Faculty Bibliography

The purpose of this study is to determine the highest-cited articles on developmental dysplasia of the hip (DDH) and analyze their bibliometric characteristics. We searched the Web of Science (WoS) for articles with the highest number of citations on DDH and recorded their number of citations in WoS, Scopus, and Google Scholar (GS). We ranked and selected the top 100 cited articles. The average number of citations in WoS was 148 (range 66-638). The most-cited article in all databases was Crowe's total hip replacement cohort on DDH. The Journal of Bone and Joint Surgery American Volume (n = 35) had the most articles in the list, and the United States (n = 46) contributed with the most articles. The University of Bern had the most publications (n = 8). Most studies were therapeutic (n = 45) or diagnostic (n = 29). Hip preservation and arthroplasty investigations have had an increment in citations in recent decades. We provide an historical perspective on research conducted on DDH. A majority of the articles were observational and therapeutic. All databases had good correlation in the number of citations.

BACKGROUND/UNASSIGNED:Total hip arthroplasty (THA) is a common orthopaedic procedure and is expected to increase with an increasing elderly population. Many of these patients suffer from chronic diseases which might be associated with anaemia. Anaemia, by itself, increases the risk of morbidity. We aimed to delineate relationship between preoperative anaemia and postoperative composite morbidities in patients undergoing primary THA. METHODS/UNASSIGNED:A cohort study analysed the data from the American College of Surgeons National Surgical Quality Improvement Program 2008-2014 database. Adult patients who underwent unilateral primary THA were included and divided into 3 groups: no anaemia, mild anaemia, and moderate-to-severe anaemia. Thirty-day mortality and morbidity were recorded as adverse events. The associations between anaemia, baseline characteristics, and adverse events were analysed after adjusting for confounders. RESULTS/UNASSIGNED:Moderate-to-severe anaemia patients were at increased risk for composite morbidity (adjusted odds ratio, 1.43 [1.17-1.74]) when compared to non-anaemics. The stratification revealed a significant effect of younger age, male gender, white race, obesity, general anaesthesia, and mean operative time >120 minutes in patients with moderate-to-severe anaemia. These patients were also at a higher risk of developing several specific morbidities. CONCLUSION/UNASSIGNED:Moderate-to-severe anaemia increases the risk for composite morbidities, but not mortality in patients undergoing primary THA. Further studies are needed to assess whether preoperative management of moderate-to-severe anaemia would improve outcomes in patients undergoing THA.

Three cases of extraskeletal myxoid chondrosarcoma (EMC) in patients who presented with pulmonary metastases and were managed with long-term close observation without systemic intervention are presented. Follow-up imaging showed slow progression of their disease over several years, and the patients remained asymptomatic from their pulmonary metastases. This clinical experience provides insight into the natural history of the disease and suggests that some patients may experience long-term survival and remain asymptomatic even without systemic intervention, thereby improving their quality of life by avoiding potentially debilitating treatments.

BACKGROUND:Idiopathic talipes equinovarus (ITEV) is a prevalent structural deformity of the foot and ankle in children. The disease-specific instrument (DSI) has commonly been used as an outcomes metric in these patients. The Patient-Reported Outcomes Measurement Information System (PROMIS) was developed to examine the quality of life across various medical conditions. PROMIS has been validated for multiple conditions; however, no studies have evaluated the use of the PROMIS in children with ITEV. METHODS:A prospective analysis was performed whereby the 2 questionnaires were mailed out to the parents of 91 patients, aged 5 to 17 years, with ITEV. Construct validity of the PROMIS Parent Proxy Profile short forms version was assessed by comparing its domains of Mobility, Fatigue, Pain Interference, and Pain Intensity to the DSI Function domain and PROMIS domains of Anxiety, Depressive Symptoms, Peer Relationships, and Pain Intensity to DSI Satisfaction domain. RESULTS:Thirty-one complete responses (34% response rate) were returned. The patients' current mean age was 8.8 years, 7 were female individuals, and 12 had unilateral ITEV. Bivariate correlation analysis, using Spearman correlation coefficients, demonstrated a moderate positive correlation between the DSI Function domain and the PROMIS Mobility domain (rs=0.52) and a moderate negative correlation between the DSI Function domain and the PROMIS Pain Interference domain (rs=-0.56), as well as the PROMIS Pain Intensity domain (rs=-0.75). A fair negative correlation (rs=-0.38) with PROMIS Fatigue domain was found. Correlations between the DSI Satisfaction domain and the PROMIS domains were fair or had little relationship. CONCLUSIONS:These results provide support for the validity of the PROMIS Mobility, Pain Interference, and Pain Intensity domains in this population, however there are no items in PROMIS that can assess overall satisfaction, as with the DSI. LEVEL OF EVIDENCE/METHODS:Level II-prospective comparative study.

Purpose/UNASSIGNED:The optimal treatment for late-presenting developmental dysplasia of the hip (DDH) is controversial. High tension forces after hip reduction increase the pressure on the femoral head, potentially causing avascular necrosis. Femoral shortening (FS) is commonly used as a means to decrease the pressure on the femoral head. We examined the effect of FS on the outcomes of patients with late-presenting DDH. Methods/UNASSIGNED:A total of 645 hips of a late-presenting DDH cohort treated with open reduction and iliac osteotomies were retrospectively reviewed; 328 hips had a FS performed (FS+) and 317 (FS-) had not. The mean age was 3.9 years (sd 1.55). We classified the hips with the Tönnis and International Hip Dysplasia Institute (IHDI) methods; and the Pediatric Outcomes Data Collection Instrument (PODCI), Iowa Hip Score (IHS) and Severin classification as outcome measurements. Results/UNASSIGNED:The FS- group had higher scores in PODCI (median 95 points; interquartile range (IQR) 78 to 91) and IHS (median 91 points; IQR 64 to 88) than the FS+ group (PODCI: median 94 points; IQR 69 to 89 points; IHS: median 89 points; IQR 62 to 87). The mean Severin scores were similar (FS- 2.65; FS+ 2.5; p = 0.93) but the FS- group had higher rates of good and excellent outcomes (FS- 56%; FS+ 41%; p < 0.00001) and lesser dislocation rates (FS- 6%; FS+ 14%; p = 0.16). Conclusion/UNASSIGNED:Although FS should be used when a hip cannot be reduced without undue tension, our results indicate that this procedure is not necessarily related to a better outcome. Level of evidence/UNASSIGNED:Therapeutic, Level III.

The Ponseti method for the correction of idiopathic talipes equinovarus (ITEV) produces excellent results, however recurrence is common, ranging from 11-37%. Recurrences require repeat manipulation and casting, frequently followed by surgical procedures. We hypothesized that at a minimum 4-year follow-up, the rate of invasive surgical interventions such as posteromedial release (PMR) or osteotomy, is low. A retrospective chart review of patients with ITEV treated by the Ponseti method from January 1999 to June 2017 was conducted. An invasive procedure was defined as a PMR or osteotomy, whereas minimally invasive procedures involved tendon lengthening and transfers. Inclusion criteria were patients with ITEV, less than 90 days old at initial visit, no previous series of casts, and potential of being 4 years old at last visit. A total of 150 feet (102 patients) were studied. Mean age at initial visit and last follow-up were 19.5 days and 7.6 years, respectively. For the initial series of casts, mean number of casts was 5.4 and 67.3% of feet had percutaneous Achilles tenotomies. Fifty-eight percent did not undergo any form of surgical procedure, while 33% underwent a tibialis anterior tendon transfer alone or in combination with a gastrocnemius recession, tendo-Achilles lengthening, or plantar fascia release. Early in the series, three feet in two patients underwent a PMR. The mean age at time of surgery was 55.3 months. In contrast to those treated for recurrence after PMR, the vast majority (98%) of feet with recurrence after Ponseti-treated ITEV had either no surgery or minimally invasive surgery

The Patient-Reported Outcomes Measurement Information System (PROMIS) was developed to examine the quality of life across various medical conditions. No studies have evaluated the use of the PROMIS in children with idiopathic talipes equinovarus (ITEV). The construct validity of the PROMIS Parent Proxy Profile short forms version was assessed by comparing its domains of Mobility, Fatigue and Pain Interference to the Function domain of the Disease Specific Instrument (DSI) for ITEV. The two questionnaires were mailed out to the parents of 93 patients, aged 5-17 years, with ITEV. We received a total of 21 complete responses (22.6% response rate). The patients' current mean age was 8.0 years (SD, 3.0 years). Seventeen were males and 4 were females. Nine had unilateral ITEV and 12 had bilateral ITEV. Bivariate correlation analysis, using Pearson correlation coefficients, demonstrated a moderate positive correlation between the DSI Function domain and the PROMIS Mobility domain (r=0.67) as well as a moderate negative correlation between the DSI Function domain and the PROMIS Pain Interference domain (r=-0.64). A fair negative correlation was found between the DSI Function domain and the PROMIS Fatigue domain (r=-0.35). These results provide support for the validity of the PROMIS Mobility Item in this population, however further studies are needed to assess the feasibility and reliability of these instrument items as well as other items within PROMIS

BACKGROUND:Simultaneous bilateral total knee arthroplasty (SBTKA) may offer certain benefits; however, its overall safety is still disputed. This study aimed at comparing the risk of thromboembolism and bleeding in patients who underwent SBTKA vs unilateral total knee arthroplasty (TKA). METHODS:The American College of Surgeons National Surgical Quality Improvement Program database from 2008 to 2015 was used to investigate the short-term postoperative complications and their risk factors following SBTKA as compared to unilateral TKA. Demographics, comorbidities, and 30-day outcomes were analyzed. Complications with an increased incidence following SBTKA were stratified to identify subgroups of patients at high risk. RESULTS:A total of 155,022 patients were identified, of which 150,581 underwent unilateral TKA and 4441 underwent SBTKA. The SBTKA group was found to be at a higher risk of venous thromboembolism (VTE), bleeding, and composite morbidity. Stratification analysis revealed that SBTKA subgroups at higher risk of VTE include patients of black or Asian origin, obese patients, and those who underwent anesthesia other than general or spinal/epidural. SBTKA subgroups at higher risk of bleeding include patients older than 85 years, those with race other than white, underweight and obese patients, and patients who underwent anesthesia other than spinal/epidural. Although none of the subgroups were protected from bleeding, patients who underwent spinal/epidural anesthesia had a lower risk of bleeding compared to other types of anesthesia. CONCLUSION/CONCLUSIONS:SBTKA confers an increased risk of postoperative VTE, bleeding, and composite morbidity at 30 days, with no increase in mortality.

Purpose/UNASSIGNED:Patients with late-presenting developmental dysplasia of the hip (DDH) are more likely to require an open reduction. Since many developing countries do not have mandated screening, there continues to be a relatively high incidence of late-presenting DDH. We report the clinical and radiographic outcomes of open reduction in a series of patients who presented late. Patients and methods/UNASSIGNED:This was a retrospective review of 712 hips in 645 patients that underwent open reduction, alone or in combination with a pelvic osteotomy. In all, 91 hips had open reduction alone and 621 had open reduction and pelvic osteotomy. Femoral shortening was performed in 221 hips. The mean age at the time of surgery was 2.1 years (1 to 6.5) and the mean follow-up time was 9.3 years (6 to 14). We used the Children's Hospital Oakland Hip Evaluation Score (CHOHES) to determine functional outcomes and the Severin classification was used to evaluate radiographic outcomes. The rate of avascular necrosis (AVN) and the need for a reoperation were also recorded and analyzed. Results/UNASSIGNED:In all 80% (570 hips) had good radiographic outcomes (Severin type I or II) and 87% had a CHOHES score of > 90 at final follow up. There was a 14% rate of AVN and only a 2% rate of redislocation. Better radiographic outcomes and lower reoperation rates were seen with patients who underwent both an open reduction and pelvic osteotomy. A trend was observed towards worse outcomes in older patients. Conclusions/UNASSIGNED:There was a high rate of good clinical and radiographic outcomes at a minimum six-year follow-up in patients with late-presenting DDH who underwent open reduction. Those who underwent open reduction in combination with a pelvic osteotomy had a higher rate of good radiographic outcomes and a lower rate of complications, particularly reoperation.

Infected nonunion of long bones may require intravenous antibiotics over a lengthy period which may result in a high rate of complications. This study aims to assess the efficacy of local antibiotics used as a replacement to prolonged intravenous therapy. Thirteen patients with infected nonunion of long bones who failed at least one previous surgery were included. The infection was treated through extensive debridement, application of antibiotic-impregnated calcium sulphate pellets and the bone stabilized with external fixation. These patients were monitored for union and infection by clinical signs, laboratory values, and radiographs over a period of 24 months. The results support an eradication of infection and union in all patients with no antibiotic-associated complications. Local antibiotic delivery using calcium sulphate pellets provides an effective method for treatment of nonunion in long bones and is free of the complications from the intravenous route.