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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVIII | Pages 205 - 205
1 Sep 2012
Kukkar N Beck RT Mai MC Sullivan DN Milbrandt JC Freitag P
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Purpose

Degenerative changes of the lumbar motion segment often lead to stenosis of the spinal canal or neuroforamen. Axial lumbar interbody fusion (AxiaLIF) is intended to indirectly increase and stabilize foraminal dimensions by restoring disc height in patients with degenerative disc disease, thereby relieving axial and radicular pain. Therefore, this study investigated the effects of AxiaLIF on anterior disc height, posterior disc height, foraminal height and foraminal width as well as to determine the effectiveness of this minimally-invasive technique for indirect decompression and restoration of disc height.

Method

Eighty-one patients who underwent a 360 degree lumbar interbody fusion at L4-S1 and L5-S1 with AxiaLIF between November 2008 and May 2010 and satisfied all inclusion criteria were included. The preoperative and three-month postoperative digital radiographs were reviewed and analyzed. Disc heights were measured in the planes of the anterior and posterior surfaces of the adjacent vertebral bodies. Foraminal height was measured as the maximum distance between the inferior margin of the pedicle of the superior vertebra and the superior margin of the pedicle of the inferior vertebra. Foraminal width was measured as the shortest distance between the edge of the superior facet of the caudal vertebra and the posterior edge of inferior endplate of the cranial vertebra. Potential magnification error between pre- and post-operative radiographs was corrected using the anterior vertebral height of L5 vertebra.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVIII | Pages 207 - 207
1 Sep 2012
Kukkar N Beck RT Mai MC Froelich JM Milbrandt JC Freitag P
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Purpose

A change in lumbar lordosis can affect the outcome following lumbar fusion, and intraoperative positioning is a prime determinant of the postoperative lordosis. The purpose of this study is to determine the change in lordosis and sacral slope (SS) following axial lumbar interbody fusion (AxiaLIF).

Method

We retrospectively reviewed 81 patients who underwent a 360 lumbar interbody fusion at L4-5/L5-S1 (two-level procedure) or solely at L5-S1 (one-level) for degenerative disc disease and spondylolithesis utilizing the AxiaLIF with posterior segmental instrumentation. For the two-level procedures, 25 patients had the AxiaLIF placed first and 27 had pedicle screws placed first. For the one-level procedures, 11 patients had the AxiaLIF placed first and 18 had pedicle screws placed first. Standing lateral preoperative radiographs were compared to standing lateral postoperative films. Lumbar Cobb angles were measured at L1-S1, L4-S1 and individual lumbar levels. SS was measured for sacral version.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVIII | Pages 116 - 116
1 Sep 2012
Kukkar N Beck RT Froelich JM Milbrandt JC Novicoff WM McLafferty RB Williams RG Saleh KJ
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Purpose

The patient-physician relationship is a complex interaction and the importance of effective communication is well documented. The importance and implications of effective physician-patient communication is highlighted by the implementation of Communication Skills as a core competency by ACGME. The purpose of this study was to evaluate anonymous surveys completed by orthopaedic clinic patients to assess their visit experiences and whether they would recommend their physician to a friend or family member.

Method

Data were collected from patients exiting SIUs Division of Orthopaedic Surgery outpatient clinics through the completion of an anonymous survey. The survey was distributed on a sample of days between 2002 and 2004 and again in 2009. Responders were asked to complete the survey and return it prior to leaving the office. Participating surgeons were aware of the project occurring but did not know the dates on which surveys would be collected from their clinic patients. All surveys were scanned for data entry and if there was any difficulty with the scanning process then the data was entered manually.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVIII | Pages 119 - 119
1 Sep 2012
Kukkar N Beck RT Dyrstad BW Pope DJ Milbrandt JC Weinhoeft AL Idusuyi OB
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Purpose

Residency programs are continually attempting to predict the performance of both current and potential residents. Previous studies have supported the use of USMLE Step 1 and 2 as predictors of Orthopaedic In-Training Examination and eventual American Board of Orthopaedic Surgery board success, while others show no significant correlation. A strong performance on OITE exams does correlate with strong residency performance, and some believe OITE scores are good predictors of future written board success. The current study was designed to examine potential differences in resident assessment measures and their predictive value for written boards.

Method

A retrospective review of resident performance data was performed for the past 10 years. Personalized information was removed by the residency coordinator. USMLE Step 1, USMLE Step 2, in-training exams (from first to fifth years of training), and written orthopaedic specialty board scores were collected. Subsequently, the residents were separated into two groups, those scoring above the 35th percentile on in-training examinations and those scoring below. Data were analyzed using correlation and regression analyses to compare and contrast the scores across all tests.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_IV | Pages 592 - 592
1 Nov 2011
Froelich JM Milbrandt JC Allan DG
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Purpose: Orthopaedic residency training requires intellectual and motor skill development. In this study we aim to develop a model to evaluate junior resident proficiency and efficiency versus senior residents in the placement of a center-center guidewire during fixation of an intertrochanteric proximal femur fracture utilizing a computer-based haptic simulator. We hypothesize the junior residents will utilize more fluoroscopy and require more time to complete the task.

Method: Post-graduate year residents (PGY) 3–5s, labeled Group II, placed a single central guide pin into a femoral head utilizing a surgical simulator four times. PGY 1–2s, labeled Group I, completed the same task six times. The residents were then evaluated based on final tip-apex distance (TAD), fluoroscopy time, time to complete the task, total number of distinct attempts at pin placement for each femur construct as well as final three-dimensional location of the pin from the isometric center of the femoral head. This project was approved by the institutional IRB.

Conclusion: In this study we displayed that based on our simulator model there was no statistical difference between Group I and II in time to completion, final placement on AP view, and tip-apex distance. There was a statistically significant difference in the anterior/posterior placement of the wire between the two groups, fluoroscopy time, and number of attempts per trial. Our findings suggest a computer based surgical simulator can identify measurable differences in surgical proficiency between junior and senior orthopaedic residents.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_IV | Pages 575 - 575
1 Nov 2011
Allan DG Rylander L Milbrandt JC Wallace A
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Purpose: Metal-on-Metal (MOM) hip resurfacing is a popular alternative to conventional hip arthroplasty. The purpose of the present study is to compare patient characteristics and radiographic findings for revision versus non-revision cases treated at a single center with a MOM resurfacing device.

Method: Eighty-nine MOM resurfacing arthroplasties were performed between December 2001 and June 2006. Subjects were assessed for implant revision status, age, gender, weight, operative side, primary diagnosis, femoral head size, and time to revision. Postoperative radiographs were assessed for acetabular cup inclination and femoral stem inclination relative to the femoral neck.

Results: Thirteen of 89 hips (14.6%) have required revision to date with follow-up ranging from 4 (a revision) to 91 months. Female gender, smaller implant size, and a diagnosis of osteonecrosis were all associated with lower device survival. A significant difference in acetabular cup angle was observed between revised and non-revised hips. However, this difference can largely be attributed to two outliers in cup position associated with early migration and the difference became non-significant when these outliers were excluded. No significant difference was found in stem angle between revised and non-revised hips. The revision rate for the first 25 hips was 24% versus 8% for the next 64 hips. Females accounted for 56% of subjects 1–25 and 23% of subjects 26–89. Seven of the 8 failures for the first 25 procedures occurred beyond 4 years follow-up. Only 2 early device failures (< 2 yrs) were identified and both were in the 26–89 subgroup.

Conclusion: Despite representing only 33% of included subjects, females accounted for 62% of revision procedures. An apparent learning curve was identified by a lower device survival proportion for the first 25 hips versus hips 26–89. However, this learning curve was not associated with failures which could be attributed to acetabular or femoral component malpositioning and is likely explained by the higher proportion of females enrolled early in the study. Taken together, we propose the apparent “learning curve” exhibited in our study is not wholly technical in nature but rather influenced by changes in patient selection over time by the operative surgeon.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_III | Pages 271 - 271
1 Jul 2011
Froelich JM Milbrandt JC Allan DG
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Purpose: The current study examines the impact of the 80-hour work week on the number of surgical cases performed by PGY2 – PGY5 Orthopedic residents. We also evaluated Orthopaedic In-training Exam (OITE) scores during the same time period.

Method: Data were collected from the ACGME national database for 3 academic years prior to and 5 years after July 1, 2003. CPT surgical procedure codes logged by all residents three years prior to and five years following implementation of the 80-hour work week were compared. The average raw OITE scores for each class obtained during the same time period were also evaluated. Data were reported as the mean ± standard deviation (SD) and group means were compared using independent t-tests.

Results: No statistical difference was noted in the number of surgical procedure codes logged prior to or after institution of the 80-hour week during any single year of training. However, an increase in the number of CPT codes logged in the PGY-3 year after 2003 did approach significance (457.7 vs. 551.9, p=0.057). There was a statistically significant increase in total number of cases performed (464.4 vs. 515.5 p=0.048). No statistically significant difference was noted in the raw OITE scores before or after work hour restrictions for our residents or nationally.

Conclusion: We found no statistical difference for each residency class in the average number of cases performed or OITE scores. We also found no statistical difference in the national OITE scores. Our data suggest that the impact of the 80 hour work has not had a detrimental effect in these two resident training measurements.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 3 - 4
1 Mar 2010
Parsley BK Allan DG Dyrstad B Milbrandt JC
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Purpose: Metal-on-metal (MOM) bearing surfaces release ions locally and into the systemic circulation. This elevation raises concern about the long term effects of elevated metal ions. The goal of the present study was to monitor serum cobalt (Co) and chromium (Cr) levels in patients after MOM resurfacing hip arthroplasty with the Cormet 2000 prosthesis. We present here pilot data on Co and Cr levels in patients with bilateral versus unilateral hip resurfacing devices.

Method: We prospectively collected patient characteristics, outcome, and serum samples from device implanted subjects at 6 months, 1, 2, and 3 years following surgery. Unilateral patients had one implant during the entire course of follow-up and bilateral patients were included after the second implant surgery was performed. Serum Co/Cr levels were determined using high-resolution inductively coupled plasma mass spectrometry. Students t-test was used to compare ion levels in two groups based on the number of resurfacing implants (bilateral versus unilateral).

Results: 41 unilateral and 9 bilateral subjects were enrolled and followed for serum Co and Cr levels. In general, Co/Cr levels were increased at all time points when compared to control levels in both groups. Bilateral subjects had average serum levels concentrations significantly higher than those observed for unilateral cases (Co: 5.99 vs 2.56 μg/L (p=0.0001); Cr: 6.66 vs 3.60 (p=0.0009).

Conclusion: Elevated serum Co/Cr levels were observed at all time points following implantation in both groups and serum levels were nearly 2 times higher in the bilateral group. Based on these preliminary findings, patients undergoing bilateral total hip resurfacing arthroplasty may need to be monitored more closely than those patients receiving unilateral devices. In addition, these bilateral cases may be at a greater risk of ion level toxicities than the unilateral population.


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_II | Pages 240 - 240
1 May 2009
Allan D Dyrstad BW Milbrandt JC Parsley BK
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Metal-on-metal (MOM) hip resurfacing devices are known to release metal ions locally and into the systemic circulation. Previous studies suggest that larger prosthetic head size will correlate to reduced wear properties and may result in lower systemic release of metal ions. This project assessed the effect of femoral head size on serum cobalt (Co) and chromium (Cr) levels in subjects after unilateral hip resurfacing with the Cormet 2000 prosthesis.

We prospectively collected patient characteristics, outcome, and serum samples from device implanted subjects at six months, one, two, and three years following surgery. Serum Co/Cr levels were determined using high-resolution inductively coupled plasma mass spectrometry. Students t-test was used to compare ion levels in two groups based on femoral head size.

Thirty-five subjects (twenty male) were followed. Co/Cr levels were increased at all time points when compared to control levels. A significant negative correlation was observed between Co and Cr levels and femoral head size. Co/Cr levels in subjects with larger femoral heads were significantly lower when compared to those implanted with smaller heads (Co, −35.8%; Cr, −33.0%). This correlated with significantly higher Co/Cr levels in females versus males, with females receiving significantly smaller heads on average.

Elevated serum Co/Cr levels were observed at all time points following implantation and in females and in subjects with femoral heads.