Faculty Bibliography

PURPOSE/OBJECTIVE:To correlate the Patient Reported Outcomes Measurement Information System Upper Extremity (PROMIS UE) score with preexisting validated outcomes scores, American Shoulder and Elbow Surgeons score (ASES), and Constant score (CS) in patients with idiopathic adhesive capsulitis (AC). METHODS:Patients with a clinical diagnosis of idiopathic AC ("freezing" or "frozen" phases) who agreed to complete the ASES, CS, and PROMIS UE scores during their office visit were included in this study. Trained researchers performed the objective clinical assessments on the included patients. Responses to the 3 outcomes scores were statistically analyzed and compared utilizing Pearson correlation coefficients. Floor and ceiling effects were calculated. RESULTS:The final cohort included 100 patients with AC of which there were 72% female and 87% right hand dominant, with a mean age of 55 years. The PROMIS UE required fewer question responses (5.02 ±1.84) compared to the fixed questions burden with ASES (12) and CS (9). The mean outcome scores were 34.6 ± 2.5 (PROMIS UE), 55 ± 22 (ASES), and 51 ± 16 (CS). The PROMIS UE displayed excellent correlation with both the ASES (r = 0.80, 95% [CI: 0.72, 0.86], p < 0.001) and CS (r = 0.76, 95% CI [0.67, 0.83], p < 0.001). Neither ceiling nor floor effects were present. CONCLUSION/CONCLUSIONS:The PROMIS UE displayed comparable efficacy to commonly used legacy outcome scores (ASES and CS) in adhesive capsulitis. A lower question burden with the PROMIS UE carries a potential for wider acceptibility with the researchers and patients with shoulder pathology.

INTRODUCTION/BACKGROUND:It is important to understand the current characteristics of orthopaedic surgery program leadership, especially in the current climate of modern medicine. The purpose of this report was to describe the demographic, academic, and geographic characteristics of current orthopaedic chairs and program directors (PDs). METHODS:Orthopaedic surgery residency programs were obtained from the Accreditation Council for Graduate Medical Education website and cross-referenced with the Electronic Residency Application Service, identifying 161 residency programs for the 2018 to 2019 cycle. All data were collected in January 2020 to best control for changes in leadership. Demographic and academic information were collected from public websites. For geographic analysis, the United States was divided into five regions, and training locations were categorized as appropriate. RESULTS:A total of 153 chairs and 161 PDs were identified. 98.0% of chairs were men versus 88.8% of PDs (P = 0.001). Chairs had been in practice and in their current position for longer than PDs (26.4 vs 16.8 years [P < 0.005] and 9.1 vs 7.1 years [P = 0.014], respectively). Chairs had more publications and were more likely to be professors than PDs. PDs were more likely to remain at both the same region and institution that they trained in residency. The most common subspecialty was sports among chairs and trauma among PDs, although when compared with national averages orthopaedic trauma and orthopaedic oncology were the most overrepresented subspecialties. CONCLUSION/CONCLUSIONS:Orthopaedic chairs are more likely to be men, have had longer careers, and have more academic accomplishments than their PD counterparts. Geography appears to have an association with where our leaders end up, especially for PDs. Subspecialization does not notably influence leadership positions, although orthopaedic trauma and orthopaedic oncology surgeons are more commonly represented than expected. This report serves to identify the current state of orthopaedic leadership and may provide guidance for those who seek these leadership positions.

Background: The purpose of this study was to determine if addition of CT to axillary radiographs (AXR) alters preoperative decision making for shoulder arthroplasty. Methods: Preoperative deidentified images (XR alone and XR with CT) of 50 patients with glenohumeral arthritis were reviewed independently by 3 reviewers in a blinded fashion. Each reviewer graded images for glenoid wear pattern as simple (Walch A1 or B1) or advanced [A2, B2, C]), adequacy of AXR and need for advanced imaging. The reviewers determined a preoperative plan for all patients based on XR alone vs. XR and CT including the arthroplasty type (anatomic or reverse total shoulder) and their plan for treating glenoid wear (eccentric or standard reaming vs. bone graft or augment). Kappa values (κ) were calculated to determine inter-rater agreement and consistency among multiple reviewers. Fisher's exact test was used to assess any difference in preoperative plan once the shoulders were separated into simple and advanced glenoid wear patterns. Results: The 3 reviewers agreed that quality of AXRs was significantly inadequate (P <.001) for assessing glenoid wear in advanced glenoid wear patterns compared to simple wear patterns. Following evaluation on AXRs alone, the need for CT imaging was significantly higher in advanced glenoid wear patterns compare to simple ones (81% vs. 31%; P <.001). The addition of CT images did not result in a significant change to the preoperative plan in simple glenoid wear patterns but in advanced glenoid wear, addition of CT can change the preoperative plan with respect to arthroplasty type and/or strategy for addressing glenoid wear. Conclusion: Axillary radiographs are often inadequate for preoperative planning in shoulder arthritis with advanced glenoid wear patterns (Walch A2, B2, C types). Addition of CT imaging to radiographs in shoulder arthritis with advanced glenoid wear can affect the preoperative decision with respect to type of shoulder arthroplasty and/or plan for addressing glenoid wear (reaming, bone graft or augmented glenoids). Level of evidence: Level IV