Literature

Evidence based literature that is truly important to your orthopaedic clinical practice.

Osseous vascular anatomy has always been clinically relevant to orthopaedists, but its importance is sometimes overlooked. In the July 19, 2017 issue of The Journal, Rego et al. provide a precise topographic map of arterial anatomy in and around the femoral head. Ever since Trueta’s classic work published in the British volume of JBJS in 1953, we’ve known that the terminal branches of the medial femoral circumflex system (also known as the lateral epiphyseal artery complex) supply blood to the majority of the femoral head.

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OrthoBuzz occasionally receives posts from guest bloggers. This guest post comes from Jason Weisstein, MD, MPH, FACS. Selecting and/or changing your electronic health record (EHR) system is an investment of time, money, and training. There should be a thorough vetting process in place so you can select the right technology for your practice. One of the many questions you should ask when evaluating an EHR for your practice is the system’s ability to capture and display data. Data capture and analysis are critical for many reasons, one of which is reporting for the Merit-Based Incentive Payment System (MIPS).

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More than 900,000 patients every year undergo knee arthroscopy in the US. Many of those procedures involve a partial meniscectomy to address symptomatic meniscal tears. Surgeons “scoping” knees under these circumstances often encounter a chondral lesion—and most proceed to debride it. However, in the July 5, 2017 issue of JBJS, Bisson et al. report on a randomized controlled trial that suggests there is no benefit to arthroscopic debridement of most unstable chondral lesions when they are encountered during partial meniscectomy. With about 100 patients ≥30 years old in each group, the authors found no significant differences in function and pain outcomes between the debridement and observation groups at the 1-year follow-up.

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Are you confused and frustrated by Medicare’s Quality-Incentive Programs, such as the Merit Based Incentive Payment System (MIPS), Comprehensive Care for Joint Replacement (CJR) program, and the Surgical Hip and Femur Fracture Treatment (SHFFT) model?  If so, this webinar is for you. On Tuesday, August 15, 2017 at 8:00 PM EDT,  The Journal of Bone & Joint Surgery (JBJS) and the American Orthopaedic Association (AOA) will host a complimentary LIVE webinar featuring the following speakers and topics:Brian McCardel, MD will discuss choosing MIPS-related quality measures, improving performance on those measures, and qualifying for bonuses.

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People 100 years old and older—centenarians—make up only 0.02% of the current US population. Nevertheless, the number of centenarians is expected to increase five-fold by 2060. That is in part what prompted Manoli III et al. to analyze a large New York State database to determine whether patients ≥100 years old who sustained a hip fracture fared worse in the hospital than younger hip-fracture patients. The study appears in the July 5, 2017 issue of The Journal of Bone & Joint Surgery. Only 0.7% of the more than 168,000 patients ≥65 years old included in the analysis sustained a hip fracture when they were ≥100 years old.

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The estimated annual cost of surgical treatment for anterior cruciate ligament (ACL) ruptures in the US is $2 billion. Are ACL surgery patients—and the health care system—getting significant value for all that money spent? In the May 3, 2017 issue of The Journal of Bone & Joint Surgery, Nwachukwu et al. set out to answer that question by retrospectively analyzing rates of return to play and satisfaction among 231 ACL-surgery patients (mean age of 27 years) who were followed for a mean of 3.7 years.

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In 2015, JBJS launched an“article exchange” collaboration with the Journal of Orthopaedic & Sports Physical Therapy (JOSPT) to support multidisciplinary integration, continuity of care, and excellent patient outcomes in orthopaedics and sports medicine. During the month of May 2017, JBJS and OrthoBuzz readers will have open access to the JOSPT article titled “Risk of Recurrence of Low Back Pain (LBP): A Systematic Review.” In that systematic review, the authors found low quality and heterogeneity among studies of this topic. They concluded that “the available research does not provide robust estimates of the risk of LBP recurrence and provides little information about factors that predict recurrence in people recently recovered from an episode of LBP.

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Shoulder surgery for complex conditions such as irreparably large rotator cuff tears has been revolutionized by the concept of reverse total shoulder arthroplasty (rTSA). Improved design of rTSA implants by multiple manufacturers has resulted in excellent functional outcomes from these procedures. I have been educated by my shoulder colleagues to the fact that primary rTSA is actually technically less demanding than primary anatomic TSA because of greater exposure of the scapula/ glenoid anatomy. When anatomic TSA clinically and/or radiographically fails, conversion to rTSA is an alternate to revision anatomic TSA.

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Spring and Summer 2017 are busy seasons for Own the Bone, the American Orthopaedic Association’s national post-fracture, systems-based, multidisciplinary fragility fracture prevention initiative: Webinar: Components of a Secondary Fracture Prevention Program – May 4 On Thursday, May 4, at 5:00pm CDT (6:00pm EDT) Paul A. Anderson, MD, FAOA, from the University of Wisconsin, and Karen Cummings, PA-C, from the University of Michigan, will discuss the components of a successful secondary fracture prevention program. Own the Bone Charlotte Symposium – June 23: Fragility Fracture Care Coordination and Secondary Fracture Prevention Join the National Association of Orthopaedic Nurses (NAON) and The American Orthopaedic Association for this full-day event on Friday, June 23.

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An estimated 40% of total costs from a total hip arthroplasty (THA) episode are accrued from post-discharge services.  With that in mind, Austin et al. embarked on a randomized controlled trial comparing outcomes among two groups of primary THA patients: those who followed a 10-week self-directed home exercise regimen (n=54) and those who received a combination of in-home and outpatient physical therapy (PT) for 10 weeks (n=54). The results were published in the April 19, 2017 edition of The Journal of Bone & Joint Surgery. At 1 month and 6 to 12 months after surgery, patients in both groups showed significant preoperative-to-postoperative improvements in function as measured by all administered instruments (Harris Hip Score, WOMAC Index, and SF-36 Physical Health Survey).

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