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Article: Patient Perception of Robotic-Assisted Total Joint Arthroplasty in a Hispanic Population.

Pinci, Marcantonio V / Torres-Lugo, Norberto J / Deliz-Jimenez, David E / Salem-Hernandez, Joseph / Claudio-Marcano, Alexandra / Ramírez, Norman / Otero-López, Antonio

Arthroplasty today

2024 Volume 25, Page(s) 101286

Abstract: Background: Robotic-assisted orthopaedic surgery has become popular and widely available, mainly for total joint arthroplasty. However, there has been a persistent concern regarding access to robotic-assisted surgery and the utilization rate of total ... ...

Abstract	Background: Robotic-assisted orthopaedic surgery has become popular and widely available, mainly for total joint arthroplasty. However, there has been a persistent concern regarding access to robotic-assisted surgery and the utilization rate of total joint arthroplasty among minority groups. As an imperative effort to close the gap regarding health inequalities, we assessed the knowledge and perspective of Hispanics regarding robotic-assisted orthopaedic surgery. Methods: A 28-item questionnaire was established to evaluate Hispanics' perceptions of robotic-assisted orthopaedic surgery. Participants answered questions about demographic features, knowledge about robotic-assisted orthopaedic surgery, and preferences regarding manual vs robotic-assisted procedures. Results: A total of 580 questionnaires were analyzed in our study, with an average age of participants of 49.1 years. Only 44.2% of the participants were familiar with robotic-assisted orthopaedic surgery. Fifty-three percent of the respondents preferred robotic-assisted surgery over conventional procedures, with many participants believing that robotic-assisted surgery leads to better outcomes (54.7%) and faster recovery (53.1%). Conclusions: Knowledge about specific factors such as clinical outcomes and costs may influence the perception and preference of Hispanics toward robotic-assisted orthopaedic surgery. Therefore, patient education may play a crucial role in the informed decision-making process in Hispanics when opting between robotic-assisted or traditional orthopaedic surgery.
Language	English
Publishing date	2024-01-13
Publishing country	United States
Document type	Journal Article
ISSN	2352-3441
ISSN	2352-3441
DOI	10.1016/j.artd.2023.101286
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Article: Simultaneous Total Hip Arthroplasty for Delayed Management of Bilateral Acetabular Fractures due to Alcohol-Withdrawal Seizures.

Pinci, Marcantonio V / Torres-Lugo, Norberto J / Acosta-Julbe, José / Deliz-Jimenez, David / Otero-López, Antonio / Criado, Alberto

Arthroplasty today

2022 Volume 18, Page(s) 7–10

Abstract: Bilateral acetabular fractures after seizure activity are rare, as most of these injuries are associated with high-energy trauma. It is hypothesized that rapid forceful contracture of hip musculature during a seizure can lead to the femoral head ... ...

Abstract	Bilateral acetabular fractures after seizure activity are rare, as most of these injuries are associated with high-energy trauma. It is hypothesized that rapid forceful contracture of hip musculature during a seizure can lead to the femoral head fracturing the medial wall and driving in proximal and medial directions. Absence of standardized surgical treatment algorithms and literature-reported outcomes makes this fracture pattern challenging to orthopedic surgeons. To the best of our knowledge, no published data describe delayed simultaneous total hip arthroplasty for treating seizure-induced bilateral acetabular fractures with protrusio. We present a patient that sustained bilateral acetabular fractures after an alcohol-withdrawal seizure. The patient underwent delayed simultaneous total hip arthroplasty 3 months later with excellent functional outcomes at the 6-month follow-up.
Language	English
Publishing date	2022-10-11
Publishing country	United States
Document type	Case Reports
ISSN	2352-3441
ISSN	2352-3441
DOI	10.1016/j.artd.2022.08.013
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Article: Adverse Soft-Tissue Reaction After Ceramic-On-Ceramic Bearing Fracture Mimicking a Periprosthetic Joint Infection.

Tresgallo-Parés, Ruben / Torres-Lugo, Norberto J / Rosado-Hernández, Edwin / Olivella, Gerardo / Ramírez, Norman / Otero-López, Antonio

Arthroplasty today

2022 Volume 13, Page(s) 93–97

Abstract: Prosthetic failure secondary to bearing fracture remains a potential complication in ceramic-on-ceramic total hip arthroplasty. We report the unusual presentation of a ceramic component fracture of a total hip arthroplasty performed 17 years ago that ... ...

Abstract	Prosthetic failure secondary to bearing fracture remains a potential complication in ceramic-on-ceramic total hip arthroplasty. We report the unusual presentation of a ceramic component fracture of a total hip arthroplasty performed 17 years ago that mimicked a periprosthetic joint infection. This case was managed based on the current guidelines and algorithms recommended for periprosthetic joint infection management. Histologic examination of periprosthetic tissue revealed an adverse inflammatory soft-tissue reaction to the ceramic fragments released from the fracture site. Our case highlights a misleading, inflammatory acute response usually associated with an infectious process corresponding to an adverse soft-tissue reaction. High clinical suspicion and a systematic approach are essential to address these deceiving clinical scenarios.
Language	English
Publishing date	2022-01-18
Publishing country	United States
Document type	Case Reports
ISSN	2352-3441
ISSN	2352-3441
DOI	10.1016/j.artd.2021.12.001
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Article ; Online: Clinical Considerations for the Use Lower Extremity Arthroplasty in the Elderly.

Otero-López, Antonio / Beaton-Comulada, David

Physical medicine and rehabilitation clinics of North America

2017 Volume 28, Issue 4, Page(s) 795–810

Abstract: There is an increase in the aging population that has led to a surge of reported cases of osteoarthritis and a greater demand for lower extremity arthroplasty. This article aims to review the current treatment options and expectations when considering ... ...

Abstract	There is an increase in the aging population that has led to a surge of reported cases of osteoarthritis and a greater demand for lower extremity arthroplasty. This article aims to review the current treatment options and expectations when considering lower extremity arthroplasty in the elderly patient with an emphasis on the following subjects: (1) updated clinical guidelines for the management of osteoarthritis in the lower extremity, (2) comorbidities and risk factors in the surgical patient, (3) preoperative evaluation and optimization of the surgical patient, (4) surgical approach and implant selection, and (5) rehabilitation and life after lower extremity arthroplasty.
MeSH term(s)	Aged ; Arthroplasty ; Humans ; Lower Extremity/physiopathology ; Lower Extremity/surgery
Language	English
Publishing date	2017
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1196791-2
ISSN	1558-1381 ; 1047-9651
ISSN (online)	1558-1381
ISSN	1047-9651
DOI	10.1016/j.pmr.2017.06.011
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Article ; Online: Opioid-Sparing Multimodal Analgesia Efficacy in Hispanic Patients Undergoing Total Knee Arthroplasty.

Olivella, Gerardo / Natal-Albelo, Eduardo / Rosado, Edwin / Rivera, Lenny / Tresgallo, Rubén / Vidal-Figueroa, José / Torres-Lugo, Norberto J / Ramírez, Norman / Zayas-Torres, Fernando / Otero-López, Antonio

JB & JS open access

2023 Volume 8, Issue 1

Abstract: Adequate pain control after total knee arthroplasty (TKA) has been associated with improved patient mobility and satisfaction, and is a task that has historically relied on opioids. Multimodal analgesic regimens can be considered a therapeutic ... ...

Abstract	Adequate pain control after total knee arthroplasty (TKA) has been associated with improved patient mobility and satisfaction, and is a task that has historically relied on opioids. Multimodal analgesic regimens can be considered a therapeutic alternative for postoperative pain control to avoid opioid consumption and its adverse side effects. This study aimed to evaluate the use of a multimodal analgesia protocol based on nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen as an alternative to reduce opioid consumption in Hispanic patients undergoing primary TKA. Methods: An institutional review board-approved, randomized controlled trial evaluated postoperative pain control after TKA in a Hispanic population. The experimental opioid-sparing group received 30-mg ketorolac intravenously every 6 hours and 1-g acetaminophen orally every 6 hours as the patient requested. The experimental group had the option to use morphine and oxycodone combined with acetaminophen as a rescue therapy. The control group received opioids in the form of 0.1-mg/kg morphine intravenously every 6 hours and/or oxycodone combined with acetaminophen (2.5 and 325 mg), 2 tablets orally every 6 hours, as the patient requested. Sociodemographic, operative, and immediate postoperative data and pain intensity measurements according to the numerical rating scale (NRS) were compared between groups. Analgesic efficacy was assessed according to the NRS scores at 12, 24, and 48 hours postoperatively. Results: Eighty-one Hispanic patients met inclusion criteria: 42 patients in the experimental group and 39 patients in the control group. None of the patients in the experimental group requested oxycodone combined with acetaminophen as a rescue therapy. Only 2 patients in the experimental group used a mean of 3.0 ± 1.4 mg of rescue morphine; in comparison, the control group consumed a mean of 28.0 ± 7.9 mg of morphine and 64.8 ± 26.0 mg of oxycodone per patient. A pain intensity decrease was observed in the experimental and control groups, with no postoperative evaluation differences at 12 hours (6.7 ± 2.9 compared with 5.9 ± 2.8; p = 0.209), 24 hours (6.2 ± 2.0 compared with 6.1 ± 2.2; p = 0.813), and 48 hours (4.7 ± 2.1 compared with 4.6 ± 1.7; p = 0.835). Conclusions: The use of a multimodal analgesic regimen based on intravenous ketorolac and oral acetaminophen was adequate in reducing postoperative pain and opioid consumption in Hispanic patients undergoing TKA. Level of evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Language	English
Publishing date	2023-02-22
Publishing country	United States
Document type	Journal Article
ISSN	2472-7245
ISSN (online)	2472-7245
DOI	10.2106/JBJS.OA.22.00062
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Article ; Online: Orthopedic Provider Gender Preference Among Patients in an Orthopedic Surgery Residency Program of a Hispanic American Community.

Iguina-González, Elena / Olivella, Gerardo / Ramos-Vicente, Andrea / Fantauzzi, Andrés / Dávila, Ana / Mangual, Danny / Torres-Lugo, Norberto J / Ramos, Gladys / Ramírez, Norman / Otero-López, Antonio / Dávila-Parrilla, Ariel

Women's health reports (New Rochelle, N.Y.)

2022 Volume 3, Issue 1, Page(s) 345–350

Abstract: Background: There are limited data regarding the gender preferences of Hispanic Americans when selecting their orthopedic surgeon. This study aimed to evaluate the gender preferences of Hispanic Americans when choosing a physician as their orthopedic ... ...

Abstract	Background: There are limited data regarding the gender preferences of Hispanic Americans when selecting their orthopedic surgeon. This study aimed to evaluate the gender preferences of Hispanic Americans when choosing a physician as their orthopedic provider. Materials and methods: A cross-sectional survey was administered to all consecutive Hispanic American patients treated at the outpatient orthopedic clinics of a tertiary medical center in Puerto Rico between October 4, 2019 and March 4, 2020. Sociodemographic status and opinion of gender preference in orthopedic surgery were assessed and analyzed between female and male respondents. Results: A total of 628 surveys were completed. There were 343 (54.6%) females and 285 (45.4%) males with an average age of 51.0 ± 13.0 years. A significantly higher portion of female respondents was widowed ( Conclusions: This study illustrates that Hispanic Americans have no gender preference when choosing an orthopedic provider. Therefore, patient preference should not be considered a factor contributing to women's under-representation in our orthopedic surgery training program. Our findings may also assist future studies in search of other indications attributed to the under-representation of females in this field.
Language	English
Publishing date	2022-03-16
Publishing country	United States
Document type	Journal Article
ISSN	2688-4844
ISSN (online)	2688-4844
DOI	10.1089/whr.2021.0126
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Article ; Online: Factors Influencing Graduating Medical Students in Puerto Rico to Pursue a Primary Care Residency in the Continental United States.

Beaton-Comulada, David / Torres-Lugo, Norberto J / Serra-López, Viviana M / Guevara-Serra, Carlos / Muñoz-Miro, Hector / Ramirez, Norman / Otero-López, Antonio

Family medicine

2022 Volume 54, Issue 8, Page(s) 629–633

Abstract: Background and objectives: Primary care physician shortage represents a challenge for many countries and territories, including Puerto Rico (PR), where a significant proportion of the graduating medical students preferred the continental United States ( ... ...

Abstract	Background and objectives: Primary care physician shortage represents a challenge for many countries and territories, including Puerto Rico (PR), where a significant proportion of the graduating medical students preferred the continental United States (C-US) to complete their training and even as the definitive setting for their practice. We surveyed medical students who graduated from medical schools in PR and have been accepted in a residency program to evaluate the influence of a set of demographics, academic, and personal factors in their decision to pursue a primary care residency program in the C-US. Methods: A 19-item questionnaire was distributed by institutional email to those medical students who graduated from one of the four Liaison Committee on Medical Education fully accredited medical schools in PR in 2019. We summarized our data by frequency and percentages. We performed data analysis with statistical significance considered for P values <.05. Results: The questionnaire had a response rate of 51% (138/273), where 49% (67/138) were accepted in a primary care residency. Sixty percent (40/67) matched in a primary care program in the C-US. Among the evaluated factors, a prior degree in C-US (65%) and first-degree relatives living in the C-US (70%) were associated with students who matched in the mainland. First-degree relatives living in PR (96%) were associated with students who remained on the island for training. Conclusions: The results provide insight into the influence that personal factors have on the decision of medical students in PR to pursue primary care training in the C-US.
MeSH term(s)	Humans ; Internship and Residency ; Primary Health Care ; Puerto Rico ; Schools, Medical ; Students, Medical ; United States
Language	English
Publishing date	2022-09-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	639374-3
ISSN	1938-3800 ; 0742-3225
ISSN (online)	1938-3800
ISSN	0742-3225
DOI	10.22454/FamMed.2022.546991
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Article ; Online: Orthopaedic trauma epidemiology after Hurricane Maria in the Puerto Rico Trauma Centre.

Rodríguez-Alejandro, Omar / Torres-Lugo, Norberto J / Mangual-Pérez, Danny / Colón-Miranda, Roberto / Sánchez-Fernández, Héctor / López-Ventosa, José / Pagán-Molderhauer, Calé / Ramírez, Norman / Otero-López, Antonio

International orthopaedics

2022 Volume 46, Issue 7, Page(s) 1447–1453

Abstract: Purpose: Hurricane Maria is the most devastating natural phenomenon in the recent history of Puerto Rico. Due to its destructive path through the island, the Puerto Rico Trauma Center (PRTC) remained the only hospital managing orthopaedic trauma in the ... ...

Abstract	Purpose: Hurricane Maria is the most devastating natural phenomenon in the recent history of Puerto Rico. Due to its destructive path through the island, the Puerto Rico Trauma Center (PRTC) remained the only hospital managing orthopaedic trauma in the immediate post-disaster period. We investigated the impact of this hurricane on the orthopaedic trauma epidemiology in the PRTC. Methods: We evaluated the admissions by the orthopaedic surgery service in terms of demographics, mechanisms of injury, and orthopaedic diagnoses for two months after the impact of Hurricane Maria (HM) on September 20, 2017. We compared our study group with the same two month period for two years prior (2015 and 2016) and after (2018 and 2019) as control periods. A p value of < 0.05 was considered statistically significant. Results: We included 384 admissions from September 20 to November 20, 2017. The majority were males (63%) and had an average age of 54 years. The most-reported mechanism of injury was fall from standing height (FFSH), showing a significant increment compared with the control periods. Contrarily, motor vehicle accidents (MVA) showed a significant reduction. Among the orthopaedic diagnoses, the hip + pelvis category showed a significant decline within the study group. Conclusions: This study highlighted the impact of HM on the orthopaedic trauma epidemiology at the PRTC. Our findings provide valuable evidence to healthcare institutions to better prepare to manage the potential changes in the orthopaedic trauma epidemiology after a major atmospheric event.
MeSH term(s)	Cyclonic Storms ; Female ; Hospitals ; Humans ; Male ; Middle Aged ; Orthopedics ; Puerto Rico/epidemiology ; Trauma Centers
Language	English
Publishing date	2022-04-23
Publishing country	Germany
Document type	Journal Article
ZDB-ID	80384-4
ISSN	1432-5195 ; 0341-2695
ISSN (online)	1432-5195
ISSN	0341-2695
DOI	10.1007/s00264-022-05409-x
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Article: Does Injection Site Matter? A Randomized Controlled Trial to Evaluate Different Entry Site Efficacy of Knee Intra-articular Injections.

Dávila-Parrilla, Ariel / Santaella-Santé, Borja / Otero-López, Antonio

Boletin de la Asociacion Medica de Puerto Rico

2015 Volume 107, Issue 2, Page(s) 78–81

Abstract: Background: Complaints of knee pain secondary to early osteoarthritis may account for up to 30% of visits to primary care physicians. Due to the proposed inflammatory changes in early osteoarthritis, intra-articular injections of corticosteroids (IACS) ... ...

Abstract	Background: Complaints of knee pain secondary to early osteoarthritis may account for up to 30% of visits to primary care physicians. Due to the proposed inflammatory changes in early osteoarthritis, intra-articular injections of corticosteroids (IACS) have been considered as an option for disease progression modification, pain control, and improvement of function. However, some studies have suggested poor accuracy rates of IA injections depending on the entry site chosen. It is therefore the aim of this study to evaluate the efficacy of IA knee corticosteroid injection in reducing pain and improving function in patients with early osteoarthritis and whether the low accuracy rates reported with the Anterolateral joint line injection site translate to worse functional and pain outcome measures as compared to Suprapatellar lateral injections. Materials and methods: The study was carried out as an open-label, randomized controlled trial with 60 sequential patients recruited. Simple randomization separated groups into anterolateral joint line or suprapatellar lateral injection sites. Improvements were measured with WOMAC and VAS scores after injection of Lidocaine and steroid solution. Results: Patients receiving IACS injections had a measurable improvement in self-reported outcomes as evidenced by standard deviation change in WOMAC and VAS scores. The majority of patients had a clinically significant improvement in VAS scores as compared to their initial measures with a notable amount of patients improving significantly as well on their WOMAC scores, irrespective of the injection site chosen. Conclusions: We have therefore continued the use of palpation-guided intra-articular knee injections in an effort to reduce costs as compared to other injection modalities with positive results in our osteoarthritis patients.
MeSH term(s)	Anesthetics, Local/administration & dosage ; Anti-Inflammatory Agents/administration & dosage ; Anti-Inflammatory Agents/therapeutic use ; Arthralgia/drug therapy ; Arthralgia/etiology ; Cost Savings ; Follow-Up Studies ; Humans ; Injections, Intra-Articular/economics ; Injections, Intra-Articular/methods ; Lidocaine/administration & dosage ; Osteoarthritis, Knee/drug therapy ; Osteoarthritis, Knee/physiopathology ; Pain Measurement ; Palpation ; Recovery of Function ; Severity of Illness Index ; Treatment Outcome ; Triamcinolone Acetonide/administration & dosage ; Triamcinolone Acetonide/therapeutic use
Chemical Substances	Anesthetics, Local ; Anti-Inflammatory Agents ; Lidocaine (98PI200987) ; Triamcinolone Acetonide (F446C597KA)
Language	English
Publishing date	2015-04
Publishing country	Puerto Rico
Document type	Comparative Study ; Journal Article ; Randomized Controlled Trial
ZDB-ID	730428-6
ISSN	0004-4849
ISSN	0004-4849
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Article: Effect of Nonsurgical Versus Surgical Management on Geriatric Hip Fracture Mortality of Hispanic-American Male Veterans.

De Virgilio-Salgado, Lucas G / Olivella, Gerardo / Ruberté, Henry / Abreu, Ricardo J / Otero-López, Antonio / Reyes-Martínez, Pedro / Ramírez, Norman / Otero-López, Francisco

Geriatric orthopaedic surgery & rehabilitation

2021 Volume 12, Page(s) 21514593211044621

Abstract: Introduction: The effect of surgical vs nonsurgical management on hip fracture mortality of Hispanic-American male veterans has not been rigorously studied: Material and methods: This was a retrospective cohort study of Hispanic-American male ... ...

Abstract	Introduction: The effect of surgical vs nonsurgical management on hip fracture mortality of Hispanic-American male veterans has not been rigorously studied Material and methods: This was a retrospective cohort study of Hispanic-American male veterans who were 65 years of age or older and suffered a femoral neck or intertrochanteric fracture from January 2008 to December 2015. Analysis between a surgical cohort (cannulated screw fixation, hemiarthroplasty, total hip arthroplasty, or cephalomedullary nail) and a non-surgical cohort was performed. In-hospital, 30-day, one-year, and two-year mortality were compared between both groups. Results: Out of 268 patients with hip fracture, 159 (59.2%) were treated surgically and 109 (40.8%) non-surgically. The overall in-hospital (9.2% vs 1.9%, Discussion and conclusion: This study shows a higher mortality rate and lower life expectancy in geriatric male patients who were treated nonsurgically in a Veterans Health Affair hospital facility that mostly serves Hispanic-American veterans. Our results provide an expansion to the findings of other geriatric studies on hip fracture with focus in a Hispanic-American veteran male population.
Language	English
Publishing date	2021-10-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2589094-3
ISSN	2151-4593 ; 2151-4585
ISSN (online)	2151-4593
ISSN	2151-4585
DOI	10.1177/21514593211044621
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