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Article ; Online: Coronal Alignment in Adult Spine Surgery.

Sharfman, Zachary T / Clark, Aaron J / Gupta, Munish C / Theologis, Alekos A

The Journal of the American Academy of Orthopaedic Surgeons

2024

Abstract: Coronal realignment is an important goal in adult spine surgery that has been overshadowed by emphasis on the sagittal plane. As coronal malalignment drives considerable functional disability, a fundamental understanding of its clinical and radiographic ... ...

Abstract	Coronal realignment is an important goal in adult spine surgery that has been overshadowed by emphasis on the sagittal plane. As coronal malalignment drives considerable functional disability, a fundamental understanding of its clinical and radiographic evaluation and surgical techniques to prevent its development is of utmost importance. In this study, we review etiologies of coronal malalignment and their radiographic and clinical assessments, risk factors for and functional implications of postoperative coronal malalignment, and surgical strategies to optimize appropriate coronal realignment in adult spine surgery.
Language	English
Publishing date	2024-02-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	1200524-1
ISSN	1940-5480 ; 1067-151X
ISSN (online)	1940-5480
ISSN	1067-151X
DOI	10.5435/JAAOS-D-23-00961
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Article ; Online: Proximal Junctional Kyphosis and Failure: Strategies for Prevention.

Arora, Ayush / Sharfman, Zachary T / Clark, Aaron J / Theologis, Alekos A

Neurosurgery clinics of North America

2023 Volume 34, Issue 4, Page(s) 573–584

Abstract: Proximal junctional kyphosis (PJK) and proximal junctional failure/fractures (PJF) are common complications following long-segment posterior instrumented fusions for adult spinal deformity. As progression to PJF involves clinical consequences for ... ...

Abstract	Proximal junctional kyphosis (PJK) and proximal junctional failure/fractures (PJF) are common complications following long-segment posterior instrumented fusions for adult spinal deformity. As progression to PJF involves clinical consequences for patients and requires costly revisions that may undermine the utility of surgery and are ultimately unsustainable for health care systems, preventative strategies to minimize the occurrence of PJF are of tremendous importance. In this article, the authors present a detailed outline of PJK and PJF with a focus on surgical strategies aimed at preventing their occurrence..
MeSH term(s)	Adult ; Humans ; Kyphosis/prevention & control ; Kyphosis/surgery
Language	English
Publishing date	2023-07-16
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1196855-2
ISSN	1558-1349 ; 1042-3680
ISSN (online)	1558-1349
ISSN	1042-3680
DOI	10.1016/j.nec.2023.06.004
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Article ; Online: The Value of 2 Orthopaedic Learning Platforms from the Learners' and Educators' Point of View.

Volaski, Harrison / Sharfman, Zachary T / Levy, I Martin

JB & JS open access

2022 Volume 7, Issue 2

Abstract: Online learning platforms are a staple of orthopaedic resident education. These platforms typically address a user's knowledge base, aiming to improve OITE and AAOS Board Examination scores. Orthopaedic residents often use these platforms as their ... ...

Abstract	Online learning platforms are a staple of orthopaedic resident education. These platforms typically address a user's knowledge base, aiming to improve OITE and AAOS Board Examination scores. Orthopaedic residents often use these platforms as their primary educational resource. However, an orthopaedic surgeon is more than an orthopaedic knowledge base; acquisition of clinical acumen is integral as well. We sought to investigate the following: From a learner's and educator's perspective, do Orthobullets (OB) and Clinical Classroom (CC) contribute to both knowledge base and clinical acumen? Methods: Thirty residents and 16 attending surgeons at a single institution were assigned to review topics and complete questions on either the OB and CC platform. Participants then filled out surveys regarding the platform they were assigned, switched platforms, and completed a final survey. Independent-samples Student Results: Residents and attendings reported a preference for OB for fact acquisition, relevance to the OITE, and explanation of answers. Senior residents (PGY5) and attending surgeons reported that CC had a greater impact on their clinical acumen. Junior residents (PGY1, PGY2, and PGY3) reported the opposite. Participants responded that both platforms expand a learner's knowledge base and clinical acumen. Conclusions: Learners and educators felt both platforms addressed knowledge base and clinical acumen. Junior residents reported a preference for OB to CC to advance their knowledge base and clinical acumen, but senior residents and attendings felt the opposite was true. Based on survey responses, these platforms were found to be additive, complementary, and that their value to the learner changes during the course of residency education. Level of evidence: III.
Language	English
Publishing date	2022-06-07
Publishing country	United States
Document type	Journal Article ; Review
ISSN	2472-7245
ISSN (online)	2472-7245
DOI	10.2106/JBJS.OA.21.00161
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Article ; Online: Did we do the right thing? The appropriateness of orthopedic operative interventions during the height of the coronavirus disease 2019 pandemic.

Batti, Kevin / Sharfman, Zachary T / Dimitroulias, Apostolos / Sen, Milan

OTA international : the open access journal of orthopaedic trauma

2022 Volume 5, Issue 1, Page(s) e197

Abstract: Purpose: During the coronavirus disease (COVID) pandemic elective surgeries were cancelled and operative indications curtailed to counteract shortages in resources. We aimed to review each orthopedic operative indication at an urban Level 1 Trauma ... ...

Abstract	Purpose: During the coronavirus disease (COVID) pandemic elective surgeries were cancelled and operative indications curtailed to counteract shortages in resources. We aimed to review each orthopedic operative indication at an urban Level 1 Trauma Center inundated with COVID. We aimed to classify the appropriateness of each operative intervention and determine if exposure to COVID impacted morbidity or mortality. Methods: All orthopedic procedures between March 16, 2020 and May 16, 2020 were reviewed. The most urgent surgical indication for each procedure was classified by 2 fellowship trained orthopedic trauma surgeons and 2 senior residents. The appropriateness of the operative intervention was determined. The American Academy of Orthopedic Surgery (AAOS) and American College of Surgeons (ACS) guidelines for surgery during the pandemic were considered. Results: Seventy-six surgical encounters were performed on 71 inpatients including 99 total procedures. No outpatient procedures were performed. Fifty-four of 71 patients were male. There was a mean age of 51.6 years. Of 71 patients, 41 presented to the emergency department without trauma activation with a mean time to presentation of 2.7 days post injury. The most urgent surgical indications included 18 hip fractures, 18 periarticular fractures, 17 open fractures, 7 severe infections, 5 pelvic fractures, 5 femoral shaft fractures, 3 spinal injuries, 1 tibial fracture, 1 tendon injury, and 1 clavicle fracture. Four procedures could have been delayed for conservative management without causing significant harm. Upon discharge 13/71 patients had tested positive for COVID, 41/71 had remained negative throughout their hospital stay, and 17/71 patients never were tested. Four patients contracted COVID in the hospital. There were 4 in hospital deaths, 2 attributed to hypoxemic respiratory failure secondary to COVID pneumonia. Conclusion: It was determined that 72/76 cases were considered appropriate in following guidelines of the AAOS and ACS. This highlights the value of halting outpatient procedures and limiting patient exposure to COVID. Comprehensive patient/provider discussions addressing the risks, benefits, alternatives to surgery, and the risk of exposure to respiratory illness are vital. It behooves the surgical team to follow established guidelines such as those of the AAOS and ACS when triaging orthopedic patients for a surgical admission.
Language	English
Publishing date	2022-02-16
Publishing country	United States
Document type	Journal Article
ISSN	2574-2167
ISSN (online)	2574-2167
DOI	10.1097/OI9.0000000000000197
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Article ; Online: Do racial disparities exist in a spine surgery practice that serves a predominately minority population? Outcomes of transforaminal lumbar interbody fusion: A retrospective review.

Volaski, Harrison A / Sharfman, Zachary T / Shah, Priyam / Eleswarapu, Ananth / Geller, David S / Krystal, Jonathan

North American Spine Society journal

2022 Volume 12, Page(s) 100171

Abstract: Background: Racial minority status is associated with inferior peri-operative outcomes following spinal fusion. Findings have largely been reported within institutions serving few minority patients. This study aimed to identify if racial disparities ... ...

Abstract	Background: Racial minority status is associated with inferior peri-operative outcomes following spinal fusion. Findings have largely been reported within institutions serving few minority patients. This study aimed to identify if racial disparities exist for transforaminal lumbar interbody fusion (TLIF) procedures within an urban academic medical center which serves a majority non-White population. Methods: This is a retrospective review of patients who underwent a TLIF procedure at our institution between 06/2016-10/2019. Primary outcome measures included length of stay (LOS), discharge disposition, 30-day return to the emergency department (ED), 30-day readmission rate, and 30-day complication rates. One-hundred-fifty-six patients (female: male, 99: 57) met inclusion criteria. Demographic and clinical data (body mass index (BMI), comorbidities, preoperative lab values) were compared. Results: The mean LOS was 6.2, 5.9, and 6 days in the White, Hispanic, and Black cohorts, respectively ( Conclusions: We found no racial disparities in terms of LOS, discharge disposition, or 30-day readmission rates. Hispanic patients demonstrated an increased utilization of the ED in the early post-operative period. Efforts to overcome language barriers, communicate instructions clearly, and outline post-operative expectations and plans may prevent the need for post-operative ED visits.
Language	English
Publishing date	2022-09-15
Publishing country	United States
Document type	Journal Article
ISSN	2666-5484
ISSN (online)	2666-5484
DOI	10.1016/j.xnsj.2022.100171
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Article ; Online: Age-Adjusted Normative Values for Hip Patient-Reported Outcome Measures.

Sharfman, Zachary T / Safran, Nathan / Amar, Eyal / Varshneya, Kunal / Safran, Marc R / Rath, Ehud

The American journal of sports medicine

2021 Volume 50, Issue 1, Page(s) 79–84

Abstract: Background: Patient-reported outcome measures (PROMs) are essential clinical instruments used for assessing patient function, assisting in clinical decision making, and quantifying outcomes of surgical and nonsurgical management. However, PROMs are ... ...

Abstract	Background: Patient-reported outcome measures (PROMs) are essential clinical instruments used for assessing patient function, assisting in clinical decision making, and quantifying outcomes of surgical and nonsurgical management. However, PROMs are often designed using patients with preexisting pathology and typically assume that a patient without the pathology would have a perfect or near perfect score. This may result in unrealistic expectations or falsely underestimate how well a patient is doing after treatment. The influence of age on PROMs about the hip of healthy individuals has not been studied. Hypothesis: We hypothesize that in asymptomatic individuals hip-specific PROM scores will decrease in an age-dependent manor. Study design: Cross-sectional study; Level of evidence, 3. Methods: In this multicenter survey study, volunteers who denied preexisting hip pathology and previous hip surgery completed 3 PROMs online or as traditional paper questionnaires. The International Hip Outcome Tool (iHOT), the modified Harris Hip Score (mHHS), and the Hip Outcome Score-Activities of Daily Living (HOS-ADL) and HOS-Sport were completed. Analysis of variance with a Tukey post hoc test was used to analyze differences in PROMs among subgroups. An independent-samples Student Results: In total 496, 571, 534, and 532 responses were collected for the iHOT, mHHS, HOS-ADL, and HOS-Sport, respectively. Respondents' PROMs were scored and arranged into 3 groups by age: <40 years, 40 to 60 years, and >60 years. The iHOT, mHHS, HOS-ADL, and HOS-Sport of these asymptomatic respondents all decreased in an age-dependent manner: iHOT (<40, 94.1; 40-60, 92.4; >60, 87.0), mHHS (<40, 94.8; 40-60, 91.3; >60, 89.1), HOS-ADL (<40, 98.4; 40-60, 95.0; >60, 90.9), and HOS-Sport (<40, 95.7; 40-60, 82.9; >60, 72.9) (analysis of variance between-group differences, Conclusion: This study demonstrated that the iHOT, mHHS, and HOS-ADL and HOS-Sport scores in asymptomatic people decrease in an age-dependent manner. It is important to compare a patient's outcome scores with the age-normalized scores to establish an accurate reference frame with which to interpret outcomes.
MeSH term(s)	Activities of Daily Living ; Adult ; Arthroscopy ; Cross-Sectional Studies ; Femoracetabular Impingement ; Hip Joint ; Humans ; Patient Reported Outcome Measures ; Treatment Outcome
Language	English
Publishing date	2021-11-22
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
ZDB-ID	197482-8
ISSN	1552-3365 ; 0363-5465
ISSN (online)	1552-3365
ISSN	0363-5465
DOI	10.1177/03635465211056666
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Article: Cigarette smoking and complications in elective thoracolumbar fusions surgery: An analysis of 58,304 procedures.

Sharfman, Zachary T / Gelfand, Yaroslav / Hoang, Henry / Ramos, Rafael De La Garza / Gomez, Jaime A / Krystal, Jonathan / Kramer, David / Yassari, Reza

Journal of craniovertebral junction & spine

2022 Volume 13, Issue 2, Page(s) 169–174

Abstract: Study design: This was retrospective cohort study.: Purpose: The current investigation uses a large, multi-institutional dataset to compare short-term morbidity and mortality rates between current smokers and nonsmokers undergoing thoracolumbar ... ...

Abstract	Study design: This was retrospective cohort study. Purpose: The current investigation uses a large, multi-institutional dataset to compare short-term morbidity and mortality rates between current smokers and nonsmokers undergoing thoracolumbar fusion surgery. Overview of literature: The few studies that have addressed perioperative complications following thoracolumbar fusion surgeries are each derived from small cohorts from single institutions. Materials and methods: A retrospective study was conducted on thoracolumbar fusion patients in the American College of Surgeons National Surgical Quality Improvement Program database (2006-2016). The primary outcome compared the rates of overall morbidity, severe postoperative morbidity, infections, pneumonia, deep venous thrombosis (DVT), pulmonary embolism (PE), transfusions, and mortality in smokers and nonsmokers. Results: A total of 57,677 patients were identified. 45,952 (78.8%) were nonsmokers and 12,352 (21.2%) smoked within 1 year of surgery. Smokers had fewer severe complications (1.6% vs. 2.0%, Conclusions: There is a positive correlation between smoking and postoperative pneumonia after thoracolumbar fusion. The incidence of blood transfusions, DVT, and LOS was decreased in smokers. Early postoperative mortality, severe complications, discharge to subacute rehabilitation facilities, extubation failure, PE, SSI, and return to OR were not associated with smoking.
Language	English
Publishing date	2022-06-13
Publishing country	India
Document type	Journal Article
ZDB-ID	2573344-8
ISSN	0976-9285 ; 0974-8237
ISSN (online)	0976-9285
ISSN	0974-8237
DOI	10.4103/jcvjs.jcvjs_15_22
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Article ; Online: Black and Hispanic Patients Do Not Stay Longer After Primary Total Knee Arthroplasty: Results From an Urban Center Serving a Predominantly Minority Cohort.

Zvi, Yoav S / Sharfman, Zachary T / Loloi, Jeremy / Seref-Ferlengez, Zeynep / Lo, Yungtai / Tiwari, Bharat / Kim, Sun Jin

The Journal of the American Academy of Orthopaedic Surgeons

2022 Volume 30, Issue 7, Page(s) 329–337

Abstract: Introduction: Previous reports identified minority race/ethnicity to be an independent risk factor for prolonged length of stay (LOS); however, these cohorts consisted of predominantly White patients. This study sought to evaluate minority status as an ... ...

Abstract	Introduction: Previous reports identified minority race/ethnicity to be an independent risk factor for prolonged length of stay (LOS); however, these cohorts consisted of predominantly White patients. This study sought to evaluate minority status as an independent risk factor for prolonged LOS after primary total knee arthroplasty (TKA) in a predominantly Hispanic and Black cohort. Methods: This was a retrospective study using an institutional database of patients who underwent primary TKA between the years 2016 and 2019. Demographic and socioeconomic data, smoking, body mass index (BMI), medical comorbidities, discharge disposition, and 30-day readmission rates were collected. Patients were first categorized into racial/ethnic groups (Hispanic, Black, or White). An univariate analysis was performed comparing patient characteristics between racial/ethnic groups using the Wilcoxon rank sum, chi-squared, and Fisher exact tests. We then categorized patients into two groups-normal LOS (discharged on postoperative day 1 to 2) and prolonged LOS (discharged after postoperative day 2). An univariate analysis was again performed comparing patient characteristics between LOS groups using Wilcoxon rank sum, chi-squared, and Fisher exact tests. After identifying risk factors markedly associated with LOS, a multivariate logistic regression analysis was performed to identify independent risk factors for prolonged LOS. Results: A total of 3,093 patients were included-47.9% Hispanic and 38.3% Black. Mean LOS was 2.9 ± 1.6 days. An univariate analysis found race/ethnicity, age, low socioeconomic status (SES), discharge disposition, insurance type, weekday of surgery, BMI >40, smoking, increased American Society of Anesthesiologists (ASA)/Charlson Comorbidity Index (CCI) and several medical comorbidities to be associated with prolonged LOS (P < 0.05). A multivariate logistic regression analysis found Black and Hispanic patients were less likely to have prolonged LOS after adjusting for associated risk factors. White race/ethnicity, nonhome discharge, low SES, weekday of surgery, smoking, BMI >40, and increased ASA and CCI were identified as independent risk factors for prolonged LOS (P < 0.05). The overall 30-day readmission rate was 3.6%, with no notable difference between racial/ethnic and LOS groups (P = 0.98 and P = 0.78). Conclusion: In contrast to previous reports, our study found that after adjusting for associated risk factors, minority patients do not have prolonged LOS after primary TKA in an urban, socioeconomically disadvantaged, predominantly minority patient cohort. White race/ethnicity, nonhome discharge, low SES, weekday of surgery, smoking, BMI >40, increased CCI, and ASA were all found to be independent risk factors for prolonged LOS. These findings highlight the need to further investigate the role of race/ethnicity on LOS after primary TKA using large-scale, randomized controlled trials with equally represented patient cohorts.
MeSH term(s)	Arthroplasty, Replacement, Knee/adverse effects ; Hispanic or Latino ; Humans ; Length of Stay ; Patient Readmission ; Postoperative Complications/etiology ; Retrospective Studies
Language	English
Publishing date	2022-04-14
Publishing country	United States
Document type	Journal Article
ZDB-ID	1200524-1
ISSN	1940-5480 ; 1067-151X
ISSN (online)	1940-5480
ISSN	1067-151X
DOI	10.5435/JAAOS-D-21-00609
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Article ; Online: Response to Letter to the Editor on "Balancing Thromboprophylaxis and Bleeding in Total Joint Arthroplasty: Impact of Eliminating Enoxaparin and Predonation and Implementing Pneumatic Compression and Tranexamic Acid".

Sharfman, Zachary T / Campbell, Joshua C / Spitzer, Andrew I

The Journal of arthroplasty

2016 Volume 31, Issue 11, Page(s) 2654

Language	English
Publishing date	2016-11
Publishing country	United States
Document type	Letter
ZDB-ID	632770-9
ISSN	1532-8406 ; 0883-5403
ISSN (online)	1532-8406
ISSN	0883-5403
DOI	10.1016/j.arth.2016.06.042
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Article ; Online: The anatomical properties of the indirect head of the rectus femoris tendon: a cadaveric study with clinical significance for labral reconstruction surgery.

Atzmon, Ran / Sharfman, Zachary T / Atoun, Ehud / Sampson, Thomas G / Amar, Eyal / Rath, Ehud

Archives of orthopaedic and trauma surgery

2019 Volume 140, Issue 1, Page(s) 85–92

Abstract: Background: Acetabular labral tear is a common pathology. In some clinical situations, primary labral repair may not be possible and labral reconstruction is indicated.: Purpose and clinical relevance: Describe the anatomy of the indirect head of the ...

Abstract	Background: Acetabular labral tear is a common pathology. In some clinical situations, primary labral repair may not be possible and labral reconstruction is indicated. Purpose and clinical relevance: Describe the anatomy of the indirect head of the rectus femoris (IHRF) tendon with clinical application in arthroscopic labral reconstruction surgery. Methods: Twenty-six cadaver hips were dissected. Thirteen measurements, each with clinical relevance to arthroscopic labral reconstruction using an IHRF tendon graft were taken on each hip. All measurements were taken in triplicate. Mean values, standard deviations and intra-observer reliability were calculated. Results: The mean footprint of the direct head of the rectus femoris tendon was 10.6 mm × 19.6 mm. The width and thickness at the confluence of both heads were 10.9 mm and 6.9 mm, respectively. The mean total length of the footprint and "free portion" of the IHRF was 55.3 mm, the mean cranial to caudal footprint measured at the 12 o'clock, 1 o'clock, and 2 o'clock positions were 22.3 mm. The mean length of the Indirect Head footprint alone was 38.1 mm. The mean length of IHRF tendon suitable for grafting was 46.1 mm and the mean number of clock face sectors covered by this graft was 3.3 clock face sectors. Intra-observer reliability was ≥ 0.90 for all recorded measurements. The origin of the IHRF on the acetabulum fans out posteriorly, becoming thinner and wider as the origin travels posteriorly. The tendon footprint is firmly attached on the lateral wall of the ilium and becomes a free tendon overlying the acetabular bone as it travels anteriorly and distally towards its muscular attachment. Conclusion: The IHRF tendon is in an ideal location for harvesting and contains the appropriate thickness, length and triangular architecture to serve as a safe and local graft source for acetabular labral reconstruction surgery.
MeSH term(s)	Acetabulum/anatomy & histology ; Arthroscopy ; Cartilage, Articular/anatomy & histology ; Humans ; Quadriceps Muscle/anatomy & histology ; Reconstructive Surgical Procedures ; Tendons/anatomy & histology
Language	English
Publishing date	2019-11-16
Publishing country	Germany
Document type	Journal Article
ZDB-ID	80407-1
ISSN	1434-3916 ; 0003-9330 ; 0344-8444
ISSN (online)	1434-3916
ISSN	0003-9330 ; 0344-8444
DOI	10.1007/s00402-019-03293-6
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