- Table of Contents [PDF]
Axillary Approach for Pectoralis Major Transfer in the Treatment of Scapular Winging - William Yetter, MD; Tara Nagaraja, MD; and Zhongyu Li, MD, PhD
|
Transfer of the sternal head of the pectoralis major tendon to the inferior pole of the scapula is a well-known intervention for symptomatic medial scapular winging. Axillary approach has not been well represented in the literature but offers similar functional outcomes with improved cosmetics. In this retrospective review, seven patients with chronic medial scapular winging underwent pectoralis major tendon via axillary approach at a single academic institution. Six of the seven patients had improved function, range of motion, and scapular winging. Transfer of the sternal head of the pectoralis major tendon to the inferior pole of the scapula via an axillary approach is a safe and effective option for scapular winging reconstruction with the advantage of direct visualization of neurovascular structures and improved cosmesis. (Journal of Surgical Orthopaedic Advances 34(2):055-058, 2025)
Key words: scapular winging, pectoralis major transfer, serratus anterior dysfunction, long thoracic nerve dysfunction
The Future of Artificial Intelligence in Hand and Upper Extremity Surgery - The Future of Artificial Intelligence in Hand and Upper Extremity Surgery
The increasing role of artificial intelligence (AI) in healthcare is largely attributed to the fact that, with continual medical advances and digitization, clinical decision-making has become more and more reliant on data. As the volume and complexity of datasets grow, it is understandably diffi cult for physicians to manually discern meaningful patterns that guide diagnoses and/or treatments. AI applications, with the ability to rapidly identify patterns in large datasets, are being developed to assist physicians for improvements in patient care and workflow efficiencies. This review provides a brief description of AI with a focus on existing and developing applications in hand and upper extremity surgery. Although AI demonstrates great promise, both foreseen and unforeseen challenges remain. (Journal of Surgical Orthopaedic Advances 34(2):059-061, 2025)
Key words: artificial intelligence, machine learning, neural networks, hand surgery, upper extremity surgery
Diversity Within Foot and Ankle Surgery: A Systematic Review - Albert T. Anastasio, MD; Justin Leal, BS; Alexis L. Cliff ord, MS; and James A. Nunley, MD
This systematic review summarizes the state of historically underrepresented minority and gender diversity in foot and ankle surgery (FA) at multiple levels, particularly leadership and research productivity. A literature search was performed following the PRISMA (Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Included studies presented demographics regarding diversity within FA and provided trends in rank, leadership, or research. Ten cross-sectional studies were included and assessed for quality using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) cross-sectional study checklist. Demographics on hundreds of FA applicants, attendings, fellowship directors, and researchers/research articles were collected. Results show disparity at each level, particularly in leadership with females accounting for one (5.5%) chair, three (15.8%) program directors, fi ve (9.8%) division chiefs, three (4.4%) fellowship directors, and one (0.9%) professor. Although there has been an increase from 12% to 14% females in FA from 2010 to 2019, parity is not met. Recognition of the lack of diversity within FA will allow for targeted approaches to an equitable workforce. (Journal of Surgical Orthopaedic Advances 34(2):062-068, 2025)
Key words: diversity, inclusion, fellowship director, minority, parity
Avascular Necrosis of the Metacarpal Head in Skeletally Immature Patients Treated with Osteochondral Autograft Transfer System - Corina C. Brown, MD; Jessica Cohen-Brown, MD; and Zhongyu Li, MD, PhD
Avascular necrosis of the metacarpal head, or Dietrich’s disease, is a rare entity with approximately 40 reported cases in the literature since the original description. No consensus exists on optimal treatment. The purpose of this case series is to report the presentation and outcome of avascular necrosis (AVN) of the metacarpal head in skeletally immature patients treated with osteochondral autograft system. The authors prospectively assessed two male skeletally immature patients and three metacarpal heads who underwent osteochondral autograft transfer systems (OATS) from the ipsilateral knee for avascular necrosis of metacarpal heads after failure of conservative treatment. Outcome measures included patient-reported pain, metacarpophalangeal joint (MPJ) range of motion (ROM) and Disability of the Arm, Shoulder, and Hand (DASH) questionnaire. Two years after surgery, both patients returned to sporting activities with pain-free fi nger motion. Mean MPJ ROM improved from a range of 0 – 60 degrees to a range of 5 degrees of hyperextension to 75 degrees of flexion postoperatively. Mean DASH score improved from 27 preoperatively to 1.25 postoperatively. Radiographs revealed consolidation of osteochondral graft without signs of arthritis. OATS is a viable treatment option for young, high-demand patients presenting with avascular necrosis of the metacarpal head. (Journal of Surgical Orthopaedic Advances 34(2):069-072, 2025)
Key words: avascular necrosis of metacarpal head, osteochondral autograft
Decreased Complication Rate with Surgical Arthroscopy Compared with Arthrotomy for Treatment of Septic Arthritis of the Knee - John M. Tarazi, MD; Alain E. Sherman, MD, MBA; Matthew J. Partan, DO; Andrew D. Goodwillie, MD; and Randy M. Cohn, MD
The purpose of this study is to compare surgical arthroscopy versus arthrotomy for septic arthritis of the knee. The American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients who underwent arthroscopy or arthrotomy for native septic knee arthritis between 2010 and 2019. Demographic, lifestyle, and comorbidity variables were recorded, and 30-day outcome variables were analyzed appropriately. Multiple logistic regression modeling was performed to compare cohorts while controlling for covariates. A sample size of 983 patients were identified. Open irrigation and debridement with arthrotomy was associated with significantly longer mean operative time and hospital stay. Patients who underwent open treatment were less likely to be discharged home and had significantly increased odds of transfusion (OR = 1.31), developing pneumonia (OR = 2.89), and sepsis (OR = 1.55). Arthroscopic irrigation and debridement for septic arthritis of the knee is associated with shorter operative time, decreased length of stay, and increased rate of home discharge. Patients who underwent arthrotomy had an increased risk of transfusion, pneumonia, and sepsis. (Journal of Surgical Orthopaedic Advances 34(2):073-077, 2025)
Key words: septic arthritis of the knee, arthroscopy, arthrotomy, complications, 30-day outcomes
Patients Requiring Manipulation Under Anesthesia After Total Knee Arthroplasty Have Higher Rates of Preoperative Depression - Sean S. Rajaee, MD, MS; Kevin T. Rezzadeh, MD, MBA; Anderson Lee, BS; Caleb R. Durst, BS; Eytan M. Debbi, MD, PhD; and Guy Paiement, MD
Arthrofi brosis is a complication after total knee arthroplasty (TKA) that can limit functionality and cause dissatisfaction. This study assesses the prevalence of preoperative depressive symptoms amongst patients who required manipulation under anesthesia (MUA) for arthrofibrosis after TKA. Patients who underwent primary TKA with need for subsequent MUA were age and sex matched to control patients who underwent primary TKA without requiring MUA. Preoperative and postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores for function, pain, and depression as well as range of motion in both groups were compared. There were 16 MUA patients and 48 non-MUA patients included in this study. There was a significantly higher percentage of patients with preoperative depression in the MUA group (62.5% vs. 10.4%, p < 0.001). (Journal of Surgical Orthopaedic Advances 34(2):078-081, 2025)
Key words: manipulation under anesthesia, arthrofibrosis, stiffness, total knee arthroplasty, depression, PROMIS
Even When Bracing Fails to Prevent Surgery, It May Improve the Lumbar Curve in Patients with Adolescent Idiopathic Scoliosis - Adam Margalit, MD; Daniel Badin, MD; and Paul D. Sponseller, MD, MBA
Bracing decreases curve progression in adolescent idiopathic scoliosis (AIS). However, many curves still progress to a surgical range. The purpose of this study was to evaluate the effects of bracing on the lumbar curve in AIS patients who required posterior spinal fusion (PSF) for thoracic curves that progressed. The records of 432 patients with AIS who underwent PSF from 2005 to 2015 were reviewed. Braced/unbraced patients were matched 1:1 for age, Lenke type, and preoperative thoracic major curve. The unbraced group had a mean lumbar curve (44°) that was greater than the braced group (34°) (p < 0.001), the proportion of Lenke 1A curves was higher in the braced group (81% vs. 39%, p < 0.001), and the unbraced group had greater odds (odds ratio [OR] = 2.3; confidence interval [CI]: 1.2 – 4.5) of spinal fusion caudal to L1. Patients in the braced group had more favorable Lenke lumbar modifiers (type A), smaller preoperative lumbar curves, and fewer fused lumbar vertebrae compared with the unbraced group. (Journal of Surgical Orthopaedic Advances 34(2):082-085, 2025)
Key words: adolescent idiopathic scoliosis, bracing, Lenke type, lumbar curve, posterior spinal fusion
Fasciocutaneous Advancement Flap for Anterior Open Wounds After Primary and Revision Total Knee Arthroplasty - Daniel Y. Hong, MD; Nicholas C. Danford, MD, MA; Chia H. Wu, MD, MBA; and R. Kumar Kadiyala, MD, PhD
Large wounds after total knee arthroplasty (TKA) may not be amenable to primary closure and may require soft tissue coverage. A bipedicle fasciocutaneous advancement flap for anterior wounds after TKA that can be achieved without need for a trained microsurgeon is proposed. Retrospective chart review was performed. Sixteen adult patients who had non-closable primary wounds after both primary and revision TKA and received the bipedicle fasciocutaneous advancement flap were included. On average, patients were older than 65 years and had multiple comorbidities. All patients had healed wounds by final follow up, including four who received the flap after revision TKA. The surgical technique for the flap is included. In conclusion, the bipedicle fasciocutaneous advancement flap is a viable coverage option for wounds not amenable to primary closure after TKA, both primary and revision. No microsurgery training or tools are necessary to perform this procedure. (Journal of Surgical Orthopaedic Advances 34(2):086-089, 2025)
Key words: total knee arthroplasty, revision total knee arthroplasty, wound complications, fasciocutaneous flap, microsurgery
How the Reputation of Orthopaedic Residency Programs Influences the Spine Surgery Fellowship Match Results - Andrew J. Sama, MBA; Joshua T. Kaiser, BS; Chester J. Donnally III, MD; Lisa K. Cannada, MD; Alan S. Hilibrand, MD; and Chad A. Krueger, MD
This study sought to evaluate recent orthopaedic spine fellowship match results as it relates to the reputation of the respective applicants’ residency programs. Applicant’s residency program, fellowship match, number of fellowship positions available per program, where each fellowship ranked each applicant, and where each applicant ranked each fellowship program were included. Residency programs were divided into five tiers using the 2018 Doximity orthopaedic residency reputation rankings. Applicants from tier-1 Doximity-ranked residency programs were more likely to be offered interviews, applied to fewer programs, and matched to their first or second ranked fellowship program much more frequently than applicants from all other tiers (p < 0.01). This study suggests that applicants can be more targeted in terms of choosing the number of interviews to attend, and fellowship programs can be more selective with interview strategy. (Journal of Surgical Orthopaedic Advances 34(1):090- 092, 2025)
Key words: fellowship match, orthopaedics, residency rankings, spine surgery, doximity
Changes to Anticipated Disposition Prevent Timely After Total Joint Arthroplasty - Rade R. Jibawi Rivera, BS; Ye Lin, MD; Julio C. Castillo Tafur, MD; Asher E. Lichtig, MD; Luke Zabawa, MD; and Mark H. Gonzalez, MD, PhD
This study evaluates the impact of preoperative disposition planning on length of stay (LOS) after total joint arthroplasty (TJA). A retrospective chart review, including patients undergoing primary TJA, was performed. Demographics, social factors, Risk Assessment and Prediction Tool (RAPT) scores, and predicted and actual disposition were used to analyze patients that exceeded their expected LOS. Six hundred seventy-nine patients met the inclusion criteria. Average predicted and actual LOS were 2.4 and 2.7 days, respectively. Three hundred thirty-six patients exceeded their anticipated LOS. The most significant factor for exceeding LOS was a change in disposition (p < 0.001). Eighty-two patients had a change in disposition. Patients that required a higher (40) or lower (42) level of care had prolonged LOS (p < 0.001). A change to either higher or lower levels of care than preoperatively anticipated results in increased LOS after TJA. (Journal of Surgical Orthopaedic Advances 34(2):093- 097, 2025)
Key words: arthroplasty, disposition, planning, length of stay
Does the Order of Lumbar Surgery and Total Joint Replacement Impact Total Joint Replacement Outcomes? - Anthony M. Steinle, BA; Andrew J. Croft; Alexander J. Volkmar, MD; Eric S. Dilbone, MD; Hui Nian, PhD; Jeff rey W. Chen, BA; Hani Chanbour, MD; Emil Varas-Rodriguez, MPH; Wilson E. Vaughan, MS; Scott L. Zuckerman, MD, MPH; Byron F. Stephens, MD, MSCI; J. Ryan Martin, MD; and Amir M. Abtahi, MD
For patients requiring both total joint replacement (TJR) and lumbar spine surgery, it is unknown whether surgical order influences TJR outcomes. The authors sought to determine if total knee (TKA) or total hip (THA) arthroplasty outcomes differed between patients who underwent TKA/THA before versus after lumbar surgery. A prospectively collected registry was queried for patients who underwent TKA or THA within 3 years of lumbar spine surgery. Patients were divided into TKA before versus after lumbar surgery, and THA before versus after lumbar surgery. Statistical analysis was performed to compare postoperative outcomes. In both the TKA and THA cohorts, no differences could be detected between before and after groups in any postoperative outcome, including knee/hip pain, complications, and reoperations. The order of lumbar and TJR surgeries does not appear to influence TJR outcomes. The severity of symptoms, patient preference, and surgeon discretion should dictate surgical order. (Journal of Surgical Orthopaedic Advances 34(2):098-101, 2025)
Key words: lumbar spine surgery, total joint replacement, knee arthroplasty, hip arthroplasty
Shedding Sunshine on Gender Inequities in Industry Compensation to Physicians: a Centers for Medicare and Medicaid Services Open Payment Analysis - Adam M. Almaguer, MD; Kyle D. Paul, MD; Alexandra M. Arguello, MD; Aseel G. Dib, MD; Erin Katz, MD; Achraf H. Jardaly, MD; Andrew T. Ko, BS; Monica Kogan, MD; Gerald McGwin, PhD; Bradley W. Wills, MD; and Brent A. Ponce, MD
The purpose of this study is to compare payments reported in the Centers for Medicare and Medicaid Services Open Payments Database according to gender. The authors hypothesized that women physicians would have fewer payments and lower total compensation from pharmaceutical and medical device companies as compared with men. A higher proportion of males received > $1,000,000 in compensation from industry, and a higher proportion of females received < $1,000 in compensation from industry. The largest discrepancy in compensation between genders was seen in royalties/licensing, faculty/speaking, and consulting. Review of Centers for Medicare and Medicaid Services Open Payment Database found that gender inequality exists in compensation from pharmaceutical and medical device companies. Female physicians receive less total compensation from industry. It is important to highlight this disparity between genders so that changes can be made to ensure that equal opportunities exist. (Journal of Surgical Orthopaedic Advances 34(2):102-107, 2025)
Key words: industry compensation, gender, inequity, inequality