Faculty Bibliography

Previous studies have shown that the accuracy of computer-assisted surgery (CAS) via computed tomography (CT) free systems is useful when applied in the clinical realm. However, few studies have compared CAS systems to the current gold standard, manually applied measuring guides. Thirty total knee arthroplasties (TKA) were performed on artificial Sawbones knees using three different navigational systems. The TKAs were performed by a fellowship-trained joint reconstruction surgeon as well as a third- and a fourth-year orthopedic resident to assess differences in performance with regard to surgical experience. Using a two-way multivariate analysis of variance (MANOVA), no statistical differences were found in the accuracy of each of the three CAS navigational systems. Similarly, no differences were found between the accuracy of CAS systems and the gold standard measuring method. No differences in performance were found between the orthopedic residents and the fellowship-trained surgeon, suggesting a relatively small learning curve and usability. Definitive assessment of the clinical efficacy should be further assessed in a cadaveric study or, ideally, by way of a randomized clinical trial.

Patients undergoing total knee arthroplasty (TKA) often experience a difficult recovery due to severe postoperative pain. Using a multimodal pain management protocol, a blinded, randomized, placebo-controlled study was designed to evaluate the efficacy of patient-selected music on reducing perceived pain. Thirty patients undergoing primary unilateral TKA were enrolled and randomized into the music group (15 patients) or the control group (15 patients). Postoperative pain scores, assessed with the visual analog scale, indicated the music group experienced less pain at 3 and 24 hours postoperatively than did the nonmusic group (at 3 hours: 1.47+/-1.39 versus 3.87+/-3.44, P=.01; at 24 hours: 2.41+/-1.67 versus 4.03+/-2.89, P=.04). Intraoperative music provides an inexpensive nonpharmacological option to further reduce postoperative pain.

Fixed-bearing, medial unicondylar knee arthroplasties were performed in 33 knees (32 patients). We report a minimum 2-year follow-up, with a mean follow-up of 3 years. Kaplan-Meier survivorship analysis reported 97% survivorship at a mean follow-up of 38 months. Average preoperative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scores improved significantly from 40+/-22 to 92+/-15 (P<.0001). Average preoperative Knee Society knee and function scores improved significantly from 52+/-7 to 90+/-9 (P<.0001) and from 48+/-16 to 84+/-17 (P<.0001), respectively. In addition, average Short Form-12 Physical Component scores significantly increased. Overall stiffness and physical function assessed via the WOMAC index also exhibited significant improvement. Of note, all categories of the WOMAC Index and the Knee Society scores experienced statistically significant improvements at 3-month follow-up, indicating a rapid return to improved function and diminished pain.

The Displaced Femoral (neck fracture) Arthroplasty Consortium for Treatment and Outcomes study is a prospective, multicenter randomized clinical trial comparing hemiarthroplasty to total hip arthroplasty (THA) in the treatment of displaced femoral neck fractures in previously independent patients. Primary outcomes were measured at 6, 12, and 24 months with the Short Form-36 (SF-36), Western Ontario and McMaster Osteoarthritis Index (WOMAC), and the Harris Hip Score and the Timed "Up & Go" Test. Forty subjects were enrolled. At 24 months, THA patients had significantly less pain on the SF-36 subscale than hemiarthroplasty patients (54.8 +/- 7.9 vs 44.7 +/- 10.5, P = .04) and scored significantly better on the SF-36 mental health subscale (54.9 +/- 9.4 vs 40.9 +/- 10.3, P = .006). Total hip arthroplasty patients also had superior WOMAC function scores (81.8 +/- 10.2 vs 65.1 +/- 18.1, P = .03). Significant differences in outcomes, without a significantly greater incidence of complications, suggest THA is a valuable treatment option for the active elderly hip fracture population.

OBJECTIVES: The Displaced Femoral (neck fracture) Arthroplasty Consortium for Treatment and Outcomes (DFACTO) study compared total hip arthroplasty (THA) to hemiarthroplasty in the treatment of displaced femoral neck fractures. DESIGN: This study was designed as a prospective, randomized clinical trial. SETTING: The study was conducted in five US academic and private medical centers. PATIENTS: Patients were composed of independent, mentally competent individuals, >50 years old who suffered a displaced femoral neck fracture without existing arthritis at the hip. Forty-one patients were enrolled. MAIN OUTCOME MEASURES: Functional outcomes and quality of life were assessed at 6 and 12 months post-fracture using the SF-36, Western Ontario and McMaster University Osteoarthritis Index (WOMAC), the Harris Hip Score, and the Timed "Up & Go" Test (TUG test). RESULTS: Groups were equivalent at baseline in terms of age, comorbid conditions, and functional status. At 6 months, there were no significant differences between the groups using the outcome measures or overall rates of complications. There was one dislocation in the THA group (5.8% of patients). At 12 months, the THA group reported significantly less pain (53.2 +/- 10.2) than the hemiarthroplasty group (42.4 +/- 11.5) using the SF-36 (p = 0.02). Using the TUG Test, we observed a greater proportion of THA patients remain functionally independent 1 year after surgery compared the hemiarthroplasty group (p = 0.08, controlling for age and sex). CONCLUSIONS: These differences in pain and functional outcomes suggest THA is a viable treatment option for the active elderly displaced femoral neck fracture population.

Advising and mentoring programs for medical students vary in their official names, scope, and structures. Catalyzed by negative student feedback regarding career advising and a perceived disconnection between faculty and students, in academic year 2003-2004, Columbia University College of Physicians and Surgeons implemented its formal Advisory Dean (AD) Program and disbanded its former advising system that used faculty volunteers. The AD Program has become a key element for enhancing the students' professional development throughout their student training, focusing on topics including, but not limited to, career counseling, professionalism, humanism, and wellness resources. Advisory deans and the dean for student affairs, familiar with resources for academic development, student support, and extracurricular activities, operate at the nexus of the program, providing personalized mentoring and advising for each student. Fully supported by administration and faculty, the program has shown early success according to student feedback. Early feedback from the Class of 2006, who had been involved in our AD Program for three years, has been encouraging. Out of 152 students, 104 (68%) provided feedback, with 93 (89%) of the respondents reporting the AD Program as a valuable initiative. Expecting to further improve on this early positive response, the AD Program will continue to foster an environment conducive to a seamless transition from student to physician.

Many factors must be considered in treating displaced femoral neck fractures. For younger patients, ORIF is preferred, whereas arthroplasty is the better option for elderly patients. For institutionalized elderly patients with a low activity level or impaired mental status, the choice should be hemiarthroplasty (either unipolar or bipolar). For high-demand, active patients, evidence continues to mount toward THA as the favored treatment option. However, there is a need for larger clinical trials to demonstrate the most cost-effective way to treat sub-populations of an ever-growing number of patients with displaced femoral neck fractures.

A survey of the American Association of Hip and Knee Surgeons was performed to investigate the perceptions and experiences of medical malpractice litigation and related concerns among its active members. Responses showed that 78% of responding surgeons had been named as a defendant in at least 1 lawsuit alleging medical malpractice. Sixty-nine percent of lawsuits in the survey had been dismissed or settled out of court, and median settlement amounts were in the range of $51,000 to $99,000. Nerve injury was the most commonly cited source of litigation, followed by limb length discrepancy, infection, vascular injury, hip dislocation, compartment syndrome, deep vein thrombosis, chronic pain, and periprosthetic fracture. Survey data suggest that there are targets for surgeon education and awareness that could improve the quality of patient communication and the informed consent process.

The purpose of this study was to evaluate the eventual publication rates of poster presentations at the annual meetings of the American Association of Hip and Knee Surgeons from 1996 to 2001 (47%). Common belief expects poster presentations to publish at a lower rate than podium presentations, the latter being typically believed to consist of studies of higher scientific value. We hypothesized that this would lead to a lower incidence of eventual peer-reviewed literature publication for posters. Comparisons from an earlier report confirmed our analysis. Also, poster studies that did survive the peer review process were found in a wide array of journals and were found to publish within a relatively short amount of time (mean, 23.6 +/- 15.7 months).