A Matched Comparison of the Rates of Achieving the Minimal Clinically Important Difference Following Conversion and Primary Total Hip Arthroplasty.

Background: Patient-reported outcome measures (PROMs) are often lower following conversion total hip arthroplasty (cTHA) compared to matched primary total hip arthroplasty (THA) controls. However, the minimal clinically important differences (MCIDs) for any PROMs are yet to be analyzed for cTHA. This study aimed to (1) determine if patients undergoing cTHA achieve primary THA-specific 1-year PROM MCIDs at comparable rates to matched controls undergoing primary THA and (2) establish 1-year MCID values for specific PROMs following cTHA.

Sarcopenia is an independent risk factor for failure to achieve the 1-year MCID of the KOOS, JR and PROMIS PF-SF10a after TKA.

Background: Sarcopenia, which is a progressive and multifactorial condition of decreased muscle strength, has been identified as an independent predictor for falls, revision, infection, and readmissions following total knee arthroplasty (TKA), but its association to patient reported outcomes (PROMs) is less studied. The aim of this study is to determine if sarcopenia and other measures of body composition are correlated with ability to achieve the 1-year minimal clinically important difference (MCID) of the KOOS JR and PROMIS-PF-SF10a following primary TKA.

Methods: A multicenter retrospective case-control study was performed.

Visceral Fat as a Risk Factor for Periprosthetic Joint Infection After Total Hip and Knee Arthroplasty.

Background: Visceral obesity, a strong indicator of chronic inflammation and impaired metabolic health, has been shown to be associated with poor postoperative outcomes and complications. This study aimed to evaluate the relationship between visceral fat area (VFA) and periprosthetic joint infection (PJI) in total joint arthroplasty (TJA) patients.

Methods: A retrospective study of 484 patients who had undergone a total hip or knee arthroplasty was performed.

Higher Surgeon Volume is Associated With a Lower Rate of Subsequent Revision Procedures After Total Shoulder Arthroplasty: A National Analysis.

Background: Studies assessing the relationship between surgeon volume and outcomes have shown mixed results, depending on the specific procedure analyzed. This volume relationship has not been well studied in patients undergoing total shoulder arthroplasty (TSA), but it should be, because this procedure is common, expensive, and potentially morbid.

Questions/purposes: We performed this study to assess the association between increasing surgeon volume and decreasing rate of revision at 2 years for (1) anatomic TSA (aTSA) and (2) reverse TSA (rTSA) in the United States.

Superior Pubic Ramus Screw Placement During Complex Acetabular Revision: Acetabular Distraction for Treatment of Pelvic Discontinuity.

Unlabelled: Insertion of a superior pubic ramus screw may be indicated for the treatment of a chronic pelvic discontinuity when utilizing acetabular distraction in revision total hip arthroplasty (THA), especially in the setting of severe bone loss in the ischium. The aim of this procedure is to stabilize and prevent abduction failure of the acetabular component when utilizing acetabular distraction.

Description: With the patient in the lateral decubitus position, the acetabulum is exposed from a standard posterior approach for a revision THA.

Radially Based Extensor Retinacular Sling Reconstruction for Extensor Carpi Ulnaris Subsheath Injuries in Elite Athletes.

Background: Extensor carpi ulnaris (ECU) subsheath injuries are an increasingly recognized cause of ulnar-sided wrist pain in elite athletes. There is a lack of surgical outcome data in elite athletes, and unique considerations exist for these patients.

Methods: We performed a retrospective review of our hand center experience of 14 elite professional or collegiate athletes who prospectively underwent radially based extensor retinacular sling ECU subsheath reconstruction by 3 hand surgery-fellowship-trained surgeons between April 2011 and April 2021.

Restoring Fertility of Patients with Severe Asherman's Syndrome in the Office Setting: A Step-by-Step Recipe for Success.

Objective: To describe an effective in-office hysteroscopic strategy to restore fertility of patients with severe Asherman's syndrome.

Design: A step-by-step video demonstration of the technique with an emphasis on the key portions of the procedure. A detailed narrated description of the steps is provided.

Implementation of a myasthenia gravis drug-disease interaction clinical decision support tool reduces prescribing of high-risk medications.

Introduction/aims: High-risk medication exposure is a modifiable risk factor for myasthenic exacerbation and crisis. We evaluated whether real-time electronic clinical decision support (CDS) was effective in reducing the rate of prescribing potentially high-risk medications to avoid or use with caution in patients with myasthenia gravis.

Methods: An expert panel reviewed the available drug-disease pairings and associated severity levels to activate the alerts for CDS.

Cost of Inpatient Falls and Cost-Benefit Analysis of Implementation of an Evidence-Based Fall Prevention Program.

Importance: There is insufficient research on the costs of patient falls in health care systems, a leading source of nonreimbursable adverse events.

Objective: To report the costs of inpatient falls and the cost savings associated with implementation of an evidence-based fall prevention program.

Design, Setting, And Participants: In this economic evaluation, a matched case-control study used the findings from an interrupted time series analysis that assessed changes in fall rates following implementation of an evidence-based fall prevention program to understand the cost of inpatient falls.

Clinical implications of preoperative echocardiographic findings on cardiovascular outcomes following vascular surgery: An observational trial.

Introduction: Peripheral artery disease and cardiac disease are often comorbid conditions. Echocardiography is a diagnostic tool that can be performed preoperatively to risk stratify patients by a functional cardiac test. We hypothesized that ventricular dysfunction and valvular lesions were associated with an increased incidence of expanded major adverse cardiac events (Expanded MACE).

Disparities in Receipt of Adjuvant Therapy After Upfront Surgical Resection for Pancreatic Ductal Adenocarcinoma.

Background: A multimodal approach of surgery and chemotherapy, with or without radiation, is the mainstay of therapy with curative-intent for resectable pancreatic ductal adenocarcinoma (PDAC). This study compared utilization trends and outcomes of upfront surgery with and without adjuvant therapy.

Methods: The National Cancer Database was queried for patients with a diagnosis of stage 1 or 2 PDAC who underwent upfront resection.

Telehealth Monitoring for Individuals Experiencing Homelessness During the Early COVID-19 Pandemic: An Innovative Clinical and Medical Education Model.

Background: People experiencing homelessness (PEH) are recognized as members of a vulnerable population with significant health and social disparities. Due to the COVID-19 pandemic, these populations are at risk for increased morbidity and mortality. The Herbert Wertheim College of Medicine (HWCOM) of Florida International University (FIU) in collaboration with the Miami-Dade County Homeless Trust presents this case series based on the results of the Telemedicine Homeless Monitoring Project, launched in April 2020.

Association of age with outcomes in locally advanced rectal cancer treated with neoadjuvant therapy followed by surgery.

Introduction: We aimed to assess the association of age with outcomes in patients with Locally Advanced Rectal Cancer (LARC) who received neoadjuvant therapy followed by major surgery.

Methods: Retrospective review of 328 patients with LARC, N = 99 < 70 years (younger) versus N = 229 ≥ 70 years (elderly) from 2004 to 2018.

Results: Elderly patients had a higher American Society of Anesthesiologists (ASA) score, Charlson Comorbidity Index (CCI), length of stay and 30-day readmissions (p < 0.

Physiological Axial Tibial Rotation of the Knee During a Weightbearing Flexion.

Axial tibial rotation is a characteristic motion of the knee, but how it occurs with knee flexion is controversial. We investigated the mechanisms of tibial rotations by analyzing in vivo tibiofemoral articulations. Twenty knees of 20 living human subjects were investigated during a weightbearing flexion from full extension to maximal flexion using a dual fluoroscopic imaging system.

Peri-Prosthetic Joint Infection in Patients Prescribed Suppressive Antibiotic Therapy Undergoing Primary Total Joint Arthroplasty: A 1:4 Case Control Matched Study.

Oral suppressive antibiotic therapy (SAT) has emerged as a potential means to increase rates of infection-free survival in many complex peri-prosthetic joint infection (PJI) cases after total joint arthroplasty (TJA). The purpose of the present study is to evaluate the risk of PJI of a new primary TJA in patients on oral SAT. A retrospective matched cohort study from five hospitals in a 20-year period within a large hospital network was performed.

Defining an abnormal p53 immunohistochemical stain in Barrett's oesophagus-related dysplasia: a single-positive crypt is a sensitive and specific marker of dysplasia.

Aims: p53 is an independent risk stratification marker in Barrett's oesophagus (BE), but no universally accepted definition exists for abnormal p53 staining. Herein, we assess p53 stains in two cohorts to: (1) define abnormal p53 staining in BE-related dysplasia (BERD) and (2) assess the specificity and sensitivity of this cut-point for the diagnosis of dysplasia.

Methods: Cohort 1 (n = 313) included (1) dysplastic BE biopsies, (2) prior non-dysplastic BE (NDBE) biopsies from the same patients and (3) NDBE biopsies from patients who never progressed to dysplasia.

Institution-Specific Perinatal Emergency Checklists: Multicenter Report on Development, Implementation, and Sustainability.

Objective: The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine endorse checklist use to improve obstetric care. However, there is limited research into development, implementation, and sustained use of perinatal emergency checklists to inform individual institutions. This study aimed to investigate the development and implementation of perinatal emergency checklists in diverse hospital settings in the United States.

Circulating Angiogenic Factor Levels in Hypertensive Disorders of Pregnancy.

BACKGROUND: Among women with hypertensive disorders of pregnancy, biomarkers may stratify risk for developing preeclampsia with severe features (sPE). METHODS: Across 18 U.S.

Outcomes of Posterior Monteggia Variant Fractures Repaired Through a Trans-Olecranon Approach.

Purpose: To evaluate the clinical and radiographic outcomes and complications following surgical treatment of adult posterior Monteggia fracture variants in which coexisting radial head and coronoid fractures were addressed through a single extensile posterior trans-olecranon approach.

Methods: We performed a retrospective review from January 1, 2010, to January 1, 2021, of all adult patients who underwent fixation of posterior Monteggia variant fractures with coexisting radial head and/or coronoid fractures through a trans-olecranon approach by a single surgeon. Patient records were reviewed for postoperative complications and radiographic outcomes.

The impact of the COVID-19 pandemic on racial disparities in patients undergoing total shoulder arthroplasty in the United States.

Introduction: The purpose of this study was to assess racial disparities in total shoulder arthroplasty (TSA) in the United States and to determine whether these disparities were affected by the COVID-19 pandemic.

Methods: Centers for Medicare and Medicaid Services (CMS) 100% sample was used to examine primary TSA volume from April to December from 2019 to 2020. Utilization was assessed for White, Black, Hispanic, and Asian populations to determine if COVID-19 affected these groups differently.

Management of Patients With Gastric Varices.

Management of patients with gastric varices represents a unique challenge for clinicians. The broad range of endoscopic and endovascular techniques currently available is in stark contrast with the limited evidence available to inform the optimal management of these patients. This article describes the classification, pathophysiology, and natural history of gastric varices; summarizes the available evidence regarding medical, endoscopic, and endovascular management of gastric varices; and provides recommendations on how to integrate these options.