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Journal of Bone & Joint Surgery
Journal Prestige (SJR): 2.722
Citation Impact (citeScore): 4
Number of Followers: 197  
  Full-text available via subscription Subscription journal
ISSN (Print) 0021-9355 - ISSN (Online) 1535-1386
Published by Journal of Bone and Joint Surgery Homepage  [4 journals]
  • JBJS: Enrichment, Connection, and Engagement
    • Authors: Swiontkowski; Marc
      Abstract: imageNo abstract available
      PubDate: Wed, 18 Mar 2020 00:00:00 GMT-
  • What’s New in Hand and Wrist Surgery
    • Authors: Dy; Christopher J.
      Abstract: No abstract available
      PubDate: Wed, 18 Mar 2020 00:00:00 GMT-
  • Primary Arthroscopic Stabilization for a First-Time Anterior Dislocation
           of the Shoulder: Long-Term Follow-up of a Randomized, Double-Blinded Trial
    • Authors: Yapp; Liam Z.; Nicholson, Jamie A.; Robinson, C. Michael
      Abstract: imageBackground: The aim of this study was to evaluate the long-term efficacy of arthroscopic Bankart repair (ABR).Methods: Eighty-eight patients with an age of ≤35 years who had sustained a primary anterior glenohumeral dislocation were enrolled in a single-center, double-blinded clinical trial. Subjects were randomized to receive either an arthroscopic washout (AWO) or ABR. Participants were reassessed after a minimum of 10 years postoperatively. Data regarding recurrent instability, revision surgery, satisfaction, and function (Disabilities of the Arm, Shoulder and Hand [DASH] and Western Ontario Shoulder Instability Index [WOSI]) scores were collected.Results: Sixty-five patients (74%; 32 in the AWO group and 33 in the ABR group) were included and had an average follow-up of 14.2 years (range,12 to 16 years). The rate of recurrent dislocation was significantly higher in the AWO group than the ABR group (47% and 12%, respectively; p = 0.002). Kaplan-Meier curves were plotted for event-free survival using recurrent instability and/or revision surgery as clinical end points. This analysis demonstrated a sustained significant difference between the groups at 10 years after surgery (58% for the AWO group versus 79% for the ABR group; log-rank test [Mantel-Cox]; p = 0.018). Long-term WOSI scores were significantly better in the ABR group. The presence of recurrent instability was associated with significantly poorer WOSI and DASH scores.Conclusions: This study demonstrates a long-term benefit in overall shoulder stability and functional outcome in high-risk patients who have undergone ABR for first-time anterior dislocation.Level of Evidence: Therapeutic Level I. See Instructions for
      Authors for a complete description of levels of evidence.
      PubDate: Wed, 18 Mar 2020 00:00:00 GMT-
  • Examining Timeliness of Total Knee Replacement Among Patients with Knee
           Osteoarthritis in the U.S.: Results from the OAI and MOST Longitudinal
    • Authors: Ghomrawi; H.M.K.; Mushlin, A.I.; Kang, R.; Banerjee, S.; Singh, J.A.; Sharma, L.; Flink, C.; Nevitt, M.; Neogi, T.; Riddle, D.L.
      Abstract: imageBackground: Patients with knee osteoarthritis may undergo total knee replacement too early or may delay or underuse this procedure. We quantified these categories of total knee replacement utilization in 2 cohorts of participants with knee osteoarthritis and investigated factors associated with each category.Methods: Data were pooled from 2 multicenter cohort studies that collected demographic, patient-reported, radiographic, clinical examination, and total knee replacement utilization information longitudinally on 8,002 participants who had or were at risk for knee osteoarthritis and were followed for up to 8 years. Validated total knee replacement appropriateness criteria were longitudinally applied to classify participants as either potentially appropriate or likely inappropriate for total knee replacement. Participants were further classified on the basis of total knee replacement utilization into 3 categories: timely (indicating that the patient had total knee replacement within 2 years after the procedure had become potentially appropriate), potentially appropriate but knee not replaced (indicating that the knee had remained unreplaced for>2 years after the procedure had become potentially appropriate), and premature (indicating that the procedure was likely inappropriate but had been performed). Utilization rates were calculated, and factors associated with each category were identified.Results: Among 8,002 participants, 3,417 knees fulfilled our inclusion and exclusion criteria and were classified into 1 of 3 utilization categories as follows: 290 knees (8% of the total and 9% of the knees for which replacement was potentially appropriate) were classified as “timely”, 2,833 knees (83% of the total and 91% of those for which replacement was potentially appropriate) were classified as “potentially appropriate but not replaced”, and 294 knees (comprising 9% of the total and 26% of the 1,114 total knee replacements performed) were considered to be “likely inappropriate” yet underwent total knee replacement and were classified as “premature”. Of the knees that were potentially appropriate but were not replaced, 1,204 (42.5%) had severe symptoms. Compared with the patients who underwent timely total knee replacement, the likelihood of being classified as potentially appropriate but not undergoing total knee replacement was greater for black participants and the likelihood of having premature total knee replacement was lower among participants with a body mass index of>25 kg/m2 and those with depression.Conclusions: In 2 multicenter cohorts of patients with knee osteoarthritis, we observed substantial numbers of patients who had premature total knee replacement as well as of patients for whom total knee replacement was potentially appropriate but had not been performed>2 years after it had become potentially appropriate. Further understanding of these observations is needed, especially among the latter group.Clinical Relevance: Undergoing total knee replacement too early may result in little or no benefit while exposing the patient to the risks of a major operation, whereas waiting too long may cause limitations in physical activity that in turn increase the risk of additional disability and chronic disease; however, little is known about timing of this surgery. We quantified the extent of premature, timely, and delayed use, and found a high prevalence of both premature and delayed use.
      PubDate: Wed, 18 Mar 2020 00:00:00 GMT-
  • Reverse Shoulder Arthroplasty Is Superior to Plate Fixation at 2 Years for
           Displaced Proximal Humeral Fractures in the Elderly: A Multicenter
           Randomized Controlled Trial
    • Authors: Fraser; Alexander Nilsskog; Bjørdal, Jonas; Wagle, Tone Mehlum; Karlberg, Anna Cecilia; Lien, Odd Arve; Eilertsen, Lars; Mader, Konrad; Apold, Hilde; Larsen, Leif Børge; Madsen, Jan Erik; Fjalestad, Tore
      Abstract: imageBackground: Almost one-third of patients with proximal humeral fractures are treated surgically, and the number is increasing. When surgical treatment is chosen, there is sparse evidence on the optimum method. The DelPhi (Delta prosthesis-PHILOS plate) trial is a clinical trial comparing 2 surgical treatments. Our hypothesis was that reverse total shoulder arthroplasty (TSA) yields better clinical results compared with open reduction and internal fixation (ORIF) using an angular stable plate.Methods: The DelPhi trial is a randomized controlled trial comparing reverse TSA with ORIF for displaced proximal humeral fractures (OTA/AO types 11-B2 and 11-C2) in elderly patients (65 to 85 years of age). The primary outcome measure was the Constant score at a 2-year follow-up. The secondary outcome measures included the Oxford Shoulder Score and radiographic evaluation. Results were reported as the mean difference with 95% confidence interval (CI). The intention-to-treat principle was applied for crossover patients.Results: There were 124 patients included in the study. At 2 years, the mean Constant score was 68.0 points (95% CI, 63.7 to 72.4 points) for the reverse TSA group compared with 54.6 points (95% CI, 48.5 to 60.7 points) for the ORIF group, resulting in a significant mean difference of 13.4 points (95% CI, 6.2 to 20.6 points; p < 0.001) in favor of reverse TSA. When stratified for fracture classification, the mean score was 69.3 points (95% CI, 63.9 to 74.7 points) for the reverse TSA group and 50.6 points (95% CI, 41.9 to 59.2 points) for the ORIF group for type-C2 fractures, which yielded a significant mean difference of 18.7 points (95% CI, 9.3 to 28.2 points; p < 0.001). In the type-B2 fracture group, the mean score was 66.2 points (95% CI, 58.6 to 73.8 points) for the reverse TSA group and 58.5 points (95% CI, 49.6 to 67.4 points) for the ORIF group, resulting in a nonsignificant mean difference of 7.6 points (95% CI, −3.8 to 19.1 points; p = 0.19).Conclusions: At a 2-year follow-up, the data suggested an advantage of reverse TSA over ORIF in the treatment of displaced OTA/AO type-B2 and C2 proximal humeral fractures in elderly patients.Level of Evidence: Therapeutic Level I. See Instructions for
      Authors for a complete description of levels of evidence.
      PubDate: Wed, 18 Mar 2020 00:00:00 GMT-
  • Performance of a Fracture Liaison Service in an Orthopaedic Setting: A
           Report of Key Indicators and Improvement of Longitudinal Outcomes
    • Authors: Senay; Andréa; Perreault, Sylvie; Delisle, Josée; Morin, Suzanne N.; Fernandes, Julio C.
      Abstract: imageBackground: Many Fracture Liaison Services (FLSs) have been successfully implemented, but very few incorporate systematic longitudinal follow-up. The objective of this study was to report on the performance of such an FLS using key performance indicators and longitudinal clinical outcomes.Methods: An FLS was implemented in 2 outpatient orthopaedic clinics. Men and women who were ≥40 years of age and had a recent fragility fracture were recruited. Participants were evaluated, treated when appropriate, and systematically followed over a 2-year period. Clinical data including chart review and questionnaires were collected. Medical services and hospitalization claims data were retrieved from administrative databases. The primary outcomes were the following key performance indicators: the numbers of investigated and treated patients, follow-up attendance, and the incidence of subsequent fractures. Secondary outcomes were the changes in bone turnover markers and quality of life, physical capacity, and pain scores between baseline and follow-up visits.Results: A total of 532 subjects with a mean age of 63.4 years were recruited; 85.7% were female. Bone mineral density results were collected for 472 subjects (88.7%) and a prescription for anti-osteoporosis medication was given to 86.6% of patients. Overall, 83.6% of patients attended at least 1 follow-up visit. The subsequent fracture incidence rate was 2.6 per 100 person-years (23 fractures). The mean level of type-I collagen C-telopeptide (CTX-1), a bone resorption marker, decreased>35%. Clinically important improvements of functional capacity scores (by 14.4% to 63.7%) and pain level (by 19.3% to 35.7%) were observed over time; however, the increase in quality-of-life scores was not clinically important (by 3% to 15.2%).Conclusions: In this FLS, the rates of investigation, treatment, and participation were>80% over a 2-year period. The subsequent fragility fracture incidence rate was
      PubDate: Wed, 18 Mar 2020 00:00:00 GMT-
  • No Difference in Outcomes Between Short and Longer-Stay Total Joint
           Arthroplasty with a Discharge Home: A Propensity Score-Matched Analysis
           Involving 46,660 Patients
    • Authors: Leroux; Timothy S.; Maldonado-Rodriguez, Naomi; Paterson, J. Michael; Aktar, Suriya; Gandhi, Rajiv; Ravi, Bheeshma
      Abstract: imageBackground: Outcomes following total hip arthroplasty (THA) and total knee arthroplasty (TKA) with a short length of hospital stay have been reported; however, most studies have not accounted for an inherent patient selection bias and discharge disposition. The purpose of this study was to utilize a propensity score to match and compare the outcomes of patients undergoing THA or TKA with short and longer lengths of stay with a discharge directly home.Methods: An administrative database from Ontario, Canada, which has a single-payer health-care system, was retrospectively reviewed to identify patients who underwent THA or TKA from 2008 to 2016. Patients were subsequently stratified into 2 groups based on their length of stay: short length of stay (≤2 days; thereafter referred to as short stay) and longer length of stay (>2 days; thereafter referred to as longer stay). Using a propensity score, patients who underwent short-stay THA or TKA were matched to patients who underwent longer-stay THA or TKA. Matching was based on 15 demographic, medical, and surgical factors. Our primary outcomes included postoperative complications, health-care utilization (readmission and emergency department presentation), and health-care costs.Results: Overall, 89,656 TKAs (14,645 short stays and 75,011 longer stays) and 52,610 THAs (9,426 short stays and 43,184 longer stays) were included in this study. Patients who underwent short-stay THA or TKA were significantly more likely (p < 0.05) to be younger, male, healthier, and from a higher socioeconomic status and to have undergone the procedure with a higher-volume surgeon. Over 95% of short-stay cases were successfully matched to longer-stay cases, and we found no significant difference in complications, health-care utilization, and costs between patients on the basis of the length of stay.Conclusions: Patients undergoing short-stay THA or TKA with a discharge home were more likely to be younger, healthy, male patients from a higher socioeconomic status. Higher-volume surgeons are also more likely to perform short-stay THA or TKA. These characteristics confirm the previously held belief that a selection bias exists when comparing cohorts based on time to discharge. When comparing matched cohorts of patients who underwent short-stay and longer-stay THA or TKA, we observed no difference in outcomes, suggesting that a short stay with a discharge home in the appropriately selected patient is safe following THA or TKA.Level of Evidence: Therapeutic Level IV. See Instructions for
      Authors for a complete description of levels of evidence.
      PubDate: Wed, 18 Mar 2020 00:00:00 GMT-
  • Risk Factors for Periprosthetic Joint Infection Following Primary Total
           Hip Arthroplasty: A 15-Year, Population-Based Cohort Study
    • Authors: Arthroplasty Collaborative (MAC; The McMaster
      Abstract: imageBackground: Periprosthetic joint infection (PJI) is one of the most devastating complications following total hip arthroplasty. The purposes of this study were to determine risk factors for PJI after primary total hip arthroplasty for osteoarthritis using a Canadian population-based database collected over 15 years and to determine the incidence of PJI, the time to PJI following primary total hip arthroplasty, and whether the PJI rate had changed over 15 years.Methods: We performed a population-based cohort study using linked administrative databases in Ontario. We included all primary total hip arthroplasties performed for osteoarthritis in patients who were ≥55 years of age. We used a Cox proportional hazards model to analyze the effect of surgical and patient factors on the risk of developing PJI. We calculated 1, 2, 5, and 10-year PJI rates. We used the Cochran-Armitage test to assess the evidence of trends in PJI rates over time.Results: A total of 100,674 patients who were ≥55 years of age underwent a primary total hip arthroplasty for osteoarthritis. The cumulative incidence for PJI at 15 years was 1.44% (95% confidence interval [CI], 1.38% to 1.50%). Risk factors associated with the development of PJI include male sex (hazard ratio [HR], 1.43 [95% CI, 1.30 to 1.51]), type-2 diabetes mellitus (HR, 1.51 [95% CI, 1.31 to 1.70]), and being discharged to convalescent care (HR, 1.36 [95% CI, 1.05 to 1.77]). Sixty-two percent of PJI cases occurred within 2 years after the surgical procedure and 98% occurred within 10 years. The rate of PJI following primary total hip arthroplasty did not change over the 15 years of our study period.Conclusions: The risk of developing PJI following primary total hip arthroplasty did not change in 15 years, despite improvements in other arthroplasty outcomes. Male sex, type-2 diabetes mellitus, and discharge to convalescent care were associated with an increased risk of PJI. The surgical approach, income quintile, and use of bone-grafting or cement were not significantly associated with increased risk of infection in our cohort.Level of Evidence: Prognostic Level III. See Instructions for
      Authors for a complete description of levels of evidence.
      PubDate: Wed, 18 Mar 2020 00:00:00 GMT-
  • The Propeller Flap for Traumatic Distal Lower-Limb Reconstruction: Risk
           Factors, Pitfalls, and Recommendations
    • Authors: Lese; Ioana; Grobbelaar, Adriaan O.; Sabau, Dan; Georgescu, Alexandru V.; Constantinescu, Mihai A.; Olariu, Radu
      Abstract: imageBackground: Defects in the distal third of the leg are difficult to cover and often require free tissue transfer, even for defects of limited sizes. Propeller flaps have been designed specifically as an alternative to free tissue transfer but at times have been associated with unacceptably high complication rates. We therefore aimed to prospectively assess our own institutional experience with this technique and to define its role in lower-limb reconstruction.Methods: All patients who had been managed with reconstruction of the distal part of the leg with a propeller flap between 2014 and 2017 were included in the study. Demographic, clinical, and follow-up data on the patients and surgical procedures were recorded with special focus on the complication profile.Results: Twenty-six patients underwent propeller flap reconstruction of the distal part of the leg: 12 flaps were based on the posterior tibial artery, and 14 were based on the peroneal artery. Postoperative complications developed in association with 1 of the 12 flaps based on the posterior tibial artery, compared with 8 of the 14 flaps based on the peroneal artery (p = 0.015). Moreover, the presence of a higher Charlson comorbidity index (≥2) was strongly associated with the development of postoperative complications (p < 0.001).Conclusions: Propeller flaps are a reliable option for traumatic reconstruction in carefully selected patients with lower-limb defects. In our experience, the rate of complications was higher for propeller flaps based on the peroneal artery and for patients with a Charlson comorbidity index of ≥2, whereas posterior tibial artery-based propeller flap reconstruction was a reliable surgical option for patients with a small defect in the distal third of the lower limb.Level of Evidence: Therapeutic Level IV. See Instructions for
      Authors for a complete description of levels of evidence.
      PubDate: Wed, 18 Mar 2020 00:00:00 GMT-
  • Primary Total Hip Arthroplasty in Patients 20 Years Old and Younger
    • Authors: Pallante; Graham D.; Statz, Joseph M.; Milbrandt, Todd A.; Trousdale, Robert T.
      Abstract: imageBackground: Historically, total hip arthroplasty (THA) performed in patients ≤20 years old has been associated with poor survivorship because of bearing-surface wear with conventional polyethylene, acetabular loosening with cemented sockets, and liner fracture in ceramic-on-ceramic (CoC) THA. For this population, there is a paucity of data regarding outcomes of THAs performed with use of modern implants and bearing surfaces. The purpose of the present study was to examine the mid- to long-term outcomes of modern THA in patients ≤20 years old.Methods: Utilizing a single-institution, prospectively collected total joint registry, we retrospectively identified 91 primary THAs performed in 78 patients ≤20 years old from 1998 to 2016. The average patient age was 17 years (range, 11 to 20 years), and the average body mass index was 26 kg/m2 (range, 16 to 49 kg/m2). Forty-eight THAs (53%) were performed in male patients, and 47 (52%) were performed on the right hip. Bearing surfaces included CoC (53 THAs, 58%), metal-on-highly cross-linked polyethylene (MoP; 28 THAs, 31%), and ceramic-on-highly cross-linked polyethylene (CoP; 10 THAs, 11%). Outcome measures included reoperations, revisions, complications, clinical outcome scores, and bearing-surface wear.Results: At an average follow-up of 8 years (range, 2 to 18 years), the average modified Harris hip score was 92 (range, 54 to 100), and 95% of patients reported feeling “much better” following the surgical procedure. Survivorship at 2, 5, and 10 years postoperatively was 96.7%, 96.7%, and 95.0% for reoperation; 98.9%, 98.9%, and 97.2% for revision; and 91.2%, 91.2%, and 89.5% for complications, respectively. The most common complications were instability (3 THAs, 3%), aseptic acetabular loosening (2 THAs, 2%), and postoperative foot drop (2 THAs, 2%). Linear articular wear averaged 0.019 mm/yr. There were no correlations between age, sex, body mass index, bearing surface, femoral head size, use of cement, or operative time and survivorship from complications, reoperations, or revisions. There were no differences in linear wear among CoC, CoP, and MoP bearing surfaces.Conclusions: In patients ≤20 years old, THAs performed with use of modern implants exhibit excellent clinical outcome scores and survivorship at mid- to long-term follow-up. CoC, CoP, and MoP bearing surfaces have similar survivorship, clinical outcomes, and bearing-surface wear in this population.Level of Evidence: Therapeutic Level IV. See Instructions for
      Authors for a complete description of levels of evidence.
      PubDate: Wed, 18 Mar 2020 00:00:00 GMT-
  • Necrotizing Fasciitis: Pillaging the Acute Phase Response
    • Authors: Hysong; Alexander A.; Posey, Samuel L.; Blum, Deke M.; Benvenuti, Michael A.; Benvenuti, Teresa A.; Johnson, Samuel R.; An, Thomas J.; Devin, Jessica K.; Obremskey, William T.; Martus, Jeffrey E.; Moore-Lotridge, Stephanie N.; Schoenecker, Jonathan G.
      Abstract: image➤Necrotizing fasciitis hijacks the acute phase response, increasing the risk of developing pathophysiologic states commonly associated with death: sepsis-induced coagulopathy (SIC), systemic inflammatory response syndrome (SIRS), and adrenal insufficiency, referred to as critical illness-related corticosteroid insufficiency (CIRCI).➤Dynamic monitoring of SIC, SIRS, and CIRCI may be informative when assessing infection severity and when directing treatment to manage these conditions as soon as they begin to develop.➤To reduce the risk of oropharyngeal colonization, N95 respirators should be worn by health-care professionals who are operating on patients with necrotizing fasciitis.
      PubDate: Wed, 18 Mar 2020 00:00:00 GMT-
  • Current Trends in Orthopaedic Surgery Residency Applications and Match
    • Authors: Trikha; Rishi; Keswani, Aakash; Ishmael, Chad R.; Greig, Danielle; Kelley, Benjamin V.; Bernthal, Nicholas M.
      Abstract: imageBackground: The current U.S. orthopaedic residency application process is becoming increasingly impersonal in the wake of an increasing number of applications. Through an analysis of orthopaedic surgery residency application statistics, we have highlighted the effect that the number of orthopaedic applications has on match rate, and we have suggested methods for a more personalized application process.Methods: Data from the Association of American Medical Colleges (AAMC) and the National Resident Matching Program (NRMP) for United States orthopaedic residency applicants from 2008 to 2018 were collected. These data included the average number of applications submitted per applicant, the average number of applications received per program, the total number of residency positions offered in the U.S., the total number of U.S. applicants, and the total number of U.S. applicants who matched to a U.S. orthopaedic surgery residency program. U.S. applicant match rates and the average number of applications received per residency position offered were calculated. Linear regression models were used to determine the rate at which these variables changed over time.Results: The average number of applications submitted by an applicant increased from 46.5 in 2008 to 74.9 in 2018. The average number of applications received per residency position offered increased from 54.1 in 2008 to 85.7 in 2018. The number of U.S. applicants was 740 in 2008 and 849 in 2018. The number of U.S. orthopaedic residency programs only slightly increased from 160 in 2008 to 171 in 2018. The match rate for U.S. medical school applicants has remained stable from 2008 to 2018 at a mean of 76.9% and a standard deviation of 2.3%.Conclusions: The match rate has remained stable from 2008 to 2018 despite an increase in the number of applications per position. This discrepancy suggests that increasing the number of submitted applications may not correlate with applicant success. We address this discrepancy and suggest methods that can potentially allow for a more targeted orthopaedic application experience.
      PubDate: Wed, 18 Mar 2020 00:00:00 GMT-
  • Quality Improvement and Patient Safety: How Leadership Can Create a
           Culture of Safety: AOA Critical Issues Symposium
    • Authors: Samora; Julie Balch; Shea, Kevin G.; Chen, Antonia F.; Turner, Philip; Frick, Steven L.
      Abstract: imageAbstract: Orthopaedic leaders need to create a shared vision and must establish trust, open lines of communication, and buy-in from all team members in order to establish a culture that is supportive of quality improvement. Leaders should encourage teams to follow evidence-based guidelines, reduce variation, take an active role in supply chain processes, and develop new ideas to improve quality and safety of care. With rapidly changing medical and surgical advancements, orthopaedic leaders must continually adapt in the face of evolving challenges.
      PubDate: Wed, 18 Mar 2020 00:00:00 GMT-
  • Improved Complex Skill Acquisition by Immersive Virtual Reality Training:
           A Randomized Controlled Trial
    • Authors: Lohre; Ryan; Bois, Aaron J.; Athwal, George S.; Goel, Danny P.
      Abstract: imageBackground: There has been limited literature on immersive virtual reality (VR) simulation in orthopaedic education. The purpose of this multicenter, blinded, randomized controlled trial was to determine the validity and efficacy of immersive VR training in orthopaedic resident education.Methods: Nineteen senior orthopaedic residents (resident group) and 7 consultant shoulder arthroplasty surgeons (expert group) participated in the trial comparing immersive VR with traditional learning using a technical journal article as a control. The examined task focused on achieving optimal glenoid exposure. Participants completed demographic questionnaires, knowledge tests, and a glenoid exposure on fresh-frozen cadavers while being examined by blinded shoulder arthroplasty surgeons. Training superiority was determined by the outcome measures of the Objective Structured Assessment of Technical Skills (OSATS) score, a developed laboratory metric, verbal answers, and time to task completion.Results: Immersive VR had greater realism and was superior in teaching glenoid exposure than the control (p = 0.01). The expert group outperformed the resident group on knowledge testing (p = 0.04). The immersive VR group completed the learning activity and knowledge tests significantly faster (p < 0.001) at a mean time (and standard deviation) of 11 ± 3 minutes than the control group at 20 ± 4 minutes, performing 3 to 5 VR repeats for a reduction in learning time of 570%. The immersive VR group completed the glenoid exposure significantly faster (p = 0.04) at a mean time of 14 ± 7 minutes than the control group at 21 ± 6 minutes, with superior OSATS instrument handling scores (p = 0.03). The immersive VR group scored equivalently in surprise verbal scores (p = 0.85) and written knowledge scores (p = 1.0).Conclusions: Immersive VR demonstrated substantially improved translational technical and nontechnical skills acquisition over traditional learning in senior orthopaedic residents. Additionally, the results demonstrate the face, content, construct, and transfer validity for immersive VR.Clinical Relevance: This adequately powered, randomized controlled trial demonstrated how an immersive VR system can efficiently (570%) teach a complex surgical procedure and also demonstrate improved translational skill and knowledge acquisition when compared with a traditional learning method.
      PubDate: Wed, 18 Mar 2020 00:00:00 GMT-
  • Fully Immersive Virtual Reality for Total Hip Arthroplasty: Objective
           Measurement of Skills and Transfer of Visuospatial Performance After a
           Competency-Based Simulation Curriculum
    • Authors: Logishetty; Kartik; Gofton, Wade T.; Rudran, Branavan; Beaulé, Paul E.; Cobb, Justin P.
      Abstract: imageBackground: Fully immersive virtual reality (VR) uses headsets to situate a surgeon in a virtual operating room to perform open surgical procedures. The aims of this study were to determine (1) if a VR curriculum for training residents to perform anterior approach total hip replacement (AA-THR) was feasible, (2) if VR enabled residents’ performance to be measured objectively, and (3) if cognitive and motor skills that were learned with use of VR were transferred to the physical world.Methods: The performance of 32 orthopaedic residents (surgical postgraduate years [PGY]-1 through 4) with no prior experience with AA-THR was measured during 5 consecutive VR training and assessment sessions. Outcome measures were related to procedural sequence, efficiency of movement, duration of surgery, and visuospatial precision in acetabular component positioning and femoral neck osteotomy, and were compared with the performance of 4 expert hip surgeons to establish competency-based criteria. Pretraining and post-training assessments on dry bone models were used to assess the transfer of visuospatial skills from VR to the physical world.Results: Residents progressively developed surgical skills in VR on a learning curve through repeated practice, plateauing, on average, after 4 sessions (4.1 ± 0.6 hours); they reached expert VR levels for 9 of 10 metrics (except femoral osteotomy angle). Procedural errors were reduced by 79%, assistive prompts were reduced by 70%, and procedural duration was reduced by 28%. Dominant and nondominant hand movements were reduced by 35% and 36%, respectively, and head movement was reduced by 44%. Femoral osteotomy was performed more accurately, and acetabular implant orientation improved in VR assessments. In the physical world assessments, experts were more accurate than residents prior to simulation, but were matched by residents after simulation for all of the metrics except femoral osteotomy angle. The residents who performed best in VR were the most accurate in the physical world, while 2 residents were unable to achieve competence despite sustained practice.Conclusions: For novice surgeons learning AA-THR skills, fully immersive VR technology can objectively measure progress in the acquisition of surgical skills as measured by procedural sequence, efficiency of movement, and visuospatial accuracy. Skills learned in this environment are transferred to the physical environment.
      PubDate: Wed, 18 Mar 2020 00:00:00 GMT-
  • How the Reputation of Orthopaedic Residency Programs Is Associated with
           Orthopaedic Fellowship Match Results
    • Authors: Krueger; Chad A.; Helms, Jonathan R.; Bell, Anthony J.; Israel, Heidi; Cannada, Lisa K.
      Abstract: imageBackground: The primary goal of the present study was to determine if applicants from higher-ranking U.S. orthopaedic surgery residency programs match at a more desired position on their fellowship match-rank list compared with those applicants from lower-ranked residency programs.Methods: San Francisco Match provided results regarding applicant data and match results from 2014 to 2018 for all orthopaedic subspecialties except the hand and the shoulder and elbow. Unmatched applicants and international medical graduates were excluded. Residency programs were divided into 5 tiers (with tier 1 being the highest-ranked residency programs and tier 5 being the lowest-ranked programs) on the basis of 2018 Doximity rankings of orthopaedic residency programs. Statistical analysis consisted of descriptive statistics, chi-square tests, and analysis of variance.Results: Two thousand eight hundred and eleven applicants met inclusion criteria. Applicants from residency programs in tiers 1 and 2 applied to significantly fewer programs than those from tiers 3, 4, or 5 (p < 0.0001). Applicants from each tier were significantly more likely to attain interviews than applicants from all tiers below them (p < 0.01). Applicants from tier-1 residency programs matched at a significantly higher position on their rank list (p < 0.001) and were more desirably ranked by fellowship programs (p = 0.003) compared with all other tiers.Conclusions: Applicants from the highest-ranking residency programs apply to fewer programs, interview at a greater percentage of these programs, and are more likely to match to 1 of their top-ranking programs than applicants from lower-ranking programs. However, the association of the applicant match position with the program ranking appears to be most pronounced when it comes to fellowships selecting which applicants to interview. These findings may help future applicants when determining which programs to apply to during the match.
      PubDate: Wed, 18 Mar 2020 00:00:00 GMT-
  • Potentially Appropriate Might Not Be the Most Appropriate: Commentary on
           an article by H.M.K. Ghomrawi, PhD, MPH, et al.: “Examining Timeliness
           of Total Knee Replacement Among Patients with Knee Osteoarthritis in the
           U.S. Results from the OAI and MOST Longitudinal Cohorts”
    • Authors: Zywiel; Michael G.
      Abstract: No abstract available
      PubDate: Wed, 18 Mar 2020 00:00:00 GMT-
  • A Word of Caution: Success May Be Limited to 2 Years and Highly Displaced
           OTA/AO B2 and C2 Injuries: Commentary on an article by Alexander Nilsskog
           Fraser, MD, et al.: “Reverse Total Shoulder Arthroplasty Is Superior to
           Plate Fixation at 2 Years for Displaced Proximal Humeral Fractures in the
           Elderly. A Multicenter Randomized Controlled Trial”
    • Authors: Cole; Peter A.
      Abstract: No abstract available
      PubDate: Wed, 18 Mar 2020 00:00:00 GMT-
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