3D Printing of Bone Spurs Before Surgical Removal During Total Knee Arthroplasty

Background: In the United States, total knee arthroplasty (TKA) is the most common performed orthopedic surgery, with over 700,000 cases per year. Overall, 21-25% underwent revision due to instability. Incorrect soft tissue balancing during the procedure can lead to improper alignment, flexion, and extension. Visualization of osteophytes in a 3D manner prior to removal is difficult and poses significant risks for improper balancing on TKA. The purpose of the study is to determine whether the utilization of 3D osteophyte models is beneficial to Orthopaedic surgeons in the course of care, specifically with regard to improving outcomes, decreasing complication rates, and decreasing OR time. Methods: A pilot study will be performed pending the approval of the IRB and research proposal by the Rothman Institute. Deidentified 3D models for upcoming procedures will be printed utilizing patient CT scans prior to date of operation. The models will be provided to Orthopaedic Surgeons at the Rothman Institute prior to the procedure. Data from at least 10 cases will be collected post-operatively, in which operating surgeons will be interviewed assess beliefs on utility of models, OR times, and rates of revision. Results: Direct interviews with Orthopaedic surgeons and residents of the Rothman Institute demonstrate early interest and support of the utilization of 3D models in the OR. Lack of IRB prevents the utilization of models in the OR, but we anticipate decrease OR time and increased satisfaction by involved surgeons. Conclusions: Initial feedback from Orthopaedic surgeons suggest a space for the utility of 3D models in the OR. A significant limitation may be accessing CT images of patients and they are often not performed prior to operations. Next steps include IRB approval and finalizing a logistical blueprint for utilization for the models in the OR, specifically whether the models will be use preoperatively or perioperatively

3D Printing of Bone Spurs Before Surgical Removal

Project Background: In the US alone, total knee arthroplasty is the most common performed orthopedic surgery, with over 700,000 cases per year.1 Overall, 21-25% underwent revision due to instability.2 The stability of a TKA depends largely on soft tissue balance for proper alignment in flexion and extension. Soft tissue balancing in TKA depends on posterior femoral condylar osteophytes, which prevent full extension of the knee and increase tension posteriorly. Pre-operative soft tissue visualization is difficult and this leaves an increased chance for implant failure and revision surgery. Having a 3D model of the bone spur before and during the surgery may decrease risk of complication and enhance soft tissue modification for proper knee balancing post TKA. Proposed Methods: We will 3D print a knee via MRI or CT that has been de-identified and provided by our mentor. The orthopedic surgeon will use this print out before or during surgery to address any concerns they have during the surgery in terms of proper balancing of the soft tissue of the knee. After approximately 10 uses within the OR, we will interview the surgeons and patients for their feedback. Patients undergoing total knee arthroplasty using the 3D printed knee will be matched with historic records of those who had undergone TKA. Rates of revision, patient satisfaction, and OR time will be compared across groups using chi-square and t-tests where appropriate. Results: We anticipate reduced OR time, increased patient satisfaction and decreased rates of revision. Conclusions: Our study demonstrates an initial use for 3D models as an aid or guide for total knee arthroplasty. Using a 3D model for TKA helps the surgeon visualize osteophytes and reduces the need for revision surgery. A larger study will need to be conducted in order to test the feasibility and practicality of 3D printing for surgery

3D Printing of Knee Models to Decrease OR Time and Reduce Revisional Surgery in Total Knee Arthroplasty (TKA)

Project Background: Osteophytes are a common problem, affecting 2% of the United States population. For many elderly people, these osteophytes will cause them to seek medical attention. Due to the 2-D nature of MRIs and CT scans, it can be difficult to gain a complete understanding of the complicated soft tissue structures surrounding the joint when performing a Total Knee Arthroplasty(TKA). Without proper removal of osteophytes and correct soft tissue balancing, there is an increased rate of revisional surgery. By utilizing a 3-D model preoperatively and within the OR, surgeons can visualize various aspects of the knee to determine what may be contributing to a soft tissue imbalance. Proposed Methods: We plan to conduct a prospective cohort study at the Rothman Institute. We will use CT images to create 3-D printed models of knees complicated with osteophytes. The surgeon will have the model to reference both preoperatively and during the surgery. We will measure the effectiveness of model by collecting data on the total procedural time, the rate of revisional surgery within the next year, and through feedback from the surgeons. Results: Although we do not currently have any results, we anticipate approval for our project shortly. We hope to have data collected within the next few months supporting our hypothesis that 3-D models will decrease both OR time and revisional surgeries. Conclusions: While the literature shows that these 3-D models may help with OR time, we have been unable to verify this yet. Additionally, revisional surgery can happen months later, so this data may be more difficult to collect in our time frame. After the pilot study has been completed, if we have promising results we hope to expand the project to include other types of surgeries affected by soft tissue balancing

Quality Improvement: Assessment of Knowledge and Attitudes Regarding the Confusion Assessment Method Delirium Screening Tool

Project AIMs: Evaluate the need for reeducation efforts on CAM Increase CAM use, comfort and knowledg

Is living in a region with high groundwater arsenic contamination associated with adverse reproductive health outcomes? An analysis using nationally representative data from India

Background: Exposure to groundwater arsenic via drinking water is common in certain geographies, such as parts of India, and causes a range of negative health effects, potentially including adverse reproductive health outcomes. Methods: We conducted an ecological analysis of self-reported rates of stillbirth, recurrent pregnancy loss, and infertility in relation to groundwater arsenic levels in India. We used a gridded, modeled dataset of the probability of groundwater arsenic exceeding 10 μg/L (World Health Organization drinking water limit) to calculate mean probabilities at the district level (n = 599 districts). A spatial integration approach was used to merge these estimates with the third India District-Level Health Survey (DLHS-3) conducted in 2007-08 (n = 643,944 women of reproductive age). Maps of district level arsenic levels and rates of each of the three outcomes were created to visualize the patterns across India. To adjust for significant spatial autocorrelation, spatial error models were fit. Findings: District-level analysis showed that the average level of stillbirth was 4.3%, recurrent pregnancy loss was 3.3%, and infertility was 8.1%. The average district-level probability of groundwater arsenic levels exceeding 10 μg/L was 42%. After adjustment for sociodemographic factors, and accounting for spatial dependence, at the district level, for each percentage point increase in predicted arsenic levels exceeding 10 μg/L increased, the rates of stillbirths was 4.5% higher (95% confidence interval (CI) 2.4–6.6, p \u3c 0.0001), the rates of RPL are 4.2% higher (95% CI 2.5–5.9, p \u3c 0.0001), and the rates of infertility are 4.4% higher (95% CI 1.2–7.7, p = \u3c 0.0001).). Conclusions: While arsenic exposure has been implicated with a range of adverse health outcomes, this is one of the first population-level studies to document an association between arsenic and three adverse reproductive pregnancy outcomes. The high levels of spatial correlation suggest that further and targeted efforts to mitigate arsenic in groundwater are needed

Symptoms of gluten ingestion in patients with non-celiac gluten sensitivity: A randomized clinical trial.

OBJECTIVES: Non-celiac gluten sensitivity (NCGS) is the presence of symptoms induced by gluten and relieved by a gluten-free diet (GFD) in patients without celiac disease or wheat allergy. Studies are mixed as to whether gluten is the main symptom trigger in patients with NCGS. Gluten immunogenic peptides (GIPs) in stool and urine are novel methods to monitor GFD compliance. Few studies have investigated their use in patients with NCGS. The aim of this study was to assess whether patients with NCGS have increased symptoms with gluten ingestion and to assess compliance with the GFD using stool and urine GIPs. METHOD: This was a prospective, randomized, double-blinded crossover trial evaluating symptoms in patients with NCGS. Thirty patients with NCGS and 43 healthy controls were placed on a GFD. Patients received 0.5 or 2 g/d of gluten for 7 d each. The remaining weeks, they received placebo for a total of 4 wk. Symptoms were evaluated weekly using the Celiac Symptom Index (CSI). Urine and stool samples were collected weekly and measured for the detection of GIPs to detect exposure to gluten. RESULTS: There was no difference in symptom severity within the NCGS group whether receiving placebo or gluten (32.69 versus 31.54, P = 0.64). Patients with NCGS had significantly higher CSI scores at baseline than healthy controls. Patients with NCGS were less likely to have stool and urine GIPs than healthy patients. CONCLUSION: Patients with NCGS were more adherent to the GFD based on stool and urine GIP results. Patients with NCGS had increased symptom severity at baseline compared with healthy controls. Neither group had significantly increased symptoms after ingestion of gluten