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Papers by Janet Conway

Plastic and Reconstructive Surgery – Global Open, Nov 30, 2023

Springer eBooks, Dec 31, 2022

Cureus

Background and purpose Spinal pseudarthrosis (SPA) is a common complication after attempted cervi... more Background and purpose Spinal pseudarthrosis (SPA) is a common complication after attempted cervical or lumbosacral spinal fusion surgery. Revision surgeries usually necessitate bone graft implementation as an adjunct to hardware revision. Iliac crest bone graft is the gold standard but availability can be limited and usage often leads to persistent postoperative pain at the donor site. There is scant literature regarding the use of reamerirrigator-aspirator (RIA)-harvested bone graft in lumbar spinal fusion. This is a collaborative study between orthopedic surgery and neurosurgery departments to utilize femur intramedullary autograft harvested using the RIA system as an adjunct graft in SPA revision surgeries. Materials and methods A retrospective review was conducted at a single center between August 2014 and December 2017 of patients aged ≥ 18 years and diagnosed with cervical, thoracic, or lumbar SPA who underwent revision fusion surgery using femur intramedullary autograft harvested using the RIA system. Plain radiographs and CT scans were utilized to confirm successful fusion. Results Eleven patients underwent 12 SPA revision surgeries using the RIA system as a source for bone graft in addition to bone morphogenetic protein 2 (BMP-2) and allograft. The mean amount of graft harvested was 51.3 mL (range: 20-70 mL). Nine patients achieved successful fusion (81.8%). The average time to fusion was 9.1 months. Four patients (36.4%) had postoperative knee pain. Regarding patient position and approach for harvesting, 66.7% (n = 8) of cases were positioned prone and a retrograde approach was utilized in 91.7% (n = 11) of cases. Interpretation This is the first case series in known literature to report the RIA system as a reliably considerable source of autologous bone graft for SPA revision surgeries. It provides a useful adjunct to the known types of bone grafts. Patient positioning and the approach choice for graft harvesting can be adjusted according to the fusion approach and the surgeon's preference.

Journal of Bone and Joint Infection, 2021

Objectives: The purpose of this case series is to describe the orthopedic management of pubic sym... more Objectives: The purpose of this case series is to describe the orthopedic management of pubic symphysis osteomyelitis with an emphasis on the key principles of treating bony infection. Furthermore, we sought to identify whether debridement of the pubic symphysis without subsequent internal fixation would result in pelvic instability. Methods: A retrospective chart review was performed to identify all cases of pubic symphysis osteomyelitis treated at both institutions from 2011 to 2020. Objective outcomes collected included infection recurrence, change in pubic symphysis diastasis, sacroiliac (SI) joint diastasis, and ambulatory status. Subjective outcome measures collected included the numeric pain rating scale (NPRS) and the 36-Item Short Form Survey (SF-36). Pubic symphysis diastasis was measured as the distance between the two superior tips of the pubis on a standard anterior-posterior (AP) view of the pelvis. SI joint diastasis was measured bilaterally as the joint space between the ileum and sacrum approximately at the level of the sacral promontory on the inlet view of the pelvis. A paired t test was utilized to compare the differences in outcome measures. An α value of 0.05 was utilized. Results: Six patients were identified, of which five were males and one was female (16.7 %), with a mean ± standard deviation (SD) follow-up of 19 ± 12 months (range 6-37 months). Mean ± SD age was 76.2 ± 9.6 years (range 61.0-88.0 years) and body mass index (BMI) was 28.0 ± 2.9 kg/m 2 (range 23.0-30.8 kg/m 2). When postoperative radiographs were compared to final follow-up radiographs, there were no significant differences in pubic symphysis diastasis (P = 0.221) or SI joint diastasis (right, P = 0.529 and left, P = 0.186). All patients were ambulatory without infection recurrence at final follow-up. Mean improvement for NPRS was 5.6 ± 3.4 (P = 0.020) and mean improvement for SF-36 physical functioning was 53.0 ± 36.8 (P = 0.032). Conclusion: This case series highlights our treatment strategy for pubic symphysis osteomyelitis of aggressive local debridement with local antibiotic therapy. Additionally, debridement of the pubic symphysis without subsequent internal fixation did not result in pelvic instability, as determined by pelvic radiographs and ability to fully weight bear postoperatively.

Injury, 2021

INTRODUCTION Segmental bone defects are a challenging clinical problem. In animal studies and cra... more INTRODUCTION Segmental bone defects are a challenging clinical problem. In animal studies and craniomaxillofacial surgery, resorbable polylactide membrane (OrthoMesh; DePuy Synthes, West Chester, PA) shows promise for treatment of bone defects. This study presents the results of the treatment of segmental bone defects with resorbable polylactide membrane, bone morphogenic protein-2 (BMP-2), and autograft. METHODS This study was approved by the institutional review board. All patients with a segmental bone defect treated with a resorbable polylactide membrane by a single surgeon from 2010 to 2019 were retrospectively reviewed. Data related to demographic variables, surgical details, and union were collected. RESULTS Eleven patients with median age of 37 years (range 22-62 years) were included in the study with segmental bone defects in the tibia (n = 3), femur (n = 4), or forearm (n = 4). Median bone defect size was 6 cm (range 3-12 cm). Etiology of bone defects included osteomyelitis (n = 7), oncologic resection (n = 3), and post-traumatic aseptic nonunion (n = 1). Flap coverage was performed in two patients. Median radiographic follow-up was 24 months (range 5-75 months). Ten patients (10/11) achieved union at a median of 17 months (range 5-46 months). Seven patients required reoperation for any reason with six patients requiring repeat grafting. CONCLUSIONS To our knowledge, this study is the largest series of patients with segmental bone defects treated with resorbable polylactide membrane. Resorbable polylactide membrane in combination with BMP-2 and autograft represents a safe and effective method of bone graft containment in segmental bone defects measuring up to 12 cm in this series. Ten of 11 patients achieved union at a median time of 16 months with 6 patients requiring repeat grafting. These results compare favorably with the induced membrane technique. This study is limited by its retrospective design, absence of control and comparison groups, and low patient numbers. Future prospective randomized study of the induced membrane technique and resorbable polylactide membrane should be undertaken to determine preferred approaches for treatment of segmental bone defects.

Plastic and Reconstructive Surgery - Global Open

Summary: Disruption of the knee extensor mechanism is an unfavorable situation because efficient ... more Summary: Disruption of the knee extensor mechanism is an unfavorable situation because efficient mobilization requires a functioning knee extensor apparatus. The purpose of this retrospective study was to report our technique of sartorius muscle transfer for restoration of extension mechanism function and the outcomes of five patients. Patients with ruptured knee extensor mechanism secondary to trauma or knee arthroplasty-related issues were studied retrospectively. In all patients, sartorius muscle was transferred to restore the quadriceps tension deficit. Increase in the knee active range of motion, increase in the extensor mechanism power by one grade on Medical Research Council scale, and improvement in the extension lag were observed in all patients. The sartorius muscle transfer can be a reliable option to restore the knee extensor mechanism in chronic quadriceps tendon injuries. Our initial results are promising and showed improvement of the extensor mechanism muscle power, increased knee active range of motion, and decreased knee extension lag. The complications we observed did not impair the successful outcome of the sartorius transfer and were anticipated given the complexity of the studied cases. We encourage additional studies of sartorius muscle transfer to treat chronic quadriceps tendon injuries.

Journal of Orthopaedic Trauma

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Journal of the American Academy of Orthopaedic Surgeons, 2021

Segmental bone defects of the tibia are amenable to multiple treatment options including classic ... more Segmental bone defects of the tibia are amenable to multiple treatment options including classic bone transport, shortening and then lengthening, induced membrane technique, transport over a nail, free fibular grafting, and medial transport of the ipsilateral fibula. These treatment options have relative advantages and disadvantages, depending on defect size, soft-tissue characteristics, the presence or absence of infection, and associated morbidity. Relatively, few large comparative studies exist, and surgeons are left to their own experience and the opinion of experts within the field to guide surgical decision-making.

European Journal of Orthopaedic Surgery & Traumatology, 2021

Gastrocnemius flaps provide reliable reconstructive solutions to soft-tissue loss of the knee and... more Gastrocnemius flaps provide reliable reconstructive solutions to soft-tissue loss of the knee and proximal tibia following orthopedic procedures. While this technique has been used and studied, little is known about its prophylactic application. Single-stage and delayed approaches were compared with respect to the timing of débridement, complications, and relationship between microorganisms and complications. Gastrocnemius flaps for soft-tissue defects of the knee joint were retrospectively reviewed. Success of the flap procedure was defined as a healed soft-tissue envelope, no evidence of infection, a good blood supply to the flap, and adherence of the flap to its bed. Independent sample t test was used to compare the corresponding parameters (level of statistical significance was 0.05). Of 43 flaps (43 patients), 18 were performed during a single-stage procedure along with the orthopedic procedure and 25 were delayed. Success of the single-stage (100%) and delayed flaps (88%) was not significantly different (p = 0.083). Complication rate did not differ significantly for single-stage (11%) and delayed flaps (24%) (p = 0.272). We were unable to establish a relationship between complications and microorganisms. Results indicate both approaches are reliable. Single-stage gastrocnemius flaps may eliminate the need for a second surgery. Level III (Therapeutic, Retrospective cohort)

Knee Surgery, Sports Traumatology, Arthroscopy, 2020

Purpose No definite treatment option with reasonable outcome has been presented for old and refra... more Purpose No definite treatment option with reasonable outcome has been presented for old and refractory flexion contracture after total knee arthroplasty (TKA). We describe a surgical technique for 21 refractory cases of knee flexion contracture, including 12 patients with history of failed manipulation under anesthesia (MUA). Methods Retrospective review was conducted for procedures performed by a single surgeon between 2005 and 2016. Twentyone knees (19 patients) with knee flexion contracture after primary TKA were treated with all the following procedures: posterior capsular release, hamstring tenotomy, prophylactic peroneal nerve decompression, and botulinum toxin type A injections. Twelve of the 21 knees had at least 1 prior unsuccessful MUA before this soft-tissue release procedure. Mean age at intervention was 60 years (range 46-78 years). Mean preoperative knee range of motion (ROM) was-27° extension (range-20° to-40°) to 100° flexion (range 90°-115°). All radiographs were evaluated for proper component sizing and signs of loosening. Results Full extension was achieved immediately after surgery in all patients. Only one knee required repeat botulinum toxin type A injection. All patients had full extension at mean follow-up of 31 months (range 24-49 months). No significant change was observed in knee flexion after the procedure (n.s.). Significant improvement was noted in the postoperative Knee Society Score (KSS) (mean 80, range 70-90) when compared with preoperative KSS (mean 45, range 25-65) (p = 0.008). Conclusion The proposed surgical technique is efficacious in treating patients with refractory knee flexion contracture following TKA to gain and maintain full extension at minimum 2-year follow-up. Level of evidence IV, retrospective case series.

The Journal of Hand Surgery, 2018

Voluntary elbow extension is essential for optimal upper limb positioning required for daily livi... more Voluntary elbow extension is essential for optimal upper limb positioning required for daily living activities, particularly above-shoulder maneuvers. The authors present a case of traumatic brachial plexus injury in which paralysis of the musculature selectively supplied by the posterior cord was based on magnetic resonance imaging and nerve conduction studies. An attempt at a radial nerve graft at another center was not effective. Ipsilateral hand function improved after multiple local tendon transfers were performed. Restoration of active elbow extension was not possible using the posterior deltoid or the latissimus dorsi because they were denervated by the primary trauma and so the trapezius muscle was used as a donor muscle unit to restore voluntary elbow extension. The patient resumed biking 6 weeks after the transfer procedure. At 2-year follow-up, full active elbow extension was regained, elbow extension power scored 4 of 5, and the patient reported that he could ride his bicycle for 70 miles.

The Journal of Arthroplasty, 2019

Background: We investigated clinical/functional outcomes and implant survivorship in patients who... more Background: We investigated clinical/functional outcomes and implant survivorship in patients who underwent two-stage revision TKA after periprosthetic joint infection (PJI), experienced acute PJI recurrence, and underwent irrigation, débridement, and polyethylene exchange (IDPE) with retention of stable implant. Methods: Twenty-four patients (24 knees) were identified who underwent two-stage revision TKA for PJI, experienced acute PJI recurrence, and then underwent IDPE between 2005 and 2016 (minimum 2-year follow-up). After IDPE, intravenous antibiotics (6 weeks) and oral suppression therapy (minimum 6 months) were administered. Data were compared with 1:2 matched control group that underwent two-stage revision TKA for chronic PJI and did not receive IDPE. Results: Average IDPE group follow-up was 3.8 years (range, 2.4-7.2). Reinfection rate after IDPE was 29% (n=7): 3 of 7 underwent second IDPE (2 of 3 had no infection recurrence) and 5 (one was patient who had recurrent infection after second IDPE) underwent another two-stage revision TKA. Control group reinfection rate was 27% (n=13) (p=0.85). For IDPE group, mean time to reinfection after two-stage revision TKA was 4.6 months (range, 1-8 months) (patients presented with acute symptoms less than 3 weeks duration). At latest follow-up, mean Knee Society Score was 70 (range, 35-85) in IDPE group and 75 (range, 30-85) in control group (p=0.53). Conclusion: IDPE for acute reinfection following two-stage revision TKA with well-fixed implants had a 71% success rate. These patients had comparable functional outcome as patients with no IDPE after two-stage revision TKA. IDPE followed by long-term suppression antibiotic therapy should be considered in patients with acute infection and stable components.

Journal of Orthopaedic Trauma, 2017

Reconstruction of segmental bone defects requires a large commitment both on the part of the pati... more Reconstruction of segmental bone defects requires a large commitment both on the part of the patient and the physician. Investing in preoperative evaluation and optimization is the only logical way to pursue such an endeavor. Unfortunately, detailed studies regarding segmental bone defects and preoperative factors are relatively lacking owing to the relatively low incidence of the problem. Fortunately, other orthopaedic pathologies (arthritis, ligamentous injuries about the knee) have high prevalence and consistency, allowing detailed analysis of preoperative factors. We review this literature, and that directly involving segmental bone defects when available, to guide surgeons planning segmental bone defect reconstruction.

Journal of orthopaedic trauma, Jan 21, 2017

Post traumatic limb length discrepancy (LLD) may present secondary to fracture shortening, maluni... more Post traumatic limb length discrepancy (LLD) may present secondary to fracture shortening, malunion, or epiphyseal growth arrest. The purpose of this study was to evaluate the outcomes of lengthening post-traumatic femoral segments utilizing a recently available magnetic intramedullary (IM) lengthening system. Retrospective cohort study SETTING:: Urban Level II Trauma CenterPatients/Participants: This study was performed to review post-traumatic patients treated for femoral shortening at our institution between 2011 and 2015. We identified seventeen femurs lengthened (14 males and 3 females). The mean age was 30 years (range, 11 - 72 years). Magnetic IM lengthening system MAIN OUTCOME MEASUREMENTS:: Amount of lengthening achieved, consolidation index (CI), and complications encountered. The mean follow up was 2.2 years (range, 1 - 3.7 years). Sixteen patients achieved the planned lengthening, a mean of 3.8 cm (range, 2.3 - 6.0 cm). Regenerate consolidation occurred at a mean of 119 ...

Journal of orthopaedic trauma, Jan 30, 2016

To determine which reconstruction treatment of long bones nonunion with segmental bone defects (S... more To determine which reconstruction treatment of long bones nonunion with segmental bone defects (SBD) is effective to restore bone length and union with good function. PubMed was utilized to identify published literature on treatment of SBD caused by fracture nonunion regardless of infection between January 1975 and December 2014. We included retrospective cohort studies with minimum sample size of 10 consecutive patients with minimum follow up of 18 months and available data on radiographic and functional outcome. Literature review revealed 24 publications with sample size of 504 patients (395 males, 109 females). Data on bone union and functional outcome and complications were collected and analyzed based on validated classification systems. Two outcome groups were categorized for bone union and functional outcome, success and failure. We then performed heterogeneity test to examine the variability or differences in the methods used by these studies and based on that we determined ...

Limb Lengthening and Reconstruction Surgery Case Atlas, 2015

A 64 year old woman presented with pain and swelling in her right ankle. She had a closed ankle f... more A 64 year old woman presented with pain and swelling in her right ankle. She had a closed ankle fracture that was corrected with open reduction and internal fixation 4 years prior to presentation. She underwent ankle fusion for post-traumatic arthritis, but her talus collapsed and a hindfoot fusion was then performed with a hindfoot fusion rod. After hindfoot fusion, the ankle developed a chronic infected nonunion. Ankle range of motion was within normal limits even though the ankle was supposed to be fused. She had a 5-cm limb length discrepancy (LLD) on her right side. Treatment included removal of the radiographically loose hindfoot fusion rod (locked only distally) and application of the Taylor Spatial Frame (TSF) (Smith & Nephew, Memphis, TN) for approximately 6 months to distract the nonunion. Two casts were applied sequentially, and then the patient transitioned to a custom ankle foot orthosis (AFO) with weight-bearing as tolerated. After treatment, she was given a 1-in. shoe lift to address the 3-cm LLD. Radiographs obtained 1 year after removal showed progressive bony healing at the fusion site. She did not have any appreciable range of motion at the ankle joint. Minimal dorsiflexion and plantarflexion were possible through the midtarsal joint, but this motion did not cause pain. She had limited inversion and eversion of the right subtalar joint (approximately 15 degrees of inversion and 15 degrees of eversion), but this motion was not painful. 1 Brief Clinical History A 64 year old woman presented with pain and swelling in her right ankle, which had been problematic for the previous 4 years. Both lower extremities had palpable pulses and diminished sensation. She had a closed ankle fracture that was initially treated with open reduction and internal fixation. The internal fixation was removed 1 year after it was inserted. She developed posttraumatic arthritis and then underwent ankle fusion. Her talus went on to collapse, and subsequently, a hindfoot fusion was performed. After these procedures, the ankle developed a chronic infection and a nonunion. She observed intermittent drainage, but this drainage had stopped a few weeks prior to presenting at our clinic. The patient stated that she did not have any systemic symptoms of infection. At initial presentation, she wore a CAMWalker boot on the right ankle. The patient had a pressure ulcer on the plantar aspect of the first metatarsal head. The right heel was valgus, and the right lower extremity was erythematous and mildly swollen when compared with the left lower extremity. Sensation in both lower extremities was diminished. Ankle range of motion was within normal limits even though the ankle was supposed to be fused. Muscle strength of the right lower *Email: jconway@lifebridgehealth.org Limb Lengthening and Reconstruction Surgery Case Atlas DOI 10.1007/978-3-319-02767-8_137-1 # Springer International Publishing Switzerland 2014

Limb Lengthening and Reconstruction Surgery Case Atlas, 2014

Journal of Bone and Joint Infection, 2019

Marjolin's tumor is a term used to describe a malignancy developing in the setting of a chronic w... more Marjolin's tumor is a term used to describe a malignancy developing in the setting of a chronic wound, infection, or other tissue subject to chronic inflammatory changes. These malignancies usually present after many years of chronicity, and can range from lower grade basal cell carcinomas to high-grade sarcomas. We present the case of a squamous cell carcinoma that developed within a chronic periprosthetic infection of a total knee arthroplasty of 7 years duration. The intra-articular location, association with an orthopaedic implant, and brief latency period are all unique features of this case.