Allopathic and Osteopathic Residents Perform Similarly on the Orthopedic In-Training Examination (OITE).

INTRODUCTION: There is a bias in the medical community that allopathic training is superior to osteopathic training, despite the lack of substantiation. The orthopedic in-training examination (OITE) is a yearly exam evaluating educational advancement and orthopedic surgery resident\u27s scope of knowledge. The purpose of this study was to compare OITE scores between doctor of osteopathic medicine (DO) and medical doctor (MD) orthopedic surgery residents to determine whether any appreciable differences exist in the achievement levels between the 2 groups. METHODS: The American Academy of Orthopedic Surgeons 2019 OITE technical report, which reports the scores from the 2019 OITE for MDs and DOs, was evaluated to determine OITE scores for MD and DO residents. The progression of scores obtained during various postgraduate years (PGY) for both groups was also analyzed. MD and DO scores throughout PGY 1-5 were compared with independent t-tests. RESULTS: PGY-1 DO residents outperformed MD residents on the OITE (145.8 vs 138.8, p \u3c 0.001). The mean scores achieved by DO and MD residents during PGY-2 (153.2 vs 153.2), 3 (176.2 vs 175.2), and 4 (182.0 vs 183.7) did not differ (p = 0.997, 0.440, and 0.149, respectively). However, for PGY-5, the mean scores for MD residents (188.6) were higher than those of DO residents (183.5, p \u3c 0.001). Both groups had trends of improvement seen throughout PGY 1 to 5 years, with both groups showing an increase in average PGY scores when compared to each preceding PGY. CONCLUSION: This study provides evidence that DO and MD orthopedic surgery residents perform similarly on the OITE within PGY 2 to 4, thus displaying equivalencies in orthopedic knowledge within the majority of PGYs. Program directors at allopathic and osteopathic orthopedic residency programs should take this into account when considering applicants for residency

Risk factors for liposomal bupivacaine resistance after total hip or knee arthroplasties: A retrospective observational cohort in 237 patients

Purpose: Liposomal bupivacaine demonstrated promise decreasing postoperative pain in total hip and total knee arthroplasty (THA/TKA). Some randomized trials have shown non-superior results; however, confounding variables were not accounted for in such analyses. This study attempts to determine risk factors associated with failure of pain management in patients receiving liposomal bupivacaine. Methods: Postoperative pain scores were collected following primary or revision arthroplasties between January 2016 and December 2017. Retrospective analysis of institutional total joint quality and outcomes registry was screened and patients undergoing primary or revision arthroplasties who completed a multi-modal pain management including liposomal bupivacaine were included in the study. Patients with a history of infection/deviated from the institutional pain management protocol were excluded. Results: A total of 237 patients were included for analysis. Younger patients less than 64 years old had significantly higher pain scores between 0 and 12 h and \u3e 24 h. Active smokers had significantly higher pain scores between 0 and 6 h and \u3e 24 h. Patients with a history of opioid use/pain management had significantly higher pain scores at 6-12 h and 24-48 h. Regression analysis indicated risk factors for resistance to liposomal bupivacaine are younger patients less than 64 years old, those undergoing primary THA, and patients with a history of smoking/pain management/opioid use. Conclusion: We identify risk factors for resistance to liposomal bupivacaine, which include younger age less than 64 years old, history of smoking/pain management/opioid use. Future studies should use these risk factors as exclusion criteria when using liposomal bupivacaine or initiating any randomized trials regarding efficacy

Microfracture of subchondral bone leads to persistent subchondral sclerosis and poorer functional outcomes following distraction arthroplasty of the ankle joint while biologic augment may improve recovery times

Category: Ankle Arthritis Introduction/Purpose: Treatment of ankle osteoarthritis (OA) continues to remain a challenge. Previous reports have demonstrated the short-term benefits of using joint distraction for the treatment of ankle (OA), however, its efficacy in long term clinical outcomes and its role in preserving the joint space remains controversial. The purpose of this study is to establish whether microfracture or biologics improve the outcomes of ankle distraction. Methods: Records of patients that underwent an ankle distraction procedure between January 2009-December 2013 were retrospectively reviewed. Four groups were identified: Group 1: distraction with no additional treatment, Group 2: distraction with microfracture, Group 3: distraction with microfracture and BMAC/PRP, Group 4: distraction with BMAC/PRP. Demographic data was recorded. Pre-and-postoperative range of motion, Foot and Ankle Outcome Scores (FAOS), complication rate, and return to activity were evaluated. Radiographic images were used to assess the joint space changes pre-operatively and post-operatively. Global comparisons were performed using chi square testing, while individual between-group comparisons were made using robust, resistant regression and Wald tests. Results: Eighty-one patients with a mean age of 47 (range, 37-69) underwent ankle distraction with a mean follow up of 5 years (range, 3-6). All treatment strategies resulted in statistically significant improvements in FAOS (<0.001). Groups that underwent microfracture had a statistically significant decrease in post-operative plantarflexion, dorsiflexion, subtalar inversion and subtalar eversion (p=0.003) as well as an overall decrease in joint space (0.002) with persistence of subchondral bone sclerosis. Patients who underwent distraction with no microfracture treatment resulted in a significant increase in post-operative joint space (p=0.001) and decreased sclerosis in the subchondral bone. Average return to activity was 6 months in patients who received BMAC/PRP with ankle distraction compared to 12 months in patients who were treated with ankle distraction and microfracture (p<0.01). Conclusion: Distraction arthroplasty results in good functional outcomes at medium term follow up. The addition of microfracture seems to create functional outcome deterioration, whereas the addition of a biologic agent either BMAC or PRP appears to benefit earlier return to function. Longer-term studies will be required to see if these effects are sustained

Rehabilitation and Return to Sport of Female Athletes

The increase in female participation in athletics over the past decade has been accompanied by an increase in injury rates as a result of higher demands placed on athletes. Although previous studies have shown that anatomic, biomechanical, hormonal, and psychological factors may play a role in differences between men and women that can influence injury risk in athletes, there is still a lack of understanding of sex-related mechanisms of injury, guidelines, and prevention strategies. This article provides an overview of common injuries affecting female athletes. We present guidelines for upper- and lower-extremity injury rehabilitation, focusing on considerations specific to the female athlete with the goal to facilitate a safe return to sports. Level of Evidence: Level V, expert opinion

Rehabilitation and Return to Sport of Female Athletes

The increase in female participation in athletics over the past decade has been accompanied by an increase in injury rates as a result of higher demands placed on athletes. Although previous studies have shown that anatomic, biomechanical, hormonal, and psychological factors may play a role in differences between men and women that can influence injury risk in athletes, there is still a lack of understanding of sex-related mechanisms of injury, guidelines, and prevention strategies. This article provides an overview of common injuries affecting female athletes. We present guidelines for upper- and lower-extremity injury rehabilitation, focusing on considerations specific to the female athlete with the goal to facilitate a safe return to sports. Level of Evidence: Level V, expert opinion

The Pregnant Patient – Why Do My Feet Hurt?

Although hormonal and anatomical changes that occur during pregnancy have been well documented, how these changes affect foot and ankle function are less understood. Changes during pregnancy in body mass, body-mass distribution, joint laxity, and muscle strength can all contribute to alterations in gait pattern that can lead to pain or injury to the foot and ankle. This review provides an overview of the various foot and ankle anatomic, biomechanic, and kinematic changes that occur during pregnancy. In addition, this article presents the most common causes of foot and ankle symptoms expressed by the pregnant patient population and discuss the management and treatment of each condition

Autologous Osteochondral Transplantation for Osteochondral Lesions of the Talus—Does Sex Play a Role?

Autologous osteochondral transplantation (AOT) is used in the treatment of osteochondral lesions (OCL) of the talus. The purpose of this study was to compare the differences in the presentation of talar OCLs and outcomes following AOT between male and female patients. Eighty-seven consecutive patients, ages 16 to 65 years, who underwent AOT were retrospectively reviewed. Patients were divided into 2 groups based on sex. Demographic data and OCL defect characteristic data were recorded. Functional outcomes were assessed pre- and postoperatively using the Foot and Ankle Outcome Score (FAOS). The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score was used to assess cartilage incorporation. Fifty-six (64%) males and 31 (36%) females with mean clinical follow-up of 47.2 months were included in this study. OCL defect size was significantly larger in male patients (112.8 mm 2) when compared with female patients (88.7 mm 2) (p < .001). Male patients presented with a lesion associated with a recognized trauma (p < .006) when compared with female patients who typically presented with associated chronic ankle instability. Mean FAOS improved pre- to postoperatively from 50 to 81 (p < .001) with a statistically significant increase found in male patients (p < .001). The mean MOCART score was 82.1 in male and 86.7 female patients (p < .001). Our study demonstrates potential gender-related differences in the presentation and mechanism of injury in the development of OCLs. It is also not unreasonable to suggest that there may also be differences in treatment and rehabilitation strategies to reduce the risk of developing OCLs in men and women

Gender Differences May Exist in the Presentation, Mechanism of Injury and Outcomes Following Bone Marrow Stimulation for Osteochondral Lesions of the Talus

Bone marrow stimulation (BMS) is indicated for patients who have symptomatic osteochondral lesions of the talus (OLT). Despite differences in ankle biomechanics and cartilage morphology between men and women, there is scant evidence examining whether these differences affect surgical outcomes. The purpose of this study was to compare the outcomes in men and women following BMS for OLTs. A retrospective analysis comparing female and male patients treated with BMS for OLT between 2007 and 2015 was performed. Clinical outcomes were evaluated using the Foot and Ankle Outcome Scores (FAOS) and Short-Form 12 (SF-12). Magnetic resonance imaging at final follow-up was evaluated with the modified magnetic resonance observation of cartilage repair tissue score. Thirty-one females and 38 males were included. In female patients, the mean FAOS pain score improved from 60 ± 16 preoperatively to 84 ± 8.9 at 1- to 2-year follow-up (p < .01), and then decreased to 80±13 at final follow-up at 3-4 years. In male patients, the mean FAOS pain score improved from 65±17 preoperatively to 83±9.2 at 1-2 year follow-up (p < .01), and then decreased to 76±14.6 at final follow-up at 3-4 years. Lateral lesions were more common in male patients. Medial lesions were more common in female patients. The outcomes following BMS in both female and male patients were good with no significant differences at short-term follow-up. FAOS scores in male patients were more likely to decrease after 1 to 2 years postsurgery, implying a possibly faster decline than in female patients

Gender Differences May Exist in the Presentation, Mechanism of Injury and Outcomes Following Bone Marrow Stimulation for Osteochondral Lesions of the Talus

Bone marrow stimulation (BMS) is indicated for patients who have symptomatic osteochondral lesions of the talus (OLT). Despite differences in ankle biomechanics and cartilage morphology between men and women, there is scant evidence examining whether these differences affect surgical outcomes. The purpose of this study was to compare the outcomes in men and women following BMS for OLTs. A retrospective analysis comparing female and male patients treated with BMS for OLT between 2007 and 2015 was performed. Clinical outcomes were evaluated using the Foot and Ankle Outcome Scores (FAOS) and Short-Form 12 (SF-12). Magnetic resonance imaging at final follow-up was evaluated with the modified magnetic resonance observation of cartilage repair tissue score. Thirty-one females and 38 males were included. In female patients, the mean FAOS pain score improved from 60 ± 16 preoperatively to 84 ± 8.9 at 1- to 2-year follow-up (p < .01), and then decreased to 80±13 at final follow-up at 3-4 years. In male patients, the mean FAOS pain score improved from 65±17 preoperatively to 83±9.2 at 1-2 year follow-up (p < .01), and then decreased to 76±14.6 at final follow-up at 3-4 years. Lateral lesions were more common in male patients. Medial lesions were more common in female patients. The outcomes following BMS in both female and male patients were good with no significant differences at short-term follow-up. FAOS scores in male patients were more likely to decrease after 1 to 2 years postsurgery, implying a possibly faster decline than in female patients