AAOS Now, June 2017
Is Surgical Approach a Risk Factor for Early Failure in THA?
Total hip arthroplasty (THA) is a reliable treatment for reducing pain and improving function in patients with osteoarthritis of the hip. However, the rate of revision THA procedures being performed is on the rise and is expected to continue to increase, according to of OrthoCarolina's Hip & Knee Center. "In order to improve long-term THA survivorship, we need to better understand the etiology and risk factors for early failure in primary total hips," he said.
What are the Benefits of the Perioperative Surgical Home?
"Setting [a] goal as cost containment, rather than value improvement, has been devastating to healthcare reform efforts. A focus on value, not just costs, avoids the fallacy of limiting treatments that are discretionary or expensive but truly effective." —Michael Porter, PhD, in "What is the value in health care?
After the Error
In the January 2017 issue of AAOS Now, my coauthor Robert J. MacArthur, MD, shared a first-person account of how a wrong-side knee procedure could occur in the era of Universal Protocol. I—David Ring, MD, PhD—also have a personal story of medical error. In 2008, I published an account of my wrong procedure—a carpal tunnel release in a patient who should have had a trigger finger release—and later spoke about my error at several meetings across the country.
Safety Program May Help "Turn the Tables on Concussion"
A study involving more than 2,500 high school football players in South Carolina found that those on teams that had participated in the USA Football Heads Up safety program had concussion rates 33 percent lower than those on teams that had not. The study was presented at the Game Changers Paper Session at the AAOS Annual Meeting in San Diego by John M. Tokish, MD.
Using Telemedicine for Orthopaedic Follow-Up
My first experience with using telemedicine for orthopaedic follow-up was in August 2014. I had performed an anterior cruciate ligament reconstruction on a 17-year-old male named Tom, who lived about 90 miles from our hospital. A week later, during a casual conversation with his father, I learned that Tom was doing well recovering at home, but was having trouble adjusting his postoperative brace. Tom's dad asked if I could "FaceTime" with Tom and show him how to adjust it.
Fighting for Funding
Nearly one of every three Americans will have a musculoskeletal condition in his or her lifetime, costing an estimated $874 billion in annual treatment and lost wages. Yet the federal funding allocated to musculoskeletal research is disproportionate to the economic burden of orthopaedic diseases and disorders. For the past 14 years, the AAOS, in conjunction with multiple specialty societies, has assembled orthopaedic patients, physicians, and researchers in Washington, D.C.
What to Expect for That First Job
The turnover rate for newly graduated orthopaedic surgeons in their first job is astoundingly high (70 percent to 80 percent), according to some sources. This is challenging not only for the young orthopaedic surgeon who often is forced to uproot his or her family to move for another job, but also for the employers who often invest significant capital in the new orthopaedic practice.
Consensus Performance Standards for Hip, Knee, and Shoulder Arthroplasty Devices
Orthopaedic surgeons are often barraged with offers to examine and use a variety of modified or new surgical techniques. These techniques often involve new instruments, new implants, or devices that have new materials associated with them. The selection of a specific surgical device, method, or approach is affected by a number of factors, such as the device's suitability for the procedure and whether it is sufficiently strong, compliant, and biocompatible.
In Search of a Biologic for Treating Back Pain
Samuel K. Cho, MD, a spine surgeon and research scientist on the faculty at Icahn School of Medicine at Mount Sinai in New York City, is leading an exploration of the molecular biology of notochordal cells. He is particularly interested in what chemical factors they may release or trigger that contribute to healthy disk cells.
No Test Is Too Sensitive, But Those Who Think So Are Almost Correct
Diagnostic tests, especially laboratory tests and imaging, are at the heart of orthopaedic decision-making. Some tests are highly sensitive, generating a lot of true positive results, but also generating a lot of false positive results. For example, the use of broad-range PCR (polymerase chain reaction) testing to detect joint infection may have high sensitivity but has been critiqued for a high rate of false positives.