Max Ruiz

All Publications

• Utility of extended reality in shoulder arthroplasty: a meta-analysis of training efficiency and glenoid guidewire accuracy. Journal of shoulder and elbow arthroplasty Ruiz, M. L., Abrams, G. D., Freehill, M. T., Cheung, E. V. 2026; 10 (3): 100051

  Abstract

  Background: Extended reality (XR) has seen increased usage in shoulder arthroplasty for both intraoperative guidance and surgical training, but its impact on technical accuracy and performance has not been quantified across studies. The objective of this analysis was to determine the impact of XR on educational efficiency and glenoid guidewire placement error. Two separate meta-analyses of randomized or quasi-experimental studies were performed.Methods: Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses search guidelines, 24 studies were identified in XR-based shoulder surgery education. After applying inclusion, 3 studies involving 55 participants were meta-analyzed. Using the same Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 35 studies were identified in XR-guided shoulder arthroplasty. After applying inclusion criteria, 7 studies involving 349 guidewire placements were meta-analyzed.Results: In the surgical education studies, XR-trained participants completed procedures faster than controls, but OSAT (Objective Structured Assessment of Technical Skills) scores did not significantly differ. Across the glenoid guidewire studies, XR guidance reduced version error and inclination error versus freehand, but entry point error was not significantly different between XR-guided procedures and freehand.Conclusion: XR-based tools appear to offer meaningful benefits for shoulder arthroplasty, but their impact may be domain-specific. XR education may substantially improve operative efficiency, while XR guidance may enhance the angular accuracy of glenoid guidewire placement without clearly changing entry point error.

  View details for DOI 10.1016/j.jsea.2026.100051

  View details for PubMedID 42502475

• Evaluation of an AI-Driven Risk Stratification System for Clinical Deterioration in Geriatric Hip Fracture Patients. Journal of orthopaedic trauma Lin, C. Q., Ruiz, M., McLellan, M., Gardner, M. J. 2026

  Abstract

  OBJECTIVES: To determine whether an artificial-intelligence-driven Clinical Deterioration Index (CDI) could identify geriatric hip-fracture patients at risk of early postoperative complications and to establish an orthopaedic-specific cutoff that identified patients at risk of deterioration.METHODS: Design: Retrospective cohort study.SETTING: Single Level I trauma center.PATIENT SELECTION CRITERIA: Patients ≥ 65 years who underwent fixation of OTA/AO 31-A/B/C hip fractures between June 2022 and December 2023 were included using ICD-10 codes S72.0-, S72.1-, and S72.2-. Exclusion criteria were pathologic fracture, revision surgery, or absence of 30-day follow-up. The CDI uses 31 clinical measures to generate a score from 0-100 reflecting risk of rapid deterioration. Patients were separated into two groups based on peak CDI in the immediate 48-hour postoperative period: CDI ≥ 65 and CDI < 65. This cutoff of 65 was established by prior institutional validation.OUTCOME MEASURES AND COMPARISONS: Primary outcomes were in-hospital complications (cognitive changes, cardiac complications, DVT/PE, etc.). Secondary outcomes included length of stay, ambulation distance, and 1-year mortality. Outcomes were compared between CDI groups.RESULTS: Of 197 patients (age range 65-98, 66% female), 15 (7.6%) exceeded the baseline CDI threshold of 65. This group had higher complication rates (93.3% vs 26.4%, P < 0.001), prolonged hospital stays (10.1 vs 5.2 days, P = 0.047), reduced ambulation at discharge (8.8 vs 42.3 feet, P < 0.001), and increased one-year mortality (20.0% vs 3.8%, P = 0.02). CDI ≥ 65 was associated with post-operative complications (OR 37.9). The institutional cutoff of 65 offered high specificity (99.3%) but low sensitivity (22.6%). An optimized threshold (47.7) improved sensitivity (77.4%) with comparable accuracy (75.0%).CONCLUSIONS: An elevated Clinical Deterioration Index (CDI) ≥ 65 correlated with poor outcomes in geriatric hip fracture patients. Specialty-specific cutoffs showed potential to improve postoperative risk stratification and identification of higher-risk patients.LEVEL OF EVIDENCE: III (retrospective cohort study).

  View details for DOI 10.1097/BOT.0000000000003212

  View details for PubMedID 42047503