45Th Annual Meeting

Eastern Orthopaedic Association 45th Annual Meeting

October 22-25, 2014 The Ritz-Carlton Amelia Island, FL

Published by Data Trace Publishing Company Grantor & Exhibitor Acknowledgements The Eastern Orthopaedic Association is grateful for the support of its educational grantors and exhibitors. Thank you for your participation and commitment to EOA. Platinum Pacira Pharmaceuticals, Inc. Gold ConvaTec, Inc. Mallinckrodt Pharmaceuticals - Hospital Division Silver Zimmer, Inc. — Grantor Bronze Arthrex, Inc. — Grantor Smith & Nephew, Inc. Copper Blue Belt Technologies Innovative Medical Products, Inc. CeramTec Medical Products Integrity Rehab Group ConforMIS Marathon Pharmaceuticals, LLC DePuy Synthes MES Solutions DJO Global, Inc. MicroAire Surgical Instruments Exactech, Inc. National Surgical Healthcare Ferring Pharmaceuticals Inc. Quill / Surgical Specialities Corp.

Exhibitors 3D Systems, Simbionix Medtronic Advanced Energy American Academy of Orthopaedic Surgeons MicroPort Orthopedics ACIGI Relaxation Modernizing Medicine, Inc. BBL Medical Facilities Nutramax Laboratories Customer Care, Inc. Biocomposites Ortho-Preferred Ceterix Orthopaedics Osiris Therapeutics, Inc. EOS imaging ProScan Reading Services Hospital Corporation of America Skeletal Dynamics iRemedy Terason LifeNet Health THINK Surgical Mallinckrodt Pharmaceuticals VirtaMed AG Medstrat Eastern Orthopaedic Association 45th Annual Meeting October 22-25, 2014 The Ritz-Carlton Amelia Island, Florida

2014 Meeting Program

Chuck Freitag Executive Director, Data Trace Management Services, a Data Trace Company Cynthia Lichtefeld Director of Operations, Data Trace Management Services, a Data Trace Company

EOA Central Offi ce, Data Trace Management Services 110 West Road, Suite 227 Towson, MD 21204 Phone: 866-362-1409 Fax: 410-494-0515 Email: [email protected] www.eoa-assn.org Please notify the EOA Central Offi ce of any changes in your home or offi ce address. This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the American Acad- emy of Orthopaedic Surgeons and the Eastern Orthopaedic Association. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians. The American Academy of Orthopaedic Surgeons designates this live activity for a maximum of 26.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

EOA President’s Message

Dear Colleagues: aren and I are honored to welcome you to the 45th Annual Meeting of the Eastern Orthopaedic Association. Thank you for attending what Kwill be a fantastic academic and social program at the luxurious Ritz- Carlton, Amelia Island. You will experience the unique collegial and educational experience that only regional meetings offer. Program Chairman, Amar Ranawat, MD from New York, and the Program Committee have prepared an informative program with a unique blend of over 200 podium presentations, 7 symposia with outstanding presenting faculty, 30 poster presentations, and, new to EOA, “rapid ﬁ re” sessions. There will be plenty of opportunity for discussion and interaction with faculty and once again, awards David W. Romness, MD will be given to the top 15 papers. You can also earn 10 SAE credits toward your MOC requirements with the EOA online Self-Assessment Exam. I am honored to welcome Mary O’Connor, MD, Chair, Department of Ortho- paedic Surgery, Mayo Clinic, Jacksonville, as the Presidential Guest Speaker. She is a true orthopaedic leader and a former Olympian. The Steel Lecturer will be YouTube and Comedy Central sensation GoRemy (Remy Munasiﬁ ), who is very creative with comedy and political comedy. His YouTube channel has been viewed over 80 million times. Our Spouse’s Committee and management team, Data Trace, have also put together a dynamic social program so there will be plenty to keep you and your family busy. Amelia Island offers endless recreational and historic opportunities. I hope you will enjoy all that the EOA Annual Meeting and Amelia Island have to offer.

Sincerely, David W. Romness David W. Romness, MD President, Eastern Orthopaedic Association

2 Table of Contents

Table of Contents

General Information Meeting-at-a-Glance ...... 4 Scientiﬁ c Program Agenda ...... 7 Activities Information ...... 10 Meeting Information ...... 13 President/Past Presidents ...... 14 Howard Steel Lecturer ...... 15 Leadership ...... 16 EOEF Supporters ...... 18 New Active Members ...... 20 Membership by State/Membership by Classiﬁ cation ...... 22 Grantor/Exhibitor Acknowledgments ...... 23 Grantor/Exhibitor Information ...... 24 First Business Meeting ...... 30 Second Business Meeting ...... 33 Past Meeting Information ...... 35

Scientifi c Program Program Chairman ...... 41 Presidential Guest Speaker ...... 43 Resident/Fellow Award Recipients ...... 44 Financial Disclosure Information ...... 46 Accreditation Information ...... 56 Scientifi c Program ...... 58 Presenters and Moderators Index ...... 86 Scientifi c Program Abstracts Thursday ...... 89 Friday ...... 130 Saturday ...... 173 Scientifi c Poster Exhibits Poster Presenters Index ...... 226 Scientifi c Poster Abstracts ...... 227 Multimedia Education Sessions List of Available Titles ...... 244 Multimedia Financial Disclosure Information ...... 249 CME Forms 2014 CME Multimedia Education Credit Record ...... 253 2014 CME Scientifi c Program Credit Record ...... 255 2014 CME Poster Credit Record ...... 257 2014 Overall Scientifi c Evaluation ...... 259 2015 Needs Assessment Survey ...... 261 Future EOA Meetings ...... Inside Back Cover

3 EOA 45th Annual MeetingAmelia Island, Florida2014

Meeting-at-a-Glance

Times and locations are subject to change. Badges or wrist bands are required for admittance to all events.

Wednesday, October 22, 2014 6:30am–8:00am President’s Council Meeting (Amelia Room) 8:00am–12:00pm Board of Directors Meeting (Amelia Room) 9:00am–10:00am Spouse’s Board Meeting (Ambassador Room) 12:00pm–5:00pm Meeting Registration (Ritz-Carlton Ballroom Foyer) 12:00pm–5:00pm Sponsor/Exhibit Setup (Ritz-Carlton Ballroom Salons 2 & 3) 12:00pm–5:00pm Speaker Ready Room (Ambassador Room) 12:00pm–5:00pm Scientiﬁ c Poster Setup (Ritz-Carlton Ballroom Foyer)

Thursday, October 23, 2014 6:00am–7:00am Scientiﬁ c Poster Session (Ritz-Carlton Ballroom Foyer) Note: Presenters will be available to answer questions. 6:00am–5:00pm Speaker Ready Room (Ambassador Room) 6:30am–3:00pm Meeting Registration (Ritz-Carlton Ballroom Foyer) 6:30am–3:00pm Technical Exhibits, Continental Breakfast, Coffee Breaks and Daily Drawing (Ritz-Carlton Ballroom Salons 2 & 3) The drawing will take place at the end of the second break in the exhibit area. You must be present to win! 7:00am–3:00pm Scientiﬁ c Sessions and Symposia (Ritz-Carlton Ballroom Salon 1) 8:00am Beach Walk (Meet in Lobby) 8:25am–8:40am First Business Meeting (Ritz-Carlton Ballroom Salon 1) 8:45am–10:15am Spouse/Children’s Hospitality (Salt Restaurant) 9:45am–10:15am Rapid Fire Sessions (Plaza Ballroom 1 & Ritz-Carlton Ballroom Foyer) 10:35am–11:05am Presidential Address (Ritz-Carlton Ballroom Salon 1) 11:05am–11:50am Howard Steel Lecture (Ritz-Carlton Ballroom Salon 1) 11:50am–12:50pm EOA Luncheon — Industry Presentations by ConvaTec and Mallinckrodt Pharmaceuticals – Hospital Division (Ritz-Carlton Ballroom Salon 1) *Not for CME Credit 1:42pm–2:12pm Rapid Fire Sessions (Plaza Ballroom 1 & Ritz-Carlton Ballroom Foyer) 2:00pm–4:00pm Fort Clinch Tour (Meet in Lobby)

* See Activities Information on pages 10-12 for more details

4 Meeting-at-a-Glance

3:00pm–4:00pm Scientiﬁ c Poster Session (Ritz-Carlton Ballroom Foyer) Note: Presenters will be available to answer questions. 4:00pm–5:00pm Multimedia Education Session (Ambassador Room) 6:15pm–7:00pm New Member Reception (Spa Pool) 7:00pm–9:30pm Welcome Reception (Oceanfront Lawn)

Friday, October 24, 2014 6:00am–7:00am Regional and AAOS President’s Breakfast Meeting with State Presidents and Board of Councilors (Santa Maria Room) 6:00am–7:00am Scientifi c Poster Session (Ritz-Carlton Ballroom Foyer) Note: Presenters will be available to answer questions. 6:00am–5:00pm Speaker Ready Room (Ambassador Room) 6:45am–3:00pm Meeting Registration (Ritz-Carlton Ballroom Foyer) 6:45am–3:00pm Technical Exhibits, Continental Breakfast, Coffee Breaks and Daily Drawing (Ritz-Carlton Ballroom Salons 2 & 3) The drawing will take place at the end of the second break in the exhibit area. You must be present to win! 7:00am–3:00pm Scientifi c Sessions and Symposia (Ritz-Carlton Ballroom Salon 1) 8:00am Beach Walk (Meet in Lobby) 8:20am–8:50am Rapid Fire Sessions (Plaza Ballroom 1 & Ritz-Carlton Ballroom Foyer) 10:00am Party Bridge (All Levels Welcome) (Lobby ) 10:30am–2:30pm Culinary at Ritz-Carlton — Salt Cooking School (Meet in Salt Restaurant) 10:50am–11:30am Presidential Guest Speaker (Ritz-Carlton Ballroom Salon 1) 11:30am–12:30pm EOA Luncheon — Industry Presentation by Pacira Pharmaceuticals, Inc. (Ritz-Carlton Ballroom Salon 1) *Not for CME Credit 12:00pm–5:00pm Back Water Fishing (Meet in Lobby) 12:30pm–5:30pm Golf Tournament (Meet at Pro Shop) 1:30pm–2:00pm Rapid Fire Sessions (Plaza Ballroom 1 & Ritz-Carlton Ballroom Foyer) 3:00pm–4:00pm Scientifi c Poster Session (Ritz-Carlton Ballroom Foyer) Note: Presenters will be available to answer questions. 4:00pm–5:00pm Multimedia Education Session (Ambassador Room) 5:30pm–7:30pm Exhibitor Reception (Ritz-Carlton Ballroom Salons 2 & 3) 5:30pm–7:30pm Kid’s Movie and Arts & Crafts (Santa Maria Room)

* See Activities Information on pages 10-12 for more details

5 EOA 45th Annual MeetingAmelia Island, Florida2014

Saturday, October 25, 2014 6:00am–7:00am Board of Directors Meeting (Amelia Room) 6:00am–7:00am Scientifi c Poster Session (Ritz-Carlton Ballroom Foyer) Note: Presenters will be available to answer questions. 6:00am–2:00pm Speaker Ready Room (Ambassador Room) 6:45am–2:00pm Meeting Registration (Ritz-Carlton Ballroom Foyer) 6:45am–2:00pm Technical Exhibits, Continental Breakfast, Coffee Breaks and Daily Drawing (Ritz-Carlton Ballroom Salons 2 & 3) The drawing will take place at the end of the fi rst break in the exhibit area. You must be present to win! 7:00am–2:02pm Scientifi c Sessions and Symposia (Ritz-Carlton Ballroom Salon 1) 8:00am Beach Walk (Meet in Lobby) 8:27am–8:42am Second Business Meeting (Ritz-Carlton Ballroom Salon 1) 9:30am Book Discussion (Café 4750) 9:39am–10:09am Rapid Fire Sessions (Plaza Ballroom 1 & Ritz-Carlton Ballroom Foyer) 11:00am–12:30pm Salt of the Earth/Custom Blending-Bar Experience (Meet in Spa Boutique) 1:00pm–5:00pm Cumberland Island Walking Tour (Meet in Lobby) 1:00pm–6:00pm Deep Sea Fishing (Meet in Lobby) 12:24pm–12:54pm Rapid Fire Sessions (Plaza Ballroom 1 & Ritz-Carlton Ballroom Foyer) 2:00pm–4:00pm Tennis Round Robin (Meet at Tennis Courts) 2:02pm–3:00pm Scientifi c Poster Session (Ritz-Carlton Ballroom Foyer) Note: Presenters will be available to answer questions. 3:00pm–4:00pm Multimedia Education Session (Ambassador Room) 6:15pm–7:15pm Jazz Band Reception (Ritz-Carlton Ballroom Foyer) 6:15pm–11:00pm Kid’s Movie and Arts & Crafts (Santa Maria Room) 7:15pm–11:00pm Founder’s Dinner Dance (Ritz-Carlton Ballroom Salons 2 & 3)

* See Activities Information on pages 10-12 for more details

6 Scientiﬁ c Program Agenda

Scientiﬁ c Program Agenda Presenters and times are subject to change.

Ritz-Carlton Ballroom Salon 1, unless otherwise speciﬁ ed.

THURSDAY, OCTOBER 23, 2014 6:00am–7:00am Scientiﬁ c Poster Session (Ritz-Carlton Ballroom Foyer) Note: Presenters will be available to answer questions. 7:00am–7:05am Welcome to EOA’s 45th Annual Meeting 7:05am–7:45am General Session 1 — Sports Medicine 7:45am–8:25am Symposium 1 — What’s New in Foot and Ankle Surgery 8:25am–8:40am First Business Meeting 8:40am–9:00am Break — Please visit Exhibitors (Ritz-Carlton Ballroom Salons 2 & 3) 9:00am–9:40am Symposium 2 — What’s New in ACL Reconstruction Surgery 9:40am–9:45am Go to Stations 9:45am–10:15am Rapid Fire Session 2A — Sports Medicine (Station A, Plaza Ballroom 1) 9:45am–10:15am Rapid Fire Session 2B — Total Knee (Station B, Plaza Ballroom 1) 9:45am–10:15am Rapid Fire Session 2C — Total Hip (Station C, Ritz-Carlton Ballroom Foyer) 9:45am–10:15am Rapid Fire Session 2D — Spine (Station D, Ritz-Carlton Ballroom Foyer) 9:45am–10:15am Rapid Fire Session 2E — Health Policy (Station E, Ritz-Carlton Ballroom Foyer) 10:15am–10:35am Break — Please visit Exhibitors (Ritz-Carlton Ballroom Salons 2 & 3) 10:35am–11:50am General Session 3 — Presidential Address and Howard Steel Lecture 11:50am–12:50pm EOA Luncheon — Industry Presentation by ConvaTec and Mallinckrodt Pharmaceuticals – Hospital Division *Not for CME Credit 12:50pm–1:38pm General Session 4 — Basic Science & Total Hip 1:38pm–1:42pm Go to Stations 1:42pm–2:12pm Rapid Fire Session 5A — Hip (Station A, Plaza Ballroom 1) 1:42pm–2:12pm Rapid Fire Session 5B — Spine (Station B, Plaza Ballroom 1) 1:42pm–2:12pm Rapid Fire Session 5C — Total Knee Reconstruction (Station C, Ritz-Carlton Ball- room Foyer) 1:42pm–2:12pm Rapid Fire Session 5D — Knee (Station D, Ritz-Carlton Ballroom Foyer) 1:42pm–2:12pm Rapid Fire Session 5E — Upper Extremity (Station E, Ritz-Carlton Ballroom Foyer) 2:12pm–2:16pm Go to General Session Room 2:16pm–3:00pm General Session 6 — Trauma/Sports/Misc. Case Presentations

7 EOA 45th Annual MeetingAmelia Island, Florida2014

3:00pm–4:00pm Scientiﬁ c Poster Session (Ritz-Carlton Ballroom Foyer) Note: Presenters will be available to answer questions. 4:00pm–5:00pm Multimedia Education Session (Ambassador Room)

FRIDAY, OCTOBER 24, 2014 6:00am–7:00am Scientiﬁ c Poster Session (Ritz-Carlton Ballroom Foyer) Note: Presenters will be available to answer questions. 7:00am–7:48am General Session 7 — Foot & Ankle and Spine 7:48am–8:16am Symposium 3 — What’s New in Trauma 8:15am–8:20am Go to Stations 8:20am–8:50am Rapid Fire Session 8A — Total Hip Reconstruction (Station A, Plaza Ballroom 1) 8:20am–8:50am Rapid Fire Session 8B — Total Knee Reconstruction (Station B, Plaza Ballroom 1) 8:20am–8:50am Rapid Fire Session 8C — Hip (Station C, Ritz-Carlton Ballroom Foyer) 8:20am–8:50am Rapid Fire Session 8D — Knee (Station D, Ritz-Carlton Ballroom Foyer) 8:20am–8:50am Rapid Fire Session 8E — Mixed Topics (Station E, Ritz-Carlton Ballroom Foyer) 8:50am–9:10am Break — Please visit Exhibitors (Ritz-Carlton Ballroom Salons 2 & 3) 9:10am–10:00am Symposium 4 — What’s New in Total Joints 10:00am–10:20am Break — Please visit Exhibitors (Ritz-Carlton Ballroom Salons 2 & 3) 10:20am–11:30am General Session 9 — BOC, OREF, AOA, AAOS Report & Presidential Guest Speaker 11:30am–12:30pm EOA Luncheon — Industry Presentation by Pacira Pharmaceuticals, Inc. *Not for CME Credit 12:30pm–1:26pm General Session 10 — Mixed Topics 1:26pm–1:30pm Go to Stations 1:30pm–2:00pm Rapid Fire Session 11A — Hip (Station A, Plaza Ballroom 1) 1:30pm–2:00pm Rapid Fire Session 11B — Knee (Station B, Plaza Ballroom 1) 1:30pm–2:00pm Rapid Fire Session 11C — Tumor (Station C, Ritz-Carlton Ballroom Foyer) 1:30pm–2:00pm Rapid Fire Session 11D — Upper Extremity (Station D, Ritz-Carlton Ballroom Foyer) 1:30pm–2:00pm Rapid Fire Session 11E — Pediatrics (Station E, Ritz-Carlton Ballroom Foyer) 2:00pm–2:04pm Go To General Session Room 2:04pm–3:00pm General Session 12 — Foot/Ankle Arthroplasty Case Presentations 3:00pm–4:00pm Scientiﬁ c Poster Session (Ritz-Carlton Ballroom Foyer) Note: Presenters will be available to answer questions. 4:00pm–5:00pm Multimedia Education Session (Ambassador Room)

8 Scientiﬁ c Program Agenda

SATURDAY, OCTOBER 25, 2014 6:00am–7:00am Scientiﬁ c Poster Session (Ritz-Carlton Ballroom Foyer) Note: Presenters will be available to answer questions. 7:00am–7:56am General Session 13 — Mixed Topics 7:56am–8:27am Symposium 5 — What’s New in Hip Preservation Surgery 8:27am–8:42am Second Business Meeting 8:42am–9:07am Break — Please visit Exhibitors (Ritz-Carlton Ballroom Salons 2 & 3) 9:07am–9:35am Symposium 6 — What’s New in Spine Surgery 9:35am–9:39am Go to Stations 9:39am–10:09am Rapid Fire Session 14A — Foot (Station A, Plaza Ballroom 1) 9:39am–10:09am Rapid Fire Session 14B — Trauma (Station B, Plaza Ballroom 1) 9:39am–10:09am Rapid Fire Session 14C — Spine (Station C, Ritz-Carlton Ballroom Foyer) 9:39am–10:09am Rapid Fire Session 14D — Total Hip Reconstruction (Station D, Ritz-Carlton Ball- room Foyer) 9:39am–10:09am Rapid Fire Session 14E — Hand (Station E, Ritz-Carlton Ballroom Foyer) 10:09am–10:24am Refreshment Break (Ritz-Carlton Ballroom Foyer) 10:24am–11:20am General Session 15 — Mixed Topics 11:20am–11:40am Refreshment Break (Ritz-Carlton Ballroom Foyer) 11:40am–12:20pm Symposium 7 — What’s New in Shoulder and Elbow Surgery 12:20pm–12:24pm Go to Stations 12:24pm–12:54pm Rapid Fire Session 16A — Trauma (Station A, Plaza Ballroom 1) 12:24pm–12:54pm Rapid Fire Session 16B — Total Hip Reconstruction (Station B, Plaza Ballroom 1) 12:24pm–12:54pm Rapid Fire Session 16C — Knee (Station C, Ritz-Carlton Ballroom Foyer) 12:24pm–12:54pm Rapid Fire Session 16D — Shoulder (Station D, Ritz-Carlton Ballroom Foyer) 12:24pm–12:54pm Rapid Fire Session 16E — Basic Science (Station E, Ritz-Carlton Ballroom Foyer) 12:54pm–12:58pm Go to General Session Room 12:58pm–2:02pm General Session 17 — Mixed Topics 2:02pm–3:00pm Scientiﬁ c Poster Session (Ritz-Carlton Ballroom Foyer) Note: Presenters will be available to answer questions. 3:00pm–4:00pm Multimedia Education Session (Ambassador Room)

9 EOA 45th Annual MeetingAmelia Island, Florida2014

Activities Information

Badges or wristbands are required for admittance to all events.

still maintained as a Union Garrison by Rangers dressed THURSDAY, OCTOBER 23, 2014 in authentic uniforms. Park “Interpretation Tours” guide you through the everyday life of a Civil War soldier. This Beach Walk state park is unusual in that it possesses both historical and 8:00am (Meet in Lobby) natural qualities. Price: Included in registration fee Price: $90 per person (12 person minimum); lunch not included Spouse/Children’s Hospitality 8:45am–10:15am (Salt Restaurant) New Member Reception Join your friends and meet new spouses while enjoying 6:15pm–7:00pm (Spa Pool) a continental breakfast. The Salt Sommelier will tell us All EOA new members are invited to attend this reception. how the Chef infuses herbs, citrus and other ﬂ avors to The EOA Board and Committee Members would like to make the resort’s house-made gourmet salts. The Salt take this opportunity to welcome you to the EOA. Sommelier will share different cooking tips and the Price: Included in registration fee healthy beneﬁ ts of these infused salts. Participants may taste and sample salts from all over the world as well as Welcome Reception learn the secrets of cooking on a salt platter that’s 250 7:00pm–9:30pm (Oceanfront Lawn) million years old. Have a wonderful evening on the Ocean Lawn over- Price: Included in registration fee; $40 per looking the water with food delicacies and drinks to be Unregistered Guest; $20 per Unregistered enjoyed. Child Attire: Resort Casual (no jacket required), spike heels not recommended. EOA Luncheon — Industry Presentations by Price: Included in registration fee; $75 per and ConvaTec Mallinckrodt Pharmaceuticals – Unregistered Adult Guest; $25 per Hospital Division Unregistered Child (5-17 years) 11:50am–12:50pm (Ritz-Carlton Ballroom Salon 1) Advances in Peri-Operative Care of the Hip & Knee Patient: Management of Surgical Site Infection & FRIDAY, OCTOBER 24, 2014 Acute Pain • Peri-Operative Pain Management for Orthopaedic Beach Walk Surgery 8:00am (Meet in Lobby) • Changing Incidence of Arthroplasty and Burden of Price: Included in registration fee Infection, Risk Mitigation of Infection, and Recent Advances in Post–Operative Wound Management Party Bridge (All levels welcome) *Not for CME credit 10:00am (Lobby) Price: Included in registration fee, lunch provided Price: Included in registration fee (Food and beverage on own.) Fort Clinch Tour 2:00pm–4:00pm (Meet in Lobby) Culinary at Ritz-Carlton — Salt Cooking School In 1847, the construction of Fort Clinch began here on 10:30am–2:30pm (Meet in Salt Restaurant) Amelia Island. A part of the park system since 1935, Spend the afternoon behind the scenes of the AAA Fort Clinch in one of the most well-preserved 19th Five Diamond Award winning restaurant. Salt Cooking Century forts is the country. Although no battles were School is a hands-on opportunity for those passionate fought here, it was garrisoned during both the Civil and about cooking to experience new techniques from the Spanish-American wars. During the 1930s, the Civil- talented chefs. Guests will immerse themselves in the ian Conservation Corps began preserving and rebuilding Salt Kitchen and learn how to artfully prepare the same many of the structures of the abandoned fort. The fort is dishes the chefs create each evening in the restaurant.

10 Activities Information

Salt Cooking School is an exclusive opportunity for Kids’ Movie Party and Arts & Crafts guests to be inspired and learn new skills they can take 5:30pm–7:30pm (Santa Maria Room) home to their own kitchens. After class, guests will enjoy Dinner and a movie—fun! Watch a great movie and nibble their own award winning lunch - Butternut Squash Soup, on snacks and treats with your friends. If younger than 5 Halibut, Herb Gnocchi, Warm Chocolate Cake and other years old, must be accompanied by an adult. tidbits. Price: Included in registration fee or $25 per Price: $155 per person (10 person minimum) Unregistered Child (5-17 years) EOA Luncheon — Industry Presentation by Pacira Pharmaceuticals, Inc. SATURDAY, OCTOBER 25, 2014 11:30am–12:30pm (Ritz-Carlton Ballroom Salon 1) Pain Management Beach Walk *Not for CME credit 8:00am (Meet in Lobby) Price: Included in registration fee, lunch provided Price: Included in registration fee Back Water Fishing 12:00pm–5:00pm (Meet in Lobby) Book Discussion Enjoy fi shing from 22’ to 24’ Bay boats. Captains with 9:30am (Café 4750) many years of local fi shing experience will guide guests BYOB – Share ideas about great reads and make new through the backwater creeks and rivers of Amelia friends. Island. You will be fi shing within 10 minutes of leaving Price: Included in registration fee (Food and beverage the dock. Guests will enjoy the tranquil nature of the on own.) surrounding area with sea birds, dolphins, and manatees, while at the same time fi shing for target species includ- Salt of the Earth/Custom Blending-Bar Experience ing the prized redfi sh, sea trout, fall fl ounder, blue fi sh, 11:00am–12:30pm (Meet in Spa Boutique) shark, and jack crevalle. Light tackle spinning rods are Hand-blend your very own salt or sugar scrub and used, and anglers will fi ght these species that can exceed whipped body crème with a scent you create from 10 pounds. After the charter, the captains will fi let and the resort’s signature aroma collection. This fun and ice the fi sh, which may be brought back to the hotel for interactive experience includes your very own “Salt the chef to prepare. Barista” who will demonstrate how to custom create Price: $325 per person (4 person minimum) your own body indulgence product using their Salt of the Earth Blend-Bar. Enjoy learning about the ben- Golf Tournament efi ts of using natural ingredients like Himalayan salt, 12:30pm–5:30pm (Meet at Pro Shop) sugar and vitamins A and E enriched grape seed oil to The 18-hole championship golf course is an avid rebuild collagen, repair damaged skin and enhance the golfer’s dream. Designed by Mark McCumber and skin’s resistance to oxidative damage. This experience Gene Littler, this north Florida golf resort’s breath- will create a memory that will last, as each guest will taking landscape is as beautiful as it is challenging. personally choose or mix scents to create his or her Meticulously maintained greens, strategically bunkered own unique fragrance. Guests will then bottle their own fairways and the ever-shifting ocean breeze ensure no body indulgence products, complete with a label they two rounds are ever the same. The tournament will be a sign and date. 1:00pm shotgun start with scramble format. Come rain Price: $45 per person (10 person minimum) or shine. Greens fees, lunch, beverage cart and transportation are included. Cumberland Island Walking Tour Price: $185 per person 1:00pm–5:00pm (Meet in Lobby) Relax on a sightseeing cruise to the National Seashore, Exhibitor Reception Cumberland Island. Enjoy a 45-minute cruise aboard the 5:30pm–7:30pm (Ritz-Carlton Ballroom Salons 2 & 3) “Cumberland Princess” and catch a glimpse of historic Before you go to dinner, start your evening off with drinks Fort Clinch and the backwaters and inlets of the St. and hors d’oeuvres with EOA. Mary’s River. Wildlife abounds both on land and in the Attire: Business Casual water—and there is always a chance of sighting a dol- Price: Included in registration fee or $75 per phin! Visit majestic Cumberland Island, which is well Unregistered Adult Guest known for its wildlife, natural settings, water fowl and

11 EOA 45th Annual MeetingAmelia Island, Florida2014

wild horses. For thousands of years people have lived on Jazz Reception/Founders’ Dinner Dance Cumberland Island (only 30 permanent residents live there 6:15pm–11:00pm (Ritz-Carlton Ballroom Foyer/Ritz- today), but never in such numbers as to permanently alter Carlton Ballroom Salons 2&3) the character of the landscape. The evening begins with a lovely reception and music Price: $150 per person (30 person minimum); lunch brought to you by the EOA Jazz Band. The band plays not included popular jazz tunes that will be enjoyed by all. Dinner will also be an event to remember with a delicious meal, good Deep Sea Fishing company, and Big Band dancing music. 1:00pm–6:00pm (Meet in Lobby) Attire: Jacket and Tie Enjoy the thrill of catching the fi sh of a lifetime aboard a Price: Included in registration fee; $150 per state-of-the-art sport fi shing boat. Troll for sailfi sh, marlin, Unregistered Adult Guest; $95 per Unregistered dolphin, kingfi sh, tuna, cobia, and shark, or bottom fi sh Child (5-17 years); $75 Surcharge for Registered for grouper, snapper, sea bass, and shark. During October Child you may experience the Giant Bull Redfi sh Run, where “bull reds” up to 50 pounds are caught around the sur- Kids’ Movie Party and Arts & Crafts rounding jetties. The captain and mate provide all the fi sh- 6:15pm–11:00pm (Santa Maria Room) ing tackle, rigged bait, and instruction required. After the While your parents are at the Founders’ Dinner, enjoy charter, the captains will fi let and ice the fi sh, which may dinner and crafts or a movie with your friends. If younger be brought back to the hotel for the chef to prepare. Box than 5 years old, must be accompanied by an adult. This lunch and beverages included. is not a babysitting service, but provided only for parents Price: $320 per person (6 person minimum) attending the Founders’ Dinner; children must be registered. Tennis Round Robin Price: Included in registration fee or $25 per 2:00pm–4:00pm (Meet at Tennis Courts) Unregistered Child (5-17 years) Price: $40 per person (4 person minimum)

12 Meeting Information

Meeting Information

FORMAT REGISTER FOR THE EXHIBITORS DAILY The educational sessions will be held October 23-25, 2014, DRAWING from approximately 7:00am until 3:00pm. Registered physicians will receive a Raffl e Ticket every day during the meeting to register with the exhibitors and grantors. TARGET AUDIENCE Place your ticket in the raffl e box for a chance to win. Draw- The 45th Annual Meeting of the Eastern Orthopaedic Associa- ings will take place on Thursday and Friday at the end of the tion has been developed primarily for orthopaedic and trauma second break and on Saturday at the end of the fi rst break in the surgeons. Physician Assistants, LPNs, and Physical Therapists Exhibit Area. would also benefi t from this program. CME ACCREDITATION SPEAKER READY ROOM The American Academy of Orthopaedic Surgeons designates this live activity for a maximum of 26.5 AMA PRA Category 1 The Speaker Ready Room is available 24 hours a day. Please Credits™. Physicians should claim only the credit commensu- contact Hotel Security for access during unscheduled times. rate with the extent of their participation in the activity. Must show ID/Badge to be admitted after hours. *17.5 CME Credits for Scientifi c Program PHYSICIAN REGISTRATION FEE *6 CME Credits for Scientifi c Poster Sessions *3 CME Credits for Multimedia Education Sessions Registration covers the Scientifi c Program Sessions, Meeting Syllabus, Poster Sessions, Multimedia Sessions, Daily Conti- To ensure correct CME credit is awarded, please complete nental Breakfast, Welcome Reception, Exhibitor/Poster Recep- the form in the back of this program, indicating the Sessions tion, Jazz Band Reception/Founders’ Dinner Dance, Coffee you attended or go online to www.eoa-assn.org to complete Breaks, and Daily Drawings. the EOA 2014 Annual Meeting CME Credit Records. CME Certifi cates will be awarded to all registered participants.

BADGES/WRISTBANDS MANAGEMENT Badges or wristbands must be worn. They are proof of reg- The Eastern Orthopaedic Association is managed by Data istration and are required for admittance to all functions and Trace Management Services, a Data Trace Company, Tow- social events. son, Maryland.

The meeting function areas, including the registration area and meeting rooms, are designated non-smoking throughout the course of the meeting. Smoking is limited to areas where not prohibited by ﬁ re department regulations.

Please be considerate and silence your cell phones during the Scientiﬁ c Program.

13 EOA 45th Annual MeetingAmelia Island, Florida2014

2014 President 45th Annual Meeting Amelia Island, Florida

David W. Romness, MD Arlington, Virginia

EOA Past Presidents

1969-1970 Howard H. Steel, MD, PhD 1991-1992 George P. Bogumill, MD, PhD 1970-1971 Howard H. Steel, MD, PhD 1992-1993 Glen A. Barden, MD 1971-1972 Warner D. Bundens Jr., MD* 1993-1994 Henry R. Cowell, MD, PhD 1972-1973 R. Joe Burleson, MD* 1994-1995 Ronald C. Hillegass, MD 1973-1974 Joseph O. Romness, MD* 1995-1996 Stephen F. Gunther, MD 1974-1975 James D. Fisher, MD* 1996-1997 L. Andrew Koman, MD 1975-1976 Marvin E. Steinberg, MD 1997-1998 Chitranjan S. Ranawat, MD 1976-1977 Leslie C. Meyer, MD* 1998-1999 Charles H. Classen Jr., MD 1977-1978 Robert N. Richards Sr., MD 1999-2000 A. Lee Osterman, MD 1978-1979 Hugo A. Keim, MD 2000-2001 James A. Nunley II, MD 1979-1980 Wallace E. Miller, MD* 2001-2002 E. Anthony Rankin, MD 1980-1981 James R. Urbaniak, MD 2002-2003 Shepard R. Hurwitz, MD 1981-1982 Stanley W. Lipinski, MD 2003-2004 John D. Lubahn, MD 1982-1983 William T. Green Jr., MD 2004-2005 Thomas P. Vail, MD 1983-1984 Emmett M. Lunceford Jr., MD* 2005-2006 J. Richard Bowen, MD 1984-1985 John F. Mosher, MD 2006-2007 Scott D. Boden, MD 1985-1986 B. David Grant, MD 2007-2008 Robert V. Dawe, MD 1986-1987 Harry R. Gossling, MD* 2008-2009 Judith F. Baumhauer, MD, MPH 1987-1988 Andrew G. Hudacek, MD* 2009-2010 Robert N. Richards Jr., MD 1988-1989 Lamar L. Fleming, MD 2010-2011 John C. Richmond, MD 1989-1990 Thomas S. Renshaw, MD 2011-2012 Henry A. Backe Jr., MD 1990-1991 Edward E. Kimbrough III, MD* 2012-2013 David S. Zelouf, MD

* Deceased

14 2014 Howard Steel Lecture

2014 Howard Steel Lecture

Remy Munasiﬁ Arlington, Virginia EOA is pleased to have comedian and YouTube sensation Remy Munasiﬁ as the 2014 Howard Steel Lecturer.

Remy Munasiﬁ launched his “GoRemy” channel on YouTube and has not stopped since. His videos have been viewed over 80 million times and he has entertained live audiences around the world. His latest record, “The Falafel Album,” is available now on Comedy Central Records. Remy currently resides in Arlington, Virginia.

15 EOA 45th Annual MeetingAmelia Island, Florida2014

2013 - 2014 EOA Leadership

Ofﬁ cers and Board of Directors

PRESIDENT TREASURER MEMBERSHIP CHAIR David W. Romness, MD Javad Parvizi, MD, FRCS Anil S. Ranawat, MD FIRST VICE PRESIDENT HISTORIAN PROGRAM CHAIR Mark J. Lemos, MD Robert P. Boran Jr., MD Amar S. Ranawat, MD SECOND VICE PRESIDENT MEMBER AT LARGE (ONE YEAR) MANAGING DIRECTOR Geoffrey H. Westrich, MD Marc J. Levine, MD E. Anthony Rankin, MD IMMEDIATE PAST PRESIDENT MEMBER AT LARGE (TWO YEARS) BOC REPRESENTATIVE David S. Zelouf, MD John D. Kelly IV, MD John C. Richmond, MD SECRETARY MEMBER AT LARGE (THREE YEARS) Michael P. Bolognesi, MD Richard M. Wilk, MD

2013 - 2014 EOA Committees

MEMBERSHIP COMMITTEE Michael Sidor, MD PRESIDENT’S COUNCIL Anil S. Ranawat, MD, Chair Robert Heapes, MD David W. Romness, MD Geoffrey H. Westrich, MD Robert P. Boran Jr., MD Mark J. Lemos, MD Richard M. Wilk, MD Geoffrey H. Westrich, MD FINANCE COMMITTEE Michael P. Ast, MD Javad Parvizi, MD, FRCS, David S. Zelouf, MD Marc J. Levine, MD Chair E. Anthony Rankin, MD

John D. Kelly IV, MD E. Anthony Rankin, MD TELECOMMUNICATIONS COMMITTEE PROGRAM/PROFESSIONAL EDUCATION Henry A. Backe Jr., MD James T. Guille, MD, Chair COMMITTEE David S. Zelouf, MD John P. McConnell, MD Amar S. Ranawat, MD, Chair AUDIT COMMITTEE James Barber, MD Michael P. Bolognesi, MD Mark J. Lemos, MD, Chair CME ACCREDITATION N. George Kasparyan, MD, Michael Sidor, MD PhD Robert N. Richards Jr., MD Steve Longenecker, MD Mark J. Lemos, MD NEWSLETTER Javad Parvizi, MD, FRCS BYLAWS COMMITTEE Scott D. Boden, MD John P. McConnell, MD, Chair Adam J. Rana, MD JAZZ BAND COORDINATOR Mark J. Romness, MD TECHNICAL EXHIBITS COMMITTEE Robert N. Richards Jr., MD

NOMINATING COMMITTEE Kevin D. Plancher, MD, Chair David S. Zelouf, MD, Chair Henry A. Backe Jr., MD Carlos J. Lavernia, MD Amar S. Ranawat, MD

16 EOA Spouse Committee

EOA Spouse Committee

Mrs. David W. Romness (Karen), Chair Mrs. Anil S. Ranawat (Dana) Mrs. Henry A. Backe Jr. (Tara) Mrs. Amar S. Ranawat (Andrea) Mrs. Scott D. Boden (Mary) Mrs. Chitranjan S. Ranawat (Gudie) Mrs. Michael P. Bolognesi (Kelly) Mrs. E. Anthony Rankin (Frances) Mrs. Robert P. Boran Jr. (Kitsy) Mrs. Robert N. Richards Jr. (Cindy) Mrs. John D. Kelly IV (Marie) Mrs. John C. Richmond (Chris) Mrs. Mark J. Lemos (Marla) Mrs. Geoffrey H. Westrich (Ellen) Mrs. Marc J. Levine (Robin) Mrs. Richard M. Wilk (Susan) Mrs. Javad Parvizi (Fariba) Mrs. David S. Zelouf (Susan) Mrs. Kevin D. Plancher (Jill) Eastern Orthopaedic Educational Foundation

EOEF Ofﬁ cers

Chitranjan S. Ranawat, MD, President Robert V. Dawe, MD, Secretary John C. Richmond, MD Treasurer Glen A. Barden, MD, ex-ofﬁ cio

EOA Board of Incorporators

Howard H. Steel, MD, PhD George J. Schonholtz, MD Warner D. Bundens Jr., MD Joseph O. Romness, MD Henry R. Cowell, MD, PhD Marcel J. Schulmann, MD B. David Grant, MD Frederick J. Knocke, MD Marvin E. Steinberg, MD Arthur F. Seifer, MD Theodore R. Lammot, III, MD Stephan A. Christides, MD Edward J. Resnick, MD

In witness whereof, we have made, subscribed, and acknowledged these Articles of Incorporation on the 25th day of May, 1970.

17 EOA 45th Annual MeetingAmelia Island, Florida2014

Eastern Orthopaedic Education Foundation THANK YOU FOR YOUR SUPPORT! Egregia Cum Laude — Over $140,000 Chitranjan S. Ranawat, MD Summa Cum Laude — $20,000- $50,000 Glen A. Barden, MD Scott D. Boden, MD Shepard R. Hurwitz, MD Maxima Cum Laude — $10,000- $19,999 J. Richard Bowen, MD Charles H. Classen Jr., MD Kevin D. Plancher, MD E. Anthony Rankin, MD David W. Romness, MD Geoffrey H. Westrich, MD Magna Cum Laude — $5,000- $9,999 Henry A. Backe Jr., MD John J. Callahan Jr., MD Robert V. Dawe, MD James T. Guille, MD Mark J. Lemos, MD Dr. John D. & Terri Lubahn Javad Parvizi, MD, FRCS Ranawat Orthopaedic Research Foundation Robert N. Richards Jr., MD John C. Richmond, MD David S. Zelouf, MD

18 Eastern Orthopaedic Education Foundation

Cum Laude — $1,000- $4,999 Hari Bezwada, MD Garry Hough, MD Premier Orthopaedics, Inc. William Banks, MD Andrew G. Hudacek, MD Amar S. Ranawat, MD Judith F. Baumhauer, MD, MPH John D. Kelly IV, MD Robert N. Richards Sr., MD Oheneba Boachie-Adjei, MD Marc J. Levine, MD Enzo J. Sella, MD George P. Bogumill, MD Stanley W. Lipinski, MD Douglas A. Shenkman, MD Michael P. Bolognesi, MD Frederic E. Liss, MD Thomas P. Vail, MD Robert P. Boran, MD Bob Mc Eneany, MD James C. Vailas, MD Mark C. Buechel, MD James A. Nunley II, MD Colin E. Couper, MD Philadelphia Hand Center, PC

Contributors — Up to $999 Todd Albert, MD Stephen F. Gunther, MD Vincent Paul, MD John Awad, MD John E. Handelsman, MD Vincent D. Pellegrini, Jr., MD Popa Anca, MD Robert Heaps, MD Mark E. Pruzansky, MD Norberto Baez, MD Douglas P. Hein, MD Anil S. Ranawat, MD Jason Baynes, MD Ronald C. Hillegass, MD Steven Robbins, MD John Beachler, MD Charles Hummer, MD Jose Rodriguez, MD Melvin Brothman, MD Thomas Hunt, MD George Rowan, MD Frank Bryan, MD Fredrick Jaffe, MD Vincent J. Sammarco, MD Fred Carter, MD John R. Rowell Jr., MD Thomas P. Sculco, MD Gaylord Clark, MD Bryan T. Kelly, MD Carl Seon, MD Gary Cortina, MD L. Andrew Koman, MD Edwin G. Singsen, MD Henry R. Cowell, MD, PhD Paul Kovatis, MD Richard Smith, MD Phani Dantuluri, MD William Kutner, MD Charles Sommer, MD Gregory DiFelice, MD Kent Lerner, MD Edwin P. Su, MD Chester Dilallo, MD Sheldon Lin, MD John Tierney, MD John DiPreta, MD Thomas Lombardo, MD Daniel Ward, MD Vincent Distefano, MD Paul A. Marchetto, MD Thomas Ward, MD John Forrest, MD David J. Mayman, MD Thomas Whitten, MD Brian J. Galinat, MD Edward McClain, MD Richard M. Wilk, MD John Gordon, MD Charles Mess, MD Winthrop University William Goulburn, MD D. Sewall Miller, MD Gary Zartman, MD David B. Grant, MD Steven Neufeld, MD Eric Zitzman, MD Lawrence Guess, MD Terrence O’Donovan, MD

19 EOA 45th Annual MeetingAmelia Island, Florida2014

2014 EOA New Members

We are pleased to welcome the following new Active members to the Eastern Orthopaedic Association:

Jack Abboudi, MD Jeff Dina, PA-C Keith Hechtman, MD Newtown Square, PA Lawrenceville, NJ Coral Gables, FL John Abraham, MD Joshua Dines, MD Jose Herrera-Soto, MD Gladwyne, PA Uniondale, NY Orlando, FL Daniel T. Altman, MD Michael L. Dockery, MD Chet Janecki, MD Pittsburgh, PA Charlotte, NC Seminole, FL Glen D. Arvan, MD Frank R. Ebert, MD Eric Johnson, MD Babylon, NY Baltimore, MD Newark, DE Michael Ast, MD Barry Fass, MD Randeep Kahlon, MD Lawrenceville, NJ New Hope, PA Newark, DE Barry I. Berger, MD Amir Fayyazi, MD John Karpie, MD Allentown, PA Allentown, PA Williamsville, NY Alex Bodenstab, MD Brett Feldman, MD Bruce Katz, MD Newark, DE Port St. Lucie, FL Newark, DE Drew Brady, MD Alexander Finger, MD Barry Kleeman, MD Newark, DE East Patchogue, NY East Patchogue, NY Christopher A. Brown, MD Stephen Finley, MD Reginald Q. Knight, MD Plantation, FL Greenville, SC Cooperstown, NY James F. Bruce Jr., MD Michael Flaherty, MD Yevgeniy Korshunov, MD Lagrange, GA Albany, NY Staten Island, NY Charles G. Caldwell, MD John Fowler, MD Keith A. Kurland, MD Waycross, GA Gibsonia, PA Coral Springs, FL Mark Callenberger, MD Michael T. Freehill, MD Harrison A. Latimer, MD Merritt Island, FL Winston-Salem, NC Salisbury, NC Eben Carroll, MD Michael Freidl, MD Eric Lebby, MD Winston-Salem, NC Brunswick, GA Allentown, PA Kevin Cassidy, MD John E. Gee, MD Lee R. Leddy, MD Great Neck, NY Valdosta, GA Charleston, SC Evan Crain, MD Adam Ginsberg, DO Elliott Leitman, MD Newark, DE Newark, DE Newark, DE Michael B. Cross, MD Matthew Goldstein, MD Frederic Liss, MD NewYork, NY Great Neck, NY Phoenixville, PA Karen Crowe, MD Julio Gonzalez, MD John G. Lunt, MD Albany, NY Venice, FL Danbury, CT Gerard Cush Jr., MD Brian M. Gordon, MD Kevin N. Mabie, MD Danville, PA Latham, NY Fall River, MA Raymond DeLorenzi, MD James L. Guyton, MD Enrico S. Mango, MD Viera, FL Memphis, TN Smithtown, NY James K. DeOrio, MD Matthew Handling, MD Stephen Manifold, MD Durham, NC Newark, DE Dover, DE Thomas D. Dibenedetto, MD James Harding, MD Eric Manoff, MD Allentown, PA Pittsﬁ eld, MA East Patchogue, NY

20 EOA New Members

Andrew J. Marcus, DO Richard A. Picerno II, MD Eric Stiefel, MD Centre Hall, PA Jacksonville, FL Valdosta, GA Gary M. McClain, MD Michael Pushkarewicz, MD Joseph Straight, MD Saint Marys, GA Newark, DE Newark, DE Morteza Meftah, MD Leo Raisis, MD Michael Suk, MD Bronx, NY Newark, DE Danville, PA Elliot Mendelsohn, MD Bryan L. Reuss, MD Scott Tarantino, MD Philadelphia, PA Orlando, FL Towson, MD Douglas F. Messina, MD Mike Riggenbach, MD Jennifer Teeter, DO Wilmington, NC Orlando, FL Williamsville, NY Frederick N. Meyer, MD Matthew Roberts, MD Steven Tooze, MD Mobile, AL New York, NY Newark, DE Steven Miller, MD Elisabeth C. Robinson, MD Tedman L. Vance, MD Ronceverte, WV Worcester, MA Atlanta, GA William Montgomery Jr. , MD Abraham Rogozinski, MD Travis B. VanDyke, MD Albany, NY Jacksonville, FL Orlando, FL James Moran, DO Chaim Rogozinski, MD Vicente E. Vena, MD Newark, DE Jacksonville, FL Johnstown, PA Andrew Morse, MD Raphael Roybal, MD Podromos Ververeli, MD Albany, NY Savannah, GA Allentown, PA David A. Moss, MD Bruce Rudin, MD Mark L. Wang, MD East Greenwich, RI Newark, DE Bryn Mawr, PA William Newell, MD Arnold M. Savenor, MD Colvin C. Wellborn, MD Newark, DE Needham, MA Mclean, VA Alvin Ong, MD Adam C. Schaaf, MD Gregory G. White, MD Egg Harbor Township, NJ North Charleston, SC New Smyrna Beach, FL Douglas Palma, MD Itchak Schwarzbard, MD Jeffrey S. Wiley, PhD Newark, DE East Patchogue, NY Winston-Salem, NC Raymond Peart, MD Christopher Shanahan, RPA James Zaslavsky, DO Lancaster, PA Williamsville, NY Newark, DE John J. Pell, MD James Slover, MD Spring City, PA New York, NY Matthew D. Pepe, MD Robert Steele, MD Egg Harbor Twp, NJ Newark, DE

21 EOA 45th Annual MeetingAmelia Island, Florida2014

Membership by State

Alabama 3 New Hampshire 10 California 1 New Jersey 82 Colorado 2 New York 86 Connecticut 46 Pennsylvania 151 District of Columbia 3 Puerdto Rico 3 Delaware 49 Rhode Island 11 Florida 71 South Carolina 21 Georgia 29 Tennessee 2 Louisiana 2 Texas 1 Massachusetts 57 Virginia 32 Maryland 54 Vermont 1 Maine 9 West Virginia 4 Michigan 1 Canada 3 North Carolina 47 Foreign 9

Membership by Classiﬁ cation

Active 689 Candidate 12 Emeritus 165 Allied Health 4 Honorary 20 TOTAL 890

22 Grantor/Exhibitor Acknowledgements

Grantor/Exhibitor Acknowledgements

The Eastern Orthopaedic Association is grateful for the support of its educational grantors and exhibitors. Thank you for your participation and commitment to the EOA. Platinum Pacira Pharmaceuticals, Inc. Gold ConvaTec, Inc. Mallinckrodt Pharmaceuticals – Hospital Division Silver Zimmer, Inc. — Grantor Bronze Arthrex, Inc. — Grantor Smith & Nephew, Inc. Copper Blue Belt Technologies Innovative Medical Products, Inc. CeramTec Medical Products Integrity Rehab Group ConforMIS Marathon Pharmaceuticals, LLC DePuy Synthes MES Solutions DJO Global, Inc. MicroAire Surgical Instruments Exactech, Inc. National Surgical Healthcare Ferring Pharmaceuticals Inc. Quill / Surgical Specialities Corp. Exhibitors 3D Systems, Simbionix Medtronic Advanced Energy American Academy of Orthopaedic Surgeons MicroPort Orthopedics ACIGI Relaxation Modernizing Medicine, Inc. BBL Medical Facilities Nutramax Laboratories Customer Care, Inc. Biocomposites Ortho-Preferred Ceterix Orthopaedics Osiris Therapeutics, Inc. EOS imaging ProScan Reading Services Hospital Corporation of America Skeletal Dynamics iRemedy Healthcare Terason LifeNet Health THINK Surgical Mallinckrodt Pharmaceuticals VirtaMed AG Medstrat

23 EOA 45th Annual MeetingAmelia Island, Florida2014

Grantor/Exhibitor Information

3D Systems, Simbionix has pioneered the fi eld of arthroscopy and developed more 7100 Euclid Avenue, Suite 180 than 6,000 innovative products and surgical procedures Cleveland, OH 44103 to advance minimally invasive orthopaedics worldwide. 216-229-2040 Arthrex is a privately held company, solely committed to www.simbionix.com delivering uncompromising quality to the healthcare professionals who use our products and the millions of patients The ARTHRO Mentor™ is an advanced training simulator whose lives we impact. for knee and shoulder arthroscopic surgical procedures. The new FAST Module and other Training modules combine BBL Medical Facilities anatomical models, haptic sensation, 3D images, and a real- 302 Washington Avenue Ext. istic set of tools including an arthroscopic camera, to help Albany, NY 12203 reduce training time and considerably improve the learn- 518-452-8200 ing curve of complex surgery techniques. This true-to-life www.bblmedicalfacilities.com hands-on experience is available at the 3D Systems, Simbio- nix booth. BBL Medical Facilities specializes in planning, design, development and construction of medical facilities throughout the ACIGI RELAXATION country. Headquartered in Albany, NY with a regional offi ce 227 West Valley Boulevard, Suite 288A in Charleston, WV, BBL provides real estate, fi nancing and San Gabriel, CA 91776 property management services with a guaranteed cost, occu- 626-281-3339 pancy date and exceptional quality. www.drfuji.com Biocomposites, Inc. Fuji Cyber Relax Chair, the No. 1 massage chair, show spe- 700 Military Cutoff Road, Suite 320 cial. Wilmington, NC 28405 910-350-8015 American Academy of Orthopaedic Surgeons www.biocomposites.com 6300 North River Road At Biocomposites, we are distinct in that our team of special- Rosemont, IL 60018 ists is singularly focused on the development of innovative 847-823-7186 calcium compounds for surgical use. With over 25 years’ www.aaos.org experience and an unrivalled dedication to quality, the prod- View the latest clinical publications and eBooks and save ucts we research, engineer and manufacture are at the fore- 30% on our OKU 11 and Comprehensive Orthopaedic front of calcium technology. Our innovative products range Review 2 package. Get details on the 2015 AAOS Annual from bone grafts to matrices that can be used in the presence Meeting in Las Vegas, NV, and learn more about our full of infection. We are proud to be driving improved outcomes selection of CME and surgical skills courses held around across a wide range of clinical applications, in musculoskel- the country and at the Orthopaedic Learning Center. Find etal infection, trauma, spine and sports injuries, for surgeons the latest medical and scientifi c publications, legislative and and patients alike. regulatory updates, member benefi ts information, and more at the AAOS booth. Blue Belt Technologies 2905 Northwest Boulevard, Suite 40 Arthrex, Inc. Plymouth, MN 55441 1370 Creekside Boulevard 763-452-4950 Naples, FL 34108 www.bluebelttech.com 800-933-4404 Blue Belt Technologies is the manufacturer of the Navio® and www.arthrex.com STRIDE™ implant. Navio is a robotic-assisted smart surgi- Arthrex is a global leader in new product development and cal system indicated for unicondylar knee and patellofemoral medical education in orthopaedics. With a corporate mis- joint replacement. The Navio combines the strengths of a sur- sion of helping surgeons treat their patients better, Arthrex geon (fl exibility, complex thinking, soft tissue management)

24 Grantor/Exhibitor Information with robotics and navigation (accurate planning and localiza- ConvaTec, Inc. tion, accurate and repeatable cutting). Through a CT-free 200 Headquarters Park Drive approach, Navio enables kinematic and anatomic registration, Skillman, NJ 08558 sophisticated implant planning with soft-tissue balancing 800-422-8811 techniques and robotics-assisted bone preparation for precise www.convatec.com and repeatable results. The STRIDE unicondylar knee system is indicated for treatment of medial and lateral compartment ConvaTec is a leading developer and marketer of innovative osteoarthritis. The STRIDE system is a bone-sparing solution medical technologies, including AQUACEL® Ag SURGI- that has been designed to pair perfectly with the precision of CAL cover dressing. As the only cover dressing to incorporate Navio. unique patented Hydrofi ber® Technology it helps improve outcomes by locking in fl uid, including harmful bacteria, and CeramTec Medical Products releasing ionic silver to help reduce the risk of infection. 903 Mohawk Avenue DePuy Synthes Royal Oak, MI 48067 248-506-5299 700 Orthopaedic Drive www.biolox.com Warsaw, IN 46581 800-473-3789 CeramTec is the world’s leading manufacturer of ceramic www.depuysynthes.com products for use in hip arthroplasty. It has been at the fore- front in the development of innovative ceramic products that DePuy Synthes companies of Johnson & Johnson is the offer the highest reliability with the lowest articulation wear world’s oldest orthopaedic company and is a leading for Total Hip Replacement. Technological advances such as designer, manufacturer, and distributor of orthopaedic the introduction of our Alumina Matrix Composite (Biolox® devices and supplies. DePuy Synthes products are used in delta) will further increase the reliability of our products. surgical therapies to treat patients with musculoskeletal con- Over 10 million Biolox® components have been implanted ditions resulting from degenerative diseases and deformities. around the world. DJO Global, Inc. Ceterix Orthopaedics 1430 Decision Street Vista, CA 92081 959 Hamilton Avenue 760-727-1280 Menlo Park, CA 94025 www.djoglobal.com 650-316-8660 www.ceterix.com DJO Global is a leading global medical device company providing solutions for musculoskeletal and vascular health, and Ceterix™ is committed to joint preservation through the pain management. The Company’s products help patients pre- development of surgical tools that expand and improve what vent injuries or rehabilitate after surgery, injury or degenera- is possible for physicians treating soft tissue injuries such as tive disease. DJO’s brands include Aircast®, DonJoy®, Pro- meniscus tears. Care®, CMF™, Empi®, Saunders®, Chattanooga Group™, DJO Surgical, Cefar-Compex® and Ormed®, Dr. Comfort, ConforMIS Bell Horn. 28 Crosby Drive Bedford, MA 01730 EOS imaging 781-345-9001 185 Alewife Brook Parkway, Suite 410 www.conformis.com Cambridge, MA 02138 ConforMIS develops and commercializes medical devices 678-564-5400 for the treatment of osteoarthritis and joint damage. www.eos-imaging.com The company’s patented “Image-to-Implant”® technol- Born from a technology awarded the Nobel Prize for Physics, ogy enables the creation of customized patient-specifi c the EOS® system is the fi rst imaging solution designed to implants and instruments that are precisely sized and capture simultaneous bilateral long length images, full body shaped to match the 3D topography of a patient’s anatomy. or localized, of patients in a weight bearing position, provid- To date, ConforMIS has developed a line of award winning ing a complete picture of the patient’s skeleton at very low personalized knee solutions to address all stages of osteo- dose exposure. EOS enables global assessment of balance arthritis. and posture as well as a 3D bone-envelope image in a weight

25 EOA 45th Annual MeetingAmelia Island, Florida2014

bearing position, and provides automatically over 100 clinical Integrity Rehab Group parameters to the orthopedic surgeon for pre- and postopera- 2803 Greystone Commercial Boulevard, Unit 18 tive surgical planning. Birmingham, AL 35242 Exactech, Inc. 205-991-7488 www.irg.net 2320 NW 66th Court Gainesville, FL 32653 Integrity Rehab Group is the preferred management solution 352-377-1140 for physician and hospital based physical and occupational www.exac.com therapy services. Our model is 100% performance based and the practice maintains total ownership of the therapy service. Based in Gainesville, Fla., Exactech develops and markets IRG delivers quality patient care, superior outcomes and oper- orthopaedic implant devices, related surgical instruments and ational effi ciencies trusted by providers across the U.S. biologic materials and services to hospitals and physicians. Exactech’s orthopaedic products are used in the restoration iRemedy Healthcare of bones and joints that have deteriorated as a result of injury 1241 SE Indian St, #108 or diseases such as arthritis. Exactech exists to improve the Stuart, FL 34997 quality of life for individuals by maintaining their activity 407-234-3027 and independence. We do this through innovative ideas, high www.iRemedy.com quality products, education and commitment to service. Distinguished by Inc. Magazine as one of the 500 fastest Ferring Pharmaceuticals, Inc. growing companies in America, iRemedy Healthcare is a 100 Interpace Parkway nationally recognized leader in the delivery of “Retail Health- Parsippany, NJ 07054 care” products and services; and is the only national organi- 973-796-1600 zation focused on providing business solutions that deliver www.ferringusa.com new forms of consumer-centric retail revenue and improved consumer/patient engagement to hospital systems, insurance Ferring Pharmaceuticals Inc. is a research based biopharma- companies, physician groups and other major healthcare- ceutical company that offers treatment for patients with osteo- related institutions. arthritis (OA) of the knee. EUFLEXXA is a highly purifi ed hyaluronan, also called Hyaluronic Acid (HA). It is the fi rst LifeNet Health bioengineered HA approved in the US for the treatment of OA knee pain. 1864 Concert Drive Virginia Beach, VA 23453 Hospital Corporation of America (HCA) 800-847-7831 www.lifenethealth.org 3 Maryland Farms, Suite 250 Brentwood, TN 37027 LifeNet Health helps save lives and restore health for thou- 877-852-4161 sands of patients each year. We are the world’s most trusted www.Pract iceWithUS.com provider of transplant solutions, from organ procurement to new innovations in bio-implant technologies and cellular ther- HCA owns and operates 165 healthcare facilities in 20 states apies—a leader in the fi eld of regenerative medicine, while with opportunities coast to coast. HCA was one of the nation’s always honoring the donors and healthcare professionals that fi rst hospital companies. We are committed to the care and allow the healing process. improvement of human life. We strive to deliver quality healthcare that meets the needs of the communities we serve. Mallinckrodt Pharmaceuticals Innovative Medical Products, Inc. 675 McDonnell Boulevard 87 Spring Lane Hazelwood, MO 63042 Plainville, CT 06062 314-654-2000 800-467-4944 www.mallinckrodt.com www.impmedical.com Mallinckrodt is a global specialty pharmaceuticals company, Innovative Medical Products, Inc. (IMP) is focused on devel- including branded medicines focused on the management of oping and marketing innovative patient positioning products pain and spasticity. The company’s portfolio also includes to benefi t and improve effi ciency in the operating room and generic specialty pharmaceutical products, active pharmaceu- hospital clinics where patient stability and positioning are tical ingredients and diagnostic imaging agents. Visit www. required. mallinckrodt.com to learn more.

26 Grantor/Exhibitor Information

Mallinckrodt Pharmaceuticals — Hospital Division changing the way the world treats chronic disease. Our 12481 High Bluff Drive, Suite 200 advanced energy products are designed to assist surgeons San Diego, CA 92130 in a variety of procedures, including orthopaedic recon- 858-436-1400 struction and trauma surgery. Aquamantys® bipolar seal- www.mallinckrodt.com/cadence ers use proprietary Transcollation® technology to provide hemostatic sealing of soft tissue and bone, while the Mallinckrodt is a global specialty pharmaceuticals company, PEAK PlasmaBlade™ uses pulsed plasma technology to including branded medicines focused on the management of provide the precision of a scalpel and the bleeding control pain and spasticity. The company’s portfolio also includes of traditional electrosurgery without extensive collateral generic specialty pharmaceutical products, active pharmaceu- tissue damage. tical ingredients and diagnostic imaging agents. Visit www. mallinckrodt.com to learn more. MES Solutions Marathon Pharmaceuticals, LLC 700 Veterans Memorial Highway, Suite 300 Hauppauge, NY 11788 1033 Skokie Boulevard, Suite 600 631-652-3002 Northbrook, IL 6062 www.messolutions.com 224-515-3401 www.marathonpharma.com MES Solutions provides independent medical examinations Marathon Pharmaceuticals, LLC is a leader in the develop- for Workers compensation, automotive and liability claims. ment, manufacturing and commercialization of specialty phar- MES has been providing IME services for over 35 years. maceuticals to treat rare diseases for high need populations. We are currently looking for physicians to join our panel. Recently Marathon Pharmaceuticals acquired the global rights MES’ Network is comprised of qualifi ed and experienced to Iprivask (desirudin by injection) a novel direct thrombin medical professionals who are prepared to provide expert inhibitor anticoagulant used for the prevention of deep vein opinions. With Health insurance’s reimbursement rates so thrombosis (DVT) which may lead to pulmonary embolism low, now is a great time to join a National IME company (PE) in patients undergoing elective hip replacement. to increase your practices revenue! Contact us today for additional information: Medstrat [email protected]. 1901 Butterfi eld Road, Suite 600 MicroAire Surgical Instruments Downers Grove, IL 60515 800-882-4224 3590 Grand Forks Boulevard www.medstrat.com Charlottesville, VA 22911 434-975-8000 In 1996, Medstrat designed the industry’s fi rst PACS spe- www.microaire.com cifi cally geared to meet the unique needs of orthopedic surgeons and their practices. Through the use of the Joints™ MicroAire’s SmartRelease™ECTR is a minimally invasive, family of products, Medstrat enables surgeons to streamline endoscopic treatment for carpal tunnel syndrome, providing a their clinical and OR operations, reduce costs and work clear alternative to open-hand surgery. SmartRelease™ECTR more effi ciently than ever before. With over 10,000 orthope- has been used to treat thousands of patients since 1992. Its dic users, 750 million images under management and a 97% benefi ts, reliability, safety and effi cacy are supported by an customer retention rate over the last fi ve years, Medstrat is impressive body of clinical data. For more information, please the clear leader in orthopedic PACS and collaborative digital visit microaire.com. templating. With our PACS Conversion Program, Medstrat MicroPort Orthopedics can migrate your practice to JointsPACS™ with minimal up- front investment. 5677 Airline Road Arlington, TN 38002 Medtronic Advanced Energy 866-872-0211 180 International Drive www.ortho.microport.com Portsmouth, NH 03301 MicroPort Orthopedics delivers the latest in orthopedic 603-842-6219 technologies and procedures for the repair and reconstruc- www.medtronicadvancedenergy.com tion of the hip and knee joint. At MicroPort Orthopedics, At Medtronic, we’re committed to Innovating for life we aim to get patients back to a state of mobility that feels by pushing the boundaries of medical technology and as natural as possible. We understand that we’re only as

27 EOA 45th Annual MeetingAmelia Island, Florida2014

good as the last patient experience. That’s why we strive Ortho-Preferred for an uncommon level of integrity. For us, that means 110 West Road, Suite 227 relentlessly pursuing technical advances that keep us Towson, MD 21204 ahead of the market and you ahead of patient expectation. 877-304-3565 It means providing the most responsive reliable service to www.ortho-preferred.com the healthcare community. Most of all, it means a complete commitment to getting the best possible results every time. Take advantage of the next evolution in professional liabil- You can depend on MicroPort Orthopedics to put integrity ity insurance with the Ortho-Preferred Program. When you in motion. choose the Ortho-Preferred Program you not only receive comprehensive professional liability insurance coverage at Modernizing Medicine, Inc. competitive rates through Medical Protective, but also additional benefi ts above and beyond your coverage through DT 3600 FAU Boulevard, Suite 202 Preferred Group, LLC, a risk-purchasing group. Choose the Boca Raton, FL Ortho-Preferred Program and fi nd out how much you could 561-880-2998 save on your professional liability insurance today! www.modmed.com Osiris Therapeutics, Inc. Modernizing Medicine is transforming how healthcare information is created, consumed, and utilized to increase 7015 Albert Einstein Drive effi ciency and improve outcomes. The Company’s product, Columbia, MD 21046 Electronic Medical Assistant ® (EMATM), is a cloud-based, 443-545-1800 specialty-specifi c, electronic medical record (EMR) system www.Osiris.com with a massive library of built-in medical content and coding Osiris Therapeutics, Inc. is the leading stem cell company, expertise, designed to save physicians’ time. having developed the world’s fi rst approved stem cell drug, remestemcel-L for graft versus host disease. Osiris’ products National Surgical Healthcare include Grafi x®, a cryopreserved placental membrane for 250 South Wacker Drive, Suite 500 acute and chronic wounds, Cartiform®, a viable cartilage Chicago, IL 60606 mesh for cartilage repair and the latest addition to Osiris’ 312-627-8240 line of products, OvationOS®, a viable bone matrix for bone www.nshinc.com repair and regeneration. Osiris is a fully integrated company with capabilities in research, development, manufacturing and National Surgical Healthcare (“NSH”) is a Chicago based distribution. Osiris has developed an extensive intellectual company that owns and operates 13 surgical hospitals and property portfolio to protect the company’s technology and 8 ASCs that are musculoskeletal-focused (orthopedics, commercial interests. spine, and pain management). All facilities are structured as joint ventures with physicians and/or with health sys- Pacira Pharmaceuticals, Inc. tems. NSH’s success is driven by our physician-focused 5 Sylvan Way operating philosophy, with a continuous focus on high Parsippany, NJ 07054 clinical quality and sustainable growth on behalf of its 973-254-3560 partners. www.pacira.com

Nutramax Laboratories Customer Care, Inc. Pacira’s primary focus lies in the development of non-opioid products for postsurgical pain control. We believe we have the 2208 Lakeside Boulevard technology to improve products’ efﬁ cacy and safety and make Edgewood, MD 21040 a critical difference to patients in terms of dosing frequency 800-925-5187 and administration. www.nutramaxlabs.com ProScan Reading Services Nutramax Laboratories, Inc. researches, develops, manufactures and markets products that improve the quality of life 5400 Kennedy Avenue for people and their pets. We manufacture safe and effective Cincinnati, OH 45213 products using high-quality, researched ingredients, and 513-229-7115 follow manufacturing standards. Cosamin® Joint Health www.proscan.com Supplement is the #1 Researched Glucosamine/Chondroitin ProScan Reading Services — Teleradiology for your Practice: Brand. Our team of board-certiﬁ ed, fellowship-trained (MSK MRI)

28 Grantor/Exhibitor Information radiologists support the launch and growth of your imaging and advanced features. The new uSmart® 3300 and uSmart® division. ProScan Reading Services is committed to improv- 3200T Ultrasound Systems optimize workﬂ ow, enhance clini- ing the quality of care through education, access, expertise cal efﬁ cacy, and increase productivity. Terason’s complete and technology. ProScan Teleradiology— Everything you MSKUS educational solution includes in-person and online need, we deliver! training, as well as our unique uConnectTM remote access.

Quill/Surgical Specialties Corporation THINK Surgical 100 Dennis Drive 47320 Mission Falls Court Reading, PA 19606 Fremont, CA 94539 877-991-1110 510-249-2300 www.surgicalspecialties.com www.thinksurgical.com Having been successfully used in tens of thousands of ortho- THINK Surgical is committed to the future of orthopaedic pedic procedures for soft tissue approximation, the Quill surgery and to improving patient care through the develop- Knotless Tissue-Closure Device is designed to evenly distrib- ment of leading-edge precision technology. THINK Surgical ute tension for incisions by replacing knots with a running develops, manufactures, and markets a computer assisted sur- closure and has demonstrated case efﬁ ciencies and cost sav- gical system for orthopaedic surgery. The system includes a ings when compared to traditional suture. Tiny barbs on the 3D planning workstation for preoperative surgical planning of suture provide immediate tissue hold on placement, making component selection, placement and surface preparation, and soft tissue approximation faster and easier for wound closure. a computer assisted tool that executes the pre-surgical plan with unparalleled precision. Skeletal Dynamics VirtaMed AG 8905 SW 87th Avenue Miami, FL 33176 Rutistrasse 12 305-596-7585 8952 Schlieren www.skeletaldynamics.com Zurich, Switzerland Skeletal Dynamics designs and markets innovative orthopedic + 41 44 500 96 90 devices. Skeletal Dynamics is focused on designing innovative www.virtamed.com solutions that have not been addressed by other manufacturers. VirtaMed, a Swiss-based company, develops virtual reality Our goal is to raise the bar with offerings for upper extremity simulators of highest realism. These simulators provide teach- orthopedic surgery. Skeletal Dynamics is a true believer in the ing and training of diagnostic and therapeutic interventions in team approach to success. Together, with the skills of our cus- endoscopic surgery. tomers, we can make a positive impact in our patients’ lives. Zimmer, Inc. Smith & Nephew, Inc. PO Box 708 7135 Goodlett Farms Parkway Warsaw, IN 46580 Cordova, TN 38016 800-613-6131 901-396-2121 www.zimmer.com www.smith-nephew.com Zimmer is a world leader in musculoskeletal health. We’re Smith & Nephew is a global medical technology business creators of innovative and personalized joint replacement with global leadership positions in Orthopaedic Reconstruc- technologies. Founded in 1927, we remain true to our purpose tion, Endoscopy, Sports Medicine, Trauma Fixation, Extremi- of restoring mobility, alleviating pain, and helping millions ties & Limb Restoration, and Advanced Wound Management. of people around the world ﬁ nd renewed vitality. Zimmer has Visit www.smith-nephew.com for more information. operations in more than 25 countries around the world, sells products in more than 100 countries and is supported by the Terason efforts of more than 8,000 employees. 77 Terrace Hall Avenue Burlington, MA 01803 781-270-4143 www.terason.com Terason continues to revolutionize ultrasound, with high- performance, portable systems providing exceptional imaging

29 EOA 45th Annual MeetingAmelia Island, Florida2014

EOA Business Meetings Eastern Orthopaedic Association

The Ritz-Carlton Amelia Island, Florida Ritz-Carlton Ballroom Salon 1

Thursday, October 23, 2014 8:25am–8:40am

First Business Meeting Agenda

I. Reading of the Minutes of the previous meeting by the Secretary (and their approval) ...... Michael P. Bolognesi, MD II. Report of the President ...... David W. Romness, MD III. Report of the Immediate Past President ...... David S. Zelouf, MD IV. Report of the First Vice President ...... Mark J. Lemos, MD V. Report of the Second Vice President ...... Geoffrey H. Westrich, MD VI. Report of the Treasurer ...... Javad Parvizi, MD, FRCS VII. Report of the Historian ...... Robert P. Boran Jr., MD VIII. Report of the Program/Professional Education Committee ...... Amar S. Ranawat, MD IX. Report of the Membership Committee ...... Anil S. Ranawat, MD X. Report of the Managing Director ...... E. Anthony Rankin, MD XI. Report of Member at Large (1 yr) ...... Marc J. Levine, MD XII. Report of Member at Large (2 yrs) ...... John D. Kelly IV, MD XIII. Report of Member at Large (3 yrs) ...... Richard M. Wilk, MD XIV. Report of the Bylaws Committee ...... John P. McConnell, MD (a) Presentation of Proposed Bylaws Changes XV. Report of the Technical Exhibit Committee ...... Kevin D. Plancher, MD XVI. Report of Finance Committee ...... Javad Parvizi, MD, FRCS XVII. Report of Audit Committee ...... Mark J. Lemos, MD XVIII. Report of Nominating Committee/Presentation of Slate ...... David S. Zelouf, MD 2014-2015 Nominating Committee: Carlos J. Lavernia, MD Michael Sidar, MD Robert Heapes, MD Robert P. Boran Jr., MD XIX. New Business (a) Nominations from the Floor for the Nominating Committee Nominating Committee Requirements: The Nominating Committee shall consist of ﬁ ve (5) Active Members of the Association, three (3) of whom shall be elected at the Annual Meeting of the Association, following nominations from the ﬂ oor, the fourth member shall be

30 Business Meetings

appointed by the President and may not be a previous offi cer of the Association. The fi fth member, who shall act as the Chair, shall be the immediate available Past President, or, in the event of his/her inability to serve shall be appointed by the President with the approval of the Board of Directors. With the exception of the Immediate Past President, the members of the Committee shall not be concurrently offi cers of the Association. No member shall serve for two (2) consecutive years on the Nominating Committee. XX. Announcement XXI. Adjournment

31 EOA 45th Annual MeetingAmelia Island, Florida2014

2013 Eastern Orthopaedic Association Annual First Business Meeting Minutes

Miami, Florida October 31, 2013

Meeting called to order at 6:46 am

1. Guille: Minutes approved

2. Zelouf: Recapped the year’s events. Spoke of his travels to the other regional societies’ meetings.

3. Backe: No report from the Past President.

4. Romness, Report of 1st Vice President: 2014 Annual Meeting at Ritz Carlton, Amelia Island, FL.

5. Lemos, Report of 2nd Vice President: 2015 Meeting will be in Hawaii at Grand Wailea Resort on June 17-20. Mike Bolognesi will be Program Chair. Doug Jackson will be Presidential Guest Speaker.

6. Westrich, Report of Treasurer: The association had a good year ﬁ nancially.

7. Boran, Historian: He will be taking photos during the meeting. 3 members died this past year.

8. Parvizi, Program Chair: Reviewed agenda. Asked people to spread word back home about the EOA meeting.

9. Plancher, Membership: We have 101 new members.

10. Rankin, Mgt. Director: Bylaws change to allow Dr. Chit Ranawat to continue as President of EOEF. Contract with Data Trace renewed.

11. Bylaws: Callahan not present. No report

12. Member at Large, Bolognesi: No report

13. Member at Large, Levin: New Jersey Orthopaedic Society present at this meeting.

14. Member at Large, Kelly: Not present

15. Technical Exhibits, Ranawat: 44 exhibitors

16. Finance Report, Westrich: EOA is doing well ﬁ nancially. Up 10%

17. Audit, Romness: Audit went well with no problems.

18. Nominating Committee, Backe: Slate reviewed.

19. New Business: Carlos Lavernia and Mike Sedor to nominating committee, Robert Heath New Hampshire; Steve Longnecker to Audit Committee

Ended 7 am.

Respectfully Submitted,

James T. Guille, M.D. Secretary

32 Business Meetings

Eastern Orthopaedic Association

The Ritz-Carlton Amelia Island, Florida Ritz-Carlton Ballroom Salon 1

Saturday, October 25, 2014 8:27am–8:42am

Second Business Meeting Agenda

I. Reading of the Minutes of the previous meeting by the Secretary (and their approval) ...... Michael P. Bolognesi, MD II. Report of Telecommunications Committee ...... James T. Guille, MD III. Report on CME Accreditation ...... Robert N. Richards Jr., MD IV. Report of Newsletter Editor ...... Scott D. Boden, MD V. Report of Jazz Band Coordinator ...... Robert N. Richards Jr., MD VI. Report of the EOEF ...... Chitranjan S. Ranawat, MD VII. Unﬁ nished Business (a) Vote on proposed Bylaws changes VIII. New Business (a) Election of 2015-2016 Nominating Committee IX. Election of the Slate of Nominees X. Installation of First Vice President as President XI. Adjourn

33 EOA 45th Annual MeetingAmelia Island, Florida2014

2013 Eastern Orthopaedic Association Second Business Meeting Minutes

Miami, Florida Saturday, November 2, 2013

Meeting called to order at 6:45 am

1. Guille: Minutes approved

2. Telecommunications, Wilk: No report

3. CME, Richards: This meeting offers 27.5 category 1 credits

4. Newsletter, Boden: No report. Open for suggestions for improvement.

5. Jazz Band, Richards: The band will perform tonight.

6. EOEF, Ranawat: Chit thanked those who donated and stated there was 100% participation by the BODs.

7. Old Business: None

8. New Business: Nominating Committee – Zelouf, chair; Sidor, elected; Lavernia, elected, Hemps. Appointment from President to be announced. Approved Slate.

9. New Slate: Steve Longnecker approved to Audit Committee.

10. Dave Zelouf gave Presidential Medal to Dave Romness

11. Romness thanked Zelouf

12. Zelouf thanked Jay Parvizi for work with Program

Ended 7:01 am.

Respectfully Submitted,

James T. Guille, M.D. Secretary

34 Past Annual Meetings

Past Annual Meetings of the Eastern Orthopaedic Association 1970–2013

First Annual Meeting Location: Cerromar Beach Hotel President: Howard H. Steel, MD, PhD Dorado Beach, Puerto Rico Dates: November 18-21, 1970 Attendance: 319 physicians / 283 spouses Location: Seaview Country Club Guest Speaker: Professor Pier Giorgio Marchetti Absecon, New Jersey Pisa, Italy Attendance: 169 physicians / 107 spouses Seventh Annual Meeting Guest Speaker: Mr. John Wells Sharrard, FRCS President: Marvin E. Steinberg, MD Shefﬁ eld, England Dates: October 13-17, 1976 Second Annual Meeting Location: The Breakers President: Howard H. Steel, MD, PhD Palm Beach, Florida Dates: October 23-26, 1971 Attendance: 345 physicians / 271 spouses Location: The Greenbrier Guest Speaker: Professor Alf L. Nachemson, MD White Sulphur Springs, West Virginia Gothenburg, Sweden Attendance: 244 physicians / 141 spouses Eighth Annual Meeting Guest Speaker: Mr. J.S. Batchelor, FRCS President: Leslie C. Meyer, MD London, England Dates: October 12-16, 1977 Third Annual Meeting Location: The Southampton Princess Hotel President: Warner D. Bundens Jr., MD Southampton, Bermuda Dates: October 18-22, 1972 Attendance: 456 physicians / 366 spouses Location: Cerromar Beach Hotel Guest Speaker: Maurice E. Muller, MD Dorado Beach, Puerto Rico Berne, Switzerland Attendance: 280 physicians / 230 spouses Ninth Annual Meeting Guest Speaker: Professor J.I.P. James, FRCS President: Robert N. Richards Sr., MD Edinburgh, Scotland Dates: October 18-22, 1978 Fourth Annual Meeting Location: Acapulco Princess Hotel President: R. Joe Burleson, MD Acapulco, Mexico Dates: October 18-21, 1973 Attendance: 392 physicians / 350 spouses Location: The Greenbrier Guest Speaker: Ian Macnab, MB, FRCS White Sulphur Springs, West Virginia Toronto, Ontario, Canada Attendance: 270 physicians / 197 spouses Tenth Anniversary Meeting Guest Speaker: Professor Joseph Trueta, FRCS President: Hugo A. Keim, MD Barcelona, Spain Dates: October 17-21, 1979 Fifth Annual Meeting Location: The Breakers President: Joseph O. Romness, MD Palm Beach, Florida Dates: October 16-20, 1974 Attendance: 395 physicians / 334 spouses Location: The Southampton Princess Hotel Guest Speaker: Jack Stevens, MS Southampton, Bermuda Newcastle Upon Tyne, England Attendance: 389 physicians / 298 spouses Eleventh Annual Meeting Guest Speaker: Professor Sir John Charnley, FRCS President: Wallace E. Miller, MD Manchester, England Dates: October 15-19, 1980 Sixth Annual Meeting Location: Cerromar Beach Hotel President: James D. Fisher, MD Dorado Beach, Puerto Rico Dates: October 15-19, 1975 Attendance: 354 physicians / 309 spouses

35 EOA 45th Annual MeetingAmelia Island, Florida2014

Guest Speaker: John C. Kennedy, MD, FRCS Guest Speaker: Richard J. Hawkins, MD London, Ontario, Canada London, Ontario, Canada Twelfth Annual Meeting Eighteenth Annual Meeting President: James R. Urbaniak, MD President: Harry R. Gossling, MD Dates: October 14-18, 1981 Dates: October 14-18, 1987 Location: The Boca Raton Hotel Location: The Homestead Hotel Boca Raton, Florida Hot Springs, Virginia Attendance: 365 physicians / 299 spouses Attendance: 227 physicians / 221 spouses Guest Speaker: Professor Heinz Wagner, MD Guest Speaker: George Bentley, ChM, FRCS Nurnberg, Germany Stanmore, England Thirteenth Annual Meeting Nineteenth Annual Meeting President: Stanley W. Lipinski, MD President: Andrew G. Hudacek, MD Dates: October 13-17, 1982 Dates: October 12-16, 1988 Location: The Southampton Princess Hotel Location: The Cerromar Beach Hotel Southampton, Bermuda Dorado, Puerto Rico Attendance: 458 physicians / 437 spouses Attendance: 321 physicians / 264 spouses Guest Speaker: Michael A.R. Freeman, MD, FRCS Guest Speaker: Marvin Tile, MD London, England Toronto, Ontario, Canada Fourteenth Annual Meeting Twentieth Anniversary Meeting President: William T. Green Jr., MD President: Lamar L. Fleming, MD Dates: October 12-16, 1983 Dates: October 11-15, 1989 Location: The Breakers Location: The Queen Elizabeth Hotel Palm Beach, Florida Montreal, Quebec, Canada Attendance: 316 physicians / 246 spouses Attendance: 300 physicians / 239 spouses Guest Speaker: Eduardo R. Luque, MD Guest Speakers: William C. Hutton, DSc Mexico City, Mexico Atlanta, Georgia Fifteenth Annual Meeting Peter J. Fowler, MD President: Emmett M. Lunceford Jr., MD London, Ontario, Canada Dates: October 10-14, 1984 Twenty-ﬁ rst Annual Meeting Location: The Acapulco Princess Hotel President: Thomas S. Renshaw, MD Acapulco, Mexico Dates: October 17-21, 1990 Attendance: 288 physicians / 248 spouses Location: The Southampton Princess Hotel Guest Speaker: Sir Dennis Paterson, MD, FRCS Southampton, Bermuda North Adelaide, South Australia Attendance: 356 physicians / 324 spouses Sixteenth Annual Meeting Guest Speaker: Mercer Rang, MB, FRCS(c) President: John F. Mosher, MD Toronto, Ontario, Canada Dates: October 16-20, 1985 Twenty-second Annual Meeting Location: The Boca Raton Hotel President: Edward E. Kimbrough III, MD Boca Raton, Florida Dates: October 16-21, 1991 Attendance: 290 physicians / 203 spouses Location: Melia Castilla Hotel Guest Speaker: Thomas P. Ruedi, MD, FACS Madrid, Spain Basel, Switzerland Attendance: 300 physicians / 239 spouses Seventeenth Annual Meeting Guest Speakers: Augusto Sarmiento, MD President: B. David Grant, MD Los Angeles, California Dates: October 15-19, 1986 Mr. R. Lew Bennett Location: The Southampton Princess Hotel Twenty-third Annual Meeting Southampton, Bermuda President: George P. Bogumill, MD, PhD Attendance: 389 physicians / 353 spouses Dates: October 14-18, 1992

36 Past Annual Meetings

Location: Hyatt Regency Cerromar Beach Hotel Twenty-ninth Annual Meeting Dorado, Puerto Rico President: Chitranjan S. Ranawat, MD Attendance: 429 physicians / 285 spouses Dates: October 14-18, 1998 Guest Speaker: Murray K. Dalinka, MD Location: Ritz Carlton Hotel Philadelphia, Pennsylvania Isla Verde, Puerto Rico Twenty-fourth Annual Meeting Attendance: 268 physicians / 142 spouses President: Glen A. Barden, MD Guest Speakers: Lawrence D. Dorr, MD Dates: October 13-17, 1993 Los Angeles, California Location: Disney’s Grand Floridian Beach Resort Bernard F. Morrey, MD Lake Buena Vista, Florida Rochester, Minnesota Attendance: 379 physicians / 299 spouses Thirtieth Anniversary Meeting Guest Speaker: Cecil H. Rorabeck, MD President: Charles H. Classen Jr., MD London, Ontario, Canada Dates: October 13-17, 1999 Twenty-ﬁ fth Annual Meeting Location: Vienna Hilton Hotel President: Henry R. Cowell, MD, PhD Vienna, Austria Dates: October 12-16, 1994 Attendance: 272 physicians / 207 spouses Location: The Southampton Princess Hotel Guest Speaker: Henry H. Bohlman, MD Southampton, Bermuda Cleveland, Ohio Attendance: 339 physicians / 280 spouses Thirty-ﬁ rst Annual Meeting Guest Speakers: Mr. John W. Goodfellow London, England President: A. Lee Osterman, MD Robert B. Salter, MD Dates: October 11-15, 2000 Toronto, Ontario, Canada Location: Disney’s Grand Floridian Resort and Spa Lake Buena Vista, Florida Twenty-sixth Annual Meeting Attendance: 179 physicians / 89 spouses President: Ronald C. Hillegass, MD Guest Speakers: James D. Heckman, MD Dates: October 11-15, 1995 Needham, Massachusetts Location: Sheraton Roma Hotel Peter J. Stern, MD Rome, Italy Cincinnati, Ohio Attendance: 430 physicians / 259 spouses Guest Speaker: Robert D. D’Ambrosia, MD Thirty-second Annual Meeting New Orleans, Louisiana President: James A. Nunley II, MD Twenty-seventh Annual Meeting Dates: October 10-14, 2001 Location: Fairmont Southampton Princess Hotel President: Stephen F. Gunther, MD Southampton, Bermuda Dates: October 16-20, 1996 Attendance: 153 physicians / 110 spouses Location: Hyatt Regency Hilton Head Guest Speakers: Leroy Walker, PhD Hilton Head Island, South Carolina Durham, North Carolina Attendance: 239 physicians / 164 spouses Michael B. Wood, MD Guest Speakers: George Cierny III, MD Rochester, Minnesota Atlanta, Georgia Michael J. Patzakis, MD Thirty-third Annual Meeting Los Angeles, California President: E. Anthony Rankin, MD Twenty-eighth Annual Meeting Dates: October 16-20, 2002 President: L. Andrew Koman, MD Location: Ritz Carlton Hotel Dates: October 14-19, 1997 Amelia Island, Florida Location: Scottsdale Princess Attendance: 230 physicians / 89 spouses Scottsdale, Arizona Guest Speakers: Professor David C. Driskell Attendance: 219 physicians / 164 spouses Baltimore, Maryland Guest Speaker: Russell F. Warren, MD Alvin H. Crawford, MD New York, New York Cincinnati, Ohio

37 EOA 45th Annual MeetingAmelia Island, Florida2014

Thirty-fourth Annual Meeting Location: The Ritz-Carlton President: Shepard R. Hurwitz, MD Lake Las Vegas, Nevada Dates: July 30-August 3, 2003 Attendance: 160 physicians/55 spouses Location: The Burlington Hotel Guest Speaker: Chitranjan S. Ranawat, MD Dublin, Ireland New York, New York Attendance: 231 physicians / 142 spouses Fortieth Annual Meeting (In conjunction with SOA) President: Judith F. Baumhauer, MD, MPH Guest Speakers: Melvin Rosenwasser, MD Dates: June 17-20, 2009 New York, New York Location: Atlantis Resort Pete Gillen Paradise Island, Bahamas Charlottesville, Virginia Attendance: 287 physicians / 121 spouses Thirty-ﬁ fth Annual Meeting Guest Speaker: James N. Weinstein, MS, DO President: John D. Lubahn, MD Hanover, New Hampshire Dates: October 13-17, 2004 Forty-ﬁ rst Annual Meeting Location: The Westin Rio Mar Beach President: Robert N. Richards Jr., MD San Juan, Puerto Rico Dates: October 14-16, 2010 Attendance: 191 physicians / 152 spouses Location: The Ritz-Carlton Guest Speaker: Terry Light, MD Naples, Florida Chicago, Illinois Attendance: 300 physicians / 98 spouses Thirty-sixth Annual Meeting Guest Speaker: Richard D. Lakshman, MD President: Thomas P. Vail, MD Philadelphia, Pennsylvania Dates: October 5-8, 2005 Forty-second Annual Meeting Location: Hyatt Regency Chesapeake Bay President: John C. Richmond, MD Cambridge, Maryland Dates: October 19-22, 2011 Attendance: 198 physicians / 86 spouses Location: The Kingsmill Guest Speaker: Ian D. Learmonth, MB, ChB, FRCS Williamsburg, Virginia Bristol, England Attendance: 312 physicians / 81 spouses Thirty-seventh Annual Meeting Guest Speaker: Brian Day, MD President: J. Richard Bowen, MD Vancouver, British Columbia, Canada Dates: October 18-21, 2006 Forty-third Annual Meeting Location: Boca Raton Resort and Club President: Henry A. Backe Jr., MD Boca Raton, Florida Dates: June 20-23, 2012 Attendance: 232 physicians / 63 spouses Location: The Sagamore Guest Speaker: G. Dean MacEwen, MD Bolton Landing, New York Newark, DE Attendance: 293 physicians/83 spouses Thirty-eighth Annual Meeting Guest Speaker: Derek McMinn President: Scott D. Boden, MD Birmingham, United Kingdom Dates: August 1-4, 2007 Forty-fourth Annual Meeting Location: The Fairmont Empress Hotel President: David S. Zelouf, MD Victoria, BC, Canada Dates: October 30-November 2, 2013 Attendance: 252 physicians / 103 spouses Location: Loews Miami Beach (In conjunction with SOA) Miami Beach, Florida Guest Speaker: Frederick S. Kaplan, MD Attendance: 369 physicians/80 spouses Pittsburgh, Pennsylvania Guest Speaker: Joseph D. Zuckerman, MD Thirty-ninth Annual Meeting New York, NY President: Robert V. Dawe, MD Dates: October 22-25, 2008

38 Please beconsiderate andsilenceyourcellphoneduring theScientiﬁ Eastern Orthopaedic Association Scientific Program Amelia Island,Florida October 23-25,2014 The Ritz-Carlton cProgram. 39

Scientiﬁ c Program

Program Chair

2014 Program Chair c Program c Scientiﬁ

Amar S. Ranawat, MD New York, New York Dr. Amar S. Ranawat was born in New York City. After graduating from Cornell University Medical College, he completed his orthopaedic residency at the Hospital for Special Surgery. In 2002 he completed his fellowship training in Adult Recon- struction under the direction of his father, Dr. Chitranjan S. Ranawat. He is currently an Associate Professor of Orthopaedic Surgery at the Hospital for Special Surgery and a member of The Hip and Knee Societies. A large portion of his practice is dedicated to complex primary and revision total joint surgery. He is an active Clinical Orthopaedic Researcher with particular interests in alternative bearing surfaces for total hip replacement and rotating-platform total knee designs. He lectures extensively at both the national and international levels. He has over 100 peer-reviewed publications, book chapters, and presentations. He has received numerous awards including: The 2013 Teaching Award given to the HSS Attending who is recognized for Outstanding Teaching on the Adult Recon- struction and Total Joint Service. The 2011 Mentorship Award given to the LHH Orthopaedic Attending who demonstrates an outstanding ability to guide, support and teach the Residents. The 2008 HAP Paul Award for the “best paper on new developments in the ﬁ eld of arthroplasty” awarded for MRI in the Early Detection of Particle Disease Following Total Hip Arthroplasty: A Prospective Study at the 2008 International Society for Technology in Arthroplasty, Seoul, South Korea. The 2007 Chief Resident’s Special Award given in recognition of excellent teaching in the LHH Orthopaedic Clinic. The Navy and Marine Corps Achievement Medal awarded in 2007 for performing emergency limb saving surgery on a Marine during exercises in Tan Tan, Morocco. The 2006 Hip Society British Traveling Fellowship awarded to two young surgeons allowing travel to selected hip centers in the United Kingdom for a period of 3 weeks in September 2006. The 2004 James A. Rand Award for the most outstanding paper in knee surgery presented at the Annual Meet- ing of the American Association of Hip and Knee Surgeons, November 2004. He is married to Andrea. They live in NYC with their 3 sons: Cole (11), Conor (9), and Caden (5).

41 EOA 45th Annual MeetingAmelia Island, Florida2014

EOA Honorary Members

Theodore R. Lammot III, MD Incorporator Mr. John Wells Sharrard, FRCS Guest Speaker 1970 Professor J. I. P. James, FRCS Guest Speaker 1972 Professor Pier Giorgio Marchetti Guest Speaker 1975 Professor Alf L. Nachemson, MD Guest Speaker 1976 Maurice E. Muller, MD Guest Speaker 1977 Professor Heinz Wagner Guest Speaker 1981 Mr. Michael A. R. Freeman, MD, FRCS Guest Speaker 1982 Eduardo R. Luque, MD Guest Speaker 1983 Sir Dennis Paterson, MD, FRCS Guest Speaker 1984 Thomas P. Ruedi, MD, FACS Guest Speaker 1985 Richard J. Hawkins, MD Guest Speaker 1986 Mr. George Bentley, ChM, FRCS Guest Speaker 1987 Marvin Tile, MD Guest Speaker 1988 William C. Hutton, DSc Guest Speaker 1989 Peter J. Fowler, MD Guest Speaker 1989 Mercer Rang, MB, FRCS (C) Guest Speaker 1990 Augusto Sarmiento, MD Guest Speaker 1991 Mr. R. Lew Bennett Guest Speaker 1991 Murray K. Dalinka, MD Guest Speaker 1992 Cecil H. Rorabeck, MD Guest Speaker 1993 Mr. John W. Goodfellow Guest Speaker 1994 Robert B. Salter, MD Guest Speaker 1994 Robert D. D’Ambrosia, MD Guest Speaker 1995 Michael J. Patzakis, MD Guest Speaker 1996 George Cierny III, MD Guest Speaker 1996 Elizabeth Capella Former Executive Director Russell F. Warren, MD Guest Speaker 1997 Lawrence D. Dorr, MD Guest Speaker 1998 Bernard F. Morrey, MD Guest Speaker 1998 Henry H. Bohlman, MD Guest Speaker 1999 James D. Heckman, MD Guest Speaker 2000 Peter J. Stern, MD Guest Speaker 2000 Leroy Walker, PhD Guest Speaker 2001 Michael B. Wood, MD Guest Speaker 2001 Professor David C. Driskell Guest Speaker 2002 Alvin H. Crawford, MD Guest Speaker 2002 Melvin Rosenwasser, MD Guest Speaker 2003 Pete Gillen Guest Speaker 2003 Terry Light, MD Guest Speaker 2004 Ian D. Learmonth, MB, ChB, FRCS Guest Speaker 2005 G. Dean MacEwen, MD Guest Speaker 2006 Fredrick S. Kaplan, MD Guest Speaker 2007 Chitranjan S. Ranawat, MD Guest Speaker 2008 James N. Weinstein, MS, DO Guest Speaker 2009 Richard D. Lackman, MD Guest Speaker 2010 Brian Day, MD Guest Speaker 2011 Derek McMinn Guest Speaker 2012 Joseph D. Zuckerman, MD Guest Speaker 2013

42 Presidential Guest Speaker

2014 Presidential Guest Speaker c Program c Scientiﬁ

Mary I. O’Connor, MD

EOA is pleased to have Mary I. O’Connor, MD, Professor of Orthopedics at the Mayo Clinic College of Medicine in Florida as the 2014 Presidential Guest Speaker. Dr. O’Connor served as Chair of the Depart- ment of Orthopedic Surgery at Mayo Clinic in Florida from 2005 to 2013, 8 year tenure per Mayo policy. She continues to serves as the Medical Director for the Mayo Foundation Ofﬁ ce of Integrity and Compliance and Associate Director of Development at Mayo Clinic Florida.

Dr. O’Connor received her MD from the Medical College of Pennsylvania in 1985. She completed her residency in orthopedics at the Mayo Clinic in Rochester, MN in 1990 and her fellowship in orthopedic oncology at the same institution in 1991. She is the past Associate Dean for Surgery Education and is the current Program Director of the Adult Reconstructive Fellowship at Mayo Clinic Florida. She has published extensively on oncology and arthroplasty related topics. Particular areas of focus include research on limb salvage in the management of sarcomas involving the pelvic and shoulder girdles and gender differences in outcomes related to joint replacement surgery. She is engaged in research to study sex differences in knee osteoarthritis and use of stem cells to treat early osteoarthritis.

Dr. O’Connor was the ﬁ rst woman to be elected into the Musculoskeletal Tumor Society (MSTS), the American Association of Hip and Knee Surgeons (AAHKS) and The Knee Society. She is the Past President of the International Society of Limb Salvage, Association of Bone and Joint Surgeons, AAHKS, MSTS, and the Ruth Jackson Orthopaedic Society. She is a member of the Board of the Perry Foundation, past member of the Advisory Committee on Research on Women’s Health at the National Institutes of Health and past Chair of the American Academy of Orthopaedic Surgeons Women’s Health Issues Advisory Board. She has served as the Co-Chair of the Movement is Life Caucus since its founding in 2010, a group focused on addressing musculoskeletal healthcare disparities in the United States.

Dr. O’Connor has received numerous awards and honors during her training and career, including being named a Distinguished Clinician at Mayo Clinic and receiving The Corinne Farrell Award from the Inter- national Skeletal Society in 2009. She received the Congressional Medal of Honor as a 1980 Olympian and was named a Health Care Hero by the Jacksonville Business Journal in 2011. She is honored to be the 2014 Eastern Orthopaedic Association Presidential Guest Speaker at the invitation of her friend, President David Romness.

43 EOA 45th Annual MeetingAmelia Island, Florida2014

2014 EOA Resident/Fellow Award Recipients

Founders’ Award C. Edward Hofﬂ er II, MD, PhD Flouroscopic Radiation Exposure: Are We Protecting Ourselves Adequately? Saturday, October 25, 2014; 1:06pm–1:12pm

Ranawat Award Alexander S. McLawhorn, MD, MBA Cost Effectiveness Of Bariatric Surgery Prior To Primary Total Knee Arthroplasty Saturday, October 25, 2014; 7:48am–7:54am

Resident Award Ryan Massimilla, BS Prospective, Randomized Study: Superior Early Outcomes Following THA Using Direct Anterior Approach Saturday, October 25, 2014; 11:04am–11:10am

Michael Pensak, MD Combination Therapy With DBM And PTH Can Not Heal A Critical Sized Murine Femoral Defect Saturday, October 25, 2014; 7:40am–7:46am

Christopher J. Williamson, MD Statins Adversely Affect Long Bones Of Corticosteroid Treated Rabbits Thursday, October 23, 2014; 12:58pm–1:04pm

EOA/OREF Resident Travel Grant Award Victor H. Hernandez, MD, MS When Is It Safe For Patients To Drive After Right Total Hip Arthroplasty? Saturday, October 25, 2014; 11:12am–11:18am

Adam E. Hyatt, MD Suture Anchor Behavior In The Setting Of Rotator Cuff Footprint Decortication Thursday, October 23, 2014; 7:21am–7:27am

Jonathan Oren, MD Implant Cost Reduction Initiative In Spine Surgery Friday, October 24, 2014; 7:40am–7:46am

Resident Travel Grant Award Jeffrey Alwine, DO Accessory Medial Portal For ACL Reconstruction: Safe Zone To Avoid Complications Thursday, October 23, 2014; 7:37am–7:43am

Alexander B. Christ, MD Targeting Skeletal Metastases Using HPMA Copolymer Nanoparticle Delivery And Retention Saturday, October 25, 2014; 1:22pm–1:28pm

44 Thursday, October23,2014; Preoperative Anemia Increases Postoperative Complications And Mortality Following Total Joint Arthroplasty Jessica Viola,BS Saturday, October25,2014; Conservative Management OfElbowDislocations With An OverheadMotionProtocol Joseph J.Schreiber, MD Saturday, October25,2014; What Factors Affect Medicare Reimbursement In Total Joint Arthroplasty? Eric M.Padegimas, MD Friday, October24,2014; Head CTScans With LowEnergy IsolatedGeriatricFemur Fractures Hemil H.Maniar, MD Thursday, October23,2014; Decreased T2 RelaxationIn Articular Cartilage Following Modelled Therapeutic Irradiation At Long-Term Follow-Up Ian Hutchinson,MD

1:02pm–1:08pm

1:14pm–1:20pm 7:32am–7:38am 1:30am–1:36pm 1:06pm–1:12pm Award Recipients 45

Scientiﬁ c Program EOA 45th Annual MeetingAmelia Island, Florida2014

Financial Disclosure Information

Eastern Orthopaedic Association has identifi ed the option to disclose as follows. The following participants have disclosed whether they or a member of their immediate family: 1. Receive royalties for any pharmaceutical, biomaterial, or orthopaedic product or device; 2. Within the past twelve months, served on a speakers’ bureau or have been paid an honorarium to present by any pharmaceutical, biomaterial, or orthopaedic product or device company; 3a. Paid Employee for any pharmaceutical, biomaterial, or orthopaedic device and equipment company, or supplier; 3b. Paid Consultant for any pharmaceutical, biomaterial, or orthopaedic device and equipment company, or supplier; 3c. Unpaid Consultant for any pharmaceutical, biomaterial, or orthopaedic device and equipment company, or supplier; 4. Own stock or stock options in any pharmaceutical, biomaterial, or orthopaedic device and equipment company, or supplier (excluding mutual funds); 5. Receive research or institutional support as a principal investigator from any pharmaceutical, biomaterial, orthopaedic device and equipment company, or supplier; 6. Receive any other fi nancial/material support from any pharmaceutical, biomaterial, or orthopaedic device and equipment company, or supplier; 7. Receive any royalties, fi nancial/material support from any medical and/or orthopaedic publishers; 8. Serves on the editorial or governing board of any medical and/or orthopaedic publication; 9. Serves on any Board of Directors, as an owner, or offi cer, on a relevant committee of any health care organization (e.g., hospital, surgery center, medical); n. No confl icts to disclose. The Academy does not view the existence of these disclosed interests or commitments as necessarily implying bias or decreasing the value of the author’s participation in the meeting.

Joseph A. Abboud, MD (1. Integra Life Sciences, Lippincott; Todd J. Albert, MD (1. Biomet, DePuy; 3b. DePuy, FacetLink; 3b. Integra Life Sciences; 5. DePuy, Zimmer; 7. Wolters 4. ASIP, Bioassets, Biomerix, Breakaway Imaging, Crosstree, Kluwer Health, Lippincott Williams & Wilkins; 8. Journal of Gentis, International Orthopaedic Alliance, Invuity, Paradigm Bone and Joint Surgery, American and Orthopaedic Spine, Philadelphia Medical Investment Group, PIONEER, Reville Knowledge Online; 9. American Shoulder and Elbow Consortium, Spinicity, Vertech; 6. United Healthcare; 7. Jay Pee, Surgeons, Mid Atlantic Shoulder and Elbow Saunders/Mosby-Elsevier, Thieme; 8. Journal of Bone and Joint Society) Surgery – American, Spine, Spine Deformity Journal; 9. AAOS, AOA, Cervical Spine Research Society, Council for Value in Spine Care, Jack Abboudi, MD (n.) Scoliosis Research Society) John A. Abraham, MD (3b. Biomet; 5. Novartis) Pouya Alijanipour, MD (n.) Daniel C. Acevedo, MD (n.) Benjamin A. Alman, MD (4. ScarX; 8. Journal of Orthopaedic Christopher Adams, MD (3a. Arthrex, Inc.; 3b. Arthrex, Inc.) Research, Journal of Orthopaedic Research PLoS One; 9. Shriners Samuel B. Adams Jr., MD (2. Harvest Terumo; 3b. Stryker, Medshape, Research Advisory Board, Orthopaedic Research Society) RTI) Jeffrey Alwine, DO (n.) Shawn Adhya, BS (n.) Divya V. Ambati, MS (n.) Edward Adler, MD (n.) Paul A. Anderson, MD (n.) Christopher S. Ahmad, MD (3b. Acumed, LLC, Arthrex, Inc.; William V. Arnold, MD, PhD (3a. Merck, Norwich Pharmaceuticals; 5. Arthrex, Inc., Major League Baseball, Stryker) 4. Merck, Norwich Pharmaceuticals; 5. Stryker, Zimmer; 8. Journal of Erol Akalin (n.) Arthroplasty) Michael J. Alaia, MD (n.) Joseph Assini, MD (n.)

Disclosures in bold indicate members of the EOA Program Committee and/or contributing staff.

46 Scott D.Boden,MD Lorraine A. Boakye, BA Jason L.Blevins, MD Eric M.Black,MD Benjamin T. Bjerke-Kroll, MD,MS Suneel Bhat,MD,MPhil CPT Adam J.Bevevino, MD Jonathan Beri,BS Pedro K.Beredjiklian,MD Pablo Benavente, MD,PhD Rebecca Bedard,MA, ATC, OTC Hany S.Bedair, MD Jennifer M.Bayron,MD Dexter Bateman,BS James Barsi,MD Jonathan Barlow, MD,MS Katherine Bagnato, ATC Henry A. Backe Jr., MD Abdo Bachoura,MD Foundation, St.Jude Children’s Research Hospital) Frederick M. Azar, MD Michael C. Aynardi, MD 3b. Zimmer;8.Journal of Arthroplasty; 9. The RothmanInstitute) Matthew S. Austin, MD MD Luke Austin, MD Amy Austin, 9. OMeGA) David E. Attarian, MD Jordon Brees,PA-C Orthopaedic SocietyforSportsMedicine) James P. Bradley, MD Thomas Bradbury, MD Thomas Bowen, MD Research Society) 5. BoneSupport,Smith&Nephew; 8.Springer; 9.Orthopaedic Mathias P. G.Bostrom,MD Surgery – American; 9. The OrthopedicLearningCenter) The HospitalforJoint Diseases, Journal ofBoneandJoint Joseph A. BoscoIII,MD 8. JSOA, AAHKS; 9.EOA, AAHKS, NCOA) 5. DePuy, Zimmer;6.OREF, AOA, Omega;7. AAHKS; Pacira, ConvaTec; 3b. Biomet; 3c.TJO, Amedica; 4.TJO, Amedica; Michael P. Bolognesi, MD John A. Bojescul,MD B. Bohn,MD Nephew; 7.OrthoForum GmbH;8.OrthoForum GmbH) 2. DJOSurgical; 3b. OrthoDevelopment, Smith&Nephew; 5.Smith& Friedrich Boettner, MD,PC Orthopaedics Today, Spine, JBJS;9. AOA, EmoryHealthNetwork) (n.) Disclosures in boldindicatemembersofthe EOA Program Committeeand/orcontributing staff. (n.) (n.) (3b. Tornier) (n.) (n.) (n.) (n.) (n.) (1. (n.) (n.) (n.) (1. Arthrex, Inc.;5. Arthrex, Inc.;9. American (n.) (7. Data Trace PublishingCompany; (3b. Arthrex) (4. Pﬁ zer;7.Elsevier; 9. AAOS, Campbell (1. Zimmer;2.Zimmer, DePuy; Medtronic, DBM;8.SpineSurgery Today, (n.) (n.) (n.) (2. Auxilium; 9.EOA) (n.) (n.) (5. Care Fusion,MAKO; 8.Bulletin of (n.) (4. Tornier,Inc.) (1. Biomet,Zimmer;2.Zimmer, (n.) (1. OrthoDevelopment, Smith&Nephew; (3b. Smith&Nephew; (n.) (n.) (n.) Stan Conte,PT, DPT, ATC Nicholas D.Colacchio,MD Arthrex, Inc.,Major League Baseball;7.SLACK, Inc.) Steven B.Cohen,MD CPT JohnP. Cody, MD Jason L.Codding,MD Surgery, BoneandJoint Journal; 9.UnitedHealthcare) Joint Surgery; 8.Journal of Arthroplasty, Journal ofBoneandJoint Trace PublishingCompany, Jaypee Publishers, Journal ofBone and Biostar Ventures; 7.Elsevier, Wolters Kluwer, SLACK, Inc.Data Ventures; 6.CDDiagnostics, Synthes,Zimmer, Biomet, Angiotech, 5. CDDiagnostics, Synthes,Zimmer, Biomet, Angiotech, Biostar Ventures, Trice, Domain,Lankenau InstituteofMedicalResearch; Innovation Technology, Synthes,Zimmer, Biomet, Angiotech, Biostar Lankenau InstituteofMedicalResearch; 4.CDDiagnostics, Hip Diagnostics, Synthes,Biomet, Angiotech, Biostar Ventures, Trice, Smith &Nephew, ConvaTec, TissueGene, PRN,Medtronic, CD Zimmer, Biomet, Angiotech, Biostar Ventures, Trice; 3b. Zimmer, Biomet, Angiotech, Biostar Ventures; 3a.CDDiagnostics, Synthes, Angiotech, Biostar Ventures; 2.CDDiagnostics, Synthes,Zimmer, Corey Clyde,BS Mark Cleary, MD,MPH Michael Citrano,BS Alexander B.Christ,MD Matthew Chin,MD Yen HsunChen,BS Publishing) Antonia F. Chen,MD,MBA Priscilla K.Cavanaugh, MS Anthony Catanzano,BS Kaitlin M.Carroll,BS Smith &Nephew) Eben A. Carroll,MD Michelle G.Carlson,MD Christian Candrian,MD Danielle Campbell,MS Alexander Cameron,BS Roberto Calderon,MD Camden B.Burns,MD Ross Budacki,MD Jeremy Bruce,MD Nick Brownstone, BA Philip Brown, MS Kristin Brown, BA Lawrence Brooks,PhD J. ScottBroderick,MD Robert Brochin,BS Edmund Z.Brinkis,MD (1. CDDiagnostics, Synthes,Zimmer, Biomet, (n.) (n.) (n.) (n.) (n.) (n.) (n.) (n.) (3b. Synthes,Smith &Nephew; 5.Synthes, (1. Zimmer;3b. Zimmer, CONMEDLinvatec; 5. (n.) (n.) (n.) (n.) (n.) (n.) (n.) (n.) (3a. Stryker; 4.Stryker) (n.) (n.) (3a. CDDiagnostics; 4.CDDiagnostics) (n.) (n.) (n.) (n.) Financial Disclosure Information (n.) (n.) (n.) (3a. Novo Nordisk; 7.SLACK 47

Scientiﬁ c Program EOA 45th Annual MeetingAmelia Island, Florida2014

Frank F. Cook, MD (n.) Emily R. Dodwell, MD, MPH, FRCSC (n.) H. John Cooper, MD (3b. Smith & Nephew, Zimmer; 8. Journal of Brandon Donnelly, MD (n.) Arthroplasty; 9. AAOS) Karan Dua, BA (n.) James A. Costanzo, MD (n.) Yanina Dubrovskaya, PharmD (n.) Michael B. Cross, MD (n.) Michael P. Duffy, MS (n.) Randall W. Culp, MD (2. Auxilium; 3b. Biomet, Small Bone Alex G. Dukas, MD (n.) Innovations, Arthrex, Inc.) Gavin Duke, MD (n.) Matthew E. Cunningham, MD, PhD (6. DePuy) Albert S. Dunn, DO (n.) Bradford L. Currier, MD (1. DePuy Spine, Stryker Spine, Zimmer Spine; 3b. Zimmer Spine; 4. Spinology Tenex; 9. Lumbar Spine Brian S. Dunoski, MD (n.) Research Society) Joseph Dwyer, MD (n.) Aaron Daluiski, MD (n.) Chris J. Dy, MD, MSPH (n.) Joseph N. Daniel, DO (3b. Wright Medical Technology, Inc.) Daniel Dziadosz, MD (n.) David M. Dare, MD (n.) Brandon Eck, BS (n.) Kurosh Darvish, PhD (n.) Folorunsho Edobor-Osula, MD, MPH (n.) Gregory Daut, MD (n.) Joseph Ehrenreich (n.) Daniel E. Davis, MD, MS (n.) Neal ElAttrache, MD (1. Arthrex, Inc.; 5. Arthrex, Inc.; Michael Day, MD, MS (n.) 9. American Orthopaedic Society for Sports Medicine) John Deegan, DO (n.) Mark R. Elliott, MD (n.) Carl Deirmengian, MD (2. CD Diagnostics, Zimmer; Marcella Elpers, BS (n.) 3a. CD Diagnostics; 3b. CD Diagnostics, Zimmer; 4. CD Diagnostics, Greg Erens, MD (4. Johnson & Johnson; 5. Stryker) KK, PK, KS, AC, MC, CD Diagnostics; 5. CD Diagnostics, Zimmer; 7. CD Diagnostics, JBJS) John A. Erickson, MD (n.) (1. K2M, Fastenetix; 2. DePuy, K2M; Gregory K. Deirmengian, MD (8. Journal of Arthroplasty) Thomas J. Errico, MD 4. Fastenetix; 5. Fridolin Trust, OMEGA, AOSpine, Paradigm Spine; Daniel J. Del Gaizo, MD (2. Cadence Pharmaceuticals; 5. Stryker, 6. K2M; 9. Harms Study Group, International Spine Study Group Zimmer; 8. Journal of Arthroplasty) (ISSG)) Craig J. Della Valle, MD (3b. Biomet, DePuy, Smith & Nephew; J. Lee Evanson, DO (n.) 4. CD Diagnostics; 5. Biomet, CD Diagnostics, Smith & Nephew, Stryker; 7. SLACK, Inc.; 8. JBJS Case Connector, Orthopaedics Ahmad Faizan, PhD (3a. Stryker) Today; 9. AAHKS) David G. Fanelli, BS (2. Biomet, CONMED Linvatec; 3b. CONMED Linvatec; 7. Springer, Thieme, Wolters Kluwer Peter Deluca, MD (n.) Health - Lippincott Williams & Wilkins; 8. Thieme, Wolters Ivan De Martino, MD (n.) Kluwer Health - Lippincott Williams & Wilkins) Ajit J. Deshmukh, MD (n.) Andrzej Fertala, PhD (5. Mentor Worldwide, LLC) Timothy W. Deyer, MD (n.) Jolanta Fertala, PhD (n.) Aman Dhawan, MD (2. Smith & Nephew, Arthrex, Biomet; 3b. Smith Allison Liefeld Fillar, MD (n.) & Nephew, Arthrex, Biomet; 5. Smith & Nephew; 8. Editorial Board of Arthroscopy Journal) Stephen H. Finley, MD (n.) (n.) Claudio Diaz, MD (n.) Russell Flato, BA (n.) Brian Dierckman, MD (n.) Kyle E. Fleck, MD (n.) Gregory S. DiFelice, MD (2. Arthrex, Inc.; 3b. Arthrex, Inc.) Sean Flynn, MD (n.) David M. Dines, MD (1. Biomet; 6. Biomet; 7. Saunders/Mosby- Michael A. Foltzer, MD Elsevier; 9. American Shoulder and Elbow Surgeons) Peter Formby, MD (n.) Joshua S. Dines, MD (2. Arthrex; 3b. Arthrex, Conmed Linvatec; Ethan J. Fraser, MD (9. Hospital for Special Surgery) 4. Tornier; 7. Lippincott Williams & Wilkins; 8. American Journal Kevin Freedman, MD (n.) Orthopedics, Journal Shoulder Elbow Surgery) Michael T. Freehill, MD (3b. Smith & Nephew; 6. DePuy Mitek, Anton E. Dmitriev, PhD (n.) Smith & Nephew) Huong T. Do, MA (n.) Andrew A. Freiberg, MD (1. Biomet, Zimmer; 3b. Zimmer; Christopher Dodson, MD (3b. Arthrex) 4. ArthroSurface, Orthopaedic Technology Group)

Disclosures in bold indicate members of the EOA Program Committee and/or contributing staff.

48 John E.Handelsman,MD,FRCS John A. Handal,MD Jason J.Halvorson, MD Amgad M.Haleem,MD,MSc M. Kelly Guyton,PhD Christina J.Gutowski, MD,MPH Simmi Gulati,RM(ASM) Society, EOA, PhiladelphiaOrthopaedicSociety) James T. Guille,MD Simon Greenbaum,BA Joshua Greenbaum,BA Orthopedic Surgeons, POSNA, ScoliosisResearch Society) New York CountyMedicalSociety, New York State SocietyOf Opinion InPediatrics; 8.Current OpinionInPediatrics; 9. AAOS, Daniel W. Green,MD Louis C.Grandizio,DO Jove Graham,PhD 7. Data Trace Publishing Company) Nitin Goyal, MD Victoria A. Gordon,BA Miguel M.Gomez,MD Peter Goljan,MD Society, OsteoarthritisResearch SocietyInternational) Rheumatism, Osteroarthritis &Cartilage; 9.OrthopaedicResearch Janssen; 5.Merck Serono, Boehringer Ingelheim Abbott; 8. Arthritis Steven R.Goldring, MD Daniel Goldberg, NA Jonathon A. Godin,MD,MBA David H.Godfried,MD Research -Part B: Applied Biomaterials) - Part B: Applied Biomaterials;8.Journal ofBiomedicalMaterials Danek, Stryker, DePuy;7.Journal ofBiomedicalMaterialsResearch Jeremy L.Gilbert,PhD Arianna Giannakos, BS Grigory E.Gershkovich, MD Berenice Gerard,BS,MHS David S.Geller, MD Thorsten Gehrke, MD Rachel E.Gaume,BS Charles Gatt,MD 3b. Tornier; 6.Zimmer, Sonoma, DJO,Breg, DePuy-Mitek,Synthes) Grant E.Garrigues,MD Grant H.Garcia,MD Brian J.Galinat,MD,MBA Brett Frykberg, MD Publishing Company;9.DataTrace PublishingCompany) Chuck Freitag (7. DataTrace PublishingCompany;8.DataTrace Disclosures in boldindicatemembersofthe EOA Program Committeeand/orcontributing staff. (3b. CayenneMedical, Stryker Orthopaedics; (n.) (n.) (n.) (n.) (n.) (n.) (8. Orthopedics;9.POSNA, ScoliosisResearch (n.) (n.) (n.) (1. Pega Medical;2. Arthrex, Inc.;7.Current (1. Zimmer;2.Zimmer, LINK,Biomet) (n.) (3b. Stryker, DePuy;5.Medtronic Sofamor (n.) (8. New Jersey) (n.) (n.) (n.) (n.) (n.) (n.) (1. Tornier;2. Tornier, DePuy-Synthes; (3b.Fidia,Bone Therapeutics, Abbott, (n.) (n.) (9. AAOS, AOA) (n.) (n.) (n.) (n.) (n.) Ashish Jain,MS Danek, Nuvasive, Zimmer) Joshua J.Jacobs,MD Iker Iriberri, MD JBJS Reviews; 9.KneeSociety, HipSociety) Richard Iorio,MD Asif Ilyas,MD David A. Iacobelli, MD 4. Stryker Orthopaedics;8.Journal ofOrthopaedic Trauma) Robert A. Hymes,MD Adam E.Hyatt,MD Lorraine Hutzler, BA Ian Hutchinson,MD Tracey Hunter, BS R. Tyler Huish,DO Ronald Huang,MD Michael J.Howley, PA-C, PhD Robert N.Hotchkiss,MD Michael D.Hossack,MD 9. AAOS, Foundation forOrthopaedic Trauma) 5. Synthes;8. Wolters KluwerHealth-Lippincott Williams & Wilkins; Daniel S.Horwitz,MD Chloe Horowitz, BS Seung-Hyun Hong,PhD C. Edward Hofﬂ Jason Hochfelder, MD 6. Stryker) Kirby Hitt,MD Justin M.Hire,MD Research Society, North American SpineSociety) Spine, PSD,Spinal Ventures, Vertiﬂ ex; 9. AAOS, CervicalSpine Stryker; 4. Amedica, Benvenue Medical,Lifespine, Nexgen, Paradigm Alan S.Hilibrand,MD Ryan Hess,MD Victor H.Hernandez,MD,MS R. FrankHennIII R. Andrew Henderson,MD,MSc Snir Heller, MD Society) International SocietyofLimbSalvage, Musculoskeletal Transplant 9. Association ofBoneJoint Surgeons, Musculoskeletal Tumor Society, John H.Healey, MD Hasan Seyed A. Anthony M.Harris,MD William T. Hardaker Jr., MD Charles P. Hannon,BS (n.) er II,MD,PhD (1. Stryker; 2.Stryker, ConvaTec; 3b. Stryker; (n.) (n.) (n.) (n.) (n.) (3b. DePuyMitek) (9. National Association ofOrthopaedicNurses) (3b. Kyocera/IMDS; 8.JAAOS, JBJS,JOA, CORR, (n.) (n.) (n.) (n.) (n.) (8. ClinicalOrthopaedicsandRelatedResearch; (n.) (n.) (4. ImplantProtection; 5.Medtronic Sofamor (n.) (3c. Stryker Orthopaedics; (n.) (1. Aesculap/B.Braun, Amedica, Biomet, (1. Aesculap/B.Braun, Amedica, (1. Biomet;3b. Biomet,Cardinal Health; (n.) (n.) (n.) (n.) Financial Disclosure Information (n.) (n.) (n.) (n.) (n.) (n.) 49

Scientiﬁ c Program EOA 45th Annual MeetingAmelia Island, Florida2014

Andre Jakoi, MD (n.) Yevgeniy Korshunov, MD (n.) Ehsan Jazini, MD (n.) Tyler M. Kreitz, MD (n.) Seth A. Jerabek, MD (3b. MAKO) James C. Krieg, MD (1. SAM Medical, Synthes CMF; 3b. Synthes, Acumed, LLC; 4. Domain Surgical, Trice Medical Technologies; Peter C. Johnson, MD (n.) 8. Journal of the American Academy of Orthopaedic Surgeons) Christopher Jones, MD (n.) Fatih Kucukdurmaz, MD (n.) LCDR Patrick W. Joyner, MD, MS (n.) Neil Kumar, MD (n.) Robin N. Kamal, MD (n.) Sameh A. Labib, MD (2. Arthrex, Inc.; 3b. Arthrex, Inc.; 5. Zimmer) Ian W. Kane, BS (n.) Paul F. Lachiewicz, MD (1. Innomed; 2. Cadence; 3b. Cadence, Justin Kane, MD (n.) Guidepoint Global Advisors, Gerson Lehrman Group; 5. Zimmer; 7. SLACK, Inc.; 8. J Arthroplasty, JSOA; 9. Hip Society, OST) Patrick W. Kane, MD (n.) Maxwell K. Langfi tt, MD (n.) Daniel G. Kang, MD (n.) Carlos J. Lavernia, MD (1. MAKO Surgical Corp.; 3b. MAKO Keith Kardos, PhD (3a. CD Diagnostics; 4. CD Diagnostics) Surgical Corp., Stryker; 4. Johnson & Johnson, Zimmer, Raj Karia, MPH (n.) MAKO Surgical Corp., Stryker, Wright, Symmetry Medical; Alexa J. Karkenny, BS (n.) 5. MAKO Surgical Corp., Stryker; 8. Journal of Arthroplasty; 9. American Association of Hip and Knee Surgeons, Florida N. George Kasparyan, MD, PhD (n.) Orthopaedic Society) Andrew Kay, BA (n.) Kyle Lavery, MD (n.) Jonathan K. Kazam, MD (n.) Mark D. Lazarus, MD (1. Tornier; 2. Tornier; 3b. Tornier; 5. Tornier) Justin Kearse, MD (n.) Adam K. Lee, MD (n.) Khaled M. Kebaish, MD (1. DePuy; 2. DePuy, Orthofi x, Inc., Gwo-Chin Lee, MD (2. DePuy, Ceramtec, Medtronic; 3b. Stryker, K2 Medical Inc.; 3b. DePuy; 5. DePuy; 9. Scoliosis Research Society) Pacifi ra; 5. Zimmer, Smith & Nephew; 8. Clinical Orthopaedics and John D. Kelly IV, MD (7. Springer; 8. Orthopedics, Orthopedics Related Research, Journal of Arthroplasty, Orthopedics, SLACK, Inc., Today) Journal of Bone and Joint Surgery) Samuel Kenan, MD (n.) Lily Lee, MS (n.) Daniel Kendoff, MD, PhD (2. Biomet, Zimmer) Steven J. Lee, MD (3b. Arthrex, Inc.) John G. Kennedy, MD, FRCS (Orth) (3b. Arteriocyte, Inc.; Thomas D. Lee, MD (n.) 5. Arteriocyte, Inc., Ohnell Family Foundation, Mr. Michael J. Andrew Lehman (n.) Levitt; 8. European Society of Sports Medicine, Knee Surgery, and LTC Ronald A. Lehman Jr., MD (5. Centinel Spine, DePuy ) Arthroscopy) Charles S. Leinberry, MD (1. Knee Creations, Zimmer; 2. Knee Constantinos Ketonis, MD, PhD (n.) Creations, Zimmer; 3c. SegWay Orthopedics; 4. Knee Creations, Saker Khamaisy, MD (n.) Zimmer; 9. American Society for Surgery of the Hand, AAOS, AOA) Paul D. Kiely, MCh, FRCS (Tr & Orth) (n.) Mark J. Lemos, MD (8. Arthroscopy Journal; 9. New Hampshire Kelly G. Kilcoyne, MD (n.) Musculoskeletal Institute, EOA) Patrick Kilmartin, BS, MS (3a. CD Diagnostics) Lawrence G. Lenke, MD (1. Medtronic; 2. DePuy, K2M; 3b. DePuy, K2M, Medtronic; 5. DePuy, Axial Biotech; 7. Quality Medical Nayoung Kim, BS (n.) Publishing; 8. Spine, Journal of Spinal Disorders & Techniques, Daniel Kiridly, BS (n.) Scoliosis, Backtalk (Scoliosis Assn), Journal of Neurosurgery: Spine, Spine Deformity Journal, www.iscoliosis.com, www. Kevin L. Kirk, DO (9. AOFAS) spineuniverse.com) William Kirkpatrick, MD (n.) Adam Levin, MD (n.) Joel C. Klena, MD (3b. Microaire) David Levi, MD (n.) Benjamin Kocher, PA-C (n.) I. Martin Levy, MD (n.) Matthew Koff, PhD (3a. Johnson & Johnson; 4. Johnson & Johnson; Valerae O. Lewis, MD (n.) 5. GE Healthcare; 6. Johnson & Johnson) Cynthia Lichtefeld (n.) L. Andrew Koman, MD (3c. Keranetics; 4. Keranetics; 6. Keranetics; 7. Data Trace Publishing Company; Gregory T. Lichtman, MD (n.) 8. Keranetics) Jay R. Lieberman, MD (n.) David E. Komatsu, PhD (n.) Cynthia P. Liefeld, PhD (n.) Disclosures in bold indicate members of the EOA Program Committee and/or contributing staff.

50 Healthcare) Journal ofBoneandJoint Surgery, Boneand Joint Journal; 9.United Publishing Company, Jaypee Publishers; 8.Journal of Arthroplasty, Technology; 7.Elsevier, Wolters Kluwer, SLACK, Inc., Data Trace TissueGene, PRN,Medtronic; 4.CDDiagnostics, HipInnovation Ryan Massimilla,BS Arthroscopy, KneeSurgery, andOrthopedicSportsMedicine) Traumatology, Arthroscopy Journal; 9.InternationalSociety of Journal ofBone&Joint Surgery [American],KneeSurgery, Sports for SpecialSurgery Journal, EvidenceBasedOrthopedics, The Solution); Springer (Revision ACL Reconstruction); 8.Hospital Robert G.Marx,MD,MSc,FRCSC Jessica Martschinske, MA, ATC, OTC Neil J.Mardis,DO Joseph Maratt,MD Jorge Manrique,MD 3a. Merck; 3b. Ceramtec, Orthopedic Technology Group) Kartik Mangudi Varadarajan, PhD Hemil H.Maniar, MD Mitchell G.Maltenfort,PhD Stryker; 8.Journal of Arthroplasty; 9. AAHKS) Arthur L.Malkani,MD A. StephenMalekzadeh,MD Zimmer, MAKO; 6.Smith&Nephew ) Orthopedic Technology Group; 5.Smith&Nephew, DePuy, Biomet, 3b. Smith&Nephew, MAKO Surgical; 3c.Biomet;4.RSABiomedical, Henrik Malchau,MD,PhD Aditya Makol, MD Anne MarieMadden Yan Ma,PhD Orthopaedic SportsMedicine) Journal; 9.InternationalSociety of Arthroscopy, KneeSurgery, Stephan Lyman, PhD Kevin Lutsky, MD Brett Lurie,MBBS Meryl R.Ludwig,MD John D.Lubahn,MD Donna M.Lopez,MSN Technologies) 5. Zimmer;7.Saunders, Wolters Kluwer;9.SAB-BlueBelt Blue Belt Technologies; 4.BlueBelt Technologies, CDDiagnostics; Jess H.Lonner, MD OREF; 8.SRSSpineDeformityJournal; 9.DePuySpine) Baron Lonner, MD Keith Lonergan, MD Nicholas Lombardi,BS Liz Loeffl Bryan J.Loeffl Frederick Liss,MD Christopher P. Lindsay, BS er (n.) (n.) er, MD Disclosures in boldindicatemembersofthe EOA Program Committeeand/orcontributing staff. (3b. Synthes) (n.) (1. DePuy;2.3b. DePuy;5.DePuy, (n.) (n.) (n.) (n.) (1. Zimmer, BlueBelt Technologies; 3b. Zimmer, (n.) (n.) (n.) (5. Auxillium, Xiafl ex) (8. American Journal ofOrthopedics,HSS (3b. Zimmer, Smith &Nephew, ConvaTec, (n.) (n.) (n.) (1. Stryker; 2.Stryker; 3b. Stryker; 5.Synthes, (n.) (n.) (n.) (1. Smith&Nephew, MAKO Surgical; (n.) (n.) (1. MAKO Surgical Corp; (7. DemosHealth(The ACL (n.) Bone Designs) Bulletproof BoneDesigns;6.MiamiDevice SolutionsandBulletproof Surena Namdari,MD,MSc Christopher D.Murawski, BS Lauren Murphy Technology Group) Surgical; 5.Biomet,DePuy, MAKO Surgical; 6.Biomet,Orthopaedic Aston Medical,MerilHealthcare, Arthrex, Ceramtec, MAKO Orhun K.Muratoglu,PhD Michael T. Munley, PhD Remy Munasifi Jeffrey Muenzer, BS Mohamed E.Moussa,MD Reza Mostafavi Tabatabaee, MD James T. Monica,MD Firoz Miyanji,MD Justin B.Mirza,DO Surgi-Center) Ather Mirza,MD Seyed Alireza Mirghasemi, MD Dominic J.Mintalucci,MD Christopher Mino,BS Michael T. Milone,BA Freeman Miller, MD Trauma) Anna N.Miller, MD Andrew Miller, MD Ryan Michels,MD Arthroplasty) 3b. Stryker Orthopaedics;5.Stryker Orthopaedics;8.Journal of R. MichaelMeneghini, MD Elliot S.Mendelsohn,MD Morteza Meftah,MD Kristin McPhillips,MD,MPH Alexander S.McLawhorn, MD,MBA Edward McFarland, MD Taylor R.McClellan,BS Lucy McCabe,BS John M.Mazur, MD 4. OrthoAlign) David J.Mayman,MD Jonas L.Matzon,MD 9. NorthCarolina Orthopaedic Association) Medical, KNGHealthConsulting, Smith&Nephew; 4.forMD; Richard C.MatherIII,MD Aaron K.Mates,MD

(n.) (n.) (1. AM Surgical; 8.Hand;9.NorthShore (3b. UnionSurgical, LLC) (3b. DePuy;5.DePuy) (n.) (n.) (n.) (3b. EliLilly;8. Journal ofOrthopaedic (n.) (n.) (n.) (n.) (n.) (n.) (n.) (n.) (3b. MAKO, Smith&Nephew; (n.) (6. DePuy-Mitek) (n.) (n.) Financial Disclosure Information (1. Zimmer, Biomet,Corin,ConforMIS, (n.) (n.) (2. Smith&Nephew; 3b. Stryker, Pivot (3b. MiamiDevice Solutionsand (n.) (1. Stryker Orthopaedics; (n.) (n.) (n.) (n.) (n.) 51

Scientiﬁ c Program EOA 45th Annual MeetingAmelia Island, Florida2014

Matthew A. Napierala, MD (n.) Nimit A. Patel, MD (n.) Alexa C. Narzikul, BA (n.) Raj G. Patel, BS (n.) Senthil T. Nathan, MD (n.) Ronak M. Patel, MD (n.) Christopher Nathasingh, BA (n.) Sujal Patel, MD (n.) Danyal Nawabi, MD (n.) Suresh Patil, MD (n.) Jim Nevelos, PhD (3a. Stryker; 4. Stryker) Sophia Paul, BA (n.) Hunter Newman, HS (n.) E. Scott Paxton, MD (n.) Peter O. Newton, MD (1. DePuy, Synthes Spine; 2. DePuy, synthes Andrew D. Pearl, MD (3b. Biomet, MAKO Surgical; 9. Bluebelt Spine; 3b. Cubis, DePuy, Synthes Spine, Thicon Endosurgery; Technologies) 4. ElectroCore; 5. DePuy, Synthes Spine, OS Imaging, Orthopediatrics; 7. Theime Publishing, International Pediatric David I. Pedowitz, MD, MS (n.) Orthopedic Think Tank, POSNA, Scoliosis Research Society, Setting Allan F. Peljovich, MD (n.) Scoliosis Straight Foundation) Michael Pensak, MD (n.) Genghis E. Niver, MD (n.) Matthew Pepe, MD (n.) Robert Nugent, BS (n.) Christopher H. Perkins, MD (2. DePuy Synthes) Mary I. O’Connor, MD (3b. Stryker, Zimmer; 3c. Accelatox, Inc.; 4. Accelatox, Inc.; 9. Association of Bone and Joint Surgeons) Steve Petersen, MD, MSc (n.) Christopher O’Grady, MD (n.) Stephanie C. Petterson, MPT, PhD (n.) Christopher W. Olcott, MD (n.) Michael Phillips, MD (n.) David L. Oliver, MD (n.) John M. Pinski, MS (n.) Jeffery Oliver, BS (n.) Michael Pitta, MD (n.) John Olson, MS (n.) Kevin D. Plancher, MD (2. Merck; 5. Pﬁ zer, Zimmer, Anika Lawrence K. O’Malley, MD (n.) Therapeutics, Seikagaku; 6.Arthrex, ConMed Linvatec, Zimmer; 7. Saunders/Mosby-Elsevier, Thieme; 8. AAOS, ASES, AANA, Craig O’Neill, MD (n.) ISAKOS, EOA, NY Chapter Arthritis Foundation, NY County Joseph T. O’Neil, MD (n.) Medical Society- Government Affairs; 9. American Journal of Orthopaedics, Operative Techniques in Sports Medicine) Alvin C. Ong, MD (3b. Stryker Orthopedics, Smith & Nephew Orthopedics, Medtronics; 5. Zimmer) Juan Pons-Villanueva, MD, PhD (n.) Jonathan Oren, MD (n.) Danielle Y. Ponzio, MD (n.) Fabio R. Orozco, MD (3b. Stryker Orthopedics, Medtronics; David A Porter, MD (n.) 5. Stryker Orthopedics, Zimmer, Analgesic Solutions) Zachary D. Post, MD (n.) Daryl Osbahr, MD (3b. DePuy Mitek) Hollis G. Potter, MD (3b. Tissue Regeneration, Inc.; Thomas Pace, MD (n.) 5. GE Healthcare; 8. Osteoarthritis and Cartilage) Donna M. Pacicca, MD (n.) Aidin Eslam Pour, MD (n.) Eric M. Padegimas, MD (n.) Sina Pourtaheri, MD (n.) Douglas E. Padgett, MD (3b. Stryker Orthopedics, Medtronics; Marcelo P. Prado, MD (n.) 5. Stryker Orthopedics, Zimmer, Analgesic Solutions; P. Edward Purdue, PhD (n.) 9. Hospital For Special Surgery, The Hip Society) James J. Purtill, MD (n.) Andrew G. Park, MD (n.) Kristen E. Radcliff, MD (1. Globus Medical; 3b. DePuy, Globus Javad Parvizi, MD, FRCS (1. Elsevier, Wolters Kluwer, SLACK, Inc. Medical, Medtronic; 4. Mergenet Medical; 5. DePuy, Medtronic, Data Trace Publishing Company, Jaypee Publishers; 3b. Zimmer, Paradigm Spine; 6. Stryker, Medtronic, Globus Medical, DePuy, Smith & Nephew, ConvaTec, TissueGene, CermaTec, Medtronic; Synthes, Relievant; 7. Lippincott; 9. ACSR) 4. Hip Innovation Technologies, CD Diagnostics, PRN; 5. OREF; 7. Elsevier, Wolters Kluwer, SLACK, Inc. Data Trace Publishing Steven M. Raikin, MD (3b. Biomet; 8. Pennsylvania) Company, Jaypee Publishers; 8. Journal of Arthroplasty, Journal of Patric Raiss, MD (n.) Bone and Joint Surgery, Bone and Joint Surgery; 9. Philadelphia Orthopaedic Society, EOA, Muller Foundation, 3M) Sendhilnathan Ramalingam, BS (n.) Mital S. Patel, MBBS, MS (n.) Lolita Ramsay, RN, PhD (n.)

Disclosures in bold indicate members of the EOA Program Committee and/or contributing staff.

52 4. ConforMIS; 5.Ceramtec;8.EOA, JOA, CORR;9.NOVA) Lucas B.Romine,MD Journal) Exactec; 5.DePuy, Smith&Nephew; 8.J Arthroplasty, CORR,HSS Jose A. Rodriguez,MD Jonathan Robinson,MD Kristin Robinson,MS Matthew M.Roberts,MD External Fixation; 8.Injury, Journal ofOrthopaedic Trauma) Craig S.Roberts,MD,MBA James Roberson,MD Michael Rivlin, MD Aldo M.Riesgo,MD Association ofNorth America) American OrthopaedicSocietyforSportsMedicine, Arthroscopy Wolters KluwerHealth-Lippincott Williams & Wilkins; 9.EOA, John C.Richmond,MD Raveesh Richard,MD Maryam Rezapoor, MS John Reynolds, BA Camilo Restrepo,MD William H.Replogle, PhD Yuan Ren,PhD,MS Daniel Reid,MD,MPH Joshua Ratner, MD Parthiv A. Rathod,MD Mohammad R.Rasouli,MD Michael J.Rasiej,MD James S.Raphael,MD Registry, J. RobertGladdenSociety, OREF) (NIAMS &NICHD);8.Orthopedics;9. American Joint Replacement E. Anthony Rankin,MD Arthroplasty; 9.HipSociety, EOEF) Chitranjan S.Ranawat, MD Musculoskeletal Medicine) Mitek; 7.Saunders/Mosby-Elsevier, Springer; 8.Current Trends in Linvatec, Nova Surgical, Stryker, MAKO; 4.ConforMIS;5. DePuy Mitek, Linvatec, Nova Surgical, Stryker, MAKO; 3b. DePuyMitek, Anil S.Ranawat, MD Amar S.Ranawat,MD Adam J. Rana, MD Rothman SpecialtyHospital) Today; 9.PhiladelphiaOrthopaedicSociety, The RothmanInstitute, & Wilkins; 8.Journal ofShoulderandElbowSurgery, Orthopedics Ascension, Zimmer;7. Wolters KluwerHealth-Lippincott Williams Ascension, Zimmer;3b. Integra, Ascension, Zimmer;5.Integra, Matthew L.Ramsey, MD Disclosures in boldindicatemembersofthe EOA Program Committeeand/orcontributing staff. (n.) (n.) (8. Archives ofBone And Joint Surgery) (n.) (n.) (n.) (n.) (1. DePuyMitek,Stryker, MAKO; 2.DePuy (3a. Stryker; 4.Stryker (n.) (n.) (n.) (1. Covidien; 3a.Covidien) (n.) (n.) (n.) (3b. Smith&Nephew, DePuy, Medacta,

(n.) (3b. Histogenics Corporation; 7.Springer, (n.) (3b. NationalInstitutesofHealth (1. MAKO; 2.DePuy, Ceramtec, ConvaTec; (1. Integra, Ascension, Zimmer;2.Integra, (n.) (3a. Allergen) (1. Stryker, DePuy;8.Journal of (n.) (7. Skeletal Trauma, Elsevier, ) Julie L.ShanerMD Brandon J.Shallop,MD Ali SinaShahi,MD Spine, Inc.;9.SettingScoliosisStraight Foundation) 3b. DePuySynthesSpine, Inc.;4.Globus; 5.DePuySynthes Suken A. Shah,MD Peter K.Sculco,MD Cary Schwartzbach, MD Jeff E.Schulman,MD Jake Schroeder, BA Joseph J.Schreiber, MD Erik Schnaser, MD Tom Schmidt-Braekling,MD Kevin Schiller, BS Thomas M.Schaller, MD Oliver Sax,BA Ian Savage-Elliot, BA Stuart M.Saunders,MD James Satalich,BS Sanguino Roger A. Thomas H.Sanders,MD Solomon P. Samuel,DEng Matthew R.Salminen,BS Heather L.Saffel, BS,MS Jason C.Saillant,MD Allison Ruel,BA Wilkins; 9.HipSociety) Therapeutics; 6.MAKO Stryker; 7.Lippincott, Williams and Harry E.Rubash,MD David W. Rowe, MD Travis Roth,MSIV Charles A. Roth,MD Mark D.Rossi,PhD,PT Kristen A. Ross,BS Keir A. Ross,BS Corey Rosenbaum,MD Melissa Rosen,MS, ATC, OTC Ben Root Orthopaedic Society, EOA) Mark J. Romness, MD Foundation) 9. EOA, AAOS, Virginia Orthopaedic Assn. Virginia HospitalCenter David W. Romness,MD (n.) (n.) (n.) (n.) (3a. CDDiagnostics) (n.) (n.) (5. Stryker; 9. AAOS) (n.) (n.) (n.) (n.) (n.) (1. DePuySynthesSpine, Inc.; (n.) (n.) (n.) (n.) (3b. Access Mediquip,Flexion (n.) (2. Stryker; 3b. Stryker ) (n.) (3a. BoehringerIngelheim;9. Virginia (n.) (n.) (3b. Tissuegene;5. Tissuegene, Integratrials; (n.) (n.) (n.) (n.) (n.) Financial Disclosure Information (n.) (n.) (8. BiomedicalEngineering) (n.) (n.) 53

Scientiﬁ c Program EOA 45th Annual MeetingAmelia Island, Florida2014

Raj H. Shani, MD (n.) Viswanathan Swaminathan, PhD (n.) K. Aaron Shaw, DO (n.) Loni Tabb, PhD (n.) Jonathan W. Shearin, MD (n.) Amy Tang (n.) Eric D. Shirley, MD (3b. Orthobullets.com; 4. Depomed, Pfi zer) Stephanie L. Tanner, MS (n.) Brian Shiu, MD (n.) Matthew A. Tao, MD (n.) Evan Siegall, MD (n.) John S. Taras, MD (2. AxoGen, Inc.; 4. Union Surgical, LLC) Ryan W. Simovitch, MD (1. Exactech; 2. Exactech, Arthrex; T. David Tarity, MD (n.) 3b. Exactech; 9. Jupiter Medical Center) Rupesh Tarwala, MD (n.) Heather Skinner (n.) Rachael Taylor, MPAS (n.) James Slover, MD, MS (5. Biomet) Samuel A. Taylor, MD (n.) Eric L. Smith, MD (3b. DePuy, Pfi zer, ConforMIS, Omni Life Sciences; 5. Stryker, DePuy, Pfi zer, ConforMIS, Omni Life Sciences; Erika L. Templeton, MD (n.) 6. Stryker, DePuy, Pfi zer, ConforMIS, Omni Life Sciences) Kevor TenHuisen, PhD (n.) Geoffrey Smith, BS (n.) Matthew W. Tetreault, BA (n.) Langan S. Smith, BS (3b. Zimmer, Smith & Nephew, ConvaTec, Brian A. Tinsley, MD, MA (n.) TissueGene, PRN, Medtronic; 4. CD Diagnositcs, Hip Innovation Technology; 7. Elsevier, Wolters Kluwer, SLACK, Inc. Data Trace Fotios Tjoumakaris, MD (n.) Publishing Company, Jaypee Publishers; 8. Journal of Arthroplasty, Anthony T. Tokarski, BS (n.) Journal of Bone and Joint Surgery, Bone and Joint Journal; 9. United Stefan Tolan, MD (n.) Healthcare) Todd S. Tomczyk, ATC (n.) Michael D. Smith, MD (n.) Denise M. Torres, MD (n.) Thomas L. Smith, PhD (4. Orthovative, LLC; 5. KeraNetics, Synthes; 8. Journal of Surgical Orthopaedic Advances) Alison P. Toth, MD (2. Genzyme, Tornier; 3b. Tornier; 5. Tornier; Niall A. Smyth, MD (n.) 6. Arthrex, Inc., Breg, DJ Orthopaedics, Mitek, Aircast(DJ), Stryker) Rebecca G. Snider,BS (8. South Carolina) LCDR Robert W. Tracey, MD (n.) Daniel Southren, BA (n.) Nicholas A. Trasolini, BSE (n.) Lawrence M. Specht, MD (n.) Natasha Trentacosta, MD (n.) Paul D. Sponseller, MD (1. Globus Medical, DePuy; 3b. DePuy; 5. DePuy; 7. Journal of Bone and Joint Surgery, Oakstone Medical; David Trofa, MD (n.) 8. Journal of Bone and Joint Surgery; 9. Scoliosis Research Society) Bradford S. Tucker, MD (2. Mitek, DePuy; 3b. Mitek, DePuy; Umasuthan Srikumaran, MD, MBA (2. Norvartis; 3a. Abbott; 6. Smith 3c. Mitek, Knee Creations; 4. Johnson & Johnson; 5. DePuy, Johnson & Nephew) & Johnson, Zimmer) Andrzej Steplewski, PhD (n.) Alex Uhr, BS (n.) Eric C. Stiefel, MD (n.) Robert M. Urban, PhD (3b. DePuy, Spinal Motion, Wright Medical Technology, Inc., Exactech, Inc.; 5. Zimmer, Wright Medical John W. Stirton, MD (n.) Technology, Inc.) Joel Stitzel, PhD (8. North Carolina; 9. Wake Forest University) Alexander Vaccaro, MD, PhD (1. DePuy, Medtronics, Stryker Spine, Spencer Stein, MD (n.) Biomet Spine, Globus, Aesculap; 3b. Gerson Lehrman Group, Guidepoint Global, Medacorp, Globus, Stryker, Medtronics, Benjamin Stone, BA (n.) Orthobullets; 4. Globus Medical, Progressive Spinal Technologies, Benjamin D. Streufert, BS (n.) Advanced Spinal Intellectual Properties, Computational Biodynamics, Sabrina Strickland, MD (8. American Journal of Sports Medicine; Stout Medical, Paradigm Spine, Replication Medica, Spinology, Spine 9. American Orthopaedic Society for Sports Medicine, AANA) Medica, Vertifl ex, Small Bone Technologies, Crosscurrent, Syndicom, In Vivo, Flagship Surgical, Location Based Intelligence, Gamma Justin Stull, BA (n.) Spine, Cytonics, Bonovo Orthopaedics, Electrocore, Flowpharma, Michael Suk, MD, JD, MPH, FACS (6. Synthes; 8. American Journal RSI, RI, Innovative Surgical Design, Spinicity; 5. Cerapedics, AO of Orthopedics, Military Medicine, Journal of Trauma Management Spine; 7. Elsevier, Thieme, Jaypee, Taylor and Francis; 8. Spine, and Outcomes; 9. AAOS, OTA, AO International) J. Neurosurgery Spine, Pan Arab J. Neurosurgery, European Spine Journal; 9. Innovative Surgical Design, Association of Collaborative Dean C. Sukin, MD (2. Biomet, DePuy; 3b. Biomet; 4. Johnson & Spine Research, Spinicity, Progressive Spinal Technologies, Johnson) Computational Biodynamics, Advanced Spinal Intellectual Properties, Jaron Sullivan, MD (n.) Location Based Intelligence, R.S.I., The Rothman Institute) Disclosures in bold indicate members of the EOA Program Committee and/or contributing staff.

54 Richard M. Wilk, MD Jeffrey L. Wild, MD C. Luke Wilcox, DO Garrison P. Wier, BS James C. Widmaier Jr., MD BAPeter White, Kris Wheeler,MD Kenneth T. Wheeler,PhD EOA) 5. Stryker Orthopedics,Exactech, DJOGlobal;9.KneeSociety, DJO Global;3b. Stryker Orthopedics,Exactech, DJOGlobal; Geoffrey H. Westrich, MD of Arthroplasty) Samuel Wellman,MD David S. Wellman, MD Andrew J. Weiland, MD Durham Weeks,MD Scott T. Watson,MD Watson,Ryan A.BA Y. Claire Wang, MD,ScD Hand Mark Wang, MD,PhD Wenzel Waldstein,MD Gilles Walch,MD LT ScottC. Wagner, MD Benjamin Wagner,BS Michael M. Vosbikian, MD Jessica Viola,BS Jesus M. Villa, MD Kushagra Verma, MD,MS Gregory S. Van Blarcum,MD Corinne VanBeek,MD ) Disclosures in boldindicatemembersofthe EOA Program Committeeand/orcontributing staff. (n.) (n.) (1. Tornier; 4.Imascap) (n.) (n.) (n.) (n.) (n.) (n.) (n.) (n.) (5.Stryker, Zimmer, Biomet,DePuy;8.Journal (4. Johnson &Johnson) (n.) (7. American Foundation forSurgery ofthe (n.) (n.) (n.) (n.) (n.) (n.) (n.) (2. Stryker Orthopedics,Exactech, (n.) (n.) (n.) (n.) Thomas Zumbrunn,MS Steven D.Zumbrun,PhD Hendrik A. Zuiderbaan,MD Foundation) Lippincott Williams & Wilkins; 9. AOA, Musculoskeletal Transplant Orthonet; 7.SLACK, Inc., Thieme, Inc., Wolters KluwerHealth- Joseph D.Zuckerman, MD Benjamin Zmistowski, MD Adam C.Zoga,MD 9. EOA) David S.Zelouf,MD Akos Zahar, MD Victoria Younger, BS,CCRP AAOS) 8. SpineDeformity;9.ScoliosisResearch Society, POSNA, 3b. DePuy, K2M,Nuvasive;5.DePuy, HarmsStudyGroup; Burt Yaszay,MD TimothyPhD Wright, Edward K. Wright Jr., PhD Jacob R. Worsham, MD Daniel Woods,MD Justin C. Wong, MD Michael Wolf,MD Brent T. Wise,MD Brian S. Winters, MD Scott Winnier,PhD Nathaniel C.H. Wingert, MD Christopher J. Williamson, MD Phillip N. Williams, MD 4. In Vivo; 6.DePuy, IMDS;9. AAOS) Gerald R. Williams, MD Jeffrey Willey,PhD (2. LinkOrthopaedics;3b. LinkOrthopaedics) (1. Orthopediatrics,K2M;2.DePuy, K2M; (n.) (n.) (n.) (n.) (n.) (n.) (n.) (8. Journal ofHandSurgery – American; (n.) (8. New York) (n.) (n.) (1. DePuy, IMDS, Wolters/Lippencott; (n.) (n.) Financial Disclosure Information (n.) (1. Exactech, Inc.;4. AposTherapy, Inc.;6. (n.) (n.) (n.) (n.) (n.) 55

Scientiﬁ c Program EOA 45th Annual MeetingAmelia Island, Florida2014

Accreditation Information for the Scientiﬁ c Program

PROGRAM COMMITTEE tional courses, guest lectureships, symposia, multimedia educational sessions and poster sessions. The Eastern Orthopaedic Association gratefully acknowledges these orthopaedic surgeons for their contribution to the development of the Scientifi c Program: OBJECTIVES Educational objectives will be met through a combination of Amar S. Ranawat, MD, Chair paper presentations, lectures and workshops in plenary, con- Michael P. Bolognesi, MD current and specialty sessions with ample time afforded for N. George Kasparyan, MD, PhD open discussion. The following objectives will be addressed Mark J. Lemos, MD during the Scientifi c Program, such that at the conclusion of this course the attendees will be expected to: Javad Parvizi, MD, FRCS 1. Improve their diagnostic, treatment and technical Adam J. Rana, MD skills in the management of orthopaedic affl ictions by Mark J. Romness, MD assimilation of scientifi c advances; MISSION 2. Discuss basic science paradigms as they relate to treatment advances; The Eastern Orthopaedic Association (EOA) was established 3. Understand some of the basic principals in practice in 1970 under the leadership of Howard H. Steel, MD and 12 management; and prominent orthopaedic surgeons. Its purpose is to promote, encourage, foster, and advance the highest quality and most 4. Critically assess emerging trends in orthopedic medi- cost effective practice of orthopaedic surgery and matters cine and evaluate their evidence basis. related thereto by providing an educational format for the free discussion and teaching of orthopaedic methods and SCIENTIFIC POSTER PRESENTATIONS principles among orthopaedic surgeons, both member and Scientifi c Posters are an important feature of the EOA Annual non-member; and to establish a forum for practicing ortho- Meeting. Posters will be on display along with their present- paedic surgeons to update their knowledge and awareness of ers each day of the Scientifi c Program. Poster Presenters will new techniques, treatment methods, and devices available for also be available to answer questions before and after the Sci- patient care, teaching, and research by using the most appro- entifi c Program. priate educational methods. MULTIMEDIA EDUCATION PURPOSE Multimedia education materials will be offered daily after the 1. To provide the participants with an objective, unbiased Scientifi c Program at the designated times. A comprehensive educational experience that will enable them to remain selection of AAOS DVDs will be available for your individual current in both the knowledge and practical elements education. of contemporary orthopaedic surgery; 2. To provide the participants with a detailed, in depth CME ACCREDITATION education of selected topics relative to the practice of This activity has been planned and implemented in accor- orthopedic surgery; dance with the accreditation requirements and policies of the 3. Allow participants to assess potential defi ciencies in Accreditation Council for Continuing Medical Education their knowledge base as it pertains to the practice of (ACCME) through the joint providership of the American orthopedic surgery; and Academy of Orthopaedic Surgeons and the Eastern Ortho- 4. Present ample opportunities for participants to paedic Association. The American Academy of Orthopaedic exchange ideas with the presenters, the faculty and Surgeons is accredited by the ACCME to provide continuing other enrollees through paper presentations, instruc- medical education for physicians.

56 wise, yourCMEcreditscannotbecertifi the EOA 2014 Annual MeetingCMECreditRecords;other- the Sessionsorgoonlinetowww. eoa-assn.org tocomplete pleted CMERecordForm attheendofyourparticipationin To receive CMEcredit,youarerequiredtoturninyourcom- CME NOTE ited bythe ACCME. the Physician’s Recognition Award fromorganizations accred- can Medical Association Category I,Level 1CMEcreditfor toward ContinuingEducationCredits. AAPA accepts Ameri- Physician’s Assistants canreceive upto26.5credithours CEC CREDIT Certifi the EOA 2014 Annual MeetingCMECreditRecords. you attendedorgoonlinetowww.eoa-assn.org tocomplete the form intheback ofthisprogram, indicatingtheSessions To ensurecorrectCMEcreditisawarded, please complete mensurate withtheextent oftheirparticipationintheactivity. 1 Credits™. this live activity foramaximumof26.5 The American Academy ofOrthopaedic Surgeons designates interest inorthopaedicswillbenefi medical profession cational needsofthepracticingorthopaedist.Othersin the EOA. This programisdesignedspecifi the lastannualmeetingandexpressed educational goalsof Program designisbasedonparticipants’ responsesfrom orthopaedic surgeons. Programs andtomeettheuniqueeducationalrequirementsof use indeveloping futureEOA Annual MeetingScientifi Attendees arerequestedtocompleteacourseevaluation for can befoundinthebackofthisprogram.) Record, NeedsAssessmentandCourseEvaluationForms cates willbeawarded toallregisteredparticipants. * 3CMEcreditsforMultimediaEducationSessions * 6CMEcreditsforPosterSessions * 17.5CMEcreditsforScientifi Physiciansshouldclaimonlythecreditcom-

(such asphysician assistants)orwithan t fromtheprogram. c Program ed. AMA PRACategory cally fortheedu- (CME Credit

CME c reproduction isspecifi reserves allofitsrightstosuchmaterial,andcommercial of thepresentationatEOA Annual Meeting. The EOA No reproductionsorrecordingsofany kind,maybemade person. these claimsshallbeassertedbyaphysicianorany other niques demonstratedthereinbysuchindividuals, whether for allclaims,whichmayariseoutoftheusetech- damages resultingtoany individuals attendingasession The EOA disclaimsany andallliabilityforinjuryorother lar situations. of thefaculty, whichmaybehelpfultoothers whoface simi- intended topresentanapproach,view, statement,oropinion appropriate forthemedicalsituationsdiscussed,but ratheris represent theonly, nornecessarilybest,methodorprocedure educational purposesonly. This materialisnotintendedto tion Annual Meetinghasbeenmadeavailable bytheEOA for The materialpresentedattheEasternOrthopaedic Associa- DISCLAIMER the product’s approval label. being used“off label”ifthedescribeduseisnotsetforthon described purpose). Any pharmaceuticalormedicaldevice is not clearedthepharmaceuticalormedicaldevice forthe cally disclosed( of thepharmaceuticalormedicaldevice isalsospecifi Academy’s CMEactivities solongasthe“off label”use maceutical ormedicaldevice maybedescribedinthe Academy policy provides that“off label”usesofaphar- clinical practice. maceuticals ormedicaldevices heorshewishestousein physician todeterminetheFDA clearancestatusofthephar- only. The FDA hasstatedthatitistheresponsibilityof FDA orhave beenclearedbytheFDA forspecifi at theEOA Annual Meeting have notbeenclearedbythe Some pharmaceuticalsormedicaldevices demonstrated FDA STATEMENT i.e., itmustbedisclosedthattheFDA has cally prohibited. Accreditation Information c purposes - 57

Scientiﬁ c Program EOA 45th Annual MeetingAmelia Island, Florida2014

2014 Scientiﬁ c Program

Thursday, October 23, 2014 (Presenters and times are subject to change.) Disclosure Information is listed on pages 46-55. Ritz-Carlton Ballroom Salon I, unless otherwise speciﬁ ed

6:00am–7:00am Scientiﬁ c Poster Session (Poster 7:27am–7:29am Discussion Presenters Available) (Ritz-Carlton Ballroom Foyer) 7:29am–7:35am Safety Of The Trans-Pec (East) Portal: An Anatomic Study 7:00am–7:05am Welcome to EOA’s 45th Annual Albert S. Dunn, DO, Orthopaedic Meeting Foundation, Stamford, CT David W. Romness, MD, President Amar S. Ranawat, MD, Program 7:35am–7:37am Discussion Chair 7:37am–7:43am Resident/Fellow Travel Grant Award General Session 1 — Sports Medicine Accessory Medial Portal For ACL Reconstruction: Safe Zone To Avoid Moderators: Mark J. Lemos, MD Complications Craig S. Roberts, MD, MBA Jeffrey Alwine, DO, Orthopaedic Foundation, Stamford, CT 7:05am–7:11am Microfracture Versus Osteochondral Autologous Transplantation For High- 7:43am–7:45am Discussion Grade Osteochondral Lesions Of The Talus: A Prospective Comparative Analysis Symposium 1 — What’s New in Foot and Ankle Sameh A. Labib, MD, Emory Surgery University, Atlanta, GA Moderator: Matthew M. Roberts, MD 7:11am–7:13am Discussion 7:45am–7:55am What Is New In Foot And Ankle 7:13am–7:19am On-Field Performance Of NFL Arthroscopy: Old Problems, New Players Following Return From Solutions Concussion Sameh A. Labib, MD, Emory Neil Kumar, MD, Hahnemann University, Atlanta, GA University Hospital, Drexel University College of Medicine, Philadelphia, PA 7:55am–8:05am Orthobiologics for Foot and Ankle Surgery 7:19am–7:21am Discussion Samuel B. Adams Jr., MD, Duke University Medical Center, 7:21am–7:27am EOA/OREF Resident/Fellow Travel Durham, NC Grant Award Suture Anchor Behavior In The 8:05am–8:15am Total Ankle Replacement Setting Of Rotator Cuff Footprint Brian S. Winters, MD, The Rothman Decortication Institute, Philadelphia, PA Adam E. Hyatt, MD, Robert Wood Johnson University Hospital, New 8:15am–8:25am Discussion Brunswick, NJ 8:25am–8:40am First Business Meeting

* Institution by abstract presenter’s name is the location where the research took place.

58 :0m90a Break—PleasevisitExhibitors 8:40am–9:00am :5m95a icsin * Institutionbyabstract presenter’s Discussion nameisthelocationwhere theresearch tookplace. 9:55am–9:57am 9:51am–9:55am Discussion 9:49am–9:51am PediatricShoulderDislocation 9:45am–9:49am Moderator: GotoStations 9:40am–9:45am Discussion 9:30am–9:40am Holistic ACL Reconstruction 9:20am–9:30am PrimaryRepair 9:10am–9:20am BacktoBPTB 9:00am–9:10am Moderator: Reconstruction Surgery Symposium 2— What’s Newin ACL A, PlazaBallroom 1) Rapid Fire Session2A—SportsMedicine Anil S.Ranawat,MD John C.Richmond,MD University,GA Atlanta, Sameh A. Labib,MD, Talus (OLT) Osteochondral LesionsOf The Treatment OfSymptomatic Line TechniquesFirst AsA Bone Marrow Stimulation Antegrade VersusRetrograde Medical CenterDurham,NC Matthew A. Tao, MD,Duke University, Osteonecrosis Resulting InRotatorCuff Tear And Pennsylvania, Philadelphia,PA John D.Kelly IV, MD,University of for SpecialSurgery, New York, NY Gregory S.DiFelice, MD, Cos Cob,CT Foundation for Active Lifestyles, Kevin D.Plancher, MD,Orthopaedic Thursday, October23, 2014 Ritz-Carlton BallroomSalonI,unlessotherwisespeciﬁ Disclosure Informationislistedonpages46-55. (Presenters andtimesare subjecttochange.) Emory (Station Hospital

:9m95a icsin 9:50am–9:54am Discussion 9:49am–9:50am 9:45am–9:49am Moderator: Discussion 10:13am–10:15am 10:09am–10:13am Discussion 10:07am–10:09am 10:03am–10:07am Discussion 10:01am–10:03am Surgical Treatment OfSymptomatic 9:57am–10:01am Plaza Ballroom 1) Rapid Fire Session2B— Total Knee Amar S.Ranawat,MD ed *Presented byBrianShiu,MD Baltimore, MD Maryland MedicalCenter, Special Surgery, New York, NY Ehsan Jazini, MD, Versus InferiorRotatorInterval Portal Bankart Repair: Trans-Subscapularis Analysis Of Anchor PlacementFor Philadelphia, PA Institute, Thomas Jefferson University, *Presented byKaitlinM.Carroll, BS Special Surgery, New York, NY David J. Mayman,MD, Blood LossIn Total Knee Arthroplasty ToDecreasing Pragmatic Approach Camilo Restrepo, MD, Patients DoInShort-Term? With Hardware InSitu:How These Total Knee Arthroplasty InPatients Phillip N. Williams, MD, Throwers Ligament Insufﬁ Treat Elbow UlnarCollateral Platelet-Rich PlasmaCanSuccessfully Medical School, New Brunswick, NJ University Robert Wood Johnson John Erickson, MD,Rutgers Patient SLAP Tears In The Middle-Aged Scientiﬁ c Program Overview ciency inHigh-Level

University of (Station B, The Rothman Hospital for Hospital for 59

Scientiﬁ c Program EOA 45th Annual MeetingAmelia Island, Florida2014

Thursday, October 23, 2014 (Presenters and times are subject to change.) Disclosure Information is listed on pages 46-55. Ritz-Carlton Ballroom Salon I, unless otherwise speciﬁ ed

9:54am–9:55am Discussion James Slover, MD, MS, NYU Hospital for Joint Diseases, New York, 9:55am–9:59am Previous Periprosthetic Joint Infection NY Predicts Infection After New Primary Arthroplasty 9:49am–9:51am Discussion Jorge Manrique, MD, The Rothman Institute, Thomas Jefferson University, 9:51am–9:55am MIS Posteriolateral Total Hip Philadelphia, PA Arthroplasty: Do We Need 6 Weeks Of Hip Precautions? 9:59am–10:00am Discussion Brett Frykberg, MD, Hospital for Special Surgery, New York, NY 10:00am–10:04am Reasons For Revision Of Single Radius And Multi-Radius Total Knee 9:55am–9:57am Discussion Designs Danielle Campbell, MS, Mahwah, NJ 9:57am–10:01am The Reliability of Modern *Presented by Eric L. Smith, MD Alumina Bearings in Total Hip Arthroplasty 10:04am–10:05am Discussion Gwo-Chin Lee, MD, University of Pennsylvania Medical Center, 10:05am–10:09am Postoperative Fever After Total Joint Philadelphia, PA Arthroplasty: Use Of A Simple Medical Workup To Avoid Delayed 10:01am–10:03am Discussion Discharge Patrick W. Kane, MD, The Rothman 10:03am–10:07am Sexual Activity In Patients Institute, Philadelphia, PA/Egg Undergoing Primary Total Hip Harbor Township, NJ Arthroplasty Carlos J. Lavernia, MD, The Center 10:09am–10:10am Discussion for Advanced Orthopedics at Larkin Hospital, South Miami, FL 10:10am–10:14am Technological Advances: The Learning Curve Effect 10:07am–10:09am Discussion David A. Iacobelli, MD, The Center For Advanced Orthopedics at Larkin 10:09am–10:13am Direct Anterior THA Requires Fewer Hospital and Arthritis Surgery Acetabular Screws Than Posterior Research Foundation, THA South Miami, FL Eric L. Smith, MD, Tufts Medical *Presented by Jesus M. Villa, MD Center, Boston, MA

10:14am–10:15am Discussion 10:13am–10:15am Discussion

Rapid Fire Session 2C — Total Hip Rapid Fire Session 2D — Spine (Station D, (Station C, Ritz-Carlton Ballroom Foyer) Ritz-Carlton Ballroom Foyer) Moderator: Javad Parvizi, MD, FRCS Moderator: Bradford L. Currier, MD

9:45am–9:49am Cost-Analysis Of The Use Of 9:45am–9:49am Biomechanical Stability Of The Tranexamic Acid To Prevent Major Stalif-C Stand-Alone Spacer In Multi- Bleeding Complications In Hip And Level And Hybrid Cervical Fusion Knee Arthroplasty Surgery Constructs * Institution by abstract presenter’s name is the location where the research took place.

60 01a–01a icsin Discussion 10:13am–10:15am PedicleScrew Re-InsertionUsing 10:09am–10:13am Discussion 10:07am–10:09am Does Antibiotic-Loaded BoneGraft 10:03am–10:07am Discussion 10:01am–10:03am Discussion 9:57am–10:01am 9:55am–9:57am :9m95a icsin 9:51am–9:55am Discussion 9:49am–9:51am * Institutionbyabstract presenter’s nameisthelocationwhere theresearch tookplace. MD *Presented byScottC. Wagner, Bethesda, MD Military MedicalCenter, Walter Reed National Daniel G.Kang, MD, Strength Does NotReduceFixation Previous PilotHole And Trajectory Wilmington, DE I. duPont HospitalforChildren, Sujal Patel, MD,Nemours/Alfred Superbugs? Used InScoliosisSurgery Lead To Surgery, New York, NY Bethesda, MD National MilitaryMedicalCenter, (Tr &Orth), Paul D.Kiely, MCh,FRCS Surgery Pediatric DeformitySpine The Off-Label Use Of BMPIn An 8 Year Trend Analysis Of Scott C. Wagner, MD, Lumbosacral Spine Predicts BiomechanicsOfHuman Finite ElementModeling Accurately *Presented byPeter Formby, MD Bethesda, MD National MilitaryMedicalCenter, Daniel G.Kang, MD, Thursday, October23, 2014 Ritz-Carlton BallroomSalonI,unlessotherwisespeciﬁ Hospital forSpecial

Disclosure Informationislistedonpages46-55. (Presenters andtimesare subjecttochange.) Walter Reed Walter Reed

10:15am–10:35am Discussion 10:11am–10:15am Transforming Resident 10:07am–10:11am Discussion 10:04am–10:07am 9:52am–9:56am Discussion 9:49am–9:52am TheRoleOfMarketing And Public 9:45am–9:49am Moderator: 00a–00a WhatDrives InpatientCharges For 10:00am–10:04am Discussion 9:56am–10:00am Ritz-Carlton Ballroom Foyer) Rapid Fire Session2E—HealthPolicy Richard C.MatherIII,MD

ed Break —PleasevisitExhibitors Durham, NC University MedicalCenter, Matthew A.Tao,Duke MD, Orthopaedic Skills Training Education — A New Horizonfor MD *Presented byEricM.Padegimas, University, Philadelphia,PA Rothman Institute, Thomas Jefferson 10-17 Student AthletesAge Hypertension And DiabetesIn The Prevalence Of Obesity, Parsippany, NJ Medical Marketing, Daniel Goldberg, NA, Gold Relations Benjamin Zmistowski,MD, Total Joint Arthroplasty? Eric C.Stiefel,MD, Center, Valdosta,GA Sports MedicineandOrthopaedic Scientiﬁ c Program Overview Mississippi (Station E, The

Scientiﬁ c Program EOA 45th Annual MeetingAmelia Island, Florida2014

Thursday, October 23, 2014 (Presenters and times are subject to change.) Disclosure Information is listed on pages 46-55. Ritz-Carlton Ballroom Salon I, unless otherwise speciﬁ ed

General Session 3 — Presidential Address and 12:58pm–1:04pm Resident/Fellow Award Statins Adversely Affect Long Howard Steel Lecture Bones Of Corticosteroid Treated Moderator: Mark J. Lemos, MD Rabbits Christopher J. Williamson, 10:35am–10:40am Introduction of Presidential MD, Einstein Medical Center, Address Philadelphia, PA Mark J. Lemos, MD, Lahey Clinic, Peabody, MA 1:04pm–1:06 pm Discussion

10:40am–11:05am Presidential Address 1:06pm–1:12pm Resident/Fellow Travel Grant Orthopaedic Legacy Award David W. Romness, MD, Decreased T2 Relaxation In Articular Commonwealth Orthopaedics, Cartilage Following Modelled Arlington, VA Therapeutic Irradiation At Long-Term Follow-Up 11:05am–11:10am Introduction of Howard Steel Ian Hutchinson, MD, Wake Forest Lecturer School of Medicine, Winston-Salem, David W. Romness, MD, NC Commonwealth Orthopaedics, Arlington, VA 1:12pm–1:14pm Discussion

11:10am–11:50am Howard Steel Lecturer 1:14pm–1:20pm Risk Factors For Periprosthetic Onward! Infection Following TKA In Young Remy Munasiﬁ , Arlington, VA Patients Taylor R. McClellan, BS, Duke 11:50am–12:50pm EOA Luncheon — Industry University Medical Center, Presentations by ConvaTec and Durham, NC Mallinckrodt Pharmaceuticals *Presented by Michael P. Bolognesi, – Hospital Division (Ritz-Carlton MD Ballroom Salon 1) *Not for CME 1:20pm–1:22pm Discussion 1:22pm–1:28pm Intraoperative Proximal Femoral General Session 4 — Basic Science & Total Hip Fracture In Primary Cementless Total Hip Arthroplasty Moderators: Geoffrey H. Westrich, MD Ali Sina Shahi, MD, The Rothman Scott D. Boden, MD Institute, Thomas Jefferson University, Philadelphia, PA 12:50pm–12:56pm The Effect Of Platelet Rich Plasma And Hyaluronic Acid On Autologous 1:28pm–1:30pm Discussion Osteochondral Transplantation: An In Vivo Rabbit Model 1:30am–1:36pm Resident/Fellow Travel Grant Niall A. Smyth, MD, Hospital for Award Special Surgery, New York, NY Preoperative Anemia Increases Postoperative Complications And 12:56pm–12:58pm Discussion Mortality Following Total Joint Arthroplasty

* Institution by abstract presenter’s name is the location where the research took place.

62 :1m20p Discussion 2:01pm–2:02pm 1:57pm–2:01pm Discussion 1:56pm–1:57pm 1:52pm–1:56pm Discussion 1:51pm–1:52pm ANext Generation Anatomically 1:47pm–1:51pm Discussion 1:46pm–1:47pm 1:42pm–1:46pm DouglasE.Padgett, MD Moderator: GotoStations 1:38pm–1:42pm Discussion 1:36pm–1:38pm * Institutionbyabstract presenter’s nameisthelocationwhere theresearch tookplace. (Station A, PlazaBallroom 1) Rapid Fire Session5A—Hip Lenox HillHospital,New York, NY *Presented by Andrew G.Park, MD Philadelphia, PA Suneel Bhat,MD,MPhil, Total Joint Arthroplasty Visiting NurseServicesFollowing The EconomicBurdenOfHome Jonathan Robinson,MD, Benign Femoral StemsIsNotClinically Subsidence Of Tapered Wedge Varadarajan, PhD *Presented byKartikMangudi Harvard MedicalSchool, Boston,MA Massachusetts General Hospitaland Andrew A. Freiberg, MD, Contoured CeramicFemoralHead Township, NJ Rothman Institute, Egg Harbor Victor H.Hernandez,MD,MS, Following TotalHip Arthroplasty Risk Factors OfIliopsoas Tendonitis Philadelphia, PA Institute, Thomas Jefferson University, Jessica Viola,BS, Thursday, October23, 2014 Ritz-Carlton BallroomSalonI,unlessotherwisespeciﬁ Disclosure Informationislistedonpages46-55. (Presenters andtimesare subjecttochange.) The Rothman NSLIJ- The

:1m21p icsin Discussion 2:11pm–2:12pm 2:07pm–2:11pm Discussion 2:06pm–2:07pm :1m20p icsin Discussion 2:01pm–2:04pm 1:57pm–2:01pm Discussion 1:53pm–1:57pm 1:49pm–1:53pm Discussion 1:46pm–1:49pm 1:42pm–1:46pm ScottD. Boden,MD Moderator: 2:02pm–2:06pm (Station B,PlazaBallroom 1) Rapid Fire Session5B—Spine ed ENDO-Klinik, Hamburg, Germany *Presented bySamuel Wellman, MD Durham, NC University MedicalCenter Taylor R.McClellan,BS,Duke Using A Dual-MobilityCup Dislocation Rate After Revision THA Michael B.Cross, MD, Replacement Stems Cemented, ModularProximalFemoral Revision THA OutcomesUsing Bethesda, MD National MilitaryMedicalCenter, Scott C. Wagner, MD, Fusion In Transforaminal LumbarInterbody Finite ElementModelingOfStability *Presented byPeter Formby, MD Bethesda, MD National MilitaryMedicalCenter, Daniel G.Kang, MD, Arthroplasty Motion In The SettingOf Total Disc Effect OnSegmental Range Of Cervical PosteriorForaminotomy’s Brook, StonyBrook, NY Camden B.Burns,MD, Pelvic Fixation Biomechanical ComparisonOfSacro- Scientiﬁ

c Program Overview Walter Reed Walter Reed HELIOS

SUNY Stony , 63

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2:04pm–2:08pm Operative Treatment of Combat- 2:01pm–2:02pm Discussion Related Spine Trauma During the Conﬂ icts in Iraq and 2:02pm–2:06pm Predictors of Discharge to Inpatient Afghanistan Rehabilitation After Total Knee Scott C. Wagner, MD, Walter Reed Arthroplasty National Military Medical Center, Zachary D. Post, MD, St. Vincent Bethesda, MD Hospital, Billings, MT

2:08pm–2:12pm Discussion 2:06pm–2:07pm Discussion

2:07pm–2:11pm Predictors Of Early Discharge After Rapid Fire Session 5C — Total Knee Total Knee Replacement Reconstruction (Station C, Ritz-Carlton Ballroom Victor H. Hernandez, MD, MS, The Foyer) Rothman Institute, Egg Harbor Township, NJ Moderator: James Slover, MD, MS 2:11pm–2:12pm Discussion 1:42pm–1:46pm Patient-Speciﬁ c Total Knees Demonstrate a Higher Manipulation Compared to “Off-The-Shelf” Rapid Fire Session 5D — Knee Amar S. Ranawat, MD, Hospital for (Station D, Ritz-Carlton Ballroom Foyer) Special Surgery, New York, NY Moderator: Gregory S. DiFelice, MD 1:46pm–1:47pm Discussion 1:42pm–1:46pm Outcomes Of ACL Reconstruction 1:47pm–1:51pm Radiation Exposure Associated With Using Closed Versus Variable Loop Preoperative CT For Robotic-Assisted Button Fixation Knee Arthroplasty Brent T. Wise, MD, Emory Danielle Ponzio, MD, The Rothman Orthopaedics and Spine Center, Institute, Thomas Jefferson University, Atlanta, GA Philadelphia, PA 1:46pm–1:48pm Discussion 1:51pm–1:52pm Discussion 1:48pm–1:52pm Avoiding Complications And 1:52pm–1:56pm Patellar Thickness And Range Of Technical Variability During ACL Motion (ROM) In Primary Total Knee Reconstructions Arthroplasty (TKA) Natasha Trentacosta, MD, Albert Carlos J. Lavernia, MD, The Center Einstein College of Medicine, for Advanced Orthopedics at Larkin Monteﬁ ore Medical Center, Hospital, South Miami, FL Bronx, NY

1:56pm–1:57pm Discussion 1:52pm–1:54pm Discussion

1:57pm–2:01pm Utility Of Synovial White Cell Count 1:54pm–1:58pm Quadriceps Tendon Repair And Neutrophil Differential During Outcomes In A Worker’s Reimplantation Surgery Compensation Cohort Corey Clyde, BS, The Rothman Elliot S. Mendelsohn, MD, Institute, Thomas Jefferson University, The Rothman Institute, Philadelphia, PA Philadelphia, PA

* Institution by abstract presenter’s name is the location where the research took place.

64 :7m15p RateOfUtilizationPhysician- 1:47pm–1:51pm 1:46pm–1:47pm Discussion Basis Study AsA AnAnatomical 1:42pm–1:46pm Moderator: Discussion 2:10pm–2:12pm ABiomechanicalComparisonOf 2:06pm–2:10pm Discussion 2:04pm–2:06pm Biomechanical Tensile Strength 2:00pm–2:04pm Discussion 1:58pm–2:00pm * Institutionbyabstract presenter’s nameisthelocationwhere theresearch tookplace. (Station E, Ritz-CarltonBallroom Foyer) Rapid Fire Session5E—UpperExtremity N.George Kasparyan,MD,PhD Hospital, Philadelphia,PA Institute, Thomas Jefferson University Eric M.Black, MD, The Rothman Ownership Effect Utilization? Shoulder Surgeries —Does University Facilities For Arthroscopic Owned SpecialtyHospitals Versus Surgi-Center, Smithtown,NY Justin B.Mirza,DO,NorthShore Outcomes Clinical The Associated Release And For EndoscopicCubital Tunnel MD *Presented byStuartM.Saunders, Salem, NC Forest University, Winston Maxwell L.Langfi Plateau Fractures Allograft InSplitDepression Tibial Calcium Phosphate And Fibular Institute, Portsmouth, VA Bone &Joint -SportsMedicine Naval MedicalCenterPortsmouth/ LCDR Patrick W. Joyner, MD,MS, MPFL Reconstruction Analysis OfCurrent Techniques For Thursday, October23, 2014 Ritz-Carlton BallroomSalonI,unlessotherwisespecifi Disclosure Informationislistedonpages46-55. tt,MD, Wake (Presenters andtimesare subjecttochange.) 1:57pm–2:01pm 1:56pm–1:57pm Discussion :2m21p Go To GeneralSessionRoom 2:12pm–2:16pm Discussion 2:11pm–2:12pm DistalRadius Volar PlateImplant 2:07pm–2:11pm 2:06pm–2:07pm Discussion 2:02pm–2:06pm 2:01pm–2:02pm Discussion 1:52pm–1:56pm Discussion 1:51pm–1:52pm ed Philadelphia, PA Philadelphia HandCenter, Brandon Donnelly, MD, The Early Outcomes Technique: Surgical Technique And Repair With Hemi-Krackow Suture Single IncisionDistalBiceps *Presented byJohn S. Taras, MD Hand Center, Philadelphia,PA Jason Saillant,MD, The Philadelphia The T-PinDevice Distal RadiusFractureFixationUsing *Presented byJohn Deegan, DO Health System Joel C.Klena,MD, VariablePlate Axis Rupture: SafetyProfi TendonFlexor Prominence And MD, PhD *Presented byC.Edward Hoffl University Hospital,Philadelphia,PA JeffersonInstitute, Thomas Jonas L.Matzon,MD, The Rothman Ulnar Nerve Decompression In Patients ConsideredFor InSitu Incidence OfUlnarNerve Instability *Presented byJustin Stull,BA Scientifi c Program Overview , Danville, PA Geisinger le Of A Locking, erII, 65

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General Session 6 — Trauma/Sports/Misc. Case David W. Romness, MD, Commonwealth Orthopaedics, Presentations Arlington, VA Moderator: Anil S. Ranawat, MD Henry A. Backe Jr., MD, Orthopaedic Specialty Group, 2:16pm–3:00pm Case Presentations Fairﬁ eld, CT Panel David S. Wellman, MD, Hospital for Special Surgery, 3:00pm–4:00pm Scientiﬁ c Poster Session (Poster New York, NY Presenters Available) (Ritz-Carlton Richard M. Wilk, MD, Lahey Ballroom Foyer) Clinic, Burlington, MA Craig S. Roberts, MD, 4:00pm–5:00pm Multimedia Education Session MBA, Orthopaedic Trauma (Ambassador Room) Associates, Louisville, KY

* Institution by abstract presenter’s name is the location where the research took place.

66 :2m73a Factors Contributing To HospitalStay Discussion 7:32am–7:38am 7:30am–7:32am OpenCalcaneusFractures And Discussion 7:24am–7:30am 7:22am–7:24am Discussion 7:16am–7:22am 7:14am–7:16am Discussion 7:08am–7:14am 7:06am–7:08am 7:00am–7:06am MatthewM.Roberts,MD Moderators: 6:00am–7:00am * Institutionbyabstract presenter’s nameisthelocationwhere theresearch tookplace. General Session7—Foot & Ankle andSpine Samuel B. Adams Jr., MD And Charges In Ankle Arthroplasty Florida Health,Jacksonville, FL Jacob R. Worsham, MD,University of Associated Injuries Philadelphia, PA Institute, Thomas Jefferson University, Joseph T. O’Neil,MD, Of The Ankle Routine MagneticResonanceImaging Peroneal Tendon On Abnormalities *Presented byBenjaminKocher, PA-C Sam Houston, TX Antonio MilitaryMedicalCenter, Fort Matthew A. Napierala, MD, Subject And Axillary CrutchesInHealthy Knee WalkerWithThe Wheeled Ambulation And Perceived Exertion Comparative StudyOf Assisted *Presented byJohn M.Pinski,MS Special Surgery, New York, NY Ethan J. Fraser, MD, Studies Quality Of Ankle CartilageRepair Level OfEvidence And Methodical Ballroom Foyer Presenters Available) Scientiﬁ c Poster Session Ritz-Carlton BallroomSalonI,unlessotherwisespeciﬁ Friday, October24, 2014 ) Disclosure Informationislistedonpages46-55. (Presenters andtimesare subjecttochange.) Hospital for (Ritz-Carlton The Rothman (Poster San

:9m83a Discussion 8:29am–8:30am DynamicHipSpacersReduce Discussion 8:25am–8:29am 8:24am–8:25am 8:20am–8:24am DouglasE.Padgett, MD Moderator: Go To Stations Discussion 8:16am–8:20am 8:08am–8:16am 7:48am–8:08am MatthewS. Austin, MD Moderator: Discussion 7:46am–7:48am Discussion 7:40am–7:46am 7:38am–7:40am Symposium 3— What’s Newin Trauma (Station A, PlazaBallroom 1) Rapid Fire Session8A— Total HipReconstruction ed Institute, PhiladelphiaPA Anthony Tokarski, BS, The Rothman Reimplantation Operative TimeDuring Special Surgery, New York, NY Morteza Meftah,MD, Standing ToSitting Functional PelvicOrientationFrom Effect OfFixed Spinal Deformity On Special Surgery, New York, NY David S. Wellman, MD, What’s Newin Trauma for Joint Diseases,New York, NY Jonathan Oren, MD,NYUHospital Spine Surgery Implant CostReductionInitiative In Grant Award EOA/OREF Resident/Fellow Travel Jefferson University, Philadelphia, PA Jason L.Codding, MD, Thomas Scientiﬁ c Program Overview

Hospital for Hospital for

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8:30am–8:34am Radiographic Patterns Of 8:24am–8:26am Discussion Osteointegration In Cementless Tapered Wedge Stems 8:26am–8:30am Race And Outcomes In Arthroplasty Jonathan Robinson, MD, NSLIJ- Surgery Lenox Hill Hospital, New York, NY Jesus M. Villa, MD, The Center For Advanced Orthopedics at Larkin 8:34am–8:35am Discussion Hospital and Arthritis Surgery Research Foundation, South Miami, 8:35am–8:39am Inﬂ uence Of Neck Cut On FL Subsidence Of Hydroxyapatite Coated Stem 8:30am–8:32am Discussion Yevgeniy Korshunov, MD, NSLIJ- Lenox Hill Hospital, New York, NY 8:32am–8:36am Resource Consumption And Outcomes In Total Knee Arthroplasty 8:39am–8:40am Discussion (TKA) Carlos J. Lavernia, MD, The Center 8:40am–8:44am Multiple Lower Extremity for Advanced Orthopedics at Larkin Arthroplasties: Quality Of Life Hospital, South Miami, FL David A. Iacobelli, MD, The Center For Advanced Orthopedics at Larkin 8:36am–8:38am Discussion Hospital and Arthritis Surgery Research Foundation, 8:38am–8:42am Higher Morbidity And Mortality South Miami, FL After Femoral Neck Fracture In *Presented by Jesus M. Villa, MD Patients With Chronic Liver Failure 8:44am–8:45am Discussion Antonia F. Chen, MD, MBA, The Rothman Institute, 8:45am–8:49am Big Heads And Trunnions: Philadelphia, PA Tribocorrosion Turbocharged Jesus M. Villa, MD, The Center For 8:42am–8:44am Discussion Advanced Orthopedics at Larkin Hospital and Arthritis Surgery 8:44am–8:48am Effects Of Fracture Union With Research Foundation, Direct Reduction Of Peritrochanteric South Miami, FL Fractures Lawrence K. O’Malley, MD, 8:49am–8:50am Discussion Greenville Health System, Greenville, SC

Rapid Fire Session 8B — Total Knee 8:48am–8:50am Discussion Reconstruction (Station B, Plaza Ballroom 1) Moderator: James J. Purtill, MD Rapid Fire Session 8C — Hip & Spine (Station C, Ritz-Carlton Ballroom Foyer) 8:20am–8:24am Does Medicare 3 Day Rule Increase Length Of Stay? Moderator: John D. Kelly IV, MD Victor H. Hernandez, MD, MS, The Rothman Institute, Egg 8:20am–8:24am Femoral Acetabular Impingement Harbor Township, NJ In Patients Undergoing Total Hip Arthroplasty

* Institution by abstract presenter’s name is the location where the research took place.

68 :9m85a Discussion 8:49am–8:50am RestoringSagittalBalanceImproves Discussion 8:45am–8:49am 8:44am–8:45am How DoesStateIncome And Discussion 8:40am–8:44am 8:39am–8:40am Discussion 8:35am–8:39am 8:34am–8:35am Discussion 8:30am–8:34am 8:29am–8:30am LabralBaseHematoma: A Tension- Discussion 8:25am–8:29am 8:24am–8:25am * Institutionbyabstract presenter’s nameisthelocationwhere theresearch tookplace. Jefferson University, Philadelphia,PA Wilmington, DE I. duPont HospitalFor Children Kushagra Verma, MD,MS, With SpinalDeformity Ambulatory CerebralPalsy Patients Clinical OutcomesFor Non- Kushagra Verma, MD,MS, Spine Care? Relate To HospitalCharges For The NumberOfUninsuredPatients Philadelphia, PA Institute, Thomas Jefferson University, JohnMD, A.Abraham, Treated With Surgical HipDislocation Intra-Articular HipPathology CanBe Special Surgery, New York, NY Anil S.Ranawat,MD, Impingement Femoral Acetabular Gait And Special Surgery, New York, NY Anil S.Ranawat,MD, Sided InjuryPattern Jacksonville, FL of Florida-Jacksonville, Kyle E.Fleck, MD,University Ritz-Carlton BallroomSalonI,unlessotherwisespeciﬁ Friday, October24, 2014 Disclosure Informationislistedonpages46-55. (Presenters andtimesare subjecttochange.) Hospital for Hospital for The Rothman Thomas Alfred :4m82a Discussion 8:26am–8:30am 8:24am–8:26am 8:20am–8:24am Moderator: :8m85a Discussion 8:48am–8:50am Discussion 8:44am–8:48am 8:42am–8:44am Discussion 8:38am–8:42am 8:36am–8:38am Discussion 8:32am–8:36am 8:30am–8:32am (Station D,Ritz-CarltonBallroom Foyer) Rapid Fire Session8D—Knee Joshua S.Dines,MD ed Tell? We HealingandHow Do We Medial MeniscusRootRepair: Are Institute, Philadelphia,PA Daniel Woods,MD, Season Injury InNFLPlayers2013 Contralateral ACL Injury And The IncidenceOfRepeat ACL Health System,Danville, PA Hemil H.Maniar, MD, Infection Subclinical WithBe Associated Painful OrthopaedicHardware May Township, NJ Rothman Institute, Egg Harbor FotiosMD, Tjoumakaris, Of Patient OutcomesOver 10 Years Osteotomy, A Retrospective Review Medial Opening Wedge High Tibial *Presented byMortezaMetta,MD for SpecialSurgery, New York, NY Amar S.Ranawat,MD, Pair Analysis Satisfaction A Prospective Matched- Anterior KneePain, Crepitation And Effect Of Anatomical Patella On Township, NJ Rothman Institute, Egg Harbor FotiosMD, Tjoumakaris, Scientiﬁ c Program Overview The Rothman Geisinger Hospital The The 69

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Rapid Fire Session 8E — Mixed Topics (Station E, Symposium 4 — What’s New in Total Joints Ritz-Carlton Ballroom Foyer) Moderator: Mary I. O’Connor, MD Moderator: Henry A. Backe Jr., MD 9:10am–9:23am Infection 8:20am–8:24am Radiographic Stage Does Not Javad Parvizi, MD, FRCS, Correlate With Symptom Severity In The Rothman Institute, Thumb Basilar Joint Arthritis Philadelphia, PA C. Edward Hofﬂ er II, MD, PhD, The Rothman Institute, Thomas 9:23am–9:36am THR and ALTR Jefferson University Hospital, Chitranjan S. Ranawat, MD, Philadelphia, PA Hospital for Special Surgery, New York, NY 8:24am–8:26am Discussion 9:36am–9:49am Revision TKR 8:26am–8:30am Electro-Chemical Testing Results Of Carlos J. Lavernia, MD, The Center Conventional Hip Stems for Advanced Orthopedics at Larkin Ahmad Faizan, PhD, Mahwah, NJ Hospital, South Miami, FL

8:30am–8:32am Discussion 9:49am–10:00am Discussion

8:32am–8:36am Post-Operative Complications 10:00am–10:20am Break – Please visit Exhibitors Following Hemiarthroplasty In Patients On Warfarin Kristin McPhillips, MD, MPH, General Session 9 — BOC, OREF, AOA, AAOS Geisinger Health System, Reports & Presidential Guest Speaker Danville, PA Moderator: David W. Romness, MD 8:36am–8:38am Discussion 10:20am–10:25am BOC Report 8:38am–8:42am Lateral Unicompartmental Knee John C. Richmond, MD, New England Arthroplasty Yields Successful Baptist Hospital, Boston, MA Outcomes And Return-To-Sport Stephanie Petterson, MPT, PhD, 10:25am–10:30am OREF Report Orthopaedic Foundation, E. Anthony Rankin, MD, Stamford, CT Providence Hospital and Howard University, Washington, DC 8:42am–8:44am Discussion 10:30am–10:35am AOA Report: Own The Bone Talk 8:44am–8:48am Teriparatide Treatment In Patients Brian J. Galinat, MD, MBA, With Persistent Pain Following Joint Christiana Care Health System, Replacement Newark, DE Seth A. Jerabek, MD, Hospital for Special Surgery, New York, NY 10:35am–10:50am AAOS Report *Presented by Michael B. Cross, MD Frederick M. Azar, MD, President, American Academy of Orthopaedic 8:48am–8:50am Discussion Surgeons, Campbell Clinic, Memphis, TN 8:50am–9:10am Break – Please visit Exhibitors

* Institution by abstract presenter’s name is the location where the research took place.

70 12:46pm–12:52pm 12:44pm–12:46pm Discussion MorphometricRiskFactors For ACL 12:38pm–12:44pm 12:36pm–12:38pm Discussion TheStandardOneGramDose 12:30pm–12:36pm MatthewS. Austin, MD Moderators: 11:30am–12:30pm 10:55am–11:30am IntroductionofPresidential Guest 10:50am–10:55am * Institutionbyabstract presenter’s nameisthelocationwhere theresearch tookplace. General Session10—Mixed Topics Geoffrey H. Westrich, MD *Presented byScottC. Wagner, MD Bethesda, MD National MilitaryMedicalCenter, Daniel G.Kang, MD, Review Retrospective Arthroplasty: A Outcomes Following CervicalDisc Hospital, KansasCity, MO K. Aaron Shaw, DO,Children’s Mercy Injury InPediatricPatients *Presented byLorraine Hutzler, BA New York,NY Hospital forJoint Diseases, Anthony Catanzano,BS,NYU Prophylaxis For MRSA Of Vancomycin IsNot Adequate *Not forCME Ballroom Salon1) Pharmaceuticals, Inc. Presentation byPacira EOA Luncheon—Industry Jacksonville, FL Mary I.O’Connor, MD,MayoClinic, Your Practice Embracing Differences To Strengthen Variety Is The SpiceOfLife: Presidential GuestSpeaker Arlington, VA Commonwealth Orthopaedics, David W. Romness,MD, Speaker Ritz-Carlton BallroomSalonI,unlessotherwisespeciﬁ

Friday, October24, 2014 Disclosure Informationislistedonpages46-55. (Presenters andtimesare subjecttochange.) Walter Reed (Ritz-Carlton :0m13p TheEffect OfSeverity OfDiseaseOn 1:30pm–1:34pm MaryI.O’Connor, MD Moderator: Go To Stations 1:26pm–1:30pm 1:24pm–1:26pm Discussion ConsumerisminHealthcare 1:18pm–1:24pm 1:16pm–1:18pm Discussion 1:10pm–1:16pm 1:08pm–1:10pm Discussion 1:02pm–1:08pm 1:00pm–1:02pm Discussion DirectCostsof Aspirin 12:54pm–1:00pm 12:52pm–12:54pm Discussion (Station A, PlazaBallroom 1) Rapid Fire Session11A—Hip ed Health System,Danville, PA Gardens, FL Orthopaedic Institute, Palm Beach Joint Diseases,New York, NY Daniel Kiridly, BS, NYUHospitalfor (TJA) Following TotalJoint Arthroplasty Cost BurdenOf30-DayReadmissions Durham, NC University MedicalCenter, Richard C.MatherIII,MD,Duke Ryan W. Simovitch, MD, Population In AnActive Athletic Arthroplasty Outcomes OfReverse Shoulder Hemil H.Maniar, MD, Isolated GeriatricFemurFractures Head CTScans With Low Energy Award Resident/Fellow TravelGrant Philadelphia, PA Thomas Jefferson University Hospital, Christina J. Gutowski,MD,MPH, Thromboembolism Prophylaxis Versus WarfarinFor Venous Scientiﬁ

c Program Overview Geisinger Palm Beach

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1:34pm–1:35pm Discussion Rapid Fire Session 11B — Knee (Station B, Plaza Ballroom 1) 1:35pm–1:39pm Outpatient Total Hip Arthroplasty As A Method To Decrease Healthcare Moderator: Sabrina Strickland, MD Cost Zachary D. Post, MD, St. Vincent 1:30pm–1:34pm The Alpha-Defensin Biomarker For Hospital, Billings, MT PJI Responds To A Wide Spectrum Of Organisms 1:39pm–1:40pm Discussion Carl Deirmengian, MD, The Rothman Institute, Philadelphia, PA 1:40pm–1:44pm Fixation Of A Non-Cemented, Hydroxyapatite Coated Acetabular 1:34pm–1:35pm Discussion Component Morteza Meftah, MD, Hospital for 1:35pm–1:39pm Compliance With Intermittent Special Surgery, New York, NY Pneumatic Compression Devices In Orthopaedic 1:44pm–1:45pm Discussion Kristin McPhillips, MD, MPH, Geisinger Health System, 1:45pm–1:49pm Evaluating 216 Adverse Tissue Danville, PA Responses In A Single Surgeon Series 1:39pm–1:40pm Discussion Danyal Nawabi, MD, Hospital for Special Surgery, New York, NY 1:40pm–1:44pm The Cost-Utility Of Total Hip *Presented by Geoffrey H. Westrich, Arthroplasty: Could WOMAC Predict MD It? David A. Iacobelli, MD, The Center 1:49pm–1:50pm Discussion For Advanced Orthopedics at Larkin Hospital and Arthritis Surgery 1:50pm–1:54pm Short-Term Results Of Novel Research Foundation, South Miami, Constrained Total Hip Arthroplasty FL Stephen H. Finley, MD, Greenville *Presented by Jesus M. Villa, MD Health System, Greenville, SC 1:44pm–1:45pm Discussion 1:54pm–1:55pm Discussion 1:45pm–1:49pm Sleep Disturbance Following Total Knee And Total Hip Arthroplasty 1:55pm–1:59pm Long-Term Clinical Results Of A Alvin Ong, MD, The Rothman First Generation Highly Cross-Linked Institute, Egg Harbor Township, NJ Polyethylene In Young And Active Patients 1:49pm–1:50pm Discussion Chitranjan S. Ranawat, MD, Hospital for Special Surgery, New York, NY 1:50pm–1:54pm Total Joint Arthroplasty In Patients With Cardiac Implantable 1:59pm–2:00pm Discussion Electrophysiological Devices Seyed Alireza Mirghasemi, MD, The Rothman Institute, Thomas Jefferson University, Philadelphia, PA

* Institution by abstract presenter’s name is the location where the research took place.

72 1:45pm–1:49pm 1:44pm–1:45pm Discussion 1:40pm–1:44pm 1:39pm–1:40pm Discussion 1:35pm–1:39pm 1:34pm–1:35pm Discussion 1:30pm–1:34pm Moderator: 1:59pm–2:00pm Discussion 1:55pm–1:59pm 1:54pm–1:55pm Discussion * Institutionbyabstract presenter’s nameisthelocationwhere theresearch tookplace. (Station C,Ritz-CarltonBallroom Foyer) Rapid Fire Session11C— Tumor Valerae O.Lewis,MD University, Philadelphia,PA JeffersonInstitute, Thomas Metastatic Pattern Soft Tissue Sarcoma: An Unusual Cardiac MetastasisOfExtremity *Presented by Thomas D.Lee, MD Erie, PA Abdo Bachoura, MD, Management OfCarpalBoss A SystematicReview Of The Surgical Philadelphia, PA Institute, Thomas Jefferson University, JohnMD, A.Abraham, Pelvic Sarcoma Invasive MethodsOfResection Surgical Navigation Allows Less Hyde Park, NY Island Jewish MedicalCenter, New Ryan Michels, MD, Tumors Segmental Presentation ofBone Reconstruction Following Intercalary Tibial Allograft Andrew G.Park, MD, Services Postoperative Home Visiting Nurse Safe CostSavings For TJA: Eliminate Ritz-Carlton BallroomSalonI,unlessotherwisespeciﬁ Friday, October24, 2014 Disclosure Informationislistedonpages46-55. (Presenters andtimesare subjecttochange.) North Shore Long UPMC Hamot,

The Rothman The Rothman 1:59pm–2:00pm Discussion OpportunisticOsteoporosisScreening: 1:55pm–1:59pm 1:54pm–1:55pm Discussion :0m15p Malignant Associated GiantCell 1:50pm–1:54pm 1:49pm–1:50pm Discussion 1:35pm–1:39pm 1:34pm–1:35pm Discussion 1:30pm–1:34pm Pedro K.Beredjiklian, MD Moderator: (Station D,Ritz-CarltonBallroom Foyer) Rapid Fire Session11D—UpperExtremity ed Philadelphia, PA Institute, Thomas Jefferson University, Special Surgery, New York, NY Joseph J. Schreiber, MD,Hospitalfor From Diagnostic Wrist CTScans Information Gleaning Additional Park Island MedicalCenter, Samuel Kenan, NorthShore, Long Lesions OfBone JohnMD, A.Abraham, Greenville, SC Greenville Health System, Hawkins ClinicoftheCarolinas/ Scott T. Watson,MD, Arthroplasty Components In Total Shoulder Of Trabecular MetalGlenoid Two Year Survival And Outcomes MD *Presented byEricM.Padegimas, Philadelphia, PA Jefferson University Hospital, The RothmanInstitute, Thomas Surena Namdari,MD,MSc, Economic Burden The UnitedStates:Incidence And Periprosthetic ShoulderInfectionIn , NY Scientiﬁ c Program Overview Steadman New Hyde The Rothman 73

Scientiﬁ c Program EOA 45th Annual MeetingAmelia Island, Florida2014

Friday, October 24, 2014 (Presenters and times are subject to change.) Disclosure Information is listed on pages 46-55. Ritz-Carlton Ballroom Salon I, unless otherwise speciﬁ ed

1:39pm–1:40pm Discussion 1:36pm–1:40pm Cleft Foot Deformity, Management And Long Term Follow-Up 1:40pm–1:44pm Arthroscopic Anchorless, John E. Handelsman, MD, FRCS, Transosseus vs Anchored Rotator Cuff Rhode Island Hospital, Brown Repair-Case Control Analysis University, Providence, RI/Cohen Lucas B. Romine, MD, Johns Hopkins Children’s Medical Center, North Hospital, Baltimore, MD Shore/Long Island Jewish Medical Center, New Hyde Park, NY 1:44pm–1:45pm Discussion 1:40pm–1:42pm Discussion 1:45pm–1:49pm Complex Intra-Articular Distal Radius Fractures Treated With Cross- 1:42pm–1:46pm Screw Fixation Of Lateral Pin Fixation And A Non-Bridging Condyle Fractures: Results Of External Fixator (CPX System) Treatment R. Tyler Huish, DO, North Shore Eric D. Shirley, MD, Nemours Surgi-Center, Smithtown, NY Children’s Clinic, Jacksonville, FL

1:49pm–1:50pm Discussion 1:46pm–1:48pm Discussion

1:50pm–1:54pm Basal Joint Arthroplasty Decreases 1:48pm–1:52pm Effect Of Femoral Rotation On Entry Carpal Tunnel Pressure Point For Trochanteric Nails Kevin Lutsky, MD, The Rothman Hemil H. Maniar, MD, Institute, Philadelphia, PA Geisinger Health System, *Presented by Nayoung Kim, BS Danville, PA

1:54pm–1:55pm Discussion 1:52pm–1:54pm Discussion

1:55pm–1:59pm Online Resources For Shoulder 1:54pm–1:58pm Wait Time And Patient Satisfaction In Instability: What Are Patients The Orthopedic Clinic Reading? Tyler M. Kreitz, MD, Thomas Grant H. Garcia, MD, Hospital for Jefferson University, Special Surgery, New York, NY Philadelphia, PA

1:59pm–2:00pm Discussion 1:58pm–2:00pm Discussion

2:00pm–2:04pm Go To General Session Room Rapid Fire Session 11E — Pediatrics (Station E, Ritz-Carlton Ballroom Foyer) General Session 12 — Foot/ Ankle Arthroplasty Moderator: Daniel W. Green, MD Case Presentations 1:30pm–1:34pm Nerve Allograft For Surgical Repair Moderator: Sameh A. Labib, MD Of Obstetric Brachial Plexus Palsy Evan Siegall, MD, Scottish Rite 2:04pm–3:00pm Case Presentations Children’s Hospital/The Hand Matthew M. Roberts, MD, Hospital Upper Extremity Center of Georgia, for Special Surgery, New York, NY Atlanta, GA Brian S. Winters, MD, The Rothman Institute, Philadelphia, PA 1:34pm–1:36pm Discussion

* Institution by abstract presenter’s name is the location where the research took place.

74 4:00pm–5:00pm 3:00pm–4:00pm * Institutionbyabstract presenter’s nameisthelocationwhere theresearch tookplace. ( Multimedia EducationSession Ballroom Foyer Presenters Available) Scientifi NC University MedicalCenter, Durham, Samuel B. Adams Jr., MD,Duke Ambassador Room c Poster Session Ritz-Carlton BallroomSalonI,unlessotherwisespecifi Friday, October24, 2014 ) Disclosure Informationislistedonpages46-55. (Presenters andtimesare subjecttochange.) ) (Ritz-Carlton (Poster ed Scientifi c Program Overview 75

Scientiﬁ c Program EOA 45th Annual MeetingAmelia Island, Florida2014

Saturday, October 25, 2014 (Presenters and times are subject to change.) Disclosure Information is listed on pages 46-55. Ritz-Carlton Ballroom Salon I, unless otherwise speciﬁ ed

6:00am–7:00am Scientiﬁ c Poster Session (Poster Eric M. Padegimas, MD, The Rothman Presenters Available) (Ritz-Carlton Institute, Thomas Jefferson University, Ballroom Foyer) Philadelphia, PA

7:38am–7:40am Discussion General Session 13 — Mixed Topics 7:40am–7:46am Resident/Fellow Award Moderators: Henry A. Backe Jr., MD Combination Therapy With E. Anthony Rankin, MD DBM And PTH Can Not Heal A Critical Sized Murine Femoral 7:00am–7:06am Patients’ Perception Of Care Defect Correlates With Quality Of Hospital Michael Pensak, MD, University Care: A Survey Of 4605 Hospitals of Connecticut Health Center, Spencer Stein, BA, NYU Hospital for Farmington, CT Joint Diseases, New York, NY 7:46am–7:48am Discussion 7:06am–7:08am Discussion 7:48am–7:54am Ranawat Award 7:08am–7:14am Patient-Reported Allergies Affect Cost Effectiveness Of Bariatric Outcomes After Lower Extremity Surgery Prior To Primary Total Knee Arthroplasty Arthroplasty Jason L. Blevins, MD, Hospital for Alexander S. McLawhorn, MD, MBA, Special Surgery, New York, NY Hospital for Special Surgery, New York, NY 7:14am–7:16am Discussion 7:54am–7:56am Discussion 7:16am–7:22am Lidocaine Chondrotoxicity In A Porcine Fracture Mode Grigory E. Gershkovich, MD, Symposium 5 — What’s New in Hip Preservation Einstein Medical Center, Surgery Philadelphia, PA Moderator: John D. Kelly IV, MD 7:22am–7:24am Discussion 7:56am–8:02am Advances in Cartilage Repair of the 7:24am–7:30am CRP And ESR As Indicators Hip For Resolution Of Periprosthetic Anil S. Ranawat, MD, Hospital for Infection Special Surgery, New York, NY Christopher P. Lindsay, BS, University of North Carolina 8:02am–8:08am Labral Reconstruction School of Medicine, Chapel John D. Kelly IV, MD, University of Hill, NC Pennsylvania, Philadelphia, PA

7:30am–7:32am Discussion 8:08am–8:14am The Role of PAO and Surgical Dislocation in 2014 7:32am–7:38am Resident/Fellow Travel Grant Javad Parvizi, MD, FRCS, Award The Rothman Institute, What Factors Affect Medicare Philadelphia, PA Reimbursement In Total Joint Arthroplasty? 8:14am–8:20am Rationale and Technique for Capsular Preservation in Hip Arthroscopy * Institution by abstract presenter’s name is the location where the research took place.

76 :8m94a Discussion 9:48am–9:49am Discussion 9:44am–9:48am 9:43am–9:44am 9:39am–9:43am Sameh A. Labib,MD Moderator: Go To Stations Discussion 9:35am–9:39am 9:25am–9:35am What’s New inSpineSurgery 9:07am–9:25am ScottD. Boden,MD Moderator: Break—PleasevisitExhibitors SecondBusinessMeeting 8:42am–9:07am Discussion 8:27am–8:42am 8:20am–8:27am * Institutionbyabstract presenter’s nameisthelocationwhere theresearch tookplace. Ballroom 1) Rapid Fire Session14A—Foot Symposium 6— What’s NewinSpineSurgery Ethan J. Fraser, MD, Special Surgery, New York, NY Talus For OsteochodralLesionsOf The Transfer Osteochondral Autologous Femoral DonorSitesInPatient Post Clinical And MRIOutcomesOf *Presented byCharlesP. Hannon,BS Special Surgery, New York, NY Ethan J. Fraser, MD, Term Follow-Up T2 MRIOutcomes At Mid-To Long- Lesions Of The Talus: Functional And Transplantation For Osteochondral Autologous Osteochondral Pottstown, PA Institute ofOrthopaedics, James T. Guille, MD,Brandywine Durham, NC University MedicalCenter, Richard C.MatherIII,MD,Duke

Ritz-Carlton BallroomSalonI,unlessotherwisespeciﬁ Saturday, October25, 2014 (Station A, Plaza (Station A, Disclosure Informationislistedonpages46-55. (Presenters andtimesare subjecttochange.) Hospital for Hospital for

9:39am–9:43am David S. Wellman, MD Moderator: Discussion 10:08am–10:09am 10:04am–10:08am Discussion 10:03am–10:04am Discussion 9:59am–10:03am 9:58am–9:59am Total AnkleArthroplastyVersus Discussion 9:54am–9:58am 9:53am–9:54am AComparisonOf Anatomic Versus 9:49am–9:53am (Station B,PlazaBallroom 1) Rapid Fire Session14B— Trauma ed Fairfax Hospital,Falls Church, VA MRI Analysis Transplantation: Functional And T2 Talus In Autologous Osteochondral Osteochondral LesionsOf The Osteotomy For Accessing Anterolateral Tibial Trapezoidal Thomas H.Sanders, MD, PhD *Presented byLolitaRamsay, RN, Technique) Tibial Nailing(TheSeMid Semi-Extended Midvastus Special Surgery, New York, NY Ethan J. Fraser, MD, Imaging Comparison To MagneticResonance Functional Outcomes And Posterior Tibial Tendoscopy: MD *Presented by Arianna Giannakos, Special Surgery, New York, NY Ethan J. Fraser, MD, University Hospital,Philadelphia,PA Justin Kane, MD, Thomas Jefferson Analysis Arthrodesis: An Arc OfMotion University Hospital,Philadelphia,PA Justin Kane, MD, Thomas Jefferson Tubular PlatingFor Fibula Fractures Scientiﬁ

c Program Overview Hospital for Hospital for INOVA 77

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Saturday, October 25, 2014 (Presenters and times are subject to change.) Disclosure Information is listed on pages 46-55. Ritz-Carlton Ballroom Salon I, unless otherwise speciﬁ ed

9:43am–9:44am Discussion Rapid Fire Session 14C — Spine 9:44am–9:48am Plate Versus Screw Fixation of Radial (Station C, Ritz-Carlton Ballroom Foyer) Neck Fractures: A Biomechanical Moderator: Scott D. Boden, MD Study Christina J. Gutowski, MD, MPH, 9:39am–9:43am Can Orthopaedic Surgeons Be Thomas Jefferson University Hospital, Trained To Accurately Gauge Tapping Philadelphia, PA Insertional Torque? Daniel G. Kang, MD, Walter Reed 9:48am–9:49am Discussion National Military Medical Center, Bethesda, MD 9:49am–9:53am Higher Mortality And Length Of *Presented by Peter Formby, MD Stay After Hip Fracture In Chronic Renal Failure Patients 9:43am–9:44am Discussion Antonia F. Chen, MD, MBA, The Rothman Institute, 9:44am–9:48am Functional Outcomes Reporting In Philadelphia, PA An Annual Meeting Over Three Years 9:53am–9:54am Discussion Kristin McPhillips, MD, MPH, Geisinger Health System, Danville, PA 9:54am–9:58am Orthopaedic Trauma In The Amish Community: Epidemiology And 9:48am–9:49am Discussion Hospital Charges Louis C. Grandizio, DO, Geisinger 9:49am–9:53am Sonication For Detection Of Infection Health System, Danville, PA In ‘Aseptic’ Nonunion Hemil H. Maniar, MD, Geisinger 9:58am–9:59am Discussion Health System, Danville, PA

9:59am–10:03am Unstable Metacarpal Fractures 9:53am–9:54am Discussion Treated with Intramedullary Nail Fixation 9:54am–9:58am Sacral Screw Strain In A Long Ather Mirza, MD, North Shore Posterior Spinal Fusion Construct Surgi-Center, Smithtown, NY With Sacral Alar-Iliac (S2AI) Versus *Presented by Justin B. Mirza, DO Iliac Fixation Daniel G. Kang, MD, Walter Reed 10:03am–10:04am Discussion National Military Medical Center, Bethesda, MD 10:04am–10:08am Decreasing Incidence and *Presented by Scott C. Wagner, MD Changing Treatment of Distal Radius Fractures Among Elderly 9:58am–9:59am Discussion Adults Benjamin D. Streufert, BS, Duke 9:59am–10:03am Operative Treatment Of New Onset University Medical Center, Radiculopathy And Myelopathy Durham, NC Secondary To Combat Injury Gregory S. Van Blarcum, MD, Walter 10:08am–10:09am Discussion Reed National Military Medical Center, Bethesda, MD

10:03am–10:04am Discussion

* Institution by abstract presenter’s name is the location where the research took place.

78 :3m95a Discussion 9:54am–9:58am 9:53am–9:54am Discussion 9:49am–9:53am 9:48am–9:49am Discussion 9:44am–9:48am 9:43am–9:44am 9:39am–9:43am David W. Romness,MD Moderator: Discussion 10:08am–10:09am 10:04am–10:08am * Institutionbyabstract presenter’s nameisthelocationwhere theresearch tookplace. Foyer) Reconstruction Rapid Fire Session14D— Total Hip (Station D,Ritz-CarltonBallroom Wilmington, DE I. duPont HospitalFor Children, Advanced OrthopedicsatLarkin Jesus M. Villa, MD, The CenterFor Undergoing THA Sex And QualityOfLifeInPatients South Miami,FL Research Foundation, Hospital and Arthritis Surgery Advanced OrthopedicsatLarkin Jesus M. Villa, MD, The CenterFor Surgery: Costs And Outcomes Assistants InJointReplacement Resident Education And Physician Hospital, SouthMiami,FL for Advanced OrthopedicsatLarkin Carlos J. Lavernia, MD, Hurting Our TJA Patients? Carrier Determinations: Are We Appropriate UseCriteria And Local Lenox HillHospital,New York, NY Yevgeniy Korshunov, MD, Signifi For THA: Analyzing CMSRadiographicCriteria Kushagra Verma, MDMS, Outcome? Which DemographicFactors Affect Adolescents InSouthEast Asia: SRS-22 FromOver 1000Healthy A Normative BaselineFor The Ritz-Carlton BallroomSalonI,unlessotherwisespecifi Saturday, October25, 2014 cant Outliers Disclosure Informationislistedonpages46-55. (Presenters andtimesare subjecttochange.) The Center NSLIJ- Alfred 00a–00a Discussion 10:08am–10:09am HypotensionFollowing Total Joint 10:04am–10:08am 10:03am–10:04am Discussion :9m95a Discussion 9:49am–9:51am RestoringIsometryinLateral Discussion 9:45am–9:49am 9:43am–9:45am 9:39am–9:43am David S.Zelouf, MD Moderator: Discussion 9:59am–10:03am 9:58am–9:59am Carlton Ballroom Foyer) Rapid Fire Session14E—Hand ed *Presented byRonaldHuang, MD Philadelphia, PA Jefferson University Hospital, T. David Tarity, MD, Thomas Inconsequential Arthroplasty IsCommon And New York,NY Hospital forSpecialSurgery, Geoffrey H. Westrich, MD, Prosthesis A ModularDualMobility(MDM) Revision Hip Arthroplasty With Short TermComplications After Lenox HillHospital,New York, NY Jonathan W. Shearin,MD, Reconstruction Ulnar CollateralLigament Jefferson University, Philadelphia,PA The RothmanInstitute, Thomas Michael M. Vosbikian, MD, Plates WithFixation VariousFracture Volar Reduction Loss After DistalRadius South Miami,FL Research Foundation, Hospital and Arthritis Surgery Scientifi c Program Overview (Station E,&Ritz- NSLIJ- 79

Scientiﬁ c Program EOA 45th Annual MeetingAmelia Island, Florida2014

Saturday, October 25, 2014 (Presenters and times are subject to change.) Disclosure Information is listed on pages 46-55. Ritz-Carlton Ballroom Salon I, unless otherwise speciﬁ ed

9:51am–9:55am Locking Shaft Screws Not Necessary 10:38am–10:40am Discussion in Volar Plate Fixation Kevin Lutsky, MD, The Rothman 10:40am –10:46am The Team Physician And The Athletic Institute, Philadelphia, PA Trainer: Do We Agree? *Presented by C. Edward Hoffl er II, Fotios Tjoumakaris, MD, The MD, PhD Rothman Institute, Egg Harbor Township, NJ 9:55am–9:57am Discussion 10:46am–10:48am Discussion 9:57am–10:01am Fingertip Amputation Treatment: A Survey Study 10:48am–10:54am Native Anterior Cruciate Ligament Andrew Miller, MD, The Rothman Length Quantifi cation Via Lateral Institute, Thomas Jefferson University Radiographic Landmark Hospital, Philadelphia, PA LCDR Patrick W. Joyner, MD, MS, *Presented by Eric M. Padegimas, Naval Medical Center Portsmouth/ MD Bone & Joint - Sports Medicine Institute, Portsmouth, VA 10:01am–10:03am Discussion 10:54am–10:56am Discussion 10:03am–10:07am Radiation Exposure To The Eye With Mini C-Arm Use During Hand 10:56am–11:02am Comparison Of Stability And Slope Surgery Neutralization Between CW And OW C. Edward Hoffl er II, MD, PhD, The HTO In The ACL Defi cient Knee Rothman Institute, Thomas Jefferson Anil S. Ranawat, MD, Hospital for University Hospital, Philadelphia, PA Special Surgery, New York, NY

10:07am–10:09am Discussion 11:02am–11:04am Discussion

10:09am–10:24am Refreshment Break 11:04am –11:10am Resident/Fellow Award Prospective, Randomized Study: Superior Early Outcomes Following General Session 15 — Mixed Topics THA Using Direct Anterior Approach Ryan Massimilla, BS, The Rothman Moderators: Amar S. Ranawat, MD Institute, Thomas Jefferson University, David S. Wellman, MD Philadelphia, PA

10:24am –10:30am Severity Of Hand OA — A Predictor 11:10am–11:12am Discussion Of Major Joint Involvement And Surgical Intervention 11:12am –11:18am EOA/OREF Resident/Fellow Travel Chitranjan S. Ranawat, MD, Hospital Grant Award for Special Surgery, New York, NY When Is It Safe For Patients To Drive After Right Total Hip Arthroplasty? 10:30am–10:32am Discussion Victor H. Hernandez, MD, MS, The Rothman Institute, Egg Harbor 10:32am –10:38am Periprosthetic Joint Infection: Could Township, NJ Bearing Surface Play A Role? Langan S. Smith, BS, The Rothman 11:18am–11:20am Discussion Institute, Thomas Jefferson University, Philadelphia, PA 11:20am–11:40am Refreshment Break *Presented by Camilo Restrepo, MD * Institution by abstract presenter’s name is the location where the research took place.

80 12:33pm–12:34pm Discussion EpidemiologyOfMultiligamentous 12:29pm–12:33pm 12:28pm–12:29pm Discussion 12:24pm–12:28pm David S. Wellman, MD Moderator: Go To Stations 12:20pm–12:24pm 12:10pm–12:20pm Discussion 12:00pm–12:10pm Subscapularis Tears Advance In Treatments OfElbow 11:50am–12:00pm Treatments For Massive RotatorCuff 11:40am–11:50am Moderator: Gregory S.DiFelice, MD * Institutionbyabstract presenter’s nameisthelocationwhere theresearch tookplace. Ballroom 1) Rapid Fire Session16A— Trauma Elbow Surgery Symposium 7— What’s NewinShoulderand Special Surgery, New York, NY Township, NJ Rothman Institute, Egg Harbor Jacksonville, Jacksonville, FL Florida College ofMedicine- Mark Elliott,MD,University of Center 10 Year Review At A Level 1 Trauma Knee Injuries And Associated Injuries: Hospital, SouthMiami,FL for Advanced OrthopedicsatLarkin Carlos J. Lavernia,MD, Intertrochanteric (IT)Fractures Surgery (CAOS) In The Treatment Of Computer-Assisted Orthopaedic Group ofSouthFlorida,Jupiter, FL Christopher Adams, MD, The Medical Joshua S.Dines,MD, Injuries In Throwing Athletes FotiosMD, Tjoumakaris, Tears Ritz-Carlton BallroomSalonI,unlessotherwisespeciﬁ Saturday, October25, 2014 Disclosure Informationislistedonpages46-55. (Presenters andtimesare subjecttochange.) (Station A, Plaza (Station A, Hospital for The Center The 12:53pm–12:54pm Discussion 12:44pm–12:48pm 12:43pm–12:44pm Discussion 12:39pm–12:43pm 12:38pm–12:39pm Discussion 12:24pm–12:28pm AmarS.Ranawat,MD Moderator: 12:49pm–12:53pm Patients With 12:48pm–12:49pm Discussion Abnormal Infection 12:34pm–12:38pm (Station B,PlazaBallroom 1) Rapid Fire Session16B— Total HipReconstruction ed RN, PhD *Presented byLolitaRamsay, Church, VA Fairfax MedicalCampus,Falls Meryl R.Ludwig, MD, Setting OfOpen Tibia Fractures Provisional PlateFixationIn The System, Danville, PA Adam K.Lee, MD, Acetabular Fractures Comminuted Posterior Wall Pilon PlateFor FixationOf MD *Presented byMichael P. Bolognesi, Durham, NC University MedicalCenter, Taylor R. McClellan,BS, Infection In Young Patients After THA Risk Factors For Periprosthetic University, Philadelphia,PA Rothman Institute, Thomas Jefferson Priscilla K.Cavanaugh,MS, Prior ToRevision Arthroplasty Parameters Need To BeInvestigated Health System,Danville, PA Hemil H.Maniar, MD, Missed Tibial ShaftFractures Are Frequently WithFractures Ipsilateral Ankle Scientiﬁ c Program Overview Geisinger Health Inova Geisinger Duke

The 81

Scientiﬁ c Program EOA 45th Annual MeetingAmelia Island, Florida2014

Saturday, October 25, 2014 (Presenters and times are subject to change.) Disclosure Information is listed on pages 46-55. Ritz-Carlton Ballroom Salon I, unless otherwise speciﬁ ed

12:28pm–12:29pm Discussion Rapid Fire Session 16C — Knee (Station C, Ritz- 12:29pm–12:33pm Delaying Reimplantation Following Carlton Ballroom Foyer) Resection Arthroplasty Does Not Moderator: Marc J. Lemos, MD Improve Outcomes: A Report From Two High Volume Orthopaedic 12:24pm–12:28pm Systemic Manifestation Of Centers Periprosthetic Infection Is Associated Anthony Tokarski, BS, The Rothman With Increased In-Hospital Mortality Institute, Philadelphia, PA Gregory K. Deirmengian, MD, The Rothman Institute, Philadelphia, PA 12:33pm–12:34pm Discussion 12:28pm–12:29pm Discussion 12:34pm–12:38pm Survivorship And Complications Of Revision Total Hip Arthroplasty With 12:29pm–12:33pm Pre-Operative Templating Of Anterior A Mid-Modular Femoral Stem Cruciate Ligament Reconstruction Jason Hochfelder, MD, NYU Hospital Using Lateral X-Ray for Joint Diseases, New York, NY LCDR Patrick W. Joyner, MD, MS, *Presented by Aldo M. Riesgo, MD Naval Medical Center Portsmouth/ Bone & Joint - Sports Medicine 12:38pm–12:39pm Discussion Institute, Portsmouth, VA

12:39pm–12:43pm Intraoperative Femur Fracture During 12:33pm–12:34pm Discussion Primary Total Hip Arthroplasty And Hemiarthroplasty 12:34pm–12:38pm Tibial Rotation And Patellar Tilt David S. Geller, MD, Monteﬁ ore Following Closing And Opening High Medical Center, Bronx, NY Tibial Osteotomy *Presented by Robert Brochin, BS Anil S. Ranawat, MD, Hospital for Special Surgery, New York, NY 12:43pm–12:44pm Discussion 12:38pm–12:39pm Discussion 12:44pm–12:48pm What Is The Optimum Acetabular Component Position And Size In 12:39pm–12:43pm Patient Perceived Outcomes And Direct Anterior Approach Total Physical Performance In TKA Hip Arthroplasty? — Inﬂ uence Carlos J. Lavernia, MD, The Center Of Stability Assessment And for Advanced Orthopedics at Larkin Impingement Hospital, South Miami, FL Parthiv A. Rathod, MD, NSLIJ-Lenox Hill Hospital, New York, NY 12:43pm–12:44pm Discussion *Presented by Jose A. Rodriguez, MD 12:44pm–12:48pm Cost-Effective Prophylaxis Against 12:48pm–12:49pm Discussion Venous Thromboembolism After Total Joint Arthroplasty: Warfarin Versus 12:49pm–12:53pm Failure Of A Modular Neck Hip Stem: Aspirin A Retrieval Study Reza Mostafavi Tabatabaee, MD, The Joseph Assini, MD, Hospital for Rothman Institute, Thomas Jefferson Special Surgery, New York, NY University, Philadelphia, PA

12:53pm–12:54pm Discussion 12:48pm–12:49pm Discussion

* Institution by abstract presenter’s name is the location where the research took place.

82 23p–24p Subscapularis Fatty Infi 12:39pm–12:43pm 12:38pm–12:39pm Discussion 12:34pm–12:38pm 12:33pm–12:34pm Discussion 12:29pm–12:33pm 12:28pm–12:29pm Discussion 12:24pm–12:28pm Kevin D. Plancher, MD Moderator: 12:53pm–12:54pm Discussion 12:49pm–12:53pm * Institutionbyabstract presenter’s nameisthelocationwhere theresearch tookplace. Carlton Ballroom Foyer) Rapid Fire Session16D— Shoulder Hospital, Philadelphia,PA Institute, Thomas Jefferson University Epaule, Centre Orthopédique Michael T. Freehill, MD,Unité In TotalShoulder Arthroplasty Clinical Evaluation After Tenotomy MD, PhD *Presented byConstatinosKetonis, Philadelphia, PA Institute, Thomas Jefferson University, Joseph Dwyer, MD, A SystematicReview Rates InOpenFracturesOf The Hand: Timing OfDebridement And Infection Institute, Egg Harbor Township, NJ Luke Austin,MD, And Postoperative SleepDisturbance The CharacterizationOfPreoperative Arthroscopic RotatorCuff Repair: Corinne VanBeek,MD, Cartilage Lesions MRI For DetectingGlenohumeral Diagnositc Accuracy OfNon-Contrast New York,NY Hospital forSpecialSurgery, Mohamed E.Moussa,MD, Arthroplasty Posterior Stabilized Total Knee Non-Modular Constrained Versus Comparison OfRevision RatesOf Ritz-Carlton BallroomSalonI,unlessotherwisespecifi Saturday, October25, 2014 Disclosure Informationislistedonpages46-55. The Rothman (Presenters andtimesare subjecttochange.) (Station D,Ritz- The Rothman ltration And The Rothman 12:49pm–12:53pm 12:48pm–12:49pm Discussion 12:34pm–12:36pm Discussion 12:30pm–12:34pm 12:28pm–12:30pm Discussion 12:24pm–12:28pm AnilS.Ranawat,MD Moderator: 12:53pm–12:54pm Discussion 12:44pm–12:48pm 12:43pm–12:44pm Discussion Ritz-Carlton Ballroom Foyer) Rapid Fire Session16E—BasicScience ed Regarding RotatorCuff Repair A Survey OfExpertOpinion Hospital, Philadelphia,PA Institute, Thomas Jefferson University JosephMD, A.Abboud, Fractures In Operative ProximalHumerus The Prevalence OfRotatorCuff Tears *Presented byLorraine A. Boakye, BA Special Surgery, New York, NY Ethan J. Fraser, MD, Model Transplantation In An In Vivo Rabbit Autologous Osteochondral TGF-Beta ExpressionFollowing Platelet-Rich PlasmaIncreases Philadelphia, PA Institute, Thomas Jefferson University, Mark Wang, MD,PhD, Therapeutic Cells For Tendon-Targeted Delivery Of Smart Collagen-Specifi *Presented byJoseph A. Abboud, MD Hospital, Philadelphia,PA Institute, Thomas Jefferson University Daniel C. Acevedo, MD, Lyon, France Santy-Hôpital PrivéJean Mermoz, Scientifi c Program Overview Hospital for c Anchors The Rothman The Rothman (Station E, The Rothman 83

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Saturday, October 25, 2014 (Presenters and times are subject to change.) Disclosure Information is listed on pages 46-55. Ritz-Carlton Ballroom Salon I, unless otherwise speciﬁ ed

12:36pm–12:40pm Variance Of Matrix 1:04pm–1:06pm Discussion Metalloproteinases (MMP) And Tissue Inhibitor Of Metalloproteinases 1:06pm–1:12pm Founders’ Award (TIMP) Concentrations In Activated, Flouroscopic Radiation Exposure: Concentrated Platelets From Healthy Are We Protecting Ourselves Male Donors Adequately? Justin M. Hire, MD, Dwight D. C. Edward Hofﬂ er II, MD, PhD, The Eisenhower Army Medical Center, Rothman Institute, Thomas Jefferson Fort Gordon, GA University Hospital, Philadelphia, PA

12:40pm–12:42pm Discussion 1:12pm–1:14pm Discussion

12:42pm–12:46pm Elimination Of Overlap In Small 1:14pm–1:20pm Resident/Fellow Travel Grant And Ring Metacarpal Measurements Award Michael Rivlin, MD, The Rothman Conservative Management Of Elbow Institute, Thomas Jefferson University Dislocations With An Overhead Hospital, Philadelphia, PA Motion Protocol *Presented by Nayoung Kim, BS Joseph J. Schreiber, MD, Hospital for Special Surgery, New York, NY 12:46pm–12:48pm Discussion 1:20pm–1:22pm Discussion 12:48pm–12:52pm Interobserver Reliability In The Measurement Of Hand Compartment 1:22pm–1:28pm Resident/Fellow Travel Grant Pressures Award Justin C. Wong, MD, The Rothman Targeting Skeletal Metastases Using Institute, Thomas Jefferson University HPMA Copolymer Nanoparticle Hospital, Philadelphia, PA Delivery And Retention *Presented by Michael M. Vosbikian, Alexander B. Christ, MD, Hospital MD for Special Surgery/Memorial Sloan Kettering Cancer Center, New York, 12:52pm–12:54pm Discussion NY

12:54pm–12:58pm Go To General Session Room 1:28pm–1:30pm Discussion

1:30pm–1:36pm Red Cell Distribution Width: An General Session 17 — Mixed Topics Unacknowledged Predictor Of Mortality Following Revision Moderator: Adam J. Rana, MD Arthroplasty Pouya Alijanipour, MD, The Rothman 12:58pm–1:04pm Elevated Hemoglobin A1C Levels Institute, Thomas Jefferson University, Correlate With Blood Glucose Philadelphia, PA Elevation In Diabetic Patients Following Local Corticosteroid 1:36pm–1:38pm Discussion Injection In The Hand: A Prospective Study 1:38pm–1:44pm Medicare Audits: Are We Hurting Our Pedro K. Beredjiklian, MD, The TKA Patients? Rothman Institute, Philadelphia, PA David A. Iacobelli, MD, The Center *Presented by Nayoung Kim, BS For Advanced Orthopedics at Larkin Hospital and Arthritis Surgery

* Institution by abstract presenter’s name is the location where the research took place.

84 3:00pm–4:00pm 2:10pm–3:00pm 2:00pm–2:02pm Discussion 1:54pm–2:00pm 1:52pm–1:54pm Discussion 1:46pm–1:52pm 1:44pm–1:46pm Discussion * Institutionbyabstract presenter’s nameisthelocationwhere theresearch tookplace. ( Multimedia EducationSession Ballroom Foyer Presenters Available) Scientifi Rothman Institute, Philadelphia,PA Antonia F. Chen,MD,MBA, Infection Risk Arthroplasty HasNoEffect On Surgical CaseOrderIn Total Joint Hill Hospital,New York, NY David A. Porter, MD, Trunnion Designs A Mechanical Analysis Of THA Modern Tapers Are More Flexible: *Presented byJesus M. Villa, MD FL Research Foundation, SouthMiami, Ambassador Room c Poster Session Ritz-Carlton BallroomSalonI,unlessotherwisespecifi Saturday, October25, 2014 ) Disclosure Informationislistedonpages46-55. (Presenters andtimesare subjecttochange.) ) (Ritz-Carlton NSLIJ-Lenox (Poster The ed Scientifi c Program Overview 85

Scientiﬁ c Program EOA 45th Annual MeetingAmelia Island, Florida2014

Presenters and Moderators Index

Pages(s) Pages(s) Joseph A. Abboud, MD 214, 215 Stephen H. Finley, MD 156 John A. Abraham, MD 142, 162, 164 Kyle E. Fleck, MD 140 Christopher Adams, MD 81 Peter Formby, MD 101, 115, 186 Samuel B. Adams Jr., MD 58, 75, 130 Ethan J. Fraser, MD 178, 181 Pouya Alijanipour, MD 221 Michael T. Freehill, MD 214 Jeffrey Alwine, DO 91 Brett Frykberg, MD 99 Joseph Assini, MD 207 Brian J. Galinat, MD, MBA 70 Luke Austin, MD 212 Grant H. Garcia, MD 168 Matthew S. Austin, MD 67, 150 Grigory E. Gershkovich, MD 174 Frederick M. Azar, MD 70 Arianna Giannakos, BS 181 Henry A. Backe Jr., MD 66, 147, 173 Daniel Goldberg, NA 104 Pedro K. Beredjiklian, MD 165 Louis C. Grandizio, DO 184 Eric M. Black, MD 126 Daniel W. Green, MD 169 Jason L. Blevins, MD 174 James T. Guille, MD 77 Lorraine A. Boakye, BA 216 Christina J. Gutowski, MD, MPH 152, 183 Scott D. Boden, MD 77, 107, 115, 186 John E. Handelsman, MD, FRCS 170 Michael P. Bolognesi, MD 109, 204 Charles P. Hannon, BS 178 111, 120, 121, Robert Brochin, BS 206 Victor H. Hernandez, MD, MS 137, 200 Camden B. Burns, MD 115 Justin M. Hire, MD 217 Kaitlin M. Carroll, BS 96 127, 147, 195, C. Edward Hofﬂ er II, MD, PhD Priscilla K. Cavanaugh, MS 204 196, 219 Antonia F. Chen, MD, MBA 139, 183, 223 Ronald Huang, MD 192 Alexander B. Christ, MD 221 R. Tyler Huish, DO 167 Corey Clyde, BS 120 Ian Hutchinson, MD 108 Jason L. Codding, MD 132 Lorraine Hutzler, BA 150 Michael B. Cross, MD 114, 149 Adam E. Hyatt, MD 90 Bradford L. Currier, MD 101 LCDR Patrick W. Joyner, MD, MS 124, 198, 209 John Deegan, DO 128 Justin Kane, MD 179, 180 Carl Deirmengian, MD 158 Patrick W. Kane, MD 98 Gregory K. Deirmengian, MD 208 N. George Kasparyan, MD, PhD 125 Gregory S. DiFelice, MD 59, 81, 122 John D. Kelly IV, MD 59, 76, 140 Joshua S. Dines, MD 81, 144 Samuel Kenan, MD 164 Albert S. Dunn, DO 91 Constantinos Ketonis, MD, PhD 213 Mark R. Elliott, MD 201 Paul D. Kiely, MCh, FRCS (Tr & Orth) 102 John A. Erickson, MD 93 Nayoung Kim, BS 168, 217, 219 Ahmad Faizan, PhD 148 Daniel Kiridly, BS 154

86 ai .Ooc,M 155 133 159 131 Eric M.Padegimas, MD 139 70,71, 154 Fabio R.Orozco,MD Jonathan Oren,MD 211 Alvin C.Ong,MD 125,184 Joseph T. O’Neil,MD 195 Lawrence K.O’Malley, MD 211 162 Mary I.O’Connor, MD 160 Remy Munasiﬁ Mohamed E.Moussa,MD 123 Reza Mostafavi Tabatabaee, MD 134,145, 155 Justin B.Mirza,DO Seyed Alireza Mirghasemi, MD Andrew Miller, MD 199 148,158,186 97 Ryan Michels,MD 77, 104,154 Elliot S.Mendelsohn,MD 177 Morteza Meftah,MD Kristin McPhillips,MD,MPH Alexander S.McLawhorn, MD,MBA Richard C.MatherIII,MD 162 175 Ryan Massimilla,BS 112 62,89,208 163 Jorge Manrique,MD 100 202 Hemil H.Maniar, MD Kartik Mangudi Varadarajan, PhD Christopher P. Lindsay, BS Valerae O.Lewis, MD Mark J.Lemos,MD 89 Thomas D.Lee,MD Gwo-Chin Lee,MD 172 Adam K.Lee,MD Carlos J.Lavernia, MD 131 136,189 Sameh A. Labib,MD Neil Kumar, MD Tyler M.Kreitz,MD Yevgeniy Korshunov, MD Benjamin Kocher, PA-C 62 106, 165,176, 146, 153,171, 138, 190,201, 58, 74,89,93, 70, 100,119, 187, 203 ae()Pages(s) Pages(s) 195 210 178 rcL mt,M 97,101 99,118 169 94 153 170 151 Eric L.Smith,MD 194 110 James Slover, MD,MS Ryan W. Simovitch, MD Evan Siegall, MD 165, 220 124 Brian Shiu,MD Eric D.Shirley, MD Jonathan W. Shearin,MD 166 K. Aaron Shaw, DO 207 Ali SinaShahi,MD JosephJ.Schreiber, MD 113, 135 Stuart M.Saunders,MD 206 58,74,130 David W. Romness,MD 66,89 Lucas B.Romine,MD 59,70 95,197 Jose A. Rodriguez,MD Jonathan Robinson,MD 70,173 Matthew M.Roberts, MD Craig S.Roberts,MD,MBA 70,157,196 Aldo M.Riesgo,MD John C.Richmond,MD 219 Camilo Restrepo,MD E. Anthony Rankin,MD 137 Chitranjan S.Ranawat, MD 182,202 222 Anil S.Ranawat, MD 118 Amar S.Ranawat, MD 130 59,212 Adam J.Rana,MD 103 Lolita Ramsay, RN,PhD 176 James J.Purtill,MD David A. Porter, MD 149 Danielle Ponzio,MD 113,161 Kevin D.Plancher, MD 70,76,99 John M.Pinski,MS 111,134 Stephanie C.Petterson,MPT, PhD Michael Pensak,MD Sujal Patel, MD Javad Parvizi, MD,FRCS Andrew G.Park, MD Douglas E.Padgett, MD Presenters andModeratorsIndex 58, 95,118,196, 66, 76,92,141, 58, 62,66,70, 199, 209,215 71, 189 204 87

Scientiﬁ c Program EOA 45th Annual MeetingAmelia Island, Florida2014

Pages(s) Pages(s) Niall A. Smyth, MD 107 Michael M. Vosbikian, MD 193, 218 Spencer Stein, MD 173 102, 104, 116, Scott C. Wagner, MD Eric C. Stiefel, MD 105 117, 152, 187 Benjamin D. Streufert, BS 185 Mark Wang, MD, PhD 215 Sabrina Strickland, MD 158 Scott T. Watson, MD 166 Justin Stull, BA 127 David S. Wellman, MD 182, 196, 201 Matthew A. Tao, MD 92, 106 Samuel Wellman, MD 66, 67, 114 John S. Taras, MD 126 Geoffrey H. Westrich, MD 107, 150, 156, 192 Fotios Tjoumakaris, MD 81, 145, 146, 198 Richard M. Wilk, MD 66 Anthony T. Tokarski, BS 134, 205 Phillip N. Williams, MD 95 Natasha Trentacosta, MD 122 Christopher J. Williamson, MD 108 Corinne VanBeek, MD 212 Brian S. Winters, MD 58, 74 Gregory S. Van Blarcum, MD 188 Brent T. Wise, MD 122 Kushagra Verma, MD, MS 142, 143, 189 Daniel Woods, MD 144 98, 136, 137, 138, Jacob R. Worsham, MD 132 Jesus M. Villa, MD 159, 190, 191, 222 David S. Zelouf, MD 193 Jessica Viola, BS 110

88 - meanfollow up39months(range24-88months).There lowup 42months(range24-124 months),Microfracture had aminimumof24months follow up(OAT -meanfol- and 31patientsweretreatedwith microfracture. All patients Results: Pain andFunction,patientreportedsatisfaction rating. Ankle-Hindfoot Scale(AHS), Visual Analog Scale(VAS) for using the American OrthopedicFoot and Ankle Society treated withmicrofracture.Patient outcomesweremeasured were treatedwithOAT. All otherhigh-gradelesionswere than 5mmorany lesionrefractorytoprevious microfracture tilage lesionthatextended tobone. Any cystic lesiondeeper fracture orOAT. Highgradelesionweredeﬁ high grade,unstableOLT lesions treatedwitheithermicro- investigation was undertaken forallpatients identiﬁ Methods: (OLT). treatment ofhigh-gradeosteochondrallesionsthetalus ture andosteochondralautologoustransplantation(OAT) for Purpose: Garrison P. Wier, BS Brian Dierckman,MD Raj H.Shani,MD Sameh A. Labib,MD Prospective ComparativeAnalysis Osteochondral LesionsOf The Talus: A Autologous Transplantation For High-Grade MicrofractureOsteochondral Versus 7:05am–7:11am MarkJ. Lemos,MD Moderators: (Ritz-Carlton Ballroom Salon1) General Session1—SportsMedicine Thursday, October23,2014 Seventeen patientswithOLT were treatedwithOAT Duringaperiodfrom2000-2009,prospective To prospectively compareoutcomesofmicrofrac- Craig S.Roberts,MD,MBA

(An asterisk(*)byanauthor’s nameindicatesthepresenter.)

ned astalarcar- 2014 Scientifi Abstracts — Thursday ed with c Program Notes: fracture. dominately involving patientshaving failed previous micro- when comparedtomicrofracture,despitetheOAT grouppre- grade OLT withOAT leadstoimproved functionaloutcomes Conclusions: nifi post-operative AHS scores(88.9vs79.4,p=0.002)andsig- <0.0001). Patients intheOAT grouphadsignifi having signifi function score,lesionsizeorchronicityofsymptoms.Despite regards tosex, age,BMI,pre-operative AHS score,painand were nosignifi return toplay. the infl ined changesinon-fi player performanceuponreturn toplay. This studyexam- recently, but thereislittledataexamining theireffects on Football League(NFL)hasundergone signifi Introduction: Michael Wolf,MD Loni Tabb,PhD Andre Jakoi, MD Craig O’Neill,MD Matthew Chin,MD Neil Kumar, MD Following ReturnFrom Concussion On-Field Performance OfNFLPlayers 7:13am–7:19am cantly lower post-operative VAS scores(p=0.0423). uence ofepidemiological factors onperformance and cantly morepriorsurgeries (76.5%vs19.4%,p Ourresultsdemonstratethattreatmentofhigh- cant differences betweenthetwo groupswith ConcussionmanagementintheNational

eld performance afterconcussionand General Session1 cant change cantly higher 89

Thursday Thursday EOA 45th Annual MeetingAmelia Island, Florida2014

Methods: NFL players active during the 2008 to 2012 sea- 7:21am–7:27am sons were considered. Weekly injury reports identifi ed con- cussed players. All players played in at least 4 games prior to and after the game of injury within the season. Players EOA/OREF Resident/Fellow Travel Grant who had missed games secondary to another injury or had Award sustained a second concussion within the same season were excluded. NFL profi les described player characteristics Suture Anchor Behavior In The Setting Of and games missed. Pro Football Focus (PFF) performance Rotator Cuff Footprint Decortication scores determined player ratings. Two-sided t-tests and both univariate and multivariate logistic regression models Adam E. Hyatt, MD were used. Kyle Lavery, MD Christopher Mino, BS Results: 131 concussions in 124 players qualifi ed for this Aman Dhawan, MD study. 55% of players missed no games. Pre-injury performance was similar to post-injury performance in players Background: Suture anchor fi xation continues to play an without games missed and in players who missed at least important role in rotator cuff repair. Mechanical failure at the 1 game. Age, BMI, experience, and previous concussion bone–anchor interface can result in suture anchor loosening, did not correlate with changes in post-injury performance migration, and pullout. Tears of the rotator cuff are highly scores. Older, more experienced players and players with prevalent in older patients, a population that has pervasive late-season concussions were more likely to return to osteopenia and osteoporosis. Poor bone quality in this popula- play without missing games. Odds of missing no games tion may increase the likelihood of pull out, and as such fi xa- increased by 20% for each additional career year and by tion may depend even more heavily on an intact cortex. Some 35% for each additional game played within the season authors advocate removing cortical bone to obtain bleeding to before injury. optimize healing potential. To our knowledge there have been no previous studies that identify the consequence, if any, of Discussion/Conclusion: No difference in player performance violating the cortical shelf when preparing the humerus for following concussion was found whether return to play was suture anchor repair. immediate or delayed. Return without missing games may be infl uenced by player age, experience, and timing of injury Methods: Demographic information and bone mineral den- within a season. NFL players exposed to repeated, high- sity was obtained for twenty fresh frozen human humeri. impact contact football are able to achieve pre-injury levels of After appropriate preparation, suture anchors were placed in a on-fi eld performance following concussion once determined predetermined location in a decorticated and non-decorticated safe for return to play. setting. Two decorticated and one control had to be eliminated due to fracture and implantation compromise. Decortication Notes: depth was analyzed using digital image analysis. Anchors were tested under physiologic cycling followed by a load to failure. The number of cycles, failure mode, stiffness and fi nal pullout strength was recorded. A Welsh t test was used to compare the biomechanical properties of the decorticated and non-decorticated groups. Further statistical analysis was used to identify any correlations between age, sex, and bone mineral density.

Results: The mean of ﬁ nal pullout load of the non-decorticated was 244.03570 ± 89.05671 (n=20), while the mean of the decorticated humeri was 62.83496 ± 38.04056 (n=18), This resulted in an ultimate failure load statistically signiﬁ - cantly higher in the decorticated group. Overall, positive correlations were found between gender and load to failure.

90 base ofthecoracoidpenetrating pectoralisminor. Distances and pectoralisminorasecond directedtoward themedial lateral tipofthecoracoid,superfi needle was insertedalong thepathofEastportalto were utilizedasdescribedbyBoileau. A 20-gauge spinal (standard posteriorandthreeanterior:Central, West, East) were mountedinamodifi Methods: arthroscopic-Latarjet-type procedures. a safe-zoneforportalplacementmedialtothecoracoid ered approachduringEastportalplacementandtoestablish to assesstheproximityofneurovascular structuresinalay- aging vitalstructures(e.g.brachialplexus). The purposewas when makingportalsmedialtothecoracoidforfearofdam- ated medialtothelevel ofthecoracoid. There isgreatconcern dure istherequiredtrans-pectoralismajor(East)portalcre- Introduction: Kevin D.Plancher, MD Stephanie C.Petterson,MPT, PhD Albert S.Dunn,DO Anatomic Study Safety Of The Trans-Pec (East)Portal: An Notes: when preparingtherotatorcuff footprint. cortex andaccordingtoourresultscaution should betaken provides agreaterunderstandingoftheeffect ofviolatingthe arthroscopic rotatorcuff repaircontinuestoevolve. This study optimal healingenvironment forsutureanchorfi Discussion: sidered duringrepair. play aroleinbone-anchorbiomechanicsandshouldbecon- repair. Inadditiontootherpatientrelatedfactors, gendermay strength ofthesutureanchor, whichmayleadtofailure ofthe the rotatorcuff footprintsignifi Conclusion: 7:29am–7:35am Five, freshfrozencadaveric torsos(10shoulders) Ourunderstandingofthebiomechanicsand Inthishumancadaver model,decortication of Uniquetotheall-arthroscopicLatarjetproce-

ed beachchairposition.Four portals cantly decreasesthepullout cial totheconjoinedtendon xation in ate ligament(ACL) reconstruction. The goalofthisstudy an Accessory medial portal(AMP)duringanteriorcruci- open andarthroscopicsurgical casesespeciallywithuse of located inaregion thatmakes itsusceptibletoinjuryduring The infrapatellarbranchofthesaphenousnerve (IBSN)is Stephanie C.Petterson,MPT, PhD Kevin D.Plancher, MD DO Jeffrey Alwine, Complications Reconstruction: Safe Zone To Avoid MedialPortalAccessory ForACL Notes: without compromisetoany vitalneurovascular structures. to thetipofcoracoidallows forasuccessfulprocedure Identifi major portalissafeforthearthroscopic-Latarjetprocedure. Discussion and (all p-values>0.09). signifi culocutaneous nerve 42.22±9.20mmfromtheneedle.No 25.49±8.07mm, axillaryartery34.13±6.05mmandthemus- lary nerve was 24.87±7.39mm,lateralcord ofbrachialplexus 9.36±2.60mm fromtheneedle.Indeepplane,axil- vein was 4.63±1.91mmandthelateralpectoralnerve was lateral pectoralnerve. Inthesuperfi medial tothecoracoid,aminimumdistance10mm portal originwas identifi Results: a paired-samplest-test. ations wereanalyzed,assessingside-to-sidedifferences using digital-calipers insuperfi to surroundingneurovascular structureswereperformedwith Resident/Fellow Travel GrantAward 7:37am–7:43am cant differences werefoundbetweenrightandleftarms cation ofasafezoneforEastportalplacementmedial Nostructuresweredamaged. A safezoneforEast

Conclusion: ed 45-50mmdistaland30-35mm cial anddeepplanes. Anatomic vari- The medialtrans-pectoralis cial plane,thecephalic General Session1

Thursday Thursday EOA 45th Annual MeetingAmelia Island, Florida2014

was to identify a safe zone for the use of an AMP in ACL Thursday, October 23, 2014 reconstruction and to avoid complications associated with the IBSN. We hypothesized with increased knee fl exion Rapid Fire Session 2A — Sports Medicine (Station A, angle, there will be less risk to the IBSN when creating an Plaza Ballroom 1) AMP. 18 cadaveric, fresh-frozen, match paired knees were used for dissection to identify all branches of the IBSN. The Moderator: Anil S. Ranawat, MD 30° arthroscope was used to make 3 medial portals; Central medial (CMP), Intermediate medial portal (IMP) and AMP were marked with 18 gauge spinal needles at three fl ex- 9:45am–9:49am ion angles (60°, 90°, 110°). Safe zones were meticulously defi ned by reference points made by the IMP, AMP and Pediatric Shoulder Dislocation Resulting In medial border of the patellar tendon. It was noted if a branch Rotator Cuff Tear And Osteonecrosis of the IBSN pierced these zones or if a needle pierced the nerve and if any commonly Two branches, superior and infe- Matthew A. Tao, MD rior, of the IBSN were found in all specimens as previously Grant E. Garrigues, MD described. The AMP at 60° was the closest portal to the Alison P. Toth, MD IBSN (5.63 mm ±5.00). The AMP was signifi cantly further from the superior IBSN 110° compared to 60° (p=0.012). Introduction: Case presentation of a 16 year-old male who The superior IBSN was pierced most frequently at the AMP sustained a traumatic rotator cuff tear after posterior shoulder at 60° (60% of specimens) and not pierced at 90° and 110°. dislocation of his dominant arm, which remained unreduced Theamount the zones were pierced was signifi cant between for 2 days. Following open reduction and rotator cuff repair, 60° and 110° (p=0.002). Therefore a safe zone at 110° of he presented to our institution 1 year later with a recurrent fl exion can be described proximal to 11.34 mm distal to massive tear and osteonecrosis of the humeral head. He had the inferior pole of the patella and 25.23 mm medial to the signifi cant pain, a documented axillary neuropathy and poor patellar tendon. The IBSN is at the greatest risk for injury overall function. when creating an AMP at 60° of knee fl exion and fl exion to Methods: Following diagnostic arthroscopy, core decompres- 110° greatly improves the safety of the AMP during ACL sion was performed under fl uoroscopic guidance. Autologous reconstruction. We caution use of an AMP at lower fl exion iliac crest bone graft was used to fi ll the void, and a cortico- angles because of the risk of nerve injury. cancellous plug of iliac crest allograft was placed into the cor- Notes: tical defect. Rotator cuff revision was then performed with a porcine extracellular matrix scaffold. Although a preoperative aspirate was negative, 2 intraoperative cultures were positive for coagulase negative staphylococcus. Infectious Disease was consulted, and the patient received 6 weeks of IV Nafcillin. He subsequently had overgrowth of the bone plug causing mechanical symptoms and ultimately a small recurrent tear. He underwent bony debridement and revision rotator cuff repair 8 months from our initial surgery.

Results: He will be 2 years out at the time of presentation and has done incredibly well. He had an extended course of physical therapy and has continued to work independently on motion and strengthening. He is completely pain-free. Axil- lary neuropathy has resolved, and his strength in all planes has improved dramatically.

Discussion and Conclusion: This represents a unique and challenging case that initially devastated an otherwise healthy teenager. It brings to light the dangers of prolonged dislocation as well as an innovative surgical solution. It also high-

92 Rapid Fire Session 2A lights the broader utility of such xenografts as this is underap- preoperatively averaged 7 ± 2 for both cohorts and postop- preciated as a viable option for massive rotator cuff tears. eratively averaged 3 ± 3 (p=0.80). Linkert Scale for function preoperatively averaged 5 ± 2 for both cohorts and postop- *The FDA has not cleared this drug and/or medical device for eratively averaged 8 ± 2 for both cohorts (p=0.94). 31/44 the use described in the presentation. (Refer to page 57). (70.5%) of patients in the antegrade cohort were satisﬁ ed with their surgery compared to 14/18 (77.8%) of patients in the ret- Notes: rograde cohort (p=0.56) Average follow-up for the antegrade cohort was 39.0 months (12-118 months). Average follow-up for the retrograde cohort was 43.6 months (6-105 months). Failure of treatment was deﬁ ned as a patient undergoing subsequent surgery including osteochondral autograft transplantation (OAT) procedure or repeat marrow stimulation. 1/18 (5.5%) patients in the retrograde cohort underwent subsequent OATs and 10/45 (22.2%) in the antegrade underwent subsequent surgery. Of the 11 lesions that failed marrow stimula-

9:51am–9:55am tion procedure, 2 were larger than 150mm2. Thursday Conclusions: No signiﬁ cant difference in outcome was seen Antegrade Versus Retrograde Bone Marrow in patients treated with antegrade marrow stimulation when Stimulation Techniques As A First Line compared to retrograde marrow stimulation, however retro- Treatment Of Symptomatic Osteochondral grade marrow stimulation had less failures and required sig- Lesions Of The Talus (OLT) niﬁ cantly less redo surgery

Sameh A. Labib, MD Notes: Michael D. Smith, MD Garrison P. Wier, BS

Background: Treatment of osteochondral lesions of the talus (OLT) remains controversial. The purpose of this study was to prospectively compare outcomes of marrow stimulation using microfracture techniques and retrograde drilling for treatment of symptomatic osteochondral lesions of the talus.

Methods: During a ten-year period, a prospective investiga- 9:57am–10:01am tion was undertaken for all patients identiﬁ ed with Talus OLT treated with either antegrade marrow stimulation /microfrac- Surgical Treatment Of Symptomatic SLAP ture or retrograde drilling. Patient outcomes were measured Tears In The Middle-Aged Patient with use of the American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale (AHS), Linkert Scale for Pain and John A. Erickson, MD Function, and overall satisfaction rating. Kyle Lavery, MD James T. Monica, MD Results: From 2000 to 2010, 63 patients with OLT met the Aman Dhawan, MD inclusion criteria. 45 patients underwent antegrade marrow Charles Gatt, MD stimulation/ Microfracture and 18 retrograde drilling. Dura- tion of symptoms averaged 37 months. Preoperative AHS Introduction: Successful arthroscopic repair of symptomatic averaged 61 ± 12 (17-87) in the antegrade cohort and 64 ± superior labral tears in young athletes has been well docu- (40-84) in the retrograde cohort. Postoperative AHS averaged mented by a number of authors. As arthroscopic shoulder pro- 79 ± 17 (14-100) in the antegrade cohort and 85 ± (57-100) cedures become increasingly more common, the practice of in the retrograde cohort. There was no signiﬁ cant difference SLAP repair in older patients has become controversial, with in the change in between the preoperative and postoperative concerns for residual postoperative pain, stiffness, and higher AHS between the two cohorts p=0.69. Linkert Scale for pain rates of revision surgery.

93 EOA 45th Annual MeetingAmelia Island, Florida2014

Methods: The MEDLINE database was systematically tex may compromise the initial biomechanical characteristics searched using key terms to ﬁ nd articles related to SLAP of anchor stability, which may in turn compromise initial tears. Nineteen studies were considered relevant, meeting repair integrity. We sought to test the hypothesis that placing the following criteria: the study contained a minimum of one the suture anchors through a transubscapularis (TS) portal group of patients who had undergone arthroscopic repair of a versus a low anterior inferior rotator interval portal (AI), Type II or IV SLAP lesion with minimum two year follow-up, will lead to a decreased rate of suture anchor perforation and the paper was an original article and not a review itself, objec- increased biomechanical stability of the anchors in a cadav- tive and/or functional scoring systems were used to evaluate eric shoulder model. post-operative outcomes, and there was a mean patient age of 40 years of at least one treatment arm of the paper or one Methods: 20 fresh-frozen bilateral human shoulder cadav- subgroup analysis. eric specimens (10 matched pairs) were randomized to either an AI or TS portal for placement of suture anchors at the 3 Results: Review of the available literature revealed mixed o’clock and 5:30 position. After soft tissue dissection that results. While many authors report equivalent outcomes of following outcome measures were recoded: 1) distance from SLAP repair in patients over forty with those under forty, oth- the portal to the cephalic, 2) the presence and length of suture ers demonstrate signiﬁ cantly higher failure rates in the older anchor penetration through the inferior glenoid rim 3) the ulti- cohort. When concomitant rotator cuff tears are present, the mate failure strength of the suture anchors. evidence favors debridement or biceps tenotomy over SLAP repair. Results: The mean portal to cephalic vein distance in AI versus TS group was 29.9 mm versus 11.2 mm respectively Conclusion: Analysis of the literature reveals mixed evidence (p< 0.05). The rate of suture anchor perforation at the 5:30 concerning the treatment of symptomatic SLAP tears in the position through the AI was 60 percent versus 10 percent active, middle-aged population. While many authors suggest through the TS group (p <0.05). Mean suture anchor perfora- excellent results can be obtained with SLAP repair in this tion at the 5:30 position through the AI was 4.4 mm versus cohort, several show age as a risk factor for surgical failure. 0.6 mm through the TS group (p <0.05). At the 3:00 position The majority of available evidence supports labral debride- mean suture anchor perforation was 0 mm versus 0.6mm in ment or biceps tenotomy over SLAP repair when concomitant the AI and TS groups respectively (p=0.36). The mean pullout rotator cuff pathology is present. strength at the 5:30 suture anchor in the AI group was 112.6 N versus 132.8 N in the TS group (p= 0.18). The mean pullout Notes: strength at the 3:00 suture anchor in the AI group was 124.9 N versus 124.1 N in the SI group (p= 0.85).

Discussion and Conclusion: Although the cephalic vein is closer when utilizing the TS portal, it is still a safe distance away from it. There was a lower rate of anchor perforation in the TS portal group for the most inferior anchor (5:30 position), but not at the 3 o’ clock position. We did not ﬁ nd a signiﬁ cant difference in the biomechanical rigidity of suture 10:03am–10:07am anchors between the two groups. The TS portal allows for improved positioning of the inferior-most anchor. Analysis Of Anchor Placement For Bankart Repair: Trans-Subscapularis Versus Inferior Notes: Rotator Interval Portal

Ehsan Jazini, MD *Brian Shiu, MD R. Frank Henn III Seyed A. Hasan

Introduction: Failure of an arthroscopic Bankart repair is multifactorial. Suture anchor penetration through the far cor-

94 and inthoseathleteswhoare unwilling orunabletoundergo who have acutedamageto anisolatedpartoftheligament, injections maybeparticularly benefi published ontheconservative treatmentoftheseinjuries.PRP this reportprovided muchbetterresultsthanthosepreviously Conclusions: weeks). There werenocomplicationsrelatedtotheinjections. age timetoreturncompetitionwas 12weeks(range:5-24 return tothrowing post-injectionwas 5weeks,andtheaver- 15 wereclassifi partial thicknesstears;7haddistally-basedand after theinjection. Twenty-two patientshadproximally-based (67%) professionalplayersreturnedtoplayprofessionally (34%); 17good;2fair; and10pooroutcomes.Four ofthesix 11 monthsafterinjection.Fifteenhadanexcellent outcome All patientswereavailable forfollow-up atanaverage of Results: the Conway Scale. and resultswereclassifi atic. Finalfollow-up was conductedbyphysical examination on aninterval throwing programwhenthey wereasymptom- two hadthreeinjections.Post-injection,patientswerestarted patients hadoneinjection;sixtwo injections;andtwenty- exam andconfi collateral ligament tears. All tearswerediagnosedbyphysical with plateletrichplasmainjectionsforpartialthicknessulnar ers (6professional,14college, and24highschool)treated Methods: tears inhigh-level throwing athletes. of plateletrichplasmainjectionsforpartialulnarcollateral Purpose: Christopher S. Ahmad, MD James P. Bradley, MD David M.Dines,MD Daryl Osbahr, MD Todd S. Tomczyk, ATC Stan Conte,PT, DPT, ATC Neal ElAttrache,MD Joshua S.Dines,MD Phillip N. Williams, MD Insuffi Treat Elbow UlnarCollateralLigament Platelet-Rich PlasmaCanSuccessfully 10:09am–10:13am ciency InHigh-Level Throwers The average agewas 17.3years(range:16-28). This was aretrospective review of44baseballplay- The purposeofthisstudywas toevaluate theeffect The useofPRPtotreatUCLinsuffi rmed bymagneticresonanceimaging.Sixteen ed asligamentsprains. The average timeto ed accordingtoamodifi cial inyoungathletes ed version of ciency in was compared betweenthetwo groups. same year. Rateofcomplicationand survival oftheprosthesis gender, andsurgeon withpatientswhounderwent TKA inthe excluded. These patients werematchedina1:2ratioforage, study andthosewithfollow upoflessthan6monthswere ware insitubefore TKA. These patientswereincludedinthe reviewed toidentifythosepatientswhohadany typeofhard- patients whohadundergone TKA from2007to2012were Methods: going TKA. knee prosthesisinpatientswithprevious kneesurgery under- study aimstoevaluate short-termcomplicationandsurvival of mation aboutoutcomeof TKA inthesepatients. The present with historyofkneesurgery orinjury. There islackofinfor- total kneearthroplasty(TKA)isinevitable insomepatients Introduction: Javad Parvizi, MD,FRCS Mohammad R.Rasouli,MD William V. Arnold, MD,PhD Raj G.Patel, BS Jeffery Oliver, BS Jonathan Beri,BS Camilo Restrepo,MD Short-Term? Hardware InSitu: How These Patients DoIn Total KneeArthroplasty InPatients With Notes: tion oftheligament. the extended rehabilitationrequiredaftersurgical reconstruc- 9:45am–9:49am AmarS.Ranawat,MD Moderator: Ballroom 1) Rapid Fire Session2B— Total Knee Thursday, October23,2014 Preoperative andpostoperative radiographsof Post-traumatickneeosteoarthritisnecessitating Rapid Fire Session2B (Station B,Plaza 95

Thursday EOA 45th Annual MeetingAmelia Island, Florida2014

Results: A total of 55 cases with hardware in situ and 110 by a single surgeon from September 2012 through October cases without hardware who underwent TKA were included. 2013. In this cohort, patients who received TXA were com- The incidence of complications was higher, albeit not statisti- pared to patients who did not receive TXA. Patients that cally signifi cantly, in the post-traumatic group compared to did not receive TXA (n=100) had a TKA using a tourniquet control. The incidence of arthrofi brosis was 7.8% in the hard- infl ated to 250 mm Hg prior to incision and defl ated prior to ware group versus 1.8% in the controls, manipulation under closure. In addition, these patients had a drain. Patients in the anesthesia for stiffness (9.1% versus 7.3%), surgical site TXA group (n=69), underwent a TKA without a tourniquet infection/periprosthetic joint infection (10.9% versus 4.5%), and no drain was used. Patients treated with TXA received 3g revision for any reason (4.6% versus 3.6%), presence of pain of TXA diluted in 45cc of NaCl applied topically to exposed around the knee (4.6% versus 3.6%), mechanical complica- tissue surfaces and was left in contact with the surfaces for tion of the implant (5.5% versus none), wound complications 5 minutes prior to irrigation and closure. Patients with a past (1.8% versus 0.9%). Survival analysis failed to show any sig- history of bleeding disorder, thromboembolic disorders, nifi cant difference between two groups in term of survival free allergy to TXA, cardiac stents, renal or liver diseases were not of revision and complications. given TXA. \ Transfusions were administered based on institutional guidelines including Hgb < 7, Hgb < 10 with cardiac Discussion and Conclusion: It appears that presence of history or symptomatic acute blood loss anemia. hardware around the knee and the underlying diagnosis of post-traumatic arthritis predisposes these patients to higher Results: The mean calculated blood loss in was 580ml (SD: incidence of all time complications following TKA. We ± 500; Range 30 to 2770ml) in the control group and 340ml believe the small sample size may have been responsible for ( SD: ± 238; Range 11 to 1951ml) in the TXA group. Seven- the difference in these complications not reaching statistical teen patients (17%) in the control group and 2 patients (2.9%) signifi cance. in the TXA group received transfusions post-operatively. 2 patients in each group were diagnosed with a pulmonary Notes: embolus requiring treatment.

Conclusions: We found TXA to signiﬁ cantly decrease postoperative blood loss and transfusion rate. Our study is under- powered to detect a statistically signiﬁ cant difference in complication rates. However, we found no difference in the rate of symptomatic DVT/PE.

*The FDA has not cleared this drug and/or medical device for the use described in the presentation. (Refer to page 57).

9:50am–9:54am Notes:

Pragmatic Approach To Decreasing Blood Loss In Total Knee Arthroplasty

David J. Mayman, MD *Kaitlin M. Carroll, BS Joseph Maratt, MD Seth A. Jerabek, MD

Introduction: Tranexamic acid (TXA) has demonstrated ben- eﬁ t in general surgery with reduction in post-operative blood loss. However, there is limited literature supporting the use of TXA in orthopaedics.

Methods: We retrospectively reviewed 169 patients that underwent a unilateral primary total knee arthroplasty (TKA)

96 Notes: their increasedrisk. arthroplasty. Patients inthis scenariomustbecounseledof of asub-clinicalinfectiondoesappeartocomplicatenew tors likely playaroleinthisincreasedrisk,thepersistence risk ofinfectioninanew prostheticjoint. While patientfac- Conclusion: and 68dayspost-arthroplasty). 2/31) wereinfectedwiththesamepathogeninbothjoints (24 (range: 24-1,093)after TJA. Two ofthesepatients(6.4%; went ontodevelop PJIinthenew jointatameanof400days of PJIinadistantjoint.Four ofthesepatients(12.9%;4/31) mean of1,110days(range:113-4,770)aftermanagement Results: tionship betweentheinfectingorganisms was analyzed. sequent PJIinthenew jointwas thendeterminedandthe rela- primary TJA aftermanagementofPJI. The incidenceofsub- arthroplasty databasetoidentifythosepatientsthatunderwent 2012. This was thencross-referencedwiththe institutional tify patientsthatweretreatedforPJIfrom April 2000toJuly Methods: joint. Therefore, thisstudyattemptstoidentify this risk. to thecommunityisriskofsubsequentPJIindistant ing totaljointarthroplasty(TJA) inadistantjoint.Unknown of PJI,patientsoftenpresentwithend-stagearthritisdeserv- infection inthatjoint.However, aftereffective management known thatpatientstreatedforPJIhave ahigh-riskofrepeat complication withhighmorbidityandmortality. Itiswell- Introduction: Gregory K.Deirmengian,MD Nitin Goyal, MD Hany S.Bedair, MD Camilo Restrepo,MD Anthony T. Tokarski,BS Benjamin Zmistowski, MD Jorge Manrique,MD Arthroplasty Predicts Infection AfterNew Primary Previous Periprosthetic JointInfection 9:55am–9:59am Thirty-one patientsunderwentprimary TJA ata The institutionalPJIdatabasewas utilizedtoiden- A historyofPJIinadistantjointincreasesthe Periprostheticjointinfection(PJI)isadreaded Notes: classiﬁ and malalignment,suggesting instabilityisamultifactoral the MRgroupwas alsoaccompaniedbycomponent failures design oftheimplant. The higher incidenceofinstabilityin state ofthepatient,allwhicharenotattributed tothe poorly vascularized tissue,and/oracompromisedmetabolic for infectioncouldbeattributed toimproperwound healing, and instabilityremainthetopreasonsforrevision. Revisions increase. Studieshave shown thatasepticfailure, infection, dures increasesevery year, theincidenceforrevision willalso Discussion andConclusion: patient reportedoutcomes. in patientdemographics,initialdiagnosis,comorbidities,or mediolateral (ML)stabilityat90°. There werenodifferences ing >10mmof AP stabilityat0°,30°,and90°aswellwith bility, withalarger numberofpatientsintheMRgrouphav- Further differences were notedinanterior-posterior (AP)sta- and theMRgroupwas revised forglobalinstability(31.7%). of patients,theSRgroupwas revised forinfection(23.7%) for revision was tibialcomponentfailure. Within thesubset Results: and analyzed. outcomes andprevious implantinformationwerecollected gle-radius (SR)andmulti-radius(MR).Patient demographics, groups basedonprevious implantmanufacturer design;sin- from thetotalpopulationwerefurtherextrapolated intotwo study wereevaluated preoperatively. A subsetof79cases patients enrolledinaprospective, post-market, multicenter Methods: implant designphilosophies. was toreview reasonsforrevision evaluated againstdifferent ening, andpolyethylene failure. The objective ofthisstudy mary reasonsforrevision beinginfection,instability, loos- plasty (TKA)continuestoincreaseeachyear, withthepri- Introduction: Kristin Robinson,MS Fabio R.Orozco,MD Kirby Hitt,MD *Eric L.Smith,MD Danielle Campbell,MS And Multi-Radius Total KneeDesigns Reasons ForRevision OfSingleRadius 10:00am–10:04am cation forrevision. Inthetotalstudypopulation,primaryreason Onehundredandseventy-seven revision TKA The incidenceofrevision total kneearthro- As thenumberof TKA proce- Rapid Fire Session2B 97

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10:05am–10:09am 10:10am–10:14am

Postoperative Fever After Total Joint Technological Advances: The Learning Arthroplasty: Use Of A Simple Medical Curve Effect Workup To Avoid Delayed Discharge David A. Iacobelli, MD Patrick W. Kane, MD *Jesus M. Villa, MD Zachary D. Post, MD Carlos J. Lavernia, MD Fabio R. Orozco, MD Mark D. Rossi, PhD, PT Alvin C. Ong, MD Introduction: We describe the “learning curve” of a novice Introduction: Postoperative fevers are a common occurrence surgeon in terms of the time required to perform total knee following total joint arthroplasty (TJA). With more emphasis replacements (TKRs) in models using the electromagnetic on accelerated recovery and shorter length of stay (LOS), (EM) navigation system and the conventional jig-based postoperative fever has implication for discharge planning and mechanical method. cost. The aims of our study were to determine which patients were at risk of developing postop fever and to investigate the Methods: Forty-eight TKR simulations were performed (24 usefuleness of a simple, relatively inexpensive, fever workup. using each method) on bone models. The mean time to perform the surgery in the EM group was signifi cantly longer Methods: Under IRB approval we retrospectively reviewed (p less than 0.001) compared to the time of the mechanical all TJA patients between June 2010 and June 2011. 745 group. A fi fth year orthopedic resident performed all simu- patients were identifi ed. Of these, 137 patients were 55 or lated procedures. A graphical model (time vs. trial number) of younger (Group A), 353 were 56-69 (Group B), and 258 the learning curve was prepared. For the statistical analyses were 70 or older (Group C). There were 455 females and 290 t-test, ANOVA and coeffi cient of variation were used. males. The surgical technique, anesthesia, and postoperative management of all patients was identical. Fever workup was Results: We observed three distinct trends within the resultant performed in all patients with temperature >100.4. Workup curve of the EM group (p=0.006). The initial eleven trials included surgical site examination, chest x-ray, urinalysis, showed a decelerating trend due to decreasing surgical times blood culture, and venous duplex. Patients were allowed on various successive trials (slope=-0.0016); the middle ones discharge if the workup was negative. Incidence, fi ndings on had an almost fl at curve due to similar times (slope=-0.0001); workup, and LOS were analyzed. the remaining seven had a variable curve (slope=-0.0004). On average, signifi cantly more time was spent performing the ini- Results: 251 patients developed a postoperative fever tial eleven trials than performing the middle or the fi nal ones for an incidence of 34%. Group B had a signifi cantly (p=0.008 and 0.046, respectively). higher incidence of postop fever (p=0.01652). Account- ing for all patients, males were more likely to develop fever Discussion and Conclusion: To a novice surgeon, it takes (p=0.02591). There was no association between postop fever up to 11 trials to “learn” the EM system and to perform it and complications. There was no correlation between fever consistently in less time. Novice surgeons should thoroughly and fi ndings on the medical workup. LOS was not increased familiarize with new techniques and practice with models or by the occurrence of fever in any group. cadavers before performing operations on patients.

Discussion and Conclusion: We found an increased inci- Notes: dence of postoperative fever in the middle age range for joint patients and in males. Postoperative fever was not associated with infection or any other postoperative complication. The use of our simple workup likely prevented increased length of stay secondary to postoperative fever after TJA.

Notes:

98 Notes: tion found. vided thebaselinerateisabove thresholdlevels forthereduc- saving will come fromareductionintransfusionrates,pro- make tranexamic acidvery likely tobecostsaving. The cost Conclusions: will notbecostsaving, unlessitreducestherevision rate. the routineuseoftranexamic acidtoreduce bloodtransfusion saving. Ifthe baselinetransfusionrateislessthan25%,then fusion orrevision rates,themorelikely itsuseistobecost Results: data atourinstitution. acid treatmentandbloodtransfusionwas taken fromcharge cost was alsoassessedwiththemodel. The costoftranexamic cedures. The impactofany secondaryeffect onrevisions on transfusion ratesonthecostofhipandkneearthroplastypro- ate theimpactofany effect oftranexamic aciduseonblood Methods: add signifi ated withanumberofpotentiallynegative outcomesandcan common occurrenceaftertotalkneearthroplastybut isassoci- ing fortheseprocedures.Bloodtransfusionisarelatively are paramountinordertopreserve accessandadequatefund- efforts toreducethecostsassociatedwiththeseprocedures projected togrow rapidlyover thenext 25years. As aresult, Introduction: Joseph A. BoscoIII,MD James Slover, MD,MS Arthroplasty Surgery Complications InHipAndKnee Acid To Prevent MajorBleeding Cost-Analysis Of The UseOf Tranexamic 9:45am–9:49am Javad Parvizi, MD,FRCS Moderator: Ritz-Carlton Ballroom Foyer) Rapid Fire Session2C— Total Hip Thursday, October24,2014 The larger theimpactoftranexamic acidontrans- cant costtotheoverall episodeofcare. We constructedaMarkov decisionmodeltoevalu- Even amodestreductioninrevision rateswill Arthroplasty proceduresarecommon,and (Station C, Notes: risk forpostoperative dislocation. tions from6to4weeksaftersurgery doesnotincreasethe Conclusions: of theeightpatients(38%)hadatraumaticdislocation. two dislocations(25%)tookplaceinthefi locate was 7.5weeksaftersurgery (range1.0to16.9weeks), was 58.8years.(range35-83years). The average timetodis- up rateis98,7%. The average ageatthetimeofdislocation patients (10hips)losttofollow-up, consequentlythefollow fi Results: with 797hipsinthestudy. tissue repairand28-36mmheads. We included698patients a standard THA usingaposteriorapproachwith posteriorsoft performed bytheseniorauthor(n=815hips). All patientshad primary THA betweenSeptember2008andDecember 2012 a consecutive single-surgeon seriesofpatientsundergoing tion protocolonthedislocationrateweretrospectively studied Methods: tion andfacilitate healingoftheposteriorsofttissuerepair. mended for6weekspostoperatively toreduceearlydisloca- hip arthroplasty(THA).Hipprecautionsarecurrentlyrecom- reported in0.5%to15%ofpatientsafterposterolateraltotal Background: Pablo Benavente, MD,PhD Wenzel Waldstein,MD Erol Akalin Tom Schmidt-Braekling,MD Friedrich Boettner, MD,PC Brett Frykberg, MD Do We Need6 Weeks OfHipPrecautions? MIS Posteriolateral Total HipArthroplasty: rst 12monthswith4weeksofhipprecautions(1.00%). Ten 9:51am–9:55am There wereeightdislocationsin797hipsthe To determinetheeffect ofreduced4weekprecau- Reducingstandardposterolateralhipprecau- Postoperative hipdislocationshave been Rapid Fire Session2C rst 4weeks.three 99

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9:57am–10:01am 10:03am–10:07am

The Reliability of Modern Alumina Bearings Sexual Activity In Patients Undergoing in Total Hip Arthroplasty Primary Total Hip Arthroplasty

Gwo-Chin Lee, MD Carlos J. Lavernia, MD Jesus M. Villa, MD Introduction: Ceramic components clinical fractures in total David A. Iacobelli, MD hip arthroplasty (THA) are rare but nonetheless serious complication. As a result of continued improvements in ceramic Introduction: Diffi culty having sex is not usually used as a material quality, manufacturing methods, and implant design prime indication for THA. In addition, traditional hip scoring made over the last 30 years the incidence of such failures has systems ignore that facet of life. Our purpose was to study the drastically. In this report we will examine the frequency of prevalence of sexual limitations in patients who underwent these ceramic component clinical failures in THA. In order primary THA and the patient’s rate of response to the topic. to get a complete picture we contacted the largest supplier of these components, and they agreed to share their most recent Methods: A pre-intervention survey including the question data. on sexual activity was conducted before surgery on 358 consecutive patients undergoing THA due to primary/secondary Materials: In the year 2000, the largest supplier of alumina osteoarthrosis. Mean age was 66 years (58% females). Patient ceramic bearings for orthopaedic applications, began a rigor- characteristics evaluated included age, gender, race, ethnic- ous program of collecting clinical fracture data for all of its ity, educational level, marital status, and religion. Pearson ceramic components. The clinical fracture data for the period Chi-Square and Fisher’s Exact Tests were used for statistical of January 2000 to June 2013 are reported here, with a review analyses. of the material properties, historical component fracture trends, and relative risk of fracture associated with alumina Results: 294 patients (82%) answered. Among them, 234 THA bearings. (80%) were sexually active including 197 (84%) who reported sexual limitations. 28% of patients aged more than 70 years Results: The data reported is divided into two separate avoided to answer while only 7% of those aged less than 50 groups. The fi rst one is the incidence of clinical fracture of years did. Compared to males, a higher proportion of females forte material. This is the original material developed in the did not answer the question (8% vs. 25%, respectively). 25% 1970’s and optimized over the years. The overall clinical of Hispanics did not answer while only 7% of non-Hispanics fracture rate of these alumina components is 0.021 percent, did. Patients who only completed elementary education did or 21 in 100,000 during the January 2000 to June 2013 time not answer as frequently (47%) as those patients with high period. The second group is composed of components manu- school (19%), college (9%), or graduate education (12%). factured from their Alumina Matrix Composite, delta. The Compared to patients who widowed (43%), a lower pro- overall clinical fracture rate for these components is 0.0001% portion of single, married, and divorced/separated patients or 1 in 100,000. Almost 80% of these alumina bearing fail- avoided the question (18%, 11%, and 16%, respectively). ures occurred within 36 months following surgery. Increasing femoral head diameter was associated with a substantially Discussion and Conclusion: A large percent of the patients reduced risk of fracture. undergoing THA are sexually active. Hip osteoarthritis signifi cantly limits sexual activity. Surgeons should incorporate Discussion: Alumina bearings used in modern THA implants questions on the topic and counsel patients prior to surgery. A are safe and reliable, with a very low risk of failure. Improve- large percent of patients over 70 years old were not responsive ments in the materials, developments in the manufacturing, to our inquiry. In addition females, Hispanics, and those with the introduction of the Alumina Matrix Composite and the lower education were less likely to respond. trend to utilize larger diameter ball heads are likely to drastically reduce the concerns that have been in the mind of sur- Notes: geons using ceramics in THA.

Notes:

100 2013 identifi academic medicalcenterbetweenJanuary2010and a singlefellowship trainedtotaljointsurgeon atatertiary Methods: rior approach THA. tion duringdirectanteriorapproach THA comparedtoposte- evaluate theneedforsupplementalacetabular cupscrew fi improving patientoutcomes. The purposeofthisstudyisto dedicated tothisarea,withafocusonidentifyingmethodsfor during totalhiparthroplasty(THA).Considerableresearchis most effective surgical techniquesortheimplantstobeused Introduction: David Trofa,MD Daniel Reid,MD,MPH Mark Cleary, MD,MPH Nicholas D.Colacchio,MD Eric L.Smith,MD Acetabular Screws Than Posterior THA Direct Anterior THA RequiresFewer Notes: which THA approach maybebestforanindividual patient. groups. Surgeons should considerthesefactors whendeciding demographic orsurgical differences identifi approach was used. Aside fromBMI,therewerenosignifi approach was signifi acetabular screws neededin THA performedbydirectanterior Discussion andConclusion: version, EBL,orbloodtransfusionsbetweenthetwo cohorts. ences inage,gender, operative time,cupabduction,ante- (26.2 kg/m2vs.30.6kg/m2). There werenosignifi mean BMIthanpatientswhounderwentaposteriorapproach who underwentananteriorapproachhadasignifi less thanthatfortheposteriorgroup(1.0vs.1.9).Patients fi same THA implantsystem. The average supplementalscrew approach primary THA’s performed. All patientsreceived the Results: cup anteversion, andcupabduction. acetabular screws used,offset (high,standard,orcoxavara), loss (EBL),bloodtransfusion,implantdesign,numberof tive side,surgical approach,operative time,estimatedblood lowing variables wereanalyzed:age,BMI, ASA score,opera- xation requiredfortheanteriorapproachwas signifi 10:09am–10:13am There were31anteriorapproachand105posterior A retrospective review ofall THA’s performedby ed 136primary THA’s (124patients). The fol- There isnouniversal consensusconcerningthe cantly lessthanwhenaposteriorsurgical The numberofsupplemental ed betweenthe cantly lower cant differ- cantly xa- cant no signifi sus 7.2±2.4degrees, respectively, plessthan0.05). There was construct infl in the2-level SASconstructcompared tothe2-level hybrid 0.05). There was asignifi degrees versus 11.6±4.6degrees, respectively; plessthan fl Results: analyzed withpairedt-testsandBonferronicorrection. spacer/plate. Rangeofmotion(ROM) datawas obtainedand A) C5-6spacer/platewithC6-7SAS,B)C5-7C) specimen underwentsequentialinstrumentationandtesting: and lateralbending(LB)loading. After intactanalysis,each simulator underaxialrotation(AR),fl were non-destructively testedwithasix-degree-of-freedom Methods: been established. biomechanical stabilityinmulti-level constructshasnotyet ity toanteriorplateconstructsinsingle-level fusions,their successful clinicaloutcomesandsimilarbiomechanicalstabil- have beendeveloped. While thesespacershave demonstrated Several “low profi gia, increasedoperative times,andwidersurgical exposures. tomy andfusionhave beenlinked topost-operative dyspha- Introduction: Rachel E.Gaume,BS LT ScottC. Wagner, MD CPT JohnP. Cody, MD LCDR Robert W. Tracey, MD CPT Adam J.Bevevino, MD LTC Ronald A. LehmanJr., MD *Peter Formby, MD Daniel G.Kang,MD FusionConstructs Hybrid Cervical Stand-Alone SpacerInMulti-Level And Biomechanical StabilityOf The Stalif-C exion-extension ROM comparedtothe2-level SAS(5.6±3.4 9:45am–9:49am Bradford L.Currier, MD Moderator: Ballroom Foyer) Rapid Fire Session2D—Spine Thursday, October23,2014 The 2-level plateconstructsignifi cant difference inlateral bendingandaxialrotation Twelve humancadaveric cervicalspines(C2-T2) exion-extension aswell(11.6±4.6degrees ver- Anterior plateconstructsforcervicaldiscec- le” integrated stand-alonespacers(SAS) cantly increasedsegmental ROM (Station D,Ritz-Carlton Rapid Fire Session2D exion-extension (FE) cantly reduced 101

Thursday ThursdayThursday EOA 45th Annual MeetingAmelia Island, Florida2014

(p greater than 0.05) between the three different 2-level con- Material properties reported in the literature were initially structs. incorporated and were later calibrated with the experimental results to provide agreement between the model and experi- Conclusion: Our study found that hybrid and 2-level SAS mental responses. In addition to the level-specifi c comparison constructs are comparable to conventional anterior plate con- of range of motion and intradiscal pressure values with those structs in lateral bending and axial rotation, but there was an of previous studies at a given moment, this study evaluated increase in fl exion-extension motion allowed with constructs the non-linear response of the model over the entire experi- that incorporated a SAS. Stand-alone cervical spacers with mental curve. integrated screws for hybrid and 2-level SAS constructs are reasonable alternatives to two level plate fi xation; however, Results: The moment-rotation curves obtained at each incre- clinical trials are necessary to determine if the increased ROM ment paralleled published and in-house experimental curves, in fl exion-extension noted in the SAS constructs translates to proving this fi nite element model’s ability to reproduce non- clinical outcome. linear spine behavior.

Notes: Conclusion: The non-linear 3D FEM presented in this study incorporates the most accurate geometry and material properties to mimic normal spine behavior. The method of calibra- tion provides a means to improve the model performance and establish conﬁ dence in the FE prediction accuracy. This technique can be used as a basis for various future FEM studies. This validated FEM is an invaluable tool in computational spine research for predicting potential clinical scenarios, and will continue to be utilized for research simulation purposes. 9:51am–9:55am Notes: Finite Element Modeling Accurately Predicts Biomechanics Of Human Lumbosacral Spine

LT Scott C. Wagner, MD Divya V. Ambati, MS Edward K. Wright Jr., PhD LTC Ronald A. Lehman Jr., MD 9:57am–10:01am Daniel G. Kang, MD Gregory S. Van Blarcum, MD Anton E. Dmitriev, PhD An 8 Year Trend Analysis Of The Off-Label Use Of BMP In Pediatric Deformity Spine Introduction: Practical limitations of cadaveric and animal Surgery spine studies such as specimen variability, time, and cost require developing a fi nite-element model (FEM). This study Paul D. Kiely, MCh, FRCS (Tr & Orth) developed and validated an FEM of a complete lumbosacral Matthew E. Cunningham, MD, PhD spine (L1-sacrum) to predict spinal responses in various biomechanical investigations. Introduction: The literature regarding the use of BMP in pediatric spine surgery is sparse. Recent studies have reported Methods: Experimentally-determined kinematic responses signifi cant increases in the use of BMP in children during of the lumbar spine served as the validation tools. Constraints spinal fusion surgery, and determined that BMP use had and bending moments replicating the experimental protocols increased to > 9.0%. This retrospective case series evalu- were applied to the model to recreate fl exion, extension, lat- ated the proportional trends over time of bone morphogenic eral bending, and axial rotation; with range of motion and protein (BMP) use in pediatric spine arthrodesis at a single intradiscal pressure values obtained at each loading step. institution.

102 Notes: the usedescribedinpresentation. (Refer topage 57). *The FDA hasnotcleared thisdrugand/ormedicaldevice for institution. surgery isneitherroutinenorthe“standardofcare”inour demonstrates thatoff-label useofBMPinpediatricspine Conclusion: eration. wound infectionsandaradiculitis,allofwhichrequiredreop- fully. Three (17.6%)childrendeveloped complications-2 months). All 17childrenwhoreceived BMPfused success- mean follow upperiod was 31months(range:25months-90 during arevision procedure(average: 11.3mg)(p=0.23). The age: 8.7mg),whiletheremaining7children,hadBMPused children hadBMPgiven duringtheirprimaryprocedure(aver- 6 girls. The meanagewas 15years(range11-18years). Ten their fusionsurgery, themaletofemaleratiowas 11boys to 3.17% in2013.Ofthe17childrenwhoreceived BMPduring in 2009,1.31%2010,4.38%2011,1.12%2012,and fusion casesin2006,0.81%2007,0.00%2008,0.72% children. BMPwas usedin1.27%of totalpediatricspine (2/105) ofSSchildrenand34.6%(9/26)Spondylolysis 757) of AIS children,2.9%(5/172)ofNMS1.9% in eachcase.Ofthe1082cases,BMPwas usedin0.1%(1/ cases, andrecombinantBMP-2was thetypeofBMPused had otherdiagnoses.BMPwas usedin17ofthe1082(1.6%) syndromic scoliosis(SS),2.4%hadspondylolysisand2.1% (AIS), 15.9%hadneuromuscularscoliosis(NMS),9.6% (70%) ofthe1082childrenhadadolescentidiopathicscoliosis spine fusionduringthe8yearstudyperiod.Seventy percent Results: were retrospectively reviewed forreportsofBMPuse. of spinalfusionsurgery betweenJuly2006and2013 ofﬁ Materials andMethods: ce notesof1082childrenwhowere Onethousandandeightytwo childrenunderwent Incontrasttorecentpublications,thisstudy The electronicmedicalrecords and ≤ 18yearsatthetime result oftheriseMRSAin thecommunity, since the ear- could beattributable totheantibioticsused; or, itcouldbea antibiotic-loaded bonegraft. The riseofMRSAinfections However, increased occurrenceofMRSAwas seenwith was effective prophylaxisforinfectioninscoliosissurgery. Discussion andConclusion: Non-ABX wereMRSA. cohort wereMRSA;however, noneofS.aureusinfectionsin in the ABX group.38%oftheS.aureusinfectionsin ABX (ABX) vs.46%(Non-ABX)].MRSAinfectionsweregreater itive: 58%(ABX)vs.54%(Non-ABX);gram negative: 42% infections was similarbetweentheinfectedgroups[gram pos- Non-ABX). The proportionofgrampositive andnegative and cerebralpalsy(25%inControl-ABXvs.27%Control- in AIS (57%inControl-ABXvs.54%Control-Non-ABX) cohort (2.8%vs.4.8%).Patient demographicsweresimilar cases. The infectionratewas signiﬁ Results: t-tests. chi-squared statistic,Fisher’s exact, andsinglesample graft group(Control-Non-ABX). Analysis completedusing ABX) andnon-infectedcaseswithoutantibioticsinbone non-infected casesintheantibiotic-loadedgroup(Control- intra-operative IVantibiotics. Controlcohortsincluded of placingantibioticsinbonegraft. All patientsreceived in bonegraft(Non-ABX).In2006,weinitiatedaprotocol compared to620casesfrom1998-2004withoutantibiotics from 2006-2010withantibioticsinbonegraft(ABX)were Methods: loaded group. were antibioticresistantpathogensseenintheantibiotic- without antibiotic-loadedallograftanddeterminedifthere We reviewed culturedpathogensfromSSIcases withand expense ofcreatingantibioticresistanceinthecommunity? gery; however, aredecreasedinfectionratesobtained atthe surgical siteinfections(SSIs) inpediatricscoliosissur- Introduction: Freeman Miller, MD Suken A. Shah,MD Sina Pourtaheri,MD Sujal Patel, MD Lead Scoliosis Surgery To Superbugs? Does Antibiotic-LoadedBoneGraftUsedIn 10:03am–10:07am 24 ABX caseswerecomparedto30Non-ABX 851consecutive pediatric scoliosissurgeries Antibiotic-loaded bonegrafthasdecreased Antibiotic-loaded bonegraft cantly lessinthe ABX Rapid Fire Session2D 103

Thursday ThursdayThursday EOA 45th Annual MeetingAmelia Island, Florida2014

lier cases predate our protocol for placing antibiotics in the between RI and control screws (943±344N v 803±422N; bone graft. p=0.09), as well as a signifi cant IT decrease between RI and control screws (6.38±4.61 in-lb v 9.56±3.84 in-lb; p=0.04). Notes: Test group screws in both the thoracic and lumbar spine had signifi cant, strong correlations between initial screw IT and POS (r=0.79, p=0.00; r=0.93, p=0.00). There was a moderate correlation between re-insertion IT and POS in the thoracic spine (r=0.56, p=0.00), but no signifi cant correlation for the lumbar spine (r=0.218; p=0.57).

Conclusion: Despite a signifi cant reduction in pedicle screw Insertional Torque with screw re-insertion, there was no signifi cant difference in pedicle screw pullout strength, which 10:09am–10:13am is most clinically signifi cant for immediate stability. There- fore, when the surgeon must remove a pedicle screw for tract Pedicle Screw Re-Insertion Using Previous inspection, re-insertion along the same trajectory may be Pilot Hole And Trajectory Does Not Reduce performed without signifi cantly compromising screw fi xation Fixation Strength strength.

Daniel G. Kang, MD Notes: * LT Scott C. Wagner, MD LTC Ronald A. Lehman Jr., MD CPT Adam J. Bevevino, MD Rachel E. Gaume, BS

Introduction: When assessing for a pedicle wall violation, often no violation is found and the same screw is re-inserted along the original trajectory. Previous studies have reported signifi cantly decreased insertional torque (IT) during this Thursday, October 23, 2014 reinsertion, but fi xation strength has never been evaluated bio- mechanically. Rapid Fire Session 2E — Health Policy (Station E, Ritz-Carlton Ballroom Foyer) Methods: 31 thoracic and 9 lumbar human cadaveric verte- Moderator: Richard C. Mather III, MD brae were evaluated. Each level was instrumented with 5.5mm (thoracic) and 6.5mm (lumbar) titanium multi-axial pedicle screws. A paired comparison was performed for each level, randomized between control and screw reinsertion test group. 9:45am–9:49am Screw IT was measured and peak IT reported in inch-pounds (in-lb). Screws were tensile loaded to failure “in line” with the The Role Of Marketing And Public screw axis and pullout strength (POS) measured in Newtons Relations (N). Daniel Goldberg, NA Results: No signifi cant difference was detected for thoracic pedicle screw POS between re-inserted (RI) and control The lecture or seminar I had in mind was less clinical than screws (732±307 N v 742±320 N; p=0.78). We found no sig- most of the presentations and more focused on how the physi- nifi cant difference in IT between the initial test screw (INI) cians can attract more patients to their practices, the role of (7.28±3.51 in-lb) and control (7.69±4.45 in-lb) (p=0.33). public relations in their practice and best practices for busi- However, IT for RI screws (5.14±4.18 in-lb) was signifi cantly ness development. I have spoken on this topic several times decreased compared to INI (29%, p=0.00) and control screws in the past including the Becker’s Orthopedic and Spine (33%, p=0.00). There were similar fi ndings for lumbar pedicle Conference is 2012, 2013 and again in 2014, as well as the screws, with no signifi cant difference for pedicle screw POS ISASS annual meeting in 2013. I have also been published in

104 hypertension anddiabetes. prevalence ofobesityassociated cadiometabolicriskfactors, prevalence ofoverweight andobesity, and (3)toidentifythe tify patientfactors associatedwithanincreased ordecreased obesity amongapopulationofhighschoolathletes,(2)iden- purpose ofthisstudywas (1)toidentifytheprevalence of underserved patientsatriskforthesechronicdiseases. The ter asanentrypointintothehealthcaresystemforpatients role ofacommunityhealthadvocate byusingthisencoun- exposure oraccesstomedicalcare,andfurtherserve ina obesity associateddiseasewhommayotherwisehave limited with anopportunitytoidentifypatientsatriskforobesityand physical examination (PPE)provides orthopaedicphysicians implications inthenearfuture. The preparticipationsports cant healthconcernwithpotentiallywidespreadpublic tension. These alarmingtrendsshouldbeviewed asasignifi lence obesityassociateddiseases,suchasdiabetesandhyper- United States.Furtherevidence supportsanincreasingpreva- matic increaseintheprevalence ofchildhoodobesityinthe Introduction: William Replogle,PhD Eric C.Stiefel,MD 10-17 And DiabetesInStudentAthletesAge The Prevalence OfObesity, Hypertension Notes: engage potentialpatientsandtrackROI. right patients. This lecturewould illustratehow toeffectively than ever aboutdecliningreimbursements andattractingthe tation ofthe Affordable Care Act, physiciansaremorewary the changinginsuranceenvironment andloomingimplemen- several medicalpublicationsinregard tothesetopics. With 9:52am–9:56am Over thepast30years there hasbeenadra- - Notes: sport enrolment. diversifying anathlete’s sportsparticipationthroughmulti- health advocate andthepotentialgeneralhealthbenefi highlights theroleoforthopaedicsurgeon asacommunity curriculum aimedatobesityprevention. Furtherthisstudy tion ofcertainsportsprogramsaspartphysical education prevalence ofobesityandassociateddisease,implementa- to fi alence ofdisease. These datamayencouragepolicy makers sports” andmulti-sportathletesdemonstratedthelowest prev- marks fornon-athletepopulations.Participation in“running populations. Ourdataiscomparabletoestablishedbench- diseases appeartobesignifi Discussion: sports demonstratedlower prevalence ofobesityandHTN. cross country, soccerandindividuals participatinginmultiple as footballandbaseball.Participants insportsofbasketball, minority populations,andparticipantsinspecifi A higherprevalence ofObesityandHTNwas seenamong qualifi 12.2% werepre-hypertensive and 21.4%ofpatientsBP 66.5% ofindividuals hadnormalBPon initialscreening, overweight andobesitywas 19.9%and23.4%respectively. Results: reference data)andpmHofdiabetes. blood pressure(usingageandsex normative anthropometric were reviewed toevaluate theprevalence ofobesity, elevated presenting forsportspreparticipationphysical examination between August 2009and August 2013fromstudentathletes Methods: nancially supportathleticprogramsbasedontheirlower ed ashypertensive, anthropometricnormative values. Among thepopulationstudied,prevalence of 21,013Physical examination formsobtained The prevalence ofobesityandassociated cant even amonginstudentathlete Rapid Fire Session2E c sportssuch ts of 105

ThursdayPoster Thursday EOA 45th Annual MeetingAmelia Island, Florida2014

charges are now relevant, billing practices must be reexam- 10:00am–10:04am ined with an emphasis on standard economic principles and quality of care. What Drives Inpatient Charges For Total Joint Arthroplasty? Notes:

Benjamin Zmistowski, MD *Eric M. Padegimas, MD Kushagra Verma, MD, MS Julie L. Shaner, MD Michael J. Howley, PA-C, PhD James J. Purtill, MD

Introduction: Price variability for total joint arthroplasty (TJA) has received substantial attention in the lay press recently, coinciding with the release of individual provider charges and reimbursement. Concurrently, new programs are 10:07am–10:11am incentivizing patients to select low-cost, high-quality providers. This study aims to quantify provider charge variation and identify the variables associated with increased charges. Transforming Resident Education — A New Horizon for Orthopaedic Skills Training Methods: The dataset of Inpatient Charge Data for Fis- cal Year 2011 provided by the Centers for Medicare and Matthew A. Tao, MD Medicaid Services (CMS) was the source of 2,750 provider Erika L. Templeton, MD charges, reimbursement, location, and volume for discharges Benjamin A. Alman, MD for providers with at least 10 claims for uncomplicated TJA. William T. Hardaker Jr., MD Providers were grouped into related regional areas using the Dartmouth Atlas. We constructed a multivariate regression Introduction: The training in orthopaedic surgery is steeped model of regional charge variability using variables from the in history, pride and tradition; however, recent changes in Dartmouth Atlas, the United States Census, the CMS, and the the healthcare landscape have called the nature of this train- WWAMI Rural Health Research Center. ing into question. Residency programs nationwide have adapted, but the core structure remains relatively intact. A Results: 427,207 TJA were accounted for in this dataset with recent change in ACGME and ABOS guidelines regulated weighted average charges of $50,105 ($5,304-$223,373). an increase to 6 months of orthopaedic education during the When including all variables, the regression model accounted PGY-1 year. Our institution has been particularly enthusiastic for 44.5% of the variation in charges between providers. about the new framework and what can be done to advance Quality measures alone accounted for 2.3% of variation. The surgical skills earlier in residency. addition of demand and supply measures to quality provided a model that accounted for only 7% of variation. Patient char- Methods: We overhauled the ﬁ rst year to include an experi- acteristics (driven by unemployment) and competitive factors ence predicated on active engagement and repetitive, hands- (driven by neighboring provider charges and regional total on training. Based on literature suggesting the superiority Medicare reimbursements) were the largest contributors to of longitudinal training, we added a 3-month skills course charge variation, accounting for 13.2% and 17.6% of varia- overlaid onto rotations in pediatrics and community orthopae- tion, respectively. dics. Through individualized teaching by PGY-3 residents and faculty, repetition and regular feedback, the goal was to have Discussion and Conclusion: Signiﬁ cant variation exists interns master basic skills early so they can focus on higher between different providers for inpatient charges associ- level tasks in the future. ated with TJA. A comprehensive model accounting for many healthcare and economic factors was only able to account Results: Although still in its infancy, this course has been for 44.5% of this variation. Furthermore, increased charges well received thus far. Residents have embraced the role of were not associated with increased quality of care. As hospital educator and have directed the curriculum. Interns have sub-

106 goes following harvesting andimplantationtrauma,as well the techniqueishistological degradation thegraftunder- osteochondral lesions(OCL). However, known concerns of is asurgical treatment strategy thathasbeenusedtotreat Purpose: John G.Kennedy, MD,FRCS(Orth) Ethan J.Fraser, MD Christopher D.Murawski, BS Charles P. Hannon,BS Amgad M. Haleem,MD Keir A. Ross,BS Niall A. Smyth,MD Rabbit Model Osteochondral Transplantation: AnIn Vivo And Hyaluronic AcidOnAutologous The Effect OfPlateletRich Plasma Notes: all thoseintraining. ately, ourhopeistoacceleratethetechnical learningcurve for wide. Byjumpstartingbasicskillsearlierandmoredeliber- curriculum tobeimplementedinresidency programsnation- We arecurrentlyindiscussiontocreateastandardized skills orthopaedic training,thereremainsroomforimprovement. Discussion andConclusion: are addingpre/post-testmetricsandself-directedcomponents. mented increasedconfi jectively improved intaskperformanceandobjectively docu- 12:50pm–12:56pm Geoffrey H. Westrich, MD Moderators: (Ritz-Carlton Ballroom Salon1) General Session4—BasicScience& Total Hip Thursday, October24,2014 Autologous osteochondral transplantation(AOT) Scott D. Boden,MD dence. This isstillinevolution aswe Despitethehighqualityof Notes: on itsown, orasanadditiontoPRP. not signifi ICRS histologicalscoreinan invivo animalmodel.HAdid dral graftatthecartilageinterface and improved themodifi Conclusion: procedure, orPRPandHAadministration. 0.328). Noadverse events occurredasaresultofthesurgical gration scoresbetweenthePRPand+HAgroups(p= there was nostatisticallysignifi controls (PRP, p=0.004;PRP+HA, p=0.011),however HA treatedgroupswas signifi integration specifi and thePRP+HAtreatedgrafts(p=0.445). Assessing graft ference betweenthemeanmodifi + 3.3;p=0.006). There was nostatisticallysignifi signifi ICRS histologicalscoreforthePRP+HAtreatedgroupwas (15.9 +2.9versus 14.5+3.6;p=0.142). The meanmodifi no statisticallysignifi fi (18.2 +2.7versus 13.5+3.3;p=0.002). The meanmodi- PRP treatedgroupwas signifi Results: using the Wilcoxon signed-ranktest. were notnormallydistributed, thevariables wereevaluated tilage RepairSociety(ICRS)scoringsystem. As theresults chemistry andassessedusingthemodifi and eosin,alcianblue,typeIIcollagenimmunohisto- osteochondral graftsectionswerestainedusinghematoxylin euthanized atthree,six,ortwelve weekspostoperatively. The with eachrabbitservingasitsown control. The rabbitswere 12; PRP+HAgroup,n=12)orsalinesolution(control) the biologicaladjunct(PRPgroup,n=12;HA and afterrandomization,thekneesweretreatedwitheither contralateral femoralcondyleandfollowing wound closure were substitutedwithosteochondralgraftsharvested fromthe condyles of36New Zealand White rabbits. These defects eter, 5mmindepth)werecreatedonthelateralfemoral Methods: results of AOT inarabbitmodel. HA individually, aswellcombined,onthehistological The purposeofthisstudywas toassesstheeffect ofPRPand improve theresultsofcartilagerepairtreatmentstrategies. acid (HA)have beendescribedhashaving thepotentialto adjuncts, includingplatelet-richplasma(PRP)andhyaluronic as itspoorincorporationatthecartilageinterface. Biological ed ICRShistologicalscorefortheHAtreatedgroupshowed cantly higherthanitscontrol(17.9+2.6versus 14.0 The meanmodifi cantly affect thehistological resultsof AOT either Bilateralosteochondraldefects(2.7mmindiam- PRPimproved theintegration of theosteochon- cally, themeanscoreofPRPand+ cant difference comparedtoitscontrol ed ICRShistologicalscoreforthe cantly higherthanitscontrol cantly higherthanthatoftheir cant difference intheinte- ed ICRSscoresofthePRP ed InternationalCar- General Session4 cant dif- ed ed 107

Thursday EOA 45th Annual MeetingAmelia Island, Florida2014

evaluate whether the probability of bone fracture is higher in 12:58pm–1:04pm patients taking these drugs together.

Resident/Fellow Award Notes:

Statins Adversely Affect Long Bones Of Corticosteroid Treated Rabbits

Christopher J. Williamson, MD Ross Budacki, MD Joseph Ehrenreich John A. Handal, MD Solomon P. Samuel, D. Eng

Introduction: Corticosteroids and statins are popular drugs taken by millions of Americans for various disease conditions. Many of these patients take both these drugs at the same time. There are limited literature reports on the 1:06pm–1:12pm adverse musculoskeletal drug interactions when these two drugs are taken together. This study evaluated the effect of two different statins (lovastatin and simvastatin) on the Resident/Fellow Travel Grant Award biomechanical properties of corticosteroid treated rabbit long bones. Decreased T2 Relaxation In Articular Cartilage Following Modelled Therapeutic Methods: 35 New Zealand White rabbits were used. The ani- Irradiation At Long-Term Follow-Up mals were assigned to four groups. Ten rabbits were used as controls; the other 25 rabbits received a once weekly 2-3 mg/ Ian Hutchinson, MD kg intramuscular corticosteroid injection of methylpredniso- John Olson, MS lone acetate injectable suspension. 16 of these 25 rabbits also L. Andrew Koman, MD received a daily oral dose of Lovastatin or simvastatin. At the Thomas L. Smith, PhD end of 10 weeks, their long bones were harvested and tested Kenneth T. Wheeler, PhD in a 3-point bending mode. From the load-deformation curve Michael T. Munley, PhD and anatomic measurements of the bone, failure strength and Jeffrey Willey, PhD modulus were calculated. Introduction: Premature joint failure and decreased mobility Results: When compared to simvastatin, the corticosteroid are major sources of morbidity among childhood cancer sur- treated rabbits did not seem to tolerate lovastatin well. Four vivors; the relative risk of premature joint replacement is 54 rabbits in the lovastatin plus corticosteroid group died before compared to unaffected siblings. Recent in vitro and ex vivo the 10-week study period were complete. The results also studies have demonstrated biomechanical and compositional showed that both statins lowered the overall biomechani- degradation of articular cartilage matrix after irradiation. Our cal properties of corticosteroid treated rabbit long bones. goal was to develop a translational platform to characterize When compared to corticosteroid only group, the femur late radiation effects in the knee joint articular cartilage in a ﬂ exural strength of rabbits in statin plus corticosteroid group rat model using total body irradiation (TBI) doses applicable decreased as much as 18% and the strength of tibia decreased to childhood cancer treatment. as much as 35%. Methods: Fourteen week old male Fisher 344 X Brown Discussion: Clinical studies always blame corticosteroids as a Norway rats (n = 3/group) were exposed to a single 1, 3, or main reason for bone fractures. However, the current results as 7 Gy total body dose of 18 MV X-rays plus a small compo- well as our previous data on atorvastatin calcium shows that nent of particulate radiation using a clinical linear accelera- a combination of corticosteroid and statin actually accelerates tor (LINAC). One year after TBI (35 human years), the right corticosteroid induced bone loss. Future clinical studies need hindlimb from each rat underwent multi-modality scanning

108 (TKA). Despitethisresearch, muchremainstobediscovered (PJI) inMedicarepatientsundergoing totalkneearthroplasty the patient-relatedriskfactors forperiprostheticjointinfection Introduction: Jonathon A. Godin,MD,MBA R. Andrew Henderson,MD,MSc *Michael P. Bolognesi,MD Taylor R.McClellan,BS Following TKA In Young Patients Risk Factors ForPeriprosthetic Infection Notes: logic processinthearticularcartilage. lowing irradiationmayresultfromaradiation-specifi Collectively, thesefi strated ingrowth plate cartilagewithincreasedcalcifi times; decreased T2 relaxationtimeswerepreviously demon- Degenerative jointdiseaseleadstoincreased T2 relaxation effects ofradiationtherapy onjointhealthwas created. Discussion: in theirradiatedrats. Histological analysisrevealed increasedcartilagedegradation the trabecularboneofproximaltibiaein7Gygroup. diated knees.MicroCTrevealed architecturaldegradation of articular cartilagewereonlyseeninofirra- in allgroups;discreteintra-substancecalcifi osteophytes extending fromthesubchondralbonewereseen was signifi Results: performed with ANOVA. pulse sequenceusinga7Tscanner. Statisticalanalysiswas maps weregeneratedusingamulti-slice/multi-echo(MSME) (µMRI, µCT&nanoCT)andhistologicalassessment. T2 1:14pm–1:20pm T2 relaxationfromtheweight-bearing tibialcartilage cantly lower thanunirradiatedcontrol.OnnanoCT, A novel investigational paradigmtostudylate Recentlarge database studieshave described ndings suggestthatjointdegeneration fol- ed lesionsinthe c patho- cation. Notes: not clear. risk ofperiprostheticinfection. The etiologyforthistrendis than females,andyoungerpatientsseemedtobeatahigher population. Maleshadahigherriskofinfectionafter TKA congruent withthoseobserved instudiesoftheMedicare increased riskforPJIinthisyoungerpopulationseemtobe Discussion and over timeinthispopulation. and lymphoma. The rateofinfectiondidnotappeartochange ratio) renaldisease,dementia,metastasis,CHF, drugabuse, increased riskforPJI,including(inorderofdecreasingodds Ratio =1.38).Of35studiedcomorbidities,23demonstrated had anincreasedriskforinfectionrelative to females(Odds from 2.15%intheSouthto1.74%Midwest.Males (1.84%) inthe60-64yearoldgroup.Ratesvaried byregion occurring inthe35-39yearoldagegroupandlowest between ratesofPJIbyage,withthehighestrate(3.54%) months to1.95%at5years. There was asignifi Results: codesamong thispopulation. common medicalcomorbiditiesutilizingCPTandICD-9 States. The databasewas searchedfordocumentationof35 PJI was stratifi diagnosis ofperiprostheticjointinfection. The incidenceof 2011. 1,635(2.0%)ofthesepatientswentontoacquirea years ofage–thatunderwentprimary TKA between2007- insured patients–thevast majorityofwhomwereunder65 used togather patientdemographicdataon83,617privately Methods: for PJIafter TKA inyoungerand/orprivately insuredpatients. regarding theepidemiology, demographics,andriskfactors The prevalence ofPJIranged from0.89%at3 The PearlDiver patientrecordsdatabasewas ed byage,gender, andregion oftheUnited

Conclusion: The factors thatdemonstrate General Session4 cant difference 109

Thursday EOA 45th Annual MeetingAmelia Island, Florida2014

techniques to achieve satisfactory implant stability with no 1:22pm–1:28pm compromise to clinical outcome.

Intraoperative Proximal Femoral Fracture In Notes: Primary Cementless Total Hip Arthroplasty

Ali Sina Shahi, MD Danielle Y. Ponzio, MD James J. Purtill, MD

Introduction: Intraoperative proximal femoral calcar fracture is a complication of primary cementless THA with reported rates of 1.5-27.8%.

Methods: A retrospective review of 2423 consecutive primary cementless THA cases of a single surgeon over 13 years identifi ed 95 hips with a proximal femoral fracture in the medial calcar noted upon insertion of the stem and managed with cerclage cables above the lesser trochanter. Multivariate analysis compared fracture rates between two implants utilized, Manu- facturer A and Manufacturer B, and evaluated potential risk 1:30am–1:36pm factors for fracture using a randomized control group of 718 primary cementless THA cases without fracture matched to the fracture cohort by date of surgery (DOS). A group of 160 Resident/Fellow Travel Grant Award patients was matched to the fracture cohort by gender, age, BMI, DOS, and preoperative scores to compare Harris Hip Preoperative Anemia Increases Score (HHS). Postoperative Complications And Mortality Following Total Joint Arthroplasty Results: The incidence of proximal femoral calcar fracture was 3.9% (95/2423), 3.5% (36/1019) using Manufacturer Jessica Viola, BS A/4.2% using Manufacturer B (59/1404). Both implants dem- Camilo Restrepo, MD onstrated increased fracture incidence over time. Multivariate Mitchell G. Maltenfort, PhD analysis revealed increased odds of fracture with decreasing Miguel M. Gomez, MD stem size. Fracture was more common amongst females. Javad Parvizi, MD, FRCS Females, on average, had a smaller stem size (Manufacturer A 2.4±0.9/Manufacturer B 3.7±2.1) than males (Manufacturer Background: There is some evidence that preoperative A 3.4±0.9/Manufacturer B 5.9±2.0). No difference was found anemia might increase the incidence of complications such in clinical outcomes with a mean HHS improvement of 19.6 as infection and increase the length of hospital stay. This points and postoperative score of 58.2 points in the fracture single institution, large cohort, case-controlled study exam- cohort. No femoral revisions were required in the fracture ines the possible association between preoperative anemia cohort. and adverse outcome following total joint arthroplasty (TJA). Discussion: In the largest single surgeon consecutive series reported, the incidence of proximal femoral calcar fracture Methods: We retrospectively collected data from our upon impaction of a cementless wedge tapered femoral stem prospective institutional database on 13,563 patients who was relatively constant during primary THA despite different underwent primary and revision TJA between January 2000 manufacturers. However, fracture incidence increased over and June 2013. We then identifi ed those patients with preop- time and with use of smaller femoral stems. If recognized, erative anemia (defi ned as Hb < 12 g/dL in women and Hb intraoperative fracture can be reliably addressed with cerclage <13 g/dl in men). A total of 2,576 patients had anemia pre-

110 Notes: tions. mized priortosurgery inaneffort toreducethesecomplica- mortality following TJA. These patientsmayneedtobeopti- likely toexhibit higher incidenceofcomplicationsandhigher study confi Discussion/Conclusion: cally signifi patients (0.2%versus 0.08%), thedifference was notstatisti- there was anincreasedincidenceofmortalityamonganemic presented withahigherrateofcomplications. Although patients. Patients withahigherCharlsoncomorbidityscore cantly higherintheanemicpatientscomparedtonon-anemic patients. The lengthofhospital staywas foundtobesignifi rates intheanemicgroup4.5%versus 1.12%innon-anemic the non-anemiccohort. We identifi tions occurredin3.9%theanemicgroupversus 0.9%in compared to11.8%innon-anemic.Genitourinarycomplica- cular complicationsoccurredin26.5%ofanemicpatients, compared tonon-anemicpatients(OR2.11).Cardiovas- Results: mortality. cal complications,infection,lengthofhospitalizationand the effect ofpreoperative anemiaontheincidenceofmedi- normal range.Multivariate analysiswas usedtodetermine operatively, and10,987patientshadhemoglobin withinthe Anemic patientshadahigherrateofcomplications rms thatpatientswithpreoperative anemiaare cant. Ourlarge cohort,singleinstitution ed increasedinfection - p=0.048. 1.6 +/-0.1intheITgroupwithasignifi The head:cupratiowas 1.7+/-0.1 inthecontrolgroupand surgical approachperformed,theheadsizeorcupsize. found withrespecttotheCharlsonComorbidityindex, the with respecttorevision surgery, but nodifferences were of ITinfemales.Inaddition,therewas signifi Results: size, cupandbearingsurface. intraoperative variables thatincluded:surgical approach,head their medicalrecordswerereviewed fordemographicand diagnosed withiliopsoasbursitis, tendinosis,ortendinitis; groin, fromthosewithgroinpain51(1.0%)patientswere postoperative visitsandunderwentultrasoundoftheaffected from thispopulation78patients(1.6%)reportedgroinpainat were reviewed betweenJanuary2007andDecember2010, tion, 4,872consecutive casesofprimaryandrevision THA Methods: of thehipimplant. ence ofITafter THA andtheratiobetweenheadcup was todetermineifthereisarelationshipbetweenthepres- cation andiliopsoastendonitis(IT). The purposeofthisstudy mechanical failure, referredpain,fractures,heterotopicossifi Arthroplasty (THA)includingsepticorasepticloosening, Introduction: Alvin C.Ong,MD Claudio Diaz,MD Zachary D.Post,MD Fabio R.Orozco,MD Ronald Huang,MD Victor H.Hernandez,MD,MS Following Total HipArthroplasty Risk Factors OfIliopsoas Tendonitis 1:42pm–1:46pm DouglasE.Padgett, MD Moderator: (Station A, PlazaBallroom 1) Rapid Fire Session5A—Hip Thursday, October23,2014 We foundasignifi This isaretrospective studydoneinourinstitu- Many thingscancausepainafter Total Hip cant difference intheincidence Rapid Fire Session5A cant difference ofa cant difference 111 -

Thursday EOA 45th Annual MeetingAmelia Island, Florida2014

Conclusion This is the ﬁ rst study to report the head:cup ratio 36mm conventional head, and a 28mm conventional head as a potential etiology for IT and may help provide surgical were tested under two dislocation modes: (A) Posterior dis- considerations for its prevention. location with internal hip rotation; (B) posterior dislocation with combined hip ﬂ exion and adduction. Wear performance Notes: of 36mm ceramic ACH implants and 36mm conventional ceramic heads articulating against UHMWPE liners was compared with a 12-station AMTI hip simulator. Two types of acetabular liners were tested: compression molded conventional PE, and highly cross-linked VitE-PE liners. To assess the femoroacetabular contact area, a FEA was completed with a 36 mm conventional head and a 36mm ACH implant. The femoral heads were modeled as rigid and articulated against UHMWPE acetabular liner modeled as plastically deform- able. Loading cases corresponding walking, chair sit and deep-knee bend were analyzed.

Results: The dislocation analysis did not show any differences between the 36 mm ACH implant and the conventional 36 mm head. Both showed increased jump distance compared 1:47pm–1:51pm to the 28 mm conventional head. There was no difference between wear rate of the ceramic ACH implants and the con- A Next Generation Anatomically Contoured ventional ceramic heads articulating against either UHMWPE Ceramic Femoral Head liner materials (current results based on 2 million cycles). For example, average wear rate of conventional PE liners articu- Andrew A. Freiberg, MD lating against, the conventional ceramic heads and the ceramic *Kartik Mangudi Varadarajan, PhD ACH implants, was 21.4 ± 4.1 mg/MC and 20.8 ± 4.2 mg/ Michael P. Duffy, MS MC, respectively. The FEA analysis also did not show any Thomas Zumbrunn, MS difference in articular contact area for the ACH and conven- Harry E. Rubash, MD tional heads articulating against UHMWPE liners. Henrik Malchau, MD, PhD Orhun K. Muratoglu, PhD Conclusion: This study showed that, as intended, an anatomically contoured large diameter femoral head designed to pro- Introduction: Large diameter femoral heads have been vide soft-tissue relief, maintains the stability of conventional successfully used to prevent dislocation after Total Hip implant of the same size, and does not alter the wear perfor- Arthroplasty (THA). However, recent studies show that the mance, and the load bearing articular contact area. distal region of contemporary femoral heads can impinge on native soft-tissues, particularly the iliopsoas, leading to Notes: activity limiting anterior hip pain. To address this we developed an Anatomically Contoured large diameter femoral Head (ACH) that maintains the hemispherical profi le of a contemporary large diameter head above the equator, while contouring the distal profi le below the equator for soft-tissue relief. The soft tissue friendly design of the ACH implant was optimized to maintain the dislocation benefi ts, and to not alter the wear performance, and load bearing femoroacetabular contact area of conventional large heads. This was verifi ed via dislocation analysis, hip simulator wear testing, and fi nite element analysis (FEA).

Methods: Implant stability was evaluated by simulating dynamic hip dislocation in MSC Adams. A 36mm ACH, a

112 Notes: patients. regimen mayhelpimprove clinicaloutcome scoresinthese in clinicalfunction.Earlymodifi 6 weekmarkandmaybeassociatedwithatransientdecline Conclusion: persistent thighpain. 1.5 yearsand1patientunderwentstrut-graftingprocedure for group underwentrevision forfailure ofosteointegration at by the1yearpostoperative visits.Onepatient insubsidence subsidence group(Mean82.2).Patients hadsimilarscores the subsidencegroup(Mean67.6)whencomparedtono score andpainscoresweresignifi ence occurredat6weeksinallpatients.MeanHarriship age of62.1yearsandmeanfollow-up of29months.Subsid- than 1.5mm. There were6malesand3femaleswithamean Results: recommended toallpatientsinthesubsidencegroup. non-subsidence groupdiffered. Protectedweightbearingwas if theclinicalrecovery patternbetweenthesubsidenceand and Harrishipscoreswererecordedanalyzedtoidentify the subsidencegroup.Preoperative andpostoperative pain post-operative radiographswereidentifi Patients withgreaterthan 1.5mmofmigrationon6week stem designsfromJanuary2006toJune2010was performed. two cementless,proximallyporouscoated,taperedwedge THAs performedbyasinglesurgeon atoneinstitutionusing Methods: with adeclineinclinicalfunction. was toassesswhethersubsidenceofthesestemsisassociated oral stemsimpactsthepatientclinically. The aimofourstudy is limitedliteratureonhow subsidenceoftaperedwedgefem- initial fi total hiparthroplasty(THA)hasbeenassociatedwithpoor Introduction: Jose A. Rodriguez,MD Rupesh Tarwala,MD Parthiv A. Rathod,MD Suresh Patil, MD Jonathan Robinson,MD Stems IsNotClinically Benign Subsidence Of Tapered Wedge Femoral 1:52pm–1:56pm xation andsubsequentriskofasepticloosening. There 10hipsoutof264 THAs, hadsubsidencegreater A review ofaprospectively collecteddatabaseof Subsidenceoftaperedwedgestemsoccursatthe Subsidenceofcementlessfemoralstemsin cation intherehabilitation cantly lower at6weeksin ed andplacedinto Notes: replacement. health system,anddramaticallyincreasesthevalue ofjoint represents asignifi over $1.5billionannualincrementalsavings in TJA. This management notroutinelyrecommendingHVNSwould result signifi Discussion: TKA was $1,153,122,128. US ofeliminatingHVNSfor THA was $353,159,509,andfor of 300,000and TKA of700,000,costsavings acrossthe mended. With anapproximateannualprojectedrateof THA (95%CI$1586to$1708) for TKA whenHVNSarenotrecom- savings of$1177(95%CI$1129to$1225)for THA and$1647 Results: were analyzedwithstandardcomparative statistics. and analyzedbyMonteCarlosimulation.Modeloutcomes model was developed basedonderived probabilitiesandcosts for associatedHVNScosts. A uniquestochasticdecisiontree TJA patients6monthspriortoandafterthispolicy change HVNS. We performedaretrospective review ofconsecutive were encouragedhomedischarge withnorecommendation for tuted byasinglesurgeon atourinstitutionwhereallpatients Methods: aim todescribetheeconomicburden thatHVNSimposes. eliminated inmostcasesof TJA postoperative care–herewe stantial costburden. Inourexperience, HVNSmaybesafely visiting nursingservicesHVNSinthemselves representasub- management oftotaljointarthroplasty(TJA) patients,home Introduction: James J.Purtill,MD Danielle Y. Ponzio,MD *Andrew G.Park, MD Suneel Bhat,MD Arthroplasty Nurse Following Services Total Joint The EconomicBurden OfHome Visiting 1:57pm–2:01pm cant economicburden annuallyintheUS.Postoperative Ourmodeldemonstratedanaverage perpatientcost OnJanuary1st,2013apolicy changewas insti- HVNSutilizedinpostoperative carein TJA isa Although purportedtoprovide value inthe cant reductionineconomicburden onthe Rapid Fire Session5A 113

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hood of requiring minor re-operations in the early postopera- 2:02pm–2:06pm tive period.

Revision THA Outcomes Using Cemented, *The FDA has not cleared this drug and/or medical device for Modular Proximal Femoral Replacement the use described in the presentation. (Refer to page 57). Stems Notes: Michael B. Cross, MD Akos Zahar, MD B. Bohn, MD Kaitlin M. Carroll, BS Thorsten Gehrke, MD Daniel Kendoff, MD, PhD

Introduction: When managing periprosthetic joint infec- 2:07pm–2:11pm tions (PJI), a large resection of the proximal femur bone may be required. The outcomes and early dislocation rates of Dislocation Rate After Revision THA Using cemented, modular proximal femoral replacements used for A Dual-Mobility Cup one and two stage revision total hip arthroplasty (THA) are unknown. Taylor R. McClellan, BS *Samuel Wellman, MD Methods: Sixty-one patients at an average age of 71 years Roberto Calderon, MD (37-86 years) underwent septic hip revision between 01/2011 Michael P. Bolognesi, MD and 06/2013. Fifty-three patients underwent a one-stage septic David E. Attarian, MD revision, and 8 patients were revised using a two-stage revi- Paul F. Lachiewicz, MD sion. A cemented modular proximal femoral replacement stem was inserted in each case. In all cases antibiotic therapy Introduction: Patients undergoing a revision THA have was administered by local antibiotics inpmMA bone cement increased risk for postoperative dislocation, as high as 20% and intravenously. The duration of the intravenous antibiotic in some series. Studies have shown that the incidence of therapy was 17±8.6 days. Outcomes of the study were recur- instability can be reduced when a larger head component is rence of the infection (including early recurrences less than implanted. Dual-mobility cup systems use this principle by 6 months), early revision of the implants for any reason and combining the advantage of a large head along with a “head early postoperative dislocation rates. within a head” articulation to increase the range of motion before impingement. A modular dual mobility (MDM) device Results: There were 41 patients available for follow-up with is used at this institution in revision THA patients who are a mean follow up time of 13.5±10 months. One patient had a determined to be at increased risk for dislocation. A few stud- recurrent infection and one patient died 5 days after surgery ies have shown that dual-mobility cups probably have lower due to unknown reason, and both these patients were consid- rates of dislocation, but more studies are needed to clarify if ered as failures. All together 39 of 41 patients (95.1%) could they are clinically effective and safe. be successfully treated by the described method. However, postoperative dislocation occurred in 7/41 (17%) cases, and Methods: Four surgeons performed 82 revision total hip three of these patients required an open reduction. Further, ten replacements (79 patients) through the posterior or direct- required minor revisions, but no patient required a revision lateral approach (72 and 10 respectively) utilizing the MDM due to aseptic loosening or implants failure. cup. The reasons for initial revision as well as early complications were retrospectively reviewed. 58 hips had a minimum Conclusion: In summary, the use of modular, cemented 3-month follow up (range 3-28 months, mean 12.2 months). proximal femoral replacements for massive bone loss encountered during septic THA are acceptable with low Results: The main reason for revision to the MDM cup was early recurrence rates of infection. Based on the difﬁ culty of instability (18, 31.0%), followed by adverse metal-on-metal this patient population, patients should be counseled that this reaction (13, 22.4%), infection (11, 19.0%), and aseptic loos- procedure has high dislocation rates and carries a high likeli- ening (9, 15.5%). There were no hip dislocations in the course

114 biomechanical propertiesofthe iliacandSAIscrew inasimi- been performed. The purposeofthisstudyistocomparethe iliac andSAIscrews; however, adirect comparisonhasnot Many studies have examined thebiomechanicalproperties of has ledtothedevelopment ofthesacral-alar-iliac (SAI)screw. point tothepelvis. The associatedmorbiditywiththisfi screw fi and longspinalfusions. With thedevelopment ofpedicle correction ofpelvicobliquity, high-gradespondylolisthesis, Introduction: James Barsi,MD David E.Komatsu, PhD BSE Trasolini, Nicholas A. Karan Dua,BA Camden B.Burns,MD Fixation Biomechanical ComparisonOfSacro-Pelvic Notes: ondary topatientcomplexity andco-morbidities. directly correlatewithprevious infectionandwas likely sec- up isneeded. The rateofinfectionwas high,but didnot ever, thisdoesnotconfi those patientswithahistoryofmultipledislocations.How- resulted ina0%rateofdislocationtheshortterm,even in Discussion andConclusion: mortality. fractures, 1cupsettling(1.7%),and(1.2%)peri-operative complications included:2(3.4%)DVTs, 2(3.4%)traumatic prosthetic jointinfectionrequiringreoperation.Otherpost-op of follow upinthisseries.6hips(10.3%)developed peri- Thursday, October24,2014 1:42pm–1:46pm ScottD. Boden,MD Moderator: Ballroom 1) Rapid Fire Session5B—Spine xation, theiliacscrew hasbeenusedasananchor Spinopelvicfi rm futurestability, sofurtherfollow xation iscommonlyusedinthe The useoftheMDMcup (Station B,Plaza xation Results: under fl testing, specimensunderwentamonotonicloadtofailure right bending,extension, andfl 1°/sec toatorqueof10Nminfourdirections–leftbending, ure testingwas performedafterpreconditioningbyloadingat screws wereconnectedwith6.35mmtitaniumrods.Subfail- a startingpoint1mminferolateraltotheS1foramen. All the were instrumentedwithSAIscrews (8.5x80mm)placedwith terior superioriliacspineandtheremainingfourspecimens screws (8.5x80mm)placedwithastartingpointatthepos- and S1.Four specimenswerefurtherinstrumented withiliac multi-axial pediclescrews (6.5x40mm)bilaterallyatL5 Methods: lar spinopelvicfi decompress cervicalnerves rootswhileavoiding theneedto Introduction: Rachel E.Gaume,BS LT ScottC. Wagner, MD CPT Adam J.Bevevino, MD LTC Ronald A. LehmanJr., MD *Peter Formby, MD Daniel G.Kang,MD Setting Of Total DiscArthroplasty OfMotion In On SegmentalRange The PosteriorCervical Foraminotomy’s Effect Notes: an alternative totheiliacscrew forspino-pelvicfi parison. These resultssupporttheuseofSAI techniqueas onstrated nostatisticaldifferences inthisbiomechanicalcom- Discussion andConclusion: torque, andyielddisplacementangles. for failure torqueangleofdisplacementatfailure, yield no statisticallysignifi bending betweenSAIandiliacscrew constructs. There were torsional stiffness in extension, fl 1:49pm–1:53pm exion atarateof1°/sec. There werenostatisticallysignifi Eightcadaveric spineswereinstrumentedwith Posteriorforaminotomyoffers theabilityto xation construct. cant differences inSAIvs.iliacscrews The iliacandSAIscrew dem- exion. Following subfailure exion, leftbendingorright Rapid Fire Session5B cant differences for xation. 115

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extend a previous fusion or revise an arthroplasty to a fusion. 1:57pm–2:01pm However, the safety of a foraminotomy in the setting of total disc replacement (TDR) is unknown. With this in mind, the goal of this study was to investigate the effect on cervical Finite Element Modeling Of Stability In segmental stability resulting from posterior foraminotomy fol- Transforaminal Lumbar Interbody Fusion lowing TDR. LT Scott C. Wagner, MD Methods: Segmental non-destructive range of motion (ROM) Divya V. Ambati, MS was analyzed in nine human cadaveric cervical spine speci- Edward K. Wright Jr., PhD mens. Following intact testing, each specimen was sequen- LTC Ronald A. Lehman Jr., MD tially tested according to the following four experimental Daniel G. Kang, MD groups: Group 1=C56 TDR, Group 2=C56 TDR with uni- Gregory S. Van Blarcum, MD lateral C56 foraminotomy, Group 3=C56 TDR with bilateral Anton E. Dmitriev, PhD C56 foraminotomy, and Group 4=C56 TDR with C56 and C45 bilateral foraminotomy. Introduction: Transforaminal lumbar interbody fusion (TLIF) is popular for the surgical treatment of degenerative Results: No signifi cant difference in ROM was found lumbar disease. The optimal construct for segmental stability between the intact, TDR, and foraminotomy specimens at remains unknown. The purpose of this study was to compare C4-5 or C6-7. There was a step-wise increase in C5-6 axial the stability of fusion constructs using standard (C) and cres- rotation from the intact state (8 degrees) to Group 4 (12 cent-shaped (CC) polyetheretherketone (PEEK) TLIF cages degrees), although the difference did not reach statistical with unilateral (UPS) or bilateral (BPS) posterior instrumenta- signifi cance. At C5-6, the degree of lateral bending remained tion. Five TLIF fusion constructs were compared using fi nite relatively constant, 8 degrees in the intact state to 8.8 degrees element (FE) analysis. in Group 4, and was not statistically different in any of the tested groups. Flexion and extension at C5-6 was signifi - Methods: A previously validated L3-L5 FE model was modi- cantly higher in the foraminotomy specimens, Groups 2 (18.1 fi ed to simulate decompression and fusion at L4-5. This model degrees), 3 (18.6 degrees), and 4 (18.2 degrees), compared to was used to analyze the biomechanics of various unilateral the intact state, 11.2 degrees. However, no ROM difference and bilateral TLIF constructs. The inferior surface of the L5 was found within foraminotomy Groups (2-4) or between the vertebra remained immobilized throughout load simulation, foraminotomy groups and the TDR group (Group 1), 15.3 and a bending moment of 10 Nm was applied on the L3 ver- degrees. tebra to recreate fl exion, extension, lateral bending and axial rotation. Various biomechanical parameters were evaluated for Conclusion: Our results indicate that cervical stability is not intact and implanted models in all loading planes. signifi cantly decreased by the presence, number, or level of posterior foraminotomies in the setting of TDR. The addi- Results: All reconstructions displayed decreased motion at tion of foraminotomies to specimens with a pre-existing TDR L4-5. Bilateral posterior fi xation conferred greater stability resulted in small and insignifi cant increases in segmental when compared to unilateral fi xation in left lateral bending. ROM. Therefore, posterior foraminotomy(s) may be con- Over 50% of intact motion remained in left lateral bending sidered a safe and viable option in the setting of recurrent or with unilateral posterior fi xation compared to less than 10% adjacent level radiculopathy following cervical disc replace- when bilateral pedicle screw fi xation was used. Posterior ment. implant stresses for unilateral fi xation were six times greater in fl exion and up to four times greater in left lateral bending Notes: compared to bilateral fi xation. No effects on segmental stability or posterior implant stresses were found. An obliquely- placed, single standard cage generated the lowest cage-end- plate stress.

Discussion and Conclusion: TLIF augmentation with bilateral posterior ﬁ xation increases fusion construct stability.

116 evaluated. Inclusioncriteriaincluded traumasustainedin or IraqiFreedombetween01JUL2003 and01JUL2013were surgery designatedinasengaged inOperationsEnduringand/ military institutionswas performed;patientsundergoing spine Methods: facilities. a ten-yearperiodatthreehigh-volume militarytreatment the operative treatmentofcombat-relatedspinetraumaover after surgical intervention. Therefore, wesetouttodescribe has beenlimitedclinicalinformationandfollow-up details history; however, ashortcomingofregistry datacollection tained inIraqand Afghanistran isreportedlythehighestin Introduction: LTC Ronald A. LehmanJr., MD Daniel G.Kang,MD Gregory S. Van Blarcum,MD LT ScottC. Wagner, MD And Afghanistan Spine Trauma DuringtheConfl Operative Treatment ofCombat-Related Notes: increase theriskforconstructfailure. tion, whichmaytheoreticallyaccelerateimplantlooseningor in allloadingmodeswithunilateralpediclescrew/rod fi Increased posteriorinstrumentationstresseswereobserved to impactsegmental stabilitywithbilateralpediclescrews. The shapeornumberofinterbodyimplantsdoesnotappear 2:04pm–2:08pm Retrospective analysisofsurgical databasesatthree The rateofcombat-relatedspinalinjurysus- icts InIraq xa- Notes: trauma. up dataforpatientssustainingoperative war-related spine information, resourceutilizationandlonger-term follow evaluation isthelargest studyevaluating thedemographic rate ofassociatedspinalcordinjury. This retrospective involve multiplespinallevels perpatientandhave ahigh bat-related spinetraumainrecordedhistory. These injuries and Afghanistan have seen thehighestincidenceofcom- Discussion andConclusion: the UnitedStateswas 1.9%. patients. The mortalityrateforallpatientsafter evacuation to nal regions. Spinalcordinjurieswerepresent in29.5%ofall per patient,andtwo patientssustained injuriestoallfourspi- (33.3%) andsacral(17.1%).1.5spinalregions wereinjured involved region (59%),followed bythoracic(43.8%),cervical (IED, 42.9%). The lumbarspinewas themostcommonly nism ofinjurywas mountedimprovised explosive device Afghanistan andIraq,respectively. The mostcommonmecha- servicemembers. 49.5%and48.6%ofinjuriesoccurredin 29.8 years.74.3%ofthesecasualtieswereenlistedUS Army to theUnitedStates. The meanageofthesecasualtieswas casualties requireddefi trauma requiringoperative intervention wereidentifi Results: ment afterevacuation. direct relationtocombatoperationsrequiringoperative treat- 302patientswithcombat-related(OIF/OEF)spine nitive surgical managementafterreturn The currentconfl Rapid Fire Session5B icts inIraq ed. 105 117

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underwent MUA to improve postoperative ROM. One manip- Thursday, October 24, 2014 ulation was unsuccessful and the patient is scheduled for Rapid Fire Session 5C — Total Knee Reconstruction revision for arthroﬁ brosis. No patients in either the matched (Station C, Ritz-Carlton Ballroom Foyer) PS group or the CR RP group underwent postoperative MUA. Clinical and radiographic analysis including pre-operative Moderator: James Slover, MD, MS ROM, deformity, side, Charnley Class, posterior tibial slope angle, epicondylar axis and posterior condylar offsets provided no insight into the reason for this higher MUA rate in 1:42pm–1:46pm the PSCR knees.

Patient-Specifi c Total Knees Demonstrate a Conclusion: MUA rates in the patient-specifi c TKA group Higher Manipulation Compared to “Off-The- were signifi cantly higher than that in both “off-the-shelf” Shelf” cohorts. No correlations were found to clearly indicate the cause of the higher MUA rateamong the PSCR knees. Early Amar S. Ranawat, MD manipulation is recommended for stiffness with these custom Peter White, BA devices.

Objective: Patient-specifi c or “custom” total knee replace- Notes: ments have been designed to fi t the arthritic knee in primary total knee arthroplasty (TKA) better than “off-the-shelf” implants. Using computer technology, patient-specifi c cutting- blocks and custom-made implants are created to more accurately fi t the contour of the knee and reproduce the anatomic J-curve with the hope of providing a better functional outcome.

Purpose: This retrospective, matched-pair study evaluates manipulation under anesthesia (MUA) rates in cemented patient-speciﬁ c cruciate-retaining (PSCR) TKA compared to that in both cemented posterior-stabilized (PS) and non- cemented cruciate-retaining rotating-platform (NC CR RP) TKA.

Materials and Methods: From 2010 through November of 2012, 21 PSCR TKAs were performed in 19 patients. Using 1:47pm–1:51pm medical records from our patient database, these patients were matched for age, side, deformity, diagnosis, Charnley Class, Radiation Exposure Associated With and preoperative range of motion (ROM) with 42 PS TKA Preoperative CT For Robotic-Assisted Knee performed during the same time period by the same surgeon Arthroplasty using the same post-operative protocols. Additionally, 11 NC CR RP TKA were performed and evaluated based on the same Danielle Y. Ponzio, MD criteria. Pre- and postoperative radiographs were performed Jess H. Lonner, MD using criteria as described by The Knee Society. Introduction: The radiation dose associated with preopera- Results: Preoperatively the PSCR TKA cohort had a larger tive computed topography (CT) for robotic-assisted knee average ROM compared to the PS TKA cohort (P-value= arthroplasty has not been reported yet is critical information 0.006). Postoperatively, however, the PSCR TKA cohort over- for the patient and surgeon to understand. all was found to have a signiﬁ cantly decreased average ROM compared to both the PS and NC CR RP TKA cohorts (2.0°- Methods: Preoperative CT scans of the involved knee, ipsilat- 110.6° P-value= 0.0002 and 2.4°-117.3° P-value= 0.0003, eral hip and ankle were retrospectively reviewed for 211 adult respectively). 6 of the 21 (28.6%) PSCR TKAs performed patients (236 knees) who underwent robotic-assisted knee

118 Notes: exposure. assisted kneearthroplasty, associatedwithcostandradiation requirement ofapreoperative CTisadisadvantage ofrobotic- arthroplasty andtheuseofalternatenavigation systems,the Discussion andConclusion: from 6to103mSv. ounted toanestimatedcumulative EDperpatientranging (range 0-12)wereobtainedin53patients(25.1%),whicham- within thehospitalsystem.OneormoreadditionalCTscans mean of15.4±10.2radiographs(range12-98)perpatient mSv. All patientsunderwentmultipleradiographs,witha DLP of3077.9±1285.8mGycmandmeanED9.25.1 age interval of3.8months(range0-14months)withamean patients underwentbilateralpreoperative CTscansatanaver- cm. The meanEDwas 4.8±3.0mSv. Twenty-fi robotic-assisted kneearthroplastywas 1545±722.9mGy Results: uted toCTexaminations was calculated. patient, andanestimatedcumulative EDofradiationattrib- performed withinthehospitalsystemwererecordedforeach the cohort,totalnumberofCTscansandradiographs of radiationexposure fortheaverage arthroplastypatientin body region. To appreciatethealternatesourcesandvolume using tissueweightingconversion factors specifi dose (ED,mSv)ofradiationwas calculatedfromtheDLP knee, ankle,andthetotalDLPforstudy. The effective obtain thedose-lengthproduct(DLP, mGycm)forthehip, arthroplasty. The dosereportwas queriedforeachpatientto The meanDLPassociatedwith preoperative CTfor Comparedtoconventional knee ve (11.8%) c toeach Notes: motion oroutcomeafterprimary TKA. satisfactory resultsanddoesnotaffect postoperative rangeof between +/-3.5mmofitsinitialpatellarthicknessprovides Discussion andConclusion or morethan110°ofKPFbeforetheprocedure. not differ amongstthoseindividuals who hadlessthan110° KAF andKPFalongwithpostoperative patellarthicknessdid range, 0.07-0.09;p-value range,0.47-0.69).Postoperative 0.001-0.11; p-value range,0.22-0.41)andpostoperatively (r ness was poorlycorrelatedtoROM preoperatively (rrange, years) forallpostoperative patellarthickness.Patellar thick- assessments. Resultsweresimilaratfollow-up (mean:2.53 based onpreoperative patellarthicknessforeachoftheROM Results: for differences inthe KAFandKPF. ness withtheROM. Independentt-testswereusedtoassess the relationshipbetweenlevels ofpreoperative patellarthick- A PearsonProductmoment(r)was alsocalculatedtoassess Knee Passive Extension(KPE)wereassessedusing ANOVA. Passive Flexion (KPF),Knee Active Extension(KAE),and active ROM. Difference inKnee Active Flexion (KAF),Knee preoperatively andatminimum2year’s markforpassive and before andafterpatellarresection.Eachpatientwas assessed were studied.Patellar thickness was measuredintraoperatively Methods: TKA. operative rangeofmotionandpatientorientedoutcomesafter study theeffects of the changeinpatellarthicknessonpost- patella toothincanresultinafracture.Ourobjective was to reduction inpostoperative kneefl for theproperROM after TKA. Overstuffi plasty patellarthicknesshasbeendeemedtobeimportant Introduction: David A. Iacobelli,MD Jesus M. Villa, MD Carlos J.Lavernia, MD (TKA) (ROM) InPrimary Total KneeArthroplasty Patellar Thickness OfMotion AndRange 1:52pm–1:56pm There was nosignifi 200consecutive patientsundergoing primary TKA Maintenanceorreductionofthepre-arthro- cant difference betweengroups Maintaining apatellarresection exion orpain.Makingthe Rapid Fire Session5C ng canresultina 119

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plantation, ﬂ uid cell count differential may be an important 1:57pm–2:01pm marker.

Utility Of Synovial White Cell Count Notes: And Neutrophil Differential During Reimplantation Surgery

Corey Clyde, BS Benjamin Zmistowski, MD Carl Deirmengian, MD Javad Parvizi, MD, FRCS

Introduction: Two-stage exchange arthroplasty remains the preferred method of surgical treatment for chronic periprosthetic joint infection (PJI) in North America. One of the major challenges with this surgical treatment is the determination of optimal timing of reimplantation surgery. Joint aspiration to determine the synovial white blood cell (WBC) count and neutrophil percentage (PMN%) prior to reimplantation is widely performed, yet the implications are rarely understood. Therefore, this study investigates the diagnostic yield of synovial fl uid WBC count and differential and the calculated thresholds for persistent infection. 2:02pm–2:06pm Methods: The institutional PJI database was utilized to identify 82 patients undergoing two-stage exchange arthroplasty Predictors of Discharge to Inpatient who had joint aspiration prior to reimplantation between Rehabilitation After Total Knee Arthroplasty February 2005 and November 2012. Persistent infection was defi ned as positive aspirate culture, positive intraoperative cul- Zachary D. Post, MD tures, or persistent symptoms of PJI—including subsequent *Victor H. Hernandez, MD, MS PJI related surgery. Receiver operating characteristic (ROC) Fabio R. Orozco, MD curve was used to calculate thresholds maximizing sensitivity Alvin C. Ong, MD and specifi city. Introduction: Projected increases in total knee arthroplasty Results: Twenty cases (24.4%; 20/82) were classifi ed as hav- (TKA) have spurred innovation focused on decreasing coming persistent PJI. Compared to aseptic patients, these patients plications and cost associated with the procedure. Included had elevated pmN% (67% versus 45%) with no difference in this is a push for decreased length of stay (LOS) and in synovial WBC count (1,231 versus 1,750 cells/µL). ROC discharge to home. In spite of improvements, many patients analysis provided an area under the curve of 0.56 and 0.68 for continue to require inpatient rehabilitation (IR) at a premium synovial WBC count and pmN%, respectively. This provided cost to the health care system. The purpose of this study was a pmN% threshold of 57% with a sensitivity and specifi c- to evaluate factors associated with patient disposition and pre- ity of 70% and 60%, respectively. The risk of persistent PJI dictors of IR after TKA. increased with increasing pmN% (OR=1.03) with a risk of persistent PJI of 45% (5/11) in patients with pmN% greater Methods: After IRB approval, a series of 800 consecutive than 90%. patients undergoing TKA between January 2011 and Decem- ber 2011 were retrospectively evaluated. Of these, 743 had Discussion: Synovial fl uid analysis prior to reimplanation as unilateral, primary TKA and were included in our analysis. part of two-stage exchange has unclear utility. While, there is Several potential disposition predictors including family sup- no apparent association between WBC count and the status of port, health status, home situation, surgical variables and persistent PJI, elevated pmN% does imply risk in reimplanta- demographics were evaluated. Binary logistic regression was tion. With little other guidance regarding the timing of reim- used for statistical analysis.

120 diffi surgery. However, despiteFast track (FT)protocols,itisoften have increased thenumberofpatientsabletogohomeafter Introduction: Alvin C.Ong,MD Fabio R.Orozco,MD Zachary D.Post,MD Victor H.Hernandez,MD,MS Knee Replacement Predictors OfEarly Discharge After Total Notes: patient supportathomeafter TKA. through increasedhomedischarge shouldfocusonimproving support athome.Futureprogramsdirecteddecreasingcosts The onlymodifi tors didnotseemtoinfl ciated withanincreasedriskofIR.Interestingly, medicalfac- that non-modifi after TKA toberecalcitrantlyhigh.Ourevaluation showed Conclusion: ASA scorealsodidnotpredictIRdischarge. ical conditionsbaseduponCharlsoncomorbidityindex and loss, lengthofsurgery orBMI,wereassociatedwithIR.Med- No surgical orotherdemographicfactors, includingblood of stay(OR=2.7),andlackassistanceathome(OR=0.38). (OR=0.5), Medicareasprimaryinsurance(OR=0.36),length nifi Results: 2:07pm–2:11pm cant predictorsofIRwereage(OR=1.072),femalegender cult topredictwhichpatients cansafelygodirectlyhome 340patients(46.5%)requireddischarge toIR.Sig- Like many institutions,wefoundourrate ofIR Advances intotal kneearthroplasty(TKA) able factors suchasageandgenderwereasso- able factor associatedwithIRwas alackof uence thedispositionofthesepatients. Notes: the successfulcompletionofFTprotocol. Patient socialfactors didnotappeartohave aninfl plete aFTprotocolandcanbesafelydischarged tohome. son ComorbiityScore),aremorelikely tosuccessfullycom- Conclusion: infl ries homes,theavailability ofhelpathome,didnothave any insurance. Socialfactors suchaspatientliving alone,2sto- CI (0.17–0.97),BMIOR0.62(0.440.87)andMedicare directly tohomeincludedCharlsonComorbidScoreOR0.4 associated withfailure tocompleteFTprotocolanddischarge (1.03 -1.3), ASA scoreOR2995%CI(1.7–498).Factors cessful ofcompletionwereage<65y/oOR1.1595%CI completion ofFTprotocol.Factors associatedwithsuc- Results: analysis. variables. Binarylogisticregression was usedforstatistical used forthestudythatincludedsocial,medicalandsurgical they werebilateralknees.Several potentialpredictorswere inclusion criteria.57wereexcluded fromthestudybecause 743 wereunilateralconsecutive primaries TKA whichmetthe institution wereincludeinthestudy. Fromthispopulation, surgery betweenJanuary2011 andDecember2011inone Methods: discharge (LOS<2days)tohomeafter TKA. tors associatedwithpatientdispositionandpredictorsofearly after surgery. The purposeofthisstudywas toevaluate fac- uences intheresultsofFT. 366 patients(50.2%)metcriteriaforsuccessful A Seriesof800consecutive TKA thatunderwent Young Healthypatients(lower ASA andCharl- Rapid Fire Session5C uence in 121

Thursday EOA 45th Annual MeetingAmelia Island, Florida2014

loop button techniques. There does appear to be a greater per- Thursday, October 23, 2014 centage of grafts that are objectively considered to be lax in Rapid Fire Session 5D — Knee the closed loop group. There is not a difference in functional (Station D, Ritz-Carlton Ballroom Foyer) outcome with either design.

Moderator: Gregory S. DiFelice, MD Notes:

1:42pm–1:46pm

Outcomes Of ACL Reconstruction Using Closed Versus Variable Loop Button Fixation

Brent T. Wise, MD Sameh A. Labib, MD Rebecca Bedard, MA, ATC, OTC Garrison P. Wier, BS Jessica Martschinske, MA, ATC, OTC Melissa Rosen, MS, ATC, OTC 1:48pm–1:52pm

Background: Graft fi xation methods and incorporation are essential for the stability of ACL reconstructions. Suspen- Avoiding Complications And Technical sory fi xation with “button” devices has gained popularity, Variability During ACL Reconstructions with both fi xed loop and variable loop varieties available. This study examines these two different methods of fi xation Natasha Trentacosta, MD in order to determine their impact on graft laxity as well as Allison Liefeld Fillar, MD patient reported outcome scores. Cynthia P. Liefeld, PhD Michael D. Hossack, MD Method: Patients with ACL reconstructions using either a I. Martin Levy, MD fi xed loop button technique or variable loop button technique performed by the primary investigator between January 2009 Introduction: Surgical reconstruction of the anterior cruciate and April 2012 were identifi ed. Data was collected including ligament (ACL) can be complicated by incorrect tunnel place- Lysholm, Tegner, and SF-12 scores, and KT-1000 testing was ment, graft tunnel mismatch, cortical breaches and inadequate performed and compared to the uninjured knee. fi xation due to screw divergence. Our goal was to determine if the use of an image intensifi er during arthroscopically assisted Results: 33 patients in the variable loop group and 11 patients transtibial ACL reconstruction (IIAA-TACLR) signifi cantly in the closed loop group completed the KT-1000 testing. The decreased the occurrence of screw divergence and cortical average KT value for the variable loop group was 0.69mm, breaches. Further, we wanted to see if IIAA-TACLR allowed while the average for the closed loop was 1.0mm resulting in for precise tunnel placement. Finally, we wanted to determine a mean difference of 0.31mm (95% CI -.93-1.53). This dif- if the use of IIAA-TACLR permitted reliable recession of the ference was not statistically signifi cant. There was a greater proximal bone plug and accurate screw placement, thereby percentage of patients with KT values >3.0 mm in the closed eliminating graft-tunnel mismatch and screw divergence. loop group (18% vs 6%). Amongst patients that completed the subjective outcomes scores, there was not a statistically Methods: 110 consecutive patients (in 112 reconstructed signifi cant difference in the post op Lysholm, Tegner, SF-12 knees) underwent identical IIAA-TACLR using a bone-patel- physical or mental component scores between the two groups. lar tendon-bone autograft performed by one surgeon. Intra- and post-operative radiographic images and operative reports Conclusion: The study fi nds that there is no difference were evaluated for each patient, looking for evidence of in objectively measured ACL graft laxity as measured by cortical breeching and screw divergence. Precision of femoral KT-1000 between grafts fi xed with variable loop versus closed tunnel placement was evaluated using a sector map modifi ed

122 procedures but results areunknown afterquadricepstendon been identifi Introduction: Steven B.Cohen,MD Ben Root Watson,BARyan A. Russell Flato,BA Matthew R.Salminen,BS Elliot S.Mendelsohn,MD Worker’s CompensationCohort Quadriceps Tendon RepairOutcomesInA Notes: avoid complicationsand enhanceprecision. reconstruction thatincorporatestunnelsinthetechnique,to A C-armwithimageintensifi mental adjustmentofthetibialtunnelandkneefl divergence during ACL reconstructionbyallowing incre- eliminated corticalbreech,grafttunnelmismatchandscrew image intensifi Discussion andConclusion: widely. (sector 1). Tibial precise, allfalling intothedesiredsectorofourlocationmap match. The positionsofthefemoraltunnelswere100percent engagement. There werenoinstancesofgraft-tunnelmis- were noinstancesoflossfi noted intra-operatively oronpost-operative images. There Results: were recorded. angles from Bernardetal.Graftrecessiondistanceandtibial 1:54pm–158pm There werenofemoralortibial corticalbreaches ed asariskfactor forpooroutcomesaftersome er enabledprecisetunnelplacementand A workers’ compensation(WC)claimhas α anglesandgraftrecessiondistancesvaried er canbeused,withany ACL xation screw majorthread The useoftheC-armwith exion angle. Notes: work afterquadricepstendonrepair. aware ofpoorfunctionalresultsandlongertimetoreturn Similar toother WC surgical treatments, surgeons shouldbe lyzed resultsofquadricepstendonrepairsinthisstudygroup. compared tonon-WCpatients.Noprevious studyhasana- there was atrendtowards inferiorIKDCandLysholm scores quadriceps tendonrepairtooklongertoreturnwork and Discussion and 93–335) versus 150days(range,47–275),respectively. in the WC groupversus non-WCgroups:205days(range, the average timetoreturnwork was signifi non-WC group. There was greaterpermanentdisabilityand cohort was 70(range,21-99)versus 79(range,35–100)inthe group. The meanpostoperative Lysholm scoreinthe WC 56 (range,17–99)versus 66(range,24–98)inthenon-WC The meanpostoperative IKDCscoreinthe WC cohortwas major complications:2in WC (11%),3innon-WC(11%). (range, 2.1-9.9years). There werewas nodifference in Results: coxon test. Scoring (Lysholm) questionnairesandcomparedusinga Wil- Documentation Committee(IKDC)andtheLysholm Knee tional outcomeswereassessedwiththeInternationalKnee occupation, timetoreturnwork, anddisabilitystatus.Func- - January, 2012.Datawas collectedincludingcomplications, that underwentquadricepstendonrepairfromJanuary, 2005 non-WC patients(meanage55,85%male)wereidentifi Methods: (non-WC) cohort. for acuterupturescomparedtoanon-workers’ compensation WC patientswhohave undergone quadricepstendonrepair repair. We soughttodeterminethefunctional outcomesin The average lengthoffollow-up was 3.7years 18 WC patients(meanage55,83%male)and 27

Conclusion: WC patientswhounderwent Rapid Fire Session5D cantly longer ed 123

Thursday EOA 45th Annual MeetingAmelia Island, Florida2014

Conclusion: Three methods of reconstruction were stronger 2:00pm–2:04pm than the native MPFL; ISP/TRF being the strongest. Addi- tionally, human gracilis allograft can withstand forces far Biomechanical Tensile Strength Analysis greater than the native MPFL; therefore, suggesting human Of Current Techniques For MPFL gracilis allograft as an acceptable tissue alternative for MPFL Reconstruction reconstruction.

LCDR Patrick W. Joyner, MD, MS Notes: Travis Roth, MS IV C. Luke Wilcox, DO Jeremy Bruce, MD Scott Winnier, PhD Aaron K. Mates, MD Charles A. Roth, MD

Introduction: Current surgical techniques for medial patellofemoral ligament reconstruction (MPFL) may employ 2:06pm–2:10pm suspensory cortical ﬁ xation and a human gracilis allograft. We examine the biomechanical strength of suspensory corti- A Biomechanical Comparison Of Calcium cal ﬁ xation and human gracilis allograft as it compares to the Phosphate And Fibular Allograft In Split strength of the native MPFL. Depression Tibial Plateau Fractures

Methods: Five different MPFL reconstruction techniques Maxwell K. Langfi tt, MD where analyzed using six matched pair human cadavers. *Stuart M. Saunders, MD Methods of fi xation examined: suspensory cortical fi xation in Gregory Daut, MD patella and femur (DTR), suspensory cortical fi xation patella Philip Brown, MS interference screw femur (TRP/ISF), interference screw Jason J. Halvorson, MD patella suspensory cortical fi xation femur (ISP/TRF), inter- Anna N. Miller, MD ference screw patella and femur (DIS), two suture anchors Joel Stitzel, PhD patella suspensory cortical fi xation femur (SAP/TRF). The Eben A. Carroll, MD vector force was anatomic, directed laterally over the lateral femoral condyle while the knee was fl exed 25°. Each method Introduction: The treatment of split depression tibial plateau was examined six times; each reconstruction utilizing a new fractures involves elevation of the depressed articular frag- human gracilis allograft. The widths of all patellae were ment with bone grafting of the resultant metaphyseal bone measured; consequently, the force necessary for 50% (sublux- defect. Biomechanical studies have touted calcium phosphate ation) and 100% patellar displacement (dislocation) could be cement as superior to autogenous cancellous bone graft. How- quantifi ed. The peak force to fi xation failure was examined ever its use is associated with higher costs. Clinical series for all methods. A native MPFL strength of 208N was used have demonstrated allograft fi bula yields outcomes similar as a control. Failure was either 100% patellar displacement or to other bone grafting options. The purpose of this study fi xation failure. was to evaluate fi bular allograft as an alternative to calcium phosphate for metaphyseal bone defect management in split Results: Three forms of reconstruction required force >208N depression tibial plateau fractures in a biomechanical model. for 100% patellar displacement and fi xation failure; DTR, TRP/ISF, and ISP/TRF. All methods of reconstruction Methods: 6 matched pairs of fresh frozen cadaveric tibiae required <208N for 50% subluxation. All methods of MPFL were systematically fractured to create a split depression reconstruction demonstrated signifi cantly different strengths fracture of the lateral plateau. During repair each tibia of a for 50% and 100% displacement of the patella as well as peak matched pair was randomly assigned to either calcium phos- force to failure (F = 8.4, F crit = 2.3 (results of ANOVA)). phate or fi bular allograft for the metaphyseal bone defect. All No reconstruction method failed as a result of the human specimens were repaired with a periarticular plate. The tibiae gracilis allograft. were then mechanically evaluated using a hydraulic test frame

124 of thecubitaltunnel. We also presentaretrospective review of cadavers oftheulnarnerve, asrelatedtoendoscopic release Introduction: BS Shawn Adhya, Ather Mirza,MD Justin B.Mirza,DO The AssociatedClinicalOutcomes Endoscopic Cubital Tunnel ReleaseAnd An AnatomicalStudy AsABasis For Notes: tibial plateaufractures. management ofmetaphyseal bonedefectsinsplitdepression ciated withfi ence inthetwo groups was equal.Given thelower costasso- From aclinicalstandpoint,themagnitudeofarticularsubsid- struction ofsimilarstiffness tothatofcalciumphosphate. Conclusions: two duringfailure testing. placement. There werenosignifi ness over fi calcium phosphatecementhada120.55Nincreaseinstiff- loading cycles. When analyzingthefatigue dataasawhole fi displacement ofthearticularsurface oftibiaerepairedwith lyzed therewas nosignifi Results: bilitative walking. All specimenswereloadedtofailure. under force-controlledcyclic fatigue loadingtoimitatereha- bular allograftversus calciumphosphateover equivalent 1:42pm–1:46pm N.George Kasparyan,MD,PhD Moderator: Ritz-Carlton Ballroom Foyer) Rapid Fire Session5E—UpperExtremity Thursday, October23,2014 When individual fatigue cycle intervals were ana- bular allograftanddisplayed0.12mmlessdis- bular allograft,itmaybeaviablealternative for Fibular allograftproducedanarticularrecon- This isananatomicalstudyinfresh-frozen cant difference inthestiffness or cant differences betweenthe (Station E, Notes: and minimallyinvasive. geons tominimizeoperative trauma. This techniqueissimple the advantage ofendoscopic visualizationinallowing sur- high degree ofanatomicalvariability inthisstudyhighlights UN, brachialartery, facial bands,andthebasilicvein. The anatomy duringrelease,includingbranchesoftheMACN, Conclusion: age follow-up was 8.2months(range:0.13-34.8months). were 24excellent, 40good,25fair and4poor(n=93). Aver- ative was 24.6(n=56). The Gabeland Amadio outcomescores average preoperative DASH scorewas 48.7(n=34),postoper- mens, andtheepimysiumoftricepsintwo specimens. The mens, thebasilicvein crossingtheulnarnerve infourspeci- including theanconeusepitrochlearismuscleintwo speci- 4.5). Aberrant structureswerenotedin8ofthe26specimens, the ulnarnerve atanaverage distanceof2.9cm,(range:1.0- (n=10), medialantebrachialcutaneousnerve branchescrossed aponeurosis distaltothemedialepicondyle. Where present degree ofvariability intheanatomyoffl condyle in12of26cadaver specimens. We observed ahigh Results: score and(3)Grippinchstrength. measures included(1)DASH score(2)Gabeland Amadio drome, utilizingendoscopicsimpledecompression.Outcome of releasein81patients(93cases)withcubitaltunnelsyn- fi est. These the positionofnerves, vessels, andaberrantanatomyofinter- fascial membranesaspotentialsitesofconstriction,well we dissected26cadaver arms. We paidspecialattentionto Methods: tion. patients treatedwithdecompressionviaendoscopicvisualiza- We notedafascial bandproximaltothemedialepi- To furtherourunderstandingofrelevant anatomy, ndings facilitated ourunderstandingoftheextent Cadaveric dissections shedlightonvulnerable Rapid Fire Session5E exor pronator 125

Thursday EOA 45th Annual MeetingAmelia Island, Florida2014

not inﬂ uenced by physician shareholder status nor facility 1:47pm–1:51pm type.

Rate Of Utilization Of Physician-Owned Conclusions: Neither shareholder status nor facility owner- Specialty Hospitals Versus University ship characteristics inﬂ uence a surgeon’s speed to indicate a Facilities For Arthroscopic Shoulder patient for surgery or the initiation of non-operative treatment Surgeries - Does Ownership Effect prior to surgery. Once indicated for surgery, patients undergo Utilization? surgery faster at physician-owned facilities and with non- shareholder physicians. Eric M. Black, MD Notes: John Reynolds, BA Mitchell G. Maltenfort, PhD Gerald R. Williams, MD Joseph A. Abboud, MD Mark D. Lazarus, MD

Background: The emergence of physician-owned specialty hospitals in orthopaedic surgery has spawned intense debate. The purpose of this study is to examine the practice patterns 1:52pm–1:56pm and surgical indications of physicians practicing at these facilities utilizing common shoulder procedures. Distal Radius Fracture Fixation Using The Methods: We retrospectively analyzed all patients undergoing T-Pin Device arthroscopic rotator cuff, Bankart, or SLAP repairs during an 18-month period by fi ve surgeons in our practice at one of fi ve Jason C. Saillant, MD facilities (two of which were physician-owned, where three of *John S. Taras, MD the fi ve surgeons were shareholders). Information on patient Peter Goljan, MD demographics, insurance status, duration of symptoms, time Lucy McCabe, BS taken to indicate a patient for surgery, and time to schedule surgery was studied with univariate and multivariate analyses Introduction: To investigate the outcomes of extraarticular to determine the infl uence of 1) facility type and 2) physician and simple intraarticular distal radius fractures treated with shareholder status. Additionally, measures of “conservative” the T-Pin, a threaded, cannulated device. treatment prior to surgical intervention were analyzed. Methods: This is a retrospective study of distal radius frac- Results: 501 patients underwent one of the three index pro- tures treated with the T-Pin distal radius fracture fi xation cedures during the study period. There were no signifi cant device. A minimum of 1 year postoperative follow-up was differences in baseline demographics (age, gender, or insur- required for inclusion in the study. The outcome data col- ance status) within facility type of physician shareholder lected included wrist range of motion, grip strength, and lat- status groups. Median duration of symptoms prior to surgery eral pinch strength. Radiographs obtained at each visit were was signifi cantly shorter in workman’s compensation patients analyzed to determine volar tilt and radial height. At the fi nal (47% less, p<0.0001) and men (31% less, p<0.001), but was follow-up visit, all patients completed the Disabilities of the not infl uenced by shareholder status nor facility ownership Arm, Shoulder and Hand (DASH) questionnaire. (p>0.05). In the multivariate analysis, time between patient Results: Twenty-four patients were included in this study. presentation and consent for surgery was not infl uenced At an average of 2 years after surgery (range, 1 to 6 years), by hospital type (p=0.39) or physician shareholder status fl exion was 89%, extension 96%, supination 99%, and prona- (p=0.50). Time from consent to surgical procedure was signif- tion 100% of contralateral wrist motion. Grip strength was icantly faster in physician-owned facilities by 13% (p=0.03), 93% (range, 40% to 137%) and lateral pinch strength was and slower with physician investors by 35% (p<0.0001). 99% (range, 48% to 130%) of the contralateral upper extrem- Weeks of nonoperative therapy prior to SLAP or rotator cuff ity. Preoperative AO fracture classifi cation disclosed 6 type repair and number of dislocations prior to Bankart repair were A2, 12 A3, 4 C1, and 2 C2 fractures. One patient lost radial

126 tendon toitsrespective hemi-Krackow limb,allowing the advanced totensiontherepair andfi passed throughthecentralaspect ofthedistaltendonand running lockingtechnique. The othersuturelimbswerethen anchor was passedupanddown theedgeoftendonina hemi-Krackow stitch. With thisrepair, onestrandfrom each single anteriorincisionwithtwo sutureanchorsutilizinga patients whounderwentprimarydistalbicepsrepairusing a Methods: using ahemi-Krackow lockingstitch. suture anchorswithtensioningofthetendonboneinterface distal bicepsrepairsusingasingleanteriorincisionandtwo Introduction: Randall W. Culp,MD Nimit A. Patel, MD Peter Goljan,MD *Justin Stull,BA Brandon Donnelly, MD Technique AndEarly Outcomes Hemi-Krackow Suture Technique: Surgical Single IncisionDistalBicepsRepair With Notes: motion earlyintheirpostoperative course. bility ofthefi diminishes postoperative softtissuecomplications. The sta- low profi for thetreatmentofextraarticular distalradiusfractures. The Conclusions: occurred. complaints. Noothercomplicationsorsecondarysurgeries After hardware removal, neitherpatientexpressed further the resultoftendernesswithwristrangemotionin1case. 0 to35).Hardware was removed electively in1caseandas radiographs. The average fi height of6mmfrominitialpostoperative- tofi 1:57pm–2:01pm le ofthedevice anditsminimallyinvasive approach A retrospective chartreview was performedof xation allows patientstobegin active rangeof The T-Pin offers stable,reliablefracturefi We presenttheearlyoutcomesof aseriesof nal DASH scorewas 4.4(range, nally tiedontopofthe nal follow-up xation Notes: surgeries andonlyonecaseoftransientnerve complaints. tional outcomesatearlyfollow-up. There werenorevision fi Conclusions: ance. One patientwas notsatisfi arm. All patientsweresatisfi cutaneous nerve. Nopatientrequiredfurthersurgery ontheir and self-limitedtinglinginthedistribution lateralantebrachial 0 to10(range:2.5)andonepatientreportedinfrequent (range: 0to36.5).Patients ratedtheirpainas0.3onascaleof (range: 70.6to121.4%). Average QuickDASH scorewas 6.5 >130°, andgripstrengthwas 101.5%oftheuninjuredarm 6.8 to34.3),allpatientshadelbow rangeofmotion0to was injuredin9cases. At anaverage of16.4months(range: 27.8 to66.4)wereincludedinthestudy. The dominantarm Results: pain level, andreportedcomplications. tionnaire. Secondaryoutcomesincludingpatientsatisfaction, abilities ofthe Arm ShoulderandHand(QuickDASH) ques- to thecontralateralarm. All patientscompletedaQuickDis- included elbow rangeofmotionandgripstrengthcompared gery oruseofallograftwereexcluded. Measuredoutcomes tendon toinsertdirectlyontobone.Patients withrevision sur- patients consideredforinsitu ulnarnerve decompressionis Introduction: Pedro K.Beredjiklian,MD Nayoung Kim,BS Kevin Lutsky, MD *C. Edward Hoffl Jonas L.Matzon,MD Decompression Patients ConsideredForInSituUlnarNerve InstabilityIn Incidence OfUlnarNerve xation andhemi-Krackow stitchprovided satisfactory func- 2:02pm–2:06pm Fourteen patientswithanaverage ageof51.3(range: Singleincisionbicepsrepairwithsutureanchor The incidenceofulnarnerve instabilityin er II,MD,PhD ed withhisarm’s cosmeticappear- ed withtheoverall surgical result. Rapid Fire Session5E 127

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unknown and pre-operative risk factors for ulnar nerve insta- 2:07pm–2:11pm bility necessitating transposition have yet to be identifi ed. We hypothesized that a relatively high percentage of patients considered for in situ ulnar nerve decompression will require Distal Radius Volar Plate Implant transposition secondary to ulnar nerve instability. Prominence And Flexor Tendon Rupture: Safety Profi le Of A Locking, Variable Axis Methods: We retrospectively identifi ed all patients undergo- Plate ing surgical treatment of cubital tunnel syndrome by in situ ulnar nerve decompression and ulnar nerve transposition over Joel C. Klena, MD a fi ve-year period. Patients requiring ulnar transposition due *John Deegan, DO to revision surgery, elbow arthritis, or elbow contracture were Andrew Lehman excluded. Patient demographics such as age, weight, height, and body mass index (BMI) were collected. Patients with Introduction: The use of volar plating in distal radius frac- pre-operative radiographs had measurements of ulnar groove ture fi xation is becoming increasingly common. Recent inves- and medial epicondyle morphology. Patients who underwent tigations have focused on complications associated with volar ulnar nerve transposition were noted if they were diagnosed plating of distal radius fractures. Flexor tendon rupture is one with instability pre-operatively, intra-operatively following such complication. While plate location beyond the distal decompression, or post-operatively. Unpaired t-tests were radius watershed line has been theorized to present a higher used to fi nd statistical differences between patients undergo- risk of fl exor tendon rupture, minimal data exists quantifying decompression and patients requiring transposition. ing the risks associated with specifi c volar plate implants and plate prominence. We sought to determine the fl exor tendon Results: Of the 363 patients who were considered for in situ rupture rate for a volar, locking, variable axis, distal radius ulnar nerve decompression, 76 patients required ulnar nerve plate and compare it to established values reported for similar transposition secondary to ulnar nerve instability. Twenty-nine implants. patients were diagnosed with instability pre-operatively, while 44 patients were identifi ed with instability intra-operatively Objectives: The primary objective of this study was to report following in situ decompression. Three patients were diag- the adverse effects associated with a volar, locking, variable nosed with instability post-operatively and underwent delayed axis distal radius plate utilized in 112 consecutive distal radius transposition. Patients who required transposition due to insta- fractures. The safety profi le for the implant is presented along bility were signifi cantly younger, taller, and had a lower BMI with safety profi les generated for two similar implants previ- than patients without instability. For those patients with pre- ously reported in the literature. operative radiographs, height and width of the ulnar groove and slope of the inferior aspect of the medial epicondyle did Methods: We reviewed 112 consecutive cases of distal radius not correlate with the need for transposition. fractures treated surgically through a volar approach utilizing a volar, locking, variable axis distal radius (VADR) plate Discussion/Conclusion: In situ ulnar nerve decompression is at a minimum follow-up of 6 months. Pre-operative images an acceptable treatment for cubital tunnel syndrome, but a rel- were utilized to classify all fractures by AO fracture grade. atively high percentage of patients will require transposition Post-surgery lateral images were used to classify plate promi- secondary to ulnar nerve instability. While patient age, height, nence into one of three groups utilizing the method previously and BMI correlate with the need for ulnar nerve transposition, described by Soong. further research is necessary to determine which patients are at greatest risk for ulnar nerve instability following decom- Results: No tendon ruptures were reported at an average pression. follow-up of nearly 4 years. 23 of 112 wrists (20.5%) had grade-0 implant prominence, 65 (58.0%) had grade-1 implant Notes: prominence and 23 wrists (20.5%) had grade-2 implant prominence. 37 fractures (33.0%) were classifi ed as AO Type A fractures, 4 (3.6%) as Type B fractures, and 71 (63.4%) as Type C fractures.

128 Notes: in 78.5%ofcases. position ofreducedprominence(Grade0or1)was achieved involving severe intra-articularfractures,plateplacementina of ﬂ safety proﬁ Conclusions: exor tendonruptures.Even withthemajorityofcases le withrespecttopost-operative complications The Synthes VADR platehasanexcellent Rapid Fire Session5E 129

Thursday EOA 45th Annual MeetingAmelia Island, Florida2014

2014 Scientiﬁ c Program Abstracts — Friday

(An asterisk (*) by an author’s name indicates the presenter.)

data on the type of study, the year of publication, the number Friday, October 24, 2014 of surgical procedures, the mean follow-up, the pre-operative General Session 7 — Foot & Ankle and Spine (Ritz- and post-operative AOFAS Score, other measures used to Carlton Ballroom Salon 1) assess outcome, and country of publication.

Moderators: Matthew M. Roberts, MD Results: Ninety-fi ve papers reporting the results of 2,703 Samuel B. Adams Jr., MD patients who underwent 2,745 surgical procedures for osteochondral lesions of the ankle were included for analysis. A total of thirty eight outcome measurement scores were used 7:00am–7:06am to assess outcome. The mean Coleman score for all scored papers was a 51.5 out of 100 and fi ve areas were identifi ed Level Of Evidence And Methodical Quality as methodolgoically weak: study size, the type of study, Of Ankle Cartilage Repair Studies description of postoperative rehabilitation, procedure for assessing outcome, and description of the selection process. Ethan J. Fraser, MD The papers were separated by surgical technique yielding a *John M. Pinski, MS mean Coleman score of 56.5 out of 100 for OATS procedures, Lorraine A. Boakye, BA 50.9 out of 100 for ACI procedures, 54.7 out of 100 for bone Keir A. Ross, BS microfracture, and 51.9 out of 100 for autologous transplanta- Charles P. Hannon, BS tion. There was no statistical difference found between the Yan Ma, PhD Coleman scores of papers each individual surgical technique John G. Kennedy, MD, FRCS (Orth) (p=0.2638). Of the ninety-fi ve studies scored, forty studies were identifi ed as prospective and fi fty-fi ve studies were clas- Background: There are many surgical techniques that attempt sifi ed as retrospective. The mean prospective Coleman score to repair osteochondral lesions of the ankle. It is not known was 54.3 out of 100 and the mean retrospective Coleman whether the studies analyzing the outcomes of these surgical score was 51.3 out of 100. There was a signifi cant difference options have strong methodological quality. in the reported post-operative AOFAS score between each surgical technique (p=0.0328). A weak correlation was found Methods: A literature search was performed using PUBMed, between the AOFAS outcome score and Coleman Methodol- Medline, EMBASE, and the Cochrane Databases identifying ogy Score weighted by patient number (r=0.2420, p=0.0433). studies whose primary intention was to examine the outcome Papers with different levels of evidence did not have signifi - of osteochondral lesions of the ankle treated with bone mar- cantly different Coleman scores (p=0.2526). Publication year row stimulation techniques, tissue transplantation (BFOA), correlated positively with the Coleman methodology score osteochondral allograft transplantation (OAT), autologous (r=0.4735, p<0.0001). osteochondral transplantation (AOT), particulated juvenile cartilage (PJC), matrix-associated chondrocyte implantation Conclusion: Investigators should exercise caution when (MACI) or autologous chondrocyte implantation (ACI). A interpreting results from studies assessing the surgical treat- further search of the references of all included papers was per- ment of osteochondral lesions of the ankle as many of these formed to ensure that all eligible studies were included in this studies have a relatively low Coleman Methodology Score, systematic review. Two independent investigators scored each which is indicative of poor methodological quality. It would paper from 0 to 100 based on ten criteria from the modifi ed be benefi cial to create a uniform, validated clinical outcome Coleman methodology score. The papers were also assigned score to assess post-operative success of surgical treatment of a level of evidence using the criteria established the American osteochondral lesions of the ankle. With more attention paid version of the Journal of Bone and Joint Surgery. We collected to study design and reporting of results, higher methodologi-

130 traveled forthe6MWTcomparedto ACs. The WKW also Results: group werecomparedusingpaired t-tests. fi Each participant’s preferenceforassistive device was identi- of perceived exertion was recorded usingtheOMNI-RPE. recorded. The SSWVwas calculatedandthesubject’s rating over manner. Pre-activity andpost-activity heartrateswere performed a6MWTutilizingeachassistive device inacross- over studyutilizing24healthyvolunteers. Eachparticipant Methods: tion whencomparedto ACs. lower perceived exertion, andprovide higherpatientsatisfac- improved assistedambulation onthe6MWTandSSWV, have (OMNI-RPE). Ourhypothesis isthatthe WKW willprovide Velocity (SSWV)andOMNIRatingofPerceived Exertion using the6Minute Walk Test (6MWT),Self-Selected Walking healthy volunteers for bothclinicalandsubjective outcomes The purposeofthisstudyistocompare ACs andthe WKW in larity asanoptionforpatientsrequiringassistive device. the Wheeled Knee Walker (WKW)hasrecentlygainedpopu- most frequentlyprescribeddevices forprotectedambulation, assistive device. While axillarycrutches(ACs) aresomeofthe treatment ofteninvolves protectedweightbearingwithan Introduction: Kevin L.Kirk,DO Donna M.Lopez,MSN *Benjamin Kocher, PA-C Matthew A. Napierala,MD Healthy Subject Knee Walker Crutches AndAxillary In And Perceived Exertion With The Wheeled Comparative Study Of AssistedAmbulation Notes: more meaningfulconclusionsfromthedata. cal qualitymaybeattainedthusenablingpractitionerstodraw ed usingasubjective questionnaire. The outcomesforeach 7:08am–7:14am The WKW showed asignifi We performedaprospective, randomizedcross- Lower extremity injuriesarecommonandtheir cant increaseindistance Notes: patients comparedto ACs. is thepreferreddevice forassistedambulation inhealthy lower perceived exertion andpost-activity heartrate,and assisted ambulation onthe6MWTandSSWV, aswell Discussion andConclusion: all, 87.5%ofparticipantspreferredthe WKW to ACs. participants utilizingthe WKW whencomparedto ACs. Over- demonstrated signifi Evaluation ofthepre-activity andpost-activity heartrates lower perceived exertion theOmni-RPEcomparedto ACs. showed asignifi chronic tears,andtendonsplits. neal tendonsincludedtendinosis, tenosynovitis, acutetears, radiologist reviewed eachMRI.Pathologies ofthepero- inclusion inthisstudy. A singleattendingmusculoskeletal ankle trauma. A totalof158(of305)MRIswere eligiblefor with documentedinversion injuries,anklesprains, orlateral in ourstudy. Studieswereexcluded ifperformedonpatients during themonthofJuly2012wereconsideredforinclusion Methods: tomatic individuals. abnormal fi The purposeofthisstudyistodeterminetheprevalence of patients, mostnotablywithregards tothespineandshoulder. the prevalence ofabnormalMRIfi Previous studiesin the orthopaedicliteraturehave discussed frequently beidentifi Introduction: Steven M.Raikin,MD Patrick W. Kane,MD Adam C.Zoga, MD David I.Pedowitz, MD,MS Joseph T. O’Neil,MD Magnetic ResonanceImaging Of The Ankle Peroneal Tendon Abnormalities OnRoutine 7:16am–7:22am Foot andankleMRIsperformedatourinstitution ndings oftheperonealtendonsonMRIinasymp- Abnormalities oftheperonealtendonscan cant increaseinSSWVandsignifi cantly lower post-activity heartratesfor ed onroutineMRIofthefoot/ankle. The WKW provides improved ndings inasymptomatic General Session7 cantly 131

Friday EOA 45th Annual MeetingAmelia Island, Florida2014

Results: The median age of the MRIs included in this study Results: The most common mechanisms were motor vehicle was 47.27 years with 100 females and 58 males. The most crashes (56%) and falls greater than six feet (23%). Five commonly occurring primary pathology was Achilles ten- patients (8%) had a posterior tibial artery transection. Fifty- dinosis (41), followed by plantar fasciitis (20) and posterior fi ve patients (78%) had a Gustillo type II or type III open tibial tendon dysfunction (20). With regards to the peroneal medial injury. Eight patients (12%) had a femoral shaft frac- tendons, 64 of the 158 (40.5%) MRIs demonstrated some ture, fourteen patients (21%) had ipsilateral ankle fractures, pathology. sixteen patients (24%) had a metatarsal fracture, and eleven patients (17%) had associated midfoot fractures. In the asso- Discussion and Conclusion: The results of this study dem- ciated midfoot fracture group 12 patients (18%) had a talus onstrate that a sizeable percentage of individuals (40.5%) will fracture and 5 patients (7%) had a cuboid fracture. Nine have peroneal tendon pathology on MRI of the foot and ankle, patients (14%) had an associated spine fracture with 66% when performed for reasons other than instability or lateral being lumbar fractures. Fifteen patients (23%) had associ- ankle trauma. This study can have important clinical implica- ated upper extremity fractures. Thirteen patients (20%) had a tions for when patients present with concerning MRI fi ndings signifi cant associated pulmonary injury. Ten patients (15%) that do not correlate clinically. Physicians providing muscu- had an associated closed head injury and six patients (9%) loskeletal care can counsel and reassure patients who present had an abdominal injury. Fifteen patients (22%) were treated with peroneal pathology on MRI but an absence of clinical with percutaneous wire fi xation and seven patients (10%) fi ndings. with open reduction internal fi xation. Forty-four (66%) were treated non-operatively. Overall all seven patients (11%) with Notes: Gustillo type III open calcaneal fracture eventually underwent a below the knee amputation.

Discussion and Conclusion: Open calcaneus fractures are severe injuries with potential for signiﬁ cant morbidity to the patient, given the high rate of concomitant injuries. Type III open injuries have a signiﬁ cant risk of needing subsequent amputation. Management of these injuries should include intravenous antibiotics, tetanus prophylaxis and urgent debridement and irrigation. 7:24am–7:30am Notes:

Open Calcaneus Fractures And Associated Injuries

Jacob R. Worsham, MD Mark R. Elliott, MD Corey Rosenbaum, MD Christopher H. Perkins, MD 7:32am–7:38am Anthony M. Harris, MD

Introduction: To describe the associated injuries, demo- Factors Contributing To Hospital Stay And graphic distribution, and management of patients sustaining Charges In Ankle Arthroplasty open calcaneus fractures. Jason L. Codding, MD Methods: A retrospective case series was performed of open Daniel E. Davis, MD calcaneal fractures at a single level-1 trauma center. Sixty-six Mitchell G. Maltenfort, PhD patients with open calcaneus fractures were identiﬁ ed from an David I. Pedowitz, MD, MS orthopaedic trauma registry. All patients were managed with surgical irrigation and debridement with or without internal Introduction: Total ankle arthroplasty (TAA) has become a ﬁ xation. more common treatment for end-stage ankle osteoarthritis.

132 Notes: information toallinvolved inthehealthcaresystem. systemic. Identifi Particular variables arepatient-specifi hospital charges have increasedconsiderablyfrom1993-2010. Discussion and showed bothdecreasedLOSand TIC of13.40%. strated decreased TIC of21.74%whileurbanprivate hospitals LOS andincreased TIC of25.18%.Ruralhospitalsdemon- 6.51%, whilelarge hospitalswereassociatedwithincreased difference inLOS.Mediumhospitalsshowed higher TIC of increased TIC of14.81%.Regionally, therewas nosignifi of 16.55%and5.89%,respectively, whilethe West hadan to theNortheast,MidwestandSouthhaddecreased TIC not associatedwithasignifi private insurershadadecreasedLOS,whilepaymentwas LOS anddecreased TIC of9.1%.ComparedtoMedicare, nifi difference onLOSor TIC. Diabeticsandfemaleshadasig- ($21,382.53 to$62,028.00).Obesityoragehadnosignifi to 2010(52days)whilemedian TIC hasincreased Results: NIS database. or private), rural,small,mediumorlarge, asdefi west, Southand West. Hospitaltypeincludedurban(academic self-pay, andnocharge. LocationincludedNortheast,Mid- age andrace.Payment includedMedicare,Medicaid,private, diabetes mellitusandobesity. Demographicsincludedgender, determine effects onLOSand TIC. Comorbiditiesincluded payment, andhospitallocationtypewereevaluated to Using amultivariate analysis,comorbidities, demographics, reviewed (1993-2010),identifyingLOSand TIC for TAA. Methods: trends. inpatient charges (TIC)of TAA isnecessarytoevaluate these identifying variables increasinglength of stay(LOS)andtotal With risinghealthcarecostsanddecliningreimbursements, cantly increasedLOS,whilewhitepatientshaddecreased Overall, medianLOShas decreasedfrom1993 The NationalInpatientSample (NIS)Databasewas

cation ofthesefactors provides important Conclusion: cantly different TIC. Compared DespitedecreasedLOSin TAA, c, regional, culturaland ned bythe cant cant ACDF amongsurgeons decreasedfrom$1123to$499. costs was 21.14%. The standarddeviation ofimplantcostper Q3 25.76%,andQ424.91%. The average savings ofimplant cal spendingrateswas asfollows: Q112.34%,Q221.96%, quarterly reductioninspendingwhencomparedwithhistori- tion was abletoreduceimplantspendingby$2,347,521. Our Results: thoracic procedures. ing variable ofcasecomplexity asseenamong lumbarand dard deviation. Studying ACDFs served tolimittheconfound- Anterior CervicalDiscectomyandFusion(ACDF) usingstan- we examined thevariance ofimplantcostduringsinglelevel vious contract. To capturethedegree ofphysicianalignment, decrease fromthehistoricalimplantpricepointspre- vious year. We expressed thecostreductionasapercentage price pointsaswellthehistoricalpointfrompre- individual implantswas recordedperthenewly negotiated required tomeetthesepricepoints.For eachcase,thecostof dor. Inordertocontinuebeapproved foruse,vendors were for eachindividual typeofspinalimplant,regardless ofven- cost datafromtheprevious year, weestablishedpricepoints implants across5vendors. Usingmarket analysisandimplant spine surgeons performed1121spinalprocedures using Methods: decrease theinter-physician variation inimplantcosts. to decreasethepricesofindividual spinalimplantsandto gram forourspinalimplants. This programwas designed In 2011ourinstitutionimplementedacost-containmentpro- $1.65 billion.Onekey driver ofrisingcostsisspinalimplants. for surgical careoflumbarspinalstenosiswas reportedtobe risen over thepastdecade.In 2007theaggregate hospitalbill Introduction: Joseph A. BoscoIII,MD Joseph D.Zuckerman, MD Thomas J.Errico,MD Tracey Hunter, BS Lorraine Hutzler, BA Jonathan Oren,MD Surgery Implant CostReductionInitiativeInSpine Award EOA/OREF Resident/Fellow Travel Grant 7:40am–7:46am Duringtheﬁ

BetweenFebruary2012andJanuary2013,our Demandforspinalsurgery anditscosthave rst yearofthisinitiative, theinstitu- General Session7 133

Friday EOA 45th Annual MeetingAmelia Island, Florida2014

Conclusions: Our initiative represents a successful cost- Radiographic evaluation included standing anteroposterior containment program. Despite the high complexity of spinal (AP) and lateral pelvic radiographs, and sitting lateral pelvic surgery and the initial reluctance among vendors to reduce radiograph, measuring functional pelvic obliquity and sagit- prices, with strong hospital and physician alignment, these tal standing and sitting pelvic tilt. Post-operative functional obstacles were overcome with signifi cant savings to the medi- anteversion and abduction angles were assessed by EBRA cal center. There were no direct fi nancial incentives to sur- software. geons for participating in the program. Their participation was achieved by increasing physician awareness of the issue. Results: There was no dislocation at minimum 2-year follow- up. All cups were within the safe zone. 25% (17 patients) had Notes: fi xed LS deformity. In all of the fl exible pelvises, there was a posterior tilt from standing to sitting with increase in functional anteversion. The change in tilt from standing to sitting was signifi cant in the fl exible pelvis group as compared to the fi xed pelvis group (26.8º ± 9.5º versus 5.9º ± 3.5º, p=0.0001)

Discussion: There is a signifi cant change in pelvic tilt from standing to sitting, especially in patients with fl exible spine, where the functional anteversion increases with sitting. The Friday, October 24, 2014 patients with fi xed pelvis have signifi cantly less anterior saggital tilt in standing (less anteversion) with less posterior sag- Rapid Fire Session 8A — Total Hip Reconstruction gital tilt in sitting. Care should be taken to adjust cup position- (Station A, Plaza Ballroom 1) ing in fi xed spinal deformities or loss of posterior pelvic tilt Moderator: Douglas E. Padgett, MD while sitting.

Notes: 8:20am–8:24am

Effect Of Fixed Spinal Deformity On Functional Pelvic Orientation From Standing To Sitting

Morteza Meftah, MD 8:25am–8:29am Chitranjan S. Ranawat, MD Amar S. Ranawat, MD Dynamic Hip Spacers Reduce Operative Introduction: Accurate and reproducible cup positioning Time During Reimplantation is one the most important technical factors that affect the outcomes of total hip arthroplasty (THA). Although Lewin- Anthony Tokarski, BS nik’s safe zone is the most accepted range for anteversion and Gregory K. Deirmengian, MD abduction angle, the effect of pelvic tilt, obliquity and effect Javad Parvizi, MD, FRCS of lumbosacral spine is not yet established. The aim of this Carl Deirmengian, MD study was to assess the change in pre-operative saggital pelvic tilt from standing to sitting, and analyze the effect of change Introduction: During two-stage exchange arthroplasty in saggital pelvic tilt on acetabular anteversion and abduction either a dynamic or static antibiotic impregnated spacer may angles. be used. Although prior literature suggests that the use of dynamic knee spacers result in improved functional outcomes, Material and Methods: Between July 2011 and October substantiation of the additional cost of dynamic hip spacers 2011, 68 consecutive unilateral THAs were implanted in 68 is not as well-established. The purpose of our study was to patients with a mean age of 71 ± 6 years old. All cases were investigate whether the use of dynamic spacers reduces opera- performed by a single surgeon via the posterolateral approach. tive time during reimplantation,

134 Rapid Fire Session 8A

Methods: Using our institutional database, we identifi ed all 8:30am–8:34am patients who underwent 2-stage exchange arthroplasty for treatment of PJI between 2006 to 2012. Detailed data was collected on all of these patients, including the operative time Radiographic Patterns Of Osteointegration during reimplantation. Cox regression analysis was used In Cementless Tapered Wedge Stems determine independent risk factors for increased operative time. Jonathan Robinson, MD Parthiv A. Rathod, MD Results: We identifi ed 223 patients who underwent reimplan- John W. Stirton, MD tation of either the knee (154 patients) or the hip (69 patients). H. John Cooper, MD The mean operative time during reimplantation was 122 Jose A. Rodriguez, MD minutes for 20 patients with a dynamic hip spacer compared to 158 minutes for 49 patients with a static hip spacer. For Introduction: A sequential radiographic analysis track- 73 patients with a static knee spacer the mean reimplanta- ing the patterns of osteointegration and bony remodeling in tion time was 131 minutes compared to 131 minutes for 81 proximally coated tapered wedge stems has yet to be fully patients with a dynamic knee spacer. The use of dynamic hip described. The aim was to study the evolution of radio- spacers was independently associated with decreased opera- graphic patterns of osteointegration and determine if there is tive time. Other independent factors leading to an increase in correlation with pre-operative bony morphology and initial operative time during reimplantation were increase in degree stem fi t. of bone loss and increase BMI. Methods: Retrospective radiographic review of consecu- Discussion and Conclusions: This study demonstrates that tive primary total hip replacements performed by one the use of dynamic spacers in the hip is associated with a surgeon using a single stem design. Procedures were decrease in operative time during reimplantation. It is possible done between January 2006 and December 2008. Patients that better maintenance of the effective joint space and soft included in the study required an anterior-posterior radio- tissue tensioning that can be achieved with the use of dynamic graph pre-operatively and anterior-posterior + lateral radiographs at 6 weeks post-operatively and at their most recent hip spacers results in ease of revision compared to static Friday spacers. Given the expense associated with operative time, visit. Radiographs were analyzed by two of the authors. this factor should be considered in substantiating the cost of Radiographic analysis included documentation of radio- dynamic hip spacers. lucent Lines (RLL), endosteal spot welds, and changes in cortical thickness at each gruen zone. Incidence of pedestal Notes: formation, calcar remodeling and subsidence were also recorded.

Results: 104 hips (94 patients) met the inclusion criteria for radiographic review with a mean follow-up of 5.5 years (Range 3.4-7.4 years). No RLL were seen over the proximal porous coated portion of the stem. Distal RLL’s were seen in 27% (zone 4) and 31%(zone 11) of stems. Cancellization of the calcar bone was seen in all patients on their fi nal radiographs. Highest incidence of spot welds were at zones 2 and 9(54% and 57% respectively). Signifi cant positive correlations were seen distal canal fi ll (DCF) and bony remodeling in zone 3(p 0.016) and 5(p 0.013).

Conclusion: Cortical hypertrophy around the midstem, lack of RLL around the proximal stem and cancellization of calcar bone are all radiographic patterns which were linked with osteointegration of proximally coated tapered wedge stems. While there was no signiﬁ cant correlation with preoperative bony morphology or initial stem ﬁ t proximally, there was

135 EOA 45th Annual MeetingAmelia Island, Florida2014

a positive correlation with DCF and corticalhypertrophy of relations between subsidence and preoperative bony morphol- zones 3 and 5. ogy or initial stem ﬁ t.

Notes: Conclusion: Stems that subsided had a neck cuts at the lesser trochanter. Preservation of calcar bone may play a role in initial stem stability and ﬁ xation. If preoperative templating calls for a low neck cut, the use of a collared stem may be beneﬁ cial.

Notes:

8:35am–8:39am

Inﬂ uence Of Neck Cut On Subsidence Of Hydroxyapatite Coated Stem

Yevgeniy Korshunov, MD 8:40am–8:44am Jonathan Robinson, MD Roger A. Sanguino Mital S. Patel, MBBS, MS Multiple Lower Extremity Arthroplasties: Jose A. Rodriguez, MD Quality Of Life

Introduction: Hydroxyapatite coated stems have been used David A. Iacobelli, MD for almost thirty years with reliably good results. Subsidence *Jesus M. Villa, MD of a stem is a rare but sometimes serious complication. The Carlos J. Lavernia, MD aim of this study was to report the incidence of subsidence and correlate stem subsidence with pre-operative bony mor- Introduction: Scarce and outdated literature exists on quality phology, initial stem fi t, and femoral neck cut length. of life (QoL) in patients with both knees and hips replaced. In this very unusual cohort of patients who had primary knee/hip Materials and Methods: Retrospective review of consecu- multiple joint replacements (MJRs) we wanted to describe: tive case series done between May 2010 and December 2012 (1) how much QoL improvement they obtain after each proce- by single surgeon at a single institution. For the purposes of dure, (2) how high and when their best QoL state is reached, this study we looked at one particular stem design. 83 patients and (3) how their QoL compares with the normal age-matched had primary total hip replacement with the stem during that population. time period. Patients included into the study had complete radiographic follow-up (defi ned as pre-operative, immediate Methods: Eleven patients (44 joints) had their QoL deter- post-operative, 6 week post-operative and 1 year follow-up mined making use of the QWB-7. Preoperative QWB-7 radiographs). 70 patients met the criteria for radiographic obtained before the fi rst replacement served as baseline. Mean analysis. Patients with stem migration greater than or equal to QWB-7 obtained over time was recorded and compared with 1.5 mm were placed in the subsidence group. The remaining the one of the corresponding normal age-matched population. patients were placed into the control group. We used statistical Mean follow-up was 12 years (range, 7-19 years). analysis to identify differences between the two groups and to Results: Compared to the baseline, QWB-7 scores improved correlate stem migration with preoperative bony morphology, postoperatively at the latest follow-up (mean difference: initial stem fi t, and femoral neck cut length. 0.100, 95% confidence-interval [CI]: 0.034-0.167). After the Results: Four patients had stem migration greater than or fourth joint had been replaced, the best mean QWB-7 (0.638, equal to 1.5 mm. All cases were identifi ed on the 6 week post- CI: 0.554-0.721) was attained at an average of 5 years (range, operative radiograph. There was a signifi cant difference found 8 months-13 years). The best mean QWB-7 obtained over in femoral neck cut length and distal canal fi ll between the time compared favorably with the one of the normal age- subsidence and control groups. There were no signifi cant cor- matched population (0.661 vs. 0.616, respectively). Patient’s

136 28mm diameterballthemaximum principalstresswas 20.3 strains astheheadsincreased from28mmto40mm.For a Results: the hip. of 2.1MPa was appliedtosimulatea2.6body-weightforceat ments wereoverlaid ontetrahedron elements. A pressureload To bettercapturethesurface stress,fi modeled. The modelhad130.6knodesand93.2kelements. trunnion usingSimulia’s ABAQUS. Various headsizeswere Methods: and strainsinthetrunnion. consequences ofusinglarge headsontheresulting stresses heads implantedareCo-Cr. Ourobjective was toassessthe the USAtodayaremadeoutof Ti alloys andover 90%ofthe lus ofelasticitytitanium(Ti) alloys. Moststems used in Cobalt-chromium (Co-Cr)hasapproximatelytwicethemodu- since theintroductionofhighlycross-linked bearingsurfaces. Introduction: David A. Iacobelli,MD Carlos J.Lavernia, MD Jesus M. Villa, MD Turbocharged Big HeadsAnd Trunnions: Tribocorrosion Notes: lot ofthefunctioneven intheseseverely impairedpatients. eased jointsisquiteaffected. Arthroplasty surgery returnsa sustained. The qualityoflifepatientswithmultipledis- ment varied over timebut, formostpatients, itwas clearand compared withpreoperative levels. Postoperative improve- with themajorityofpatients,achieving ahigherQoLwhen who undergo MJRsattainsignifi Discussion low-up (0.577,CI:0.488-0.667). level comparedtonormalsubjects(0.616)bythelatestfol- mean QWB-7fl 8:45am–8:49am Trunnions hadasignifi A 3Dmodelwas constructedofastandard12/14

and Conclusion: The useoflarge headshasincreased10fold uctuated over timeanditwas ataninferior Ourdatasuggeststhatpatients cant increaseinstresses and cant improvement inQoL, rst ordermembraneele- Notes: double modulartrunnion. can bemagnifi contribute totribocorrosionandmetalionrelease. This effect and stressesatthetrunnionheadjunctioncansignifi strains atthetrunnion-headjunction. This increaseinmotion increase inheadsizesignifi Discussion andConclusion: stresses acrosstheballdiametersstudied. was 43.8MPa. Ourdatashows atwo-fold increaseintrunnion MPa, fora32mmballitwas 36.0MPa, andfora40mmballit each patientaccordingtoage, BMI,and ASA score. directly withthosewhowere privately insured. We matched patient rehabaftersurgery. Medicarerecipients werematched ing 2011weanalyzedpatients whoweredischarged toin- Methods: of stayaftertotaljointarthroplasty. evaluate whetherornotMedicare3dayruleincreaselength ing benefi prevent improperandexcessive utilizationoftheskillednurs- 3 days. The 3-daystayrulewas institutedseveral yearsagoto nursing facility ifitfollows ahospitalinpatientstayofatleast Introduction: Fabio R.Orozco,MD Zachary D.Post,MD Alvin C.Ong,MD Victor H.Hernandez,MD,MS Of Stay? Does Medicare3Day RuleIncreaseLength 8:20am–8:24am James J. Purtill,MD Moderator: (Station B,PlazaBallroom 1) Rapid Fire Session8B— Total KneeReconstruction Friday, October24,2014 ts underMedicare. The purposeofthisstudywas to Fromaconsecutive cohort of800 TKA donedur- ed ifanadditionalinterface exists, suchasina Medicarewillonlycover transfertoaskilled cantly augmentsthestressesand Ourmodelsuggeststhat Rapid Fire Session8B cantly 137

Friday EOA 45th Annual MeetingAmelia Island, Florida2014

Results: A total of 322 patients were discharged directly to Results: Overall and compared to Whites, African-Americans inpatient rehab facility after surgery. There were 209 Medi- were signifi cantly younger (70 vs. 64 years, respectively and care patients and 113 Private patients. The LOS was 2.3 days for all comparisons), had fewer Hispanics (75% vs. 32%), for privately insured patients and 3.02 for Medicare recipients. underwent more transfusions (28% vs. 42%), and had more No difference was found between the two groups with regards revisions (12% vs. 20%). In the primary group, the preopera- to age, BMI, and ASA score. tive diagnoses between the two groups were signifi cantly different. In addition and preoperatively, pain intensity (7.9 vs. Conclusion: We found Medicare 3 days rule increased the 8.2), QWB-7 total (0.532 vs. 0.527), SF-36 pain (36 vs. 33), length of stay of patients that needed inpatient rehabilitation and WOMAC-total (52 vs. 57) were signifi cantly different. when compared to patients who were privately insured. In the Postoperatively, pain intensity (0.58 vs. 1.44), QWB-7 total current medical economic climate, we recommend that this (0.607 vs. 0.578), SF-36 pain (69 vs. 64), and WOMAC-total outdated rule be revised in order to decrease unnecessary cost (5 vs. 9) were also signifi cantly different (MANCOVA). and expenditure. Discussion and Conclusion: African Americans underwent Notes: surgery early in life with more pain and functional impairment when compared to Whites. They had more revisions and worse preoperative and postoperative outcomes even on primary surgeries. Race seems to be strongly associated with outcomes. Particular attention should be given to the preoperative diagnoses and pain management on these patients.

Notes:

8:26am–8:30am

Race And Outcomes In Arthroplasty Surgery

Jesus M. Villa, MD Carlos J. Lavernia, MD 8:32am–8:36am David A. Iacobelli, MD Resource Consumption And Outcomes In Introduction: We wanted to study a large case-series of THA/ Total Knee Arthroplasty (TKA) TKA and to determine the relationships of race with outcomes as well as the root causes of disparities if any. Carlos J. Lavernia, MD David A. Iacobelli, MD Methods: A consecutive series of 2,435 cases (primaries/ Jesus M. Villa, MD revisions) performed in a single hospital by a single surgeon Lawrence Brooks, PhD was studied. Revisions due to infections were excluded. Data on race was available for 2,288 cases which were fi nally Introduction: Patient’s psychosocial and functional outcomes included. African-Americans (AA) (n=131) and Whites are associated with the fi nancial aspects of TKA in our stud- (n=2,157) were compared on demographics, preoperative ied sample. diagnoses, Charlson, ASA; length of stay (LOS); transfusion rates; discharge disposition (home vs. facility); preoperative Methods: We retrospectively studied 131 consecutive unilat- and postoperative pain intensity as measured by a visual ana- eral TKA patients (mean age 71.8 years; 72.5% women). We logue scale (VAS, 0-10), QWB-7, SF-36, WOMAC, Hip Har- extracted fi nancial information from the hospital’s account- ris and Postel-D’Aubigne scores, HSS Knee score as well as ing software that included charges, direct costs, and indirect Knee Society Knee and Function Scores. T-tests, Chi-Square, costs. Each patient was administered the QWB-7, SF-36, and and MANCOVA (to adjust for age, ethnicity, and diagnosis) WOMAC. Functional measures included the Hospital for Spe- were used. cial Surgery scale (HSS) and the Knee Society Function Score

138 which 1539hadliver failure. Operative fi resulted inatotalof128,700 closed hipfracturepatients,of using theElixhausercomorbidity setfrom2002-11. This base. Patients with CLFwereidentifi identifi Methods: with ahigherriskofcomplicationafterhipfracturesurgery. pose ofthisstudywas toevaluate ifliver failure isassociated osteoporosis secondarytoalteredbonemetabolism. The pur- living longerandconsequently, aremorelikely todevelop Introduction: Alvin C.Ong,MD Fabio R.Orozco,MD Mitchell G.Maltenfort,PhD Zachary D.Post,MD Antonia F. Chen,MD,MBA Chronic LiverFailure Femoral Neck FractureInPatients With After Higher MorbidityAndMortality Notes: rect costsfor TKA. cantly associatedwithhighercharges, directcosts,andindi- Discussion andConclusion: -0.42), directcosts(r=-0.40),andindirect-0.39). low-up was signifi -0.36; KSFS,r=-0.44). The QWB-7scoreatthe2-yearfol- (HSS, r=-0.47;KSFS,-0.46),andindirectcosts with: charges (HSS,r=-0.41;KSFS,-0.46),directcosts three months,theHSSandKSFSweresignifi strongest atthreemonthfollow-up (p’s lessthan0.001). At cost andfunctionaldataatall-timepoints. This fi Results: T-tests wereusedtoassesstheeffects ofgenderandethnicity. tions wereusedtoevaluate therelationshipbetweenvariables. and 24monthfollow-up. Pearson-product momentcorrela- (KSFS). Datawas collectedpre-operatively andat3,6,12, 8:38am–8:42am ed fromtheNationwide Inpatient Sample(NIS)data- A signifi A Patients withclosedfemoralneckfracturewere Patients withchronicliver failure (CLF)are cant inverse relationshipwas foundbetween cantly inversely correlatedwith:charges (r= Worse outcomesaresignifi ed withinthisgroup xation consistedof cantly correlated nding was - ships retainingleg lengthandappropriatehipoffset. Multiple fractures allows preservation of anatomickinematicrelation- Introduction: Thomas M.Schaller, MD J. ScottBroderick,MD Stephanie L. Tanner, MS Lawrence K.O’Malley, MD Fractures Direct ReductionOfPeritrochanteric Effects OfFractureUnion With Notes: cially withregards tobloodandwound management. should betaken whenmanagingthispatientpopulationespe- higher associatedmorbidityandmortality. Extraprecaution ure sustainfemoralneckfracturesatayoungerage,andhave Discussion andConclusion: CLF patientswhohadamedianstayof5days(p<0.001). patients was 6days,whichwas signifi 1.64, 95%CI1.11-2.41). The medianlengthofstayforCLF 95% CI1.41-1.83)andwound complications(p=0.01,OR CI 1.56-2.90),greaterriskoftransfusion(p<0.001,OR1.60, tality thanthosewithoutliver failure (p<0.001,OR2.12,95% internal fi to receive ahemiarthroplastyassurgical fi (29.8%, p<0.001).Bothpatientpopulationsweremorelikely male (47.8%)comparedtonon-chronicliver failure patients patients withfemoralneckfracturesweremorelikely tobe without liver failure (78.3years±12.9,p<0.001).CLF at youngerages(67.9years±12.8)comparedtopatients Results: tivariate logisticregression. were evaluated. Statisticalanalysiswas performedusingmul- ity, lengthofstay(LOS),andpostoperative complications intervention wereexcluded. Gender, age,in-hospitalmortal- arthroplasty (THA).Patients managedwithmorethanone hemiarthroplasty (partialhip),internalfi 8:44am–8:48am xation and THA. Patients withCLFhadhigher mor- Patients withCLFsustainedfemoralneckfractures Anatomic reduction ofperitrochanterichip Patients withchronicliver fail- Rapid Fire Session8B cantly longerthannon- xation, ortotalhip xation, followed by 139

Friday EOA 45th Annual MeetingAmelia Island, Florida2014

articles have described clamp-assisted reduction for diffi cult Friday, October 24, 2014 subtrochanteric and femoral shaft fractures, however little has been written describing direct reduction of intertrochanteric Rapid Fire Session 8C — Hip & Spine fractures. The aim of this study is to evaluate union rates and (Station C, Ritz-Carlton Ballroom Foyer) reduction quality of peritrochanteric (intertrochanteric and subtrochanteric) hip fractures reduced using open, biologi- Moderator: John D. Kelly IV, MD cally friendly direct reduction techniques and fi xed with cephalomedullary fi xation or side plate hip screw. 8:20am–8:24am Methods: We retrospectively reviewed peritrochanteric hip fractures (OTA 31A1-A3) between 2006 and 2013 in which Femoral Acetabular Impingement In some form of direct reduction was used prior to and/or dur- Patients Undergoing Total Hip Arthroplasty ing fi xation. Direct reduction was used when positioning and traction alone were unsatisfactory in correcting alignment and Kyle E. Fleck, MD displacement. All patients who had a low-energy fall, were Kris Wheeler, MD at least 50 years old, and treated by one of two orthopaedic Edmund Z. Brinkis, MD trauma surgeons were included. The outcomes measured included: instruments used for direct reduction, intraoperative/ Introduction: Increasing evidence has emerged that supports postoperative alignment, and radiographic union rates. femoroacetabular impingement as a major cause of osteoarthritis of the hip in young adults. A review of the literature Results: Overall, forty-one patients were included, with reveals no studies looking at the prevalence of FAI in patients an average age of seventy-four years old. All patients had that have undergone total hip arthroplasty. Our hypothesis is anatomic or near anatomic reduction (within 5 degrees of that there will be a high prevalence of patients with previously anatomic) assessed with intraoperative fl uoroscopy. The undiagnosed femoroacetabular impingement undergoing total instruments used for direct reduction included clamps, push- hip arthroplasty. ers, cobbs, bone-hooks, K-wires and unicortical plates. The overall primary union rate was 93%, with three patients devel- Methods: We evaluated the prevalence of FAI in patients oping a nonunion requiring revision surgery. All patients with that underwent primary total hip arthroplasty at our institu- primarily united fractures maintained their anatomic reduction tion beginning January 1, 2010, thru December 31, 2012, by at fi nal follow-up. inspecting the patient’s preoperative radiographs for signs of pincer or cam impingement. Pincer impingement was diag- Discussion and Conclusion: With the use of biologically nosed by evidence of acetabular retroversion or by evidence friendly direct reduction techniques, near anatomic reductions of global acetabular over coverage. Cam impingement was can be obtained in low-energy peritrochanteric fractures with diagnosed with an alpha angle greater than 50.5° on the AP minimal complications. This data supports the use of direct Pelvis or lateral hip radiograph. reduction for peritrochanteric hip fractures when indirect reduction techniques alone are insuffi cient. Results: The study consisted of 116 right hips and 124 left hips to evaluate for cam and pincer impingement. The mean Notes: alpha angle on the right was 71.4° (range: 32.6-103°) and 71.2° (range: 24.5-118°) on the left. An alpha angle greater than 50.5° was found on 91.3% right hips and 85.4% left hips. Evidence of pincer impingement was found in 89% of the patients with at least one positive sign and 45% of patients had at least four positive signs. Coxa Profunda was the most common sign of pincer impingement with 63% and 64% of the right and left hips being positive, respectively. 98% of the patients had at least one positive radiographic fi nding of either cam or pincer impingement.

Conclusions: A large number of patients undergoing total hip arthroplasty at our institution had previously undiagnosed

140 Background: Oliver Sax,BA Jaron Sullivan, MD Anil S.Ranawat, MD PatternInjury Labral BaseHematoma: A Tension-Sided Notes: this processisamajorcauseofhiparthritis. femoroacetabular impingementgiving furtherevidence that ± 6.57;acetabular version (3o’clock),14.91±7.19;femoral (1 o’clock),2.29±7.3;acetabular version (2o’clock),10.67 ± 8.87. The mean CT measurementswere:acetabular version coronal centeredge,25.36± 6.73; sagittalcenteredge,23.6 radiographic measurementsangles were:alpha,47.82±5.74; and CTfi hematoma. Labralbasehematomapatientshadradiographic had intra-operative fi phic labrumwithlabralbasehematomaand7(5.0%)patients in thisstudyperiodwhere11(7.8%)patientshadahypertro- Results: motion. radiography andcomputerizedtomography(CT),rangeof included pre-operative fi score outcomes,andintra-operative pictures. Additional data data includedpatientdemographics,procedures,functional who displayedlabralbasehematomawereselected.Collected bloody fl period. Labralbasehematomaisdefi Methods: hematoma andcorrespondingbonemorphologyofthehip. tive istoinvestigate theetiologicalfactors of basallabral computerized tomography fi a hypertrophiclabraltearassociatedwithradiographicand is thatlabralbasehematomaamoresignifi articular injuryassociatedwithhipinstability. Ourhypothesis known aslabralbasehematoma,auniquetension-sidedintra- 8:25am–8:29am uid locatedwithinahypertrophiclabrum.Patients ndings consistentwithmildinstability. The mean The seniorauthorperformed141hiparthroscopies This was aprospective casestudyover atwo year This studyidentifi ndings consistentwithalabralbase ndings ofpatientexam, intra-articular ndings ofinstability. The objec- es anintra-articularfi ned asanarticular-sided cant injurythan nding 13 (68%)patientswalked withaneutralfoot progression,4 Results: changes infootprogressionangles. to determinerelationshipsbetween FAI, gait, andpainwith surements ofFAI were collected. This datawas analyzed Pain associatedwitheachgaitwas recordedandx-raymea- rotation (+15º)gait fromtheir normalbaselineprogression. were instructedtowalk withaninternal(-15º)andexternal patients whopresentedwithhippainwereselected.Patients Methods: in footprogressionangle. sion angle,aswellevaluate changesinpainwith gate therelationshipbetweenFAI andbaselinefootprogres- these lesions. The objective ofthepresentstudyistoinvesti- and internalrotation,duetoamechanicalblockcreatedby decreased rangeofmotionandpain,particularlyinfl acetabulum (pincerlesion).Patients withFAI generallyhave head-neck junctionofthefemur(CAMlesion)and/ordeep condition defi Background: Oliver Sax,BA James Satalich,BS Rachael Taylor,MPAS Anil S.Ranawat, MD Gait AndFemoralAcetabular Impingement Notes: bility. also beconsistentwithanintra-articularfi with impingement. Additionally, labralbasehematomamay This isdifferent thanacompression-sidedlabraltear, seen hematoma, whichwefeelisatension-sidedlabralbaseinjury. Conclusion: tistically signifi 13.93 ±4.97.Comparisonofthetwo cohortsrevealed nosta- version, 13.5±11.12. The meaninternalrotationat90ºis 8:30am–8:34am 19patientspresentedtotheclinic withhippain. Inaclinicalprospective studystarting2/11/14, This isthefi ned byabnormaldevelopment ofboneatthe Femoral acetabular impingement(FAI) isa cant difference. rst descriptionofalabralbase Rapid Fire Sesseion8C nding ofhipinsta- exion 141

Friday EOA 45th Annual MeetingAmelia Island, Florida2014

(21%) walked with an out-toe gait, and 1 (5.3%) walked with suffered a recurrence of disease in the follow up period. One an in-toe gait. X-ray measurements indicated a high incidence patient progressed to total hip replacement. None developed of FAI in those who walk with neutral and out toe progression avascular necrosis. Complications included one screw removal at baseline, and also with increased pain with internal rotation. for prominence. All patients wereambulatory and complained of minimal pain at last follow up. Conclusion: People with FAI are more likely to walk with a neutral to out-toe progression, and have increased pain with Conclusion and Discussion: Intra-articular neoplastic pathol- internal rotation. This can be used in the clinical setting as a ogy of the hip is rare and extremely difﬁ cult to control. We diagnostic tool. The present analysis will help clarify biome- studied the outcomes of 8 patients who underwent surgi- chanical associations between gait and hip pain. cal dislocation and total synovectomy for intra-articular hip pathology. We found that although one patient progressed Notes: to total hip arthroplasty, none suffered a recurrence or major complication. All had reasonable functional outcomes with respect toambulation and pain. Surgical dislocation is therefore a reasonable procedure for treatment of these neoplastic synovial conditions of the hip.

Notes:

8:35am–8:39am

Intra-Articular Hip Pathology Can Be Treated With Surgical Hip Dislocation

John A. Abraham, MD Brandon J. Shallop, MD 8:40am–8:44am Javad Parvizi, MD, FRCS

As in other joints, PVNS and synovial chondromatosis of the How Does State Income And The Number hip requires total synovectomy for treatment. Although chal- Of Uninsured Patients Relate To Hospital lenging, total synovectomy can be performed in the hip via a Charges For Spine Care? surgical dislocation. No recent studies have studied hip dislocation and synovectomy as a surgical treatment option for Kushagra Verma, MD, MS PVNS or synovial chondromatosis of the hip. The purpose of Eric M. Padegimas, MD this study is to evaluate the outcomes of patients treated with Alexander Vaccaro, MD, PhD surgical dislocation and total synovectomy of the hip speciﬁ - Todd J. Albert, MD cally for PVNS or synovial chondromatosis. Alan S. Hilibrand, MD Kristen E. Radcliff, MD Methods: We retrospectively reviewed an institutional database to identify patients who underwent hip dislocation and Introduction: Charge and reimbursement data from the synovectomy as treatment for PVNS or synovial chondro- Centers for Medicare Services demonstrated signiﬁ cant varia- matosis of the hip. Selected patient records were queried and tion in the hospital charge and charge to reimbursement ratio analyzed for recurrence rate, function, complications, and (CRR) of spine care across the country. The purpose of this conversion rate to total hip post hip dislocation and synovec- study is to determine if the state-to-state variation is correlated tomy. All patients were followed for a minimum of 2 years with state income and the percent of uninsured patients using with follow up MRI and clinical examination. data from the United States Census Bureau.

Results: 8 patients were identiﬁ ed with either PVNS or syno- Methods: Four “diagnosis related groups” were analyzed: vial chondromatosis of the hip. All patients underwent surgi- 460 (Thoracic/lumbar fusion), 473 (Cervical spine fusion), cal dislocation and total synovectomy. Of the 8 patients, none 491 (Nonfusion back/neck), 552 (Medical back). For each

142 Notes: mean income. doxically, reimbursements tendtofavor stateswithhigher recoup fi each state. These increasedcharges mayrefl care increasewiththenumberofuninsuredpatientswithin Conclusions: CRR was associatedwith%uninsured(0.530/<0.0001). (0.605/<0.0001) andinversely with%insured(-0.299/0.05). (0.377/0.006). Reimbursement correlatedwithincome Medical Back:Charge correlatedwiththe%uninsured (0.524/<0.0001). (0.675/<0.0001). CRRwas associatedwith%uninsured (0.415/0.002), whilereimbursement correlatedwithincome Nonfusion Surgery: Charge correlatedwiththe%uninsured (0.623/0.001). (-0.264/0.080). CRRwas associatedwith%uninsured (0.675/<0.0001), andwas inversely relatedto%uninsured (0.288/0.040). Reimbursement correlatedwithincome Cervical fusion:Charge correlatedwiththe%uninsured (0.623/<0.001). with income(-0.311/0.043)andassociated%uninsured income (0.612/<0.0001).CRRwas inversely correlated % uninsured(0.519/<0.0001),whilereimbursement with Results: with aPearson’s correlation. % uninsuredwas investigated. Associations weredetermined the correlationbetweencharge, reimbursement, andCRRto ment, andCRRtostateincomewereanalyzed.Inaddition, group, thecorrelationbetweenmedicarecharge, reimburse- nancial lossesfromtreatinguninsuredpatients.Para- Thoracic/lumbar fusion:Charge correlatedwith Overall, hospitalcharges andCRRforspine ect aneffort to (0.33/0.091). total score(0.39/0.043)with a trendtowards betterhealth transferring (0.52/0.006),overall function (0.51/0.006),and improved sitting(0.40/0.035),while higher T1PA improved – seefi incidence (PI),sacralslope(SS),and T1 Pelvic Angle (T1PA ments. Given thatSVA mayvary withpatientposition,pelvic (0.30/0.015). Nocorrelationwas foundwithothermeasure- (0.24/0.38), overall function (0.25/0.30),andtotalscore tion betweenSVA andtransfers(r=0.27,p0.026),social sitting tolerance(294±166min). There was alinearcorrela- (61±19), overall function(70±22),totalscore(56±15),and (43±18), comfort/emotions(80±18),social(55±29),health Clinical outcomes:dailyliving (43±18),transfers/mobility (-53±17°), andsagittalvertical axis(SVA, -0.3±6.6cm). uity (8.1±6.8°), T2-T12 kyphosis (36±16°), T12-S1 lordosis radiographic parameters:majorCobb(29±16°),pelvicobliq- (2008 –2011)with2-yearfollow-up wereincluded.Mean Results: 6 domains,eachscored0to100(best). and clinicaloutcomesusingtheCPCHILDQuestionnaire– relationship betweenmultipleradiographicmeasurements were studied.UsingPearson’s correlation,weevaluated the cal outcome,sittingtolerance,andseatedradiographicdata CP whounderwentPSFtothepelvis.Demographic,clini- reviewed prospectively collected datafrompatientswith Methods: palsy (CP). restored sagittalbalanceandclinicaloutcomesincerebral patients. This studyevaluated theassociationbetween patients but nosuchguidelinesexist forprimarilyseated been associatedwithadverse outcomesinadultdeformity Introduction: Paul D.Sponseller, MD Burt Yaszay,MD Peter O.Newton, MD Firoz Miyanji,MD Suken A. Shah,MD Kushagra Verma, MD,MS Deformity Cerebral Palsy Patients With Spinal Clinical OutcomesForNon-Ambulatory Restoring Sagittal BalanceImproves 8:45am–8:49am gure) weremeasuredonasubsetofpatients.HigherPI 93patients(age13.7±2.7yr)whounderwentPSF Fromamulticenterdatabase,weretrospectively A positive sagittalbalance(>5cm)has Rapid Fire Sesseion8C 143

Friday EOA 45th Annual MeetingAmelia Island, Florida2014

Conclusion: Restoration of sagittal balance to a neutral or tively will be the basis for defi ning the retear and contralateral slightly positive SVA and T1PA are associated with better ACL tear rates in the NFL population. transferring, function, social interaction, and total care-giver satisfaction in CP. Beyond a certain threshold, however, a Methods: An internet search was utilized to identify NFL positive SVA or T1PA is likely detrimental. T1PA can be players who incurred an ACL injury in the 2013 season. All evaluated intra-operatively in the prone position to improve identifi ed players were confi rmed to have an ACL tear on the the clinical outcomes of these children. NFL injury report. A separate search was then undertaken to identify which tears represented a repeat ACL rupture after Notes: primary reconstruction and which players had previously suffered a contralateral ACL injury.

Results: 56 ACL ruptures were identifi ed throughout the 2013 season from mini-camps, training camps, throughout the pre-season and regular season, and into the playoffs through 1/12/14. 2/56 (3.5%) of the ACL tears represented a repeat ACL injury while 3/56 (5.4%) represented a player who had incurred a contralateral ACL tear. In the remaining Friday, October 24, 2014 ACL injuries 51/56 (91%), a history of previous ACL injury was not obtainable and therefore deemed to be a primary Rapid Fire Session 8D — Knee ACL injury. (Station D, Ritz-Carlton Ballroom Foyer) Moderator: Joshua S. Dines, MD Conclusion: The incidence of ACL retears and contralateral ACL injuries in NFL players was calculated at nearly 9% of ACL tears in 2013. This percentage likely underestimates 8:20am–8:24am the actual incidence as each player’s complete medical history was unavailable for close review. These fi ndings illus- trate that both repeat ACL injury after reconstruction and The Incidence Of Repeat ACL Injury And contralateral ACL injury are signifi cant problems for the Contralateral ACL Injury In NFL Players In NFL athlete. 2013 Season Clinical Relevance/Future Directions: Defi ning both the Daniel Woods, MD ACL retear rate and the contralateral ACL tear rate can pro- Peter Deluca, MD vide signifi cant information in counseling players undergo- Christopher Dodson, MD ing ACL reconstruction as well as provide important infor- Matthew R. Salminen, BS mation regarding player personnel decisions. This initial epidemiologic study provides the basis for future prospec- Background: ACL injuries are common in the elite NFL ath- tive studies to accurately defi ne these values, and eventually lete, and ACL reconstruction has been effectively utilized to identify specifi c risk factors for ACL retear and contralateral allow athletes to continue to participate in NFL competition. ACL tear. Recent data by Andrews et al reports a 63% return to play rate after ACL reconstruction with more experienced, established Notes: and higher round draft picks returning at a much higher rate.1 Repeat ACL rupture after reconstruction as well as the rate of contralateral ACL ligament injury has been defi ned in the general population by Bourke et al, who noted survival of the ACL graft to be 95%, 93%, 91% and 89% at 2,5,10 and 15 years and the survival of the contralateral ACL graft to be 97%, 93%, 90% and 87% at 2,5,10 and 15 years after primary ACL reconstruction.2 This initial epidemiologic study sought to defi ne the incidence of repeat and contralateral ACL tears in the NFL in 2013. Continuing to compile this data prospec-

144 scores, indicatingthatbiologic healingisnotapre-requisite sion; however, thisdidnotcorrelate withfunctionaloutcome and healingwas associatedwithdecreasedmeniscus extru- ing excessive stressinducedbytherepair. Successful repair meniscus tearsaway fromtherepairin4/6patients,indicat- of themeniscusroot. There was anincrease in peripheral Conclusion: series. relation betweenhealingandclinicaloutcomescoresinthis scores were14.7and79.6respectively. There was nocor- sion averaged 1.57mm. The average WOMAC andLysholm averaged 1.8mm.Inpatientswithevidence ofhealing,extru- patients withrecurrenttearsoftheroot,meniscalextrusion of tearorlackbiologichealingtherootattachment.In repair in4/6patients.3patientsdemonstratedrecurrence 23-41). MRIdemonstratedanew tearmedialtotheprior group. The average follow-up timewas 29months(range Results: gists accordingtopre-defi reviewed bytwo fellowship trainedmusculoskeletal radiolo- healing was assessedusinga3 Tesla MRI.studieswere using Lysholm and WOMAC scoresandqualityofmeniscus cal techniquebyasinglesurgeon. Outcomesweredetermined medial meniscusrootrepairusinganidenticalpull-outsurgi- Methods: outcome. high resolutionMRIandcorrelatethisappearancetoclinical evaluate thebiologichealingofmeniscusroottearsthrough tibial attachment. The purposeofthisinvestigation was to restoration ofthemeniscusthroughbiologichealingto Reversal ofthisoutcome ispredicatedonthesuccessful in contactareaoftheaffected compartmentoftheknee. loss ofhoopstress,increasedpeakpressure,andreduction Introduction: Matthew Pepe,MD MD Amy Austin, David Levi, MD Bradford S. Tucker, MD Gregory T. Lichtman,MD Nicholas Lombardi,BS MD Fotios Tjoumakaris, Healing andHow Do We Tell? Medial MeniscusRootRepair: Are We 8:26am–8:30am There were4femalesand2malesinthestudy Sixpatientswereidentifi 3of6patientsdemonstratedrecurrenttearing Meniscusroottearsareassociatedwith ned criteria. ed ashaving undergone a Notes: ies evaluating rotatorcuff repair. for clinicalhealing. A similarfi term safetyandeffi Discussion: were observed. such asinfection,patellarfracture, subluxationordislocations revealed nomal-alignment,orosteolysis.Nocomplications cally insignifi groups. AKP incidencebetween Attune andPFCwas statisti- Results: and patellardisplacementbytwo independentobservers. set, posterioroffset, jointline,patellarthickness,tilt measurements includedoverall limbalignment,anterioroff- spectively withminimum6monthfollow-up. Radiographic facing. Clinicalandradiographicanalysis was performedpro- formed viamedialparapatellarapproachwithpatellarresur- gender, andbodymassindex (BMI). All surgeries wereper- (Depuy) werematchedtothePFCSigmagroupbasedonage, 55 consecutive posteriorstabilizedcemented Attune TKAs Material andMethods: AKP inamatchedpairanalysis. cacy andperformanceof ananatomicpatellaanditseffect on prospective, matchedpairstudywas toassessthesafety, effi rotation, patellartiltandoverstuffi patellofemoral maltracking,trochleargeometry, femoralmal- Potential implant/techniquerelatedcontributors to AKP are cause ofpatient’s dissatisfaction aftertotalkneearthroplasty. Introduction: Chitranjan S.Ranawat, MD *Morteza Meftah,MD Amar S.Ranawat, MD Prospective Matched-Pair Analysis Knee Pain, CrepitationAndSatisfaction: A Effect OfAnatomicalPatella OnAnterior 8:32am–8:36am The meanfunctionaloutcomesweresimilarinboth Attune kneedesign demonstratesexcellent short- cant (3.6%and3.8%).Radiographicanalysis Anterior kneepain(AKP)isarecognized cacy. At minimum6-monthfollow-up, BetweenJuly2012andMay2013, nding hasbeenshown instud- ng. The primaryaimof this Rapid Fire Session8D 145 -

FridayFriday EOA 45th Annual MeetingAmelia Island, Florida2014

anatomical patella with shows less AKP than single radius (range:0-86,StDev:20.15) respectively. Obesity (BMI >30) patella design. Longer follow-up is required to assess func- had no effect on reported Lysholm (67.65±24.30) or WOMAC tional outcome of this design. (19.46±21.34) scores. In this series, 2 patients (3.2%) developed an infection, 1 patient (1.6%) experienced delayed union Notes: and 3 patients (4.8%) required surgical lysis of adhesions. At follow-up 17 patients (27.4%) received viscosupplementation, 13 patients (21.0%) had undergone surgery to remove painful hardware and two patients (3.2%) required total knee replacements.

Conclusion: HTO delays the need for total knee replacement and is an effective procedure in both obese and non-obese patients alike. While many patients in this study continued to require treatment for their osteoarthritis, only a small few felt their pain severe enough to warrant further surgical interven- 8:38am–8:42am tion.

Medial Opening Wedge High Tibial Notes: Osteotomy, A Retrospective Review Of Patient Outcomes Over 10 Years

Fotios Tjoumakaris, MD Nicholas Lombardi, BS Bradford S. Tucker, MD Matthew Pepe, MD

Introduction: High tibial osteotomy (HTO) has become a well-established treatment for unicompartmental osteoarthritis 8:44am–8:48am of the knee. Over the last 30 years, various techniques have been used to treat this ailment. The purpose of this study is to Painful Orthopaedic Hardware May Be retrospectively review the outcomes of patients who received Associated With Subclinical Infection medial open wedge HTO over the last ten years (2002-2012) using a modern, low profi le fi xation device. In addition, we Hemil H. Maniar, MD sought to determine if obese patients had a less favorable out- Nathaniel C. H. Wingert, MD come than their non-obese counterparts. Kristin McPhillips, MD, MPH Michael A. Foltzer, MD Materials and Methods: Ninety-three patients were prospec- Thomas Bowen, MD tively identifi ed from a surgical database as having undergone Daniel S. Horwitz, MD a HTO by one of two fellowship trained orthopedic surgeons from 2002-2012 utilizing a low profi le fi xation device. Mini- Introduction: Sonication is a promising technology that has mum follow-up was one year for inclusion in the study. Out- recently demonstrated subtle, clinically silent implant infec- comes were measured using Lysholm and WOMAC scores. tions to be a cause of certain orthopaedic treatment failures. Radiographs were evaluated to determine delayed union or Subclinical infection is a possible cause of painful hardware non-union at the osteotomy site. after osteosynthesis, but has not previously been investigated using sonication. Results: 93 patients were identifi ed from the database 62 (68%) were available for follow-up and are included in this Methods: A total of 72 consecutive patients underwent hard- analysis. Average follow-up time was 48 months (range 17 to ware removal for pain (52 patients) or for scheduled routine 137). There were 43 males and 19 females. The average age removal (20 patients). All were treated at a single medical was 45 years old. The average fi nal Lysholm and WOMAC center from September 2010 to May 2013. Sonication cultures scores were 62.78 (range:13-95,StDev:24.95) and 18.55 were obtained for all explanted hardware during this time

146 graphic stagingofbasilarthumb arthritisdoesnotpredict Introduction: Pedro K.Beredjiklian,MD Nayoung Kim,BS Kevin Lutsky, MD Jonas L.Matzon,MD C. Edward Hoffl Joint Arthritis With SymptomSeverity In Thumb Basilar Radiographic StageDoesNotCorrelate Notes: with concurrentorstagedjointarthroplasty. hardware, andespeciallyforapatientundergoing removal sonication shouldbeconsideredforpatientswithpainful trauma hardware have subclinicalimplantinfection.Implant Discussion andConclusion: clinical signsofinfectionpostoperatively. treated withprophylactic oralantibioticsandnonemanifested sonication result(0%).Patients withpositive sonicationwere undergoing scheduledroutineremoval, noneshowed positive implant bacterialcolonization(9.6%).Outof20patients for pain,fi Results: units). growth ofgreaterthanorequalto20CFU(colony forming conducted. Sonicationresultswereconsideredpositive for period andaretrospective review ofsonicationresultswas 8:20am–8:24am Henry A. Backe Jr., MD Moderator: (Station E,Ritz-CarltonBallroom Foyer) Rapid Fire Session8E—Mixed Topics Friday, October24,2014 Outof52patientsundergoing hardware removal ve hadpositive sonicationresultconsistentwith Conventional wisdom hasheldthatradio- er II,MD,PhD A subsetofpatientswithpainful Notes: ing oftreatmentresponse. arthritis mayimprove surgical decision-makingandmonitor- radiographic andsubjective componentsofthumbbasaljoint study toconfi complaints anddegree ofradiographicseverity, thisisthefi traditionally heldadisconnectbetweenpatient’s subjective degree ofpatientsymptoms. While conventional wisdomhas disease inthumbbasaljointarthritisdoesnotcorrelatewith Discussion andConclusion: stage was foundtobegoodexcellent. results (p>0.600).Interobserver reliabilityforradiographic patients. Dominanthandinvolvement didnotaffect survey (rho=0.14). The dominanthandwas involved in40%(25)of = -0.013),SF-12mental(rho0.019)orphysical Eaton-Littler stagedidnotcorrelatewithQuickDASH (rho (n=20) stage2,45%(n=28)3,and10%(n=6)4. on radiographicgrade,therewere13%(n=8)stageI,32% 62.3 years(range32-81),wereenrolledinthestudyBased Results: radiographic stageandobjective outcomemeasures. analysis was utilizedtodeterminethecorrelationbetween radiographic osteoarthritisstageforeachpatient.Statistical fellowship-trained handsurgeon assignedanEaton-Littler diagnoses, orunwillingnesstoparticipatewereexcluded. A physical surveys. Patients withbilateraldisease,concomitant scores, includingtheQuickDASH, SF-12mental,and evaluation. All patientscompletedself-reported disability was basedonhistory, physicalexamination, andradiographic unilateral thumbbasilarjointosteoarthritis. The diagnosis who presentedtoahandsurgery clinicwiththediagnosisof Methods: validated outcomemeasuresofsymptomseverity. lar thumbarthritisradiographicstagedoesnotcorrelatewith patient-reported symptomseverity. We hypothesizethatbasi- Fifteenmenand47women, withanaverage age We prospectively enrolledconsecutive patients rm thisscientifi cally. Validated metricsthatlink The severity ofradiographic Rapid Fire Session8E rst 147

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aggressive solution conditions on the corrosion performance 8:26am–8:30am of different tapers.

Electro-Chemical Testing Results Of Notes: Conventional Hip Stems

Ahmad Faizan, PhD Viswanathan Swaminathan, PhD Jim Nevelos, PhD Kevor TenHuisen, PhD R. Michael Meneghini, MD

Introduction: Electro-chemical testing has been used to understand the corrosion potential of hip replacement systems [1]. This in vitro test was designed to evaluate the relative electro-chemical performance of three different commercially available hip femoral component tapers to understand 8:32am–8:36am the effect of taper material combination: Ti6Al4V/CoCrMo [Accolade II] vs. TMZF/CoCrMo [Accolade TMZF]) and Post-Operative Complications Following design: V40 taper [Accolade II] vs. C taper [Secur-Fit] on the Hemiarthroplasty In Patients On Warfarin electro-chemical performance under physiologically relevant loading conditions. Kristin McPhillips, MD, MPH Hemil H. Maniar, MD Methods: Testing involved a short-term loading scheme Jove Graham, PhD where cyclic load magnitude was incremented in steps (from Daniel S. Horwitz, MD 100 N up to 3200 N, 3 min at each load at 3 Hz, R=0.1) followed by a long-term loading scheme where cyclic loading Introduction: There has been an increase in the number of continued for 1 million cycles (3200 N at 3 Hz, R=0.1). After patients taking warfarin, but no specifi c recommendations 1 million cycles loading, samples were allowed to recover exist regarding the reversal of anticoagulation prior to hemiar- for a period of time and the short-term loading scheme was throplasty. The risk of bleeding is thought to be less if the INR repeated. All tests were performed in phosphate buffered is less than 1.5 at the time of surgery. We sought to examine saline solution at room temperature. Electrochemical mea- the effect of INR at the time of surgery on the risk of post- surements were taken periodically throughout the duration of operative hematoma or infection. the test. Methods: This study was a retrospective review of electronic Results: The results showed that the average current and health records from patients who underwent hemiarthroplasty currentamplitude increased and the potential dropped with for a femoral neck fractures at level 1 and level 2 trauma cen- increasing load magnitude. For different groups, the onset ters who were taking warfarin and had an INR more than 1.3 load ranged from 960 to 1204 N, and the mean currents at upon admission. INR at admission and at surgery, time from maximum applied load ranged from 1.3 to 2.2 µA. No sta- presentation to surgery, estimated blood loss, and the surgery tistically signifi cant differences were observed between dif- length were recorded. The primary outcome was hematoma or ferent taper designs or material combinations tested in this deep infection (HDI) requiring reoperation within 60 days. study. Results: 91 hips in 88 patients were included in the study. Discussion and Conclusion: The results from this in vitro Mean INR at admission was 2.49 (range 1.34-8.20) and bench top testing showed that these differences in material the mean time until surgery was 42 hours. Mean INR at the combination and taper design did not infl uence the electro- time of surgery was 1.52 (range 1.05-2.28). There were 7 chemical performance of the tapers. Further study will include HDI (5 confi rmed infections and 2 noninfected hematomas) exploration of the effects of taper surface fi nish, taper assem- that required reoperation within 60 days of the procedure; bly conditions, more complex loading mechanisms, and more 6 patients with HDI had INR more than 1.5 at the time of

148 samples t-testswereusedtoanalyze continuousvariables. as moderateorvigorousbased on ACSM guidelines.Paired radiographic evaluation. Sporting activities werecategorized included Lysholm, Tegner, andHSSscoringcomplete Preoperative andannualpostoperative clinicalevaluation BMI 26.27(range18.1-40.4)]wereperformedbyKDP. [15 men,39women; meanage67years(range43-87); Methods: sports participationonsurvivorship oflateralUKA. study was todeterminelong-termoutcomesandtheimpact of pared toitsmedialUKAcounterpart. The purposeofthis (UKA), however, somehave suggestedinferiorresultscom- increased theuseoflateralunicompartmentalarthroplasty ~10% ofallosteoarthriticknees.Expandedindicationshave less commonthanisolatedmedialdisease,accountingfor Introduction: Kevin D.Plancher, MD DO Jeffrey Alwine, Stephanie C.Petterson,MPT, PhD And Return-To-Sport Arthroplasty Yields SuccessfulOutcomes Knee Lateral Unicompartmental Notes: thromboembolic disease. reversal ofanticoagulationmayresultinincreasedrisk loss, hematomaandinfection,but thatamoreaggressive INR atthetimeofsurgery maypredisposetoincreasedblood Discussion andConclusion: time ofsurgery. than 1.5and237mLforpatientswithINRmoreat estimated bloodlosswas 177mLforpatientswithINRless embolic complicationshaving INR below 1.5died. The mean surgery, 1hadanINRbelow 1.5. Two patientswiththrombo- 8:38am–8:42am From 2001to2013,54lateralUKAin49patients Isolated lateralcompartmentosteoarthritisis Ourdatasuggestthathigher Notes: with isolatedlateralcompartmentdisease. years, demonstratesthesuccessofthisprocedureforpatients affect outcome.Low recurrencerate,<5%atanaverage of5 ties. Returntodemandingsportingactivities didnotadversely adults allowing return todesiredhigh-level sportingactivi- Conclusion: (5.5%). as defi ethylene wear, orfullthicknessarthriticprogression. Failure, was noevidence ofcomponentloosening,osteolysis,poly- tennis (N=10),basketball (N=1),and icehockey (N=1). There to vigoroussportsactivities includingdownhill skiing(N=10), patients returnedtosportingactivities; 61%(N=33)returned tively and1.4°ofvalgus postoperatively, achangeof4.6°. All ROM <120°).Mechanicalaxiswas 6°ofvalgus preopera- erative meanROM was 0-120°(onlyonepatienthadafl signifi signifi signifi Results: increase bonemineraldensity (BMD). While studieshave rosis thathasbeenshown toincreaseboneremodeling and manage. Teriparatide isabone anabolictherapy forosteopo- total hiparthroplasty(THA)can beasignifi arthroplasty (TKA)andthighstempainfollowing arevision Introduction: David J.Mayman, MD Kaitlin M.Carroll,BS *Michael B.Cross,MD Seth A. Jerabek, MD Replacement With Persistent Pain Following Joint Teriparatide Treatment InPatients 8:44am–8:48am cantly improved from64.1to93.0(p<0.001).Postop- cantly improved from3.1to4.8(p<0.001),andHSS cantly improved from59.2to93.2(p<0.001), Tegner ned byconversion to TKA, occurredin3/55patients At anaverage of5.03years(range2-10),Lysholm Lateral UKAyieldsexcellent outcomesinactive Tibial stempainfollowing arevision totalknee Rapid Fire Session8E cant problemto exion 149

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shown that teriparatide may increase bone mineral density Friday, October 24, 2014 and decrease risk of fractures in osteoporotic individuals there are a limited number of studies on the effect of teriparatide in General Session 10 — Mixed Topics arthroplasty. (Ritz-Carlton Ballroom Salon 1)

Methods: We report on a case series of patients who pre- Moderators: Matthew S. Austin, MD sented with persistent stem pain after revision TKA or THA Geoffrey H. Westrich, MD who were treated post-operatively with teriparatide. Four patients at an average age of 71 years (58-81 years) had persistent stem pain between 2012 and 2013. Three patients pre- 12:30pm–12:36pm sented with post-operative tibial stem pain status post revision TKA and 1 patient presented with post-operative thigh pain The Standard One Gram Dose Of status post revision THA. Patients were treated conservatively Vancomycin Is Not Adequate Prophylaxis and reported pain during activities of daily living. Patients For MRSA were prescribed a daily dose of 20mcg injection of teriparatide for three months and 1 year if they were previously diag- Anthony Catanzano, BS nosed with osteoporosis. *Lorraine Hutzler, BA Results: There were four patients included in our case series Michael Phillips, MD with a mean follow-up time of 6 months (range 3-12 months). Yanina Dubrovskaya, PharmD All patients were treated conservatively with teriparatide, cal- Joseph A. Bosco III, MD cium and vitamin D. All patients reported an improvement in Introduction: The indications for vancomycin prophylaxis pain and increase in activity. One patient discontinued teripa- to prevent Methicillin-Resistant Staphylococcus aureus ratide after 3 months and one patient had a history osteopo- (MRSA) surgical site infections are increasing. The recom- rosis. All patients were successfully treated by teriparatide mended dose of vancomycin has traditionally been one post-operatively. gram IV. However, the increasing prevalence of obesity in Conclusion: Arthroplasty surgeons should consider teripara- our population coupled with increasing resistance of MRSA tide as an anabolic agent to treat persistent stem pain status to vancomycin has resulted in recent recommendations for post revision THA or TKA. This is the ﬁ rst report to show weight-based dosing of vancomycin at 15mg/kg. We hypoth- efﬁ cacy of a daily injection administration of teriparatide in esize that the standard one gram dose of vancomycin is inad- patients with persistent pain following revision THA or TKA. equate to meet the recently recommended dosage of 15mg/ kg. * The FDA has not cleared this drug and/or medical device for the use described in the presentation. (Refer to page 57). Methods: Since 2009, all patients at our institution undergoing elective total joint and spine surgery are screened for Notes: staphylococcus aureus nasal colonization prior to surgery. We reviewed the data on adult patients who had a MRSA positive nasal screen and underwent surgery between Janu- ary 2009 and January 2012. All patients were given 1 gram of vancomycin within an hour prior to surgical incision as prophylaxis. Using the revised dosing protocol of 15mg/kg of body weight for vancomycin, proper dosage was calculated for each patient. These values were then compared to the 1 gram dose given to the patients at time of surgery. Patients were assessed as either underdosed (a calculated weight-based dose >1 gram) or overdosed (a calculated weight-based dose <1 gram). Additionally, we used actual case times to and phar- macokinetic equations to determine the VAN levels at the end of the procedures.

150 index (NWI)would beassociated with ACL injurywhencom- slope anddepth,decreased intercondylarnotchwidth injury. We hypothesizedthatincreasedmedialtibial plateau morphometric factors thoughttopredisposepatients to ACL rospective, comprehensive case-controlanalysisofidentifi Introduction: Donna M.Pacicca, MD Neil J.Mardis,DO Brian S.Dunoski,MD K. Aaron Shaw, DO In Pediatric Patients Morphometric RiskFactors ForACL Injury Discussion: and all6were<20mg/L. MRSA positive SSIshadwound closure levels of<15mg/L MIC’s of>1.0mg/L.Based1gdosing,5/6patientswith SSIs. Ofthese6patients;4hadstrainsofMRSAwith VAN with WB dose.Sixpatientsdeveloped post-operative MRSA 60% ofpatientswith1gdosecomparedto12%(p=0.0005) predicted VAN level attheendofprocedure was <15mg/Lin dosed and10%patientsweredeterminedtobeoverdosed. The dosing recommendations,69%weredeterminedtobeunder- tive forMRSA.Outofthese216patients,usingthe15mg/kg Results: Notes: health careproviders mustuseweight-baseddosing. vancomycin. Inordertoavoid incorrectdosingofvancomycin increasingly importanttoaccuratelydosepatientswhorequire resistant bacteria,especiallyMRSA,ishigh,itbecoming inadequate. Insettings,suchashospitals,wheretheriskfor our patientswithMRSASSI’s had VAN levels whichwere Based intheMIC’s oftheindividual strainsofMRSA,4/6 prophylaxis in60%ofpatientsusingthe1gram VAN dose. at thewound closurewereinadequatetoprovide MRSA body weight. Additionally thecalculatedserum VAN levels -op vancomycin prophylaxis wereunderdosed,given their 12:38pm–12:44pm During thestudyperiod,216patientstestedposi- Sixty ninepercentofthepatientsreceiving peri- The purposeofthisstudywas toperformaret- ed Notes: disruption. focal approachtotheskeletally immaturepatientwithan ACL population. This studyfurtherhighlightstheneed foramulti- disposition for ACL injuryinaskeletally immaturepatient regard topotentialintra-articularbony parametersandpre- Discussion andConclusions: signifi plateau depthweretheonlyparameterstoapproachstatistical ACL injuryusingalogistic regression. NWIandmedialtibial group. However, noparameterwas foundtobepredictive of NWI was found tobesignifi control (N=28,14maleandfemale,14.29±1.08years), of 14.2±2.08years. When comparedtotheage-matched inclusionary criteria,13malesand15female,average age sustained an ACL disruption. Twenty-eight patientsmetall 74 malesand54femaleswithanaverage ageof15.27years Results: height andvolume. eral tibialplateauwidth,depth,andslope,eminence intercondylar notchwidthandvolume, NWI,medialandlat- etal radiologist,measuringnumerousparameters,toinclude were analyzedbyafellowship-trained pediatricmusculoskel- condition associatedwithligamentous laxity. The MRIstudies ACL injury, withoutassociatedligamentousinjuryormedical of skeletally immaturepatientswhosustainedanon-contact of the ACL werereviewed. Inclusionarycriteriaconsisted All imagingreportsindicatinganacuteintra-substanceinjury ture patientsbetween1January2009and2013. nance imaging(MRI)studiesperformedonskeletally imma- Methods: tion. pared toanage-matchedcontrolinapediatricpatientpopula- cance. Onehundredandtwenty-eightpatients,including We retrospectively reviewed kneemagneticreso- cantly smallerinthe ACL injured Noconsensusexists with General Session10 151

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12:46pm–12:52pm 12:54pm–1:00pm

Outcomes Following Cervical Disc Direct Costs of Aspirin Versus Warfarin For Arthroplasty: A Retrospective Review Venous Thromboembolism Prophylaxis

Daniel G. Kang, MD Christina J. Gutowski, MD, MPH *LT Scott C. Wagner, MD Benjamin Zmistowski, MD LTC Ronald A. Lehman Jr., MD Jess H. Lonner, MD LCDR Robert W. Tracey, MD Javad Parvizi, MD, FRCS CPT John P. Cody, MD Introduction: Recent clinical evidence supports the utiliza- Introduction: Cervical radiculopathy is a common problem tion of aspirin as a safe and effi cacious strategy to prevent in society that causes signifi cant disability. Cervical disc venous thromboembolism (VTE) after total joint arthroplasty. arthroplasty (CDA) is increasingly being used as an alterna- This study aims to determine the fi nancial implications of tive to anterior discectomy and fusion (ACDF). We set out to using aspirin instead of warfarin in terms of direct costs asso- further evaluate the outcomes of cervical disc arthroplasty. ciated with the patient’s episode of care.

Methods: We performed a retrospective review of 176 con- Methods: The institutional arthroplasty database was utilized secutive patients undergoing CDA at a single, military tertiary to analyze the preoperative, clinical, and fi nancial data on medical center from 2008 to 2012. All construct types (1-level 6,372 patients undergoing primary and revision total joint CDA, 2-level CDA/ACDF hybrid, and multi-level CDA) were arthroplasty at our institution between January 2008 and included for review. March 2010. Mode of VTE prophylaxis (aspirin or warfarin) for each patient was recorded. Patients readmitted for postop- Results: Of the 176 patients, 40 were female (22.7%) with an erative complications related to VTE prophylaxis or infection average age of 41.6±8.1 years. Surgical indication was radicu- were identifi ed. Line-by-line charges were gathered for all lopathy in 141 patients (84.4%), myelopathy in 13 patients patients in this cohort for their index arthroplasty admission, (7.8%), and both in 10 patients (6.0%). Average follow-up as well as any subsequent readmissions for related complica- was 8.5±7.6 months. 111 patients (63.1%) underwent single- tions. Charges associated with the two groups were compared, level CDR. CDR/ACDF hybrid constructs were used in 52 and linear regression analysis was utilized to isolate the effect patients (29.5%) and 13 patients (7.4%) underwent a two- of anticoagulation on total charges. level CDR. The most frequently addressed levels were C6-7 (42.0%) and C5-6 (39.6%). At most recent follow up, average Results: An episode of care associated with the aspirin CDA range of motion was 7.46 degrees (±3.6 degrees). 94.5% cohort (n=1,213 patients) resulted in an average total cost of of patients experienced complete resolution of their pre-oper- $54,181, compared to $63,718 for patients receiving warfarin ative symptoms and 93.6% of patients returned to full activ- (n=4,159). Twenty-fi ve patients (2%) receiving aspirin expe- ity. 36 patients (21.8%) experienced persistent posterior neck rienced a post-operative complication related to VTE prophy- pain. Other complications included one superfi cial infection, laxis, resulting in 11 readmissions (0.9%), compared to 241 fi ve recurrent laryngeal nerve injuries and 18 patients report- (5.8%) complications and 89 (2.1%) readmissions in warfarin ing persistent dysphagia. patients. When adjusting for surgeon, day and year of surgery, Charlson index, joint, revision versus primary, BMI, and gen- Conclusion: This is the largest non-sponsored single center der, aspirin was an independent predictor of decreased total study of cervical disc arthroplasty. Our data demonstrates charges and decreased cost of index hospitalization. relief of pre-operative symptoms (94.5%) and return to full activity (93.6%) with an average follow-up of 8.5 months. Discussion and Conclusion: This study supports the cost- There was a low complication rate without device or implant savings that can be achieved by using aspirin rather than war- related complications. Arthroplasty continues to be a safe and farin in primary and revision arthroplasty settings. The use of reliable option in treating patients with cervical radiculopathy aspirin compared to warfarin results in 11.75% cost saving for or myelopathy. each total joint arthroplasty.

Notes: Notes:

152 (1/1068). HeadCTscansshould have alimited roleinthe in geriatricpatientsthatsustain alow energy fall at0.09% injury thatrequiresneurosurgical invention isextremely small Discussion andConclusion: cal intervention. infarct-1), andonlyoneofthepatients requiredneurosurgi- (7%) patientshadacuteﬁ tion. Ofthe214patientswhounderwentheadCTscan, 14 on someformofantiplateletoranticoagulationmedica- was 83years(range65-99years). 140patients(65%)were being evaluated bythetraumateam. Average patient age the Emergency Department(ED)withonly18%(38/214) fractures. The majorityofthepatientswereevaluated by mal femurfractures,11%shaftfracturesand5%distal of theirevaluation. Ofthesepatients,84%suffered proxi- fourteen patients(20%)underwentaheadCTscanaspart femur fracturefollowing low energy falls. Two hundred Results: symptoms andmedicalhistorywerereviewed. the traumadatabaseandelectronicmedicalrecord,presenting evaluation betweenJanuary2004andDecember2011.Using energy falls andunderwentaheadCTscanduringtheirinitial geriatric patientswhomsustainedafemurfracturefromlow Methods: fairly limited. low energy falls, theneedforobtainingaHeadCTscanis this agegroup. We hypothesizedthatforpatientswhosuffer scans arecommonlyusedduringthediagnosticworkup for ture inthisagegroup.HeadCT(computerizedtomography) trauma patients.Femurfracturesarethemostcommonfrac- increased, andinturnsohasthepercentageofgeriatric Introduction: Daniel S.Horwitz,MD Denise M. Torres, MD Michael Suk,MD,JD,MPH,FACS Jeffrey L. Wild, MD David G.Fanelli, BS Hemil H.Maniar, MD Geriatric Femur Fractures Head CTScans With Low Energy Isolated Resident/Fellow Travel GrantAward 1:02pm–1:08pm Duringthestudyperiod,1068patientssustained After IRBapproval, weretrospectively reviewed all The geriatricpopulation(>65years) has ndings (hemorrhage-12,tumor-1, The incidenceofatraumatic

demonstrated anotchingrate of 6%. There werenocases of ASES scoreimproved from34to72.Radiographicevaluation to 139°. The Constant scoreimproved from37to84. The 32% to84%. Active forward elevation improved from42° Results: were recorded. nent lucenciesandcomponentsubsidence.Complications evidence ofscapularnotching,humeralandglenoidcompo- ASES score.Postoperative radiographswereevaluated for value (SSV),rangeofmotion,strength,ConstantScoreand patients includedvisualanalogscale,subjective shoulder of theirprostheticshoulderafterRTSA. Follow-up ofthese patients whoindicatedareturntosportandhighdemand use follow-up of4.6years.Ofthiscohortweidentiﬁ and highdemandpriortosurgical intervention ata mean 72) whounderwentRTSA andindicatedthey wereathletic Methods: higher demandpopulation. evaluates theclinicalandradiographicoutcomesinanathletic in moreathleticandhigherdemandindividuals. This study that requireareverse shoulderarthroplastyareoftenfound ity low demandpopulation.However, shoulderpathologies indicated fortreatingashoulderconditionsinlimitedactiv- Introduction: Justin Kearse, MD Jordon Brees,PA-C Berenice Gerard,BS,MHS Frank F. Cook,MD Ryan W. Simovitch, MD Population Arthroplasty InAnActiveAthletic Outcomes OfReverse Shoulder Notes: trauma. patients withahistoryandphysical ﬁ work-up ofthispatientpopulationandshouldbereserved for 1:10pm–1:16pm VAS improved from7.2to1.8.SSVimproved from We evaluated 68consecutive patients(meanage, Reverse shoulderarthroplasty isprimarily ndings thatsupporthead General Session10 ed 41 153

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glenoid or humeral component loosening. There was one post- Friday, October 24, 2014 operative dislocation and one acromion stress fracture postoperatively. One shoulder required a revision. Rapid Fire Session 11A — Hip (Station A, Plaza Ballroom 1) Discussion and Conclusion: RTSA can dramatically reduce pain and restore function in an active athletic population with Moderator: Mary I. O’Connor, MD mid-term follow-up. Sixty percent of patients that participated in sports were able to return to sport after RTSA. There was no evidence of humeral or glenoid component loosening or 1:30pm–1:34pm mechanical failure directly related to sporting activity. Future studies should examine if these results are durable with long The Effect Of Severity Of Disease On Cost term follow-up. Burden Of 30-Day Readmissions Following Notes: Total Joint Arthroplasty (TJA) Daniel Kiridly, BS Alexa J. Karkenny, BS Lorraine Hutzler, BA James Slover, MD, MS Richard Iorio, MD Joseph A. Bosco III, MD

1:18pm–1:24pm Introduction: In order to control the unsustainable rise in healthcare costs the Federal Government is experimenting with the bundled payment model for total joint arthroplasty Consumerism in Healthcare (TJA). In this risk sharing model, providers are given one payment, which covers the costs of the TJA, as well as any addi- Richard C. Mather III, MD tional medical costs related to the procedure for up to 90 days. Central to value-based healthcare is the shifting of fi nancial Theamount and severity of comorbid conditions strongly risk to decision makers in the healthcare system. Much atten- infl uences readmission rates and costs of readmissions in TJA tion is focused on provider risk through mechanisms such as patients. value-based purchasing, bundled payments, tiering and shared Methods: Using our administrative database, we identifi ed savings. However, the impact of increased cost sharing by all Medicare patients from 2008 to 2012 who were admitted patients receives less attention but promises to be a powerful for a primary or revision total hip arthroplasty (THA) or total force. Healthcare consumerism is the movement fueled by knee arthroplasty (TKA) at our institution. We then identi- this increased cost sharing. In this abstract we will outline the fi ed all unplanned readmissions occurring within a 30 day early impact of healthcare consumerism and how it has and window from the patient’s discharge. For each readmission, will affect musculoskeletal care. In particular, we will focus we compiled all of the direct costs incurred by the institution on the opportunities available to orthopaedic surgeons and – including implant costs, hospital room and board, medica- how embracing this movement can be a positive disruptive tions, and medical supplies. force on orthopaedic practice. Results: Both the costs of readmission and the readmission Notes: rate tended to increase as severity of illness increased. The readmission burden also increased as severity of illness (SOI) increased, but increased most markedly in the extreme SOI patients.

Conclusion: Given the large ﬁ nancial burden of patients with a high SOI, providers should attempt to modify the long-term risk factors of some of their patients prior to TJA in order to change their SOI class and reduce ﬁ nancial risk. However,

154 BMI, 28.1versus 30.2. The average cost of THA forpatients younger, 58.97 yearsversus 68.33years,andhadalower of 4outpatientsrequiredtransfer. The outpatientgroupwas average lengthofstay, 24.4hours versus 59.2hours. A total tions betweenthetwo groups.Outpatientshadamuchshorter Results: overall cost. lyzing complications,lengthofstay, demographicdataand approval, aretrospective case-controlwas performedana- 78 controlsdoneataparentinpatienthospital.UnderIRB 23 hourspost-op.Outpatientswerethencomparedwith required tobedischarged ortransferredtothehospitalby tient hospital. All patientsdoneatthesurgery centerwere at anoutpatientsurgery centerowned byaparentinpa- Methods: outpatient surgery center. traditional inpatient THA withthesameproceduredoneatan this studyistocompareoutcomesandcost-effectiveness of quality atafractionofthecostcurrentrates. The aimof cial constraintsinthehealthcareindustrywilldemandhigher mobilization postoperatively. Additionally, impendingfi arthroplasty (THA)have ledtoshorterlengthofstayandearly and standardizationofpostoperative protocolsaftertotalhip Introduction: Dean C.Sukin,MD Alvin C.Ong,MD Michael C. Aynardi, MD *Fabio R.Orozco,MD Zachary D.Post,MD Method To DecreaseHealthcareCost Outpatient Total HipArthroplastyAsA Notes: patients withahighseverity ofillness. providers mayopttosimplychangetheircasemixexclude given thediffi 1:35pm–1:39pm There was nodifference withrespecttocomplica- From2008-2011,119patientsunderwent THA culty ofmodifyinglong-termriskfactors, some Advancements inanalgesia,rehabilitation, nan- Notes: stay, andatasubstantialsavings tothehealthcaresystem. with noincreaseincomplications,amuchshorterlengthof selected patientscanundergo THA inanoutpatientsetting for outpatient THA, thisstudysuggeststhatappropriately stay atmany institutions. While not allpatientsarecandidates strategies andearlymobilizationhave decreasedlengthof mally invasive approaches,multi-modalpainmanagement decrease costaregrowing inpopularity. Utilizationofmini- Discussion andConclusion: compared to$35,480. done intheoutpatientsettingwas signifi cup placement. absence ofradiolucency. EBRAsoftware was usedtoassess Hypertrophic Reactive CancellousBone),trabeculae, and integration was assessedbasedonSIHRCaB(StressInduced classifi est follow upwererecorded.Radiographicanalysisincluded Average HospitalforSpecialSurgery (HSS)hipscoresatlat- follow up(108weremale,103female)analyzed. who hadaminimum5year(range,5-9years)radiographic Methods: on radiographicandclinicalanalysis. cacy ofamodernhemisphericalacetabular component based performed today. Inthis study, welookatthesafetyandeffi cemented cupsremainsoneofthemostsuccessfulprocedures Introduction: Chitranjan S.Ranawat, MD Amar S.Ranawat, MD Morteza Meftah,MD Component Hydroxyapatite CoatedAcetabular Fixation OfANon-Cemented, 1:40pm–1:44pm cation basedonDeleeandCharnley’s zonesandosseo- 211consecutive patientsbetween2003and2007 Total hiparthroplasty(THR)withnon- Innovative methodstosafely Rapid Fire Session11A cantly lower, $24,529 155 -

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Results: At 5-9 year clinical follow up, average HSS score stem, but 199 had a modular cobalt-chromium neck and 17 was 34.8, with 4.02% undergoing revisions for any reason, were monolithic. Patients presenting with new-onset pain such as dislocation (1.34%), loose stem (0.89%), stem frac- were worked up for infection and investigated with metal- ture (0.89%), pain/bursitis (0.45%), and infection (0.45%). At ion levels and magnetic resonance imaging (MRI). Cases 5-9 year radiographic follow up, there were no revisions per- suspected of having an adverse local tissue response (ALTR) formed due to mechanical failures or due to failure to osseo- based on MRI also received an ultrasound-guided biopsy. integrate. No association of bearing surfaces to survivorship Intraoperative tissue samples were graded and retrieved was noted. implants were examined.

Discussion and Conclusion: The hemispherical, peripheral Results: At a mean follow-up of 19.3 months, 80 of 216 hips press-ﬁ t, acetabular component was examined in a large, (37%) have been revised and 11 are awaiting revision. 73 of consecutive series by a single surgeon with a minimum 5 80 hips were revised for ALTR, which only occurred in the year radiographic follow up. We have demonstrated excel- modular neck design. All monolithic hips remain asymptom- lent radiographic osseointegration at latest follow up with no atic. Metal-ion tests in the ALTR cases showed mean cobalt mechanical failures, high survivorship, and excellent clinical levels of 8.6ng/ml and mean chromium levels of 1.8ng/ml. 58 outcome scores. of 166 MRI exams showed moderate-severe levels of synovial response. Ultrasound-guided biopsy had a false-negative rate Notes: of 48% for diagnosing ALTR. The mean aseptic lymphocytic vasculitis-associated lesion (ALVAL) score for the revised cases was 8.1. Corrosion was visible on all tapers at the neck- stem but not the head-neck junction.

Conclusions: Early failures of modern modular THA occur due to corrosion at the neck-stem junction, resulting in ALTR. Surveillance with metal-ion levels and MRI may be indicated for all patients regardless of symptoms as the early survivorship is poor and the ultimate failure rate may be catastrophi- 1:45pm–1:49pm cally high.

Notes: Evaluating 216 Adverse Tissue Responses In A Single Surgeon Series

Danyal Nawabi, MD *Geoffrey H. Westrich, MD Allison Ruel, BA Brett Lurie, MBBS Matthew Koff, PhD Huong T. Do, MA Hollis G. Potter, MD 1:50pm–1:54pm

Introduction: Recent total hip arthroplasty (THA) stem Short-Term Results Of Novel Constrained designs have introduced modularity at the neck-stem junction. Total Hip Arthroplasty Corrosion at the modular junction is the cause of reported failure. This study evaluated the outcomes of all patients with Stephen H. Finley, MD a recently recalled modular neck-stem implanted by a single Thomas Pace, MD surgeon. Rebecca G. Snider, BS Stephanie L. Tanner, MS Methods: This is a prospective study of 216 THAs by a single surgeon in 195 patients (79 men and 116 women) with a mean Background: The persistently unstable total hip arthro- age of 65.4 years (20-88 years). All hips had a titanium-alloy plasty (THA) has continued to be problematic for the

156 Notes: strained liners. rate ofcomponentfailure comparedtopreviously usedcon- implant demonstratesagreaterarcofmotionwithdecreased or thoseknown tohave recurrentinstability. Furthermore, this may beaviablealternative forpatientsatriskinstability average of3.4yearsfollow-up suggestingthisprosthesis remained 99.2%stable,with0%componentfailure rateatan Conclusions: assessment. preoperatively to98.9(range 65-100)atthefi Hip Scoresimproved fromameanof68.8(range58-87) osteolysis, polyethylenewear, orstemsubsidence.Harris thigh pain.Radiographicreview showed noevidence of reported continuedgroinpain,andthreehad failure whenincludingrevision forany reason.Sixpatients 0.7% dislocationrate,0%componentfailure rate,and2.3% Results: Scores (HHS)tothoserecordedpostoperatively. tions, groin/thighpain,andcomparedpreoperative HarrisHip We reviewed serialradiographs,postoperative complica- 2007. Patients werefollowed foraminimumoftwo years. by theseniorauthorbetweenNovember 2003and August with 129consecutive primaryconstrained THAs performed Methods: instability. decreased failure ratessecondarytocomponentfailure and strained implantthatoffers improved rangeof motion,and pose was toshow theshorttermresultswithanewer con- less thansatisfactory componentfailure rates.Ourpur- unstable THA, secondaryto limitedrangeofmotionand been recommendedasasalvage optionforthepersistently Constrained acetabular components,tothisdate,have only orthopaedic surgeon withlimited satisfactory options. With ameanfollow-up of3.4years,therewas a This isaretrospective review of117patients This novel constrainedacetabular prosthesis nal clinical Notes: signifi cern withCrossfi follow-up inyoung-active patients.Moreover, oxidationcon- has anexcellent survivorship ratesataminimum10-year Conclusion: Kaplan-Meier survivorship was 100%forallfailures. ening, periprostheticinfectionordislocationinthiscohort. (range 0-0.082) There werenorevisions forosteolysisorloos- Results: vorship wereanalyzed. (Roman software), clinicalandradiographicdatasurvi- 10-years follow-up (mean11.5±0.94years),wearrates solid acetabular shellwithacetabular liner. At minimum femoral stem,Cobalt-Chromium(Co-Cr)head,and posterolateral approach. All componentswerenon-cemented All operationswereperformedbytheseniorsurgeon viaa 10). Indicationforsurgery includedosteoarthritisinallcases. to 55years)andthemeanUCLAwas 7.3±1.5(range5– The meanageofpatientswas 47.4±7.8yearsold(range24 Institutional Review Board-approved prospective database. of 5andabove atthetimeofsurgery wereidentifi University ofCalifornia Los Angeles activity (UCLA)score and 17females)ageof55yearsyoungerwithanaverage ber 2003,52hipsconsecutive THAs (43patients;26males Materials andMethods: patients inyoungandactive patients. cemented totalhiparthroplastyusingmetalonHCLPEin assess minimum10-yearwearratesandsurvivorship ofnon- active patients. The purposeofthisprospective studywas to wear ratesandclinicalperformanceofHCLPEinyoung hip arthroplasty(THA). There islimiteddataregarding was introducedtoimprove wearrelatedosteolysisintotal Background: Amar S.Ranawat, MD Morteza Meftah,MD Chitranjan S.Ranawat, MD Polyethylene In Young AndActivePatients First GenerationHighly Cross-Linked Long-Term ClinicalResultsOfA 1:55pm–1:59pm cance. The meanlinearwearwas 0.019±0.018mm/year This studydemonstratesthatmetalonHCLPE Highlycross-linked polyethylene (HCLPE) re upto10yearhasnotshown any clinical BetweenJanuary2001toDecem- Rapid Fire Session11A ed fromour 157

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defensin-negative samples. Gram-positive bacteria (87%), Friday, October 24, 2014 gram-negative bacteria (10 %), and yeast (3%) demonstrated Rapid Fire Session 11B — Knee no statistically signifi cant differences in the mean associated (Station B, Plaza Ballroom 1) synovial fl uid alpha-defensin S/CO (4.7, 5.3, 3.8 respectively). Similarly, the virulence of the organism had no statistically Moderator: Sabrina Strickland, MD signifi cant infl uence on the mean alpha-defensin S/CO.

Conclusions: This study demonstrates that a wide variety 1:30pm–1:34pm of gram-positive bacteria, gram-negative bacteria, and yeast result in a positive synovial fl uid alpha-defensin level, without The Alpha-Defensin Biomarker For any evidence of an organism-specifi c infl uence. The alpha- PJI Responds To A Wide Spectrum Of defensin test appears to provide diagnostic value for PJI, Organisms regardless of the infecting organism. Notes: Carl Deirmengian, MD Alexander Cameron, BS Kevin Schiller, BS Michael Citrano, BS Simmi Gulati, RM (ASM) Patrick Kilmartin, BS, MS Keith Kardos, PhD

Introduction: Alpha-Defensin has been identifi ed as a highly accurate synovial fl uid biomarker for periprosthetic joint infection (PJI), and has been previously demonstrated to match the MSIS defi nition for PJI. The purpose of this study 1:35pm–1:39pm is to describe the breadth of organisms that stimulate alpha- defensin during PJI, and secondarily, to identify any organ- Compliance With Intermittent Pneumatic ism-specifi c infl uence on alpha-defensin levels. Compression Devices In Orthopaedic Methods: A retrospective review of 1937 de-identifi ed syno- Kristin McPhillips, MD, MPH vial fl uid samples having both the Synovasure PJI test and Hemil H. Maniar, MD culture identifi ed 498 alpha-defensin-positive samples, and Jove Graham, PhD 1439 alpha-defensin-negative samples. Samples were received Michael Suk, MD, JD, MPH, FACS from 418 surgeons in 42 states. 239 of the alpha-defensin-pos- Daniel S. Horwitz, MD itive synovial fl uid samples (48%) had organism growth from the synovial fl uid, whereas only 19 of the alpha-defensin- Introduction: Hospitalized patients are at a high risk for negative samples (1.3%) had organism growth. A total of 41 venous thromboembolism. Mechanical prophylaxis, in the different species of bacteria and yeast were isolated and clas- form of intermittent pneumatic compression devices (IPCs), sifi ed by cell type, species, Gram-type, and virulence. Mean is effective and IPCs are the standard of care for patients after alpha-defensin signal to cutoff (S/CO) levels were calculated orthopaedic surgery but they must be used in conjunction with for these various classifi cations of organisms, and the ANOVA chemoprophylaxis. IPCs may be uncomfortable or inconve- test was utilized to identify any potential organism-specifi c nient for patients and the compliance with these devices in infl uences on the synovial fl uid alpha-defensin level. orthopaedic patients is unknown.

Results: All organisms typically isolated in relationship to Methods: Over a 10 day period we observed compliance with arthroplasty were found to result in a positive synovial ﬂ uid IPC use in patients being treated by orthopaedic surgeons at a alpha-defensin level. The mean semi-quantitative alpha-defen- level 1 trauma center, including primary patients and consult sin S/COamong 239 alpha-defensin positive, culture-positive patients. Patients were observed twice daily between 7am samples was 4.68, compared to 0.30among 1439 alpha- and 5pm with a minimum of six hours between observations.

158 Years (QALY) gainedaccordingtopreoperative diseasesever- Methods: or late-stage THA interventions couldbemore cost-effective. tigation mightprovide informationastowhetherearly-stage preoperative stateinthecost-effectiveness of THA; our inves- US haspreviously evaluated theimpactofhipjoint-specifi Introduction: Carlos J.Lavernia, MD Lawrence Brooks,PhD *Jesus M. Villa, MD David A. Iacobelli,MD Could WOMAC PredictIt? The Cost-UtilityOf Total HipArthroplasty: Notes: of IPCs. be educatedabouttheriskofDVT andPEtheproperuse for thromboembolicdisease,andpatientsnursesshould non-trauma patients. All orthopaedicpatientsareathighrisk patients weremorelikely tobecompliantwithIPCsthan were patients areinchairsthanwhenthey areinbed. Trauma in orthopaedicpatientsispoor. Complianceisworse when Discussion andConclusion: (79 of335,95%CI33%-49%)fornon-traumapatients was 41%(133of323,95%CI=17%-32%),comparedto24% than fornon-traumapatients;intraumapatients,compliance The complianceratefortraumapatientssignifi was observed between1and21times(mean=3.8,median=3). patients inbedversus 9%forpatientsinchairs.Eachpatient pliance ratewas 32%(212of660). Compliance was 41%for patients wereinbed,180thechair. The overall com- patients over the10-dayperiod.Ofthoseobservations, 480 Results: machine “on”wheninbedorthechair. Compliance was defi 1:40pm–1:44pm 660observations weretaken from174unique We estimated thecostofQuality-Adjusted-Life- To thebestofour knowledge, nostudyinthe ned aswearingthedevices withthe ComplianceratewithIPCs cantly different . c Notes: severity ofdisease. intervention even inolderpatientsorthosewithgreater performed earlier, primary THA remains acost-effective disease have ensued. Despitebeingmorecost-effective when effective thanwaiting tointervene untilthelatterstagesof (early inthetimelineofend-stagejointdisease)ismorecost- THA performedinpatientswithlesspainanddisability Discussion andConclusion: QALY gained). had theleastcost-effective interventions ($25,937.33per years ofageorolderandwithworse WOMAC totalscores the cost-effectiveness of THA decreased. Those patients75 total scores($8,256.32perQALY gained). As patientsaged, effectiveness was achieved bypatientswithbetter WOMAC cost-effective intervention. Overall, thehighestmeancost- WOMAC scoreswereconsistentlyassociatedwithaless quality oflifeimproved postoperatively. Worse preoperative Results: group. was donetosetapartalow (better)andahigh(worse) score 4 years. A mediansplitofpreoperative WOMAC scores ity. We studied159unilateralprimary THA, meanfollow-up: complaint following totalknee (TKA)andtotalhiparthro- Introduction: MD Luke Austin, Victoria Younger, BS,CCRP Benjamin Zmistowski, MD Carl Deirmengian,MD Fabio R.Orozco,MD Zachary D.Post,MD Alvin C.Ong,MD And Total HipArthroplasty Sleep DisturbanceFollowing Total Knee 1:45pm–1:49pm Inbothgroups,costsweresimilarandtheirmean Postoperative sleepdisturbanceisacommon Ourdatasuggeststhatprimary Rapid Fire Session11B 159

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plasty (THA). Modern arthroplasty techniques and postop- 1:50pm–1:54pm erative protocols have focused on rapid recovery of patient function and pain. However, little information exists on sleep recovery following TKA and THA arthroplasty. Since Total Joint Arthroplasty In Patients With adequate sleep plays a role in postoperative healing and also Cardiac Implantable Electrophysiological in patient satisfaction, it is necessary to investigate and char- Devices acterize sleep disturbances in patients undergoing THA and TKA. Seyed Alireza Mirghasemi, MD Reza Mostafavi Tabatabaee, MD Methods: With IRB approval, forty-two consecutive Mohammad R. Rasouli, MD patients undergoing total knee (n=35) or total hip (n=7) Mitchell G. Maltenfort, PhD arthroplasty were enrolled in this prospective study. Alvin C. Ong, MD Patients were surveyed preoperatively and postoperatively Javad Parvizi, MD, FRCS at intervals of 2, 4, 6, 12, and 24 weeks. Patient outcomes were scored using the Pittsburgh Sleep Quality index Introduction: Number of patients with implantable cardiac (PSQI), and the Visual Analog Score (VAS). A lower PSQI electrophysiological devices (ICEDs) is increasing and ortho- score indicated improved sleep. Results were evaluated paedic surgeon will encounter more patients with ICEDs using a student’s t test. requiring total joint arthroplasty (TJA). However, there is paucity of literature about perioperative morbidity and mortal- Results: Sixty-one percent of patients reported pre-operative ity in these patients following TJA. The present study aims to PSQI scores indicative of sleep disturbance (score >6 out evaluate risk of cardiac complications and mortality following of 21), with an average preoperative PSQI of 7. A statisti- TJA in patients with ICEDs using nationally representative cally signifi cant improvement in PSQI was achieved at 3 data. months (mean score 4.9, p 0.042) and continued to improve through 6 months. A PSQI score < 5, considered normal, Methods: Using ICD-9 codes, we queried the Nationwide was achieved by 65% (15/23) at 3 months, and 65% (15/23) Inpatient Sample from 2002 to 2011 to identify cases have at 6 months. been coded for both history of pacemaker or defi brillator implantation and TJA. Prioperative complications were identi- Conclusions: Sixty-one percent of patients undergoing TKA fi ed using the same coding system. Logistic regression was or THA have sleep disturbance preoperatively. Following sur- performed to analyze data. gery, pain improves quickly but sleep disturbance lags behind and signifi cant improvements are not seen until 3 months fol- Results: Over the study period, percent of cases with ICED lowing the procedure. increased. Mortality rate was higher in patients with pacemaker (0.32%) and defi brillator (0.28%) compared to con- Notes: trols (0.15%). Myocardial infarction was also observed more frequently in patients with pacemaker (0.34%) and defi brillator (0.65%) compared to the control group (0.30%). Car- diac complications occurred in 0.83% of controls compared to 0.64% and 0.95% in pacemaker and defi brillator groups respectively. Logistic regression adjusting for confound- ers including arrhythmias and comorbidities indicated that ICEDs are not associated with increased risk of in-hospital mortality and cardiac complications. The pacemaker and defi brillator groups were more likely to have atrial fi brillation and two times more likely to have other dysrhythmias. Atrial fi brillation and other dysrhythmias were associated with mortality (odds ratio (OR) of 2.53 and 11.56 respectively), cardiac complications (OR of 16.41 and 30.43

160 6-month periodspriorto(July-December 2012,n=230)and tinely recommended. A retrospective analysis compared as ofJanuary1,2013suchthatHVNSwerenolongerrou- period, post-acutecarewas dictated byaprotocolchange 509 elective primary THA and TKA patientsover a1-year Methods: without services. lished theutilityofHVNScomparedtodischarge tohome compared toinpatientrehabilitation.Nostudyhasestab- cations, decreasedreadmissionrates,andcost rate ofdischarge tohome,decreasedpostoperative compli- ported tofacilitate ashorterlengthofstay(LOS),increased the post-acutecareperiodfollowing primary TJA aresup- Introduction: James J.Purtill,MD Suneel Bhat,MD,MPhil Danielle Y. Ponzio,MD Andrew G.Park, MD Services Postoperative Home Visiting Nurse Safe CostSavings For TJA: Eliminate Notes: these devices onpostoperative arrhythmias. ing TJA whichmainlyseemstoberelatedprotective effects of tality andcardiaccomplicationscomparedtocontrolsfollow- patients withICEDsarenotatgreaterriskofin-hospitalmor- Discussion andConclusion: 3.91 respectively). respectively) andmyocardialinfarction (ORof2.05and 1:55pm–1:59pm Amongst aconsecutive singlesurgeon series of Homevisitingnurseservices(HVNS)in Ourfi ndings indicatedthat Notes: quality ofcare. differences suggestingoverall cost-savings withnolossof readmissions, andpatientsatisfaction showed nosignifi decreased kneestiffness requiringMUA. Other complications, discharge tohomerate,decreasedoffi TJA whichwas associatedwithdecreasedLOS,increased dramatically diminishedHVNSutilizationfollowing primary Discussion: PT visits. 8.3±4.5 visits,consistingof4.4±1.5nursevisitsand3.7±3.7 satisfaction remainedfavorable. HVNSpatientsreceived were received (104±24pre-vs.92±8post-protocol).Patient protocol). A decreasednumberofweeklyoffi an increasedneedforkneeMUA (2.17%pre-vs.0%post- (3.91% pre-vs.2.86%post-protocol),withtheexception of 2.5±1.4 to2.1±1.1days.Complicationratewas similar (265/279) with10usingHVNS.MeanLOSdecreasedfrom 88.3% (203/230),188ofwhichutilizedHVNS,to95% tocol change,thedischarge to homerateimproved from arthroplasty type,andMedicareusage.Following thepro- Results: phone calls. patient satisfaction (PressGaney), andnumberofoffi rate, complicationreoperationreadmission included discharge dispositions, LOS,discharge tohome after (January-June2013,n=279)thechange.Outcomes Patient groupswerecomparableinage,gender, A singlesurgeon post-acutecareprotocolchange Rapid Fire Session11B ce phonecalls,and ce phonecalls cant ce 161

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amputation. Functional results based on the MSTS system Friday, October 24, 2014 in 12 patients were good or excellent. All cases progressed Rapid Fire Session 11C — Tumor to full weight bearing in less than one year and regained full (Station C, Ritz-Carlton Ballroom Foyer) active knee motion. Leg length discrepancy was minimized in children in this series by preservation of growth plates. Moderator: Valerae O. Lewis, MD Discussion: This case series demonstrates that segmental tibial defects can be successfully treated with cryopreserved 1:30pm–1:34pm allograft. VFG could be an ideal biological solution, however it is associated with increased donor site morbidity, increased Intercalary Tibial Allograft Reconstruction surgical time associated with the complex microvascular Following Segmental Resection of Bone procedure. The low risk of site infections in our series with Tumors allograft reconstruction is likely attributable to meticulous surgical technique and adequate soft tissue repair using Ryan Michels, MD muscle fl ap. The tibia’s anatomical and mechanical axes are Samuel Kenan, MD similar, thus decreasing shear and bending forces across the Adam Levin, MD donor-host bone interfaces. In the femur the anatomic and mechanic axes are different. These differences in biomechan- Introduction: The optimal surgical reconstructive modal- ics necessitate the surgeon to consider different reconstructive ity for segmental tibial defects following wide resection of options when treating these anatomic locations. malignant bone tumors has been debated in the literature. The current reconstructive options include vascularized fi bular Conclusion: Segmental tibia surgical defects after wide resec- graft (VFG), Fresh frozen allograft, Extra corporal irradiated tion of malignant bone tumors present a unique reconstructive autograph, either option combined with VFG. The question challenge, which can be successfully treated with cryopre- remains whether a simple intercalary allograft to bridge the served allograft. Our long-term clinical outcome demonstrated defect can obtain equivalent long-term results to VFG proce- an excellent result in most patients. dures. Notes: Materials and Methods: From 1984 to 2012, 13 patients with malignant tibial bone tumors underwent segmental resection and reconstruction using fresh frozen allograft. There were 6 children (M-3, F- 2, Age range 6-13) with open physes and 7 adults (M-5, F-2, Age range 18-60). Tumors included Osteosarcoma in-3, Ewing’s Sarcoma-4, Adamantinoma-3, and Myofi broblastic Sarcoma-3. Allograft fi xation in Children was with locking plate in order to minimize growth plate damage. Muscle fl ap coverage over reconstruction was performed in all cases and consisted of gastrocnemius fl ap for proximal tibia defects and soleus muscle fl ap for distal tibia. 1:35pm–1:39pm Results: All patients’ radiographic and histological fi ndings were retrospectively analyzed. Tumor free surgical margin Surgical Navigation Allows Less Invasive was obtained in all cases. The proximal and distal osteotomy Methods Of Resection Of Pelvic Sarcoma site went on to boney union in all patients. No infections occurred in the population. Complications included allograft John A. Abraham, MD stress fracture in two children treated successfully with autogenous iliac crest bone graft and improved fi xation. A broken Introduction: Pelvic Sarcoma is a challenging problem. plate and allograft fracture in an adult patient was treated Although wide resection is necessary for adequate treatment, successfully by intramedullary fi xation. One patient had local it is often technically extremely diffi cult to achieve the desired recurrence at 10 years follow up treated with below knee surgical margins. Traditional methods of hemipelvectomy

162 Discussion: case imaginganddescriptionswillbepresented. surgery, while maintainingnegative surgical margins. Detailed less thanwould be expected fromtraditionalpelvicresection cases, theincisionlength,surgical time,andbloodlosswere approach, inspiteofthetumormassesbeinganterior. Inall resections thatwereperformedthroughanall-posterior than atraditionalilioinguinalincision. Two casesweresacral resection was performed throughaglutealincision,rather One casewas a type IIIhemipelvectomy, in whichtheentire sion, whichisthemostcommonsiteofwound breakdown. incision was notused,removing the“T”portionofinci- pelvis. Inboththesecases,theanteriorlimboftraditional the pelvis,minimizingexposure oftheinnertable mies inwhichallbonecutsweremadefromtheoutertableof negative inallcases. Two casesweretypeIIhemipelvecto- Blood lossrangedfrom400to3500cc.Surgical margins were pelvis resection.Surgical timerangesfrom4to8hours. Results: surgical time,bloodlossand margins arerecorded 5 patientsareidentifi navigation andanonstandardapproachareused identifi resection formalignantpelvictumors. The patientsinwhich Methods: or alternateapproaches. sions, lessinvasive surgical dissection,shortersurgical times, to achieve thenecessarysurgical margins withsmallerinci- to modifythetraditionalmethodsofpelvicresectioninorder of thisstudyistodetermineifsurgical navigation canbeused oncology anditsroleiscurrentlybeingdefi cal navigation hasrecentlybeeninvestigated inorthopedic often spanningtwelve ormorehoursofsurgical time.Surgi- require extensive surgical exposure anddiffi Notes: surgical navigation. ments over standardsurgical resection techniqueutilizing small series,thispilotisthefi modifi negative margin resectionswithless bloodloss,smalleror modifi demonstrate thatsurgical navigation canindeedbeusedto improve theeaseandsafetyofthesediffi gation hasrecentlybeenstudiedasamethodtopotentially ed incisions,andreducedsurgical time. Although a y thetraditionalapproachtopelvicresection,enabling All 5patientsunderwentsurgical navigation assisted A surgical databaseofpatientsundergoing pelvis Pelvicresectionsarechallenging.Surgical navi- ed thatfi t thecriteria.Incisionlength, rst todemonstrateimprove- cult operations. We ned. The purpose cult dissection ed. Notes: would beusefulinguidingtreatmentconsiderations. of studieswithlow levels ofevidence. Higherquality studies surgical treatmentofcarpalbossislimitedbyasmallnumber satisfactory patientoutcomes. The available literatureonthe extensive debridementorCMCarthrodesisappearstoresultin uncommon following carpalbossexcision, additional,more arthrodesis. While persistent symptomsofpainarenot ing procedureandmayresultinoutcomessimilartoCMC Discussion: cation rates. pain relief,reoperationrates,symptomrecurrenceorcompli- 6months to10years. There werenosignifi 3/36 hadanoverlying ganglioncyst. Follow uprangedfrom were identifi excision followed byarthrodesis. 86femalesand78males identifi remained: 1level III,7level IVevidence. 206patientswere the applicationofinclusionandexclusion criteria,8studies Results: Fisher’s exact testwas usedforstatisticalanalysis. ative symptomrecurrence, reoperationsandcomplications. Variables ofinterestincludedbasicdemographics,post-oper- ies toreportdatawithatleast6monthsofclinicalfollow up. patients wereexcluded. Secondaryselectionrequiredthestud- to includeEnglishlanguagearticles.Reportswithlessthan5 AND ganglion cyst ORcarpalboss”andappliedlimitations retrieved fromMEDLINEusingthesearchquery“carpalboss Methods: mal surgical treatmentmethod. carpal bosswas systematically reviewed toidentifytheopti- esis. The existing literatureonthesurgical managementof ever: simpleexcision orexcision followed byCMCarthrod- clear consensusonthemosteffective surgical technique,how- and middlecarpo-metacarpal(CMC)jointsbases. There isno ance thatoftendevelops over thedorsalaspectofindex Introduction: John D.Lubahn,MD *Thomas D.Lee,MD Abdo Bachoura,MD Management OfCarpalBoss A SystematicReview Of The Surgical 1:40pm–1:44pm ed: 168underwentsimpleexcision, 38underwent A totalof41studieswereidentifi Two authorsindependentlyreviewed articles ed. 70/207caseshadahistoryoftrauma,while Simpleexcision isatechnicallylessdemand- The carpalbossisabenign bony protuber- Rapid Fire Session11C ed. Following cant differences in 163

FridayPoster Friday Abstracts EOA 45th Annual MeetingAmelia Island, Florida2014

1:45pm–1:49pm 1:50pm–1:54pm

Cardiac Metastasis Of Extremity Soft Tissue Malignant Associated Giant Cell Lesions Of Sarcoma: An Unusual Metastatic Pattern Bone

John A. Abraham, MD Samuel Kenan, MD Paul A. Anderson, MD Introduction: Soft tissue sarcomas are aggressive malignant Michelle G. Carlson, MD neoplasms of the musculoskeletal system. The usual pattern of Andrew J. Weiland, MD metastasis is to the lungs, although other patterns can be seen. We report the unusual occurrence of intra-cardiac metastases Malignant associate giant cell lesions are exceedingly rare of soft tissue sarcoma in two patients. and may exhibit insidious progress. The clinical radiographi- cal and pathological fi nding may be indistinguishable from Methods: Medical records of two patients with intra-cardiac benign giant cell tumor. Early recognition is important to metastases of soft tissue sarcoma are reviewed. ensure appropriate treatment. Occasionally benign appearing osteoclast-like giant cells are present in diffuse and Results: Two patients with soft tissue sarcoma metasta- large number producing striking resemblance to giant cell ses to the myocardium are identifi ed. One patient had a tumor. Incorrect diagnosis of giant cell tumor could be made diagnosis of small round cell sarcoma, and the other had especially if tumor cells show subtle atypia. Limited biopsy an undifferentiated pleiomorphic sarcoma. Both had other may not provide enough representative tissue for correct sites of metastatic disease. Both patients received chemo- diagnosis. Malignant transformation of giant cell tumor therapy. One patient underwent open heart excision of the without antecedent history of radiation or multiple surgical intra-cardiac metastasis, the other elected palliative treat- procedures is exceedingly rare. Most osteosarcoma contains ment. Both patients died of disease within 6 weeks of diag- focal clusters of benign osteoclast-like giant cells morpho- nosis of intra-cardiac metastasis. Imaging for patients will logically indistinguishable from those seen in giant cell. be presented. The classifi cation of malignant giant cell lesions includes: 1. Primary malignant giant cell tumor (PMGCT) 2. Sec- Conclusion: Soft tissue sarcomas are rare malignant ondary malignant giant cell tumor (SMGCT) 3. Giant cell tumors of the musculoskeletal system, demonstrating an rich osteosarcoma (GCROS) 4. Anaplastic giant cell rich aggressive metastatic pattern. We report the unusual occur- sarcoma. The distinction between all the groups and benign rence of an intra-cardiac metastasis in two patients. In giant cell tumor is extremely important as the clinical treat- spite of aggressive treatment, both patients died rapidly of ment and prognostic outcome is different. All shows similar disease, demonstrating the aggressive nature of this type of radiographic features, histologically all have osteoclast-like metastasis. giant cells and anaplastic spindle stromal cells. The correct diagnosis is challenging. The combination of subtle criteria Notes: may help in making the correct diagnosis. Exemplifi ed cases from each group will be presented with discussion of treatment and outcome.

Notes:

164 Discussion: risk fordistalradiusfracture(OR=6.5). ity of87%,andpatientswithHU 268 inthedistalradiushadasensitivity of87%andspecifi 320), ascomparedtonon-fracturecontrols. A HUthresholdof HU, atthedistalradius(227vs.312)andulnarhead(211 had signifi Results: osteopenic changes. within oneweekofinjurywereusedtominimizedisuse a CTscanobtainedforotherindications.scans compared with15matchedcontrols(mean=35years)thathad a CTdocumenteddistalradiusfracture(mean=36years)were bone HUvalues ofthedistalradiusandulna.15patientswith density measurementsweremadeusingregional cancellous Methods: cation ofpatientsinneedfurthermanagement. dictive ofdistalradiusfracturerisk,therebyallowing identifi could beusedtoassesslocalbonequalityandwould bepre- density. We hypothesizedthatHUvalues ofthedistalradius obtained fromdiagnosticCTscanstocalculateregional bone Introduction: Andrew J. Weiland, MD Michelle G.Carlson,MD MD Paul A.Anderson, Joseph J.Schreiber, MD Diagnostic Wrist CTScans Gleaning Additional Information From Osteoporosis Screening:Opportunistic Notes: assessments, initiationoftreatment,orappropriatereferral. bone diseasework up,suchasadditionalimaging,laboratory 268 inthedistalradiusbeconsideredforfurthermetabolic patient. - We suggestthatpatientswithHUvalues below with minimaleffort, atnoadditionalcostorradiationtothe from any diagnosticCTscanusingmodernsoftware programs distal radiusfracture.-HUmeasurementscanbeobtained identifi ulna. - A thresholdHUvalue of268inthedistalradiuswas bone density, asassessedwithHU,inthedistalradiusand 1:55pm–1:59pm ed thatisassociatedwith6.5timesincreasedriskfor The cohortofpatientswithadistalradiusfracture cantly lower regional bonedensity, asassessed with Quantitative CTscanswereperformedandbone Patients withadistalradius fracturehadlower Hounsfi eld Unit(HU)values canbeeasily ≤ 268 wereatanincreased c- - plasty didnotchangesubstantially over thedecadeofstudy Conclusions: increased from$26,757in2002 to$48,421in2011. dollars, themediantotalcharges forashoulderPJIpatient academic hospitals(OR1.93;p<0.0001). Adjusted to2011 hospitals hadgreaterriskofinfectionthanpatientsinurban older age(OR0.98/year;p<0.0001).Patients inurbanprivate 2.43; p=0.00031)ordefi 2.38; p=0.0011)andanemiafromeitherbloodloss(OR PJI wereweightloss(OR2.62;p=0.00047),drugabuse (OR this periodoftime. The factors moststronglyassociatedwith years studiedwas 0.98%anddidnotvary signifi Results: identify predisposingfactors forshoulderPJI. codes. Multivariate logisticregression analysiswas utilizedto for device removal (80.01)andprostheticinfection(996.66) through 2011.ShoulderPJIwas identifi in theNationalInpatientSampling(NIS)databasefrom2002 identifi Methods: arthroplasty intheUnitedStates. disposing factors, andeconomicburden ofPJIafter shoulder The purposeofthisstudywas toanalyzetheincidence, pre- little known aboutinfectionsfollowing shoulderarthroplasty. cause ofmorbidityfollowing shoulderarthroplasty. There is Background Javad Parvizi, MD,FRCS Gerald R. Williams, MD Matthew L.Ramsey, MD Mitchell G.Maltenfort,PhD *Eric M.Padegimas, MD Surena Namdari,MD,MSc Burden United States: IncidenceAndEconomic Periprosthetic ShoulderInfection In The 1:30pm–1:34pm Pedro K.Beredjiklian, MD Moderator: (Station D,Ritz-CarltonBallroom Foyer) Rapid Fire Session11D—UpperExtremity Friday, October24,2014 ed usingtheICD9-CMcodes81.80,81.81and81.88 The overall infection rateover thecourseoften Patients whounderwent shoulderarthroplastywere : Periprostheticjointinfection(PJI)isamajor The incidenceofPJIfollowing shoulderarthro- ciency (OR2.05;p<0.0001)and Rapid Fire Session11D ed usingarthrotomy cantly over 165

FridayPoster Friday Abstracts EOA 45th Annual MeetingAmelia Island, Florida2014

period. This study identifi ed some modifi able risk factors and lary lateral views were reviewed for any evidence of loosen- the economic burden that is associated with shoulder PJI. The ing. rising number of shoulder arthroplasties performed will result in a greater absolute number of shoulder PJI cases in the Results: Thirty-four patients’ data were available with two future with an increasing economic burden on the health care. year follow-up. Average age was 66.6 years. Average duration of follow-up was 31 months (Range 23-49). Four patients Notes: (11.8%) were revised to a reverse total shoulder arthroplasty, all for the indication of subscapularis failure and pain at an average of 9 months post operatively. There were no implants with radiographic evidence of loosening. VAS scores improved an average of 4.8 from pre-op to the fi nal follow-up. Forward elevation and external rotation improved an average of 72° (0-130°) and 43° (0-80°) respectively from pre-op exam to fi nal follow-up.

Conclusion: Trabecular metal glenoid component survival was 100% at 2 year follow-up in this cohort of patients. While long term follow-up is needed, these early results are promising.

1:35pm–1:39pm Notes:

Two Year Survival And Outcomes Of Trabecular Metal Glenoid Components In Total Shoulder Arthroplasty

Scott T. Watson, MD Stefan Tolan, MD Keith Lonergan, MD

Introduction: Glenoid component failure remains a substantial cause of Total Shoulder Arthroplasty (TSA) failure and surgical revisions. Trabecular metal backed glenoid components have become popular in recent years. This technology has well documented survival results in Hip and Knee arthroplasty, however to our knowledge there are no published 1:40pm–1:44pm reports of survival in TSA. The purpose of this study is to report the two year survival and clinical outcomes of patients Arthroscopic Anchorless, Transosseus who received a trabecular metal glenoid component in a pri- vs Anchored Rotator Cuff Repair — Case mary anatomic total shoulder arthroplasty. Control Analysis Methods: Radiographs and clinical records for all patients Lucas B. Romine, MD who underwent an anatomic TSA with a trabecular metal Umasuthan Srikumaran, MD, MBA glenoid component were reviewed retrospectively. The pri- Kelly G. Kilcoyne, MD mary outcome was survival of the implant deﬁ ned as no revi- Edward McFarland, MD sion surgery at least 23 months postoperatively. Secondary Steve Petersen, MD, MSc outcomes were: any evidence of loosening of the component on postoperative imaging, VAS scores at two year follow-up Introduction: Recent advancements in surgical instrumenta- compared to pre-op, and improvement in forward elevation tion have permitted an all-arthroscopic, anchorless transosseus and external rotation range of motion. AP, oblique, and axil- repair, which reproduces the “gold standard” of open transos-

166 Notes: tear sizeagainst theanchorless,transosseusgroup. anchorless, transosseustechniques,despitesignifi between arthroscopicstandardanchoredapproachesand in functionalorpatientreportedoutcomeswereidentifi Discussion and to SSV, VAS painscore,and ASES score. There was nodifference betweenthetwo groupswithrespect SSV, VAS, and ASES scorescomparedtopreoperative scores. postoperative improvement inbothgroupswithrespectto larger tearsize. At 12monthfollow up, therewas signifi anchorless, transosseusgroupwas foundtohave signifi differ betweengroups.Comparedtotheanchoredgroup, Results: recorded complications. tive shoulderscore(SSV),rangeofmotion, ASES score,and tear size. We collectedvisualanalog(VAS) painscore,subjec- scapularis. Baselinedemographicdataincludedage,sex, and tears, revision cuff repair, andisolatedrepairsofthesub- anchorless, transosseusrepair. We excluded partialthickness repair (singleanddoublerow), whilethecasegroupincluded from 2011to2013. The controlgroupincludedanchored arthroscopic rotatorcuff repairperformedbyasinglesurgeon Methods: anchored rotatorcuff repair. cal outcomesofarthroscopicanchorless,transosseusversus arthroscopic anchoredtechnique.Ourgoalistoassessclini- all-arthroscopic, anchorless,transosseusrepairtostandard seus repair. To date,thereisnopublishedliteraturecomparing Baselinedemographicdataforageandsex did not We conductedaretrospective case-controlstudyof

Conclusion: Nosignifi cant differences cant biasin ed cantly cant syndrome whichresolved andonepatienthadmildtransient ulnar variance. Onepatientdeveloped complex regional pain ries, orangularcollapses. Two patientshadanincreasein There werenopintrackinfections,non-unions,tendoninju- were slightlyoutsideofacceptedrangesinthreepatients. parameters following reduction,(P>0.33)althoughparameters loss ofreductionandnosignifi at lastfollow upwere10.8and9.1respectively. There was no 82% ofthenon-injuredside;meanDASH andPRWHE scores respectively, meanwrist AROM increasedtoaminimumof grip andlateralpinchstrengthrecovered 82.2%and95.1% Results: comes. PRWHE andDASH wereusedtodeterminesubjective out- strength, andactive wristrangeofmotion(AROM). The software. Patients werealsoevaluated forgripstrength,pinch each timepointfromdigitizedradiographsusingDigimizer and 10-14months.Radiographicvariables weremeasuredat radiographs wereobtainedpre-op,post-op,at8-12weeks rehabilitation began, meanof8days(range2-16).Standard sis was applied,mean6days(range2-10)andformalwrist spanning external fi and percutaneousfi in thisstudy. All patientsweretreatedwithclosedreduction (AO typeC)distalradiusfractures(DRFs)wereincluded Methods: DASH score. assessed viaradiographicvariables, functionaloutcomes,and for rangeofmotionin AO typeCdistalradiusfractures, as was hypothesizedtomaintainanatomicreductionandallow and anon-spanningexternal fi treated withclosedreduction,crosspinmultiplanarfi complex, intra-articulardistalradiusfractures(AO typeC) Introduction: BS Shawn Adhya, Ather Mirza,MD Justin B.Mirza,DO R. Tyler Huish,DO System) And ANon-BridgingExternalFixator(CPX Fractures Treated With Cross-Pin Fixation DistalRadius Complex Intra-Articular 1:45pm–1:49pm At average follow-up of17months(range12-36), Twenty-three patientswithcomplex, intra-articular This studyaimstoassessthe outcomesof xation usingK-wiresattachedtoanon- xator. Postoperatively, aremovable ortho- xator. The useofthisdevice cant changeinradiographic Rapid Fire Session11D xation, 167

FridayPoster Friday Abstracts EOA 45th Annual MeetingAmelia Island, Florida2014

superfi cial radial nerve sensitivity without functional compro- carpal tunnel immediately before and after BJA was measured mise. All patients returned to their prior employment and/or using a commercially available pressure monitor device. In activities. patients with concomitant CTS undergoing both BJA and carpal tunnel release (CTR), the pressure was measured after Conclusion: Twenty-three patients with complex intra- BJA but prior to release of the transverse carpal ligament. articular DRFs were treated with closed reduction, cross pin fi xation, and a non-spanning external fi xator. Subse- Results: The pressure within the carpal tunnel decreased after quently, patients demonstrated excellent radiographic, BJA in all patients. The mean pressure prior to BJA was 20.5 functional, and subjective outcomes (Final DASH of 10.8). mmHg and decreased signifi cantly to 8.0 mmHg after BJA. Two patients experienced complications that resolved Patients with concomitant CTS had a mean pre-BJA pressure without functional compromise. This preliminary study of 26.8 mmHg, which decreased to signifi cantly 6.8 mmHg suggests that the non-spanning external fi xator may be after BJA. indicated for complex intra-articular DRFs if closed reduction is possible. Discussion and Conclusion: BJA decompresses the carpal tunnel and decreases the pressure within. In patients with Notes: concomitant CTS the BJA alone (without additional release of the transverse carpal ligament) decreases the carpal tunnel pressure. Further study is warranted to determine the need for discrete release of the transverse carpal ligament in patients with CTS who are undergoing BJA.

Notes:

1:50pm–1:54pm

Basal Joint Arthroplasty Decreases Carpal Tunnel Pressure

Kevin Lutsky, MD *Nayoung Kim, BS 1:55pm–1:59pm Asif Ilyas, MD Pedro K. Beredjiklian, MD Online Resources For Shoulder Instability: Introduction: There is a well-documented association What Are Patients Reading? between carpal tunnel syndrome (CTS) and thumb car- pometacarpal (CMC) arthritis, and these conditions com- Grant H. Garcia, MD monly coexist. We have observed that patients with who Samuel A. Taylor, MD have previously undergone thumb basal joint arthroplasty Chris J. Dy, MD, MSPH (BJA) seem rarely to present subsequently with CTS. Our Alexander B. Christ, MD hypothesis is that BJA decreases the pressure within the Ronak M. Patel, MD carpal tunnel. Joshua S. Dines, MD

Methods: Nineteen patients (4 with co-existent CTS) under- Introduction: Evaluations of the medical literature suggest going BJA were enrolled in the study. The pressure within the many online sites provide poor quality information. Our stud-

168 Notes: terms. help directpatientstopropersitesandguideInternetsearch need tobeaware ofinformationavailable online,andshould highly dependentofthespecifi ceptably highreadinglevel. The qualityofinformation is shoulder instabilityisofteninaccurateand/oratanunac- Discussion andConclusions: ment. eight-mentioned thermalcapsulorrhaphyasaprimarytreat- tioned surgical optionsforshoulderinstabilityandofthese, occurring in88%ofwebsites.Only23sites(28.0%)men- sites withreadinglevels above 8thgrade(pequals0.001), 0.001) seetable1.Qualitywas signifi advanced for“shoulderinstability”websites(plessthan 0.001). However, thereadinglevel was signifi shoulder” (quality:plessthan0.001;accuracy: pequals instability” comparedtowebsitesusingtheterm“loose ity andaccuracy was producedusingtheterm“shoulder Results: sites found. affected thequality, accuracy, andreadabilityoftheweb- search term,authortype,andpresenceofcommercialbias analyses ofvariance) wereusedtodeterminewhetherthe grade level. Comparative statistics(independent t-testsand evaluated usingtheFleisch-Kincaidscoreforreading Reviewers wereblinded. The readabilityofwebsiteswas noting iffourpotentialsurgery optionswerementioned. based on AAOS/ASES patientwebsites,inadditionto information usingasetofpre-determinedscoringcriteria 3 reviewers independentlygaugedqualityandaccuracy of Bing). We evaluated thefi were enteredintothreesearchengines(Google, Yahoo and ity”, “looseshoulder”and“shoulderdislocation”),which which weselectedthreesearchterms(“shoulderinstabil- Methods: shoulder instability. ies purposewas toinvestigate thevalue ofonlineresourcesfor 82uniquewebsiteswereevaluated. Higherqual- This was aprospective investigational studyin rst 25resultsfromeachsearch. c searchtermused.Clinicians Onlineinformationregarding cantly higherinweb- cantly more strength byoneyear. achieved 3/5strengthandmayyetachieve betterbiceps progress to3/5strengthwithcontinuedfollow-up, andone with returnof2/5bicepsbyoneyear, 3have continuedto return of2/5bicepsorbetter, and3have not.Ofthepatients Results: follow-up. mary outcomemeasurewas return of2/5bicepsby1year evidence ofreinnervation ofaffected musculature. The pri- months, asapreliminarylooktodetermineifthereisearly up. Ourdatarepresentsshort-termfollow-up, average 14 Inclusion criteriawereaminimumof8monthsfollow- there was noreturnofbicepsfunctionby6monthsage. repaired withnerve allograft. Surgical repairwas electedif 9 patientswhosebrachialplexus palsiesweresurgically Methods: graft. match thegraft,decreasedORtime,andreadysupplyof vention ofautograftdonor sitemorbidity, abilitytosize- gaps toolongfordirectrepairoruseofanerve tube,pre- the literature.Benefits ofthistechniqueincludebridging nerve graftsisanew technique notcurrentlydescribedin tion andrepairofthebrachialplexus. The useof allograft decades includingseveral techniquesforsurgical explora- palsy (OBPP)hascontinuedtoevolve forthepastseveral Introduction: Joshua Ratner, MD Allan F. Peljovich, MD Evan Siegall, MD Obstetric Brachial Plexus Palsy AllograftForSurgicalNerve RepairOf 1:30pm–1:34pm Daniel W. Green, MD Moderator: (Station E,Ritz-CarltonBallroom Foyer) Rapid Fire Session11E—Pediatrics Friday, October24,2014 Within our cohort of9patients,6have hadclear This paperpresentsaretrospective review of Treatment ofobstetricbrachialplexus Rapid Fire Session11E

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Conclusions: Our data shows that OBPP lesions surgically two-toed or three-toed feet with excellent function after 7 repaired with nerve allograft can lead to reinnervation of years and 4.5 years, respectively. The older girl was reex- affected musculature similarly to other techniques. Further amined at age 43. She is pain free, able to run, walk on her follow-up is required to fully compare fi nal outcomes of this metatarsal heads and heels, and wears normal shoes. Patient technique versus others. stated that surgery transformed her life. Her brother, now 50, expressed equal satisfaction. Notes: Discussion and Conclusion: Cleft foot is amenable to correction by uncomplicated surgery. In the younger children, simple cleft closure and straightening of curly toes produces good function and acceptable cosmesis. Cleft closure in older patients requires basal metatarsal osteotomies with reduction held by temporary transverse pin fi xation. Deformed rigid toes are best ablated. Elaborate toe reconstruction should be avoided. The aim is to produce feet that are normal in width, function well and fi t comfortably in regular shoes. Relatively simple surgical correction is described for disabling and cosmetically unacceptable cleft foot deformity. These techniques were effective in 8 feet in four patients followed from 4.5 to 30 years.

Notes:

1:36pm–1:40pm

Cleft Foot Deformity, Management And Long Term Follow-Up

John E. Handelsman, MD, FRCS David H. Godfried, MD Folorunsho Edobor-Osula, MD, MPH

Introduction: Absence of central rays create a cleft or lob- ster claw foot. Residual toes are curled and ultimately rotate inwards and ankylose. These feet are unstable and shoe fi tting is diffi cult. This study evaluates the long-term results of specifi c surgical techniques. 1:42pm–1:46pm

Methods: Eight feet were treated. Two siblings, a girl aged 3 Screw Fixation Of Lateral Condyle and a boy aged 18 months were managed by excision of skin Fractures: Results Of Treatment in the cleft and soft tissue suture apposition. Flexed toes were corrected by standard curly toe releases. Two older siblings, a Eric D. Shirley, MD girl aged 13 and a boy aged 20, required basal osteotomies of John M. Mazur, MD residual metatarsals and transverse Kischner wire fi xation to achieve and maintain correction. Ankylosed toes were ampu- Introduction: Fixation of lateral condyle distal humeral tated. fractures has traditionally been achieved with K-wires. Screw fi xation provides the advantage of compression across the Results: Eight feet in four patients have been surgically cor- fracture site. The results of screw fi xation and risk of iatro- rected. The younger children have cosmetically acceptable genic physeal damage are not well defi ned. This study was

170 may occur, withfl plications atearlyfollow-up. Smalldegrees ofmotionloss in satisfactory unionwithminimalriskofgrowth platecom- Discussion: 0-25°). (range, 0-25°)andthemeanlossoffl fi arrest oralterationsofthecarryingangle.For patientswith of fl ing. Hardware was symptomaticwithprominenceorloss as onepatientrequiredrevision fi tion. Initialfractureunionwas achieved in99%ofpatients, rate whenlateralovergrowth was excluded asacomplica- 34-802. The overall complicationratewas 19%,witha5% a closedreduction.Meanfollow upwas 148days,range 53 patientsrequiredopenreduction,42underwent sion criteria.Meanpatientagewas 5.8years,range2-12. Results: growth arrest. complications. Radiographswerereviewed forhealingand ined forresidualsymptoms,alignment,rangeofmotion,and isolated fractureswereincluded.Clinicalnotesexam- tution was undertaken. Patients ages 12yearsandunderwith condyle elbow fracturesusingscrew fi Methods: condyle fractures. designed toevaluate theeffi Notes: not beenwellestablishedintheliterature. tion oflateralcondylefracturesintheshort-term,whichhas Conclusion: nal follow-up >12months,themeanextension losswas 2° exion in4%ofpatients. There werenocasesofgrowth 95patientstreatedover a7-yearperiodmetinclu- A retrospective studyofpatientstreatedwithlateral Screw fi This studydemonstratesthesafetyofscrew fi exion defi xation oflateralcondylefracturesresults cacy ofscrew fi cits larger thanextension defi xation withbonegraft- exion was 8°(range, xation atasingleinsti- xation forlateral cits. xa- Notes: proximal femoralnail. rotation beforeselectingtheentrypointintrochanteric C-arm inanappropriateplanetakingintoaccountthefemoral the femoralrotationtoanatomicalpositionor Discussion andConclusion: to believe thathe/sheissignifi Selecting astartingpointatthatrotationwillleadthesurgeon coplanar withthemedialdownslope ofthegreatertrochanter. 20 degrees ofexternal rotationthemetallicpointappearstobe tance betweenthemetallicpointandallneedlesdecreases. At Results: increments ineitherdirection. and internalrotation,theC-armwas rotatedin10degree the fi each samplewas measuredonlateralimage,basedwhich, rior totheentrypoint. The anteversion ofthefemoralneck marked asareference point—6mmmedialand12ante- line andthesuperiorborderofneckwas identifi bony density, thejunctionofproximalintertrochanteric this at3mmintervals inthesamecoronalplane. A distinct with aneedle;two additionalneedleswereinsertedlateralto in anatomicalposition. The optimalstartingpointwas marked Methods: femoral rotationonfi position ofthefemurduringsiteselectionandinfl teric nail.However, thereisnodescriptionoftherotational lateral C-armview isthecorrectstartingpointfortrochan- posterior) C-armview andinlinewiththefemoralshaft the greatertrochanterjustmedialtoitstipin AP (antero- of choicetotreatperitrochantericfemurfractures. A pointon Introduction: Daniel S.Horwitz,MD Thomas Bowen, MD David G.Fanelli, BS Hemil H.Maniar, MD For TrochantericNails Effect Point OfFemoralRotationOnEntry 1:48pm–1:52pm rst anatomical AP imagewas taken. To mimicexternal With increasingexternal rotationthecoronaldis- Four saw bonesampleswereselectedandmounted Trochanteric entrynailhasbecometheimplant nding theoptimalstartingposition. Itisessentialtoeithercorrect cantly moremedial. Rapid Fire Session11E ed and uence of 171

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1:54pm–1:58pm

Wait Time And Patient Satisfaction In The Orthopedic Clinic

Tyler M. Kreitz, MD Brian S. Winters, MD David I. Pedowitz, MD, MS

Purpose: The purpose of this study was to examine the relationship between wait time and overall patient satisfaction and likelihood to recommend the practice in the orthopedic clinic.

Methods: This is a retrospective cross-sectional study using routinely collected wait times and satisfaction survey results for 3125 new patients in the orthopedic clinic from June 2011 through October 2013. Wait time was calculated from the time of scheduled appointment to time in the exam room. A general linear mixed statistical model was used to evaluate the effect of increasing wait time on overall satisfaction and likelihood to recommend the practice.

Results: The likelihood of an excellent (OR 0.86) and excellent or very good (OR 0.82) rating for overall satisfaction showed signiﬁ cant correlation per 15 minutes of additional wait time. The likelihood of a strongly agree (OR 0.9) and strongly agree or agree (OR 0.85) response to recommend the practice showed no signiﬁ cant correlation per 15 minutes of additional wait time.

Conclusion: Minimizing wait times in the outpatient orthopedic clinic may improve overall patient satisfaction but may not affect likelihood of those patients to recommend the practice to others. An increase in wait time of 15 minutes reduces the odds of a positive satisfaction result without affecting the likelihood to recommend the practice. This may suggest that although the patient may have been less satisﬁ ed with their individual experience, they did not believe this to be indicative of the overall practice. Our data shows a correlation between wait time and patient satisfaction.

Notes:

172 quality ofcare: (HACs) and5Patient SafetyIndicators(PSIs)tomeasure We usedthefollowing 8Hospital-acquiredConditions reported experience forhospitalsacrossthenationin2011. hospitals) toexamine complicationratesandpatient Methods: nent totheﬁ accepted qualityofcareindicators,many ofwhichareperti- of HealthcareProviders andSystems(HCAHPS)scoreswith ception ofcaremeasuredbyHospitalConsumer Assessment patient satisfaction. Inthisreport,wecorrelatedpatientper- correlation betweenthetechnicalqualityofcarereceived and to determinepaymentshospitals.Itisuncleariftherea they received isakey performancemetricandisbeingused tiatives toreachthisgoal. The patient’s perceptionofthecare to continuetheimplantationofpaymentforperformanceini- The CentersforMedicareandMedicaidServices(CMS)plan cal careisthegoalofhealthreforminUnitedStates. Introduction: Joseph A. BoscoIII,MD Lorraine Hutzler, BA Raj Karia,MPH Michael Day, MD,MS Spencer Stein,MD 4605 Hospitals With QualityOfHospitalCare: ASurvey Of Patients’ Perception OfCareCorrelates 7:00am–7:06am Henry A. Backe Jr., MD Moderators: Ballroom Salon1) General Session13—Mixed Topics Saturday, October25,2014 We usedtheHospitalComparedatabase (4605 eld oforthopaedicsurgery. Increasing qualitywhilereducingcostofmedi- E. Anthony Rankin,MD

(An asterisk(*)byanauthor’s nameindicatesthepresenter.) (Ritz-Carlton 2014 Scientiﬁ Abstracts —Saturday c Program tions demonstratedaninverse relationship betweenpatient patient centeredmedicalcare. The majorityofourcorrela- cation rateshave beenproposedasessentialcomponentsof Conclusion: (P<0.05). experience scoresthanthosewithlower complicationrates dehiscence wereassociatedwithsigniﬁ ative deathduetotreatableconditions, VTEs, andwound VCAIs, manifestationofpoorglycemiccontrol,post-oper- rates ofPSIs.Hospitalswithhigherpressureulcers, (71.1%) reportedratesofHACs and2871(62%)reported Results: care. the quartilestocorrelatepatientexperience withqualityof HCAHP quartiles,andatestfortrendwas appliedacross tors (HACs andPSIs)were thencalculatedforeachofthe of thefourHCAHPSquestions. The 13qualityindica- were divided intoquartilesbasedonperformanceeach communication, andresponsiveness ofstaff. Hospitals tal rating,willingnesstorecommendthehospital,doctor lowing 4questionsontheHCAHPSsurvey: overall hospi- We gaugedpatientexperience usingresponsestothefol- PSIs HACs • • • • • • • • • • • • • Accidental punctureorlaceration. Postoperative wound dehiscence Postoperative venous thromboembolism(VTE) Iatrogenic pneumothorax Postoperative deathfromtreatablecomplication Manifestations ofpoorglycemiccontrol Catheter-associated urinarytractinfection(CAUTI) Vascular catheter-associated infection(VCAI) Falls andtrauma Serious pressureulcers Blood incompatibility Air embolism Foreign objectretainedpost-operatively Of the4605hospitalsreportingHCAHPSdata,3273 Favorable patient experience andlow compli- cantly worse patient General Session13 173

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experience and complication rates. This negative correlation lected at 2-years postoperatively. Logistic regression models suggests that reducing these complications can lead to a better were used to examine the association between PRA, LOS and hospital experience. Our data on physician communication 2-year outcomes. and the timely responsiveness of staff also supports previous conclusions that complication rates may be improved by Results: 541 primary THA and 607 primary TKA patients, optimizing patient interactions. The two global domains of with 1,102 PRA (mean, 0.96 allergies/patient), were included. patient experience did demonstrate some correlations between 70% of allergies were drug-related, 14% food, and 16% envi- higher complication rates and better patient experience sug- ronmental. Increasing number of PRA was associated with gesting factors such as service recovery may be at play. Over- increased LOS for TKA, but not for THA. Each additional all, our results suggest that patient experience is generally PRA increased the likelihood of staying in the hospital for correlated with the quality of care provided. more than 5 days by 16% following TKA. Increasing number of PRA was signiﬁ cantly associated with worse WOMAC Notes: pain, stiffness and functional scores, and worse overall improvement in quality of life (QoL) after TKA. PRA were also correlated with worse WOMAC pain and functional scores, decreased improvement in QoL, and decreased overall satisfaction after THA.

Discussion and Conclusion: Number of PRA is an independent risk factor for increased LOS after TKA and worse outcomes at 2-years after TKA and THA. Patients with multiple reported allergies should be identiﬁ ed preoperatively and counseled about the risks of suboptimal postoperative results. 7:08am–7:14am These ﬁ ndings may have implications for surgeon and hospital reimbursement, as value-based payment becomes linked to Patient-Reported Allergies Affect Outcomes patient-reported satisfaction. After Lower Extremity Arthroplasty Notes: Jason L. Blevins, MD Benjamin T. Bjerke-Kroll, MD, MS Alexander S. McLawhorn, MD, MBA David M. Dare, MD Peter K. Sculco, MD Seth A. Jerabek, MD

Introduction: Factors other than surgical expertise and component positioning inﬂ uence patient outcomes after arthroplasty. Perceptions of pain, depression and somatiza- tion have been shown to inﬂ uence musculoskeletal disorders. Patient-reported allergies (PRA) are often discussed clinically, 7:16am–7:22am but have not been examined critically in the orthopaedic literature. We hypothesized that multiple PRA portend increased Lidocaine Chondrotoxicity In A Porcine length of stay (LOS) and worse outcomes after lower extrem- Fracture Mode ity arthroplasty. Grigory E. Gershkovich, MD Methods: All patients undergoing primary unilateral total hip James S. Raphael, MD arthroplasty (THA) and total knee arthroplasty (TKA) from Solomon P. Samuel, DEng October to December 2010 at a single institution were retrospectively reviewed. Allergies, sensitivities, and intolerances Introduction: Numerous studies have demonstrated the chon- were recorded from medical records, with basic demographic drotoxicity of lidocaine, but no study has examined its chon- and LOS data. WOMAC and satisfaction scores were col- drotoxicity during acute trauma. This novel study examined

174 Notes: vent chondrotoxicity. does notprovide enoughprotectionagainst lidocainetopre- Finally, thelocalenvironment withininjuredsynovial joints native thancellculture for studyinglocalanesthetictoxicity. that porcinecartilageexplants areaquicker andsuitablealter- injecting lidocaineintoinjuredjoints. The studydemonstrates our hypothesis,andphysicians mustremainvigilantwhen Discussion and anywhere between22-54%. Individually, thereductioninexplant viabilityvaried from reduction inviabilitywithinthelidocaineexposure group. the threeanimalsdemonstratedastatisticallysignifi synovial spaceafter30minutes. The combinedODdatafrom tures. We wereabletoverify thepresenceofanestheticin Results: was comparedusingstudentt-test. explant viabilitybetween thecontrolandexperimental group measured after6hat570nmtoassessexplant viability. The then added,andtheopticaldensity(OD)ofmediawas cell culturemediumfor24hours. AlamarBlue reagentwas tal group.Cartilageexplants wereincubatedinastandard the controlgroupand29weretaken fromtheexperimen- sites wereobtained. A totalof23sampleswereobtainedfrom minutes, 3mmdiametercartilagebiopsiesfromthefracture lidocaine. The leftjointreceived saline(control). After 30 joint received alateralsuprapatellar20mlinjectionof2% mini-open techniqueanda1cmosteotome. The rightstifl femoral condylesofbilateralstifl minutes ofeuthanasia.Fracturesthemedialandlateral Methods: would causechondrotoxicityinthetraumasetting. in aporcinecadaver model. We hypothesizedthat lidocaine the chondrotoxicityoflidocaineduringpre-existing trauma The mini-opentechniqueproducedconsistentfrac- Three porcinecadavers wereutilizedwithin30

Conclusions: The preliminarydatasupports e jointswerecreatedviaa cant 34% e Notes: larger samplestofurthersupportthesefi the sensitivity andspecifi ing 2-stagerevision. Combiningthetwo testsgreatlyaffects use ofCRPandESRasindicatorstheresolutionPJI dur- Discussion andConclusion: was 100%whenneithertestwas elevated. notably, thenegative predictive value ofpersistentinfection were 76%,81%,and91%forthosetestsrespectively. Most and 100%whenthetestswerecombined. The specifi Sensitivity was 50% forelevated CRP, 75%forelevated ESR, tion withinthefi Results: (16 knees,9hips). secutive 2-stagerevisions forPJIwereidentifi years post-operatively. Between7/2004and7/2012,25con- of infectionwas defi 2-stage revisions, as wellasafterre-implantation.Eradication the responseofCRPandESRbetweentwo stagesofthe joint databaseswas conducted. We identifi Methods: re-implantation forPJI. eradication ofinfectionbetweenstagesa2-stagerevision/ to determinetheutilityofserumCRPandESRinevaluating exists regarding thispractice. The purposeofthisstudywas stages ofa2-stageprocedure;however, apaucity ofdata use theseteststodetermineifinfectionisresolved between tant testsintheinitialdiagnosisofPJI.Many surgeons also Sedimentation Rate(ESR)have beenestablishedasimpor- Serum levels ofC-Reactive Protein(CRP)andErythrocyte the infectioniseliminated,canre-implantationtake place. and several weeksofantibioticsadministered. Onlythen,if where allimplantsareremoved, atemporaryspacerplaced, cult problemtotreat,oftennecessitatinga2-stageprocedure Introduction: Daniel J.DelGaizo,MD Christopher W. Olcott,MD Christopher P. Lindsay, BS Of Periprosthetic Infection CRP AndESRAsIndicators ForResolution 7:24am–7:30am Outofthe25cases,4experienced evidence ofinfec- A retrospective review ofourinstitutionaltotal Periprostheticjointinfection(PJI)isadiffi rst 2yearsfromthesecondstageprocedure. ned asclinicallyinfectionfreeatleast2 city. Moreresearchisneededwith Resultsofthisstudysupportthe ndings. General Session13 ed andanalyzed ed foranalysis cities - 175

Saturday Friday EOA 45th Annual MeetingAmelia Island, Florida2014

does not encourage improved quality of care. If reimburse- 7:32am–7:38am ment is to be driven by quality metrics, evidence-based reimbursement (i.e. reward to high-volumes centers of clinical Resident/Fellow Travel Grant Award excellence) should be considered. Understanding how quality measures in TJA relate to Medicare billing may enhance qual- What Factors Affect Medicare ity of care and reward institutions that have better clinical Reimbursement In Total Joint outcomes. Arthroplasty? Notes: Eric M. Padegimas, MD Benjamin Zmistowski, MD Kushagra Verma, MD, MS Julie L. Shaner MD Michael J. Howley, PA-C James J. Purtill, MD

Introduction: Medicare costs have been increasing since the inception of the program and they are projected to continue increasing exponentially. In order to increase transparency and contain costs, the Centers for Medicare and Medicaid 7:40am–7:46am Services (CMS) released charge and reimbursement data for 2011. Concurrently, the demand for total joint arthroplasty Resident/Fellow Award (TJA) is projected to increase signiﬁ cantly. Our purpose is to study reimbursement variability for TJA and what factors affect it. Enhanced understanding of Medicare billing may Combination Therapy With DBM And allow the orthopaedic community to better manage the eco- PTH Cannot Heal A Critical Sized Murine nomic changes coming. Femoral Defect

Methods: In 2011, the CMS released a dataset of Medicare Michael Pensak, MD reimbursement, provider charges, location and volume of dis- Seung-Hyun Hong, PhD charges for the top 100 most billed Diagnosis Related Groups Alex G. Dukas, MD (DRGs). These were grouped into patient referral areas using Jennifer M. Bayron, MD the Dartmouth Atlas. We created a multivariate regression Brian A. Tinsley, MD, MA model by referral area with population and healthcare vari- Ashish Jain, MS ables identifi ed from the Dartmouth Atlas, CMS, WWAMI Amy Tang Rural Health Research Center, and United States Census. Aditya Makol, MD David W. Rowe, MD Results: 427,207 TJA with weighted average reimbursement Jay R. Lieberman, MD of $14,324.84 ($9,103-$38,686) were identifi ed. Our regression model accounted for 52.5% of variability. Variables Introduction: Orthopaedic surgeons continue to search for regarding hospital ownership accounted for 2.4% of variabil- cost-effective bone graft substitutes to enhance bone repair. ity, socioeconomic 10.9%, competitive institutions 14.5%, Teriparatide (PTH 1-34) and demineralized bone matrix supply and demand 19.9%, and quality of care 4.8%. Quality (DBM) have been used in patients to promote bone healing. metrics such as TJA provider volume and patient satisfaction We evaluated the effi cacy of combination therapy with DBM were both signifi cantly inversely correlated with reimburse- and PTH in healing a critical sized femoral defect. We used ment. novel lineage-specifi c reporter mice to evaluate the osteoprogenitor response to this treatment. Discussion and Conclusion: Reimbursement for TJA is highly variable. Quality of care measures only account for Methods: Critical sized femoral defects (2mm) were 4.8% of variability and institutions with worse metrics have created in male lineage-specifi c transgenic mice greater reimbursements. The current reimbursement system expressing Col3.6GFPtopaz (pre-osteoblastic marker),

176 Notes: defects inhumans. should notbeusedtotreatnonunionsorfractureswithbone osteoprogenitor responsetothisregimen. This combination Quantitation offrozenhistologicsectionsrevealed alimited DBM andPTHfailed tohealacriticalsizedfemoraldefect. Discussion andConclusion: osteoprogenitor cells. groups andtimepointsthedefectswerelargely absentof ability. Histologicanalysisrevealed thatacrossalltreatment the radiographicreviewers indicatinghighinterobserver reli- healed. A weightedKappavalue of0.87was achieved among to GroupI.Only1of120(0.83%)defectsacrossall3groups healing was signifi 1.03. ANOVA andposthoctestingrevealed thatat56days I, 1.57+/-0.68;GroupII,3.00+/-1.29;andIII,2.90+/- The average healingscoreat56dayswas asfollows: Group lack ofhealingacrossalltreatmentgroupsattimepoints. Results: niques. the defectusingcomputer-automated histomorphometrictech- sections wereanalyzedforosteoprogenitorresponsewithin ate healingbythreeindependentreviewers. Frozenhistologic and evaluated usinga5-pointscaledscoringsystemtoevalu- came fi istered for28daysoruntilthepointofsacrifi 7, 14,28and56daysaftersurgery. Injectionswereadmin- gene pertreatmenttimepoint. Animals weresacrifi DBM +30µLsalineinjection. There were5micepertrans- Group II,PTH30µginjectiondaily+DBM,andIII, ated: GroupI,PTH30µginjectiondailyandemptydefect, (pericyte/myofi -SMA-Cherry Col2.3GFPemerald (osteoblasticmarker) and rst. Radiographsweretaken atthetimeofsacrifi Radiographicanalysisofthespecimensshowed a broblast marker). Threegroupswereevalu- cantly betterinGroupsIIandIIIcompared Combinationtherapy with ce ifthelatter ced at ce in acostwellbelow thestandard $100,000/QALY WTP alone. The addition ofbariatricsurgery priorto TKA results iatric surgery prior to TKA yieldedgreaterutility than TKA Discussion andConclusion: $47,590/QALY). found amedianICERwas $14,038/QALY (95%CI,$5,004- for independentvariables. Probablisticsensitivity analysis $13,997/QALY. Resultswerestableacrossbroadvalue ranges ICER betweenthesetwo procedureswas approximately for patientsundergoing bariatricsurgery priorto TKA, the TKA. With $1,136additionalcosts over themodelperiod gained thanpatientsreceiving bariatric surgery prior to Results: threshold of$100,000/QALY. analyses wereperformed,usingawillingness-to-pay(WTP) ratio (ICER).One-way, two-way andprobabilisticsensitivity outcome measurewas theincrementalcost-effectiveness and utilitieswerediscountedat3%peryear. The principal were expressed inquality-adjustedlife-years(QALYs). Costs tient Survey dataandadjustedto2012USdollars.Utilities from theliterature.CostswereestimatedusingNationalInpa- of transitionbetweeneachstateanditsutilitywerederived (2) bariatricsurgery two yearspriorto TKA. The probability bid obesityandend-stagekneeOA: (1)immediate TKA, and cost-utility oftwo treatmentprotocolsforpatientswithmor- Methods: obesity andkneeosteoarthritis(OA). gery priorto TKA forpatientsfailing medicalmanagementof study was todeterminethecost-effectiveness ofbariatricsur- for weightlosspriorto TKA isunknown. The purposeofthis tive treatmentformorbid obesity, but itscost-effectiveness linearly withbodymassindex. Bariatricsurgery isaneffec- after totalkneearthroplasty(TKA).Costsfor TKA increase Introduction: Emily R.Dodwell,MD,MPH,FRCSC Robert G.Marx,MD,MSc,FRCSC Y. Claire Wang, MD,ScD Daniel Southren,BA Alexander S.McLawhorn, MD,MBA Prior To Primary Total KneeArthroplasty Cost Effectiveness OfBariatricSurgery Ranawat Award 7:48am–7:54am Obesepatientsundergoing TKA hadlower QALYs A Markov modelwas constructed tocomparethe Obesityisassociatedwithadverse outcomes

Inmorbidlyobesepatients,bar- General Session13 177

Saturday Friday EOA 45th Annual MeetingAmelia Island, Florida2014

threshold. Bariatric surgery prior to TKA is likely a cost- to assess osteochondral graft tissue in 73 patients. Quantita- effective option for improving outcomes in morbidly obese tive T2 relaxation time values were recorded in a subset of patients with end-stage knee OA indicated for knee replace- 61 patients. T2 values were analyzed in both the superﬁ cial ment. and deep halves of the articular cartilage. Regions of interest included tissue within the graft and adjacent, normal cartilage, Notes: which served as a control.

Results: The mean follow up was 47.2 months, with average patient age of 37 years. Mean FAOS improved signiﬁ cantly (p0.05).

Conclusions: This study demonstrated that AOT is an effective treatment for OCLs of the talus, with good mid-to long- term functional outcomes. While MOCART scoring indicated Saturday, October 25, 2014 good structural integrity of the graft, quantitative T2 mapping Rapid Fire Session 14A — Foot suggests that graft tissue may not always mirror native hyaline (Station A, Plaza Ballroom 1) cartilage, particularly in superﬁ cial regions. Further prospective, randomized controlled trials are required to compare Moderator: Sameh A. Labib, MD AOT to other surgical procedures used for treating OCL of the talus.

9:39am–9:43am Notes:

Autologous Osteochondral Transplantation For Osteochondral Lesions Of The Talus: Functional And T2 MRI Outcomes At Mid-To Long-Term Follow-Up

Ethan J. Fraser, MD *Charles P. Hannon, BS 9:44am–9:48am Sean Flynn, BS Keir A. Ross, BS Timothy W. Deyer, MD Clinical And MRI Outcomes Of Femoral Huong T. Do, MS Donor Sites In Patient Post Osteochondral John G. Kennedy, MD, FRCS (Orth) Autologous Transfer For Osteochodral Lesions Of The Talus Background: For large or cystic lesions osteochondral lesions (OCL) of the talus, autologous osteochondral transplantation Ethan J. Fraser, MD (AOT) can be utilized to restore native architecture of the John G. Kennedy, MD, FRCS (Orth) articular surface. There are no studies in the literature compar- Keir A. Ross, BS ing quantitative imaging and functional outcomes following Ian Savage-Elliot, BA AOT. The purpose of this study was to investigate functional, Timothy W. Deyer, MD MRI, and T2 mapping outcomes to quantitatively assess repair tissue and the association with functional outcomes. Background: Autologous osteochondral transplantation (AOT) has demonstrated good clinical outcomes in the short- Methods: Eighty-seven ankles in 85 patients that underwent to-med term. The procedure is indicated for large or cystic AOT were retrospectively reviewed. Functional outcomes osteochondral lesions (OCL) or after failed reparative treat- were assessed pre and post-operatively using the Foot and ment such as microfracture. However, there are concerns Ankle Score (FAOS). The Magnetic Resonance Observa- regarding donor graft harvest from an uninjured knee. The tion of Cartilage Repair Tissue (MOCART) score was used purpose of this study was to assess donor site morbidity

178 Rapid Fire Session 14A

(DSM) in patients undergoing AOT for talar OCLs and to Conclusions: In this subset of patients with donor site mor- compare these fi ndings with post-operative magnetic reso- bidity, symptoms typically resolved before two year post- nance imaging (MRI) of the donor knee. operatively. In patients with persistent symptoms, two patients had a “fair” knee score, but no “poor” results were reported. Methods: Thirty-nine patients who underwent AOT of the Percent infi ll of repair tissue and MOCART scores were talus from 2006 to 2012, with the donor graft being taken lower for the symptomatic group overall, with lower scores from the lateral trochlear ridge of the ipsilateral knee, were in cartilage surface and subchondral ingrowth. Subscales of included in the study and retrospectively reviewed. Post- the MOCART score were higher in the asymptomatic group. operative magnetic resonance imaging (MRI) of the donor Overall, the MRI fi ndings of donor sites in AOT patients are knee was obtained for all patients. Any complaints of post- worse when persistent knee pain is present two or more years operative knee pain or stiffness were recorded. Patients post-operatively. with symptoms in the ipsilateral knee at two years postoperatively were further assessed using the Lysholm Score. Notes: Lysholm scores are currently being collected for the remainder of the cohort. A senior musculoskeletal radiologist also assessed the post-operative MRI of the donor knee in all cases and graded them using the MOCART scoring system. Percentage of cartilage infi ll at the donor site was also calculated via MRI.

Results: Patients were a mean age of 36.1 years and mean 9:49am–9:53am follow up period of was 41.8 months. The patients included in this study were a subset of a series of 87 AOT procedures A Comparison Of Anatomic Versus Tubular (7% DSM). Knee MRI was obtained in this study cohort Plating For Fibula Fractures when post-operative knee symptoms persisted. The average time to post-op MRI was 11.9 months (range 3-48 months). Justin Kane, MD Friday Mean MOCART score was 60 out of 100 points. Of the 39 Andrew Kay, BA knees included, six (15%) had donor site symptoms of pain Joseph N. Daniel, DO (4 patients), stiffness (1 patient) or persistent swelling (1 David I. Pedowitz, MD, MS patient) noted on two year clinical follow up. The remainder Steven M. Raikin, MD of the cohort had knee symptoms that indicated MRI evalua- James C. Krieg, MD tion, however, symptoms resolved after a period of physical therapy. Mean MOCART for those patients with DSM at two Introduction: Numerous implant designs exist for the treat- years was 53.3 compared with 61.2 for the asymptomatic ment of fi bula fractures. In-situ studies have failed to demon- cohort. In the patients with symptoms persisting two years or strate a difference in strength between implants. Studies sug- more, Lysholm scores for two were rated as “fair”, three were gest that locking constructs may be benefi cial in the setting of rated as “good” and one was “excellent’ with an average score osteoporotic bone. However, a paucity of data exist assessing of 85.1 out of 100. Post-operative MRI showed variable infi ll fi xation of fi bula fractures in healthy patients with non-osteo- of the defect surface between the groups with 75.5 % of the porotic bone. This study aims to assess whether there is a dif- asymptomatic group having complete infi ll compared to 66.7 ference in quality of fracture reduction in the setting of SER-2 % in the DSM group. Subchondral bone exposure was not ankle fractures with either standard one-third tubular plating evident in any patients. Similarly, MRI showed no evidence of or anatomic plating. effusion or adhesion in any of the patients. MRI assessment also revealed 83.3 percent vs 84.5 percent had intact or par- Methods: A retrospective review of 201 patients treated for tially intact subchondral lamina in the DSM and asymptom- an SER-2 ankle fracture by four foot and ankle fellowship atic groups, respectively. Subchondral bone pathology such as trained orthopaedic surgeons at a single tertiary care practice edema, granulation tissue, cysts or sclerosis was evident in 50 was undertaken. Offi ce notes, operative reports, pre-operative percent of the symptomatic group compared with 54.5 percent imaging, and post-operative imaging were reviewed to colin the asymptomatic group. lect patient demographics and assess the quality of reduction of the fi bula. Quality of reduction was assessed established

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radiographic parameters to determine whether an anatomic fusion. The purpose of our study was to assess changes in reduction was achieved. range of motion and functional outcomes following both treatment modalities. Results: One-third tubular plating was used to treat 120 patients. 111 (92.5%) of these patients had an anatomic reduc- Methods: Patients undergoing tibio-talar arthrodesis and TAA tion of their fi bula fracture. Anatomic plating was used to treat were enrolled as part of an ongoing prospective study. Over- 81 patients. 74 (91.4%) of these patients had an anatomic all arc of motion and midfoot arc of motion were assessed reduction of their fi bula fracture. No statistical signifi cance by anterioposterior, lateral, mortise, and fl exion/extension existed between one-third tubular plates and anatomic plates radiographs. All patients completed Foot and Ankle Ability in achieving anatomic reduction. Comparing the success rates Measure (FAAM) ADL and Sports subscale forms and VAS of achieving an anatomic reduction for each plate design pain scores. yielded no statistical signifi cance. Results: 35 patients who underwent TAA and 7 patients who Discussion and Conclusion: With the rising cost of health underwent tibio-talar arthrodesis were available for follow-up. care, we must weigh the use of costlier implants and new Average total arc of motion was 34.4 degrees (range 17.0- innovations that may offer no signifi cant benefi t to patients 52.2) with average midfoot arc of 11.1 degrees (range 0.9– while increasing the overall cost of treatment. Newer implant 28.8) in the TAA cohort. Average total arc of motion was 22.9 designs for distal fi bular fractures may be benefi cial in certain degrees (range 6.9-32.4) with average midfoot arc of 21.6 circumstances. However, in the treatment of SER-2 ankle degrees (range 8.3-41.4) motion in the arthrodesis cohort. fractures, no benefi t was found comparing anatomic and one- Average VAS pain score was 3.8 (range 0-44) following TAA third tubular plates in achieving anatomic reductions. and 38.5 (range 0-87) following arthrodesis. Average FAAM ADL and Sports subscale scores were 84.8 (range 35.7-100.0) Notes: and 55.5 (range 15.6-100) and 66.3 (range 28.6-90.5) and 55.5 (range 15.6-100.0) for TAA and fusion, respectively.

Discussion and Conclusion: TAA offers superior results compared to fusion in regards to preserving normal arc of motion, pain relief, and post-operative function. The relative increase of midfoot arc compared to total arc seen in fusion patients may play a role in the inferior results compared to TAA and may predispose these patients to degenerative changes at adjacent joints to the fused tibiotalar joint. 9:54am–9:58am Notes: Total Ankle Arthroplasty Versus Arthrodesis: An Arc Of Motion Analysis

Justin Kane, MD Geoffrey Smith, BS Kristin Brown, BA Heather L. Saffel, BS, MS Steven M. Raikin, MD David I. Pedowitz, MD, MS

Introduction: Advancements in total ankle arthroplasty (TAA) have increased successful long term outcomes and, coupled with preservation of near normal joint kinematics; provide the theoretical benefi t of protecting against progression of arthritis to adjacent joints. However, there are few reports offering comparison of midfoot range of motion with plantarfl exion and dorsifl exion of the foot following TAA and

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of data regarding access to lateral lesions. This study showed 9:59am–10:03am improved functional outcome scores after lateral tibial trapezoidal osteotomy. Quantitative T2 mapping relaxation values Anterolateral Tibial Trapezoidal Osteotomy in both superﬁ cial and deep components of the repair tissue For Accessing Osteochondral Lesions Of were similar, suggesting that the repair tissue at the site of The Talus In Autologous Osteochondral osteotomy resembles normal, native cartilage. Transplantation: Functional And T2 MRI Analysis Notes:

Ethan J. Fraser, MD *Arianna Giannakos, BS Charles P. Hannon, BS Keir A. Ross, BS Hunter Newman, HS Timothy W. Deyer, MD John. G. Kennedy, MD, FRCS (Orth) 10:04am–10:08am Background/Purpose: Osteochondral lesions (OCL) of the talus are common injuries and have a poor propensity to heal. Posterior Tibial Tendoscopy: Functional Outcomes of reparative procedures, including bone marrow stimulation, worsen with increased lesion size. Thus, replace- Outcomes And Comparison To Magnetic ment procedures such as autologous osteochondral transplan- Resonance Imaging tation (AOT) are often indicated for large, cystic lesions. The Ethan J. Fraser, MD surgical approach to access the OCL depends on the location Arianna Giannakos, BS and size of the lesion. Although a medial malleolar osteotomy Keir A. Ross, BS has been described as an approach for AOT of medial lesions, Charles P. Hannon, BS lateral lesions require a different approach. The purpose of Friday Gavin Duke, MD this study is to report functional and MRI outcomes in a series Marcelo P. Prado, MD of patients that underwent a novel approach for lateral OCL- John. G. Kennedy, MD, FRCS (Orth) the lateral tibial trapezoidal osteotomy. Background: Operative treatment of early tibialis poste- Methods: Records of patients that underwent a lateral tibial rior tendon (TPT) pathology historically required an open trapezoidal osteotomy for AOT were retrospectively reviewed. approach. Traditional open exposures have been a cause Pre-and-postoperative FAOS scores and demographic data of concern as postoperative scarring may cause further were recorded. Magnetic Resonance Observation of Cartilage stenosis and infl ammation of the tendons. Comparison of Repair Tissue (MOCART) was used to assess morphologic tendoscopy and magnetic resonance imaging (MRI) for state of tibial cartilage at the repair site of the osteotomy. diagnosis and treatment of early TPT pathology has yet to Quantitative T2-mapping MRI was analyzed in 0.2mm2 be reported. The purpose of this study was to compare the regions of interest in the superfi cial and deep cartilage layers diagnostic sensitivity of MRI and tendoscopy and to report of the repair site of the osteotomy and in adjacent normal car- quantitative functional outcomes of tibialis posterior ten- tilage to serve as control tissue. doscopy. Results: Seventeen patients at an average age of 36.9 years Methods: Records and MRI of 12 patients that underwent (range: 17-76) underwent a lateral tibial trapezoidal oste- tendoscopy of the TPT were retrospectively reviewed. Mean otomy with a mean follow-up of 54.7 months (range: 8-87). follow-up was. Preoperative MRI fi ndings were available FAOS pain scores signifi cantly improved from an average in ten patients and were compared to tendoscopic fi ndings 39.22 (range: 14-66) out of 100 points preoperatively to 81.21 to assess the diagnostic agreement between each modality.. (range: 19-98) postoperatively (p0.05). Functional outcomes were assessed using the Foot and Ankle Conclusion: Although outcomes of surgical approaches to Outcome Score (FAOS) and Short Form-12 (SF-12) General accessing medial lesions have been reported, there is a paucity Health Questionnaire pre-and-postoperatively.

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Results: Mean patient age was 51 years (range, 26 to 77). cerns remain regarding iatrogenic injury to the patella-femoral Mean duration of preoperative symptoms was 13.5 months joint. The SeMid technique merges the midvastus approach (range, 2 to 30). Pathologies included tenosynovitis, tendi- with the technical advantages of semi-extended tibial nailing. nosis, tendonitis, stenosis, and partial thickness tear. Preop- erative MRI fi ndings were in agreement with tendoscopyic Methods: IRB approved retrospective-prospective study. fi ndings in seven out of ten cases. Tendoscopy diagnosed Inclusion criteria: (1) age 18-75; (2) tibial shaft fracture; and and treated pathology that was missed on MRI in three of ten (3) treated by orthopedic trauma surgeon using the SeMid cases. Mean FAOS improved from a preoperative score of technique. At the one year follow up visit, patients were asked 56.25 to a postoperative score of 77. The mean SF-12 score to complete SMFA and VAS surveys assessing knee pain. improved from a preoperative score of 32.9 to a postoperative Range of motion and X-rays were also evaluated. score of 50.25. Results: Since 2011, 67 patients underwent the SeMid tech- Conclusions: Although MRI is considered the preferred nique. Fourteen patients with 16 tibia shaft fractures (average imaging technique for tendon pathology, tendoscopy may be age 43.5 years with 53.3 weeks of follow up) are analyzed. a more sensitive diagnostic tool. Tendoscopy provides mini- Average VAS pain rating was 1.40 (±1.55 SD; range 0-5). mally invasive diagnosis of pathology at the time of surgery Six patients (43%) denied any knee pain. The SMFA resulted and can provide functional improvements in the short-term in low index scores and good functional outcomes: mean for early TPT pathology. Full extent of the benefi ts over tradi- dysfunction score= 10.66 (±7.04 SD); mean bothersomeness tional open surgery requires further study. score= 9.31 (±6.39 SD). Scores were particularly low for diffi culty with mobility (18.65±14.51SD). Full range of motion Notes: (ROM) was achieved between 6 to 12 months post-operative, averaging -1.31 (±2.77 SD) to 137.5 (±3.16 SD). No signifi - cant iatrogenic damage to the patella-femoral cartilage was identifi ed at arthrotomy closure. There were no infections or non-unions.

Discussion and Conclusion: Semi-extended tibial nailing using SeMid technique has shown promising early clinical results with respect to post-operative knee pain and function. Saturday, October 25, 2014 At 1 year after surgery, patients reported minimal pain and low levels of dysfunction and bothersomeness. The SeMid Rapid Fire Session 14B — Trauma technique allows the surgeon to beneﬁ t from the logistical and (Station B, Plaza Ballroom 1) technical advantages of semi-extended tibial nailing without violating the patella-femoral cartilage, hopefully leading to Moderator: David S. Wellman, MD less anterior knee pain and maintaining knee range of motion.

Notes: 9:39am–9:43am

Semi-Extended Midvastus Tibial Nailing (The SeMid Technique)

Thomas H. Sanders, MD *Lolita Ramsay, RN, PhD A. Stephen Malekzadeh, MD Daniel Dziadosz, MD Cary Schwartzbach, MD

Introduction: Anterior knee pain hinders recovery after intramedullary nailing of the tibia. More orthopaedic surgeons are utilizing the semi-extended technique for tibial nailing. Con-

182 Notes: sure andthehardware isburied andunobtrusive. fractures, especiallysincescrew fi the utilizationoftwo obliquescrews insimpletransverse neck when thereisbonelossorcomminution,thisstudysupports tures. While plate-and-screw constructsaremoreappropriate lar strengthandstiffness totransverse, non-comminutedfrac- Discussion andConclusion: failed bypulloutandfracture. ure modefortheplatewas platebendingwhilethescrews occurred at229Nfortheplateand206Nscrews. Fail- the screw construct was 1.8timesstiffer. Ultimatefailure loading frommedialtolateral(oppositeoftheplate)where stiffness ofbothconstructswas similarinallplanesexcept for Results: recorded foreachspecimen. using anMTSmachine.Stiffness andloadtofailure were ent planes,90degrees apartandorthogonaltotheradialshaft The radialheadwas loadedincantilever bendingin4differ- radius was pottedinpolymethylmethacrylate bonecement. were fi oblique headlesscompressionscrews, andallleft-sidedradii subsequently fi osteotomy was created attheneckofeachradius,whichwas scans wereobtainedtomeasurebonedensity. A transverse performed toensureabsenceofpreexisting trauma.DEXA and theradiiwereremoved. X-rayandvisualinspectionwere Methods: cadaver model. load tofailure, ofthesetwo fi was thatthemechanicalproperties,specifi two obliquely-orientedscrews. The hypothesisofthisstudy tures canbeachieved withaplateandscrew constructorwith Hypothesis: Christopher Jones,MD Kurosh Darvish,PhD Asif Ilyas,MD Christina J.Gutowski, MD,MPH Fractures: ABiomechanical Study Plate Versus Screw FixationofRadialNeck 9:44am–9:48am xed withaplateandscrews. The distalaspectofeach All tenradiiwerefreeofpreexisting injury. The Ten matched-paircadaver armswereskeletonized Fixationofnon-comminutedradialneckfrac- xed: allright-sidedradiiwerefi xation strategies aresimilarina The two strategies provide simi- xation requireslessexpo- cally stiffness and xed withtwo caution whenmanagingthispatient populationaslongerLOS and LOScomparedtopatients withoutCRF. We recommend especially thoseondialysis,have highermorbidity, mortality, Discussion andConclusion: tion. with CRFDhadlongerLOSregardless ofsurgical interven- 6.80). Patients withoutCRFhadshorterLOSwhilepatients higher stillinCRFDpatients(p<0.001,OR5.10,95%CI3.83- those withoutCRF(p<0.001,OR1.68,95%CI1.43-1.96)and CRF. In-hospitalmortalitywas higherinCRF patientsthan DVTs (p=0.03,OR1.70,95%CI1.04-2.77)thanthosewithout greater SSIs(p<0.001,OR2.74,95%CI1.68-4.47),andmore wound complications(p=0.02,OR1.84,95% CI1.12-3.03), compared tothosewithoutCRF. CRFDpatientshadgreater and requiretransfusion(p<0.001,OR1.46,95%CI1.36-1.56) sacral decubitusulcers(p=0.001,OR1.55,95%CI1.19-2.02) Results: sis was performedusingmultivariate logisticregression. postoperative complicationswereevaluated. Statisticalanaly- gender, lengthofstay(LOS),in-hospitalmortality, andall with CRFwhoreceived dialysisinthehospital(CRFD). Age, identifi of 68,750closedhipfracturepatients,7,906whichwere the years2007-2011forconsistency. This resultedinatotal because ofchangesintheCRFclassifi identifi as defi was queriedforpatientswithclosedfemoralneckfractures, Methods: fracture. sis, areassociatedwithahigherriskofcomplicationsafterhip was toevaluate ifrenalfailure patients,withorwithoutdialy- to anincreasedriskofhipfracture. The purposeofthisstudy loss ofbonemineraldensityandosteoporosis,whichcanlead Introduction: Alvin C.Ong,MD Fabio R.Orozco,MD Mitchell G.Maltenfort,PhD Zachary D.Post,MD Antonia F. Chen,MD,MBA Patients Hip FractureInChronic RenalFailure AndLengthOfStay After Higher Mortality 9:49am–9:53am ned byICD-9code820.08.Patients withCRFwere ed withCRFbut notondialysisand1,148patients ed inthisgroupusingtheElixhausercomorbidityset; Patients withCRFwere morelikely todevelop The NationwideInpatientSample(NIS)database Chronic renalfailure (CRF)isassociated with Hip fracturespatientswithCRF, Rapid Fire Session14B cation, wefocusedon 183

Saturday EOA 45th Annual MeetingAmelia Island, Florida2014

and increased complications are likely directly related to the mendations for inpatient rehabilitation or skilled nursing increased mortality we found. facilities at time of discharge, yet all patients were discharged home. Amish and Mennonite groups were similar except for a Notes: higher percentage of males in the Mennonite group. Hospital charges did not differ based on insurance status.

Discussion and Conclusion: Amish patients are at risk for a variety of orthopaedic injuries related to agricultural accidents and their unique means of transportation. Hospital charges did not vary based on insurance status. Socio-religious beliefs must be taken into consideration when educating these 9:54am–9:58am patients regarding post-operative and post-injury care, as attendance at outpatient follow-up is low.

Orthopaedic Trauma In The Amish Notes: Community: Epidemiology And Hospital Charges

Louis C. Grandizio, DO Michael Suk, MD, JD, MPH, FACS Benjamin Wagner, BS Jove Graham, PhD Joel C. Klena, MD 9:59am–10:03am Introduction: The Amish are an uninsured, conservative Christian religious group who live an agrarian lifestyle and Unstable Metacarpal Fractures Treated with are at risk for injuries from horse-drawn carriage accidents Intramedullary Nail Fixation and farm related trauma. Little is known about the specifi c types of orthopaedic injuries they sustain and the hospital Ather Mirza, MD changes associated with their treatment. The purpose of this *Justin B. Mirza, DO study is to defi ne epidemiology of orthopaedic trauma in the Shawn Adhya, BS Amish community and to analyze the hospital charges associated with their treatment. Introduction: Fractures of the metacarpals account for nearly 36% of all hand fractures. While many metacarpal fractures Methods: 79 Amish patients who had been seen in our emer- can be treated through nonsurgical means, unstable meta- gency department with a traumatic orthopaedic injury from carpal fractures which are subject to malrotation, displace- 2006 through 2013 were identifi ed. Data collection included ment, foreshortening and angulation require reduction and demographics, injury complex and mechanism, Injury Sever- stable fi xation. Flexible intramedullary nail (IMN) fi xation ity Score (ISS), operative interventions and hospital charges. of fractures has become the cornerstone of treatment of long A retrospective cohort of 40 Old Order Anabaptist (Menno- bone fractures with the medullary cavity. It provides distinct nite) patients with health insurance was included for compari- advantages over other methods because it is minimally inva- son. sive with minimal soft tissue dissection, stability of fi xation, and enhancing bone healing by preventing distraction of the Results: For Amish patients, occupational injuries (52%) and fracture site. This is a particularly great option for patients buggy accidents (16%) accounted for the highest percent- presenting multiple metacarpal fractures. Our study evaluates age of admissions. 87% sustained at least one fracture, most outcomes in a case series of unstable metacarpal fractures commonly of the hand and wrist (11%). Facial injuries were treated with fl exible intramedullary nail (IMN) fi xation. the most common associated injury (30%). 58% of Amish patients required operative intervention. Total hospital charges Methods: This study includes 55 cases of fractures healed averaged $58,031 per patient. Transportation related injuries by clinical and radiographic assessment at an average of 12.7 had the highest hospital charges. 11% of patients had recom- weeks. The outcomes were assessed via a radiological study

184 including theelderly, but neitherrecenttrends ofincidence in absolutenumbersandincidence ofDRFacrossagegroups, eral studiesinthepasttwo decadeshave described increases porosis andtosubsequentinjury, including hipfracture.Sev- cause ofsignifi mon upperextremity fractureintheelderlypopulationanda Introduction: Richard C.MatherIII,MD R. Andrew Henderson,MD,MSc Sendhilnathan Ramalingam, BS Robin N.Kamal,MD Jonathan A. Godin,MD,MBA Benjamin D.Streufert,BS Among Elderly Adults Treatment ofDistalRadius Fractures Decreasing IncidenceandChanging Notes: allowed formobilizationofthePIPjoint. mal complications. A removable orthosis,insteadofacast, tion ofusualactivities, reducedimmobilization,andmini- zation offractures,earlyrangemotionwithresump- Conclusion: excision. metacarpal thatledtotendonirritationandrequiredoperative the pin.Inonecase,abony extosis formedontheaffected cases of“backingout”thatrequiredreoperationtoreplace irritation thatresolved withoutfunctionalimpairmentandtwo 6.5. Complicationsincludedthreecasesofextensor tendon post-operatively. MeanDASH scoreatfi follow-up andwerecapableof72.4%motionattwo weeks weeks. Patients regained fullfi Results: and GripPinchStrengthtests. and Hand(DASH), active wristrangeofmotion(AROM), come asmeasuredbytheDisabilitiesof Arm, Shoulder of longitudinalandangularcollapse,fi 10:04am–10:08am Pinswereremoved inallcasesatanaverage of13.9 We foundthatthistechniqueallowed forstabili- Distalradiusfracture(DRF)isthemostcom- cant morbidity. DRFhasbeenlinked toosteo- nger rangeofmotionatfi nal follow-up was nal functionalout- nal Notes: changing surgical management deserve furtherinvestigation. trends inDRFelderlyadults, thisdecreasingincidenceand While increasingemphasisonosteoporosismaybeaffecting ment trendsshow increasedopenfi incidence ofDRFhasdecreasedover thesameperiod. Treat- numbers ofDRFfrom2005to2011inUSelderlyadults,the Discussion andConclusion: variation intreatment. fracture patternswereexamined, aswereregional andgender in 2007to29.4%2011. Trends intreatmentofvarious but theproportion treatedwithopenfi 2011. Closedtreatmentrepresented79.6%ofthetotaltreated, treated withclosedoropenfi of DRF:Inthe5%Medicaresample,29,570patientswere year beforeDRFand8.50%intheafterDRF. Treatment x-ray absorptiometryscanwas performedin6.73%the low vitaminDin1.8%,andtobaccouse4.7%.Dual-energy diagnosis ofosteoporosiswas presentin11.0%ofpatients, ing 4.33%inthe Western US.IntheyearpriortoDRF, a dence intheNortheasternUSdecreased9.12%whileincreas- had decreasedincidenceofDRFfrom2005to2011.Inci- dence infemaleswas higherthaninmales,andbothgroups decrease from64.67to49.84per10,000person-years.Inci- incidence was patients age85yearsandolder, witha22.93% the sameperiod. The agegroupwiththelargest decreasein fell 7.17%from19.65to18.24per10,000person-yearsover from 83,512in2005to89,1072011,but theincidence care population. Total numbersofDRFincreased6.70% patients diagnosedwithDRFwereidentifi Results: and comorbiditieswithinthispopulationwereexamined. Fractures werestratifi on patientsbeforeandafterdiagnosisofDRFwereanalyzed. sis. Additional proceduresanddiagnostictesting performed of treatmentswerecomparedrelative toeachotherforanaly- Sample usingCPTcodesforclosedandopenfi Treatment ofDRFwas identifi Medicare hospitalclaimsdatasetviathePearlDiver Database. fi distal radiusfracturebetween2005and2011wereidenti- Methods: impacted theincidenceortreatmentofDRF. treating bonemineraldensitychangesinelderlyadultshas It isnotwellknown ifrecentemphasis on diagnosingand nor dataontreatmentinelderlyadultstheUSareavailable. ed bysearchingICD-9diagnosiscodesinacomprehensive IncidenceofDRF:Between2005and2011,571,384 USMedicareenrolleeswhowerediagnosedwith ed accordingtopatientdemographics, xation forDRFfrom2005to Despiteincreasesinabsolute ed ina5%MedicarePatient xation inthispopulation. Rapid Fire Session14B xation rosefrom21.2% ed intheMedi- xation. Rates 185

Saturday EOA 45th Annual MeetingAmelia Island, Florida2014

We determined that junior level residents were not as accurate Saturday, October 25, 2014 as either the senior level residents (p less than 0.05) or the Rapid Fire Session 14C — Spine attending surgeons (p less than 0.05), but there was no differ- (Station C, Ritz-Carlton Ballroom Foyer) ence noted between junior residents and the “perfect” model (p greater than 0.05). Moderator: Scott D. Boden, MD Conclusion: Our data suggest that surgeons at all levels of training can be taught to accurately gauge 2.5 in-lbs of tap- 9:39am–9:43am ping insertional torque, and that this skill does not regress with subsequent testing at 1-week intervals. Therefore, Resi- Can Orthopaedic Surgeons Be Trained dent and Staff surgeons can be easily trained to assess intra- To Accurately Gauge Tapping Insertional operative IT which obviates the need for an IT screw driver in Torque? the operating room. Notes: Daniel G. Kang, MD *Peter Formby, MD LTC Ronald A. Lehman Jr., MD CPT Adam J. Bevevino, MD LT Scott C. Wagner, MD LCDR Robert W. Tracey, MD

Introduction: Tapping insertional torque (IT) is a metric used to estimate pedicle screw size. Prior studies have shown that 9:44am–9:48am obtaining a tapping IT value of 2.5 in-lbs predicts optimal pedicle fi ll when selecting screw size intra-operatively. Aside Functional Outcomes Reporting In An from utilization of an intraoperative torque meter, there are Annual Meeting Over Three Years currently no guides to assess tapping IT values. The purpose of this study was to determine if surgeons at all levels (intern Kristin McPhillips, MD, MPH to attending) could be trained to assess torque by “feel” to Hemil H. Maniar, MD obviate the need for intra-operative gauges. Michael Suk, MD, JD, MPH, FACS Daniel S. Horwitz, MD Methods: Ten surgeons at our institution at different levels of training (attending, senior resident, and junior resident) Introduction: There is an increasing focus in orthopaedic underwent a 30-repetition round of torque training with three trauma on measuring outcomes using validated functional separate tap sizes (4.5, 5.5, 6.5mm), followed by a round of outcomes instruments. Recent work published in the Journal testing. Each participant subsequently performed two addi- of Orthopaedic Trauma showed a lack of validated outcome tional rounds of testing spaced 1-week apart. Testing was measures in papers over a fi ve year period. This study exam- performed utilizing polyurethane foam blocks at a density of ines the utilization rate, strength and validity of outcomes 10 pounds/ft3 (pcf), which most closely resembled cancellous instruments used in papers accepted for presentation at the bone based on our pilot test. Torque values were recorded uti- Orthopaedic Trauma Association (OTA) annual meeting from lizing a digital torque gauge meter. Data were then analyzed 2011 through 2013. with an ANOVA test with a post hoc comparison of means for any signifi cant differences. Methods: We reviewed the papers presented at the OTA annual meeting in 2011, 2012, and 2013. Papers that were not Results: We found no signifi cant difference (p greater than eligible to use functional outcomes measures (biomechanics, 0.05) between each training level and our “perfect” model. We animal studies, and basic science) were excluded. Articles also found that there was no signifi cant difference between meeting the inclusion criteria were reviewed for the use of rounds of testing for all participants (p > 0.05). Addition- functional outcomes instruments. The total number of instru- ally, there was no signifi cant difference between the standard ments used was recorded and each instrument was assigned to deviations measured between rounds (p greater than 0.05). one of three categories (generic, validated, and nonvalidated)

186 studied inthissetting. with ‘aseptic’ nonunion.Sonicationhasnotpreviously been hardware infectionisapossible causeforasubsetofpatients unexplained orthopaedictreatmentfailures. Clinicallysilent identiﬁ Introduction: Daniel S.Horwitz,MD Thomas Bowen, MD Michael A. Foltzer, MD Kristin McPhillips,MD,MPH Nathaniel C.H. Wingert, MD Hemil H.Maniar, MD ‘Aseptic’ Nonunion Sonication ForDetectionOfInfection In Notes: come measuresinorthopaedictraumapatients. be directedtoward validating anatomicallyappropriateout- important stepinimproving outcomes—futureefforts should comes usinginstrumentsthataresupportedbyevidence isan were validated within thecategory ofuse.Measuringout- ments usedwereeithergenericornonvalidated andvery few functional outcomesinstruments;abouthalfoftheinstru- and 2013OTA annualmeetinghada61%utilizationrateof Discussion andConclusion: interest. validated and11(9%)werevalidated withinthecategory of were generic,19(16%)nonvalidated, 54(45%)were 119 functionaloutcomeinstrumentswerereported;46(38%) reported atleastonefunctionaloutcomeinstrument. A totalof cles reviewed mettheinclusioncriteria;ofthose63(61%) Results: instrument was validated withinthecategory ofuse. come instrumentswereexamined todeterminewhetherthe Measures andInstruments. Additionally, valid functionalout- based onthe AO handbookofMusculoskeletal Outcomes 9:49am–9:53am ed subclinicalinfectionasacauseofcertainotherwise Of266abstractssubmitted,102(38%)ofthearti- Inrecentyears,sonicationtechnologyhas Submissionstothe2011,2012, Notes: treatment ofasepticnonunion. Sonication doesnotappeartohave aroleintheevaluation or infection amongpatientswithclinicallyasepticnonunion. not demonstrateany casesofsubclinicalimplantassociated Discussion andConclusion: deep infectionpost-operatively. CFU perplate(38.1).Nopatientsdemonstratedpersistent (61.9%) and16patientsdemonstratedgrowth lessthan20 results (100.0%). Twenty sixpatientsdemonstratednogrowth nonunion, all42demonstratednegative sonicationculture Results: greater than20CFU(colony formingunits)perplate. results wereconsideredpositive forculturegrowth equaltoor ware removal foradiagnosisofasepticnonunion.Sonication reviewed inaconsecutive seriesofpatientsundergoing hard- hardware. Sonicationcultureresultswereretrospectively tion cultureswereperformedforallexplanted orthopaedic laboratory signsofinfection.Duringthistimeperiod,sonica- judged bytheattendingsurgeon tomanifestnoclinicalor center fromSeptember2010toMay2013. All patientswere nonunion afterosteosynthesisweretreatedatasinglemedical Methods: throsis andS1screw failure. With the increasingpopularityof to thelumbosacralspinehave asigniﬁ Introduction: Lawrence G.Lenke, MD Khaled M.Kebaish, MD Rachel E.Gaume,BS LCDR Robert W. Tracey, MD LTC Ronald A. LehmanJr., MD *LT Scott C. Wagner, MD Daniel G.Kang,MD Iliac (S2AI) Versus IliacFixation Spinal FusionConstruct With Sacral Alar- Sacral Screw StrainInALongPosterior 9:54am–9:58am Among 42patientsconsecutively treatedforaseptic A totalof42consecutive patientswithaseptic Longinstrumentedposterior fusionconstructs Inthisseries,sonicationdid Rapid Fire Session14C cant rateofpseudoar- 187

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Sacral Alar-Iliac (S2AI) fi xation with its purported advantages 9:59am–10:03am of 1) decreased implant profi le and 2) obviating the need for a lateral offset connector, the biomechanical properties with respect to S1 screw strain remain unknown. We set out to Operative Treatment Of New Onset compare the biomechanical effect of S2AI versus traditional Radiculopathy And Myelopathy Secondary iliac screw fi xation on S1 screw strain. To Combat Injury

Methods: Five fresh-frozen human cadaveric specimens were Gregory S. Van Blarcum, MD instrumented from L2-pelvis, maintaining all osteoligamen- LT Scott C. Wagner, MD tous structures, with bilateral titanium 6.0x40-mm pedicle Daniel G. Kang, MD screws and 5.5-mm cobalt-chromium rods. Bilateral S1 LTC Ronald A. Lehman Jr., MD pedicles were instrumented with 8.0x50-mm screws that were centrally cored out and two uniaxial strain gauges inserted Introduction: Several recent studies have examined the at 0 degrees and 90 degrees. S2AI and/or Iliac fi xation with rates of combat-related spinal injury sustained in Operations 8.0x80-mm titanium pedicle screws was performed to evalu- Enduring (OEF) and Iraqi Freedom (OIF) using joint trauma ate four different constructs: (1) Bilateral S1 Screws (control); registries. We set out to describe combat-related spine trauma (2) Bilateral S2AI; (3) Bilateral Iliac; (4) Hybrid (S2AI with over a 10-year period at three high-volume military treatment contralateral Iliac). Bilateral S1 screw strain was measured facilities, and thereby determine the frequency of new onset (microstrain), and pure moment loads (12.0 Nm) were applied myelopathy and radiculopathy secondary to combat injuries. in axial rotation (AR), fl exion-extension (FE) and lateral Methods: We performed a retrospective analysis of a surgi- bending (LB). One way repeated measure ANOVA was used cal database at three military institutions. Patients undergoing to analyze the S1 screw strain data. spine surgery following a combat-related injury in Operations Results: Compared to S1 screws alone, both S2AI and Iliac Enduring and/or Iraqi Freedom between July 2003 and July fi xation signifi cantly reduced sacral screw strain in FE by 2013 were evaluated. Inclusion criteria consisted of: evidence 58% and 67%, respectively (p less than 0.05), in AR by 35% of myelopathic or radicular symptoms requiring operative and 41%, respectively (p less than 0.05), while no signifi cant treatment following documented trauma. difference in LB for either construct (p greater than 0.05). Results: 105 patients with combat-related (OIF/OEF) spine Hybrid constructs demonstrated a signifi cant reduction in only trauma requiring operative intervention were identifi ed. 15 FE, with reduction in screw strain by 56% for S2AI and 59% patients had radiculopathy or myelopathy as their primary for Iliac fi xation, with no difference in AR and LB moments. complaint after injury. The average age was 39 years, with When S2AI and Iliac fi xation were compared, there was no 80% injured in Iraq and 20% in Afghanistan. The most com- signifi cant difference in screw strain for all bending moments mon mechanism of injury was mounted improvised explosive (p greater than 0.05). Similarly, hybrid constructs demon- device (IED, 33%). All patients were diagnosed with herni- strated no side-to-side signifi cant difference between S2AI ated nucleus pulposus (HNP). The cervical spine was most and Iliac fi xation for all bending moments (p greater than commonly involved (53%), followed by lumbar (40%), and 0.05). one patient has a thoracic HNP. Average time from injury to Conclusions: Both S2AI and Iliac fi xation provide signifi cant index surgery was 21.9 months. C5-C6 was the most com- reduction in S1 sacral screw strain compared to sacral fi xation monly treated level (75% of cervical), and L5-S1 was the alone. Bilateral S2AI fi xation is a viable and biomechani- second most common (83% of lumbar). 53% of patients had cally comparable alternative to traditional Iliac fi xation, and continued symptoms following surgery, and two had at least presents another option to achieve protection of the S1 sacral one revision surgery. Two patients were medically retired. screws for long segment constructs to the pelvis. Conclusion: To our knowledge, this is the largest study evalu- Notes: ating the treatment of traumatic myelopathy or radiculopathy following combat-related trauma. Spinal symptoms are a signifi cant source of disability in the military, even in patients sustaining combat-related injuries, and further studies are needed to elucidate the impact these disorders have on military readiness/preparedness.

188 (-0.11), andoverall SRS-22score(-0.11). Age was correlated gender was associatedwith worse pain(-0.15),mentalhealth and Mental(3.7±0.6,F3.8±0.6,M3.7±0.6, p<0.001).Male M4.2±0.7, p<0.001),Image (3.9±0.6, F3.9±0.6,M3.9±0.6), ity (3.9±0.4,F4.0±0.5,M3.9±0.6),Pain (4.3±0.6; F4.4±0.6, Mean (4.0±0.4,F4.0±0.4,M3.9±0.4,p<0.0001), Activ- (18.5±3.6). SRS-22scoreforallpatientsandbygender: dual), height(157±12cm),weight(46±11.2kg),BMI gender (42%F, 58%M),household status(640single/379 22 (meanage14.4±1.6).Demographicsasfollows: Results: relation followed byan ANOVA. excluded. Statisticalanalysiswas donewithaPearson’s cor- with apriorspinehistoryoractive medicalproblemswere household status(single/dualparentincome).Participants age, gender, householdincome(range<$30Kto>$200K)and lowing demographicfactors wereassesed:height,weight, to anonymously completetheSRS-22inEnglish. The fol- and schoolboard,1200adolescents(age10-18)wereasked the SRS-22inSE Asia. After approval fromthelocalhospital Methods: infl lish abaselinefortheSRS-22inSE Asia and2)evaluate the ited normative dataisavailable. This study aimsto:1)estab- demographics. While theSRS-22isusedinternationally, lim- for theSRS-22inUSanddescribedimpactofpatient Introduction: Suken A. Shah,MD Baron Lonner, MD Yuan Ren,PhD,MS Senthil T. Nathan,MD Kushagra Verma, MD,MS Affect Outcome? East Asia: Which DemographicFactors Over 1000Healthy AdolescentsInSouth A NormativeBaselineFor The SRS-22From Notes: 10:04am–10:08am uence ofpatientdemographicsontheSRS-22. 1019 unaffected adolescentscompletedtheSRS- This isaprospective observational studyutilizing Previous studieshave establishedabaseline Notes: analyzed theeffect ofdemographicsontheoutcomescore. the fi to datagathered intheUnitedStates. This studyestablishes status diddonotaffect SRS-22. These fi correlated withabetterSRS-22score.Incomeandhousehold Conclusion: was associatedwithlesspain(0.07/0.02). with aworse image(r=-0.17,p<0.000),whilehigherBMI undergone primary THA performed over a2yearperiodby reviewed preoperative radiographsforallpatientswho had Materials andMethods: primary THA and did notmeetCMSradiographiccriteria. criteria. Inourstudyweevaluated patientswhounderwent gible for THA, apatientmustmeet2outof5radiographic for totalhip(THA)andkneearthroplasty(TKA). To be eli- proposed setsofobjective clinicalandradiographic criteria tain costs,CenterforMedicareandMedicaidServices(CMS) cant expenses tothehealthcaresystem.Inanattemptcon- procedure withgoodoutcomes,but isassociatedwithsignifi Introduction: Jose A. Rodriugez, MD H. JohnCooper, MD Parthiv A. Rathod,MD Jonathan Robinson,MD John W. Stirton,MD Yevgeniy Korshunov, MD THA: Signifi Analyzing CMSRadiographicCriteriaFor Saturday, October25,2014 9:39am–9:43am David W. Romness,MD Moderator: (Station D,Ritz-CarltonBallroom Foyer) Rapid Fire Session14D— Total HipReconstruction rst normative baselinefortheSRS-22inSE Asia and Younger age,femalegender, andhigherBMI Total jointreplacement isanelective surgical cant Outliers Inthisretrospective caseserieswe Rapid Fire Session14D ndings areincontrast 189 -

Saturday Saturday Friday EOA 45th Annual MeetingAmelia Island, Florida2014

a single surgeon. All radiographs were graded based on CMS ing surgery. Statistical analyses were conducted to examine criteria. We identifi ed all cases that met less than 2 of 5 crite- the effect of premorbid pain and other patient characteristics ria, and analyzed them for the following data points: age, gen- on outcomes (WOMAC, SF-36, and QWB-7). A high pain (n der, diagnosis, length of follow-up, MRI, need for injection, = 248) and low pain (n = 267) group were determined by a arthroscopy, reoperation, pre- and post-operative Harris Hip median split of preintervention WOMAC pain scores. Step- Scores, and overall outcome. wise regression analysis was used to determine whether presurgical WOMAC pain scores predicted follow-up WOMAC Results: 249 cases were included in the study. There were function scores when controlling for key demographic and 11 cases with fewer than 2 of 5 CMS radiographic criteria. clinical variables. A p-value of less than 0.001 was considered Minimum follow-up was 1 year, with average follow-up 25 signifi cant. months. Of the 11 THAs 9 were performed for dysplasia, 1 for osteoarthritis, and 1 for avascular necrosis. Nine clinical Results: After surgery, subjects with very high presurgical outcomes were rated as excellent, one as good and one as pain levels had signifi cantly worse outcomes than those with poor. lower pain levels as measured by QWB-7, SF-36 Bodily Pain, SF-36 Physical Functioning, WOMAC Pain, and WOMAC Conclusion: The results of this study suggest that the current Stiffness scores. Stepwise regression analyses found that age CMS preoperative radiographic criteria may exclude patients at follow-up, time since procedure, and baseline WOMAC who would otherwise receive signifi cant benefi t from the pain scores signifi cantly predicted follow-up WOMAC func- procedure. The goal of optimizing utilization is not simply to tion scores. The preintervention WOMAC pain score was the decrease the number of procedures being performed, but to strongest predictor of outcome. eliminate the unnecessary procedures. Orthopaedic surgeons need to play an active role in defi ning the appropriate use of Discussion and Conclusion: Preintervention pain signifi - criteria for various procedures including primary THA. cantly infl uences patient-reported outcomes after TJA. Our data suggests that waiting until a patient experiences extreme Notes: levels of pain before operating will lead to worse outcomes.

Notes:

9:44am–9:48am

Appropriate Use Criteria And Local Carrier 9:49am–9:53am Determinations: Are We Hurting Our TJA Patients? Resident Education And Physician Assistants In Joint Replacement Surgery: Carlos J. Lavernia, MD Costs And Outcomes Jesus M. Villa, MD David A. Iacobelli, MD Jesus M. Villa, MD Carlos J. Lavernia, MD Introduction: Pain is an important indication for arthroplasty surgery. Insurance companies and in particular Medicare are Introduction: Physician Assistants (PA-C) are assuming an refusing to pay for a procedure until the pain level is very increasingly important role in the practice of medicine. Pre- severe. Our objective was to assess the effects of the presurgi- vious reports in general surgery, trauma, and intensive care cal pain level in arthroplasty patients on the outcomes of TJA. units have evaluated the possible effects of using PA-Cs on hospital costs or patient outcomes. However, little information Methods: A consecutive series of 640 TJA patients were is available on this regard in the arthroplasty setting. There- interviewed prior to surgery and at minimum 2-years follow- fore, our objective was to evaluate in a teaching institution the

190 tive effects of THA on both. due tohiparthritisandQoL todeterminethepostopera- study therelationshipsbetween limitationsinsexual activity the abilityofpatientstohave sex. Ourobjectives wereto a highqualityoflife(QoL).Hiparthritissignifi Introduction: David A. Iacobelli,MD Carlos J.Lavernia, MD Jesus M. Villa, MD Undergoing THA Sex AndQualityOfLife InPatients Notes: or patientoutcomes. ident shortageswithoutadversely affecting hospitalresources ing costsofarthroplastysurgery andrelieve working hourres- PA-Cs inorthopedicsurgical practicesmaymitigatethegrow- Discussion andConclusion: tively, PPOswerenotsignifi PA-C versus thosewhoreceived itfromresidents.Postopera- [SD]; plessthan0.05)inpatientswhoreceived carefromthe icantly lower ($13,901+/-$5,733[SD]vs.$15,470$6,016 7.0 days;plessthan0.001)andthemeantotalcostwas signif- combined), themeanLOSwas signifi Results: costs (fi studied. Outcomesstudiedincludedhospitallengthofstay, did (n=111)onthesecondhalf.Patients wereretrospectively patients (n=89)inthefi included forstatisticalanalyses.Residentstookcareof surgeon inasingleinstitution; 200patientswerefi patients underwenttotalhip/kneereplacementsbyasingle Methods: patient perceived outcomes(PPOs). could have onhospitalLOS,costs,andpostoperative effects thattheuseofaPA-C insteadoforthopedicresidents 9:54am–9:58am xed andvariable), QWB-7,SF-36,andthe WOMAC. Regarding LOSandhospitalcosts(forallprocedures Duringaperiodofoneyear, 248consecutive Beingactive sexually hasbeenassociatedwith rst halfoftheyearwhilePA-C cantly different. Increasing theutilizationof cantly shorter(5.1vs. cantly affects nally Notes: indication for THA. due tohiparthritisshouldbeseriouslyconsideredasaprime patients undergoing THA. Any limitationinsexual activity ity seemstobeakey componentoftheoverall QoLamong plays akey roleinthe sex lives ofpatients.Sexual activ- Discussion andConclusion: scores (51vs.67). peared withtheexception oftheSF-36physical function different. Postoperatively, allsignifi D’Aubigné-Postel (11.1vs.13.5)scoresweresignifi WOMAC total(54vs.37),Harris(4763)andMerle- (44 vs.67),SF-36physical componentsummary(27vs.35), SF-36 physical function(19vs.44),SF-36social (8 vs.6,respectively). The QWB-7 Total (0.522vs.0.569), same patternwas observed regarding thefrequency ofpain (VAS) of8whilepatientswithoutlimitationshad6. The tively, patientswithlimitationshadameanpain intensity reported limitationswhileonly72%ofmalesdid.Preopera- sexual lifeof82%patientsinthisseries.96%females Results: and MANCOVA wereused. Mean agewas 65years(45%females).Chi-Square,t-tests, tel scoreswerecomparedbetweengroupsafteradjustments. QWB-7, SF-36, WOMAC, HarrisandMerle-D’Aubigné-Pos- operative andpostoperative Pain intensity/frequency VAS, ethnicity, maritalstatus,educationlevel, andreligion.Pre- Patient characteristicsevaluated includedage,gender, race, them intotwo groups(withorwithoutsexual limitations). primary THA duetoosteoarthritiswerestudied. We divided Methods: Hiparthritiscausedasignifi 159consecutive patientswhounderwentunilateral Ourdatasuggeststhatthehip Rapid Fire Session14D cant differences disap- cant interferenceinthe cantly 191

Saturday Saturday Friday EOA 45th Annual MeetingAmelia Island, Florida2014

ity had postoperative instability and required further surgery. 9:59am–10:03am 3 of the dislocations occurred in patients who had both the acetabular and femoral component revised, 1 occurred in a Short Term Complications After Revision patient who had a heterotopic ossiﬁ cation excision, and 1 had Hip Arthroplasty With A Modular Dual an acetabular revision and head exchange only. 1 patient who Mobility (MDM) Prosthesis dislocated post operatively had a sciatic nerve palsy.

Geoffrey H. Westrich, MD Conclusions: The MDM prosthesis appears to have an Erik Schnaser, MD acceptable short-term complication profi le following revision Mathias P. G. Bostrom, MD total hip arthroplasty. When used in the setting of recurrent instability, the failure rate was observed to be very low (3.5%) Introduction: Dual mobility constructs have been used in compared to historical controls. These devices will need to be Europe for several years. Due to their large jump distance further monitored for long-term issues that may arise. and perceived enhanced stability, there has been signifi cant interest in using these devices in a revision setting. Providing Notes: the ability to stabilize the cup with screws, the modular dual mobility (MDM) cup offers the benefi t of providing enhanced cup fi xation with the perceived benefi ts of enhanced stability. These devices recently were approved in the United States and there is a paucity of information regarding their success in the revision setting.

Objectives: The main purpose of this study is to evaluate the short term complications associated with the modular dual mobility (MDM) prosthesis used for revision total hip arthroplasty at a single institution. 10:04am–10:08am

Methods: We conducted a retrospective review of all revi- Hypotension Following Total Joint sion procedures done at our institution using the MDM device Arthroplasty Is Common And (Stryker Orthopaedics). Our hospital billing database was Inconsequential queried to identify all MDM devices implanted. From this list, all revision hip procedures were identifi ed including liner T. David Tarity, MD and femoral head exchange, complete acetabular revision *Ronald Huang, MD plus head exchange, liner exchange with complete femoral Michael M. Vosbikian, MD revision, and complete both component revisions. Diffi cult Kirsten A. Ross, BS total hip procedures such as fusion take downs, excision of Jeffrey Muenzer, BS heterotopic ossifi cation, and hip fracture conversions with James J. Purtill, MD existing hardware were also included. All inpatient and outpatient records were reviewed and complications related to the Introduction: Hypotension is commonly encountered in the prostheses were identifi ed. All surgeries were performed by postoperative total joint arthroplasty (TJA) patient and may surgeons who were fellowship trained in adult reconstruction. complicate recovery. The purpose of this study was to evaluate the incidence and risk factors of postoperative hypotension Results: Our institution began using MDM prosthesis in following TJA. Further we investigated the implications of 2011. We identifi ed 134 MDM prostheses used between hypotension on patient mobilization, the development of asso- 2011-2013. 11 (8.2%) patients required further surgery after ciated complications and discharge from hospitalization. revision. The most common indication for further surgery was recurrent instability (n=5, 3.7%), infection (n=3, 2.2%), Methods: One hundred consecutive primary and revision acetabular failure (n=2, 1.4%), and facial dehiscence (n=1, TJA cases performed at a single institution between July 2012 0.07%) The average follow up was 7.7 months (range 0-30). and August 2012 were retrospectively reviewed. Demograph- The most common reason for revision was instability (n=56). ics, comorbidities, antihypertensive medications, laboratory Two (3.5%) of the 56 patients who had pre revision instabil- results, perioperative vital signs, and postoperative complica-

192 Notes: unnecessary postoperative bloodtransfusionadministration. agement ofthese“atrisk”patientsmaydecreasetherate hypertension aremostatrisk.Properidentifi postoperative complications.Patients withpoorlycontrolled infrequent andnotassociatedwithcardiacorsignifi Discussion andConclusion: of stayordelayinphysical therapy was observed. postoperative hypotension.Nosignifi tive hypotension. Transfusion ratewas higherinpatientswith preoperative medicationswerenotpredictorsofpostopera- of postoperative hypotension.Cardiaccomorbiditiesand erative systolicBPinthePACU wereindependentpredictors pressure atpatients’ pre-admissiontestingandlower postop- mean ageof62.7yearsatthetimesurgery. Increasedblood 2% onPOD3. There were53femalesand47maleswitha operative day(POD)1,25%ofpatientson POD2andonly hypotension however, thisdissipatedover time;37%post- Results: between patientswithandwithoutpostoperative hypotension. lized. Complicationratesandlengthofstaywerecompared recorded. Multivariate logisticregression analysiswas uti- or absolutesystolicbloodpressurelessthan90mmHgwas postural changesorpreoperative tothepostoperative course a greaterthan20pointdropinsystolicbloodpressureduring tions wererecordedforeachpatient.Hypotensiondefi Fifty-onepatientsmetourdefi Prolongedhypotension was cant difference inlength nition ofpostoperative cation andman- cant ned as least lossofvolar tilt at 0.84°. at anaverage of3.82°,while the“Company E”plates hadthe locking plates,“Company C”hadthegreatestlossofvolar tilt ferences betweenimplantbrands. Among thevariable-angle Among these,onlyvolar tiltdemonstratedsignifi 0.302mm ±0.07495),andvolar tilt(decreased-2.03°±0.20). height (decreased-1.01mm±0.12),ulnarvariance (increased cantly changefrominitialtofi Results: year. at bothday0andafi between 2009-2012,withpost-operative radiographsavailable Plate from“Company D”, andplatefrom“Company E”), pany A”, platefrom“Company B”,platefrom“Company C”, undergone volar platefi Methods: determine theirabilitytomaintainreduction. radius fractureswithvarious volar lockingplatesin orderto this studywas toreview consecutive operatively treateddistal as totheirabilitymaintainfracturereduction. The goalof plate optionswhensurgery isselected,but limiteddataexists ing fracturereduction. Today, asurgeon hasmultiplevolar and successfuloutcomeshingeuponachieving andmaintain- Introduction: Asif Ilyas,MD Mitchell G.Maltenfort,PhD Mark Wang, MD,PhD Christopher Jones,MD Dominic J.Mintalucci,MD Genghis E.Niver, MD Joseph Dwyer, MD James A. Costanzo,MD Constantinos Ketonis, MD,PhD Michael M. Vosbikian, MD Fixation WithVarious VolarPlates Fracture Reduction LossAfterDistalRadius 9:39am–9:43am David S.Zelouf, MD Moderator: (Station E,Ritz-CarltonBallroom Foyer) Rapid Fire Session14E—Hand Saturday, October25,2014 The threeparametersthatwerefoundtosignifi A retrospective review of127patientswhohad Distalradiusfracturesarecommoninjuries nal radiographtaken ataminimum of1 xation(including platefrom“Com- nal radiographswereradial Rapid Fire Session14E

cant dif- - 193

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Discussion/Conclusion: Loss of some aspect of fracture COR on the humerus was then found using radiographic reduction was routinely observed following volar plat- parameters. 7 points on the humerus located at and around ing. Loss of volar tilt showed signifi cant variability when the COR and three points paralleling the supinator crest of compared between implant manufacturers. “Company B” the ulna were chosen and the distances from these points and “Company E” maintained volar tilt signifi cantly better were then calculated using a digital caliper at 0,30,60,90, and than the “Company A,” “Company C,” and “Company D” 130 degrees of fl exion. Differences in potential ligamentous implants. Ulnar variance and radial height changed signifi - lengths (“graft elongation”) were calculated and statistical cantly over time but did not show a signifi cant difference analysis performed using a 3x7 repeated measures analysis of between the various implants. Radial inclination and articular variance with Bonferroni corrections for pairwise compari- step-off did not change signifi cantly over time or between the sons. various implants. Consider variability exists between volar plates in their ability to maintain fracture reduction, particu- Results: The mean age of the specimens was 65.8 +/- 11.2 larly volar tilt. Surgeons should consider these fi ndings when yr. The average length of the lateral ligamentous insertion selecting a volar plate. onto the ulna was 17.2 +/- 4.1 mm. There was no perfectly isometric point along the humerus or ulna. However, in 13/13 Notes: specimens, the COR was the most isometric point for the humeral reconstruction site with an average graft elongation of 1.14 mm. Differences in humeral tunnel position dramatically affected graft elongation at all 3 ulnar points (P<.0001). The most an isometric point was that of the humeral location posterior to the center of rotation with a mean graft elongation of 5.1 +/- 0.07 mm. Mean difference in elongation between the least and most isometric point was 4.28 +/- 0.53mm 9:45am–9:49am (P<0.0001). Overall the ulnar position had minimal effect on graft elongation (P = 0.05), with mean differences between Restoring Isometry in Lateral Ulnar ulnar positions all less than 1mm regardless of statistical sig- Collateral Ligament Reconstruction nifi cance. Conclusion: Although no perfectly isometric points were Jonathan W. Shearin, MD found, the humeral center of rotation consistently reproduced Michael J. Alaia, MD the most isometry when assessing graft elongation over range Steven J. Lee, MD of motion. Differences in ulnar tunnel placement did not result in signifi cant changes in graft elongation. This data will assist Introduction: Posterolateral rotatory instability (PLRI) of the surgeons in proper tunnel placement in LUCL reconstruction. elbow is an often-missed diagnosis when evaluating patients Humeral tunnels placed at the center of rotation will optimize with elbow pain or instability. Reconstruction of the lateral graft isometry. Placement of ulnar tunnels are less critical and ulnar collateral ligament (LUCL) typically restores stabil- lack a single, optimal isometric point along the ulna, support- ity and improves pain. Creating an isometric reconstruction ing the use of double or. would provide stability without limiting range of motion or putting excessive force on the tendon graft. However, restora- Notes: tion of isometry may be diffi cult, and there is no consensus regarding proper placement of bone tunnels to produce isometry. We hypothesize that by placing the humeral attachment of the LUCL at the center of rotation (COR) on the humerus will provide the most isometric reconstruction.

Methods: Thirteen cadavers from mid-humerus to the hand were analyzed. In all specimens the soft tissue and common extensor origin were removed leaving only the lateral ligamentous complex. The morphology of the ligament complex was assessed and anatomic measurements were taken. The

194 Notes: the shaftportionofvolar platesdoesnotappear justifi tion orhardware failure. The routineuseoflockingscrews in bility toallow forearlyrangeofmotionwithoutlossreduc- locking, bicorticallyplacedshaftscrews provide adequatesta- quently occurinpatientswithlow bone mineraldensity. Non- Discussion andConclusion: failure. radial height=11.5°). There werenoinstancesof hardware (mean volar tilt=5.4°,meanradial inclination=21.5°,mean All patientshealedwithinacceptableradiographicparameters screws in39patients, and2.4mmshaftscrews 18patients. was 24.4weeks. The implantusedincorporates3.5mmshaft were 33menand14women. The average lengthoffollowup teria. The average agewas 62years(range:50-79yo). There Results: or iffollow-up was inadequate. excluded fromanalysis if lockingshaftscrews wereutilized of reductionandincidencehardware failure. Patients were examined andmeasurements obtainedtoassessmaintenance perform earlyrangeofmotionexercises. Radiographswere screws foradistalradius fracture.Patients werepermittedto volar platefi patients over age50over a2yearperiodwhounderwent Methods: ware failure. plates isnotrequiredtomaintainreductionorprevent hard- routine useoflockingscrews intheshaftportionofvolar shaft screws isnotwelldefi distal radiusfractures. The indicationsfortheuseoflocking dence oflow bonemineraldensityinpatients whosustain locking platesispoorbonequality, andthereisahighinci- in theshaftportionofplate.Oneindicationforuse designed suchthatthereistheoptiontouselockingscrews of treatmentfordistalradiusfractures.Many implantsare Introduction: Jonas Matzon,MD *C. Edward Hoffl Kevin Lutsky, MD Volar PlateFixation Locking ShaftScrews in NotNecessary 9:51am–9:55am There were47patientswhomettheinclusioncri- A retrospective review was performedofall xation usinganimplantwithnon-lockingshaft Volar platefi er II,MD,PhD ned. Ourhypothesisisthatthe xation isacommonmethod Distalradiusfracturesfre- ed. Discussion/Conclusion: ics. than fi closure was morelikely tobeperformedbyhandwithfewer and byacademicpracticesurgeons. Skeletal shorteningwith Replantation was morecommonlyperformedinternationally than 30yearsofexperience orplasticsurgery backgrounds. care was lesslikely performedbysurgeons withgreater there was awidevariation oftreatmentpreferences. Wound scenario (Allenlevel 2,3,4,andvolar obliqueamputation) 38% international,respondedtothesurvey. For eachclinical Results: predictors. adjusted oddsratiosfortreatmentchoicescontrollingall erence questions.Logisticregressions wereusedtoestimate various level longfi prised of6demographicquestions,5clinicalscenarioswith selected internationalhandsocieties. The survey was com- the American Association forSurgery oftheHand,aswell Methods: ground. years ofexperience, institution typeandtrainingback- to surgeon demographicfactors suchascountryoforigin, Treatment oflongfi replantations, allwithreportedgoodoverall outcomes. care, tomoreinvolved interventions includingfl Treatment optionsrangefromsimplistic,suchaswound injuries inbothwork andnon-work relatedaccidents. Introduction: Christopher Jones,MD William Kirkpatrick,MD MD Jack Abboudi, Michael Rivlin, MD *Eric M.Padegimas, MD Andrew Miller, MD Study Amputation Fingertip Treatment: ASurvey anecdotal inpartgiven thelimitedamountofcomparative ing background.However, clinicaldecisionmakingislikely principles vary accordingtopracticedemographics andtrain- preferences amonghandsurgeons. Differences intreatment gertip amputationqueried,thereisawiderangeoftreatment 9:57am–10:01am ve yearsofexperience comparedtootherdemograph- A totalof199handsurgeons, 62%fromtheUSand A 16questionsurvey was senttothemembersof Distalfi ngertip amputations,and5treatmentpref- ngertip amputationsvary according ngertip amputationsarecommon For alllevels andorientationoffi Rapid Fire Session14E aps and n- 195

Saturday Saturday Poster Abstracts EOA 45th Annual MeetingAmelia Island, Florida2014

research. The survey highlights the need for a prospective ran- eye dosage is 1,250 mrem per month). 46 procedures were domized trial to determine the most effective treatments for performed over the collection period. The most commonly distal ﬁ ngertip amputations. performed procedures included ORIF distal radius fractures (14), metacarpal and phalangeal surgery (9), and basilar Notes: thumb arthritis surgery (7). ORIF of the distal radius fracture was associated with higher average exposure time (93.57 sec) and average accumulated dosage (51.73 mGy).

Discussion/Conclusion: Our study suggests that eye radiation exposure, from routine mini C-arm ﬂ uoroscopy use, on an average monthly basis, does not approach previously reported critical eye radiation loads associated with cataracts. 10:03am–10:07am Notes: Radiation Exposure To The Eye With Mini C-Arm Use During Hand Surgery

C. Edward Hoffl er II, MD, PhD Mark Wang, MD, PhD Frederick Liss, MD Asif Ilyas, MD Saturday, October 25, 2014 Charles S. Leinberry, MD Pedro K. Beredjiklian, MD General Session 15 — Mixed Topics (Ritz-Carlton Ballroom Salon 1) Introduction: Fluoroscopic radiation exposure is a potential occupational health risk to the Hand Surgeon, given operator Moderators: Amar S. Ranawat, MD proximity and the relative lack of eye shielding. At present, David S. Wellman, MD the amount of radiation exposure to the eye, associated with the routine use of mini C-arm fl uoroscopy is unknown. The association of eye radiation exposure and the early develop- 10:24am –10:30am ment of cataracts have been previously reported. The purpose of this study is to test that eye radiation exposure, sustained Severity Of Hand OA — A Predictor Of during routine mini C-arm use, does not exceed that of previ- Major Joint Involvement And Surgical ously reported critical radiation dosages to the eye. Intervention Methods: Over a four month period, eye radiation exposure Chitranjan S. Ranawat, MD was measured in four Board-Certifi ed Hand Surgeons utiliz- Morteza Meftah, MD ing mini C-arm fl uoroscopy during routine surgical proce- Amar S. Ranawat, MD dures. Eye dosimeters were secured to surgical loupes at the level of the orbit. Accumulated radiation dosage was analyzed Introduction: The presence of hand OA increases the risk for and compared to control badges on a monthly basis, and back- developing OA in other major joints1. Genetic predisposition ground exposure was eliminated. For each procedure, mini has been implicated in its causation2. The association of hand C-arm radiation output was logged, including the dose rate, OA with symptomatic and asymptomatic major joint(s) has total accumulated dosage, and total exposure time. not been previously studied. Therefore, the goal of this study was to correlate the severity of hand OA with other major Results: Average monthly eye dosimetry values included the joint(s) involvement and need for surgical intervention. following: dose rate was 0.50±0.03 mGy/sec, total accumulated dosage was 32.16±7.88 mGy, and total exposure time Material and Methods: 100 consecutive patients with mean was 75.72±16.36 sec. Average monthly eye radiation exposure age of 71.6 were recruited. All patients had a hand photo values were less than 30 mrem (previously reported maximum taken for visual documentation of the hand joints. Radiograph

196 Notes: in causationofOA. emphasizes theneedtoinvestigate thegeneticpredisposition joints OA andtheirprogressionwerenottracked, thisstudy of surgical intervention. Although theonsetofhandandother hand involvement with othermajorjointinvolvement andrisk ing toregistry-based studies,somebearingcouplesareassoci- tating complicationoftotalhip arthroplasty(THA). Accord- Introduction: Arthur L.Malkani,MD Javad Parvizi, MD,FRCS Mitchell G.Maltenfort,PhD MD Pouya Alijanipour, *Camilo Restrepo,MD Langan S. Smith,BS Bearing SurfacePlay ARole? Periprosthetic JointInfection: Could Discussion: showed positive family historyforarthritis. patients had3othermajorjointsinvolved. 76%ofthepatients 33% and29%,respectively. 75%ofthepatientshad2and7% on patients’ history, foot-toeandshoulderwas involved in Spine involvement was presentin72%ofthepatients.Based had bilateraland6%(5)‘two joint(hip&knee)’ surgery. 81.1% (30)oftheserequiredkneereplacement.33%(28) present in37%ofthepatientsandallweresymptomatic. hip patientsrequiredreplacement.Kneeinvolvement was 14.7% (13)wereasymptomatic.62.5%(55)ofsymptomatic the patients,ofwhom85.2%(75)weresymptomaticand Radiographic analysisshowed thehipinvolved in88%of Results: gren-Lawrence (KL)scalebyanindependent radiologist. severity ofhandinvolvement was determinedusingtheKell- Patient’s family historyofinvolvement was captured. The of handandallmajorsymptomaticjoint(s)wereanalyzed. 10:32am –10:38am Severe handOA was presentin91%ofthepatients. This isthefi Periprostheticjointinfection (PJI)isadevas- rst studyassociatingtheseverity of Notes: investigations. is compellingandbegs forfuturebasicsciencemechanistic risk factor fordevelopment ofPJI. The fi confi multivariate analyses, thatcontrolledforallthesevariables, surface maybeusedinyoungerandhealthierpatients,the Although, wehadoriginallythoughtthatceramicbearing ing surface mayhave aninfl Discussion: 2.6, CI:1.02-6.54). factor correlatingwithhigherincidenceofPJI(oddsratio: index), MOPbearingsurface was foundtobeanindependent mass index andlengthofhospitalstay, Charlsoncomorbidity ate analysis,controllingforpotentialconfounders(age,body difference was statistically signifi and 11/2,643(0.4%)patientswithCOPdeveloped PJI. This Results: independently correlatedwithPJI. was performedtodeterminewhetherbearingcouplingwas PJI was defi complications andotherrelevant informationwereextracted. Demographic factors, comorbidities, lengthofhospitalstay, during 2005-2009intwo high-volume arthroplastycenters. mary THA withMOPorCOPbearingsurfaces performed query was performedtofi Materials andMethods polyethylene [MOP]versus ceramic onpolyethylene [COP]). dence ofPJIintwo commonlyused bearingcouples(metalon was todeterminewhethertherewas any difference intheinci- ated withanincreasedriskofPJI. The purposeofthisstudy rms thatuseofmetalfemoralheadisanindependent Inourdata,25/2,921(0.9%)patientswithMOP ned basedonMSIScriteria.Multivariate analysis The fi The nding ofthisstudysuggeststhatthebear- A retrospective multi-institutional nd allpatientswhoreceived pri- uence ontheincidenceofPJI. cant. After themultivari- nding ofthisstudy General Session15 197

Saturday Friday EOA 45th Annual MeetingAmelia Island, Florida2014

better care for student athletes can lead to quicker diagnoses, 10:40am –10:46am rehabilitation and recovery.

The Team Physician And The Athletic Notes: Trainer: Do We Agree?

Fotios Tjoumakaris, MD Nicholas Lombardi, BS Luke Austin, MD Matthew Pepe, MD Kevin Freedman, MD Katherine Bagnato, ATC 10:48am –10:54am Bradford S. Tucker, MD

Background: It is standard practice in high school athletic Native Anterior Cruciate Ligament Length departments for athletic trainers (ATs) to formulate a diagno- Quantifi cation Via Lateral Radiographic sis and treatment plan for injured high school student athletes. Landmark In select instances, the athletes are then referred on for defi nitive medical management and treatment by a supervising team LCDR Patrick W. Joyner, MD, MS physician. The purpose of this investigation was to determine Travis Roth, MS IV the rate of agreement between physician and AT with regard C. Luke Wilcox, DO to student athlete injury and diagnosis. Jeremy Bruce, MD Ryan Hess, MD Methods: Between 2010 to 2012, a prospective athletic injury Christopher O’Grady, MD database was maintained by a regional healthcare system ath- Charles A. Roth, MD letic training staff. All athletes injured during this time were included in the database. All patients that were referred on for Background: Graft tunnel mismatch, a complication of ante- physician evaluation and treatment were identifi ed, and this rior cruciate ligament reconstruction, is a condition in which data was retrospectively analyzed. Specifi c diagnosis (both the bone-patella-tendon-bone autograft or allograft is either by trainer and physician), physician subspecialty, and diag- too long or short, and can result in compromised fi xation. We nostic concordance were analyzed and determined by review aim to fi nd a radiographic landmark, on lateral knee X-ray, of medical records and radiologic imaging. This study is a which will allow for a simple, easy, and reproducible method retrospective review of a prospective database with Level III of quantifying native ACL length. Materials & evidence. Methods: 130 patients (66 male & 64 female), underwent, as Results: 344 incidents met our inclusion criteria (both AT and a standard part of their knee arthroscopy procedure, measure- physician evaluation). 305 (88.7%) of the AT and physician ment of their native ACL. These native ACL’s where measured diagnoses were in agreement. Of the 39 diagnoses that were percutaneously with a spinal needle. The lengths of the native discordant, 3 (7.7%) required surgical management. 16 of ACL’s where compared with one lateral knee X-ray landmark the 39 misdiagnoses (41%) involved fractures and 9 (23.1%) and a clinical landmark: Blumensaat’s line and patellar liga- involved sprains. ATs displayed the highest accuracy diagnos- ment, respectively. The mean percent difference, absolute dif- ing dislocations and abrasions/lacerations (100%). Concus- ference, and a correlation between Blumensaat’s line and the sions were also diagnosed very accurately (98.5%). native ACL length where calculated.

Conclusions: When using a physician diagnosis as the accu- Results: In males, the average length of the ACL was racy barometer, ATs are highly skilled professionals who are 32.5mm, Blumensaat’s line was 33.0mm, and the patel- well trained in the evaluation of acute athletic injuries, with a lar ligament was 49.2mm. The absolute difference between nearly 90% accuracy rate. This study identifi ed areas where Blumensaat’s line and the native ACL was 1.2mm±1.3mm, further education and communication may be necessary the mean percent difference 0.9%±2.9, and the correlation amongst providers, namely fractures, and joint sprains. With coeffi cient was 0.88. The correlation coeffi cient between the increased diagnostic agreement among medical professionals, patellar ligament and the native ACL was 0.08. In females, the

198 tive computedtomography(CT)scans.Coronaland sagittal Correction was assessedusingpre-operative andpost-opera- ing andtranslationmeasurements wereonceagain performed. slope neutralization.Following thisprocedure,stabilitytest- cedures was foran8-10mmcorrectionwithmaximalsagittal medial titaniumplateandscrews (n=8). The goalofbothpro- knees underwentanopeningwedge(MOW) HTO usinga a lateraltitaniumplateandscrews (n=8). The contralateral of thekneesunderwentclosingwedge(LCW)HTO using testing repeatedandcompartmenttranslationrecorded.Half gation software. The ACL was thensectionedandstability medial compartmentswas measuredusing ACL specifi cadaveric specimens(n=16)andtranslationofthelateral and 30°), andPivot-shift testswereperformedonintact hip-to-toe Methods: used HTO techniques. changes inPTSandkneekinematicsusingtwo commonly Background: Hendrik A. Zuiderbaan,MD Saker Khamaisy, MD Durham Weeks,MD Anil S.Ranawat, MD The ACL Defi Neutralization BetweenCWAndOW HTO In Comparison OfStabilityAndSlope Notes: native ACL. length ofBlumensaat’s lineisequivalent tolengthofthe Conclusion: fi and thecorrelationcoeffi 1.3mm±1.3mm, themeanpercentdifference was 0.4%±2.8, difference betweenBlumensaat’s lineandnative ACL was was 30.3mm,andthepatellarligament44.2mm. The absolute average lengthofthe ACL was 30.6mm,Blumensaat’s line cient betweenthepatellarligamentandnative ACL was 0.1. 10:56am–11:02am Anterior drawer (ATT at90°),Lachman(ATT at As ageneralrule,regardless ofageorsex, the The purposeofthisstudywas toquantify cient Knee cient was 0.84. Thecorrelationcoef- c navi- Notes: knee kinematicswiththein30°offl in kneestabilityduring ATT testingthatapproachesnormal using aclosingtechniqueconferssignifi In the ACL defi greater PTSneutralization(avg 7º) thanopeningwedgeHTO. Conclusions: higher than5.1º(±0.9)foundusingMOW. achieved withaLCWwas 7.1º(±1.8),whichwas signifi not reachsignifi onal correctionwas improved intheMOW, thisdifference did compared to5.9º(±1.8)intheLCWgroup. Although thecor- alignment correctionintheMOW groupwas 7.2º(±0.95) Lachman, andPivot shifttesting. The mean Tibial Coronal in anteriortibialtranslation(ATT) during Anterior drawer, Results: and analyzed. alignment changesaswellallkinematicdatawererecorded were candidatesfor THA wererandomizedtoreceive their Methods: THA performedthroughDA versus anterolateral approach. ized studywas designedtoexamine thevery earlyoutcomeof formed throughtheDA approach. This prospective, random- known istheimmediatetovery earlyoutcome of THA per- tional outcomethanothersurgical approaches. What isnot performed throughdirectanteriorapproachhasabetterfunc- Introduction: Javad Parvizi, MD,FRCS Mitchell G.Maltenfort,PhD Ryan Massimilla,BS Direct AnteriorApproach Early OutcomesFollowing THA Using Prospective, Study: Randomized Superior Resident/Fellow Award 11:04am –11:10am Sectioningthe ACL resultedinasignifi 84Patients withend-stagearthritisofthehipwho ClosingwedgeHTO generatessignifi There arenumerousstudiesthatsuggest THA cient knee,thisdegree ofslopecorrection cance. The meantibialslopeneutralization

General Session15 exion. cant improvement cant increase cantly cantly 199

Saturday Friday EOA 45th Annual MeetingAmelia Island, Florida2014

surgery using DA (44 patients) or DL approach (40 patients). versial. Most studies recommend 6 weeks but recent advances The type of anesthesia, prosthesis, postoperative rehabilita- in surgical approach, pain management and rapid recovery tion, and all other protocols were exactly the same. The may have changed this time frame. The purpose of this surgery was performed by the same surgeon in each patient. study was to prospectively evaluate driving safety after THA The functional outcome on day 1, day 2, week 6, week 12, through brake time reaction. six months, one year were measured using TUG, Gait Speed, Chair Test, LASA, Harris Hip score and LEFS. Hospital Methods: After IRB approval, 30 patients who were sched- length of stay, blood transfusion, narcotic consumption and uled for, and underwent, right THA were prospectively other parameters between the two cohorts were compared evaluated between October 2013 and March 2014. Driving also. performance was evaluated using the Brake Reaction Test that measured brake time after a stimulus. All patients underwent a Results: Patients receiving THA through DA had signiﬁ - preoperative assessment to establish a baseline. Patients were cantly higher functional scores in all domains during the early then re-tested at 2, 4 and 6 weeks post operatively. Patients period following surgery. The difference in functional scores were allowed to drive when the post-operative reaction time appeared to level out at six months. Patients undergoing THA was equal to or less than their pre-operative baseline. General using the DA approach were also able to drive earlier, return linear repeated measurement was used for analysis. to work earlier, and appear to regain muscle functionality more quickly than patients receiving THA through the antero- Results: All 30 patients completed the pre-op and 2 week lateral approach. post-op tests. The mean pre-op reaction time was 0.607 sec. The mean 2-week reaction time was 0.566 sec. Of the 30 Discussion: It appears that the use of DA approach for THA study patients, 26 (87 %) were able to reach their baseline does provide a better functional outcome during the early time (or better) by 2 weeks. Three patients (10%) reached period of recovery, which includes return to functional inde- their baseline at the 4 week post-op test and only 1 (3%) did pendence such as driving, and returning to work. not return to base line until the 6 week mark. Evaluation of confounding variables revealed no differences with respect to Notes: age, gender, and the use of assistance devices in the group.

Conclusion: Most patients in this study were able to return to normal brake response times by 2 weeks after THA. This represents a substantial improvement from current recommendations. These ﬁ ndings have allowed us to encourage patients to re-evaluate their driving ability as soon as 2 weeks after THA.

Notes: 11:12am–11:18am

EOA/OREF Resident/Fellow Travel Grant Award

When Is It Safe For Patients To Drive After Right Total Hip Arthroplasty?

Victor H. Hernandez, MD, MS Alvin C. Ong, MD Fabio R. Orozco, MD Anne Marie Madden Zachary D. Post, MD

Introduction: Driving restrictions after total hip arthroplasty (THA) can be inconvenient and burdensome for patients. When patients may safely be allowed to drive remains contro-

200 comparable intermsofaccuracy. We foundthatradiation nifi that theuseofCAOS topinanITfracturedoesnotaddsig- Discussion andConclusion: 0.008). the conventional groupitwas 11.43+/-1.7seconds(plessthan navigated proceduresitaveraged 6.14+/-0.67seconds whilein sure was measuredandfoundsignifi more than2.5cmwas 29%inbothgroups.Radiationexpo- (p=0.48). The percentageofpinplacementswitha TAD of was 2.1+/-0.2cmand2.3+/-0.2 forthestandardgroup p lessthan0.001). The mean TAD forthenavigated group eral view werehighlycorrelated(0.95and0.79,respectively; (p=0.94). Radiographicmeasurementsforboth AP andlat- in themodelswhichstandardtechniquewas used minutes withthenavigated techniqueand6.1+/-0.8minutes Results: relation wereusedforstatisticalanalysis. assess reproducibility. Mann-Whitney testand Spearman cor- distance (TAD); blindedre-testwereperformedinallcasesto used tomeasurepinplacementaccuracy using thetip-apex were performedonallmodelsaftertheprocedure,and the totalnumberofsecondsradiation.Digitalradiographs time was collected,andradiationexposure was measuredas sus astandardfl placement was randomizedtoanavigated system(n=13)ver- Methods: control groupinthissimulatedrandomizedcontrolledtrial. signifi Introduction: Jesus M. Villa, MD David A. Iacobelli,MD Carlos J.Lavernia, MD Intertrochanteric (IT)Fractures (CAOS)Surgery In The Treatment Of Computer-Assisted Orthopaedic 12:24pm–12:28pm David S. Wellman, MD Moderator: (Station A, PlazaBallroom 1) Rapid Fire Session16A— Trauma Saturday, October25,2014 cant extra timetopinplacement.Bothtechniques were cant decreaseinradiationexposure ascomparedtoa Average timetopinplacementwas 6.4+/-0.7(SE) 25hipmodelswithsofttissuewereused.Pin Navigated ITfracturepinningresultedina uoroscopic technique(n=12). Total procedure Ourdataclearlydemonstrated cantly different, inthe Posterolateral cornerinjuries were highlyassociatedwith nerve injurywas lower thanprevious reportedintheliterature. Conclusion: closed headinjuryin21%. abdominal injuryoccurredin18%ofpatientsandasevere tures, and15%hadassociatedpelvicringinjuries. An intra- fractures, 12%hadassociatedipsilateralfemoralshaftfrac- four percentofkneeshadassociatedipsilateraltibialplateau most common.Openkneedislocationoccurredin5%. Twenty gross dislocationandofthoseanteriorwas the 39% ofinjuries.Forty seven percentofkneespresentedwith tained 77%oftheinjurieswithmotorvehicle crashescausing average ageofthepatientwas 36yearsoldandmalessus- posterior cruciateligament andposterolateralcorner. The being combineddisruptionoftheanteriorcruciateligament, injury in12%withthemostcommon(33%)pattern Results: terns. netic resonanceimagesavailable forligamentousinjurypat- trauma center. Subgroupof105kneeswithappropriatemag- and/or dislocationsfrom2002-2012presentingatalevel 1 four patients(129knees)withmultiligamentous kneeinjuries Methods: patterns anddescribeassociatedinjuries. Introduction: Anthony M.Harris,MD Christopher H.Perkins,MD Corey Rosenbaum,DO Mark R.Elliott,MD Review AtALevel 1 Trauma Center Injuries AndAssociatedInjuries: 10 Year Epidemiology OfMultiligamentousKnee Notes: almost 50%. exposure whenusingthenavigation systemwas reducedby 12:29pm–12:33pm Vascular injuryoccurredin12%,peronealnerve Retrospective chartreview ofonehundredtwenty The incidenceofarterialinjuryandperoneal To characterizemultiligamentouskneeinjury Rapid Fire Session16A 201

Saturday Saturday Poster Friday Abstracts EOA 45th Annual MeetingAmelia Island, Florida2014

peroneal nerve injuries. One-fourth of knee dislocations were Results: Twenty (14 male, 6 female) patients met inclu- associated with ipsilateral tibial plateau fractures and just over sion criteria. The average age at injury was 48 years (range, half presented with a spontaneously reduced knee, which is 18-80). Injuries were secondary to motor vehicle collisions comparable with the current literature. There is a high inci- (17), falls (2), and snowmobile accidents (1). Fourteen dence of associated injuries with ipsilateral femur and pelvic patients had posterior femoral head dislocations, and 13/14 injuries being the most common. Due to the high rate of were reduced within 12 hrs. Thirteen fractures were clas- spontaneous reductions, polytrauma patients should be closely sifi ed as OTA 62-A types, 4 were 62-B, and 2 were 62-C. evaluated for multiligamentous knee injuries. Fourteen patients had associated marginal impaction. Patients were followed for an average of 10.1 months (range, 3-33) Notes: and achieved union by an average of 13 weeks (range, 7-27). Radiographic outcomes at fi nal follow-up were graded according to Matta (3 excellent, 8 good, 5 fair, 4 poor). One patient (5%) had loss of fi xation (fragment displacement of 6.8 mm) and was one of 3 reoperations (2 for post-traumatic arthritis and 1 for avascular necrosis). All revision procedures were total hip arthroplasties.

Conclusion: All fractures achieved union with failure rates 12:34pm–12:38pm similar to other techniques. Using locking compression pilon plates as a means of cortical substitution is a viable alternative Pilon Plate For Fixation Of Comminuted for ﬁ xation of comminuted posterior wall acetabular fractures. Posterior Wall Acetabular Fractures *The FDA has not cleared this drug and/or medical device for Adam K. Lee, MD the use described in the presentation. (Refer to page 57). Kristin McPhillips, MD, MPH James C. Widmaier Jr., MD Notes: Daniel S. Horwitz, MD

Purpose: In fractures of the posterior wall of the acetabulum, restoration of the articular surface is necessary to optimize clinical outcomes. Fractures of the posterior wall with comminution are a subset of these injuries where fi xation and maintenance of reduction are often diffi cult due to the presence of multiple small fragments. The concept of cortical substitution, using plates to recreate the contour of the posterior 12:39pm–12:43pm wall, can be applied to improve results. We present a series of comminuted posterior wall acetabular fractures treated with a Provisional Plate Fixation In The Setting Of novel use of a stainless steel pilon plate and hypothesize that Open Tibia Fractures the design of the plate will maintain reduction. The Food and Drug Administration has not approved labeling the device for Meryl R. Ludwig, MD the described purpose. *Lolita Ramsay, RN, PhD Robert A. Hymes, MD Methods: All patients eighteen years or older with commi- Michael Pitta, MD nuted posterior wall acetabular fractures treated by two ortho- Jeff E. Schulman, MD paedic trauma surgeons with the locking compression pilon plate from 2008-2013 were retrospectively reviewed. Patients Introduction: This study analyzed the risk of complica- with inadequate imaging follow-up were excluded. Patient tions in open tibia shaft fractures treated with intramedullary demographics, injury mechanism, fracture characteristics, nailing and provisional plate fi xation. Our hypothesis was time to union, maintenance of fi xation, reoperations, and other that using provisional plate fi xation prior to nailing will not complications were recorded. increase complications.

202 Notes: removal oftheplateafternailingshouldbeconsidered. tion. Although thelocalwound complicationrateislow, undergoing intramedullarynailingshouldbeused withcau- used tomaintainfracturealignmentinopentibiafractures Discussion plates. = .56,95%CI[.13,2.43]),comparedtoretainedprovisional (AOR =.42,95%CI[.07,2.67]),andany complication(AOR plating, removing theplatedecreasedonesoddsforinfection 1.15, 95%CI[.31,4.32]).In35patientswithprovisional increase theoddsforothertypesofcomplication(AOR = for infection(95%CI[.50,4.34]),but didnotsignifi for Gustillo,provisional plateusehada1.48higherodds down) and11.1%hadothercomplications. After controlling 16.7% hadasuperfi 42.9% removed). The complicationratewas 27.8%,ofwhich use occurredin32.4%ofextremities (57.1%permanent, 3 andmeanfollow-up was 10.4months.Provisional plate collisions. Forty-four percentofinjurieswereGustillotype 75% weremale,and67.3%injuredbymotorvehicle 27 insuffi 104 afterexclusions (7forage,4died,1acuteamputation; Results: were reviewed. classifi graphic data,mechanism,sideofinjury, Gustilloand AO/OTA medullary nailing,withorwithoutprovisional plating.Demo- 2013; opentibiafracture;andoperatively treatedwithintra- to level ItraumacenterbetweenJanuary1,2005toJune30, Records wereincludedifpatients18orolder;admitted Methods: cation, secondaryprocedures,andoperative reports There were143patientswith anopentibiafracture, cient follow-up). Patients averaged 37yearsold, Approval was obtainedbythehospitalIRB.

and Conclusion: cial ordeepinfection(4.6%wound break- Provisional platestabilization cantly There arechancesofdisplacement ofthemalleolarfracture A highindex of suspicionisrequiredtodiagnosethisinjury. commonly associatedwithalow energy tibialshaftfracture. Discussion andConclusion: the tibialnail. medial malleolidisplacedwhenstabilizedbeforepassageof operative X-raysand1was seenonCTScan.Noneofthe 13/14 medialmalleolarfractureswereclearlyevident inpre- energy and6/14(43%)wereduetolow energy mechanism. nail. 8/14(57%)medialmalleolusfractureswereduetohigh posterior malleolusdisplacedduring/afterpassageofthe patient withpreorintraoperatively diagnosedandstabilized remained unrecognizedand1requiredrevision surgery. No was completelymissedpreoperatively. In2patientstheinjury scan identiﬁ on initialinjuryﬁ (66.6%) patients,theposteriormalleoluswas notseenclearly tern ofthetibialshaftfracturewas notconsistent.In20/30 injuries. Infractureswithhighenergy mechanismthepat- malleoli werelow energy and12/30(40%)werehighenergy rior andmedialmalleolusrespectively. 18/30(60%)posterior 30/369 (8.1%)and14/369(3.7%)hadafractureoftheposte- Results: imaging wereanalyzedforthestudy. spective analysis.Mechanismofinjury, operative notes,and fracture, between2004and2013,wereincludedintheretro- AO/OTA-42 fracturewithassociatedipsilateraldistalarticular Methods: injuries. eate thesearticularinjuries,andreportthenumberofmissed surface maybemissed. The purposeofthestudywas todelin- tibial shaft,anassociatedfractureinvolving thedistalarticular Introduction: Daniel S.Horwitz,MD Michael Suk,MD,JD,MPH,FACS Kristin McPhillips,MD,MPH Raveesh Richard,MD David G.Fanelli, BS Hemil H.Maniar, MD Fractures AreFrequently Missed Ipsilateral AnkleFractures With Tibial Shaft 12:44pm–12:48pm A totalof369patientswereincludedinthestudy. All skeletally maturepatients whosustainedan ed thefracture.In9/30(30%)patientsinjury Duetothepredominantvisibleinjuryof lms andwas missed.In11/20(55%)aCT A posteriormalleolarfractureis Rapid Fire Session16A 203

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during nailing and hence ﬁ xation should be done prior to the 47 (13%) readmitted for infection. Four patients in the aspetic nailing procedure. cohort with two positive minor criteria (9.0%; 4/44) had subsequent infection compared to 11 aseptic patients with less Notes: than two positive minor criteria (1.3%; 11/856).

Conclusion: Elevated inﬂ ammatory markers, joint leukocyto- sis and neutrophilia, or an isolated positive culture in the setting of an otherwise aseptic appearing joint is not uncommon. However, when multiple tests are positive and more than two minor MSIS criteria are fulﬁ lled, the risk of PJI is increased. Patients with two or more minor MSIS criteria should be 12:49pm–12:53pm worked up for PJI thoroughly.

Notes: Patients With Abnormal Infection Parameters Need To Be Investigated Prior To Revision Arthroplasty

Priscilla K. Cavanaugh, MS Benjamin Zmistowski, MD Anthony T. Tokarski, BS Camilo Restrepo, MD Saturday, October 25, 2014 Javad Parvizi, MD, FRCS Rapid Fire Session 16B — Total Hip Reconstruction Introduction: In the setting of painful joint arthroplasty, (Station B, Plaza Ballroom 1) ruling out periprosthetic joint infection (PJI) is imprecise. A clear and uniform defi nition of PJI—relying upon culture, Moderator: Amar S. Ranawat, MD systemic infl ammatory markers, and local signs of infection— has been provided by the Musculoskeletal Infection Society (MSIS). While providing a clear diagnosis when major crite- 12:24pm–12:28pm ria are fulfi lled, the meaning of one or two minor criteria in an aseptic case is unclear. This study investigates (a) the inci- Risk Factors For Periprosthetic Infection In dence of positive minor criteria in the work-up of PJI, and (b) Young Patients After THA implications of positive results. Taylor R. McClellan, BS Methods: The cohort consisted of 620 revision knee and 638 *Michael P. Bolognesi, MD revision hip arthroplasties performed between 2006-2011. R. Andrew Henderson, MD, MSc Results of preoperative and intraoperative work-up of PJI Jonathon A. Godin, MD, MBA were collected. The MSIS defi nition of PJI was used to classify cases as infected or aseptic. Subsequent readmissions for Introduction: The patient-related risk factors for peripros- PJI were identifi ed and used to assess importance of positive thetic joint infection (PJI) after total hip arthroplasty (THA) minor criteria. have recently been evaluated in several large Medicare database studies. However, much remains to be discovered regard- Results: The MSIS defi nition classifi ed 358 (28.5%) cases as ing the epidemiology, demographics, and risk factors for PJI infected. In the aseptic group, 648 patients had zero (72%), after THA in younger and/or privately insured patients. 207 had one (23%), and 45 had two (5%) positive minor criteria. In the PJI patients the presence of minor criteria was zero Methods: A patient records database was used to gather in 4 patients (1%), one in 22 patients (6%), two in 90 patients patient demographic data on 45,202 privately-insured patients (25%), three in 97 patients (27%), and four in 147 patients that underwent primary THA between 2007-2011. The vast (41%). The aseptic group had 14 (2% of aseptic cases) majority of these patients were under 65 years of age. 750 patients readmitted for infection, while the infected group had (1.7%) of these patients went on to acquire a diagnosis of

204 ment ofchronicperiprosthetic jointinfection(PJI)istwo- Introduction: Javad Parvizi, MD,FRCS Craig J.Della Valle, MD Alex Uhr, BS Matthew W.Tetreault, BA Mohammad R.Rasouli,MD Anthony Tokarski,BS Centers Orthopaedic Outcomes: From AReport Two High Volume Resection ArthroplastyDoesNotImprove Delaying ReimplantationFollowing Notes: younger population observed inotherstudiesseemtobelargely conserved inthis stitute riskfactors forPJIinelderlyand/orMedicarepatients torial innature.Further, themedicalcomorbiditieswhichcon- seems tobehigherinyoungerpatients. This islikely multifac- Discussion andConclusion: and complicateddiabetes. nary disease,alcoholanddrugabuse, liver disease,anemia, for PJI(oddsratio>1.0)includingdementia,chronicpulmo- comorbidities evaluated, 20demonstratedanincreasedrisk PJI prevalence bysex orregion ofthecountry. Ofthe35 years old(1.74%). There werenosignifi (2.85%) trendingdownward withincreasing ageuntil65-69 the highestrateoccurringin30-34yearoldpopulation signifi from 0.81%at30daysto1.66%5years. There was a Results: then calculatedforallcomorbidconditions. States. Relative riskandoddsratiosfordeveloping PJIwere of PJIwas stratifi CPT andICD-9codesamongthispopulation. The incidence documentation of35commonmedicalcomorbiditiesutilizing periprosthetic jointinfection. The databasewas searchedfor 12:29pm–12:33pm cant difference intheprevalence ofPJIbyage,with Cumulative incidenceofPJIinthiscohortranged InNorth America, thepreferredsurgical treated byage,gender, andregion oftheUnited Interestingly, theriskofPJI cant differences in Notes: still remainsunknown. guide surgeons regarding theoptimaltimingofreimplantation plantation mayneedtobeindividualized, thebestmetricto of two-stage exchange arthroplasty. Although timingofreim- between fi be delayed.Basedonourfi reimplantation forpatientswith“severe” infectionshould at any time. 1.95) andspacerexchange (2.56)werepredictorsoffailure model showed thatBMI (OR=1.04),kneeinfection tors ofreimplantationfailure. The Coxproportionalhazards but nottimetoreimplantationweresomeofthepredica- exchange (OR=12.21), andpolymicrobialPJI(OR=9.48) indicated thatPJIofknee(OddsRatio(OR)=2.08),spacer experienced subsequent failure. Logisticregression analysis ± 1.9years(minimumof90days).97patients(22.4%) duration offollow upfromtimeofreimplantationwas 2.4 Results: subsequent failure oftheprosthesisduetoinfection. proportional hazardtestwereusedtodeterminepredictorsof treatment ofPJI.Multivariate logisticregression andCox defi plasty between2002and2012.Reimplantationfailure was identify allPJIcasestreatedwithtwo-stage exchange arthro- Methods: dure intermsofinfectioncontrol. a two-stage exchange infl determine ifthetimingbetweenfi timing forreimplantationisunknown. This studyaimsto ally occurs6-8weeksafterresectionarthroplastytheoptimal stage exchange arthroplasty. Although reimplantationgener- ned astheneedforfurthersurgical intervention forthe The fi The rst andsecondstagedoesnotinfl We useddatafromtwo highvolume centersto Conclusions: nal cohortconsistedof433patients.Mean uenced theoutcomeofthisproce- Itisacommonlyheldbeliefthat ndings, itappearsthatthetiming Rapid Fire Session16B rst andsecondstagesof uence theoutcome 205

Saturday Saturday Poster Friday Abstracts EOA 45th Annual MeetingAmelia Island, Florida2014

procedure, these stems provide a safe and effective solution 12:34pm–12:38pm for many femoral problems.

Survivorship And Complications Of Notes: Revision Total Hip Arthroplasty With A Mid- Modular Femoral Stem

Jason Hochfelder, MD *Aldo M. Riesgo, MD Edward Adler, MD Richard Iorio, MD Christopher Nathasingh, BA 12:39pm–12:43pm Nick Brownstone, BA Lawrence M. Specht, MD Intraoperative Femur Fracture During Introduction: The number of revision total hip arthroplasties Primary Total Hip Arthroplasty And (THA) performed each year continues to rise; however, there Hemiarthroplasty is no consensus on the optimal femoral implant. Diaphy- seal fi tting mid-modular femoral components with variable David S. Geller, MD metaphyseal sizing options are the most utilized femoral *Robert Brochin, BS stems for revision THA in the United States. Corrosion at Simon Greenbaum, BA the mid-modular interface leading to aseptic loosening and Introduction: Total hip arthroplasty and hemiarthroplasty implant failure, as well as loosening leading to subsidence, are commonly performed orthopedic procedures with over have been reported. The purpose of this study is to evaluate 300,000 performed annually in the US. These numbers can be the survivorship and complications of diaphyseal fi tting mid- expected to increase with the aging population. Intraoperative modular femoral components used in revision THA. femur fracture during femoral stem implant is a recognized Methods: We reviewed all revision THA with a diaphyseal event that may result in additional cost and complications for fi tting mid-modular femoral component performed by 10 the patient. The purpose of this study is to evaluate the inci- different surgeons at two high volume academic medical cen- dence of this event. ters. The number of failures and the reason for failure were Methods: A retrospective observational review of x-ray recorded. Failure was defi ned as aseptic loosening, mechani- images following all primary press fi t total hip arthoplas- cal failure, septic revision, periprosthetic fracture, or need for ties and hemiarthroplasties over a 3-year period (January revision for any reason. Radiographs were reviewed for signs 2010-December 2012) was performed at an academic medical of boney ingrowth and signs of loosening. center. Intraoperative fracture was considered when cerclage Results: One hundred fi fty-eight patients were identifi ed wire was noted. Statistical difference between genders and who had a total of 161 revision THA with diaphyseal fi tting age cohorts (less than 65 vs. greater than or equal to 65 years) mid-modular femoral components. The average follow-up was performed using chi-square analysis. was 3 years. At fi nal follow-up, 5 (3%) patients required re- Results: A total of 859 primary non-cemented total hip revision for failure of the femoral component; 4 for loosen- arthroplasties and hemiarthroplasties were performed in 859 ing of femoral component and 1 for fracture of the femoral unique patients over the study period. The study population component. There were a total of 24 (14.9%) revisions for consisted of 509 females and 350 males with an average age any reason, with the most common reason being septic fail- of 65.8 years and an age range of 15-102 years. Intraopera- ure (10 of 24). tive fracture occurred in 49 cases (5.7%). The average age Discussion and Conclusion: To our knowledge this is the of patients with intraoperative fracture was 68.1 years with largest reported series of revision THA with diaphyseal fi tting a range of 21-102 years. Intraoperative fracture occurred in mid-modular femoral components. Our results show that these 11.1% of patients greater than 91 years, but there was not stems have a low rate of aseptic loosening, subsidence, and a signifi cant difference in fracture incidence between age mechanical failure. While revision THA may be a challenging cohorts. Fracture occurrence rates in females (33, 6.5%) and

206 size strategy (GroupC). The incidenceofinstability andpsoas stability assessment(GroupB andC)changeinthecup – 3rd100correspondingtothe useofintraoperative anterior A- 1st100DAA THA cases, GroupB-2nd100andC The studypopulationwas divided intothreegroups;Group nifi measured onpreoperative radiographsafter adjustingformag- operative standingradiographs.Native femoralheadsize, mine acetabular inclinationandanteversion on6weekpost- Radiographic analysiswas donebytwo observers todeter- April 2009to April 2011were reviewed atasinglecenter. secutive DAA THAs performedby a singlesurgeon from Methods: learning curve. to stabilityandimpingementasapartofsinglesurgeon’s lar cuppositionindirectanteriorapproachwithreference Introduction: John W. Stirton,MD Jonathan Robinson,MD Ajit J.Deshmukh,MD *Jose A. Rodriguez,MD Parthiv A. Rathod,MD Impingement — Infl Anterior Approach Total HipArthroplasty? Component Position InDirect AndSize What Is The Optimum Acetabular Notes: Clinicians shouldbecognizantofthispotentialcomplication. and limblengthdiscrepanciesmaycarrysignifi 17,000 patientsperyear. Costofrevision, additionalsurgery, realized intraoperative fracturemayoccurinapproximately incidence inpressfi of 5.7%falls withinpreviously reported rangesoffracture Discussion andConclusion: males (16,4.6%)didnotsignifi 12:44pm–12:48pm cation, was usedtocalculatethe native acetabular cupsize. uence OfStabilityAssessmentAnd Clinicalandradiographicrecordsoffi Ouraimwas tostudytheevolution ofacetabu- t hiparthroplasty. These fi An intraoperative fracturerate cantly differ. ndings suggest cant burden. rst 300con- Notes: ity). terior overhang (cup-neckimpingementandanteriorinstabil- THA toavoid anterioroverhang (psoasimpingement)orpos- cup sizeshouldbeasclosetothenative cupsizewithDAA makes theuseoflarge headspossible.However, theimplanted anteversion islower inthe DAA. Increasingthecupsize Discussion: in 1patient. psoas releasewas performedin3patientsandcuprevision and groupC(2%).For PIrelatedgroinpain,anarthroscopic was higheringroupB(12%)ascomparedto A (2%) in theothergroups. The incidence ofPI-relatedgroinpain 1). There were2anteriordislocations ingroup A withnone (±2.60mm] ascomparedtogroupC[1.4(±1.4)mm](Figure icantly higherinGroup A [5.2(±2.1)mm]and groupB[5.8 implanted cupsizeandcalculatednative cupsizewas signif- to group A [24.3°(±7.5°)]. The difference betweenthe Group B[12.5°(±3.3°)]andC[13.6°(±2.3°)]ascompared the groups.Meananteversion was signifi Results: graphic outcomemeasures. to seeifthereweredifferences intheseclinicalandradio- determined forthethreegroups.Statisticalanalysiswas done impingement (PI)–relatedgroinpainat2yearfollow-up was hip arthroplasty. Despitetheincreasing popularityanduseof geon inadjustingneckanteversion, lengthandoffset intotal were introducedtoprovide increasedversatility tothesur- Introduction: Geoffrey H. Westrich, MD TimothyPhD Wright, Marcella Elpers,BS Ivan DeMartino,MD MD Joseph Assini, Retrieval Study Failure OfAModularNeck HipStem: A 12:49pm–12:53pm Meanvalues forabductionweresimilarinall For optimumanteriorstability, thetarget cup Femoralstemswithdual-taper modularity Rapid Fire Session16B cantly lower in 207

Saturday Saturday Poster Friday Abstracts EOA 45th Annual MeetingAmelia Island, Florida2014

these femoral stems, concerns regarding corrosion at the neck- Saturday, October 25, 2014 stem interface exist. Rapid Fire Session 16C — Knee Methods: We analyzed 60 modular-neck stem implants. The (Station C, Ritz-Carlton Ballroom Foyer) stem bodies were made of titanium alloy and the modular necks were made of CoCr alloy. Patient demographic data Moderator: Marc J. Lemos, MD were collected from medical records including patient age, BMI, length of implantation (LOI), reason for revision and modular neck characteristics (neck angle, length, version and 12:24pm–12:28pm offset). The retrieved implants were explanted mostly for adverse local tissue reaction (ALTR) after a mean LOI of 21.4 Systemic Manifestation Of Periprosthetic ±8.2 months. The neck angle was 127° in 42 cases and 132° Infection Is Associated With Increased In- in 18 cases. The neck length included 30 mm (38), 34 mm Hospital Mortality (50%), and 38 mm (12%). The average patient age at revision was 64.6 (±8.4) years. Each modular neck was assessed and Gregory K. Deirmengian, MD graded for fretting and corrosion according to the Goldberg’s Anthony T. Tokarski, BS criteria using a 1 to 4 scale (1 none, 4 severe). The taper inter- Javad Parvizi, MD, FRCS face of the modular stem was divided in 4 zones (anterior, Alex Uhr, BS posterior, medial and lateral) and the modular neck taper was divided in 2 regions (proximal and distal) and 4 zones (ante- Introduction: Although it is known that patients with sys- rior, posterior, medial and lateral). temic infl ammatory response syndrome (SIRS) and septice- mia can have increased in-hospital complications, few have Results: Evidence of fretting and corrosion was assessed on investigated systemic illness in the presence of periprosthetic all tapers at the neck-stem junctions but not at the head-neck joint infection (PJI). The purpose of this study was to deter- junction. The mean fretting score was 1.7 for the neck and 1.2 mine the incidence of SIRS in patients with acute PJI treated for the stem. The mean corrosion score was 3.5 for the neck on an urgent basis and to report outcomes in these patients. and 3.9 for the stem. The LOI showed a linear relation with higher scores. The proximal medial zone and the distal medial Methods: Using our institutional database, we identifi ed all and lateral zones had more corrosion and fretting than all patients surgically treated for deep PJI on an urgent basis from other regions of the modular neck. No relations were observed 2002-2012. Electronic medical records were used to collect with neck angle and neck length. patient demographics, preoperative vital signs, blood culture results, in-hospital mortality, ICU admissions, and subsequent Discussion and Conclusions: This implant is associated with reoperation for deep infection. Patients were classifi ed as hav- high rate of failure secondary to fretting and corrosion at the ing SIRS based on the criteria set by the American College of femoral neck-taper junction. The higher corrosion scores on Chest Physicians. the medial and lateral side of the neck taper junction could be related to high stresses at that zones. Results: During the study period, 491 patients were treated for deep PJI on an urgent basis. Of those, 128 (26%) devel- Notes: oped SIRS preoperatively. At least one concomitant blood culture was present in 30 (6%) of the patients with SIRS. In total, there were 7 in-hospital deaths for our cohort. Patients with SIRS and at least one positive blood culture were at a signifi - cantly higher risk of in-hospital mortality (10% vs 0.9%; p = 0.002). Systemic illness was not an independent risk factor for ICU admission or recurrence of PJI.

Discussion and Conclusions: Our study demonstrates that patients who develop SIRS preoperatively and present with concomitant positive blood cultures are at an increased risk of in-hospital mortality. We have also shown that there is a high incidence of preoperative SIRS in patients with acute PJI.

208 case; effectively thelengthofgrafttunnelmismatch. or recessioninthetibialtunnel was measured attheendof intra-operative measurements. The amountofgraftprotrusion and tibialtunnellengths;where comparedtotheirrespective culations; Blumensaat’s line,patellarligament, overall graft, used tocalculatethetibialtunnellength. All pre-operative cal- length onlateralX-ray;subsequently, Blumensaat’s linewas overall graftlengthwas calculatedfromthepatellarligament mensaat’s lineandthepatellar ligament wererecorded. The X-Rays wereobtainedpriorto ACLR. The lengthofBlu- independent drillingofthefemoralandtibialtunnels.Lateral 27.8±11.8 years. All ACLR wereperformedanatomicallywith 7 female);allwereBTBautograft. Average patient agewas Methods: measure. cruciate ligament (ACL) lengthwas asecondaryoutcome between Blumensaat’s lineandthereconstructedanterior calculate tibialtunnellengthpre-operatively. The similarity We investigate thelateralkneeX-rayasatemplatetohelp or allograftcanbecomplicatedbygrafttunnelmismatch. (ACLR) withbone-patella-tendon-bone (BTB)autograft Introduction: Charles A. Roth,MD Christopher O’Grady, MD Jeremy Bruce,MD Ryan Hess,MD C. Luke Wilcox, DO Travis Roth,MSIV LCDR Patrick W. Joyner, MD,MS Lateral X-Ray Cruciate LigamentReconstructionUsing Pre-Operative Templating OfAnterior Notes: presence ofPJI. undertaken inpatientspresentingwithsystemicillnessthe Given theseﬁ 12:29pm–12:33pm 20consecutive ACLR wereperformed(13male, ndings, carefulmedicalmanagementshouldbe Anterior cruciateligamentreconstruction Notes: structed ACL. Blumensaat’s lineisessentiallythesamelengthasrecon- BTB autoandallografts. Additionally, wedemonstratedthat in minimizingtheriskofgrafttunnelmismatchwhenusing ACLR andcalculatingthetibialtunnellengthiseffective Conclusion: was 0.81. 0.2 ispoor)forBlumensaat’s lineandthereconstructed ACL correlation coefﬁ ative andintra-operative tibialtunnellengthwas 6.43%. The saat’s lineandreconstructed ACL was 0.72%andpre-oper- 2.1±2.6mm. The meanpercentdifference betweenBlumen- was 4.5±4.5mm,andtheaverage grafttunnelmismatchwas 1.4±1.2mm, pre-operative andintra-operative tibialtunnel of Blumensaat’s lineandthereconstructed ACL was Results: was converted into3Dcomputermodels. A novel software pre- andpostoperative computerizedtomography(CT) which wedges inallcaseswereidentical. All cadavers underwent decreasing HTO (OWO). The dimensions oftheplanned HTO (CWO) and8underwentmedialopeningwedgeslope- used; 8underwentlateralclosingwedgeslope-decreasing Methods: slope-decreasing HTO. and patellaraxialtiltfollowing closingandopeningwedge Purpose: Andrew D.Pearl,MD Benjamin Stone,BA Durham Weeks,MD Hendrik A. Zuiderbaan,MD Saker Khamaisy, MD Anil S.Ranawat, MD Osteotomy Closing AndOpeningHigh Tibial Tibial RotationAndPatellar Tilt Following 12:34pm–12:38pm The average difference betweenthelength This studywas performedtoevaluate tibialrotation Sixteenkneesoffresh-frozencadavers were This methodofpre-operatively templatingan cient (greaterthan0.8isexcellent, lessthan Rapid Fire Session16C 209

Saturday Saturday Poster Friday Abstracts EOA 45th Annual MeetingAmelia Island, Florida2014

code was developed, based on iterative closest point (ICP) tional performance of patients before surgery and compared it mathematical algorithm, to match the 3D models of the pre- to the patient perceived outcomes. and postoperative bone surfaces and calculate changes in tibial axial rotation, tibial slope, tibial coronal axis and patellar axial tilt after surgery. Methods: We studied 51 patients undergoing primary TKA Results: There was no signifi cant difference in the tibial coro- secondary to osteoarthritis. Patients were divided in two nal axis correction between CWO and OWO. In the CWO groups based on their preoperative ability to do a squat to 90 group, mean tibial slope correction, axial tibial rotation, and degrees (group 1=able; group 2=not able). The Timed Up and patellar tilt change were 11° (±3.8), 7.7° (±4) and 5.6° (±3.9), Go (TUG) test, PPO (WOMAC, QWB-7, SF-36) along with respectively. In the OWO group, the respective values were 5° Knee Society Knee and Function Score (KSKS, KSFS), and (±5), 2.8° (±2.3) and 2.4° (±0.9). All three parameters were Hospital for Special Surgery (HSS) scores were collected 2 signifi cantly higher in the CWO group. After CWO, the tibia weeks preoperatively in both groups. We compared the preop- was rotated externally and the patella was tilted laterally in all erative TUG, PPO, and knee scores within groups. cases. However, after OWO, in 50% of the cases the tibia was Results: Group 1 [19 patients (37%)] had signifi cantly faster rotated externally and the patella was tilted laterally while in TUG performance (14.5 sec.), and better WOMAC total score the other 50% of the cases the tibia was rotated internally and (52.1), and QWB-7 (0.555) than group 2 (23.0 sec., 56.9, the patella was tilted medially. 0.529; respectively). Group 1 had signifi cantly better KSKS Conclusions: Tibial rotation and patellar axial tilt are signifi - (62.3), KSFS (49.5), and HSS Knee Score (67.3) when com- cantly greater following CWO compared to OWO. In addi- pared to group 2 (46.5, 38.1, 58.3; respectively). In group 1, tion, after all CWO procedures the tibia rotates externally and correlations between TUG and PPO scores ranged from 0.02 the patella tilts laterally. After OWO, the tibial rotation and (SF-36 social) to -0.7 (SF-36 role). The correlation coeffi - patellar tilt may occur in either direction. cients ranged from 0.006 (SF-36 vitality) to -0.63 (KSFS) in group 2. Clinical Relevance: Tibial rotation and axial changes of the patella should be taken into consideration while planning Discussion and Conclusion: Although some of the physical closing and opening wedge HTO. performance parameters correlated with patient oriented outcomes the global statistical agreement was weak. For patients Notes: who could squat to 90 degrees their PPO and knee scores were associated with faster mobility. PPO may be measuring attitudes and perceptions and not “real” outcomes.

Notes:

12:39pm–12:43pm

Patient Perceived Outcomes And Physical Performance In TKA

Carlos J. Lavernia, MD Jesus M. Villa, MD David A. Iacobelli, MD Mark D. Rossi, PhD

Introduction: Patient’s answers in questionnaires such as the WOMAC and SF-36 do not always correlate with the actual physical performance of the patients. We assessed the func-

210 Notes: warfarin might beabetterchoice. of VTE ishighandtheprobabilityofbleedingnegligible, aspirin isalsothepreferredagent,althoughifprobability to warfarin. Inpatientswithno prior VTE undergoing TKA, in patientsundergoing THA withouthistoryof VTE compared Conclusion: sponding agesinthe TKA group. cost perQALY gainedbyaspirinwas greaterthanthecorre- $15,117.20 and$24,458.10respectively. In THA patients, at theageof85. The corresponding numbersfor TKA were $24,506.20 following THA, whichincreasedto$47,148.10 At theageof55years,costperQALY gainedbyaspirinwas For eithersurgery, cost/QALY ofaspirinincreasedwithage. rin costlessandsaved moreQALYs thanwarfarin (Table III). Results: (THA)). TJA (totalkneearthroplasty(TKA)ortotalhip the available literatureforaspirinandwarfarin andtypeof life-years (QALYs) forallevents wereobtainedbasedon model. Transition probabilities,costs,andquality-adjusted site bleeding,andsurgical siteinfectionweredefi chronic pulmonaryhypertension, operative andnon-operative lism, deepvenous thrombosis,postphlebiticsyndrome, Methods: ness analysis. warfarin withaspirinusingaMarkov cohortcost-effective- farin. This studyaimstocomparecostandhealthbenefi comparing thecostandhealthbenefi following totaljointarthroplasty(TJA), therearenostudies thromboembolism (VTE)prophylaxis inlow riskpatients gesting aspirinisaneffective andsafeagentforvenous Background: Javad Parvizi, MD,FRCS Mitchell G.Maltenfort,PhD Mohammad R.Rasouli,MD Reza Mostafavi Tabatabaee, MD Arthroplasty: WarfarinAspirin Versus Thromboembolism After Total Joint Cost-Effective Prophylaxis Against Venous 12:44pm–12:48pm Inallagegroupsandforboth THA and TKA, aspi- A Markov modelwas created. Pulmonaryembo- Aspirin isthepreferred VTE prophylaxisagent Although recentlypublishedguidelinessug- ts ofaspirinwithwar- ned inthe ts of plex. Although thesefi NMCCKs, but recognizethatthesecasescanbemorecom- low, wedidseeatrendtowards ahigherrevision ratewith Discussion: 0.83-3.70). revision duetomechanicalfailure (Hazard ratio1.75;95%CI, was foundbetween PSandNMCCKwithregard toriskof compared to19NMCCKs(2.32%).Nosignifi 11 PSkneesrequiredrevision formechanicalfailure (1.34%) sions forinfection,fracture,andothercauseswereexcluded, Results: identifi PS totalkneesand817NMCCKs.Reasonsforrevision were portional hazardsmodel. The fi cohort, implantsurvivorship was examined usingaCoxpro- the baselinecharacteristics.Inpropensityscore-matched propensity scorematchingadjustingforthedifferences in and confoundinginthisobservational study, weperformed manufacturer. To reducetheeffect oftreatment selectionbias who received primaryNMCCKimplantsfromthesame received primaryPStotalkneeswerecomparedwithpatients Methods: traditional PSdesign. compare revision ratesformechanicalfailures comparedtoa been implantedatourinstitution,thegoalofthisstudywas to arthroplasty (NMCCK). As many oftheseprostheses have referred toasnonmodularconstrainedcondylartotalknee used asanintermediaryoption,withouttheuseofstems, been usedwithintramedullarystems,somedevices have been Although traditionalconstrainedtotalkneeprostheseshave achieve stability, andincreasingconstraintmayberequired. tissue-balancing techniquesalonemaybeinsuffi deformities resultinattenuationofcollateralligaments, soft ment isessentialforasuccessfuloutcome. When angular Introduction: Robert Marx,MD,MSc,FRCSC Stephan Lyman, PhD Lily Lee,MS Geoffrey H. Westrich, MD Mohamed E.Moussa,MD Stabilized Total KneeArthroplasty Modular Constrained Versus Posterior Comparison OfRevision RatesOfNon- 12:49pm–12:53pm ed. The average follow-up was 51months. After revi- BetweenMay2007andDec2012,patientswho While revisions rates inbothcohortsarequite Attaining stabilityduringtotalkneereplace- ndings areconsistentwith reportsof nal cohortconsistedof817 Rapid Fire Session16C cant difference cient to 211

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midterm success with NMCCK prostheses, other studies have (ICRS) grade 3 and 4) and 6 partial (ICRS grade 1 and 2) shown an incidence of femoral loosening, and stemmed fi xa- lesions of the humeral head along with 13 full and 7 partial tion may be more appropriate in certain clinical situations. lesions of the glenoid. For detecting humeral lesions on MRI, the radiologists’ combined accuracy was 78%, sensitivity Notes: was 43%, and specifi city was 91%. The combined accuracy for detecting glenoid lesions on MRI was 84%, sensitivity was 53%, and specifi city was 93%. Combining the readers, low-grade lesions (ICRS grades 1 and 2) of the glenoid and humerus were read as negative on MRI in 63% and 86% of cases, respectively. Inter-observer agreement for detecting humeral lesions with non-contrast MRI was fair (K = 0.24) and considered moderate (K = 0.41) for detecting glenoid Saturday, October 25, 2014 lesions. The ICC was 0.24 for the size of humeral lesions and 0.47 for glenoid lesions, indicating fair and moderate agree- Rapid Fire Session 16D — Shoulder ment, respectively, between and among the radiologists’ lesion (Station D, Ritz-Carlton Ballroom Foyer) characterizations and the surgeon’s measurements. Moderator: Kevin D. Plancher, MD Conclusion: Overall accuracy of non-contrast MRI at detecting a glenohumeral articular cartilage lesion is good, however, interpretation is reader dependent and accuracy is signifi cantly 12:24pm–12:28pm reduced for detecting low-grade lesions. Based on these fi ndings we recommend that patients with rotator cuff tendinopa- Diagnositc Accuracy Of Non-Contrast MRI thy undergoing arthroscopy be informed that the presence and For Detecting Glenohumeral Cartilage severity of cartilage lesions may be underestimated on MRI. Lesions Notes: Corinne VanBeek, MD Mohammad R. Rasouli, MD Mitchell G. Maltenfort, PhD Javad Parvizi, MD, FRCS

Introduction: The purpose of this study was to determine the prevalence of glenohumeral articular cartilage lesions in patients with rotator cuff tendinopathy and assess the accuracy 12:29pm–12:33pm of non-contrast magnetic resonance imaging (MRI) at detecting these defects compared to the gold standard of arthroscopy. Arthroscopic Rotator Cuff Repair: The Characterization Of Preoperative And Materials and Methods: Non-contrast MRI images obtained Postoperative Sleep Disturbance in 84 consecutive patients undergoing shoulder arthroscopy for rotator cuff tendinopathy (mean age 54.8 yrs; range, Luke Austin, MD 17-82) were prospectively evaluated for glenohumeral carti- Matthew Pepe, MD lage lesions. Two fellowship trained, experienced musculo- Bradford S. Tucker, MD skeletal radiologists, blinded from arthroscopic ﬁ ndings, inde- Alvin C. Ong, MD pendently evaluated the glenoid and humeral head cartilage on Robert Nugent, BS two occasions, separated by an eight week interval. Brandon Eck, BS Fotios Tjoumakaris, MD Results: At arthroscopy, humeral head cartilage lesions were detected in 23 patients (frequency, 27.4%) and glenoid car- Introduction: Sleep disturbance is a common complaint of tilage lesions were found in 20 patients (frequency, 23.8%). patients with a rotator cuff tear. Poor sleep, along with pain, There were 17 full (International Cartilage Repair Society are often the driving symptoms for patients to proceed with

212 Notes: SANE) improved andpain(VAS) decreased. expected, following rotator cuff repairfunction(SSTand use ofnarcoticpainmedicationnegatively affects sleep. As improves tolevels comparablewiththegeneralpublic. The going rotatorcuff repair. Following surgery sleepdisturbance Conclusions: found tonegatively affect sleep. tors vs.PSQIwas performed.Preoperative narcoticusewas variable linearregression ofallsurgical anddemographic fac- 38% ofpatientscontinuedtohave sleepdisturbance.Multi- baseline tofi VAS painscoreandSANEallofwhichimproved from follow-up). SleepdisturbancecorrelatedwithSSTscore, and continuedthrough6months(p0.0179,SE0.757,93% achieved at3months(p0.0012,SE0.593,91%follow-up) surgery, astatisticallysignifi tive PSQIscoresindicative ofsleepdisturbance.Following Results: lected foranalysis. (SANE). Demographicandsurgical factors werealsocol- Score (VAS), andsingleassessmentnumericevaluation score Index (PSQI),SimpleShoulder Test (SST), Visual Analog outcomes werescoredusingthePittsburgh SleepQuality operatively atintervals of2,6,12,18and24 weeks.Patient tive study. Patients weresurveyed preoperatively andpost- cuff repairforfullthicknesstearswereenrolledinaprospec- Methods: bance improves following arthroscopicrotatorcuff repair. with asymptomaticrotatorcuff tear, and2)thatsleepdistur- hypothesize 1)thatsleepdisturbanceisprevalent inpatients is noevidence thatsurgery improves sleepdisturbance. We bance inpatientsundergoing rotatorcuff repair, andthere rotator cuff repair. To date,nostudiesexamine sleepdistur- Eighty-ninepercentofpatientsreportedpreopera- Fifty-sixpatientsundergoing arthroscopicrotator nal follow-up. Sixmonthsfollowing surgery only Sleepdisturbanceiscommoninpatientsunder- cant improvement inPSQIwas Notes: tion rates. The timingtodebridementhas notbeenshown toalterinfec- infection rateforopenfracturesofthehandisrelatively low. hand fractureshasnotbeenshown toalter infectionrates. The with antibioticsalone. The timingofdebridement inopen encountered afteranopenfracturecanbetreatedsuccessfully of antibioticsandinfectionrate. The majorityofinfections tively low. There isacorrelationbetweentheadministration the overall infectionrateforopenfracturesofthehandisrela- Discussion showing nocorrelationtotheincidenceofinfection. rate. Two studieslooked specifi study, including193fractures, resultedina3.6%infection 4.2%. Debridementwithin12hoursofinjurydefi two studies,including188fractures,withaninfectionrateof Debridement within6hoursofinjurywas clearlydefi receive antibioticsperioperatively hada9.4%infectionrate. yielded a4.4%infectionrate.Ofthe171patientswhodidnot patients whoreceived antibioticsintheperioperative period There were77infections(4.6%infectionrate).Ofthe1391 articles with1669openfracturesofthehandwereincluded. Results: quantitative datawereextracted. open fracturesofthehandwereincluded.Descriptive and rospective andprospective) whichincludedrelevant datafor searches ofbibliographieswereperformed. All studies(ret- Cochrane computerizedliteraturedatabasesandmanual Methods: ment andantibioticadministration. determine infectionratesandtheeffect oftimingdebride- review theavailable literatureonopenfracturesofthehandto tures ofthehand. The aimofthisstudywas tosystematically bone fractures,withlimitedguidelinesavailable foropenfrac- rates andtreatmentguidelineshasfocusedprimarilyonlong Introduction: Asif Ilyas,MD *Constentinos Ketonis, MD,PhD Joseph Dwyer, MD Systematic Review Rates InOpenFracturesOf The Hand: A Timing OfDebridementAndInfection 12:34pm–12:38pm The initialsearchyielded61references. Twelve SearchesoftheMEDLINE,EMBASE, and / Conclusion: Existingliteratureonopenfractureinfection The available literatureindicatesthat cally attimingtodebridement, Rapid Fire Session16D ned inone ned in 213

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Notes: 12:39pm–12:43pm

Subscapularis Fatty Inﬁ ltration And Clinical Evaluation After Tenotomy In Total Shoulder Arthroplasty

Michael T. Freehill, MD Iker Iriberri, MD 12:44pm–12:48pm Juan Pons-Villanueva, MD, PhD Christian Candrian, MD Patric Raiss, MD The Prevalence Of Rotator Cuff Tears In Gilles Walch, MD Operative Proximal Humerus Fractures

Introduction: A subscapularis tenotomy utilized during total Joseph A. Abboud, MD shoulder arthroplasty (TSA) has been suggested to produce Introduction: Proximal humerus fractures and rotator cuff detrimental effects on both muscle characteristics and clini- tears (RCTs) have both been shown to have increasing rates cal results. The aim of this study was to assess the structural with advancing age, theoretically leading to signifi cant over- changes of the subscapularis muscle and its clinical outcomes lap in the two pathologies. The purpose of this study was when subscapularis tenotomy was performed during TSA. to examine the prevalence, associated factors, and effect on Methods: Retrospective report of 24 shoulders in 20 patients, treatment of rotator cuff tears in surgically treated proximal after TSA was performed with subscapularis tenotomy, with humerus fractures. a mean age of 67.4 years. At mean follow-up of 72.6 months, Materials and Methods: A retrospective review was per- a clinical evaluation was performed, as well as postoperative formed of all adult patients who had surgery for a proximal CT scan to evaluate progression of fatty infi ltration (FI) of the humerus fracture from January 2007 to June 2012 in the subscapularis muscle. Interobserver and intraobserver reliabil- Shoulder & Elbow department of a large academic institu- ities for the assessment of subscapularis FI were also studied. tion. Patient demographics, fracture characteristics, type of Results: Subscapularis FI increased signifi cantly from a surgery done, presence and management of rotator cuff tears, mean value of 0.70 to 1.65. No FI progression was observed complications, and revisions were recorded. Logistic regres- in 6 (25%) shoulders, one stage progression in 12 (50%), sion analysis was performed to determine which factors were two stages in 5 (21%), and 3 stages in 1 (4%). No difference associated with the presence of a rotator cuff tear. For those in Constant score was observed between patients with lower fractures with tears, description of tear pattern and manage- postoperative FI (Goutallier Stage 0 and 1) and those with ment were recorded. higher FI (Stages 2 and 3) of the subscapularis muscle. How- Results: 349 fractures were reviewed in 345 patients. Of ever, a higher gain in Constant score (50 points) was observed these, 30 (8.6%) were found to have concomitant RCTs. when subscapularis FI did not increase. For interobserver Those with RCTs were older (average age 68.7 years vs. 63.1 and intraobserver reliabilities, the strength of the agreement years), more likely to have had a dislocation (40% vs. 12.5%), was low for both preoperative and postoperative assessments, and were more likely to have undergone arthroscopic repair or when analyzed by kappa statistics. reverse total shoulder arthroplasty than those without a RCT. Conclusions: Our data suggests progression of subscapularis Of the 30 RCTs, only 5 were known or suspected preopera- FI can impact the gain seen in clinical outcome. However, tively. Most (22 of 30) were treated with suture repair at the these results are guarded secondary to the low reproducibility time of surgery, but 5 patients received a reverse total shoulder and the artifact of postoperative CT scans. This data sug- arthroplasty based on the intraoperative fi nding of a RCT. gests a need of an alternative method for assessing muscle Conclusion: A concomitant RCT in association with a proxi- characteristics. Prospective randomized studies are needed to mal humerus fracture is relatively common, though somewhat further analyze differences both radiographically and clini- less than would be expected based on the average age of the cally between subscapularis tenotomy and lesser tuberosity patient population. RCTs are associated with older patients osteotomy.

214 respondents. 92.2%(95/103) responded thatthey would per- Routine DVT prophylaxis was notused byalarge numberof a consensusagreementontime frameforthestartoftherapy. early, supervised physical therapy; however, wedidnotfi regard toalaboringjob. Mostshoulderspecialistsallow regardless ofthetearsize. This timeframeincreasedwith return towork atasedentaryjob1-2weeksaftersurgery ing tooursurvey, mostshouldersurgeons allowed patientsto (54.5%) for5-6weeksafterrepairofalltearsizes. Accord- sling withapillow was usedbyamajorityoftherespondents (24/49) ofthequestions.Ofnotewefoundthatanabduction onstrated aconsensusresponse(>50%agreement)on49% vey. 92.8%respondents answeredevery question. We dem- and 111members(29.8%)completedallorpartofthesur- Results: terns onotherissuesrelatingtorotatorcuff problems. rotator cuff surgery, aswelltheirthoughtsandpracticepat- gery respondtofrequentlyasked questions(FAQs) regarding Surgeons (ACESS) todeterminehow experts inshouldersur- (ASES) andthe Association ofClinicalElbow andShoulder of membersthe American ShoulderandElbow Surgeons Materials andMethods: are oftenvariable. after rotatorcuff surgery. Answers tomost ofthesequestions perioperative management,restrictions,therapy andwork have importantquestionsfortheirsurgeon regarding surgery, Introduction: Gerald R. Williams, MD E. ScottPaxton, MD MD *Joseph A.Abboud, Daniel C. Acevedo, MD Rotator CuffRepair OpinionRegardingA Survey OfExpert Notes: require theavailability ofareverse shoulderprosthesis. and thosewithafracture-dislocation,inrarecasesmay 12:49pm–12:53pm We surveyed 372members ofthe ASES and ACESS, Many patientssuffering fromrotatorcuff tears We conductedanonlinesurvey nd Notes: some questionswithvariable responses. Further researchisneededtohelpclarifythebestanswers rotator cuff repairtoassistothersincounselingtheirpatients. determine commonclinicalpracticesamongexperts regarding based onclinicalexperience. The purposeofourstudywas to likely refl (24/49) ofthequestionsinourstudy. Variability inresponses Conclusion: form arotatorcuff repaironasmoker. novel artifi cerns ofcell-basedtreatment. Ourlaboratoryhasengineereda retain cellswithintheinjurysite,andpotentialsafetycon- include theineffi the injurysite.Limitationsofpreviously explored methods healing have focusedonmodulatingcellularresponses at outcome. Currentmolecularstrategies toimprove tendon a challengingclinicalproblemimpactingpatientfunctional Introduction: Andrzej Fertala,PhD Andrzej Steplewski, PhD Jolanta Fertala,PhD Pedro K.Beredjiklian,MD Mark Wang, MD,PhD Cells Tendon-Targeted Of Delivery Therapeutic Collagen-Specifi Smart collagen-targeting anchor, controlleddelivery andretention sites.. Potentialbenefi controlled targeting oftherapeuticcells tocollagen-specifi Saturday, October25,2014 12:24pm–12:28pm AnilS.Ranawat,MD Moderator: (Station E,Ritz-CarltonBallroom Foyer) Rapid Fire Session16E—BasicScience ects clinicalpracticesthathave evolved over time cial collagen-specifi We demonstratedaconsensusresponsefor49% Fibrosisaftertendoninjuryandrepairremains cient therapeuticcelldelivery, failure to ts ofthe ACSA includeaninducible c anchor(ACSA), enablingthe c Anchors For Rapid Fire Session16E

c 215

Saturday Saturday Poster Friday Abstracts EOA 45th Annual MeetingAmelia Island, Florida2014

of cells within an injury site, and decreased requirement of 12:30pm–12:34pm therapeutic cells and duration of treatment. The purpose of this study is to test the hypothesis that 1) GFP-tagged ACSA is expressed on the surface of engineered cells in a promoter Platelet-Rich Plasma Increases TGF- dependent fashion, and 2) ACSA expression enhances the Beta Expression Following Autologous attachment of the cell construct to collagen, and that this Osteochondral Transplantation In An In expression does not interfere with cell proliferation. Vivo Rabbit Model

Methods: The engineered construct includes the following Ethan J. Fraser, MD features: Murine fi broblasts (NIH 3T3), specifi c anchoring to *Lorraine A. Boakye, BA human type I collagen (C-terminus, α2 chain), tetracycline Keir A. Ross, BS (Tet)-responsive promoter, and GFP tag for localization. The Jonh M. Pinski, MS stable expression of the ACSA-GFP construct was confi rmed Niall A. Smyth, MD by culturing the selected transfected cells in the presence Amgad M. Haleem, MD, MSc or the absence of doxycycline (Dox). The presence of the John G. Kennedy, MD, FRCS (Orth) ACSA-GFP was confi rmed by Western blot and microscopy. Cell attachment assays were performed on cells expressing Purpose: Platelet-rich plasma (PRP) has been investigated as the ACSA construct (Tet-On) and non-induced cells (Tet- an adjunct to autologous osteochondral transplantation (AOT) Off). Cells were seeded on human collagen I-coated plates. and other cartilage repair procedures. Although the exact com- Proliferation assays were performed colorimetrically (Sigma- bination of growth factors essential to the restorative proper- Aldrich). ties of PRP are unknown, transforming growth factor-beta1 (TGF-β1) has been suggested to stimulate mesenchymal stem Results: GFP-tagged ACSA is expressed on the surface of cells and chondrocytes and inhibit catabolic activity. The aim engineered cells is a Tet promoter-dependent fashion. Specifi c of this study was to explore the effect of PRP on expression antibodies identifi ed the following: the extracellular fragment patterns of TGF-β1 following AOT in a rabbit model. We of the construct, the GFP portion, and DAPI-stained nuclei. hypothesized that TGF-β1 would have a different expression ACSA enhances the attachment of the cell construct to colla- pattern in cartilage of PRP treated compared to saline treated gen, and this expression does not interfere with cell prolifera- knees. tion. Methods: Twelve New Zealand white rabbits were treated Discussion/Conclusion: Fibrosis after tendon injury remains with bilateral AOT. A randomly selected knee was injected a vexing clinical problem, and current molecular strategies with autologous PRP and the other knee received saline injec- for improving tendon healing are limited by ineffi cient and tion. Animals were euthanized at three, six, and 12 weeks non-specifi c therapeutic delivery. This novel cellular con- post-operatively. TGF-β1 antibody was used to stain articular struct enables the controlled expression of collagen-targeting cartilage sections. Predetermined histological regions of inter- anchors at the surface of therapeutic cells, enhancing cellular est (ROI) were evaluated in both donor and graft sites using attachment to collagen-rich sites without disrupting cell pro- computer software. The total number of chondrocytes and liferation. Potential benefi ts may include the controlled target- number of chondrocytes expressing TGF-β1 in each ROI were ing of therapeutic cells to the injury site, improved tendon quantifi ed. Analysis focused on the percentage of cells stained healing effi ciency, and the reduced dispersion of cells into to control for variability in overall cellularity in each ROI. surrounding tissue. Results: Percentage of cells stained was higher in PRP Notes: treated knees for all ROIs. The difference between stain- ing at the right interface of graft and host tissue in PRP and saline treated knees was not signifi cant (p=0.72). This difference was signifi cant in all other ROIs (p≤0.05). There was a signifi cantly higher percentage of cells stained in the PRP group compared to saline at each post-operative time point (p≤0.05). Percentage of cells stained when combining data at all post-operative time points and ROIs indicated that TGF-β1

216 tration withageinfourofsix targets tested. However, TIMP-2 Results: 1), TIMP-2 and TIMP-4 werealsoassessed. these proteases,tissueinhibitorofmetalloproteinase1(TIMP- 60 yearsold. The levels ofthepharmacologicalinhibitors derived frombloodofhealthy, malevolunteers (n=92),19to MMP-2, MMP-9and ADAMTS13 inactivated platelets Methods: are involved inpost-wound tissueremodeling. directed towards matrixmetalloproteinases(MMPs)which topic hasfocusedongrowth factors andcytokines, withlittle clinical applicationshashadmixed results.Researchonthis such asactivated, concentratedplatelets,inorthopaedic Introduction: John A. Bojescul,MD M. Kelly Guyton,PhD Steven D.Zumbrun,PhD David L.Oliver, MD Peter C.Johnson,MD J. LeeEvanson, DO Justin M.Hire,MD Healthy MaleDonors In Activated, ConcentratedPlateletsFrom Metalloproteinases (TIMP)Concentrations (MMP) And Tissue InhibitorOf Variance OfMatrixMetalloproteinases Notes: be aviableadjunctive therapy incartilagerepair. role inthechondrogeniceffect ofPRP PRP mayincrease TGF- to salinefollowing AOT. Ourfi exhibit increasedpatternsof TGF- Conclusions: (p<0.01). expression was higherinPRPknees(41%±27vs.15%20) 12:36pm–12:40pm Notably, there was nosignifi Inthisstudy, theauthorsmeasuredlevels of FemoralcondylesofrabbitstreatedwithPRP The useofautologousbloodconcentrates, β 1 expression. TGF- ndings suggestthatadjunctive β 1 expression compared cant changeinconcen- in vivo β andPRPmay 1 mayplaya Notes: ute tolongerhealingtimesinthispopulation. centrated plateletsfromolderpatients,andmayalsocontrib- may diminishtheeffectiveness oftheuseactivated, con- decreased availability ofpharmacologicallyactive MMP-2 remodel theextracellular matrixduringwound healing. A A). MMP-2targets native collagens,gelatinandelastinto global inhibitorsofMMPs,includingMMP-2(Gelatinase Discussion andConclusion: pared tothose30yearsandyounger. in concentrationforsubjectsolderthan30yearsofagecom- and TIMP-4 demonstrateda statisticallysignifi axis angle(CAA)weremeasured. gram, shaftlengths,shaft-bending angle(SBA), andcapital- radiographs. Usingacustomized imagemeasurementpro- dimensional imagesthatareequivalent to‘perfectorthogonal’ projections torepresentlateralandposteroanterior(PA) two 3D imageswereconverted tosagittalandcoronal weighted reconstructed intheplaneofeachstudiedmetacarpal. The digital 3Dimagereformattingsoftware, CTsectionswere ring metacarpalsformthebasisforthisstudy. Usingcustom Methods: lateral plane. data incorrectlydescribesnormalmetacarpalanatomyinthe raw CTimagedata. We hypothesizethatcurrentplainx-ray ment usinganovel digitalreconstructiontechniquebasedon ring metacarpalsrelevant todeterminingfracturedisplace- aims todescribenormalanatomicmeasurementsofsmalland normal anatomicalparametershave beendescribed.Ourstudy Introduction: Pedro K.Beredjiklian,MD Kevin Lutsky, MD *Nayoung Kim,BS Michael Rivlin, MD Metacarpal Measurements Elimination OfOverlapInSmallAndRing 12:42pm–12:46pm Thirty-fi To date,onlyplainradiographicdefi ve scansofthesmalland30 TIMP-2 and TIMP-4 are and TIMP-4 TIMP-2 Rapid Fire Session16E cant increase nitions of 217

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Results: Our results show that CAA averaged 14 and 12 partmental pressure by physical examination compared with degrees in the ring and small metacarpals respectively. Apex needle measurement in a simulated compartment syndrome of dorsal SBA averaged 12 and 10 degrees in the ring and small the hand. metacarpals respectively. On the PA images the shafts are nearly straight. In contrast to prior reported values, we found Methods: Cadaveric hands were confi gured with intravenous the CAA to be less acute and the metacarpal curvature less fl uid infusion and an arterial line monitor to create and con- pronounced on the lateral projection. We also demonstrated tinuously measure intracompartmental pressures in the thenar that much of the metacarpal apex dorsal bend is in the shaft and hypothenar compartments. Seventeen assessors were itself. asked to determine the presence or absence of compartment syndrome based on physical exam and handheld intracompart- Discussion/Conclusion: Normal anatomic parameters of mental measurements. A pressure of 30 mmHg or greater was metacarpals are based primarily on radiographic data, and as positive for compartment syndrome. such are limited due to bony overlap in the lateral plane, as well as imperfect radiographic projections that are known to Results: By clinical examination of the thenar eminence, the distort anatomical relationships. This novel method of image sensitivity and specifi city of diagnosing compartment syn- reconstruction eliminates metacarpal overlap and defi nes pre- drome was 48.6% and 78.6%, respectively, with a positive cise anatomical reference for metacarpals. Our novel imaging predictive value (PPV) of 85.7% and negative predictive value modality reveals differences in anatomic parameters com- (NPV) of 36.7%. Using the handheld intracompartmental pared to accepted existing data based on plain radiographs. monitor, the sensitivity and specifi city increased to 97.3% and 85.7% with a PPV of 94.7% and an NPV of 92.3%. By Notes: clinical examination alone, diagnosis of compartment syndrome in the hypothenar compartment revealed a sensitivity and specifi city of 61.6% and 83.3% with an increase to 100% and 100% with handheld monitoring, respectively. For the hypothenar compartment, the use of handheld monitoring improved the PPV from 92.3% to 100% and the NPV from 40% to 100%, compared with physical exam alone.

Discussion/Conclusion: In contrast to handheld intra-com- partmental needle monitoring, physical examination demonstrates poor sensitivity and speciﬁ city in the diagnosis of compartment syndrome. We strongly recommend the use of handheld invasive pressure monitoring in order to augment the 12:48pm–12:52pm accuracy and reliability of the diagnosis of compartment syndrome and potentially improve patient outcomes. Interobserver Reliability In The Measurement Of Hand Compartment Notes: Pressures

Justin C. Wong, MD *Michael M. Vosbikian, MD Joseph Dwyer, MD Asif Ilyas, MD

Introduction: Compartment syndrome of the hand is an uncommon but potentially devastating diagnosis. Its timely diagnosis is dependent upon accurate physical examination or compartment pressure measurements. However, the efﬁ cacy of either technique in the hand has not been previously established. The aim of this study was to determine the reliability and accuracy of clinical assessment of elevated intracom-

218 2.3 days(range1-8).Insulindependent diabeticshadsignifi the injection,andaverage durationofhyperglycemia was (62%) hadthehighesthyperglycemic levels within 24hrsof dL (range123-385)at24hours post-injection. The majority (range 90-160)priortoinjection,andincreased208mg/ 5.6 –10.0). The average bloodglucoselevel was 116mg/dL Results: injection glucoselevels wereperformeddaily. the normalfasting bloodglucoselevels were obtained.Post- and wristtendonitis(n=1). The mostrecentHA1C level and tunnel syndrome(n=2),thumbbasaljointosteoarthritis ger fi triamcinolone acetonidewas given forthediagnosesoftrig- non-insulin dependentdiabetics. An injectionof1mL/10mg patients wereinsulindependentdiabetics,whileeleven were nine men)withanaverage ageof63yearswereincluded. Ten more thanoneinjection. Twenty one patients(twelve women, injection ofcorticosteroid. We excluded patientswhorequired presenting withdisordersofthehandorwristrequiringan Methods: glycemic responsetocorticosteroidinjectionsindiabetics. HA1C levels aredirectlycorrelatedtothedegree ofthehyper- over timeindiabetics. The purposeofthisstudyistotestthat (HA1C) isthemainstaymeasureofplasmaglucosecontrol serum glucoselevels indiabeticpatients.Hemoglobin A1C Introduction: C. Edward Hoffl Kevin Lutsky, MD Jonas L.Matzon,MD Jake Schroeder, BA *Nayoung Kim,BS Pedro K.Beredjiklian,MD Injection In The Hand: AProspective Study Patients Following LocalCorticosteroid With BloodGlucoseElevation InDiabetic Elevated HemoglobinA1CLevels Correlate 12:58pm–1:04pm AdamJ. Rana,MD Moderator: (Ritz-Carlton Ballroom Salon1) General Session17-Mixed Topics Saturday, October25,2014 nger (n=13),DeQuervain’s tenosynovitis (n=3),carpal The average HA1Clevel was 6.8mmol/mol(range We prospectively investigated diabeticpatients Locallyadministeredcorticosteroidselevate er II,MD,PhD - for eachc-arm. tinuous minuteseach. Ten dosimeterexposures wererecorded mini andthreestandardc-arms scannedthewristfor15con- Fluoroscopy positionand settingswerestandardized. Three with itshandsfl tive equipment. The modelwas positionedatahandtable while “Shielded”dosimeterswereplacedbeneaththeprotec- equipment attheeyes, thyroid, chest,groinandindex fi “Exposed” thermoluminescentdosimetersoverlaid protective attenuating glasses,athyroid shield,apronandgloves. Methods: sure. how muchpersonalshieldingequipmentcandecreaseexpo- most atriskduringdistalradiusfracturesurgery todetermine ously appreciated. We examined whichpartofthesurgeon is suggest thateyes andhandsreceive moreexposure thanprevi- protection reliesonthyroid shieldsandaprons,recentdata Introduction: Asif Ilyas,MD C. Edward Hoffl Protecting Ourselves Adequately? Flouroscopic RadiationExposure: Are We Notes: this commonclinicalscenario. and mayrepresentanimportanttoolforpatienteducationin following localadministrationofcorticosteroidsinthehand, correlate stronglywiththedegree ofbloodglucoseelevation Discussion/Conclusion: the durationofhyperglycemic event (r=0.32). levels increasedpost-injection(r=0.76).Butnocorrelationfor high baselineHA1Clevels andtheextent towhichglucose insulin dependent. There was asignifi cantly higherpost-injectionbloodglucoselevels thannon- Founders’ Award 1:06pm–1:12pm An anthropomorphicmodelwas fi While traditionalintraoperative fl anking avolar plateddistalradiussawbone. er II,MD,PhD

ItappearsthatbaselineHA1Clevels cant correlationbetween General Session17 t withradiation- uoroscopy nger 219

Saturday Friday EOA 45th Annual MeetingAmelia Island, Florida2014

Results: Hand exposure averaged 3.1 mrem/min (range 2.2- ing early mobilization is integral to optimizing functional and 4.8), or 14.9 times more than other recorded exposures. Eye motion outcomes, but must be done appropriately to mini- exposure averaged 0.4 mrem/min, or 1.7 times more than mize the risk of recurrent instability. We managed a cohort of average thyroid, chest and groin exposure. Gloves reduced patients who had sustained a simple elbow dislocation with an hand exposure 69.4%. Glasses decreased eye exposure 65.6%. overhead motion protocol, and hypothesized that immediate Hand exposure with the mini was 26.5% less than the stan- motion in an inherently stable position could maximize range dard. Eye exposure was 165% less with the mini. of motion and functional outcomes while minimizing the risk of recurrent instability. Discussion/Conclusion: Surgeons’ hands receive the most radiation exposure during fl ouroscopy. Radiation-attenuating Methods: 27 patients were included who sustained a simple gloves substantially reduced exposure. Eyes are exposed as elbow dislocation and were treated non-operatively with an well, but to a lesser extent. Minimum safe is exposure level is overhead motion protocol designed to convert gravity from a debatable. Radiation-attenuating glasses substantially reduced distracting to a stabilizing force. Motion was initiated at an exposure. Thyroid, chest and groin exposure is minimal, yet average of 1.3 days following initial presentation, and average these areas are most commonly protected. Some but not all follow-up was 27 months. Final arc of motion and prevalence mini c-arm units have lower exposure than standard units. of instability were the primary outcomes measures. This may refl ect source placement within the c-arm housing, duty cycle and fi ltering. During fl ouroscopy, surgeons’ hands Results: Final mean arc of motion was 6 to 137 degrees in the experience the largest exposure, which can be mitigated by fl exion-extension axis, with 87 degrees of pronation and 86 protective equipment and fl uoroscopy selection. Some but not degrees of supination. No recurrent instability was observed all mini c-arm units have lower exposure than standard units. in this cohort, and all patients were fully functional and without limitations at latest follow-up. Notes: Conclusion: We demonstrate that with an appropriate, supervised rehabilitation protocol, early motion can be initiated following an elbow dislocation event, and excellent functional outcomes can reliably be obtained. The motion protocol utilized in this cohort places patients in a supine position with the arm overhead, thereby minimizing the varus and distraction gravitational force and transitioning the triceps into an elbow stabilizer. The early motion maximizes the ability to achieve a full fl exion-extension arc, while the positioning allows the collateral ligamentous complexes to heal in an isometric fashion. A functional arc of motion was reliably obtained, with no observed cases of recurrent instability. 1:14pm–1:20pm Notes: Resident/Fellow Travel Grant Award

Conservative Management Of Elbow Dislocations With An Overhead Motion Protocol

Joseph J. Schreiber, MD Sophia Paul, BA Robert N. Hotchkiss, MD Aaron Daluiski, MD

Introduction: The preferred management of simple elbow dislocations is a non-operative rehabilitation protocol. Initiat-

220 tumors demonstratedHPMA localization tothetumor, and Results: histologic, cellular, andbiochemicalanalysis. hours post-injection,sacrifi were theninfraredimagedinvivo at3hours,24and48 Fluor was administeredviaretro-orbitalinjection. The mice growth was confi with weeklyradiographsforevidence of tumor. Oncetumor into thelefttibialplateau. The micewerethenfollowed plateau ofBalb/cnudemice,followed by controlinjections breast carcinomacellswereinjectedintotherighttibial Materials andMethods: of HPMA. vest TAMs (tumor-associated macrophages) toconfi nanoparticle localizationtothesiteoftumor, andtohar- model forcarcinomametastatictobone,confi cells themselves. The goalsofthisstudyweretodevelop a rophage populationsoftumors,inadditiontothecarcinoma that process. Therefore, onestrategy maybetotarget themac- survival, andmacrophage differentiation maybeessentialin tions arecriticalinthelocalcontroloftumorcellgrowth and infl (Extravasation throughLeaky Vasculature andsubsequent into thelysosomalcompartmentsofmyeloidcellsviaELVIS tion (EPR)effect, whicharetheninternalizedandsequestered nanoparticles throughtheEnhancedPermeabilityandReten- tory tissuesdemonstratepreferentialuptake andretentionof and systemiccomplications.Solidtumorsinfl chemotherapy, whichareassociatedwithsignifi strategies forbonelesionsincluderadiationandsystemic 350,000 patientsintheUnitedStateseachyear. Current Introduction: John H.Healey, MD Steven R.Goldring,MD P. Edward Purdue,PhD Yen HsunChen,BS Chloe Horowitz, BS Alexander B.Christ,MD Retention Copolymer And Delivery Nanoparticle Targeting SkeletalMetastasesUsingHPMA Resident/Fellow Travel GrantAward 1:22pm–1:28pm ammatory cell-mediatedSequestration).Myeloidpopula- Tumors were successfullygrown in13/22mice. All Skeletal metastasisfromcarcinomaaffects rmed, HPMAcoupledtoIRDyeand Alexa- MDA-MB-231 osteotropichuman ced, andtheirtumorsharvested for cant local rm HPMA

amma- rm uptake Notes: TAMs inpromotingorpreventing tumorgrowth. metastatic cancerinbone,andtofurtherexplore theroleof in vivo. This modelcanbeusedfortargeted drugdelivery to onstrated HPMAnanoparticlelocalizationtothesetumors a modeltotestmetastaticcarcinomainmice,andhave dem- Discussion andConclusion: confocal microscopy. HPMA depositionwithinthetumorbedwas conﬁ postoperatively were0.9,1.3and3.1%,respectively. Mean Results: analysis. calculated basedonreceiver operatingcharacteristic (ROC) porated intomultivariate analysis.Optimalthresholdswere son comorbidityindex andspeciﬁ hereditary anemiaswereexcluded. Age, gender, BMI, Charl- one, three,andtwelve months was assessed.Patients with during 2000-2009wereincluded.Postoperative mortalityat patients whounderwentrevision hiporkneearthroplasty Methods: joint arthroplasty. levels couldberelatedtomortalityfollowing revision total injury. The purposeofstudywas toexamine whetherRDW peripheral arterydisease,pulmonarydiseaseandacutekidney tality predictorinpatientswithacuteandchronicheartfailure, complete bloodcellanalysis.Ithasbeenshown tobeamor- measure oferythrocyte heterogeneity, isroutinely reportedin Introduction: Javad Parvizi, MD,FRCS Benjamin Zmistowski, MD Fatih Kucukdurmaz, MD Snir Heller, MD MD Pouya Alijanipour, Following Revision Arthroplasty Unacknowledged PredictorOfMortality Red CellDistribution Width: An 1:30pm–1:36pm The mortalityratesatone,three,andtwelve months Inthissingleinstitutionalretrospective study, 2,261 Redbloodcelldistribution width(RDW), a We have successfullydeveloped c comorbiditieswereincor- General Session17 rmed with 221

Saturday Friday EOA 45th Annual MeetingAmelia Island, Florida2014

preoperative RDW values during admission were signifi cantly (n=145) and low pain (n=153) group were determined by a higher in patients deceased at one (15.4 versus 14.1), three median split of preintervention WOMAC pain scores. Step- (15.6 versus 14.1), and twelve (15.4 versus 14.1) months. wise regression analysis was used to determine whether pre- The fi nal postoperative RDW values were also signifi cantly surgical WOMAC pain scores predicted follow-up WOMAC higher in patients deceased at one (16.1 versus 14.6), three function score when controlling for key demographic and (16.3 versus 14.6), and twelve (16.2 versus 14.5) months. clinical variables. Both preoperative and fi nal postoperative RDW values were independently correlated with mortality at all time points. Results: After surgery, subjects with high presurgical pain ROC provided an optimal threshold for the fi nal RDW prior levels had signifi cantly worse outcomes than those with low to discharge of 14.65 to predict 90-day mortality (sensitivity: pain levels as measured by QWB-7 [0.571+/-0.01 (S.E.) 87%, specifi city: 61%). vs. 0.625+/-0.01], SF-36 Bodily Pain (60.31+/-2.12 vs. 73.85+/-1.92), SF-36 Physical Functioning (42.22+/-2.11 vs. Conclusion: RDW is an inexpensive parameter that is an 52.27+/-1.88), WOMAC Pain (2.35+/-0.34 vs. 0.88+/-0.19), independent predictor of mortality following revision arthro- WOMAC Function (10.36+/-1.13 vs. 5.5+/-0.75), WOMAC plasty. It should be analyzed as part of the routine periopera- Stiffness (0.84+/-0.13 vs. 0.33+/-0.07), and WOMAC Total tive work-up and used to counsel patients on their postopera- scores (13.55+/-1.53 vs. 6.71+/-0.94). Stepwise regression tive risk. Higher RDW values (anisocytosis) might refl ect the analyses found that age at follow-up, Hispanic ethnicity, and sum of multiple physiologic impairments that ultimately lead baseline WOMAC pain scores signifi cantly predicted follow- to a fatal outcome. up WOMAC function scores. The pre-intervention WOMAC pain score was the strongest predictor of outcome. Notes: Discussion and Conclusion: Preintervention pain signifi - cantly infl uences patient-reported outcomes after TKA. Our data suggests that waiting until a patient experiences extreme levels of pain before operating will lead to worse outcomes.

Notes:

1:38pm–1:44pm

Medicare Audits: Are We Hurting Our TKA Patients?

David A. Iacobelli, MD 1:46pm–1:52pm *Jesus M. Villa, MD Carlos J. Lavernia, MD Modern Tapers Are More Flexible: A Lawrence Brooks, PhD Mechanical Analysis Of THA Trunnion Designs Introduction: Pain is an important indication for arthroplasty surgery. Insurance companies and in particular Medicare are David A Porter, MD refusing to pay for a knee arthroplasty until the pain level is Robert M. Urban, PhD stratospheric and in some cases requiring 3 months of conser- Joshua J. Jacobs, MD vative management. Our objective was to assess the effects of Jeremy L. Gilbert, PhD the presurgical pain level on the outcome of TKA. Jose A. Rodriguez, MD H. John Cooper, MD Methods: A consecutive series of 298 TKA patients were interviewed prior to surgery and at minimum 2-years follow- Background: There is renewed concern surrounding the ing surgery. Statistical analyses were conducted to examine potential for corrosion at the modular head-neck junction to the effect of premorbid pain and other patient characteristics cause early failure in modern hip implants. Although taper on outcomes (WOMAC, SF-36, and QWB-7). A high pain corrosion involves a complex interplay of many factors, previ-

222 joint arthroplasty(TJA) patientsareterriblecomplications, Introduction: Javad Parvizi, MD,FRCS Mitchell G.Maltenfort,PhD Camilo Restrepo,MD Joshua Greenbaum,BA Antonia F. Chen,MD,MBA Risk Arthroplasty HasNoEffect OnInfection Surgical CaseOrder In Total Joint Notes: with increasingfrequency inmodernhiparthroplasty. and mayinpartexplain why tapercorrosionisbeingseen increased riskofcorrosionatthemodularhead-necktaper, fl Conclusions /ClinicalRelevance of thestem. tion betweenfl ties ofthebasealloy. There was asignifi part tothetapergeometryandinmaterialproper- Nm2) andmostrigid(623trunnions,whichwas duein nearly anorderofmagnitudebetweenthemostfl was awiderangeofvalues amongthevarious stemsspanning Results: observers. were usedtomeasuretapergeometriesbytwo independent different taperdesignsfrom16manufacturers. Digitalcalipers 1991-2012 andretrieved between2004-2012. There were10 of various femoraltrunnions.Stemswereimplantedbetween femoral stemswas performedtocalculate thefl Methods: historical trendsinhow trunnionshave changedover time. fl retrieval. Purpose: This studywas designedtodocumentthe femoral trunnionwithanincreasedlikelihood ofcorrosionat ous studieshave correlateddecreasingfl exural rigiditymaypredisposeparticularprosthesestoan exural rigidityofvarious trunniondesigns,andtodescribe 1:54pm–2:00pm Meanfl A multi-centerretrieval analysisof85modular exural rigidityofthetrunnionandreleasedate Periprostheticjointinfections (PJIs)intotal exural rigiditywas 262Nm2,however there : This widevariability in exural rigidityofthe cant negative correla- exural rigidity exible (80 165 fi 2027 secondcases,1467third769fourthand TKA was 1.2%.For THAs, therewere2339fi Results: infected caseonthelikelihood ofapatientbeinginfected. used toestimatetheeffect ofcaseorderandpresenceprior determined bytheMSIScriteria.Logisticregression was within thesameoperatingroom.Development ofaPJIwas was determinedbythecasestarttimeondayofsurgery revision TJA forsepticorasepticreasons.Surgical caseorder Patients wereincludedifthey wereundergoing primaryor arthroplasty–TKA) atasingleinstitutionfrom2007-10. TJAs (6686totalhiparthroplasty–THA,6211knee Methods: follow aninfectedcasehave ahigher infectionrisk. independent riskfactor forPJIin TJA, andif TJA patientsthat of ourstudyweretodetermineifsurgical caseorderwas an case orderaffects thedevelopment ofPJIs. Thus, thepurposes but nostudyhasbeenconductedtoevaluate whethersurgical Notes: of developing asubsequentinfectionmaybelesslikely. higher infectionrisk. With improved steriletechnique,therisk and TJA patientsthatfollow aninfectedcasedonothave a surgical caseorderisnotanindependentriskfactor forPJI, Discussion and cance, theresultwould stillnotbeclinicallymeaningful. if thesamplesizewerelarge enoughforstatisticalsignifi 0.9-1.1,p=0.97) perincrementinposition,implyingthateven (0.81%,p=0.82). Caseorderhadanoddsratioof1.0(95%CI infected caseprecedednon-infectedcasesin105/12897 TJAs infected caseweresignifi and 208fi cases, 1756second1577third878fourth fth orhighercases.For TKAs, therewere1792fi The average infectionratein THA was 1.1%and fth orhighercases.Neithercaseordernorprior A retrospective studywas conductedon12897

Conclusion: cant inany oftheseanalyses. An Ourstudydemonstratesthat General Session17 rst cases, rst - 223

Saturday Friday

Eastern Orthopaedic Association Scientific PosterExhibits Scientifi report theirfi Scientifi Poster presenterswillhave anopportunityto Please plantovisittheScientifi on theMeeting-at-a-GlanceSchedule. c Program inRitz-CarltonBallroomFoyer. c Posters willbeondisplayduringthe October 23–25,2014 ndings atdesignatedtimesindicated c Posters. 225

Poster Abstracts EOA 45th Annual MeetingAmelia Island, Florida2014

2014 EOA Poster Presenters

Poster(s) Page(s) Joseph A. Abboud, MD 1 227 Michael P. Bolognesi, MD 15 234 Robert Brochin, BS 6 230 Priscilla K. Cavanaugh, MS 2 227 Carl Deirmengian, MD 3 228 Gregory K. Deirmengian, MD 4 229 Christina J. Gutowski, MD, MPH 7, 8 230, 231 Victor H. Hernandez, MD, MS 18 236 C. Edward Hofﬂ er II, MD, PhD 10 232 Constantinos Ketonis, MD, PhD 5 229 Nayoung Kim, BS 11 232 Kevin Lutsky, MD 12 233 Hemil H. Maniar, MD 13 233 Jorge Manrique, MD 14 234 Eric M. Padegimas, MD 16, 17, 19 235, 237 Chitranjan S. Ranawat, MD 20 237 Mohammad R. Rasouli, MD 21 238 Maryam Rezapoor, MS 22 238 Aldo M. Riesgo, MD 9 231 Eric C. Stiefel, MD 23 239 Anthony T. Tokarski, BS 24 239 Corinne VanBeek, MD 25 240 Scott C. Wagner, MD 26, 27 241 Mark Wang, MD, PhD 28 242 Brent T. Wise, MD 29 243

226 follow-up was 5.1years±2.5(range:0.8–7.4 ± 3.4days. The average timefrom operationtolong-term The average timefrominjurytooperation was 5.2days operation was 73.6±10.0years(range 59.3–88.8years). tures wereidentifi Results: 12). Elbow Score(OES);andtheShort-Form HealthSurvey (SF- Arm, ShoulderandHand(QuickDASH) score;theOxford ing clinicaloutcomemeasures:theQuickDisabilitiesof the with aphysicalexamination, radiographs,andthefollow- anchors inadoublerow fashion. Eachpatientwas evaluated gically repairedusingbiocompositefullythreadedsuture 2013 atasingleinstitutionwas studied. All casesweresur- with thistechniquefromJanuary1,2006toDecember31, Methods: evaluated. anchor fi requiring reoperation. To addresstheseconcerns,asuture plicated byhardware failure andprominence,frequently impairment. Traditional surgical treatmentsareoftencom- patients, causingsignifi Introduction: Corinne VanBeek,MD Jonathan Barlow, MD,MS * Dexter Bateman,BS Elderly In The Displaced OlecranonFractures Suture Anchor FixationOf Joseph A. Abboud, MD Joseph A.Abboud, Poster 1 xation techniquewas developed andclinically NinefemalepatientswithMayoIIAorIIBfrac- A consecutive seriesofelderlypatientstreated Olecranonfracturesarecommoninelderly ed. Themeanpatientageattimeof cant morbidityandfunctional (An asterisk(*)byanauthor’s nameindicatesthepresenter.) 2014 Poster Abstracts Thursday-Saturday chronic kidney disease(CKD)and endstagerenaldisease Introduction: Alvin C.Ong,MD Fabio R.Orozco,MD Zachary D.Post,MD Mohammad R.Rasouli,MD Mitchell G.Maltenfort,PhD Antonia F. Chen,MD,MBA Priscilla K.Cavanaugh, MS Arthroplasty Joint Undergoing Total Chronic RenalFailure Patients In Complications AndMortality treatments. symptomatic hardware, ascomparedwithtraditionalsurgical this techniquereducescomplicationsandreoperationsfor long-term radiographicandclinicaloutcomes.Importantly, ranon fracturesintheelderlypopulationprovides excellent Discussion andConclusion: tively. 4.05 forthephysicalandmentalcomponentscales,respec- Survey (SF-12)scoreswere49.02±16.59and55.38 score was 6.43±9.47;andtheaverage Short-Form Health Score (OES)was 47.17±2.04;theaverage QuickDASH displacement. Postoperatively, theaverage OxfordElbow patients healeduneventfully inacceptablepositionwithout intraoperative complicationsorreoperations.Eightofnine to becontacteddespitemultipleattempts. There wereno One patienthaddeceased,andtwo patientswereunable years). Sixpatientswereavailable forlong-termfollow-up. Poster 2

There isapaucityoflarge studiescomparing Sutureanchorﬁ Poster Abstracts xation ofolec- 227

Poster Abstracts EOA 45th Annual MeetingAmelia Island, Florida2014

(ESRD) versus non-CKD/ESRD patients undergoing TJA. thetic joint infection (PJI), and has been previously dem- This study aims (1) to identify in-hospital complications onstrated to match the MSIS definition for PJI. The pur- and mortality in CKD/ESRD and non-CKD/ESRD patients, pose of this study is to describe the breadth of organisms and (2) to compare in-hospital complications and mortality that stimulate alpha-defensin during PJI, and secondarily, between dialysis and renal transplantation patients undergoing to identify any organism-specific influence on alpha- TJA. defensin levels.

Methods: Using the ICD-9 diagnosis and procedure codes, Methods: A retrospective review of 1937 de-identifi ed we queried the Nationwide Inpatient Sample database for synovial fl uid samples having both the Synovasure PJI test patients with and without the diagnosis of CKD/ESRD under- and culture identifi ed 498 alpha-defensin-positive samples, going primary or revision total knee or hip arthroplasty from and 1439 alpha-defensin-negative samples. Samples were 2007 to 2011. The same coding system was used to determine received from 418 surgeons in 42 states. 239 of the alpha- in-hospital complications. There were 38,308 renal failure defensin-positive synovial fl uid samples (48%) had organ- and 978,378 non-CKD/ESRD arthroplasty cases. Further, the ism growth from the synovial fl uid, whereas only 19 of renal failure group was divided into a renal transplant group the alpha-defensin-negative samples (1.3%) had organism (n=1,055) and dialysis group (n=1,747). growth. A total of 41 different species of bacteria and yeast were isolated and classifi ed by cell type, species, Gram-type, Results: In multivariate analysis, CKD/ESRD was associ- and virulence. Mean alpha-defensin signal to cutoff (S/CO) ated with greater risk of surgical site infection (SSI) (OR= levels were calculated for these various classifi cations of 1.4, 95% CI: 1.3-1.5), wound complications (OR=1.1, 95% organisms, and the ANOVA test was utilized to identify any CI: 1.0-1.2), transfusions (OR= 1.6, 95% CI: 1.5-1.6), deep potential organism-specifi c infl uences on the synovial fl uid vein thrombosis (OR=1.2, 95% CI: 1.0-1.4) and mortality alpha-defensin level. (OR= 2.1; 95% CI: 1.8-2.5) than non-CKD/ESRD patients. Dialysis patients had signifi cantly higher rates of SSI, wound Results: All organisms typically isolated in relationship to complications, transfusions and mortality compared to renal arthroplasty were found to result in a positive synovial fl uid transplant patients. alpha-defensin level. The mean semi-quantitative alpha- defensin S/CO among 239 alpha-defensin positive, culture- Discussion and Conclusion: Our fi ndings emphasize the positive samples was 4.68, compared to 0.30 among 1439 importance of CKD as a predictor of clinical outcome in TJA. alpha-defensin-negative samples. Gram-positive bacteria Appropriate CKD patients who are renal transplant candidates (87%), gram-negative bacteria (10 %), and yeast (3%) dem- may benefi t from transplantation prior to TJA if they are on onstrated no statistically signifi cant differences in the mean dialysis. associated synovial fl uid alpha-defensin S/CO (4.7, 5.3, 3.8 respectively). Similarly, the virulence of the organism had no statistically signifi cant infl uence on the mean alpha-defensin S/CO. Poster 3 Conclusions: This study demonstrates that a wide variety The Alpha-Defensin Biomarker For of gram-positive bacteria, gram-negative bacteria, and yeast PJI Responds To A Wide Spectrum Of result in a positive synovial fl uid alpha-defensin level, without Organisms any evidence of an organism-specifi c infl uence. The alpha- defensin test appears to provide diagnostic value for PJI, Carl Deirmengian, MD regardless of the infecting organism. Alexander Cameron, BS Kevin Schiller, BS Michael Citrano, BS Simmi Gulati, RM (ASM) Patrick Kilmartin, BS, MS Keith Kardos, PhD

Introduction: Alpha-Defensin has been identified as a highly accurate synovial fluid biomarker for peripros-

228 presence ofPJI. undertaken inpatientspresenting withsystemicillnessinthe Given thesefi incidence ofpreoperative SIRSinpatientswith acutePJI. in-hospital mortality. We have alsoshown thatthereisahigh concomitant positive blood culturesareatanincreasedriskof patients whodevelop SIRS preoperatively and present with Discussion andConclusions: PJI independent riskfactor forICUadmission orrecurrenceof ity (10%vs0.9%;p=0.002).Systemicillnesswas notan were atasignifi Patients withSIRSand at leastonepositive bloodculture In total,therewere7in-hospitaldeathsforourcohort. culture was presentin30(6%)ofthepatientswithSIRS. oped SIRSpreoperatively. At leastoneconcomitantblood for deepPJIonanurgent basis.Ofthose,128(26%)devel- Results: Chest Physicians. ing SIRSbasedonthecriteriasetby American College of reoperation fordeepinfection.Patients wereclassifi results, in-hospitalmortality, ICUadmissions,andsubsequent patient demographics,preoperative vitalsigns,bloodculture 2002-2012. Electronicmedicalrecordswereusedtocollect patients surgically treatedfordeepPJIonanurgent basisfrom Methods: patients. treated onanurgent basisandtoreportoutcomesinthese determine theincidenceofSIRSinpatientswithacutePJI thetic jointinfection(PJI). The purposeofthisstudywas to investigated systemicillnessinthepresenceofperipros- mia canhave increasedin-hospitalcomplications,few have temic infl Introduction: Alex Uhr, BS Javad Parvizi, MD,FRCS Anthony Tokarski,BS Gregory K.Deirmengian,MD In-Hospital Mortality Infection IsAssociated With Increased Systemic Manifestation OfPeriprosthetic . Poster 4 Duringthestudyperiod,491patientsweretreated ammatory responsesyndrome(SIRS)andseptice- Usingourinstitutionaldatabase,weidentifi ndings, carefulmedical management shouldbe Although itisknown thatpatientswithsys- cantly higherriskofin-hospital mortal- Ourstudydemonstratesthat ed ashav- ed all Methods: this commonclinicalproblem. the literatureregarding outcomesofoperative intervention for stiffness canbechallenging,andthereisapaucityofdatain Introduction: Pedro K.Beredjiklian,MD Nayoung Kim,BS Kevin Lutsky, MD Jonas L.Matzon,MD * Joseph Dwyer, MD Post-Traumatic Stiffness Finger For Results OfOperativeIntervention TAM postoperatively. Patients involved inworker’s compen- physical therapy isessentialtomaximizeimprovements in results oftheseoperationsare generallylimited.Immediate offer modestimprovements inselectpatients,but theoverall Discussion/Conclusion: age orpreoperative TAM. TAM improvement hadavery weakcorrelation withpatient degrees fornon-worker’s compensationpatients.Degree of claim improved anaverage of9.3degrees, comparedto55.9 age of19.3degrees. Patients withworker’s compensation cal therapy afterseven days(avg. 11.5days)lostanaver- average of57.3degrees, whereasthosewhostartedphysi- seven days(avg. 2.7days)oftherelease improved byan after release.Patients whostartedphysicaltherapy within = -30to115).Four patients hadanetdecreasein TAM in TAM aftersurgical releaseaveraged 42degrees (range Results: plateaued inphysicaltherapy. follow up.Patients were followed untilrangeofmotion recorded priortosurgical releaseandatthepatient’s last and initiationoftherapy. Total Active Motion(TAM) was We recordedthenumberofdaysbetweensurgical release treatment, healthhistory, andworkers compensationstatus. demographic dataincludingage,initialdiagnosisand lectomy, tenolysis,and hardware removal. We collected tion. Nineteenpatientshadproceduresincludingcapsu- (tenolysis, capsularreleases)withoutbony reconstruc- only patientswhowereundergoing softtissueprocedures to improve post-traumaticfi three yearperiodwhounderwentanoperative procedure Constantinos Ketonis, MD Poster 5 Average follow upwas 151days.Improvements We retrospectively identifi Surgical treatmentofpost-traumatic fi Surgical releaseforstiff fi , PhD nger stiffness. We included ed allpatientsover a Poster Abstracts ngers can nger 229

Poster Abstracts EOA 45th Annual MeetingAmelia Island, Florida2014

sation claims demonstrated signiﬁ cantly lower TAM improve- 17,000 patients per year. Cost of revision, additional surgery, ment after surgical intervention. and limb length discrepancies may carry signiﬁ cant burden. Clinicians should be cognizant of this potential complication.

Poster 6 Poster 7 Intraoperative Femur Fracture During Plate Versus Screw Fixation of Radial Neck Primary Total Hip Arthroplasty and Fractures: A Biomechanical Study Hemiarthroplasty Christina J. Gutowski, MD, MPH David S. Geller, MD Asif Ilyas, MD *Robert Brochin, BS Kurosh Darvish, PhD Simon Greenbaum, BA Christopher Jones, MD

Introduction: Total hip arthroplasty and hemiarthroplasty are Hypothesis: Fixation of non-comminuted radial neck frac- commonly performed orthopedic procedures with over 300,000 tures can be achieved with a plate and screw construct or with performed annually in the US. These numbers can be expected to two obliquely-oriented screws. The hypothesis of this study increase with the aging population. Intraoperative femur fracture was that the mechanical properties, specifi cally stiffness and during femoral stem implant is a recognized event that may result load to failure, of these two fi xation strategies are similar in a in additional cost and complications for the patient. The purpose cadaver model. of this study is to evaluate the incidence of this event. Methods: Ten matched-pair cadaver arms were skeleton- Methods: A retrospective observational review of x-ray ized and the radii were removed. X-ray and visual inspection images following all primary press fi t total hip arthoplas- were performed to ensure absence of preexisting trauma. ties and hemiarthroplasties over a 3-year period (January DEXA scans were obtained to measure bone density. A 2010-December 2012) was performed at an academic medical transverse osteotomy was created at the neck of each radius, center. Intraoperative fracture was considered when cerclage which was subsequently fi xed: all right-sided radii were wire was noted. Statistical difference between genders and fi xed with two oblique headless compression screws, and all age cohorts (less than 65 vs. greater than or equal to 65 years) left-sided radii were fi xed with a plate and screws. The distal was performed using chi-square analysis. aspect of each radius was potted in polymethylmethacrylate bone cement. The radial head was loaded in cantilever bend- Results: A total of 859 primary non-cemented total hip ing in 4 different planes, 90 degrees apart and orthogonal to arthroplasties and hemiarthroplasties were performed in 859 the radial shaft using an MTS machine. Stiffness and load to unique patients over the study period. The study population failure were recorded for each specimen. consisted of 509 females and 350 males with an average age of 65.8 years and an age range of 15-102 years. Intraopera- Results: All ten radii were free of preexisting injury. The tive fracture occurred in 49 cases (5.7%). The average age stiffness of both constructs was similar in all planes except for of patients with intraoperative fracture was 68.1 years with loading from medial to lateral (opposite of the plate) where a range of 21-102 years. Intraoperative fracture occurred in the screw construct was 1.8 times stiffer. Ultimate failure 11.1% of patients greater than 91 years, but there was not occurred at 229N for the plate and 206N for the screws. Fail- a signifi cant difference in fracture incidence between age ure mode for the plate was plate bending while the screws cohorts. Fracture occurrence rates in females (33, 6.5%) and failed by pullout and fracture. males (16, 4.6%) did not signifi cantly differ. Discussion and Conclusion: The two strategies provide Discussion and Conclusion: An intraoperative fracture rate similar strength and stiffness to transverse, non-comminuted of 5.7% falls within previously reported ranges of fracture fractures. While plate-and-screw constructs are more appro- incidence in press fi t hip arthroplasty. These fi ndings suggest priate when there is bone loss or comminution, this study realized intraoperative fracture may occur in approximately supports the utilization of two oblique screws in simple

230 which createsjointreactionforces attheproximalanddis- that theinterosseousligament tensions thebow oftheradius mum interosseousdistanceincreases nearly8%. This suggests in theabsenceofdynamicforearm muscleforces,themaxi- Discussion/Conclusion: plete IOLdisruption(7.7%increase). central bandrelease(1.8%increase),and21.3mmaftercom- distance averaged 19.8mmintheuninjuredarm,20.1mmafter 84O aftercompleteIOLdisruption.Maximuminterosseous was asimilarincreaseinpronation: 69Obeforeinjuryand disruption and100OaftertheentireIOLwas sectioned. There forearms was 87O. This increasedto95Oaftercentralband Results: were performed. son offorearmmotionandmaximuminterosseousspace and annularligamentwereleftintact.Statisticalcompari- entire IOLand TFCC radioulnarligaments. The radialhead seous ligament(IOL)centralband,and2)releaseofthe distance werere-measuredafter:1)releaseoftheinteros- tral forearmalignment.Forearm rotationandinterosseous length oftheforearmwas measuredinlateralelbow, neu- and curve-fi measured withagoniometer. Usingdigitalradiograph Methods: and inasimulatedEssex-Lopresti injury. investigated thechangeinradioulnarinterosseousdistance on forearmrotationalmechanicsisnotwell-understood. We radioulnar instabilityinthetransverse plane,anditseffect ity inthelongitudinalaxishasbeenwellstudied.However, Introduction: Christopher Jones,MD Kurosh Darvish,PhD Christina J.Gutowski, MD,MPH Essex-Lopresti Injuries Transverse RadioulnarInstabilityIn trusive. requires lessexposure andthehardware isburied andunob- transverse neckfractures,especiallysincescrew fi Poster 8 Average maximumsupinationoftheuninjured Pronosupinationrangeoftencadaver armswas t software, theinterosseousdistancealong InEssex-Lopresti injuries,radioulnarinstabil- InasimulatedEssex-Lopresti injury, xation mid-modular femoralcomponents. The average follow-up who hadatotalof161revision THA withdiaphysealfi Results: for signsofboney ingrowth andsignsofloosening. need forrevision forany reason.Radiographswerereviewed mechanical failure, septicrevision, periprostheticfracture,or were recorded.Failure was defi centers. The numberoffailures andthereasonforfailure different surgeons attwo highvolume academicmedical fi Methods: in revision THA. diaphyseal fi study istoevaluate thesurvivorship andcomplicationsof ing tosubsidence,have beenreported. The purposeofthis loosening andimplantfailure, aswelllooseninglead- rosion atthemid-modularinterface leadingtoaseptic femoral stemsforrevision THA intheUnitedStates.Cor- variable metaphysealsizingoptionsarethemostutilized Diaphyseal fi there isnoconsensusontheoptimalfemoralimplant. ties (THA)performedeachyearcontinuestorise;however, Introduction: Lawrence M.Specht,MD Nick Brownstone, BA Christopher Nathasingh,BA Richard Iorio,MD MD Edward Adler, *Aldo M.Riesgo,MD Jason Hochfelder, MD Mid-Modular FemoralStem Revision Total HipArthroplasty With A Survivorship AndComplicationsof Lopresti injury. of comparative forearmradiographsindiagnosing anEssex- IOL healingpotential.Futurework willfocusontheutility implications inthetreatmentofEssex-Lopresti injuriesand and constrainingforearmmotion. These fi in thisstudyisconsistentwiththeIOL’s roleinstabilizing rotation. The notableincreaseinforearmrotationobserved tal radioulnarjoints,facilitating smoothandstableforearm tting mid-modularfemoralcomponentperformedby10 Poster 9 Onehundredfi We reviewed allrevision THA withadiaphyseal tting mid-modularfemoralcomponentsused tting mid-modularfemoralcomponentswith The numberofrevision totalhiparthroplas- fty-eight patients wereidentifi ned asasepticloosening, ndings mighthave Poster Abstracts ed tting 231

Poster Abstracts EOA 45th Annual MeetingAmelia Island, Florida2014 was 3 years. At fi nal follow-up, 5 (3%) patients required re- Results: Average monthly eye dosimetry values included revision for failure of the femoral component; 4 for loosen- the following: dose rate was 0.50±0.03 mGy/sec, total accu- ing of femoral component and 1 for fracture of the femoral mulated dosage was 32.16±7.88 mGy, and total exposure component. There were a total of 24 (14.9%) revisions for time was 75.72±16.36 sec. Average monthly eye radia- any reason, with the most common reason being septic fail- tion exposure values were less than 30 mrem (previously ure (10 of 24). reported maximum eye dosage is 1,250 mrem per month). 46 procedures were performed over the collection period. Discussion and Conclusion: To our knowledge this is the The most commonly performed procedures included ORIF largest reported series of revision THA with diaphyseal fi tting distal radius fractures (14), metacarpal and phalangeal sur- mid-modular femoral components. Our results show that these gery (9), and basilar thumb arthritis surgery (7). ORIF of stems have a low rate of aseptic loosening, subsidence, and the distal radius fracture was associated with higher average mechanical failure. While revision THA may be a challenging exposure time (93.57 sec) and average accumulated dosage procedure, these stems provide a safe and effective solution (51.73 mGy). for many femoral problems. Discussion/Conclusion: Our study suggests that eye radiation exposure, from routine mini C-arm fl uoroscopy use, on an average monthly basis, does not approach previously reported Poster 10 critical eye radiation loads associated with cataracts.

Radiation Exposure To The Eye With Mini C-Arm Use During Hand Surgery Poster 11 C. Edward Hoffl er II, MD, PhD Mark Wang, MD, PhD Handedness-Based Patient Perceptions Of Frederick Liss, MD Asif Ilyas, MD Disability From Common Hand Disorders Charles S. Leinberry, MD Nayoung Kim, BS Pedro K. Beredjiklian, MD Michael T. Milone, BA Mitchell G. Maltenfort, PhD Introduction: Fluoroscopic radiation exposure is a poten- Pedro K. Beredjiklian, MD tial occupational health risk to the Hand Surgeon, given operator proximity and the relative lack of eye shielding. Introduction: The QUICK Disabilities of the Arm, Shoul- At present, the amount of radiation exposure to the eye, der and Hand (QDASH) Outcome Measure is a commonly associated with the routine use of mini C-arm fl uoroscopy utilized questionnaire for people with upper limb disor- is unknown. The association of eye radiation exposure and ders. Although intuition suggests that disease of the more the early development of cataracts have been previously utilized “dominant” hand would be associated with higher reported. The purpose of this study is to test that eye radia- patient perceptions of disability, our clinical experience tion exposure, sustained during routine mini C-arm use, suggests otherwise. We hypothesize that whether the dis- does not exceed that of previously reported critical radia- eased hand is the dominant hand does not affect disability tion dosages to the eye. scores. Methods: Over a four month period, eye radiation exposure was measured in four Board-Certifi ed Hand Surgeons utiliz- Methods: Patient charts from our institution were retrospec- ing mini C-arm fl uoroscopy during routine surgical proce- tively reviewed over a two year period who initially presented dures. Eye dosimeters were secured to surgical loupes at the with unilateral carpal tunnel syndrome (CT), DeQuervain’s level of the orbit. Accumulated radiation dosage was ana- tenosynovitis (DQ), lateral epicondylitis (LE), thumb basal lyzed and compared to control badges on a monthly basis, joint arthritis (TBJ), or trigger fi nger (TF). Charts were and background exposure was eliminated. For each proce- reviewed for hand dominance, side of injury, QDASH, and dure, mini C-arm radiation output was logged, including the SF-12 health survey scores. Linear regression was performed dose rate, total accumulated dosage, and total exposure time. to estimate the effect of diagnosis and hand dominance on

232 ligaments oftheotherfi ligament instabilizingpinch. However, injuriestothecollateral (RCL) isthoughttobethemost disablingduetotheroleofthis the thumb. Injurytotheindex fi phalangeal joints(MPJ)ofthefi Introduction: Pedro K.Beredjiklian,MD Nayoung Kim,BS Kevin Lutsky, MD Ligament Injury Joint Collateral Metacarpophalangeal Disability Due To Finger in females. lower QDASH scoresfor malesandfornon-dominanthands males. Itisnotclearwhetheracommoncauseexplains the hand dominance,itappearstobepresentinfemalesover Discussion/Conclusion: or DEQ. statistical associationwithgenderandhandednessforLE but therewas noassociationwithdominance. There was no QDASH scoreswere8.08 +/-3.10pointshigherthanmales males. Subgroupanalysisconfi differential betweendominantandnon-dominantwithin nant handscoresinboththesediagnosesandtherewas no QDASH scoreswere12-14 pointslower thanfemaledomi- / -SE)andfor TF (39.03+/-2.73vs29.17+/-2.72).Male hand forCMC(40.76+/-2.22vs31.291.87,mean+ scores wereabouttenpointslower inthenon-dominant found toaffect thesedifferentials. For females,QDASH hands. When genderwas includedintheanalysis,itwas have differential effects ondominantandnon-dominant diagnosis andhanddominance,thatdiagnosescould showed thatQDASH scoreswereassociatedwithboth within eachdiagnosis-specifi fer accordingtohand-dominanceaswellforthose for eachofthefi (637 female,379male;meanage60years):191to244 Results: dominant hands. diagnoses tohave differential impacts ondominantandnon- QDASH scores;aninteractiontermwas includedtoallow Poster 12 QDASH scoreswereavailable for1016patients Collateralligamentinjuriestothemetacarpo- ve diagnoses.SF-12scoresdidnotdif- ngers cancausepain,diffi Where thereisadifference between c subgroup.Linearregression nger radial collateral ligament nger radialcollateralligament ngers are less common than in ngers are lesscommonthanin rmed thatforCTS,female culty with nizing thepotentialfunctionalimpactoftheseinjuries. its. Surgeons shouldremainvigilantindiagnosing andrecog- with injurytothisligament issimilartothatoftheotherdig- tance inpinch,however thedegree ofdisabilityassociated to bethemostclinicallyimportantfi and disability. The index fi ments oftheMPJsfi Discussion andConclusion: available was 28.7. The average DASH score inthe28patientswhomthiswas small fi For theringfi there were15RCLand8ulnarcollateralligament (UCL). patients reportedmoderateorsevere pain.For thelongfi ing digits. The average agewas 44years(range:13-82yo).26 patients withinjuriestothecollateralligaments oftheremain- patients inwhomthiswas available was 28.0. There were56 moderate tosevere pain. The average DASH scoreinthe10 Of thesepatients,65%(n=15)complainedofmoderateor fi Results: other digits. were comparedtoinjuriesofthecollateralligaments ofthe years was performed.InjuriestotheRCLofindex fi with fi Methods: from index RCLinjurytothatoftheotherfi ligament injuryofthefi was toassessthedegree ofdisabilityassociatedwithcollateral grip, orlimitationsinfunction. The purposeofthecurrentstudy that hasdemonstratedimproved ratesofdetectionforhip Introduction: Daniel S.Horwitz,MD Thomas Bowen, MD Michael A. Foltzer, MD Kristin McPhillips,MD,MPH Nathaniel C.H. Wingert, MD Hemil H.Maniar, MD Hardware Sonication OfClinically Infected Trauma nger RCL. The average agewas 44years(range:16-67yo). Poster 13 nger MPJcollateralligamentinjuriesover thepast3 nger therewere25RCLinjuriesand0UCLinjuries. There were23patientswith injuriestotheindex A retrospective review ofallpatientspresenting nger therewere5RCLand1UCLinjury. Inthe Sonicationisarelatively new technology ngers, and to compare the disability ngers, andtocomparethedisability nger MPJRCListypicallythought ngers canbeassociatedwithpain Injuriestothecollateralliga- nger CLduetoitsimpor- ngers. ngers. Poster Abstracts nger nger 233

Poster Abstracts EOA 45th Annual MeetingAmelia Island, Florida2014

and knee arthroplasty infections. The utility of sonication in of repeat infection in that joint. However, after effective infected trauma hardware has not previously been investi- management of PJI, patients often present with end-stage gated. arthritis deserving total joint arthroplasty (TJA) in a distant joint. Unknown to the community is the risk of subsequent Methods: 32 consecutive patients were treated for infected PJI in the distant joint. Therefore, this study attempts to hardware at a single institution from September 2010 to May identify this risk. 2013. Sonication and routine cultures were obtained for all patients. Sonication and routine culture results were retro- Methods: The institutional PJI database was utilized to spectively reviewed in a consecutive series of patients treated identify patients that were treated for PJI from April 2000 with hardware removal for implant associated infection. Clini- to July 2012. This was then cross-referenced with the insti- cal, radiographic, laboratory, and intraoperative ﬁ ndings were tutional arthroplasty database to identify those patients collected for each patient. Sonication results were considered that underwent primary TJA after management of PJI. The positive for growth of greater than or equal to 20 CFU (colony incidence of subsequent PJI in the new joint was then deter- forming units). mined and the relationship between the infecting organisms was analyzed. Results: Among 32 patients with clinically infected hardware, 30 showed positive routine cultures (93.8%) Results: Thirty-one patients underwent primary TJA at a and 19 showed positive sonication cultures (59.4%). All mean of 1,110 days (range: 113-4,770) after management 19 patients with positive sonication results produced the of PJI in a distant joint. Four of these patients (12.9%; 4/31) same bacterial species as grown by routine cultures. There went on to develop PJI in the new joint at a mean of 400 days was one patient for whom sonication identiﬁ ed additional (range: 24-1,093) after TJA. Two of these patients (6.4%; organisms not detected by routine cultures. There were no 2/31) were infected with the same pathogen in both joints (24 patients with a negative routine culture and positive sonica- and 68 days post-arthroplasty). tion culture. Conclusion: A history of PJI in a distant joint increases the Discussion and Conclusion: Sonication of clinically infected risk of infection in a new prosthetic joint. While patient fac- trauma hardware is a viable practice and provides clinically tors likely play a role in this increased risk, the persistence meaningful results. The routine use of sonication cultures in of a sub-clinical infection does appear to complicate a new this patient population offers little additional value over rou- arthroplasty. Patients in this scenario must be counseled of tine cultures and may not be indicated. their increased risk.

Poster 14 Poster 15

Previous Periprosthetic Joint Infection Risk Factors For Periprosthetic Infection In Predicts Infection After New Primary Young Patients After THA Arthroplasty Taylor R. McClellan, BS Jorge Manrique, MD *Michael P. Bolognesi, MD Benjamin Zmistowski, MD R. Andrew Henderson, MD, MSc Anthony T. Tokarski, BS Jonathon A. Godin, MD, MBA Camilo Restrepo, MD Hany S. Bedair, MD Introduction: The patient-related risk factors for peripros- Nitin Goyal, MD thetic joint infection (PJI) after total hip arthroplasty (THA) Gregory K. Deirmengian, MD have recently been evaluated in several large Medicare database studies. However, much remains to be discovered Introduction: Periprosthetic joint infection (PJI) is a regarding the epidemiology, demographics, and risk fac- dreaded complication with high morbidity and mortality. It tors for PJI after THA in younger and/or privately insured is well-known that patients treated for PJI have a high-risk patients.

234 tions, allwithreportedgood overall outcomes. Treatment of more involved interventions includingfl ment optionsrangefromsimplistic, suchaswound care,to injuries inbothwork andnon-work related accidents. Treat- Introduction: Christopher Jones,MD William Kirkpatrick,MD MD Jack Abboudi, Michael Rivlin, MD *Eric M.Padegimas, MD Andrew Miller, MD Study Amputation Fingertip Treatment: ASurvey younger population observed inotherstudiesseemtobelargely conserved inthis stitute riskfactors forPJIinelderlyand/orMedicarepatients torial innature.Further, themedicalcomorbiditieswhichcon- seems tobehigherinyoungerpatients. This islikely multifac- Discussion andConclusion: and complicateddiabetes. nary disease,alcoholanddrugabuse, liver disease,anemia, for PJI(oddsratio>1.0)includingdementia,chronicpulmo- comorbidities evaluated, 20demonstratedanincreasedrisk PJI prevalence bysex orregion ofthecountry. Ofthe35 years old(1.74%). There werenosignifi (2.85%) trendingdownward withincreasingageuntil65-69 the highestrateoccurringin30-34yearoldpopulation signifi from 0.81%at30daysto1.66%5years. There was a Results: ing PJIwerethencalculatedforallcomorbidconditions. of theUnitedStates.Relative riskandoddsratiosfordevelop- The incidenceofPJIwas stratifi ities utilizingCPTandICD-9codesamongthispopulation. searched fordocumentationof35commonmedicalcomorbid- diagnosis ofperiprostheticjointinfection. The databasewas of age.750(1.7%)thesepatientswentontoacquirea 2011. The vast majorityofthesepatientswereunder65years insured patientsthatunderwentprimary THA between2007- to gatherpatientdemographicdataon45,202privately- Methods: Poster 16 cant difference intheprevalence ofPJIbyage,with Cumulative incidenceofPJIinthiscohortranged The PearlDiver patientrecordsdatabasewas used Distalfi ngertip amputations arecommon Interestingly, theriskofPJI ed byage,gender, andregion cant differences in aps andreplanta- distal fi domized trialtodeterminethemosteffective treatmentsfor research. The survey highlightstheneedforaprospective ran- anecdotal inpartgiven thelimitedamountofcomparative ing background.However, clinicaldecisionmakingislikely principles vary according topracticedemographicsandtrain- preferences amonghandsurgeons. Differences intreatment gertip amputationqueried,thereisawiderangeoftreatment Discussion/Conclusion: of experience compared tootherdemographics. more likely tobeperformedbyhandwithfewer thanfi demic practicesurgeons .Skeletal shorteningwithclosurewas tion was morecommonlyperformedinternationallyandbyaca- years ofexperience orplastic surgery backgrounds. Replanta- care was lesslikely performedbysurgeons withgreaterthan30 there was awidevariation oftreatmentpreferences. Wound scenario (Allenlevel 2,3,4,andvolar obliqueamputation) 38% international,respondedtothesurvey. For eachclinical Results: odds ratiosfortreatmentchoicescontrollingallpredictors. questions. Logisticregressions wereusedtoestimateadjusted level longfi of 6demographicquestions,5clinicalscenarioswithvarious selected internationalhandsocieties. The survey was comprised the American Association forSurgery oftheHand,aswell Methods: ence, institutiontypeandtrainingbackground. graphic factors suchascountryoforigin,yearsexperi- long fi cause ofmorbidityfollowing shoulderarthroplasty. There is Background Javad Parvizi, MD,FRCS Gerald R. Williams, MD Matthew L.Ramsey, MD Mitchell G.Maltenfort,PhD *Eric M.Padegimas, MD Surena Namdari,MD,MSc Burden United States: IncidenceAndEconomic Periprosthetic Shoulder Infection In The Poster 17 ngertip amputationsvary accordingtosurgeon demo- ngertip amputations. A totalof199handsurgeons, 62%fromtheUSand A 16questionsurvey was senttothemembersof ngertip amputations, and 5 treatment preference ngertip amputations,and5treatmentpreference : Periprostheticjointinfection (PJI)isamajor For alllevels andorientationoffi Poster Abstracts ve years n- 235

Poster Abstracts EOA 45th Annual MeetingAmelia Island, Florida2014

little known about infections following shoulder arthroplasty. The purpose of this study was to analyze the incidence, pre- Poster 18 disposing factors, and economic burden of PJI after shoulder arthroplasty in the United States. Fever After Total Joint Arthroplasty: Use Of A Simple Workup To Avoid Delayed Methods: Patients who underwent shoulder arthroplasty were Discharge identiﬁ ed using the ICD 9-CM codes 81.80, 81.81 and 81.88 in the National Inpatient Sampling (NIS) database from 2002 Alvin C. Ong, MD through 2011. Shoulder PJI was identiﬁ ed using arthrotomy *Victor H. Hernandez, MD, MS for device removal (80.01) and prosthetic infection (996.66) Zachary D. Post, MD codes. Multivariate logistic regression analysis was utilized to Fabio R. Orozco, MD identify predisposing factors for shoulder PJI. Ian W. Kane, BS

Results: The overall infection rate over the course of the Introduction: Postoperative fevers are a common occurrence ten years studied was 0.98% and did not vary signifi cantly following total joint arthroplasty (TJA). With more emphasis over this period of time. The factors most strongly associ- on accelerated recovery and shorter length of stay (LOS), ated with PJI were weight loss (OR 2.62; p =0.00047), drug postoperative fever has implication for discharge planning and abuse (OR 2.38; p = 0.0011) and anemia from either blood cost. The aims of our study were to determine which patients loss (OR 2.43; p=0.00031) or defi ciency (OR 2.05; p < were at risk of developing postop fever and to investigate the 0.0001) and older age (OR 0.98/year; p < 0.0001). Patients usefuleness of a simple, relatively inexpensive, fever workup. in urban private hospitals had greater risk of infection than patients in urban academic hospitals (OR 1.93; p < 0.0001). Methods: Under IRB approval we retrospectively reviewed all Adjusted to 2011 dollars, the median total charges for a TJA patients between June 2010 and June 2011. 745 patients shoulder PJI patient increased from $26,757 in 2002 to were identifi ed. Of these, 137 patients were 55 or younger $48,421 in 2011. (Group A), 353 were 56-69 (Group B), and 258 were 70 or older (Group C). There were 455 females and 290 males. The Conclusions: The incidence of PJI following shoulder surgical technique, anesthesia, and postoperative management arthroplasty did not change substantially over the decade of of all patients was identical. Fever workup was performed in study period. This study identifi ed some modifi able risk fac- all patients with Temp>100.4. Workup included surgical site tors and the economic burden that is associated with shoul- examination, chest x-ray, urinalysis, blood culture, and venous der PJI. The rising number of shoulder arthroplasties per- duplex. Patients were allowed discharge if the workup was neg- formed will result in a greater absolute number of shoulder ative. Incidence, fi ndings on workup and LOS were analyzed. PJI cases in the future with an increasing economic burden on the health care. Results: 251 patients developed a postoperative fever for an incidence of 34%. Group B had a signifi cantly higher incidence of postop fever. Accounting for all patients, males were more likely to develop fever. There was no association between postop fever and complications. There was no correlation between fever and fi ndings on the medical workup. LOS was not increased by the occurrence of fever in any group.

Conclusion: We found an increased incidence of postoperative fever in the middle age range for joint patients and in males. Postoperative fever was not associated with infection or any other postoperative complication. The use of our simple postoperative fever workup after TJA likely led to decreased length of stay and consequently decreased cost.

236 to 0.47)respectively. Charlotte, Boston,Philadelphia,Phoenix,Dallas(range0.38 CRR variability wereMS, AL, VA, PA, SC(0.43to0.54)and 2.4) respectively. The statesandreferralareaswiththe highest CO, NV, SD(4.65to5.44)andMD,RI,DE,ND, MA(1.05to 1.63. Stateswiththehighestandlowest CRRwereCA,FL, $54.5 ±25.4,Reimbursement $14.7±3.2and(CRR) 3.77± ton (0.39to0.47)respectively. For CervicalFusion:Charge and Philadelphia,San Antonio, Memphis,Fort Worth, Hous- est CRRvariability wereNJ,PA, VA, AL, GA(0.42to0.54) 1.94) respectively. The statesandreferralareaswiththehigh- FL, NV, NJ(4.39to4.86)andMD, VT, RI,DE,ME(1.06to 1.52. Stateswiththehighestandlowest CRRwereCA,CO, Reimbursement $27.8±16.7(inthousands),andCRR3.47 Results: CRR. fi was analyzedbystateandreferralareatocalculatecoef- evaluated withaPearson’s correlation.Geographicvariability reimbursement ratio(CRR)wereanalyzed. Associations were The average hospitalcharge, reimbursement, andcharge to 460 (Thoracic/lumbarfusion),473(Cervicalspinefusion). Methods: regional variability inthe costofspinecare. with thehighestcosttoreimbursement ratioandhighest Diagnosis RelatedGroups. This studyaimstoidentifyregions released 2011charge andreimbursement dataaccordingto Introduction Kristen E.Radcliff, MD Alan S.Hilibrand,MD Suken A. Shah,MD Todd J. Albert, MD Alexander Vaccaro, MD,PhD Kushagra Verma, MD,MS Eric M.Padegimas, MD Database Surgery. AnAnalysis Of The 2011Medicare And Reimbursements ForSpineFusion Geographic Variability InHospitalCharges cients ofvariation (ratioofstandarddeviation tomean)for Poster 19 For Thoracic/lumbar fusion:Charge $95.5±47.1, Two “diagnosisrelatedgroups”wereanalyzed: The CentersforMedicareServicesrecently Amar S.Ranawat MD Morteza Meftah,MD Chitranjan S.Ranawat, MD Polyethylene In Young AndActivePatients First GenerationHighly Cross-Linked Long-Term ClinicalResultsOfA patterns. the medicalcommunitywillincreasinglyscrutinizethese within individual referralareas.Policy makers, patientsand have thelowest. Signifi bursement ratiowereCA,FL,CO,NVwhileMD,RI,DE Medicare payment.Stateswiththehighestcharge toreim- be expected given thatsurgeon feesare5-foldhigherthan are four-fold higherthanthereimbursements, whichmay Conclusions: vorship wereanalyzed. (Roman software), clinicalandradiographicdatasurvi- mum 10-yearsfollow-up (mean11.5±0.94years),wearrates solid acetabular shellwithHCLPE acetabular liner. At mini- femoral stem,Cobalt-Chromium(Co-Cr)head,and posterolateral approach. All componentswerenon-cemented All operationswereperformedbytheseniorsurgeon viaa 10). Indicationforsurgery includedosteoarthritis inallcases. to 55years)andthemeanUCLAwas 7.3±1.5(range5– The meanageofpatientswas 47.4±7.8yearsold(range24 Institutional Review Board-approved prospective database. of 5andabove atthetimeofsurgery wereidentifi University ofCalifornia Los Angeles activity (UCLA)score 17 females)ageof55yearsandyoungerwithanaverage 2003, 52hipsconsecutive THAs (43patients;26malesand Material andMethods: patients inyoungandactive patients. cemented totalhiparthroplastyusingmetalonHCLPEin assess minimum10-yearwearratesandsurvivorship ofnon- active patients. The purposeofthisprospective studywas to wear ratesandclinicalperformanceofHCLPEinyoung hip arthroplasty(THA). There islimiteddataregarding was introducedtoimprove wearrelatedosteolysisintotal Background Poster 20 : Highlycross-linked polyethylene (HCLPE) Nationally, hospitalcharges toMedicare cant charge variability alsoexists BetweenJanuary2001toDecember Poster Abstracts ed fromour 237

Poster Abstracts EOA 45th Annual MeetingAmelia Island, Florida2014

Results: The mean linear wear was 0.019 ± 0.018 mm/year cantly increased the risk of wound complications (OR=2.05), (range 0-0.082) There were no revisions for osteolysis or loos- respiratory complications (OR=1.91), and ARF (OR=4.74). ening, periprosthetic infection or dislocation in this cohort. Lung transplant was associated with respiratory complications Kaplan-Meier survivorship was 100% for all failures. (OR=3.37), and ARF (OR=6.10). Bone marrow transplant was associated with cardiac complications (OR=1.56), and Conclusion: This study demonstrates that metal on HCLPE ARF (OR=4.31). Pancreas transplant was not statistically has an excellent survivorship rates at a minimum 10-year associated with complications. There was no signifi cant dif- follow-up in young-active patients. Moreover, oxidation conference between transplant and non-transplant groups regard- cern with Crossfi re up to 10 year has not shown any clinical ing both the incidence of pulmonary embolism and in-hospital signifi cance. mortality.

Discussion and Conclusion: It seems that transplant patients might be at an increased risk of in-hospital complications, Poster 21 particularly ARF. Further studies with longer follow up are recommended. Total Joint Arthroplasty In Transplant Recipients: In-Hospital Adverse Outcomes Poster 22 Mohammad R. Rasouli, MD Priscilla K. Cavanaugh, MS Major Adverse Events Following Total Joint Antonia F. Chen MD, MBA Arthroplasty In Patients With Coronary Mitchell G. Maltenfort, PhD Zachary D. Post, MD Revascularization Fabio R. Orozco, MD Maryam Rezapoor, MS Alvin C. Ong, MD Mohammad R. Rasouli, MD Reza Mostafavi Tabatabaee, MD Introduction: The increase in patients undergoing organ Mitchell G. Maltenfort, PhD transplantation along with their improved survival rates has Alvin C. Ong, MD increased the number of transplant recipients undergoing total Javad Parvizi, MD, FRCS joint arthroplasty (TJA). This study aims to determine in-hospital complications in transplant recipients undergoing TJA. Introduction: There is a paucity of literature about outcome of total joint arthroplasty (TJA) in patients with history of Methods: The Nationwide Inpatient Sample database was coronary revascularization including angioplasty/stent or queried for patients coded for history of transplant and hip coronary artery bypass graft (CABG). This study evaluates or knee arthroplasty (primary or revision) over the period of perioperative complications and mortality in these patients 1993-2011. Approximately 0.19% of TJA cases had at least undergoing TJA. one transplant among kidney, heart, liver, lung, pancreas or bone marrow, with kidney transplants representing the largest Methods: We used the Nationwide Inpatient Sample data group. Transplants were most commonly seen in revision hip from 2002 to 2011. Using the Ninth revision of the Interna- (0.50%), followed by primary hip (0.30%). Logistic regres- tional Classifi cation of Disease (ICD-9-CM) codes, we identi- sion was used to analyze data. fi ed patients with a history of coronary revascularization and compared in-hospital complications in these patients with Results: Kidney transplant signifi cantly increased risk of controls (no history of coronary revascularization). periprosthetic joint infection (PJI) (odds ratio (OR)=2.05), systemic infection (OR=2.95), deep venous thrombosis (DVT) Results: Cardiac complications occurred in 1.06%, 0.95% (OR=2.11), acute renal failure (ARF) (OR=3.61), respira- and 0.82% of cases with prior CABG, coronary angioplasty/ tory (OR=1.37), and cardiac (OR=1.22) complications. Liver stent and controls, respectively. Using multivariate analysis, transplant was signifi cantly associated with PJI (OR=2.33), history of coronary revascularization was not associated with respiratory complications (OR=1.68), cardiac complications a higher risk of cardiac complications. However, myocardial (OR=1.34), and ARF (OR=4.49). Heart transplant signifi - infarction (MI) occurred at signifi cantly higher rate in CABG

238 presenting forsportspreparticipation physical examination between August 2009and August 2013from studentathletes Methods: sion anddiabetes. of obesityassociatedcadiometabolicriskfactors, hyperten- overweight andobesity, and(3)toidentifytheprevalence associated withanincreasedordecreasedprevalence of tion ofhighschoolathletes,(2)identifypatientfactors (1) toidentifytheprevalence ofobesityamongapopula- for thesechronicdiseases. The purposeofthisstudywas health caresystemforpatientsunderserved patientsatrisk advocate by usingthisencounterasanentrypointintothe cal care,andfurtherserve inaroleofcommunityhealth may otherwisehave limitedexposure oraccesstomedi- at riskforobesityandassociateddiseasewhom paedic physicianswithanopportunitytoidentifypatients ipation sportsphysicalexamination (PPE)provides ortho- public healthimplicationsinthenearfuture. The prepartic- as asignifi and hypertension. These alarmingtrendsshouldbeviewed prevalence obesityassociateddiseases,suchasdiabetes the UnitedStates.Furtherevidence supportsanincreasing matic increaseintheprevalence ofchildhoodobesityin Introduction: William Replogle,PhD Eric C.Stiefel,MD 10-17 And DiabetesInStudentAthletesAge The Prevalence OfObesity, Hypertension independent predictorofin-hospitaladverse events. perioperative cardiacarrhythmia,particularly AF, tobean and complications(except forMI)after TJA. We alsofound tion doesnotseemtoincreaseriskofin-hospitalmortality Discussion andConclusion: independent predictorsofmortality. predictor ofallcomplications.Otherdysrhythmias werealso other arrhythmias andnoarrhythmia. AF was anindependent 8.48% and0.28%ofpatientswithatrialfi and mortality. Cardiaccomplicationsoccurred in5.36%, ization didnotincreasetheriskofnon-cardiaccomplications groups comparedtothecontrols.Priorcoronaryrevascular- (odds ratio(OR):1.24)andangioplasty/stenting(OR:1.96) Poster 23 21,013Physical examination formsobtained cant healthconcernwithpotentiallywidespread Over thepast30years there hasbeenadra- Priorcoronaryrevasculariza- brillation (AF), sport enrolment. diversifying anathlete’s sportsparticipationthroughmulti- health advocate andthepotentialgeneralhealthbenefi highlights theroleoforthopaedicsurgeon asacommunity curriculum aimedatobesityprevention. Furtherthisstudy tion ofcertainsportsprogramsaspartphysical education prevalence ofobesityandassociateddisease,implementa- to fi alence ofdisease. These datamayencouragepolicy makers sports” andmulti-sportathletesdemonstratedthelowest prev- marks fornon-athletepopulations.Participation in“running populations. Ourdataiscomparabletoestablishedbench- diseases appeartobesignifi Discussion: sports demonstratedlower prevalence ofobesityandHTN. cross country, soccerandindividuals participatinginmultiple as footballandbaseball.Participants insportsofbasketball, minority populations,andparticipantsinspecifi A higherprevalence ofObesityandHTNwas seenamong qualifi 12.2% werepre-hypertensive and 21.4%ofpatientsBP 66.5% ofindividuals hadnormalBPon initialscreening, overweight andobesitywas 19.9%and23.4%respectively. Results: reference data)andPMHofdiabetes. blood pressure(usingageandsex normative anthropometric were reviewed toevaluate theprevalence ofobesity, elevated stage exchange arthroplasty. Although reimplantationgener- ment ofchronicperiprosthetic jointinfection(PJI)istwo- Introduction: Javad Parvizi, MD,FRCS Craig J.Della Valle, MD Alex Uhr, BS Matthew W.Tetreault, BA Mohammad R.Rasouli,MD Anthony Tokarski,BS Two High Volume Centers Orthopaedic Improve Outcomes: From AReport Resection ArthroplastyDoesNot Delaying ReimplantationFollowing Poster 24 nancially supportathleticprogramsbasedontheirlower ed ashypertensive, anthropometricnormative values. Among thepopulationstudied,prevalence of The prevalence ofobesityand obesityassociated InNorth America, thepreferredsurgical treat- cant even amonginstudentathlete Poster Abstracts c sportssuch ts of 239

Poster Abstracts EOA 45th Annual MeetingAmelia Island, Florida2014

ally occurs 6-8 weeks after resection arthroplasty the optimal Jonathan K. Kazam, MD timing for reimplantation is unknown. This study aims to Joseph A. Abboud, MD determine if the timing between the fi rst and second stages of a two-stage exchange infl uenced the outcome of this proce- Introduction: The purpose of this study was to determine dure in terms of infection control. the prevalence of glenohumeral articular cartilage lesions in patients with rotator cuff tendinopathy and assess the accuracy Methods: We used data from two high volume centers of non-contrast magnetic resonance imaging (MRI) at detect- to identify all PJI cases treated with two-stage exchange ing these defects compared to the gold standard of arthros- arthroplasty between 2002 and 2012. Reimplantation fail- copy. ure was defi ned as the need for further surgical intervention for the treatment of PJI. Multivariate logistic regression Materials and Methods: Non-contrast MRI images obtained and Cox proportional hazard test were used to determine in 84 consecutive patients undergoing shoulder arthroscopy predictors of subsequent failure of the prosthesis due to for rotator cuff tendinopathy (mean age 54.8 yrs; range, 17-82) infection. were prospectively evaluated for glenohumeral cartilage lesions. Two fellowship trained, experienced musculoskeletal Results: The fi nal cohort consisted of 433 patients. Mean radiologists, blinded from arthroscopic fi ndings, independently duration of follow up from time of reimplantation was 2.4 evaluated the glenoid and humeral head cartilage on two occa- ± 1.9 years (minimum of 90 days). 97 patients (22.4%) sions, separated by an eight week interval. experienced subsequent failure. Logistic regression analysis indicated that PJI of knee (Odds Ratio (OR) = 2.08), spacer Results: At arthroscopy, humeral head cartilage lesions exchange (OR = 12.21), and polymicrobial PJI (OR = 9.48) were detected in 23 patients (frequency, 27.4%) and gle- but not time to reimplantation were some of the predicators of noid cartilage lesions were found in 20 patients (frequency, reimplantation failure. The Cox proportional hazards model 23.8%). There were 17 full (International Cartilage Repair showed that BMI (OR = 1.04), knee infection (OR = 1.95) Society (ICRS) grade 3 and 4) and 6 partial (ICRS grade 1 and spacer exchange (2.56) were predictors of failure at any and 2) lesions of the humeral head along with 13 full and 7 time. partial lesions of the glenoid. For detecting humeral lesions on MRI, the radiologists’ combined accuracy was 78%, sen- Conclusions: It is a commonly held belief that reimplanta- sitivity was 43%, and specifi city was 91%. The combined tion for patients with “severe” infection should be delayed. accuracy for detecting glenoid lesions on MRI was 84%, Based on our fi ndings, it appears that the timing between fi rst sensitivity was 53%, and specifi city was 93%. Combining and second stage does not infl uence the outcome of two-stage the readers, low-grade lesions (ICRS grades 1 and 2) of exchange arthroplasty. Although timing of reimplantation may the glenoid and humerus were read as negative on MRI in need to be individualized, the best metric to guide surgeons 63% and 86% of cases, respectively. Inter-observer agree- regarding the optimal timing of reimplantation still remains ment for detecting humeral lesions with non-contrast MRI unknown. was fair (K = 0.24) and considered moderate (K = 0.41) for detecting glenoid lesions. The ICC was 0.24 for the size of humeral lesions and 0.47 for glenoid lesions, indicating fair and moderate agreement, respectively, between and among Poster 25 the radiologists’ lesion characterizations and the surgeon’s measurements. Diagnositc Accuracy Of Non-Contrast MRI For Detecting Glenohumeral Cartilage Conclusion: Overall accuracy of non-contrast MRI at Lesions detecting a glenohumeral articular cartilage lesion is good, however, interpretation is reader dependent and accuracy is Corinne VanBeek, MD signifi cantly reduced for detecting low-grade lesions. Based Bryan J. Loeffl er, MD on these fi ndings we recommend that patients with rotator Alexa C. Narzikul, BA cuff tendinopathy undergoing arthroscopy be informed that Victoria A. Gordon, BA the presence and severity of cartilage lesions may be under- Michael J. Rasiej, MD estimated on MRI.

240 sustaining any SCIwereunabletoreturnduty. Despiteits functional recovery afterinjury. Almost halfofallpatients and nopatientssustainingan ASIA A SCIhadsignifi etrating traumawas themostcommonmechanismofinjury, related spinalcordinjuries(SCI). We foundthatballisticpen- est seriescharacterizingoperative intervention forcombat- Conclusion: in rehabilitation. 20.1 months.Onepatientdiedfromanunrelatedinjurywhile follow up,andtheaverage timefrominjurytoretirementwas 42.0% ofpatientsweremedicallyretireduponmostrecent was nosignifi age lengthoffollow upafterinjurywas 27.8months. There by mountedimprovised explosive device (IED,32.3%). Aver- mechanism ofinjurywas gunshotwound (45.2%), followed 48.4% sustainedcomplete(ASIA A) SCI. The mostcommon laris orcaudaequina. The meanpatientagewas 26.0years. ing fourpatientswithinjuriesisolatedtotheconusmedul- sustained completeorincompletespinalcordinjuries,includ- after returntotheUnitedStates.31(29.5%)ofthesepatients tive surgical managementforcombat-relatedspine injuries Results: cord injury(SCI). ing operative treatment,withacompleteorincompletespinal sustained indirectrelationtocombatoperationswhilerequir- 2013 wereevaluated. Inclusioncriteriaconsistedoftrauma Enduring and/orIraqiFreedombetweenJuly2003and spine surgery following acombat-relatedinjuryinOperations three militaryinstitutionswas performed.Patients undergoing Methods: treatment. combat-related SCI,andreportoutcomesfollowing operative related spinalcordinjuries(SCI). We setouttocharacterize and clinicalfollow-up aftercompleteandincomplete,combat- Introduction: LTC Ronald A. LehmanJr., MD Daniel G.Kang,MD Gregory S. Van Blarcum,MD LT ScottC. Wagner, MD Requiring Operative Treatment Combat-Related SpinalCord Injuries Characterization AndOutcomesOf Poster 26 Ourreview identifi Retrospective analysisofsurgical databasesat To ourknowledge, thisstudyisthefi cant recovery offunctionany ASIA A patients. Few studieshave describedtheinjurypattern ed 105casualtiesrequiringdefi rst andlarg- cant ni- sistent dysphagia. rent laryngealnerve injuriesand18patientsreporting per- complications includedone superfi (21.8%) experienced persistentposteriorneckpain.Other and 93.6%ofpatientsreturnedtofullactivity. 36patients enced completeresolutionoftheirpre-operative symptoms was 7.46degrees (±3.6degrees). 94.5%ofpatientsexperi- At mostrecentfollow up,average CDA rangeofmotion addressed levels wereC6-7(42.0%)andC5-6(39.6%). (7.4%) underwentatwo-level CDR. The mostfrequently structs wereusedin52patients(29.5%)and13 underwent single-level CDR.CDR/ACDF hybrid con- age follow-up was 8.5±7.6months. 111patients(63.1%) 13 patients(7.8%),andbothin10(6.0%). Aver- was radiculopathyin141patients(84.4%),myelopathy with anaverage ageof41.6±8.1years.Surgical indication Results: included forreview. CDA, 2-level CDA/ACDF hybrid,andmulti-level CDA) were medical centerfrom2008to2012. All constructtypes(1-level secutive patientsundergoing CDA atasingle,militarytertiary Methods: plasty. out tofurtherevaluate theoutcomesofcervicaldiscarthro- non-sponsored studiesevaluating clinicaloutcomes. We set as asafealternative to ACDF, however therehave beenfew industry sponsoredFDA IDEtrialshave establishedCDA native toanteriordiscectomy andfusion(ACDF). Various arthroplasty (CDA) isincreasingly beingusedasanalter- in societythatcausessignifi Introduction: CPT JohnP. Cody, MD LCDR Robert W. Tracey, MD LTC Ronald A. LehmanJr., MD Daniel G.Kang,MD LT ScottC. Wagner, MD Arthroplasty: ARetrospective Review Outcomes Following Disc Cervical the militaryhealthcaresystem. relative rarity, combatrelatedSCIisasignifi Poster 27 Ofthe176patients,40werefemale(22.7%) We performedaretrospective review of176con- Cervicalradiculopathyisacommonproblem cant disability. Cervicaldisc cial infection,fi Poster Abstracts cant burden to ve recur- 241

Poster Abstracts EOA 45th Annual MeetingAmelia Island, Florida2014

Conclusion: This is the largest non-sponsored single center surface of engineered cells in a promoter dependent fashion, study of cervical disc arthroplasty. Our data demonstrates and 2) ACSA expression enhances the attachment of the cell relief of pre-operative symptoms (94.5%) and return to full construct to collagen, and that this expression does not inter- activity (93.6%) with an average follow-up of 8.5 months. fere with cell proliferation. There was a low complication rate without device or implant related complications. Arthroplasty continues to be a safe and Methods: The engineered construct includes the following reliable option in treating patients with cervical radiculopathy features: Murine fi broblasts (NIH 3T3), specifi c anchoring to or myelopathy. human type I collagen (C-terminus, α2 chain), tetracycline (Tet)-responsive promoter, and GFP tag for localization. The stable expression of the ACSA-GFP construct was confi rmed by culturing the selected transfected cells in the presence Poster 28 or the absence of doxycycline (Dox). The presence of the ACSA-GFP was confi rmed by Western blot and microscopy. Smart Collagen-Specifi c Anchors For Cell attachment assays were performed on cells expressing Tendon-Targeted Delivery Of Therapeutic the ACSA construct (Tet-On) and non-induced cells (Tet- Cells Off). Cells were seeded on human collagen I-coated plates. Proliferation assays were performed colorimetrically (Sigma- Mark Wang, MD, PhD Aldrich). Pedro K. Beredjiklian, MD Jolanta Fertala, PhD Results: GFP-tagged ACSA is expressed on the surface of Andrzej Steplewski, PhD engineered cells is a Tet promoter-dependent fashion. Specifi c Andrzej Fertala, PhD antibodies identifi ed the following: the extracellular fragment of the construct, the GFP portion, and DAPI-stained nuclei. Introduction: Fibrosis after tendon injury and repair ACSA enhances the attachment of the cell construct to colla- remains a challenging clinical problem impacting patient gen, and this expression does not interfere with cell prolifera- functional outcome. Current molecular strategies to tion. improve tendon healing have focused on modulating cellular responses at the injury site. Limitations of previously Discussion/Conclusion: Fibrosis after tendon injury remains explored methods include the ineffi cient therapeutic cell a vexing clinical problem, and current molecular strategies delivery, failure to retain cells within the injury site, and for improving tendon healing are limited by ineffi cient and potential safety concerns of cell-based treatment. Our labo- non-specifi c therapeutic delivery. This novel cellular con- ratory has engineered a novel artifi cial collagen-specifi c struct enables the controlled expression of collagen-targeting anchor (ACSA), enabling the controlled targeting of thera- anchors at the surface of therapeutic cells, enhancing cellular peutic cells to collagen-specifi c sites. Potential benefi ts of attachment to collagen-rich sites without disrupting cell pro- the ACSA include an inducible collagen-targeting anchor, liferation. Potential benefi ts may include the controlled target- controlled delivery and retention of cells within an injury ing of therapeutic cells to the injury site, improved tendon site, and decreased requirement of therapeutic cells and healing effi ciency, and the reduced dispersion of cells into duration of treatment. The purpose of this study is to test the surrounding tissue. hypothesis that 1) GFP-tagged ACSA is expressed on the

242 extensor lagandrangeofmotion2.9°103°,respec- 4/5. The quadricepstendonreconstructionshadanaverage 8.4° and107.9°,respectively, withstrengthmaintainedat months, theaverage extensor lagandrangeofmotionwas mum follow upof2yearsandanaverage follow upof65 range ofmotionwas 105.1°.Ofthepatientswithamini- Results: pleted anSF-36form. lowed toanaverage of65months.Ninethese10com- patients, withaminimumoftwo yearsfollow up,werefol- underwent evaluation atanaverage of46months. Ten lar tendonand7quadricepsruptures. All patients were enrolled. The 17reconstructionsconsistedof10patel- were identiﬁ following TKA betweenJanuary2003and2012 knee extensor mechanism using Achilles tendonallograft Methods: after TKA. allograft following patellarandquadricepstendonrupture of extensor mechanism reconstructionusing Achilles tendon long-term outcomes. This studypresentslong-termresults cians totheoptimaltreatmentandprovide insightintothe complication. Limitedpublisheddataexists toguidephysi- total kneearthroplastyisaninfrequentbut devastating Background: James Roberson,MD Thomas Bradbury, MD Aidin EslamPour, MD Greg Erens,MD Brent T. Wise,MD Allograft AfterKneeArthroplasty Reconstruction UsingAchilles Tendon Long-Term ResultsOfExtensorMechanism Poster 29 The average extensor lagwas 6.6°andaverage Patients whounderwent reconstructionoftheir ed. Sixteenpatientswith17reconstructions Disruptionoftheextensor mechanismafter on overall function. technique, theinjuryandprocedurehave aprofoundimpact while maintainingrangeofmotion.Despitethesuccessthis predictably restoreextensor mechanismfunctionandstrength riceps tendonrupturesfollowing TKA. This techniquecan who sustainnotonlypatellartendonruptures,but alsoquad- reconstruction isareliableanddurabletreatmentforpatients Conclusion: the SF-36. patients werebelow themeanforage-matchedcontrolson of thosebeinginthequadtendongroup. All but oneofthe tively. Five patientsdiedduringthefollow upperiodwith4 This studydemonstratesthat Achilles tendon Poster Abstracts 243

Poster Abstracts EOA 45th Annual MeetingAmelia Island, Florida2014

Individual Orthopaedic Instruction/ Multimedia Education

Schedule: Thursday, October 23, 2014 4:00 pm–5:00 pm Friday, October 24, 2014 4:00 pm–5:00 pm Saturday, October 25, 2014 3:00 pm–4:00 pm

The following AAOS DVDs are available for individual viewing at the above times in the Ambassador Room.

1. Anatomy of the Knee (25 minutes) Stephen L. Brown, MD; Patrick M. Connor, MD; Donald F. D’Alessandro, MD; James E. Fleischli, MD

2. Pectoralis Major Transfer for Irreparable Rotator Cuff Tears (11 minutes) Sumant G. Krishnan, MD and Kenneth C. Lin, MD

3. Surgical Dislocation and Debridement for Femoro-Acetabular Impingement (22 minutes) Christopher L. Peters, MD and Jill A. Erickson, PhD

4. Hip Resurfacing: Direct Anterior Approach (12 minutes) William J. Hozack, MD; Michael M. Nogler, MD; Stefan Kreuzer, MD; and Martin Krismer, MD

5. Imageless Navigation in Hip Resurfacing Arthroplasty (15 minutes) Michael L. Swank, MD and Amy L. Hallock, MEd

6. Basics of Computer Navigation in Total Knee Arthroplasty (11 minutes) James B. Stiehl, MD

7. Lateral Approach for Valgus Total Knee Arthroplasty (12 minutes) James B. Stiehl, MD

8. Molded Articulating Cement Spacers for Treatment of Infected Total Knee Arthroplasty (12 minutes) Adolph V. Lombardi Jr., MD, FACS; Keith R. Berend, MD; and Joanne B. Adams, BFA

9. Arthroscopic Suprascapular Nerve Release (23 minutes) Laurent Lafosse, MD

10. Open Repair of Acute and Chronic Distal Biceps Ruptures (25 minutes) James Michael Bennett, MD; Thomas Lynn Mehlhoff, MD; and James Burlin Bennett, MD

11. Arthroscopic Acetabular Labral Repair: Surgical Technique (9 minutes) Marc J. Philippon, MD; Mike J. Huang, MD; Karen K. Briggs, MPH, MBA; and David A. Kupper- smith, BS

244 Multimedia Education

12. Anterior Cruciate Ligament Reconstruction Using Achilles Allograft and Interference Screws (10 minutes) Colin G. Looney, MD and William I. Sterett, MD

13. Osteochondral Lesion of the Talus (OLT): Technique of Osteochondral Autologous Graft Transfer (11 minutes) Sameh A. Labib, MD and Brett A. Sweitzer, MD

14. Revision ACL Reconstruction Using the Anatomic Double Bundle Concept (14 minutes) Freddie H. Fu, MD; Nicholas J. Honkamp, MD; Wei Shen, MD, PhD; Anil S. Ranawat, MD; and Fotios Tjoumikaris, MD

15. The Krukenberg Procedure for Children (25 minutes) Hugh Godfrey Watts, MD; John F. Lawrence, MD; and Joanna Patton, ROT

16. Single Incision Direct Anterior Approach to Total Hip Arthroplasty (13 minutes) William J. Hozack, MD; Michael M. Nogler, MD; Javad Parvizi, MD, FRCS; Eckart Mayr, MD; and Krismer Martin, MD

17. Medial Patellofemoral Ligament Reconstruction (13 minutes) Ryan E. Dobbs, MD; Patrick E. Greis, MD; and Robert T. Burks, MD

18. Hip Arthroscopy: Operative Set-Up and Anatomically Guided Portal Placement (8 minutes) Allston Julius Stubbs, MD; Karen K. Briggs, MPH, MBA; and Marc J. Philippon, MD

19. Anatomy of the Shoulder (24 minutes) Donald F. D’Alessandro, MD

20. Anterolateral Approach in Minimally Invasive Total Hip Arthroplasty (18 minutes) Leonard Remia, MD

21. Patient Speciﬁ c Knee Design: An Evolution in Computer-Assisted Surgery (22 minutes) Adolph V. Lombardi Jr., MD, FACS; Keith R. Berend, MD; and Joanne B. Adams, BFA

22. Hemiarthroplasty for a Comminuted Fracture of the Proximal Humerus (20 minutes) Jon J.P. Warner, MD; Darren J. Friedman, MD; Zachary R. Zimmer, BA; and Laurence D. Higgins, MD

23. Rotator Interval Repari of the Shoulder: Biomechanics and Technique (7 minutes) LCDR Matthew T. Provencher, MD, MC, USN and Daniel J. Solomon, MD

24. Excision of Calcaneonavicular Tarsal Coalition ( 7 minutes) Maurice Albright, MD; Brian Grottkau, MD; and Gleeson Rebello, MD

25. Extensile Surgical Approach for the Resection of Large Tumors of the Axilla and Brachial Plexus (9 minutes) James C. Wittig, MD; Alex R. Vap, BA; Camilo E. Villalobos, MD; Brett L. Hayden, BA; Andrew M. Silverman, BA; and Martin M. Malawer, MD Multimedia Education

245 EOA 45th Annual MeetingAmelia Island, Florida2014

26. The Anterior Supine Intermuscular Approach in Primary Total Hip Arthroplasty (18 minutes) Keith R. Berend, MD; Adolph V. Lombardi Jr., MD; and Joanne B. Adams, BFA, CMI

27. Robotic Arm-Assisted Unicompartmental Knee Arthroplasty: An Introductory Guide (15 minutes) Christopher John Dy, MD; Kristofer Jones, MD; Samuel Arthur Taylor, MD; Anil Ranawat, MD; and Andrew D. Pearle, MD

28. Vertical Humeral Osteotomy for the Revision of Humeral Components in Shoulder Arthroplasty (21 minutes) Geoffrey Van Thiel, MD; Gregory P. Nicholson, MD; James Patrick Halloran, MD; Dana Piasecki, MD; Matthew T. Provencher, MD; and Anthony A. Romeo, MD

29. Techniques for Safe Portal Placement in the Shoulder: The Ring of Fire (13 minutes) Keith D. Nord, MD; Bradford A. Wall, MD; Prithviraj Chavan, MD; and William H. Garrett, BS

30. Reconstruction of the Medial Collateral Ligament of the Elbow (12 minutes) James Michael Bennett, MD; Thomas Lynn Melhoff, MD; and Rodney K. Baker

31. Reconstruction of Abductor Mechanism-Gluteus Maximus Flap Transfer (15 minutes) Leo Whiteside, MD and Marcel Roy, PhD

32. Kinematic Alignment with Modiﬁ ed Conventional Instruments Instead of Patient-Speciﬁ c Guides (26 minutes) Stephen Howell, MD

33. Arthroscopic Management of Femoroacetabular Impingement (12 minutes) J. W. Thomas Byrd, MD

34. Arthroscopic Suprascapular Nerve Decompression: Etiology, Diagnosis, and Surgical Technique (21 minutes) Sanjeev Bhatia, MD; Adam B. Yanke, MD; Neil S. Ghodadra, MD; Seth Sherman, MD; Anthony A. Romeo, MD; and Nikhil N. Verma, MD

35. Combined Cartilage Restoration and Distal Realignment for Patellar and Trochlear Chondral Lesions (12 minutes) Peter Chalmers, MD; Adam B. Yanke, MD; Seth Sherman, MD; Vasili Karas, BS; and Brian Cole, MD, MBA

36. Simple Arthroscopic Anterior Capsulo-Labral Reconstruction of the Shoulder (17 minutes) Stephen J. Snyder, MD and Jeffrey D. Jackson, MD

37. Proximal Humerus Resection for Parosteal Osteosarcoma (16 minutes) Yvette Ho, MD; Camilo E. Villalobos, MD; and James C. Wittig, MD

38. Biceps Tenodesis: Open Subpectoral and Arthroscopic Technique (19 minutes) Adam B. Yanke, MD; Peter N. Chalmers, MD; Anthony A. Romeo, MD; and Nikhil N. Verma, MD

246 Multimedia Education

39. Total Shoulder Arthroplasty: Steps to Get It Right (15 minutes) Richard J. Hawkins, MD

40. ACL Anatomic Single Bundle Reconstruction Technical Note and Results (20 minutes) Michael W. Moser, MD; Gonzalo Samitier Solis, MD; Terese L. Chmieleski, PT, PhD; and Trevor Lentz, PT

41. Surgical Repair of Proximal Hamstring Avulsion in the Athlete (15 minutes) Tal S. David, MD and Gabriel L. Petruccelli, MD

42. Removal of a Broken Intramedullary Nail and Exchange Nailing for Tibial Nonunion (10 minutes) Kenneth A. Egol, MD; Abiola Atanda, MD; Mathew Hamula, BA, BS; and Jason P. Hochfelder, MD

43. Radical Resection of the Glenoid and Scapular Neck for Sarcoma and Reconstruction (11 minutes) Brendon J. Comer, BA; Brett L. Hayden, BA; Camilo E. Villalobos, MD; and James C. Wittig, MD

44. Shoulder Arthrodesis: Surgical Technique (11 minutes) Ryan Warth, MD and Peter J. Millett, MD, MSc

45. Approaches to the Hip: Minimally Invasive Posterolateral Total Hip Arthroplasty (24 minutes) Cesare Faldini, MD; Francesco Traina, MD; Mohammadreza Chehrassan, MD; Raffaele Borghi, MD; Daniele Fabbri, MD; Matteo Nanni, MD; Federico Pilla, MD; Marco Pedrini, MD; and Sandro Giannini, MD

46. Modiﬁ ed Anterolateral Approach with Femoral Anterior Cortical Window for Revision Total Hip Arthroplasty (15 minutes) Amgad M. Haleem, MD, MSc; Morteza Meftah, MD; Brian Domingues, BA; and Stephen J. Incavo, MD

47. Spine Scapular Non-Union ORIF Solution (8 minutes) Thomas W. Wright, MD and Gonzalo Samitier Solis, MD, PhD

48. Fixation of Odontoid Fractures with an Anterior Screw: Surgical Technique (14 minutes) Manuel Valencia, MD; Paulina De La Fuente, MD; Selim Abara, MD; Felipe Novoa, MD, Andres Leiva, MD; and Arturo Olid, MD

49. Partial Two-Stage Exchange for Infected Total Hip Arthroplasty (16 minutes) Adolph V. Lombardi Jr., MD, FACS; Timothy Ekpo, DO; Keith R. Berend, MD; Michael J. Morris, MD; and Joanne B. Adams, BFA, CMI

50. Medial Mobile-Bearing UKA with Twin-Peg Femoral Design and Enhanced Instrumentation (18 minutes) Keith R. Berend, MD; Adolph V. Lombardi Jr., MD, FACS; Jason M. Hurst, MD; Michael J. Morris, MD; Joanne B. Adams, BFA, CMI; Keri L. Satterwhite; and Michael A. Sneller, BS Multimedia Education

247 EOA 45th Annual MeetingAmelia Island, Florida2014

51. Surgical Treatment of Spondylolisthesis by Posterolateral Arthrodesis and Instrumentation (9 minutes) Antonello Montanaro, MD; Francesco Turturro, MD; Cosma Calderaro, MD; Luca Labianca, MD; Vicenzo Di Sanzo, MD, PhD; Pierpaola Rota, MD; Alessandro Carducci, MD; and Andrea Ferretti, MD

52. Transosseous Equivalent Pectoralis Major Tendon Repair (8 minutes) Kevin W. Farmer, MD and Gonzalo Samitier Solis, MD, PhD

53. Posterolateral Corner Primary Repair And Reconstruction Case Based (18 minutes) Mark D. Miller, MD; Sean Higgins; and Brian C. Werner, MD

248 Raffaele Borghi, MD Sanjeev Bhatia,MD 9. AAOS, American Association ofHipandKneeSurgeons) Arthroplasty, Journal ofBoneandJoint Surgery – American, Orthopedics; Stryker; 8.ClinicalOrthopaedicsandRelatedResearch, Journal of Keith R.Berend, MD James MichaelBennett,MD Orthopedics; 5. Ascension Orthopedics) James BurlinBennett,MD Rodney K.Baker MD Abiola Atanda, MD Maurice Albright, Joanne B. Adams, BFA, CMI MD Selim Abara, bias ordecreasingthevalue oftheauthor’s participationinthemeeting. The Academy doesnotview theexistence ofthesedisclosedinterests orcommitmentsasnecessarilyimplying The following participantshave disclosedwhetherthey oramemberoftheirimmediatefamily: Eastern Orthopaedic Association hasidentifi n. No Confl Serves onany BoardofDirectors,asanowner oroffi 9. Serves ontheeditorial or governing boardofany medicaland/ororthopaedicpublication; 8. Receive any royalties, fi 7. Receive any otherfi 6. Receive researchorinstitutionalsupportasaprincipal investigator fromany pharmaceutical, 5. Ownstockoroptionsinany pharmaceutical,biomaterial,ororthopaedicdevice andequip- 4. UnpaidConsultantforany pharmaceutical,biomaterial, ororthopaedicdevice andequipment 3c. Paid Consultantforany pharmaceutical,biomaterial,ororthopaedicdevice andequipmentcom- 3b. Paid Employee forany pharmaceutical,biomaterial,ororthopaedicdevice andequipmentcom- 3a. Within thepasttwelve months,served onaspeakers’ bureau orhave beenpaidanhonorariumto 2. Receive royalties forany pharmaceutical,biomaterial,ororthopaedicproductdevice; 1. (n.) (n.) (n.) (n.) care organization (e.g.,hospital,surgery center, medical). dic device andequipment company orsupplier; biomaterial, orthopaedicdevice andequipmentcompany, orsupplier; ment company, orsupplier(excluding mutualfunds); company, orsupplier; pany, orsupplier; pany, orsupplier; present byany pharmaceutical,biomaterial,ororthopaedicproductdevice company; (n.) (1. Biomet;3b. Biomet;5.Biomet,Kinamed,Pacira, (n.) (2. Ascension Orthopedics;3b. Ascension (9. AAOS) (n.) icts toDisclose. Multimedia Financial Disclosure nancial/materialsupportfromany pharmaceutical,biomaterial,ororthopae- nancial/material supportfromany medicaland/ororthopaedicpublishers; ed theoptiontodiscloseasfollows. Prithviraj Chavan, MD Peter N.Chalmers,MD Alessandro Carducci,MD Cosma Calderaro,MD Medicine) International Societyof Arthroscopy, KneeSurgery, OrthopaedicSports of North America, American OrthopaedicSocietyforSportsMedicine, Surgical; 5.Smith&Nephew; 7.Springer; 9. Arthroscopy Association J. W. Thomas Byrd,MD Arthroscopy Association ofNorth America) Robert T. Burks,MD Stephen L.Brown, MD Siemens) Karen K.Briggs,MPH,MBA cer, onarelevant committeeofany health (1. Arthrex, Inc.;2. Arthrex, Inc.;3b. Arthrex, Inc.;9. (n.) (5. Arthrex, Inc.,Smith&Nephew, DePuy, Synthes) (n.) (n.) (3b. Smith&Nephew, A2 Surgical; 4. A2 (n.) Multimedia FinancialDisclosure (5. Ossur, Smith&Nephew, Arthrex, Inc., 249

Multimedia Financial Disclosure EOA 45th Annual MeetingAmelia Island, Florida2014

Mohammadreza Chehrassan, MD (n.) James Patrick Halloran, MD (n.) Terese L. Chmieleski, PT, PhD (n.) Mathew Hamula, BA, BS (n.) Brian Cole, MD, MBA (1. Arthrex, Inc., DJ Orthopaedics, Lippincott, Richard J. Hawkins, MD (1. Ossur; 3b. DJ Orthopaedics; 7. Wolters Elsevier; 2. Genzyme; 3b. Zimmer, Arthrex, Inc., Carticept, Biomimmetic, Kluwer Health - Lippincott Williams & Wilkins; 9. American Shoulder and Allosource, DePuy; 5. Regentis, Arthrex, Smith & Nephew, DJ Ortho; 7. Elbow Surgeons) Lippincott, Elsevier, WB Saunders; 8. JBJS, AJSM, Cartilage, JSES, AJO, Brett L. Hayden, BA (n.) Elsevier) Laurence D. Higgins, MD (6. Arthrex, Inc., Smith & Nephew, Breg, DePuy; Brendon J. Comer, BA (n.) 9. American Shoulder and Elbow Surgeons, Arthroscopy Association of Patrick M. Connor, MD (1. Biomet; 3b. Zimmer; 9. NFLPS, OrthoCarolina North America) Research Institute) Sean Higgins (n.) Donald F. D’Alessandro, MD (3b. Biomet Sports Medicine) Yvette Ho, MD (6. imedicalapps.com) Tal S. David, MD (2. Arthrex, Inc., Cayenne Medical, Inc.; 3c. Cayenne Nicholas J. Honkamp, MD (n.) Medical, Inc., Arthrex, Inc.; 4. Cayenne Medical, Inc.; 5. KFx Medical, Inc.; 7. SLACK Inc.; 8. Orthopedics, SLACK Inc.; 9. American Jason P. Hochfelder, MD (n.) Orthopaedic Society for Sports Medicine, Arthroscopy Association of North Stephen Howell, MD (1. Biomet; 2. Biomet, Stryker; 3b. Biomet, Stryker; America, Arthritis Foundation) 5. Stryker; 7. Saunders/Mosby-Elsevier; 8. Knee, American Journal of Paulina De La Fuente, MD (n.) Sports Medicine; 9. International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine) Vicenzo Di Sanzo, MD, PhD (n.) William J. Hozack, MD (1. Stryker; 3b. Stryker; 5. Stryker; 8. Journal of Ryan E. Dobbs, MD (4. Orthopaedic Implant Company) Arthroplasty; 9. Hip Society) Brian Domingues, BA (3a. Stryker, Corin USA; 4. Stryker, MAKO Surgical) Michael Huang, MD (6. Genzyme, Smith & Nephew) Christopher John Dy, MD (n.) Jason M. Hurst, MD (3b. Biomet; 5. Biomet, Kinamed, Pacira, Stryker) Kenneth A. Egol, MD (1. Exactech, Inc.; 3b. Exactech, Inc.; 5. Synthes, Stephen J. Incavo, MD (1. Innomed, Zimmer; 3b. Zimmer; 4. Zimmer; OREF, OTA, OMEGA; 7. SLACK Inc., Wolters Kluwer Health - Lippincott 8. Journal of Arthroplasty; 9. American Association of Hip and Knee Williams & Wilkins; 8. Journal of Orthopaedic Trauma) Surgeons) Timothy Ekpo, DO (n.) Jeffrey D. Jackson, MD (3a. Arthrex, Inc.) Jill A. Erickson, PA-C (n.) Kristofer Jones, MD (n.) Daniele Fabbri, MD (n.) Vasili Karas, BS (n.) Cesare Faldini, MD (n.) Stefan Kreuzer, MD (1. Smith & Nephew, Synvasive; 2. Corin USA, Stryker, Salient Surgical, MAKO; 3b. Corin USA, Stryker, Salient Surgical, MAKO; Kevin W. Farmer, MD (2. Arthrex, Inc., Exactech; 3b. Arthrex, Inc., 5. MAKO, Synvasive, Corin USA) Exactech; 9. American Orthopaedic Society for Sports Medicine, Florida Orthopaedic Society) Sumant G. Krishnan, MD (1. Innovation Sports; 3b. Mitek, Tornier; 4. Johnson & Johnson, Pﬁ zer, Merck; 6. Mitek, Tornier) Andrea Ferretti, MD (n.) Martin Krismer, MD (6. Stryker Orthopaedics) James E. Fleischli, MD (5. Biomet) David A. Kuppersmith, BS (n.) Darren J. Friedman, MD (2. Allen Medical, Arthrex, Inc.; 3b. Allen Medical) Luca Labianca, MD (n.) Freddie H. Fu, MD (1. Arthrocare; 3a. Stryker; 4. Stryker; 7. SLACK Inc.; Sameh A. Labib, MD (2. Arthrex, Inc.; 4. ConforMIS, Inc., Zimmer; 9. 8. Saunders/Mosby-Elsevier; 9. AAOS, American Orthopaedic Society for AAOS, American Orthopaedic Foot and Ankle Society) Sports Medicine, International Society of Arthroscopy, Knee Surgery, and Laurent Lafosse, MD (1. TAG; 2. TAG; 3b. TAG 3c. TAG; 5. TAG) Orthopaedic Sports Medicine, OREF) John F. Lawrence, MD (n.) William H. Garrett, BS (n.) Andres Leiva, MD (n.) Neil S. Ghodadra, MD (n.) Trevor Lentz, PT (n.) Sandro Giannini, MD (3b. Smith & Nephew, Medacta Active Implants; Kenneth C. Lin, MD (n.) 8. Springer, Musculoskeletal Surgery Elsevier, Foot and Ankle Surgery, Springer; 9. European Foot & Ankle Society, International Societies of Adolph V. Lombardi Jr., MD, FACS (1. Biomet, Innomed; 2. Biomet; Orthopaedic Centers, Società Italiana Ortopedia e Traumatologia) 3b. Biomet, Pacira; 5. Biomet, Kinamed, Pacira, Stryker; 8. Clinical Orthopaedics and Related Research, Journal of Arthroplasty, Journal Patrick Greis, MD (4. Merck) of Bone and Joint Surgery – American, Journal of Orthopaedics and Brian Grottkau, MD (9. AAOS) Traumatology, Journal of the American Academy of Orthopaedic Surgeons, Knee, Surgical Technology International; 9. Hip Society, Knee Society, Amgad M. Haleem, MD, MSc (n.) Mount Carmel Education Center at New Albany, Operation Walk USA, Amy L. Hallock, MEd (n.) Orthopaedic Research and Education Foundation)

250 Federico Pilla,MD Dana Piasecki,MD Research Institute) Society forHip Arthroscopy, AOSSM, SteadmanPhilippon 6. Smith&Nephew; 7.SLACK Inc.,Elsevier; 9.International MIS; 5.Ossur, Arthrex, Siemens,Smith&Nephew; Arthrosurface; 3b. Smith&Nephew; 4. Arthrosurface, Hipco, Marc J.Philippon,MD Gabriel L.Petruccelli,MD Arthroplasty; 9. AAOS) Christopher L.Peters,MD Marco Pedrini,MD Andrew D.Pearle, MD Joanna Patton, ROT Healthcare) CD Diagnostics, EOA, HipSociety, OREF, ORS,SmartTech, United SLACK Inc.;9. AAHKS, ABOS, BritishOrthopaedic Association, American Academy ofOrthopaedicSurgeons, Orthopedics Today, Journal ofBoneandJoint Surgery –British,Journal ofthe Orthopaedics, Journal ofBoneandJoint Surgery - American, of Orthopedics,Current OpinioninOrthopaedics,International Kluwer Health-Lippincott Williams & Wilkins ;8. American Journal Stryker, Zimmer;7.Saunders/Mosby-Elsevier, SLACK Inc., Wolters 5. 3m,Musculoskeletal Transplant Foundation, NIAMS&NICHD, Salient Surgical, Smith&Nephew, Stryker, TissueGene, Zimmer; Javad Parvizi, MD,FRCS Arturo Olid,MD Felipe Novoa, MD Nephew, Zimmer, Arthrex, Inc.) Smith &Nephew, Cayenne;4.Bledsoe;5.DePuy, Synthes,Smith& Keith D.Nord,MD Springer) Michael M.Nogler, MD Zimmer; 5.EBI, Tornier, Zimmer;7.SLACK Inc.) Gregory P. Nicholson,MD Matteo Nanni,MD Orthopaedic SocietyforSportsMedicine) Michael W. Moser, MD Michael J.Morris,MD Antonello Montanaro,MD Medical SolutionsUSA,Smith&Nephew, ConMedLinvatec) Ready, VuMedi; 5. Arthrex, Inc.,OrthoRehab,Ossur Americas, Siemens Peter J.Millett,MD,MSc Medicine, MillerOrthopaedicReview Enterprises) Lippincott Williams & Wilkins; 9. American OrthopaedicSocietyforSports Mark D.Miller, MD Thomas L.Mehlhoff, MD Morteza Meftah,MD Eckart Mayr, MD Krismer Martin,MD Martin M.Malawer, MD Colin G.Looney, MD (n.) (2. Stryker; 3b. Stryker; 5.Stryker) (n.) (n.) (n.) (n.) (1. Arthrex, Inc.;2.Smith&Nephew, Cayenne;3b. (n.) (n.) (7. Saunders/Mosby-Elsevier, Wolters KluwerHealth- (n.) (n.) (n.) (3b. Biomet;5.Biomet,Kinamed,Pacira, Stryker) (1. Smith&Nephew, Bledsoe, Donjoy, (n.) (5. OREF, OMEGA,Omeros; 9. AAOS, American (2. Stryker; 3b. Stryker; 5.Stryker Heraeus; 7. (n.) (3b. Biomet,Covidien, NIAMS&NICHD, (1. Arthrex, Inc.;3b Arthrex, Inc.;4.Game (n.) (1. Biomet;2.3b. Biomet;8.Journal of (1. Innomed,Zimmer;3b. Zimmer, Tornier; 4. (5. KFxMedical,Inc.) (n.) Geoffrey S. Van Thiel, MD Manuel Valencia,MD Francesco Turturro,MD Francesco Traina,MD Fotios P. Tjoumakaris, MD Taylor,Samuel Arthur MD Brett A. Sweitzer, MD Michael L.Swank, MD for SportsMedicine, Arthroscopy Association ofNorth America) International SocietyforHip Arthroscopy, American OrthopaedicSociety Inc.; 5.Bauerfeind, AG; 8. VuMedi.com, Journal of Arthroscopy; 9. Allston J.Stubbs,MD Inc. Technology Company;8.Knee, Journal of Arthroplasty) 3c. Exactech, Inc.;4.BlueOrthopaedics ComputerCompany, Traumis, Company, Zimmer;3b. BlueOrthopaedicsComputerCompany, Zimmer James B.Stiehl,MD & Nephew, Ossur, Siemens) William I.Sterett,MD AAOS, American OrthopaedicSocietyforSportsMedicine, SOMOS) American OrthopedicSportsMedicineSocietyUpdate;9. Daniel J.Solomon,MD of Arthroscopy, KneeSurgery, andOrthopaedicSportsMedicine) Knee Surgery, andOrthopaedicSportsMedicine;9.InternationalSociety Gonzalo SamitierSolis,MD,PhD Wright Medical;7. Wolters KluwerHealth-Lippincott Williams & Wilkins) 3a. RedynsMedical;3b. Synthes;4.RedynsMedical,Johnson &Johnson, Sawbones/Paciﬁ cResearch Laboratories, Wright Medical Technology, Inc.; Stephen J.Snyder, MD Michael A. Sneller, BS Andrew M.Silverman, BA Seth Sherman,MD Wei Shen,MD,PhD Keri L.Satterwhite Marcel Roy, PhD Pierpaola Rota,MD Surgeon, ArthroscopyNorth America) of Association Orthopaedic SocietyforSportsMedicine, American ShoulderandElbow in SportsMedicine, OrthopaedicJournal ofSportsMedicine;9. American Health, Techniques inShoulderandElbowSurgery, Operative Techniques and ElbowSurgery, SLACK Inc.,Orthopedics Today, Orthopedics,Sports Inc., DJSurgical; 7.Saunders/Mosby-Elsevier; 8.Journal ofShoulder Inc.; 5. Arthrex, Inc.,DJOSurgical, Smith&Nephew, Ossur;6. Arthrex, Anthony A. Romeo,MD Leonard Remia,MD Gleeson Rebello,MD Anil Ranawat, MD Orthopaedic SportsMedicine, SanDiego ShoulderInstitute, SOMOS) AANA, InternationalSocietyof Arthroscopy, KneeSurgery, and Hyperguide; 9. AAOS, AOSSM, American ShoulderandElbowSurgeons, Disorders, Knee, Orthopedics,SLACK Inc., Vindico Orthopaedic Matthew T. Provencher, MD (3c. SignalMedicalCorp.) (4. MAKO, ConforMIS) (n.) (n.) (n.) (n.) (3b. Encore Medical;6.Encore Medical) (1. Zimmer, Innomed;2.BlueOrthopaedicsComputer (n.) (n.) (3b. Smith&Nephew; 4.Johnson &Johnson, (n.) (n.) (1. Biomet;3b. Arthrex, Inc.;5. Arthrex, Inc.,Smith (n.) (1. Arthrex, Inc.,DJOrthopaedics,Linvatec, (3b. Brainlab, DePuy;6.Brainlab, DePuy) (2. Arthrex, Inc.,Paciﬁ cMedical;8. Arthroscopy, (n.) (1. Arthrex, Inc.;2. Arthrex, Inc.;3b. Arthrex, (n.) (n.) (2. Ferring Pharmaceutical) (n.) Multimedia FinancialDisclosure (8. Arthroscopy, BMCMusculoskeletal (8. InternationalSocietyof Arthroscopy, 251

Multimedia Financial Disclosure EOA 45th Annual MeetingAmelia Island, Florida2014

Alex R. Vap, BA (n.) Hugh Godfrey Watts , MD (n.) Nikhil N. Verma, MD (1. Smith & Nephew; 2. Arthrosurface; 3b. Smith Brian C. Werner, MD (n.) & Nephew, Arthrex, Inc.; 4. Omeros; 5. Arthrex, Inc., Smith & Nephew, Leo Whiteside, MD (1. Smith & Nephew, Stryker; 2. Smith & Nephew; Athletico, ConMed Linvatec, Miomed, Mitek, Arthrosurface; 7. Vindico 3b. Signal Medical Corp.; 3c. Smith & Nephew; 4. Signal Medical Corp.; Medical-Orthopedics Hyperguide, Arthroscopy; 8. Journal of Knee 8. Journal of Arthroplasty, Clinical Orthopaedics and Related Research, Surgery: Arthroscopy: SLACK Inc.; 9. Arthroscopy Association Learning Journal of Orthopaedics and Traumatology) Center Committee) James C. Wittig, MD (n.) Camilo E. Villalobos, MD (n.) Thomas W. Wright, MD (1. Exactech, Inc.; 5. Exactech, Inc.; 7. Wolters Bradford A. Wall, MD (n.) Kluwer Health - Lippincott Williams & Wilkins; 8. Journal of Hand Jon J.P. Warner, MD (1. Zimmer, Tornier; 6. Arthrocare, DJ Orthopaedics, Surgery – American) Arthrex, Inc., Mitek, Breg, Smith & Nephew) Adam B. Yanke, MD (n.) Ryan Warth, MD (n.) Zachary R. Zimmer, BA (n.)

252 C M E F O R M S

Eastern Orthopaedic Association

45th Annual Meeting October 23–25, 2014

The Ritz-Carlton Amelia Island, Florida

2014 CME Credit Record

Multimedia Education

Instructions: To ensure correct CME credit is awarded, please complete this form, indicating the DVDs you watched. Return this form to the EOA Registration Desk or complete the Credit Record online at www. eoa-assn.org. This form may also be mailed to EOA, 110 West Road, Suite 227, Towson, MD 21204. CME Certiﬁ cates will be awarded to all registered participants. Unless you have provided a legible email address, please allow up to 30 days to receive your CME certiﬁ cate.

Please Print:

Name:

Address:

City: State: Zip:

Phone: Fax:

Email Address:

Thank you for your cooperation. CME INFO

253 C M E F O R M S

2014 CME Credit Record Multimedia Education

Please place an × in the box by each DVD viewed and write any comments you may have in the space provided. You will be awarded hour per hour credit for time of participation.

DVD 1 (25 min) DVD 12 (10 min) DVD 23 (7 min) DVD 34 (21 min) DVD 45 (24 min) DVD 2 (11 min) DVD 13 (11 min) DVD 24 (7 min) DVD 35 (12 min) DVD 46 (15 min) DVD 3 (22 min) DVD 14 (14 min) DVD 25 (9 min) DVD 36 (17 min) DVD 47 (8 min) DVD 4 (12 min) DVD 15 (25 min) DVD 26 (18 min) DVD 37 (16 min) DVD 48 (14 min) DVD 5 (15 min) DVD 16 (13 min) DVD 27 (15 min) DVD 38 (19 min) DVD 49 (16 min) DVD 6 (11 min) DVD 17 (13 min) DVD 28 (21 min) DVD 39 (15 min) DVD 50 (18 min) DVD 7 (12 min) DVD 18 (8 min) DVD 29 (13 min) DVD 40 (20 min) DVD 51 (9 min) DVD 8 (12 min) DVD 19 (24 min) DVD 30 (12 min) DVD 41 (15 min) DVD 52 (8 min) DVD 9 (23 min) DVD 20 (18 min) DVD 31 (15 min) DVD 42 (10 min) DVD 53 (18 min) DVD 10 (25 min) DVD 21 (22 min) DVD 32 (26 min) DVD 43 (11 min) DVD 11 (9 min) DVD 22 (20 min) DVD 33 (12 min) DVD 44 (11 min)

Please indicate the DVD(s) you found to be most meaningful and any comments. Begin with the DVD number. ______

Please indicate any feedback that you may have concerning other DVDs. Begin with the DVD number. ______

Please indicate any comments or suggestions that you have regarding the Multimedia Presentations. ______CME INFO

254 C M E F O R M S

Eastern Orthopaedic Association 45th Annual Meeting October 23–25, 2014 The Ritz-Carlton Amelia Island, Florida 2014 CME Credit Record

Scientiﬁ c Program

Instructions: To ensure correct CME credit is awarded, please complete this form, indicating the Sessions you attended. Return this form to the EOA Registration Desk or go online to www.eoa-assn.org to complete the Credit Record. This form may also be mailed to EOA, 110 West Road, Suite 227, Towson, MD 21204. CME certiﬁ cates will be awarded to all registered participants. Unless you have provided a legible email address, please allow up to 30 days to receive your CME certiﬁ cate. Please Print: Name: Address: City: State: Zip: Phone: Fax: Email Address:

2014 CME Credit Record Scientiﬁ c Program

Please rate by circling the appropriate number: 5 = Excellent 4 = Good 3 = Satisfactory 2 = Fair 1 = Poor

Thursday, October 23, 2014

Presented objective balanced, & Satisﬁ ed my educational Sessions Check if Attended Achieved stated objectives scientiﬁ cally rigorous content and/or professional needs General Session 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 Symposia 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 Symposia 2 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 Rapid Fire Session 2A or Session 2B or Session 2C 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 or Session 2D or Session 2E

General Session 3 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 CME INFO

255 C M E F O R M S

Thursday, October 23, 2014 (Cont.)

Presented objective balanced, & Satisﬁ ed my educational Sessions Check if Attended Achieved stated objectives scientiﬁ cally rigorous content and/or professional needs General Session 4 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 Rapid Fire Session 5A or Session 5B or Session 5C 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 or Session 5D or Session 5E General Session 6 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1

Friday, October 24, 2014

Presented objective balanced, & Satisﬁ ed my educational Sessions Check if Attended Achieved stated objectives scientiﬁ cally rigorous content and/or professional needs

General Session 7 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1

Symposium 3 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1

Rapid Fire Session 8A or Session 8B or Session 8C 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 or Session 8D or Session 8E

Symposium 4 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1

General Session 9 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1

General Session 10 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 Rapid Fire Session 11A or Session 11B or Session 11C 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 or Session 11D or Session 11E

General Session 12 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1

Saturday, October 25, 2014

Presented objective balanced, & Satisﬁ ed my educational Sessions Check if Attended Achieved stated objectives scientiﬁ cally rigorous content and/or professional needs

General Session 13 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1

Symposium 5 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1

Symposium 6 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 Rapid Fire Session 14A or Session 14B or Session 14C 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 or Session 14D or Session 14E

General Session 15 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1

Symposium 7 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1

Rapid Fire Session 16A or Session 16B or Session 16C 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 or Session 16D

CME INFO or Session 16E

General Session 17 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1

256 C M E F O R M S

Eastern Orthopaedic Association

45th Annual Meeting October 23–25, 2014

The Ritz-Carlon Amelia Island, Florida

2014 CME Credit Record

Poster Presentations

Instructions: To ensure correct CME credit is awarded, please complete this form, indicating the posters viewed. Return this form to the EOA Registration Desk or go online to www.eoa-assn.org to complete the Credit Record. This form may also be mailed to EOA, 110 West Road, Suite 227, Towson, MD 21204. CME certiﬁ cates will be awarded to all registered participants. Unless you have provided a legible email address, please allow up to 30 days to receive your CME certiﬁ cate.

Please Print:

Name:

Address:

City: State: Zip:

Phone: Fax:

Email Address:

Thank you for your cooperation. CME INFO

257 C M E F O R M S

2014 CME Credit Record Poster Presentations

Please indicate posters viewed and include comments in the space provided. Each poster viewed will account for 10 minutes of CME credit. There is a maximum of 3 CME credits available during the course of the meeting for viewing posters (or a total 18 posters). Poster Sessions attended: (Please check the boxes of the poster sessions you attended).

1 7 13 19 25 2 8 14 20 26 3 9 15 21 27 4 10 16 22 28 5 11 17 23 29 6 12 18 24

Please indicate the poster(s) you found to be most meaningful and any comments. Begin with the poster number. ______

Please indicate any feedback that you may have concerning other posters. Begin with the poster number. ______

Please indicate any comments or suggestions that you have regarding the Poster Presentations. ______CME INFO

258 C M E F O R M S

2014 Overall Scientiﬁ c Evaluation

Your feedback is critical to program planning and future course development. Please take a few minutes to complete and return this evaluation form to the registration desk prior to departure.

High Some Little No Why did you choose to attend this Meeting? Importance Importance Importance Importance Course Topic(s) ...... Learning Method(s) ...... Program Faculty ...... Location of Program ...... Timeliness ...... Obtaining CME Credit ...... Poster Presentations ...... How did we do overall? Excellent Good Fair Poor Course Educational Objectives ...... Practical Application to Practice ...... Faculty Selection ...... Opportunity to Interact with Faculty ...... Course Syllabus ...... Opportunity to Ask Questions ...... Lighting, Seating, and General Environment . Course Length ...... Registration Fee ...... Refreshment Breaks, Food and Beverages . . . Lodging Accommodations ...... Cost of Lodging Accommodations ...... Overall Course Rating ...... How did we do on Poster Presentations? Excellent Good Fair Poor Poster Educational Objectives ...... Practical Application to Practice ...... Opportunity to Interact with Poster Presenter/Co-Author ...... Poster Syllabus Material ...... Opportunity to Ask Questions ......

Poster Location ...... CME INFO

259 C M E F O R M S

How did we do on Multimedia? Excellent Good Fair Poor Multimedia Educational Objectives ...... Practical Application to Practice ...... DVD Selection ...... Multimedia Location ......

The program content was: Just right Too Advanced Too basic

How much of the content was new to you? Almost all About 75% About 50%

About 25% Almost none

Would you recommend this meeting to colleagues? Yes No

Did you perceive industry (commercial) bias in this meeting? Yes No

If yes, describe ______

What I liked best about this meeting: ______

How I would improve this meeting: ______

Overall, did we deliver what you came to learn? Yes No

What did you learn from attending this meeting? List an example of something you learned that can be applied to your practice: ______

CME INFO

260 C M E F O R M S

2015 Needs Assessment Survey

Please list any medical topics that you would like included in future programs planned by EOA. ______

Please list any Ofﬁ ce Management Topics that you would like included in the program. ______CME INFO

261

Future Meetings 46th Annual Meeting June 17-20, 2015 Grand Wailea Maui, Hawaii

47th Annual Meeting October 19-22, 2016 The Ritz-Carlton New Orleans, Louisiana Grantor & Exhibitor Acknowledgements The Eastern Orthopaedic Association is grateful for the support of its educational grantors and exhibitors. Thank you for your participation and commitment to EOA. Platinum Pacira Pharmaceuticals, Inc. Gold ConvaTec, Inc. Mallinckrodt Pharmaceuticals - Hospital Division Silver Zimmer, Inc. — Grantor Bronze Arthrex, Inc. — Grantor Smith & Nephew, Inc. Copper Blue Belt Technologies Innovative Medical Products, Inc. CeramTec Medical Products Integrity Rehab Group ConforMIS Marathon Pharmaceuticals, LLC DePuy Synthes MES Solutions DJO Global, Inc. MicroAire Surgical Instruments Exactech, Inc. National Surgical Healthcare Ferring Pharmaceuticals Inc. Quill / Surgical Specialities Corp.