Off-Label Bone Morphogenetic Protein 2 Use Results in Successful Posterolateral Lumbar Fusion in a Veteran Population.

Introduction: Patients within the US Veterans Health Administration (VA) system have higher rates of comorbidities and chronic pain, increasing risks of complications/poor outcomes following spine surgery. Although the use of bone morphogenetic protein 2 (BMP-2) is established for anterior lumbar interbody fusion, its indications for off-label use in posterolateral fusion are unclear. The objective of this study was to evaluate safety and utility of BMP-2 in posterolateral fusion through a 15-year experience at the VA.

Effect of Instrumented Spine Surgery on Length of Stay.

Introduction: Total joint arthroplasty studies have identified that surgeries that take place later in the week have a longer length of stay compared with those earlier in the week. This has not been demonstrated in studies focused on anterior cervical diskectomy and fusions or minimally invasive lumbar laminectomies. All-inclusive instrumented spine surgeries, however, have not been analyzed.

Vertebral Augmentation in Spine Surgery.

Vertebral augmentation has been a well-studied adjunct percutaneous procedure in spine surgery. Cement augmentation has been used in the treatment of compression fractures through kyphoplasties or vertebroplasties. Historically, data have shown no difference between treating compression fractures conservatively versus with percutaneous cement augmentation procedures.

The Impact of Hospital Size and Teaching Status on Outcomes Following Total Ankle Arthroplasty.

The popularity and utilization of total ankle arthroplasty (TAA) as treatment for ankle arthritis has increased exponentially from 1998 to 2012. Overall the outcomes have improved for TAA with the introduction of new-generation implants and this has increased the focus on optimizing other variables affecting outcomes for TAA. The purpose of this study was to examine the effects of hospital characteristics and teaching status on outcomes for TAA.

Performance metrics and economics of superior labrum anterior-posterior tear repairs in Major League Baseball pitchers.

Background: Superior labrum anterior-posterior tears (SLAP) can be a career-altering injury for Major League Baseball (MLB) pitchers. Surgery and postoperative rehabilitation keep pitchers on the injured list (IL) for extended time, which results in a significant cost to a team. To date, no analyses have focused on the financial cost of SLAP repairs in MLB pitchers.

Expandable vs Static Interbody Devices for Lateral Lumbar Interbody Fusion.

Lateral lumbar interbody fusion (LLIF) has paved a way for minimally invasive surgical treatment of a wide variety of spine pathologies. Interbody devices are used to stabilize painful disc levels, provide indirect decompression of neural elements, correct deformity, restore lordosis, and provide a sound durable fusion. Through the years, new static and expandable interbody devices have been developed in an attempt to improve radiographic and clinical outcomes in lumbar spine surgery.

Length of Stay, Discharge Disposition, and 90-Day Complications and Revisions Following Primary Total Hip Arthroplasty: A Comparison of the Direct Anterior, Posterolateral, and Direct Superior Approaches.

Background: The direct anterior (DA) approach is becoming increasingly popular for primary total hip arthroplasty (THA). The aim of this study is to evaluate early postoperative complication and revision rates based on surgical approach, comparing DA, posterolateral (PL), and direct superior (DS) approaches.

Methods: After institutional review board approval, a total joint arthroplasty database from a single institution was used to identify all patients who underwent elective primary THA between July 2013 and November 2017 with a DA, PL, or DS hip approach.

Efficacy of Imaging Modalities Assessing Fatty Infiltration in Rotator Cuff Tears.

Background: Fatty atrophy is a diagnosis characterized by the combination of fatty infiltration and muscle atrophy of the rotator cuff. Studies have shown a strong positive correlation between the level of fatty infiltration and the risk of experiencing a chronic rotator cuff tear. Therefore, the purpose of the present study was to review the current literature on radiographic imaging of fatty infiltration and fatty atrophy to better aid surgeons in predicting functional outcome and to help guide patient decisions.

Biomechanical comparison of 2 augmented glenoid designs: an integrated kinematic finite element analysis.

Background: Augmented glenoid implants are available to help restore the biomechanics of the glenohumeral joint with excessive retroversion. It is imperative to understand their behavior to make a knowledgeable preoperative decision. Therefore, our goal was to identify an optimal augmented glenoid design based on finite element analysis (FEA) under maximum physiological loading.

Impact of the 7-Day Disabled List Rule Change on Economics and Performance After Reported Concussion Injuries in Major League Baseball.

Background: The incidence of concussions is increasing in Major League Baseball (MLB), and the cost of these injuries in 2008 was reportedly as high as US$423 million. Team officials are more aware of concussion injuries, and one measure to address this issue was the creation of a concussion-specific 7-day disabled list (DL) in 2011.

Purpose: To evaluate concussion trends among MLB players and the impact of concussion-specific 7-day DL status on postinjury player performance and team financials.

Comparison of Microbial Count on Various Surfaces in Operating Rooms at Different Times of the Day.

The purpose of this study was to determine the degree of microbial contamination of surfaces in the operating room (OR) and to understand the relationship between time and location of contamination. Five OR surfaces were sampled at two time points on three consecutive Mondays and Thursdays. Each sample was cultured on a blood agar plate and introduced to a liquid nutrient broth.

The effect of glenohumeral radial mismatch on different augmented total shoulder arthroplasty glenoid designs: a finite element analysis.

Background: Augmented glenoid implants to correct bone loss can possibly reconcile current prosthetic failures and improve long-term performance for total shoulder arthroplasty. Biomechanical implant studies have suggested benefits from augmented glenoid components, but limited evidence exists on optimal design.

Methods: An integrated kinematic finite element analysis (FEA) model was used to evaluate optimal augmented glenoid design based on biomechanical performance in translation in the anteroposterior plane similar to clinical loading and failure mechanisms with osteoarthritis.

The impact of preoperative opioid use on outcomes after arthroscopic rotator cuff repair.

Background: Preoperative opioid use has been correlated to suboptimal outcomes in orthopedic surgery. This study evaluated the effect of preoperative opioid use on outcomes after arthroscopic rotator cuff repair (RCR).

Methods: A retrospective review was performed of 79 patients who underwent arthroscopic RCR; of these, 31 with a history of preoperative opioid use were compared with a control group of 48 patients without a history of preoperative opioid use.

Patient-reported symptom-mapping in carpal tunnel syndrome.

Introduction: To date, no method has been described or utilized to study the distribution of symptoms in carpal tunnel syndrome. We describe a technique of symptom-mapping that yields a population-based "anatomic profile" of carpal tunnel syndrome.

Methods: Symptoms were mapped on visual questionnaires depicting the volar hand, wrist, and forearm.

Concussion rates and effects on player performance in Major League Baseball players.

Background: Major League Baseball (MLB) players are throwing the ball faster and hitting harder than ever before. Although some safety measures have been implemented, by decreasing the 15 days on the disabled list (DL) to the 7 days on the DL, concussion rates remain high across positions and may impact player performance. Our hypothesis was, there would be an increase in concussion incidence following implementation of the 7 day DL, but this would not have a negative impact on player's postconcussion performance.

Factors Affecting the Cost and Profitability of Arthroscopic Rotator Cuff Repair.

Purpose: To examine the cost metrics and profitability of rotator cuff repairs (RCRs) in a large health care system.

Methods: A retrospective study was performed using value analysis team data from 2 hospitals within a large metropolitan health system from 2010 to 2014. Cost and profit metrics were collected and compared against surgeon volume, surgeon subspecialty training, implant costs, Current Procedural Terminology (CPT) coding, length of stay, and hospital site.

A prospective randomized controlled trial to identify the optimal postoperative pain management in shoulder arthroplasty: liposomal bupivacaine versus continuous interscalene catheter.

Background: Shoulder arthroplasty is the fastest growing joint replacement surgery in the United States, and optimal postoperative pain management is critical to optimize outcomes for these surgeries. Liposomal bupivacaine (LB) has gained popularity for its potential to provide extended postoperative pain relief with possibly fewer side effects. The goal of this study was to assess the impact of LB compared with continuous interscalene nerve block (CISB) in terms of postoperative pain control, outpatient pain scores, and patient-reported and functional outcomes after shoulder arthroplasty surgery.

Return to Play and Prior Performance in Major League Baseball Pitchers After Repair of Superior Labral Anterior-Posterior Tears.

Background: The published return-to-play (RTP) rates for Major League Baseball (MLB) pitchers who have undergone surgical repair of superior labrum anterior-posterior (SLAP) tears vary widely and are generally accepted to be lower in the subset of competitive throwers. The efficacy of surgical treatment for MLB players is largely unknown.

Purpose: To examine the RTP rate and performance of MLB pitchers who have undergone SLAP tear repair between 2003 and 2010.

National trends in proximal humerus fracture treatment patterns.

Background: The treatment of proximal humerus fractures (PHF) is largely surgeon dependent with no clear guidelines for selecting the optimal method of treatment.

Aims: The aim of this study was to evaluate trends and variations in treatment methods of PHF in the United States from 2004 to 2012 and to determine the regional differences in treatment.

Methods: The National Inpatient Sample was used to identify all patient discharges with diagnosis codes for PHF and the data were classified based on ICD-9 procedure codes.

Medicaid payer status is linked to increased rates of complications after treatment of proximal humerus fractures.

Background: Low socioeconomic status and Medicaid insurance as a primary payer have been associated with major disparities in resource utilization and risk-adjusted outcomes for patients undergoing total joint arthroplasty. With the expansion of Medicaid through the Affordable Care Act in 2014, examination of these disparities has become increasingly relevant for the treatment of proximal humerus fracture (PHF).

Methods: The Healthcare Cost and Utilization Project Nationwide Inpatient Sample database was used to identify patients who were treated for PHF from 2002 to 2012.

Lipocalin-2 released in response to cerebral ischaemia mediates reperfusion injury in mice.

Thrombolysis remains the only effective therapy to reverse acute ischaemic stroke. However, delayed treatment may cause serious complications including hemorrhagic transformation and reperfusion injury. The level of lipocalin-2 (LCN2) is elevated in the plasma of ischaemic stroke patients, but its role in stroke is unknown.