures increased 135%, from 118,126 to 278,136. In comparison, the number of arthroscopic SLAP repairs increased 464%, from 765 to 4,313 (P < .0001). This represented a population-based incidence of 4.0/100,000 in 2002 and 22.3/100,000 in 2010. The mean age of patients undergoing arthroscopic SLAP repair in 2002 was 37 ± 14 years. The mean age in 2010 was 40 ± 14 years (P < .0001). CONCLUSIONS The data suggest a substantial increase in the number of arthroscopic SLAP repairs that is significantly more rapid than the rising rate of outpatient orthopedic surgical procedures. In addition, there is a significant increase in the age of patients who are being treated with arthroscopic SLAP repairs.

Comparison of ultrasound-guided versus blind glenohumeral injections: a cadaveric study.

BACKGROUND Intra-articular glenohumeral (GH) injections are important for diagnostic and therapeutic purposes. It has been suggested that ultrasound guided injections are more accurate than blind or freehand injections. This study assessed the accuracy of ultrasound-guided GH injections compared with freehand injections in fresh cadavers. METHODS The study used 80 shoulder specimens from fresh cadavers. Ultrasound guidance was used to inject radiopaque contrast in 40 shoulders, and freehand technique was used in the remaining 40. All injections were performed by 2 surgeons (A and B) through a posterior approach. After the injections, radiographs were obtained of the specimens to assess the accuracy of the injections. RESULTS Sixty-six of 80 (82.5%) injections were accurately administered into the GH joint. Ultrasound-guided injections were accurate in 37 of 40 specimens (92.5%) compared with freehand injections, which were accurate in only 29 of 40 specimens (72.5%; P = .02). Both surgeons independently had higher accuracy using ultrasound-guidance compared with the freehand technique (surgeon A: 90% vs 65%, P = 0.058; surgeon B: 95% vs 80%, P = 0.15). The average time for injections was 52 seconds by the freehand technique and 166 seconds using ultrasound guidance (P < 0.001). CONCLUSIONS The data from this cadaveric study suggest that ultrasound-guided injections are more accurate at reaching the GH joint than freehand injections. The ultrasound-guided injections took substantially longer to administer. Once familiar with the technique, surgeons can expect improved accuracy and efficacy of GH joint injections using ultrasound guidance in the clinical setting.

Revision Total Joint Arthroplasty: The Epidemiology of 63,140 Cases in New York State

Recent evidence suggests a substantial rise in the number of revision total joint arthroplasty (TJA) procedures performed. The New York State SPARCS inpatient database was utilized to identify revision total shoulder, knee, and hip arthroplasty procedures between 1993 and 2010. Yearly incidence and related epidemiology were analyzed. A total of 1,806 revision TSA, 26,080 revision TKA, and 35,254 revision THA cases were identified. The population-based incidence of these procedures increased 288%, 246%, and 44% respectively (P<0.001). Revision burden for hip arthroplasty decreased from 16.1% in 2001 to 11.5% in 2010 (P<0.001). The rates of revision TSAs and TKAs increased at a substantially faster rate than that of revision THAs. Revision burden for hip arthroplasty steadily has decreased since 2001.

Shoulder arthroplasty in New York State, 1991 to 2010: changing patterns of utilization

BACKGROUND Shoulder arthroplasty is now used to treat an expanding variety of glenohumeral disorders. METHODS This study assessed the demographic patterns and utilization rates of shoulder hemiarthroplasty (HA) and anatomic or reverse total shoulder arthroplasty (TSA) within New York State (NYS) from 1991 to 2010. Using the New York Statewide Planning and Research Cooperative System database, all shoulder arthroplasty procedures that occurred within NYS during the study period were retrospectively identified and analyzed. RESULTS During the 20-year period, 24,040 shoulder arthroplasty procedures were performed. During the second decade (2001-2010), there was a 393% increase in utilization of TSA with a 98% increase in HA. This disproportionate increase is likely due to the introduction and expanding indications of reverse TSA as an effective procedure in place of HA for the treatment of proximal humerus fractures and rotator cuff arthropathy, as rotator cuff arthropathy as a primary indication for HA was significantly less prevalent in period 2. Also notable was an identifiable disparity in race; whites represented approximately 80% of the shoulder arthroplasty procedures in both decades, whereas African Americans made up <5%. This is significantly different from the general racial demographics of NYS during both periods analyzed. DISCUSSION It is clear that the volume of shoulder arthroplasty procedures performed in NYS is increasing, mirroring the national experience. This trend reflects the expanding indications, the general success of these procedures, the aging demographic of our population, and a greater desire and willingness of patients to consider operative management to maintain or to improve quality of life.

Femoral neck fractures in New York State. Is the rate of THA increasing, and do race or payer influence decision making?

Objectives: To evaluate the treatment trends for femoral neck fractures in New York State over the past 10 years. Methods: The Statewide Planning and Research Cooperative System database from the New York State Department of Health was used to identify patients who sustained femoral neck fractures from 2000 to 2010. Multivariate logistic regression analysis was performed with the dependent variable being total hip arthroplasty (THA) versus hemiarthroplasty (HA) and independent variables being age, sex, race, insurance type, and comorbidity index. Results: From 2000 to 2010, there were 44,425 patients admitted to New York State hospitals with femoral neck fractures, of which 86% occurred in patients older than 70. Of the total, 73.5% were treated with HA, 19.5% with internal fixation (IF), and 7% with THA. The overall rate of treatment with THA increased slightly, but this was not statistically significant (P = 0.11), and it only increased for patients younger than 70 years. The rate of HA increased significantly from 69.9% to 75.4% (P < 0.001), and the rate of IF showed a statistically significant reduction from 21.9% to 16.8% (P < 0.001). Results of the multivariate logistic regression analysis showed that for every 10-year increase in age, there was a 31% reduction in treatment with THA compared with HA. White patients were just as likely to receive THA as non-whites, and patients with private insurance were 41% more likely to receive THA than self-pay and federally insured patients. Conclusions: The rate that THA is being performed as treatment of femoral neck fractures is increasing for patients younger than 70 years but decreasing for patients older than 80 years. The rate of IF is decreasing. Patients with private insurance were more likely to receive THA than patients with federal insurance. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Comparing the Incidence and Clinical Data for Simultaneous Bilateral Versus Unilateral Total Hip Arthroplasty in New York State Between 1990 and 2010

A New York State database reported information on all total hip arthroplasty cases between 1990 and 2010 comparing unilateral (242,588 cases) to simultaneous bilateral (4538 cases) procedures. Our data showed that the population incidence of this surgery increased 120.2% over twenty years, yet the proportionate number of simultaneous cases has decreased. Simultaneous procedures were found to occur more commonly in younger patients with private insurance. In addition, bilateral procedures showed an increase in PE, DVT, length of stay, and discharge to rehab facilities; whereas mortality and blood transfusions compared to unilateral procedures showed no difference.

The Effect of Platelet-rich Fibrin Matrix on Rotator Cuff Healing in a Rat Model.

The purpose of the current study was to determine if the application of platelet-rich fibrin matrix could improve regeneration of the tendon-bone insertion site in a rat rotator cuff repair model. 25 Lewis syngeneic rats underwent bilateral tenotomy and repair of the supraspinatus tendon. 10 separate rats were used for PRFM harvest. All left (control) shoulders underwent transosseous rotator cuff repair, while all right (treatment) shoulders were repaired similarly with PRFM augmentation. 9 rats were sacrificed at 2-weeks and ten at 4-weeks for biomechanical testing. 3 separate rats were sacrificed at 2-weeks and 4-weeks each for histologic analysis of the insertion site. At 2 weeks, the experimental group repairs were significantly stronger in ultimate load to failure (P=0.01), stress (P=0.03), and stiffness (P=0.03). Differences in biomechanical testing were not found between the groups at 4 weeks. Histological analysis revealed less collagen organization and cartilage formation at the insertion site in the experimental group. Semiquantitative histologic analysis confirmed our qualitative assessment of the specimens. PRFM does not recapitulate the native enthesis, but rather induces an exuberant and disordered healing response that is characterized by fibrovascular scar tissue.

Factors Motivating Medical Students in Selecting a Career Specialty: Relevance for a Robust Orthopaedic Pipeline.

Introduction: Selection of a career specialty by medical students is a complex and individualized decision. Our goals were to understand the factors that influenced medical students in selecting their career specialty, identify the stage at which this decision was made, and understand the role of demographics, mentors, and curricula in this process. Methods: Medical students from 10 institutions participated in a web-based survey. Results were stratified by sex, race/ethnicity, and level of interest in orthopaedic surgery. Results: A total of 657 students responded to the survey. Specialty content (mean rating, 8.4/10) and quality of life/lifestyle/stress level (7.5/10) were the primary motivating factors in selecting a specialty. Interest in orthopaedic surgery was lower in women than in men (2.7 versus 3.9; P < 0.01) and was equivalent among race/ethnicity groups. Although 27% of students reported moderate or extensive medical school curriculum exposure to orthopaedics, this education did not sway them toward the specialty. Conclusions: Levels of interest in orthopaedics among medical students may be lower than generally assumed. Increasing the attractiveness of the specialty will require a multifaceted approach, including recognition of lifestyle factors, adjustments in the orthopaedic clerkship to make the specialty more appealing, mentorship by orthopaedic faculty, and conversion of high levels of interest in the specialty among minority medical students into successful residency applications. Level of Evidence: IV