The Ideal Orthopaedic Surgeon: Comparing Patient Preferences of Surgeon Attributes to Notions Held by Orthopaedic Postgraduates.

Introduction: Stereotypes have been a barrier to providing patients a diverse orthopaedic workforce. Our goal was to identify stereotypes and disparities among doctors and their patients regarding the attributes that should determine a competent orthopaedic surgeon. Materials and Methods: A cross-sectional descriptive multicenter study was conducted in India. Tailored questionnaires were administered to patients and orthopaedic postgraduates to determine the attributes they believe patients prefer in their orthopaedic surgeon. Likert data and data on preferred sex of the surgeon were analyzed as categorical data sets using frequency statistics. Participants were asked to rank surgeon attributes and analysis was based on frequency of an item among top 5 surgeon attributes. Results: 304 patients and 91 orthopaedic postgraduates participated in the study. 70.4% and 73% of patients and 27.5% and 29.6% of postgraduates preferred an orthopaedic surgeon with greater physical strength as an outpatient consultant or operating surgeon respectively. 81% of patients had no preference of the sex of their doctor. 56% of postgraduates felt patients would prefer a male operating surgeon, none felt their patient would prefer female orthopaedic surgeon. 92.3% of the female postgraduates felt patients would prefer a male orthopaedic surgeon. Patients most often ranked years of experience, surgical outcomes, time spent with patients, reputation, and physical strength in their top 5 surgeon attributes and sex, religion, and community were given least importance. Conclusion: Diversity among the orthopaedic workforce is necessary to optimize patient care. It is our collective responsibility to educate our patients and trainees and redress the misconceptions and stereotypes that plague our profession. Supplementary Information: The online version contains supplementary material available at 10.1007/s43465-023-00988-2.

Pelvic Osteotomy in Patients With Previous Sacral-Alar-Iliac (SAI) Fixation.

INTRODUCTION: Patients with neuromuscular disease are at high risk for developing hip dysplasia and scoliosis. The purpose of this study was to investigate the technical challenges and outcomes of pelvic osteotomy in patients with prior sacral-alar-iliac (SAI) fixation. METHODS: We reviewed clinical and radiographic records of patients aged 18 years and below who underwent pelvic osteotomy after SAI fixation. We recorded technical challenges during the osteotomy, time from SAI fixation to osteotomy, type of osteotomy, migration index, and distance from the SAI screw to the acetabulum. A 2-sample Wilcoxon rank-sum test was used to assess the data. RESULTS: Nineteen patients were included. Technical challenges were defined as having greater intraoperative fluoroscopy times and noted difficult osteotomy in the operative report. The mean time from SAI fixation to pelvic osteotomy was 2.2±1.5 years. For all 12 Chiari osteotomies, the ilium could not be laterally displaced; however, medial displacement of the distal segment of the osteotomy allowed adequate coverage. All 7 Dega osteotomies were performed by cutting the cortex at the tip of the SAI screw. The screw improved proximal leverage and provided a strong buttress for bone graft. The mean migration index before pelvic osteotomy was 59±19%, and at most recent follow-up was 13±4%. Twelve patients, who had a noted complicated osteotomy, had SAI screws that were ≤1.87 cm ( P <0.01) from the acetabulum and significantly increased intraoperative fluoroscopy time (1.76 vs. 1.18 min, P <0.01). CONCLUSIONS: The presence of SAI screws may cause iliac osteotomies to be technically challenging if the tip of the SAI screw is ≤1.87 cm to the acetabulum. When initially implanting SAI screws in neuromuscular patients, surgeons should attempt to place screw tips ∼2 cm from the acetabulum in the event these patients require subsequent pelvic osteotomy. LEVEL OF EVIDENCE: Level IV.