Breaking News Spring 2016

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Breaking News Spring 2016
Orthopaedic Surgery and Rehabilitation
Breaking News
for alumni & friends of the University of Nebraska Medical Center
Department of Orthopaedic Surgery and Rehabilitation
Operation Walk USA: Giving the gift of mobility
Through Operation Walk USA, two patients
received free joint replacements in December
from UNMC associate professor and orthopaedic
surgeon Curtis Hartman, M.D.
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.
HOII Tyler Larson, M.D., left, and Curtis Hartman, M.D. visit Randy Robins after
his Dec. 15 total hip replacement.
patient: 59-year-old Brenda Bostic, of Bellevue.
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.
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.
When he found out he was accepted, Robins was grateful for
the chance to get his life back.
“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.”
“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.”
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.
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
see WALK pg. 14
Rothman-Ranawat Fellows visit Omaha
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.
Breaking News | Spring 2016
Message from the chair
Leading the way
Our department has always strived to be a local and national leader
in orthopaedic care. Through our outstanding patient care, cuttingedge 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.
Breaking News
Spring 2016
Breaking News is published
three times a year for alumni
and friends of the UNMC
Department of Orthopaedic
Surgery and Rehabilitation.
Kevin L. Garvin, M.D.
David Staiert, MBA
Sydnie Hochstein, MS
For questions or comments,
email [email protected]
or call 402.559.5609
Department of Orthopaedic Surgery
981080 Nebraska Medical Center
Omaha, NE 68198-1080
Find us online! www.unmc.
Breaking News | 2
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.
Kevin L. Garvin, M.D.
Professor and Chair
L. Thomas Hood, M.D., Professorship
2016 AAOS Annual Meeting
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.
(Moderator and presenter).
Bragdon, C.; Barr, C.; Nielsen, C.;
Berry, D.; Della Valle, C.; Garvin, K.;
et. al.: Minimum 13-Year Multicenter
Study of THR with Highly CrossLinked Polyethylene and Standard
Diameter Femoral Heads.
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).
Cornett, C.; Vincent, S.; Crow, J.;
Hewlett, A.: Bacterial Spine Infections
in Adults: Evaluation and Management.
Frank, J.; Kayupov, E.; Deirmengian, G.;
Sporer, S.; Hartman, C.; et. al.: Paper
236: Oral Antibiotics Reduce Reinfection
Following 2-Stage Exchange: A MultiCenter, Randomized Controlled Trial.
From left, Dr. Khalid Azzam (2014), Dr. Curtis Hartman (2008),
Dr. Beau Konigsberg (2007) and Dr. Jason Erpelding (2011).
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).
Scherl, S.: ICL 406: Problems and
Procedures in Pediatric Trauma:
Case Based Learning (Presenter).
Garvin, K.; Hartman, C.: Revision
Total Knee Arthroplasty Essentials: A
Case-based Approach (Presenters).
Cornett, C.: ICL 169: Surgical
Management of Cervical
Spondylotic Myelopathy.
Garvin, K.: Complex Primary
Total Hip Arthroplasty: A Casebased Approach (Presenter).
Garvin, K.: ICL 202-Preventing
Hospital Readmissions and Limiting
the Complications Associated with
Total Hip Arthroplasty. Prevention
and Management of Infection
and Wound Complications
Garvin, K.: Management of Infected
Total Joint Arthroplasty in 2016 – Where
Do We Stand Now? (Presenter).
From left, Dr. Craig Mahoney (2001), Dr. Hani Haider and Dr.
Paul Duwelius (1987).
Garvin, K.: Symposium Y: Preoperative
Optimization of Total Joint Arthroplasty
Surgical Risk. Staphylococcus
aureus Colonization (Presenter).
From left, Dr. Jeffrey Farber (1988), Dr. Tim Fitzgibbons and
Dr. Richard Bergstrom (1974).
Garvin K.: Symposium E: Hot Topics
and Controversies in Revision
Total Hip Arthroplasty. Posterior
Approach for revisions (Presenter).
Garvin, K.: High-Dose Antibiotic
Containing Spacers for Infected THA.
The Hip Society Specialty Day.
From left, Dr. Khalid Azzam (2014), Dr. Eric Bonness
(2017) and Dr. Courtney Grimsrud (2017).
Breaking News | 3
Garvin, K.: Is This Knee Infected?
The Knee Society Specialty Day.
From left, Dr. Kevin Garvin, Dr. James Ballard (2002) and Dr.
Edward Prince (2005).
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
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).
L. Scott Levin, M.D. offered critiques to UNMC Orthopaedic
Residents at this year’s Resident Research Forum.
Breaking News | 4
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.
2015 Annual Resident Research Forum
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 Followup 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”
Breaking News | 5
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”
Primary Care Sports Medicine
physician joins orthopaedic clinic
Ross Mathiasen, M.D., offers patients a number
of non-surgical treatment options, such as the
ultrasound-guided intra-articular shoulder injection
pictured above.
Ross Mathiasen, M.D., joins
Nebraska Medicine’s sports
medicine team to provide
comprehensive care for patients
of any age.
“It is a natural fit for us to be located in the
“Traditionally, injections of large joints are
orthopaedic clinic.”
done using fluoroscopy or blind injections,”
As a primary care sports medicine
or physical therapy, depending on the
Common injections include glenohumeral,
specialist, Ross Mathiasen, M.D., plays a
patient’s treatment plan.
hip, knee, carpometacarpal and
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 onestop-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.
Breaking News | 6
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
“Having more access to care is important
for our program,” McKune said. “With
athletics, a week can mean a lot of lost
Dr. Mathiasen said. “With the ultrasound, I
can do them here in the clinic and can see
the medication being injected in the right
acromioclavicular joints, subacromial,
greater trochanter and pes bursae, and
tendon sheaths such as proximal biceps.
time for the athlete. We want to make it
Dr. Mathiasen earned his medical degree
as easy and seamless as possible for the
from UNMC in 2010 and completed an
emergency medicine residency at the
In addition to treating common sportsrelated injuries including concussions,
overuse injuries and acute musculoskeletal
injuries, Dr. Mathiasen also performs
cutting-edge ultrasound-guided injections.
The ultrasound machine, a new acquisition
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.
for the Orthopaedic Clinic, is a valuable
Dr. Mathiasen sees patients at both the
asset because it allows Dr. Mathiasen to
Durham Outpatient Center and Oakview
visually see the needle and underlying
Medical Center Orthopaedic clinics.
critical structures in real time.
For appointments call: 402-559-8000.
Continuing Education and Grand Rounds
CME 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 [email protected]
Presentations given from November 2015 – March 2016:
November 2015
January 2016 (cont.)
“The Spine Injured Patient: Initial Evaluation and
Emergency Treatment” (Scott Vincent, M.D.)
25 “The Spine in Osteogenesis Imperfecta”
(Maegen Wallace, M.D.)
“Sterility in the OR” (Paul Johnson, M.D.)
“Thermal Injuries” (Joseph Morgan, M.D.
Rush University, Hand Surgery Fellow)
February 2016
“When the decision is NOT to medically
intervene….now what?” (Carri Siedlik, APRN,
Nebraska Medicine Palliative Care)
“Identifying and managing high ankle
sprains and syndesmotic injuries in
athletes” (Courtney Grimsrud, M.D.)
“Beach chair versus lateral decubitus position in
shoulder arthroscopy” (Eric Bonness, M.D.)
“Infection in total shoulder arthroplasty”
(Matthew Teusink, M.D.)
“Ankle Fractures” (Justin Siebler, M.D.)
December 2015
“Radial head arthroplasty” (Philipp Streubel, M.D.)
“Evaluation and Management of the Failed
MoM THA” (Curtis Hartman, M.D.)
January 2016
Morbidity and Mortality Conference (Chief Residents)
“Biceps Pathology” (Mark Dietrich, M.D.)
18 “Ulnar Sided Wrist Pain and DRUJ
Pathology” (Andrew Kirkpatrick, M.D.)
March 2016
Rothman-Ranawat Traveling Fellows Lectures
“TBD” (M. Layne Jenson, M.D.)
Guest speakers enhance resident education
Bringing 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
March 2016
Joseph Morgan, M.D., hand fellow,
Rush University, “Thermal Injuries”
December 2015
L. Scott Levin, M.D., chair of the Department of
Orthopedic Surgery, Penn Medicine, “Orthoplastic
Surgery: Replantation to Transplantation”
February 2016
Carri Siedlik, APRN, Nebraska Medicine
Palliative Care, “When the decision is NOT
to medically intervene….now what?”
Breaking News | 7
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”
Save the date!
Nebraska Orthopaedic
Surgery Residency Program
Graduation Ceremonies
Class of 2016
FRIDAY, JUNE 10, 2016
Congratulations to the 2016 graduates
Best of luck to all four residents on their upcoming graduation and fellowship
opportunities. The Class of 2016 is pictured above, left to right.
Paul J. Nielsen, M.D.
Hand Fellowship, Indiana Hand to Shoulder Center, Indianapolis, IN
Scott A. Vincent, M.D.
Spine Surgery Fellowship, University of Wisconsin School of Medicine and Public
Health, Madison, WI
Kaitlin C. Neary, M.D.
Foot and Ankle Fellowship, U.C. Davis/Reno Orthopedic Clinic, Sacramento, CA and
Reno/Tahoe, NV
Paul Hong, M.D.
Spine Surgery Fellowship, University of Pittsburgh Medical Center, Pittsburgh, PA
Welcome to the Class of 2021
The 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!
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
Breaking News | 8
Resident Presentations
8:00 a.m. - 12:00 p.m.
Michael F. Sorrell Center for
Health Science Education
UNMC Campus (42nd and Emile)
Room 1005
Golf Outing
Indian Creek Golf Club
12:30 p.m. Tee Time
3825 North 202nd Street
Guest Speakers
8:00 a.m. - 12:00 p.m.
Michael F. Sorrell Center for
Health Science Education
UNMC Campus (42nd and Emile)
Room 1005
Omaha Country Club
6:00 p.m. Cocktail Hour
7:00 p.m. Dinner and Program
6900 Country Club Road
Omaha, NE
Dr. James Ballard with his wife, Beckie, and their four children, Corey, Taylor,
Jared and Katie.
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.”
Alumni Feature:
James Ballard, M.D.,
Class of 2002
James 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 (19962002), the department was under the leadership of
Breaking News | 9
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 fellowshiptrained 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.
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!
Publications, presentations & honors
Department faculty and residents present many lectures, seminars, and courses at local and regional, as well as national and
international 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 professional
activities from November 2015 - March 2016:
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.
Breaking News | 10
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:
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
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.: 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 Casebased Approach
Garvin, K.: Management
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
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
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:
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 KneeJoint 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 CrossLinked 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
Breaking News | 11
Knee System in Abrasive
and Non-abrasive Conditions
and Femoral Scratching
Test, Arthrex. March 15Dec. 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
Member, Membership
Committee, March
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
European Journal
of Epidemiology,
Clinical Orthopaedics
and Related Research,
Journal of Bone and Joint
Surgery, 1990-present
Nebraska Medicine:
Perioperative Executive
Committee, Jan.
Ambulatory Executive
Committee, 2014-present
Surgical Services
Executive Committee,
Dyad Committee, Dec.
2014-Oct. 2015
Finance Committee,
Executive Board,
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
Adult Reconstruction Hip
Program Subcommittee,
American Academy of
Orthopaedic Surgeons,
Feb. 2012-March 2016
The Knee Society:
PUBLICATIONS (continued from pg. 11)
Committee, 2013-present
Department Deputy
for Orthopaedics, One
Chart, 2013-present
Consultant Reviewer:
Chair, Focused Peer
Review Committee,
Clinical Service Chief,
Orthopaedic Surgery,
Journal of Orthopaedic
Research, October
Clinical Orthopaedics
and Related Research,
Information Technology
Oversight Committee,
Allied Health Committee,
Credentials Committee,
Quality and Patient Safety
Committee, 2008-present
Reviewer, European Journal
of Orthopaedic Surgery and
Traumatology, 2015-present
Focused Peer Review
Committee, 2004-present
Physician’s Health
Committee, 2004-present
Review Panel Member,
Orthopedics, 2013-present
Consultant Reviewer:
Daccarett, M:
Member, Public Relations
Committee, Orthopaedic
Trauma Association,
March 2016-2019
Trauma Committee Member,
UNMC, 2008-present
Clinical Orthopedics
and Related Research,
Dietrich, M;
PEDIATRICS, 2005-present
Sideline Physician for area high
school teams, 2013-present
Journal of Pediatric
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:
Breaking News | 12
Journal of Engineering
in Medicine:
Reviews Editor,
IMechE Part H, March
Editorial Board
Member, IMechE Part
H, 2009-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,
Coordinator/Liaison Officer,
Working Group 2 (Implant
Wear), ISO TC150 US Tag,
International Standards
Organization, 2013-present
Director, Scientific
Review and Information
Technology, Sept.
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
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, MidAmerica Orthopaedic
Association, 2015-2016
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
United States Delegation
to Committee SC 150
(Medical Devices),
American Society of
Testing and Materials:
Reviewer, 2007-present
International Society
of Technology in
Arthroplasty (ISTA):
Board of Directors,
Biomedical Engineering
Committee, The
American Academy of
Orthopaedic Surgeons;
Official Representative
for Orthopaedic Research
Society, Feb. 2011-present
Haider, H:
Surgical Services New
Technology and Products
Committee, 2011-present
Website Development
Committee, 2011-present
Konigsberg, B:
M2 ICE Course Instructor,
September 2009-present
M3 Course Instructor
September 2009- present
Nebraska Orthopaedic Hospital:
Utilization Review
Committee, 2013-present
Finance Committee,
Adult Reconstruction Hip
Program Committee, American
Association of Orthopaedic
Surgeons. June 2015-present
UNMC College of Medicine:
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
Committee, 2016-present
Medical Executive
Committee, 2016-present
Focused Peer Review
Committee, 2008-present
Emergency Department
Committee, Jan.
Surgical Services
Committee, Jan.
Breaking News | 13
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
Orthopaedics, Sept.
Chairman, Finance
Committee, 2014-2015
Treasurer, 2014-2015
Journal of the American
Geriatrics Society,
Sept. 2010-present
Education Committee,
Orthopaedic Trauma
Association, 2012-2015
McGarry, S:
AO North America:
Fellowship Advisory
Board, 2011-present
Faculty, 1997-present
Faculty Senate, June
Continuing Education
Committee, Oct.
Tissue Bank Review
Committee, Member,
Musculoskeletal Transplant
Foundation (MTF):
Course Director,
UNMC Orthopaedic
Surgery Grand Rounds,
Oct. 2010-present
Executive Committee,
Committee Member,
Feb. 2012 – present
Instructor, M1, M2 ICE
Course, Aug. 2010-present
Medical Board of Trustees,
April 2006-present
Instructor, 2nd Year
Medical Students,
Nebraska Medicine
Jenson, M.L.:
Children’s Hospital and
Medical Center:
Program Developer,
New Sports Medicine
Program, 2013-Present
Periop Quality, Safety
& Patient Experience
Committee, Sept.
DVT/PE Preventative
Practices Committee,
Sept. 2014 – present
Children’s Hospital of
Omaha Bylaws Committee,
Member, Jan. 2008-present
National Comprehensive
Cancer Network (NCCN):
Soft Tissue Sarcoma
Panel, July 2007-present
Consultant Reviewer:
Clinical Orthopaedics
and Related Research,
March 2011-present
Section Chief, Orthopaedics,
VA Medical Center,
Jan. 2009-present
Orthopaedics, Feb.
Techniques in
Orthopaedics, June
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.
Omaha Education
Committee, January
Omaha Transfusion
Committee, January
Omaha Trauma
Performance Improvement
and Patient Safety
Committee, 2009-present
Bone Cancer Panel,
May 2006-present
Membership Committee,
Metro Omaha Medical
Society, April 2012-present
Consultant Reviewer:
Nebraska Medicine
Mormino, M:
Mid-America Orthopaedic
PUBLICATIONS (continued from pg. 13)
Pediatric Orthopaedic
Society of North America:
Board of Directors,
Program Committee,
May 2013-present
Advocacy Committee,
May 2013-present
American Orthopaedic
2014- present
Traveling Fellowship
Committee, June
Chair, ASEAN Traveling
Fellowship Subcommittee,
June 2011-present
Trauma Process
Safety Committee,
Continuing Medical
Education Committee,
Clinical Effectiveness
Trauma Committee,
Perioperative Surgical
Services Operations
Committee, 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,
Hand Faculty, 2014-present
Faculty, AO Trauma North
America, 2012-present
Nebraska Medicine:
Streubel, P:
Trauma Peer Review
Committee, 2014-present
Director, Orthopaedic
CME Planning Committee,
Research and Development
Committee, UNMC,
Ambulatory Center
for Surgical Innovation
Planning Committee,
UNMC, 2014-present
Consultant Reviewer:
Journal of Shoulder
and Elbow Surgery,
Consultant Reviewer
Career Launch Oversight
Committee, UNMC,
Siebler, J:
Association, June 2015-present
Journal of Orthopaedic
Trauma, 2012-present
Journal of Shoulder
and Elbow Surgery,
Revista Ciencias de la
Salud, Universidad del
Rosario, 2014-present
Teusink, M:
Wallace, M:
Children’s Hospital &
Medical Center
Credentials Committee,
Jan. 2016-present
Committee, Sept.
Emerging Leaders Program,
American Orthopaedic
WALK (continued from pg. 1)
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:
Curtis Hartman, M.D. prepares for a left knee replacement
with patient Brenda Bostic.
Breaking News | 14
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
staff adopts
a family for
the holidays
The Department of Orthopaedic
Surgery and Rehabilitation
went beyond the call of duty
this holiday season to help
out a family in need.
2016 Extraordinary Nurse:
Rachel Johnson, BSN, RN
Rachel Johnson was chosen as
this year’s Extraordinary Nurse by
colleagues in the Nebraska Medicine
Orthopaedic Clinic.
between providers, patients and staff.
Rachel Johnson was nominated as
an Extraordinary Nurse in March and
will be recognized by the hospital
during National Nurses Week in May.
“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.”
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
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 News
Congratulations 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.
Breaking News | 15
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.
U.S. Postage
Permit No. 454
Omaha, NE
Department of Orthopaedic Surgery
981080 Nebraska Medical Center
Omaha, NE 68198-1080
In this issue
1 Giving the gift of mobility
Through Operation Walk USA and Nebraska Medicine, two Omahaarea 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.
Breaking News | Summer 2015
Find us
Visit www.unmc.edu/orthosurgery
to view or share this newsletter
with friends and colleagues.
Want to join our e-newsletter list?
Email [email protected]
to sign up!
Severe glenoid erosion after humeral head
replacement: Revision using reverse total shoulder
Philipp N. Streubel, M.D., Assistant Professor
Hand, Shoulder and Elbow Surgery, Department of Orthopaedic Surgery
Case Report
provide a stable surface on which
Humeral head replacement (shoulder
to implant an anatomic glenoid
incisions, active forward elevation to
hemiarthroplasty) has a long track
45 degrees and intact deltoid function.
record for management of a wide
be corrected with reaming the high
Radiographs showed a stable humeral
side to correct retroversion of up to
component with significant central wear
including avascular necrosis of the
15 degrees. In greater amounts of
of the glenoid medial to the base of the
coracoid (Figure 1).
retroversion, posterior bone grafting
or augmented implants may be used
for glenohumeral arthritis is mainly
[8, 9]. In the most severe forms of
A CT scan was obtained, which confirmed
chosen in younger patients and those
glenoid wear, insufficient bone stock
a central wear pattern, with insufficient
not willing to accept postoperative
may preclude the ability to place an
bone stock to allow placement of an
anatomic glenoid component [10].
anatomic glenoid component (Figure
native glenoid may continue to be a
Reverse total shoulder arthroplasty
2).Reverse total shoulder arthroplasty
source of persistent pain or become
(RTSA) may be indicated as it offers
was recommended to allow for glenoid
symptomatic in a delayed fashion
reliable glenoid fixation even in the
component placement and maximize
due to glenoid erosion [3-5]. Revision
presence of only minimal glenoid
shoulder function in a shoulder with likely
of a painful hemiarthroplasty to an
bone stock [11, 12].
poor structural rotator cuff tendons.
anatomic total shoulder arthroplasty
has been shown to yield reproducible
Intraoperatively, significant scarring and
improvement in pain, range of motion
revision of a hemiarthroplasty to
advanced rotator cuff degeneration was
and function [6, 7].
RTSA with allograft augmentation
noted with a non-repairable subscapularis
in a patient with rheumatoid arthritis
and severe glenoid wear.
extraction underwent uneventfully with
Glenoid erosion plays a determinant
role in the surgeon’s ability to place
reaming and broaching in preparation of
a glenoid component. In central wear
Case Example:
a 10 mini (83mm) stem (Comprehensive
patterns, the glenoid can frequently
A 53-year-old male with a history
be prepared with reaming only, to
of rheumatoid arthritis was referred
Warsaw, IN). After glenoid exposure,
to UNMC for revision of bilateral
a central wear pattern was confirmed
shoulder hemiarthroplasties that had
with significant medialization of the
been performed 16 years prior. Over
joint line. However, the inferior border
the last several months the patient
of the glenoid was found to represent
had developed constant shoulder
the paleoglenoid (Figure 2B). A central
pain and progressive loss of function
guide pin was then placed by aligning
with more severe symptoms on
the inferior aspect of the Mini (25mm)
the right side. On physical exam
base plate guide with the inferior border
Figure 1: Right shoulder hemiarthroplasty, 16
years after implantation.
A. Anteroposterior view
showing a stable humeral
component with significant 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 1A
Figure 1B
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
Figure 2A
graft were thereby achieved. A 36 mm
Figure 2B
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.
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
Figure 3A
was pain free and very satisfied with
Figure 3B
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. Inferior 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.
the outcome. Forward elevation had
improved to 90 degrees. Radiographs
showed adequate implant position with
lateralization of the base plate (Figure 3).
modular component systems. J Shoulder Elbow Surg,
Barlow, J.D., et al.: Shoulder arthroplasty for rheumatoid
arthritis: 303 consecutive cases with minimum 5-year
2011. 20(5): p. 778-82.
painful humeral head replacement with glenoid arthrosis.
Collins, D.N., Harryman, D.T. 2nd, Wirth, M.A.: Shoulder
J Shoulder Elbow Surg, 2009. 18(2): p. 220-4.
arthroplasty for the treatment of inflammatory arthritis. J
Bone Joint Surg Am, 2004. 86-A(11): p. 2489-96.
Elbow Surg, 2011. 20(1): p. 123-30.
of motion, and functional outcomes after hemiarthroplasty
osteoarthritis of the shoulder. A systematic review and
meta-analysis. J Bone Joint Surg Am, 2005. 87(9): p. 19475.
Steinmann, S.P., Cofield, R.H.: Bone grafting for glenoid
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
Levine, W.N., et al.: Hemiarthroplasty for glenohumeral
arthroplasty. J Shoulder Elbow Surg, 2012. 21(4): p. 514-
osteoarthritis: results correlated to degree of glenoid wear.
J Shoulder Elbow Surg, 1997. 6(5): p. 449-54.
Shoulder Elbow Surg, 2014. 23(7): p. 1066-72.
deficiency in total shoulder replacement. J Shoulder
Bryant, D., et al.: A comparison of pain, strength, range
Klika, B.J., et al.: Structural bone grafting for glenoid
deficiency in primary total shoulder arthroplasty. J
Bartelt, R., et al.: Shoulder arthroplasty in patients aged
fifty-five years or younger with osteoarthritis. J Shoulder
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