Joseph Bosco, M.D.

Cost-effectiveness analysis of custom total knee cutting blocks
Slover, James D; Rubash, Harry E; Malchau, Henrik; Bosco, Joseph A
2012 Feb;27(2):180-185, Journal of arthroplasty
The purposes of this study were to examine the cost-effectiveness of this technology and to determine improvements in patient outcome needed to make custom total knee cutting blocks cost-effective. A Markov decision model was used to evaluate the cost-effectiveness of custom cutting blocks compared with traditional instrumentation in total knee arthroplasty. The analysis demonstrates routine use of custom cutting blocks for total knee arthroplasty will not be cost-effective unless it results in a significantly reduced revision rate. The reduction necessary increases with increasing costs for the custom blocks. Further research will be necessary to determine if this can be achieved using custom cutting blocks. Patients, surgeons, payers, and institutions should consider this when determining their support of this technology in the absence of supportive data
— id: 149940, year: 2012, vol: 27, page: 180, stat: Journal Article,

Is repetitive intraoperative splash basin use a source of bacterial contamination in total joint replacement?
Glait, Sergio A; Schwarzkopf, Ran; Gould, Steven; Bosco, Joseph; Slover, James
2011 Sep;34(9):e546-e549, Orthopedics (Thorofare NJ)
Splash basins are used in arthroplasty cases to wash instruments. Several studies in the literature have shown these basins being a potential source of bacterial infection. This study assesses the risk of contamination of intraoperative splash basins used to wash and store instruments. A total of 46 random clean primary arthroplasty cases (32 hips, 13 knees, and 1 unicondylar knee) were studied by taking cultures of sterile splash basins as soon as they are opened (controls) and again at wound closure after instruments and debris have come into contact with the sterile water. All cultures were taken with sterile culture swabs and sent to the laboratory for aerobic, anaerobic, and fungal culture. Outcome measured was any positive culture. A total of 92 cultures from 46 cases were tested. Only 1 (2.17%) control culture, which grew Streptococcus viridans, was positive for bacterial growth. One of 46 samples (2.17%) taken at wound closure was positive for coagulase-negative Staphylococcus. Mean time between basin opening and wound closure was 180+/-45 minutes. For the 1 infected sample taken at the conclusion of the case, it was 240 minutes. Previous studies show contamination rates as high as 74% for splash basins used intraoperatively. Our study contradicts the belief that splash basins are a high source of infection, with only 2.17% of basins showing contamination. Splash basins can be a potential source of contamination, but the risk is not as high as previously cited in the orthopedic literature
— id: 139475, year: 2011, vol: 34, page: e546, stat: Journal Article,

Blood, bugs, and motion - what do we really know in regard to total joint arthroplasty?
Glassner, Philip J; Slover, James D; Bosco, Joseph A 3rd; Zuckerman, Joseph D
2011 ;69(1):73-80, Bulletin of the NYU Hospital for Joint Diseases
In total joint arthroplasty, it is often necessary to formulate decisions that are not clearly evidence-based. This review presents some current controversial topics in total joint arthroplasty, including preoperative autologous blood donation versus erythropoietin (EPO) usage, preoperative screening and treatment for methicillin resistant Staphylococcus aureus (MRSA), and the use of continuous passive motion (CPM) following total knee arthroplasty, providing an evidence-based guide for the treating orthopaedic surgeon. Our review shows that preoperative autologous blood donation is over utilized, with EPO being under utilized. Surgeons are encouraged to develop patient-specific strategies, which have been shown to decrease transfusion rates, reduce wasted autologous blood, and increase EPO use. Definitive conclusions regarding MRSA screening for orthopaedic patients cannot be drawn; but due to the significant cost and morbidity associated with a postoperative MRSA infection, we believe a screen and treat protocol should be considered for all patients being admitted to the hospital for elective or emergent surgery. Short-term (3 to 5 days) inpatient use of CPM is recommended at this time. It is low-cost, has minimal risk, and may be a factor in decreasing the length of stay, potentially leading to significant cost savings. However, no long-term benefits of CPM use have been established
— id: 128798, year: 2011, vol: 69, page: 73, stat: Journal Article,

Cost-effectiveness of a Staphylococcus aureus screening and decolonization program for high-risk orthopedic patients
Slover, James; Haas, Janet P; Quirno, Martin; Phillips, Michael S; Bosco, Joseph A 3rd
2011 Apr;26(3):360-365, Journal of arthroplasty
We conducted a Markov decision analysis to assess the cost savings associated with a preoperative Staphylococcus aureus screening and decolonization program on 365 hip and knee arthroplasties and 287 spine fusions. A 2-way sensitivity analysis was also used to calculate the needed reduction in surgical site infections to make the program cost saving. If cost of treating an infected hip or knee arthroplasty is equal to the cost of a primary knee arthroplasty, then the screening program needs to result in a 35% reduction in the revision rate, or a relative revision rate of 65% for patients in the screening program, to be cost saving. For spine fusions, the reduction in the revision rate to make the program cost saving is only 10%. Universal Staphylococcus aureus screening and decolonization for hip and knee arthroplasty and spinal fusion patients needs to result in only a modest reduction in the surgical site infection rate to be cost saving
— id: 132306, year: 2011, vol: 26, page: 360, stat: Journal Article,

Perioperative strategies for decreasing infection: a comprehensive evidence-based approach
Bosco, Joseph A 3rd; Slover, James D; Haas, Janet P
2010 Jan;92(1):232-239, Journal of bone & joint surgery (American volume)
— id: 106103, year: 2010, vol: 92, page: 232, stat: Journal Article,

Perioperative strategies for decreasing infection: a comprehensive evidence-based approach
Bosco, Joseph A 3rd; Slover, James D; Haas, Janet P
2010 ;59:619-628, Instructional course lectures (American Association of Orthopaedic Surgeons)
Surgical site infections are a devastating complication of orthopaedic procedures and result in increased morbidity and mortality as well as higher costs. Universally, patients with surgical site infections have a worse outcome than uninfected patients. Payers of health care and regulatory organizations, such as the Centers for Medicare and Medicaid Services and the Joint Commission, are demanding both accountability and a reduction in the occurrence of surgical site infections. To effectively prevent such infections, the clinician must address preoperative, intraoperative, and postoperative factors, along with interventions. In the areas where evidence-based literature demonstrates a clear best practice, such as prophylactic antibiotic use and surgical scrub techniques, physicians and health care professionals will be held accountable for compliance with these standards. This accountability will be quantified and will be made available to the public. It is also evident that payers will reward and/or penalize physicians for failure to comply with established standards of care. For the health and safety of patients, surgeons are obligated to become familiar with the known best practices and standards of care with respect to the reduction of surgical site infections
— id: 109519, year: 2010, vol: 59, page: 619, stat: Journal Article,

Staphylococcus aureus Decolonization Protocol Decreases Surgical Site Infections for Total Joint Replacement
Hadley, Scott; Immerman, Igor; Hutzler, Lorraine; Slover, James; Bosco, Joseph
2010 ;2010:924518-924518, Arthritis
We investigated the effects of implementation of an institution-wide screening and decolonization protocol on the rates of deep surgical site infections (SSIs) in patients undergoing primary knee and hip arthroplasties. 2058 patients were enrolled in this study: 1644 patients in the treatment group and 414 in the control group. The treatment group attended preoperative admission testing (PAT) clinic where they were screened for MSSA and MRSA colonization. All patients were provided a 5-day course of nasal mupirocin and a single preoperative chlorhexidine shower. Additionally, patients colonized with MRSA received Vancomycin perioperative prophylaxis. The control group did not attend PAT nor receive mupirocin treatment and received either Ancef or Clindamycin for perioperative antibiotic prophylaxis. There were a total of 6 deep infections in the control group (1.45%) and 21 in the treatment group (1.28%); this represented a decrease of 13% (P = .809) in the treatment versus control group. This decrease represented a positive trend in favor of staphylococcus screening, decolonization with mupirocin, and perioperative Vancomycin for known MRSA carriers
— id: 140540, year: 2010, vol: 2010, page: 924518, stat: Journal Article,

Meniscal repair and reconstruction
Jarit, Gregg J; Bosco, Joseph A 3rd
2010 ;68(2):84-90, Bulletin of the NYU Hospital for Joint Diseases
Meniscus injuries are one of the most commonly encountered problems by orthopaedic surgeons today. Surgical techniques for the treatment of meniscal tears are evolving. While many tears can only be treated with partial menisectomy, there are an increasing number of surgical techniques to repair or reconstruct the meniscus. Because of the large increases in contact pressures across the articular cartilage due to loss of meniscal tissue, there has been increased focus on preventing the development of degenerative joint disease from meniscal injuries requiring partial or subtotal menisectomy. Some of these newer techniques include allografts, scaffolds, collagen implants, and repair enhancements. The common goal of these newer techniques is to preserve or restore as much normal, functioning meniscal tissue as possible. This review aims to review the various techniques and history of meniscus repair as well as examine of the newer techniques being introduced to reconstruct or replace the meniscus
— id: 111378, year: 2010, vol: 68, page: 84, stat: Journal Article,

Prevalence of Staphylococcus aureus Colonization in Orthopaedic Surgeons and Their Patients: A Prospective Cohort Controlled Study
Schwarzkopf, Ran; Takemoto, Richelle C; Immerman, Igor; Slover, James D; Bosco, Joseph A
2010 Sep;92(9):1815-1819, Journal of bone & joint surgery (American volume)
BACKGROUND: Methicillin-resistant Staphylococcus aureus and methicillin-sensitive Staphylococcus aureus surgical site infections are an increasing health problem in the United States. To date, no study, as far as we know, has evaluated the prevalence of Staphylococcus aureus colonization in orthopaedic surgeons. The purpose of our study was to assess the prevalence of methicillin-resistant Staphylococcus aureus and methicillin-sensitive Staphylococcus aureus colonization in orthopaedic surgery attending surgeons and residents at our institution compared with that in our high-risk patients. METHODS: We performed nasal swab cultures in seventy-four orthopaedic attending surgeons and sixty-one orthopaedic surgery residents at our institution, screening for methicillin-resistant Staphylococcus aureus and methicillin-sensitive Staphylococcus aureus. We compared these results with a prospective database of nasal cultures of patients undergoing joint replacement and spine surgery. RESULTS: A total of 135 physicians were screened. Of those physicians, 1.5% were positive for methicillin-resistant Staphylococcus aureus and 35.7% were positive for methicillin-sensitive Staphylococcus aureus. None of the sixty-one residents were positive for methicillin-resistant Staphylococcus aureus. However, 59% were positive for methicillin-sensitive Staphylococcus aureus. Of the seventy-four attending surgeons, 2.7% were positive for methicillin-resistant Staphylococcus aureus and 23.3%, for methicillin-sensitive Staphylococcus aureus. Previous studies at our institution have demonstrated a 2.17% prevalence of nasal carriage of methicillin-resistant Staphylococcus aureus and an 18% rate of methicillin-sensitive Staphylococcus aureus in high-risk patients. Thus, no difference was found between the prevalence of methicillin-resistant Staphylococcus aureus in residents or attending surgeons and that in the high-risk patients. However, the prevalence of methicillin-sensitive Staphylococcus aureus colonization in the surgeons (35.7%) was significantly higher than that in the high-risk patient group (18%) (p < 0.01). CONCLUSIONS: At a major teaching hospital, a higher prevalence of methicillin-sensitive Staphylococcus aureus colonization was found among attending and resident orthopaedic surgeons compared with a high-risk patient group, but the prevalence of methicillin-resistant Staphylococcus aureus colonization was similar
— id: 111540, year: 2010, vol: 92, page: 1815, stat: Journal Article,

Proximal biceps tendon--a biomechanical analysis of the stability at the bicipital groove
Kwon, Young W; Hurd, Jason; Yeager, Keith; Ishak, Charbel; Walker, Peter S; Khan, Sami; Bosco, Joseph A 3rd; Jazrawi, Laith M
2009 ;67(4):337-340, Bulletin of the NYU Hospital for Joint Diseases
The subscapularis tendon, coracohumeral ligament, and transverse humeral ligament are all believed to contribute to biceps tendon stability within the bicipital groove. In order to examine the relative contribution of these soft tissue structures to proximal biceps tendon stability, 11 fresh frozen cadaveric shoulder specimens were prepared and mounted onto a custom jig. A three-dimensional digitizer was utilized to record biceps tendon excursion in various shoulder positions. In sequential order, these structures were then sectioned, and biceps tendon excursion was again recorded. We found that sectioning of the subscapularis tendon significantly increased biceps tendon excursion, compared to intact specimens (8.1 +/- 4.1 mm vs. 4.3 +/- 3.6 mm; p < 0.006). In contrast, isolated sectioning of the transverse humeral ligament or the coracohumeral ligament did not significantly increase biceps excursion (5.4 +/- 2.5 mm, p = 0.26; 5.6 +/- 1.3 mm, p = 0.24). When two structures were sectioned, significant excursion in the biceps tendon only occurred in specimens where the subscapularis tendon was one of the sectioned structures. The preliminary data suggest that, of the three tested soft tissue structures, the subscapularis tendon is the most important stabilizer of the proximal biceps and that clinically significant lesions of the proximal biceps tendon may be associated with a defect in the subscapularis tendon
— id: 105972, year: 2009, vol: 67, page: 337, stat: Journal Article,

Patellofemoral arthritis
Minkowitz, Reuven B; Bosco, Joseph A 3rd
2009 ;67(1):30-38, Bulletin of the NYU Hospital for Joint Diseases
Patellofemoral joint arthritis is a common condition which can be extremely debilitating. Although it is a common condition, the treatment of isolated patellofemoral arthritis varies and remains controversial. The objective of this review is to provide an overview of the current understanding of patellofemoral arthritis and various different surgical options, indications, and their respective outcomes
— id: 99283, year: 2009, vol: 67, page: 30, stat: Journal Article,

Treatment of medial collateral ligament injuries
Miyamoto, Ryan G; Bosco, Joseph A; Sherman, Orrin H
2009 Mar;17(3):152-161, Journal of the American Academy of Orthopaedic Surgeons
The medial collateral ligament is the most frequently injured ligament of the knee. The anatomy and biomechanical role of this ligament and the associated posteromedial structures of the knee continue to be explored. Prophylactic knee bracing has shown promise in preventing injury to the medial collateral ligament, although perhaps at the cost of functional performance. Most isolated injuries are treated nonsurgically. Recent studies have investigated ligament-healing variables, including modalities such as ultrasound and nonsteroidal anti-inflammatory drugs. Concomitant damage to the anterior or posterior cruciate ligaments is a common indication to surgically address the high-grade medial collateral ligament injury. The optimal treatment of multiligamentous knee injuries continues to evolve, and controversy exists surrounding the role of medial collateral ligament repair/reconstruction, with data supporting both conservative and surgical management
— id: 94694, year: 2009, vol: 17, page: 152, stat: Journal Article,

Stress fractures and stress reactions of the diaphyseal femur in collegiate athletes: an analysis of 25 cases
Koenig, Scott J; Toth, Alison P; Bosco, Joseph A
2008 Sep;37(9):476-480, American journal of orthopedics (Belle Mead, NJ)
In this review of prospectively collected data, representing the largest series of its kind, we identified 25 stress injuries of the diaphyseal femur in 20 athletes at an NCAA (National Collegiate Athletic Association) Division I university. All 20 patients successfully completed rehabilitation and returned to activity without limitations. Seventeen of these patients (representing 22 injuries) were female, and all 5 patients who sustained 2 stress injuries were female. The higher proportion of injured females in this study, and the histories of menstrual irregularities and disordered eating, raised the concern that the female athlete triad may be a factor. It is important to consider the diagnosis of stress injuries of the diaphyseal femur when evaluating thigh pain in running athletes, especially females, as early diagnosis and treatment lead to excellent outcomes and full return to activity. Magnetic resonance imaging should be considered the gold standard in the diagnostic evaluation of these injuries. Further, as stress fractures may be the first presentation of the female athlete triad, it is also important for orthopedic surgeons to identify the presence of risk factors that may predispose athletes to recurrent stress injuries and other health problems
— id: 95185, year: 2008, vol: 37, page: 476, stat: Journal Article,

Treatment of an open infected type IIB distal clavicle fracture: case report and review of the literature
Strauss, Eric J; Kaplan, Kevin M; Paksima, Nader; Bosco, Joseph A 3rd
2008 ;66(2):129-133, Bulletin of the NYU Hospital for Joint Diseases
Clavicle fractures are common skeletal injuries that are typically managed nonoperatively, which results in a high rate of fracture union with few or no long-term sequelae. Type II distal clavicle fractures are an exception, with reported rates of nonunion ranging from 22% to 44%. This high rate of nonunion has led to controversy regarding the appropriate treatment of type II injuries. The following case report describes a type IIB distal clavicle fracture, in which nonoperative management was complicated by the breakdown of skin over the fracture site and the subsequent development of infection. This is a rare complication of conservative management. Thorough operative debridement, fracture stabilization via external fixation, and identification of the causative organism allowed for successful outcome in the management of this complex presentation
— id: 93319, year: 2008, vol: 66, page: 129, stat: Journal Article,

A history of the NYU hospital for joint diseases
Bosco, JA; Koenig, S
2007 NOV ;18(1):44-46, Eklem hastaliklan ve cerrahisi = Joint diseases & related surgery
— id: 76788, year: 2007, vol: 18, page: 44, stat: Journal Article,

Sagittal and coronal biomechanics of the knee: a rationale for corrective measures
Levine, Harlan B; Bosco, Joseph A 3rd
2007 ;65(1):87-95, Bulletin of the NYU Hospital for Joint Diseases
— id: 73031, year: 2007, vol: 65, page: 87, stat: Journal Article,

Articular cartilage restoration of the knee
Shah, Mehul R; Kaplan, Kevin M; Meislin, Robert J; Bosco, Joseph A 3rd
2007 ;65(1):51-60, Bulletin of the NYU Hospital for Joint Diseases
Articular cartilage defects are common and play a significant role in degenerative joint disease. Cartilage is unable to regenerate, secondary to an inherent lack of vascular supply, thus, various techniques have been described in an attempt to treat and potentially restore these defects. Treatment decisions should be based on appropriate evaluation and classification of the pathology. Only then can the surgeon choose to perform a repair or a restoration of the articular surface. Current literature and techniques for the treatment of articular cartilage defects are reviewed, with an algorithm developed for the management of articular cartilage defects by orthopaedic surgeons.
— id: 73027, year: 2007, vol: 65, page: 51, stat: Journal Article,

Analysis of the Cross-Sectional Area of the Adductor Longus Tendon: A Descriptive Anatomic Study
Strauss, Eric J; Campbell, Kirk; Bosco, Joseph A
2007 Jun;35(6):996-999, American journal of sports medicine
BACKGROUND: Strain injury to the adductor longus muscle is a common cause of groin pain in athletes and generally occurs in the proximal portion of the muscle, near its origin from the anterior aspect of the pubis. The composition and cross-sectional anatomy of this muscle's origin has not been previously described. HYPOTHESIS: We hypothesize that the adductor longus muscle origin is composed mainly of muscle fibers and that the tendon composes only a small part of the cross section at the origin of the muscle. STUDY DESIGN: Descriptive laboratory study. METHODS: We harvested 42 adductor longus muscles from 28 cadavers and measured the cross-sectional dimensions of the tendon with microcalipers. Next, we determined the relative contributions of the tendon and muscle fibers to the cross-sectional anatomy of the muscle using optical scanning. These 2 sets of measurements were obtained at 3 locations: at the muscle origin and 1.0 and 2.0 cm distal to the origin. RESULTS: The average length and width of the tendon was 11.6 and 3.7 mm, respectively, at the origin. The average cross-sectional areas of the tendon were 49.3, 27.9, and 25.7 mm(2) at points 0.0, 1.0, and 2.0 cm from its origin, respectively. The origin of the adductor longus muscle was composed of 37.9% tendon and 62.1% muscle tissue. At 1.0 cm from the origin, the percentage of tendon decreased to 34%. At 2.0 cm from the origin, the tendon composed 26.7% of the cross section. CONCLUSION: The cross-sectional area of the tendon of the adductor longus muscle is relatively small. The muscle origin is composed predominantly of direct attachment of muscle fibers. CLINICAL RELEVANCE: Knowledge of the cross-sectional anatomy of the adductor longus muscle at its origin may help clinicians better understand the complex nature of injuries in this area
— id: 71328, year: 2007, vol: 35, page: 996, stat: Journal Article,

High-altitude illness and muscle physiology
Weil, Wayne M; Glassner, Philip J; Bosco, Joseph A 3rd
2007 ;65(1):72-77, Bulletin of the NYU Hospital for Joint Diseases
High-altitude illness is a growing concern in sports medicine that affects persons shortly after they have climbed to a new high-altitude level to which their body is not acclimatized. With the increasing popularity of extreme sports, such as high-altitude mountaineering, skiing, and snowboarding, the incidence of complications arising from sports activities at high altitudes is increasing. High-altitude pulmonary edema and high-altitude cerebral edema are potentially fatal conditions. The study of high-altitude muscle physiology has broad ramifications in creating training programs for elite endurance athletes. A thorough understanding of the pathophysiology, presentation, treatment, and prevention of high-altitude illness is necessary for the treatment of these patients.
— id: 73029, year: 2007, vol: 65, page: 72, stat: Journal Article,

Orthopaedic surgery chief resident - grand rounds presentations
Bosco, Joseph A
2006 ;64(3-4):93-93, Bulletin of the NYU Hospital for Joint Diseases
— id: 71332, year: 2006, vol: 64, page: 93, stat: Journal Article,

Cervical spine injuries in the athlete
Chang, David; Bosco, Joseph A
2006 ;64(3-4):119-129, Bulletin of the NYU Hospital for Joint Diseases
— id: 71331, year: 2006, vol: 64, page: 119, stat: Journal Article,

Glenohumeral bone loss and anterior instability
Chen, Andrew L; Bosco, Joseph A 3rd
2006 ;64(3-4):130-138, Bulletin of the NYU Hospital for Joint Diseases
— id: 71330, year: 2006, vol: 64, page: 130, stat: Journal Article,

Hand injuries in rock climbers
Kubiak, Erik N; Klugman, Jeffrey A; Bosco, Joseph A
2006 ;64(3-4):172-177, Bulletin of the NYU Hospital for Joint Diseases
Rock climbing, whether practiced in nature on cliffs and boulders or indoors on walls made of resin and wood, has grown in popularity in recent years. An estimated five million people participate in 'rocking' at least three times a year. Climbing places unique demands on the upper extremity, especially the hands. The flexor tendons and flexor pulleys are prone to sprains and ruptures. Pulley injuries occur in up to 20% of climbers. The A2 pulley of the ring finger is the most frequently injured. Most pulley injuries can be successfully treated with a week of immobilization, followed by a range of motion (ROM) exercises for one week. Isometric training on a finger board can be started once ROM exercises are painless. A return to climbing can be initiated when the climber is able to avoid grip positions that produce pain; however, the closed crimp grip should be avoided at this time. Surgical reconstruction using the technique described by Widstrom is recommended for acute injuries with clinical evidence of bowstringing. Ultrasound and MRI are the current modalities best suited for confirming clinical findings
— id: 71329, year: 2006, vol: 64, page: 172, stat: Journal Article,

Renal tumor with associated venous tumor thrombus prolapsing through tricuspid valve during diastole
Patel, Rupa; Schwartzbard, Arthur; Bosco, Joseph; Torre, Pablo; Taneja, Samir S
2005 Jul;66(1):195-195, Urology
We describe the case of a 76-year-old man with a renal cell carcinoma thrombus extending into the right atrium, prolapsing across the tricuspid valve into the right ventricle during diastole, and producing sufficient portal venous pressure to result in intestinal venous thrombosis and necrosis of the upper gastrointestinal mucosa. The related published studies are reviewed and discussed
— id: 58656, year: 2005, vol: 66, page: 195, stat: Journal Article,

Traumatic superficial temporal artery pseudoaneurysms in a minor league baseball player: a case report and review of the literature
Romero, Anthony C; Fulkerson, Eric; Rockman, Caron B; Bosco, Joe; Rosen, Jeffrey
2004 May;33(4):200-205, American journal of orthopedics (Belle Mead, NJ)
Traumatic STA aneurysm is a rare complication of facial trauma occuring typically in young men. We present the case of a minor league baseball player who developed 2 pseudoaneurysms after being struck by a baseball and review all cases associated with sports activities. Reports associated with sports activities are increasing and may represent an increasing incidence. The team physician should suspect this condition when a player presents with a new temporal mass after facial trauma. Diagnosis is typically made on history and physical examination, but can be confirmed by duplex ultrasound. Definitive treatment is surgical resection of the aneurysm after proximal and distal ligation of the vessel
— id: 46026, year: 2004, vol: 33, page: 200, stat: Journal Article,

SLAP lesions of the shoulder
Maurer, Stephen G; Rosen, Jeffrey E; Bosco, Joseph A 3rd
2003 ;61(3-4):186-192, Bulletin (Hospital for Joint Diseases)
SLAP lesions are becoming a more recognized cause of shoulder pain and disability. The diagnosis of these lesions is difficult due to vague symptoms and high degree of overlap with other shoulder disorders, and this requires a high index of suspicion. Advances in MR arthrography may lead to advances in preoperative diagnosis of labral tears, but definitive diagnosis, classification, and management is greatly facilitated with the use of the shoulder arthroscopy. Further basic science and clinical research should enhance our ability to manage patients with these lesions effectively
— id: 42880, year: 2003, vol: 61, page: 186, stat: Journal Article,

The ACL-deficient knee: natural history and treatment options
Goldstein J; Bosco JA 3rd
2001 2002;60(3-4):173-178, Bulletin (Hospital for Joint Diseases)
Injury to the anterior cruciate ligament removes the major stabilizing structure to anterior tibial translation. The initial trauma may lead to meniscal and cartilage damage, predisposing the knee to early degenerative changes. Moreover, a knee with an isolated ACL rupture may have recurrent episodes of instability that can lead to a similar degenerative course. At this time, one cannot accurately predict which patients will tolerate ACL deficiency, and which patients will not. Current long-term studies support a progressive worsening condition in the ACL and meniscal deficient knees. Physical therapy together with lifestyle modifications may be necessary. Those unwilling to make these types of changes or those with associated injuries may benefit from ACL reconstruction
— id: 36202, year: 2001, vol: 60, page: 173, stat: Journal Article,

Lateral ankle and subtalar instability
Miller CA; Bosco JA 3rd
2001 2002;60(3-4):143-149, Bulletin (Hospital for Joint Diseases)
— id: 36203, year: 2001, vol: 60, page: 143, stat: Journal Article,

Ultra high molecular weight polyethylene wear in total hip arthroplasty
Bosco JA 3rd; Ong BC
2000 May;23(5):499-503, Orthopedics (Thorofare NJ)
— id: 36204, year: 2000, vol: 23, page: 499, stat: Journal Article,

Spontaneous echocardiographic contrast within an unruptured sinus of Valsalva aneurysm: a potential embolic source diagnosed by transesophageal echocardiography
Steinberg E; Wun H; Bosco J; Kronzon I
1996 Nov-Dec;9(6):880-881, Journal of the American Society of Echocardiography
A 75-year-old male patient had an unexplained transient ischemic attack. Transesophageal echocardiography revealed a large, unruptured Sinus of Valsalva aneurysm which contained spontaneous echo contrast. This finding represents a potential source of embolism
— id: 12491, year: 1996, vol: 9, page: 880, stat: Journal Article,

Long-term outcome of Volz total wrist arthroplasties
Bosco JA 3rd; Bynum DK; Bowers WH
1994 Feb;9(1):25-31, Journal of arthroplasty
The authors determined the outcomes of 18 consecutive Volz total wrist arthroplasties that were followed for an average of 8.6 years. Nine of these wrists were followed for 10 or more years. Fourteen wrists were replaced for rheumatoid arthritis and four for post-traumatic degenerative joint disease. Forty-nine degrees of combined flexion and extension and 25 degrees of combined ulnar and radial deviation were maintained. The balance of wrist motion was dependent upon the design and location of the metacarpal prosthesis. A 24% loss in carpal height (subsidence) occurred during the study period. Four metacarpal components were loose (22%), three of which were placed in patients with degenerative joint disease. One radial component (6%) was loose. Fifteen of 18 wrists (83%) had little or no pain. The three wrists with moderate or severe pain were in patients with degenerative joint disease. There were five (28%) complications. One revision was performed and another was recommended. Overall, the long-term outcome of total wrist arthroplasty was favorable in patients with rheumatoid arthritis
— id: 36205, year: 1994, vol: 9, page: 25, stat: Journal Article,

Loosening of a femoral stem associated with the use of an extended-lip acetabular cup liner. A case report
Bosco JA; Benjamin JB
1993 Feb;8(1):91-93, Journal of arthroplasty
A case of femoral component loosening secondary to impingement on an extended-lip acetabular cup liner is presented. This impingement led to the accelerated creation of particulate polyethylene wear debris. The particulate polyethylene induced an osteolytic response about the femoral component, which contributed to the failure of this component. It is recommended that intraoperative examination for impingement, especially in extension, be performed when using liners of this design
— id: 36207, year: 1993, vol: 8, page: 91, stat: Journal Article,

Survivorship analysis of cemented high modulus total hip arthroplasty
Bosco JA; Lachiewicz PF; DeMasi R
1993 Sep;(294):131-139, Clinical orthopaedics & related research
Ninety-four high-modulus total hip arthroplasties (THAs) were performed from 1977 to 1982 using the Computer Assist Design (CAD) and HD-2 prostheses. Eighty-six hips were followed for an average of 6.7 years. The cement gun was used throughout the study period, and distal bone or cement plug use was begun in 1979. The results of these arthroplasties were evaluated retrospectively using both survivorship analysis and observed success rates. Using a standard hip rating system, 19 hips were rated as excellent, 44 as good, 15 as fair, and 11 as poor. Failure was defined as definitely visible radiographic migration of either component, or reoperation for revision of one or both components. There was no significant difference between the HD-2 and CAD prostheses. There were five hips revised for aseptic loosening and revision was advised in an additional three hips. One hip with late sepsis required removal of both components. The five- and ten-year survivorships of the acetabular components were 97% +/- 3 and 58% +/- 17, respectively. Those of the femoral components were 93% +/- 5 and 78% +/- 13, respectively. For the components combined, the survivorship at five years was 91% +/- 6 but only 50% +/- 17 at ten years. Survivorship analysis provided a different and more realistic appraisal of the long-term results of the arthroplasties in this series than did the observed success rates. The contemporary cement techniques of the late 1970s and early 1980s may not be sufficient for the long-term survival of high-modulus THAs. Additional techniques may be necessary for improved long-term survival
— id: 47548, year: 1993, vol: , page: 131, stat: Journal Article,

Complications of allografts in arthroplasty
Habermann ET; Bosco JA 3rd
1993 Apr;4(2):64-67, Seminars in arthroplasty
— id: 36206, year: 1993, vol: 4, page: 64, stat: Journal Article,