Browsing by Author "Wagner, Russell"
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Item Comparative Analysis of Same-Day Surgery Cancellations for Total Joint Arthroplasty Patients at JPS between 2018 and 2019(2022) Lyons, Cody; Wagner, RussellBackground Same-day surgery cancellations create an enormous financial burden by wasting hospital resources such as healthcare professional labor hours, operating room time, and underutilizing surgical equipment. The aim of this study was to follow-up a previous study investigating reasons for same-day surgery cancellations, and to determine if there has been a decrease in same-day surgery cancellations in 2019 compared to 2018 after the implementation of an optimization clinic. Methods This is an incidence study comparing knee and hip replacement surgical candidates between two years. We will review the reasons for cancellations during 2018 and compare those with our data collected for 2019 knee and hip replacement same-day surgery cancellations. Results We are awaiting data collection and analysis for same-day surgery cancellations in 2019, but the top three reasons for cancellation in 2018 included the discovery or development of a new medical condition and/or contraindication to surgery, abnormal pre-operative test results, and the lack of beds being available. An optimization clinic for all preoperative arthroplasty patients was instituted after collection of the 2018 data. The data collected should reveal if the optimization clinic has led to a decrease in same-day surgery cancellations, and therefore, hospital losses. Conclusions In the 2018 data collection, two areas were identified as having potential for immediate improvement, availability of hospital beds and problems with surgical equipment, implant, or supply. Based on 2018 findings, implementation of strategies to eliminate these issues could decrease the yearly cancellation rate by an additional 30%. With new information on 2019 cancellations, we will not only compare 2018 vs. 2019, but we could follow the data longitudinally to see where JPS could potentially save hundreds of thousands of dollars in the future.Item Contribution of bone cement volume with increased bone loss in the fixation of a patellar implant(2016-03-23) Wagner, Russell; Kosmopoulos, Victor; Mikeska, AndrewPurpose: Complications related to the patellofemoral joint after total knee arthroplasty (TKA) represent up to 50% of TKA re-operations. Shear forces at the bone-cement-implant interface produce wear and occasionally result in failure of fixation of the patellar implant. During revision surgery, variable amounts of patellar bone loss are observed from implant removal. Different volumes of bone cement are thus used to fill the remaining bone cavity and to fix the patellar implant. This study aims to computationally simulate and evaluate the fixation mechanics of the patellar implant-cement-bone interface with increasing amounts of bone loss. Materials and Methods: Patellar implant fixation to bone using bone cement in revision TKA was simulated using the finite element method. To study the fixation mechanics with increasing bone loss, the diameter of the bone cavity prepared around each of the three implant pegs (used as implant anchors into the bone) was uniformly increased by 0.5 mm. This resulted in a total of 5 bone-cement-implant models, with a bone cement thickness around the pegs ranging from 0.5 mm to 2.5 mm, loaded in shear to test fixation success. Results: Findings from the study indicate that increasing the cement thickness (bone hole diameter) is beneficial in increasing stiffness of the construct, reducing mean implant and cement stresses, reducing interface contact pressure between bone-and-cement and between cement-and-implant, and also reducing the maximum relative motion between these structures at these interfaces. Conclusions: Data collected from this finite element analysis support using an increased bone hole diameter, and thus bone cement filling around the implant pegs, for patellar implant fixation in revision TKA.Item EFFECT OF TIBIAL SLOPE ON FLEXION AND FEMORAL ROLLBACK IN TOTAL KNEE ARTHROPLASTY: A CADAVERIC STUDY(2014-03) Chambers, Andrew W.; Wood, Addison; Kosmopoulos, Victor; Sanchez, Hugo; Wagner, RussellPurpose (a): Reduced posterior tibial slope (PTS) and posterior tibiofemoral translation (PTFT) in posterior cruciate retaining (PCR) total knee arthroplasty (TKA) has been shown to result in suboptimal postoperative knee flexion due to the occurrence of tibiofemoral impingement. Although reduced PTS and PTFT have been shown independently to negatively affect total knee flexion following TKA, there has never been a study to our knowledge that has shown the effect of PTS on PTFT. We evaluated the relationship between PTS, PTFT, and total knee flexion in a cadaveric model after TKA. Methods (b): We obtained nine transfemoral fresh frozen cadaver specimens and preformed a balanced PCR TKA. The pre-operative and post-operative PTS were precisely measured with c arm fluoroscopy and the post-operative PTS was changed in 1 degree increments using custom shims for the TKA trial components. We successively measured the total flexion using a motion tracking system in response to a 25 lb force applied to the hamstrings at 1 degree increments of posterior tibial slope (1-10 degrees). Relative PTFT was measured at maximal flexion with C-arm fluoroscopy. Results (c): We used Tukey ANOVA test to determine significant changes in flexion and PTFT as a function of PTS. We found that there was an average increase in flexion of 2.3 o per degree increase of PTS from 1o (1 degree) to 5 o (p. Conclusions (d): Small increases in PTS in the range of 1o to 5o appear to significantly increase knee flexion and PTFT. As the PTS is further increased above 5 o, these findings suggest that flexion and PTFT do not continue to increase significantly. This is the first study to find a direct relationship between PTS and PTFT. These findings may be explained by changes in PCL tension with different PTS. As the flexion gap is loosened above a threshold (5 o) with increased PTS, the relatively lax PCL likely fails to initiate PTFT and subsequent total knee flexion is subsequently decreased due to posterior tibiofemoral soft tissue impingement. Additionally, we did not observe a correlation between native PTS and optimal degree of post-operative PTS. Although these results suggest that increasing PTS above 5o does not improve flexion or PTFT, clinical judgment and proper flexion gap balancing remain paramount in maximizing post-operative knee flexion. In vivo studies will be necessary to further substantiate these conclusions.Item Effects of Urinary Tract Infection on Hip and Knee Arthroplasty Outcomes(2021) Garcia, Laura; Barnes, Kalan; Dalton, Stewart; Teigen, Kari; Wagner, RussellIntroduction: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are common procedures performed in the United States. However, the effects of periprosthetic joint infections (PJI) can be devastating leading to invasive interventions and potentially impaired functionality, decreased patient satisfaction, and increased mortality. Risk factors for the development of PJIs have been well-documented, however, the association between urinary tract infections (UTIs) and PJIs remains controversial. Our aim was to establish the risk of developing a PJI in patients with an identified UTI in the preoperative, perioperative, and postoperative periods. Methods: Through retrospective chart review, data was abstracted from electronic medical records from JPS Health Network of all patients with a scheduled THA and TKA since 2014. We identified patients with UTIs 15 days prior to surgery and followed up with 12 months post-surgery for subsequent development of PJI. Results: A total of 2,220 surgeries were scheduled, and 1,697 surgeries were completed. Forty-six patients with a UTI completed surgery within 15 days of the UTI diagnosis, and 2 patients developed a PJI (4.3%, 95% Confidence limits: 0.5%, 14.8%) within 12 months post-surgery. Out of 1,274 patients with a surgery without UTI, 47 (3.7%, 95% confidence limit: 2.7%, 4.9%) developed a PJI. Conclusions: Our data does not suggest UTI in the preoperative period increases the risk of PJIs after THA and TKA. However, the study needs more power to establish significant results. Future analysis will look at the association between UTIs in the postoperative setting and PJI development.Item Effects of Urinary Tract Infection on Hip and Knee Arthroplasty Outcomes(2020) Wagner, Russell; Teigen, Kari; Barnes, Kalan; Garcia, Laura; Dalton, StewartIntroduction: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are common procedures performed in the United States. However, the effects of periprosthetic joint infections (PJI) can be devastating leading to invasive interventions and potentially impaired functionality, decreased patient satisfaction, and increased mortality. Many risk factors for the development of PJIs have been well-documented, however, the association between urinary tract infections (UTIs) and PJIs remains controversial. Our aim was to establish the risk of developing a PJI in patients with an identified UTI in the preoperative, perioperative, and postoperative periods. Methods: Through retrospective chart review, data was abstracted from electronic medical records from JPS Health Network of all patients with a scheduled THA and TKA since 2014. We identified patients with UTIs 15 days prior to surgery and followed up with 12 months post-surgery for development of PJI. Results: A total of 2,220 surgeries were scheduled, and 1,697 surgeries were completed. Forty-six patients with a UTI completed surgery within 15 days of the UTI diagnosis, and 2 patients developed a PJI (4.3%, 95% Confidence limits: 0.5%, 14.8%) within 12 months post-surgery. Out of 1,274 patients with surgery without UTI, 47 (3.7%, 95% confidence limit: 2.7%, 4.9%) developed a PJI. Conclusions: Our data does not suggest UTI in the preoperative period increases the risk of PJIs after THA and TKA. However, the study needs more power to establish significant results and future analysis will look at the association between UTIs in postoperative settings and development of PJI.Item Establishing Experimental Sample Uniformity Prior to Patella Component Fixation Testing(2018-03-14) Wagner, Russell; Kosmopoulos, Victor; Beck, Cameron; Hogsett, Cameron; Nestlerode, Christina; Nwannunu, BrianPurpose: It is imperative to perform quality control studies to validate experimental sample quality prior to testing. Due to the inherent inconsistency when using cadaveric bone as a means to test clinically relevant hypotheses, one such quality check is to geometrically study the variability present in the bone samples. Thus, as a quality control step prior to investing resources to undertake the overall aim of studying patella component fixation in total knee arthroplasty (TKA), this study aims to establish sample uniformity by analyzing patella length, width, and depth. Methods: Ten random pairs of patellae were harvested from a possible 39 embalmed cadavers. Each patella was then prepared by an orthopaedic surgeon, as if performing an intraoperative TKA, for fixation of a patella implant component. After preparation but before adding a patellar component and cement, the surgeon visually inspected each patella and separated each pair with the better bone quality sample as part of the control group and the other as part of the treatment group. Measurements were then taken by two independent observers using a caliper to determine the superior-inferior patellar length (SIL), medial-lateral width (MLW), and the sectioned patellar thickness (TH). T-tests were performed to establish interobserver measurement reliability and the geometric uniformity between the control and treatment groups and between the left and right samples. Results: There was no significant difference between readers in the SIL (p=0.48), MLW (p=0.58) and TH (p=0.23) measurements. No significant differences were found when comparing between the control and experimental groups for any of the three measures (SIL p=0.21, MLW p=0.44, TH p=0.90). There was however, a significant difference observed in the sectioned preparation TH (p=0.007) when comparing left and right knee patellae. Conclusions: Based on the geometric outcomes measured (SIL, MLW, TH) the results of this study validate the sample uniformity when comparing patellae based on control and treatment groups rather than right verses left. Doing so helps control sample quality for completing the overall aim to study cement fixation methods of the patellar component in TKA.Item EVALUATION OF INTRAOPERATIVE LIGAMENT INJURY DURING TOTAL KNEE ARTHROPLASTY INVOLVING RESIDENT TRAINING(2014-03) Joseph, Ryan; Wagner, Russell; Webb, BrianThe purpose of this study is to evaluate if the operative experience level of residents affects the incidence of ligament injuries in patients who have received a total knee arthroplasty. Purpose (a): The focus of this study was to evaluate intraoperative errors in the performance of total knee arthroplasties (TKAs) and compare the error rate of when a junior resident versus a senior resident served as the primary surgeon. Methods (b): A restrospective analysis was performed on all of the TKAs performed by either a junior or senior resident, directly supervised by Russell Wagner, MD, over a four year period of time. This study identified 346 cases, 143 of which were performed by a junior resident and 203 of which were performed by a senior resident. Incidence of injury was also evaluated to determine if intraoperative errors occur as frequently throughout a given rotation or if the occurrences decreased as the rotation progressed. In addition to this, differences between rotations taking place at the beginning of the year and rotations occuring at the end of the year was also investigated. Finally, the last factor analyzed was whether there was a correlation between a patient’s BMI and a ligament injury. Results (c): Of the 346 total knee arthroplasties performed from January 1, 2008 to December 31, 2012, there was an incidence of ligament injury in 7.5% of the cases. The occurrence of injury in which junior residents performed the surgery was 6.3%, compared to 8.3% when senior residents performed the surgery. There were no significant differences between junior or senior residents performing the surgery with regards to intraoperative ligament or tendon injury (p=. 58). The most common ligament injured was the medial collateral in 11 (3%); other ligament injuries included the posterior cruciate ligament in 10 (3%), the patellar tendon in 3 (1%), the popliteus tendon in 2 (.5%), and the lateral collateral ligament and iliotibial band in 1 (.3%). There was no relationship between ligament/tendon damage and in which month of the rotation the surgery was performed. There was also no correlation between rotations during the beginning versus the end of the year. 1 ligament/tendon injury occurred in 89 patients (1%) with a BMI of 30 or less while 25 ligament/tendon injuries occurred in 257 patients (10%) with a BMI of more than 30. This difference was statistically significant (p=.034). Conclusions (d): This analysis suggests that supervised junior residents may safely play a more active role when performing total knee arthroplasty since their involvement is not associated with increased intraoperative ligament or tendon injury. This information may assist attending orthopaedic surgeons and resident training programs in determining the role of junior residents during surgery.Item Muscular Architecture of the Posterior Knee and the Basic Science Implications(2016-03-23) Wood, Addison; Wagner, Russell; Reeves, Rustin; Smith, MorganIntroduction: Musculoskeletal modelling plays an integral role in estimating clinically relevant muscle and joint contact forces which rely upon cadaveric experimentation. The muscular architecture of the posterior knee is often overlooked; yet can play an important role in knee mechanics and balancing. In this sense, the contribution of the popliteus muscle to a well-functioning total knee arthroplasty is often debated in the literature and requires further clarification. Furthermore, prior literature involved smaller sample sizes and did not look for differences in muscle architecture between males and females. Methods: 12 embalmed cadaver specimens were dissected to reveal the origin and insertion of the gastrocnemius, semimembranosus, and popliteus muscles. The orientation of these muscles and the breadth of the insertion of the popliteus muscle were recorded in relation to the long axis of the tibia using a goniometer. Muscle volume was assessed via water displacement can and graduated cylinder. Muscle fiber length and pennation angle were determined under a dissecting scope using a ruler and goniometer. Fiber length was determined via dissection and measurement from 3 separate areas and averaged for each muscle. Using these data, physiological cross sectional area (PCSA) was calculated by multiplying each muscle’s volume by the cos of the pennation angle and then dividing by it’s fiber length. Results were initially analyzed using descriptive statistics. Comparison between groups was performed via ANOVA with a post hoc Tukey test for multiple comparisons. Results: Mean muscle volumes for females: popliteus 12.6 ml, gastrocnemius 108.1 ml, and semimembranosus 81.9 ml (n=7). Mean muscle volumes for males: popliteus 20.5 ml, gastrocnemius 195.6 ml, and semimembranosus 174.3 ml (n=5). Significant differences between males and females were found in all three volumes (p=.001, p=.002, and p=.010 respectively). Significant differences between males and females were also found in PCSA for the popliteus and semimembranosus muscles (p=.008, p=.003 respectively). There were no significant differences found between males and females in fiber length, overall muscle length (excludes tendon), or orientation (Table 1,2,3). The mean orientations of the popliteus, medial gastrocnemius, and lateral gastrocnemius with respect to the long axis of the tibia were 145.3 degrees, 163.8 degrees, and 162.4 degrees respectively. The tibial attachment site of the popliteus muscle spanned between 38.3 degrees and 25.5 degrees in relation to the long axis of the tibia. Several data points were unable to be adequately collected due to incidents occurring during dissection (represented by the letter x in the tables). Results were compared to prior literature when possible and were found to be similar. Discussion and Conclusion: Currently, few musculoskeletal models include the popliteus muscle for kinematic and kinetic studies of the knee. The role of the popliteus muscle in knee mechanics and balancing should not be underestimated and merits inclusion into computational knee models and joint simulations. The ratio of popliteus PCSA to semimembranosus PCSA was 1:2.35 in females and 1:3.03 in males with an overall ratio of 1:2.69 irrespective of sex. These ratios, combined with the orientation of the popliteus, infer that the muscle plays a significant role in force generation across the knee joint. These findings also illustrate the need for subject-specific PCSA to be calculated for more reliable modelling due to the wide degree of muscular variation being present.Item Patellar Component Fixation Strength with Varying Bone Defect Following Revision Total Knee Arthroplasty(2019-03-05) St. Louis, Blake; Nwannunu, Brian; Kosmopoulos, Victor; Powell, Jake; Wagner, Russell; Beck, CameronPurpose: Total knee arthroplasty (TKA) is an effective surgical treatment with only an 8.2% revision rate. A revision TKA can be initiated for several reasons including prosthetic loosening, infection, and pain. During a revision TKA, the three pronged “patellar button” may need to be removed and replaced from the posterior aspect of the patella. After removal, the quality of the remaining patellar bone is evaluated to determine if another patellar component is a viable option. Anecdotally, orthopedic surgeons visually inspect the patella to evaluate the amount of bone defect present. They then have to decide whether to replace the patellar button or pursue another path of repair. Currently there is no scientific basis to assist them in deciding how to best proceed. This study aims to determine the maximum shear force prior to failure of a cemented patellar component with varying degrees of bone defect. Methods: 60 pairs of patellae were harvested from embalmed cadavers. Each patella pair was visually inspected by an orthopedic surgeon and separated based on bone quality into a control (better bone quality) and experimental group (worse bone quality). Those within the experimental group were further divided into three groups, of 20 each, consisting of either a single defect, double defect, or triple defect. The patellae were then prepared as if performing an intraoperative revision TKA. Before cementing the patellar component, defects were created in each patella according to their experimental group (single, double, or triple defect) using a Dremel tool and metal washer to ensure each defect was the same size. A patellar component was then cemented to each patella using the same surgical procedure used during a revision TKA. After allowing the cement to cure, the patellae were potted into a mold using fiber glass resin. Maximum shear force was then tested with a material testing system (MTS). Results: The 60 pairs of patella range in age from 56 years old to 99 years old with an average age of 80. Thirty-one patella pairs were male (51.67%) and 29 pairs were female (48.33%). Data is currently being collected and analyzed regarding the shear force of the patellar component with the 3 different varying bone defect sizes. Conclusions: The further evaluation of the data will serve to provide physicians with clarity when faced with the question of what to do with the patella in the case of a revision TKA.Item Postoperative Lithium Toxicity after Total Hip Arthroplasty in Patient with Acute Kidney Injury(2020) Roberts, Tyler; Wagner, Russell; Lindsley, JoshuaWe document the first case of lithium toxicity in a 62-year-old female with schizoaffective disorder following total hip arthroplasty. Pre-operatively, the patient had subtherapeutic levels of lithium (0.5 mEq/L; normal range, 0.6 and 1.5 mEq/L) stable on maintenance dosing. She continued receiving this regimen post-operatively. On post-operative day 3, she was found to have an acute kidney injury (Creatinine 1.2 mg/dl, up from .5 mg/dl baseline), supratherapeutic lithium levels (2.5 mEq/L; normal range, 0.6 and 1.5 mEq/L), and signs of acute lithium toxicity. Immediate discontinuation of lithium and initiation of supportive care lead to full recovery. This report demonstrates the need for orthopedic surgeons to actively surveil post-operative lithium levels in patients with concomitant mood disorders, paying special attention to renal function and avoiding of nephrotoxic agents.Item Preliminary Results from the DFW Viet-American Health Pilot Study(2023) Nguyen, Ngoc; Vu, Christine; Li, Wenjun; Zhang, Yuqing; Spence, Emily E.; Wagner, Russell; Pham, Alena; Tran, Thanh; Franklin, Patricia; Nguyen, Uyen-SaIntroduction Arthritis is a chronic condition that can cause pain, physical disability, and reduced quality of life (QOL). The prevalence, severity, symptoms, and management of osteoarthritis (OA) are known to differ by race and ethnicity. Studies on racial differences focused mostly on Black or Hispanic populations with little attention on Asian Americans, such as socioeconomically marginalized, medically under-served, and hard-to-reach Vietnamese-Americans (VietAmericans). This pilot study investigated the occurrence, symptoms, knowledge, and management of arthritis among Viet-Americans. Methods From 7/1/22-8/31/22 and with help from community leaders of faith-based community organizations, we recruited people of Vietnamese descent of age ≥ 45 years and living in the Dallas-Fort Worth (DFW) metroplex.. We translated and adapted a linguistically and culturally appropriate questionnaire from English to Vietnamese using the Translation, Review, Adjudication, Pretesting, and Documentation(TRAPD) Model. Participants completed the survey which asked about their demographics, height, weight, chronic conditions, the 12-item Knee Injury and Osteoarthritis Outcome Survey (KOOS), the Veterans RAND 12-item Health Survey (VR12), and awareness of knee osteoarthritis (OA). We then calculated the body mass index and summary scores for KOOS pain, function, and QOL. Results Of 272 participants who completed the questionnaire (82% enrollment rate), 53% were women and 54% were ≥ 65 years old. The average stay in the US was 30 years (±12.8). The results indicated a low prevalence of overweight (21%) and obesity (6%). Knee OA occurred in 20% of men and 25% of women. Of note, 13% of men and 22% of women said they have rheumatoid arthritis (RA). Only 41% of participants knew that an optimal weight could prevent knee OA. About a third of men and women reported knee pain (KOOS QOL pain score <70). Additionally, 25% of men, 35% of women, and 36% of those ≥65 years reported experiencing pain weekly, daily, or constantly. Furthermore, 40% of men, 53% of women, and 56% of those ≥65 years reported having fair or poor general health. Compared to a year ago, 50% of men and women rated their physical health as slightly or much worse. Although 95% of patients had medical insurance, most of the participants (84%) used alternative pain management such as massages, herbal medicines, and acupressure. Conclusion Participants reported a high prevalence of both OA and RA despite a low prevalence of overweight or obesity. Many people were unaware of risk factors related to OA and how weight management is crucial in the prevention of this disease. The results may be limited by the participants’ knowledge of medical conditions such as OA and RA. The next phase of the study will investigate and examine the reliability and validity of the translated instruments, the accuracy of self-reported OA and RA, and factors associated with poor health, including arthritis-related pain.Item Reasons for Surgery Cancellation on the Day of Surgery for Total Joint Arthroplasty Patients at John Peter Smith Hospital(2020) Wagner, Russell; Vachon, Brad; Heinrich, CarlPurpose: The aim of this study was to investigate reasons behind cancellations for knee and hip replacement patients at John Peter Smith (JPS) Hospital. We hope to identify any areas for improvement to help optimize patient outcomes and use of hospital resources. Methods: This is an incidence study consisting of knee and hip replacement surgical candidates and procedures during the 2018 calendar year. Retrospective chart review was completed and exploratory data analysis performed to categorize cases by reason(s) for cancellation. Results: There were 332 total scheduled procedures, of which 41 were cancelled. Reasons for cancellations were divided into the following categories: Abnormal test results accounted for the majority of cancellations (n=9, 21.95%). Development of a contraindication before the procedure accounted for 19.51% (n=8). Lack of available beds accounted for 14.64% (n=6). Equipment/implant/supply issues accounted for 14.64% (n=6). Surgeon/physician scheduling conflict accounted for 12.20% (n=5). Need for medical optimization accounted for 9.76% (n=4). Financial/insurance issues accounted for 2.44% (n=1). Surgical procedure no longer indicated accounted for 2.44% (n=1). Patient cancellation unrelated to medical or financial factors accounted for 2.4% (n=1). Conclusions: Of the significant cancellation reasons, there were two areas we identified as having potential for immediate improvement. These are the availability of hospital beds and problems with surgical equipment, implant, or supply. Based on these findings, the development and implementation of a plan to address these issues could potentially decrease the yearly cancellation rate by almost 30%.Item Recurrent Heterotopic Ossification and Varus Deformity of the Knee Following Retrograde Intramedullary Nailing of Fractured Femur(2020) Wagner, Russell; Read, JordanBackground: Retrograde femoral nailing is an indicated procedure for femoral shaft fractures. Heterotopic ossification, tibial deformity, and fibular collateral ligament laxity are rare and not well understood complications of retrograde femoral nailing. Case Information: This case documents a 16-year-old female who suffered polytraumatic injuries following a high-speed motor vehicle accident. Following repair of left ipsilateral femoral neck and shaft fracture with sliding hip screw and retrograde femoral intramedullary nailing patient developed left knee stiffness, loss of motion, and pain. Following arthroscopy patient was found to have heterotopic ossification and arthrofibrosis. Nine months later patient was taken for third orthopedic procedure after development of left knee varus due to tibial deformity, fibular collateral ligament laxity, and recurrent heterotopic ossification. Conclusion: This case illustrates patient with recurrent development of heterotopic ossification, development of knee varus treated with high tibial open angle osteotomy, and advancement of the proximal attachment of the fibular collateral ligament with the use of intramedullary nailing locking screw hole remnants.Item Single stage bilateral flexible intramedullary fixation of periprosthetic distal femur fractures(2020) Wagner, Russell; Sambhariya, Varun; Rahman, Shawn; Neal, David; Tran, ApolloWe present a patient with bilateral Rorabeck II/Su III periprosthetic distal femur fractures treated successfully with bilateral single stage flexible intramedullary fixation. Flexible intramedullary fixation of Rorabeck II/Su III periprosthetic distal femur fractures provides the benefits of shorter operative time, lower blood loss, and preservation of bone stock compared to plate fixation and distal femur replacement. We suggest that for patients with similar injuries flexible intramedullary fixation can be a viable treatment option.Item The Radiographic Prepatellar Fat Thickness Ratio Correlates with Infection Risk following Total Knee Arthroplasty(2018-03-14) Hogan, Sean; Burge, Ross; Sanchez, Hugo; Wagner, Russell; Bates, Christopher1. Purpose Obesity has been associated with complications following a total knee arthroplasty (TKA). Surgical Site Infection (SSI) following TKA is one of the feared complications as it increases revision rates, costs, and stress to the patient. There is conflicting evidence in the literature regarding BMI and risk of infection after TKA and some studies have suggested that site-specific fat distribution may be a better metric for determining risk of postoperative infections. Here we investigate the correlation of soft tissue distribution about the knee to surgical site infection following TKA. 2. Methods We retrospectively review 572 patients who underwent primary TKA at a single institution from 2006 to 2010. We introduce the Prepatellar Fat Thickness Ratio (PFTR) as a radiographic means to quantitatively assess fat distribution about the knee and evaluate this measurement’s ability to assess the risk of developing a SSI following TKA. 3. Results The PFTR was shown to be a better predictor of SSI than BMI in both the univariate (p=0.05) and multivariate (p=0.01) analyses. 4. Conclusions While BMI cannot fully account for variations in adipose distribution, the PFTR may account for this variability and may be a helpful tool for assessing a patient’s preoperative risk of SSI after TKA.Item The Combined Effect of Translational and Rotational Malreduction on Sacroiliac Joint Contact Surface Area(2016-03-23) Wood, Addison; Wagner, Russell; Barcak, Eric; Lopez, JenniferPURPOSE: Boney apposition of sacroiliac articular surfaces or anatomic reduction is of paramount importance to achieve long term stabilization through fusion of the sacroiliac joint. The amount of contact surface area in these fixated joints provides some insight into the potential fusion rates of a joint. There is a bulk of literature supporting an association between anatomic reduction and good long term outcomes, yet most of these studies define an acceptable reduction as having less than 1 cm of displacement which would be unacceptable in other areas of the skeletal system. METHODS: 14 sacroiliac joints specimens were dissected prior to scanning each face of the sacroiliac joint with a multi laser 3D scanner (NextEngine, Inc,). The 3D models were then imported into AutoCAD modeling software (Autodesk, Inc,) for manipulation. Prior to manipulation, the major and minor axes of the sacroiliac joint are defined and used as pathways for superior, posterosuperior, and posterior displacements of the sacrum on the ilium. In addition, a vertical axis as served as the center of internal and external rotation manipulations. Contact surface area for each specimen was then calculated while in the fully anatomically reduced state. This measurement was repeated as the sacrum was displaced in 2mm increments, up to maximum of 25mm, separately in all 3 translational directions. This method was repeated and contact surface area measurements recorded as the ilium was rotated internally and externally in 1 degree increments, up to maximum of 10 degrees, at each increment of translational displacement. RESULTS: Work in progress, however, all 14 specimens have been scanned with a 3D laser scanner and data collection is underway. DISCUSSION AND CONCLUSION: Current literature has only addressed planar translations of the ilia in relation to the sacrum. This is in stark contrast to the reality of typical sacroiliac disruptions which involve multiple translations in combination with internal/external rotation of the ilia. Therefore, the goal of this study was to evaluate the acceptable tolerances of malreduced sacroiliac joints through contact surface area changes in response to combined translations and rotations about the sacroiliac joint. By overcoming the limitations of prior 2 dimensional comparisons we provide a clearer picture of the necessity of anatomic reduction and the need for increased aggressiveness in the treatment of sacroiliac disruptions through our 3D study.Item TOPAZ RADIOFREQUENCY COBLATION FOR LATERAL EPICONDYLITIS: A RETROSPECTIVE STUDY(2014-03) Sumko, Dan; Wagner, Russell; Sumko, Michael H.This is a retrospective study involving patients with chronic lateral epicondylitis of the elbow. From 1996 through 2012, 108 elbows in 87 patients underwent TOPAZ (radiofrequency ablation) applied to the lateral epicondyle. Patients were contacted by phone and data collected which showed 86% excellent results with follow-up ranging from 2-18 years. This minimally invasive procedure proved to be an effective modality, with no significant complications, for the treatment of chronic tennis elbow. Purpose (a): To evaluate outcomes of TOPAZ radiofreqency coblation for recalcitrant lateral epicondylitis. Methods (b): The pool of subjects ranged in age from 41 to 72 and had a history of at least 3 months of conservative treatment to include NSAIDs, activity modification, bracing, night splints, and at least 3 steroid injections. All of these had failed to give any long term relief. Subjects were prepared for surgery by marking out the tender area on the skin in a usual rectangular shape. After adequate anesthesia, varying from local with sedation to general, a longitudinal incision was made in the mid-area of the pre-op delineated rectangular area. Most were done without the aid of a tourniquet. The radio-frequency (TOPAZ) tip was touched to the surface of the tendon every 3-4 mm, and every third touch penetrated the tendon surface to a depth of 3-4 mm. When the area of the tendon corresponding to the rectangular skin markings was treated, (making a checkerboard pattern) the wound was closed with subcuticular 3'0 monocryl suture and steri-stripped. A dressing of a simple fluff was held in place with a curlex roll and coban. The patient was instructed to keep the dressing dry until the first post op visit at day 7-10, with no excessive lifting (greater than one pound for 1 week and then no greater than 8 pounds for an additional 2 weeks). Return to normal activities was permitted at week 6 weeks. 87 patients who had undergone TOPAZ radiofrequency coblation therapy for lateral epicondylitis by the same surgeon during a period from 1996-2012 were contacted via telephone. In addition to eliciting the Numeric Pain Scale for the operative elbow, the patients were also asked a series of additional questions pertaining to their satisfaction and results of the procedure seen below. "Was the procedure performed on your right or left elbow? Or Bilaterally?* How would you rate the overall results of your procedure on a scale of 0-10, 10 being a perfect outcome? Does your elbow have a negative impact on your daily activities? Never, Occasionally, Always? How would you rate the appearance of the scar from the procedure, on a scale of 0-10, 10 being a perfect scar that is hardly noticeable? How would you rate your pain since the procedure, on a scale of 0-10, 10 being excrucitating? Postoperatively, do you experience a decreased range of motion? Postoperatively, do you experience any weakness on that side? 8. How would you rate your overall relief of previous pain: Total, Partial, or None? *If both elbows were operated on, questions 2, 4, & 5 were asked for both sides separately." Results (c): Of the 87 patients surveyed, 21 had received TOPAZ bilaterally accounting for 108 total elbows. Male 45% Female 55%. Age - Mean: 56 years old (s=7.85) Years Since Procedure Mean: 9.2 years (s=3.39). Left Elbow 43% Right Elbow 57%. Bilateral TOPAZ 24% Overall Satisfaction out of 10 Mean: 8.6 (s=2.17) Negative impact on ADLs? No: 86% Yes:8% Partially: 7% Appearance of Scar out of 10 Mean: 7.50 (s=2.31) Pain Since Surgery (Numeric Pain Scale) Mean: 1.70 (s=2.81). Experience decreased ROM? None: 98% Partial: 2% Complete: 0% Experience weakness? Never: 87% Sometimes: 11% Always: 2% Relief of symptoms - Total: 86% Partial: 10% None: 4% Conclusions (d): TOPAZ has been shown to be an effective, minimally invasive modality for treatment of recalcitrant lateral epicondylitis.