J. Harrast - Academia.edu (original) (raw)

Papers by J. Harrast

Research paper thumbnail of 61. Evolving Clinical Practice Patterns in Abdominoplasty: A 16-YEAR Analysis of Continuous Certification Tracer Data from the American Board of Plastic Surgery

Plastic and Reconstructive Surgery - Global Open

PURPOSE: This study evaluates changes in practice patterns in abdominoplasty based on a 16-year r... more PURPOSE: This study evaluates changes in practice patterns in abdominoplasty based on a 16-year review of tracer data collected by the American Board of Plastic Surgery (ABPS) as part of the Continuous Certification process. METHODS: ABPS tracer data was reviewed from 2005 to 2020, comparing data between two

Research paper thumbnail of High Incidence of Hemiarthroplasty for Shoulder Osteoarthritis Among Recently Graduated Orthopaedic Surgeons

Clinical Orthopaedics and Related Research®, 2014

Background Primary glenohumeral osteoarthritis is a common indication for shoulder arthroplasty. ... more Background Primary glenohumeral osteoarthritis is a common indication for shoulder arthroplasty. Historically, both total shoulder arthroplasty (TSA) and hemi-shoulder arthroplasty (HSA) have been used to treat primary glenohumeral osteoarthritis. The choice between procedures is a topic of debate, with HSA proponents arguing that it is less invasive, faster, less expensive, and technically less demanding, with quality of life outcomes equivalent to those of TSA. More recent evidence suggests TSA is superior in terms of pain relief, function, ROM, strength, and patient satisfaction. We therefore investigated the practice of recently graduated orthopaedic surgeons pertaining to the surgical treatment of this disease. Questions/purposes We hypothesized that (1) recently graduated, board eligible, orthopaedic surgeons with fellowship training in shoulder surgery are more likely to perform TSA than surgeons without this training; (2) younger patients are more likely to receive HSA than TSA; (3) patient sex affects the choice of surgery; (4) US geographic region affects practice patterns; and (5) complication rates for HSA and TSA are not different. Methods We queried the American Board of Orthopaedic Surgery's database to identify practice patterns of orthopaedic surgeons taking their board examination. We identified 771 patients with primary glenohumeral osteoarthritis treated with TSA or HSA from 2006 to 2011. The rates of TSA and HSA were compared based on the treating surgeon's fellowship training, patient age and sex, US geographic region, and reported surgical complications. Results Surgeons with fellowship training in shoulder surgery were more likely (86% versus 72%; OR 2.32; 95% CI, 1.56-3.45, p \ 0.001) than surgeons without this training to perform TSA rather than HSA. The mean age for patients receiving HSA was not different from that for patients receiving TSA (66 versus 68, years, p = 0.057). Men were more likely to receive HSA than TSA when compared to women (RR 1.54; 95% CI, 1.19-2.00, p = 0.0012). The proportions of TSA and HSA were similar regardless of US geographic region

Research paper thumbnail of 32. Evolution of Clinical Practice Patterns in Liposuction: A Sixteen-Year Review of Continuous Certification Tracer Data from the American Board of Plastic Surgery

Plastic and Reconstructive Surgery - Global Open

Research paper thumbnail of Practice Patterns for Arthroscopy

Research paper thumbnail of Complications of Hardware Removal

Journal of Bone and Joint Surgery, 2021

BACKGROUND While hardware removal may improve patient function, the procedure carries risks of un... more BACKGROUND While hardware removal may improve patient function, the procedure carries risks of unexpected outcomes. Despite being among the most commonly performed orthopaedic procedures, scant attention has been given to its complication profile. METHODS We queried the American Board of Orthopaedic Surgery (ABOS) de-identified database of Part II surgical case lists from 2013 through 2019 for American Medical Association Current Procedural Terminology (CPT) implant-removal codes (20680, 20670, 22850, 22852, 22855, 26320). Hardware removal procedures that were performed without any other concurrent procedure ("HR-only procedures") were examined for associated complications. RESULTS In the 7 years analyzed, 13,089 HR-only procedures were performed, representing 2.1% (95% confidence interval [CI], 2.1% to 2.2%) of the total of 609,150 surgical procedures during that period. A complication was reported to have occurred in association with 1,256 procedures (9.6% [95% CI, 9.1% to 10.1%]), with surgical complications reported in association with 1,151 procedures (8.8% [95% CI, 8.3% to 9.3%]) and medical/anesthetic complications reported in association with 196 procedures (1.5% [95% CI, 1.3% to 1.7%]). Wound-healing delay/failure (2.1% [95% CI, 1.8% to 2.3%]) and infection (1.6% [95% CI, 1.4% to 1.8%]) were among the most commonly reported complications after HR-only procedures, but other serious events were reported as well, including unexpected reoperations (2.5% [95% CI, 2.2% to 2.7%]), unexpected readmissions (1.6% [95% CI, 1.4% to 1.8%]), continuing pain (95% CI, 1.2% [1.0% to 1.4%]), nerve injury (0.6% [95% CI, 0.4% to 0.7%]), bone fracture (0.5% [95% CI, 0.4% to 0.6%]), and life-threatening complications (0.4% [95% CI, 0.3% to 0.5%]). CONCLUSIONS Hardware removal is one of the most commonly performed orthopaedic procedures and was associated with an overall complication rate of 9.6% (95% CI, 9.1% to 10.1%) in a cohort of recently trained orthopaedic surgeons in the United States. Although specific complications such as infection, refractures, and nerve damage were reported to have relatively low rates of occurrence, and associated life-threatening complications occurred rarely, surgeons and patients should be aware that hardware removal carries a definite risk. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Research paper thumbnail of Resident Independence Performing Common Orthopaedic Procedures at the End of Training

The Journal of Bone and Joint Surgery, 2019

Background: The Accreditation Council for Graduate Medical Education (ACGME) has established mini... more Background: The Accreditation Council for Graduate Medical Education (ACGME) has established minimum exposure rates for specific orthopaedic procedures during residency but has not established the achievement of competence at the end of training. The determination of independence performing surgical procedures remains undefined and may depend on the perspective of the observer. The purpose of this study was to understand the perceptions of recently graduated orthopaedic residents on the number of cases needed to achieve independence and on the ability to perform common orthopaedic procedures at the end of training. Methods: We conducted a web survey of all 727 recently graduated U.S. orthopaedic residents sitting for the 2018 American Board of Orthopaedic Surgery Part I Examination in July 2018. The surveyed participants were asked to assess the ability to independently perform 26 common adult and pediatric orthopaedic procedures as well as to recommend the number of cases to achieve independence at the end of training. We compared these data to the ACGME Minimum Numbers and the average ACGME resident experience data for residents who graduated from 2010 to 2012. Results: For 14 (78%) of the 18 adult procedures, >80% of respondents reported the ability to perform independently, and for 7 (88%) of the 8 pediatric procedures, >90% reported the ability to perform independently. The residentrecommended number of cases for independence was greater than the ACGME Minimum Numbers for all but 1 adult procedure. For 18 of the 26 adult and pediatric procedures, the mean 2010 to 2012 graduated resident exposure was significantly less than the mean number recommended for independence by 2018 graduates (p < 0.05). Conclusions: Overall, recently graduated residents reported high self-perceived independence in performing the majority of the common adult and pediatric orthopaedic surgical procedures included in this study. In general, recently graduated residents recommended a greater number of case exposures to achieve independence than the ACGME Minimum Numbers. According to the Accreditation Council for Graduate Medical Education (ACGME), the goal of residency training is for residents to achieve autonomy and independence by the time of graduation. Orthopaedic residents log cases online through the ACGME electronic case log system during residency training to document numbers and types of procedures performed 1,2 .

Research paper thumbnail of Perceptions of the Recommended Resident Experience with Common Orthopaedic Procedures

The Journal of Bone and Joint Surgery, 2019

Background: U.S. orthopaedic residency training is anchored by the Accreditation Council for Grad... more Background: U.S. orthopaedic residency training is anchored by the Accreditation Council for Graduate Medical Education (ACGME) requirements, which include minimum numbers for 15 categories of procedures. The face validity of these recommendations and expectations for exposure to other common procedures has not been rigorously investigated. The main goals of this investigation were to understand the perceptions of program directors and early practice surgeons regarding the number of cases needed in residency training and to report which of the most commonly performed procedures residents should be able to perform independently upon graduation. Methods: We sent surveys to 157 current program directors of ACMGE-approved orthopaedic surgery residency programs and to all examinees sitting for the American Board of Orthopaedic Surgery (ABOS) Part II Oral Examination in 2017, requesting that they estimate the minimum number of exposures for the 22 adult and 24 pediatric procedures that are most commonly performed during residency and the first 2 years in practice. Where applicable, we compared these with the ACGME "Minimum Numbers" and the average ACGME resident experience data from 2010 to 2012 for resident graduates. For each of the 46 procedures, participants were asked if every orthopaedic resident should be able to independently perform the procedure upon graduation. We compared the percent for independence between the early practice surgeons and the program directors. Results: For the majority of adult and pediatric procedures, the early practitioners reported significantly higher numbers of cases needing to be performed during residency than the program directors. ACGME Minimum Numbers were always lower than the case numbers that were recommended by the early practice surgeons and the program directors. Overall we found good-to-excellent agreement for independence at graduation between program directors and early practitioners for adult cases (intraclass correlation coefficient [ICC], 0.98; 95% confidence interval [CI], 0.82 to 0.99) and moderateto-good agreement for pediatric cases (ICC, 0.96; 95% CI, 0.74, 0.99).

Research paper thumbnail of Resident Surgical Skills Web-Based Evaluation

Journal of Bone and Joint Surgery, 2019

Investigation performed at 16 residency programs Background: Evaluation of surgical skill compete... more Investigation performed at 16 residency programs Background: Evaluation of surgical skill competency is necessary as graduate medical education moves toward a competency-based curriculum. This study by the American Board of Orthopaedic Surgery (ABOS) and the Council of Orthopaedic Residency Directors (CORD) compares 2 web-based evaluation tools that assess the level of autonomy that is demonstrated by residents during surgical procedures in the operating room as measured by faculty. Methods: Two hundred and ninety-four residents from 16 orthopaedic surgery residency programs were evaluated by 370 faculty using 2 web-based evaluation tools in a crossover design in which residents requested faculty review of their surgical skills before starting a case. One thousand, one hundred and fifty Ottawa Surgical Competency Operating Room Evaluation (O-Score) assessments, which included a 9-question evaluation of 8 steps of the surgical procedure, were compared with 1,186 P-score evaluations, which included a single-question summative evaluation. Twenty-five different surgical procedures were evaluated. Results: There were no significant differences in rates of resident requests or faculty completion of the 2 scores. The most common surgical procedures that were assessed were total knee arthroplasty (n = 254, 11%), carpal tunnel release (n = 191, 8%), open reduction and internal fixation (ORIF) of stable hip fractures (n = 170, 7%), ORIF of simple ankle fractures (n = 169, 7%), and total hip arthroplasty (n = 166, 7%). Both instruments disclosed significant differences in competency among entry, intermediate, and advanced-level residents. The findings support the construct validity of the evaluation method. The survey results indicated that >70% of the faculty were confident that use of either the P-score or the O-score allowed them to distinguish a resident who can perform the surgery independently from one who needs additional training. Conclusions: This research has led to the modification of the O-score and the P-score into a combined OP-score instrument. The ABOS envisions that the OP-score instrument can be used with an expanded number of surgical procedures as a required element of residency training in the near future. Clinical Relevance: This study allows the profession of orthopaedic surgery education to take a leadership role in the measurement of competence for surgical skills for orthopaedic surgeons in residency training, an important clinically relevant topic to the practice of orthopaedic surgery. Disclosure: There was no source of external funding for this study. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked "yes" to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work (http://links.lww.com/JBJS/F131).

Research paper thumbnail of Operative Experience During Orthopaedic Residency Compared with Early Practice in the U.S

The Journal of bone and joint surgery. American volume, Jan 4, 2018

The goal of surgical education is to prepare the trainee for independent practice; however, the r... more The goal of surgical education is to prepare the trainee for independent practice; however, the relevance of the current residency experience to practice remains uncertain. The purpose of this study was to identify the surgical procedures most frequently performed in orthopaedic residency and in early surgical practice and to identify surgical procedures performed more often or less often in orthopaedic residency compared with early surgical practice. This retrospective cohort study included American Medical Association (AMA) Current Procedural Terminology (CPT) codes (n = 4,329,561 procedures) reported by all U.S. orthopaedic surgery residents completing residency between 2010 and 2012 (n = 1,978) and AMA CPT codes for all procedures (n = 413,370) reported by U.S. orthopaedic surgeons who took the American Board of Orthopaedic Surgery Part II certifying examination between 2013 and 2015 (n = 2,205). Relative rates were determined for AMA CPT codes and AMA CPT code categories for ad...

Research paper thumbnail of Trends in primary and revision knee arthroplasty among orthopaedic surgeons who take the American Board of Orthopaedics part II exam

International orthopaedics, Oct 22, 2016

A certified list of all operative cases performed within a six month period is required of surgeo... more A certified list of all operative cases performed within a six month period is required of surgeons by the American Board of Orthopaedic Surgery (ABOS) as a prerequisite to taking the Part II Oral Examination. Using the data on these cases collected and maintained by ABOS, this study assessed the influence of prior fellowship training in adult reconstruction on the volume and surgeon-reported complication rate of knee joint arthroplasty cases over time. All data were self reported to a secure Internet database (SCRIBE) by candidates who applied to take Part II of the ABOS Examination for the first time. This database was searched for all procedures done between 2003 and 2013 with CPT codes for total and revision knee arthroplasty and removal of knee implant (static or dynamic spacer) to determine procedural volumes and early complication rates among Board-eligible orthopaedic surgeons with and without adult reconstructive fellowship training. More than 43,000 knee arthroplasty surge...

Research paper thumbnail of Trends in Primary and Revision Hip Arthroplasty Among Orthopedic Surgeons Who Take the American Board of Orthopedics Part II Examination

The Journal of arthroplasty, Jul 26, 2016

A certified list of all operative cases performed within a 6-month period is a required prerequis... more A certified list of all operative cases performed within a 6-month period is a required prerequisite for surgeons taking the American Board of Orthopaedic Surgery Part II oral examination. Using the American Board of Orthopaedic Surgery secure Internet database database containing these cases, this study (1) assessed changing trends for primary and revision total hip arthroplasty (THA) and (2) compared practices and early postoperative complications between 2 groups of examinees, those with and without adult reconstruction fellowship training. Secure Internet database was searched for all 2003-2013 procedures with a Current Procedural Terminology code for THA, hip resurfacing, hemiarthroplasty, revision hip arthroplasty, conversion to THA, or removal of hip implant (Girdlestone, static, or dynamic spacer). Adult reconstruction fellowship-trained surgeons performed 60% of the more than 33,000 surgeries identified (average 28.1) and nonfellowship-trained surgeons performed 40% (averag...

Research paper thumbnail of 5:3150. Intervertebral subluxation, lumbar lordosis, but not Cobb angle correlate with surgical rates in adult thoracolumbar and lumbar scoliosis: a multicenter analysis

The Spine Journal, 2005

4 kg). Nucleotomy was performed in two non-consecutive levels. SIS membrane was implanted in one ... more 4 kg). Nucleotomy was performed in two non-consecutive levels. SIS membrane was implanted in one disc whereas the other level was left empty. Lateral plain radiographs of the lumbar spine were obtained to measure disc height. MRI (1.5T and 4.7 spectrometer) T2-weighted images were used for measuring the disc water content. Total RNA was isolated from rabbit discs and the PCR was carried out with the following primers: collagen I and II, aggrecan, decorin, metalloproteinases MMP9 and 13, Fas. Rabbit GAPDH was used as the housekeeping gene. Statistical analysis was performed with a Student t test to compare with gene expression levels in normal discs; pϽ.05 was considered significant. RESULTS: Animals showed no signs of pain or restrained mobility after surgery and were sacrificed after 2 months. Disc height of nucleotomy sites was significantly reduced in comparison with controls (0.51ϩ0.021 vs. 0.89ϩ0.030 mm, respectively). A similar reduction of disc height to 0.47ϩ0.018 mm was observed in the SIS-implanted site. H&E stained sections revealed the formation of fibrocartilagenous tissue. Gene expression profile was examined for both operated and control levels. A total number of 18 discs were analyzed by RT-PCR conducted at the 2-month time point. Each group (normal, nucleotomy, and SIS) consisted of 3 to 4 discs. Although the amount of extracted RNA in the nucleotomy groups was significantly lower than in the other groups, it was sufficient enough to perform the analysis without pooling the disc samples. The gene expression level for all different primers was then normalized to the GAPDH expression in each disc and is represented. Compared with normal discs, all operated levels presented an up-regulated expression of collagen types I and II and metalloproteinases MMP9 and 13, even though only the SIS implanted discs demonstrated a significant difference for collagen type I, type II, and MMP 13. The discs that underwent nucleotomy showed a significantly lower level of expression of both aggrecan and decorin as compared with normal discs (37% and 27% of normal level of expression, respectively). CONCLUSIONS: We investigated the fate of SIS implanted into a rabbit degenerative disc. The biodegradability of SIS was confirmed as well as

Research paper thumbnail of A Clinical Impact Classification of Scoliosis in the Adult

Spine, 2006

Study Design. Multicenter, prospective, consecutive clinical series. Objectives. To establish and... more Study Design. Multicenter, prospective, consecutive clinical series. Objectives. To establish and validate classification of scoliosis in the adult. Summary of Background Data. Studies of adult scoliosis reveal the impact of radiographic parameters on selfassessed function: lumbar lordosis and frontal plane obliquity of lumbar vertebrae, not Cobb angle, correlate with pain scores. Deformity apex and intervertebral subluxations correlate with disability. Methods. A total of 947 adults with spinal deformity had radiographic analysis: frontal Cobb angle, deformity apex, lumbar lordosis, and intervertebral subluxation. Health assessment included Oswestry Disability Index and Scoliosis Research Society instrument. Deformity apex, lordosis (T12-S1), and intervertebral subluxation were used to classify patients. Outcomes measures and surgical rates were evaluated. Results. Mean maximal coronal Cobb was 46°and lumbar lordosis 46°. Mean maximal intervertebral subluxation (frontal plane) was 4.2 mm (sagittal plane, 1.2 mm). In thoracolumbar/lumbar deformities, the loss of lordosis/ higher subluxation was associated with lower Scoliosis Research Society pain/function and higher Oswestry Disability Index scores. Across the study group, lower apex combined with lower lordosis led to higher disability. Higher surgical rates with decreasing lumbar lordosis and higher intervertebral subluxation were detected. Conclusions. A clinical impact classification has been established based on radiographic markers of disability. The classification has shown correlation with self-reported disability as well as rates of operative treatment.

Research paper thumbnail of Spinal Appearance Questionnaire

Spine, 2011

Cross sectional. This study presents the factor analysis of the Spinal Appearance Questionnaire (... more Cross sectional. This study presents the factor analysis of the Spinal Appearance Questionnaire (SAQ) and its psychometric properties. Although the SAQ has been administered to a large sample of patients with adolescent idiopathic scoliosis (AIS) treated surgically, its psychometric properties have not been fully evaluated. This study presents the factor analysis and scoring of the SAQ and evaluates its psychometric properties. The SAQ and the Scoliosis Research Society-22 (SRS-22) were administered to AIS patients who were being observed, braced or scheduled for surgery. Standard demographic data and radiographic measures including Lenke type and curve magnitude were also collected. Of the 1802 patients, 83% were female; with a mean age of 14.8 years and mean initial Cobb angle of 55.8° (range, 0°-123°). From the 32 items of the SAQ, 15 loaded on two factors with consistent and significant correlations across all Lenke types. There is an Appearance (items 1-10) and an Expectations factor (items 12-15). Responses are summed giving a range of 5 to 50 for the Appearance domain and 5 to 20 for the Expectations domain. The Cronbach&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s α was 0.88 for both domains and Total score with a test-retest reliability of 0.81 for Appearance and 0.91 for Expectations. Correlations with major curve magnitude were higher for the SAQ Appearance and SAQ Total scores compared to correlations between the SRS Appearance and SRS Total scores. The SAQ and SRS-22 Scores were statistically significantly different in patients who were scheduled for surgery compared to those who were observed or braced. The SAQ is a valid measure of self-image in patients with AIS with greater correlation to curve magnitude than SRS Appearance and Total score. It also discriminates between patients who require surgery from those who do not.

Research paper thumbnail of Frequency and Complications after Operative Fixation of Clavicle Fractures

Journal of Shoulder and Elbow Surgery, 2013

Introduction: Operative interventions for the young active patient with glenohumeral arthritis ar... more Introduction: Operative interventions for the young active patient with glenohumeral arthritis are limited. Hemiarthroplasty with concentric glenoid reaming, Ream and Run, is one option with the originator of the procedure reporting good long-term results and no revisions within the first year. The purpose of this study is to be the first besides the original author to report results with the Ream and Run procedure, comparing survivorship and patient outcomes. Methods: 36 patients underwent 38 hemiarthroplasties with concentric glenoid reaming for degenerative arthritis, posttraumatic arthritis, hypoplastic glenoids, instability arthropathy and chondrolysis by two senior surgeons between 2007-2010. There were 35 males with a mean age of 48.0 years (19.5-62.3). 32 patients had eccentric glenoid bone loss. 17 patients had the reaming performed with reamers that were 2 mm larger than the prosthetic humeral head diameter and the remainder had standard glenoid reamers. Two patients were lost to followup. The remaining 34 patients (36 shoulders), were retrospectively

Research paper thumbnail of Trends in Hip Arthroscopy

Journal of Bone and Joint Surgery, 2012

Recent advances in diagnosis and instrumentation have facilitated the arthroscopic treatment of h... more Recent advances in diagnosis and instrumentation have facilitated the arthroscopic treatment of hip pathology. However, little has been reported on trends in the utilization of hip arthroscopy. The purpose of this study was to examine changes in the use of hip arthroscopy as reflected in the American Board of Orthopaedic Surgery (ABOS) database. We also surveyed directors of both sports and joint reconstruction fellowships to determine attitudes toward hip arthroscopy training. The number of hip arthroscopy cases in the ABOS database during 1999 through 2009 was determined. A survey was devised to determine the type of hip arthroscopy training that was currently being offered at the fellowship level. The number of hip arthroscopy procedures performed by ABOS candidates increased significantly from 0.02 cases per candidate in 1999 to 0.36 cases per candidate in 2009 (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). From 2003 through 2009, a significantly greater percentage of ABOS candidates with sports fellowship training (10.4%) than candidates without such training (2.9%) performed hip arthroscopy (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). During this same time period, candidates in the Northeast and Northwest performed the most hip arthroscopy procedures as a percentage of total procedures (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). Nearly half of the sports and joint reconstruction fellowships that included hip arthroscopy as a component of the training in 2010 had added it within the past three years. Fellows performed fewer than twenty hip arthroscopy cases per year in the majority of training programs. The number of hip arthroscopy procedures performed by candidates taking Part II of the ABOS examination increased eighteenfold between 1999 and 2009. This increase is likely the result of several factors, including an increase in the number of programs offering training in hip arthroscopy.

Research paper thumbnail of Performance of Candidates Selecting the Subspecialty of Spine Surgery for the Part II American Board of Orthopaedic Surgery Oral Certification Examination

Journal of Bone and Joint Surgery, 2013

The American Board of Orthopaedic Surgery (ABOS) was founded in 1934 to establish standards for t... more The American Board of Orthopaedic Surgery (ABOS) was founded in 1934 to establish standards for the certification of orthopaedic surgeons and educational requirements for postgraduate training in orthopaedic surgery. Educational standards have been well established for residency training, with specific requirements spelled out to successfully complete the five-year accredited orthopaedic residency program. These requirements are clearly noted on the ABOS web site1. Over the past fifteen years, there has been a rapid increase in the number of postgraduate fellowship programs encompassing the multiple subspecialties of orthopaedic surgery. At present, >90% of graduates take a postgraduate fellowship upon completion of their residency training according to ABOS internal documentation obtained from application material. Fellowships in the subspecialties of orthopaedic surgery accredited by the Accreditation Council for Graduate Medical Education (ACGME) are available in the Graduate Medical Education Directory published by the American Medical Association2. There is a wide disparity in the number of accredited or non-accredited fellowships depending on the subspecialty selected. For instance, surgery of the hand and sports medicine have almost 100% of their fellowships accredited by the ACGME with stringent educational, training, and faculty requirements overseen by the Residency Review Committee for Orthopaedic Surgery. Other subspecialties have far fewer accredited programs. These include spine surgery, which has eighteen accredited fellowships of approximately seventy-five available programs. Presently, the ABOS has not mandated educational and training requirements for fellowships as it has previously for resident training. The ABOS recognizes that postgraduate fellowship training has become an accepted path following completion of residency. The board is also aware that non-accredited fellowships are not subject to the same educational and training requirement reviews that accredited fellowships undergo on a regular basis. From 2006 to 2010, there were 359 candidates who sat for the ABOS Part II oral examination as …

Research paper thumbnail of Surgical Trends in Bankart Repair

The American Journal of Sports Medicine, 2011

Background: Arthroscopic Bankart repair emerged in the 1990s as a minimally invasive alternative ... more Background: Arthroscopic Bankart repair emerged in the 1990s as a minimally invasive alternative to open repair. The optimal technique of surgical stabilization of the unstable glenohumeral joint remains controversial. Hypothesis: A review of the American Board of Orthopaedic Surgery (ABOS) data would show a trend toward an increasing number of arthroscopic versus open Bankart procedures. Study Design: Descriptive epidemiology study. Methods: A query of the ABOS database for all cases of open or arthroscopic Bankart repair from 2003 through 2008 was performed, as the CPT (Current Procedural Terminology) codes for arthroscopic repair were introduced in 2003. All cases coded with CPT codes for arthroscopic Bankart repair (29806) or open Bankart repair (23455) were reviewed. Additional data were obtained on the surgeons (year of procedure, geographic location, fellowship training, subspecialty examination area) as well as the patients (age, gender, follow-up length, complications, obje...

Research paper thumbnail of The International Knee Documentation Committee Subjective Knee Evaluation Form

The American Journal of Sports Medicine, 2006

Background The International Knee Documentation Committee Subjective Knee Evaluation Form may be ... more Background The International Knee Documentation Committee Subjective Knee Evaluation Form may be used to measure symptoms, function, and sports activity for people with a variety of knee disorders, including ligamentous and meniscal injuries, osteoarthritis, and patellofemoral dysfunction. To date, normative data have not been established for this valid, reliable, and responsive outcomes instrument. Purpose To provide clinicians and researchers with normative data to facilitate the interpretation of results on the International Knee Documentation Committee Subjective Knee Evaluation Form. Study Design Cross-sectional survey. Methods The Subjective Knee Evaluation Form was mailed to 600 people in each of 8 age/gender categories (18-24 years, 25-34 years, 35-50 years, and 51-65 years for both male subjects and female subjects). Participants were drawn from a panel of 550 000 households (1 300 000 subjects) representative of noninstitutionalized persons in the United States and were ma...

Research paper thumbnail of Are Recent Graduates of Orthopaedic Training Programs Performing Less Fracture Care? American Board of Orthopedic Surgeons Part II

Journal of Orthopaedic Trauma, 2012

Objectives: The purpose of this study was to evaluate whether there has been a change in the amou... more Objectives: The purpose of this study was to evaluate whether there has been a change in the amount of fracture care performed by recent graduates of orthopaedic residency programs over time.

Research paper thumbnail of 61. Evolving Clinical Practice Patterns in Abdominoplasty: A 16-YEAR Analysis of Continuous Certification Tracer Data from the American Board of Plastic Surgery

Plastic and Reconstructive Surgery - Global Open

PURPOSE: This study evaluates changes in practice patterns in abdominoplasty based on a 16-year r... more PURPOSE: This study evaluates changes in practice patterns in abdominoplasty based on a 16-year review of tracer data collected by the American Board of Plastic Surgery (ABPS) as part of the Continuous Certification process. METHODS: ABPS tracer data was reviewed from 2005 to 2020, comparing data between two

Research paper thumbnail of High Incidence of Hemiarthroplasty for Shoulder Osteoarthritis Among Recently Graduated Orthopaedic Surgeons

Clinical Orthopaedics and Related Research®, 2014

Background Primary glenohumeral osteoarthritis is a common indication for shoulder arthroplasty. ... more Background Primary glenohumeral osteoarthritis is a common indication for shoulder arthroplasty. Historically, both total shoulder arthroplasty (TSA) and hemi-shoulder arthroplasty (HSA) have been used to treat primary glenohumeral osteoarthritis. The choice between procedures is a topic of debate, with HSA proponents arguing that it is less invasive, faster, less expensive, and technically less demanding, with quality of life outcomes equivalent to those of TSA. More recent evidence suggests TSA is superior in terms of pain relief, function, ROM, strength, and patient satisfaction. We therefore investigated the practice of recently graduated orthopaedic surgeons pertaining to the surgical treatment of this disease. Questions/purposes We hypothesized that (1) recently graduated, board eligible, orthopaedic surgeons with fellowship training in shoulder surgery are more likely to perform TSA than surgeons without this training; (2) younger patients are more likely to receive HSA than TSA; (3) patient sex affects the choice of surgery; (4) US geographic region affects practice patterns; and (5) complication rates for HSA and TSA are not different. Methods We queried the American Board of Orthopaedic Surgery's database to identify practice patterns of orthopaedic surgeons taking their board examination. We identified 771 patients with primary glenohumeral osteoarthritis treated with TSA or HSA from 2006 to 2011. The rates of TSA and HSA were compared based on the treating surgeon's fellowship training, patient age and sex, US geographic region, and reported surgical complications. Results Surgeons with fellowship training in shoulder surgery were more likely (86% versus 72%; OR 2.32; 95% CI, 1.56-3.45, p \ 0.001) than surgeons without this training to perform TSA rather than HSA. The mean age for patients receiving HSA was not different from that for patients receiving TSA (66 versus 68, years, p = 0.057). Men were more likely to receive HSA than TSA when compared to women (RR 1.54; 95% CI, 1.19-2.00, p = 0.0012). The proportions of TSA and HSA were similar regardless of US geographic region

Research paper thumbnail of 32. Evolution of Clinical Practice Patterns in Liposuction: A Sixteen-Year Review of Continuous Certification Tracer Data from the American Board of Plastic Surgery

Plastic and Reconstructive Surgery - Global Open

Research paper thumbnail of Practice Patterns for Arthroscopy

Research paper thumbnail of Complications of Hardware Removal

Journal of Bone and Joint Surgery, 2021

BACKGROUND While hardware removal may improve patient function, the procedure carries risks of un... more BACKGROUND While hardware removal may improve patient function, the procedure carries risks of unexpected outcomes. Despite being among the most commonly performed orthopaedic procedures, scant attention has been given to its complication profile. METHODS We queried the American Board of Orthopaedic Surgery (ABOS) de-identified database of Part II surgical case lists from 2013 through 2019 for American Medical Association Current Procedural Terminology (CPT) implant-removal codes (20680, 20670, 22850, 22852, 22855, 26320). Hardware removal procedures that were performed without any other concurrent procedure ("HR-only procedures") were examined for associated complications. RESULTS In the 7 years analyzed, 13,089 HR-only procedures were performed, representing 2.1% (95% confidence interval [CI], 2.1% to 2.2%) of the total of 609,150 surgical procedures during that period. A complication was reported to have occurred in association with 1,256 procedures (9.6% [95% CI, 9.1% to 10.1%]), with surgical complications reported in association with 1,151 procedures (8.8% [95% CI, 8.3% to 9.3%]) and medical/anesthetic complications reported in association with 196 procedures (1.5% [95% CI, 1.3% to 1.7%]). Wound-healing delay/failure (2.1% [95% CI, 1.8% to 2.3%]) and infection (1.6% [95% CI, 1.4% to 1.8%]) were among the most commonly reported complications after HR-only procedures, but other serious events were reported as well, including unexpected reoperations (2.5% [95% CI, 2.2% to 2.7%]), unexpected readmissions (1.6% [95% CI, 1.4% to 1.8%]), continuing pain (95% CI, 1.2% [1.0% to 1.4%]), nerve injury (0.6% [95% CI, 0.4% to 0.7%]), bone fracture (0.5% [95% CI, 0.4% to 0.6%]), and life-threatening complications (0.4% [95% CI, 0.3% to 0.5%]). CONCLUSIONS Hardware removal is one of the most commonly performed orthopaedic procedures and was associated with an overall complication rate of 9.6% (95% CI, 9.1% to 10.1%) in a cohort of recently trained orthopaedic surgeons in the United States. Although specific complications such as infection, refractures, and nerve damage were reported to have relatively low rates of occurrence, and associated life-threatening complications occurred rarely, surgeons and patients should be aware that hardware removal carries a definite risk. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Research paper thumbnail of Resident Independence Performing Common Orthopaedic Procedures at the End of Training

The Journal of Bone and Joint Surgery, 2019

Background: The Accreditation Council for Graduate Medical Education (ACGME) has established mini... more Background: The Accreditation Council for Graduate Medical Education (ACGME) has established minimum exposure rates for specific orthopaedic procedures during residency but has not established the achievement of competence at the end of training. The determination of independence performing surgical procedures remains undefined and may depend on the perspective of the observer. The purpose of this study was to understand the perceptions of recently graduated orthopaedic residents on the number of cases needed to achieve independence and on the ability to perform common orthopaedic procedures at the end of training. Methods: We conducted a web survey of all 727 recently graduated U.S. orthopaedic residents sitting for the 2018 American Board of Orthopaedic Surgery Part I Examination in July 2018. The surveyed participants were asked to assess the ability to independently perform 26 common adult and pediatric orthopaedic procedures as well as to recommend the number of cases to achieve independence at the end of training. We compared these data to the ACGME Minimum Numbers and the average ACGME resident experience data for residents who graduated from 2010 to 2012. Results: For 14 (78%) of the 18 adult procedures, >80% of respondents reported the ability to perform independently, and for 7 (88%) of the 8 pediatric procedures, >90% reported the ability to perform independently. The residentrecommended number of cases for independence was greater than the ACGME Minimum Numbers for all but 1 adult procedure. For 18 of the 26 adult and pediatric procedures, the mean 2010 to 2012 graduated resident exposure was significantly less than the mean number recommended for independence by 2018 graduates (p < 0.05). Conclusions: Overall, recently graduated residents reported high self-perceived independence in performing the majority of the common adult and pediatric orthopaedic surgical procedures included in this study. In general, recently graduated residents recommended a greater number of case exposures to achieve independence than the ACGME Minimum Numbers. According to the Accreditation Council for Graduate Medical Education (ACGME), the goal of residency training is for residents to achieve autonomy and independence by the time of graduation. Orthopaedic residents log cases online through the ACGME electronic case log system during residency training to document numbers and types of procedures performed 1,2 .

Research paper thumbnail of Perceptions of the Recommended Resident Experience with Common Orthopaedic Procedures

The Journal of Bone and Joint Surgery, 2019

Background: U.S. orthopaedic residency training is anchored by the Accreditation Council for Grad... more Background: U.S. orthopaedic residency training is anchored by the Accreditation Council for Graduate Medical Education (ACGME) requirements, which include minimum numbers for 15 categories of procedures. The face validity of these recommendations and expectations for exposure to other common procedures has not been rigorously investigated. The main goals of this investigation were to understand the perceptions of program directors and early practice surgeons regarding the number of cases needed in residency training and to report which of the most commonly performed procedures residents should be able to perform independently upon graduation. Methods: We sent surveys to 157 current program directors of ACMGE-approved orthopaedic surgery residency programs and to all examinees sitting for the American Board of Orthopaedic Surgery (ABOS) Part II Oral Examination in 2017, requesting that they estimate the minimum number of exposures for the 22 adult and 24 pediatric procedures that are most commonly performed during residency and the first 2 years in practice. Where applicable, we compared these with the ACGME "Minimum Numbers" and the average ACGME resident experience data from 2010 to 2012 for resident graduates. For each of the 46 procedures, participants were asked if every orthopaedic resident should be able to independently perform the procedure upon graduation. We compared the percent for independence between the early practice surgeons and the program directors. Results: For the majority of adult and pediatric procedures, the early practitioners reported significantly higher numbers of cases needing to be performed during residency than the program directors. ACGME Minimum Numbers were always lower than the case numbers that were recommended by the early practice surgeons and the program directors. Overall we found good-to-excellent agreement for independence at graduation between program directors and early practitioners for adult cases (intraclass correlation coefficient [ICC], 0.98; 95% confidence interval [CI], 0.82 to 0.99) and moderateto-good agreement for pediatric cases (ICC, 0.96; 95% CI, 0.74, 0.99).

Research paper thumbnail of Resident Surgical Skills Web-Based Evaluation

Journal of Bone and Joint Surgery, 2019

Investigation performed at 16 residency programs Background: Evaluation of surgical skill compete... more Investigation performed at 16 residency programs Background: Evaluation of surgical skill competency is necessary as graduate medical education moves toward a competency-based curriculum. This study by the American Board of Orthopaedic Surgery (ABOS) and the Council of Orthopaedic Residency Directors (CORD) compares 2 web-based evaluation tools that assess the level of autonomy that is demonstrated by residents during surgical procedures in the operating room as measured by faculty. Methods: Two hundred and ninety-four residents from 16 orthopaedic surgery residency programs were evaluated by 370 faculty using 2 web-based evaluation tools in a crossover design in which residents requested faculty review of their surgical skills before starting a case. One thousand, one hundred and fifty Ottawa Surgical Competency Operating Room Evaluation (O-Score) assessments, which included a 9-question evaluation of 8 steps of the surgical procedure, were compared with 1,186 P-score evaluations, which included a single-question summative evaluation. Twenty-five different surgical procedures were evaluated. Results: There were no significant differences in rates of resident requests or faculty completion of the 2 scores. The most common surgical procedures that were assessed were total knee arthroplasty (n = 254, 11%), carpal tunnel release (n = 191, 8%), open reduction and internal fixation (ORIF) of stable hip fractures (n = 170, 7%), ORIF of simple ankle fractures (n = 169, 7%), and total hip arthroplasty (n = 166, 7%). Both instruments disclosed significant differences in competency among entry, intermediate, and advanced-level residents. The findings support the construct validity of the evaluation method. The survey results indicated that >70% of the faculty were confident that use of either the P-score or the O-score allowed them to distinguish a resident who can perform the surgery independently from one who needs additional training. Conclusions: This research has led to the modification of the O-score and the P-score into a combined OP-score instrument. The ABOS envisions that the OP-score instrument can be used with an expanded number of surgical procedures as a required element of residency training in the near future. Clinical Relevance: This study allows the profession of orthopaedic surgery education to take a leadership role in the measurement of competence for surgical skills for orthopaedic surgeons in residency training, an important clinically relevant topic to the practice of orthopaedic surgery. Disclosure: There was no source of external funding for this study. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked "yes" to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work (http://links.lww.com/JBJS/F131).

Research paper thumbnail of Operative Experience During Orthopaedic Residency Compared with Early Practice in the U.S

The Journal of bone and joint surgery. American volume, Jan 4, 2018

The goal of surgical education is to prepare the trainee for independent practice; however, the r... more The goal of surgical education is to prepare the trainee for independent practice; however, the relevance of the current residency experience to practice remains uncertain. The purpose of this study was to identify the surgical procedures most frequently performed in orthopaedic residency and in early surgical practice and to identify surgical procedures performed more often or less often in orthopaedic residency compared with early surgical practice. This retrospective cohort study included American Medical Association (AMA) Current Procedural Terminology (CPT) codes (n = 4,329,561 procedures) reported by all U.S. orthopaedic surgery residents completing residency between 2010 and 2012 (n = 1,978) and AMA CPT codes for all procedures (n = 413,370) reported by U.S. orthopaedic surgeons who took the American Board of Orthopaedic Surgery Part II certifying examination between 2013 and 2015 (n = 2,205). Relative rates were determined for AMA CPT codes and AMA CPT code categories for ad...

Research paper thumbnail of Trends in primary and revision knee arthroplasty among orthopaedic surgeons who take the American Board of Orthopaedics part II exam

International orthopaedics, Oct 22, 2016

A certified list of all operative cases performed within a six month period is required of surgeo... more A certified list of all operative cases performed within a six month period is required of surgeons by the American Board of Orthopaedic Surgery (ABOS) as a prerequisite to taking the Part II Oral Examination. Using the data on these cases collected and maintained by ABOS, this study assessed the influence of prior fellowship training in adult reconstruction on the volume and surgeon-reported complication rate of knee joint arthroplasty cases over time. All data were self reported to a secure Internet database (SCRIBE) by candidates who applied to take Part II of the ABOS Examination for the first time. This database was searched for all procedures done between 2003 and 2013 with CPT codes for total and revision knee arthroplasty and removal of knee implant (static or dynamic spacer) to determine procedural volumes and early complication rates among Board-eligible orthopaedic surgeons with and without adult reconstructive fellowship training. More than 43,000 knee arthroplasty surge...

Research paper thumbnail of Trends in Primary and Revision Hip Arthroplasty Among Orthopedic Surgeons Who Take the American Board of Orthopedics Part II Examination

The Journal of arthroplasty, Jul 26, 2016

A certified list of all operative cases performed within a 6-month period is a required prerequis... more A certified list of all operative cases performed within a 6-month period is a required prerequisite for surgeons taking the American Board of Orthopaedic Surgery Part II oral examination. Using the American Board of Orthopaedic Surgery secure Internet database database containing these cases, this study (1) assessed changing trends for primary and revision total hip arthroplasty (THA) and (2) compared practices and early postoperative complications between 2 groups of examinees, those with and without adult reconstruction fellowship training. Secure Internet database was searched for all 2003-2013 procedures with a Current Procedural Terminology code for THA, hip resurfacing, hemiarthroplasty, revision hip arthroplasty, conversion to THA, or removal of hip implant (Girdlestone, static, or dynamic spacer). Adult reconstruction fellowship-trained surgeons performed 60% of the more than 33,000 surgeries identified (average 28.1) and nonfellowship-trained surgeons performed 40% (averag...

Research paper thumbnail of 5:3150. Intervertebral subluxation, lumbar lordosis, but not Cobb angle correlate with surgical rates in adult thoracolumbar and lumbar scoliosis: a multicenter analysis

The Spine Journal, 2005

4 kg). Nucleotomy was performed in two non-consecutive levels. SIS membrane was implanted in one ... more 4 kg). Nucleotomy was performed in two non-consecutive levels. SIS membrane was implanted in one disc whereas the other level was left empty. Lateral plain radiographs of the lumbar spine were obtained to measure disc height. MRI (1.5T and 4.7 spectrometer) T2-weighted images were used for measuring the disc water content. Total RNA was isolated from rabbit discs and the PCR was carried out with the following primers: collagen I and II, aggrecan, decorin, metalloproteinases MMP9 and 13, Fas. Rabbit GAPDH was used as the housekeeping gene. Statistical analysis was performed with a Student t test to compare with gene expression levels in normal discs; pϽ.05 was considered significant. RESULTS: Animals showed no signs of pain or restrained mobility after surgery and were sacrificed after 2 months. Disc height of nucleotomy sites was significantly reduced in comparison with controls (0.51ϩ0.021 vs. 0.89ϩ0.030 mm, respectively). A similar reduction of disc height to 0.47ϩ0.018 mm was observed in the SIS-implanted site. H&E stained sections revealed the formation of fibrocartilagenous tissue. Gene expression profile was examined for both operated and control levels. A total number of 18 discs were analyzed by RT-PCR conducted at the 2-month time point. Each group (normal, nucleotomy, and SIS) consisted of 3 to 4 discs. Although the amount of extracted RNA in the nucleotomy groups was significantly lower than in the other groups, it was sufficient enough to perform the analysis without pooling the disc samples. The gene expression level for all different primers was then normalized to the GAPDH expression in each disc and is represented. Compared with normal discs, all operated levels presented an up-regulated expression of collagen types I and II and metalloproteinases MMP9 and 13, even though only the SIS implanted discs demonstrated a significant difference for collagen type I, type II, and MMP 13. The discs that underwent nucleotomy showed a significantly lower level of expression of both aggrecan and decorin as compared with normal discs (37% and 27% of normal level of expression, respectively). CONCLUSIONS: We investigated the fate of SIS implanted into a rabbit degenerative disc. The biodegradability of SIS was confirmed as well as

Research paper thumbnail of A Clinical Impact Classification of Scoliosis in the Adult

Spine, 2006

Study Design. Multicenter, prospective, consecutive clinical series. Objectives. To establish and... more Study Design. Multicenter, prospective, consecutive clinical series. Objectives. To establish and validate classification of scoliosis in the adult. Summary of Background Data. Studies of adult scoliosis reveal the impact of radiographic parameters on selfassessed function: lumbar lordosis and frontal plane obliquity of lumbar vertebrae, not Cobb angle, correlate with pain scores. Deformity apex and intervertebral subluxations correlate with disability. Methods. A total of 947 adults with spinal deformity had radiographic analysis: frontal Cobb angle, deformity apex, lumbar lordosis, and intervertebral subluxation. Health assessment included Oswestry Disability Index and Scoliosis Research Society instrument. Deformity apex, lordosis (T12-S1), and intervertebral subluxation were used to classify patients. Outcomes measures and surgical rates were evaluated. Results. Mean maximal coronal Cobb was 46°and lumbar lordosis 46°. Mean maximal intervertebral subluxation (frontal plane) was 4.2 mm (sagittal plane, 1.2 mm). In thoracolumbar/lumbar deformities, the loss of lordosis/ higher subluxation was associated with lower Scoliosis Research Society pain/function and higher Oswestry Disability Index scores. Across the study group, lower apex combined with lower lordosis led to higher disability. Higher surgical rates with decreasing lumbar lordosis and higher intervertebral subluxation were detected. Conclusions. A clinical impact classification has been established based on radiographic markers of disability. The classification has shown correlation with self-reported disability as well as rates of operative treatment.

Research paper thumbnail of Spinal Appearance Questionnaire

Spine, 2011

Cross sectional. This study presents the factor analysis of the Spinal Appearance Questionnaire (... more Cross sectional. This study presents the factor analysis of the Spinal Appearance Questionnaire (SAQ) and its psychometric properties. Although the SAQ has been administered to a large sample of patients with adolescent idiopathic scoliosis (AIS) treated surgically, its psychometric properties have not been fully evaluated. This study presents the factor analysis and scoring of the SAQ and evaluates its psychometric properties. The SAQ and the Scoliosis Research Society-22 (SRS-22) were administered to AIS patients who were being observed, braced or scheduled for surgery. Standard demographic data and radiographic measures including Lenke type and curve magnitude were also collected. Of the 1802 patients, 83% were female; with a mean age of 14.8 years and mean initial Cobb angle of 55.8° (range, 0°-123°). From the 32 items of the SAQ, 15 loaded on two factors with consistent and significant correlations across all Lenke types. There is an Appearance (items 1-10) and an Expectations factor (items 12-15). Responses are summed giving a range of 5 to 50 for the Appearance domain and 5 to 20 for the Expectations domain. The Cronbach&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s α was 0.88 for both domains and Total score with a test-retest reliability of 0.81 for Appearance and 0.91 for Expectations. Correlations with major curve magnitude were higher for the SAQ Appearance and SAQ Total scores compared to correlations between the SRS Appearance and SRS Total scores. The SAQ and SRS-22 Scores were statistically significantly different in patients who were scheduled for surgery compared to those who were observed or braced. The SAQ is a valid measure of self-image in patients with AIS with greater correlation to curve magnitude than SRS Appearance and Total score. It also discriminates between patients who require surgery from those who do not.

Research paper thumbnail of Frequency and Complications after Operative Fixation of Clavicle Fractures

Journal of Shoulder and Elbow Surgery, 2013

Introduction: Operative interventions for the young active patient with glenohumeral arthritis ar... more Introduction: Operative interventions for the young active patient with glenohumeral arthritis are limited. Hemiarthroplasty with concentric glenoid reaming, Ream and Run, is one option with the originator of the procedure reporting good long-term results and no revisions within the first year. The purpose of this study is to be the first besides the original author to report results with the Ream and Run procedure, comparing survivorship and patient outcomes. Methods: 36 patients underwent 38 hemiarthroplasties with concentric glenoid reaming for degenerative arthritis, posttraumatic arthritis, hypoplastic glenoids, instability arthropathy and chondrolysis by two senior surgeons between 2007-2010. There were 35 males with a mean age of 48.0 years (19.5-62.3). 32 patients had eccentric glenoid bone loss. 17 patients had the reaming performed with reamers that were 2 mm larger than the prosthetic humeral head diameter and the remainder had standard glenoid reamers. Two patients were lost to followup. The remaining 34 patients (36 shoulders), were retrospectively

Research paper thumbnail of Trends in Hip Arthroscopy

Journal of Bone and Joint Surgery, 2012

Recent advances in diagnosis and instrumentation have facilitated the arthroscopic treatment of h... more Recent advances in diagnosis and instrumentation have facilitated the arthroscopic treatment of hip pathology. However, little has been reported on trends in the utilization of hip arthroscopy. The purpose of this study was to examine changes in the use of hip arthroscopy as reflected in the American Board of Orthopaedic Surgery (ABOS) database. We also surveyed directors of both sports and joint reconstruction fellowships to determine attitudes toward hip arthroscopy training. The number of hip arthroscopy cases in the ABOS database during 1999 through 2009 was determined. A survey was devised to determine the type of hip arthroscopy training that was currently being offered at the fellowship level. The number of hip arthroscopy procedures performed by ABOS candidates increased significantly from 0.02 cases per candidate in 1999 to 0.36 cases per candidate in 2009 (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). From 2003 through 2009, a significantly greater percentage of ABOS candidates with sports fellowship training (10.4%) than candidates without such training (2.9%) performed hip arthroscopy (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). During this same time period, candidates in the Northeast and Northwest performed the most hip arthroscopy procedures as a percentage of total procedures (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). Nearly half of the sports and joint reconstruction fellowships that included hip arthroscopy as a component of the training in 2010 had added it within the past three years. Fellows performed fewer than twenty hip arthroscopy cases per year in the majority of training programs. The number of hip arthroscopy procedures performed by candidates taking Part II of the ABOS examination increased eighteenfold between 1999 and 2009. This increase is likely the result of several factors, including an increase in the number of programs offering training in hip arthroscopy.

Research paper thumbnail of Performance of Candidates Selecting the Subspecialty of Spine Surgery for the Part II American Board of Orthopaedic Surgery Oral Certification Examination

Journal of Bone and Joint Surgery, 2013

The American Board of Orthopaedic Surgery (ABOS) was founded in 1934 to establish standards for t... more The American Board of Orthopaedic Surgery (ABOS) was founded in 1934 to establish standards for the certification of orthopaedic surgeons and educational requirements for postgraduate training in orthopaedic surgery. Educational standards have been well established for residency training, with specific requirements spelled out to successfully complete the five-year accredited orthopaedic residency program. These requirements are clearly noted on the ABOS web site1. Over the past fifteen years, there has been a rapid increase in the number of postgraduate fellowship programs encompassing the multiple subspecialties of orthopaedic surgery. At present, >90% of graduates take a postgraduate fellowship upon completion of their residency training according to ABOS internal documentation obtained from application material. Fellowships in the subspecialties of orthopaedic surgery accredited by the Accreditation Council for Graduate Medical Education (ACGME) are available in the Graduate Medical Education Directory published by the American Medical Association2. There is a wide disparity in the number of accredited or non-accredited fellowships depending on the subspecialty selected. For instance, surgery of the hand and sports medicine have almost 100% of their fellowships accredited by the ACGME with stringent educational, training, and faculty requirements overseen by the Residency Review Committee for Orthopaedic Surgery. Other subspecialties have far fewer accredited programs. These include spine surgery, which has eighteen accredited fellowships of approximately seventy-five available programs. Presently, the ABOS has not mandated educational and training requirements for fellowships as it has previously for resident training. The ABOS recognizes that postgraduate fellowship training has become an accepted path following completion of residency. The board is also aware that non-accredited fellowships are not subject to the same educational and training requirement reviews that accredited fellowships undergo on a regular basis. From 2006 to 2010, there were 359 candidates who sat for the ABOS Part II oral examination as …

Research paper thumbnail of Surgical Trends in Bankart Repair

The American Journal of Sports Medicine, 2011

Background: Arthroscopic Bankart repair emerged in the 1990s as a minimally invasive alternative ... more Background: Arthroscopic Bankart repair emerged in the 1990s as a minimally invasive alternative to open repair. The optimal technique of surgical stabilization of the unstable glenohumeral joint remains controversial. Hypothesis: A review of the American Board of Orthopaedic Surgery (ABOS) data would show a trend toward an increasing number of arthroscopic versus open Bankart procedures. Study Design: Descriptive epidemiology study. Methods: A query of the ABOS database for all cases of open or arthroscopic Bankart repair from 2003 through 2008 was performed, as the CPT (Current Procedural Terminology) codes for arthroscopic repair were introduced in 2003. All cases coded with CPT codes for arthroscopic Bankart repair (29806) or open Bankart repair (23455) were reviewed. Additional data were obtained on the surgeons (year of procedure, geographic location, fellowship training, subspecialty examination area) as well as the patients (age, gender, follow-up length, complications, obje...

Research paper thumbnail of The International Knee Documentation Committee Subjective Knee Evaluation Form

The American Journal of Sports Medicine, 2006

Background The International Knee Documentation Committee Subjective Knee Evaluation Form may be ... more Background The International Knee Documentation Committee Subjective Knee Evaluation Form may be used to measure symptoms, function, and sports activity for people with a variety of knee disorders, including ligamentous and meniscal injuries, osteoarthritis, and patellofemoral dysfunction. To date, normative data have not been established for this valid, reliable, and responsive outcomes instrument. Purpose To provide clinicians and researchers with normative data to facilitate the interpretation of results on the International Knee Documentation Committee Subjective Knee Evaluation Form. Study Design Cross-sectional survey. Methods The Subjective Knee Evaluation Form was mailed to 600 people in each of 8 age/gender categories (18-24 years, 25-34 years, 35-50 years, and 51-65 years for both male subjects and female subjects). Participants were drawn from a panel of 550 000 households (1 300 000 subjects) representative of noninstitutionalized persons in the United States and were ma...

Research paper thumbnail of Are Recent Graduates of Orthopaedic Training Programs Performing Less Fracture Care? American Board of Orthopedic Surgeons Part II

Journal of Orthopaedic Trauma, 2012

Objectives: The purpose of this study was to evaluate whether there has been a change in the amou... more Objectives: The purpose of this study was to evaluate whether there has been a change in the amount of fracture care performed by recent graduates of orthopaedic residency programs over time.