Impact of Large Database Studies on Orthopedic Surgery Literature: Are We Advancing the Field?

Background: While database studies have become more prevalent in the literature, there is concern over their value. In addition, the questions they are suitable to answer are limited. Questions/Purposes: We sought to determine the incidence of database studies in the orthopedic literature and in each subspecialty. In addition, we wanted to assess the impact of database studies on the literature by determining whether citations and Altmetric Attention Scores (AAS) varied by study type (studies using internal or external databases and those not using databases). Methods: We searched PubMed for articles published in impactful orthopedic surgery journals in the year 2018. All articles were discoverable on the Altmetric explorer portal database. Impact was determined by journal impact factor. Study design, subspecialty, number of citations, and AAS were obtained. Univariable analyses were conducted between study type, demographic variables, and the outcome of either citation count or AAS. Multivariable analyses were performed to identify independent predictors of the primary outcomes. Subgroup analyses were performed to differentiate the impact of external and internal database studies compared with non-database studies. Results: A total of 2684 total articles were eligible for inclusion. Of these, 366 studies (13.6%) were database studies. Hip and knee articles had the greatest incidence of database studies. Database studies had significantly more citations (5.9 vs 4.0) and significantly higher AAS (12.8 vs 11.3) compared with non-database studies. External database studies had significantly more citations (6.7 vs 4.8) and significantly higher AAS (14.0 vs 10.7) than internal database studies. Internal database studies had higher traditional citation counts but similar AAS to non-database studies. Conclusions: In 2018, database studies in well-reputed orthopedic journals had a greater number of citations but similar AAS compared with non-database studies. Further studies are warranted.

Evaluating Diversity and Inclusion Content on Graduate Medical Education Websites.

Websites are important tools for programs to provide future residency applicants with freely accessible information regarding their program, including diversity, equity, and inclusion (DEI) initiatives. OBJECTIVE: To describe the variability of DEI content in residency programs and compare DEI website content by specialty. METHODS: Using the 2021 Accreditation Council for Graduate Medical Education (ACGME) list of residency programs, residency training websites were identified and evaluated. Information was extracted from program websites as indicators of DEI content. Chi-square analysis and one-way ANOVA were chosen to assess for statistical differences. RESULTS: In total, 4644 program websites representing 26 specialties were assessed. Among all the programs, the average DEI completeness of a program website was 6.1±14.6% (range 0-100%). While 6.2% of all programs had a diversity webpage, only 13.3% included a commitment to DEI, and few programs (2.7%) provided information about underrepresented in medicine (URiM) faculty. CONCLUSIONS: Graduate medical education programs can enhance information for current and prospective applicants about DEI initiatives on their websites. Including DEI initiatives on residency websites may improve diversity recruitment efforts.

Do Orthopedic Surgery Residency Program Web Sites Address Diversity and Inclusion?

Background: Orthopedic surgery is one of the least diverse medical specialties. Other medical specialties have employed diversity-related initiatives to increase the number of students underrepresented in medicine (URM). Furthermore, with the suspension of visiting student rotations during the COVID-19 pandemic, medical students used residency program Web sites as a main source of program-specific information. Aims/Purpose: The purpose of this study was to measure the extent to which orthopedic surgery residency program Web sites describe diversity and inclusion initiatives. Methods: The Electronic Residency Application Service (ERAS) was used to identify U.S. orthopedic surgery residency programs. The programs' Web sites were reviewed, and data on commitments to diversity and inclusion were collected. Descriptive statistics of these data were generated. Results: There were 192 residency programs identified and 3 were excluded from the analysis due to lack of Web sites. Of the remaining 189 residency program Web sites, only 55 (29.10%) contained information on diversity and inclusion. Information on a commitment to improving diversity and inclusion was the most prevalent data point found among program Web sites, although it was found on only 15% of program Web sites. Conclusion: Orthopedic surgery residency programs rarely address topics related to diversity and inclusion on their program Web sites. An emphasis on opportunities for URM students and initiatives related to diversity and inclusion on program Web sites may improve URM outreach and serve as one method for increasing URM matriculation into orthopedic surgery.

Diversity and Inclusion on General Surgery, Integrated Thoracic Surgery, and Integrated Vascular Surgery Residency Program Websites.

BACKGROUND: Increasing diversity in medicine is receiving more attention, yet underrepresented in medicine (UiM) surgeons remain a small fraction of all surgeons. Whether surgical training programs attempt to attract UiM applicants to their programs, and therefore their specialties, through program website information is unclear. OBJECTIVE: To analyze the scope of diversity and inclusion (D&I) related information on US allopathic and osteopathic general surgery, integrated thoracic surgery, and integrated vascular surgery residency program websites. METHODS: Residency programs were identified through the Electronic Residency Application Service (ERAS) in July 2020. We searched surgical program websites and collected data on the presence or absence of variables labeled "diversity & inclusion" or "underrepresented in medicine." Variables found on program websites as well as sites linked to the program website were included. We excluded programs identified in ERAS as fellowship training programs. Programs without webpages were also excluded. RESULTS: We identified 425 residency programs and excluded 22 from data analysis. Only 75 of the 403 included programs (18.6%) contained D&I-related information. The presence of individual variables was also low, ranging from 4.5% for opportunities related to early exposure to the specialty to 11.1% for a written or video statement of commitment to D&I. CONCLUSIONS: In 2020, as recruitment and interviews moved entirely online, few US allopathic and osteopathic general surgery, integrated thoracic surgery, and integrated vascular surgery residency programs provided D&I-related information for residency applicants on their program websites.

Linked kinematic knee balancing in unicompartmental knee arthroplasty.

The traditional approach of restoring a neutral mechanical axis to the lower extremity during total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) has long been favored due its consistency and reproducibility. The kinematic alignment approach, which accounts for the patient's natural knee alignment and is commonly a few degrees varus to the mechanical axis, has gained popularity in recent years as a technique which reestablishes a more anatomic alignment. Linked Anatomic Kinematic Arthroplasty (LAKA), an extension of the kinematic approach that employs computer-assisted surgical (CAS) navigation, can improve the accuracy and precision of kinematic measurements in unicompartmental knee arthroplasties. This article will describe the LAKA technique in UKA and review early clinical outcomes associated with this technique.

Patient Adherence in an Academic Medical Center's Low-dose Computed Tomography Screening Program.

OBJECTIVES: Low-dose computed tomography (LDCT) screening is an important tool for reducing lung cancer mortality. This study describes a single center's experience with LDCT and attempts to identify any barriers to compliance with standard guidelines. MATERIALS AND METHODS: This is a retrospective review of a single university-based hospital system from 2015 to 2019. All individuals who met eligibility for lung cancer screening were entered into a database. The definition of adherence with the screening program was determined by the recommended timeline for the follow-up LDCT. Cohorts were split by adherence and demographics were compared. RESULTS: A total of 203 LDCTs were performed in 121 patients who met eligibility for LDCT and had appropriate surveillance from 2015 to 2019. The average age was 64 years old. The overall adherence rate for prescribed LDCTs was 59.1%. Patients with Lung-RADS score 2 had 2.43 times higher odds of adherence relative to patients with Lung-RADS score 1 (odds ratio [OR]=2.43; 95% confidence interval [CI]: 1.23-4.83; P=0.011). African American patients had 42% lower odds of adherence relative to white patients (OR=0.58; 95% CI: 0.32-1.06; P=0.076). Patients with non-District of Columbia zip codes had 57% higher odds of adherence relative to those with District of Columbia zip codes, although this did not reach statistical significance (OR=1.57; 95% CI: 0.87-2.82; P=0.136). CONCLUSIONS: Despite the implementation of a multidisciplinary, academic LDCT screening program, overall adherence rate to prescribed follow-up scans was suboptimal. Socioeconomic disparities and African American race may negatively affect adherence to lung cancer screening LDCT guidelines. Patients with concerning findings on initial LDCT had a higher association of adherence to guidelines.

Total Hip Arthroplasty for the Sequelae of Femoral Neck Fractures in the Pediatric Patient.

Although rare, total hip arthroplasty (THA) may be indicated in pediatric patients with degenerative changes of the hip joint after previous trauma. To illustrate management principles in this patient population, this study describes the case of a 15-year-old female who sustained bilateral femoral neck fractures after a generalized tonic-clonic seizure, an atypical, low-energy mechanism for this injury. These fractures were not diagnosed until 14 weeks after the seizure episode, at which point they had progressed to nonunion on the left side, malunion on the right side, and degenerative hip joint changes were developing bilaterally. Bilateral THA was ultimately performed, and the patient had favorable outcomes at 1 year postoperatively. In determining the optimal management strategy for such patients, a multidisciplinary approach should be used, with input from the patient's family, pediatrician, pediatric endocrinologist, pediatric orthopaedic surgeon, and adult reconstruction surgeon. From a surgical standpoint, this report highlights the importance of selecting the appropriate bearing surfaces, broaching technique, mode of implant fixation, and implant features when performing THA in the active pediatric patient.