R L Barrack

Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, United States

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Publications (264)562.65 Total impact

  • Adam Sassoon, Denis Nam, Ryan Nunley, Robert Barrack
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    ABSTRACT: Patient-specific cutting blocks have been touted as a more efficient and reliable means of achieving neutral mechanical alignment during TKA with the proposed downstream effect of improved clinical outcomes. However, it is not clear to what degree published studies support these assumptions.
    Clinical Orthopaedics and Related Research 07/2014; · 2.79 Impact Factor
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    ABSTRACT: Aseptic loosening and osteolysis commonly limit the survivorship of total hip prostheses. Retention of a well-fixed acetabular component, rather than full acetabular revision, has multiple advantages, but questions have lingered regarding the clinical success and prosthetic survivorship following this procedure. We examined the impact of acetabular component position, polyethylene type, liner insertion technique, femoral head size, and simultaneous revision of the entire femoral component (as opposed to head and liner exchange) or bone-grafting on mid-term to long-term prosthetic survival following such limited revisions.METHODS: One hundred hips in 100 patients with osteolysis, polyethylene wear, or femoral component loosening underwent revision total hip arthroplasty with retention of the acetabular component. Acetabular component inclination and anteversion were measured on prerevision radiographs and were categorized according to predetermined positional safe zones (inclination of 35° to 55° and anteversion of 5° to 25°). Operative reports were reviewed for femoral head size, polyethylene liner type (conventional or highly cross-linked), liner insertion technique (use of the existing locking mechanism or cementation), whether the patient had revision of the entire femoral component, and use of bone graft. Outcomes of interest included the Harris hip score, University of California at Los Angeles (UCLA) activity score, episodes of instability, and need for repeat revision.RESULTS: At an average of 6.6 years (range, two to fourteen years) postoperatively, the Harris hip and UCLA activity scores were both significantly improved compared with the preoperative scores (p < 0.0001 and p < 0.01, respectively). Overall, the failure rate was 13%. In addition, 6% of the patients had postoperative instability. Hips in which the acetabular component was outside of the safe zone for inclination had a higher rate of failure (p = 0.048). Use of conventional, rather than highly cross-linked, polyethylene at the time of revision was also associated with an increased rate of repeat revision (p = 0.025).CONCLUSIONS: Revision total hip arthroplasty with retention of the acetabular component is associated with good outcomes in hips with an appropriately positioned, well-fixed acetabular component. Acetabular components outside the safe zone for inclination were at a higher risk for failure, as was use of conventional polyethylene.LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
    The Journal of bone and joint surgery. American volume. 06/2014; 96(12):1015-1020.
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    ABSTRACT: Although the volume of total knee arthroplasties (TKAs) performed in the United States continues to increase, recent reports have shown the percentage of patients who remain "unsatisfied" is as high as 15% to 30%. Recently, several newer implant designs have been developed to potentially improve patient outcomes.
    Clinical Orthopaedics and Related Research 06/2014; · 2.79 Impact Factor
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    ABSTRACT: With more than 650,000 knee arthroscopies and 175,000 anterior cruciate ligament reconstructions performed annually in the United States, patients presenting for total knee arthroplasty are increasingly likely to have had previous knee surgery. The purpose of this study was to assess the prevalence of previous knee surgery in patients undergoing total knee arthroplasty and to test the hypothesis that patients with previous knee surgery undergo total knee arthroplasty at a younger age.
    The Journal of bone and joint surgery. American volume. 05/2014; 96(10):801-5.
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    ABSTRACT: Haematomas, drainage, and other non-infectious wound complications following total knee replacement (TKR) have been associated with long-term sequelae, in particular, deep infection. However, the impact of these wound complications on clinical outcome is unknown. This study compares results in 15 patients re-admitted for wound complications within 90 days of TKR to 30 matched patients who underwent uncomplicated total knee replacements. Patients with wound complications had a mean age of 66 years (49 to 83) and mean body mass index (BMI) of 37 (21 to 54), both similar to that of patients without complications (mean age 65 years and mean BMI 35). Those with complications had lower mean Knee Society function scores (46 (0 to 100 vs 66 (20 to 100), p = 0.047) and a higher incidence of mild or greater pain (73% vs 33%, p = 0.01) after two years compared with the non re-admitted group. Expectations in patients with wound complications following TKR should be tempered, even in those who do not develop an infection. Cite this article: Bone Joint J 2014;96-B:619-21.
    The bone & joint journal. 05/2014; 96-B(5):619-621.
  • Denis Nam, Robert L Barrack, Hollis G Potter
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    ABSTRACT: Adverse tissue reactions are known to occur after total hip arthroplasty using both conventional and metal-on-metal (MoM) bearings and after MoM hip resurfacing arthroplasty (SRA). A variety of imaging tools, including ultrasound (US), CT, and MRI, have been used to diagnose problems associated with wear after MoM hip arthroplasty and corrosion at the head-trunnion junction; however, the relative advantages and disadvantages of each remain a source of controversy. The purposes of this review were to evaluate the advantages and disadvantages of (1) US; (2) CT; and (3) MRI as diagnostic tools in the assessment of wear-related corrosion problems after hip arthroplasty. A systematic literature review was performed through Medline, EMBASE, Scopus CINAHL, and the Cochrane Library without time restriction using search terms related to THA, SRA, US, CT, MRI, adverse tissue reactions, and corrosion. Inclusion criteria were Level I through IV studies in the English language, whereas expert opinions and case reports were excluded. The quality of included studies was judged by their level of evidence, method of intervention allocation, outcome assessments, and followup of patients. Four hundred ninety unique results were returned and 40 articles were reviewed. The prevalence of adverse local tissue reactions in both asymptomatic and symptomatic patients varies based on the method of evaluation (US, CT, MRI) and imaging protocols. US is accessible and relatively inexpensive, yet has not been used to report synovial thicknesses in the setting of wear-related corrosion. CT scans are highly sensitive and provide information regarding component positioning but are limited in providing enhanced soft tissue contrast and require ionizing radiation. MRI has shown promise in predicting both the presence and severity of adverse local tissue reactions but is more expensive. All three imaging modalities have a role in the assessment of adverse local tissue reactions and tribocorrosion after total hip arthroplasty. Although US may serve as a screening technique for the detection of larger periprosthetic collections, only MRI has been shown to predict the severity of tissue destruction found at revision and correlate to the degree of tissue necrosis at histologic evaluation.
    Clinical Orthopaedics and Related Research 03/2014; · 2.79 Impact Factor
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    ABSTRACT: Venous thromboembolic events, either deep venous thrombosis or pulmonary embolism, are important complications in patients undergoing knee or hip arthroplasty. The purpose of this study was to evaluate the effectiveness of a mobile compression device (ActiveCare+S.F.T.) with or without aspirin compared with current pharmacological protocols for prophylaxis against venous thromboembolism in patients undergoing elective primary unilateral arthroplasty of a lower-extremity joint. A multicenter registry was established to capture the rate of symptomatic venous thromboembolic events following primary knee arthroplasty (1551 patients) or hip arthroplasty (1509 patients) from ten sites. All patients were eighteen years of age or older with no known history of venous thromboembolism, coagulation disorder, or solid tumor. Use of the compression device began perioperatively and continued for a minimum of ten days. Patients with symptoms of deep venous thrombosis or pulmonary embolism underwent duplex ultrasonography and/or spiral computed tomography. All patients were evaluated at three months postoperatively to document any evidence of deep venous thrombosis or pulmonary embolism. Of 3060 patients, twenty-eight (0.92%) had venous thromboembolism (twenty distal deep venous thrombi, three proximal deep venous thrombi, and five pulmonary emboli). One death occurred, with no autopsy performed. Symptomatic venous thromboembolic rates observed in patients who had an arthroplasty of a lower-extremity joint using the mobile compression device were noninferior (not worse than), at a margin of 1.0%, to the rates reported for pharmacological prophylaxis, including warfarin, enoxaparin, rivaroxaban, and dabigatran, except in the knee arthroplasty group, in which the mobile compression device fell short of the rate reported for rivaroxaban by 0.06%. Use of the mobile compression device with or without aspirin for patients undergoing arthroplasty of a lower-extremity joint provides a noninferior risk for the development of venous thromboembolism compared with current pharmacological protocols. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence. PEER REVIEW This article was reviewed by the Editor-in-Chief and one Deputy Editor, and it underwent blinded review by two or more outside experts. It was also reviewed by an expert in methodology and statistics. The Deputy Editor reviewed each revision of the article, and it underwent a final review by the Editor-in-Chief prior to publication. Final corrections and clarifications occurred during one or more exchanges between the author(s) and copyeditors.
    The Journal of Bone and Joint Surgery 02/2014; 96(3):177-83. · 3.23 Impact Factor
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    ABSTRACT: Background A recent proposed modification in surgical technique in total knee arthroplasty (TKA) has been the introduction of the “kinematically aligned” TKA, in which the angle and level of the posterior joint line of the femoral component and joint line of the tibial component are aligned to those of the “normal,” pre-arthritic knee. The purpose of this study was to establish the relationship of the posterior femoral axis of the “kinematically aligned” total knee arthroplasty (TKA) to the traditional axes used to set femoral component rotation. Methods 114 consecutive, unselected patients with preoperative MRI images undergoing TKA were retrospectively reviewed. The transepicondylar axis (TEA), posterior condylar axis (PCA), antero-posterior axis (APA) of the trochlear groove, and posterior femoral axis of the kinematically aligned TKA (KAA) were templated on axial MRI images by two, independent observers. The relationships between the KAA, TEA, APA, and PCA were determined, with a negative value indicating relative internal rotation of the axis. Results On average, the KAA was 0.5° externally rotated relative to the PCA (minimum of − 3.6°, maximum of 5.8°), − 4.0° internally rotated relative to the TEA (minimum of − 10.5°, maximum of 2.3°), and − 96.4° internally rotated relative to the APA (minimum of − 104.5°, maximum of − 88.5°). Each of these relationships exhibited a wide range of potential values. Conclusions Using a kinematically aligned surgical technique internally rotates the posterior femoral axis relative to the transepicondylar axis, which significantly differs from current alignment instrument targets.
    The Knee 01/2014; · 2.01 Impact Factor
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    ABSTRACT: The use of TKAs in young patients is increasing. Demographic characteristics and activity levels among this patient group may affect implant selection, performance, and survivorship. Patient age (≤ 55 years) and preoperative diagnosis have been used to define this patient group, with the presumption that these patients are more active than older patients with similar indications for TKA. We questioned whether (1) demographic features of young patients support high activity expectations after TKA, and (2) preoperative or postoperative functional activity measures support projections that young patients are active after TKA. We retrospectively compared demographic characteristics (gender, BMI, diagnosis) and functional activity profile (as determined by preoperative and postoperative UCLA activity score and functional subscores of The Knee Society and WOMAC instruments) for 150 patients 55 years old or younger (181 TKAs) and 262 patients who were between 65 to 75 years old (314 TKAs) at the time of surgery. Younger patients having TKAs were significantly more likely than older patients to be female (74% versus 60%, p < 0.001) and to have diagnoses other than osteoarthritis (18% versus 3%, p < 0.001). BMI was significantly greater among younger female patients than among other age and gender combinations (35 kg/m(2) versus 31 kg/m(2), p < 0.001). Male patients had higher mean postoperative UCLA activity scores (5.5 versus 4.4, p < 0.001), Knee Society function subscores (80.2 versus 66.4, p < 0.001), and WOMAC function subscores (82.8 versus 74.2, p < 0.01) compared with female patients, but these were not different in older versus younger patients. Sustained high activity levels are not likely to be a principal cause of revision TKAs among younger patients when considering age and diagnosis alone. Determining the effect of activity on survivorship of prosthetic designs and techniques should be based on measured functional activity instead of using age and diagnosis as surrogates for activity. Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
    Clinical Orthopaedics and Related Research 11/2013; · 2.79 Impact Factor
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    ABSTRACT: Revision THAs are expected to increase; however, few studies have characterized the prognosis of revision THAs in younger patients. We performed a case-control study to evaluate intermediate-term survivorship, complications, and hip and activity scores after revision THAs in patients 55 years and younger, compared these outcomes with the results of primary THAs in a matched patient population, and evaluated risk factors for failed revisions. Ninety-three patients (103 hips) had a minimum of 4 years after revision THA, died, or had rerevision surgery. They were matched with 98 patients (103 hips) with primary THAs. Survivorship, complications, and clinical outcomes were compared between the groups using t-tests. Risk factors for failure also were assessed with chi-square analysis. At mean followup of 6.7 years, 71 revision THAs (69%) survived, compared with 102 (99%) primary THAs (odds ratio [OR], 45.9; 95% CI, 16.5-128.4; p < 0.001). Complications occurred in 29% of the revision group and 6% of the primary group (OR, 6.64; 95% CI, 4.14-10.67; p < 0.001). After revision THA, the average improvement in Harris hip score was 19.2 compared with 34.4 after primary THA (p < 0.001). The UCLA activity score improved by an average of 0.87 after revision compared with 2.36 after primary THA (p < 0.001). Conventional polyethylene was associated with failure after revision THA (OR, 2.98; 95% CI, 1.87-4.76; p = 0.004). At intermediate-term followup, young patients undergoing revision THAs had markedly higher failure and complication rates and more modest clinical improvements compared with patients in a matched cohort who had primary THAs. Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
    Clinical Orthopaedics and Related Research 11/2013; · 2.79 Impact Factor
  • Denis Nam, Ritesh R Shah, Ryan M Nunley, Robert L Barrack
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    ABSTRACT: The purpose of this study was to use 3-dimensional, weight-bearing images corrected for rotation to establish normative data of limb alignment and joint line orientation in asymptomatic, adult knees. One hundred adults (200 lower extremities) were recruited to receive weight-bearing, simultaneous biplanar imaging of both lower extremities. Multiple radiographic parameters were measured from 3D images, corrected for limb rotation. 70.0% of knees were in neutral, 19.5% in varus, and 10.5% in valgus overall alignment. Only 31 % of knees possessed both a neutral mechanical axis and the absence of joint line obliquity. There was substantial agreement between the 2D and 3D images for overall mechanical alignment (κ=0.77), but only a moderate agreement for joint line obliquity (κ=0.58). A substantial portion of asymptomatic adults possess either a varus or valgus mechanical alignment and joint line obliquity.
    The Journal of arthroplasty 10/2013; · 1.79 Impact Factor
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    ABSTRACT: Acetabular component malposition is linked to higher bearing surface wear and component instability. Outcomes following total hip arthroplasty and surface replacement arthroplasty depend on multiple surgeon and patient-dependent factors. The purpose of this study was to examine the frequency in which acetabular components are placed within a predetermined target range. We evaluated postoperative anteroposterior pelvic radiographs for every consecutive primary total hip arthroplasty and surface replacement arthroplasty completed from 2004 to 2009 at a single institution. Acetabular component abduction and anteversion angles were determined using Martell Hip Analysis Suite software. We defined target ranges for abduction and anteversion for both total hip arthroplasty (30° to 55° and 5° to 35°, respectively) and surface replacement arthroplasty (30° to 50° and 5° to 25°, respectively). Surgeon and patient-related factors were analyzed for risk associated with placing the acetabular component outside the target range. Of the 1549 total hip arthroplasties, 1435 components (93%) met our abduction target, 1472 (95%) met our anteversion target, and 1363 (88%) simultaneously met both targets. Of the 263 surface replacement arthroplasties, 233 components (89%) met our abduction target, 247 (94%) met our anteversion target, and 220 (84%) simultaneously met both targets. When previously published target ranges of abduction (30° to 45°) and anteversion (5° to 25°) angles were used, only 665 total hip replacements (43%) met the abduction target, 1325 (86%) met the anteversion target, and 584 (38%) simultaneously met both targets. Of the surface replacement arthroplasties, 181 (69%) met the abduction target, 247 (94%) met the anteversion target, and 172 (65%) simultaneously met both targets. Low-volume surgeons were 2.16 times more likely to miss target component position compared with high-volume surgeons (p = 0.002). The odds of missing the target increased by ≥0.2 for every 5 kg/m2 increase in body mass index. Minimally invasive approaches, diagnosis, years of surgical experience, femoral head size, and age of the patient did not affect component position. Increased odds of component malposition were found with lower-volume surgeons and higher body mass index. No other variables had a significant effect on component placement. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
    The Journal of Bone and Joint Surgery 10/2013; 95(19):1760-1768. · 3.23 Impact Factor
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    ABSTRACT: TKA is among the fastest growing interventions in medicine, with procedure incidence increasing the most in younger patients. Global knee scores have a ceiling effect and do not capture the presence of difficulty or dissatisfaction with specific activities important to patients. We quantified the degree of residual symptoms and specific functional deficits in young patients who had undergone TKA. In a national multicenter study, we quantified the degree of residual symptoms and specific functional deficits in 661 young patients (mean age, 54 years; range, 19-60 years; 61% female) at 1 to 4 years after primary TKA. To eliminate observer bias, satisfaction and function data were collected by an independent, third-party survey center with expertise in administering medical outcomes questionnaires for federal agencies. Overall, 89% of patients were satisfied with their ability to perform normal daily living activities, and 91% were satisfied with their pain relief. After TKA, 66% of patients indicated their knees felt normal, 33% reported some degree of pain, 41% reported stiffness, 33% reported grinding/other noises, 33% reported swelling/tightness, 38% reported difficulty getting in and out of a car, 31% reported difficulty getting in and out of a chair, and 54% reported difficulty with stairs. After recovery, 47% reported complete absence of a limp and 50% had participated in their most preferred sport or recreational activity in the past 30 days. When interviewed by an independent third party, about 1/3 of young patients reported residual symptoms and limitations after modern TKA. We recommend informing patients considering surgery about the high likelihood of residual symptoms and limitations after contemporary TKA, even when performed by experienced surgeons in high-volume centers, and taking specific steps to set patients' expectations to a level that is likely to be met by the procedure as it now is performed. Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
    Clinical Orthopaedics and Related Research 09/2013; · 2.79 Impact Factor
  • Clinical Orthopaedics and Related Research 08/2013; · 2.79 Impact Factor
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    ABSTRACT: BACKGROUND: Although there is extensive literature supporting a high success rate, there are limited data on return to work after total knee arthroplasty (TKA). QUESTIONS/PURPOSES: We sought to determine (1) the percentage of patients who returned to work after TKA; (2) what percentage returned to their original job; (3) whether this varied based on the physical job demand category; and (4) whether there were differences between men and women in terms of the likelihood of returning to work after TKA. METHODS: A multicenter study was conducted of patients of working age (18-60 years) who underwent TKA 1 to 5 years previously. An independent third-party survey center with expertise in collecting healthcare data for state and federal agencies collected the data. Definitions from the US Department of Labor's Dictionary of Occupational Titles were used to determine physical job demand categories of sedentary, light, medium, heavy, and very heavy. Complete data were collected on 661 patients undergoing TKA (average age 54 years, 61% women). RESULTS: Seventy-five percent (494 of 661) were employed in the 3 months before their TKA and 98% (482 of 494) returned to work after surgery; 89% (440 of 494) returned to the same job. Before surgery, physical demand categories of the patients' jobs were sedentary 12%, light 10%, medium 24%, heavy 24%, and very heavy 30%. The return to work rate for those employed during the 3 months before surgery by physical demand category was sedentary 95%, light 91%, medium 100%, heavy 98%, and very heavy 97%. Men were more likely than women to have worked within the 3 months before TKA but there was no difference between sexes in return to work after TKA. CONCLUSIONS: In this group of young patients, most returned to work at their usual occupation after TKA. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
    Clinical Orthopaedics and Related Research 06/2013; · 2.79 Impact Factor
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    ABSTRACT: BACKGROUND: Proposed benefits of total hip resurfacing arthroplasty over total hip arthroplasty (THA) include better proprioception, but this has not been rigorously tested or validated. QUESTIONS/PURPOSES: Our purpose was to apply an advanced testing device that objectively quantifies dynamic postural stability to determine if total hip resurfacing is associated with improved proprioception compared with standard or large-head THA. METHODS: Three groups of 25 patients (total hip resurfacing, THA femoral head > 32 mm, THA femoral head ≤ 32 mm) and a matched control group were recruited. All participants had UCLA scores ≥ 5 and Harris hip scores ≥ 90 at the time of testing. Testing was conducted using a commercially available device that uses a multidirectional, powered platform to measure deviations of the center of mass and consisted of trials with both double- and single-limb support. RESULTS: Double-limb testing showed no differences between groups. In single-limb testing, the operative side performed better in patients who had undergone total hip resurfacing versus THA, but this difference disappeared when the operative side was normalized to the nonoperative side. When compared with control subjects who had not had arthroplasty, both operative and nonoperative sides showed significantly worse proprioception for all arthroplasty cohorts, suggesting that decreased proprioception is associated with arthritis of the hip in young adults. CONCLUSIONS: Total hip resurfacing arthroplasty did not result in improved proprioception compared with THA. These results tend to refute the concept that improved proprioception is a rationale for selecting total hip resurfacing over THA in young patients. LEVEL OF EVIDENCE: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
    Clinical Orthopaedics and Related Research 06/2013; · 2.79 Impact Factor
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    ABSTRACT: BACKGROUND: Few data exist regarding the impact of socioeconomic factors on results of current TKA in young patients. Predictors of TKA outcomes have focused primarily on surgical technique, implant details, and individual patient clinical factors. The relative importance of these factors compared to patient socioeconomic status is not known. QUESTIONS/PURPOSES: We determined whether (1) socioeconomic factors, (2) demographic factors, or (3) implant factors were associated with satisfaction and functional outcomes after TKA in young patients. METHODS: We surveyed 661 patients (average age, 54 years; range, 18-60 years; 61% female) 1 to 4 years after undergoing modern primary TKA for noninflammatory arthritis at five orthopaedic centers. Data were collected by an independent third party with expertise in collecting healthcare data for state and federal agencies. We examined specific questions regarding satisfaction, pain, and function after TKA and socioeconomic (household income, education, employment) and demographic (sex, minority status) factors. Multivariable analysis was conducted to examine the relative importance of these factors for each outcome of interest. RESULTS: Patients reporting incomes of less than USD 25,000 were less likely to be satisfied with TKA outcomes and more likely to have functional limitations after TKA than patients with higher incomes; no other socioeconomic factors were associated with satisfaction. Women were less likely to be satisfied and more likely to have functional limitations than men, and minority patients were more likely to have functional limitations than nonminority patients. Implants were not associated with outcomes after surgery. CONCLUSIONS: Socioeconomic factors, in particular low income, are more strongly associated with satisfaction and functional outcomes in young patients after TKA than demographic or implant factors. Future studies should be directed to determining the causes of this association, and studies of clinical results after TKA should consider stratifying patients by socioeconomic status. LEVEL OF EVIDENCE: Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
    Clinical Orthopaedics and Related Research 04/2013; · 2.79 Impact Factor
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    Clinical Infectious Diseases 03/2013; · 9.37 Impact Factor
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    ABSTRACT: BACKGROUND: Potential advantages suggested but not confirmed for surface replacement arthroplasty (SRA) over THA include lower frequency of limp, less thigh pain, less limb length discrepancy, and higher activity. QUESTIONS/PURPOSES: We therefore determined whether patients having SRA had a limp, thigh pain, or limb length discrepancy less frequently or had activity levels higher than patients having THA. METHODS: In a multicenter study, we surveyed 806 patients aged 18 to 60 years with a premorbid UCLA activity score of 6 or more who underwent hip arthroplasty for noninflammatory arthritis at one of five orthopaedic centers. Patients had either a cementless THA with an advanced bearing surface (n = 682) or an SRA (n = 124). The patients were demographically comparable. Specific telephone survey instruments were designed to assess limp, thigh pain, perception of limb length, and activity levels. Minimum followup was 1 year (mean, 2.3 years; range, 1.1-3.9 years). RESULTS: When controlled for age, sex, and premorbid activity level, patients with SRA had a higher incidence of complete absence of any limp, lower incidence of thigh pain, lower incidence of perception of limb length discrepancy, greater ability to walk continuously for more than 60 minutes, higher percentage of patients who ran after surgery, greater distance run, and higher percentage of patients who returned to their most favored recreational activity. CONCLUSIONS: When interviewed by an independent third party, patients with SRA reported higher levels of function with fewer symptoms and less perception of limb length discrepancy compared to a similar cohort of young, active patients with THA. LEVEL OF EVIDENCE: Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
    Clinical Orthopaedics and Related Research 03/2013; · 2.79 Impact Factor
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    ABSTRACT: A national quality improvement initiative identifies certain avoidable complications as "never events," and includes venous thromboembolism (VTE). This study examines the incidence and cost of VTE following total knee arthroplasty (TKA) compared to other causes of readmission and the degree to which VTE was preventable. One hundred twenty-one readmissions (105 patients) were reviewed to determine the reason for readmission, cost, and compliance with SCIP VTE prophylaxis guidelines. The most common reasons for readmission were limited motion (18.2%), wound complication (14%), surgical site infection (9.9%), and bleeding (9.9%). VTE was less common (3.3%), and all occurred despite adequate prophylaxis. The cost of bleeding, wound complications, infection, and limited motion each exceeded the cost of VTE. These results challenge the identification of VTE as a "never event."
    The Journal of arthroplasty 03/2013; · 1.79 Impact Factor

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5k Citations
562.65 Total Impact Points

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Institutions

  • 2008–2013
    • Thomas Jefferson University Hospitals
      Philadelphia, Pennsylvania, United States
  • 2006–2013
    • Barnes Jewish Hospital
      San Luis, Missouri, United States
  • 2004–2013
    • Washington University in St. Louis
      • Department of Orthopaedic Surgery
      Saint Louis, MO, United States
  • 2012
    • University of Victoria
      Victoria, British Columbia, Canada
    • UConn Health Center
      • Department of Orthopaedic Surgery
      Farmington, CT, United States
  • 2011
    • Intermountain Medical Center
      Salt Lake City, Utah, United States
  • 2009–2011
    • Johns Hopkins University
      • Department of Orthopaedic Surgery
      Baltimore, MD, United States
    • Fellowship of Orthopaedic Researchers
      Metairie, Louisiana, United States
    • Vancouver Island Health Authority
      Victoria, British Columbia, Canada
  • 2008–2011
    • Thomas Jefferson University
      Philadelphia, Pennsylvania, United States
  • 2008–2009
    • Rush University Medical Center
      • Department of Orthopaedic Surgery
      Chicago, IL, United States
  • 2007–2009
    • Rothman Institute
      Philadelphia, Pennsylvania, United States
  • 2003–2009
    • The University of Western Ontario
      • Division of Orthopaedic Surgery
      London, Ontario, Canada
  • 1984–2006
    • Tulane University
      • Department of Orthopaedics
      New Orleans, Louisiana, United States
  • 2001–2004
    • Louisiana State University Health Sciences Center New Orleans
      • Department of Orthopaedic Surgery
      Shreveport, LA, United States
    • University of Miami
      كورال غيبلز، فلوريدا, Florida, United States
  • 1995
    • Naval Medical Research Center
      Silver Spring, Maryland, United States
  • 1991–1994
    • Massachusetts General Hospital
      • Department of Orthopaedic Surgery
      Boston, MA, United States
    • University of California, San Francisco
      • Department of Orthopaedic Surgery
      San Francisco, CA, United States
  • 1989–1993
    • Naval Hospital Bremerton
      Bremerton, Washington, United States