Showcasing Clinical and Outcomes Research

Showcasing Clinical and Outcomes Research

Clinical trials conducted within the Department of Orthopedic Surgery are critical to advancing the science of the field and optimizing the restorative capacity of medicine. Our orthopedic surgeons are currently working on the following trials.

PUBLICATIONS

Peer-reviewed scientific papers

Racial Differences in Care and Outcomes After Total Hip and Knee Arthroplasties: Did the Comprehensive Care for Joint Replacement Program Make a Difference?

Okewunmi J, Mihalopoulos M, Huang HH, Mazumdar M, Galatz LM, Poeran J, Moucha CS.

Full text: The Journal of Bone and Joint Surgery

Accelerometry Data Delineates Phases of Recovery and Supplements Patient-Reported Outcome Measures Following Lumbar Laminectomy

Bienstock DM, Shankar D, Kim J, Gao M, Srivastava K, Bronson WH, Chaudhary SB, Poeran J, Iatridis JC, Hecht AC.

Objective: Patient-reported outcome measures (PROMs) are traditionally used to track patients' recoveries after spine surgery. Wearable accelerometers have adjunctive value because of the continuous, granular, and objective data they provide. We conducted a prospective study of lumbar laminectomy patients to 1) determine if time-series data from wearable accelerometers could delineate phases of recovery and 2) compare accelerometry data to PROMs during recovery tracking.

Full article: World Neurosurgery

Outpatient Versus Inpatient Total Shoulder Arthroplasty: A Cost and Outcome Comparison in a Comorbidity Matched Analysis

Carbone A, Vervaecke AJ, Ye IB, Patel AV, Parsons BO, Galatz LM, Poeran J, Cagle P.

Objective: Previous studies comparing total and reverse shoulder arthroplasty (TSA/RSA) are subject to surgeon selection bias. This study objective is to compare the outcomes and cost
of outpatient TSA/RSA to inpatient TSA/RSA.

Full text: Journal of Orthopaedics

Economic Impact of Comorbidities in Total-Ankle Arthroplasty and Ankle Arthrodesis

Chan JJ, Guzman JZ, Garden E, Chan JC, Poeran J, Zubizarreta N, Mazumdar M, Vulcano E.

Objective: The demand for total-ankle arthroplasty (TAA) and ankle arthrodesis surgery is increasing. Findings from other orthopaedic populations suggest an increasing comorbidity
burden among those planned for surgery; however, data on TAA and ankle arthrodesis is limited. The goal of this study is to examine the comorbidity burden for TAA and ankle arthrodesis.

Full text: Orthopaedics and Traumatology: Surgery and Research

High-fat diet causes inferior vertebral structure and function without disc degeneration in RAGE-KO mice

D'Erminio DN, Krishnamoorthy D, Lai A, Hoy RC, Natelson DM, Poeran J, Torres A, Laudier DM, Nasser P, Vashishth D, Illien-Jünger S, Iatridis JC.

Objective: Back pain and spinal pathologies are associated with obesity in juveniles and adults, yet studies identifying causal relationships are lacking and none investigate sex differences. This study determined if high-fat (HF) diet causes structural and functional changes to vertebrae and intervertebral discs (IVDs); if these changes are modulated in mice with systematic ablation for the receptor for advanced glycation end products (RAGE-KO); and if these changes are sex-dependent.

Full text: Journal of Orthopaedic Research

Orthopedic Surgeon and Care Team Perceptions and Use of Patient-Reported Outcomes in Total-Joint Replacement Patients

Snyder DJ, Park C, Zastrow R, Ahn A, Keswani A, Koenig KM, Bozic KJ, Jevsevar DS, Poeran J,
Moucha CS.

Objective: The recent shift toward value-based health care and bundled payments in orthopedic surgery has increased the use of patient-reported outcomes (PROs) in standard clinical care. Such assessments of patient function and satisfaction are particularly important among total-joint arthroplasty (TJA) patients to monitor postoperative health.

Full text: Bulletin of the Hospital for Joint Diseases

Barriers to Collection and Use of Patient-Reported Outcomes a Multi-Institutional Survey of Surgeons and Care Teams

Snyder DJ, Park C, Keswani A, Garden E, Koenig KM, Bozic KJ, Poeran J, Moucha CS,
Jevsevar DJ.

Objective: Currently there is a lack of insight into what total-joint replacement (TJR) surgeons and care teams perceive to be the greatest barriers to collection and use of patient-reported outcomes (PROs). The goal of this study was to provide insight on this topic using a
multi-institutional survey.

Full text: Bulletin of the Hospital for Joint Diseases

Long-Term Follow-Up of Perianchor Cyst Formation After Rotator Cuff Repair

Matijakovich D, Solomon D, Benitez CL, Huang HH, Poeran J, Berger N, Lebaschi A, Seneviratne A.

Objective: Perianchor cyst formation (PCF) can occur after arthroscopic rotator cuff repair with poly-L-lactic acid (PLLA) anchors; however, little is known about PCF after all-suture anchor (ASA) use.

Full text: JSES International

Peripheral Nerve Block Use in Ankle Arthroplasty and Ankle Arthrodesis: Utilization Patterns and Impact on Outcomes

Chan JJ, Garden E, Chan JC, Poeran J, Zubizarreta N, Mazumdar M, Galatz LM, Vulcano E.

Objective: Ankle arthrodesis and total-ankle arthroplasty (TAA) are often associated with significant postoperative pain. While this may be mitigated by the use of peripheral nerve blocks (PNB), large-scale data are lacking. Using national data, we aimed to evaluate PNB utilization pattern and its impact on outcomes.

Full text: Journal of Anesthesia

Enhanced Recovery Components for Posterior Lumbar Spine Fusion: Harnessing National Data to Compare Protocols

Echt M, Poeran J, Zubizarreta N, Girdler SJ, Mazumdar M, Galatz LM, Memtsoudis SG, Hecht AC, Chaudhary S.

Objective: The aim of this study was to assess the most commonly used components of enhanced recovery after surgery (ERAS) combinations and their relative effectiveness.

Full text: Clinical Spine Surgery

Analysis of Common Shoulder Injuries in Collegiate Baseball Players

Vargas L, Charen D, Huang HH, Poeran J, Colvin A.

Objective: Baseball players are highly susceptible to shoulder injuries due to repetitive overhead throwing. The purpose of this study was to investigate men's collegiate baseball shoulder injury rates and associated risk factors.

Full text: The Physician and Sportsmedicine

Safety of Tranexamic Acid in Hip and Knee Arthroplasty in High-Risk Patients

Poeran J, Chan JJ, Zubizarreta N, Mazumdar M, Galatz LM, Moucha CS.

Objective: With increasing use of tranexamic acid in total hip and knee arthroplasties, safety concerns remain. Using national claims data, this study examined tranexamic acid use in patients with preexisting comorbidities. The hypothesis was that tranexamic acid use is
not associated with increased complication risk in hip and knee arthroplasty patients with comorbidities.

Full text: Anesthesiology

Enhanced Recovery After Surgery Protocols in Lower Extremity Joint Arthroplasty: Using Observational Data to Identify the Optimal Combination of Components

Chen KK, Chan JJ, Zubizarreta NJ, Poeran J, Chen DD, Moucha CS.

Objective: Enhanced recovery after surgery (ERAS) protocols are increasingly used in orthopedic surgery. Data are lacking on which combinations of ERAS components are (1) the most commonly used and (2) the most effective in terms of outcomes.

Full text: The Journal of Arthroplasty

Metric Selection, Metric Targets, and Risk Adjustment Should be Considered in the Design of Gainsharing Models for Bundled Payment Programs in Total Joint Arthroplasty

Keswani AH, Snyder DJ, Ahn A, Austin DC, Jayakumar P, Grauer JN, Poeran J, Bozic KJ, Moschetti WE, Jevsevar DS, Galatz LM, Bronson MJ, Chen DD, Moucha CS.

Objective: Under bundled payment models, gainsharing presents an important mechanism to ensure engagement and reward innovation. We hypothesized that metric selection, metric targets, and risk adjustment would impact surgeons' performance in gainsharing models.

Full text: The Journal of Arthroplasty

Examining the Association of Knee Pain with Modifiable Cardiometabolic Risk Factors

Charen DA, Solomon D, Zubizarreta N, Poeran J, Colvin AC.

Objective: A well-established link exists between obesity and knee osteoarthritis, and recent research has implicated diabetes mellitus as a potential cause of cartilage degeneration. The objective of this study was to use the National Health and Nutrition Examination Survey (NHANES) database to examine the association between knee pain and various metabolic factors.

Full text: Arthritis Care & Research

Administration of Tranexamic Acid During Total-Shoulder Arthroplasty is not Associated with Increased Risk of Complications in Patients with a History of Thrombotic Events

Carbone A, Poeran J, Zubizarreta N, Chan J, Mazumdar M, Parsons BO, Galatz LM, Cagle PJ.

Objective: Tranexamic acid (TXA) has been shown to reduce blood loss and transfusion risk in various orthopedic surgeries including shoulder arthroplasty. However, concerns still exist
regarding its use in patients with a history of thrombotic events. Using national claims data, we aimed to study the safety of TXA administration in shoulder arthroplasty patients with a history of thrombotic events.

Full text: Journal of Shoulder and Elbow Surgery


Trends in Periprosthetic Knee Infection and Associated Costs: A Population-Based Study Using National Data

Brochin R, Poeran J, Vig KS, Keswani A, Zubizarreta N, Galatz LM, Moucha C.

Objective: Given increasing demand for primary knee arthroplasties, revision surgery is also expected to increase, with periprosthetic joint infection (PJI) a main driver of costs. Recent data on national trends is lacking. We aimed to assess trends in PJI in total knee arthroplasty revisions and hospitalization costs. From the National Inpatient Sample (2003–2016), we extracted data on total-knee arthroplasty revisions (n = 782,449). We assessed trends in PJI prevalence and (inflation-adjusted) hospitalization costs (total as well as per-day costs) for
all revisions and stratified by hospital teaching status (rural/urban by teaching status), hospital bed size (≤299, 300–499, and ≥500 beds), and hospital region (Northeast, Midwest, South, and West). 

Full text: The Journal of Knee Surgery

Examining the Association of Knee Pain with Modifiable Cardiometabolic Risk Factors

Charen DA, Solomon D, Zubizarreta N, Poeran J, Colvin AC.

Objective: A well-established link exists between obesity and knee osteoarthritis, and recent research has implicated diabetes mellitus as a potential cause of cartilage degeneration.
The objective of this study was to use the National Health and Nutrition Examination Survey (NHANES) database to examine the association between knee pain and various metabolic factors.

Full text: Arthritis Care & Research

Letters/Editorials

CORR Insights®: Has the Affordable Care Act Been Associated with Increased Insurance Coverage and Early-Stage Diagnoses of Bone and Soft-tissue Sarcomas in Adults?

Poeran J.

Full text: Clinical Orthopaedics and Related Research

Submitted Papers/Works in Progress

Adult reconstruction

  • Ren R, Lim TY, Stern B, Huang HH, Poeran J, Hayden BL, Chen D, Moucha CS. Relationships Between Baseline Mental Health and Improvements in Patient-Reported Outcomes After Total Hip and Knee Arthroplasty.

  • Banashefski BD, Huang HH, Poeran J, Moucha CS. Impact of Comprehensive Care for Joint Replacement bundled payment model on postoperative physical therapy orders after total-joint replacement.

  • Raymond H, Alasadi H, Zubizarreta N, Hayden BL, Chen D, Burnett G, Park C, DeMaria S, Poeran J, Moucha CS. Primary spoken language and variances in use of regional anesthesia in total-joint arthroplasty.

  • Pitaro NL, Herrera ML, Stern B, Chen DD, Moucha CS, Hayden BL, Poeran J. Current State of Joint Classes at High-Volume Joint Replacement Centers and a Suggested Model for Curriculum Evaluation.

  • Pitaro NL, Barbera J, Ranson W, Zubizarreta N, Poeran J, Chen D, Moucha CS, Hayden BL. Evaluating Resource Utilization for in-Person and Virtual Joint Classes in Total-Joint Arthroplasty: An Analysis of Attendance Patterns at a Large Metropolitan Health System.

  • Raymond HE, Barbera J, Huang HH, Poeran J, Chen D, Moucha CS, Hayden BL. Risk of infection following total knee or hip arthroplasty after receipt of multiple corticosteroid or hyaluronic acid injections.

  • Pitaro NL, Shah K, Alasadi H, Kiani S, Herrera M, Poeran J, Hayden BL, Moucha CS. Common Patient-Reported Outcome Measures in Total-Joint Arthroplasty May Inadequately Measure Sleep: A PRO Correlation Analysis.

  • Kiani SN, Maron SZ, Rosenzweig S, Zubizarreta N, Keswani A, Galatz LM, Mazumdar M, Poeran J, Moucha CS. Did payment reform lead to patient selection in hip and knee arthroplasties? An observational study using New York State data.

  • Raymond HE, Barbera J, Zubizarreta N, Poeran J, Chen D, Hayden BL, Moucha CS. Racial disparities in manipulation under anesthesia rates following total-knee arthroplasty.

  • Mihalopoulos M, Poeran J, Mueller J, McCardle K, Galatz LM, Bronson M, Chen D, Moucha CS. Reporting of readmissions after total-joint arthroplasty: Experience and lessons learned from a large health system.

  • Mihalopoulos M, Okewunmi J, Huang H, Poeran J, Moucha C. The Effect of the Comprehensive Care for Joint Replacement Bundled Payment Program on Sex Disparities in Total Hip and Knee Arthroplasties.

Foot/Ankle Surgery

  • Meyers J, Lieber A, Luginbuhl J, Zubizarreta N, Vulcano E, Gokcen E, Poeran J, Kelly M. National Cost Comparisons Between Orthopaedics and Podiatry in Ankle Fracture Fixation.
    Shoulder/Elbow surgery

  • Vervaecke AJ, Carbone A, Zubizarreta N, Poeran J, Parsons BO, Verborgt O, Galatz LM, Cagle PJ. Surgical treatment of rotator cuff tears in the elderly population: Repair or reverse shoulder arthroplasty?

  • Vervaecke AJ, Carbone A, Ye I, Zubizarreta N, Poeran J, Parsons BO, Verborgt O, Cagle PJ, Galatz LM. Cost Analysis of Shoulder Arthroplasty at a Large Academic Center: Implications for Bundled Payments.

Spine

  • Herrera MM, Tiao J, Rosenberg A, Bienstock D, Shankar D, Kim J, Poeran J, Iatridis JC, Hecht AC. Novel Physical Activity Metrics Characterize a More Rapid Postoperative Recovery of Cervical than Lumbar Stenosis Surgery Patients.

  • Tiao J, Herrera MM, Rosenberg A, Bienstock D, Shankar D, Kim J, Poeran J, Iatridis JC, Hecht AC. Identification and Utilization of Novel Activity Measures to Better Characterize Pre/Postoperative Experience of Lumbar Laminectomy Patients.

  • Alasadi H, Chakrani Z, Alasadi Y, Zubizarreta N, Poeran J, Chaudhary S. Perioperative complications associated with epidural injections followed by cervical decompression and fusion.

  • Alasadi H, Alasadi Y, Chakrani Z, Zubizarreta N, Poeran J, Chaudhary S. Who Gets Cervical Epidural Injections? A National Study on Utilization Patterns.

  • Banashefski BD, Stern B, Poeran J, Chaudhary S. A Low-Cost Pilot to Increase PRO Response Rates in an Urban Spine Clinic.

  • Banashefski BD, Stern B, Chaudhary S, Poeran J. Development of an Evidence-Based Framework to Increase Patient-Reported Outcome Response Rates for Orthopedic Practices.

Orthopedic Trauma

  • Chan J, Charen DA, Huang H, Galatz LM, Poeran J, Forsh D. Surgical repair of femoral neck fractures: Internal fixation is associated with higher resource utilization than arthroplasty.

  • Chakrani Z, Alasadi H, Stern B, Zubizarreta N, Poeran J, Forsh D. Prolonged Opioid Use After ORIF of Tibial Shaft Fractures.
    Sports Medicine

  • Tiao J, Herrera M, Wang K, Cassie R, Ren R, Poeran J, Colvin A. A National Survey to Compare Prices Charged for Platelet-Rich Plasma (PRP) Injections.

  • Tiao J, Herrera M, Wang K, Cassie R, Ren R, Poeran J, Colvin A. Patients’ Willingness to Pay for Platelet-Rich Plasma (PRP) Injections.

  • Holmes K, Poeran J, Colvin A. Various Research Projects Using United States Olympic and Paralympic Committee Data.

Hand Surgery

  • London D, Xiao RC, Zubizarreta N, Poeran J, Hausman M. Distal Radius Fractures in the Elderly: Impact of Patient Frailty on Cost of Care.

Conferences

2021 Annual Meeting of the American Academy of Orthopedic Surgeons
Paper Presentations

  • Shankar DS, Bienstock D, Kim J, Gao M, Srivastava K, Bronson W, Chaudhary S, Poeran J, Iatridis JC, Hecht AC. Wearable Accelerometers Demonstrate Similar Postoperative Recovery Patterns in Lumbar Laminectomy and Cervical Laminoplasty Patients.

  • Snyder D, Huang HH, Keswani A, Chen DD, Bronson MJ, Galatz LM, Poeran J, Moucha CS. The Added Financial Burden of Femoral Neck Fractures in the Comprehensive Care for Joint Replacement Program: Implications for Bundled Payment Design.

  • Carbone A, Vervaecke AJ, Ye I, Zubizarreta N, Poeran J, Parsons BO, Verborgt O, Cagle PJ, Galatz LM. Cost Analysis of Shoulder Arthroplasty at a Large Academic Center: Implications for Bundled Payments.

  • Bienstock D, Shankar DS, Kim J, Gao M, Srivastava K, Bronson W, Chaudhary S, Poeran J, Iatridis JC, Hecht AC.The Oswestry Disability Index and Short Form-12 Physical Component Summary are not Impacted by Recall Bias in Lumbar Laminectomy Patients: A Prospective Study Using Data from Fitness Trackers

  • Carbone A, Vervaecke AJ, Poeran J, Zubizarreta N, Galatz LM, Cagle PJ. Outpatient vs. Inpatient Total Shoulder Arthroplasty: A Cost and Outcome Comparison in a Comorbidity Matched Analysis

Poster Presentations

  • Carbone A, Vervaecke AJ, Ye I, Zubizarreta N, Poeran J, Galatz LM, Cagle PJ. What are the Significant Drivers of Cost and Readmission in Outpatient vs. Inpatient Total Shoulder Arthroplasty?

  • Obi T, Charen D, Huang HH, Poeran J, Colvin AC. Gender Differences in Knee Injuries among National Collegiate Athletic Association Basketball Players.

2021 Annual Meeting of the American Association of Hip and Knee Surgeons
E-poster Presentations

  • Herrera MM, Kiani SN, Pitaro NL, Poeran J, Hayden BL, Chen DD, Moucha CS. Total Joint Arthroplasty Costs Associated With Meaningful Improvements In Comorbidity Subgroups.

  • Pitaro NL, Kiani SN, Herrera MM, Alasadi H, Shah K, Poeran J, Chen DD, Hayden BL, Moucha CS. Quantifying Sleep Patterns Before and After Joint Arthroplasty: Novel Targets to Improve Outcomes

2021 Cervical Spine Research Society 49th Annual Meeting

  • Shankar DS, Kim J, Bienstock DM, Gao M, Lee Y, Zubizarreta N, Poeran J, Lin JD, Chaudhary SB, Hecht AC. A Comparison of Postoperative Opioid Use in Cervical Laminectomy with Instrumented Fusion vs Cervical Laminoplasty with Reconstruction Patients

11th Annual Orthopaedic Summit 2021

  • Shah KC, Poeran J, Zubizarreta N, Hayden BL, Chen D, Moucha CS. Is Preoperative Bisphosphonate Use Associated with Periprosthetic Fracture after Total Hip Arthroplasty?

Other Highlights Involving Member of the Center

  • Jashvant Poeran: Invited for podcast for anesthesiologist audience together with Dr. Calin S. Moucha: https://podcasts.apple.com/us/podcast/featured-article-podcast-safety-tranexamic-acid-in/id994631213?i=1000523296561

  • Paper presented at 2021 Postgraduate Assembly meeting (PGA) of the New York State Society of Anesthesiologists as among the 10 most significant clinical papers published in Anesthesiology in 2021 (Poeran J, Chan JJ, Zubizarreta N, Mazumdar M, Galatz LM, Moucha CS. Safety of Tranexamic Acid in Hip and Knee Arthroplasty in High-risk Patients. Anesthesiology. 2021;135(1):57-68.)

  • Jashvant Poeran: participated in international effort to develop consensus on peripheral nerve block use in patients undergoing hip and knee arthroplasty collaborating with a large group of international experts and led by Dr. Stavros Memtsoudis
    Reference: Memtsoudis SG, Cozowicz C, Bekeris J, Bekere D, Liu J, Soffin EM, Mariano ER, Johnson RL, Go G, Hargett MJ, Lee BH, Wendel P, Brouillette M, Kim SJ, Baaklini L, Wetmore DS, Hong G, Goto R, Jivanelli B, Athanassoglou V, Argyra E, Barrington MJ, Borgeat A, De Andres J, El-Boghdadly K, Elkassabany NM, Gautier P, Gerner P, Gonzalez Della Valle A, Goytizolo E, Guo Z, Hogg R, Kehlet H, Kessler P, Kopp S, Lavand'homme P, Macfarlane A, MacLean C, Mantilla C, McIsaac D, McLawhorn A, Neal JM, Parks M, Parvizi J, Peng P, Pichler L, Poeran J, Poultsides L, Schwenk ES, Sites BD, Stundner O, Sun EC, Viscusi E, Votta-Velis EG, Wu CL, YaDeau J, Sharrock NE. Peripheral nerve block anesthesia/analgesia for patients undergoing primary hip and knee arthroplasty: recommendations from the International Consensus on Anesthesia-Related Outcomes after Surgery (ICAROS) group based on a systematic review and meta-analysis of current literature. Reg Anesth Pain Med. 2021;46:971-985.

  • Jashvant Poeran: Participated in International Consensus Meeting (ICM) to develop consensus on VTE prophylaxis in orthopedic surgery, collaborating with a large group of international experts and led by Dr. Javad Parvizi. Papers forthcoming in 2022 in the Journal of Bone and Joint Surgery