Richard A. Berger's research while affiliated with Rush University Medical Center and other places
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Publications (286)
Purpose
The use of implant arthroplasty in the distal radioulnar joint is increasing. Two main types of implants are commonly used, ulnar head prosthesis (UHP) and hemi or semi-constrained total distal radioulnar joint arthroplasty. The literature consists mainly of small patient series. The purpose of this study was to examine our long-term outcom...
Purpose To evaluate the functional outcome and complications following primary ulnar head or total distal radial ulnar joint (DRUJ) arthroplasty in patients who have a partial or total wrist fusion.
Methods We conducted a retrospective review of 33 primary DRUJ implants in 31 patients who had a partial or total wrist fusion. Follow-up time averaged...
Background
Progressive arthritis in the unresurfaced compartments of the knee is one failure mode after partial knee arthroplasty(PKA). While progressive arthritis after PKA is typically treated with revision to TKA(rTKA), staged bicompartmental knee arthroplasty(sBiKA) –the addition of another PKA - is an alternative. This study compared outcomes...
Outpatient total hip replacement (THA) using the anterior-based muscle-sparing (ABMS) approach provides a substantial benefit for appropriate patients. Outpatient THA relies on adherence to standardized interdisciplinary protocols to ensure patient safety and clinical success. The cornerstones to such protocols are proper patient selection, preoper...
Purpose
To determine the functional outcome and complications after conversion from a painful and unstable ulnar head prosthesis to a semiconstrained distal radioulnar joint arthroplasty.
Methods
We conducted a retrospective review of 11 ulnar head prostheses in 10 patients with porous coated stems that were revised to semiconstrained prostheses....
Background
Total knee arthroplasty (TKA) is particularly challenging in patients with marked deformities or existing hardware due to the inability to use traditional instrumentation. One potential technique to mitigate this obstacle is the use of patient-specific cutting guides. The purpose of this study was to evaluate the use of custom cutting gu...
Background
Tibial component loosening is one of the most common modes of failure in contemporary total knee arthroplasty (TKA). Limited literature is available on the outcomes of isolated tibial revision with retention of the cruciate retaining (CR) femoral component. The purpose of this study was to determine the results of isolated tibial revisio...
Unicompartmental knee arthroplasty and patellofemoral arthroplasty were pioneered in the 1970s but abandoned by most in favor of total knee arthroplasty because of inconsistent early outcomes. Advancements in implant design, instrumentation, indications, and surgical techniques have enhanced results and led to a resurgence in both unicompartmental...
Background
Unicompartmental knee arthroplasty (UKA) is an effective alternative to total knee arthroplasty (TKA) in isolated unicompartmental disease; however, mid-term to long-term results in young patients are unknown. The purpose of this study is to determine the mid-term outcomes of fixed-bearing medial UKA in patients less than 55 years of age...
The purpose of this retrieval study was to determine the effect of implant positioning on wear, taking patient‐related factors into account. Therefore, the volumetric material loss of 59 retrieved tibial liners was quantitatively determined using a coordinate measuring‐machine. All retrievals were made of the same polyethylene and design by a singl...
Isolated lateral arthritis of the knee is a pattern of degeneration that will present to every surgeon that treats patients with knee pain. Although this is a less common condition than medial or tricompartmental disease, the diagnosis and treatment of lateral arthritis is an important component of treating the arthritic knee. With proper patient s...
Background:
The purpose of this study is to compare open reduction and internal fixation (ORIF) to distal femoral replacement (DFR) for treatment of displaced periprosthetic distal femur fractures.
Methods:
We identified 72 patients with minimum 2-year follow-up following a displaced periprosthetic distal femur fracture: 50 were treated with ORI...
Background:
Previous reports on the outcomes of isolated head and liner exchange in revision total hip arthroplasty have found high rates of instability after these surgeries. Most reports have studied constructs using ≤28 mm femoral heads. The purpose of this study was to determine if modern techniques with the use of larger head sizes can improv...
Ninety-six wrists (56 right and 40 left) in 96 patients (36 males and 60 females, mean age 38, range 15–77 years) underwent repair of ulnotriquetral ligament split tears between 2007 and 2016. Mayo wrist scores, visual analogue scale pain scores, and objective measures including grip strength and range of motion were obtained. Patients were assesse...
Background:
Patients commonly report difficulty kneeling after total knee arthroplasty (TKA). The purpose of this study was to retrospectively assess patients' ability to kneel after TKA and to prospectively determine whether patients with reported difficulty can be taught to kneel.
Methods:
Attempts were made to reach 307 consecutive TKAs in 25...
Background:
Patients between 45 and 54 years old will be the fastest-growing cohort seeking total knee arthroplasty (TKA) over the next 15 years. The purpose of this investigation is to determine the clinical outcomes of TKA in patients less than 50 years old at a minimum of 10 years. We hypothesized that this patient population would have a high...
»Ulnar-sided wrist pain encompasses a variety of pathologies including arthritis, tendinopathy, ligament injuries, and instability.»A careful physical examination can narrow the differential diagnosis, and adjunctive imaging may prove useful to confirm clinical suspicion.»The mainstay of nonoperative treatment is immobilization, hand therapy, and c...
Objective The objective of this article is to evaluate the outcomes and complication rate for Adams–Berger anatomic reconstruction of the distal radioulnar joint (DRUJ), in addition, to determine the role of sigmoid notch anatomy on failure.
Methods We conducted a retrospective chart review to evaluate adult patients that had undergone reconstructi...
Background:
Rapid-pathway outpatient (OTJA) and one-night inpatient (ITJA) arthroplasty require close follow-up by the surgeon. We quantify and characterize the total perioperative touches required in the first 7 days, and compare OTJA and ITJA patients.
Methods:
We reviewed 103 consecutive primary total joint arthroplasty (TJA) patients from Ap...
Superficial radial intraneural ganglion cysts are rare. Only nine previous cases have been described. We provide two examples with a wrist joint connection and review the literature to provide further support for the unifying articular (synovial) theory for the pathogenesis and treatment of intraneural ganglia.
Purpose:
Distal radioulnar joint (DRUJ) prostheses designed as semiconstrained devices aiming to replace the function of the ulnar head, sigmoid notch of the radius, and triangular fibrocartilage complex have demonstrated the capacity to restore the functional status of the DRUJ. However, soft tissue complications including tendons, nerves, and wo...
Background:
This study reviews long-term outcomes of partial wrist denervation focusing on need for and time to revision procedure.
Methods:
A retrospective study was conducted of all patients undergoing partial wrist denervation between 1994 and 2014. At average latest follow-up of 6.75 years (range, 1-21 years), clinical and radiographic data...
Background
Early wound healing complications and persistent drainage are associated with an increased risk of infection following knee arthroplasty. However, the scenario in which a patient sustains an acute, traumatic wound dehiscence has not been investigated. The purpose of this study was to determine the outcomes of an acute traumatic wound deh...
Background
With the increasing interest in fast recovery and outpatient joint arthroplasty, short-acting local anesthetic agents and minimal narcotic use are preferred. Lidocaine is a fast-onset, short-duration local anesthetic that has been used for many years in spinal anesthesia. However, lidocaine spinal anesthesia has been reported to have a r...
Rupture of the patella tendon during or following total knee arthroplasty (TKA) can be an extremely challenging complication to manage. The following case reports will describe several surgical options for the management of patella tendon ruptures, but it is important to identify those patients who are at greater risk for rupture of the patella ten...
Background:
Hip and knee arthroplasties length of stay continues to shorten after advances in perioperative and intraoperative management, as well as financial incentives. Some authors have demonstrated good results with outpatient arthroplasty, but safety and general feasibility of such procedures remain unclear. Our hypothesis is that outpatient...
Purpose:
To determine the past experiences with, current use of, and anticipated use of online learning and simulation-based education among practicing U.S. physicians, and how findings vary by age.
Method:
The authors surveyed 4,648 randomly sampled board-certified U.S. physicians, September 2015 to April 2016, using Internet-based and paper qu...
Purpose:
Professional development (PD)-both for-credit continuing medical education (CME) and informal self-directed or point-of-care learning-is vital to all physicians. The authors sought to understand physicians' PD perceptions and practices and how these vary by specialty and practice type.
Method:
The authors administered an Internet and pa...
Background:
As outpatient total hip (THA) and knee arthroplasties (TKA) increase in popularity, concerns exist about the safety of discharging patients home the same day. The purpose of this study is to determine the complications associated with outpatient total joint arthroplasty (TJA) and to identify high-risk patients who should be excluded fr...
Rapid recovery and early discharge after total joint arthroplasty are becoming more common. To develop a successful, safe, outpatient arthroplasty practice, surgeons must have the support of a multidisciplinary team, which includes an orthopaedic surgeon, an anesthesiologist, nurses, physical therapists, and a discharge planner. The authors of this...
The current interest in minimally invasive total hip arthroplasty stems from the potential to improve postoperative recovery. This is accomplished by utilizing mobile windows to reduce soft tissue trauma and preserve intact musculotendinous units. Minimally invasive techniques have been developed for the anterolateral (Hardinge) and posterior appro...
Background Scapholunate (SL) interosseus ligament injuries detected at an early stage could allow the surgeon to prevent progression through the spectrum of injury that leads to instability, and eventually osteoarthritis. We contend that early instability following injury can be detected by visualizing the relative motions and distances between the...
Minimally invasive has been used to describe a wide spectrum of knee replacement procedures. This spectrum starts with a small skin incision with a standard incision into the capsular and the quadriceps muscle and includes patellar eversion. The spectrum currently ends with a small skin incision with a minimal capsular incision without quadriceps m...
Minimally invasive surgery (MIS) for unicondylar knee arthroplasty (UKA) was instituted in the early 1990s by John Repicci [1, 2]. While there had been a long history of UKA dating back to the early 1970s [3–6], the techniques and surgical approaches were modeled after total knee arthroplasty (TKA). The results were not equal to TKA, and many surge...
The current interest in minimally invasive total hip arthroplasty stems from the potential to improve postoperative recovery. This is accomplished by utilizing mobile windows to reduce soft tissue trauma and preserve intact musculotendinous units. Minimally invasive techniques have been developed for the anterolateral (Hardinge) and posterior appro...
Rapid recovery protocols, including outpatient joint replacement pathways, have been successful in decreasing hospital care costs without sacrificing outcomes after total knee arthroplasty (TKA). However, in order for an orthopaedic surgeon to start performing outpatient TKAs, one must have an adequate support staff, access to multimodal anesthesia...
Purpose In an attempt to restore natural carpal kinematics more closely, bone-ligament-bone (BLB) grafts have been described for treating scapholunate (SL) injury. In this article we report the long-term results of capitohamate BLB autograft for the treatment of SL dissociation.
Methods The medical records of patients treated with capitohamate BLB...
We reviewed 27 patients who underwent revision for an adverse local tissue reaction (ALTR) secondary to corrosion at the head-neck junction with MoP bearings. Serum cobalt and chromium levels were elevated in all cases, with a mean cobalt of 11.2ppb and chromium of 2.2ppb. Patients underwent modular bearing exchange, including a ceramic head with a...
Extensor mechanism disruption following total knee arthroplasty is a rare but devastating complication. The purpose of this study was to report our experience with extensor mechanism allograft reconstruction for chronic extensor mechanism failure.
Fifty consecutive extensor mechanism allograft reconstructions were performed in forty-seven patients...
Rapid recovery protocols, including outpatient joint replacement pathways, have been successful in decreasing hospital care costs without sacrificing outcomes after total knee arthroplasty (TKA). However, in order for an orthopaedic surgeon to start performing outpatient TKAs, one must have an adequate support staff, access to multimodal anesthesia...
Minimally invasive surgery (MIS) for unicondylar knee arthroplasty (UKA) was instituted in the early 1990s by John Repicci [1, 2]. While there had been a long history of UKA dating back to the early 1970s [3–6], the techniques and surgical approaches were modeled after total knee arthroplasty (TKA). The results were not equal to TKA, and many surge...
Importance
Despite general support for the goals of maintenance of certification (MOC), concerns have been raised about its effectiveness, relevance, and value.Objective
To identify barriers and enabling features associated with MOC and how MOC can be changed to better accomplish its intended purposes.Design, Setting, and Participants
Grounded t...
The distal radioulnar joint is responsible for stabile forearm rotation. Injury to this joint can occur following a variety of mechanisms including wrist fractures, ligamentous damage or degenerative wear. Accurate diagnosis requires a clear understanding of the anatomy and mechanics of the ulnar aspect of the wrist. Injuries can be divided into th...
Background Studies have established an increased risk of radiocarpal joint posttraumatic arthritis in patients with displaced intra-articular fractures of the distal radius, although this phenomenon has yet to be evaluated in the distal radioulnar joint (DRUJ).
Purpose We hypothesized that patients with displaced intra-articular fractures of the si...
An outpatient (or rapid-recovery) total hip arthroplasty can be safely performed using amultidisciplinary team, including the orthopedic surgeon, anesthesiologist, nurses (at all pointsof care), physical therapists, and discharge planners/social workers.In order to have success implementing a rapid-recovery program, key factors that the surgicaltea...
Purpose:
To validate a measure of reflection on participation in quality improvement (QI) activities and to identify associations with characteristics of QI projects, participants, and teams.
Method:
This was a prospective validation study of all Mayo Clinic team participants who submitted QI projects for maintenance of certification (MOC) credi...
Forty-nine patients revised from UKA to TKA and 43 from HTO to TKA were matched to 43 aseptic, both component revision TKAs (rTKA) and 97 primary TKAs. At a mean of 4.8 years, the KSS and function scores in the UKA to TKA, HTO to TKA and primary TKA cohorts were similar. Total operative times were significantly higher in the HTO to TKA and rTKA gro...
To assess the quality of an initiative to improve the diagnosis and management of osteoporosis in patients over 50 years of age with distal radius fractures (DRF).
A retrospective review was conducted to determine the baseline percentage of individuals undergoing osteoporosis screening after DRF. Thereafter, a study was implemented in which DRF pat...
Unicompartmental knee arthroplasty (UKA) has a faster short-term recovery than total knee arthroplasty (TKA). The purpose of this study was to determine the feasibility and safety of performing outpatient UKAs in a consecutive group of patients presenting with unicompartmental knee osteoarthritis.
A total of 105 consecutive patients underwent unico...
Health care professionals access various information sources to quickly answer questions that arise in clinical practice. The features that favorably influence the selection and use of knowledge resources remain unclear. We sought to better understand how clinicians select among the various knowledge resources available to them, and from this to de...
Importance:
Answering clinical questions affects patient-care decisions and is important to continuous professional development. The process of point-of-care learning is incompletely understood.
Objective:
To understand what barriers and enabling factors influence physician point-of-care learning and what decisions physicians face during this pr...
Wrist magnetic resonance imaging (MRI) has established utility in the diagnosis of wrist ligament tears, including complete tears of the ulnotriquetral ligament (UTL) and other components of the triangular fibrocartilage complex. A new type of longitudinal split tear of the UTL has recently been described with no imaging correlate. Our aims were to...
Background:
Diagnosis of periprosthetic joint infection (PJI) can be difficult in the early postoperative period after total hip arthroplasty (THA) because normal cues from the physical examination often are unreliable, and serological markers commonly used for diagnosis are elevated from the recent surgery.
Questions/purposes:
The purposes of t...
Eighty-five fixed bearing medial unicompartmental arthroplasties were performed in 42 men and 33 women with a mean age of 49years (range, thirty-three to fifty-five years old) at the time of surgery. At a mean of 4.0years (range two to twelve years), the mean pre-operative Knee Society score improved from 49 to 95.1 points (P<0.0001) and the mean U...
A variety of minimally invasive approaches to hip surgery in combination with multimodal anesthesia techniques and rapid rehabilitation can facilitate early discharge after total hip arthroplasty (THA). Hip replacement can be performed as outpatient surgery using the surgical technique of THA through a modified abductor-sparing Watson-Jones (antero...
Resection of the ulnar head in cases of debilitating pain owing to arthrosis of the distal radioulnar joint can provide satisfying relief. However, there is mounting evidence that pain with heavier use, instability, and torque-generating weakness in more active individuals may result in less satisfying outcomes. Implant arthroplasty can provide a m...
Our objective is to assess the utility of the radial torsion angle (RTA) as described by Bindra et al. in the clinical setting among patients with previous distal radial fractures compared to normal controls [4]. We hypothesize that the side-to-side RTA difference will be increased in subjects with previous forearm fracture as compared to normal su...
Background: Corrosion at the modular head-neck junction of the femoral component in total hip arthroplasty has been identified as a potential concern, although symptomatic adverse local tissue reactions secondary to corrosion have rarely been described.
Methods: Weretrospectivelyreviewedtherecordsoftenpatientswithametal-on-polyethylenetotalhipprost...
Background:
In a previously reported series of 51 patients with 62 cemented, fixed-bearing unicompartmental knee arthroplasties, we reported a 10-year, 98% survival rate with an average knee score of 92 points. The survivorship and modes of failure past 10 years are incompletely understood.
Questions/purposes:
At 15-year followup we sought to de...
The risk factors for and results of operatively treated peri-prosthetic femoral fractures sustained within 90 days following primary THA were evaluated. 5,313 consecutive THAs were reviewed and 32 (0.60%) fractures were identified which included 9 A(g), 2 B(1), 18 B(2), 1 B(3), and 2 A(g)/B(2) fractures. 19 (61%) patients sustained 23 complications...
The Accreditation Council for Continuing Medical Education mandates that continuing medical education (CME) be developed around professional practice gaps. Accordingly, CME course directors must identify the intended learners, assess learners' needs, identify gaps in knowledge, and evaluate their CME activities. Writing gap statements is challengin...
Minimally invasive has been used to describe a wide spectrum of knee replacement procedures. This spectrum starts with a small
skin incision with a standard incision into the capsular and the quadriceps muscle and includes patellar eversion. The spectrum
currently ends with a small skin incision with a minimal capsular incision without quadriceps...
PURPOSE
To identify which motion is able to best visualize dynamic scapholunate joint instabilities using 4-dimensional (4D) CT.
METHOD AND MATERIALS
Three patients with a clinical suspicion of unilateral dynamic scapholunate wrist ligament injury were scanned in a prone position in this IRB-approved study using a dual source 128-slice CT scanner...
To evaluate the potential effect of partial wrist denervation on wrist kinesthesia, we hypothesized that anesthetizing the anterior interosseous nerve and the posterior interosseous nerve does not impair the kinesthesia.
We performed a double-blinded, prospective, randomized study on 80 healthy volunteers (20-54 y old) to compare the ability to det...
The triangular fibrocartilage complex (TFCC) with its ulnar foveal attachment is the primary stabilizer of the distal radioulnar joint (DRUJ). The purpose of this study was to describe a technique for measuring the degree of subluxation of the DRUJ in wrist magnetic resonance imaging (MRI) examinations to predict tears involving the foveal attachme...
This article examines industry's involvement in medicine, particularly with respect to surgeons and clinical research, as well as continuing medical education. We describe some historical events involving industry and how these events have led to guidelines by various organizations to handle conflicts of interest. We also review the advantages and...
Purpose:
To develop a 4D [three-dimensional (3D) + time] CT technique to capture high spatial and temporal resolution images of wrist joint motion so that dynamic joint instabilities can be detected before the development of static joint instability and onset of osteoarthritis (OA).
Methods:
A cadaveric wrist was mounted onto a custom motion sim...
To examine the distribution of encapsulated nerve endings called mechanoreceptors in the human distal interphalangeal (DIP) joint and surrounding structures.
We processed 12 right index finger DIP joints and surrounding structures from fresh cadavers for immunohistochemistry of the anti-protein gene product 9.5 (PGP9.5) and silver staining to detec...
PURPOSE
To use non-gated 4-dimensional (4D) CT to detect subtle dynamic joint instabilities, which can only be observed during joint motion.
METHOD AND MATERIALS
A motion device was constructed to simulate radioulnar deviation of the wrist joint. A cadaveric forearm was mounted to this device, producing periodic radioulnar motion through a maximum...
Unlike tears of the peripheral triangular fibrocartilage or avulsions of the distal radioulnar ligaments, longitudinal split tears of the ulnotriquetral (UT) ligament do not cause any instability to the distal radioulnar joint or the ulnocarpal articulation. It is mainly a pain syndrome that can be incapacitating. However, because the UT ligament a...
Unlabelled:
While others have reported short-term comparisons between various minimally invasive surgical (MIS) approaches to total hip arthroplasty (THA) and their conventional analogues, longer-term data is lacking, as is information indicating whether MIS approaches to THA provide a biomechanically complete recovery. Furthermore, different MIS...
The stabilizing constraints of the distal radioulnar joint (DRUJ) include its bony geometry and the surrounding soft tissue support. Given the shallow nature of the sigmoid notch, reconstruction of the palmar and dorsal ligamentous sleeve provides the best solution for restoring stability in cases of chronic DRUJ instability. The pertinent anatomy,...
Imaging the DRUJ requires knowledge of the complex bony, muscular, and ligamentous anatomy that contribute to this unique joint. Standard well-positioned radiography is always the appropriate first step in any imaging evaluation of the wrist. High-resolution MRI of the wrist, preferably performed at 3T, helps to delineate the important ligamentous...
Few studies have evaluated the results of revision of well-fixed components for stiffness, and some authors have recommended against this intervention based on poor reported results. Thirty-five consecutive patients underwent revision of both femoral and tibial components for stiffness. At a mean of 54.5 months (range, 25-134), the mean arc of moti...
Controversy still exists regarding the location and nature (static or dynamic) of the forearm joint axis. This might be due to inconsistent results from in-vitro data and less precise methods of analysis. We present the first in-vivo kinematic analysis of normal forearm joint rotation described by helical axis analysis.
Data obtained from computed...
A third-generation TKA system was designed to address problems encountered with earlier designs including a high rate of patellofemoral complications. At a minimum of 5 years, we previously reported survivorship of 98.7% using revision for any reason as the endpoint for a cohort that includes the patients described in this report. That cohort was u...
The biomechanical performance of the Darrach procedure, its stabilizing methods and the effectiveness of an ulnar head prosthesis was evaluated in this experiment.
The purpose of this study was to: (1) analyze the dynamic effects of the resection of the distal ulna on radioulnar convergence; and (2) evaluate the mechanical performance of two soft t...
Unicompartmental knee arthroplasty (UKA) was introduced in the early 1970s but did not receive substantial support because total knee arthroplasty was flourishing. In the early 1990s, interest in UKA increased with the introduction of a minimally invasive surgical approach. It is important that the indications for this demanding but achievable surg...
Aspects of afferent inputs, generally termed proprioception, are being increasingly studied. Extraneous factors such as cutaneous inputs can dramatically interfere while trying to design studies in order to determine the participation of the different structures involved in proprioception in the wrist position sense. We tried to determine validity...
Minimally invasive surgery (MIS) for unicondylar knee arthroplasty (UKA) was instituted in the early 1990s by John Repicci.1,2 While there had been a long history of UKA dating back to the early 1970s,3–6 the techniques and surgical approaches were modeled after total knee arthroplasty (TKA). The results were not equal to TKA
and many surgeons aban...
The current interest in minimally invasive total hip arthroplasty stems from the potential to improve postoperative recovery. This is accomplished by utilizing mobile windows to reduce soft tissue trauma and preserve intact musculotendinous units. Minimally invasive techniques have been developed for the anterolateral (Hardinge) and posterior appro...
Citations
... Total knee arthroplasty (TKA) has been widely used in the treatment of severe knee osteoarthropathy. TKA treatment can effectively reduce joint pain, activity limitations and deformities in patients and consequently improve the range of motion of the knee joint [1]. To the best of our knowledge, prosthesis selection in TKA is a crucial factor affecting the postoperative recovery of patients. ...