Citations

Background: Arthroscopic treatment of excessive acetabular coverage with pincer morphology or coxa profunda can be challenging. In patients with excessive acetabular coverage with nondistractible hips, an outside-in capsuolotomy can be considered to gain safe and efficient intra-articular access to the hip. Indications: The indications for an outside-in capsulotomy include patients with acetabular retroversion, a lateral center-edge angle >40°, coxa profunda or protrusio, or stiff, older male patients who remain hip preservation candidates. Technique Description: The outside-in capsulotomy is performed once it is recognized that traction on the operative extremity will not provide adequate working space for safe intra-articular access. Traction is taken off the operative extremity, and an anterolateral portal is localized to the 12:00 position on the hip joint with the use of fluoroscopy. The camera is then placed in a juxta-capsular location, and a modified anterior portal is created under direct arthroscopic visualization. We then proceed with extracapsular dissection to identify the indirect head of the rectus. An outside-in capsulotomy is then performed parallel to the indirect head of the rectus, approximately 5 mm distal to its insertion on the acetabular rim. Prior to deep completion of the capsulotomy, the hip joint is flexed to 30° to protect the articular cartilage of the femoral head. Once intra-articular access is obtained, traction can be reapplied, and one can proceed with hip arthroscopy in a standard fashion. Results: This technique decreases the traction time needed, given that the capsulotomy is performed without traction applied. Additionally, the amount of force required for hip distraction is decreased once the capsuolotomy has been completed, through usual sectioning of the iliofemoral ligament. The presented technique is both safe and efficacious, with no published difference in complications as compared to standard inside-out access. A published series of patients with severe pincer morphology and lateral overcoverage who undergo hip arthroscopy with outside-in access demonstrates satisfactory postoperative improvements in patient-reported outcome measures. Discussion/Conclusion: The outside-in capsulotomy provides a means for safe access to the hip joint in otherwise limited or nondistractible hips.

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) allows patients to complete extended antimicrobial treatment at home, improving quality of life and reducing healthcare costs. National guidelines outline best practices for antimicrobial administration, vascular access management, monitoring, and recommend involving an infectious disease physician and a multidisciplinary team. Evaluating adherence to these practices can identify improvement opportunities and enhance outcomes. The primary objective of this study was to assess patient outcomes related to adherence to OPAT best practices at Mayo Clinic Health System – Southwest Wisconsin (MCHS–SWWI). Secondary objectives included evaluating adherence to key process metrics and identifying associations between baseline characteristics and outcomes. Methods This retrospective cohort study included adults discharged from MCHS–SWWI on home OPAT from November 2021 to July 2024. Patients were excluded if under 18 years old or if they received OPAT in non-home settings (e.g., skilled nursing, infusion center). Data on process metrics, outcomes, and safety were collected through manual chart review. These findings were evaluated against established best practices to assess the OPAT program's adherence and determine the impact of this adherence on patient outcomes. Statistical analysis used Pearson’s chi-square tests and Wilcoxon rank sum tests to measure associations of patient characteristics with outcomes. Results A total of 164 patients were included. The MCHS-SWWI OPAT program demonstrated high adherence ( > 85%) to majority of established best practices. Successful OPAT completion occurred in 92.7% of patients, and overall incidence of adverse events and poor outcomes was generally low. Adherence to best practices was below 85% for vascular access selection (81.7%) and completion of weekly labs and vascular access care throughout the OPAT course (∼69%). Conclusion High adherence to OPAT best practices led to a generally low incidence of adverse events, treatment failures, and other unfavorable patient outcomes. The results of this study provide valuable insights to guide institutional quality improvement initiatives aimed at optimizing patient outcomes in OPAT therapy through targeted interventions. Disclosures All Authors: No reported disclosures

Background: Institutions that participate in PCORnet ® transform their local electronic health record (EHR) data into the PCORnet ® Common Data Model (CDM), which is then used to generate data extracts for PCORnet ® Studies. PCORnet ® Studies can also include institutions that do not participate in PCORnet, and for these organizations, the cost of instantiating a PCORnet ® CDM can be prohibitive. Fast Health care Interoperability Resources (FHIR) provides an alternative method of obtaining EHR data. Objective: To determine whether data obtained through FHIR might be a viable study solution for those sites that do not participate in PCORnet. ® This mixed-methods project had 2 objectives: (1) survey sites participating in PCORnet on the availability of FHIR (FHIR survey); (2) compare the coverage of a FHIR-based data extract using REDCap with one from the PCORnet ® CDM across 3 sites (FHIR extract). Methods: (1) FHIR survey: A series of questions were asked about the use of FHIR in a production capacity. (2) FHIR extract: REDCap FHIR and PCORnet ® CDM extracts were created based on study variables from 2 prior PCORnet ® Studies. Data were extracted for 40 patients and concordance measures were computed between the 2 sources. Results: (1) FHIR survey: Of responding organizations, 73% (n=49) reported that FHIR was deployed in a production capacity. (2) FHIR extract: Results were highly variable. Cohen kappa ranged from 0.01 to 0.76 for certain diagnoses, 0.24 to 0.84 for laboratory results, and 0.1 to 0.87 for medications. Conclusions: Despite differences in data, certain studies may be well-suited for FHIR-based extracts.

Abstract Purpose Iliopsoas tendinitis following total hip arthroplasty (THA) has been described to result from acetabular component overhang as well as prominent femoral collars. Yet, a portion of patients experience iliopsoas tendinitis in the setting of well-positioned components. The purpose of this study was to assess anatomic factors predisposing to iliopsoas tendinitis after THA. Methods Patients with THAs performed at three academic institutions who subsequently underwent arthroscopic iliopsoas release were retrospectively reviewed from 2015 to 2025 and propensity matched in a 1:3 fashion to a control group of THAs without subsequent iliopsoas release. Controls were matched by age, surgery date, laterality, sex, surgical approach, and implanted femoral component. Patients with iliopsoas tendinitis and subsequent release (THA-IP) were evaluated for anterior acetabular component overhang and femoral collar overhang, when a collar was present. We also evaluated the absolute and relative profile of the lesser trochanter on anteroposterior radiographs, understanding that when less of the lesser trochanter is visualized, the trochanter is anatomically displaced posterolaterally, resulting in a more arduous route from the inner pelvic origin of the iliopsoas to its insertion on the femur. Results Forty-five patients (mean age: 57±11; 71% female; 19 direct anterior, 10 anterolateral, 16 posterior approach) undergoing THA-IP were analyzed and matched to 135 controls. Both groups demonstrated a median cup size of 54 mm and head size of 36 mm. Average time to iliopsoas release after THA was 4 years. Anterior cup overhang of >2 mm was present in 49% of THA-IP patients, with 18% having collared femoral components, and 9% demonstrating collar overhang of >2 mm. Overall, 19 THA-IP patients had <2 mm of cup and collar overhang and 26 patients had >2 mm of overhang. THA-IP patients with <2 mm of cup and collar overhang had significantly greater relative posterolateralization of the lesser trochanter compared to those with overhang of >2 mm (p=0.010) and to controls (p=0.037). Conclusion Visualizing “Less of the Lesser” on anteroposterior hip radiographs and associated posterolateralization of the lesser trochanter may be an anatomic risk factor for iliopsoas tendinitis following THA, even in the presence of satisfactorily positioned components.

Abstract Purpose To investigate clinical outcomes, including patient reported outcome measures (PROMs), subjective anterior groin pain and hip flexion strength, and reoperation rates following arthroscopic iliopsoas fractional lengthening after total hip arthroplasty (THA). Methods Patients who were indicated for arthroscopic iliopsoas fractional lengthening after ipsilateral THA were prospectively identified between 2023-2025 at a single institution. Pre- and post-operative PROMs, including Visual Analog Scale (VAS), Tegner activity scale, Single Assessment Numeric Evaluation (SANE), and subjective anterior groin pain and hip flexion strength were analyzed. Reoperations at final follow-up were also evaluated. Results A total of 44 hips in 41 patients (23 females and 18 males) were included (mean age: 64.7 ± 10.2, mean BMI: 29.9 ± 5.9 kg/m2). Fifty-five percent of patients underwent surgery on their right hip. The mean postoperative follow-up timeframe was 10.0 ± 7.1 months. There was a significant improvement in postoperative PROMs compared to pre-operative levels for VAS at rest (1.3 ± 1.9 vs. 2.9 ± 2.2), VAS with use (3.1 ± 3.8 vs. 8.0 ± 1.6), Tegner activity scale (2.9 ± 1.3 vs. 2.1 ± 1.1), and SANE (74.0 ± 20.3 vs. 47.9 ± 23.4) (p<0.001 for all). Over 90% of patients reported feeling much better or slightly better regarding their anterior groin pain at 2-weeks post-operatively (93%), 6 weeks post-operatively (90%), 3 months post-operatively (93%), and at final follow-up (91%). Regarding hip flexion strength, 73% reported feeling much better or slightly better at 2-weeks post-operatively, 95% at 6-weeks post-operatively, 85% at 3 months post-operatively, and 61% at final follow-up. Only 2 patients (5%) reported feeling much weaker at final follow-up. Two of 44 hips (5%) underwent reoperation at final follow-up. One patient underwent a 2-stage revision THA at 5 months postoperatively due to infection, while 1 patient underwent an open iliopsoas release with acetabular screw removal and liner exchange. Overall, the mean surgery satisfaction was 8.1 ± 2.6 on a scale of 1-10. Conclusion Patients who underwent arthroscopic iliopsoas fractional lengthening following THA demonstrated satisfactory postoperative outcomes, with over 90% reporting durably improved anterior groin pain and nearly two-thirds reporting increased hip flexor strength throughout follow-up.

Importance The choice of induction agent during rapid sequence intubation (RSI) of critically ill adults may affect clinical outcomes. Although ketamine and etomidate are frequently used for RSI, their comparative effectiveness remains controversial. Objective To compare the safety of etomidate vs ketamine for emergency RSI in critically ill adults. Design, Setting, and Participants This cohort study used a target trial emulation with observational data collected between March 1, 2022, and April 30, 2024, from 18 emergency departments across Brazil, with data from the Brazilian Airway Registry Cooperation. Adults who underwent RSI and received either etomidate or ketamine as a sole hypnotic agent were included; those with preintubation cardiac arrest or immediate postintubation transfer were excluded. Exposure Administration of etomidate or ketamine as the induction agent for RSI. Main Outcomes and Measures The primary outcome was 28-day in-hospital mortality. Secondary outcomes included 7-day in-hospital mortality, first-attempt intubation success, and major adverse events (new hemodynamic instability, severe hypoxemia, and cardiac arrest) within 30 minutes after intubation. Inverse probability of treatment weighting was used to adjust for confounding. Risk ratios (RRs) and risk differences (RDs) with 95% CIs were used to compare outcomes between groups. Results Among 1810 patients (median age, 64 years [IQR, 50-74 years]; 1048 men [57.9%]), 514 received ketamine and 1296 received etomidate. The median shock index was higher in the ketamine group than the etomidate group (0.81 [IQR, 0.65-1.01] vs 0.76 [IQR, 0.59-0.99]), and preintubation vasopressor use was more common in the ketamine group than the etomidate group (191 of 514 [37.2%] vs 391 of 1296 [30.2%]). Weighted 28-day mortality was higher with etomidate than ketamine (60.5% [95% CI, 57.2%-63.8%] vs 54.4% [95% CI, 45.0%-63.9%]; RR, 1.14 [95% CI, 1.03-1.27]; RD, 7.6% [95% CI, 2.0%-13.3%]). Seven-day mortality was also higher with etomidate than ketamine (35.2% [95% CI, 32.0%-38.3%] vs 30.1% [95% CI, 23.5%-36.7%]; RR, 1.19 [95% CI, 1.04-1.35]). New hemodynamic instability within 30 minutes after intubation was more frequent with ketamine (24.2% [95% CI, 20.4%-28.0%] vs 18.9% [95% CI, 16.7%-21.0%]; RR, 0.78 [0.64-0.95]). There were no statistically significant differences in the other secondary outcomes. Conclusions and Relevance In this cohort study of critically ill adults undergoing RSI, etomidate use was associated with higher in-hospital mortality at 7 and 28 days compared with ketamine. These findings highlight the need for definitive randomized clinical trials to compare both agents.

Abstract Jagim, AR, Dobbs, WC, Horswill, CA, Twohey, E, Fields, JB, and Jones, MT. Prevalence and magnitude weight loss among collegiate wrestlers. J Strength Cond Res 40(1): 90–97, 2026—The purpose of this study was to examine the percentage of wrestlers who compete in their minimal weight class (MWC), and the magnitude of weight loss. Data from the 2023–2024 collegiate season were retrospectively analyzed resulting in a sample of 9,638 collegiate male wrestlers from the National Association of Intercollegiate Athletics ( n = 1,904) and all 3 divisions of the National Collegiate Athletics Association ( n = 7,734). All wrestlers completed skinfold assessments for weight certification at the start of the competition season. The lowest recorded weight class (LRW) achieved by each wrestler during the season was also recorded and used to determine magnitude of weight loss. Out of the 4,605 (53.2%) of wrestlers who competed in their MWC, their average amount of weight loss was significantly higher than those who did not compete in their MWC (3.9 ± 2.5 vs. 3.2 ± 2.9 kg.; p < 0.001), yet they had an initial lower body fat percentage (12.7 ± 2.9 vs. 17.5 ± 4.8%; p < 0.001). At the time of weight certification, wrestlers weighed 8.1 ± 4.5 (95% confidence interval (CI): 8.0–8.2; effect size (ES) = 1.8) kg more than their minimal wrestling weight. The LRW was 3.6 ± 2.9 (95% CI: 3.6–3.7; ES = 1.2) kg lower than their weight at the time of weight certification. Given that slightly more than half of the male wrestlers competed in their MWC, coaches and sports practitioners should recognize that not all athletes follow the traditional assumption of cutting to the lowest possible weight class. Importantly, those who did achieve their MWC had lower initial body fat percentages, limiting the amount of weight they could safely lose. This underscores the need for individualized weight management strategies that consider body composition and health implications.

Abstract Twohey, E, Dobbs, WC, Malone, CM, Fields, JB, Jones, MT, and Jagim, AR. The use of a consumer-grade bioelectrical impedance analysis device for weight certification in collegiate wrestling: Implications for minimal wrestling weight determination. J Strength Cond Res 39(12): 1321–1326, 2025—Wrestlers are required to complete a preseason weight certification assessment, which includes a weigh-in, a hydration test, and a body fat percentage (BF%) measurement. This information is then used to establish their minimal wrestling weight (MWW) and minimal weight class. Skinfold (SKF) is the primary method used for determining body fat for collegiate wrestling, yet impedance devices are being considered for use in the future. The purpose of this study was to examine differences in body fat and the resulting MWW values derived from SKF and a consumer-grade multifrequency bioelectrical impedance analysis (MFBIA) device. Thirty-one collegiate male wrestlers produced a urine sample for urine specific gravity assessment to ensure adequate hydration status. Subjects then completed a weigh-in, followed by 2 body composition assessments using a (a) MFBIA device and (b) skinfold calipers to determine body density and BF%. No significant differences were observed for estimates of BF% (SKF: 13.4 ± 2.8% vs. MFBIA: 14.0 ± 3.3%; p = 0.198) or computed MWW values (SKF: 69.8 ± 8.7 kg vs. MFBIA: 69.4 ± 9.7 kg; p = 0.348) between devices. When determining the minimal weight class for each device, there were discrepancies in 11 of the 31 wrestlers (35%). Although the current MFBIA device can provide an acceptable estimate of BF% and similar resulting MWW value at the group level, the methods cannot be used interchangeably.

Abstract Purpose: CD4 T-cell immunity is associated with improved survival in patients with breast cancer. We previously reported a phase I trial evaluating a folate receptor alpha (FRα) vaccine administered with cyclophosphamide (CP), demonstrating excellent safety and immunogenicity. To simplify the vaccine strategy for ease of use, we report here the results of a randomized phase II trial evaluating a lower vaccine dose alongside the original dose, administered with or without CP pretreatment. Patients and Methods: Patients with triple-negative breast cancer who completed all systemic and local therapies were assigned to receive either low-dose (825 μg) or high-dose (2.5 mg) vaccine peptides plus GM-CSF in six 4-week cycles, with or without CP prior to vaccination. Safety was monitored, and immunogenicity was evaluated before and after vaccination. Results: A total of 80 patients were dosed with vaccine, and 58 patients were evaluable for immunogenicity. Vaccination was well tolerated and elicited immunity in 83% of patients. Levels of FRα-specific T cells were high, persistent, and comparable with T-cell levels against tetanus toxoid. No differences in immunity were observed between the two doses. CP pretreatment also did not affect the immune responses. Recurrences occurred in eight evaluable patients and were unrelated to the treatment arm. No patients died during the study because of their disease. Conclusions: The reduced-dose FRα vaccine is as effective as the original dose and does not require CP to generate maximal immunity. These findings may inform the design of trials testing efficacy in triple-negative breast cancer or other cancers.