Monique Chambers, MD, MSL

All Publications

• Personality Characteristics of Orthopedic Surgery Residents and Faculty: Cross-Sectional Study From the Profiling Orthopaedic Surgery Trainees (POST) Study Group. Journal of surgical education Davie, R. A., Harrison, N., Pool, R. N., Rosopa, P. J., Tanner, S. L., Scannell, B., Hartley, B., Aleem, A. W., Ode, G. E. 2025; 82 (8): 103538

  Abstract

  There is growing interest in the assessments of noncognitive and affective domains in orthopedic trainees to aid in resident education, improve interpersonal relationships between residents and faculty, and improve physician leadership skills.1-5 The purpose of this study is to examine personality traits of orthopedic trainees and faculty using the Big Five personality dimensions.The Big Five was administered to residents (n = 151) and faculty (n = 57) at 10 academic medical institutions. Descriptive statistics were analyzed including the means of each Big Five dimension among residents and faculty. Independent samples t-tests and chi-square analyses were performed.Faculty were significantly greater on Conscientiousness compared to residents (M = 74.7 vs 69.8, d = 0.33) and significantly greater among seniors than juniors (M = 74.0 vs 68.0, d = 0.42). Juniors demonstrated greater Extraversion compared to faculty (M = 61.9 vs. 52.2, d = 0.30). Faculty demonstrated greater Agreeableness than seniors (M = 68.5 vs 63.0, d = 0.44).There are significant differences in certain Big Five personality dimensions between orthopedic residents and faculty. Better understanding of how these differences could influence interpersonal communication during orthopedic training is critical to improving interconnection in residency programs.

  View details for DOI 10.1016/j.jsurg.2025.103538

  View details for PubMedID 40381338

• Examining the Outliers: Characteristics of the Most and Least Diverse Programs in Orthopaedics. The Journal of the American Academy of Orthopaedic Surgeons Oladimeji, A., Chambers, M., Kelly, T. N., Hidaka, C., Ode, G. E. 2025; 33 (10): e551-e562

  Abstract

  In 2021, the American Orthopaedic Association (AOA) Orthopaedic Research Information Network (ORIN)was created to give applicants insight into orthopaedic surgery residency programs nationwide. This study uses this database to investigate the characteristics of residency programs based on their proportion of female and underrepresented minority in medicine (URiM) trainees.The number and proportion of URiM and female residents at 172 programs during the 2020-2021 academic year and 179 programs each during the 2021-2022 and 2022-2023 academic years were recorded. Each program was ranked based on the proportion of URiM or female residents and grouped into quintiles and deciles. Characteristics of programs (institution type, proportion of URiM or female faculty, United States Medical Licensing Exam (USMLE) scores, American Board of Orthopedic Surgery (ABOS) Part I board pass rates) were compared between the top and bottom deciles or quintiles.Programs among the top decile for URiM representation had a mean 35% representation, whereas representation in the bottom decile ranged from 0% to 7%. Programs within the top decile for female representation ranged from a mean of 35% to 40%. The mean proportion of female residents among the bottom decile ranged from 0% to 7%. Top decile programs for racial diversity had a greater proportion of URiM faculty, whereas those in the top decile for female representation had more female faculty compared with bottom decile counterparts. Only four programs were in the top decile for both URiM and female representation. Top and bottom decile programs differed little regarding USMLE scores or ABOS Part I pass rates of their residents.The results of this study support the notion that recruitment and retention methods among programs with more female and URiM representation are potentially different. In addition, programs with more diverse faculties tend to have more diverse residency classes and that programs with the highest and lowest diversity do not differ regarding standardized testing scores among matriculated residents.

  View details for DOI 10.5435/JAAOS-D-24-00475

  View details for PubMedID 40101172

• Total Hip Arthroplasty in Black/African American Patients: an Updated Nationwide Analysis. Journal of racial and ethnic health disparities Sheth, M., Chambers, M., Gronbeck, C., Harrington, M. A., Halawi, M. J. 2021; 8 (3): 698-703

  Abstract

  The purpose of this was to investigate recent trends in procedure utilization, comorbidity profiles, hospital length of stay (LOS), 30-day outcomes, and risk factors for adverse events (AEs) among Black patients undergoing total hip arthroplasty (THA).Using the American College of Surgeons National Surgery Quality Improvement Program, we retrospectively reviewed all Black patients who underwent elective, primary THA between 2011 and 2017. Mixed effects logistic regression analyses were performed to determine the trends in the study outcomes across each individual year. Multivariate logistic regression analyses were performed to identify independent risk factors for AEs.A total of 11,574 Black patients were analyzed. Over the study period, there was an increase by 109% in THA procedures performed in this racial group. During the same time, there were reductions in the prevalence of anemia, dyspnea, tobacco smoking, and osteonecrosis (p < 0.001). The rates of 30-day surgical complications, readmissions, reoperations, and mortality remained unchanged. Only the rate of medical complications demonstrated improvement, driven by a decrease in the incidence of postoperative myocardial infarction (p < 0.001). There was also a significant reduction in LOS > 2 days (68 to 37%, p < 0.001). Independent risk factors for AEs were body mass index > 35, American Society of Anesthesiologists score > 2, dependent functional status, diabetes, bleeding disorders, chronic kidney disease, and osteonecrosis as the surgical indication.Between 2011 and 2017, there were improving trends in procedure utilization, comorbidity profiles, and LOS among Black patients undergoing primary THA, but the overall rates of 30-day outcomes remained unchanged. We identified a number of risk factors that may help guide preoperative optimization and patient counseling to mitigate postoperative AEs.

  View details for DOI 10.1007/s40615-020-00829-0

  View details for PubMedID 32725608

  View details for PubMedCentralID 2592576

• Gender and Total Joint Arthroplasty: Variable Outcomes by Procedure Type. Arthroplasty today Patel, A. P., Gronbeck, C., Chambers, M., Harrington, M. A., Halawi, M. J. 2020; 6 (3): 517-520

  Abstract

  Recent reports on the influence of gender on the outcomes of total joint arthroplasty were limited by either lack of longitudinal data or absent stratification by total hip arthroplasty (THA) or total knee arthroplasty (TKA). As a result, there remains a lack of clarity on this topic.The American College of Surgeons National Surgical Quality Improvement Program was queried for all primary, elective THAs and TKAs performed between 2011 and 2017. Differences in demographics, comorbidity profiles, operative time, hospital length of stay (LOS), and 30-day outcomes were compared between male and female patients. Multivariate analyses were performed separately for THA and TKA.A total of 418,885 patients were analyzed; 59.1% were females. Compared with males, females were likely to be older, have a higher body mass index, identify as nonwhite, and require preoperative functional assistance (P < .001). Females had lower rates of diabetes, hypertension, anemia, and kidney disease but a higher rate of chronic steroid use (P < .001). They were also likely to have shorter operative times for both THA and TKA (P < .001). After controlling for the aforementioned differences, female gender was an independent risk factor for readmission, reoperation, and wound infection after THA (P < .001). In contrast, male sex was an independent risk factor for readmission, reoperation, and overall complications after TKA (P < .001). Regardless of the procedure, females were 64%-82% more likely to require an LOS >2 days than males.A variable effect of gender was observed on the post-total joint arthroplasty LOS and outcomes depending on the procedure type (THA or TKA). Differences attributed to gender should be accounted for in risk-stratification models. Future studies are also needed to elucidate the underlying causes of gender differences in joint arthroplasty.

  View details for DOI 10.1016/j.artd.2020.06.012

  View details for PubMedID 32743033

  View details for PubMedCentralID PMC7387670

• Total Knee Arthroplasty in Ambulatory Surgery Centers: The New Reality! Arthroplasty today Chambers, M., Huddleston, J. I., Halawi, M. J. 2020; 6 (2): 146–48

  Abstract

  By streamlining surgical care and eliminating postoperative hospitalization, the transition to ambulatory total knee arthroplasty (TKA) has the potential to improve efficiency and minimize the costs of care. However, practical, legal, and financial implications remain to be addressed. The Centers for Medicare and Medicaid Services has also yet to address concerns generated by the removal of TKA from the Inpatient-Only List and provide guidance on patient selection. Rolling out regulatory changes that impact high-volume procedures, such as TKA, in a short period of time and without appropriate feedback can only lead to further confusion. As surgeons, we are in a unique business model that requires us to constantly innovate to deliver high quality care, while also taking financial cuts as a result of our innovations.

  View details for DOI 10.1016/j.artd.2020.03.004

  View details for PubMedID 32346586

• Biologic Adjuvants for the Management of Osteochondral Lesions of the Talus. The Journal of the American Academy of Orthopaedic Surgeons Hogan, M. V., Hicks, J. J., Chambers, M. C., Kennedy, J. G. 2019; 27 (3): e105-e111

  Abstract

  Surgical techniques for the management of recalcitrant osteochondral lesions of the talus have improved; however, the poor healing potential of cartilage may impede long-term outcomes. Repair (microfracture) or replacement (osteochondral transplants) is the standard of care. Reparative strategies lead to production of fibrocartilage, which, compared with the native type II articular cartilage, has decreased mechanical and wear properties. The success of osteochondral transplants may be hindered by poor integration between grafts and host that results in peripheral cell death and cyst formation. These challenges have led to the investigation of biologic adjuvants to augment treatment. In vitro and in vivo models have demonstrated promise for cartilage regeneration by decreasing inflammatory damage and increasing the amount of type II articular cartilage. Further research is needed to investigate optimal formulations and time points of administration. In addition, clinical trials are needed to investigate the long-term effects of augmentation.

  View details for DOI 10.5435/JAAOS-D-16-00840

  View details for PubMedID 30431502

• The role of biologic in foot and ankle trauma-a review of the literature. Current reviews in musculoskeletal medicine Zhao, E., Carney, D., Chambers, M., Ewalefo, S., Hogan, M. 2018; 11 (3): 495-502

  Abstract

  The use of biologics in orthopedics is becoming increasingly popular as an adjuvant in healing musculoskeletal injuries. Though many biologics involved in the management of foot and ankle injuries are used based on physician preference, reports of improved outcomes when combined with standard operative treatment has led to further clinical interest especially in foot and ankle trauma.The most recent studies have shown benefits for biologic use in patients predisposed to poor bone and soft tissue healing. Biologics have shown benefit in treating soft tissue injuries such as Achilles ruptures as well as the complications of trauma such as non-unions and osteoarthritis. Biologics have shown some benefit in improving functional and pain scores, as well as reducing time to heal in foot and ankle traumatic injuries, with particular success shown with patients that have risk factors for poor healing. As the use of biologics continues to increase, there is a need for high-level studies to confirm early findings of lower level reports.

  View details for DOI 10.1007/s12178-018-9512-1

  View details for PubMedID 30054808

  View details for PubMedCentralID PMC6105477

• Bone Bruise Patterns in Skeletally Immature Patients With Anterior Cruciate Ligament Injury: Shock-Absorbing Function of the Physis. The American journal of sports medicine Novaretti, J. V., Shin, J. J., Albers, M., Chambers, M. C., Cohen, M., Musahl, V., Fu, F. H. 2018; 46 (9): 2128-2132

  Abstract

  Bone bruises are frequently found on magnetic resonance imaging (MRI) after anterior cruciate ligament (ACL) injury and have been related to the force associated with the trauma. Yet, little is known about the bone bruise distribution pattern of skeletally immature (SI) patients, as the presence of an open physis may play a role in energy dissipation given its unique structure.To describe and compare the location and distribution of tibial and femoral bone bruises, observed on MRI, between 2 groups of ACL-injured knees: the first group with an open physis and the second with a closed physis. Additionally, based on the bone bruise distribution pattern, the secondary aim of the study was to propose a new classification of bone bruise in SI patients.Cross-sectional study; Level of evidence, 3.A retrospective review was conducted to identify all cases of primary ACL tears in patients ≤16 years old, with MRI within 6 weeks of injury between January 2012 and December 2016. Overall, 106 patients were identified: 53 with open physis (skeletally immature [SI] group) and 53 with closed physis as control (skeletally mature [SM] group). MRI scans were reviewed to assess for the presence and location of bone bruises. Longitudinal bone bruise distribution was described as epiphyseal and metaphyseal in both femur and tibia. The proposed classification for tibia and femur has 2 parts: the location of the bone bruise in the (I) lateral, (II) medial, or (III) medial and lateral parts of the bone; and if the bone bruise (a) does not or (b) does cross the physis. For the tibia, if the bone bruise is also present in the central portion, a letter C is added.The SI group had significantly fewer bone bruises cross the physis and extend into the metaphysis than did the SM group for both the tibia (25% vs 85%, respectively; P < .0001) and the femur (4% vs 42%; P < .0001). The most common patterns observed in the SI group were type IIICa in the tibia (medial/lateral and central, not extending into the metaphysis: 42%) and type Ia in the femur (lateral, not extending into the metaphysis: 59%).The data from this study shows that patients with an open physis at the occurrence of an acute ACL rupture have unique bone bruise patterns as compared with those with a closed physis. In the SI patients, the bone bruise pattern is significantly less frequently observed in the tibial and femoral metaphysis.

  View details for DOI 10.1177/0363546518777247

  View details for PubMedID 29883199

• Pipeline program recruits and retains women and underrepresented minorities in procedure based specialties: A brief report. American journal of surgery Mason, B. S., Ross, W., Chambers, M. C., Grant, R., Parks, M. 2017; 213 (4): 662-665

  Abstract

  As the US population continues to grow in racial and ethnic diversity, we also continue to see healthcare disparities across racial lines. Considerable attention has been given to creating a physician workforce that better reflects the population served by healthcare professionals. To address the low numbers of women and underrepresented minorities in procedural based specialties, Nth Dimensions has sought to address and eliminate healthcare disparities through strategic pipeline initiatives. This is a retrospective observational cohort study of 118 medical students from 29 accredited US medical schools, who were awarded a position in the Nth Dimensions Summer Internship program between 2005 and 2012. Overall, 84 NDSI scholars applied and 81 matched into procedure-based specialties; therefore the overall retention rate was 75% and the overall match rate across the eight cohorts was 72.3%. Through intervention-based change, the authors hypothesize that greater numbers in the residency training cohorts can lead to a greater number of physicians with diverse backgrounds and perspectives. Ultimately, this will enhance quality of care for all patients and improve decision making process that influence healthcare systems.Strategic pipeline programs increase successful recruit women and underrepresented minorities to apply and matriculate into procedure based residency programs. This is a retrospective observational cohort study of 118 medical students who completed the Nth Dimensions Summer Internship program between 2005 and 2012. Overall, 84 NDSI scholars applied and 81 matched into procedure-based specialties; therefore the overall retention rate was 75% and the overall match rate across the eight cohorts was 72.3%.

  View details for DOI 10.1016/j.amjsurg.2016.11.022

  View details for PubMedID 28302274

• Two-Stage Revision Total Knee Arthroplasty in the Setting of Periprosthetic Knee Infection. Instructional course lectures Sayeed, Z., Anoushiravani, A. A., El-Othmani, M. M., Chambers, M. C., Mihalko, W. M., Jiranek, W. A., Paprosky, W. G., Saleh, K. J. 2017; 66: 249-262

  Abstract

  Two-stage revision total knee arthroplasty (TKA) is the standard of care for patients who require a revision procedure for the mangement of a late or chronic periprosthetic knee infection. A careful examination of two-stage revision TKA is warranted as the number of patients who require revision TKA in the United States continues to rise. Surgeons should understand the intricacies involved in two-stage revision TKA, including the indications, procedural variations, and current deliberations on two-stage revision TKA in the literature. Surgeons also should understand the alternative treatments for periprosthetic knee infections.

  View details for PubMedID 28594503

• Single-Stage Revision Total Knee Arthroplasty in the Setting of Periprosthetic Knee Infection: Indications, Contraindications, and Postoperative Outcomes. Instructional course lectures Anoushiravani, A. A., Sayeed, Z., El-Othmani, M. M., Chambers, M. C., Mihalko, W. M., Jiranek, W. A., Paprosky, W. G., Saleh, K. J. 2017; 66: 235-247

  Abstract

  Single-stage revision total knee arthroplasty has become an increasingly common treatment option for patients with failed knee prostheses. Periprosthetic knee infection is the leading and most devastating cause of revision total knee arthroplasty. Although periprosthetic knee infection has been extensively studied in the orthopaedic literature, the role of single-stage revision total knee arthroplasty for the treatment of periprosthetic knee infection warrants further research. As healthcare reform shifts from a volume-based to a value-based system, it is imperative that orthopaedic surgeons understand the procedural indications, risks, and benefits of single-stage revision total knee arthroplasty.

  View details for PubMedID 28594502

• Effect of Time of Operation on Hip Fracture Outcomes: A Retrospective Analysis. The Journal of the American Academy of Orthopaedic Surgeons Barinaga, G., Wright, E., Cagle, P. J., Anoushiravani, A. A., Sayeed, Z., Chambers, M. C., El-Othmani, M. M., Saleh, K. J. 2017; 25 (1): 55-60

  Abstract

  Hip fractures are a common source of morbidity, mortality, and cost burden for elderly patients. We conducted a retrospective analysis of patients with hip fracture treated during the day or night at a rural level I academic trauma center and compared the postoperative outcomes and resource utilization for both groups.Patients aged ≥55 years with hip fractures treated with definitive surgical fixation from April 2011 to April 2013 were included in this study. Patients who underwent surgery between 7 AM and 5 PM were included in the day cohort, while those who underwent surgery between 5 PM and 7 AM were included in the night cohort. A total of 441 patients met the study inclusion criteria.Comparison of the baseline characteristics of the two cohorts did not demonstrate significant variance. Although postoperative outcomes and resource utilization trends varied between the day and night cohort, only in-hospital cost was significantly higher in the day cohort (P = 0.04). Postoperative variables, including blood loss, [INCREMENT]hematocrit level, length of surgery, length of stay, time to surgery, in-hospital mortality, and 30-day readmission, did not vary significantly.Our study demonstrates a significantly higher cost associated with hip fracture procedures performed between 7 AM and 5 PM. In addition, perioperative blood loss and length of surgery were used as markers of physician fatigue; however, no statistically significant difference among these variables was found between hip fracture intervention performed during the day versus at night.III, retrospective observational study.

  View details for DOI 10.5435/JAAOS-D-15-00494

  View details for PubMedID 27902537

• Breast Radiation Exposure in Female Orthopaedic Surgeons. The Journal of bone and joint surgery. American volume Valone, L. C., Chambers, M., Lattanza, L., James, M. A. 2016; 98 (21): 1808-1813

  Abstract

  Breast cancer prevalence is higher among female orthopaedic surgeons compared with U.S. women. The most common breast cancer site, the upper outer quadrant (UOQ), may not be adequately shielded from intraoperative radiation. Factors associated with higher breast radiation exposure (protective apron size and type, surgeon position, and C-arm position) have yet to be established.An anthropomorphic torso phantom, simulating the female surgeon, was placed adjacent to a standard operating table. Dosimeters were placed over the UOQ and lower inner quadrant (LIQ) of the breast, bilaterally. Scatter radiation dose-equivalent rates were measured during continuous fluoroscopy to a pelvic phantom (simulating the patient). Four apron sizes (small, medium, large, and extra-large), 2 apron types (cross-back and vest), 2 surgeon positions (facing the table and 90° to the table), and 2 C-arm positions (anteroposterior and cross-table lateral projection) were tested.The median dose-equivalent rate of scatter radiation to the UOQ (0.40 mrem/hr) was higher than that to the LIQ of the breast (0.06 mrem/hr) across all testing, although this was not statistically significant (p = 0.05). The cross-back aprons provided higher protection to the LIQ compared with the vests (p < 0.05). Lead protection in sizes that were too small or too large for the torso had higher breast radiation dose-equivalent rates. C-arm cross-table lateral projection was associated with higher breast radiation exposure (0.98 mrem/hr) compared with anteroposterior projection (0.13 mrem/hr) (p < 0.001).Breast radiation exposure is higher in a C-arm lateral projection compared with an anteroposterior projection. Higher dose-equivalent rates were observed for the UOQ compared with the LIQ of the breast and for aprons that were too small or too large, although these differences did not reach significance. Factors that may reduce radiation exposure include lead protection of appropriate size and distancing the axilla from the patient and x-ray tube.Increased breast cancer prevalence has been reported for female orthopaedic surgeons. The UOQ of the breast may be at risk for intraoperative radiation exposure. Methods of reducing exposure are warranted.

  View details for DOI 10.2106/JBJS.15.01167

  View details for PubMedID 27807113

• Comparing In-Hospital Total Joint Arthroplasty Outcomes and Resource Consumption Among Underweight and Morbidly Obese Patients. The Journal of arthroplasty Sayeed, Z., Anoushiravani, A. A., Chambers, M. C., Gilbert, T. J., Scaife, S. L., El-Othmani, M. M., Saleh, K. J. 2016; 31 (10): 2085-90

  Abstract

  As orthopedic surgeons search for objective measures that predict total joint arthroplasty (TJA) outcomes, body mass index may aid in risk stratification. The purpose of this study was to compare in-hospital TJA outcomes and resource consumption amongst underweight (body mass index ≤19 kg/m(2)) and morbidly obese patients (≥40 kg/m(2)).Discharge data from 2006 to 2012 National Inpatient Sample were used for this study. A total of 1503 total hip arthroplasty (THA) and 956 total knee arthroplasty (TKA) patients were divided into 2 cohorts, underweight (≤19 kg/m(2)) and morbidly obese (≥40 kg/m(2)). Patients were matched by gender and 27 comorbidities by use of Elixhauser Comorbidity Index. Patients were compared for 13 in-hospital postoperative complications, length of stay, total hospital charge, and disposition. Multivariate analyses were generated by SAS software. Significance was assigned at P value <.05.Underweight patients undergoing primary TJA had higher risk for developing postoperative anemia compared with morbidly obese patients (TKA: odds ratio [OR], 3.1; 95% CI, 2.3-4.1; THA: OR, 1.8; 95% CI, 1.5-2.3). Underweight THA candidates displayed greater risk for deep venous thrombosis (75.36% vs 24.64%; OR, 3.1; 95% CI, 1.1-8.4). Underweight TJA patients were charged more (TKA: USD 51,368.90 vs USD 40,128.80, P = .001, THA: USD 57,451.8 vs USD 42,776.9, P < .001) compared to the morbidly obese patients. Length of stay was significantly longer for underweight THA patients (4.6 days vs 3.5 days, P = .008) compared to morbidly obese counterparts.Our results indicate underweight, compared to morbidly obese, TJA patients are at a greater risk for postoperative anemia and consume more resources.

  View details for DOI 10.1016/j.arth.2016.03.015

  View details for PubMedID 27080111

• Health Care Reform: Impact on Total Joint Replacement. The Orthopedic clinics of North America Chambers, M. C., El-Othmani, M. M., Saleh, K. J. 2016; 47 (4): 645-52

  Abstract

  The US health care system has been fragmented for more than 40 years; this model created a need for modification. Sociopoliticomedical system-related factors led to the Affordable Care Act (ACA) and a restructuring of health care provision/delivery. The ACA increases access to high-quality "affordable care" under cost-effective measures. This article provides a comprehensive review of health reform and the motivating factors that drive policy to empower arthroplasty providers to effectively advocate for the field of orthopedics as a whole, and the patients served.

  View details for DOI 10.1016/j.ocl.2016.05.005

  View details for PubMedID 27637650

• Reducing Length of Stay in Total Joint Arthroplasty Care. The Orthopedic clinics of North America Walters, M., Chambers, M. C., Sayeed, Z., Anoushiravani, A. A., El-Othmani, M. M., Saleh, K. J. 2016; 47 (4): 653-60

  Abstract

  As health care reforms continue to improve quality of care, significant emphasis will be placed on evaluation of orthopedic patient outcomes. Total joint arthroplasty (TJA) has a proven track record of enhancing patient quality of life and are easily replicable. The outcomes of these procedures serve as a measure of health care initiative success. Specifically, length of stay, will be targeted as a marker of quality of surgical care delivered to TJA patients. Within this review, we will discuss preoperative and postoperative methods by which orthopedic surgeons may enhance TJA outcomes and effectively reduce length of stay.

  View details for DOI 10.1016/j.ocl.2016.05.006

  View details for PubMedID 27637651

• Approach to Decrease Infection Following Total Joint Arthroplasty. The Orthopedic clinics of North America Hatz, D., Anoushiravani, A. A., Chambers, M. C., El-Othmani, M. M., Saleh, K. J. 2016; 47 (4): 661-71

  Abstract

  Surgical site infection in total joint arthroplasty is a challenging complication that warrants discussion with regard to prevention and management. Limiting postoperative infection rate is a paramount quest in the orthopedic community. Several preoperative risk factors have been identified in orthopedic literature with regards to likelihood of developing postoperative infection. This article evaluates several factors that predispose total joint arthroplasty patients to infection. Methods of patient surgical preparation designed to decrease postoperative infection, decreasing intraoperative traffic during procedural settings, and elaborate intraoperative prophylactic advancements are assessed. Approaches to decrease postoperative infection by discussing means of lowering rates of postoperative transfusion, wound drainage, and hematoma formation are analyzed.

  View details for DOI 10.1016/j.ocl.2016.05.007

  View details for PubMedID 27637652

• Reducing 30-day Readmission After Joint Replacement. The Orthopedic clinics of North America Chambers, M. C., El-Othmani, M. M., Anoushiravani, A. A., Sayeed, Z., Saleh, K. J. 2016; 47 (4): 673-80

  Abstract

  Hospital readmission is a focus of quality measures used by the Center for Medicare and Medicaid (CMS) to evaluate quality of care. Policy changes provide incentives and enforce penalties to decrease 30-day hospital readmissions. CMS implemented the Readmission Penalty Program. Readmission rates are being used to determine reimbursement rates for physicians. The need for readmission is deemed an indication for inadequate quality of care subjected to financial penalties. This reviews identifies risk factors that have been significantly associated with higher readmission rates, addresses approaches to minimize 30-day readmission, and discusses the potential future direction within this area as regulations evolve.

  View details for DOI 10.1016/j.ocl.2016.05.014

  View details for PubMedID 27637653

• Planning, Building, and Maintaining a Successful Musculoskeletal Service Line. The Orthopedic clinics of North America Sayeed, Z., El-Othmani, M. M., Anoushiravani, A. A., Chambers, M. C., Saleh, K. J. 2016; 47 (4): 681-8

  Abstract

  Within the past 3 decades, a recent trend in the growth of musculoskeletal service lines has been seen nationally. Orthopedics offers an appealing concourse for implementation of service-line care. Within this review, the authors address the components involved in planning and building a musculoskeletal service line. The authors also address methods by which orthopedic surgeons can maintain the efficacy of their service lines by examining how orthopedic surgeons can navigate their service line through recent advents in health care reform. Finally, the authors review successful examples of musculoskeletal service lines currently in practice within the orthopedic community.

  View details for DOI 10.1016/j.ocl.2016.05.010

  View details for PubMedID 27637654

• Patient Centeredness in Total Joint Replacement: Beyond the Slogan. The Orthopedic clinics of North America Zeineddine, H. A., El-Othmani, M. M., Sayeed, Z., Chambers, M. C., Saleh, K. J. 2016; 47 (4): 697-706

  Abstract

  Patient-centered care (PCC) is gaining considerable momentum among health care professionals and policy-making authorities. The need for PCC stems from the innumerable benefits of adopting such a system. The practice of PCC in orthopedic surgery in general, and in total joint replacement in particular, is still in its youth. However, present literature already establishes the need for applying PCC in total joint replacement. Extensive research and effort should be invested to better grasp and define the dimensions of PCC as they relate to total joint replacement.

  View details for DOI 10.1016/j.ocl.2016.05.012

  View details for PubMedID 27637656

• Affordable Care Organizations and Bundled Pricing: A New Philosophy of Care. The Orthopedic clinics of North America Barinaga, G., Chambers, M. C., El-Othmani, M. M., Siegrist, R. B., Saleh, K. J. 2016; 47 (4): 707-16

  Abstract

  Under the Patient Protection and Affordable Care Act (ACA), the Centers for Medicare and Medicaid Services' Innovation was chartered to develop new models of health care delivery. The changes meant a drastic need to restructure the health care system. To minimize costs and optimize quality, new laws encourage continuity in health care delivery within an integrated system. Affordable care organizations provided a model of high-quality care while reducing costs. Bundled payments can have a substantial effect on the national expenditures. This article examines new developments in bundle payments, affordable care organizations, and gainsharing agreements as they pertain to arthroplasty.

  View details for DOI 10.1016/j.ocl.2016.05.013

  View details for PubMedID 27637657

• Can a Strategic Pipeline Initiative Increase the Number of Women and Underrepresented Minorities in Orthopaedic Surgery? Clinical orthopaedics and related research Mason, B. S., Ross, W., Ortega, G., Chambers, M. C., Parks, M. L. 2016; 474 (9): 1979-85

  Abstract

  Women and minorities remain underrepresented in orthopaedic surgery. In an attempt to increase the diversity of those entering the physician workforce, Nth Dimensions implemented a targeted pipeline curriculum that includes the Orthopaedic Summer Internship Program. The program exposes medical students to the specialty of orthopaedic surgery and equips students to be competitive applicants to orthopaedic surgery residency programs. The effect of this program on women and underrepresented minority applicants to orthopaedic residencies is highlighted in this article.(1) For women we asked: is completing the Orthopaedic Summer Internship Program associated with higher odds of applying to orthopaedic surgery residency? (2) For underrepresented minorities, is completing the Orthopaedic Summer Internship Program associated with higher odds of applying to orthopaedic residency?Between 2005 and 2012, 118 students completed the Nth Dimensions/American Academy of Orthopaedic Surgeons Orthopaedic Summer Internship Program. The summer internship consisted of an 8-week clinical and research program between the first and second years of medical school and included a series of musculoskeletal lectures, hands-on, practical workshops, presentation of a completed research project, ongoing mentoring, professional development, and counselling through each participant's subsequent years of medical school. In correlation with available national application data, residency application data were obtained for those Orthopaedic Summer Internship Program participants who applied to the match between 2011 through 2014. For these 4 cohort years, we evaluated whether this program was associated with increased odds of applying to orthopaedic surgery residency compared with national controls. For the same four cohorts, we evaluated whether underrepresented minority students who completed the program had increased odds of applying to an orthopaedic surgery residency compared with national controls.Fifty Orthopaedic Summer Internship scholars applied for an orthopaedic residency position. For women, completion of the Orthopaedic Summer Internship was associated with increased odds of applying to orthopaedic surgery residency (after summer internship: nine of 17 [35%]; national controls: 800 of 78,316 [1%]; odds ratio [OR], 51.3; 95% confidence interval [CI], 21.1-122.0; p < 0.001). Similarly, for underrepresented minorities, Orthopaedic Summer Internship completion was also associated with increased odds of orthopaedic applications from 2011 to 2014 (after Orthopaedic Summer Internship: 15 of 48 [31%]; non-Orthopaedic Summer Internship applicants nationally: 782 of 25,676 [3%]; OR, 14.5 [7.3-27.5]; p < 0.001).Completion of the Nth Dimensions Orthopaedic Summer Internship Program has a positive impact on increasing the odds of each student participant applying to an orthopaedic surgery residency program. This program may be a key factor in contributing to the pipeline of women and underrepresented minorities into orthopaedic surgery.Level III, therapeutic study.

  View details for DOI 10.1007/s11999-016-4846-8

  View details for PubMedID 27113596

  View details for PubMedCentralID PMC4965371

• Osteolysis Complicating Total Knee Arthroplasty. JBJS reviews Gilbert, T. J., Anoushiravani, A. A., Sayeed, Z., Chambers, M. C., El-Othmani, M. M., Saleh, K. J. 2016; 4 (7)

  Abstract

  Osteolysis is a process mounted by the host immune system that relies on several variables, including patient-related factors, type of insert material, modes of wear, and implant design. Imaging techniques such as radiography, computed tomography (CT) scans, magnetic resonance imaging (MRI), and tomosynthesis aid in diagnosing osteolysis. Surgical options for the treatment of osteolysis include the insertion of bone grafts, bone cement, and prosthetic augmentation. Although no approved pharmacological therapies for the specific treatment of osteolysis exist, the use of bisphosphonates and statins decreases the risk of osteolysis.

  View details for DOI 10.2106/JBJS.RVW.15.00081

  View details for PubMedID 27509327

• Assessing In-Hospital Outcomes and Resource Utilization After Primary Total Joint Arthroplasty Among Underweight Patients. The Journal of arthroplasty Anoushiravani, A. A., Sayeed, Z., Chambers, M. C., Gilbert, T. J., Scaife, S. L., El-Othmani, M. M., Saleh, K. J. 2016; 31 (7): 1407-12

  Abstract

  Poor nutritional status is a preventable condition frequently associated with low body mass index (BMI). The purpose of this study is to comparatively analyze low (≤19 kg/m(2)) and normal (19-24.9 kg/m(2)) BMI cohorts, examining if a correlation between BMI, postoperative outcomes, and resource utilization exists.Discharge data from the 2006-2012 National Inpatient Sample were used for this study. A total of 3550 total hip arthroplasty (THA) and 1315 total knee arthroplasty (TKA) patient samples were divided into 2 cohorts, underweight (≤19 kg/m(2)) and normal BMI (19-24.9 kg/m(2)). Using the Elixhauser Comorbidity Index, all cohorts were matched for 27 comorbidities. In-hospital postoperative outcomes and resource utilization among the cohorts was then comparatively analyzed. Multivariate analyses and chi-squared tests were generated using SAS software. Significance was assigned at P < .05.Underweight patients undergoing THA were at higher risk of developing postoperative anemia and sustaining cardiac complications. In addition, underweight patients had a decreased risk of developing postoperative infection. Resource utilization in terms of length of stay and hospital charge were all higher in the underweight THA cohort. Similarly, in the underweight TKA cohort, a greater risk for the development of hematoma/seroma and postoperative anemia was observed. Underweight TKA patients incurred higher hospital charge and were more likely to be discharged to skilled nursing facilities.Our results indicate that low-BMI patients were more likely to have postoperative complications and greater resource utilization. This serves a purpose in allowing orthopedic surgeons to better predict patient outcomes and improve treatment pathways designed toward helping various patient demographics.

  View details for DOI 10.1016/j.arth.2015.12.053

  View details for PubMedID 27133161

• Acrylic bone cement in total joint arthroplasty: A review. Journal of orthopaedic research : official publication of the Orthopaedic Research Society Saleh, K. J., El Othmani, M. M., Tzeng, T. H., Mihalko, W. M., Chambers, M. C., Grupp, T. M. 2016; 34 (5): 737-44

  Abstract

  Acrylic bone cement has a variety of applications in orthopedic surgery. Primary uses in total arthroplasties are limited to prostheses fixation and antibiotic delivery. With the large number of total joint arthroplasties expected to continue to rise, understanding the role bone cement plays in the success of total joint arthroplasty can have a significant impact on daily practice. The literature is inconclusive on whether cemented or cementless fixation technique is superior, and choice of fixation type is mainly determined by surgeon preference and experience. Surgeons should understand that if poor techniques exist, short-term outcomes of the replaced joint may be at risk. Statement of clinical significance: This article attempts to clarify some points of bone cement use through a review of the mechanical properties related to bone cement, a comparison to alternative materials, influence of additives, and the effects on surgical outcomes. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:737-744, 2016.

  View details for DOI 10.1002/jor.23184

  View details for PubMedID 26852143

• Economics of All-Polyethylene Versus Metal-Backed Tibial Prosthesis Designs. Orthopedics Chambers, M. C., El-Othmani, M. M., Sayeed, Z., Anoushiravani, A., Schnur, A. K., Mihalko, W. M., Saleh, K. J. 2016; 39 (3 Suppl): S61-6

  Abstract

  With the large number of total knee arthroplasties being performed and expectations that these numbers will be on the rise over the coming decades, efforts to provide cost-efficient care are of greater interest. The preferred design of knee arthroplasty implants has changed over time, with the original all-polyethylene tibial (APT) design being replaced by metal-backed tibial (MBT) components, as well as more recent considerations of newer APT designs. Modern APT components have been shown to have similar or superior outcomes than MBT components. Despite their limitations, APT components can be used to reduce the economic burden to the provider, medical institution, and health care system as a whole. There is a paucity of evidence-based literature directly comparing the cost associated with APT and MBT components. The purpose of this report is to review the literature to assess the available data regarding direct and indirect costs of both designs so that orthopedic surgeons can account for economic differences in everyday practice. [Orthopedics. 2016; 39(3):S61-S66.].

  View details for DOI 10.3928/01477447-20160509-18

  View details for PubMedID 27219732

• Postoperative Radiographic Assessment of the Vega Posterior-Stabilized TKA. Orthopedics Beason, A. M., Zhang, H., Anoushiravani, A. A., Sayeed, Z., Chambers, M. C., El-Othmani, M. M., Mihalko, W. M., Saleh, K. J. 2016; 39 (3 Suppl): S56-60

  Abstract

  Different biomechanical designs are incorporated into various total knee arthroplasty (TKA) implants. The posterior-stabilized prosthesis design utilizes a polyethylene post and femoral cam in place of the posterior cruciate ligament. This produces a more stable component interface, increased range of motion, and potentially a less technical procedure. This study aimed to assess the short-term (>2 year) outcomes associated with the Vega System posterior-stabilized knee prosthesis (Aesculap Implant Systems, Center Valley, Pennsylvania) based on postoperative radiographs using the Knee Society Roentgenographic Evaluation and Scoring System (KSRESS). Thirty-seven TKA patients who had received the Vega posterior-stabilized knee prosthesis and had postoperative radiographs at each follow-up for a minimum of 2 years were enrolled, retrospectively. Two independent observers evaluated the radiographs using KSRESS. Descriptive statistics were used to analyze the data. The average age and body mass index of patients enrolled was 67 years (range, 51-89 years) and 38.5 kg/m(2) (range, 21.2-54 kg/m(2)), respectively. Patients had radiographic follow-up for an average of 36 months (range, 24-58 months). Comparison between first and last available postoperative radiographs revealed a stable femoral and tibial interface with no significant change in prosthesis alignment over the follow-up period. Assessment of the short-term survivorship of the Vega posterior-stabilized prosthesis using KSRESS revealed no significant change in alignment after 2 years of follow-up; however, mid- to long-term studies assessing this junction are needed. A future prospective study using KSRESS in combination with clinical follow-up is recommended to allow comparison of the Vega posterior-stabilized to other prostheses. [Orthopedics. 2016; 39(3):S56-S60.].

  View details for DOI 10.3928/01477447-20160509-19

  View details for PubMedID 27219730