Virtual Interviews in the Era of COVID-19: Expectations and Perceptions of Orthopaedic Surgery Residency Candidates and Program Directors

Orthopaedic surgery residency program directors (PDs) and candidates consider interviews to be central to the application process. In-person interviews are typical, but virtual interviews present a potentially appealing alternative. Candidate and PD expectations and perceptions of virtual interviews during the 2020/2021 orthopaedic surgery application cycle were assessed. Methods: Candidates and PDs were surveyed electronically. Questions covered pre-virtual-interview and post-virtual-interview expectations and perceptions, and past in-person experiences (PDs and reapplicants) on the relative importance of application components, ability to assess fit, interview costs, and preferred interview mode. Identical questions allowed between-group comparisons. Results: Responses included n = 29 PDs and n = 99 candidates. PDs reported diminished ability to assess candidate fit; social, clinical, and surgical skills; and genuine interest in the virtual context (each p ≤ 0.01). They placed greater importance on research and less on the interview in the virtual vs. in-person context (each p = 0.02). Most candidates (78%) reported fair/good ability to demonstrate potential and were better able to assess research opportunities than expected (p \u3c 0.01). Candidates expected virtual interviews to increase the importance of research, transcripts, and recommendations (for each, p ≤ 0.02) and decrease the importance of the interview itself (p \u3c 0.01). Compared with PDs, candidates overvalued research, United States Medical Licensing Examination scores, transcripts, and recommendations (each p ≤ 0.02) and may have slightly undervalued the virtual interview (p = 0.08). Most candidates (81%) and PDs (79%) preferred in-person interviews, despite both groups reporting monetary savings. Conclusions: Despite cost savings associated with virtual interviews, orthopaedic surgery residency PDs and candidates identified reduced abilities to assess candidate or program fit and displayed a preference for in-person interviews

Holding Traction During CT: Simple Tricks to Maintain Reduction in the Lower Extremity

Traction is one of the pillars of orthopaedic injury management, as it can provide both temporizing and definitive treatment for anatomic malalignment associated with joint dislocations and fractures. In the realm of modern orthopaedic care, post-traction imaging provides the surgeon with information about resting fracture position and the overall effects of traction that are critical to preoperative planning. However, there are often circumstances in which an orthopaedic surgery provider is faced with the discrepancy between the proper sequence of orthopaedic care and the need for emergent, advanced imaging to evaluate other organ systems. In other words, they are often forced to choose between holding manual traction and sustaining high radiation exposure versus permitting subpar imaging to be obtained without traction. Out of necessity to optimize occupational health and orthopaedic care, the techniques described in this manuscript were developed. The primary aim of the present manuscript is to describe these simple, cost-effective, and mobile techniques in detail, while providing rationale for their value in the toolbox of the orthopaedic provider

Fluorescence-Guided Surgical Debridement of Chronic Osteomyelitis Utilizing Doxycycline Bone Labeling: A Technical Trick Revived

The present manuscript discusses the concept of fluorescence-guided surgical debridement of chronic osteomyelitis in the orthopaedic patient based upon a two-fold mechanism, natural fluorescence of healthy bone combined with bone labeling by tetracyclines. The senior author prefers preoperative administration of oral doxycycline 100 mg twice daily for at least 1 month. The excitation source of choice is an ordinary blacklight, as this is both cost-effective and readily attainable. Intraoperatively, viable bone is noted to fluoresce a greenish hue which is then used to guide the debridement. Previous studies have demonstrated that bleeding bone is not a reliable indicator of a bone’s true metabolic state. This technical trick will offer orthopaedic surgeons an adjunct to their treatment algorithm of chronic osteomyelitis

Virtual Interviews in the Era of COVID-19: Expectations and Perceptions of Orthopaedic Surgery Residency Candidates and Program Directors

Orthopaedic surgery residency program directors (PDs) and candidates consider interviews to be central to the application process. In-person interviews are typical, but virtual interviews present a potentially appealing alternative. Candidate and PD expectations and perceptions of virtual interviews during the 2020/2021 orthopaedic surgery application cycle were assessed. Methods: Candidates and PDs were surveyed electronically. Questions covered pre-virtual-interview and post-virtual-interview expectations and perceptions, and past in-person experiences (PDs and reapplicants) on the relative importance of application components, ability to assess fit, interview costs, and preferred interview mode. Identical questions allowed between-group comparisons. Results: Responses included n = 29 PDs and n = 99 candidates. PDs reported diminished ability to assess candidate fit; social, clinical, and surgical skills; and genuine interest in the virtual context (each p ≤ 0.01). They placed greater importance on research and less on the interview in the virtual vs. in-person context (each p = 0.02). Most candidates (78%) reported fair/good ability to demonstrate potential and were better able to assess research opportunities than expected (p \u3c 0.01). Candidates expected virtual interviews to increase the importance of research, transcripts, and recommendations (for each, p ≤ 0.02) and decrease the importance of the interview itself (p \u3c 0.01). Compared with PDs, candidates overvalued research, United States Medical Licensing Examination scores, transcripts, and recommendations (each p ≤ 0.02) and may have slightly undervalued the virtual interview (p = 0.08). Most candidates (81%) and PDs (79%) preferred in-person interviews, despite both groups reporting monetary savings. Conclusions: Despite cost savings associated with virtual interviews, orthopaedic surgery residency PDs and candidates identified reduced abilities to assess candidate or program fit and displayed a preference for in-person interviews

Virtual Interviews in the Era of COVID-19: Expectations and Perceptions of Orthopaedic Surgery Residency Candidates and Program Directors

Orthopaedic surgery residency program directors (PDs) and candidates consider interviews to be central to the application process. In-person interviews are typical, but virtual interviews present a potentially appealing alternative. Candidate and PD expectations and perceptions of virtual interviews during the 2020/2021 orthopaedic surgery application cycle were assessed. Methods: Candidates and PDs were surveyed electronically. Questions covered pre-virtual-interview and post-virtual-interview expectations and perceptions, and past in-person experiences (PDs and reapplicants) on the relative importance of application components, ability to assess fit, interview costs, and preferred interview mode. Identical questions allowed between-group comparisons. Results: Responses included n = 29 PDs and n = 99 candidates. PDs reported diminished ability to assess candidate fit; social, clinical, and surgical skills; and genuine interest in the virtual context (each p ≤ 0.01). They placed greater importance on research and less on the interview in the virtual vs. in-person context (each p = 0.02). Most candidates (78%) reported fair/good ability to demonstrate potential and were better able to assess research opportunities than expected (p \u3c 0.01). Candidates expected virtual interviews to increase the importance of research, transcripts, and recommendations (for each, p ≤ 0.02) and decrease the importance of the interview itself (p \u3c 0.01). Compared with PDs, candidates overvalued research, United States Medical Licensing Examination scores, transcripts, and recommendations (each p ≤ 0.02) and may have slightly undervalued the virtual interview (p = 0.08). Most candidates (81%) and PDs (79%) preferred in-person interviews, despite both groups reporting monetary savings. Conclusions: Despite cost savings associated with virtual interviews, orthopaedic surgery residency PDs and candidates identified reduced abilities to assess candidate or program fit and displayed a preference for in-person interviews

Effects of Veterans’ Mental Health Service-Connections on Patient-Reported Outcomes Following Total Joint Arthroplasty

Background Studies report poor outcomes of elective orthopaedic surgeries among civilian patients receiving Workers’ Compensation (WC). However, little is known about surgical outcomes in veterans receiving similar benefits through the Veterans Affairs (VA) service-connected (SC) disability compensation program. Methods Veterans undergoing primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) at a VA Medical Center between 07/2019–12/2021 were analyzed by SC status. Outcomes were evaluated using Hip disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS-JR) and Knee injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR) scores collected preoperatively and at 2- and 12-months postoperatively. Repeated measures mixed models were used to test for the effect of SC on HOOS-JR/KOOS-JR scores, controlling for baseline age, sex, and Charlson Comorbidity Index (CCI). SC and baseline joint function (stratified into quartiles using baseline HOOS-JR/KOOS-JR scores) were analyzed for effects on achieving substantial clinical benefit (SCB) at 12-month follow-up. Results The analysis included 67 hips and 142 knees. SC and non-SC (NSC) veterans had similar baseline HOOS-JR/KOOS-JR and CCI. HOOS-JR remained similar between groups through 12 months (79.9 ± 19.2 vs. 82.7 ± 18.8) as did KOOS-JR (70.4 ± 15.6 vs. 74.6 ± 15.3). The designation of any SC and mental health SC reached significance for KOOS-JR (P = 0.034 and P = 0.032, respectively). For HOOS-JR and KOOS-JR, baseline function score quartile significantly influenced final score (P \u3c 0.001), with patients in the lowest quartiles (i.e., worst baseline function) exhibiting significantly greater improvements than patients in higher quartiles. Conclusions Mental health SC and high preoperative functional status are variables that may have unfavorable influences on self-reported outcomes of TKA in veteran patients. SC status does not appear to influence the outcomes of THA or the likelihood of achieving SCB after either THA or TKA. Regardless of SC status, most veterans can expect significant clinical improvements after total joint arthroplasty

Postmatch Perceptions of Virtual Interviews Among Orthopaedic Surgery Program Directors and Candidates: Results of an Online Survey

Background: Interviews are considered fundamental to the residency application. Universal implementation of virtual interviews (VIs) caused substantial modifications to the 2020/2021 residency application cycle. Previous work elucidated the expectations and perceptions of candidates and program directors (PDs) prior to the match. The authors aimed to assess whether the match results affected perceptions of VIs. Methods: An online survey was distributed to candidates and PDs of the 2020/2021 orthopaedic surgery residency application cycle. Questions assessed match results, the perceived impact of VIs, and interview format preferences for upcoming application cycles. Results: Responses included 39 PDs (20% response rate) and 71 candidates (14% response rate). PDs in the sample reported filling all positions. Of the 71 candidates, 19 went unmatched. Candidates had significantly higher prematch expectations of the impact of VIs than PDs (P=0.039). PDs reported significantly different changes in perception of VIs after the match compared with candidates, with more positive views of VIs reported (P=0.009). Compared with matched candidates, unmatched candidates expressed significantly greater dissatisfaction with the match result (P\u3c0.001). Conclusions: PDs reported higher satisfaction with VIs than expected after the match compared with prematch expectations. Candidates’ opinions of VIs postmatch were polarized. Unmatched candidates expressed a high level of dissatisfaction with the match and overwhelmingly felt VIs negatively affected their chances of matching. A large majority of PDs and matched candidates were satisfied with the outcomes of the match and VIs; nevertheless, this did not confer broad support for continuing VIs in the future. Level of Evidence: Level I

Effects of Veterans’ Mental Health Service-Connections on Patient-Reported Outcomes Following Total Joint Arthroplasty

Background Studies report poor outcomes of elective orthopaedic surgeries among civilian patients receiving Workers’ Compensation (WC). However, little is known about surgical outcomes in veterans receiving similar benefits through the Veterans Affairs (VA) service-connected (SC) disability compensation program. Methods Veterans undergoing primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) at a VA Medical Center between 07/2019–12/2021 were analyzed by SC status. Outcomes were evaluated using Hip disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS-JR) and Knee injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR) scores collected preoperatively and at 2- and 12-months postoperatively. Repeated measures mixed models were used to test for the effect of SC on HOOS-JR/KOOS-JR scores, controlling for baseline age, sex, and Charlson Comorbidity Index (CCI). SC and baseline joint function (stratified into quartiles using baseline HOOS-JR/KOOS-JR scores) were analyzed for effects on achieving substantial clinical benefit (SCB) at 12-month follow-up. Results The analysis included 67 hips and 142 knees. SC and non-SC (NSC) veterans had similar baseline HOOS-JR/KOOS-JR and CCI. HOOS-JR remained similar between groups through 12 months (79.9 ± 19.2 vs. 82.7 ± 18.8) as did KOOS-JR (70.4 ± 15.6 vs. 74.6 ± 15.3). The designation of any SC and mental health SC reached significance for KOOS-JR (P = 0.034 and P = 0.032, respectively). For HOOS-JR and KOOS-JR, baseline function score quartile significantly influenced final score (P \u3c 0.001), with patients in the lowest quartiles (i.e., worst baseline function) exhibiting significantly greater improvements than patients in higher quartiles. Conclusions Mental health SC and high preoperative functional status are variables that may have unfavorable influences on self-reported outcomes of TKA in veteran patients. SC status does not appear to influence the outcomes of THA or the likelihood of achieving SCB after either THA or TKA. Regardless of SC status, most veterans can expect significant clinical improvements after total joint arthroplasty

Trends and Epidemiology of Knee Extensor Mechanism Injuries Presenting to United States Emergency Departments From 2001 to 2020

Objectives Injuries to the native extensor mechanism (EM) of the knee are potentially disabling and often require surgical treatment. Large-scale, updated epidemiological data on these injuries is lacking. The objective of the current study was to examine recent trends in EM injuries presenting to United States (US) Emergency Departments (EDs) over the last 20 years using a nationally representative sample. Methods This study retrospectively analyzed the National Electronic Injury Surveillance System (NEISS) database to identify cases of EM injuries (defined as either a quadriceps tendon rupture, a patella fracture, or a patellar tendon rupture) presenting to EDs in the US from 2001 to 2020. Results During the study period, an estimated 214,817 EM injuries occurred in an at-risk population of 6,183,899,410 person-years for an overall incidence rate of 3.47 per 100,000 person-years. Patella fractures (PFs) were the most common injury type, representing 77.5% of all EM injuries (overall incidence rate: 2.69), followed by patellar tendon ruptures (PTRs; 13.5%; incidence: 0.48) and quadriceps tendon ruptures (QTRs; 9%; incidence: 0.31). Demographic characteristics and mechanisms of injury differed between injury types. Annual incidence rates increased significantly during the study period for all EM injury types, with PTRs demonstrating the largest relative increase (average annual percent increase: PF, 2.8%; PTR, 7.2%; QTR, 5.3%). Accounting for population growth yielded an increasing incidence of all EM injuries combined from 3.65 in 2001 to 4.9 in 2020. The largest relative increases in incidence rates were observed in older age groups. Conclusion Extensor mechanism injuries of the knee are increasing in the US, which likely reflects an aging and more active population. These types of injuries are associated with substantial functional impairment and recent increases in incidence rates highlight the need for injury prevention and management strategies

Effects of Veterans’ Mental Health Service-Connections on Patient-Reported Outcomes Following Total Joint Arthroplasty

Background Studies report poor outcomes of elective orthopaedic surgeries among civilian patients receiving Workers’ Compensation (WC). However, little is known about surgical outcomes in veterans receiving similar benefits through the Veterans Affairs (VA) service-connected (SC) disability compensation program. Methods Veterans undergoing primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) at a VA Medical Center between 07/2019–12/2021 were analyzed by SC status. Outcomes were evaluated using Hip disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS-JR) and Knee injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR) scores collected preoperatively and at 2- and 12-months postoperatively. Repeated measures mixed models were used to test for the effect of SC on HOOS-JR/KOOS-JR scores, controlling for baseline age, sex, and Charlson Comorbidity Index (CCI). SC and baseline joint function (stratified into quartiles using baseline HOOS-JR/KOOS-JR scores) were analyzed for effects on achieving substantial clinical benefit (SCB) at 12-month follow-up. Results The analysis included 67 hips and 142 knees. SC and non-SC (NSC) veterans had similar baseline HOOS-JR/KOOS-JR and CCI. HOOS-JR remained similar between groups through 12 months (79.9 ± 19.2 vs. 82.7 ± 18.8) as did KOOS-JR (70.4 ± 15.6 vs. 74.6 ± 15.3). The designation of any SC and mental health SC reached significance for KOOS-JR (P = 0.034 and P = 0.032, respectively). For HOOS-JR and KOOS-JR, baseline function score quartile significantly influenced final score (P \u3c 0.001), with patients in the lowest quartiles (i.e., worst baseline function) exhibiting significantly greater improvements than patients in higher quartiles. Conclusions Mental health SC and high preoperative functional status are variables that may have unfavorable influences on self-reported outcomes of TKA in veteran patients. SC status does not appear to influence the outcomes of THA or the likelihood of achieving SCB after either THA or TKA. Regardless of SC status, most veterans can expect significant clinical improvements after total joint arthroplasty