William Macaulay - Academia.edu (original) (raw)

Papers by William Macaulay

Research paper thumbnail of Patient Education Before Hip or Knee Arthroplasty Lowers Length of Stay

The Journal of Arthroplasty, 2010

From April 2006 to May 2007, 261 patients undergoing primary unilateral total hip arthroplasty or... more From April 2006 to May 2007, 261 patients undergoing primary unilateral total hip arthroplasty or total knee arthroplasty were offered voluntary participation in a one-on-one preoperative educational program. Length of stay (LOS) and inpatient data were monitored and recorded, prospectively. Education participants enjoyed a significantly shorter LOS than nonparticipants for both total hip arthroplasty (3.1 ± 0.8 days vs 3.9 ± 1.4 days; P = .0001) and total knee arthroplasty (3.1 ± 0.9 days vs 4.1 ± 1.9 days; P = .001). Keywords: patient education, preoperative care, hip arthroplasty, knee arthroplasty, length of stay.

Research paper thumbnail of Publication Rates of Scientific Presentations at the American Association of Hip and Knee Surgeons Annual Meetings from 1996 to 2001

The Journal of Arthroplasty, 2007

National orthopedic subspecialty meetings are a research forum where volumes of investigations ar... more National orthopedic subspecialty meetings are a research forum where volumes of investigations are presented after a peer-reviewed selection process. The objective of this investigation was to determine the publication rate of recent scientific presentations presented at the American Association of Hip and Knee Surgeons (AAHKS) annual meetings. From 1996 to 2001, 168 (58%) of 292 podium abstracts presented at meetings were published. The average time to publication was 21.7 F 14.7 months. Three major orthopedic journals constituted 89% of the publications. The 58% publication rate for AAHKS ranks as one of the higher rates for orthopedic specialty meetings and validates the selection process for abstracts presented. In addition, AAHKS meetings are an excellent source for a wide array of quality research and scientific information. Key words: hip prosthesis, knee prosthesis, abstract, publication, research quality.

Research paper thumbnail of Predicting Short-Term Outcome of Primary Total Hip Arthroplasty

The Journal of Arthroplasty, 2010

The purpose of this study was to investigate factors affecting the short-term outcome of primary ... more The purpose of this study was to investigate factors affecting the short-term outcome of primary total hip arthroplasty (THA) and develop a multivariate regression equation to predict the short-term outcome of primary THA. Prospectively collected data for 101 primary THAs performed at a single institution were used in this study. Twelve independent variables were analyzed via correlation and multivariate regression analyses. Correlation analyses showed that three variables significantly influenced Western Ontario and McMaster Universities Osteoarthritis (WOMAC) physical function (PF) score at minimum follow-up of 1 year: preoperative WOMAC PF score (P b .0001), sex (GN, P = .0159), and the presence of preoperative comorbidities (CMB, P = .0246). Multivariate regression analysis yielded the following equation: Outcome = PF0.45 − GN9 + CMB8 + 62, which can be used to predict the general short-term outcome of primary THA.

Research paper thumbnail of Does a High-Flexion Design Affect Early Outcome of Medial Unicondylar Knee Arthroplasty?

Journal of Arthroplasty, 2011

Recently, implant companies have sought to target a more active segment of the population with hi... more Recently, implant companies have sought to target a more active segment of the population with high-flex implants. Our aim was to compare a successful medial UKA implant with its newer high-flex version. Sixty-one patients (nonflex, 33; high-flex [HF], 28) were prospectively followed after medial UKA with a minimum of 2-year follow-up. Patients were evaluated using Short Form 12, Western Ontario

Research paper thumbnail of Studies Presented in Poster Format at the Annual Meetings of the American Association of Hip and Knee Surgeons

The Journal of Arthroplasty, 2007

The purpose of this study was to evaluate the eventual publication rates of poster presentations ... more The purpose of this study was to evaluate the eventual publication rates of poster presentations at the annual meetings of the American Association of Hip and Knee Surgeons from 1996 to 2001 (47%). Common belief expects poster presentations to publish at a lower rate than podium presentations, the latter being typically believed to consist of studies of higher scientific value. We hypothesized that this would lead to a lower incidence of eventual peer-reviewed literature publication for posters. Comparisons from an earlier report confirmed our analysis. Also, poster studies that did survive the peer review process were found in a wide array of journals and were found to publish within a relatively short amount of time (mean, 23.6 ± 15.7 months). Key words: podium, poster, abstract, publication rate, research quality.

Research paper thumbnail of Intraoperative Music Reduces Perceived Pain After Total Knee Arthroplasty – A Blinded, Prospective, Randomized, Placebo-Controlled Clinical Trial

Journal of Knee Surgery, 2008

Patients undergoing total knee arthroplasty (TKA) often experience a difficult recovery due to se... more Patients undergoing total knee arthroplasty (TKA) often experience a difficult recovery due to severe postoperative pain. Using a multimodal pain management protocol, a blinded, randomized, placebocontrolled study was designed to evaluate the efficacy of patient-selected music on reducing perceived pain. Thirty patients undergoing primary unilateral TKA were enrolled and randomized into the music group 15 patients) or the control group (15 patients). Postoperative pain scores, assessed with the visual analog scale, indicated the music group experienced less pain at 3 and 24 hours postoperatively than did the nonmusic group (at 3 hours: 1.4761.39 versus 3.8763.44, P = .01; at 24 hours: 2.4161.67 versus 4.0362.89, P = .04). Intraoperative music provides an inexpensive nonpharmacological option to further reduce postoperative pain. [J Knee Surg. 2008;21:275-278.] The authors are from the Center for Hip and Knee Replacement,

Research paper thumbnail of Fixed-bearing, medial unicondylar knee arthroplasty rapidly improves function and decreases pain: a prospective, single-surgeon outcomes study

The journal of knee surgery, 2008

Fixed-bearing, medial unicondylar knee arthroplasties were performed in 33 knees (32 patients). W... more Fixed-bearing, medial unicondylar knee arthroplasties were performed in 33 knees (32 patients). We report a minimum 2-year follow-up, with a mean follow-up of 3 years. Kaplan-Meier survivorship analysis reported 97% survivorship at a mean follow-up of 38 months. Average preoperative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scores improved significantly from 40+/-22 to 92+/-15 (P<.0001). Average preoperative Knee Society knee and function scores improved significantly from 52+/-7 to 90+/-9 (P<.0001) and from 48+/-16 to 84+/-17 (P<.0001), respectively. In addition, average Short Form-12 Physical Component scores significantly increased. Overall stiffness and physical function assessed via the WOMAC index also exhibited significant improvement. Of note, all categories of the WOMAC Index and the Knee Society scores experienced statistically significant improvements at 3-month follow-up, indicating a rapid return to improved function and dimini...

Research paper thumbnail of Unicompartmental knee arthroplasty: a controversial history and a rationale for contemporary resurgence

The journal of knee surgery, 2008

Treatment of isolated compartment osteoarthritis with unicompartmental knee arthroplasty (UKA) ha... more Treatment of isolated compartment osteoarthritis with unicompartmental knee arthroplasty (UKA) has had mixed reported results and still remains a controversial procedure. More recently, adherence to more stringent patient selection criteria and refined surgical technique has resulted in improved clinical outcomes and survivorship. The popularization of UKA as a more tissue-sparing procedure and minimally invasive alternative to total knee arthroplasty has also played an integral role in its recent resurgence. This review details the history, evolution, and varied results of UKA. Many different prostheses have emerged, some with exceptional long-term results. Long-term prospective analyses will be critical in determining the role of UKA as a mainstay in the treatment of single compartment knee degenerative joint disease.

Research paper thumbnail of Staple Line Reinforcement Reduces Postoperative Pancreatic Stump Leak After Distal Pancreatectomy

Journal of Gastrointestinal Surgery, 2007

Pancreatic stump leak is the major source of morbidity after stapled distal pancreatectomy. We hy... more Pancreatic stump leak is the major source of morbidity after stapled distal pancreatectomy. We hypothesized that reinforcement of the stapler system with a buttress mat can improve leak rates when compared to standard stapling alone. We performed 13 consecutive distal pancreatectomies using our reinforced stapler system, forming our experimental group. A historical control group was composed of 18 patients undergoing stapled pancreatic closure without reinforcement. The main outcome measure was pancreatic leak in the postoperative period. Pancreatic leaks included fistulas and fluid collections (sterile or infected). Hospital length of stay was recorded as a secondary measure. Postoperative pancreatic leak rate was zero in the experimental group, but 39% in the control group (P = 0.025). Development of a pancreatic leak resulted in prolonged hospital stays: 13.6 vs 8.3 days (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.03). We conclude that staple line reinforcement is a simple and effective method of reducing pancreatic stump leakage after distal pancreatectomy. The economic impact of lower leak rates is reflected in significantly shorter hospital stays. The results of our study should be validated in a randomized controlled trial.

Research paper thumbnail of Total Hip Arthroplasty Functional Outcomes Are Independent of Acetabular Component Orientation When a Polyethylene Liner is Employed

The Journal of Arthroplasty, 2015

This study evaluated patient-reported outcomes in patients undergoing primary total hip arthropla... more This study evaluated patient-reported outcomes in patients undergoing primary total hip arthroplasty with a polyethylene liner to determine the influence of cup orientation and other variables on patient-reported outcomes. A total of 477 cases were prospectively monitored through average 4.7 years follow-up. Cup position was measured on pelvis radiographs. Patients completed the Western Ontario and McMaster Universities Osteoarthritis Index and Short Form 12 Health Survey questionnaires. Average cup abduction was 43.1° ± 7.5° and anteversion was 13.3° ± 7.5°. Three hundred cups were within the target zone. All outcomes&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; improvement from baseline and cup position was not an independent risk factor for the Western Ontario and McMaster Universities Osteoarthritis Index or Short Form 12 Health Survey improvement. Accurate cup orientation may not be critical to maximizing patient-perceived outcomes if the combined anteversion is within a normal range, the hip joint is properly balanced, and a polyethylene liner is coupled with a metal or ceramic femoral head.

Research paper thumbnail of Repair of a Chronic Ruptured Quadriceps Tendon With a Medial Gastrocnemius–Hemisoleus–Calcaneal Block Flap

Research paper thumbnail of Extradigital glomus tumor in the knee: excision with ultrasound guided needle localization

Skeletal radiology, 2015

Glomus tumors are rare neoplasms that are usually subungual in location, but can infrequently be ... more Glomus tumors are rare neoplasms that are usually subungual in location, but can infrequently be found elsewhere in the body. When they occur in extradigital locations, they present a diagnostic challenge that may result in delay of definitive management. We report a case of a 51-year-old male who experienced decade long chronic pain because of a glomus tumor in the suprapatellar fat pad of the knee. This case is unique not only because of the glomus tumor's location, but also because it ultimately required ultrasound-guided needle localization for excision.

Research paper thumbnail of Redefining the Acetabular Component Safe Zone for Posterior Approach Total Hip Arthroplasty

The Journal of arthroplasty, Jan 18, 2015

Acetabular component orientation influences joint stability in total hip arthroplasty (THA). The ... more Acetabular component orientation influences joint stability in total hip arthroplasty (THA). The purpose of this study was to evaluate the effect of cup orientation and other variables on hip dislocation risk and to define a posterior approach specific safe zone. A cohort of 1289 posterior approach primary THA cases was prospectively followed and component position measured radiographically. Cup malposition, with respect to the Lewinnek safe zone, was an independent risk factor for dislocation (OR1.88). Modifying the anteversion safe zone limits to 10-25° strongly predicted increased dislocation risk (OR2.69). No dislocations occurred within a zone defined by a circle centered at 41.4° abduction and 17.1° anteversion, radius 4.3°. Utilizing a posterior approach specific safe zone of 10-25° anteversion and 30-50° abduction may minimize THA dislocations. Level III.

Research paper thumbnail of Liberal versus restrictive blood transfusion strategy: 3-year survival and cause of death results from the FOCUS randomised controlled trial

Lancet, Jan 9, 2014

Blood transfusion might affect long-term mortality by changing immune function and thus potential... more Blood transfusion might affect long-term mortality by changing immune function and thus potentially increasing the risk of subsequent infections and cancer recurrence. Compared with a restrictive transfusion strategy, a more liberal strategy could reduce cardiac complications by lowering myocardial damage, thereby reducing future deaths from cardiovascular disease. We aimed to establish the effect of a liberal transfusion strategy on long-term survival compared with a restrictive transfusion strategy. In the randomised controlled FOCUS trial, adult patients aged 50 years and older, with a history of or risk factors for cardiovascular disease, and with postoperative haemoglobin concentrations lower than 100 g/L within 3 days of surgery to repair a hip fracture, were eligible for enrolment. Patients were recruited from 47 participating hospitals in the USA and Canada, and eligible participants were randomly allocated in a 1:1 ratio by a central telephone system to either liberal trans...

Research paper thumbnail of Introduction

Operative Techniques in Orthopaedics

Research paper thumbnail of Total hip resurfacing: a viable alternative to total hip arthroplasty for the young active hip patient in the United States?

Current Orthopaedic Practice, 2008

Research paper thumbnail of Understanding economic evaluations: a review of the knee arthroplasty literature

The American journal of knee surgery, 1999

The study reviewed the literature to appraise the quality, quantity, and type of economic evaluat... more The study reviewed the literature to appraise the quality, quantity, and type of economic evaluation as it pertains to the knee arthroplasty literature. A computerized bibliographic search of MEDLINE from 1966-1996 was conducted, revealing a total of 43,178 articles dealing with cost analysis, of which 1611 were orthopedic. Of the economic orthopedic studies, only 63 dealt with the topic of knee arthroplasty. These studies were retrieved, of which only 40 papers met the inclusion criteria. These 40 studies were evaluated for methodological soundness based on established economic principles. None of the 40 studies met the established criteria to form a comprehensive economic evaluation. These results indicate that the orthopedic literature is lacking in economically sound evaluations, and guidelines are offered to aid orthopedists in appraising and improving the quality of economic studies.

Research paper thumbnail of Cost-effectiveness analysis of fixation options for intertrochanteric hip fractures

The Journal of bone and joint surgery. American volume, 2014

Intertrochanteric hip fractures are a major source of morbidity and financial burden, accounting ... more Intertrochanteric hip fractures are a major source of morbidity and financial burden, accounting for 7% of osteoporotic fractures and costing nearly $6 billion annually in the United States. Traditionally, "stable" fracture patterns have been treated with an extramedullary sliding hip screw whereas "unstable" patterns have been treated with the more expensive intramedullary nail. The purpose of this study was to identify parameters to guide cost-effective implant choices with use of decision-analysis techniques to model these common clinical scenarios. An expected-value decision-analysis model was constructed to estimate the total costs and health utility based on the choice of a sliding hip screw or an intramedullary nail for fixation of an intertrochanteric hip fracture. Values for critical parameters, such as fixation failure rate, were derived from the literature. Three scenarios were evaluated: (1) a clearly stable fracture (AO type 31-A1), (2) a clearly uns...

Research paper thumbnail of Total hip arthroplasty in young patients with osteoarthritis

American journal of orthopedics (Belle Mead, N.J.), 2009

Total hip arthroplasty (THA), an effective treatment for patients with end-stage arthritic hip co... more Total hip arthroplasty (THA), an effective treatment for patients with end-stage arthritic hip conditions, provides dramatic pain relief, enhances mobility, and restores function.The success of THA in older patients, in concert with improvements in techniques and biomaterials, has stimulated demand for this procedure in younger, more active patients hoping to regain full activity. Although young age remains a relative contraindication to THA, the weight of this factor has diminished. Several investigators have reported results of low-friction arthroplasty in young patients. Unfortunately, the value of these studies is limited because of heterogeneous hip pathology in the younger groups, particularly given that preoperative pathology has proved to significantly affect implant survival. In this review of the literature, we focus on THA survival in young, active patients with a preoperative diagnosis of noninflammatory osteoarthritis.

Research paper thumbnail of Fixed-bearing, medial unicondylar knee arthroplasty rapidly improves function and decreases pain: a prospective, single-surgeon outcomes study

The journal of knee surgery, 2008

Fixed-bearing, medial unicondylar knee arthroplasties were performed in 33 knees (32 patients). W... more Fixed-bearing, medial unicondylar knee arthroplasties were performed in 33 knees (32 patients). We report a minimum 2-year follow-up, with a mean follow-up of 3 years. Kaplan-Meier survivorship analysis reported 97% survivorship at a mean follow-up of 38 months. Average preoperative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scores improved significantly from 40+/-22 to 92+/-15 (P<.0001). Average preoperative Knee Society knee and function scores improved significantly from 52+/-7 to 90+/-9 (P<.0001) and from 48+/-16 to 84+/-17 (P<.0001), respectively. In addition, average Short Form-12 Physical Component scores significantly increased. Overall stiffness and physical function assessed via the WOMAC index also exhibited significant improvement. Of note, all categories of the WOMAC Index and the Knee Society scores experienced statistically significant improvements at 3-month follow-up, indicating a rapid return to improved function and dimini...

Research paper thumbnail of Patient Education Before Hip or Knee Arthroplasty Lowers Length of Stay

The Journal of Arthroplasty, 2010

From April 2006 to May 2007, 261 patients undergoing primary unilateral total hip arthroplasty or... more From April 2006 to May 2007, 261 patients undergoing primary unilateral total hip arthroplasty or total knee arthroplasty were offered voluntary participation in a one-on-one preoperative educational program. Length of stay (LOS) and inpatient data were monitored and recorded, prospectively. Education participants enjoyed a significantly shorter LOS than nonparticipants for both total hip arthroplasty (3.1 ± 0.8 days vs 3.9 ± 1.4 days; P = .0001) and total knee arthroplasty (3.1 ± 0.9 days vs 4.1 ± 1.9 days; P = .001). Keywords: patient education, preoperative care, hip arthroplasty, knee arthroplasty, length of stay.

Research paper thumbnail of Publication Rates of Scientific Presentations at the American Association of Hip and Knee Surgeons Annual Meetings from 1996 to 2001

The Journal of Arthroplasty, 2007

National orthopedic subspecialty meetings are a research forum where volumes of investigations ar... more National orthopedic subspecialty meetings are a research forum where volumes of investigations are presented after a peer-reviewed selection process. The objective of this investigation was to determine the publication rate of recent scientific presentations presented at the American Association of Hip and Knee Surgeons (AAHKS) annual meetings. From 1996 to 2001, 168 (58%) of 292 podium abstracts presented at meetings were published. The average time to publication was 21.7 F 14.7 months. Three major orthopedic journals constituted 89% of the publications. The 58% publication rate for AAHKS ranks as one of the higher rates for orthopedic specialty meetings and validates the selection process for abstracts presented. In addition, AAHKS meetings are an excellent source for a wide array of quality research and scientific information. Key words: hip prosthesis, knee prosthesis, abstract, publication, research quality.

Research paper thumbnail of Predicting Short-Term Outcome of Primary Total Hip Arthroplasty

The Journal of Arthroplasty, 2010

The purpose of this study was to investigate factors affecting the short-term outcome of primary ... more The purpose of this study was to investigate factors affecting the short-term outcome of primary total hip arthroplasty (THA) and develop a multivariate regression equation to predict the short-term outcome of primary THA. Prospectively collected data for 101 primary THAs performed at a single institution were used in this study. Twelve independent variables were analyzed via correlation and multivariate regression analyses. Correlation analyses showed that three variables significantly influenced Western Ontario and McMaster Universities Osteoarthritis (WOMAC) physical function (PF) score at minimum follow-up of 1 year: preoperative WOMAC PF score (P b .0001), sex (GN, P = .0159), and the presence of preoperative comorbidities (CMB, P = .0246). Multivariate regression analysis yielded the following equation: Outcome = PF0.45 − GN9 + CMB8 + 62, which can be used to predict the general short-term outcome of primary THA.

Research paper thumbnail of Does a High-Flexion Design Affect Early Outcome of Medial Unicondylar Knee Arthroplasty?

Journal of Arthroplasty, 2011

Recently, implant companies have sought to target a more active segment of the population with hi... more Recently, implant companies have sought to target a more active segment of the population with high-flex implants. Our aim was to compare a successful medial UKA implant with its newer high-flex version. Sixty-one patients (nonflex, 33; high-flex [HF], 28) were prospectively followed after medial UKA with a minimum of 2-year follow-up. Patients were evaluated using Short Form 12, Western Ontario

Research paper thumbnail of Studies Presented in Poster Format at the Annual Meetings of the American Association of Hip and Knee Surgeons

The Journal of Arthroplasty, 2007

The purpose of this study was to evaluate the eventual publication rates of poster presentations ... more The purpose of this study was to evaluate the eventual publication rates of poster presentations at the annual meetings of the American Association of Hip and Knee Surgeons from 1996 to 2001 (47%). Common belief expects poster presentations to publish at a lower rate than podium presentations, the latter being typically believed to consist of studies of higher scientific value. We hypothesized that this would lead to a lower incidence of eventual peer-reviewed literature publication for posters. Comparisons from an earlier report confirmed our analysis. Also, poster studies that did survive the peer review process were found in a wide array of journals and were found to publish within a relatively short amount of time (mean, 23.6 ± 15.7 months). Key words: podium, poster, abstract, publication rate, research quality.

Research paper thumbnail of Intraoperative Music Reduces Perceived Pain After Total Knee Arthroplasty – A Blinded, Prospective, Randomized, Placebo-Controlled Clinical Trial

Journal of Knee Surgery, 2008

Patients undergoing total knee arthroplasty (TKA) often experience a difficult recovery due to se... more Patients undergoing total knee arthroplasty (TKA) often experience a difficult recovery due to severe postoperative pain. Using a multimodal pain management protocol, a blinded, randomized, placebocontrolled study was designed to evaluate the efficacy of patient-selected music on reducing perceived pain. Thirty patients undergoing primary unilateral TKA were enrolled and randomized into the music group 15 patients) or the control group (15 patients). Postoperative pain scores, assessed with the visual analog scale, indicated the music group experienced less pain at 3 and 24 hours postoperatively than did the nonmusic group (at 3 hours: 1.4761.39 versus 3.8763.44, P = .01; at 24 hours: 2.4161.67 versus 4.0362.89, P = .04). Intraoperative music provides an inexpensive nonpharmacological option to further reduce postoperative pain. [J Knee Surg. 2008;21:275-278.] The authors are from the Center for Hip and Knee Replacement,

Research paper thumbnail of Fixed-bearing, medial unicondylar knee arthroplasty rapidly improves function and decreases pain: a prospective, single-surgeon outcomes study

The journal of knee surgery, 2008

Fixed-bearing, medial unicondylar knee arthroplasties were performed in 33 knees (32 patients). W... more Fixed-bearing, medial unicondylar knee arthroplasties were performed in 33 knees (32 patients). We report a minimum 2-year follow-up, with a mean follow-up of 3 years. Kaplan-Meier survivorship analysis reported 97% survivorship at a mean follow-up of 38 months. Average preoperative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scores improved significantly from 40+/-22 to 92+/-15 (P<.0001). Average preoperative Knee Society knee and function scores improved significantly from 52+/-7 to 90+/-9 (P<.0001) and from 48+/-16 to 84+/-17 (P<.0001), respectively. In addition, average Short Form-12 Physical Component scores significantly increased. Overall stiffness and physical function assessed via the WOMAC index also exhibited significant improvement. Of note, all categories of the WOMAC Index and the Knee Society scores experienced statistically significant improvements at 3-month follow-up, indicating a rapid return to improved function and dimini...

Research paper thumbnail of Unicompartmental knee arthroplasty: a controversial history and a rationale for contemporary resurgence

The journal of knee surgery, 2008

Treatment of isolated compartment osteoarthritis with unicompartmental knee arthroplasty (UKA) ha... more Treatment of isolated compartment osteoarthritis with unicompartmental knee arthroplasty (UKA) has had mixed reported results and still remains a controversial procedure. More recently, adherence to more stringent patient selection criteria and refined surgical technique has resulted in improved clinical outcomes and survivorship. The popularization of UKA as a more tissue-sparing procedure and minimally invasive alternative to total knee arthroplasty has also played an integral role in its recent resurgence. This review details the history, evolution, and varied results of UKA. Many different prostheses have emerged, some with exceptional long-term results. Long-term prospective analyses will be critical in determining the role of UKA as a mainstay in the treatment of single compartment knee degenerative joint disease.

Research paper thumbnail of Staple Line Reinforcement Reduces Postoperative Pancreatic Stump Leak After Distal Pancreatectomy

Journal of Gastrointestinal Surgery, 2007

Pancreatic stump leak is the major source of morbidity after stapled distal pancreatectomy. We hy... more Pancreatic stump leak is the major source of morbidity after stapled distal pancreatectomy. We hypothesized that reinforcement of the stapler system with a buttress mat can improve leak rates when compared to standard stapling alone. We performed 13 consecutive distal pancreatectomies using our reinforced stapler system, forming our experimental group. A historical control group was composed of 18 patients undergoing stapled pancreatic closure without reinforcement. The main outcome measure was pancreatic leak in the postoperative period. Pancreatic leaks included fistulas and fluid collections (sterile or infected). Hospital length of stay was recorded as a secondary measure. Postoperative pancreatic leak rate was zero in the experimental group, but 39% in the control group (P = 0.025). Development of a pancreatic leak resulted in prolonged hospital stays: 13.6 vs 8.3 days (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.03). We conclude that staple line reinforcement is a simple and effective method of reducing pancreatic stump leakage after distal pancreatectomy. The economic impact of lower leak rates is reflected in significantly shorter hospital stays. The results of our study should be validated in a randomized controlled trial.

Research paper thumbnail of Total Hip Arthroplasty Functional Outcomes Are Independent of Acetabular Component Orientation When a Polyethylene Liner is Employed

The Journal of Arthroplasty, 2015

This study evaluated patient-reported outcomes in patients undergoing primary total hip arthropla... more This study evaluated patient-reported outcomes in patients undergoing primary total hip arthroplasty with a polyethylene liner to determine the influence of cup orientation and other variables on patient-reported outcomes. A total of 477 cases were prospectively monitored through average 4.7 years follow-up. Cup position was measured on pelvis radiographs. Patients completed the Western Ontario and McMaster Universities Osteoarthritis Index and Short Form 12 Health Survey questionnaires. Average cup abduction was 43.1° ± 7.5° and anteversion was 13.3° ± 7.5°. Three hundred cups were within the target zone. All outcomes&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; improvement from baseline and cup position was not an independent risk factor for the Western Ontario and McMaster Universities Osteoarthritis Index or Short Form 12 Health Survey improvement. Accurate cup orientation may not be critical to maximizing patient-perceived outcomes if the combined anteversion is within a normal range, the hip joint is properly balanced, and a polyethylene liner is coupled with a metal or ceramic femoral head.

Research paper thumbnail of Repair of a Chronic Ruptured Quadriceps Tendon With a Medial Gastrocnemius–Hemisoleus–Calcaneal Block Flap

Research paper thumbnail of Extradigital glomus tumor in the knee: excision with ultrasound guided needle localization

Skeletal radiology, 2015

Glomus tumors are rare neoplasms that are usually subungual in location, but can infrequently be ... more Glomus tumors are rare neoplasms that are usually subungual in location, but can infrequently be found elsewhere in the body. When they occur in extradigital locations, they present a diagnostic challenge that may result in delay of definitive management. We report a case of a 51-year-old male who experienced decade long chronic pain because of a glomus tumor in the suprapatellar fat pad of the knee. This case is unique not only because of the glomus tumor's location, but also because it ultimately required ultrasound-guided needle localization for excision.

Research paper thumbnail of Redefining the Acetabular Component Safe Zone for Posterior Approach Total Hip Arthroplasty

The Journal of arthroplasty, Jan 18, 2015

Acetabular component orientation influences joint stability in total hip arthroplasty (THA). The ... more Acetabular component orientation influences joint stability in total hip arthroplasty (THA). The purpose of this study was to evaluate the effect of cup orientation and other variables on hip dislocation risk and to define a posterior approach specific safe zone. A cohort of 1289 posterior approach primary THA cases was prospectively followed and component position measured radiographically. Cup malposition, with respect to the Lewinnek safe zone, was an independent risk factor for dislocation (OR1.88). Modifying the anteversion safe zone limits to 10-25° strongly predicted increased dislocation risk (OR2.69). No dislocations occurred within a zone defined by a circle centered at 41.4° abduction and 17.1° anteversion, radius 4.3°. Utilizing a posterior approach specific safe zone of 10-25° anteversion and 30-50° abduction may minimize THA dislocations. Level III.

Research paper thumbnail of Liberal versus restrictive blood transfusion strategy: 3-year survival and cause of death results from the FOCUS randomised controlled trial

Lancet, Jan 9, 2014

Blood transfusion might affect long-term mortality by changing immune function and thus potential... more Blood transfusion might affect long-term mortality by changing immune function and thus potentially increasing the risk of subsequent infections and cancer recurrence. Compared with a restrictive transfusion strategy, a more liberal strategy could reduce cardiac complications by lowering myocardial damage, thereby reducing future deaths from cardiovascular disease. We aimed to establish the effect of a liberal transfusion strategy on long-term survival compared with a restrictive transfusion strategy. In the randomised controlled FOCUS trial, adult patients aged 50 years and older, with a history of or risk factors for cardiovascular disease, and with postoperative haemoglobin concentrations lower than 100 g/L within 3 days of surgery to repair a hip fracture, were eligible for enrolment. Patients were recruited from 47 participating hospitals in the USA and Canada, and eligible participants were randomly allocated in a 1:1 ratio by a central telephone system to either liberal trans...

Research paper thumbnail of Introduction

Operative Techniques in Orthopaedics

Research paper thumbnail of Total hip resurfacing: a viable alternative to total hip arthroplasty for the young active hip patient in the United States?

Current Orthopaedic Practice, 2008

Research paper thumbnail of Understanding economic evaluations: a review of the knee arthroplasty literature

The American journal of knee surgery, 1999

The study reviewed the literature to appraise the quality, quantity, and type of economic evaluat... more The study reviewed the literature to appraise the quality, quantity, and type of economic evaluation as it pertains to the knee arthroplasty literature. A computerized bibliographic search of MEDLINE from 1966-1996 was conducted, revealing a total of 43,178 articles dealing with cost analysis, of which 1611 were orthopedic. Of the economic orthopedic studies, only 63 dealt with the topic of knee arthroplasty. These studies were retrieved, of which only 40 papers met the inclusion criteria. These 40 studies were evaluated for methodological soundness based on established economic principles. None of the 40 studies met the established criteria to form a comprehensive economic evaluation. These results indicate that the orthopedic literature is lacking in economically sound evaluations, and guidelines are offered to aid orthopedists in appraising and improving the quality of economic studies.

Research paper thumbnail of Cost-effectiveness analysis of fixation options for intertrochanteric hip fractures

The Journal of bone and joint surgery. American volume, 2014

Intertrochanteric hip fractures are a major source of morbidity and financial burden, accounting ... more Intertrochanteric hip fractures are a major source of morbidity and financial burden, accounting for 7% of osteoporotic fractures and costing nearly $6 billion annually in the United States. Traditionally, "stable" fracture patterns have been treated with an extramedullary sliding hip screw whereas "unstable" patterns have been treated with the more expensive intramedullary nail. The purpose of this study was to identify parameters to guide cost-effective implant choices with use of decision-analysis techniques to model these common clinical scenarios. An expected-value decision-analysis model was constructed to estimate the total costs and health utility based on the choice of a sliding hip screw or an intramedullary nail for fixation of an intertrochanteric hip fracture. Values for critical parameters, such as fixation failure rate, were derived from the literature. Three scenarios were evaluated: (1) a clearly stable fracture (AO type 31-A1), (2) a clearly uns...

Research paper thumbnail of Total hip arthroplasty in young patients with osteoarthritis

American journal of orthopedics (Belle Mead, N.J.), 2009

Total hip arthroplasty (THA), an effective treatment for patients with end-stage arthritic hip co... more Total hip arthroplasty (THA), an effective treatment for patients with end-stage arthritic hip conditions, provides dramatic pain relief, enhances mobility, and restores function.The success of THA in older patients, in concert with improvements in techniques and biomaterials, has stimulated demand for this procedure in younger, more active patients hoping to regain full activity. Although young age remains a relative contraindication to THA, the weight of this factor has diminished. Several investigators have reported results of low-friction arthroplasty in young patients. Unfortunately, the value of these studies is limited because of heterogeneous hip pathology in the younger groups, particularly given that preoperative pathology has proved to significantly affect implant survival. In this review of the literature, we focus on THA survival in young, active patients with a preoperative diagnosis of noninflammatory osteoarthritis.

Research paper thumbnail of Fixed-bearing, medial unicondylar knee arthroplasty rapidly improves function and decreases pain: a prospective, single-surgeon outcomes study

The journal of knee surgery, 2008

Fixed-bearing, medial unicondylar knee arthroplasties were performed in 33 knees (32 patients). W... more Fixed-bearing, medial unicondylar knee arthroplasties were performed in 33 knees (32 patients). We report a minimum 2-year follow-up, with a mean follow-up of 3 years. Kaplan-Meier survivorship analysis reported 97% survivorship at a mean follow-up of 38 months. Average preoperative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scores improved significantly from 40+/-22 to 92+/-15 (P<.0001). Average preoperative Knee Society knee and function scores improved significantly from 52+/-7 to 90+/-9 (P<.0001) and from 48+/-16 to 84+/-17 (P<.0001), respectively. In addition, average Short Form-12 Physical Component scores significantly increased. Overall stiffness and physical function assessed via the WOMAC index also exhibited significant improvement. Of note, all categories of the WOMAC Index and the Knee Society scores experienced statistically significant improvements at 3-month follow-up, indicating a rapid return to improved function and dimini...