Passing the Torch Strojnik, Marija
American scientist,
05/2024, Volume:
112, Issue:
2
Journal Article
Strojnik assesses the core values of scientific research. The work of the true research scientist must include enhancing the health of the overall research enterprise, fostering integrity in science, ...and promoting the public's understanding of science for the purpose of improving the human condition. All scientists should practice and promote ethics and excellence at all times in their research. The true scientist is also dedicated to mentorship and to the advancement of knowledge through research, service, and teaching. And then, of course, there is the work itself: The true scientist must painstakingly check and recheck their results, methodologies, and assumptions. Only in that way, in community with equal-minded peers, can we build the scientific advances and engineering bases of our increasingly technological society.
We reviewed the shoulder arthroplasty (SA) literature to correlate citations, methodological characteristics and quality of most-cited articles in this field. We hypothesized that a greater number of ...citations would be found for high-quality clinical studies.
We searched the Web of Knowledge database for the 50 most-cited articles about SA and collected author name, publication year, country of origin, journal, article type, level of evidence (LoE), subject of paper, type of arthroplasty and metrics (number of citations and citation rate). Coleman Methodology Score (CMS) was computed for clinical articles. Statistical analysis of variance and correlation coefficients were used to investigate the relationship between different variables.
Out of the selected 50 studies on SA, 26% were nonclinical. There were 15,393 citations overall (mean 307.8), with a mean 19.5 citations per year (range 48.3-6.7). Thirty or 60% of all articles were LoE IV. All studies were published between 1984 and 2011 in 8 journals. Reverse SA (RSA) was the most common subject (36% of studies). The United States was the country responsible for most contributions (50% of studies). CMS ranged from 81 to 38 (mean 59.6). RSA received the highest number of citations (
< .001), independently from country of origin (
= .137) and LoE (
= .723). CMS correlated with citation rate (
= 0.397;
= .013) and publication year (tau = 0.397;
= .013), but not with LoE (
= .204).
In SA literature, citation rate positively correlates with methodological quality of a study, independently from publication country and LoE. Among most-cited papers, RSA is the most common standalone subject.
Distal clavicular resection (DCR) is a procedure used to alleviate acromioclavicular joint (ACJ) pain, often done alongside rotator cuff repair (RCR). This investigation explored the relationships ...between DCR and RCR, outcomes of DCR during RCR, and complication rates of DCR.
This retrospective study used electronic medical record data from the TriNetX database. Cohorts were subdivided based on the timeline of DCR in comparison to RCR, as well as comparing RCR with DCR against RCR without DCR.
In total 46 534 patients underwent RCR with 14.8% (6898) of these patients also undergoing DCR. And 72.8% (5021) had DCR during RCR, and 10.7% (740) had DCR after RCR. Less than 5% (<10) of patients with preexisting ACJ pain required DCR 3 years postoperatively, and 0.002% (78) patients without ACJ pain developed ACJ pain within 3 years. Less that 20 patients underwent DCR within 3 years of being diagnosed with ACJ pain. Patients who had RCR with DCR were more likely to have chronic pain postoperatively (
< .0001).
Patients undergoing RCR do not require subsequent DCR. Performing DCR does not offer significant benefit when compared to performing isolated RCR without DCR in patients with preexisting ACJ pain, but increases risk for ACJ instability and chronic pain.
This retrospective review aimed to assess if open payments made by industry arthroplasty companies to physicians and hospital systems were significantly affected by implant type and geographic ...variation.
Data was obtained from the Centers for Medicare and Medicaid Services (CMS) publicly available open payment datasets (2016-2019). Geographic locations were identified using regions as defined by the US Census Bureau. A linear regression was calculated to predict the open payment made based on the created variable region, the most used implant type (reverse vs anatomic, n > 30 to be included), and their hypothesized interaction.
A significant regression equation was found for the hypothesized interaction between implant and region,
= 3.446,
< .0001, with an
of 0.005. Within the regression, the implant type alone was not significantly related to the open payment (
= .070) but only became significant when paired with the region in the South (US$5807;
< .0001) and West (US$5638;
= .0012) compared to the Northeast.
Our multivariate linear regression model revealed that reverse total shoulder implants were associated with higher open payments, but only within the South and West regions. This indicates that the contributions made by industry arthroplasty companies are a function of both implant and region.
Prolonged opioid use is associated with higher complications and worse patient-reported outcomes following total shoulder arthroplasty (TSA). Identified risk factors for prolonged postoperative use ...are related to several medical comorbidities, gender, diagnoses of anxiety or depressive disorders, and preoperative opioid use. In this study, we hypothesized that patient-reported mental health characteristics can help to identify patients at risk of worse postoperative pain control, worse sleep, and higher opioid utilization following TSA.
Ninety-three consecutive patients were asked to fill out 2 mental health questionnaires prior to undergoing TSA. Following surgery, patients filled out a daily pain diary to track their daily pain, pain medication use, and quality and duration of their sleep for 30 days. Preoperative opioid use and postoperative refill were determined by the New York State Prescription Monitoring Program. Mixed-model linear regressions were conducted. Significance was defined as
< 0.05.
Postoperative opioid refill was associated with female gender, preoperative opioid therapy, higher inpatient opioid use, worse anxiety, depression, somatization, and pain catastrophizing scores. The number of days using opioids postoperatively was associated with worse pain catastrophizing scale (PCS) and somatization scores (patient health questionnaire-15). Preoperative opioid therapy was associated with worse somatization scores, whereas no opioids used after surgery were associated with better somatization scores. Worse sleep quality and duration were associated with worse PCS scores.
A greater mental health burden is associated with worse postoperative pain control and higher opioid utilization during the acute postoperative period. This is especially evident in the pain catastrophizing and somatization domains.
Background Although glenoid bone grafting and metallic augmented baseplates have demonstrated success in restoring the glenohumeral joint line in the recent literature, there remain no consensus ...guidelines defining the use of one versus the other. Methods Between 2017 and 2020, 15 primary RTSA with screw-in metallically augmented glenoid baseplates were identified and 2:1 matched by age, sex, and body mass index with primary bony-augmented glenoid baseplate patients. Patients with previous glenoid implantation or fracture were excluded. Charts, routine radiographic series (Grashey, Scapula Y, Axillary lateral), and 3-dimensional computed tomography (3D CT) scans were retrospectively reviewed. Structural patient-specific metal or bony augmentation was indicated based on preoperative glenoid morphology as identified by 3D CT. Aseptic failure was identified as hardware breakage and/or shift in glenoid baseplate component position. Results There were 45 eligible cases with mean age of 65.7 years (range 44-85 years) and 65.5 years (range 42-82 years) for the metallic-augmented and bone graft group, respectively. Correspondingly, mean follow up was 22.6 months (range 12-53 months), and 27.3 months (range 11-53 months). At latest follow up, there were no baseplate failures in the metallic augment group and 2 baseplate failures (7%) in the bone graft group at a mean of 42.5 months (range 32-53 months) postoperatively. Mean age of the bone failure group was 64.5 years (range 64-65 years). Conclusion Contemporary reversed shoulder arthroplasty glenoid baseplate designs appear to have low incidence of failure. Further analysis is necessary to determine if a critical degree of glenoid retroversion or inclination is preferable with a specific form of augmentation. Level of Evidence III; Retrospective Cohort Comparison.
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