Bone and Joint Surgery

• A Treatment Pathway Variation for Chronic Prosthesis-Associated Infections

  Thu, 01 Oct 2020 00:00:00 GMT-05:00
  Brügger, Jan; Saner, Simon; Nötzli, Hubert P.

  Background: Periprosthetic joint infections (PJIs) are relatively rare but are on the rise because of the increasing total number of implantations performed. Treatment of PJI remains individualized and involves both surgical and medical treatment, with variations depending on the time of implantation, the duration and severity of the infection, tissue damage, and the underlying microorganism. In this case series study, we investigated clinical and functional outcomes of a variation of the Liestal algorithm in patients with PJI following total hip arthroplasty. Methods: This study included 32 patients (33 cases) who were treated for chronic PJI with 2-stage exchange using a cement spacer during the period of 2003 to 2014. In contrast to other treatment pathways, antibiotic therapy was targeted to the causative microorganism as early as possible despite the presence of a cement spacer. Second-look surgery was performed 4 days after removal of the primary implant and a 4-week antibiotic-free window was interposed before definitive reimplantation. Thereafter, antibiotic treatment continued for approximately 6 weeks. All patients were followed for a minimum of 2 years. Parameters investigated were the duration of infection-free survival, functional outcome, and epidemiological data. Results: At 2 years of follow-up and at the most recent follow-up (on average, 7 years after reimplantation), 100% of the patients were free of signs of infection, and the mean Harris hip score (HHS) was 89 at the latest follow-up. Conclusions: A meticulously performed 2-stage exchange for PJI with early targeted antibiotic treatment, second-look surgery, an antibiotic-free window before reimplantation, and antibiotic treatment post-reimplantation of medium duration is associated with excellent infection-related and good functional outcome after ≥2 years of follow-up even in cases of chronic PJI. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

• Anterolateral Versus Posterolateral Approach for Lateral Condylar Fractures of the Humerus in Children

  Thu, 01 Oct 2020 00:00:00 GMT-05:00
  Tomori, Yuji; Nanno, Mitsuhiko; Takai, Shinro

  Background: Two surgical approaches, an anterolateral and a posterolateral approach, have been advocated for lateral condylar fractures (LCFs) of the humerus in children. The purpose of this study was to evaluate the radiographic and clinical outcomes of the 2 surgical approaches. Methods: We retrospectively analyzed the data of consecutive patients <15 years of age with an LCF treated via open reduction and internal fixation through 1 of 2 surgical approaches during the period of April 2000 to March 2019. Patients were classified into the anterolateral (AL) and posterolateral (PL) groups, according to the surgical approach used. Postoperative complications and radiographic and clinical findings (including range of motion and findings on the basis of the Flynn criteria) were investigated. To investigate humeral deformity, the Baumann angle and the carrying angle were measured on anteroposterior radiographs. Results: Sixty-one of 82 patients met the inclusion criteria. The AL group included 17 patients (13 male, 4 female), and the PL group included 44 patients (28 male, 16 female). In the PL group, 7 patients had cubitus varus deformity, 3 had malunion due to unacceptable reduction of fracture fragments, and 6 had elbow joint contracture. In the AL group, the overall clinical results were excellent for 15 patients and good for 2. In the PL group, the clinical results were excellent for 12 patients, good for 14, fair for 6, and poor for 12. Conclusions: An anterolateral approach would be the optimal approach for an LCF in pediatric patients. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

• Predictors of Successful Treatment 1 Year After Arthroscopic Partial Meniscectomy: Data from the OME Cohort

  Thu, 01 Oct 2020 00:00:00 GMT-05:00
  Cleveland Clinic Sports Health

  Background: Arthroscopic partial meniscectomy (APM) is one of the most common orthopaedic procedures. Understanding factors that predict better patient-reported outcomes is important for guiding patient and clinician decision-making. The purpose of this study was to evaluate predictors of pain and function after APM in a large, multisite, academic health system cohort. Methods: We prospectively enrolled 665 patients who were ≥40 years of age and who had APM without any concomitant ligament or cartilage-resurfacing procedures. There were 486 subjects (73%) who completed baseline and follow-up questionnaires including demographic variables (age, sex, body mass index [BMI], education level), surgical findings (meniscal tear type, articular cartilage grade), and patient-reported outcomes (Knee injury and Osteoarthritis Outcome Score [KOOS] Pain, Physical Function Short Form [PS], and knee-related Quality of Life [QOL]; and Veterans RAND 12-Item [VR-12] Mental Component Score [MCS] and Physical Component Score [PCS]). We constructed multivariable statistical models to assess predictors of improvement in patient-reported outcomes, as well as a model to assess predictors of a successful improvement of at least 10 points in either KOOS Pain or KOOS-PS. Results: The mean age was 55 years, 46% of patients were female, and the mean BMI was 30 kg/m2. There were clinically important and significant improvements (p < 0.001) in all patient-reported outcomes from baseline to the 1-year follow-up. The following factors predicted less improvement in at least 1 patient-reported outcome: higher baseline score, higher BMI, older age, less education, current smoking, lower VR-12 MCS, prior ipsilateral surgical procedure, bipolar medial compartment cartilage lesions, and a lateral meniscal tear. Eighty-three percent of subjects had a successful improvement of 10 points in either KOOS Pain or KOOS-PS. The odds of successful improvement were lower in patients with a medial meniscal root tear, a lateral meniscal tear, or higher baseline KOOS Pain score. Conclusions: Eighty-three percent of patients improved by at least 10 points in pain and function after APM. Patients with a medial meniscal root tear or a lateral meniscal tear had decreased odds of a clinically important improvement in pain or function after APM. Increased BMI, smoking, and worse VR-12 MCS are potentially modifiable risk factors that predict less improvement after APM and warrant further study. Level of Evidence: Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.

• Application of a Customized Total Talar Prosthesis for Revision Total Ankle Arthroplasty

  Thu, 01 Oct 2020 00:00:00 GMT-05:00
  Morita, Shigeki; Taniguchi, Akira; Miyamoto, Takuma; Kurokawa, Hiroaki; Tanaka, Yasuhito

  Background: The rate of revision surgery for total ankle arthroplasty (TAA) is higher than for hip and knee arthroplasties. Tibiotalocalcaneal arthrodesis is widely used; however, it requires a large allograft. Thus, the use of a customized total talar prosthesis in combination with the tibial component of TAA (combined TAA) may be an effective strategy for talar component subsidence. This study aimed to evaluate the clinical and radiographic effectiveness of the combined TAA in such revision cases. Methods: Between 2000 and 2015, 10 patients (10 women; 10 ankles) were treated using the combined TAA for revision after standard TAA or combined procedures that included the use of a talar body prosthesis. In 6 patients, the tibial component was concurrently replaced. The median follow-up period was 49 months (interquartile range [IQR], 24.5 to 90 months). The Japanese Society for Surgery of the Foot (JSSF) ankle-hindfoot scale score, a numerical rating scale (NRS) pain score, passive range of motion of the ankle, and the presence of osteophytes and degenerative changes in the adjacent joints were assessed preoperatively and at final postoperative follow-up. Results: The median NRS pain score improved significantly, from 7 (IQR, 6.25 to 8.75) to 2 (IQR, 1 to 3). The median JSSF ankle-hindfoot scale total score improved significantly, from 64 (IQR, 56.25 to 71.5) to 88.5 (IQR, 79.75 to 96). In the subcategories of this scale, the median pain score improved from 20 (IQR, 20 to 27.5) to 35 (IQR, 30 to 40), and the median function score improved from 34 (IQR, 26.5 to 37) to 43.5 (IQR, 39.75 to 46). The median range of motion improved from 29° (IQR, 25.5° to 35°) to 35° (IQR, 31.25° to 43.75°). No significant difference in osteophyte formation was found. Degenerative changes in the adjacent joint were found only in the talonavicular joint. Conclusions: The combined TAA, used in revision for postoperative complications after standard TAA or combined procedures including the use of a talar body prosthesis, was associated with improved objective JSSF ankle-hindfoot scale scores, subjective pain assessment, and range of motion in the ankle. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

• A Novel Method for Accurate Preoperative Templating for Total Hip Arthroplasty Using a Biplanar Digital Radiographic (EOS) System

  Thu, 01 Oct 2020 00:00:00 GMT-05:00
  Huang, Jun; Zhu, Ye; Ma, Wenxia; Zhang, Zhigang; Shi, Weidong; Lin, Jun

  Background: Accurate preoperative planning for total hip arthroplasty (THA) relies on conventional anteroposterior radiographs. The difficulty of determining the magnification factor of radiographs is a major limitation. Despite the use of markers for calibration, identifying the plane of the hip joint is a major challenge. The aim of this study was to evaluate the accuracy of a novel method for image calibration and preoperative planning in THA involving the use of a biplanar radiographic (EOS imaging) system and a self-designed coin device. Methods: Biplanar radiographs (with the self-designed coin device) and a conventional anteroposterior radiograph (with a coin) were made for 26 patients after primary THA. The agreement between the actual and calculated diameters for each method was assessed using the concordance correlation coefficient (CCC) and Bland-Altman plots. In addition, 15 patients undergoing primary THA were prospectively enrolled to evaluate the EOS imaging-based method (EOS method), with biplanar radiographs made with use of the coin device. The accuracy of the preoperative predicted size of the implants was evaluated. Results: Both the EOS and conventional anteroposterior radiograph-based methods were reliable in repeated measurements of the diameter of the artificial femoral head in the reproducibility study, with the average CCCs for both methods >0.990. The agreement between the actual and EOS-based calculated diameters of the artificial femoral head was excellent, with a CCC of >0.990, while the agreement was poor between the actual and anteroposterior radiograph-based calculated diameters, with a CCC of <0.75. The EOS method exhibited a lower absolute difference (0.09 ± 0.07 mm) between the actual and calculated diameters compared with conventional anteroposterior radiography (1.26 ± 0.86 mm) (p < 0.001). EOS-based preoperative plans also exhibited excellent performance on the accuracy of the planning of the cups and stems; only 1 patient (6.7%) had a final implanted cup that differed by 1 size from the predicted size. Two patients (13.3%) had final implanted stems that differed by 1 size from the predicted size, and for 1 patient (6.7%), the stem size was off by ≥2 sizes. Conclusions: We describe a novel and easy-to-use method for the accurate calibration of radiographs and preoperative planning for THA. The EOS method evaluated in this study is an alternative method for preoperative planning in clinical practice.

• Anatomic Total Shoulder Arthroplasty with All-Polyethylene Glenoid Component for Primary Osteoarthritis with Glenoid Deficiencies

  Thu, 01 Oct 2020 00:00:00 GMT-05:00
  Matsen, Frederick A. III; Whitson, Anastasia J.; Somerson, Jeremy S.; Hsu, Jason E.

  Background: This study evaluated the ability of shoulder arthroplasty using a standard glenoid component to improve patient self-assessed comfort and function and to correct preoperative humeral-head decentering on the face of the glenoid in patients with primary glenohumeral arthritis and type-B2 or B3 glenoids. Methods: We identified 66 shoulders with type-B2 glenoids (n = 40) or type-B3 glenoids (n = 26) undergoing total shoulder arthroplasties with a non-augmented glenoid component inserted without attempting to normalize glenoid version and with clinical and radiographic follow-up that was a minimum of 2 years. The Simple Shoulder Test (SST), the percentage of humeral-head decentering on the glenoid face, and bone ingrowth into the central peg were the main outcome variables of interest. Similar analyses were made for concurrent patients with type-A1, A2, B1, and D glenoid pathoanatomy to determine if the outcomes for type-B2 and B3 glenoids were inferior to those for the other types. Results: The SST score (and standard deviation) improved from 3.2 ± 2.1 points preoperatively to 9.9 ± 2.4 points postoperatively (p < 0.001) at a mean time of 2.8 ± 1.2 years for type-B2 glenoids and from 3.0 ± 2.5 points preoperatively to 9.4 ± 2.1 points postoperatively (p < 0.001) at a mean time of 2.9 ± 1.5 years for type-B3 glenoids; these results were not inferior to those for shoulders with other glenoid types. Postoperative glenoid version was not significantly different (p > 0.05) from preoperative glenoid version. The mean humeral-head decentering on the glenoid face was reduced for type-B2 glenoids from −14% ± 7% preoperatively to −1% ± 2% postoperatively (p < 0.001) and for type-B3 glenoids from −4% ± 6% preoperatively to −1% ± 3% postoperatively (p = 0.027). The rates of bone integration into the central peg for type-B2 glenoids (83%) and type-B3 glenoids (81%) were not inferior to those for other glenoid types. Conclusions: Shoulder arthroplasty with a standard glenoid inserted without changing version can significantly improve patient comfort and function and consistently center the humeral head on the glenoid face in shoulders with type-B2 and B3 glenoids, achieving >80% osseous integration into the central peg. These clinical and radiographic outcomes for type-B2 and B3 glenoids were not inferior to those outcomes for other glenoid types. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

• The Impact of Patient Age on Foot and Ankle Arthrodesis Supplemented with Autograft or an Autograft Alternative (rhPDGF-BB/β-TCP)

  Thu, 01 Oct 2020 00:00:00 GMT-05:00
  Berlet, Gregory C.; Baumhauer, Judith F.; Glazebrook, Mark; Haddad, Steven L.; Younger, Alastair; Quiton, Jovelyn D.; Fitch, David A.; Daniels, Timothy R.; DiGiovanni, Christopher W.

  Background: A recent survey of orthopaedic surgeons asking about risk factors for nonunion following foot and ankle arthrodesis revealed that patient age is considered to be a relatively low risk factor, despite the potential for autologous graft quality to deteriorate with increasing age. The purpose of the current study was to evaluate the impact of patient age and graft type on fusion rates following hindfoot and ankle arthrodesis. Methods: In this study, we analyzed data from a previously published clinical trial, comparing fusion success in 397 subjects who underwent hindfoot or ankle arthrodesis (597 joints) supplemented with either autograft or an osteoinductive autograft alternative, recombinant human platelet-derived growth factor-BB homodimer carried in beta-tricalcium phosphate (rhPDGF-BB/β-TCP). The odds of fusion success were compared among subjects older or younger than age thresholds of 55, 60, 65, 70, and 75 years. The odds of fusion success were also compared between autograft and rhPDGF-BB/β-TCP among subjects older than each age threshold. Results: In the autograft group, the joints of subjects who were younger than the age thresholds of 60 and 65 years had >2 times the odds of successful fusion compared with those of older subjects. There was no significant difference in the odds of fusion success between the older and younger subjects at the age threshold of 55 years. In the rhPDGF-BB/β-TCP group, there was no significant difference in the odds of successful fusion between older and younger subjects at any age threshold. When the odds of fusion success were compared between the 2 graft materials in subjects who were older than each age threshold, rhPDGF-BB/β-TCP had approximately 2 times the odds of fusion success compared with autograft for all thresholds, except 55 years. Conclusions: The presented evidence suggests that age is an identifiable and concerning risk factor for hindfoot and ankle arthrodesis nonunion, a finding in contrast to the wider perception in the surgeon community. Notably, patients ≥60 years of age had significantly lower odds of fusion success with the use of autograft. The data reveal that use of rhPDGF-BB/β-TCP as an alternative bone-healing adjunct may help mitigate the risk of nonunion when these procedures are performed in the elderly population. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

• Elective Orthopaedic Surgery During COVID-19: A Safe Way to Get Back on Track

  Thu, 01 Oct 2020 00:00:00 GMT-05:00
  Zorzi, Claudio; Piovan, Gianluca; Screpis, Daniele; Natali, Simone; Marocco, Stefania; Iacono, Venanzio

  Background: The novel coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has greatly changed our way of living and working. We have developed a method to treat urgent patients in a safe way, and we applied the same protocol to resume elective surgical procedures. Methods: We reorganized the system and the management of our orthopaedic department to perform elective surgical procedures in a safe way. During the COVID-19 lockdown, 614 patients underwent elective orthopaedic procedures. Results: No major postoperative complications were recorded. None of the orthopaedic surgeons, health-care personnel, or hospitalized patients was infected in this period of activity. Conclusions: During COVID-19, it is possible to perform elective surgical procedures in a safe way.

• Mortality in Patients with Proximal Femoral Fracture During the COVID-19 Pandemic: A U.K. Hospital's Experience

  Thu, 01 Oct 2020 00:00:00 GMT-05:00
  Mamarelis, Georgios; Oduoza, Uche; Chekuri, Ravi; Estfan, Rami; Greer, Tony

  Background: Coronavirus disease 2019 (COVID-19) is a worldwide pandemic, with a case mortality ratio of approximately 6.4% at the time of writing (May 2020). Mortality increases in elderly patients with comorbidities. Patients with hip fracture have an average age of 80 years, with an estimated 2.8 comorbidities per patient. Evidence is lacking regarding the mortality rate of patients with hip fracture admitted during the COVID-19 pandemic. Our aim was to investigate the mortality rate among patients with a proximal femoral fracture who were admitted to our hospital during the COVID-19 pandemic. Methods: We conducted a retrospective review of all patients with a proximal femoral fracture admitted to Southend University Hospital in the U.K. from March to April 2020 (during the COVID-19 pandemic). Data collected included demographics (patient age, body mass index, sex), comorbidities, and blood test values along with COVID-19 diagnosis (based on positive microbiological sample and clinical and radiographic findings) and operative characteristics (time to operation, length of stay, American Society of Anesthesiologists [ASA] classification, Nottingham Hip Fracture Score). The primary outcome was the 30-day mortality rate for patients with a hip fracture who were COVID-19 positive or negative. Kaplan-Meier survival analysis was conducted along with Mann-Whitney U tests and Fisher exact tests. Results: Forty-one patients were included in the study, of whom 37 had an available SARS-CoV-2 (severe acute respiratory syndrome-coronavirus 2) swab test result. The overall 30-day mortality was 22%. Eleven patients tested positive for COVID-19. There was a significant difference in the mortality rate between those who tested positive and those who tested negative (54.5% versus 7.69%, respectively; Fisher exact test, p = 0.004) and between the operative patients who tested positive and the operative patients who tested negative (37.5% versus 4.34%, respectively; Fisher exact test, p = 0.043). Conclusions: Patients with a proximal femoral fracture may be at higher risk for mortality during the COVID-19 pandemic. We noted that patients with a proximal femoral fracture who tested positive for COVID-19 had a higher 30-day mortality rate compared with those who tested negative. Additional research is required to ascertain the benefits of a reduction in time to operation. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

• Combined Transfer of the Gluteus Maximus and Tensor Fasciae Latae for Irreparable Gluteus Medius Tear Using Contemporary Techniques: Short-Term Outcomes

  Thu, 01 Oct 2020 00:00:00 GMT-05:00
  Maldonado, David R.; Annin, Shawn; Chen, Jeffrey W.; Yelton, Mitchell J.; Shapira, Jacob; Rosinsky, Philip J.; Lall, Ajay C.; Domb, Benjamin G.

  Background: Combined transfer of the gluteus maximus and tensor fasciae latae (TFL) has been acknowledged as a treatment for irreparable full-thickness gluteus medius tears; yet, there is a paucity of reports on outcomes for this topic in the current literature. The purpose of the present study was to report short-term patient-reported outcome scores in patients who underwent combined transfer of the gluteus maximus and TFL in the setting of an irreparable gluteus medius tear. Methods: Data for patients who underwent hip preservation and hip arthroplasty between July 2011 and November 2017 were prospectively collected and retrospectively reviewed. Patients were considered for this study if they had undergone combined transfer of the gluteus maximus and TFL for irreparable gluteus medius tears. Inclusion criteria consisted of patients who had a minimum 1-year follow-up for the modified Harris hip score, Non-Arthritic Hip Score, Hip Outcome Score Sports Specific Subscale, visual analog scale score for pain, and patient satisfaction. The exclusion criterion was Workers' Compensation status. Results: The study included 18 hips in 18 patients who underwent combined transfer of the gluteus maximus and TFL, with a mean follow-up of 39.75 months (range, 12.04 to 93.88 months). The average age was 68.48 ± 11.05 years, the average body mass index was 29.54 ± 6.23 kg/m2, and 13 patients were female. Abductor strength improved in 7 of 17 patients, with abduction data unavailable for 1 patient. Significant improvements were observed in modified Harris hip score from 49.73 ± 16.85 to 74.94 ± 17.91 (p < 0.001), Non-Arthritic Hip Score from 55.02 ± 22.53 to 72.78 ± 19.17 (p = 0.032), and visual analog scale for pain from 5.42 ± 3.42 to 1.57 ± 1.68 (p = 0.0004). No secondary surgeries were reported. Conclusions: Significant improvements in patient-reported outcomes were observed in patients who underwent combined transfer of the gluteus maximus and TFL for the treatment of irreparable full-thickness gluteus medius tears at short-term follow-up. Level of Evidence: Level IV. See Instructions for Authors for a complete description of levels of evidence.

• Preoperative Skin Cultures Predict Periprosthetic Infections in Revised Shoulder Arthroplasties: A Preliminary Report

  Thu, 01 Oct 2020 00:00:00 GMT-05:00
  Matsen, Frederick A. III; Whitson, Anastasia; Hsu, Jason E.

  Background: Current approaches do not provide a practical method for the accurate prediction of a Cutibacterium periprosthetic joint infection (PJI) in failed arthroplasties. Thus, surgeons revising failed arthroplasties must decide whether to exchange the implants and to institute antibiotic treatment without knowing the results of cultures of deep specimens obtained at the revision procedure. This study tests the hypothesis that the results of preoperative culture specimens of the skin surface obtained in the clinic can predict the presence of culture-positive Cutibacterium PJIs. Methods: Revision shoulder arthroplasties performed between October 3, 2017, and February 4, 2020, that had both preoperative clinic culture specimens and surgical culture specimens were included in this analysis. Culture results were assigned a value from 0 to 4. The percentage of the total skin bacterial load contributed by Cutibacterium (Cutibacterium percentage) was determined. To reduce concern about contamination, a robust criterion for culture-positive Cutibacterium PJI was applied: ≥2 surgical specimens with a Cutibacterium value of ≥1. The predictive values for a culture-positive Cutibacterium PJI were determined for a clinic skin culture Cutibacterium value of >1 and a clinic skin percentage of Cutibacterium of ≥75%. Results: Eighteen cases met the inclusion criteria; of these, 7 (6 male patients) met our criterion for a culture-positive Cutibacterium PJI. For all patients, a preoperative clinic skin Cutibacterium value of >1 predicted the presence of a culture-positive Cutibacterium PJI with an accuracy of 89%, and a clinic skin Cutibacterium percentage of ≥75% predicted the presence of a culture-positive Cutibacterium PJI with an accuracy of 94%. For male patients, a preoperative clinic skin Cutibacterium value of >1 predicted the presence of a culture-positive Cutibacterium PJI with an accuracy of 91%, and a clinic skin Cutibacterium percentage of ≥75% predicted the presence of a culture-positive Cutibacterium PJI with an accuracy of 100%. Conclusions: A simple culture specimen of the unprepared skin surface obtained in a clinic prior to revision shoulder arthroplasty may provide valuable assistance to surgeons planning a revision arthroplasty. Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

• Surgical Approach to Total Hip Arthroplasty Affects the Organism Profile of Early Periprosthetic Joint Infections

  Thu, 01 Oct 2020 00:00:00 GMT-05:00
  Buchalter, Daniel B.; Teo, Greg M.; Kirby, David J.; Aggarwal, Vinay K.; Long, William J.

  Background: The optimal approach for total hip arthroplasty (THA) remains hotly debated. While wound complications following the direct anterior approach are higher than with other approaches, the organism profile of periprosthetic joint infections (PJIs) by approach remains unknown. Our goal was to compare the organism profiles of PJIs following direct anterior and non-anterior THA. Methods: We retrospectively reviewed 12,549 primary THAs (4,515 direct anterior and 8,034 non-anterior) that had been performed between January 2012 and September 2019 at a university-affiliated single-specialty orthopaedic hospital to identify patients with an early postoperative PJI. Criteria used for the diagnosis of a PJI were the National Healthcare Safety Network, which screens for PJI that occurs within 90 days of index arthroplasty, and the Musculoskeletal Infection Society guidelines. Patient demographic information and organism characteristics were recorded for analysis. Results: We identified 84 patients (38 who underwent the direct anterior approach and 46 who underwent the non-anterior approach) with an early postoperative PJI following primary THA (0.67% total THA PJI rate, 0.84% direct anterior THA PJI rate, and 0.57% non-anterior THA PJI rate). The direct anterior THA cohort had a significantly lower body mass index and American Society of Anesthesiologists score than the non-anterior THA cohort (29.5 versus 35.2 kg/m2, p < 0.0001; 2.29 versus 2.63, p = 0.016, respectively). Regarding organism profile, patients in the direct anterior THA cohort had significantly more monomicrobial gram-negative infections than the non-anterior THA cohort (4 versus 0, p = 0.038). We did not identify any demographic risk factors other than approach for gram-negative PJI. There were no significant differences in methicillin-resistant Staphylococcus aureus, methicillin-sensitive Staphylococcus aureus, coagulase-negative Staphylococcus, obligate anaerobes, polymicrobial, or PJIs due to other organisms by approach. Conclusions: Direct anterior THA approaches have a greater risk of monomicrobial gram-negative PJI, likely due to the unique microbiome of the inguinal region. While targeted infection prophylaxis may reduce these infections, it is not entirely effective on its own. Future studies with larger sample sizes are required to help us develop more targeted perioperative infection prophylaxis. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

• Exchange of Modular Components Improves Success of Debridement, Antibiotics, and Implant Retention: An Observational Study of 575 Patients with Infection After Primary Total Hip Arthroplasty

  Thu, 01 Oct 2020 00:00:00 GMT-05:00
  Svensson, Karin; Rolfson, Ola; Nauclér, Emma; Lazarinis, Stergios; Sköldenberg, Olof; Schilcher, Jörg; Johanson, Per-Erik; Mohaddes, Maziar; Kärrholm, Johan

  Background: Debridement, antibiotics, and implant retention (DAIR) is a surgical treatment for periprosthetic joint infection (PJI). DAIR is a desirable treatment option from an economic and patient perspective, if successful. The aim of this observational study was to compare the rates of success, defined as no additional reoperations due to PJI, between DAIR with exchange of modular components and DAIR without exchange in patients who had first-time PJI after primary total hip arthroplasty (THA). Methods: Patients with PJI at the site of a primary THA who were treated with DAIR in Sweden between January 1, 2009, and December 31, 2016, were identified in the Swedish Hip Arthroplasty Register. Supplementary questionnaires were sent to orthopaedic departments for additional variables of interest related to PJI. The primary end point was another reoperation due to PJI within 2 years after the first-time DAIR. DAIR with exchange was compared with DAIR without exchange using Kaplan-Meier survival analysis and Cox regression analysis. Results: A total of 575 patients treated with DAIR for a first-time PJI at the site of a primary THA were analyzed; 364 underwent component exchange and 211 did not. The exchange of components was associated with a lower rate of reoperations due to PJI after DAIR (28.0%) compared with non-exchange (44.1%). The Kaplan-Meier implant survival estimate for exchange was 71.4% (95% confidence interval [CI] = 66.9% to 76.3%) compared with 55.5% (95% CI = 49.1% to 62.7%) for non-exchange. With the analysis adjusted for confounders, DAIR with exchange was associated with a significantly decreased risk of another reoperation due to PJI compared with non-exchange (hazard ratio [HR] = 0.51 [95% CI = 0.38 to 0.68]). Conclusions: In patients with a first-time PJI at the site of a primary THA, DAIR with exchange of modular components was superior to non-exchange DAIR. Surgeons should strive to exchange components when they perform DAIR, but there is a need to further identify how DAIR best should be practiced and which patients benefit from it. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

• The Use of Porous Titanium Coating and the Largest Possible Head Do Not Affect Early Cup Fixation: A 2-Year Report from a Randomized Controlled Trial

  Thu, 01 Oct 2020 00:00:00 GMT-05:00
  Tsikandylakis, Georgios; Mortensen, Kristian R.L.; Gromov, Kirill; Troelsen, Anders; Malchau, Henrik; Mohaddes, Maziar

  Background: Cups are more frequently revised than stems after uncemented total hip arthroplasty, which warrants the development of cup surfaces that provide long-lasting, stable fixation. Large heads have become popular with the aim of reducing dislocation rates, but they generate greater frictional torque that may compromise cup fixation. We aimed to investigate (1) if a novel porous titanium surface provides superior cup fixation when compared with a porous plasma spray (PPS) surface and (2) if the use of the largest possible head compromises cup fixation when compared with a 32-mm head. Methods: Ninety-six patients were randomized to receive either a cup with a porous titanium coating (PTC) or a cup with PPS. A second randomization was performed to either the largest possible (36 to 44-mm) or a 32-mm head in metal-on-vitamin-E-infused polyethylene bearings. Roentgen stereophotogrammetric analysis (RSA) examinations were obtained postoperatively at 3, 12, and 24 months. The primary outcome was proximal cup migration when comparing the 2 cup surfaces and also when comparing the largest possible head with the 32-mm head. The patients were followed for 2 years. Results: The median (and interquartile range) proximal cup migration was 0.15 mm (0.02 to 0.32 mm) for the PTC cup and 0.21 mm (0.11 to 0.34 mm) for the PPS cup. The largest possible head had a proximal cup migration of 0.15 mm (0.09 to 0.31 mm), and the 32-mm head had a proximal cup migration of 0.20 mm (0.04 to 0.35 mm). There were no significant differences between the cup surface (p = 0.378) or the head size (p = 0.693) groups. Conclusions: Early cup fixation was not superior with the novel PTC cup; the use of the largest possible head (36 to 44 mm) did not compromise early cup fixation. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

• The Effect of Body Mass Index Class on Patient-Reported Health-Related Quality of Life Before and After Total Hip Arthroplasty for Osteoarthritis: Registry-Based Cohort Study of 64,055 Patients

  Thu, 01 Oct 2020 00:00:00 GMT-05:00
  Mukka, Sebastian; Rolfson, Ola; Mohaddes, Maziar; Sayed-Noor, Arkan

  Background: Overweight status and obesity represent a global epidemic, with serious consequences at the individual and community levels. The number of total hip arthroplasties (THAs) among overweight and obese patients is expected to rise. Increasing body mass index (BMI) has been associated with a higher risk of mortality and reoperation and lower implant survival. The evaluation of perioperative health-related quality of life (HRQoL) has recently gained importance because of its direct relation to, and impact on, patients' physical, mental, and social well-being as well as health-service utilization. We sought to evaluate the influence of BMI class on HRQoL preoperatively and at 1 year following THA in a register-based cohort study. Methods: This observational cohort study was designed and conducted on the basis of registry data derived from the Swedish Hip Arthroplasty Register (SHAR) and included 64,055 primary THAs registered between January 1, 2008, and December 31, 2015. Patients' baseline preoperative and 1-year postoperative EuroQol-5 Dimension-3 Level (EQ-5D-3L) responses were documented by the treating department and reported to the SHAR through the patient-reported outcome measures program. The EQ-5D-3L includes a visual analogue scale (EQ VAS), which measures the patient's overall health status. Results: At 1 year of follow-up, all BMI classes showed significant and clinically relevant improvements in all HRQoL measures compared with preoperative assessment (p < 0.05). Patients reported improved perception of current overall health status for the EQ VAS. Underweight, overweight, and all obesity classes showed increasingly worse 1-year HRQoL compared with normal weight, both with unadjusted and adjusted calculations. Conclusions: In this study, we found that all BMI classes had significant improvement in HRQoL at 1 year following THA. Patients who were underweight, overweight, or obese (classes I to III), compared with those of normal weight, reported worse hip pain and EQ-5D-3L and EQ VAS responses prior to THA and at 1 year postoperatively. These results can assist both health-care providers and patients in establishing reasonable expectations about THA outcomes. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

• Epiphyseal Angulation and Related Spatial Orientation in Slipped Capital Femoral Epiphysis: Theoretical Model and Biomechanical Explanation of Varus and Valgus Slip

  Thu, 01 Oct 2020 00:00:00 GMT-05:00
  Gautier, Emanuel; Passaplan, Caroline; Gautier, Lucienne

  Background: The management of slipped capital femoral epiphysis (SCFE) is controversial. Surgical decision-making is based regularly on the chronicity, stability, and severity of the slip. The purpose of this study was to determine the true angulation and spatial orientation of the epiphysis in hips with SCFE and contralateral hips. Methods: Eighteen hips in 18 patients with SCFE were included in the analysis. Trigonometric calculations, based on angle measurements using 2 conventional radiographs in planes that are perpendicular to each other, were used to determine the angulation of the epiphysis and its orientation in space. Results: The mean absolute epiphyseal obliquity of the SCFE hips was 56.2° and the spatial orientation was 36.5°. The mean obliquity of the contralateral side was 34.0°, with a related spatial orientation of 16.8°. The maximum error can reach up to 9.9° (or 41%) when comparing the calculated angles with the angle measurements on radiographs. Conclusions: On standard radiographs, the epiphyseal angulation in SCFE is consistently underestimated. As a consequence, the assigned classification of some patients may be 1 severity group too low, which impacts the value of traditional severity classification for surgical decision-making. The analysis of the spatial orientation of the slip with the concomitant direction of the resultant shear can partially explain varus and valgus slip in SCFE. Level of Evidence: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

• Nonoperative Treatment of Anterior Glenoid Rim Fractures After First-Time Traumatic Anterior Shoulder Dislocation: A Study with 9-Year Follow-up

  Thu, 01 Oct 2020 00:00:00 GMT-05:00
  Wieser, Karl; Waltenspül, Manuel; Ernstbrunner, Lukas; Ammann, Elias; Nieuwland, Arend; Eid, Karim; Gerber, Christian

  Background: Primary traumatic anterior shoulder dislocations can be associated with displaced anterior glenoid rim fractures. Nonoperative treatment of such fractures has been shown to have excellent results in a small cohort of patients; as such, we have been treating these fractures nonoperatively, regardless of fragment size and degree of displacement, provided that post-reduction computed tomography scans revealed an anteroposteriorly centered humeral head. The aim of this study was to analyze the medium- to long-term results of nonoperative treatment of displaced anterior glenoid rim fractures, assessing in particular the residual instability and development of osteoarthritis. Methods: In a 2-center study, 30 patients with a mean age of 48 years (range, 29 to 67 years) were evaluated clinically with use of the Subjective Shoulder Value, Constant score, American Shoulder and Elbow Surgeons score, and Western Ontario Shoulder Instability index, as well as radiographically with use of radiographs and computed tomography scans at a mean follow-up of 9 years (range, 5 to 14 years). Results: Fracture-healing was documented in all patients. Seven patients (23%) had post-fracture onset of osteoarthritis (5 with Samilson grade I and 2 with Samilson grade IV). Of these, 1 patient had recurrent instability that was successfully treated with hemiarthroplasty 9 years after the index injury (relative Constant score, 101%), and was excluded from further analysis. No other patient had a recurrent redislocation, subluxation, or positive apprehension. The other 6 patients with new-onset radiographic osteoarthritis were pain-free (mean Constant score pain scale, 15 points) with good shoulder function (relative Constant score, 84% to 108%). A total of 26 patients (90%) rated their functional outcome as good or very good, and 3 patients (10%) rated it as fair. The mean relative Constant score was 97% (range, 61% to 108%), the mean American Shoulder and Elbow Surgeons score was 92 points (range, 56 to 100 points), and the mean Western Ontario Shoulder Instability index score was 126 points (range, 0 to 660 points). All patients returned to full-time work. Conclusions: Nonoperative treatment of anterior glenoid rim fractures following primary traumatic anterior shoulder dislocation results in excellent clinical outcomes with a very low rate of residual instability and, thus, treatment failure. Asymptomatic radiographic osteoarthritis occurred in roughly 1 of 4 patients. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

• Motorized Internal Limb-Lengthening (MILL) Techniques Are Superior to Alternative Limb-Lengthening Techniques: A Systematic Review and Meta-Analysis of the Literature

  Thu, 01 Oct 2020 00:00:00 GMT-05:00
  Sheridan, Gerard A.; Falk, David P.; Fragomen, Austin T.; Rozbruch, S. Robert

  Background: The field of limb lengthening has undergone substantial advancement in recent years with respect to the subjective patient experience, the rate of surgical complications, and the time required to achieve regenerate consolidation. We aimed to assess the performance of motorized internal limb lengthening (MILL) devices when compared with alternative methods of limb lengthening through systematic review and meta-analysis. Methods: Studies comparing MILL methods with alternative forms of limb lengthening were included for systematic review. Medical Subject Headings (MeSH) terms, specifically "PRECICE," "STRYDE," "FITBONE," "limb lengthening," "Ilizarov," "distraction osteogenesis," and "motorized internal limb lengthening," were used to search a number of electronic bibliographic databases, including PubMed, the International Clinical Trials Registry Platform (World Health Organization), the Cochrane Library, ClinicalTrials.gov, and the EU Clinical Trials Register. The primary outcome measures were time to union and total length (centimeters) achieved. Kaplan-Meier survivorship curves were generated, and the 2-sample t test with equal variances was utilized to compare groups. Secondary outcomes including problems, obstacles, and sequelae were compared using a random-effects meta-analysis. To detect any evidence of publication bias, the Egger test for small-study effects was used. A number of bone-healing indices, when reported, were compared between groups. Results: A total of 143 limbs were lengthened using MILL techniques. These were compared with 98 limbs that were lengthened with the use of alternative techniques. The MILL cohort was found to have significantly fewer problems (p < 0.001; relative risk [RR] = 0.31; 95% confidence interval [CI], 0.19 to 0.52) and sequelae (p = 0.002; RR = 0.57; 95% CI, 0.40 to 0.81) on random-effects meta-analysis. Both deep and superficial infectious complications were fewer for MILL procedures across all of the studies. Conclusions: MILL is associated with fewer complications than alternative methods of limb lengthening. Because of the advancements in the field of limb lengthening toward fully implantable remote-controlled internal limb-lengthening devices, MILL techniques are likely to dominate the field of limb lengthening in the foreseeable future. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

• In-Bundle Surgeons More Likely Select Cemented Femoral Fixation in Total Hip Arthroplasty for At-Risk Patients: The Medicare Comprehensive Care for Joint Replacement Bundled Model

  Thu, 01 Oct 2020 00:00:00 GMT-05:00
  Edelstein, Adam I.; Hume, Eric L.; Pezzin, Liliana E.; McGinley, Emily L.; Dillingham, Timothy R.

  Background: Bundled payment models for lower-extremity arthroplasty have been shown to lower costs but have not reliably improved quality. It is unknown how the bundled payment model may affect surgeons' decisions that impact the quality of arthroplasty care. The purpose of this study was to compare the utilization of femoral component fixation modes by surgeons performing total hip arthroplasties (THAs) in at-risk patients in areas subject to Medicare's Comprehensive Care for Joint Replacement (CJR) bundled payment model compared with patients treated by surgeons in areas exempt from the policy. Methods: Elective, primary THAs among elderly persons were identified from Medicare claims during 2017 and 2018, including the use of cemented or cementless femoral fixation. Multivariable regression models, applied to samples stratified by sex, were used to assess the association between CJR bundle participation and the use of femoral fixation mode. Analyses were adjusted for patient age, race or ethnicity, comorbidity burden, low-income status, and Census division of the hospital. Results: Of 118,676 Medicare patients who underwent THA, 9.1% received cemented femoral components, and use of cement varied significantly by geographic region (p < 0.001). Patients who received cemented fixation, compared with patients who received cementless fixation, had significant differences in mean age (and standard deviation) at 78.3 ± 6.9 years compared with 74.5 ± 6.1 years (p < 0.001) for female patients and 77.3 ± 6.8 years and 74.2 ± 5.9 years (p < 0.001) for male patients; were more likely to be White at 94.0% compared with 92.7% (p < 0.001) for female patients and 95.1% compared with 93.8% (p = 0.046) for male patients; and had higher mean Elixhauser comorbidity index at 2.6 ± 2.2 compared with 2.3 ± 2.0 (p < 0.001) for female patients and 2.8 ± 2.4 compared with 2.4 ± 2.1 (p < 0.001) for male patients. In adjusted analyses, female patients in the CJR bundled payment model were more likely to have cemented fixation compared with female patients not in the CJR model (odds ratio [OR], 1.11 [95% confidence interval (CI), 1.05 to 1.16]; p < 0.001), whereas male patients in the CJR bundled payment model were less likely to have cemented fixation compared with male patients not in the CJR model (OR, 0.91 [95% CI, 0.83 to 0.99]; p = 0.029). Conclusions: In the bundled environment, surgeons were more likely to choose cemented femoral fixation for elderly female patients. This may be due to in-bundle surgeons being more risk-averse and avoiding cementless fixation in patients at risk for fracture or implant-related complications. Further research is needed to directly examine the impact of the bundle on surgeon decision-making.

• Failure Rates of Autograft and Allograft ACL Reconstruction in Patients 19 Years of Age and Younger: A Systematic Review and Meta-Analysis

  Thu, 01 Oct 2020 00:00:00 GMT-05:00
  Cruz, Aristides I. Jr.; Beck, Jennifer J.; Ellington, Matthew D.; Mayer, Stephanie W.; Pennock, Andrew T.; Stinson, Zachary S.; VandenBerg, Curtis D.; Barrow, Brooke; Gao, Burke; Ellis, Henry B. Jr.

  Background: Graft choice for pediatric anterior cruciate ligament reconstruction (ACLR) is determined by several factors. There is limited information on the use and outcomes of allograft ACLR in pediatric patients. The purpose of this systematic review and meta-analysis was to quantify reported failure rates of allograft versus autograft ACLR in patients ≤19 years of age with ≥2 years of follow-up. We hypothesized that there would be higher rates of failure for allograft compared with autograft ACLR in this population. Methods: PubMed/MEDLINE and Embase databases were systematically searched for literature regarding allograft and autograft ACLR in pediatric/adolescent patients. Articles were included if they described a cohort of patients with average age of ≤19 years, had a minimum of 2 years of follow-up, described graft failure as an outcome, and had a Level of Evidence grade of I to III. Qualitative review and quantitative meta-analysis were performed to compare graft failure rates. A random-effects model was created to compare failure events in patients receiving allograft versus autograft in a pairwise fashion. Data analysis was completed using RevMan 5.3 software (The Cochrane Collaboration). Results: The database search identified 1,604 studies; 203 full-text articles were assessed for eligibility. Fourteen studies met the inclusion criteria for qualitative review; 5 studies were included for quantitative meta-analysis. Bone-patellar tendon-bone (BTB) represented 58.2% (n = 1,012) of the autografts, and hamstring grafts represented 41.8% (n = 727). Hybrid allografts (autograft + supplemental allograft) represented 12.8% (n = 18) of all allograft ACLRs (n = 141). The unweighted, pooled failure rate for each graft type was 8.5% for BTB, 16.6% for hamstring, and 25.5% for allograft. Allografts were significantly more likely than autografts to result in graft failure (odds ratio, 3.87; 95% confidence interval, 2.24 to 6.69). Conclusions: Allograft ACLR in pediatric and adolescent patients should be used judiciously, as existing studies revealed a significantly higher failure rate for allograft compared with autograft ACLR in this patient population. Additional studies are needed to improve the understanding of variables associated with the high ACLR failure rate among pediatric and adolescent patients. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

• Restructuring of an Orthopaedic Surgery Residency Research Rotation Correlates with Increased Academic Productivity in Teaching Faculty

  Thu, 01 Oct 2020 00:00:00 GMT-05:00
  Granger, Caroline J.; Rothy, Alexander; Nigh, Evan; Hernandez, Victor H.; Baraga, Michael; Conway, Sheila Ann

  Introduction: Contribution toward clinical research is paramount to the education of physician trainees and is required by the Accreditation Council for Graduate Medical Education. From 1987 through 2015, our single institution orthopaedic surgery residency research experience included 2 dedicated research rotations. Because few resident projects were pursued to completion, feedback was used to restructure the curriculum, including the appointment of 2 clinical orthopaedic faculty to serve as codirectors, development of a revised curriculum, use of research teams, and a centralized research database. Our group previously displayed increased resident productivity within 2 years after the 2015 implementation. The aim of this study was to investigate the impact of orthopaedic residency curricular changes on scholarly activity of orthopaedic teaching faculty. Methods: The curriculum vitae (CVs) of a single institution's orthopaedic teaching faculty were collected and retrospectively reviewed from 2014 through 2018 to determine academic productivity of clinical faculty. Indicators of academic productivity included peer-reviewed publications (including journal impact factors) and podium or poster presentations. Results: Twenty-three of 27 faculty members responded to our request for CVs. One hundred three CVs were reviewed on 23 faculty. All academic indicators increased over 5 years. Multivariate analysis of variance (MANOVA) using a multivariate repeated measures analysis was completed. A sphericity χ2 test was violated for all measures, precluding us from using unadjusted univariate analysis. Univariate MANOVA with repeated measures displays significance regarding impact factor (f < 0.02, p < 0.05) and journal publications (f < 0.004, p < 0.05). Subsequent multivariate analysis shows similar results regarding impact factor (f < 0.0008), journal publications (0.0005), and poster presentations (f < 0.016). Conclusions: Improved structure of an established resident research rotation combined with enhanced faculty mentorship resulted in a significant increase in academic productivity for clinical teaching faculty of the department of orthopaedic surgery. This increase parallels that seen in orthopaedic resident research productivity; indicating a positive impact on teaching faculty scholarly activity. Level of Evidence: III.

• The Content and Accessibility of Orthopaedic Residency Program Websites

  Thu, 01 Oct 2020 00:00:00 GMT-05:00
  Sherman, Nathan C.; C. Sorenson, Jacob; M. Khwaja, Ansab; L. DeSilva, Gregory

  Background: Applicants to orthopaedic surgery residency programs face a competitive match. Internet resources such as program websites allow prospective applicants to gauge interest in particular programs. This study evaluated the content and accessibility of orthopaedic surgery residency program websites. Methods: Existing orthopaedic surgery residency programs for the 2020 application cycle were identified on the Electronic Residency Application Service (ERAS) website. Individual program websites were accessed through links directly from the ERAS website, and a Google search for each program was performed to corroborate accessibility. Programs websites were then reviewed and evaluated on the presence of 20 criteria selected for their potential to influence resident recruitment (10) and education (10), respectively. The results were compared with the lone 2001 study and with orthopaedic fellowship website analyses. Results: One hundred eighty-nine orthopaedic surgery residency programs were accredited at the time of the study. Only 6 programs (3.2%) did not have a website identifiable through ERAS or Google searches, leaving a final sample size of 183 websites. Approximately 73.3% of all recruitment content and 44.9% of education content were present on the websites available. There was a significant increase in all available recruitment and education content (p < 0.05) when compared with the lone 2001 study. Orthopaedic residency program websites provide comparable recruitment content at a higher rate (71.1%) than orthopaedic fellowship websites (59.6%) but fall slightly below average in presentation of education content (44.9% vs 45.9%). Conclusion: This is the first study in nearly 20 years to assess the content and accessibility of orthopaedic residency program websites. There is noticeable variability in the presentation of website content, but approximately 73.3% of recruitment content and 44.9% of the educational content were easily accessible through internet search. Orthopaedic surgery residency programs and their applicants may benefit from standardization of program websites and an increase in recruitment and education content.

• Use of the Behavior Assessment Tool in 18 Pilot Residency Programs

  Thu, 01 Oct 2020 00:00:00 GMT-05:00
  Armstrong, April D.; Agel, Julie; Beal, Matthew D.; Bednar, Michael S.; Caird, Michelle S.; Carpenter, James E.; Guthrie, Stuart T.; Juliano, Paul; Karam, Matthew; LaPorte, Dawn; Marsh, J. Lawrence; Patt, Joshua C.; Peabody, Terrance D.; Wu, Karen; Martin, David F.; Harrast, John J.; Van Heest, Ann E.

  Background: The purpose of this study was to determine the feasibility and evaluate the effectiveness of the American Board of Orthopaedic Surgery Behavior Tool (ABOSBT) for measuring professionalism. Methods: Through collaboration between the American Board of Orthopaedic Surgery and American Orthopaedic Association's Council of Residency Directors, 18 residency programs piloted the use of the ABOSBT. Residents requested assessments from faculty at the end of their clinical rotations, and a 360° request was performed near the end of the academic year. Program Directors (PDs) rated individual resident professionalism (based on historical observation) at the outset of the study, for comparison to the ABOSBT results. Results: Nine thousand eight hundred ninety-two evaluations were completed using the ABOSBT for 449 different residents by 1,012 evaluators. 97.6% of all evaluations were scored level 4 or 5 (high levels of professional behavior) across all of the 5 domains. In total, 2.4% of all evaluations scored level 3 or below reflecting poorer performance. Of 431 residents, the ABOSBT identified 26 of 32 residents who were low performers (2 or more < level 3 scores in a domain) and who also scored "below expectations" by the PD at the start of the pilot project (81% sensitivity and 57% specificity), including 13 of these residents scoring poorly in all 5 domains. Evaluators found the ABOSBT was easy to use (96%) and that it was an effective tool to assess resident professional behavior (81%). Conclusions: The ABOSBT was able to identify 2.4% low score evaluations (

• Applicant Fit and Diversity in the Orthopaedic Surgery Residency Selection Process: Defining and Melding to Create a More Diverse and Stronger Residency Program

  Thu, 01 Oct 2020 00:00:00 GMT-05:00
  Modest, Jacob M.; Cruz, Aristides I. Jr; Daniels, Alan H.; Lemme, Nicholas J.; Eberson, Craig P.

  No abstract available

  

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