Faculty Bibliography

The purpose of this study was to examine the relationship between sex, race, and preoperative function in a large diverse patient population undergoing hip and knee arthroplasty. An observational study was conducted on 3542 consecutive primary unilateral total hip and knee arthroplasties. Harris Hip and Knee Society Scores were used to quantify preoperative function. The results demonstrate lower function, with average Harris Hip Scores that were 4.9 (P < .0001) and 8.77 (P < .001) and average Knee Society Scores that were 6.03 (P < .06) and 12.8 (P < .001) points lower in African American and Hispanic patients than white patients for the population, respectively. This study demonstrates that Hispanic and African American patients have worse preoperative hip and knee function before arthroplasty than white patients. Future efforts to elucidate the reasons for this decreased function as well as efforts to rectify any disparities should target these patient populations

BACKGROUND: We reviewed all revision operations performed by a single surgeon on previous hemi- and total shoulder arthroplasties from November 1987 to March 2005. METHOD: Thirty-five patients' charts were reviewed to determine the causes of failures. In addition, their outcomes after the revision surgery were analyzed. RESULTS: Overall, results were satisfactory in 71% by Neer criteria at a mean follow-up of 27.6 months. Outcomes were related to reason for failure. When failure was because of glenoid erosion, loosening, or humeral loosening, the mean improvement in forward elevation (FE) (28.9 degrees ) and external rotation (ER) (16.1 degrees ) was significantly better (P=.024 FE; P=.000 ER) than when the failure was because of infection, soft-tissue problems, or pain of undetermined origin (FE=-5.6 degrees ; ER=-6.8 degrees ).Likewise, UCLA scores in the first group were significantly better than in the second group (P=.003). In the first group, 16/18 patients were satisfied, while in the second group only 4/17 were satisfied. CONCLUSION: Our data suggest that patients whose revisions are because of glenoid erosion or component loosening can expect to have better outcomes than those whose revisions are performed for infection, instability, or other soft-tissue problems

Anterior glenohumeral instability complicated by bone loss is a challenging problem and, when severe, may require surgical treatment with bone grafting. We review our institution's experience with humeral head and glenoid bone grafting for large Hill-Sachs lesions and glenoid defects. MATERIALS AND METHODS: Patients who underwent intra-articular bone reconstruction for Hill-Sachs and large glenoid defects for anterior instability at our institution during 2002-2008 were retrospectively reviewed. Those who had undergone concomitant humeral head replacement were excluded. Six patients were identified as having undergone allograft or autograft iliac crest bone graft reconstruction of the glenoid, with four available for full follow-up (average 39 months; range, 7 to 63). Five patients were identified as having undergone humeral head allograft reconstruction and four were available for full follow-up (average 28 months; range, 11 to 40). The remaining three patients were available for telephone follow-up. American Shoulder and Elbow Society (ASES) and University of California, Los Angles (UCLA) scores were recorded and radiographs obtained. RESULTS: Average postoperative ASES and UCLA scores for glenoid bone graft patients were 91 and 33, respectively. Average postoperative ASES and UCLA scores for humeral bone graft patients were 85.3 and 28.4, respectively. Glenoid bone graft shoulders, when compared to the opposite normal side, lost an average of 3 degrees of forward flexion, 10 degrees of external rotation, and two levels of internal rotation. Humeral head bone-grafted shoulders, lost an average of 23 degrees of forward flexion, 8 degrees of external rotation, and two levels of internal rotation. No episodes of recurrent subluxation or dislocations were reported. Radiographs showed no evidence of graft resorption or hardware prominence. CONCLUSIONS: Bone grafting procedures around the shoulder for the treatment of instability provided relief from recurrent instability and good functional results

BACKGROUND: There has been an increasing number of arthroscopic surgeries performed in general orthopedic surgery practice, as well as a rapid evolution of arthroscopic techniques. The objective of this investigation was to assess the adequacy of arthroscopic training in U.S. orthopedic residency programs from a resident and program director perspective. MATERIALS AND METHODS: The study was performed with a mail-in survey to orthopaedic surgery residents and program directors. Out of 151 programs contacted, we received responses from 24 program directors (15.9%) and 272 residents (11.1% of 2447 possible residents in years 2 through 5 in 2006). Program demographics and resident and program director assessments of arthroscopic surgical training was obtained from the questionnaire. Assessment of open surgical techniques was used as a control. The responses from fifth-year residents (83 of a possible 612 in 2006 (13.6%)) and program directors were used for detailed analysis. RESULTS: Only 32% (27/83) of fifth-year residents felt there was adequate time dedicated to arthroscopic training, compared to 66% (16/24) of program directors (p < 0.01). Thirty-four percent (28/83) of fifth-year residents felt as prepared in arthroscopy as open techniques, in contrast to 58% (14/24) of program directors, who felt fifth-year residents were appropriately prepared in arthroscopic techniques (p = 0.03). The amount of surgery that residents are allowed to perform correlated significantly (p < 0.01) with confidence levels. CONCLUSIONS: Fifth-year residents who were surveyed felt less prepared in arthroscopic training, compared to open surgical procedures. Program directors surveyed over estimated confidence levels in fifth-year residents performing arthroscopic procedures. To ensure that graduating residents are appropriately prepared for the current demands of a clinical setting, it may be necessary to reexamine residency requirements to ensure adequate practice in developing arthroscopic surgical skills

Stress fractures of the pubic rami are rare occurrences and most frequently occur in association with total hip arthroplasty (THA). Reported historically with both cemented and noncemented THA components, postoperative stress fractures likely occur secondary to a rapid postoperative increase in patient activity following years of disability. Though stress fractures of the pubic rami should be considered in the differential diagnosis of groin pain following THA, they require a high degree of suspicion. Diagnosis may be achieved via bone scan after ruling out alternative causes of postoperative groin pain and after accounting for associated medical conditions. Treatment is minimally invasive, requiring a limited period of weightbearing and activity modifIcation, often with full resolution of groin pain and a return to postoperative activity levels

The issue of athletic participation after hip and knee arthroplasty has become more relevant in recent years, with an increase in the number of young and active patients receiving joint replacements. This article reviews patient-, surgery-, implant-, and sports-related factors, and discusses currently available guidelines that should be considered by the physician when counseling patients regarding a return to athletic activity after total joint arthroplasty. Current evidence regarding appropriate athletic participation after total hip arthroplasty, resurfacing hip arthroplasty, total knee arthroplasty, and unicondylar knee arthroplasty is reviewed