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Comparison of radiographs and computed tomography (CT) imaging for preoperative evaluation and planning for shoulder arthroplasty

Liuzza, Lindsey G.; Abdelshahed, Mina M.; Oh, Cheongeun; Roach, Ryan; Looze, Christopher; Capeci, Craig; Kwon, Young W.; Zuckerman, Joseph D.; Virk, Mandeep S.
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
ISSN: 1045-4527
CID: 4921782

Osteochondral allografts: applications in treating articular cartilage defects in the knee

Capeci, Craig M; Turchiano, Michael; Strauss, Eric J; Youm, Thomas
Chondral injury in the knee is a unique challenge to the orthopaedic surgeon. Given the high probability of progression to knee arthrosis, the treatment of symptomatic cartilage defects of the knee has become an important surgical intervention in young, active patients. The demand for an alternative to prosthetic resurfacing has driven the trend towards biologic resurfacing and joint preservation. Osteochondral allografts are composed of hyaline cartilage attached to subchondral bone and are suited for large osteochondral lesions. This allograft tissue must be harvested, processed, and stored appropriately to reduce the risks of graft failure and potential complications. With appropriate indications and surgical techniques, osteochondral allografts have been shown to have good long-term graft survival and patient outcomes.
PMID: 24032585
ISSN: 2328-4633
CID: 593232

Subtrochanteric femoral fractures in patients receiving long-term alendronate therapy: imaging features

Chan, Sarah Shock; Rosenberg, Zehava Sadka; Chan, Keith; Capeci, Craig
OBJECTIVE: A paradoxical association between long-term alendronate therapy and low-energy subtrochanteric femoral fractures has been recently recognized. A retrospective review of 34 such femoral fractures was performed. CONCLUSION: Subtrochanteric femoral fractures associated with long-term alendronate therapy present with minimal trauma, may be chronic, and when incomplete may be missed. The characteristic imaging features include initial involvement and focal thickening of the lateral cortex, transverse orientation, medial beak, and superior displacement and varus angulation at the fracture site
PMID: 20489100
ISSN: 1546-3141
CID: 109798

Patella tendon rupture after arthroscopic resection of the prepatellar bursa--a case report

Epstein, David M; Capeci, Craig M; Rokito, Andrew S
The use of arthroscopic techniques for excision of the pre-patellar bursa has become more common in recent years for the treatment of prepatellar bursitis. The current literature includes several case series that report few complications with this technique. We report the case of a 73-year-old male who sustained a low-energy patella tendon rupture 2 months after arthroscopic resection of the prepatellar bursa. We hypothesize that during arthroscopic excision of the prepatellar bursa there was an iatrogenic injury to the patellar tendon, which contributed to the subsequent rupture. Surgical repair was successfully performed using an open technique with a 1-year follow-up. To our knowledge, this is the first case report of patella tendon rupture following arthroscopic excision of the prepatellar bursa
PMID: 21162710
ISSN: 1936-9727
CID: 133849

Bilateral low-energy simultaneous or sequential femoral fractures in patients on long-term alendronate therapy

Capeci, Craig M; Tejwani, Nirmal C
BACKGROUND: While alendronate therapy has been shown to decrease the risk of vertebral and femoral neck fractures in postmenopausal osteoporotic patients, recent reports have associated long-term alendronate therapy with unilateral low-energy subtrochanteric and diaphyseal femoral fractures in a small number of patients. To our knowledge, there has been only one report of sequential bilateral femoral fractures in patients on long-term bisphosphonate therapy. METHODS: We retrospectively reviewed the case log of the senior author over the last four years to identify patients who presented with a subtrochanteric or diaphyseal femoral fracture after a low-energy mechanism of injury (a fall from standing height or less) and who had been taking alendronate for more than five years. Radiographs were reviewed, and the fracture patterns were recorded. Serum calcium levels were recorded when available. RESULTS: Seven patients who sustained low-energy bilateral subtrochanteric or diaphyseal femoral fractures while on long-term alendronate therapy were identified. One patient presented with simultaneous bilateral diaphyseal fractures, two patients had sequential subtrochanteric fractures, and four patients had impending contralateral subtrochanteric stress fractures noted at the time of the initial fracture. Of the latter four, one patient had a fracture through the stress site and the other three patients had prophylactic stabilization of the site with internal fixation. No patient had discontinued alendronate therapy prior to the second fracture. All patients were women with an average age of sixty-one years, and they had been on alendronate therapy for an average of 8.6 years. All fractures were treated with reamed intramedullary nailing and went on to union at an average of four months. CONCLUSIONS: In patients on long-term alendronate therapy who present with a subtrochanteric or diaphyseal femoral fracture, we recommend radiographs of the contralateral femur and consideration of discontinuing alendronate in consultation with an endocrinologist. If a contralateral stress fracture is found, prophylactic fixation should be considered
PMID: 19884427
ISSN: 1535-1386
CID: 105183

Operative experience in an orthopaedic surgery residency program: the effect of work-hour restrictions

Baskies, Michael A; Ruchelsman, David E; Capeci, Craig M; Zuckerman, Joseph D; Egol, Kenneth A
BACKGROUND: The implementation of Section 405 of the New York State Public Health Code and the adoption of similar policies by the Accreditation Council for Graduate Medical Education in 2002 restricted resident work hours to eighty hours per week. The effect of these policies on operative volume in an orthopaedic surgery residency training program is a topic of concern. The purpose of this study was to evaluate the effect of the work-hour restrictions on the operative experiences of residents in a large university-based orthopaedic surgery residency training program in an urban setting. METHODS: We analyzed the operative logs of 109 consecutive orthopaedic surgery residents (postgraduate years 2 through 5) from 2000 through 2006, representing a consecutive interval of years before and after the adoption of the work-hour restrictions. RESULTS: Following the implementation of the new work-hour policies, there was no significant difference in the operative volume for postgraduate year-2, 3, or 4 residents. However, the average operative volume for a postgraduate year-5 resident increased from 274.8 to 348.4 cases (p = 0.001). In addition, on analysis of all residents as two cohorts (before 2002 and after 2002), the operative volume for residents increased by an average of 46.6 cases per year (p = 0.02). CONCLUSIONS: On the basis of the findings of this study, concerns over the potential adverse effects of the resident work-hour polices on operative volume for orthopaedic surgery residents appear to be unfounded
PMID: 18381332
ISSN: 1535-1386
CID: 76797

Massive femoral osteolytic lesion secondary to disengagement of a total knee tibial locking pin: case report [Case Report]

Sathappan, Sathappan S; Capeci, Craig; Teicher, Matthew; Di Cesare, Paul E
The Anatomic Modular Knee (AMK; Depuy, Warsaw, Ind) was one of the first designs to incorporate a modular locking mechanism for the tibial insert; fixation was secured using a screw-in tibial tray-locking pin. This case report describes a patient who presented with instability and worsening knee pain 15 years following a primary total knee arthroplasty using the AMK prosthesis. Radiographs and intraoperative assessment revealed proximal migration of the tibial tray-locking pin into the medial femoral condyle resulting in a large osteolytic defect
PMID: 17665788
ISSN: 1538-8506
CID: 74162

Clinical outcome of total hip arthroplasty using the normalized and proportionalized femoral stem with a minimum 20-year follow-up

Sathappan, Sathappan S; Teicher, Matthew L; Capeci, Craig; Yoon, Michelle; Wasserman, Bradley R; Jaffe, William L
Currently, there are several femoral stem designs available for use, but few have an extended track record. We have previously reported on 10- and 15-year outcome studies of total hip arthroplasty (THA) using a cemented normalized and proportionalized femoral stem from a single surgeon series. This is a follow-up study reporting the minimum 20-year outcome of this femoral stem design. The study began with THA performed in a consecutive series of 184 patients; stem fixation was achieved using first-generation cementing techniques. The overall early complication rate was 10%. There were 23 patients (31 hips) who had been followed-up for a minimum 20-year period (average 21.3 years). Mean d'Aubigne and Postel scores improved from 5.9 to 11.3; mean Harris hip scores improved from 43.8 to 92.8. Kaplan-Meier survivorship was 93% at 20 years (95% confidence interval); there were no stem failures. The use of a cemented normalized and proportionalized femoral stem in primary THA provides satisfactory long-term clinical and radiological outcomes in patients.
PMID: 17400091
ISSN: 0883-5403
CID: 72813

Component asymmetry in simultaneous bilateral total knee arthroplasty

Capeci, Craig M; Brown, Edward C 3rd; Scuderi, Giles R; Scott, W Norman
Component size asymmetry and knee scores were determined in a review of 253 patients undergoing simultaneous or same-day, bilateral total knee arthroplasty (TKA). Asymmetry in component sizes was found in 22 (8.7%) pairs of femoral components, 17 (6.7%) pairs of tibial components, and 13 (5.1%) pairs of patellar components. Asymmetric and symmetric total knee arthroplasties were seen equally in men and women, and there was no statistical difference in knee scores and range of motion between patients with symmetric or asymmetric arthroplasties. Asymmetry rates for anterior referenced femoral components were significantly higher than posterior referenced components, an unexpected finding of unknown significance. Awareness of the incidence of component asymmetry and the practice of independent sizing of each knee during bilateral TKA is important to continue the success of bilateral TKA in a growing patient population.
PMID: 16877164
ISSN: 0883-5403
CID: 165722

Surgical approaches in mini-incision total knee arthroplasty

Scuderi, Giles R; Tenholder, Mark; Capeci, Craig
Mini-incision total knee arthroplasty can be accomplished through versions of exposures used in standard total knee arthroplasty. Modifications of the medial parapatellar, subvastus, and midvastus approaches are presented, and potential advantages and disadvantages of each approach are reviewed. When making the transition to smaller incisions and arthrotomies, the medial parapatellar seems to be the most versatile. The ability to do a total knee arthroplasty through a mini incision, and ultimately the success of the procedure, will depend on appropriate patient selection.
PMID: 15534520
ISSN: 0009-921x
CID: 165720