for alumni & friends of the University of Nebraska Medical Center Department of Orthopaedic Surgery and Rehabilitation

Breaking NewsOrthopaedic Surgery and Rehabilitation

Breaking News | Spring 2016

see WALK pg. 14

Operation Walk USA: Giving the gift of mobility

Rothman-Ranawat Fellows visit Omaha

Randy Robins has always taken care of everybody else first. He’s mostly raised his four children on his own, is a grandfather to six and describes himself as someone who has lived under the radar.

Robins has met life’s challenges head on. Not long after his youngest daughter and son were diagnosed with cancer, he came down with a rare form of cancer himself. Then came the pain in Robins’ left hip. He had felt discomfort for years, but after his recovery from cancer, the pain became unmanageable.

“I’m a pretty tough guy,” he said, “I always have been. I just couldn’t will myself through the pain this time.”

At just 63 years old, Robins was forced to retire early. He had little insurance and was still paying off his cancer bills. That’s when Robins’ daughter heard about Operation Walk USA. She applied on his behalf.

Through Operation Walk USA, 80 patients across the country receive free joint replacements. All of these patients would not otherwise be able to get the new joints they so desperately need, due to lack of insurance coverage, financial or other constraints.

When he found out he was accepted, Robins was grateful for the chance to get his life back.

“I consider myself fortunate to be here,” he said. “I’m not ready to hang it up yet. I want to live again. I want to work again.”

Robins underwent a left hip replacement on Dec. 15, 2015, under the care of Curtis Hartman, M.D. That same day, Dr. Hartman performed another surgery on a second Operation Walk

The Department of Orthopaedic Surgery and Rehabilitation hosted The Hip Society’s 2016 Rothman-Ranawat Traveling Fellowship on March 21-22. The four fellows spent two days at UNMC, learning from our surgeons, participating in grand rounds and conferences, touring our Biomechanics Laboratory and giving presentations.

Learn more about the Rothman-Ranawat Traveling Fellowship in the fall issue of Breaking News.

Through Operation Walk USA, two patients received free joint replacements in December from UNMC associate professor and orthopaedic surgeon Curtis Hartman, M.D.

patient: 59-year-old Brenda Bostic, of Bellevue.

Bostic became very aware of the onset of knee pain and arthritis nearly 20 years ago. She tried to minimize the pain with cortisone shots, frequent doctor visits and other procedures. The pain, however, had started to affect her daily life. A mother of three, grandmother of ten and great-grandmother to one, Bostic loved cheerleading at her grandchildren’s sporting events.

“I used to enjoy jumping up and down and running along the field to support them,” she said. “But I just couldn’t do that anymore.”

In October 2015, Bostic felt numbness in her knee and rushed to the emergency room, where she was told she needed a knee replacement. When visiting with her doctors at UNMC, she mentioned she had no insurance.

HOII Tyler Larson, M.D., left, and Curtis Hartman, M.D. visit Randy Robins after his Dec. 15 total hip replacement.

Message from the chair

Kevin L. Garvin, M.D. Professor and Chair L. Thomas Hood, M.D., Professorship

Sincerely,

Leading the way

Our department has always strived to be a local and national leader in orthopaedic care. Through our outstanding patient care, cutting-edge research and innovative educational residency program, I believe we have made a name for ourselves in the orthopaedic world.

As with any great team, however, the work never stops. This year is already off to a strong start. Many of our faculty members participated as presenters and moderators at the 2016 American Academy of Orthopaedic Surgeons Annual Meeting in Orlando, FL. In total, UNMC faculty participated in 17 presentations, instructional course lectures, symposia and specialty day activities at the annual meeting.

The department continued our longtime involvement with Operation Walk USA. Dr. Curtis Hartman volunteered his time to perform two joint replacements on Omaha-area patients in need. Both UNMC and Nebraska Medicine donated time, supplies and OR space to make this life-changing event happen.

On the clinical front, our Sports Medicine Program recently welcomed the addition of a new primary care sports medicine specialist, Dr. Ross Mathiasen. Dr. Mathiasen began seeing patients at both the Durham Outpatient Center and Oakview Medical Clinic. This addition furthers our goal of providing comprehensive sports medicine care to athletes and active people of all ages.

In the past several months, we have welcomed a number of guest speakers, including L. Scott Levin, M.D., professor and chair of Orthopaedics at the University of Pennsylvania School of Medicine. In March, we hosted four national and international orthopaedic surgeons through The Hip Society’s 2016 Rothman-Ranawat Traveling Fellowship. The fellows spent two days in Omaha, observing our faculty members and presenting to our residents. Hosting visiting speakers provides a valuable chance for our residents and faculty to network and learn from some of the brightest minds in orthopaedics.

As busy as 2016 has already been, there is still more to come. Preparations are already underway for our Class of 2016 resident graduation ceremonies. We hope to see many of you back on campus for our graduation events on June 10-11. More details will be sent out in the coming months.

I hope you enjoy this edition of Breaking News. As always, we are beyond grateful for your continued support as department alumni and friends of the program.

Breaking NewsSpring 2016

Breaking News is published three times a year for alumni and friends of the UNMC Department of Orthopaedic Surgery and Rehabilitation.

Chair:Kevin L. Garvin, M.D.

Administrator:David Staiert, MBA

Communications:Sydnie Hochstein, MS

For questions or comments, email sydnie.hochstein@unmc.edu or call 402.559.5609

Department of Orthopaedic Surgery 981080 Nebraska Medical Center

Omaha, NE 68198-1080

Find us online! www.unmc.edu/orthosurgery

Breaking News | 2

Breaking News | 3

2016 AAOS Annual Meeting

From left, Dr. Khalid Azzam (2014), Dr. Eric Bonness (2017) and Dr. Courtney Grimsrud (2017).

The 2016 American Academy of Orthopaedic Surgeons Annual Meeting was held in Orlando, Florida, March 1-5. Many UNMC faculty members participated in this year’s meeting.POSTER PRESENTATIONS:

Bragdon, C.; Barr, C.; Nielsen, C.; Berry, D.; Della Valle, C.; Garvin, K.; et. al.: Minimum 13-Year Multicenter Study of THR with Highly Cross-Linked Polyethylene and Standard Diameter Femoral Heads.

Cornett, C.; Vincent, S.; Crow, J.; Hewlett, A.: Bacterial Spine Infections in Adults: Evaluation and Management.

PAPER PRESENTATIONS:

Frank, J.; Kayupov, E.; Deirmengian, G.; Sporer, S.; Hartman, C.; et. al.: Paper 236: Oral Antibiotics Reduce Reinfection Following 2-Stage Exchange: A Multi-Center, Randomized Controlled Trial.

INSTRUCTIONAL COURSE LECTURES:

Scherl, S.: ICL 406: Problems and Procedures in Pediatric Trauma: Case Based Learning (Presenter).

Cornett, C.: ICL 169: Surgical Management of Cervical Spondylotic Myelopathy.

Garvin, K.: ICL 202-Preventing Hospital Readmissions and Limiting the Complications Associated with Total Hip Arthroplasty. Prevention and Management of Infection and Wound Complications

(Moderator and presenter).

Garvin, K.: ICL 461: Total Hip Arthroplasty – How Do I Get Out of This Problem? The femoral/acetabular anteversion is not what I expected (Presenter).

CASE PRESENTATIONS:

Scherl, S.: Challenges in the Management of Fractures in Adolescents: A Case Based Approach (Moderator).

Scherl, S.: Case Presentation: Pediatric Orthopaedic Trauma: Principles of Management (Table Facilitator).

Streubel, P.: Complex Shoulder Arthroplasty: Case Discussions and Management (Presenter).

Garvin, K.; Hartman, C.: Revision Total Knee Arthroplasty Essentials: A Case-based Approach (Presenters).

Garvin, K.: Complex Primary Total Hip Arthroplasty: A Case-based Approach (Presenter).

Garvin, K.: Management of Infected Total Joint Arthroplasty in 2016 – Where Do We Stand Now? (Presenter).

SYMPOSIA:

Garvin, K.: Symposium Y: Preoperative Optimization of Total Joint Arthroplasty Surgical Risk. Staphylococcus aureus Colonization (Presenter).

Garvin K.: Symposium E: Hot Topics and Controversies in Revision Total Hip Arthroplasty. Posterior Approach for revisions (Presenter).

SPECIALTY DAY:

Garvin, K.: High-Dose Antibiotic Containing Spacers for Infected THA. The Hip Society Specialty Day.

Garvin, K.: Is This Knee Infected? The Knee Society Specialty Day.

From left, Dr. Khalid Azzam (2014), Dr. Curtis Hartman (2008), Dr. Beau Konigsberg (2007) and Dr. Jason Erpelding (2011).

From left, Dr. Craig Mahoney (2001), Dr. Hani Haider and Dr. Paul Duwelius (1987).

From left, Dr. Jeffrey Farber (1988), Dr. Tim Fitzgibbons and Dr. Richard Bergstrom (1974).

From left, Dr. Kevin Garvin, Dr. James Ballard (2002) and Dr. Edward Prince (2005).

Breaking News | 4

Featured Speaker: L. Scott Levin, M.D.L. Scott Levin, MD, FACS, is the Paul B. Magnuson Professor of Bone and Joint Surgery, Chair of the Department of Orthopaedic Surgery at the University of Pennsylvania School of Medicine, and Professor of Surgery (Plastic Surgery). He is also the Director of the Penn Musculoskeletal and Rheumatology Service Line.

Dr. Levin is Board-certified in Orthopaedic Surgery and has a certificate of added qualification in hand surgery. In addition, he is Board-certified in Plastic Surgery and is responsible for developing the field of “Orthoplastic Surgery.”

As an accomplished clinician, his expertise focuses on surgery of the hand and upper extremity, reconstructive microsurgical techniques for extremity reconstruction and limb salvage. His research interests focus predominantly on extremity soft tissue reconstruction and vascularized composite allotransplantation.

Dr. Levin established and was the Director of Duke’s Human Tissue Laboratory and also directed the Anatomic Gifts Program. He established a Human Tissue Laboratory at Penn which opened in May 2011. The lab acts as a teaching tool and a research facility benefiting students, residents and CME participants. Dr. Levin is also the head of the Vascularized Composite Allotransplantation Program at Penn.

In September 2011, he directed the team that performed a bilateral hand and arm transplant. In 2015, as Director of the Pediatric Hand Transplantation Program of Children’s Hospital of Philadelphia, he led the team that performed the world’s first bilateral hand transplant in a child.

Dr. Levin has been recognized for his commitment to teaching, winning the 2007 Master Clinician/Teacher Award for his accomplishments in both clinical care and education at Duke and in 2014 was awarded the I.S. Ravdin Master Clinician Award, Penn Medicine Award of Excellence at the Ruth and Raymond Perelman School of Medicine at the University of Pennsylvania.

He has published more than 264 peer reviewed journal articles, 73 book chapters and 11 books. In addition, Dr. Levin actively participates in senior leadership activities of many international and national professional societies and associations including serving as Orthopaedic Regent of the American College of Surgeons, President of the World Society of Reconstructive Microsurgery (2013-2015), President of the American Society for Reconstructive Microsurgery (2006-2007), member at large of the American Society of Plastic and Reconstructive Surgeons, President of the American Society for Reconstructive Transplantation (2010-2012) and member of the Board of Directors of the American Board of Plastic Surgery (2006-2012).

Dr. Levin has been honored as a North American Traveling Fellow, the American British Canadian Travelling fellow by the American Orthopedic Association and the Sterling Bunnell Traveling Fellowship by the American Society for Surgery of the Hand. In 2015, he was awarded the Andrew J. Weiland Medal by the American Society for Surgery of the Hand. He has served as the Orthopaedic Trauma Association’s Landstuhl Scholar, caring for our war injured soldiers in Germany.

L. Scott Levin, M.D. offered critiques to UNMC Orthopaedic Residents at this year’s Resident Research Forum.

L. Scott Levin, M.D. was the featured speaker at this year’s resident research forum, held Friday, Dec. 11.

Held in the Michael F. Sorrell Center for Health Science Education

Breaking News | 5

Fifteen orthopaedic residents gave presentations at the research forum, each followed by a question and answer session from faculty advisers.

Talk titles are listed below:

Erik Bowman, M.D., HO II, “Outcomes of Nonoperative Management of Surgical Neck Proximal Humerus Fractures in Patients with Underlying Glenohumeral Arthritis”

Tyler Larson, M.D., HO II, “Postoperative Sciatic Nerve Dysfunction Following Posterior Approach for Acetabular Fracture with and without Traumatic Posterior Hip Dislocation”

Ryan Miller, M.D., HO II, “Pneumatic Tourniquet in Upper Extremity Surgery: Is Use with or without Padding Equivalent?”

Lenny Grossman, M.D., HO III, “Initial Experience with Percutaneous IM rodding of Humeri in Children with Osteogenesis Imperfecta”

Sayfe Jassim, M.D., HO III, “Hybrid Total Knee Arthroplasty – A Retrospective Outcomes Review”

Benjamin Ogden, M.D., HO III, “A Performance Improvement Project in Antibiotic Administration for Open Fractures”

Noah Porter, M.D., HO III, “Five-year Outcome Follow-up of Glenoid Anchor Peg Component Fixation Utilizing Autologous Bone Graft in Total Shoulder Arthroplasty”

Eric Bonness, M.D., HO IV, “A Fracture Boot Stress Model for the Determination of Ankle Stability in Patients with Isolated Fibular Fractures”

Courtney Grimsrud, M.D., HO IV, “Long-term Outcomes and Satisfaction of Rotationplasty Patients in the Treatment of Lower Extremity Sarcomas”

Paul Johnson, M.D., HO IV, “Defining the Role of Head of Bed Angle in Cerebral Deoxygenation Events during Upper Extremity Surgery in the Beach Chair Position”

Andrew Kirkpatrick, M.D., HO IV, “30-Day Readmission and Postoperative Complications Following Elective Primary Total Joint Arthroplasty in the Veterans Health Administration VISN 23 Network”

Paul Hong, M.D., HO V, “Safety and Efficacy of Liposomal Bupivicaine (Exparel) in Lumbar Spine Surgery”

Scott Vincent, M.D., HO V, “A Multicenter Prospective Assessment of the Value of Work Done by an Orthopaedic Resident During Call”

Kaitlin Neary, M.D., HO V, “Suture Button Fixation versus Syndesmotic Screws in Supination External Rotation Type 4 Injuries: A Cost Effectiveness Analysis”

Paul Nielsen, M.D., HO V, “Prepping the External Fixator In Situ During Two Stage Pilon Surgical Treatment: Postoperative Complications”

Visiting speaker: L. Scott Levin, M.D.: “Orthoplastic Surgery: Replantation to Transplantation”

2015 Annual Resident Research Forum

Breaking News | 6

Primary Care Sports Medicine physician joins orthopaedic clinicRoss Mathiasen, M.D., joins Nebraska Medicine’s sports medicine team to provide comprehensive care for patients of any age.

As a primary care sports medicine

specialist, Ross Mathiasen, M.D., plays a

unique role in the world of orthopaedics

and sports medicine. Dr. Mathiasen works

hand-in-hand with orthopaedic surgeons,

physical therapists, athletic trainers and

other specialists to provide a medical

home for athletes and active individuals.

In his weekly clinics, Dr. Mathiasen offers

a number of non-surgical treatment

options to patients of all ages and activity

levels. He works in conjunction with

Sports Medicine Program Coordinator

Rusty McKune, ATC, to provide a one-

stop-shop for the active population.

“My goal is to get the athlete back to full

participation in the sport or activity as

quickly and safely as possible, and with

optimal performance,” says Dr. Mathiasen.

“It is a natural fit for us to be located in the

orthopaedic clinic.”

The location creates a unique team

approach to caring for athletes and other

active patients. It provides quick access

to primary care, MRI services, surgeons

or physical therapy, depending on the

patient’s treatment plan.

“Having more access to care is important

for our program,” McKune said. “With

athletics, a week can mean a lot of lost

time for the athlete. We want to make it

as easy and seamless as possible for the

patient.”

In addition to treating common sports-

related injuries including concussions,

overuse injuries and acute musculoskeletal

injuries, Dr. Mathiasen also performs

cutting-edge ultrasound-guided injections.

The ultrasound machine, a new acquisition

for the Orthopaedic Clinic, is a valuable

asset because it allows Dr. Mathiasen to

visually see the needle and underlying

critical structures in real time.

“Traditionally, injections of large joints are

done using fluoroscopy or blind injections,”

Dr. Mathiasen said. “With the ultrasound, I

can do them here in the clinic and can see

the medication being injected in the right

place.”

Common injections include glenohumeral,

hip, knee, carpometacarpal and

acromioclavicular joints, subacromial,

greater trochanter and pes bursae, and

tendon sheaths such as proximal biceps.

Dr. Mathiasen earned his medical degree

from UNMC in 2010 and completed an

emergency medicine residency at the

University of Iowa in 2013. He went on

to pursue two fellowships at Iowa in

emergency medicine research (2014) and

primary care sports medicine (2015).

He is currently an assistant professor in

the Department of Emergency Medicine.

Dr. Mathiasen sees patients at both the

Durham Outpatient Center and Oakview

Medical Center Orthopaedic clinics.

For appointments call: 402-559-8000.

Ross Mathiasen, M.D., offers patients a number of non-surgical treatment options, such as the ultrasound-guided intra-articular shoulder injection pictured above.

Breaking News | 7

Continuing Education and Grand RoundsCME Accredited Grand Rounds are held in Room 1005 of the Sorrell Center, Mondays 6:30 A.M.

Continuing education seminars and Grand Rounds presentations by department faculty, current residents and guest speakers are open to any interested participants. To obtain an updated schedule or information on how to earn CME credits for these presentations, contact Geri Miller at (402) 559-2258 or gmiller@unmc.edu.

Presentations given from November 2015 – March 2016:

November 2015

2 “The Spine Injured Patient: Initial Evaluation and Emergency Treatment” (Scott Vincent, M.D.)

9 “Sterility in the OR” (Paul Johnson, M.D.)

16 “Thermal Injuries” (Joseph Morgan, M.D. Rush University, Hand Surgery Fellow)

23 “Ankle Fractures” (Justin Siebler, M.D.)

December 2015

7 “Radial head arthroplasty” (Philipp Streubel, M.D.)

14 “Evaluation and Management of the Failed MoM THA” (Curtis Hartman, M.D.)

January 2016

4 Morbidity and Mortality Conference (Chief Residents)

11 “Biceps Pathology” (Mark Dietrich, M.D.)

18 “Ulnar Sided Wrist Pain and DRUJ Pathology” (Andrew Kirkpatrick, M.D.)

February 2016

1 “When the decision is NOT to medically intervene….now what?” (Carri Siedlik, APRN, Nebraska Medicine Palliative Care)

8 “Identifying and managing high ankle sprains and syndesmotic injuries in athletes” (Courtney Grimsrud, M.D.)

15 “Beach chair versus lateral decubitus position in shoulder arthroscopy” (Eric Bonness, M.D.)

22 “Infection in total shoulder arthroplasty” (Matthew Teusink, M.D.)

March 2016

21 Rothman-Ranawat Traveling Fellows Lectures

28 “TBD” (M. Layne Jenson, M.D.)

January 2016 (cont.)

25 “The Spine in Osteogenesis Imperfecta” (Maegen Wallace, M.D.)

Guest speakers enhance resident educationBringing in visiting speakers who offer new and innovative ideas in surgical techniques, research topics and patient care is an integral part of the resident educational experience. Guest presentations are made possible with the help of annual contributions to our Development Fund.

The following speakers presented from November 2015 - March 2016:

November 2015

17 Joseph Morgan, M.D., hand fellow, Rush University, “Thermal Injuries”

December 2015

11 L. Scott Levin, M.D., chair of the Department of Orthopedic Surgery, Penn Medicine, “Orthoplastic Surgery: Replantation to Transplantation”

February 2016

1 Carri Siedlik, APRN, Nebraska Medicine Palliative Care, “When the decision is NOT to medically intervene….now what?”

March 2016

21-22 Rothman-Ranawat Traveling Fellows

Derek F. Amanatullah, M.D., Ph.D., “Fluted tapered modular femoral components vs. monolithic femoral components in revision THA”

Atul Kamath, M.D., “Obesity and associated comorbidities as predictors of complications after THA”

Bharath Loganathan, MBBS, D.Ortho, MS (Ortho), MRCS (Edin), “Bearing decisions in primary and revision THA”

Matthew Wilson, MBBS, FRCS, “Reinfection outcomes following single and two-staged surgical revision of infected THA”

Breaking News | 8

Congratulations to the 2016 graduates

Paul J. Nielsen, M.D.

Scott A. Vincent, M.D.

Kaitlin C. Neary, M.D.

Paul Hong, M.D.

Hand Fellowship, Indiana Hand to Shoulder Center, Indianapolis, IN

Spine Surgery Fellowship, University of Wisconsin School of Medicine and Public

Health, Madison, WI

Foot and Ankle Fellowship, U.C. Davis/Reno Orthopedic Clinic, Sacramento, CA and

Reno/Tahoe, NV

Spine Surgery Fellowship, University of Pittsburgh Medical Center, Pittsburgh, PA

Welcome to the Class of 2021The results are in! The UNMC Department of Orthopaedic Surgery will add five new residents in July. The residents who will be joining our program are listed below, along with the medical schools they attended. Join us in welcoming the Class of 2021!

Best of luck to all four residents on their upcoming graduation and fellowship opportunities. The Class of 2016 is pictured above, left to right.

Save the date!Nebraska Orthopaedic Surgery Residency Program Graduation CeremoniesClass of 2016

FRIDAY, JUNE 10, 2016

Resident Presentations8:00 a.m. - 12:00 p.m.Michael F. Sorrell Center for Health Science EducationUNMC Campus (42nd and Emile)Room 1005

Golf OutingIndian Creek Golf Club12:30 p.m. Tee Time3825 North 202nd Street

SATURDAY, JUNE 11, 2016

Presentations/Discussion/Guest Speakers8:00 a.m. - 12:00 p.m.Michael F. Sorrell Center for Health Science EducationUNMC Campus (42nd and Emile)Room 1005

BanquetOmaha Country Club6:00 p.m. Cocktail Hour7:00 p.m. Dinner and Program6900 Country Club RoadOmaha, NE

Josh Cameron, M.D. | University of Oklahoma College of Medicine

Christopher Deans, M.D. | University of Nebraska Medical Center

David Kusin, M.D. | Case Western Reserve University School of Medicine

Kent Rinehart, M.D. | East Tennessee State University Quillen College of Medicine

Phillip Thomas, M.D. | University of Minnesota Medical School

Alumni Feature: James Ballard, M.D., Class of 2002James Ballard, M.D., isn’t exactly sure what initially drew him to Nebraska. When he applied for residency with the Department of Orthopaedic Surgery and Rehabilitation, he knew very little about UNMC. But when he traveled to Omaha in the dead of winter for an interview, he fell in love with the city.

A west coast native, Dr. Ballard grew up in Los Angeles California and earned his undergraduate degree from Brigham Young University in Provo, Utah. While at BYU, Dr. Ballard served a two-year mission for his church in Madrid, Spain. Four years of medical school followed at the Baylor College of Medicine in Houston, Texas.

When considering his options for an internship, UNMC eventually moved to the top of the list. Omaha would make a great place for Dr. Ballard and his wife to raise their young, growing family. The orthopaedic program itself attracted him because the residents were happy, but still worked hard.

“That was important for me,” Dr. Ballard said. “That meant they were well-trained but treated very well.”

During the time Dr. Ballard was in his residency (1996-2002), the department was under the leadership of

the late Dr. James R. Neff (chair, 1991-2000). Dr. Neff made a lasting impression on the young Dr. Ballard.

“I’ll never forget him sitting me down in this big chair in his office and talking to me,” Dr. Ballard said. “He had the unique presence of being highly intelligent and yet very kind and down to earth.”

Following his graduation from UNMC in 2002, Dr. Ballard completed an adult reconstruction fellowship at the Desert Orthopedic Center in Las Vegas, Nevada. From there he made his way to the south Portland, Oregon, metro area, where he currently works in private practice at the Oregon Orthopedic & Sports Medicine Clinic. When he first moved to Oregon, he was the only fellowship-trained total joint surgeon in Portland, and started his practice saying “yes” to almost every referral request. It ended up being a “baptism by fire,” Dr. Ballard said.

These days, Dr. Ballard focuses exclusively on hip and knee replacements. About 20 percent of his case load is dedicated to revisions – many of them complex revisions. He was involved in the first “fast-track” joint system in the city, in which he and his partners run two operating rooms with two full teams, including two anesthesiologists. The system has more than doubled their capacity to do total joint replacements. In addition, Dr. Ballard performed the first outpatient total hip replacement in the state. His team now does outpatient total hips and knees routinely and recently performed their 100th case.

Looking back, Dr. Ballard credits the orthopaedic residency program and the UNMC faculty for their role in his career as an orthopaedic surgeon.

“I have many fond memories of my years in Omaha,” Dr. Ballard said. “It laid the foundation for my career.”

Dr. Ballard and his wife, Beckie, have four children, ages 20, 18, 15 and 13. His oldest is currently serving a two-year church mission trip in Florida and the second oldest is a senior in high school, gearing up to start college. Please keep Dr. Ballard and his family in your thoughts as Beckie persists in her three-and-a-half-year battle with cancer.

Dr. James Ballard with his wife, Beckie, and their four children, Corey, Taylor, Jared and Katie.

Did you know?Dr. Ballard is the mastermind behind this newsletter’s name, “Breaking News.” Upon the inception of the department newsletter in 2001, he entered and won the naming contest!

Breaking News | 9

Save the date!

Breaking News | 10

Publications (peer-reviewed):

Streubel, P.; Moustoukas, M.; Obremskey, W.: Locked plating versus cephalomedullary nailing of unstable intertrochanteric femur fractures. European Journal of Orthopaedic Surgery & Traumatology, 1-6. Epub: Feb. 26, 2016.

Urish, K.; DeMuth, P.; Kwan, B.; Craft, D.; Ma, D.; Haider, H.; et al.: Antibiotic-tolerant Staphylococcus aureus Biofilm Persists on Arthroplasty Materials. Clinical Orthopaedics and Related Research, 1-8. Epub: Feb. 1, 2016.

Chiang, J.; Johnson, J.; Tarkin, I.; Siska, P.; Farrell, D.; Mormino, M.: Plate augmentation for femoral nonunion: more than just a salvage tool? Archives of Orthopaedic and Trauma Surgery, 136(2), 149-156. Feb. 1, 2016.

Cornett, C.; Vincent, S.; Crow, J.; Hewlett, A.: Bacterial Spine Infections in Adults: Evaluation and Management. Journal of the American Academy of Orthopaedic Surgeons, 24(1), 11-18. Jan. 1, 2016.

Presentations (National and International):

16th Annual AAOS/OTA Trauma Update, San Diego, CA, March 31 – April 3, 2016:

• Scherl, S.: Pediatric Fracture Update.

• Scherl, S.: Pediatric Fracture Cases.

Garvin, K.: Prosthetic Knee Infection: Epidemiology, Diagnosis and Management. Orthopaedic Research Society Annual Meeting, Scientific Workshop: Strategies to Improve TKA: Collaboration of the ORS/KS, Orlando, FL, March 5-7, 2016.

2016 American Academy of Orthopaedic Surgeons Annual Meeting, Orlando, FL, March 1-5, 2016:

• Garvin, K.: High-Dose Antibiotic Containing Spacers for Infected THA. The Hip Society Specialty Day.

• Garvin, K.: Is This Knee Infected? The Knee Society Specialty Day.

• Garvin, K.: ICL 461: Total Hip Arthroplasty – How Do I Get Out of This Problem? The femoral/acetabular anteversion is not what I expected (Presenter).

• Garvin, K.: Symposium Y: Preoperative Optimization of Total Joint Arthroplasty Surgical Risk. Staphylococcus aureus Colonization (Presenter).

• Streubel, P.: Complex Shoulder Arthroplasty: Case Discussions and Management (Presenter).

• Garvin, K.: Complex Primary Total Hip Arthroplasty: A Case-based Approach (Presenter).

• Garvin, K.: Management

of Infected Total Joint Arthroplasty in 2016 – Where Do We Stand Now? (Presenter).

• Garvin, K.; Hartman, C.: Revision Total Knee Arthroplasty Essentials: A Case-based Approach (Presenters).

• Frank, J.; Kayupov, E.; Deirmengian, G.; Sporer, S.; Hartman, C.; et al.: Paper 236: Oral Antibiotics Reduce Reinfection Following 2-Stage Exchange: A Multi-Center, Randomized Controlled Trial.

• Garvin, K.: ICL 202-Preventing Hospital Readmissions and Limiting the Complications Associated with Total Hip Arthroplasty. Prevention and Management of Infection and Wound Complications (Moderator and presenter).

• Garvin K.: Symposium E: Hot Topics and Controversies in Revision Total Hip Arthroplasty. Posterior Approach for revisions (Presenter).

• Bragdon, C.; Barr, C.; Nielsen, C.; Berry, D.; Della Valle, C.; Garvin, K.; et al.: Poster Presentation: Minimum 13-Year Multicenter Study of THR with Highly Cross-Linked Polyethylene and Standard Diameter Femoral Heads.

• Cornett, C.: ICL 169:

Surgical Management of Cervical Spondylotic Myelopathy.

• Cornett, C.; Vincent, S.; Crow, J.; Hewlett, A.: Poster Presentation: Bacterial Spine Infections in Adults: Evaluation and Management.

• Scherl, S.: Case Presentation: Pediatric Orthopaedic Trauma: Principles of Management (Table Facilitator).

• Scherl, S.: ICL 406: Problems and Procedures in Pediatric Trauma: Case Based Learning (Presenter).

• Scherl, S.: Challenges in the Management of Fractures in Adolescents: A Case Based Approach (Moderator).

Kristine & Webb Browne Visiting Professor Conference, University of Oklahoma College of Medicine, Oklahoma City, OK, Feb. 4-5, 2016:

• Esposito, P.: Musculoskeletal Impact of Childhood Obesity.

• Esposito, P.: Medical & Surgical Management of Osteogenesis Imperfecta.

• Esposito, P.: The Spine & Upper Extremity in Osteogenesis Imperfecta.

12th Annual International Pediatric Orthopaedic Symposium, Orlando, FL, Dec. 8-12, 2015:

Publications, presentations & honorsDepartment faculty and residents present many lectures, seminars, and courses at local and regional, as well as national andinternational meetings. They also serve in leadership positions and offices for local, state, national and international organizations. The following are our faculty and staff’s presentations and publications, awards and achievements, offices held, and other professionalactivities from November 2015 - March 2016:

• Scherl, S.: Knee Pain in an Adolescent.

• Scherl, S.: Lower Extremity Trauma: A Case-Based Approach (Panel Discussion).

• Scherl, S.: Challenges in Upper Extremity Trauma (E-moderator).

Hartman, C.: Small Group Instructor, AAHKS Resident Arthroplasty Course, Dallas, TX, Nov. 5-7, 2015.

Current Grants:

Pellegrini, V.; Garvin, K.: Comparative Effectiveness of Pulmonary Embolism Prevention after Hip and Knee Replacement: Balancing Safety and Efficacy, Medical University of South Carolina/PCORI. 2016-2020. Pellegrini (PI), Garvin (CI).

Haider, H.: Wear of Total Knee-Joint Prostheses, NYUM. Feb. 1 , 2016 – Jan. 31, 2017, PI.

Haider, H.: An In-vitro Wear Durability Study of the iBalance Unicondylar Knee System with Vit. E stabilized Highly Cross-Linked Bearings, Arthrex. Oct. 1, 2015-March 31, 2016, PI.

Alexander, D.; Ianno, N.; Garvin, K.: Preventing Biofilm Growth on Metal alloys used for Medical Implants and Devices by Femtosecond Laser Surface Processing Techniques, Nebraska Research Initiative (NRI). July 2015-June 2017, Alexander (PI), Ianno (CI), Garvin (CI).

Haider, H.: Comparative Testing of Ceramic Femoral Heads for Total Hip Arthroplasty, Amedica – Phase 1. June 15, 2015-May 31, 2016, PI.

Haider, H.: In-vitro Durability Study of the Arthrex PS

Knee System in Abrasive and Non-abrasive Conditions and Femoral Scratching Test, Arthrex. March 15-Dec. 31, 2015, PI.

Haider, H.: A simulator Study of the Wear of Biomet Hinged Total Knee Replacement Bearing Components, Ortho. PD. K055.09. Jan. 14-Dec. 31, 2015, PI.

Kielian, T.; Garvin, K.; Hartman, C.: “A Study of the Effect of Surgeries on Human Immune Status.” Sponsored by Pfizer, Inc. Oct. 2014-July 2016. Kielian, T. (PI); Garvin, K. (CI); Hartman, C. (CI); et al.

Haider, H.; O’Leary, E.: AngioTeacher Interactive Educational Software, UNMC Cardiology. May 23, 2014-completion, Haider (CI), O’Leary (CI).

Wang, D.; Garvin, K.; Hartman, C.: Early Detection and Intervention of Orthopaedic Implant Loosening using Polymer Theranostics, DHHS/NIH/NIAMS. March 26, 2013-Feb. 28, 2017, Wang, D (PI); Garvin, K (CI); Hartman, C (CI).

Hartman, C.; Konigsberg, B.: A Multicenter, Randomized, Clinical Outcome of Visionaire Patient Matched Technology vs. Standard Surgical Instrumentation in Total Knee Arthroplasty, Clinical Trial, Smith & Nephew. Feb. 18, 2011-Feb. 18, 2016, PI: Hartman, C (PI); Konigsberg, K (CI), Clinical Trial.

Community Service/Volunteer

Hartman, C.: Volunteer Surgeon, Operation Walk USA, Omaha, NE, Dec. 15, 2015.

Scherl, S.; Wallace, M.; Knierim, A.; Grimsrud, C.;

Bruening, C.; Craig, M.; Burke, B.; Hochstein, S.: Perry Outreach Program: Women in Orthopaedics, UNMC/The Perry Initiative. Omaha, NE, Nov. 7, 2015.

Honors and Awards:

Garvin, K.:

• Top Reviewer, Board of Trustees, Clinical Orthopaedics and Related Research, Nov. 2015.

• Best Doctors in America, 1996-2016.

• America’s Top Doctors, Castle Connolly Medical Ltd., 2007-2016.

Memberships and Offices Held:

Garvin, K.:

Second Vice President, The Hip Society, March 2015- March 2016

Nebraska Medicine:

• Perioperative Executive Committee, Jan. 2015-present

• Ambulatory Executive Committee, 2014-present

• Surgical Services Executive Committee, 2014-present

• Dyad Committee, Dec. 2014-Oct. 2015

UNMC:

• Finance Committee, 2012-present

• Executive Board, 2000-present

Adult Reconstruction Hip Program Subcommittee, American Academy of Orthopaedic Surgeons, Feb. 2012-March 2016

The Knee Society:

• Member, Membership Committee, March 2014-present

• Member, Research Committee, March 2012-March 2017

Member, Membership Committee, American Orthopaedic Association, 2010-2016, (Chair: 2014-2015)

Board Member, Omaha Sports Commission, Omaha, NE 2007-present

Board of Trustees, University of South Dakota Foundation, 2006-present

Editorial Board Member, Techniques in Knee Surgery, 2002-present

Consultant Reviewer:

• British Bone and Joint Journal, Nov. 2014-present

• The Knee, March 2012-present

• European Journal of Epidemiology, 1995-present

• Clinical Orthopaedics and Related Research, 1991-present

• Journal of Bone and Joint Surgery, 1990-present

Cornett, C:

Nebraska Medicine:

• One Chart Operational Owner, Dec. 2015-present

• Provider Advisory Group for Patient Experience, Nov. 2015-present

• Medical Director of Physical and Occupational Therapy, The Nebraska Medical Center and Bellevue Medical Center, 2014-present

• Physician Advisory Team

Breaking News | 11

Breaking News | 12

Committee, 2013-present

Department Deputy for Orthopaedics, One Chart, 2013-present

Consultant Reviewer:

• Journal of Orthopaedic Research, October 2015-present

• Clinical Orthopaedics and Related Research, 2014-present

Daccarett, M:

Member, Public Relations Committee, Orthopaedic Trauma Association, March 2016-2019

Reviewer, European Journal of Orthopaedic Surgery and Traumatology, 2015-present

Review Panel Member, Orthopedics, 2013-present

Trauma Committee Member, UNMC, 2008-present

Dietrich, M;

Sideline Physician for area high school teams, 2013-present

Esposito, P:

Elected International Ambassador of the Bone and Joint Decade (BJD), Oct. 2014-Nov. 2017

Board of Directors, Physician Director, Children’s Specialty Physicians, Feb. 2012-2015

Medical Advisory Council, Osteogenesis Imperfecta Foundation, July 2011-present

Board of Directors, Advisory Board, Children’s Hospital & Medical Center, 2010-present

Medical Staff Committees, Children’s Hospital & Medical Center:

• Chair, Focused Peer Review Committee, 2016-present

• Clinical Service Chief, Orthopaedic Surgery, 2009-present

• Information Technology Oversight Committee, 2009-present

• Allied Health Committee, 2008-present

• Credentials Committee, 2008-present

• Quality and Patient Safety Committee, 2008-present

• Focused Peer Review Committee, 2004-present

• Physician’s Health Committee, 2004-present

Consultant Reviewer:

• Clinical Orthopedics and Related Research, 2010-present

• PEDIATRICS, 2005-present

• Journal of Pediatric Orthopaedics, 2008-present

Haider, H:

Journal of Engineering in Medicine:

• Reviews Editor, IMechE Part H, March 2012-present

• Editorial Board Member, IMechE Part H, 2009-present

• Reviewer, 2007-present

International Society of Technology in Arthroplasty (ISTA):

• Director, Scientific Review and Information Technology, Sept.

2011-present

• Board of Directors, 2005-present

Biomedical Engineering Committee, The American Academy of Orthopaedic Surgeons; Official Representative for Orthopaedic Research Society, Feb. 2011-present

Basic Science Education Committee (BSEC), The Orthopaedic Research Society, 2011-present

Editorial Board, Journal Advances in Orthopedics, June 2010-present

Reviewer of abstracts, Orthopaedic Research Society, Aug.2009-present

International Standards Organization (ISO):

• Elected Deputy Chair of the US Delegation, 2015-present

• Coordinator/Liaison Officer, Working Group 2 (Implant Wear), ISO TC150 US Tag, International Standards Organization, 2013-present

• United States Delegation to Committee SC 150 (Medical Devices), 2002-present

American Society of Testing and Materials:

• Technical (Expert) contact, Friction of Hips Standard Writing Committee, Working Group/Item WK 28778, ASTM International, 2011-present

• Co-Chair, Knee Wear Testing Standards Committee, ASTM International, 2002-present

• Chair, Ankle Replacement Testing Standards Committee, ASTM International, 2000-present

Reviewer:

• Clinical Orthopaedics and Related Research, July 2010-present

• Journal of Orthopaedic Research, 2007-present

Hartman, C:

Board of Directors, Metro Omaha Medical Society Foundation, Jan. 2015-present

Membership Committee, Metro Omaha Medical Society, Jan. 2013-present

Orthopaedic Basic Science Subcommittee, American Academy of Orthopaedic Surgeons, Feb. 2012-March 2016

Finance Committee, Mid-America Orthopaedic Association, 2015-2016

UNMC:

• UNMC Graduate Faculty, May 2013-present

• Dissertation Committee, Tyler Scherr, Ph.D. Student, Department of Pathology and Microbiology, UNMC College of Medicine, 2012-present

• Dissertation Committee, Raheleh Miralami, Ph.D. Student, MSIA Program, UNMC College of Medicine, 2012-present

• Dissertation Committee, Ke Ren, Ph.D. Student, Department of Pharmaceutical Sciences, UNMC College of Pharmacy, 2012-present

PUBLICATIONS (continued from pg. 11)

Breaking News | 13

• Surgical Services New Technology and Products Committee, 2011-present

• Website Development Committee, 2011-present

• M2 ICE Course Instructor, September 2009-present

• M3 Course Instructor September 2009- present

Nebraska Orthopaedic Hospital:

• Utilization Review Committee, 2013-present

• Finance Committee, 2012-present

Hasley, B:

Children’s Hospital & Medical Center:

• Chair, Department of Surgery, 2016-present

• Medical Director of the Pediatric Orthopaedic Clinics of the Children’s Specialty Physicians, May 2013-present

Medical Staff Committees, Children’s Hospital & Medical Center:

• Chair, Surgical Services Interdisciplinary Committee, 2016-present

• Medical Executive Committee, 2016-present

• Focused Peer Review Committee, 2008-present

Jenson, M.L.:

Children’s Hospital and Medical Center:

• Emergency Department Interdisciplinary Committee, Jan. 2015-Present

• Surgical Services Interdisciplinary Committee, Jan. 2014-Present

• Program Developer, New Sports Medicine Program, 2013-Present

Konigsberg, B:

Adult Reconstruction Hip Program Committee, American Association of Orthopaedic Surgeons. June 2015-present

UNMC College of Medicine:

• Faculty Senate, College of Medicine, Jan. 2014-present

• Dissertation Thesis Committee, Krishna Sarma, Ph.D. student, Department of Genetics, Cell Biology and Anatomy, Dec. 2013-present

• Admissions Committee, May 2011–present

• Course Director, UNMC Orthopaedic Surgery Grand Rounds, Oct. 2010-present

• Instructor, M1, M2 ICE Course, Aug. 2010-present

• Instructor, 2nd Year Medical Students, Aug.2009-present

Nebraska Medicine

• Periop Quality, Safety & Patient Experience Committee, Sept. 2015-present

• DVT/PE Preventative Practices Committee, Sept. 2014 – present

Membership Committee, Metro Omaha Medical Society, April 2012-present

Section Chief, Orthopaedics, VA Medical Center, Jan. 2009-present

Consultant Reviewer:

• Techniques in Orthopaedics, June

2015-present

• Orthopaedics, Sept. 2013–present

• Journal of the American Geriatrics Society, Sept. 2010-present

McGarry, S:

UNMC:

• Faculty Senate, June 2013-present

• Continuing Education Committee, Oct. 2012-present

• Tissue Bank Review Committee, Member, 2006-present

Musculoskeletal Transplant Foundation (MTF):

• Executive Committee, Jan.2015-present

• Membership/Nominations Committee Member, Feb. 2012 – present

• Medical Board of Trustees, April 2006-present

Children’s Hospital of Omaha Bylaws Committee, Member, Jan. 2008-present

National Comprehensive Cancer Network (NCCN):

• Soft Tissue Sarcoma Panel, July 2007-present

• Bone Cancer Panel, May 2006-present

Consultant Reviewer:

• Clinical Orthopaedics and Related Research, March 2011-present

• Orthopaedics, Feb. 2011-present

Mormino, M:

Mid-America Orthopaedic Association:

• Chairman, Finance Committee, 2014-2015

• Treasurer, 2014-2015

Education Committee, Orthopaedic Trauma Association, 2012-2015

AO North America:

• Fellowship Advisory Board, 2011-present

• Faculty, 1997-present

Nebraska Medicine

• Medical Director Perioperative Services, 2008- present

• Medical Director Orthopaedic Surgery Clinic, 2000- present

• Graduate Medical Education Committee

Consultant Reviewer:

• Journal of Orthopaedic Trauma, Feb. 2014-present

• Journal of Surgical Education, 2010-present

• Journal of the American Academy of Orthopaedic Surgeons, 1999-present

Scherl, S:

Children’s Hospital & Medical Center:

• Omaha Surgical Services Interdisciplinary Committee, Jan. 2012-present

• Omaha Education Committee, January 2011-present

• Omaha Transfusion Committee, January 2010-present

• Omaha Trauma Performance Improvement and Patient Safety Committee, 2009-present

Breaking News | 14

Pediatric Orthopaedic Society of North America:

• Board of Directors, 2015-2017

• Program Committee, May 2013-present

• Advocacy Committee, May 2013-present

American Orthopaedic Association:

• Traveling Fellowship Committee, June 2012-present

• Chair, ASEAN Traveling Fellowship Subcommittee, June 2011-present

Siebler, J:

Nebraska Medicine:

• Trauma Peer Review Committee, 2014-present

• Director, Orthopaedic CME Planning Committee,

2014- present

• Trauma Process Improvement/Patient Safety Committee, 2014-present

• Continuing Medical Education Committee, 2015-present

• Clinical Effectiveness Trauma Committee, 2015-present

• Perioperative Surgical Services Operations Committee, 2015-present

Career Launch Oversight Committee, UNMC, 2015-present

Faculty, AO Trauma North America, 2012-present

Streubel, P:

Research and Development Committee, UNMC, 2015-present

Contributing Editor, 2015 Yearbook of Hand and Upper Limb Surgery, 2015

Test Writer, AANA/ASES Maintenance of Certification Exam Program 2015

AO North America

• Trauma Faculty, 2014-present

• Hand Faculty, 2014-present

Consultant Reviewer

• Journal of Orthopaedic Trauma, 2012-present

• Journal of Shoulder and Elbow Surgery, 2012-present

• Revista Ciencias de la Salud, Universidad del Rosario, 2014-present

Teusink, M:

Emerging Leaders Program, American Orthopaedic

Association, June 2015-present

Ambulatory Center for Surgical Innovation Planning Committee, UNMC, 2014-present

Consultant Reviewer:

• Journal of Shoulder and Elbow Surgery, 2014-present

• Orthopaedics, 2013-present

Wallace, M:

Children’s Hospital & Medical Center

• Credentials Committee, Jan. 2016-present

• Medical/Surgical Interdisciplinary Committee, Sept. 2015-present

WALK (continued from pg. 1)

Curtis Hartman, M.D. prepares for a left knee replacement with patient Brenda Bostic.

PUBLICATIONS (continued from pg. 13)

They recommended Operation Walk USA.

“When I was accepted I was absolutely ecstatic,” she said. “I’ve never been accepted for anything I applied for in my life.”

After her left knee replacement in December, Bostic should be back cheering from the sidelines in no time.

Operation Walk USA provides all aspects of treatment – surgery, hospitalization, and pre-and post-operative care – at no cost to participating patients.

UNMC Orthopaedic faculty members have participated in the program for many years and enjoy the opportunity to give the gift of mobility to these patients each year.

The facts:

• Arthritic disease affects 46 million Americans

• In just 6 years, Operation Walk USA has benefited more than 600 patients nationwide

• In 2016, 55 surgeons will provide free joint replacements to 80 patients

Breaking News | 15

Orthopaedic staff adopts a family for the holidays

2016 Extraordinary Nurse: Rachel Johnson, BSN, RNRachel Johnson was chosen as this year’s Extraordinary Nurse by colleagues in the Nebraska Medicine Orthopaedic Clinic.

Rachel Johnson was nominated as an Extraordinary Nurse in March and will be recognized by the hospital during National Nurses Week in May.

Johnson has been the nurse case manager for the orthopaedic trauma service for a little over a year and has quickly become the go-to person for any issues that arise in trauma. Her job requires her to be a liaison

between providers, patients and staff.

“She does an excellent job communicating with all involved in care; reaching out to other providers, care facilities and families,” colleagues wrote in her nomination form. “She ensures that all teams are coordinated to provide the best care for our patients.”

In addition to her positive attitude and professionalism in the clinic workplace, Johnson excels in her role as nurse, patient advocate, social worker, caregiver, resource, friend and role model for the entire department.

Faculty NewsCongratulations to Dr. Philipp Streubel and Dr. Catalina Amador, on the birth of their daughter, Ana Streubel, on Jan. 14, 2016. Ana weighed 7-pounds, 20-ounces, and measured 20 inches. She is their second child, along with big sister, Olivia.

Dr. Streubel is an assistant professor in the Department of Orthopaedic Surgery and Rehabilitation. Dr. Amador is an assistant professor in the Department of Pathology and Microbiology.

The Department of Orthopaedic Surgery and Rehabilitation went beyond the call of duty this holiday season to help out a family in need.

Clinic and Academic staff, faculty and residents joined forces to raise $175 for the father of a two-time pediatric transplant patient at Nebraska Medicine.

The donation far exceeded our goal of $75, and was used to buy gift cards to JCPenny and Walmart. The gift cards were delivered to the family in December, just in time for Christmas.

This year, a total of 68 departments adopted 58 Nebraska Medicine patients and their families. Many of these patients stay at the hospital for an extended period of time, which leaves their families in great financial need.

The Adopt-a-Family program is just one way for hospital and university employeesto not only provide Christmas presents, but also a few basic necessities.

Thanks to the generous support of hundreds of employees, the program has never had to turn a family away.

Breaking News | Summer 2015

Department of Orthopaedic Surgery 981080 Nebraska Medical Center Omaha, NE 68198-1080

www.unmc.edu/orthosurgery

In this issue1 Giving the gift of mobility Through Operation Walk USA and Nebraska Medicine, two Omaha-area patients received free joint replacements from associate professor Curtis Hartman, M.D.

3 Faculty participate at AAOS meeting UNMC Orthopaedic Surgery faculty members presented at the annual AAOS meeting in Orlando, FL, in March 2016.

6 Physician joins sports medicine program

Ross Mathiasen, M.D., recently joined the Orthopaedic clinic. He specializes in primary care sports medicine and provides care for active individuals of every age.

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PAIDPermit No. 454

Omaha, NE

Find us online!Visit www.unmc.edu/orthosurgery to view or share this newsletter with friends and colleagues.

Want to join our e-newsletter list? Email sydnie.hochstein@unmc.edu to sign up!

Severe glenoid erosion after humeral head replacement: Revision using reverse total shoulder arthroplastyPhilipp N. Streubel, M.D., Assistant ProfessorHand, Shoulder and Elbow Surgery, Department of Orthopaedic Surgery

Case Report

DEPARTMENT OF ORTHOPAEDIC SURGERY & REHABILITATION | CASE REPORT | SPRING 2016

Figure 1: Right shoul-der hemiarthroplasty, 16 years after implantation. A. Anteroposterior view showing a stable humeral component with signifi-cant medialization of the humeral head. B. Axillary view showing central wear and medialization beyond the base of the coracoid. Suture anchors from prior subscapularis repair are noted.

Figure 1BFigure 1A

Background:

Humeral head replacement (shoulder

hemiarthroplasty) has a long track

record for management of a wide

variety of shoulder conditions,

including avascular necrosis of the

humeral head and glenohumeral

joint arthritis[1]. Hemiarthroplasty

for glenohumeral arthritis is mainly

chosen in younger patients and those

not willing to accept postoperative

restrictions [2]. However, the

native glenoid may continue to be a

source of persistent pain or become

symptomatic in a delayed fashion

due to glenoid erosion [3-5]. Revision

of a painful hemiarthroplasty to an

anatomic total shoulder arthroplasty

has been shown to yield reproducible

improvement in pain, range of motion

and function [6, 7].

Glenoid erosion plays a determinant

role in the surgeon’s ability to place

a glenoid component. In central wear

patterns, the glenoid can frequently

be prepared with reaming only, to

provide a stable surface on which

to implant an anatomic glenoid

component. Posterior wear may

be corrected with reaming the high

side to correct retroversion of up to

15 degrees. In greater amounts of

retroversion, posterior bone grafting

or augmented implants may be used

[8, 9]. In the most severe forms of

glenoid wear, insufficient bone stock

may preclude the ability to place an

anatomic glenoid component [10].

Reverse total shoulder arthroplasty

(RTSA) may be indicated as it offers

reliable glenoid fixation even in the

presence of only minimal glenoid

bone stock [11, 12].

This case report describes the

revision of a hemiarthroplasty to

RTSA with allograft augmentation

in a patient with rheumatoid arthritis

and severe glenoid wear.

Case Example:

A 53-year-old male with a history

of rheumatoid arthritis was referred

to UNMC for revision of bilateral

shoulder hemiarthroplasties that had

been performed 16 years prior. Over

the last several months the patient

had developed constant shoulder

pain and progressive loss of function

with more severe symptoms on

the right side. On physical exam

he had well-healed deltopectoral

incisions, active forward elevation to

45 degrees and intact deltoid function.

Radiographs showed a stable humeral

component with significant central wear

of the glenoid medial to the base of the

coracoid (Figure 1).

A CT scan was obtained, which confirmed

a central wear pattern, with insufficient

bone stock to allow placement of an

anatomic glenoid component (Figure

2).Reverse total shoulder arthroplasty

was recommended to allow for glenoid

component placement and maximize

shoulder function in a shoulder with likely

poor structural rotator cuff tendons.

Intraoperatively, significant scarring and

advanced rotator cuff degeneration was

noted with a non-repairable subscapularis

tendon defect. Humeral implant

extraction underwent uneventfully with

reaming and broaching in preparation of

a 10 mini (83mm) stem (Comprehensive

Shoulder System, Biomet Zimmer,

Warsaw, IN). After glenoid exposure,

a central wear pattern was confirmed

with significant medialization of the

joint line. However, the inferior border

of the glenoid was found to represent

the paleoglenoid (Figure 2B). A central

guide pin was then placed by aligning

the inferior aspect of the Mini (25mm)

base plate guide with the inferior border

References:

1. Barlow, J.D., et al.: Shoulder arthroplasty for rheumatoid arthritis: 303 consecutive cases with minimum 5-year follow-up. J Shoulder Elbow Surg, 2014. 23(6): p. 791-9.

2. Collins, D.N., Harryman, D.T. 2nd, Wirth, M.A.: Shoulder arthroplasty for the treatment of inflammatory arthritis. J

Bone Joint Surg Am, 2004. 86-A(11): p. 2489-96.

3. Bartelt, R., et al.: Shoulder arthroplasty in patients aged fifty-five years or younger with osteoarthritis. J Shoulder

Elbow Surg, 2011. 20(1): p. 123-30.

4. Bryant, D., et al.: A comparison of pain, strength, range of motion, and functional outcomes after hemiarthroplasty and total shoulder arthroplasty in patients with osteoarthritis of the shoulder. A systematic review and meta-analysis. J Bone Joint Surg Am, 2005. 87(9): p. 1947-

56.

5. Levine, W.N., et al.: Hemiarthroplasty for glenohumeral osteoarthritis: results correlated to degree of glenoid wear. J Shoulder Elbow Surg, 1997. 6(5): p. 449-54.

6. Groh, G.I., Wirth, M.A.: Results of revision from hemiarthroplasty to total shoulder arthroplasty utilizing

modular component systems. J Shoulder Elbow Surg,

2011. 20(5): p. 778-82.

7. Hattrup, S.J.: Revision total shoulder arthroplasty for painful humeral head replacement with glenoid arthrosis. J Shoulder Elbow Surg, 2009. 18(2): p. 220-4.

8. Klika, B.J., et al.: Structural bone grafting for glenoid deficiency in primary total shoulder arthroplasty. J

Shoulder Elbow Surg, 2014. 23(7): p. 1066-72.

9. Steinmann, S.P., Cofield, R.H.: Bone grafting for glenoid deficiency in total shoulder replacement. J Shoulder

Elbow Surg, 2000. 9(5): p. 361-7.

10. Antuna, S.A., et al.: Glenoid revision surgery after total shoulder arthroplasty. J Shoulder Elbow Surg, 2001. 10(3):

p. 217-24.

11. Walker, M., et al.: The use of the reverse shoulder arthroplasty for treatment of failed total shoulder arthroplasty. J Shoulder Elbow Surg, 2012. 21(4): p. 514-

22.

12. Giuseffi, S.A., et al.: Short-stem uncemented primary reverse shoulder arthroplasty: clinical and radiological outcomes. Bone Joint J, 2014. 96-B(4): p. 526-9.

Figure 3A

Figure 2A

DEPARTMENT OF ORTHOPAEDIC SURGERY & REHABILITATION | CASE REPORT | SPRING 2016

Figure 2. Glenoid wear, CT imaging. A. Axial cut at the mid-glenoid level. Severe medialization of the glenoid is noted with insufficient bone stock to allow placement of an anatomic glenoid component. B. Coronal cut showing medialization of the joint line. The inferior border of the glenoid represents the paleoglenoid and serves as a reference for lateralization of the baseplate.

Figure 2B

Figure 3. Follow-up radiographs. A. Anteroposterior view of the shoulder showing adequate implant positioning. Note lateralization of the humerus with regards to the lateral edge of the acromion. Infe-rior placement of the baseplate and glenosphere allow for maximum purchase into native bone, while avoiding inferomedial impingement of the baseplate. B. Axillary view confirms adequate version of the glenosphere. Central screw placement into the scapular spine maximizes fixation. The base plate has been lateralized to the lateral edge of the coracoid base.

Figure 3B

of the glenoid. Contact of two thirds

of the back side of the base plate onto

native bone, could thereby be achieved.

In order to maximize stabilization and

restore glenoid bone stock, structural

femoral head cancellous allograft was

placed backing the superior aspect of

the base plate. After final reaming, the

base plate was fixed with one central

non-locking screw and four peripheral

locking screws. Excellent fixation of the

baseplate and compression of the bone

graft were thereby achieved. A 36 mm

glenosphere and a +5 tray with liner

were placed. The joint was reduced

and satisfactory stability and range of

motion were achieved. After wound

irrigation, a subdeltoid drain was placed,

and the deltopectoral interval and skin

were closed.

The shoulder was immobilized in a

sling. Passive range-of-motion (ROM)

exercises were started at two weeks

followed by active assisted ROM at six

weeks. Strengthening ensued at the

three-month mark.

Six months after surgery, the patient

was pain free and very satisfied with

the outcome. Forward elevation had

improved to 90 degrees. Radiographs

showed adequate implant position with

lateralization of the base plate (Figure 3).