Literature
Evidence based literature that is truly important to your orthopaedic clinical practice.
- Written by OrthoBuzz for Surgeons
- Category: Literature
The October 4, 2017 issue of JBJS contains another in a series of “What’s Important” personal essays from orthopaedic clinicians. This “What’s Important” article comes from Drs. Peter Scoles and Shepard Hurwitz. The authors suggest that integration of medical school curricula with the first year of postgraduate training is a practical approach to improving efficiency and reducing costs to both doctors in training and the academic medical centers that help train them. In explaining specific ways to change the paradigm for training orthopaedic surgeons, the authors conclude that an integrative approach would accelerate the process for qualified candidates, while lowering costs and ensuring adequate training opportunities for all.
- Written by OrthoBuzz for Surgeons
- Category: Literature
Osteochondral allograft transplantations (OCAs) are becoming a mainstay of treatment for knee-cartilage injuries. To help ensure that the allograft plug is transplanted with <1 mm of step-off from the surrounding recipient cartilage, many surgeons restrict themselves to orthotopic OCAs—matching the graft-recipient condyles in a lateral-to-lateral or medial-to-medial fashion. However, in the October 4, 2017 issue of The Journal of Bone & Joint Surgery, Wang et al. demonstrated that both orthotopic and non-orthotopic (e.g., lateral condyle-to-medial condyle) OCA resulted in significantly improved outcomes in 77 cases followed for a mean of 4.3 years.
- Written by OrthoBuzz for Surgeons
- Category: Literature
A significant portion of metastatic disease comes with no clear identification of a primary tumor; this is unfortunately the case with many spinal metastases. In the October 4, 2017 issue of The Journal, Ma et al. evaluate the survival and patient-reported quality-of-life (QOL) outcomes for patients with spinal metastases from cancer of unknown primary origin. Their prospective longitudinal study confirms that a more aggressive strategy that combines surgery and radiation therapy results in better QOL (as measured with the four-domain FACT-G instrument) than radiation alone.
- Written by OrthoBuzz for Surgeons
- Category: Literature
Sometimes the most talented, skilled physicians with whom you work are also prone to displaying challenging behaviors. Often, these physicians are not cognizant of how their colleagues perceive them. So how can you—as the supervisor, friend, and/or peer of such clinicians—help ensure that patients continue to benefit from their clinical and surgical gifts without behavioral difficulties diminishing their contributions? On Thursday, October 26, 2017 at 8:00 pm EDT, the American Orthopaedic Association (AOA) and The Journal of Bone & Joint Surgery (JBJS) will host a complimentary webinar that will deliver practical and effective methods you can use to help physicians who are clinically outstanding, but behaviorally difficult, start to make remedial changes.
- Written by OrthoBuzz for Surgeons
- Category: Literature
Minimizing perioperative blood loss during total knee arthroplasty (TKA) helps curtail the risks and costs of allogeneic blood transfusions. Currently, the most popular pharmacological approach to blood conservation is the antifibrinolytic agent tranexamic acid (TXA). But in a randomized trial published in the October 4, 2017 edition of The Journal of Bone & Joint Surgery, Boese et al. found that a similar and much less expensive compound, epsilon-aminocaproic acid (EACA), performed almost as effectively and just as safely as TXA in patients undergoing unilateral knee replacement. Although the 98 patients in the study who received TXA averaged less estimated blood loss than the 96 patients who received EACA, no transfusions were required in either group, and there were no statistically significant or clinically relevant between-group differences in the change in hemoglobin levels.
- Written by OrthoBuzz for Surgeons
- Category: Literature
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.
- Written by OrthoBuzz for Surgeons
- Category: Literature
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).
- Written by OrthoBuzz for Surgeons
- Category: Literature
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.
- Written by OrthoBuzz for Surgeons
- Category: Literature
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.
- Written by OrthoBuzz for Surgeons
- Category: Literature
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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