A comparison of quantitative and qualitative shoulder range of motion with patient-reported outcomes.

BACKGROUND: The evaluation of shoulder function requires a combination of physical examination of shoulder range of motion and measures of functional outcome measures. Although efforts have been made to define range of motion for clinical evaluation with respect to functional outcomes, a disconnect still exists when defining a successful outcome. We aim to compare quantitative and qualitative measures of shoulder range of motion with patient-reported outcome measures. METHODS: Data from 100 patients who presented to the office of a single surgeon with a chief complaint of shoulder pain were evaluated for this study. Evaluation included American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, Single Assessment Numeric Evaluation relative to the shoulder of interest, demographic information, and range of motion in the shoulder of interest. RESULTS: Internal rotation angle did not correlate with patient-reported outcomes, whereas external rotation and forward flexion angles did. Qualitative internal rotation as measured by hand-behind-back reach demonstrated a weak to moderate correlation with patient-reported outcomes, and a significant difference in global range of motion and functional outcome measures were identified in patients who can or cannot reach above the belt line or to the thoracic spine. Qualitative assessment of forward flexion demonstrated that patients who can reach specific anatomic landmarks have significantly improved functional outcome measures, and the same is true when comparing patients who can externally rotate past neutral. CONCLUSIONS: Hand-behind-back reach can be used as a clinical marker of global range of motion and functional outcome measures for patients with shoulder pain. Goniometer measurement of internal rotation has no relationship with patient-reported outcomes. Forward flexion and external rotation assessment with qualitative cutoffs can additionally be used clinically to determine functional outcome for patients with shoulder pain.

High-Mobility Hole Transport in Single-Grain PbSe Quantum Dot Superlattice Transistors.

Epitaxially-fused superlattices of colloidal quantum dots (QD epi-SLs) may exhibit electronic minibands and high-mobility charge transport, but electrical measurements of epi-SLs have been limited to large-area, polycrystalline samples in which superlattice grain boundaries and intragrain defects suppress/obscure miniband effects. Systematic measurements of charge transport in individual, highly-ordered epi-SL grains would facilitate the study of minibands in QD films. Here, we demonstrate the air-free fabrication of microscale field-effect transistors (µ-FETs) with channels consisting of single PbSe QD epi-SL grains (2-7 µm channel dimensions) and analyze charge transport in these single-grain devices. The eight devices studied show p-channel or ambipolar transport with a hole mobility as high as 3.5 cm2 V-1 s-1 at 290 K and 6.5 cm2 V-1 s-1 at 170-220 K, one order of magnitude larger than that of previous QD solids. The mobility peaks at 150-220 K, but device hysteresis at higher temperatures makes the true mobility-temperature curve uncertain and evidence for miniband transport inconclusive.

Return to Sport and Sports-Specific Outcomes After Osteochondral Allograft Transplantation in the Knee: A Systematic Review of Studies With at Least 2 Years' Mean Follow-Up.

PURPOSE: To report current data on return-to-sport rates and sports-specific patient-reported outcomes after osteochondral allograft (OCA) transplantation for cartilage defects of the knee. METHODS: We performed a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines that included studies from 1975 to 2018 with a minimum 2-year mean follow-up that reported return-to-sport rates or sports-specific patient-reported outcomes. Outcomes, reoperations, and complications were provided in table format, and a subjective analysis was performed. RESULTS: This review included 13 studies with 772 patients who underwent OCA transplantation at a mean of 24 to 91 months' follow-up. The return-to-sport rate ranged from 75% to 82%. For patient-reported outcomes, the Knee Injury and Osteoarthritis Score Sport increased in 4 studies, the Tegner activity scale score increased in 3 studies but decreased in 1, and the Marx activity scale score increased in 1 study but decreased in 2. Studies reporting improvements in the Cincinnati Knee Score and Knee Injury and Osteoarthritis Score Sport reached the minimal clinically important difference. The reoperation rate was high (ranging from 34% to 53% in more than half of studies), with reoperations primarily performed for loose body removal or debridement. CONCLUSIONS: This systematic review of 13 studies suggests that OCA transplantation for cartilage defects allows most athletes to return to sport (range, 75%-82%). Most studies reported improvements in sports-specific patient-reported outcomes at follow-up and reached the minimal clinically important difference. However, the reoperation rate was high in several studies, with a large percentage of patients requiring loose body removal or debridement. The long-term survival of the allografts is largely unknown, but this study suggests OCA transplantation consistently improves function in athletes with chondral injuries. LEVEL OF EVIDENCE: Level IV, systematic review of Level III and IV studies.

Thirty-Three-Year Follow-up Following Silicone Scaphoid Arthroplasty: A Case Report.

CASE: A 64-year-old man presented with a 3-year history of right wrist pain and swelling 33 years after a silicone scaphoid arthroplasty for chronic scaphoid nonunion. Radiographs demonstrated a deformed scaphoid implant, carpal and distal radius cysts, and mild carpal collapse. He elected to undergo a wrist arthrodesis with a dorsal fusion plate after failing conservative management. CONCLUSION: Although carpal bone silicone implant arthroplasties of the wrist have long been abandoned, our patient was pain free and fully functional for 3 decades. He was pleased to undergo serial examinations with radiographs for 30 years without any therapeutic intervention.

Culture Negative Pasteurella multocida Confirmed Prosthetic Hip Infection using Next-generation Sequencing.

Introduction: Prosthetic joint infections (PJIs) are a dreaded complication of joint arthroplasty. Zoonotic organisms such as Pasteurella multocida (PM) rarely cause PJIs. Still, these organisms can be challenging to treat due to a low suspicion index and inadequate growth on culture. Next-generation sequencing (NGS) can be used to identify organisms in culture-negative PJIs. This is the first reported case of a PM positive total hip arthroplasty PJI using NGS. Case Report: We report the case of a 70-year-old male presenting with a periprosthetic hip infection. PM was identified in high relative abundance on NGS and grew in culture. Subsequent intraoperative samples were culture negative for Pasteurella, but NGS demonstrated continued presence of Pasteurella. Conclusion: PM is a rare case of PJI, but a high index of suspicion must be maintained in the appropriate clinical context. NGS is a vital tool for the identification of culture-negative organisms like PM.

Six-Week Radiographic Follow-up Does Not Change Management for Nonoperatively Treated Extraarticular Metacarpal Shaft Fractures.

BACKGROUND: Metacarpal fractures are common and account for over 30% of all hand fractures. Previous literature has shown similar outcomes between operative and nonoperative management of metacarpal shaft fractures. There is little information regarding the natural history of conservatively managed metacarpal shaft fractures and changes in management based on follow-up radiographs. METHODS: A retrospective chart review was performed on all patients who presented to a single institution with an extraarticular metacarpal shaft or base fracture between 2015 and 2019. RESULTS: Thirty-one patients with 37 metacarpal fractures were included for review: average age 41 years, male 48%, right hand dominant 91%, and average follow-up duration 7.3 weeks. At follow-up, a change of 2.4° in angulation (P = .0005) and a change in shortening of 0.1 mm (P = .0386) were noted over the 6-week time interval. No fractures had malrotation at presentation, and none developed malrotation during the follow-up period. CONCLUSIONS: Recent systematic reviews and meta-analysis have suggested that metacarpal fractures treated nonoperatively had similar outcomes to surgical fixation at 12 months of follow-up. We found that extraarticular metacarpal shaft fractures that do not meet operative indications at the initial visit should be expected to heal reliably with minimal change in angulation and shortening over time. The transition to removable brace or no brace at the 2-week follow-up is likely sufficient, and additional follow-up is not necessary and will reduce cost. LEVEL OF EVIDENCE: Level III.

Predictors of Academic Productivity Among Spine Surgeons.

INTRODUCTION: The relationship between research productivity in training and future productivity as an attending spine surgeon is not well-established in the literature nor has the effect of geographic location of training institutions on future academic success been investigated. The aim of our study was to (1) summarize characteristics of academically productive spine surgeons, (2) assess predictors of long-term academic productivity, and (3) establish the effect of geographic location on long-term academic productivity. METHODS: A query was conducted of the 2021 to 2022 North American Spine Society Spine Fellowship Directory of all orthopaedic and neurosurgical spine fellowship selection committee members for each institution participating in the spine fellowship match. The attending publication rate and h- index were determined. A multivariate linear regression model was developed. P value was set to <0.05. RESULTS: We identified 310 orthopaedic and neurosurgical spine surgeons, representing 76 fellowship programs. Multivariate linear regression analysis identified that the publications during residency ( P < 0.001) and during fellowship ( P < 0.001) were significant predictors of an increased publication rate as an attending surgeon. By contrast, the preresidency publication rate ( P = 0.729) was not significantly predictive of the attending publication rate. Multivariate analysis of h- index found that residency publication rate had a positive correlation ( P = 0.031) compared with preresidency ( P = 0.579) or fellowship ( P = 0.257) rates. Attendings who had attended residency in the Northeast and currently practicing in the Northeast had a higher publication rate ( P < 0.001 and P = 0.004, respectively). DISCUSSION: A higher number of publications in residency and fellowship were markedly predictive of an increased publication rate as an attending spine surgeon. By contrast, preresidency publications may not be indicative of future academic productivity as an attending. Location may also contribute to attending publication rate and favor those who undergo residency training and ultimately practice in the Northeast.

Long-Term Outcomes of Massive Rotator Cuff Tear Repair: A Systematic Review.

BACKGROUND: With an increase in the treatment options available for massive rotator cuff tears, understanding the long-term outcomes of the chosen modality is important. QUESTIONS/PURPOSE: The purpose of this study was to systematically review the available literature on repair of massive rotator cuff repairs and learn the longevity of outcomes, the failure rate, outcomes after failure, and any contributing factors to poor outcomes or failure. METHODS: We conducted a systematic review of the MEDLINE, Cochrane, and Embase databases to find studies that investigated the long-term results of repair of massive rotator cuff repairs. Studies were excluded if they did not stratify results of massive tears, provide a definition for a massive rotator cuff tear, or report isolate patients with long-term follow-up. RESULTS: Six studies met the inclusion criteria, for a total of 472 shoulders; average patient age was 57.6 years. Follow-up ranged from 119 to 240 months. Outcome scores improved significantly following repair and were maintained throughout follow-up. The repair failure rate across studies was 39.2%. Patients who suffered retear had significantly worse outcome scores than patients with intact tendons at long-term follow-up. CONCLUSIONS: The existing literature on long-term follow-up after massive rotator cuff repair is scarce and not of high level of evidence. This review found repair of massive rotator cuff tears leads to long-term maintained improvements in outcome measures. Failure of repair is quite common, but results following failure are superior to preoperative outcomes.

Management and Scheduling of Spine Surgery in a Level 1 Trauma Center in the Setting of the COVID-19 Pandemic: Feasibility and Considerations for Reimplementation of Elective Spine Surgery.

Introduction: Determination of what constitutes necessary surgery in the setting of acute hospital resource strain during the COVID-19 pandemic is an unprecedented challenge for healthcare systems. Over the past two years during the COVID-19 pandemic, there have been many changes in reviews of medically necessary spine surgery. There continues to be no clear guidelines on recommendations and further discussion is necessary to continue to provide appropriate and high-level care during future pandemics. Significance: This review critically appraises and evaluates current barriers to medically necessary spine surgery during the COVID-19 pandemic and evaluates future decision making to maintain spine surgery during future pandemics or limitations in medical care. Results: Multiple studies included in this review have shown that while various orthopaedic surgeries may be considered elective, medically necessary spine surgery will need to continue during settings of limited medical care. This review discussed multiple methods and recommendations to limit transmission of virus from patients to providers and providers to patients. Conclusion: Continued medically necessary spine surgery in the setting of the COVID-19 pandemic and future pandemics should continue while limiting risk of transmission to continue providing high-level medical care and allowing hospitals to maintain financial responsibility.

An inexpensive programmable optogenetic platform for controlled neuronal activation regimens in C. elegans.

In Caenorhabditis elegans, optogenetic stimulation has been widely used to assess neuronal function, control animal movement, or assay circuit responses to controlled stimuli. Most studies are performed on single animals and require high-end components such as lasers and shutters. We present an accessible platform that enables controlled optogenetic stimulation of C. elegans in two modes: single animal stimulation with locomotion tracking and entire population stimulation for neuronal exercise regimens. The system consists of accessible electronic components: a high-power light-emitting diode, Arduino board, and relay are integrated with MATLAB to enable programmable optogenetic stimulation regimens. This system provides flexibility in optogenetic stimulation in freely moving animals while providing quantitative information of optogenetic-driven locomotion responses. We show the applicability of this platform in single animals by stimulation of cholinergic motor neurons in C. elegans and quantitative assessment of contractile responses. In addition, we tested synaptic plasticity by coupling the entire-population stimulation mode with measurements of synaptic strength using an aldicarb assay, where clear changes in synaptic strength were observed after regimens of neuronal exercise. This platform is composed of inexpensive components, while providing the illumination strength of high-end systems, which require expensive lasers, shutters, or automated stages. This platform requires no moving parts but provides flexibility in stimulation regimens.

A Nomogram for Predicting 30-day Mortality in Elderly Patients Undergoing Hemiarthroplasty for Femoral Neck Fractures.

INTRODUCTION: Femoral neck fractures in the elderly are increasingly common as a result of a growing geriatric population with 1-year mortality rates approaching 35%. While preoperative medical optimization and early time to surgery have reduced morbidity and mortality, patients with numerous medical comorbidities remain high risk for death in the perioperative period. Identifying those with greatest risk with a scoring system or nomogram may assist multidisciplinary teams in reducing mortality following hemiarthroplasty. PURPOSE: Identify predictors of 30-day mortality in elderly patients who underwent hemiarthroplasty for a femoral neck fracture to generate a predictive nomogram to determine the probability of post-operative mortality. METHODS: Retrospective evaluation using data from the ACS-NSQIP database from 2005 to 2014 with CPT code 27125 for hip hemiarthroplasty. Multiple factors including demographics and comorbidities were compared in patients who experienced 30-day mortality and those who did not. T-test and chi-square tests were used to analyze data and a multivariate model was generated using logistic regression. RESULTS: Advanced age (odds ratio (OR) 1.04), underweight BMI (OR 1.55), male sex (OR 1.80), reduced functional status (OR 2.04), heart failure within 30 days prior to surgery (OR 2.22), American Society of Anesthesiologists grade > 2 (OR > 2.50), disseminated cancer (OR 3.43) were all found to have statistically significant odds ratios for 30-day mortality following hemiarthroplasty. CONCLUSION: A tool based on easily identifiable risk factors, demographics, and comorbidities was developed that can help predict elderly patients who will experience mortality within 30 days of following hemiarthroplasty. In addition to identifying high risk patients, the nomogram can serve as a counseling tool for physicians to use with patients and their families to assist with better understanding of perioperative mortality risk.

Patient-reported Quality of Life Following Stereotactic Body Radiotherapy and Conventionally Fractionated External Beam Radiotherapy Compared with Active Surveillance Among Men with Localized Prostate Cancer.

BACKGROUND: Evidence supporting the efficacy of stereotactic body radiotherapy (SBRT) for localized prostate cancer is accumulating, but comparative studies of patient-reported quality of life (QOL) following SBRT versus conventionally fractionated external beam radiotherapy (EBRT) or active surveillance (AS) are limited. OBJECTIVE: To compare QOL of patients pursuing SBRT and EBRT versus AS. DESIGN, SETTING, AND PARTICIPANTS: A population-based cohort of 680 men with newly diagnosed localized prostate cancer was prospectively enrolled from 2011 to 2013. INTERVENTION: SBRT, EBRT without androgen deprivation therapy, or AS. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: QOL was prospectively assessed before treatment (baseline), and at 3, 12, and 24mo after treatment using the validated Prostate Cancer Symptom Indices, which contain four domains: sexual dysfunction, urinary obstruction/irritation, urinary incontinence, and bowel problems. Propensity weighting via logistic regression models was used to balance baseline characteristics, and the mean QOL scores of EBRT and SBRT patients were compared against AS patients as the control group. RESULTS AND LIMITATIONS: Compared with AS patients, EBRT patients had worse urinary obstructive/irritative symptoms and sexual dysfunction at 3mo, and worse bowel symptoms at 3 and 24mo. SBRT patients had similar scores as AS patients in all domains and across all time points; however, due to small sample size, worse sexual function and urinary incontinence in SBRT patients cannot be ruled out. Further research is needed to assess long-term outcomes. CONCLUSIONS: In a nonrandomized cohort of men with localized prostate cancer, SBRT appeared to result in favorable QOL results through 2yr of follow-up, but worse sexual function and urinary incontinence compared with AS cannot be ruled out completely. Larger studies with longer follow-up are needed to confirm these findings. PATIENT SUMMARY: Stereotactic body radiotherapy (SBRT) and active surveillance appear to have similar quality of life outcomes through 2yr, although worse sexual function and urinary incontinence from SBRT cannot be ruled out completely.

Patient Perceptions of Surgeon Reimbursement for Rotator Cuff Repair.

BACKGROUND: Previous studies in the arthroplasty, spine, and shoulder and elbow literature have shown that patients perceive Medicare reimbursement to surgeons to be much higher than current reimbursement schedules. PURPOSE: To evaluate patient perceptions of surgeon reimbursement for various rotator cuff repair (RCR) procedures. STUDY DESIGN: Cross-sectional study. METHODS: We surveyed 153 patients who presented to a single surgeon's orthopaedic sports medicine clinic between October 2016 and March 2017. Patients with a new complaint of hip or knee pain, those with a new complaint of shoulder pain, or those who had undergone shoulder surgery 1 year or more prior to their current visit were included. Patients were asked how much they thought surgeons should be reimbursed for RCR procedures, including arthroscopic repair of a simple tear and a massive tear as well as open repair of an acute tear and a chronic tear. They were also asked to estimate how much they thought surgeons were reimbursed by Medicare for these procedures. They were then given actual Medicare reimbursement rates for these procedures and asked whether they believed surgeons should be reimbursed that amount. RESULTS: For arthroscopic repair of a rotator cuff tear, patients believed that surgeons should receive a mean (±SEM) reimbursement of US$5645 ± $442. This was significantly more than their estimate of what surgeons were actually reimbursed by Medicare ($3644 ± $408; P = .001). Patients also believed that surgeons should be reimbursed more than their estimate of what surgeons were actually reimbursed for arthroscopic repair of a massive tear ($8066 ± $708 vs $4694 ± $476; P = .0001), open repair of an acute tear ($8428 ± $768 vs $4549 ± $396; P = .00001), and open repair of a chronic tear ($8902 ± $844 vs $4639 ± $438; P = .00001). Both types of patient perceptions were higher than the actual state Medicare reimbursement data for all procedures surveyed (P < .001). CONCLUSION: Consistent with previous literature, patients perceive Medicare reimbursement for RCR to be higher than what surgeons are actually reimbursed. As the United States health care system enters a bundled care environment, price transparency is increasingly important. This study indicates a need for patient education on how their health care costs are allocated.