The Iowa orthopaedic journal最新文献

{"title":"A Cross-Sectional Study of Gender-Specific Influences of Orthopedic Subspecialty Selection.","authors":"Katelyn T Koschmeder, Amelia C Hurley-Novatny, Alex A Marti, Kathryn M Sharp, Shannon E Linderman, Alex R Coffman, Catherine R Olinger","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Per the American Academy of Orthopaedic Surgeons, 6.5% of practicing orthopedic surgeons are female and a majority subspecialize in pediatrics, hand, and foot and ankle surgery. The study purpose is to evaluate influences of orthopedic subspecialty selection, specifically factors such as perceived strength, lifestyle, and mentorship influence on subspecialty decisions and to identify if gender plays a role in these perceptions.</p><p><strong>Methods: </strong>An IRB approved cross-sectional study was conducted via email distribution of a REDCap^TM survey to U.S. licensed orthopedic surgeons. Data regarding demographics, professional degree, training and current practice location, and perceptions regarding orthopedic surgery was obtained using Likert rating scales. Data was analyzed using descriptive statistics with two-tailed student's t-tests (α=0.05).</p><p><strong>Results: </strong>The survey yielded 282 responses (182 females and 100 males). Overall, the distribution of residents (28%), fellows (6%), and attendings (66%) correlates well with the prevalence of each respective physician category in the field of orthopedic surgery. The study demonstrated no difference in subspecialty choice based on mentorship, work-life-balance, career advancement, subspecialty culture, salary potential, family planning, or schedule. However, a statistically significant difference exists regarding stereotypes, perceived strength required, and perception of discrimination from pursuing a specific orthopedic subspecialty. 27% of females and 10% of males reported discouragement from any subspecialty (p<0.05). Adult reconstructive and oncology were most frequently discouraged. Women reported not choosing a subspecialty because of perceived physical demands more often than men (p<0.001). Women reported an increased use of adaptive strategies in the operating room (p<0.001). Women were also more likely to report feeling discouraged from pursuing a subspecialty due to their gender (p<0.001). Both men and women reported mentorship as the most influential factor in subspecialty selection.</p><p><strong>Conclusion: </strong>Women and men reported different factors were important in their decision of subspecialty. Women were more likely to be discouraged from a subspecialty and experience discrimination based on their perceived strength compared to male peers. Residents, fellows, and attending surgeons valued mentorship as the most influential in their subspeciality choice. This study suggests intrinsic and extrinsic influences that may differentially affect male and female orthopedic surgeons when they choose a subspecialty. <b>Level of Evidence: III</b>.</p>","PeriodicalId":94233,"journal":{"name":"The Iowa orthopaedic journal","volume":"44 1","pages":"1-10"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11195877/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141452595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronal Malalignment Is Infrequently Present in Patients With Aseptic Tibial Loosening.","authors":"Jacob M Wilson, Zach C Cox, Martin Faschingbauer, Stephen M Engstrom, Gregory G Polkowski, J Bohannon Mason, J Ryan Martin","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Coronal lower extremity malalignment and improper implant position have been described as risk factors for aseptic tibial loosening following primary total knee arthroplasty (TKA). However, several prior studies have shown no association between alignment and implant loosening. Meanwhile, there is increasing interest in kinematic alignment. Therefore, we sought to determine the incidence of coronal malalignment of the limb and tibial component in patients that were revised secondary to aseptic tibial loosening.</p><p><strong>Methods: </strong>A cohort of 73 patients that were revised for aseptic tibial loosening was identified. Patient demographics were recorded. Radiographs from the primary procedure (preoperative and postoperative) were reviewed to determine the index coronal alignment of the knee and tibial component. Adequate alignment was noted if limb alignment was in neutral or appropriate valgus alignment and tibial implant position was within 3° of the neutral mechanical axis.</p><p><strong>Results: </strong>Four (5.5%) patients had varus alignment of the tibial component >3°. Therefore, 69/73 (94.5%) patients had well-aligned tibial implants. The average coronal alignment of the limb was 3° of valgus and six (8.2%) patients had coronal varus limb alignment (all >0° anatomic varus).</p><p><strong>Conclusion: </strong>Limb and tibial implant malalignment were infrequently seen in patients revised secondary to aseptic tibial loosening. Most patients fell within previously described \"safe\" alignment parameters (<3° varus for the tibial component and neutral or valgus limb alignment). Specifically, malalignment was only present in approximately six to eight percent of patients. Therefore, factors other than alignment appear to contribute most to the development of aseptic tibial loosening. <b>Level of Evidence: III</b>.</p>","PeriodicalId":94233,"journal":{"name":"The Iowa orthopaedic journal","volume":"44 2","pages":"44-48"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11726476/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of the Advanced One-Step Mixing System Under Non-Vacuum on the Mechanical Properties of Acrylic Bone Cement.","authors":"Jillian V Schommer, Alexander Cm Chong, Troy D Erickson","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The specific aim of this study was to evaluate the mechanical properties of cement prepared with the advanced one-step mixing system and whether the addition of vacuum conditions yielded an appreciable improvement in the biomechanical strength or overall quality of bone cement.</p><p><strong>Methods: </strong>The advanced one-step mixing system was used. Twelve specimens were prepared by mixing under vacuum conditions and 12 specimens were prepared by mixing without a vacuum. Radiographs of cement specimens were analyzed to determine the porosity of the test region. Tensile testing of the specimens was performed with a loading rate of 2.54mm/min at room temperature. The ultimate tensile strength (UTS) and the tensile elastic modulus (E) were determined for each sample.</p><p><strong>Results: </strong>The UTS of the bone cement samples mixed under vacuum conditions were not significantly different than those mixed without vacuum (vacuum: 39±6MPa; non-vacuum: 35±6MPa; p=0.637). The E of samples mixed under vacuum conditions was significantly higher than the bone cement mixed without vacuum (vacuum: 2.78±0.06GPa; non-vacuum: 2.63±0.15GPa; p=0.019). Radiographic images showed samples mixed under vacuum conditions contained fewer defects than the samples mixed without vacuum (vacuum: 3.5%±3.3% (range: 0.0%-9.0%); non-vacuum: 6.9%±1.0% (range: 4.6%-8.2%)).</p><p><strong>Conclusion: </strong>Mixing bone cement with the advanced one-step mixing system under vacuum conditions does not produce an appreciable difference in the UTS of the bone cement in a bench biomechanical testing model compared to the bone cement mixed without vacuum. It does, however, create a less porous cement mixture with a higher E compared to cement mixed without vacuum. <b>Level of Evidence: V</b>.</p>","PeriodicalId":94233,"journal":{"name":"The Iowa orthopaedic journal","volume":"44 1","pages":"63-68"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11195905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141452605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Perioperative Radiotherapy Effective in Preventing Local Recurrence in Myxofibrosarcoma?","authors":"Shah Fahad, Abigai Grothe, Qiang An, Benjamin J Miller","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Myxofibrosarcoma (MFS) is a rare type of soft tissue sarcoma that is locally aggressive and has a high risk of recurrence. The effectiveness of perioperative radiotherapy (RT) in preventing local recurrence (LR) of MFS remains uncertain. This retrospective study aimed to evaluate the impact of perioperative radiotherapy on local recurrence in patients with MFS.</p><p><strong>Methods: </strong>A total of 75 patients diagnosed with MFS and treated at a single institution were included in the study. Patient data, including demographics, tumor characteristics, and treatment variables, were collected from electronic medical records. The primary endpoint was the occurrence of local recurrence.</p><p><strong>Results: </strong>Among the patients, 25/75 (33.3%) received radiation therapy, while 50/75 (66.7%) did not. Local recurrence in the radiated group was 28% (7/25) compared to 36% (18/50) in the non-irradiated group (p = 0.20). The LR rate trended higher in patients who received RT postoperatively (adjuvant) (6/12, 50%) than preoperatively (neoadjuvant) (1/13, 7.6%) (p = 0.124). Of the 54 patients with negative margins, the local recurrence rate was lower in the radiated group (1/12, 8.33) than the non-irradiated group (9/36, 25%) (p = 0.034). A subgroup analysis based on tumor grade did not reveal any significant differences in recurrence rates between the radiated and non-irradiated groups. Furthermore, there was no significant difference in recurrence rates between the irradiated and non-irradiated groups at the one-year (p = 0.32), two-year (p = 0.24), and five-year (p = 0.32) follow-up marks.</p><p><strong>Conclusion: </strong>Although radiotherapy demonstrated a trend toward reduction in recurrence rates in patients with MFS in this study, the observed difference did not reach statistical significance. Neoadjuvant radiation appears to be more effective than adjuvant radiation. However, there was a significant reduction in recurrence in patients with negative margins who received radiation demonstrating that effective surgical resection continues to be the most important intervention in patients with myxofibrosarcoma. <b>Level of Evidence: III</b>.</p>","PeriodicalId":94233,"journal":{"name":"The Iowa orthopaedic journal","volume":"44 1","pages":"85-92"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11195901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141452607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2024 Graduating Orthopedic Residents.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":94233,"journal":{"name":"The Iowa orthopaedic journal","volume":"44 1","pages":"xi-xiii"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11195899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141452591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Iowa Orthopedic Journal Editors Emeriti.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":94233,"journal":{"name":"The Iowa orthopaedic journal","volume":"44 1","pages":"iii"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11195878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141452606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New Orthopedic Faculty.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":94233,"journal":{"name":"The Iowa orthopaedic journal","volume":"44 1","pages":"xvi"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11195907/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141452610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peri-Operative Management of Periacetabular Osteotomy: A Report of Current Practices from the Anchor Group, Supporting Literature, and Areas for Future Investigation.","authors":"Michael Willey, Andrea M Spiker, Matthew R Schmitz, Etienne L Belzile, Rafael J Sierra, John Clohisy, Michael Stover","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Periacetabular osteotomy (PAO) is a well-established surgical treatment for hip dysplasia, but very few studies report the impact of peri-operative management strategies on early pain and function. The purpose of this study is to describe peri-operative management variability among a group of experienced surgeons and review the literature supporting these practice patterns.</p><p><strong>Methods: </strong>We surveyed 16 surgeons that perform PAO to document various aspects of peri-operative management at four stages: pre-operative, intra-operative, post-operative in the hospital, and at discharge. Our goal was to report current surgical pain management strategies, adjunct medications, type of anesthesia, deep venous thrombosis and heterotopic ossification prophylaxis strategies, initiation of physical therapy, and use of continuous passive motion (CPM). We reviewed current literature to identify studies supporting these perioperative strategies and identify knowledge gaps that would benefit from further investigation.</p><p><strong>Results: </strong>Of the 16 surgeons surveyed, 75% had been in practice greater than 10 years and most had not altered their post-operative protocol for more than 3 years. 15/16 surgeons felt that length of stay could be reduced at their institution with improved peri-operative pain management. 6/16 were considering or had already implemented outpatient PAO as a part of their practice. We found significant variability in the pain medications provided at all peri-operative stages. 14/16 utilized general anesthesia, and many utilized epidural or peripheral nerve blocks. 6/16 surgeons utilized surgical field block (also referred to as periarticular block). These surgeons advocated that surgical field block was an effective intervention with no/minimal complication risk. There is very little literature critically evaluating efficacy of these perioperative management strategies for PAO.</p><p><strong>Conclusion: </strong>There is significant practice variability in peri-operative management of PAO surgery. We report various strategies utilized by a group of experienced surgeons and review supporting literature. There are significant knowledge gaps in best surgical pain management strategies, adjunct medications, surgical field blocks, and use of CPM that need further investigation. <b>Level of Evidence: IV</b>.</p>","PeriodicalId":94233,"journal":{"name":"The Iowa orthopaedic journal","volume":"44 1","pages":"159-166"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11195894/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141452552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Influence of Patient Provider Educational Interactions and Associated Preoperative Variables on Outcomes in the Hip Dysplasia Population.","authors":"Alisa Drapeaux, Michael Willey, John Davison","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Patient provider interactions influence patient treatment adherence, clinical outcomes, patient satisfaction, and an overall patient's engagement in healthcare decisions. The purpose of this study was to examine the effectiveness of patient provider educational interactions and associated variables on patient reported outcomes in the hip dysplasia population.</p><p><strong>Methods: </strong>A secondary data analysis was completed with 6-month postoperative survey data from participants, who had undergone periacetabular osteotomy. Data analysis including demographic variables, patient reported outcome results, and pre-operative knowledge retention.</p><p><strong>Results: </strong>A significant difference was found between participants' expectations of crutch use and physical therapy care with actual performance (p<0.001 and p=0.01) and with engagement in pre-operative support based on mental health history (p=0.02).</p><p><strong>Conclusion: </strong>Pre-operative interactions with a provider team and prior patients (pre-operative support) can influence a patient's educational experience. Providers should review educational interventions and offer pre-operative support to patients. <b>Level of Evidence: VI</b>.</p>","PeriodicalId":94233,"journal":{"name":"The Iowa orthopaedic journal","volume":"44 2","pages":"13-26"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11726470/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Orthopedic Surgery <50 Days Following Covid-19 Infection Is Not Associated With Increased Postoperative Complications.","authors":"Katelyn T Koschmeder, J Adam Driscoll, Taylor Den Hartog, Christopher Halbur, Ryan Bailey, Ethan Kuperman, Brendan M Patterson, Catherine Olinger, Nicolas O Noiseux","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Recent literature indicates that COVID-19 infection is a negative predictor of good outcomes following elective orthopedic surgery. However, the ideal timing of surgery after infection is unclear. The purpose of this study was to compare the rates of post-operative complications between those who underwent elective orthopedic surgery <50 days and >50 days after COVID-19 infection.</p><p><strong>Methods: </strong>This is a pilot study utilizing retrospective review of 28 adult subjects who underwent orthopedic surgery including 17 total-knee arthroplasties, seven total-hip arthroplasties, three posterior spinal fusions, and one common peroneal decompression. These subjects were indicated for an orthopedic surgery that was canceled due to positive pre-operative COVID-19 testing. The subjects were rescheduled for surgery between March 2020-December 2022.There were two cohorts: those who underwent surgery <50 days after COVID-19 infection (n=14) and subjects who underwent surgery >50 days after COVID-19 infection (n=14). Demographics, preoperative comorbid conditions, and post-operative complications were recorded and compared.</p><p><strong>Results: </strong>There were no significant demographic differences between the two cohorts with respect to age, body mass index, weight, and American Society of Anesthesiologists (ASA) grade. The two cohorts had no significant difference in pre-existing comorbid conditions with hypertension and peripheral vascular disease being the most common comorbidities overall. There were six postoperative complications involving four subjects within 90 days of surgery. One subject developed a postoperative pulmonary embolism (PE), and another subject developed a surgical-site infection, sepsis, and renal failure; both in the >50 days cohort. One patient in each cohort required reoperation. There was no difference in postoperative complications such as deep vein thrombosis (DVT), PE, sepsis, renal failure, and intensive care unit (ICU) admission between the two cohorts.</p><p><strong>Conclusion: </strong>This pilot cohort study demonstrates that COVID-19 infection within 50 days of orthopedic surgery does not significantly increase the risk of postoperative complications such as DVT, PE, surgical site infection, renal failure, ICU admission, reoperation, or death. Further evaluation of the effects of COVID-19 on surgical outcomes in larger cohorts is warranted. <b>Level of Evidence: III</b>.</p>","PeriodicalId":94233,"journal":{"name":"The Iowa orthopaedic journal","volume":"44 2","pages":"133-138"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11726471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}