Scholars@Duke
David Edward Attarian

David Edward Attarian

Professor Emeritus of Orthopaedic Surgery
Orthopaedic Surgery
david.attarian@duke.edu
DUMC Box 104002, Durham, NC 27710
311 Trent Drive, Durham, NC 27710
Office hours

Selected Publications

The Role of Sleep Apnea in Postoperative Neurocognitive Disorders Among Older Noncardiac Surgery Patients: A Prospective Cohort Study.

Journal Article Anesth Analg · January 1, 2025 BACKGROUND: Obstructive sleep apnea is associated with increased dementia risk, yet its role in postoperative neurocognitive disorders is unclear. Here, we studied whether the severity of untreated obstructive sleep apnea is associated with the severity of ... Full text Link to item Cite

Healthy but not osteoarthritic human meniscus-derived matrix scaffolds promote meniscus repair.

Journal Article Front Bioeng Biotechnol · 2024 Meniscus tissue is commonly injured due to sports-related injuries and age-related degeneration and approximately 50% of individuals with a meniscus tear will develop post-traumatic osteoarthritis (PTOA). Given that the meniscus has limited healing potenti ... Full text Link to item Cite

Synergistic roles of CBX4 chromo and SIM domains in regulating senescence of primary human osteoarthritic chondrocytes.

Journal Article Arthritis Res Ther · October 12, 2023 BACKGROUND: Cellular senescence is a critical factor contributing to osteoarthritis (OA). Overexpression of chromobox homolog 4 (CBX4) in a mouse system was demonstrated to alleviate post-traumatic osteoarthritis (PTOA) by reducing cellular senescence. Add ... Full text Open Access Link to item Cite

Association of Dipeptidylpeptidase 4 (CD26) With Chondrocyte Senescence and Radiographic Progression in Knee Osteoarthritis.

Journal Article Arthritis Rheumatol · July 2023 OBJECTIVE: To evaluate the association of dipeptidylpeptidase 4 (DPP-4; also known as CD26) with cellular senescence of human cartilage and progression of knee osteoarthritis (OA). METHODS: Articular cartilage sections and chondrocytes were acquired from 3 ... Full text Link to item Cite

A Validated Pre-operative Risk Prediction Tool for Extended Inpatient Length of Stay Following Primary Total Hip or Knee Arthroplasty.

Journal Article J Arthroplasty · May 2023 BACKGROUND: As value-based reimbursement models mature, understanding the potential trade-off between inpatient lengths of stay and complications or need for costly postacute care becomes more pressing. Understanding and predicting a patient's expected bas ... Full text Link to item Cite

A Preoperative Risk Prediction Tool for Discharge to a Skilled Nursing or Rehabilitation Facility After Total Joint Arthroplasty.

Journal Article J Arthroplasty · April 2021 BACKGROUND: Discharge to rehabilitation or a skilled nursing facility (SNF) after total joint arthroplasty remains a primary driver of cost excess for bundled payments. An accurate preoperative risk prediction tool would help providers and health systems i ... Full text Link to item Cite

The Calpain Gene is Correlated With Metal-on-Metal Hip Replacement Failures.

Journal Article J Arthroplasty · January 2021 BACKGROUND: Metal-on-metal (MOM) total hip arthroplasty is associated with unacceptable failure rates secondary to metal ion reactions. Efforts to identify which patients will go on to failure have been limited; recently, there has been a suggestion for a ... Full text Link to item Cite

All-Polyethylene Tibia: An Opportunity for Value-Based Care in Bundled Reimbursement Initiatives.

Journal Article Orthopedics · January 1, 2021 Surgeons play a critical role in making cost-effective decisions that maintain high-quality patient outcomes, which is the current focus of the Centers for Medicare & Medicaid Services. All-polyethylene tibial (APT) components often cost less during total ... Full text Link to item Cite

Synovial cell cross-talk with cartilage plays a major role in the pathogenesis of osteoarthritis.

Journal Article Sci Rep · July 2, 2020 We elucidated the molecular cross-talk between cartilage and synovium in osteoarthritis, the most widespread arthritis in the world, using the powerful tool of single-cell RNA-sequencing. Multiple cell types were identified based on profiling of 10,640 syn ... Full text Link to item Cite

Roadmap for Transforming Preoperative Assessment to Preoperative Optimization.

Journal Article Anesth Analg · April 2020 Preoperative assessment typically equates to evaluating and accepting the presenting condition of the patient (unless extreme) and commonly occurs only a few days before the planned surgery. While this timing enables a preoperative history and examination ... Full text Link to item Cite

Overview: Value-based Care for Orthopedic Surgery

Conference Techniques in Orthopaedics · January 1, 2020 An overview of health care value definitions, the current health care paradigm and brief history of the origins of value-based care in orthopedics are presented. The 4 pillar strategic approach for achieving high-value musculoskeletal services includes (1) ... Full text Cite

Tranexamic acid or epsilon-aminocaproic acid in total joint arthroplasty? A randomized controlled trial.

Journal Article Bone Joint J · September 2019 AIMS: Antifibrinolytic agents, including tranexamic acid (TXA) and epsilon-aminocaproic acid (EACA), have been shown to be safe and effective for decreasing perioperative blood loss and transfusion following total hip arthroplasty (THA) and total knee arth ... Full text Link to item Cite

Preoperative Optimization Checklists Within the Comprehensive Care for Joint Replacement Bundle Have Not Decreased Hospital Returns for Total Knee Arthroplasty.

Journal Article J Arthroplasty · July 2019 BACKGROUND: The Comprehensive Care for Joint Replacement (CJR) model has resulted in the evolution of preoperative optimization programs to decrease costs and hospital returns. At the investigating institution, one center was not within the CJR bundle and ... Full text Link to item Cite

Should Medical Severity-Diagnosis Related Group Classification Be Utilized for Reimbursement? An Analysis of Elixhauser Comorbidities and Cost of Care.

Journal Article J Arthroplasty · July 2019 BACKGROUND: The Center for Medicare and Medicaid Services (CMS) classifies reimbursement for total hip arthroplasty (THA) and total knee arthroplasty (TKA) based on Medical Severity-Diagnosis Related Groups (MS-DRGs) 469 (with major complication/comorbidit ... Full text Link to item Cite

Predicting Inpatient Dissatisfaction Following Total Joint Arthroplasty: An Analysis of 3,593 Hospital Consumer Assessment of Healthcare Providers and Systems Survey Responses.

Journal Article J Arthroplasty · May 2019 BACKGROUND: The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, created by the Centers for Medicare and Medicaid, is directly tied to hospital reimbursement. The purpose of this study is to identify factors that are predic ... Full text Link to item Cite

A Weighted Index of Elixhauser Comorbidities for Predicting 90-day Readmission After Total Joint Arthroplasty.

Journal Article J Arthroplasty · May 2019 BACKGROUND: Evolving reimbursement models increasingly compel hospitals to assume costs for 90-day readmission after total joint arthroplasty. Although risk assessment tools exist, none currently reach the predictive performance required to accurately iden ... Full text Link to item Cite

A Novel Risk Calculator Predicts 90-Day Readmission Following Total Joint Arthroplasty.

Journal Article J Bone Joint Surg Am · March 20, 2019 BACKGROUND: A reliable prediction tool for 90-day adverse events not only would provide patients with valuable estimates of their individual risk perioperatively, but would also give health-care systems a method to enable them to anticipate and potentially ... Full text Link to item Cite

Predicting Costs Exceeding Bundled Payment Targets for Total Joint Arthroplasty.

Journal Article J Arthroplasty · March 2019 BACKGROUND: The Center for Medicare and Medicaid Services has instituted bundled reimbursement models for total joint arthroplasty (TJA), which includes target prices for each procedure. Some patients exceed these targets; however, currently there are no t ... Full text Link to item Cite

Utilization of an Electronic Patient Portal Following Total Joint Arthroplasty Does Not Decrease Readmissions.

Journal Article J Arthroplasty · February 2019 BACKGROUND: At the investigating institution, an electronic messaging portal (MyChart) allows patients to directly communicate with their healthcare provider. As reimbursement models evolve, there is an increasing effort to decrease 90-day hospital resourc ... Full text Link to item Cite

Early to Midterm Clinical and Radiographic Survivorship of the All-Polyethylene Versus Modular Metal-Backed Tibia Component in Primary Total Knee Replacement.

Journal Article J Surg Orthop Adv · 2019 The purpose of this study was to compare the all-polyethylene tibial component with the modular metal-backed component in primary total knee arthroplasty. A retrospective review of 1064 patients recorded clinical failure, as determined by need for revision ... Link to item Cite

Characterizing Patient Preferences Surrounding Total Knee Arthroplasty.

Journal Article JB JS Open Access · December 20, 2018 BACKGROUND: Episode-based bundled payments for total knee arthroplasty emphasize cost-effective patient-centered care. Understanding patients' perceptions of components of the total knee arthroplasty care episode is critical to achieving this care. This st ... Full text Link to item Cite

Skilled Nursing Facilities After Total Knee Arthroplasty: The Time for Selective Partnerships Is Now!

Journal Article J Arthroplasty · December 2018 BACKGROUND: Bundled payment initiatives for total knee arthroplasty (TKA) patients are dramatically impacted by discharges to skilled nursing facilities (SNFs), making target prices set by the Center for Medicare and Medicaid Services difficult to achieve. ... Full text Link to item Cite

Preoperative Patient Profile in Total Hip and Knee Arthroplasty: Predictive of Increased Medicare Payments in a Bundled Payment Model.

Journal Article J Arthroplasty · September 2018 BACKGROUND: The shift toward value-based bundled payment models in total joint arthroplasty highlights the need for identification of modifiable risk factors for increased spending as well as opportunities to mitigate perioperative treatment of chronic dis ... Full text Link to item Cite

Conversion vs Primary Total Hip Arthroplasty: Increased Cost of Care and Perioperative Complications.

Journal Article J Arthroplasty · August 2018 BACKGROUND: With the increasing incidence of hip fractures and hip preservation surgeries, there has been a concomitant rise in the number of conversion total hip arthroplasties (THAs) performed. Prior studies have shown higher complication rates in conver ... Full text Link to item Cite

The James A. Rand Young Investigator's Award: Battling the Opioid Epidemic with Prospective Pain Threshold Measurement.

Journal Article J Arthroplasty · July 2018 BACKGROUND: Responsible analgesic prescribing is paramount in the opioid epidemic era, yet no standardized protocol exists. We aim to (1) quantify and correlate outpatient opioid need after total knee and hip arthroplasties (TKA and THA) with preoperative ... Full text Link to item Cite

Association Between Pseudotumor Formation and Patient Factors in Metal-on-Metal Total Hip Arthroplasty Population.

Journal Article J Arthroplasty · July 2018 BACKGROUND: Pseudotumor formation from metal-on-metal (MoM) hip implants is associated with implant revision. The relationship between pseudotumor type and patient outcomes is unknown. METHODS: We retrospectively reviewed patients with a MoM total hip arth ... Full text Link to item Cite

Inpatient Consults and Complications During Primary Total Joint Arthroplasty in a Bundled Care Model.

Journal Article J Arthroplasty · April 2018 BACKGROUND: The Centers for Medicare and Medicaid Services (CMS) are implementing changes in hospital reimbursement models for total joint arthroplasty (TJA), moving to value-based bundled payments from the fee-for-service model. The purpose of this study ... Full text Link to item Cite

TSG-6 - a double-edged sword for osteoarthritis (OA).

Conference Osteoarthritis Cartilage · February 2018 PURPOSE: To explore mechanisms underlying the association of TSG-6 with osteoarthritis (OA) progression. METHODS: TSG-6-mediated heavy chain (HC) transfer (TSG-6 activity) and its association with inflammatory mediators were quantified in knee OA (n=25) sy ... Full text Link to item Cite

Risk Factors, Outcomes, and Timing of Manipulation Under Anesthesia After Total Knee Arthroplasty.

Journal Article J Arthroplasty · January 2018 BACKGROUND: Knee stiffness requiring manipulation under anesthesia (MUA) is an undesirable outcome following total knee arthroplasty (TKA), but risk factors for, and optimal timing of, MUA remain unclear. METHODS: Primary TKAs performed at a single center ... Full text Link to item Cite

Saphenous Nerve Block From Within the Knee Is Feasible for TKA: MRI and Cadaveric Study.

Journal Article Clin Orthop Relat Res · January 2018 BACKGROUND: Surgeon-performed periarticular injections and anesthesiologist-performed femoral nerve or adductor canal blocks with local anesthetic are in common use as part of multimodal pain management regimens for patients undergoing TKA. However, femora ... Full text Link to item Cite

Modeling the Potential Economic Impact of the Medicare Comprehensive Care for Joint Replacement Episode-Based Payment Model.

Journal Article J Arthroplasty · November 2017 BACKGROUND: The Medicare program has initiated Comprehensive Care for Joint Replacement (CJR), a bundled payment mandate for lower extremity joint replacements. We sought to determine the degree to which hospitals will invest in care redesign in response t ... Full text Link to item Cite

What Should Define Preoperative Anemia in Primary THA?

Journal Article Clin Orthop Relat Res · November 2017 BACKGROUND: The use of tranexamic acid (TXA) in THA decreases the risk of transfusion after surgery. However, nearly 10% of patients still undergo a transfusion, which has been independently associated with an increased risk of complications. Preoperative ... Full text Link to item Cite

Outcomes of Modular Dual Mobility Acetabular Components in Revision Total Hip Arthroplasty.

Journal Article J Arthroplasty · September 2017 BACKGROUND: There is a high rate of dislocation after revision total hip arthroplasty. This study evaluated the outcomes of 1 modular dual mobility component in revision total hip arthroplasty in patients at high risk of dislocation. METHODS: We reviewed 6 ... Full text Link to item Cite

Pilot prospective study of post-surgery sleep and EEG predictors of post-operative delirium.

Journal Article Clin Neurophysiol · August 2017 OBJECTIVE: Delirium is a common post-operative complication associated with significant costs, morbidity, and mortality. We sought sleep/EEG predictors of delirium present prior to delirium symptoms to facilitate developing and targeting therapies. METHODS ... Full text Link to item Cite

A randomised trial of peri-operative positive airway pressure for postoperative delirium in patients at risk for obstructive sleep apnoea after regional anaesthesia with sedation or general anaesthesia for joint arthroplasty.

Journal Article Anaesthesia · June 2017 Previous pilot work has established an association between obstructive sleep apnoea and the development of acute postoperative delirium , but it remains unclear to what extent this risk factor is modifiable in the 'real world' peri-operative setting. In a ... Full text Link to item Cite

What Factors Drive Inpatient Satisfaction After Knee Arthroplasty?

Journal Article J Arthroplasty · June 2017 BACKGROUND: The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, developed by the Centers for Medicare & Medicaid Services, is directly tied to hospital reimbursement. The purpose of this study is to analyze survey response ... Full text Link to item Cite

Perioperative Dexamethasone Administration Does Not Increase the Incidence of Postoperative Infection in Total Hip and Knee Arthroplasty: A Retrospective Analysis.

Journal Article J Arthroplasty · August 2016 BACKGROUND: Dexamethasone is frequently used for the treatment of postoperative nausea and vomiting and as an adjunct in multimodal postoperative analgesia after total joint arthroplasty; however, the incidence of periprosthetic joint infection (PJI) after ... Full text Link to item Cite

Percent Body Fat Is More Predictive of Function After Total Joint Arthroplasty Than Body Mass Index.

Journal Article J Bone Joint Surg Am · May 18, 2016 BACKGROUND: Obesity has an important impact on the future of total joint arthroplasty; however, the definition and influence of obesity on surgical risks and outcomes remain controversial. Our hypothesis was that percent body fat was better than body mass ... Full text Link to item Cite

The Future of Perioperative Medicine

Journal Article ASA Moniter · April 10, 2016 Open Access Cite

Opioid-Based Analgesia: Impact on Total Joint Arthroplasty.

Journal Article J Arthroplasty · December 2015 The objective of this study was to characterize the impact of opioid-based analgesia in total joint arthroplasty. The primary outcomes were incidence of in-hospital complications, length of stay, and discharge destination. Six hundred and seventy-three pri ... Full text Link to item Cite

Current Evidence Does Not Support Medicare's 3-Day Rule in Primary Total Joint Arthroplasty.

Journal Article Am J Orthop (Belle Mead NJ) · October 2015 Patients who undergo total joint arthroplasty and are destined for discharge to an extended-care facility--particularly Medicare beneficiaries--are required to have an inpatient stay of at least 3 consecutive days. The primary objective of this study was t ... Link to item Cite

Medicare's 3-Day Rule: Time for a Rethink.

Journal Article J Arthroplasty · September 2015 A pilot study was undertaken to examine the impact of Medicare's 3-day rule on length of stay (LOS). One hundred consecutive patients who underwent primary total joint arthroplasty and were discharged to extended care facilities were retrospectively review ... Full text Link to item Cite

The Association of ASA Class on Total Knee and Total Hip Arthroplasty Readmission Rates in an Academic Hospital.

Journal Article J Arthroplasty · May 2015 Total hip and knee arthroplasties are two of the most successful orthopaedic procedures. However, with the increasing demand, estimated future costs for these procedures are enormous. Recent data suggest post-discharge care may account for up to 35% of tot ... Full text Link to item Cite

Preoperative pain level and patient expectation predict hospital length of stay after total hip arthroplasty.

Journal Article J Arthroplasty · April 2015 The purpose of this study was to identify preoperative predictors of length of stay after primary total hip arthroplasty in a patient population reflecting current trends toward shorter hospitalization and using readily obtainable factors that do not requi ... Full text Open Access Link to item Cite

Patient expectation is the most important predictor of discharge destination after primary total joint arthroplasty.

Journal Article J Arthroplasty · April 2015 The purpose of this study was to identify preoperative predictors of discharge destination after total joint arthroplasty. A retrospective study of three hundred and seventy-two consecutive patients who underwent primary total hip and knee arthroplasty was ... Full text Open Access Link to item Cite

Preoperative predictors of extended hospital length of stay following total knee arthroplasty.

Journal Article J Arthroplasty · March 2015 The purpose of this study was to identify the preoperative predictors of hospital length of stay after primary total knee arthroplasty in a patient population reflecting current trends toward shorter hospitalization and using readily obtainable factors tha ... Full text Open Access Link to item Cite

Bilateral symmetry in lower extremity mechanics during stair ascent and descent following a total hip arthroplasty: a one-year longitudinal study.

Journal Article Clin Biomech (Bristol) · January 2015 BACKGROUND: Total hip arthroplasty is the standard treatment to reduce pain and improve function in people with advanced hip osteoarthritis; however, persisting asymmetrical gait patterns have been identified in level walking. Therefore, this study evaluat ... Full text Link to item Cite

Percent body fat more associated with perioperative risks after total joint arthroplasty than body mass index.

Journal Article J Arthroplasty · September 2014 Understanding the impact of obesity on elective total joint arthroplasty (TJA) remains critical. Perioperative outcomes were reviewed in 316 patients undergoing primary TJA. Higher percent body fat (PBF) was associated with postoperative blood transfusion, ... Full text Open Access Link to item Cite

Risk versus reward: total joint arthroplasty outcomes after various solid organ transplantations.

Journal Article J Arthroplasty · August 2014 Clinical outcomes were retrospectively reviewed for 76 primary total hip (THA) and total knee arthroplasties (TKA) performed after kidney, liver, cardiac, and lung transplantation with follow-up of 30.2 and 41.2 months, respectively. For the THA and TKA co ... Full text Link to item Cite

Total hip arthroplasty surgical approach does not alter postoperative gait mechanics one year after surgery.

Journal Article PM R · March 2014 OBJECTIVE: To investigate the differences in gait biomechanics on the basis of surgical approach 1 year after surgery. DESIGN: This was a descriptive laboratory study to investigate the side-to-side differences in walking mechanics at a self-selected walki ... Full text Open Access Link to item Cite

Impact of perioperative allogeneic and autologous blood transfusion on acute wound infection following total knee and total hip arthroplasty.

Journal Article J Bone Joint Surg Am · February 19, 2014 BACKGROUND: Patients undergoing total hip or knee arthroplasty frequently receive blood transfusions. The relationship between transfusion and the risk of infection following total joint arthroplasty is unclear. In this study, we sought to examine the impa ... Full text Link to item Cite

Outcomes of primary total joint arthroplasty after lung transplantation.

Journal Article J Arthroplasty · January 2014 Lung transplantation is increasingly common with improving survival rates. Post-transplant patients can be expected to seek total hip (THA) and knee arthroplasty (TKA) to improve their quality of life. Outcomes of 20 primary total joint arthroplasties (15 ... Full text Link to item Cite

Unicompartmental knee arthroplasty and total knee arthroplasty among Medicare beneficiaries, 2000 to 2009.

Journal Article J Bone Joint Surg Am · November 20, 2013 BACKGROUND: Unicompartmental knee arthroplasty is a less-invasive alternative to total knee arthroplasty for patients with arthritis affecting only the medial or lateral compartment. However, little is known about recent trends in the use of these procedur ... Full text Link to item Cite

Does surgical approach during total hip arthroplasty alter gait recovery during the first year following surgery?

Journal Article J Arthroplasty · October 2013 Featured Publication Multiple surgical approaches exist for total hip arthroplasty (THA). Each approach has risks and benefits in regard to complications and changes in postoperative gait. This study examined the effect of three surgical approaches on postoperative gait mechan ... Full text Link to item Cite

Simultaneous vs staged bilateral total knee arthroplasty among Medicare beneficiaries, 2000-2009.

Journal Article J Arthroplasty · September 2013 Simultaneous bilateral total knee arthroplasty (TKA) reportedly has higher postoperative complication rates than staged procedures, but little is known about recent trends and outcomes among Medicare patients. In a 5% national sample of Medicare beneficiar ... Full text Link to item Cite

Developing a high-efficiency operating room for total joint arthroplasty in an academic setting.

Journal Article Clin Orthop Relat Res · June 2013 Featured Publication BACKGROUND: Developing a high-efficiency operating room (OR) for total joint arthroplasty (TJA) in an academic setting is challenging given the preexisting work cultures, bureaucratic road blocks, and departmental silo mentalities. Also, academic instituti ... Full text Link to item Cite

Creation of a femoral cortical window to facilitate total hip arthroplasty in patients with sickle cell hemoglobinopathies.

Journal Article J Arthroplasty · February 2013 Featured Publication Patients with sickle cell hemoglobinopathies often have femoral head osteonecrosis with collapse, and can benefit greatly from total hip arthroplasty. However, numerous procedural challenges and perioperative complications make these cases difficult. More ... Full text Link to item Cite

Late liner disassociation of a Pinnacle system acetabular component.

Journal Article Orthopedics · April 2012 Featured Publication This article describes a case of late locking mechanism failure and disassociation of a Pinnacle acetabular cup (DePuy, Warsaw, Indiana) and Marathon polyethylene liner (DePuy) 53 months after routine primary total hip arthroplasty in an active patient. Fo ... Full text Link to item Cite

The effect of total hip arthroplasty surgical approach on postoperative gait mechanics.

Journal Article J Arthroplasty · September 2011 Featured Publication Surgical approach for total hip arthroplasty (THA) is determined by clinician preference from limited prospective data. This study aimed to examine the effect of surgical approach (direct lateral, posterior, and anterolateral) on 6-week postoperative gait ... Full text Link to item Cite

Pain coping skills training for patients with elevated pain catastrophizing who are scheduled for knee arthroplasty: a quasi-experimental study.

Journal Article Arch Phys Med Rehabil · June 2011 Featured Publication OBJECTIVES: To (1) describe a behavioral intervention designed for patients with elevated pain catastrophizing who are scheduled for knee arthroplasty, and (2) use a quasi-experimental design to evaluate the potential efficacy of the intervention on pain s ... Full text Link to item Cite

Greater trochanteric osteoplasty in revision hip arthroplasty: two case reports.

Journal Article Am J Orthop (Belle Mead NJ) · January 2011 Featured Publication Proximal migration of the greater trochanter can make revision hip arthroplasty challenging, particularly in regard to surgically exposing the joint, establishing leg length, avoiding postoperative impingement and instability, and achieving a functional hi ... Link to item Cite

Tissue sparing total femoral arthroplasty: technical note.

Journal Article J Surg Orthop Adv · 2011 Featured Publication It is predicted that the number of revision hip and knee arthroplasties will double by the years 2026 and 2015, respectively. As the burden of end-stage prosthetic disease increases, there will be a greater potential need for total femoral arthroplasty. Th ... Link to item Cite

Aging is not associated with bone marrow-resident progenitor cell depletion.

Journal Article J Gerontol A Biol Sci Med Sci · October 2010 Featured Publication Changes in progenitor cell biology remain at the forefront of many theories of biologic aging, but there are limited studies evaluating this in humans. Aging has been associated with a progressive depletion of circulating progenitor cells, but age-related ... Full text Link to item Cite

Activity scale for arthroplasty patients after total hip arthroplasty.

Journal Article J Arthroplasty · January 2010 Featured Publication The purpose of the Activity Scale for Arthroplasty Patients (ASAP) is to develop and validate a self-report questionnaire that demonstrated discrimination of functional gains, low burden, appropriate concurrent validity, and was not limited by ceiling effe ... Full text Link to item Cite

Posterior capsular injections of ropivacaine during total knee arthroplasty: a randomized, double-blind, placebo-controlled study.

Journal Article J Arthroplasty · September 2009 Featured Publication We investigated the hypothesis that a posterior capsular injection of ropivacaine would improve pain and accelerate functional recovery after total knee arthroplasty in a randomized, double-blind, placebo-controlled study design. Sixty-six patients receive ... Full text Link to item Cite

Managing risk and liability associated with hip and knee implants

Journal Article Current Orthopaedic Practice · April 1, 2009 Hip and knee replacement surgery has proven to be among the great success stories of twentieth century medicine and technology. Orthopaedic surgeons and their patients expect and demand near perfect outcomes after hip and knee replacements. However, not ev ... Full text Cite

Cementless porous-coated anatomic total hip arthroplasty at Duke: 18- to 24-year follow-up.

Journal Article J Surg Orthop Adv · 2009 Featured Publication The porous-coated anatomic (PCA) total hip was a first-generation cementless implant system introduced in 1983 for both primary and revision total hip arthroplasty. Between February 1983 and June 1989, 219 uncemented PCA total hips were implanted in 194 pa ... Link to item Cite

Medicolegal aspects of hip and knee arthroplasty.

Journal Article Clin Orthop Relat Res · April 2005 Featured Publication Hip and knee arthroplasties usually are satisfying for the patient and the surgeon; however, these procedures also have considerable risks for generating a medical malpractice lawsuit. Strict adherence to the standard of care and recently implemented patie ... Full text Link to item Cite

MR imaging of infrapatellar plica injury.

Journal Article AJR Am J Roentgenol · May 2003 Featured Publication OBJECTIVE: Injury to the infrapatellar plica (ligamentum mucosum) has not been previously described in the radiology literature to our knowledge. This article shows the MR imaging appearance of injury to the infrapatellar plica. CONCLUSION: Injury to the i ... Full text Link to item Cite

Observations on the growth of loose bodies in joints.

Journal Article Arthroscopy · October 2002 Featured Publication The categorization, origin, natural history, and histopathology of loose bodies in joints are well described in the literature. Clinical and basic science data have indirectly concluded that loose bodies grow over time; however, to date, there is no clearl ... Full text Link to item Cite

The derotation sign for perioperative diagnosis of significant partial-thickness rotator cuff tears.

Journal Article Arthroscopy · March 2002 Featured Publication PURPOSE: To describe and evaluate a simple perioperative test (the derotation sign) that differentiates significant (grade 3) partial-thickness and small full-thickness rotator cuff tears from insignificant (grades 1 and 2) partial-thickness rotator cuff t ... Full text Link to item Cite

Multifocal osteonecrosis and human immunodeficiency virus infection.

Journal Article J South Orthop Assoc · 2002 Featured Publication Over the past decade, a causal relationship between infection with human immunodeficiency virus (HIV) and osteonecrosis has been proposed. This case report (the first example presented in the English orthopaedic literature) of multifocal (> 3 sites) osteon ... Link to item Cite

The team physician: ethics and enterprise.

Journal Article J Bone Joint Surg Am · February 2001 Featured Publication Full text Link to item Cite

Septic sacroiliitis: the overlooked diagnosis.

Journal Article J South Orthop Assoc · 2001 Featured Publication Infection of the sacroiliac joint is extraordinarily rare. However, the initial symptoms and signs associated with this condition are mundane, thus leading to delay in diagnosis, or even misdiagnosis. I report an extremely unusual pyogenic sacroiliitis cau ... Link to item Cite

Isolated acute hip adductor brevis strain.

Journal Article J South Orthop Assoc · 2000 Featured Publication Acute muscle strain occurs as a result of an eccentric contraction that exceeds the biomechanical strength of the musculotendinous junction of a single muscle within a synergistic group. To date, only the (hip) adductor longus was shown to sustain this typ ... Link to item Cite

Atraumatic floating clavicle and total claviculectomy.

Journal Article J South Orthop Assoc · 1999 Featured Publication We describe a patient with a floating clavicle of atraumatic origin treated by total claviculectomy. Clavicular function and anatomy are summarized relative to complete excision. Other treatment options for panclavicular instability are also discussed. ... Link to item Cite

Industrialized health care and midcareer crises.

Journal Article Pharos Alpha Omega Alpha Honor Med Soc · 1999 Featured Publication Link to item Cite

Bipolar arthroplasty for recurrent total hip instability.

Journal Article J South Orthop Assoc · 1999 Featured Publication Bipolar arthroplasty has been reported as a method for correction of recurrent dislocations of total hip replacements. This retrospective review of six patients with multiple dislocations of total hip replacements treated by conversion to simple bipolar hi ... Link to item Cite

Diagnosis and management of laryngeal trauma in sports.

Journal Article South Med J · June 1996 Featured Publication The management of sports-related laryngeal trauma presents a diagnostic and therapeutic challenge. The application of basic treatment principles such as airway monitoring, thorough physical examination, and fiberoptic laryngeal examination will direct the ... Full text Link to item Cite

Management of nonunion below proximal humeral prosthesis.

Journal Article Contemp Orthop · April 1995 Featured Publication Fractures below proximal humeral prostheses are rare and their successful management presents technical difficulties. Closed treatment usually results in nonunion. A case illustrating this disabling complication is reported and a literature review is prese ... Link to item Cite

Conversion of hip arthrodesis to total joint arthroplasty.

Journal Article Contemp Orthop · January 1995 Featured Publication Conversion of a hip arthrodesis to a total joint arthroplasty is an uncommon procedure compared to the standard or revision total hip replacement. In this report, two illustrative cases are presented in which conversion to a total joint arthroplasty was pe ... Link to item Cite

Annular ligament reconstruction in chronic posttraumatic radial head dislocation in children.

Journal Article Contemp Orthop · September 1993 Featured Publication Traumatic radial head dislocation without an associated fracture is an unusual injury in children. Occasionally, the diagnosis is missed or the injury is not treated acutely, leading to chronic radial head dislocation. The recommended treatment has been co ... Link to item Cite

Lateral condyle fractures: missed diagnoses in pediatric elbow injuries.

Journal Article Mil Med · September 1990 Featured Publication Pediatric elbow injuries represent diagnostic dilemmas to all health care personnel. In particular, nondisplaced lateral condyle fractures are often missed when the child first presents for evaluation, and if left untreated, can potentially produce disastr ... Link to item Cite

Neuromas of the superficial radial nerve.

Journal Article Mil Med · August 1988 Featured Publication Link to item Cite

Biomechanical characteristics of human ankle ligaments.

Journal Article Foot Ankle · October 1985 Featured Publication The purpose of this study was to define the biomechanical characteristics of the isolated, individual bone-ligament-bone complexes of the human ankle. Twenty human ankles were dissected of all soft tissues to leave only the tibia, fibula, talus, and calcan ... Full text Link to item Cite

A biomechanical study of human lateral ankle ligaments and autogenous reconstructive grafts.

Journal Article Am J Sports Med · 1985 Featured Publication The purpose of this study was to investigate the biomechanical behavior of human anterior talofibular and calcaneofibular ligaments, as well as peroneus brevis, split peroneus brevis, and toe extensor tendon grafts. This article represents the first publis ... Full text Link to item Cite

Myocardial blood flow and oxygen consumption in the empty-beating, fibrillating, and potassium-arrested hypertrophied canine heart.

Journal Article Ann Thorac Surg · April 1983 Myocardial oxygen consumption and blood flow distribution were examined in severely hypertrophied canine hearts in the empty-beating, fibrillating, and pharmacologically arrested states. Hypertrophy was produced using a subcoronary valvular aortic stenosis ... Full text Link to item Cite

Depressed high-energy phosphate content in hypertrophied ventricles of animal and man: the biologic basis for increased sensitivity to ischemic injury.

Journal Article Ann Surg · September 1982 Featured Publication It is frequently stated that hypertrophied ventricles tolerate ischemia less well than nonhypertrophied ventricles. The authors' earlier studies in a rat supravalvular aortic stenosis model and canine valvular aortic stenosis model, both with concentric le ... Full text Link to item Cite

The coronary pressure-flow determinants left ventricular compliance in dogs.

Journal Article Circ Res · October 1981 Displacement of the left ventricular diastolic pressure-dimension relationship (change in compliance) has been observed with alterations in coronary perfusion pressure. The relative contribution of coronary (myocardial) blood flow, as compared with the per ... Full text Link to item Cite

Characteristics of chronic left ventricular hypertrophy induced by subcoronary valvular aortic stenosis. II. Response to ischemia.

Journal Article J Thorac Cardiovasc Surg · March 1981 Featured Publication The increased susceptibility of hearts with chronic left ventricular hypertrophy (CLVH) to damage during ischemia has been suggested but not documented. The purpose of this study was to isolate ischemic events in hearts with CLVH from reperfusion events. U ... Link to item Cite

Characteristics of chronic left ventricular hypertrophy induced by subcoronary valvular aortic stenosis. I. Myocardial blood flow and metabolism.

Journal Article J Thorac Cardiovasc Surg · March 1981 Featured Publication Using a canine model of subcoronary valvular aortic stenosis, we determined myocardial blood flow, high-energy phosphate content, and mitochondrial function in eight hearts with chronic left ventricular hypertrophy. Fourteen normal hearts were used for con ... Link to item Cite

Metabolic deterioration during global ischemia as a function of time in the intact normal dog heart.

Journal Article J Thorac Cardiovasc Surg · February 1981 High-energy phosphate content and mitochondrial function were analyzed at the initiation and completion of ischemic contracture in dog hearts exposed to normothermic ischemia while on cardiopulmonary bypass. Contracture initiation and completion were detec ... Link to item Cite

An improved technique for producing ventricular hypertrophy with a subcoronary valvular aortic stenosis model.

Journal Article Ann Thorac Surg · September 1980 Although techniques for producing aortic valve stenosis proximal to the ostia of the coronary arteries have been described in experimental animals, only moderate left ventricular hypertrophy has been obtained. A technique for plicating the noncoronary sinu ... Full text Link to item Cite