Meyer was graduated from Kent State University and earned his medical degree from Northeastern Ohio University College of Medicine. He completed his internship and residency at the Akron General Medical Center, in Ohio, and completed a fellowship in Musculoskeletal Pathology at the University of Florida. Meyer's professional expertise is the treatment of tumors of the bone and soft tissue as well as robot assisted joint replacement surgery. He currently serves as Department Head of Orthopaedic Oncology at Ochsner Medical Center in New Orleans Louisiana. He has published multiple articles in reputed journals.
Background: Total knee arthroplasty (TKA) outcomes can depend upon patient related factors such as body mass index (BMI), and surgical related factors such as component alignment. Current literature comparing BMI and TKA component alignment is inconclusive. Some studies find limited differences in outcomes and others demonstrate inferior results. Malpositioning of the tibial or femoral component is associated with early failure. The aim of this study was to evaluate the relationship between BMI and TKA component alignment.
Methods: 320 primary cemented posterior cruciate-substituting TKAs were performed by three surgeons over 12 months beginning in January 2009. 69 TKAs were excluded due to inadequate radiographs. 149 knees were placed in the obese group (BMI>30) and 102 knees were placed in the non obese group (BMI<30). Postsurgical radiographs were reviewed by a PGY-5 orthopaedic surgery resident blinded to the individual’s BMI. Five radiographic measurements were included: coronal tibiofemoral angle (CTFA), coronal femoral component angle (CFCA), coronal tíbial component angle (CTCA), sagittal femoral component angle (SFCA), and sagittal tibial component angle (STCA).
Pre-surgical BMI was calculated through medical records. Chi square test was used to compare the groups with regard to sex and operative side. Student T test was used to compare the groups with regard to age, CTFA, CFCA, CTCA, SFCA, and STCA. Statistical significance was set for P=0.05.
Results: No statistically significant differences were found between the two groups with regard to sex or operative side. The mean patient age for the non obese group was significantly higher than the obese group (71.4 and 63.9, respectively P=0.001). No significant difference was found between the mean values for CTFA, CFCA, CTCA, SFCA, and STCA between the non obese and obese group (P=0.0556, P=0.2246, P=0.7264 P=0.5223 and P=0.7059, respectively).
Discussion: Malpositioning of TKA components is associated with early failure. Current literature questions if BMI is directly related to component malpositioning. We found no statistically significant relationship between obesity and TKA alignment.
Nicolas Bowers is an internal medicine resident at Sunnybrook Hospital, and the University of Toronto. He was active in medical education research throughout medical school at the University of Toronto under the supervision of Dr. Tulin Cil, surgical oncologist, and continues to do so as an Internal Medicine resident. He plans to continue his medical education research as a resident, focusing on innovative technologies that can be useful in medical education. He plans to specialize in cardiology following his internal medicine training.
Purpose: It has been demonstrated that physicians are at risk for the development of musculoskeletal disorders (MSKD) due to the ergonomic stresses of their work environments. The impact of these disorders can translate to loss of work time and productivity, as well as decreased physical and psychosocial health. However, little work has been done investigating the prevalence of MSKD in surgical or medical trainees. The purpose of this study is to determine the prevalence and patterns of MSKD in orthopaedic surgery and internal medicine residents. Methods: A modified version of the Physical Discomfort Survey was developed and distributed to all orthopaedic surgery and internal medicine residents at a single institution. The prevalence of musculoskeletal symptoms in specific anatomical regions was compared between the two groups. Results: Both internal medicine and orthopaedic residents reported a high prevalence of upper extremity, back and lower extremity MSKD (ranging from 47% to 69%). Internal medicine residents had a higher prevalence of neck symptoms (53% vs. 28%, p=0.01) and upper back symptoms (31% vs. 9%, p=0.01) than orthopaedic surgery trainees. 40% of orthopaedic surgery and 29% of internal medicine residents perceived that their clinical activities contributed to MSKD. Conclusions: This data suggests that both orthopaedic surgery and internal medicine residents have MSKD, which may be due to factors within their diverse training environments. Thus, the impact of residency training on MSKD should be acknowledged for both groups. This is particularly important for programs when considering overall resident health issues. The implementation of early interventions, even at the residency level, may be beneficial in the prevention of future significant MSKD in physicians.