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  1. Article ; Online: Editorial Commentary: Endoscopic Hip Abductor Repair Results in Excellent Outcomes in Challenging Patients: Surgical Indications Require Additional Clarification.

    Balazs, George C

    Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association

    2024  

    Abstract: Hip abductor pathology exists on a spectrum, potentially involving symptoms of pain, weakness, loss of active motion, and disordered movement. Imaging findings may include tendinosis, detachment of a portion of the footprint, fluid imbibition with ... ...

    Abstract Hip abductor pathology exists on a spectrum, potentially involving symptoms of pain, weakness, loss of active motion, and disordered movement. Imaging findings may include tendinosis, detachment of a portion of the footprint, fluid imbibition with undersurface tearing at the footprint, or full-thickness detachment of 1 or both tendons with or without evidence of fatty infiltration or atrophy of the associated muscle bellies. Yet, sometimes there are no imaging findings at all. Endoscopic repair of hip abductor tendon tears is growing in popularity and interest. Recent research suggests that with treatment of concomitant pathology, excellent clinical results are durable, even in patients with potentially poor prognoses (eg - older patients with poor preoperative patient reported outcome measures). While techniques have become increasingly refined, surgical indications remain vague and confusing. Future research could consider why some patients are taken to the operating room, while most are not.
    Language English
    Publishing date 2024-01-12
    Publishing country United States
    Document type Editorial
    ZDB-ID 632528-2
    ISSN 1526-3231 ; 0749-8063
    ISSN (online) 1526-3231
    ISSN 0749-8063
    DOI 10.1016/j.arthro.2023.12.021
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Editorial Commentary: Subacromial Balloon Spacer for Irreparable Rotator Cuff Tears Produces Clinical Improvement, Yet the Mechanism of Action Is Unclear.

    Balazs, Cdr George C

    Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association

    2024  Volume 40, Issue 2, Page(s) 551–552

    Abstract: Subacromial balloon spacers, a treatment option for massive irreparable rotator cuff tears, have been available in the United States since 2021 and much longer in Europe. The device has been described as a humeral head depressor that increases the ... ...

    Abstract Subacromial balloon spacers, a treatment option for massive irreparable rotator cuff tears, have been available in the United States since 2021 and much longer in Europe. The device has been described as a humeral head depressor that increases the subacromial space, centers the humeral head preventing superior migration, and improves deltoid mechanical advantage. This is not convincing. Balloon deflation occurs 3 months after implantation, eliminating the head-depressing effect, and the balloon fully degrades within 15 months. Some propose scarring in the subacromial space smoothes the acromial-humeral articulation; this is also unconvincing. The scar is not thick. Clinical studies largely report unchanged or worsened acromiohumeral interval after surgery. Short-term case series show improvement in pain and function, but comparative studies show mixed results. There may be some advantages over partial rotator cuff repair, but debridement alone may be sufficient treatment, and the generally positive short-term results do not determine whether symptom relief persists over the long term after balloon degradation. A recent clinical study does show mid-term improvement, but the mechanism remains unclear, and, if it is a result of smooth subacromial scarring, tuberoplasty may be an alternative.
    MeSH term(s) Humans ; Rotator Cuff Injuries/surgery ; Cicatrix/surgery ; Shoulder Joint/surgery ; Arthroplasty/methods ; Pain/surgery ; Treatment Outcome
    Language English
    Publishing date 2024-01-31
    Publishing country United States
    Document type Editorial ; Comment
    ZDB-ID 632528-2
    ISSN 1526-3231 ; 0749-8063
    ISSN (online) 1526-3231
    ISSN 0749-8063
    DOI 10.1016/j.arthro.2023.09.015
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: In Frozen Shoulder, US-Guided Versus Blind Administration of Intra-Articular Corticosteroid Injections Increased Accuracy of Injections but Did Not Improve Clinical Outcomes at 12 Weeks.

    Balazs, Cdr George C

    The Journal of bone and joint surgery. American volume

    2021  Volume 103, Issue 22, Page(s) 2144

    MeSH term(s) Adrenal Cortex Hormones/therapeutic use ; Bursitis/drug therapy ; Humans ; Injections, Intra-Articular
    Chemical Substances Adrenal Cortex Hormones
    Language English
    Publishing date 2021-11-08
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 220625-0
    ISSN 1535-1386 ; 0021-9355
    ISSN (online) 1535-1386
    ISSN 0021-9355
    DOI 10.2106/JBJS.21.01007
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Low Tensile Strength Suture With Transosseous Tunnels and Suture Anchors 5 mm in Diameter or Greater Are Associated With Higher Failure Rates in Primary Patellar Tendon Repair.

    Katsma, Mark S / Land, Vaughn / Renfro, S Hunter / Culp, Hunter / Balazs, George C

    Arthroscopy, sports medicine, and rehabilitation

    2024  Volume 6, Issue 2, Page(s) 100908

    Abstract: Purpose: To determine the rate of and risk factors for clinical failure and return to military duty following primary patellar tendon repair with either transosseous trunnel repair or suture anchor repair.: Methods: The Military Health System Data ... ...

    Abstract Purpose: To determine the rate of and risk factors for clinical failure and return to military duty following primary patellar tendon repair with either transosseous trunnel repair or suture anchor repair.
    Methods: The Military Health System Data Repository (MDR) was queried to identify all adult patients undergoing surgical treatment of a patellar tendon rupture in the Military Health System from 2014 to 2018. Patients who underwent either transosseous tunnel repair or suture anchor repair were included. Health records were examined to collect additional data. Univariate analysis and multivariate logistic regression models were used to determine independent risk factors for rerupture.
    Results: A total of 450 knees in 437 patients were included. Transosseous tunnel repair was the most frequently used technique (314/450, 77%), followed by suture anchor repair (113/450, 25%). Rerupture occurred in 33 knees (7%). There was no difference in rerupture rate between transosseous tunnel repair and suture anchor repair (
    Conclusions: There is no statistically significant difference in failure rate between transosseous tunnel repair and suture anchor repair in primary patellar tendon ruptures. However, the use of low tensile strength suture with transosseous tunnels and the use of suture anchors 5.0 mm in diameter or greater resulted in significantly higher failure rates. These data suggest that use of high tensile strength suture in transosseous tunnel repair and use of suture anchors less than 5.0 mm in diameter in suture anchor repair result in lower failure rate in primary patellar tendon repair.
    Level of evidence: Level III, retrospective cohort study.
    Language English
    Publishing date 2024-02-14
    Publishing country United States
    Document type Journal Article
    ISSN 2666-061X
    ISSN (online) 2666-061X
    DOI 10.1016/j.asmr.2024.100908
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: Machine Learning to Predict Discharge Destination After Total Knee Arthroplasty and Total Hip Arthroplasty.

    Booth, Gregory J / Cole, Jacob / Geiger, Phil / Balazs, George C / Hughey, Scott / Nepa, Natalie / Goldman, Ashton

    Journal of surgical orthopaedic advances

    2024  Volume 32, Issue 4, Page(s) 252–258

    Abstract: Discharge destination impacts costs and perioperative planning for primary total knee (TKA) or hip arthroplasty (THA). The purpose of this study was to create a tool to predict discharge destination in contemporary patients. Models were developed using ... ...

    Abstract Discharge destination impacts costs and perioperative planning for primary total knee (TKA) or hip arthroplasty (THA). The purpose of this study was to create a tool to predict discharge destination in contemporary patients. Models were developed using more than 400,000 patients from the National Surgical Quality Improvement Program database. Models were compared with a previously published model using area under the receiver operating characteristic curve (AUC) and decision curve analysis (DCA). AUC on patients with TKA was 0.729 (95% confidence interval [CI]: 0.719 to 0.738) and 0.688 (95% CI: 0.678 to 0.697) using the new and previous models, respectively. AUC on patients with THA was 0.768 (95% CI: 0.758 to 0.778) and 0.726 (95% CI: 0.714 to 0.737) using the new and previous models, respectively. DCA showed substantially improved net clinical benefit. The new models were integrated into a web-based application. This tool enhances clinical decision making for predicting discharge destination following primary TKA and THA. (Journal of Surgical Orthopaedic Advances 32(4):252-258, 2023).
    MeSH term(s) Humans ; Arthroplasty, Replacement, Knee ; Arthroplasty, Replacement, Hip ; Patient Discharge ; Postoperative Complications ; Machine Learning
    Language English
    Publishing date 2024-03-18
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2189157-6
    ISSN 2158-3811 ; 1548-825X ; 1059-1052
    ISSN (online) 2158-3811
    ISSN 1548-825X ; 1059-1052
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Disparities in Demographics in Hip Arthroplasty Between U.S. Active Duty Military and the ACS-NSQIP Clinical Registry.

    Abraham, Vivek M / Junge, Joshua M / Booth, Greg / Olsen, Aaron A / Balazs, George C / Goldman, Ashton H

    Military medicine

    2024  

    Abstract: Introduction: Patient demographics, such as sex and age, are known risk factors for undergoing revision following primary total hip arthroplasty (THA). The military population is unique because of the increased rates of primary and secondary ... ...

    Abstract Introduction: Patient demographics, such as sex and age, are known risk factors for undergoing revision following primary total hip arthroplasty (THA). The military population is unique because of the increased rates of primary and secondary osteoarthritis of the hip. Treatment options are limited for returning patients to their line of duty; however, THA has been shown to be an effective option. The primary purpose of this study was to evaluate and contrast the demographic differences of patients undergoing primary THA between the U.S. active duty military population and the general population. The secondary goal was to identify the proportion of primary THA performed at the MTF within the military health system (MHS).
    Methods: This was an exempt study determined by the local institutional review board. A retrospective analysis of the MHS Data Repository (MDR) and the National Surgical Quality Improvement Program (NSQIP) was performed. The databases were used to identify the patients who underwent THA from January 1, 2015 to December 31, 2020. The MDR was used to identify demographics such as sex, age, setting of surgery, geographic location, previous military deployments, history of deployment-related injuries, branch of service, and rank. The NSQIP database was queried for sex and age. The median age of the population was compared using the Mann-Whitney U test and gender was compared using the Chi-square test.
    Results: The MDR was used to evaluate 2,734 patients, whereas the NSQIP database was used to evaluate 223,832 patients. In the military population, patients who underwent THA were 87.7% male with an average age of 45 years, whereas in the general population as measured via the NSQIP database, 45.2% patients were male with an average age of 66.0 years. Comparing the two groups, we demonstrated that the military patients were significantly more likely to be younger (P < .001) and males (P < .001). Only 29.6% of primary THAs were performed within the MTF.
    Conclusions: Patients in the MHS are undergoing THA at a younger age and are more likely to be male compared to the general population. A significant portion of primary THAs in the MHS are also being performed at civilian institutions. These demographics may result in increased risk of revision; however, long-term studies are warranted to evaluate survivorship in this unique population.
    Language English
    Publishing date 2024-02-12
    Publishing country England
    Document type Journal Article
    ZDB-ID 391061-1
    ISSN 1930-613X ; 0026-4075
    ISSN (online) 1930-613X
    ISSN 0026-4075
    DOI 10.1093/milmed/usae029
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Oral opioid prescribing to active duty US military personnel: a cross-sectional population.

    Junge, Joshua M / Murray, Hailey / Goldman, Ashton H / Booth, Gregory J / Balazs, George C

    Regional anesthesia and pain medicine

    2023  

    Abstract: Introduction: While civilian opioid prescriptions have seen a dramatic decline in recent years, there are few studies investigating trends in opioid prescription in the active duty military population. We evaluated oral opioid prescribing patterns to ... ...

    Abstract Introduction: While civilian opioid prescriptions have seen a dramatic decline in recent years, there are few studies investigating trends in opioid prescription in the active duty military population. We evaluated oral opioid prescribing patterns to active duty military personnel in the Military Health System (MHS) from 2017 to 2020 to determine the incidence of opioid prescriptions as well as demographic and military-specific risk factors for receiving an oral opioid prescription.
    Methods: The MHS Data Repository was queried from 2017 to 2020 to identify all outpatient oral opioid prescriptions to active duty military personnel in August of each year as well as demographic information on the study population. Data were evaluated in a logistic regression model, and ORs of receiving an oral opioid prescription were calculated for each factor.
    Results: The proportion of active duty military personnel receiving an oral opioid prescription declined from 2.71% to 1.26% (53% relative reduction) over the study period. Within the logistic regression model, female military personnel were significantly more likely to receive opioid prescriptions compared with men, and there was a stepwise increase in likelihood of an opioid prescription with increasing age. Army and Marine personnel, personnel without a history of military deployment and those stationed within the continental USA were significantly more likely to receive an opioid prescription.
    Discussion: The substantial decrease in oral opioid prescriptions to active duty military personnel mirrors data published in the civilian community. The identified risk factors for receiving an opioid prescription may be potential targets for future interventions to further decrease prescribing.
    Language English
    Publishing date 2023-07-28
    Publishing country England
    Document type Journal Article
    ZDB-ID 1425299-5
    ISSN 1532-8651 ; 1098-7339 ; 0146-521X
    ISSN (online) 1532-8651
    ISSN 1098-7339 ; 0146-521X
    DOI 10.1136/rapm-2023-104495
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: A history of shoulder instability is more common in young patients undergoing total shoulder arthroplasty.

    Kallevang, Jonathan K / Wieschhaus, Kyle / Olsen, Aaron A / Goldman, Ashton H / Hammond, James / Balazs, George C

    Journal of shoulder and elbow surgery

    2023  Volume 32, Issue 8, Page(s) 1689–1694

    Abstract: Background: Previous studies have shown an association between shoulder instability and the development of glenohumeral arthritis leading to total shoulder arthroplasty (TSA). The primary goal of this study was to evaluate if a history of shoulder ... ...

    Abstract Background: Previous studies have shown an association between shoulder instability and the development of glenohumeral arthritis leading to total shoulder arthroplasty (TSA). The primary goal of this study was to evaluate if a history of shoulder instability was more common in patients aged <50 years undergoing TSA. The secondary objective was to determine if a history of prior surgical stabilization is more common in patients aged <50 years undergoing TSA.
    Methods: Using the military health system data repository (MDR) and the Military Analysis and Reporting Tool (M2), we identified 489 patients undergoing primary TSA from October 1, 2013, to May 1, 2020, within the Military Health System (MHS). Patients aged <50 years were matched 1:2 with patients aged ≥50 years based on sex, race, and military status, with the final study population comprising 240 patients who underwent primary TSA during the study period. Electronic medical records were examined, and factors showing univariate association (P < .2) were included in a binary logistic regression analysis to determine associations between demographic or clinical factors and TSA prior to age 50 years.
    Results: The groups differed significantly in shoulder arthritis subtype, with the older group having significantly more primary osteoarthritis (78% vs. 51%, P < .001). The younger group had significantly more patients with a history of shoulder instability (48% vs. 12%, P < .001), prior ipsilateral shoulder surgery of any type (74% vs. 34%, P < .001), and prior ipsilateral shoulder stabilization surgery (31% vs. 5%, P < .001). In the resultant logistic regression model, a history of shoulder instability (OR 5.0, P < .001) and a history of any prior ipsilateral shoulder surgery (OR 3.5, P < .001) were associated with TSA prior to the age of 50 years.
    Conclusions: Shoulder instability is a risk factor for TSA before age 50 years. It is unclear how surgical stabilization influences the development of secondary glenohumeral arthritis in shoulder instability. Patients should be counseled that recurrent instability could lead to earlier TSA, regardless of whether surgical stabilization is performed.
    MeSH term(s) Humans ; Joint Instability/surgery ; Joint Instability/complications ; Arthroplasty, Replacement, Shoulder/adverse effects ; Shoulder Joint/surgery ; Shoulder/surgery ; Treatment Outcome ; Retrospective Studies ; Reoperation ; Osteoarthritis/surgery ; Osteoarthritis/complications
    Language English
    Publishing date 2023-01-31
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1170782-3
    ISSN 1532-6500 ; 1058-2746
    ISSN (online) 1532-6500
    ISSN 1058-2746
    DOI 10.1016/j.jse.2023.01.004
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: The Adductor Sling Technique for Pediatric Medial Patellofemoral Ligament Reconstruction Better Resists Dislocation Loads When Compared With Adductor Transfer at Time Zero in a Cadaveric Model.

    Balazs, George C / Meyers, Kathleen N / Dennis, Elizabeth R / Maher, Suzanne A / Shubin Stein, Beth E

    Arthroscopy, sports medicine, and rehabilitation

    2023  Volume 6, Issue 1, Page(s) 100831

    Abstract: Purpose: To characterize the ability of the intact medial patellofemoral ligament (MPFL) and the adductor transfer and adductor sling MPFL reconstruction techniques to resist subluxation and dislocation in a cadaveric model.: Methods: Nine fresh- ... ...

    Abstract Purpose: To characterize the ability of the intact medial patellofemoral ligament (MPFL) and the adductor transfer and adductor sling MPFL reconstruction techniques to resist subluxation and dislocation in a cadaveric model.
    Methods: Nine fresh-frozen cadaveric knees were placed on a custom testing fixture with the femur fixed parallel to the floor, the tibia placed in 20° of flexion, and the patella attached to a load cell. The patella was displaced laterally, and subluxation load (in newtons), dislocation load (in newtons), maximum failure load (in newtons), patellar displacement at failure, and mode of failure were recorded. Testing was conducted with the MPFL intact and after the adductor sling and adductor transfer reconstruction techniques. Statistical analysis was completed using 1-way repeated-measures analysis of variance with the Holm-Šidák post hoc test.
    Results: The subluxation load was not significantly different between groups. The native MPFL dislocation load was significantly higher than the dislocation loads of both reconstruction techniques, but no significant difference between the dislocation loads of the 2 reconstruction techniques occurred. The native MPFL failure load was significantly higher than the failure loads of both reconstruction techniques. The adductor sling failure load was significantly higher than the adductor transfer failure load. The mode of failure varied across groups. The native MPFL failed by femoral avulsion, patellar avulsion, and midsubstance tear. The main mode of failure for adductor transfer was pullout, whereas failure for the adductor sling technique most often occurred at the sutures. Most of the native MPFLs and all adductor sling reconstructions failed after dislocation. The adductor transfer reconstructions were much more variable, with failures spanning from before subluxation through dislocation.
    Conclusions: Our cadaveric model showed that neither the adductor transfer technique nor the adductor sling technique restored failure load to that of the native condition. There was no significant difference in the subluxation or dislocation loads between the 2 MPFL reconstructions, but the adductor sling technique resulted in a higher load to failure. The adductor transfer technique frequently failed before subluxation or dislocation when compared with the adductor sling technique and the native MPFL.
    Clinical relevance: The best technique for MPFL reconstruction in patients with open physes is a topic of debate. Given the long-term consequences of MPFL injury and potential for growth plate disturbance, it is important to study MPFL reconstruction techniques thoroughly, including in the laboratory setting.
    Language English
    Publishing date 2023-12-12
    Publishing country United States
    Document type Journal Article
    ISSN 2666-061X
    ISSN (online) 2666-061X
    DOI 10.1016/j.asmr.2023.100831
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Grit and postoperative opioid use after total joint arthroplasty.

    Ernst, Andrew J / Briggs, Avery M / Spooner, Rebecca / Balazs, George C / Goldman, Ashton H

    Hip international : the journal of clinical and experimental research on hip pathology and therapy

    2023  Volume 34, Issue 2, Page(s) 156–160

    Abstract: Introduction: Perioperative multimodal protocols following total joint replacements have significantly decreased the amount of perioperative and postoperative opioids. Further identification of those requiring more or less opioids through ... ...

    Abstract Introduction: Perioperative multimodal protocols following total joint replacements have significantly decreased the amount of perioperative and postoperative opioids. Further identification of those requiring more or less opioids through individualisation, may further aid in reducing the amount prescribed. Therefore, the purpose of the study was to evaluate whether a patient's grit, the measurable psychological strength of character to persevere during hardship, measured by postoperative opioid consumption.
    Methods: Consecutive patients who had undergone either primary or revision total knee arthroplasty (TKA) or total hip arthroplasty (THA) from February 2019 to August 2020 at our institution logged their opioid use for the first 2 weeks postoperatively, detailing the type, dosage, and number of narcotics they consumed. Those who completed their logs and a grit questionnaire had their average morphine equivalent dose (MED) and grit score calculated. Analysis was then performed to evaluate if any association existed between these 2 variables.
    Results: There was no correlation between grit score and postoperative opioid consumption in the first 2 weeks following discharge after total joint arthroplasty. A total of 144 patients were eligible to participate and a total of 86 patients met inclusion criteria, 48 patients in the TKA group and 38 in the THA group. Of all patients, 63% were male. The average MED was 95.5 for THAs and 192 for TKAs. The average grit score was 4.23 for THAs and 4.19 for TKAs.
    Conclusions: There is not an apparent association between grit score and postoperative opioid consumption in the first 2 weeks after total joint arthroplasty. General psychological resiliency may not be an important predictor of postoperative opioid use with modern postoperative protocols.
    MeSH term(s) Humans ; Male ; Female ; Analgesics, Opioid/therapeutic use ; Arthroplasty, Replacement, Hip/adverse effects ; Pain, Postoperative/drug therapy ; Opioid-Related Disorders/etiology ; Opioid-Related Disorders/drug therapy ; Arthroplasty, Replacement, Knee/adverse effects ; Morphine ; Retrospective Studies
    Chemical Substances Analgesics, Opioid ; Morphine (76I7G6D29C)
    Language English
    Publishing date 2023-06-06
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1162513-2
    ISSN 1724-6067 ; 1120-7000
    ISSN (online) 1724-6067
    ISSN 1120-7000
    DOI 10.1177/11207000231176507
    Database MEDical Literature Analysis and Retrieval System OnLINE

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