AAOS Now, April 2018
New AUC on DDH Offers Guidance for Pediatricians and Orthopaedists
At the AAOS 2018 Annual Meeting in New Orleans, the AAOS Board of Directors approved the release of Appropriate Use Criteria covering Management of Developmental Dysplasia of the Hip (DDH) in Infants Up to 6 Months of Age. Based on the Academy’s previously issued Clinical Practice Guideline (CPG) on DDH, this new AUC is noteworthy because it provides a customized version for orthopaedic surgeons as well as generalists/pediatricians.
Tips for Implementing Previsit Patient-reported Outcomes Collection
Quantifying pain intensity and magnitude of physical limitations using patient-reported outcomes measures (PROMs) can help determine whether and how well specific interventions will lead to meaningful improvements. But routine collection of PROMs is a challenge, as evidenced by the 30 percent to 80 percent response rate generated by joint registries.
AAOS Tackles Controversies Surrounding the Use of Biologics in Orthopaedic Surgery
Clinical use of biologics to treat orthopaedic problems has greatly outpaced the evidence. This rise is primarily due to widespread use of “minimally manipulated” autologous therapies that are either blood products or have been interpreted as falling within the Public Health Service Act Section 361 pathway, which does not require premarket approval from the U.S. Food and Drug Administration (FDA).
Universal Protocol Is a Team Responsibility
The AAOS Patient Safety Committee continues to address important issues with its series of roundtable discussions. The following roundtable focuses on how to use universal protocol more effectively by including the surgical team as active participants in the process and how doing so can lead to a safer and more efficient operating room (OR). Moderator David Ring, MD, PhD, Patient Safety Committee chair, led the discussion, which included Michael Archdeacon, MD; Dwight W.
MRI Safety Update 2018: Is Contrast Safe?
A 41-year-old woman has a rapidly growing wrist mass that does not seem typical for a ganglion. Her orthopaedic surgeon recommends a contrast-enhanced magnetic resonance imaging (MRI) scan to evaluate for a potential mass. However, the patient explains that she does not want to get “gadolinium poisoning.” How do you address her concerns? MRI creates exquisitely detailed images of the body using a combination of a strong magnetic field, radiofrequency excitations, and advanced mathematics.
Do AAOS ACL Injury Recommendations Impact Patient Care?
Anterior cruciate ligament (ACL) tears are high-profile injuries. Every week, they are highlighted on sports TV, radio, and social media. Here in Houston, Texans rookie quarterback Deshaun Watson’s strong campaign for NFL rookie of the year was abruptly halted by an ACL tear. If we look at the sport the rest of the world calls football, the United States women have a stellar record in World Cup competition. However, U.S.
Decision Aids Enhance Patient-Provider Communication
“Medical decision science is a field that encompasses several related pursuits,” wrote the authors of the 2008 article “Medical Decision Making: A Physician’s Guide.” “As a normative endeavor, it proposes standards for ideal decision making. As a descriptive endeavor, it seeks to explain how physicians and patients routinely make decisions, and has identified both barriers to, and facilitators of, effective decision making.
Depression Associated with Low Patient Satisfaction Scores Following Hallux Valgus Surgery
Depression is often associated with poor subjective outcomes following orthopaedic surgery, yet the relationship between the mood disorder and hallux valgus surgery has not been well studied. “Depression is prevalent in this population, and outcomes after surgical correction of hallux valgus can sometimes be suboptimal,” said Rachel Shakked, MD, of The Rothman Institute in Philadelphia. Dr.
Study Found Low Follow-up Rates in Patients Who Underwent Surgery for Traumatic Pelvic Injuries
A study that followed patients in Kentucky who were treated surgically for unstable pelvic ring injuries found that 12 percent of them did not appear for a single follow-up appointment, and 41 percent did not complete the 90-day global period. Patients who were older and who had diabetes were less likely to follow up, as were those who lived farther away from the trauma center.
BMI Affects Mortality Risk After Revision TKA
The impact of obesity on complications after primary total knee arthroplasty (TKA) is well known. Less understood, however, are the effects of obesity on the long-term mortality risk in patients undergoing revision TKA. Researchers at the Mayo Clinic sought to assess the association between body mass index (BMI) and mortality risk in a large cohort of patients undergoing revision TKA.
Cartilage Wear Pattern May Help Identify Pre-arthritic Hip Disorder
Cartilage lesions in patients with symptomatic, pre-osteoarthritic diseases are very common, according to Cecilia Pascual-Garrido, MD, who presented results from Paper 899, “Are there Disease-Specific Articular Cartilage Wear Patterns in Various Pre-arthritic Hip Disorders?” during the AAOS 2018 Annual Meeting. Dr.
Study: Pin Site Overlap in Staged Tibial Fixation Not Related to Infection Risk
A study of distal tibial pilon fractures managed with external fixation followed by definitive fixation found no association between pin site overlap and the development of deep infection. The study, presented at the AAOS 2018 Annual Meeting by Jeffrey Potter, MD, FRCSC, also found no relationship between infection and the distance between proximal plate extent and pin site.