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Low back pain is one of the most common reasons for physician visits in the United States and is a chief complaint frequently seen by orthopedic surgeons. Patients with chronic low back pain can experience recurring debilitating pain and disability, decreasing their quality of life. A commercially available software platform, Explorys (Explorys, Inc, Cleveland, Ohio), was used to mine a pooled electronic health care database consisting of the medical records of more than 26 million patients. According to the available medical history data, 1.2 million patients had a diagnosis of low back pain (4.54%). The information was used to determine the incidence of low back pain in patients with a history of nicotine dependence, obesity (body mass index, >30 kg/m(2)), depressive disorders, and alcohol abuse. Relative risk was then calculated for the defined modifiable risk factors. Patients with nicotine dependence, obesity, depressive disorders, and alcohol abuse had a relative risk of 4.489, 6.007, 5.511, and 3.326 for low back pain, respectively, compared with patients without the defined risk factor. A statistically significant difference was found in the incidence of low back pain between all 4 groups with the risk factors evaluated and the general population (P<.05). By determining treatable patient risk factors for low back pain, physicians can monitor at-risk patients and focus on prevention and control of debilitating disease. These approaches can decrease the number of patients with isolated low back pain who are seen by orthopedic surgeons. [Orthopedics. 2016; 39(3):e413-e416.].

The objective of this study was to validate the use of a software platform (Explorys, Inc., Cleveland, OH) by determining whether the association observed between obesity and revision of total knee arthroplasty (TKA) was obtained within this database. Risk of revision in cohorts with a BMI > 30, as well as cohorts with a BMI between 30-35, 35-40 and >40 was compared to patients with a BMI between 18 and 30 (relative risk, RR). Risk in men versus women was examined. From this database, 70,070 patients were identified that had undergone a TKA. Risk of revision increased as a function of BMI; RR achieved significance in the following cohorts: all patients with a BMI > 30, all patients with a BMI > 40, men with a BMI > 30 and men with a BMI > 40. All other subgroups showed increased RR but did not reach significance. In obese patients, RR was greater in men than in women, and the effect was significant in all groups examined except patients with a BMI between 35 and 40. Data from this study contribute to the process of demonstrating the Explorys software platform is a valid and useful method to investigate associations across large populations.

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Several technologies are available to assist surgeons with acetabular component positioning in total hip arthroplasty. The purpose of this study was to determine whether surgical positioning software would improve cup position compared with fluoroscopy. This prospective, randomized study compared 200 primary total hip arthroplasty cups placed with and without surgical positioning software. All cases were performed by a single surgeon using the direct anterior approach with fluoroscopy. The target abduction and anteversion angles were set at 40° and 20°, respectively, and measured postoperatively. Cup placement time, total fluoroscopy time, and cup position were compared between groups. Mean abduction was 40.4° (range, 32.7°−49.0°) in the software group compared with 42.3° (range, 33.7°−51.1°) in the control group. The cups placed using software were significantly closer to the target abduction angle ( P <.001) with fewer outliers. Mean anteversion was 20.8° (range, 11.2°−31.7°) in the software group compared with 21.8° (range, 11.3°−34.3°) in the control group ( P =.063). Eighty-seven percent of cups in the software group fell within 5° of the abduction target, compared with only 68% in the control group ( P <.01). Cup placement took longer in the software group (7:04 minutes vs 4:58 minutes, P <.001), and 2 seconds more total fluoroscopy time was used in that group as well (12.9 seconds vs 11.1 seconds, P <.001). The software improved both the accuracy and the precision of cup placement, with only modest increases in surgical time and fluoroscopy time. [ Orthopedics . 2019; 42(1):42–47.]

The present studies examine whether information contained in medical records can be used to predict outcomes following two orthopedic procedures: repair of hip fracture and total knee replacement. Study 1 reports the acute, in-hospital recovery data from the medical records of 119 hip fracture patients. Study 2 is a prospective, longitudinal investigation of 3-month postoperative recovery of 110 total knee replacement patients. Patients characterized by a greater number of post-traumatic stress risk factors experienced poorer outcomes following orthopedic surgery. Our results suggest that patients at risk for negative outcomes can be identified by information readily available to medical personnel.

The forces created by the attachment of the serratus anterior during underhand throwing are the likely etiology of the injury in our patient. Physicians should maintain a high clinical index of suspicion for stress fracture in underhand athletes with lateral rib pain.

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