Complication and revision rates after reverse total shoulder revision from hemiarthroplasty: a systematic review.

Background: Thus, the purpose of the present study was to (1) characterize common postoperative complications and (2) quantify the rates of revision in patients undergoing hemiarthroplasty to reverse total shoulder arthroplasty revisional surgery. We hypothesize that hardware loosenings will be the most common complication to occur in the sample, with the humeral component being the most common loosening. Methods: This systematic review adhered to PRISMA reporting guideline. For our inclusion criteria, we included any study that contained intraoperative and/or postoperative complication data, and revision rates on patients who had undergone revision reverse total shoulder arthroplasty due to a failed hemiarthroplasty. Complications include neurologic injury, deep surgical site infections, hardware loosening/prosthetic instability, and postoperative fractures (acromion, glenoid, and humeral fractures). Results: The study contained 22 studies that assessed complications from shoulders that had revision reverse total shoulder arthroplasty from a hemiarthroplasty, with a total sample of 925 shoulders. We found that the most common complication to occur was hardware loosenings (5.3%), and of the hardware loosenings, humeral loosenings (3.8%) were the most common. The revision rate was found to be 10.7%. Conclusion: This systematic review found that revision reverse total shoulder arthroplasty for failed hemiarthroplasty has a high overall complication and reintervention rates, specifically for hardware loosening and revision rates.

Analysis of Social Media Perceptions Among Orthopaedic Surgery Residency Applicants and Social Media Use by Residency Programs During the 2020 to 2021 Cycle.

Owing to the coronavirus 2019 pandemic limiting both applicants and residency programs in their ability to connect in-person, it is likely that a shift toward virtual connections was made. We aimed to query applicants regarding their perspectives of orthopaedic residency program social media use. Furthermore, we aimed to quantify the number of orthopaedic surgery residency programs with active social media accounts. METHODS: All applicants to a single orthopaedic surgery residency were surveyed regarding their perceptions of social media use by orthopaedic surgery residency programs. After this, we evaluated social media use by orthopaedic surgery residency programs. RESULTS: Of total, 54.3% of applicants indicated that an orthopaedic surgery residency program they followed on social media posted content that increased their interest in the program. Furthermore, 77.8% of the applicants believed that orthopaedic surgery residency programs should have social media accounts, specifically Instagram. Of the orthopaedic surgery residencies identified, 113 (58.9%) had Instagram, 84 (43.8%) had Twitter, and 21 (10.9%) had Facebook accounts. DISCUSSION: Applicants largely feel that orthopaedic surgery residencies should have social media accounts. Orthopaedic surgery residencies saw the value in connecting with students virtually, as shown by nearly 90% of the programs, with social media starting their accounts this year.

The use of systematic reviews to justify orthopaedic trauma randomized controlled trials: A cross-sectional analysis.

OBJECTIVE: Orthopaedic trauma is one of the largest surgical fields in medicine, and as such, requires the latest evidence to ensure the best standard of care. Systematic reviews are an invaluable resource that compiles an exhaustive summary of the most current evidence on a given clinical question. The primary aim of this study is to evaluate the use of systematic reviews as justification in conducting randomized controlled trials published in high impact orthopaedic trauma journals. METHODS: We analyzed randomized controlled trials published in the top three high impact orthopaedic trauma journals between 2015 and 2018. We performed data extraction blind, independent, and in duplicative manner to ensure the validity of the findings. For each trial, data was extracted by the number of systematic reviews cited in each clinical trial and whether or not the study used a systematic review as justification for conducting the trial. A subgroup of general orthopaedic clinical trials were included for comparison. RESULTS: Of 144 articles retrieved, 128 were included. Overall, 71.1% (91/128; [95% CI, 63.2-78.9]) of included orthopaedic trauma randomized controlled trials referenced a systematic review and 28.9% (37/128) of studies did not cite a systematic review. Of the 91 trials that referenced a systematic review, 33.0% (30/91; [95% CI, 23.3-42.6]) of RCTs cited a systematic review as trial justification, whether that be "verbatim" or "inferred". "Verbatim" justifications occurred in 20.0% (6/30; [95% CI, 5.7-34.3]) of included trauma RCTs that cited a systematic review as justification for conducting the trial and "inferred" justifications occurred in 80.0% (24/30; [95% CI, 65.7-94.3]). CONCLUSION: Systematic reviews are frequently cited in orthopaedic trauma RCTs but are not commonly cited as justification for conducting a clinical trial. Ideally, evidentiary uncertainty regarding a research question should be established by existing literature through a systematic review to reduce research waste.

An Evaluation of Publication Bias in High-Impact Orthopaedic Literature.

BACKGROUND: Statistical analysis of systematic reviews allows the results of previous studies to be combined and synthesized to assess the overall health effect of the intervention in question. Systematic reviews can also be used to guide the creation of clinical practice guidelines and are considered to have a high level of evidence. Thus, it is important that their methodological quality is of the highest standard. Publication bias presents 2 problems: (1) studies with significant results may be overrepresented in systematic reviews and meta-analyses ("false positives") and (2) studies without significant results may not be included in systematic reviews and meta-analyses ("false negatives") because each study, on its own, was underpowered, meaning that some treatment options that may have clinical benefit will not be adopted. METHODS: We performed a study to evaluate the techniques used by authors to report and evaluate publication bias in the top 10 orthopaedic journals as well as 3 orthopaedic-related Cochrane groups. Two authors independently screened the titles and abstracts to identify systematic reviews and meta-analyses. We assessed publication bias in the systematic reviews that did not assess publication bias themselves. RESULTS: Our final sample included 694 systematic reviews or meta-analyses that met our inclusion criteria. Our review included 502 studies (72%) that focused on clinical outcomes, with the majority of the remaining studies focused on predictive and prognostic accuracy (20%) or diagnostic accuracy (5%). Publication bias was discussed in 295 (42.5%) of the included studies and was assessed in 135 (19.5%). Of the studies that assessed publication bias, 31.9% demonstrated evidence of publication bias. Only 43% and 22% of studies that involved use of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines discussed and assessed publication bias, respectively. CONCLUSIONS: Publication bias is infrequently discussed and assessed in the high-impact orthopaedic literature. Furthermore, nearly one-third of the studies that assessed for publication bias demonstrated evidence of publication bias. In addition to these shortcomings, fewer than half of these studies involved use of the PRISMA guidelines and yet only one-fourth of the studies assessed for publication bias. CLINICAL RELEVANCE: By understanding the degree to which publication bias is discussed and presented in high-impact orthopaedic literature, changes can be made by journals and researchers alike to improve the overall quality of research produced and reported.

An Evaluation of Spin in Lower Extremity Joint Trials.

BACKGROUND: Spin is a specific type of reporting bias that misrepresents data and results within randomized controlled trials (RCTs). Because spin may provide a surgeon with an inaccurate representation of trial results, thus misconstruing the surgeons' interpretation thereof and possibly negatively affecting patient care, it is important that spin is identified within publications. The primary goal of our study was to determine the prevalence of spin found within the abstracts of lower extremity joint trials. METHODS: Using Google Scholar's H-5 index, we selected the top 20 journals in the orthopedic surgery category. We then conducted a PubMed search on July 2nd, 2018 using the advanced search feature, encompassing all RCTs published in these journals from January 1, 2016 to January 1, 2017. Spin was evaluated using a standardized protocol, using a previously published protocol on the Open Science Network. RESULTS: Our final sample consisted of 46 trials published in 9 of the top 20 orthopedic surgery journals. Spin was found in 27 (58.7%) of the 46 abstracts. Evidence of spin in the abstract results was found in 19 (41.3%) of the 46 articles, and spin in abstract conclusions was found in 15 (32.6%) of the 46 articles. CONCLUSIONS: Our study found that a significant number of lower extremity joint RCTs contain one or more form of spin in either their abstract results, conclusions, or both. In addition, our investigation revealed that a sizable portion of these lower extremity orthopedic joint RCTs are not registered or do not report their registration, and funding sources are also underreported.

An Evaluation of the Rotator Cuff Repair Research Pipeline.

BACKGROUND: We conducted a study of recommendations from the American Academy of Orthopaedic Surgeons (AAOS) guideline, "Optimizing the Management of Rotator Cuff Problems." Using these recommendations, we conducted searches of clinical trial registries and bibliographic databases to note the extent to which new research has been undertaken to address areas of deficiency. HYPOTHESIS: Newly conducted research regarding rotator cuff repair and injury is available that will fill knowledge gaps identified by the AAOS guideline. STUDY DESIGN: Cross-sectional study. METHODS: For each recommendation in the AAOS guideline, we created PICO (participants, intervention, comparator, outcome) questions and search strings. Searches were conducted of ClinicalTrials.gov, the World Health Organization's International Clinical Trials Registry Platform, MEDLINE via PubMed, and EMBASE to locate studies undertaken after the final literature search performed by the AAOS work group. RESULTS: We located 210 newly registered trials and 448 published studies that are relevant to the recommendations made in the rotator cuff guideline. The majority of the recommendations have been addressed by relevant registered trials or published studies. Of the 448 published studies, 185 directly addressed the guideline recommendations. Additionally, 71% of the 185 published studies directly addressing the recommendations were randomized trials or systematic reviews/meta-analyses. The most important finding of our study was that the recommendations in the AAOS rotator cuff guideline have been adequately addressed. CONCLUSION: Orthopaedic researchers have adequately addressed knowledge gaps regarding rotator cuff repair treatment and management options. As such, the AAOS may consider a guideline update to ensure that recommendations reflect current findings in orthopaedic literature.