Joseph P. DeAngelis

Bio: Joseph P. DeAngelis is an academic researcher from Beth Israel Deaconess Medical Center. The author has contributed to research in topics: Medicine & Medial patellofemoral ligament. The author has an hindex of 19, co-authored 62 publications receiving 1002 citations. Previous affiliations of Joseph P. DeAngelis include Vanderbilt University Medical Center & Astellas Pharma.

Cemented Versus Uncemented Hemiarthroplasty for Displaced Femoral Neck Fractures: A Prospective Randomized Trial With Early Follow-Up

Abstract: Objective:To prospectively compare the functional outcome associated with cemented and uncemented hemiarthroplasty.Design:Prospective randomized control trial.Setting:University-affiliated level 1 trauma center.Patients/Participants:All individuals designated for hemiarthroplasty, older than 55 year

Biomechanical evaluation of arthroscopic rotator cuff repairs over time.

Abstract: Purpose The aim of this study was to assess the contact pressure, force, and area over time for 4 common arthroscopic rotator cuff repair techniques. Methods The transosseous-equivalent, single-row, triangle double-row, and suture-chain transosseous repair techniques were used to repair a full-thickness tear of the supraspinatus in 16 cadaveric shoulders. Continuous data points were collected immediately after repair and for 160 minutes at set time intervals by use of a custom thin film pressure sensor. Results Each of the 4 rotator cuff repair techniques showed decreased contact force, pressure, and area 160 minutes after the repair was performed. The transosseous-equivalent construct had the highest contact pressure and force initially and at all time points up to 160 minutes. Although the 3 double-row constructs had greater pressure and force at all time points compared with the single-row repair, only the transosseous-equivalent group showed a statistically greater pressure and force when compared with single-row repair ( P Conclusions Contact pressure, force, and pressurized footprint area decrease 160 minutes after repair regardless of repair technique. The transosseous-equivalent group had the highest contact pressure and force at all time points. Clinical Relevance The decrease in contact pressure and force after rotator cuff repair may have important implications in evaluating tendon-to-bone healing and determining the optimal rehabilitation protocol.

Changes in Contact Area in Meniscus Horizontal Cleavage Tears Subjected to Repair and Resection.

Abstract: Purpose To assess the changes in tibiofemoral contact pressure and contact area in human knees with a horizontal cleavage tear before and after treatment. Methods Ten human cadaveric knees were tested. Pressure sensors were placed under the medial meniscus and the knees were loaded at twice the body weight for 20 cycles at 0°, 10°, and 20° of flexion. Contact area and pressure were recorded for the intact meniscus, the meniscus with a horizontal cleavage tear, after meniscal repair, after partial meniscectomy (single leaflet), and after subtotal meniscectomy (double leaflet). Results The presence of a horizontal cleavage tear significantly increased average peak contact pressure and reduced effective average tibiofemoral contact area at all flexion angles tested compared with the intact state ( P P P Conclusions The presence of a horizontal cleavage tear in the medial meniscus causes a significant reduction in contact area and a significant elevation in contact pressure. These changes may accelerate joint degeneration. A suture-based repair of these horizontal cleavage tears returns the contact area and contact pressure to nearly normal, whereas both partial and subtotal meniscectomy lead to significant reductions in contact area and significant elevations in contact pressure within the knee. Repairing horizontal cleavage tears may lead to improved clinical outcomes by preserving meniscal tissue and the meniscal function. Clinical Relevance Understanding contact area and peak contact pressure resulting from differing strategies for treating horizontal cleavage tears will allow the surgeon to evaluate the best strategy for treating his or her patients who present with this meniscal pathology.

Analysis of a New All-Inside Versus Inside-Out Technique for Repairing Radial Meniscal Tears

Abstract: Purpose The purpose of this study was to compare gap formation, strength, and stiffness of repaired radial tears of the meniscus treated using a new all-inside technique versus a traditional inside-out suture technique. Methods Radial tears were created in 36 fresh-frozen porcine menisci. Repairs were performed using a novel all-inside suture-based meniscal repair device or an inside-out technique. The repairs were tested for cyclic loading and load to failure. The displacement, response to cyclic loading (100, 300, and 500 cycles), and mode of failure were recorded, and the construct's stiffness was calculated. Results The all-inside repairs using the novel device resulted in a significantly lower displacement (gap formation) after 100, 300, and 500 cycles ( P = .002, P = .001, and P = .001, respectively). The ultimate load to failure was significantly greater for the all-inside repairs (111.61 N v 95.01 N; P = .03). The all-inside repairs showed greater stiffness (14.53 N/mm v 11.19 N/mm; P = .02). The all-inside repairs failed most often by suture breakage (suture failure). The inside-out repairs failed most commonly when the suture pulled through the tissue (tissue failure) ( P Conclusions For repair of radial tears of the meniscus, the vertical suture configuration created by the all-inside technique resulted in lower displacement, higher load to failure, and greater stiffness compared with the horizontal inside-out technique. Clinical Relevance In a porcine specimen meniscus repair model, the biomechanical properties of a vertical all-inside technique were superior to that of a horizontal inside-out technique. Future studies of biomechanical and clinical outcomes in human meniscal repairs with this device are warranted to explore whether this repair method is valuable to clinical practice and patient outcomes.

Metallic implant biomaterials

Abstract: Human tissue is structured mainly of self-assembled polymers (proteins) and ceramics (bone minerals), with metals present as trace elements with molecular scale functions. However, metals and their alloys have played a predominant role as structural biomaterials in reconstructive surgery, especially orthopedics, with more recent uses in non-osseous tissues, such as blood vessels. With the successful routine use of a large variety of metal implants clinically, issues associated with long-term maintenance of implant integrity have also emerged. This review focuses on metallic implant biomaterials, identifying and discussing critical issues in their clinical applications, including the systemic toxicity of released metal ions due to corrosion, fatigue failure of structural components due to repeated loading, and wearing of joint replacements due to movement. This is followed by detailed reviews on specific metallic biomaterials made from stainless steels, alloys of cobalt, titanium and magnesium, as well as shape memory alloys of nickel–titanium, silver, tantalum and zirconium. For each, the properties that affect biocompatibility and mechanical integrity (especially corrosion fatigue) are discussed in detail. Finally, the most critical challenges for metallic implant biomaterials are summarized, with emphasis on the most promising approaches and strategies.

A cadaver study

Abstract: J Bone Joint Surg [Br] 2008;90-B:1114-18. Received 31 January 2008; Accepted after revision 14 April 2008 Compartment syndrome of the foot requires urgent surgical treatment. Currently, there is still no agreement on the number and location of the myofascial compartments of the foot. The aim of this cadaver study was to provide an anatomical basis for surgical decompression in the event of compartment syndrome. We found that there were three tough vertical fascial septae that extended from the hindfoot to the midfoot on the plantar aspect of the foot. These septae separated the posterior half of the foot into three compartments. The medial compartment containing the abductor hallucis was surrounded medially by skin and subcutaneous fat and laterally by the medial septum. The intermediate compartment, containing the flexor digitorum brevis and the quadratus plantae more deeply, was surrounded by the medial septum medially, the intermediate septum laterally and the main plantar aponeurosis on its plantar aspect. The lateral compartment containing the abductor digiti minimi was surrounded medially by the intermediate septum, laterally by the lateral septum and on its plantar aspect by the lateral band of the main plantar aponeurosis. No distinct myofascial compartments exist in the forefoot. Based on our findings, in theory, fasciotomy of the hindfoot compartments through a modified medial incision would be sufficient to decompress the foot.

Management of hip fractures in the elderly.

Abstract: The purpose of this clinical practice guideline is to help improve treatment and management of hip fractures in the elderly based on current best evidence. The guideline contains twenty-five recommendations, including both diagnosis and treatment. Of those recommendations, strong evidence supports regional analgesia to improve preoperative pain control, similar outcomes for general or spinal anesthesia, arthroplasty for patients with unstable (displaced) femoral neck fractures, the use of a cephalomedullary device for the treatment of patients with subtrochanteric or reverse obliquity fractures, a blood transfusion threshold of no higher than 8 g/dL in asymptomatic postoperative patients, intensive physical therapy postdischarge, use of an interdisciplinary care program in patients with mild to moderate dementia, and multimodal pain management after hip fracture surgery. In addition to the recommendations, the work group highlighted the need for better research in the treatment of hip fractures.