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).

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.

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.

Purpose: The purpose of this study was to examine the effects of baseline mental health on functional outcomes after primary knee arthroplasty by reviewing the data collected in a multi-center prospective observational cohort study. We hypothesized that those patients with lower baseline mental health status would demonstrate significantly worse outcomes vs. their counterparts with higher mental status following primary total knee arthroplasty.

Method: Data from a multi-center prospective cohort study of PS (posterior stabilizing implant) and CR (cruciate retaining implant) primary knee arthroplasty were compared to determine the relationship between baseline mental health status and functional outcomes post-surgery. Subjects were followed from the time of the index surgery to monitor outcomes and complications. Validated quality of life instruments, including SF-36, WOMAC, Knee Society Score, and an activity scale were used. The rates of improvement from 0 to 12 months were analyzed for this study.

Results: Baseline data was available for 436 subjects in the primary PS study and 493 subjects in the primary CR study. Patients improved significantly on all SF-36 and WOMAC components between baseline and 12 months post-surgery. Correlation and regression analysis between WOMAC and SF-36 showed that Global Health (GH), Mental Health (MH), and Mental Component Score (MCS) subscales on the SF-36 were significantly associated with positive post-operative changes in WOMAC scores.

Conclusion: This study examined the effects of baseline mental health on functional outcomes after primary knee arthroplasty and found that baseline mental health was a significant predictor of functional outcomes twelve months after surgery. This relationship between mental health and outcomes needs to be examined carefully to help surgeons better prepare their patients for surgery.

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.