Past Issues

Reconstructive Review Past Issues

Vol 8, No 2 December, 2018

REVIEW

Understanding Iliotibial Band-Sparing Total Hip Arthroplasty: Alternatives to Traditional THA Approaches
Russell Nevins, Kevin M Sagers

Coronal Alignment in TKA: Traditional Principles Versus New Concepts
Thomas J Parisi, Jason M Jennings, Douglas A Dennis

ORIGINAL ARTICLE

Dual Antibiotic Therapy with Vancomycin and Cefazolin for Surgical Prophylaxis in Total Knee Arthroplasty
Anna Cohen-Rosenblum, Madison Crutcher, Jane Gui, Wendy Novicoff, Stephen Nelson, James Browne

Is Utilizing a Modular Stemmed Tibial Component in Obese Patients Undergoing Primary Total Knee Replacement Cost-Effective?
J. Ryan Martin, Jesse Otero, Walter Beaver, Bryan Springer, William Griffin

Perioperative Complications Following One-Stage Bilateral and Unilateral Total Hip Arthroplasty via Direct Anterior Approach
John Attenello, Maria Opanova, Anne Richardson Wright, Michele Saruwatari, Kelvin Naito, Sean Chan, Sean Saito, Samantha Andrews, Cass Nakasone

Vol 8, No 1 September, 2018

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CASE REPORT

Popliteal Artery Complications of Total Knee Replacement – Our Experience In Large Volume Centre and Review of Literature
Sunku Nithin, A V Guruva Reddy, Sagi Muralidhar

Conversion Knee Arthroplasty Using a Rotating Hinge as a Salvage Prosthesis Following Periprosthetic Joint Infection and Ligamentous Insufficiency: A Case Report
Jon E. Minter

ORIGINAL ARTICLE

Decreased Incidence of Periprosthetic Joint Infection in Total Hip Arthroplasty with Use of Topical Vancomycin
David A Crawford, Keith R Berend, Joanne B Adams, Adolph V Lombardi

Correction of Femoral Acetabular Impingement at the Time of Primary THA
Edward J. McPherson, Sherif M. Sherif, Madhav Chowdhry, Matthew V. Dipane

Manipulation Rate Is Not Increased After Customized Total Knee Arthroplasty
Andrew Brecher Kay, William B Kurtz, Gregory M Martin, Bryan M Huber, Robert J Tait, Terry A Clyburn

Vol 7, No 4 December, 2017

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ORIGINAL ARTICLE

Elevated Lip Liner Positions Improving Stability in Total Hip Arthroplasty – An Experimental Study
Suleman Qurashi, William Parr, Bob Jang, William R Walsh

Bio-Occlusive Gauze with Tegaderm: A Dressing for Surgical Wounds in Primary THA and TKA
Madhav Chowdhry, Matthew Dipane, Edward J. McPherson

REVIEW

Periprosthetic Distal Femur Fractures: Review of Current Treatment Options
Justin M Head

CASE STUDY

Femoral Head-Trunnion Dissociation in Metal-on-Polyethylene Total Hip Arthroplasty – A Unique Case Report
Nick N. Patel, George N. Guild III, Greg A. Erens

COMMENTARY

Search Engine Optimization for Medical Publishing
David Faroo

Vol 7, No 3 September, 2017

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ORIGINAL ARTICLE
Native Patella Retention Versus Resurfacing in a Cohort of Staged Bilateral Total Knee Patients
Justin M Head, Ryan Nelson, Mark Dyball, Bruce D Lawrence

Exploration of Serum 25-Hydroxy Vitamin D in Total Joint Arthroplasty within a Subtropical Climate
Brandon Naylor, Amy King, Sarah Voges, Terry Blackwell, Robin Huff, Harold "Del" Schutte

Mid-Term Follow Up Results of Mini-Subvastus Approach for Total Knee Arthroplasty in Obese Patients
Aditya laxmikant Kekatpure, Nilen A Shah, Prithviraj Prabhakar Nistane, Pritam K Agrawal

The 16-Year Evolution of Proximal Modular Stem Design – Eliminating Failure of Modular Junction
Thomas Tkach, Timothy McTighe

Simulator Study of MOM using Steep-cup Flexion - A Clinically Relevant Incorporation of Intermittent Edge-loading
Ian Clarke, Julia Shelton, John Bowsher, Christina Savisaar, Thomas Donaldson

Dissemination of Pathogens by Mobile Phones in a Single Hospital
Michael B Canales, Grace C Craig, John Boyd Jr., Mario Markovic, Richard A Chmielewski

CASE REPORT

Successes and Failures of a Freedom™ Constrained Cup Used in a Major Salvage Procedure
Thomas Donaldson, Ian Clarke

Vol 7, No 2 June, 2017

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ORIGINAL ARTICLE

The Performance of Mixed Manufacturer Metal On Metal Total Hip Replacements
Richard Barker Cook, Jeremy M. Latham, Robert J.K. Wood

The Effect of Patellar Denervation by Circumpatellar Electrocautery on Anterior Knee Pain Following Total Knee Replacement – An Experimental Study
Balaji Zacharia, Manu Paul

A Single Surgeon, 10 Year Experience with the Oxford Partial Knee System: What a Difference Experience, Instruments, Implants, and Technique Can Make
David Mauerhan, Nigel L Rozario

SURVEY

Patient Factors Affecting Surgeon Selection and the Decision to Delay Total Knee Arthroplasty
Keith Berend, Ruizhi Zhao, Angeline Carlson, Mark Stultz

CASE REPORT

Anterolateral Oblique Distal Femoral Osteotomy for the Removal of Well Fixed Cemented Femoral TKA Components
Keith A. Fehring, Cody C. Wyles, J. Ryan Martin, Robert T. Trousdale

Posterior Femoral Single Limb Osteotomy for the Removal of Well-Fixed Modular Femoral Neck Components
Keith A Fehring, J. Ryan Martin, Peter K Sculco, Saaed Kalantari, Robert T Trousdale

COMMENTARY

Health Care Regulation Spending Trap
Timothy McTighe

Return to Work Following Total Knee Replacement
Hugh Cameron

Vol 7, No 1 March, 2017

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ORIGINAL ARTICLE

Medial Tibial Reduction Osteotomy is Associated with Excellent Outcomes and Improved Coronal Alignment
J. Ryan Martin, Daniel Levy, Todd Miner, David Conrad, Jason Jennings, Douglas Dennis

Thigh Pain Occurrence Rate in a Short, Tapered, Porous, Proximally-Coated Cementless Femoral Stem - Clinical and Radiological Results at 2-Year Follow-Up
Michele Ulivi, Luca Claudio Orlandini, Peter Fennema, Valentina Meroni, Daniele Castoldi

CLINICAL/SURGICAL

Leg and Femoral Neck Length Evaluation Using an Anterior Capsule Preservation Technique in Primary Direct Anterior Approach Total Hip Arthroplasty
Stephen J Nelson, Murillo Adrados, Raj J Gala, Erik J Geiger, Matthew L Webb, Lee Rubin, Kristaps J Keggi

Diagnosing and Treating Popliteal Tendinopathy After Total Knee Arthroplasty
J. Ryan Martin, Allison Fout, Andrew C Stoeckl, Douglas A Dennis

CASE REPORT

Total Hip Arthroplasty Loosening Due to Mycobacterium Tuberculosis: A Case Report and Review of the Literature
Anis Tebourbi, Ahmed Elloumi, Khaled Hadhri, Mohamed Ben Salah, Mouadh Nefiss, Ramzi Bouzidi, Mondher Kooli

COMMENTARY

Osteoarthritis or Osteoarthrosis: Commentary on Misuse of Terms
Panayot Tanchev

Vol 6, No 4 December, 2016

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CLINICAL/SURGICAL

The iDuo Bi-compartmental Knee Replacement: Our Early Experience.
Peter Jemmett, Stuart Roy

ORIGINAL ARTICLE

The History, Technical Specifications and Efficacy of Plasma Spray Coatings Applied to Joint Replacement Prostheses
Andrew McCabe, Martin Pickford, James Shawcross

CASE STUDY

Patient Specific Component Alignment in Total Hip Arthroplasty
James William Pierrepont, Catherine Zoe Stambouzou, Brad Peter Miles, Peter Bede O'Connor, Leonard Walter, Andrew Ellis, Rob Molnar, Jonathan Victor Baré, Michael Solomon, Stephen McMahon, Andrew Shimmin, Ed Marel

CASE REPORT

Prosthetic Fracture of a Cemented Exeter Femoral Stem (Case Report)
Michael Facek, Yasser Khatib, Eric Swarts

Prosthetic Hip Loosening Due to Brucellar Infection: Case Report and Literature Review
Anis Tebourbi, Khaled Hadhri, Mohamed Ben Salah, Ramzi Bouzidi, Mondher Kooli

Vol 6, No 3 September, 2016

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CASE REPORT

Trunnion Corrosion and Early Failure in Monolithic Metal-on-Polyethylene TMZF Femoral Components: A Case Series
Peter Walker, David Campbell, Paul Della Torre, Declan Brazil, Timothy McTighe

Robot-assisted Total Hip Arthroplasty after Chiari Pelvic Osteotomy: A Case Report
Marius Dettmer, Amir Pourmoghaddam, Stefan W Kreuzer

Combination of Accelerometer-Based Navigation and Force Sensor for Precise Bone Resection and Appropriate Soft Tissue Balancing in Total Knee Arthroplasty
Yasushi Oshima, Joseph Fetto

CLINICAL/SURGICAL

Restoration of Femoral Condylar Anatomy for Achieving Optimum Functional Expectations: Component Design and Early Results
Sridhar Durbhakula, Laura F. Rego

ORIGINAL ARTICLE

Oxford Partial Knee Replacement as a Gateway to Outpatient Arthroplasty “Lessons Learned along the Journey”
Michael E Berend

Tourniquet Application During Total Knee Arthroplasty Does Not Benefit Perioperative Blood Loss or Transfusion Requirement with the Routine Use of Tranexamic Acid
Tyler Steven Watters, Daniel L Levy, Raymond H Kim, Todd M Miner, Douglas A Dennis, Jason M Jennings

COMMENTARY

Modular Necks and Corrosion - Review of Five Cases
Timothy McTighe, Declan Brazil

Vol 6, No 2 July, 2016

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ORIGINAL ARTICLE

Our Experience with Short Stem Hip Replacement Surgery
Sumeet Rastogi, Sanjiv K S Marya

SuperPATH® Minimally Invasive Total Hip Arthroplasty - An Australian Experience
Suleman Qurashi, Jason Chinnappa, Pasquale Rositano, Stephen Asha

CASE REPORT

Combination Intravenous and Intra-Articular Tranexamic Acid Compared with Intravenous Only Administration and No Therapy in Total Knee Arthroplasty: A Case Series Study
Chris Buntting, Rami Sorial, Simon Coffey, Guy Eslick

Quadriceps Tendon Rupture and Contralateral Patella Tendon Avulsion Post Primary Bilateral Total Knee Arthroplasty: A Case Report
Gaurav Sharma, Vaibhav Bagaria, Shyam Nadange, Chaitanya Waghchoure, Smit Shah, Ravishanker Tangirala, Farokh Wadia

REVIEW

Total Hip Arthroplasty in Sickle Cell Disease
Mojieb Manzary

Vol 6, No 1 April, 2016

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ORIGINAL ARTICLE

Trunnion Corrosion causing Failure in Metal-on-Polyethylene Total Hip Arthroplasty with Monolithic Femoral Components
Megan Manthe, Kurt Blasser, Christopher Beauchamp, Mary I O'Connor

Experience with Modular Necks for Cemented Total Hip Arthroplasty
Hugh Cameron, Timothy McTighe

Comparison of Functional Outcomes of Total Knee Arthroplasty Using Two Different Single Radius Implants
Amir Pourmoghaddam, Marius Dettmer, Stefany Malanka, Stefan Kreuzer

CASE REPORT

Stress analysis of a Burch-Schneider cage in an acetabular bone defect: A case study
Katrien Plessers, Hans Mau

CLINICAL/SURGICAL

Bone Preservation in a Novel Patient Specific Total Knee Replacement.
William B. Kurtz, John E. Slamin, Scott W. Doody

Vol 5, No 4 December, 2015

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ORIGINAL ARTICLE

Multimodal Venous Thromboembolism Prophylaxis with Preoperative Thrombophilia Screening Examinations for Total Hip and Knee Arthroplasties
Yasushi Oshima, Joseph Fetto

New Instrumentation Reduces Operative Time in Medial Unicompartmental Knee Arthroplasty Using the Oxford Mobile Bearing Design
Keith Berend, Jason Hurst, Michael Morris, Joanne Adams, Adolph Lombardi

BASIC SCIENCE

Third-body Wear Damage Produced in CoCr Surfaces by Hydroxyapatite and Alumina Ceramic Debris: A 10-cycle Metal-on-Metal Simulator Study
Thomas Halim, Michelle Burgett-Moreno, Thomas Donaldson, Ian Clarke

CASE REPORT

Modular Head Mismatch in THA
Timothy McTighe

CLINICAL/SURGICAL

Early Experience with a Modern Generation Knee System: Average 2 Years' Follow-up
Thomas Paszicsnyek

COMMENTARY

The Power of One Publication
Timothy McTighe

Vol 5, No 3 October, 2015

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ORIGINAL ARTICLE

Surgeon Assessment of Gapping versus Kinetic Loading using Intraoperative Sensors During TKA
Patrick A Meere, Justin G LaMont, Jorge Baez, Michael N Kang, Vijay J Rasquinha, Christopher R Anderson, Cale A Jacobs

A Minimum 2-Year Follow-up Using Modular Trabecular Metal Tibial Components in Total Knee Arthroplasty
Eddy D Zandee van Rilland, Joseph C Varcadipane, Olga Geling, Megan Murai Kuba, Cass K Nakasone

Margin-of-safety Algorithm Used with EOS Imaging to Interpret MHRA Warning for 46-48mm MOM Arthroplasty
Ian Clarke, Jean-Yves Lazennec

“Table-less” and “Assistant-less” Direct Anterior Approach to Hip Arthroplasty
Daniel C Allison, Lawrence R Menendez, William W Brien, Timothy McTighe

CASE REPORT

Pendulum Test: A Highly Accurate and Simple Physical Examination Maneuver to Identify Hip Pathology
Yasushi Oshima, Joseph Fetto

COMMENTARY

Safety Issue of Hip Resurfacing
Timothy McTighe

LETTER TO EDITOR

Letter to the Editor
John Keggi

Vol 5, No 2 July, 2015

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ORIGINAL ARTICLE

The Incidence of Dislocation (Utilizing a Neck Sparing Stem) in Community Based Practices with the Posterior Approach
Edward J. McPherson, Bradley K. Vaughn, Louis Keppler, Declan Brazil, Timothy McTighe

CASE REPORT

Excessive Anteversion Leads to Failure at 3 Years Due to Impingement as Evidenced by Twin Notches in Ti6A4V Stem
Thomas Donaldson, Michelle Burgett-Moreno, Ian Clarke

Early Intraprosthetic Dislocation of Dual-Mobility Total Hip Arthroplasty Implant Following Attempted Closed Reduction: A Case Report
Joseph Schirmers, MD, Ryan Horazdovsky, MD, Scott Marston, MD

Biomechanical Alignment of Main Wear-Pattern on MOM Total Hip Replacement
Paul Burton, Erla Medina, Michelle Burgett-Moreno, Thomas Donaldson, Ian Clarke

Short-Stem Hip Arthroplasty as a Solution for limited Proximal Femoral Bone Stock
Ai E Gamboa, David Graham Campbell, Peter Lewis

CONTROVERSIAL ISSUES (I.E. MODULARITY, TAPERS, MOM, ETC.)

Metallic Modular Taper Junctions in Total Hip Arthroplasty
Timothy McTighe, Declan Brazil, Louis Keppler, John Keggi, Edward McPherson

Vol 5, No 1, March 2015

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ORIGINAL ARTICLE

Mobile Versus Fixed Bearing Medial Unicompartmental Knee Arthroplasty: A Series of 375 Patients
Robert Murphy, Tyler Fraser, William Mihalko

The Impact of use of Double Set-up on Infection Rates in Revision Total Knee Replacement and Limb Salvage Procedures
Jennifer Waterman, Jon Minter, Paul Ghattas, Brandon Green

Incision Length in Small Incision Total Knee Arthroplasty: How Long of an Incision Is Needed?
Edward McPherson, Brian Czarkowski, Matthew Dipane, Sherif Sherif

BASIC SCIENCE

In Vitro Characterization of Lavage Splash and Effectiveness of Lavage Shield
Steven Nishiyama, Ronald Hillock

CLINICAL/SURGICAL

Subgroup Analysis of Topical Tranexamic Acid in Primary Total Hip Arthroplasty
Walter Anazonwu

Vol 4, No 4, December 2014

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ORIGINAL ARTICLE

Influence of Posterior Condylar Offset on Maximal Flexion and Outcome Scales Following TKA in Asian Patients
Sae Kwang Kwon

Functional Outcomes of Revision Total Knee Arthroplasty Following Failed Unicompartmental Knee Arthroplasty
Christopher Ironside, Simon Coffey, Guy Eslick, Rami Sorial

Management of Complex Knee Deformities in Asian Population: Our Experience of 11 Cases
Syed Shahid Noor

Blood Conservation Strategies in Total Hip and Knee Arthroplasty
David Liu

CLINICAL/SURGICAL

Osteolysis In a Well Fixed Acetabular Cup, Retain or Revise?
Mojieb Manzary

CASE REPORT

Total Hip Arthroplasty in Failed Hip Fractures: A Case Series
Syed Shahid Noor

Vol 4, Sup 2, October 2014

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International Congress for Joint Reconstruction (ICJR) Abstract Supplement: Pan Pacific Orthopaedic Congress
July 16 - 19, 2014, Hilton Waikoloa, HI

Vol 4, No 3, September 2014

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Peri-Prosthetic Infection in the Orthopedic Tumor Patient
Daniel C. Allison MD, MBA, FACS; Eddie Huang, MD; Elke R. Ahlmann, MD; Scott Carney, MD; Ling Wang, PA-C; Lawrence R. Menendez, MD, FACS

Surgical Stabilization of the Medial Capsulo-Ligamentous Envelope in Total Knee Arthroplasty
Brandon Green, DO; Jon Minter, DO; Paul Ghattas, DO; Jennifer Waterman, DO

Early Intraprosthetic Dislocation of Dual-Mobility Total Hip Arthroplasty Implant Following Attempted Closed Reduction: A Case Report
Scott B. Marston, MD; Joseph D. Schirmers, MD; Ryan D. Horazdovsky, MD

Early Results of a Modular Cementless Tibial Component for Total Knee Arthroplasty
Raj K. Sinha, MD, PhD; Cristian Balcescu

No Rationale for Gender Specific Femoral Stems for Total Hip Arthroplasty
Raj K. Sinha, MD, PhD; Vangalea Weems, BS, PA-C; Margaret J. Cutler, RN

Smart PEEK Modified by Self-Initiated Surface Graft Polymerization for Orthopedic Bearings
Masayuki Kyomoto, PhD; Toru Moro, MD, PhD; Shihori Yamane, MSc; Kenichi Watanabe,
BS; Yoshio Takatori, MD, PhD; Sakae Tanaka, MD, PhD; Kazuhiko Ishihara, PhD

Vol 4, Sup 1, July 2014

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International Congress for Joint Reconstruction (ICJR) Abstract Supplement: Pan Pacific Orthopaedic Congress
July 16 - 19, 2014, Hilton Waikoloa, HI

Vol 4, No 2, June 2014

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Osseointegration Implant Post Coupling With External Prosthetic Limb – Continuation of Previous Case Reports "Stage III"
Ronald W. Hillock, MD; Danny L Tatum, BCP; Edward Dolegowski, PT

Management of Medial Collateral Ligament Injury During Primary Total Knee Arthroplasty: A Systematic Review
Dr. Paul Kenneth Della Torre, BSc, MBBS; Dr. Andrew Stephens, BAppSc, MBBS; Dr. Horng Lii Oh, GCSpMed, MBBS; Dr Akshay Kamra, MBBS; Dr. Bernard Zicat, BSc, MD, CM, FRACS (Orth), FAOrthA; Dr. Peter Walker, MBBS, FRACS (Orth), FAOrthA

Total Hip Stem Classification System
Timothy McTighe, Dr. HS (hc); John Keggi, MD; S. David Stulberg, MD; Louis Keppler, MD; Declan Brazil, PhD; Edward J. McPherson, MD, FACS

Improving Pre-Operative Flexion in Primary TKA: A Surgical Technique EmphasizingKnee Flexion with 5-Year Follow-Up
Edward J. McPherson, MD, FACS; Denise Portugal, MD; Matthew V. Dipane, BA; Sherif M.
Sherif, MD

Subgroup Analysis of Topical Tranexamic Acid in Total Knee Arthroplasty
John R. Tuttle, MD; Walter Anazonwu, BS; Lee E. Rubin, MD

Vol 4, No 1, March 2014

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Massive Pseudotumor in a 28mm Ceramic-Polyethylene Revision THA: A Case Report
Edward J. McPherson, MD, FACS; Matthew V. Dipane, BA; Sherif M. Sherif, MD

Mechanical Performance of a Self-Unplugging Surgical Suction Instrument: A Randomized Controlled Trial
James B. Stiehl, MD

Utility of Carbon Fiber Implants in Orthopedic Surgery: Literature Review
Ronald Hillock, MD; Shain Howard, BS

MOM Failure Modes: An In-Depth Look at Metal Ions and Implant Wear
Tom Donaldson, MD; Ed McPherson, MD; Michelle Burgett, BA; Ian Clarke, PhD

Post-operative Weight Gain After Total Knee Arthroplasty: Prevalence and Its Possible Attenuation Using Intraoperative Sensors
Gregory J. Golladay, MD; Gerald J. Jerry, MD; Kenneth A. Gustke, MD; Martin W. Roche, MD; Leah Elson, BSc; Christopher Anderson, MSc

Does the Kinematch® Prosthesis Impair Knee Flexion in Patients with Trochlear Dysplasia?
Ronald Grelsamer, MD; Paul Cavallaro, BS

Osteolysis with Ceramic on Highly Cross-linked Polyethylene
Joseph Fetto, MD

Grateful for Medical Advancements: Commentary
Timothy McTighe, Dr. HS (hc), Executive Director, JISRF and Editor-in-Chief, Reconstructive Review

Vol 3, No 3, December 2013

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The Fate of the PCL in Cruciate Retaining TKA, A Critical Review of Surgical Technique
Sherif M. Sherif, M.D., Matthew V. Dipane, B.A., Edward J. McPherson, M.D., FACS

Strategies to Decrease Blood Loss in Patients Who Undergo Total Knee Replacement: A Prospective Study of One Hundred and Fifty Cases
Nilen A. Shah, MBBS, D. Orth., MS Orth. (Bombay, India), MCh Orth. (Liverpool, U.K.), Anand Gupta, DNB Orth., and Dipak V. Patel, MD (USA), MSc Orth. (London, U.K.), MS Orth., D. Orth., FCPS Orth. (Bombay, India)

Early Results of a Modular Revision System in Total Knee Arthroplasty
Michael J. Morris, MD; Keith R. Berend, MD; Joanne B. Adams, BFA; Adolph V. Lombardi, Jr., MD, FACS

Modular Femoral Tapered Revision Stems in Total Hip Arthroplasty
Benjamin M. Frye, MD, Keith R. Berend, MD, Michael J. Morris, MD, Joanne B. Adams, BFA, Adolph V. Lombardi, Jr., MD, FACS

Current Concepts in Trochleoplasty for Major Trochlear Dysplasia
Philippe Beaufils, Mathieu Thaunat, Nicolas Pujol, Sven Scheffler, Roberto Rossi, and Mike Carmont

Initial Misdiagnosis of a Traumatic Ceramic Femoral Head Fracture
Mohammad H. Fard-Aghaie, Mustafa Citak, Joao Correia, Carl Haasper, Thorsten Gehrke, and Daniel Kendoff

Successful Closed Reduction of a Dislocated Constrained Total Hip Arthroplasty
Motoki Sonohata, Warit Waewsawangwong, Stuart B. Goodman

A Rare Dissociation at the Neck–Stem Interface
A. Kouzelis, C.S. Georgiou, and P. Megas

Tibial Stress Fracture After Computer-Navigated Total Knee Arthroplasty
F. Massai, F. Conteduca, A. Vadalà†, R. Iorio, L. Basiglini, and A. Ferretti

Stage II Osteointegration Implant (OI) Skin Coupling Procedure (Continuation from Case Report September 2013)
Ronald Hillock, MD, John Keggi, MD, Robert Kennon, MD, Edward McPherson, MD, Terry Clyburn, MD, Declan Brazil, PhD, and Timothy McTighe, Dr. H.S. (hc)

Anesthesia and Pain Control for Osteointegration Implantation Into the Femur
Andrew Zak, MD, Ronald Hillock, MD