Faculty Bibliography

PURPOSE: To identify trends in industry sponsorship of orthopaedic trauma research presented at the annual meetings of the Orthopaedic Trauma Association since the establishment of conflict of interest (COI) reporting policies in 1993. BACKGROUND: Industry plays a large role in funding orthopaedic basic science and clinical research. The purpose of this study was to analyze the role of industrial support in orthopaedic research as documented in the final programs of the annual meetings of the Orthopaedic Trauma Association (OTA), determine the incidence and nature of COI in the papers and posters accepted for OTA presentation, and report any changes in the frequency of reporting since disclosure policies were enacted in 1993. METHODS: This paper analyzes COI for all years since the adoption of the reporting policies 1993-2002. From 1993-1998, presenters of posters and papers presented at the Orthopaedic Trauma Association annual meetings were required to disclose COI greater than dollar 500, the type of monetary distribution was not recorded. From 1999-2002, presenters of posters and papers were required to acknowledge the type of COI: 1. research grant, 2. miscellaneous non-income support, 3. royalties, 4. stock, and 5. consultant fees. All COI categories were recorded for each year Linear regression was used to determine significance of trends in the pooled data. RESULTS: There was an increase in the percentage of papers accepted and presented at the OTA between 1993 and 2002 with COI. The number of papers reporting COI rose from 7.6% in 1993 to 12.6% in 2002 (p = 0.0129). There was no significant increase in posters with COI over that same time period. No changes were observed in the nature of industrial involvement since the change in reporting enacted in 1999. There were no observed trends in NIH or OTA grant distribution between 1993 and 2002. DISCUSSION AND CONCLUSION: Industry is playing an increasing role in the funding oforthopaedic research. The majority of industrial support is in the form of research grants. The increasing industrial support of scientific research in the public sector is to be applauded as long as it does not lead to the sequestering and suppression of information that may be disadvantageous to the industrial sponsor

To encourage consistent care for patients with musculoskeletal complaints, the AAOS developed treatment algorithms to aid primary care physicians in the management of these patients. A survey was designed to assess whether a random group of primary care physicians treated their patients in a manner consistent with these algorithms. The AAOS algorithm for shoulder pain was used to develop a questionnaire for primary care physicians. An Internet company provided access to a national base of physicians who volunteered to complete the survey. Ten questions were presented on five shoulder conditions: rotator cuff disease, fractures, instability, arthritis, and frozen shoulder The 'correct' answer was based upon the AAOS algorithm. The survey was completed by 706 physicians who treated variable (one to greater than ten) numbers of shoulder patients per month. Forty-eight percent of the physicians treated acute trauma according to the algorithm, 87% treated arthritis, and 58% treated instability. Only 46% of physicians chose the correct answer for an acute rotator cuff tear and 29% for chronic rotator cuff symptoms. Forty-four percent followed the algorithm for frozen shoulder. Overall only 49% of the patients described were treated according to the AAOS algorithms. Based on the number of shoulder patients seen each month, in one month over 2000 patients could be tested by the surveyed physicians in a manner inconsistent with the treatment algorithms, suggesting the need for improved musculoskeletal education for primary care physicians

An anatomic study was conducted on 49 dried cadaveric humeri and 24 dried cadaveric scapula to ascertain the variability of the following parameters: humeral neck angle, humeral head retroversion, humeral head medial offset, humeral head posterior offset, humeral head diameter glenoid height, glenoid width, and the glenoid height to width ratio. For verification purposes, the results of this study were found to be within 1.5% to 14.3% of other anatomic studies published in the literature. This observed variability was then compared to that provided by an 'anatomic' shoulder prosthesis (Equinoxe, Exactech, Inc.); viewed independently, this prosthesis can restore humeral neck angle in 94% of humeri, 'secondary' retroversion in 92% of humeri, medial offset in 100% of humeri, posterior offset in 100% of humeri, and humeral head diameter in 96% of humeri. Additionally, the glenoid prosthesis height to width ratio was found to be within 5% and 10% of 71% and 96% of cadaveric glenoids, respectively. The results of this analysis indicate that a dual-offset 'anatomic ' shoulder prosthesis has the capability to successfully restore glenohumeral anatomy in this representative population

Glenoid loosening is a common failure mode observed in total shoulder arthroplasty. In an effort to isolate the affect of differing fixation techniques on loosening, an edge displacement test was conducted using two, pear-shaped, UHMWPE glenoid designs: one keel and one peg, each having a glenohumeral radial mismatch of 4.3 mm. The susceptibility of each design to loosening was established by quantifiably comparing the maximum glenoid edge displacement before and after 100,000 cycles of eccentric loading by the humeral head along both the superoinferior (SI) and anteroposterior (AP) glenoid axes. Regardless of the axes tested, the results of this study indicate that no discernable difference in edge displacement (distraction and compression) occurred before or after cyclic, eccentric loading for either the keeled or pegged glenoid designs. Additionally, each keel andpeg glenoid remained firmly fixed after testing, suggesting that either fixation technique provides sufficient resistance to edge displacement

This study compares the results of arthroscopic and arthroscopically assisted mini-open rotator cuff repair in a series of 84 patients who underwent repair of small, medium, or large tears between March 1997 and September 2001 with at least 2 years of follow-up. There were 42 arthroscopic repairs and 42 mini-open repairs. Of the patients, 81 (96.4%) had good or excellent UCLA (University of California, Los Angeles) scores (40 arthroscopic repairs [95.2%] and 41 mini-open repairs [97.6%]); there were 2 fair results and 1 poor outcome. The ASES (American Shoulder and Elbow Surgeons) scores averaged 91.1 for the arthroscopic group and 90.2 for the mini-open group (P > .05). Six patients required further surgery (three from the arthroscopic group and three from the mini-open group). Of 84 patients, 83 (98.8%) reported being satisfied with the procedure. At greater than 2 years of follow-up, arthroscopic and mini-open rotator cuff repairs produced similar results for small, medium, and large rotator cuff tears with equivalent patient satisfaction rates

In a prospective, consecutive study conducted at a university teaching hospital, we evaluated the effects of Parkinson's disease (PD) on hip fracture outcomes. We followed 920 community-dwelling patients, aged 65 or older, who sustained a hip fracture that was operatively treated between July 1, 1987, and June 30, 1998. Presence or absence of PD had no bearing on type of surgery performed. Examined outcomes were postoperative complication rates; in-hospital mortality; length of hospital stay; discharge status (to home or to a skilled nursing facility); and mortality rate, place of residence, recovery of prefracture ambulatory ability, and return to prefracture activities of daily living (ADLs) 1 year after surgery Thirty-one patients (3.4%) had a history of PD before hip fracture. Patients with PD were more likely to be male, to live with another person, to have less ambulatory ability, and to be dependent in ADLs before hip fracture. Compared with patients without PD, they were hospitalized significantly longer and were more likely to be discharged to a skilled nursing facility. In addition, they declined more in level of independence in basic ADLs but not as much in instrumental ADLs at 1-year follow-up. Rates of postoperative complications, recovery of ambulatory ability within 1 year, and mortality within 1 year did not differ. These findings may guide orthopedic surgeons in counseling patients with PD and a hip fracture

The effect of glenohumeral arthritis and subsequent total shoulder arthroplasty (TSA) on shoulder proprioception has not been evaluated previously. A prospective analysis of 20 consecutive patients with unilateral advanced glenohumeral arthritis who underwent TSA was undertaken. Shoulder proprioception testing for passive position sense and detection of motion was performed 1 week before surgery and 6 months after TSA. The presence of glenohumeral arthritis had a significant effect on position sense for all 3 planes tested (flexion, abduction, and external rotation). There were significant differences (P < .05) compared with the uninvolved shoulder and with a group of 20 age- and gender-matched subjects without a history of shoulder problems. Six months after TSA, position sense was significantly improved (P < .05) and was not significantly different from that in the contralateral shoulder or the comparison group. Detection of motion was also significantly worse in the arthritic group compared with that in the uninvolved contralateral side (P < .05). Six months after TSA, the sensitivity to detection of motion improved (P < .01) and was not significantly different than that in the uninvolved contralateral shoulder. In addition, the postoperative values for the involved shoulder were not significantly different than those in the age- and gender-matched comparison group. This study demonstrates a significant decrease in proprioceptive function in patients with advanced glenohumeral arthritis. After TSA, there was a marked improvement in proprioception

The diagnosis and treatment of osseous deficiencies associated with anterior shoulder instability have been a challenge to physicians for centuries. Whereas historical goals centered on the stable reduction and prevention of recurrent dislocation, current standards of success are predicated on the restoration of motion and strength and the return to functional activities, including competitive athletics. Reestablishment of anterior shoulder stability thus requires the recognition of osseous defects of the humeral head and glenoid, as well as a thorough understanding of the available treatment options in the context of a disciplined treatment algorithm. Although many surgical procedures have been described for the management of osseous deficiencies in association with anterior shoulder instability, in the authors' experience, such procedures are seldom necessary. The purpose of this summary is to review treatment options as well as indications and techniques to address these bony deficiencies

We describe temporal and regional variation in hip fracture rates for people aged 65 or older in New York state (NYS) from 1985 to 1996. Our descriptive study was of all hip fracture cases admitted to NYS hospitals during that period. Case data were obtained from the Statewide Planning and Research Cooperative System (SPARCS) of the NYS Department of Health. US Census Bureau population estimates were obtained for each year from 1985 to 1996 to compute the annual hip fracture rate for each NYS county. These rates were adjusted for differences in age, gender, and race and were compared using logistic regression. Approximately 14,000 hip fractures occurred annually from 1985 to 1996. The annual rate (number of hip fractures per 1000 population) decreased from 6.4 in 1985 to 5.3 in 1996. White women aged 85 or older had the highest rate (26/1000); nonwhite men aged 65 to 69 had the lowest rate (<1/1000). Statewide annual rates decreased slightly over time, but this change was not reflected in all age, gender, and race subgroups. There was important, consistent variation in county rates after adjustment for age, gender, and race. Other researchers have identified geographic variation in national rates, but the postulated environmental and weather-related factors (eg, water fluoridation use; rainfall and sunshine amounts) have explained only a small proportion of this variation. Identification of risk factors that can better explain regional rate variation may lead to development of intervention strategies that could significantly reduce the risk for hip fracture among people 65 or older