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Article ; Online: Virtual Reality and Surgical Simulation Training for Orthopaedic Surgery Residents: A Qualitative Assessment of Trainee Perspectives.

Kuhn, Andrew W / Yu, Justin K / Gerull, Katherine M / Silverman, Richard M / Aleem, Alexander W

JB & JS open access

2024 Volume 9, Issue 1

Abstract: Background: The demonstrated benefits of virtual reality (VR) in orthopaedic surgical training are numerous. However, it is relatively unknown how best to implement VR into an already established orthopaedic resident education curriculum and how ... ...

Abstract	Background: The demonstrated benefits of virtual reality (VR) in orthopaedic surgical training are numerous. However, it is relatively unknown how best to implement VR into an already established orthopaedic resident education curriculum and how trainees will engage and use these technologies longitudinally. Methods: This was an exploratory, qualitative research study performed in accordance with Consolidated Criteria for Reporting Qualitative Research guidelines. Orthopaedic surgery residents at a single institution were recruited during the 2022 to 2023 academic year. Semistructured interviews were conducted. Data were analyzed through grounded theory methodology, beginning with open coding, followed by axial coding, and concluding with selective coding that describes orthopaedic surgery residents' current perceptions of VR as a training tool. Results: Six residents participated in interviews before thematic saturation was achieved. Average interview length was 13:27 (±2:59) minutes. Residents felt that currently, VR is most useful for interns and junior residents as an educational adjunct for learning anatomy, surgical exposures, and the steps of a procedure in a risk- and judgment-free arena. There seems to be a "ceiling effect" with VR given current technological limitations, and residents remarked that there is an associated "opportunity cost" with using VR technology. Some residents may find it more time-efficient to study texts, videos, or surgical guides rather than use VR. Cost (limited number of headsets) and technological barriers (i.e., hardware, software, and Wi-Fi issues) were some of the described barriers to VR utilization. Residents felt that there needs to be dedicated technological support to help with these issues. At this time, given these limitations of VR, many preferred VR as an optional educational adjunct rather than as a required curricular tool or assessment of surgical competency. Conclusions: There is current utility for VR in orthopaedic surgical training. Future technological advances may make VR more central to resident education. This study describes resident perceptions about the technology and best use practices for the technology. Level of evidence: Qualitative Study, Level V Evidence.
Language	English
Publishing date	2024-03-20
Publishing country	United States
Document type	Journal Article ; Review
ISSN	2472-7245
ISSN (online)	2472-7245
DOI	10.2106/JBJS.OA.23.00142
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Multi-investigator collaboration in orthopedic surgery research compared to other medical fields: Update comparing 2021-2009.

Kuhn, Andrew W / Rund, Joseph M / Wolf, Brian R / Brophy, Robert H

Journal of orthopaedic research : official publication of the Orthopaedic Research Society

2023 Volume 42, Issue 4, Page(s) 873–877

Abstract: The purpose of this study was to assess the prevalence of multicenter studies in the orthopedic literature compared to general medicine and other surgical subspecialty studies as an update to a previous study. The number of multicenter research studies ... ...

Abstract	The purpose of this study was to assess the prevalence of multicenter studies in the orthopedic literature compared to general medicine and other surgical subspecialty studies as an update to a previous study. The number of multicenter research studies across three orthopedic surgery journals was higher in 2021 compared to 2009 (7.2% [95% CI: 5.1%-9.4%, χ
MeSH term(s)	Humans ; Orthopedics ; Orthopedic Procedures
Language	English
Publishing date	2023-10-17
Publishing country	United States
Document type	Multicenter Study ; Journal Article
ZDB-ID	605542-4
ISSN	1554-527X ; 0736-0266
ISSN (online)	1554-527X
ISSN	0736-0266
DOI	10.1002/jor.25703
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Article: Pediatric Open Long-Bone Fracture and Subsequent Deep Infection Risk: The Importance of Early Hospital Care.

Kuhn, Andrew W / Troyer, Stockton C / Martus, Jeffrey E

Children (Basel, Switzerland)

2022 Volume 9, Issue 8

Abstract: The purpose of the current study was to identify risk factors for deep infection after an open long-bone fracture in pediatric patients. Systematic billing queries were utilized to identify pediatric patients who presented to a level I trauma center from ...

Abstract	The purpose of the current study was to identify risk factors for deep infection after an open long-bone fracture in pediatric patients. Systematic billing queries were utilized to identify pediatric patients who presented to a level I trauma center from 1998 to 2019 with open long-bone fractures. There were 303 open long-bone fractures, and 24 (7.9%) of these became infected. Fractures of the tibia/fibula (
Language	English
Publishing date	2022-08-17
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2732685-8
ISSN	2227-9067
ISSN	2227-9067
DOI	10.3390/children9081243
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Article: Upper Extremity Pain and Overuse Injuries in Fly-Fishing: A North American Cross-Sectional Survey and Implications for Injury Prevention.

Kuhn, Andrew W / Kuhn, John E

Orthopaedic journal of sports medicine

2020 Volume 8, Issue 10, Page(s) 2325967120959303

Abstract: Background: Fly-fishing requires rhythmic, coordinated movements to successfully cast a fly line. Previous studies have shown that the biomechanical demands of fly-casting may cause some individuals to develop upper extremity pain or injuries.: ... ...

Abstract	Background: Fly-fishing requires rhythmic, coordinated movements to successfully cast a fly line. Previous studies have shown that the biomechanical demands of fly-casting may cause some individuals to develop upper extremity pain or injuries. Purpose: To report the rates, trends, and contributing factors of upper extremity pain and overuse injuries in a sample of North American recreational fly-fishers. Study design: Descriptive epidemiology study. Methods: Participants were reached via 3 popular online fly-fishing forums in April 2019. Each consenting North American participant over 18 years of age was given a link to a unique survey that recorded his or her demographic and orthopaedic histories, fly-fishing experience, equipment, casting techniques, upper extremity pain after fly-fishing, and chronic outcomes. Results: The 162 fly-fishers included were 63.3 (± 11.5) years of age, and 95.1% were men. In total, 59 (36.4%) reported experiencing upper extremity pain immediately after fly-fishing. Pain was rated a 4.0 (interquartile range, 3.0-6.0) on a 10-point Likert scale, commonly lasting less than 1 day (45.0%) or between 1 day and 1 week (45.0%). The majority (62.7%) reported not needing to see a medical provider for their pain/soreness. Those who did most commonly received diagnoses of elbow or rotator cuff tendinitis. Pain/soreness was associated with casting in an elliptical/sidearm fashion, compared with overhead or 2-handed casting ( Conclusion: In this sample of recreational fly-fishers, no aspects of fly-fishing were associated with long-term upper extremity disability, and only a little more than a third reported having transient pain immediately after fishing. Casting style, using weighted lines or added weight, and grip style were all associated with pain. These are modifiable risk factors that can be adjusted to reduce the risk of upper extremity pain immediately after fly-fishing.
Language	English
Publishing date	2020-10-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	2706251-X
ISSN	2325-9671
ISSN	2325-9671
DOI	10.1177/2325967120959303
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Article ; Online: Factors Associated with the Success and Timing of Orthopaedic Surgery Resident Research Thesis Project Publication.

Kuhn, Andrew W / Inclan, Paul M / Brogan, David M / Aleem, Alexander W / Brophy, Robert H

JB & JS open access

2023 Volume 8, Issue 1

Abstract: Scholarship and research are important aspects of orthopaedic surgery training. Many orthopaedic surgery residency programs have developed dedicated research curricula, often culminating in a capstone thesis project with the intended goal of peer- ... ...

Abstract	Scholarship and research are important aspects of orthopaedic surgery training. Many orthopaedic surgery residency programs have developed dedicated research curricula, often culminating in a capstone thesis project with the intended goal of peer-reviewed publication. However, data on the success of these programs are scarce. The purpose of the current study was to determine the success rate and time to publication of resident research thesis projects at our own institution while evaluating factors associated with these outcomes. Methods: Resident research thesis projects performed over the past 15 years were aggregated and reviewed. Additional data regarding the projects and former trainees who performed them were collected using public resources which included measures of current academic aptitude (i.e., H-index and number of publications) as well as project and publication characteristics. Cox and linear regression analyses were conducted to assess the relation between numerous predictor variables and the success and time to publication. All analyses were conducted at the 95% confidence interval (CI) level. Results: Sixty-eight (n = 68; 83%) resident research thesis projects were published an average of 2,582.8 days, or roughly 7 years from the start of their residency training. Graduate adjusted H-index was associated with increased success and decreased time to publication (hazard ratio 1.183 [95% CI: 1.059-1.322], p = 0.003). A lower journal impact factor was associated with taking significantly shorter time to reach publication ( Discussion/conclusion: Over the past 15 years, 83% of orthopaedic resident research thesis projects at our institution were published. A higher adjusted H-index was associated with greater completion and faster timing to publication. A lower journal impact factor was also associated with quicker publication. These data highlight the publication metrics of a formalized resident research program and identify factors associated with success and timing of publication.
Language	English
Publishing date	2023-01-12
Publishing country	United States
Document type	Journal Article ; Review
ISSN	2472-7245
ISSN (online)	2472-7245
DOI	10.2106/JBJS.OA.22.00072
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Article ; Online: Use of Publicly Obtained Data in Sports Medicine Research: A Systematic Review and Bibliometric Analysis.

Inclan, Paul M / Kuhn, Andrew W / Troyer, Stockton C / Solomon, Gary S / Matava, Matthew J

The American journal of sports medicine

2023 Volume 52, Issue 5, Page(s) 1367–1373

Abstract: Background: Publicly obtained data (POD) have recently been utilized frequently by sports medicine researchers to describe injury patterns, risk factors, and outcomes in elite athletes. The relative ease of this type of research that is based solely on ... ...

Abstract	Background: Publicly obtained data (POD) have recently been utilized frequently by sports medicine researchers to describe injury patterns, risk factors, and outcomes in elite athletes. The relative ease of this type of research that is based solely on internet and media sources has resulted in a near exponential increase in the number of these POD studies. Purpose: To systematically review the sports medicine literature for studies based solely on POD. Study design: Systematic review and bibliometric analysis; Level of evidence, 4. Methods: A systematic review of POD studies published since 2000 was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies of interest were those relying on publicly available injury reports or online media for data acquisition in collegiate, semiprofessional, and professional athletes. Results: There were 209 POD studies published between 2000 and 2022, with 173 (82.8%) of these studies published after 2016. Studies were published most frequently on athletes participating in North American professional leagues: National Football League (n = 69 [28.4%]), Major League Baseball (n = 56 [23.0%]), National Basketball Association (n = 37 [15.2%]), and National Hockey League (n = 33 [13.6%]). The most common injuries assessed were head injuries/concussions (n = 43 [21.1%]), anterior cruciate ligament injuries (n = 33 [16.2%]), and ulnar collateral ligament injuries (n = 23 [11.3%]). One-quarter of the studies (n = 53 [25.4%]) reported only 1 POD source, and 1 study (0.5%) reported no source. Additionally, 65 studies (31.1%) listed nonspecific POD resources or solely cited previous literature to describe the POD search methodology and data acquisition. Conclusion: POD studies are exponentially increasing in number, particularly across major North American professional sports leagues, with significant variability in the injury of interest, search methodology, and number of data sources. The accuracy of the conclusions reached based on the POD methodology appears highly variable. Given the potential impact of these publications as both contributors to current knowledge and drivers of future research, the sports medicine community should be aware of the inherent biases and limitations of POD injury studies.
MeSH term(s)	Humans ; Athletic Injuries/etiology ; Sports Medicine ; Brain Concussion/complications ; Football/injuries ; Bibliometrics
Language	English
Publishing date	2023-06-12
Publishing country	United States
Document type	Systematic Review ; Journal Article
ZDB-ID	197482-8
ISSN	1552-3365 ; 0363-5465
ISSN (online)	1552-3365
ISSN	0363-5465
DOI	10.1177/03635465231177054
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Zs.B 1910: Show issues

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Article ; Online: Gluteus Maximus Transfer for Irreparable Hip Abductor Deficiency: A Systematic Review and Meta-Analysis.

Song, Bryant M / Inclan, Paul M / Kuhn, Andrew W / Stronach, Benjamin M / Pascual-Garrido, Cecilia

The Journal of arthroplasty

2023 Volume 39, Issue 4, Page(s) 1117–1124.e1

Abstract: Background: Gluteus maximus tendon transfer has recently been described as a treatment option for irreparable abductor tendon tears. The purpose of this study was to systematically review outcomes following gluteus maximus tendon transfer for hip ... ...

Abstract	Background: Gluteus maximus tendon transfer has recently been described as a treatment option for irreparable abductor tendon tears. The purpose of this study was to systematically review outcomes following gluteus maximus tendon transfer for hip abductor deficiency. Methods: The published literature was queried for outcomes following gluteus maximus transfer in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Outcomes of interest included preoperative and postoperative functional scores, resolution of pain and gait abnormalities, postoperative rehabilitation protocols, surgical complications, reoperation rates, and postoperative magnetic resonance imaging. In total, 10 studies with a total of 125 patients (76% women) with a mean age of 67 years (range, 30 to 87) were identified for inclusion. Results: Modified Harris Hip Score (+30.1 ± 6.6 [95% confidence interval: +15.5 to +46.5]) and Visual Analog Scale for pain (-4.1 ± 1.1 [95% confidence interval: -7.1 to -1.0]) were improved following gluteus maximus transfer, compared to preoperative levels. No significant improvement was noted in abduction strength and 33% of patients demonstrated a residual Trendelenburg gait postoperatively. The overall complication rate was 5.6% (7 of 125), with a reoperation rate of 1.6% (2 of 125). Conclusions: Gluteus maximus tendon transfer for abductor insufficiency has demonstrated reliable outcomes at 3 years, with improvement in hip function and pain. However, patients demonstrate modest improvements in abduction strength, and a significant subset will continue to demonstrate a Trendelenburg gait postoperatively.
MeSH term(s)	Humans ; Buttocks/surgery ; Muscle, Skeletal/surgery ; Pain ; Tendons ; Thigh
Language	English
Publishing date	2023-10-23
Publishing country	United States
Document type	Meta-Analysis ; Systematic Review ; Journal Article
ZDB-ID	632770-9
ISSN	1532-8406 ; 0883-5403
ISSN (online)	1532-8406
ISSN	0883-5403
DOI	10.1016/j.arth.2023.10.036
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Zs.A 2134: Show issues

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Article: Spinal Anesthetic Type and Independent Risk Factors for Postoperative Urinary Retention Following Total Joint Arthroplasty.

Kuhn, Andrew W / Lynch, Jonathan R / Ahlers, Carolyn G / Polkowski, Gregory G

Journal of surgical orthopaedic advances

2021 Volume 29, Issue 4, Page(s) 225–229

Abstract: While risk factors for postoperative urinary retention (POUR) after total joint arthroplasty (TJA) have been identified, its association with type of spinal anesthetic has not yet been thoroughly investigated. Patients undergoing primary TJA between 2013- ...

Abstract	While risk factors for postoperative urinary retention (POUR) after total joint arthroplasty (TJA) have been identified, its association with type of spinal anesthetic has not yet been thoroughly investigated. Patients undergoing primary TJA between 2013-2018 were reviewed. From August 2013 to March 2016 bupivacaine was primarily given and from March 2016 through August 2018, most, although not all, received mepivacaine. Patient demographics as well as intraoperative data were recorded. One-thousand and fifty-four patients were included. POUR rates were not significantly different between groups (5.5% vs 6.1%, p = 0.675). Those who received mepivacaine had a significantly shorter length of stay (LOS) (1 vs. 2 days, p < 0.001). However, spinal anesthetic type was not significantly associated with either POUR or LOS after controlling for between-group differences. Older age (odds ratio [OR] 1.024 [95% confidence interval {CI}:1.000-1.049]; p = 0.049) and a history of benign prostatic hyperplasia or urinary incontinence/retention (OR 2.155 [95% CI:1.114-4.168]; p = 0.023) were confirmed as independent risk factors for POUR. (Journal of Surgical Orthopaedic Advances 29(4):225-229, 2020).
MeSH term(s)	Aged ; Anesthesia, Spinal/adverse effects ; Anesthetics ; Arthroplasty, Replacement, Hip ; Humans ; Postoperative Complications/epidemiology ; Retrospective Studies ; Risk Factors ; Urinary Retention/epidemiology ; Urinary Retention/etiology
Chemical Substances	Anesthetics
Language	English
Publishing date	2021-01-08
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
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Article ; Online: Reverse Total Shoulder Arthroplasty Versus Hemiarthroplasty for the Treatment of Proximal Humerus Fractures: A Model-Based Cost-Effectiveness Analysis.

Sheibani-Rad, Shahin / Kuhn, Andrew W / Berrigan, Patrick S / Bedi, Asheesh

The Journal of the American Academy of Orthopaedic Surgeons

2021 Volume 29, Issue 24, Page(s) e1353–e1361

Abstract: Introduction: Compared with hemiarthroplasty (HA), reverse total shoulder arthroplasty (RTSA) may provide greater cost and health-related benefits for patients with complex three- and four-part proximal humeral fractures. This study set out to compare ... ...

Abstract	Introduction: Compared with hemiarthroplasty (HA), reverse total shoulder arthroplasty (RTSA) may provide greater cost and health-related benefits for patients with complex three- and four-part proximal humeral fractures. This study set out to compare RTSA versus HA for the incremental cost per incremental improvement in quality adjusted life years (QALYs) for a hypothetical cohort of patients with proximal humerus fractures. Methods: Parameters and characteristics for a hypothetical cohort of elderly patients with proximal humerus fractures were collected through the literature. A cohort-level Markov decision model was constructed. Incremental cost-effectiveness ratios representing the difference in cost divided by the difference in QALYs were calculated, and scenario, one-way, and probabilistic analysis were conducted. Results: RTSA was associated with lower cost and greater effectiveness compared with HA. The predicted cost difference corresponded to a saving of $99,626 per 100 individuals treated, and the predicted difference in QALY was 16.8 per 100 individuals treated. Results were sensitive to the discount rate, the health-related quality of life assigned to health states, and the cost of the surgical procedures. In probabilistic analysis, 77.1% of iterations were cost-effective at a threshold willingness-to-pay for a QALY of $100,000 US dollars. Discussion: Findings suggest that RTSA may be a cost-effective alternative to HA for treating elderly patients requiring surgery for proximal humerus fractures. Data availability: The model and corresponding code are available on request to the corresponding author. Level of evidence using the journal of the american academy of orthopedic surgeons guidance: Level III.
MeSH term(s)	Aged ; Arthroplasty, Replacement, Shoulder ; Cost-Benefit Analysis ; Hemiarthroplasty ; Humans ; Humerus ; Quality of Life ; Shoulder Fractures/surgery ; Treatment Outcome ; United States
Language	English
Publishing date	2021-04-30
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-21-00166
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Zs.A 4048: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article: Gluteus Maximus Transfer for Hip Abductor Deficiency.

Inclan, Paul M / Schwabe, Maria T / Song, Bryant M / Kuhn, Andrew W / Layon, Daniel R / Clohisy, John C / Pascual-Garrido, Cecilia

Arthroscopy techniques

2023 Volume 12, Issue 5, Page(s) e671–e676

Abstract: Hip abductor deficiency resulting from gluteus medius and minimus pathology is increasingly recognized as a generator of lateral-sided hip pain. In the setting of a failed gluteus medius repair or in patients with irreparable tears, transfer of the ... ...

Abstract	Hip abductor deficiency resulting from gluteus medius and minimus pathology is increasingly recognized as a generator of lateral-sided hip pain. In the setting of a failed gluteus medius repair or in patients with irreparable tears, transfer of the anterior portion of the gluteus maximus muscle can be performed to treat gluteal abductor deficiency. The classic description of the gluteus maximus transfer technique relies solely on bone tunnel fixation. This article describes a reproducible technique that incorporates the addition of a distal row to the tendon transfer, which may improve fixation by both compressing the tendon transfer to the greater trochanter and providing improved biomechanical strength to the transfer.
Language	English
Publishing date	2023-04-16
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2653101-X
ISSN	2212-6287
ISSN	2212-6287
DOI	10.1016/j.eats.2023.01.002
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