Orthopaedic Outcomes and Research Shoulder and Elbow Volume 4

ORTHOPAEDIC OUTCOMES

&

RESEARCH

Shoulder & Elbow

VOLUME 4

COMPLEX SHOULDER & ELBOW SERVICES • Shoulder and elbow surgery, including replacement, arthroscopy and open • Arthritis, osteoarthritis and rheumatoid arthritis • Brachial plexus repair reconstruction • Distal biceps and triceps rupture repair • Lateral epicondylitis (tennis elbow) and medial epicondylitis (golfer’s elbow) • Tendonitis and tendon rupture treatment • Treatment of rotator cuff injuries • Treatment of shoulder and elbow fractures and instability

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Jefferson Health | Orthopaedic Outcomes & Research

SHOULDER & ELBOW

Dear Colleagues, I am happy to share with you some of the clinical and research efforts of shoulder specialists from Rothman Orthopaedic Institute at Jefferson Health and Philadelphia Hand to Shoulder Center at Jefferson Health.

From young children undergoing tendon transfer surgery for brachial plexus birth palsy to adults undergoing total shoulder arthroplasty, the treatment goal is always to restore function to the highest level possible.

Our team of shoulder specialists includes surgeons who value doing clinical and scientific research that furthers the understanding and treatment of shoulder disorders. This Orthopaedic Outcomes & Research report contains some highlights of that work that have appeared in leading orthopedic journals.

In some cases, the published articles showcase the surgical innovation of our team, such as in the case of nerve transfers for restoring shoulder function in children devastated by acute flaccid myelitis. In other cases, the articles detail how our care team is working to optimize the continuum of care for patients, from pre-surgery opioid education to a more individualized matching of post-operative rehabilitative services based on the patient’s medical-social profile.

Not every research advance is complicated or high tech. In another study published by our team, surgeons report that the addition of 3% hydrogen peroxide to the standard skin preparation can significantly reduce the chances of infection with Cutibacterium acnes during shoulder arthroplasty.

I invite you to learn more about Jefferson’s Health’s research-informed shoulder care in the pages ahead. You can also visit our website at JeffersonHealth.org/Ortho.

To refer a patient, please call 215-503-8888.

Thank you for your interest.

Sincerely,

Alexander R. Vaccaro, MD, PhD, MBA Richard H. Rothman Professor and Chair Department of Orthopaedic Surgery, Jefferson Health Sidney Kimmel Medical College, Thomas Jefferson University

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Philadelphia Hand to Shoulder Center Studies The Utilization of Nerve Transfer for Reestablishing Shoulder Function in the Setting of Acute Flaccid Myelitis: A Single-Institution Review Acute flaccid myelitis (AFM) is a rare but devastating disease of young children. The typical presentation involves acute-onset flaccid paralysis in one or more extremities after an acute viral illness that may resemble a self-limited upper respiratory tract infection.

Although clinical symptoms for AFM can be severe, diagnosing these children can be difficult due to varying presentations. Early management of these patients involves mostly supportive care. Long-term outcomes demonstrate that functional recovery of involved muscle groups plateaus around six to nine months and is often incomplete, leaving patients with clinically substantial long-term deficits.

Jefferson Health researchers led by Dan Zlotolow, MD, conducted a study to evaluate the efficacy of nerve transfers for restoring shoulder function in young patients with AFM. The study consisted of a retrospective review of all patients diagnosed with AFM at a single institution. Shoulder function was evaluated using the active movement scale (AMS), which has a range of 0 (no contraction) to 7 (full motion). Children at a minimum of six months after diagnosis with a plateaued AMS score of 4 or less were indicated for surgery.

Of 47 AFM patients identified, 11 underwent nerve transfer surgery with a minimum of one-year follow-up, and they were included in the analysis. The mean time from symptom onset to surgery was 12 months and average follow-up was 19 months.

A total of six different nerve transfers with five different donor nerves were used individually or in conjunction with each other among the 11 patients. The mean AMS score at follow-up for shoulder rotation and abduction was 4.6 and 2.8, respectively. Three patients (27%) gained meaningful shoulder external rotation (AMS 5-7), with only one patient gaining an AMS of 7.

Six patients (55%) gained meaningful shoulder external rotation (AMS 5-7), with five gaining an AMS of 7. Nine of 11 patients (45%) had full external rotation function, defined as an AMS score of 7, at final follow-up.

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Jefferson Health | Orthopaedic Outcomes & Research

Retraction of the muscles from scapular spine with exposure of the suprascapular nerve, which is being presented by the freer and labeled with the asterisk (*) in the images above.

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SHOULDER & ELBOW

7

6

Mean AMS Score

5

4

n Shoulder

Abduction

3

n Shoulder External Rotation

2

1

0

SA t o

SSC +

SA t o IC t o

SSC +

Ax ( x3)

SA t o LT t o

SSC +

Axil lary

SA t o Rad ial t o

SSC +

Axil lary

IC ( x2) to

Uln ar to

SSC +

Axil lary

IC ( x4) to IC ( x3) to

SSC +

Rad ial t o Ax Axil illar lary y

Values are based on Active Movement Scale (AMS) scores; SA = spinal accessory nerve; SSC = suprascapular nerve; IC = intercostal nerve; LT = long thoacic nerve; ER = external rotation; IR = internal rotation.

Source: Dan Zlotolow, MD

The most common transfers were spinal accessory nerve to suprascapular nerve (eight cases), and from the intercostal nerves x 3 to axillary nerve (five cases). Patients who received a transfer from the radial nerve to the axillary nerve (two cases) had the best functional returns, with a mean AMS score of 6.5 in both external rotation and abduction at follow-up.

The researchers found no intraoperative or postoperative complications related to the nerve transfers. While outcomes in general seemed favorable, the study said longer-term

assessment is needed to evaluate the full potential of nerve transfers.

“There are many challenges to the treatment of patients with AFM,” the researchers wrote.

“The pattern of musculature affected in AFM is unpredictable and necessitates that donor nerves be identified on an individual basis.”

They concluded that “combination procedures that involve a transfer from the radial nerve to the axillary nerve may provide the best functional results.”

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Single Versus Double Tendon Transfer to Improve Shoulder External Rotation During the Treatment of Brachial Plexus Birth Palsy Brachial plexus birth palsy (BPBP) continues to be a substantial issue affecting 1 to 3 per 1,000 live births. While up to 80% to 90% of BPBP injuries may resolve with minimal long-term functional deficits, one center noted that 27% of its BPBP referrals involved children with contractures requiring operative intervention to help regain some form of function.

Tendon transfers are commonly performed in patients with BPBP to improve function, but a C5-7 injury pattern presents an especially challenging scenario due to increased involvement of muscles that perform internal rotation. Transferring two tendons in patients with C5-7 injury has the potential complication of loss of midline function, which is problematic because daily activities such as buttoning, dressing and personal care depend on that movement.

the modified Mallet (MM) classification scores.

Twenty-two such patients had complete records of preoperative and postoperative MM scores, including 11 sex-matched patients in both the 1TT and 2TT groups.

The review found: • When comparing preoperative and postoperative MM categories, there were significant improvements in both the 1TT and 2TT groups for global abduction and external rotation.

• MM hand to neck scores were significantly improved in the 2TT group but not in the 1TT group.

• Internal rotation scores significantly decreased in both groups.

•B oth groups demonstrated significant increases in total scores from the MM scores.

Jefferson Health researchers led by Dan Zlotolow, MD, investigated whether a single tendon transfer (1TT) as opposed to the traditional double tendon transfer (2TT) resulted in any difference in functional outcomes in patients with C5-7 BPBP.

“1TT and 2TT procedures result in substantial gains in upper extremity functions for patients as measured by the MM score, specifically within the global abduction and external rotation subcategories; however, a significant loss occurs for internal rotation for both groups,” the researchers concluded.

A retrospective review was conducted of all patients with C5-7 BPBP who underwent tendon transfer to improve shoulder external rotation during a five-year period at two institutions. Outcomes were assessed using

“The 1TT and 2TT procedures have similar outcomes, and therefore, one should consider performing 1TT surgery in patients with C5-7 to mitigate risk of further decreases in midline function.”

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Jefferson Health | Orthopaedic Outcomes & Research

Single Tendon Transfer Compared to Double Transfer Modified Mallet and Shoulder ROM Preoperative Single Versus Double Tendon Transfer Shoulder Abduction

External Rotation

Internal Rotation

Hand to Neck

Hand to Spine

Hand to Mouth

Sum

Shoulder Abduction ROM

3.27

2.18

3.55

2.00

2.00

2.33

14.55

96

Single tendon

Double tendon 3.18 2.09 3.82 2.00 2.00 2.00 15.09 86 Difference P value

0.09 0.09 -0.27 0.00 0.00 0.33 -0.55 10 .63

.56

.19

1.00

1.00

.13

.44

.42

Note: ROM = range of motion Modified Mallet and Shoulder ROM Preoperative Versus Postoperative Single Tendon Transfer Shoulder Abduction

External Rotation

Internal Rotation

Hand to Neck

Hand to Spine

Hand to Mouth

Sum

Shoulder Abduction ROM

Single tendon

3.27

2.18

3.55

2.00

2.00

2.33

14.55

96

Double tendon

3.73

3.64

2.73

2.36

2.00

2.64

17.09

119

Difference +0.45 +1.45 -0.82 +0.36 0.00 +0.3 +2.55 +23 P value

.017

<.005

<.005

.053

1.0

.25

<.005

.10

Note: ROM = range of motion Modified Mallet and Shoulder ROM Preoperative Versus Postoperative Double Tendon Transfer Shoulder Abduction

External Rotation

Internal Rotation

Hand to Neck

Hand to Spine

Hand to Mouth

Sum

Shoulder Abduction ROM

Single tendon 3.18 2.09 3.82 2.00 2.00 2.00 15.09 86 Double tendon

3.73

3.64

2.64

2.45

2.00

3.00

16.91

114

Difference +0.55 +1.55 -1.18 +0.45 0.00 +1.0 +1.82 +28 P value

<.005

<.005

<.005

<.05

1.0

.09

<.0005

.005

Note: ROM = range of motion Modified Mallet and Shoulder ROM Postoperative Single Versus Double Tendon Transfer Shoulder Abduction

External Rotation

Single tendon

3.73

Double tendon

3.73

Difference

0.00 0.00 +0.09 -0.09 0.00 0.36

P value

.1.0

Hand to Neck

Hand to Spine

Hand to Mouth

3.64

2.73

2.36

2.00

2.64

17.09

119

3.64

2.64

2.45

2.00

3.00

16.91

114

1.0

.72

.72

1

.44

MM Sum

Shoulder Abduction ROM

Internal Rotation

0.18 .83

5 .64

Note: MM = Modified Mallet; ROM = range of motion Source: Dan Zlotolow, MD

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Rothman Orthopaedic Institute Studies Predicting Postoperative Course After Total Shoulder Arthroplasty Using a Medical-Social Evaluation Model As the U.S. healthcare system focuses on delivering value-based care, researchers are trying to identify patient factors that may predict healthcare utilization, complication rates, length of stay and costs. The hope is to deliver the best outcome for each patient in the most cost-efficient manner.

The analysis, reported in the Journal of the American Academy of Orthopaedic Surgeons, found that both medical and social survey scores were significantly higher for patients who required postoperative home care or inpatient rehabilitation compared to those who did not.

Jefferson Health researchers led by Daniel Davis, MD, and Matthew Ramsey, MD, conducted a study to determine if a medicalsocial scoring tool could predict resource requirements for doing total shoulder arthroplasty (TSA).

There was a weak correlation between hospital length of stay and the social score, but not the medical score. No variable was predictive of readmission.

A retrospective analysis was conducted of 453 patients undergoing inpatient TSA by a single practice at an academic medical center. Preoperative medical and social surveys were completed by each patient using surveys developed by the Rothman Orthopaedic Institute.

A medical score was tabulated from a 41-question review of medical history with a total possible score of 124. A social score was tallied using a 16-question survey with a total score of 23 points. The researchers collected information on demographics, comorbidity score, hospital course, postdischarge disposition and readmission.

The study group was almost evenly divided between men and women and the average age was 67.8 The average length of stay in the hospital was 1.6 days.

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“This study found that Medical and Social Survey Scores can stratify patients who are at risk of requiring more advanced postdischarge care and/or a longer hospital stay,” the researchers said. “With this, we can match patients to the most appropriate level of postoperative care.”

The Jefferson Health researchers said their institution is using the scores to help decide the ideal surgical location and also, with the use of a nurse navigator, to guide postoperative recovery location.

“The main goal is to decrease length of stay in a hospital and match rehabilitation stays and home care to only those patients who truly will benefit from those services,” they said. “This system of preoperative scoring and demand matching is the beginning stage to accomplishing these goals.”

Jefferson Health | Orthopaedic Outcomes & Research

Statistical Results of Analysis Show There is Notable Association Between Medical Score and BMI as well as an Association with the Social Score and Age and Female Sex

Social Assessment

Medical Assessment

Variable

Statistic P

Statistic P

Sex (M versus F)

3.67

4.28

Age

R = 0.15

R = 0.01

0.81

BMI

R = –0.08

0.07

R = –0.15

0.001

Charlson Comorbidity Index

R = 0.09

0.06

R = –0.02

0.70

Elixhauser Comorbidity Index

R = 0.07

0.12

R = -0.003

0.95

4.20

0.06 <0.001

4.53

0.61

BMI = body mass index Source: Matthew Ramsey, MD

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Addition of 3% Hydrogen Peroxide to Standard Skin Preparation Reduces Cutibacterium acnes – positive Culture Rate in Shoulder Surgery: A Prospective Randomized Controlled Trial Cutibacterium acnes (C acnes) is an anaerobic bacterium thought to inhabit the dermal layer of the posterior shoulder more commonly than the anterior shoulder, axilla, or other joints of the body such as the knee or hip.

Men are reported to carry a heavier bacterial burden than women, with 70% of healthy male patients having positive punch biopsy cultures for C acnes after sterile surgical preparation. As a consequence of its prevalence, anaerobic nature, and presence in the deeper layers of the skin, C acnes has been a vexing target to control preoperatively and in the past decade has been recognized as the most commonly isolated organism to cause postoperative infection following shoulder surgery.

Hydrogen peroxide is an inexpensive and effective antimicrobial agent that can be implemented in surgical skin preparation.

Jefferson Health researchers led by Surena Namdari, MD, designed a study to evaluate the decolonization of Cutibacterium acnes when adding hydrogen peroxide to a standard sterile preparation for shoulder surgery.

The study, published in Journal of Shoulder and Elbow Surgery, was a single-institution, prospective randomized controlled trial of male patients undergoing shoulder arthroplasty between April 2018 and May 2019. A total of 140 patients were randomized either to a standard skin preparation (70) or to an additional sterile preparation with 3% hydrogen peroxide (70).

After draping, a 3-mm punch biopsy was obtained from the posterior portal site of all patients. Anaerobic and aerobic culture substrates were used and held for 13 days.

Twelve (17.1%) patients in the hydrogen peroxide group and 24 (34.2%) in the traditional group had positive cultures for C acnes. Cultures were positive at a mean of 4.5 days in the hydrogen peroxide group and 4.1 days in the traditional group. There were no cases of skin reaction to the surgical preparation in either group.

“The results of this study suggest that the addition of hydrogen peroxide to preoperative surgical site preparation can reduce the C acnes culture rate,” the researchers concluded. “Hydrogen peroxide is inexpensive and can be added to the typical skin preparation used prior to shoulder surgery without substantial risk of skin reactions.”

The researchers said further study is needed to determine the most effective duration for applying the hydrogen peroxide preparation during skin preparation.

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Jefferson Health | Orthopaedic Outcomes & Research

Bacterial Abundance in Positive Cultures Positive Cutibacterium Acnes Cultures

Very Light Growth

Light Growth

Moderate Growth

Heavy Growth

Traditional

24

9

5

7

3

Hydrogen peroxide

12

3

0

5

4

.033

.48

.14

.48

.65

P value

Source: Surena Namdari, MD

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The Effect of Preoperative Education on Opioid Consumption in Patients Undergoing Arthroscopic Rotator Cuff Repair: A Prospective, Randomized Clinical Trial – 2-Year Follow-up Drug overdose is a leading cause of injuryrelated death in the U.S., with more than 70,000 deaths in 2017. It is estimated that 68% of such deaths involve a prescription or illicit opioid.

As the opioid epidemic continues to take a big toll in the U.S., government and medical providers are taking measures to try to reduce the opioid dependence rate. Different strategies have been proposed, including patient education programs and use of multimodal pain therapies.

Jefferson Health researchers previously conducted an award-winning study (2018 Neer Award) that demonstrated the effectiveness of preoperative opioid education in reducing postoperative opioid consumption after arthroscopic rotator cuff repair (ARCR). The education included a two-minute video and information on recommended postoperative opioid use, side effects, dependence and addiction.

• Significantly fewer prescriptions were filled by the study group (mean 2.9) compared to the control group (mean 6.3).

• Fewer pills (60 on average) were consumed by study patients compared to 120 for controls.

• Fewer morphine-milligram equivalents were consumed on average by study patients (375) compared to controls (725).

• Overall, 18.6% of patients became opioid dependent (defined as getting six or more opioid prescriptions), and that was not limited to those with a history of opioid use.

Among 102 opioid-naive patients, 9.8% became dependent, a number similar to the findings of other studies.

• Opioid education at the time of surgery helped both opioid naive patients and those with prior opioid use, but the most profound effect, according to the two-year followup, was on patients who had a history of opioid use.

In a two-year follow-up to that study, researchers led by Luke Austin, MD, looked to see if the effects of the patient education were long lasting. A total of 140 patients who had ARCR were included in the twoyear follow-up analysis, with half from the original study group that received opioid education and half in a control group.

“Our study found that opioid education does impart significant long-term benefits to patients undergoing ARCR,” the researchers reported. They suggested that orthopedic surgeons could substantially reduce patients’ post-operative opioid consumption and dependence by incorporating a standard preoperative opioid education program.

The researchers used prescription datamonitoring software to gauge opioid use.

“Explaining the risk of opioids to patients and involving them in the pain management process including the decision to use opioids, can result in a substantial reduction in opioid use and, thus, dependence,” they concluded.

The analysis, published in Journal of Shoulder and Elbow Surgery, found that: • Patients who had been in the original study and received opioid education had a lower rate of opioid dependence at two years (11.4%) compared to controls (25.7%).

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Jefferson Health | Orthopaedic Outcomes & Research

Flow Diagram of Study Participants E N RO L L MEN T

Assessed for eligibility (n=159)

Excluded (n=19) • Not meeting inclusion criteria (n=19) • Declined to participate (n=0) • Other reasons (n=0)

Randomized (n=140)

Allocated to education cohort (n=70) • Received allocated intervention (n=70) • Did not receive allocated intervention (give reasons) (n=0)

A LLOC AT ION

Allocated to control cohort (n=70) • Received allocated intervention (n=70) • Did not receive allocated intervention (give reasons) (n=0)

Lost to follow-up (give reasons) (n=0)

F OLLOW-U P

Lost to follow-up (give reasons) (n=0)

Analyzed (n=70) • Excluded from analysis (give reasons) (n=0)

A N A LYSIS

Analyzed (n=70) • Excluded from analysis (give reasons) (n=0)

Source: Luke Austin, MD

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The Distress and Risk Assessment Method Predicts Postoperative Narcotic Use in Patients Undergoing Rotator Cuff Repair Narcotic pain medications are frequently used in orthopedic surgery for acute postoperative pain control. According to a 2015 study, orthopedic surgeons are the third highest prescribers of opioids among physicians, accounting for 7.7% of all opioid prescriptions nationwide.

As part of strategies to reduce opioid use in medical and surgical settings, researchers have begun to study the use of psychomotor and distress scores to predict postoperative outcomes, including opioid use, after orthopedic care.

In a study published in Journal of Shoulder and Elbow Surgery, Jefferson Health researchers led by Joseph A. Abboud, MD, explored whether preoperative psychological distress plays a role in postoperative pain medication requirements after arthroscopic rotator cuff repair (ARCR). They analyzed the correlation between preoperative Distress and Risk Assessment Method (DRAM) scores, modified Zung scores, and postoperative narcotic use in patients who had the procedure.

From October 2017 to January 2019, 150 patients were identified, consented and enrolled in the study, with 114 completing all of the questionnaires required to be included in the analysis. The study excluded patients with prior shoulder surgery, greater than 1-tendon ARCR and preoperative narcotic use. Fifty-seven percent of the patients were male with an average age of 58.

Preoperative DRAM scores – a psychological assessment tool composed of the Modified

Zung Depression Index and the Modified Somatic Perception Questionnaire – were collected from all patients. Postoperative narcotic use was evaluated via survey and the numbers were converted into total morphine equivalents.

The study, published in Journal of Shoulder and Elbow Surgery, found that increased preoperative DRAM scores predicted higher postoperative morphine equivalent units.

When the researchers divided patients into those whose Zung score was below 17 (considered “normal” psychologically) and those who scored 17 or higher (considered “at risk” for depression), 44 of the 114 patients (39%) fell into the at-risk category.

“This group showed a statistically significant trend toward higher postoperative morphine equivalent unit intake,” they reported, noting that “the role of mental health disorders on orthopedic outcomes should not be understated.”

“Baseline psychological distress as assessed with the DRAM questionnaire does predict postoperative narcotic use in rotator cuff surgery,” the researchers concluded. “In identifying these patients at risk for increased postoperative narcotic use, one can offer preoperative psychological counseling, use preoperative narcotics consents that allow for close monitoring and individualize multimodal pain regimens to help limit narcotics use and abuse in the future,” The researchers plan to next do research that addresses whether patients’ DRAM scores improve after ARCR.

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SHOULDER & ELBOW

Preoperative Assessments Can Predict Post-operative Opioid Use DRAM vs. MEUs

Postoperative Morphine Equivalent Units

1000 900 800 700 600 500

R2 = 0.0974

400 300 200 100 0 0

5

10

15

20

25

30

35

40

45

50

Preperative DRAM Score

Zung Drepression Index vs. MEUs

Postoperative Morphine Equivalent Units

1000 900 800 700 600 500 400

R2 = 0.09911

300 200 100 0 0

5

10

15

20

25

30

35

40

45

Preperative Zung Depression Index Preoperative health assessment correlations with postoperative opiod use illustrates statistically significant correlation between the DRAM score (top) and a component of the DRAM scoe (modified Zung score; bottom) with our postoperative outcome, MEUs, Correlation scores measured via nonparametic statistical analysis using Spearman’s rho. DRAM, Depression Risk Assessment Method questionaire; MEUs, Morphine equivalent units of opioids consumed in 2 weeks postoperatively.

Source: Joseph Abboud, MD

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SHOULDER & ELBOW SURGICAL VOLUME (JEFFERSON HEALTH) March 2020 to February 2021 Abington Hospital

81

Jefferson Bucks Hospital

45

Jefferson Torresdale Hospital

85

Jefferson Cherry Hill Surgery Center

401

Jefferson Surgery Center – Blue Bell

85

Jefferson Methodist Hospital

398

Jefferson Health – Navy Yard

115

Jefferson Washington Township Hospital PhyCare ASC

9 33

Physician Care Surgical Hospital

463

Rothman Orthopaedic Specialty Hospital

596

Thomas Jefferson University Hospital

52

GRAND TOTAL 2,363

Surgical volumes include all procedures performed at Jefferson Health hospitals and ambulatory surgery centers.

Source: Jefferson internal data

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Jefferson Health | Orthopaedic Outcomes & Research

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Funded Clinical Trials Prospective Post-Market Clinical and Radiographic Follow-up Study of the DePuy Global Unite Shoulder System.

DePuy (09/2014- current) Efficacy of BioWick SureLock Implant for the Reattachment of Soft Tissue to Bone in Subjects Undergoing Rotator Cuff Repair.

Joseph A Abboud, MD; Gerald R Williams, MD; Surena Namdari, MD

Surena Namdari, MD; Joseph A Abboud, MD

Zimmer Biomet (07/2017-current) Post Market Clinical Follow-Up Study of the Titan Reverse Shoulder System Used in Primary or Revision Total Shoulder Arthroplasty.

Surena Namdari, MD; Matthew L Ramsey, MD

Integra LifeSciences (06/2014–current) A Retrospective and Prospective Data Collection Study of the TITAN Modular Total Shoulder System (TSS).

Surena Namdari, MD; Matthew L Ramsey, MD

Integra LifeSciences (03/2015–current) Retrospective and Prospective Clinical Outcomes of the Zimmer Nexel Total Elbow.

Zimmer Biomet (06/2015–current) Prospective Post-Market Clinical Follow-up of the Zimmer Biomet Trabecular MetalTM Reverse Shoulder System.

Zimmer Biomet (08/23/2011–current)

Influence of Lateralization on Outcomes After Reverse Arthroplasty: A Randomized Controlled Trial.

DJO Surgical (10/2016–current)

Tornier Shoulder Outcomes (SHOUT) Study

Surena Namdari, MD; Matthew L Ramsey, MD

Matthew L Ramsey, MD; Charles L Getz, MD; Surena Namdari, MD; Luke Austin, MD Joseph Abboud, MD; Surena Namdari, MD; Gerald Williams, MD; Luke Austin, MD Joseph Abboud, MD; Mark Lazarus, MD

Tornier, Inc. (10/2014–current) A Post-Market, Prospective, Non-Randomized, Multi-Center, Open-Label Clinical Evaluation of the Integra Titan Modular Shoulder System 2.5 for Primary Shoulder Joint Replacement.

Surena Namdari, MD; Matthew L Ramsey, MD

Integra LifeSciences (03/2017–current) Plasma, joint fluid and arthroscopy fluid HIV and HCV viral load in shoulder arthroscopy.

Roche Diagnostics Corporation (02/2019–current).

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Surena Namdari, MD; Joseph Abboud, MD; Mark Lazarus, MD; Matthew L. Ramsey, MD

Jefferson Health | Orthopaedic Outcomes & Research

Prospective, Randomized, Double-Blind, Placebo Controlled Study to Evaluate the Safety and Efficacy of Pulsed Electromagnetic Field (PEMF) Therapy as an Adjunctive Treatment to Surgical Repair of Full Thickness Rotator Cuff Tears.

Joseph Abboud, MD; Surena Namdari, MD

Orthofix (06/2019–current) Operative versus Non-operative Treatment for Atraumatic Rotator Cuff Tears: A Multicenter Randomized Controlled Pragmatic Trial.

Joseph Abboud, MD

Patient-Centered Outcomes Research Institute (PCORI grant) (07/2019–current).

Prospective, Multi-Center, Randomized Clinical Study of Total Shoulder Arthroplasty Comparing Exactech Guided Personalized Surgery (GPS) vs.

Conventional Instrumentation.

Joseph Abboud, MD

Exactech (05/2019–current) Photodynamic therapy to decrease C. acnes of the the shoulder girdle prior to arthroscopic shoulder surgery.

OREF grant (06/2019-current)

Surena Namdari, MD; Joseph Abboud, MD; Mark Lazarus, MD; Matthew L. Ramsey, MD

OMEGA Grant (Shoulder & Elbow Division) 2020

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Jefferson Health Department of Orthopaedic Surgery Philadelphia, PA 19107 Patient Appointments: 1-800-JEFF-NOW Patient Transfers: 1-800-JEFF-121 Physician Referrals: 215-503-8888 JeffersonHealth.org/Ortho

CS 21-0873