Publications by authors named "Michael A Mont"

Background: Osteoarthritis (OA) is the leading cause of disability among US adults and most commonly affects the knee. Guidelines for knee OA treatment include behavioral, nonpharmacological, pharmacological, and surgical interventions. While emerging knee OA treatments show promise for pain control, data gaps remain regarding the efficacy, safety, comparative effectiveness, and real-world value of treatments.

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Osteonecrosis of the femoral head (ONFH) is a chronic progressive debilitating disease that often affects young and active patients. It results from vascular interruption to the femoral head and can be caused by trauma, chronic corticosteroid use, chronic alcoholism, and coagulopathies. Treatment includes core decompression, a surgical procedure that may help delay or forestall disease progression if performed at the early stages of the disease.

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Article Synopsis
  • There is currently no universal guideline on how much activity patients should restrict themselves to after total hip arthroplasty (THA), which is the surgery to replace a hip joint.
  • A systematic review analyzed various studies to see if allowing more activity post-surgery affects outcomes like implant survivorship, patient satisfaction, and ability to return to sports.
  • Results indicated that patients who were more active post-THA generally had similar or better results regarding implant longevity, and there was a positive relationship between higher activity levels and improved mental health and satisfaction, although more detailed studies are needed for concrete guidelines.
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  • The study focuses on soft-tissue balancing in total knee arthroplasty (TKA), emphasizing a new method called the modified pendulum knee drop (PKD) test to quantitatively assess knee stiffness rather than relying on subjective observations.
  • Eleven cadaver specimens were used in robotic-assisted TKA procedures, with some receiving cruciate-retaining and others posterior-stabilized implants, while the PKD test was applied to analyze the stiffness changes due to varying insert thicknesses.
  • An inertial measurement unit (IMU) sensor recorded the knee's range of motion and oscillation characteristics to calculate stiffness, with results averaged over multiple trials for each insert thickness tested.
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Value-based care models are health care economic frameworks that aim to prioritize and financially incentivize quality of care, provider performance, and patient experience. The focus on value-based care metrics will undoubtedly lead to a greater weight placed on economic analyses in arthroplasty. Authors of cost analyses in arthroplasty often use the term "cost" in ways that have vastly different underlying meanings.

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Relative value units (RVUs) were first introduced by the Omnibus Budget Reconciliation Act of 1989 to standardize physician compensation based on the effort, skill, and resources required for medical services. This methodology replaced the "usual, customary, and reasonable" standard, which reduced variability in payments across providers. RVUs are comprised of physician work, practice expenses, and malpractice costs.

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Health care delivery systems throughout the United States have transitioned to a value-based care model, shifting away from a fee-for-service model to instead emphasize patient health outcomes and the quality of medical care. Social determinants of health (SDOH) have been shown to have a large impact on patient health outcomes and thus, must play an integral role in the implementation of a value-based model. This is of particular interest in the field of lower extremity joint arthroplasty, where demand is rising in conjunction with expanded access to care.

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Background: The Area Deprivation Index (ADI) is a weighted index comprised of 17 census-based markers of material deprivation and poverty. The purpose of this study was to determine whether patients undergoing total hip arthroplasty (THA) in areas of high ADI (greater disadvantage) were associated with differences in 90 days: 1) medical complications; 2) emergency department (ED) utilizations; and 3) readmissions.

Methods: A nationwide database was queried for primary THA patients from 2010 to 2020.

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Article Synopsis
  • The study compares the efficiency of robotic-assisted direct anterior (DA) total hip arthroplasty (THA) without fluoroscopy to traditional DA THA that uses fluoroscopy in two orthopaedic surgeons performing surgeries on cadaver specimens.
  • Results showed that the robotic-assisted approach had significantly shorter acetabular reaming times and required fewer acetabular reamers compared to conventional techniques.
  • Total surgical times and other workflow metrics were similar between the two methods, indicating potential advantages of robotic assistance in terms of efficiency without sacrificing overall surgical outcomes.
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Recently, robotic-arm assisted total knee arthroplasties have become popular because of their promise to lead to enhanced accuracy and efficient planning of the procedure, as well as improved radiographic and clinical outcomes. One robotic system is based on computed tomography (CT) to help with preoperative planning, intraoperative adjusting, and bone cutting for these procedures. The purpose of this article is to describe the second-generation iteration of this CT-based robotic technique by describing the new features using an actual total knee arthroplasty case.

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Introduction: The prevalence of total shoulder arthroplasties is on the rise annually. Improvements in implant quality, construct stability, and surgical techniques have notably enhanced post-operative results, prompting an expansion of indications for shoulder arthroplasty. Despite its high success rate, opportunities for enhancement remain, especially in preoperative planning and intraoperative execution.

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Article Synopsis
  • Osteonecrosis of the femoral head (ONFH) affects over 20,000 individuals in the U.S. annually, yet the mechanisms behind its progression are not well understood, prompting research into various contributing factors.
  • A study was conducted on 105 ONFH patients to evaluate risk factors, femoral head anatomy, and necrotic lesion size, utilizing multivariable regression to identify predictors of femoral head collapse.
  • Findings revealed that alcohol exposure, a larger necrotic lesion, and higher alpha angles increased the risk of collapse, while greater femoral head offset appeared to protect against it; the study emphasizes the need for larger future studies to further investigate these relationships.
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