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  • SAGE Publications  (16)
  • Kamath, Atul F.  (16)
  • 1
    Online Resource
    Online Resource
    Effect of Angular Deformities of the Proximal Femur on Impingement-Free Hip Range of Motion in a Three-Dimensional Rigid Body Model
    SAGE Publications ; 2015
    In:  HIP International Vol. 25, No. 6 ( 2015-11), p. 574-580
    Details
    In: HIP International, SAGE Publications, Vol. 25, No. 6 ( 2015-11), p. 574-580
    Abstract: Abnormalities in hip morphology can reduce range of motion (ROM) through femoroacetabular impingement (FAI). Structural issues, such as asphericity of the head-neck junction and regional or global acetabular over-coverage, have been extensively discussed in the literature. The effect of varying femoral neck-shaft angle or torsion on native hip range of motion, however, has been poorly studied. Our hypothesis was that varying neck-shaft angles or femoral torsion affect the impingement-free ROM of the hip and can be treated by femoral osteochondroplasty or acetabular rim resection. Material and methods A computer-aided design tool and a 3-D model of the hip were used to simulate incremental deformation of the proximal femur. Neck-shaft angles ranging from 90-160°, and femoral torsions ranging from -15-50°, were created. Femoroacetabular impingement was defined as bone-to-bone contact within physiological hip ROM, as described in the literature. Results and conclusion With decreasing neck-shaft angles (≤110°) or femoral torsion (≤10°), impingement occurred at the anterosuperior rim area. With increasing neck-shaft angles (≥135°) and femoral torsion (≥25°) posteroinferior or ischiofemoral impingement occurred. Acetabular rim trimming could compensate for neck-shaft angles ≥90° and femoral torsion ≥-5°, without creating acetabular dysplasia. Femoral impingement zones in low neck-shaft and low femoral torsion angles were found to be distal to the head-neck junction at the mid-cervical region. The cross-sectional area at this neck region was the smallest, and thus osteochondroplasty at this location may prove potentially dangerous.
    Type of Medium: Online Resource
    ISSN: 1120-7000 , 1724-6067
    URL: Article
    DOI: 10.5301/hipint.5000260
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2015
    detail.hit.zdb_id: 1475775-8
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  • 2
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    Total Hip Arthroplasty Outperforms Hemiarthroplasty in Patients Aged 65 Years and Older: A Propensity-Matched Study of Short-Term Outcomes
    SAGE Publications ; 2019
    In:  Geriatric Orthopaedic Surgery & Rehabilitation Vol. 10 ( 2019-01-01), p. 215145931987685-
    Details
    In: Geriatric Orthopaedic Surgery & Rehabilitation, SAGE Publications, Vol. 10 ( 2019-01-01), p. 215145931987685-
    Abstract: Displaced femoral neck fractures in the elderly individuals may be treated with total hip arthroplasty (THA) or hip hemiarthroplasty (HHA). However, it is unclear what the short-term medical outcomes are related to these surgical options. The purpose of this study was to compare early postoperative outcomes in THA patients to those of HHA patients. Methods: In this study, we compared 30-day mortality, likelihood of still being in the hospital at 30 days, postoperative major and minor complications, discharge disposition, reoperation and readmission, length of stay, days from admission to surgery, and operative time between THA and HHA. Using the American College of Surgeons National Surgical Quality Improvement Project database, hip fracture patients ≥65 years old from 2008 to 2016 were identified. After propensity score matching, there were 2795 THAs and 2795 HHAs. To assess the effect of THA on the above-mentioned outcomes, bivariate regression models were created. Results: The THA patients ≥65 years old were at reduced risk for mortality ( P = .029) and still being in the hospital at 30 days ( P = .017). The THA patients were at an increased risk for minor complications ( P = .011) and longer operative times ( P 〈 .001). However, THA patients were more likely to have a home discharge ( P 〈 .001). Discussion: Patients ≥65 years who underwent THA for hip fractures had reduced short-term mortality risk, were more likely to be discharged home, and had less likelihood of being in the hospital at 30 days. This is the first study to explore short-term outcomes in patients ≥65 and has direct implications for alternate payment and merit-based payment models. Conclusion: As hip fracture treatment has come under scrutiny with respect to alternate payment models and merit-based incentive payments, this analysis of short-term outcomes warrants consideration when evaluating treatment pathways.
    Type of Medium: Online Resource
    ISSN: 2151-4593 , 2151-4593
    URL: Article
    DOI: 10.1177/2151459319876854
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2019
    detail.hit.zdb_id: 2589094-3
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  • 3
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    Extreme Hinge Axis Positions Are Necessary to Achieve Posterior Tibial Slope Reduction With Small Coronal-Plane Corrections in Medial Opening Wedge High Tibial Osteotomy
    SAGE Publications ; 2022
    In:  Orthopaedic Journal of Sports Medicine Vol. 10, No. 5 ( 2022-05-01), p. 232596712210943-
    Details
    In: Orthopaedic Journal of Sports Medicine, SAGE Publications, Vol. 10, No. 5 ( 2022-05-01), p. 232596712210943-
    Abstract: Both coronal- and sagittal-plane knee malalignment can increase the risk of ligamentous injuries and the progression of degenerative joint disease. High tibial osteotomy can achieve multiplanar correction, but determining the precise hinge axis position for osteotomy is technically challenging. Purpose: To create computed tomography (CT)–based patient-specific models to identify the ideal hinge axis position angle and the amount of maximum opening in medial opening wedge high tibial osteotomy (MOWHTO) required to achieve the desired multiplanar correction. Study Design: Descriptive laboratory study. Methods: A total of 10 patients with lower extremity CT scans were included. Baseline measurements including the mechanical tibiofemoral angle (mTFA) and the posterior tibial slope (PTS) were calculated. Virtual osteotomy was performed to achieve (1) a specified degree of PTS correction and (2) a planned degree of mTFA correction. The mean hinge axis position angle for MOWHTO to maintain an anatomic PTS (no slope correction) was 102.6° ± 8.3° relative to the posterior condylar axis (PCA). Using this as the baseline correction, the resultant hinge axis position and maximum opening were then calculated for each subsequent osteotomy procedure. Results: For 5.0° of mTFA correction, the hinge axis position was decreased by 6.8°, and the maximum opening was increased by 0.49 mm for every 1° of PTS correction. For 10.0° of mTFA correction, the hinge axis position was decreased by 5.2°, and the maximum opening was increased by 0.37 mm for every 1° of PTS correction. There was a significant difference in the trend-line slopes for hinge axis position versus PTS correction ( P = .013) and a significant difference in the trend-line intercepts for maximum opening versus PTS correction ( P 〈 .0001). Conclusion: The mean hinge axis position for slope-neutral osteotomy was 102.6° ± 8.3° relative to the PCA. For smaller corrections in the coronal plane, more extreme hinge axis positions were necessary to achieve higher magnitudes of PTS reduction. Clinical Relevance: Extreme hinge axis positions are technically challenging and can lead to unstable osteotomy. Patient-specific instrumentation may allow for precise correction to be more readily achieved.
    Type of Medium: Online Resource
    ISSN: 2325-9671 , 2325-9671
    URL: Article
    DOI: 10.1177/23259671221094346
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2706251-X
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  • 4
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    Multi-axial correction system in the treatment of radial club hand
    SAGE Publications ; 2009
    In:  Journal of Children's Orthopaedics Vol. 3, No. 6 ( 2009-12), p. 493-498
    Details
    In: Journal of Children's Orthopaedics, SAGE Publications, Vol. 3, No. 6 ( 2009-12), p. 493-498
    Abstract: Radial club hand is a well-recognized congenital malformation characterized by hypoplasia of bone and soft tissue on the radial aspect of the forearm and hand. The modalities of treatment have traditionally varied from stretching casts with soft-tissue procedures to the use of multiple corrective osteotomies. These osteotomies can be stabilized by a variety of methods, including external fixators that allow the possibility of gradual distraction with neohistiogenesis. This current study outlines the usage of one such device (multi-axial correction system [MAC]) in the management of deformity associated with severe radial club hand. Methods Three consecutive cases of unilateral or bilateral severe (Bayne type IV) congenital radial club hand were corrected using MAC fixation in the last 5 years. This is a retrospective review of all three cases. Data parameters included: patient demographics, presentation findings, degree of deformity, amount of correction/lengthening, length of procedure, length of treatment, and associated complications. The surgical technique is described in detail for the benefit of the readership. Results The three patients with severe congenital radial club hand had a total of four limb involvements that underwent correction using osteotomies and usage of the MAC device for external fixation. All three patients underwent successful correction of deformity with the restoration of alignment, lengthening of forearm for improvement of function, and stabilization of the wrist (mean duration, mean lengthening, mean time to consolidation). The MAC system was well tolerated in all patients and associated complications were limited. Conclusion The MAC fixator seems to be a good alternative modality of stabilization and correction for severe congenital radial club hand deformities. Its usage is fairly simple and it provides the ease of application of a mono-lateral fixator with far superior three-dimensional control, like the circular external fixator. We recommend that clinicians should add this modality to their armamentarium for the deformity correction of severe radial club hand and others in general.
    Type of Medium: Online Resource
    ISSN: 1863-2521 , 1863-2548
    URL: Article
    DOI: 10.1007/s11832-009-0196-3
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2009
    detail.hit.zdb_id: 2268264-8
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  • 5
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    Patient Engagement Approaches in Total Joint Arthroplasty: A Review of Two Decades
    SAGE Publications ; 2021
    In:  Journal of Patient Experience Vol. 8 ( 2021-01), p. 237437352110365-
    Details
    In: Journal of Patient Experience, SAGE Publications, Vol. 8 ( 2021-01), p. 237437352110365-
    Abstract: Patient engagement is a comprehensive approach to health care where the physician inspires confidence in the patient to be involved in their own care. Most research studies of patient engagement in total joint arthroplasty (TJA) have come in the past 5 years (2015-2020), with no reviews investigating the different patient engagement methods in TJA. The primary purpose of this review is to examine patient engagement methods in TJA. The search identified 31 studies aimed at patient engagement methods in TJA. Based on our review, the conclusions therein strongly suggest that patient engagement methods in TJA demonstrate benefits throughout care delivery through tools focused on promoting involvement in decision making and accessible care delivery (eg, virtual rehabilitation, remote monitoring). Future work should understand the influence of social determinants on patient involvement in care, and overall cost (or savings) of engagement methods to patients and society.
    Type of Medium: Online Resource
    ISSN: 2374-3735 , 2374-3743
    URL: Article
    DOI: 10.1177/23743735211036525
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
    detail.hit.zdb_id: 2857285-3
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  • 6
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    Hip Arthroscopy in Smokers: A Systematic Review of Patient-Reported Outcomes and Complications in 18,585 Cases
    SAGE Publications ; 2021
    In:  The American Journal of Sports Medicine Vol. 49, No. 4 ( 2021-03), p. 1101-1108
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 49, No. 4 ( 2021-03), p. 1101-1108
    Abstract: Although the negative effects of smoking have been documented for other types of arthroscopic procedures, there is limited information regarding its influence on hip arthroscopy outcomes. Purpose: To examine the effect of smoking on the following outcomes after hip arthroscopy: patient-reported outcomes (PROs), the degree of improvement in PROs relative to baseline, complication rates, and rates of revision arthroscopy and/or conversion to total hip arthroplasty (THA). Study Design: Systematic review. Methods: The PubMed, Embase, and Cochrane Library databases were queried for studies published between January 1, 1985, and January 14, 2020, comparing the outcomes of hip arthroscopy between smokers and nonsmokers. Case reports, basic science studies, and studies investigating pediatric patients or lacking a description of outcomes were excluded. Included outcome tools were the modified Harris Hip Score, the visual analog scale (VAS) for pain and satisfaction, and the Hip Outcome Score (HOS)–Sports Specific and HOS–Activities of Daily Living. Preoperative characteristics and operative indications were also recorded. Results: Postoperative combined means (± SD) were better in nonsmokers versus smokers for the modified Harris Hip Score (75.67 ± 20.88 vs 82.32 ± 15.5; P = .001), the VAS pain (3.13 ± 2.79 vs 2.13 ± 2.21; P 〈 .001), and the HOS–Sports Specific (62.54 ± 25.38 vs 71.7 ± 23.3; P 〈 .001). There was no difference between groups in VAS satisfaction ( P = .23) or HOS–Activities of Daily Living ( P = .13). The extent of PRO score improvement relative to baseline values was similar in smokers and nonsmokers in all PRO measures ( P 〉 .05 for all). Smokers demonstrated higher rates of postoperative thromboembolic ( P = .0177) and infectious ( P = .006) complications. There was no difference between rates of revision arthroscopy ( P = .47) and THA conversion ( P = .31). Conclusion: Smoking adversely affects certain postoperative PROs and is associated with higher postoperative complication rates. Further studies are required investigating the degree of PRO improvement and long-term arthroscopy revision and THA conversion rates.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/0363546520922854
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
    detail.hit.zdb_id: 2063945-4
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  • 7
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    Venture Capital Investment in Orthopaedics: Has the Landscape Changed over the Past Two Decades (2000–2019)?
    SAGE Publications ; 2022
    In:  Surgical Innovation Vol. 29, No. 1 ( 2022-02), p. 103-110
    Details
    In: Surgical Innovation, SAGE Publications, Vol. 29, No. 1 ( 2022-02), p. 103-110
    Abstract: Background. Innovations in orthopaedic technologies often require significant funding. Although an increasing trend has been observed for third-party investments in other medical fields, no study has examined the influence of venture capital (VC) funding in orthopaedics. Therefore, this study analyzed trends in VC investments related to the field of orthopaedic surgery, as well as the characteristics of recipients of these investments. Methods. Venture capital investments into orthopaedic-related businesses were reviewed from 2000 to 2019 using Capital IQ, a proprietary intelligence platform documenting financial investments. Metrics categorized were investments by year, investment amount, and subspecialty domain as per the American Academy Orthopaedic Surgeons website. The compound annual growth rate (CAGR) for both quantity and dollar amount of investments was calculated over the study period and the two decade-long periods (2000–2009 and 2010–2019). Results. Over two decades, 673 VC investments took place, involving a total of US$3.5 billion. Both the number and dollar value of investments were greater in the second decade (440, US$1.9 billion), compared to the first decade (233, US$1.6 billion). Both quantity and dollar amount of VC investments grew over the first decade, with a CAGR 9.53% and 4.97%, respectively. However, investment growth declined in the latter decade. The largest and most frequent investments took place within spine surgery and adult reconstruction. Conclusion. An initially rising trend in VC investment in orthopaedic-related businesses may have plateaued over the past decade. These findings may have important implications for continued investment into orthopaedic innovations and collaboration between the surgical community and private sector.
    Type of Medium: Online Resource
    ISSN: 1553-3506 , 1553-3514
    URL: Article
    DOI: 10.1177/15533506211031072
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2233576-6
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  • 8
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    High Rates of Occult Infection After Shoulder Fracture Fixation: Considerations for Conversion Shoulder Arthroplasty
    SAGE Publications ; 2015
    In:  HSS Journal ® Vol. 11, No. 3 ( 2015-10), p. 198-203
    Details
    In: HSS Journal ®, SAGE Publications, Vol. 11, No. 3 ( 2015-10), p. 198-203
    Type of Medium: Online Resource
    ISSN: 1556-3316 , 1556-3324
    URL: Article
    DOI: 10.1007/s11420-015-9450-z
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2015
    detail.hit.zdb_id: 2210985-7
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  • 9
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    Hip Arthroscopy for Labral Tears : Review of Clinical Outcomes with 4.8-Year Mean Follow-Up
    SAGE Publications ; 2009
    In:  The American Journal of Sports Medicine Vol. 37, No. 9 ( 2009-09), p. 1721-1727
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 37, No. 9 ( 2009-09), p. 1721-1727
    Abstract: Arthroscopy of the hip joint is a relatively new diagnostic and therapeutic option for labral tears. Purpose More data are needed to characterize the utility and effectiveness of hip arthroscopy and identify patient-related factors that might predict functional outcome. Study Design Case series; Level of evidence, 4. Methods This retrospective study with prospective follow-up examined the clinical outcomes of 52 consecutive patients undergoing hip arthroscopy for labral tears. Outcomes measures included clinical outcome and the modified Harris hip score. Any complications associated with the procedure were recorded. Exclusion criteria included age younger than 18 years or prior ipsilateral hip surgery. Results Mean patient age was 42 years. Mean follow-up was 4.8 years. Twenty-one patients (40.4%) had a traumatic cause of the labral tears. Eight patients (15.4%) had possible secondary gain issues. Four (7.7%) patients suffered transient nerve palsies; in 1 case, the guide wire broke during initial cannulation. Three patients (5.8%) went on to total hip arthroplasty after hip arthroscopy. On multivariate analysis, left-sided surgery, a higher preoperative activity level, and duration of symptoms greater than 18 months were found to be positive predictors of good or excellent outcomes. Smoking and secondary gain issues were significant negative predictors of good or excellent outcomes. Only prior level of activity was a significant positive predictor of return to activity after surgery. A traumatic cause of the labral tear was a significant negative predictor of return to activity. Chondromalacia and osteoarthritis were not significant predictors of negative outcome. Postoperative modified Harris hip score improved 40% from 56.8 preoperatively to 80.4 (P 〈 .001). No cases of patients with secondary gain issues achieved good or excellent outcomes. Overall percentage of good or excellent outcomes was 56%, or 66% when those with secondary gain issues were excluded; 84% of patients were able to return to sports or equivalent level of preoperative recreational activity. Neither preoperative radiographic osteoarthritis nor grade of intraoperative chondromalacia predicted postoperative outcome. Conclusion This series supports the hypothesis that hip arthroscopy provides safe and reliable improvement of labral symptoms in the majority of patients.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/0363546509333078
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2009
    detail.hit.zdb_id: 2063945-4
    SSG: 31
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  • 10
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    Open reduction of medial epicondyle fractures: Operative tips for technical ease
    SAGE Publications ; 2009
    In:  Journal of Children's Orthopaedics Vol. 3, No. 4 ( 2009-08), p. 331-336
    Details
    In: Journal of Children's Orthopaedics, SAGE Publications, Vol. 3, No. 4 ( 2009-08), p. 331-336
    Abstract: In the pediatric population, medial humeral epicondylar fractures account for nearly 12% of all elbow fractures. There is ongoing debate about the surgical management of medial epicondyle fracture cases. Our technique in the operative management of medial epicondyle fractures uses the external application of an Esmarch bandage, as well as provisional fixation with needle rather than K-wire fixation. This technique decreases the need for soft-tissue release and, therefore, theoretically, maintains soft-tissue vascularity of the small fracture fragments. Moreover, it preserves the soft-tissue tension medially. It involves the use of a bandage that is universally available in orthopedic operating rooms, including those in developing nations. It is easy to apply by either the principal or assisting surgeon. With practice, it cuts down operative time and can help substitute for an assistant. This relatively simple operative technique makes for a more seamless operative process, improved reduction, and key preservation of soft-tissue vascularity.
    Type of Medium: Online Resource
    ISSN: 1863-2521 , 1863-2548
    URL: Article
    DOI: 10.1007/s11832-009-0185-6
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2009
    detail.hit.zdb_id: 2268264-8
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