Literature

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

OrthoBuzz occasionally receives posts from guest bloggers. This guest post comes from Leon S. Benson, MD. Appropriate Use Criteria (AUC) are suggested treatment algorithms for a variety of common orthopaedic conditions, published by the American Academy of Orthopaedic Surgeons. These algorithms follow logically from the AAOS’s earlier work in publishing Clinical Practice Guidelines, and the methodology behind development of Appropriate Use Criteria is available in great detail on the AAOS website. It is clear that the recent creation of Appropriate Use Criteria for carpal tunnel syndrome (CTS), like the other AUC algorithms, was very thoughtful and included the input of numerous experts.

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Given the prevalence of opioid prescriptions, many patients present for total knee arthroplasty (TKA) having been on long-term opioid therapy. In the January 4, 2017 edition of The Journal of Bone & Joint Surgery, Ben-Ari et al. determined that patients taking opiate medications for more than three months prior to their TKA were significantly more likely than non-users of opioids to undergo revision surgery within a year after the index procedure. Among the more than 32,000 TKA patients from Veterans Affairs (VA) databases included in the study, nearly 40% were long-term opioid users prior to surgery.

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In the January 4, 2017 issue of The Journal, Swart et al. provide a well-done Markov decision analysis on the cost effectiveness of three treatment options for femoral neck fractures in patients between the age of 40 and 65: open reduction and internal fixation (ORIF), total hip arthroplasty (THA), and hemiarthroplasty. Plugging the best data available from the current orthopaedic literature into their model, the authors estimated the threshold age above which THA would be the superior strategy in this relatively young population.

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OrthoBuzz occasionally receives posts from guest bloggers. This guest post comes from Grigory Gershkovich, MD. Shoulder arthroplasty continues to grow in popularity, and as the number of shoulder arthroplasties rises, so will the number of revisions. Infection is one major reason for shoulder arthroplasty failure, and Propionibacterium has been increasingly recognized as a major culprit. However, Propionibacterium infection is difficult to diagnose. Despite improved detection techniques, diagnosis at the time of revision remains elusive because obvious signs of acute infection are often absent. The need to perform explantation in the setting of clinically apparent periprosthetic infection is obvious, but the appropriateness of single-stage revision with antibiotic treatment in shoulders with only apparent mechanical failures remains questionable.

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OrthoBuzz occasionally receives posts from guest bloggers. This guest post comes from Brett A. Freedman, MD. In the December 21, 2016 edition of the Journal of Bone & Joint Surgery, Bunta, et al. published an analysis of data from the Own the Bone quality improvement program collected between January 1, 2010 and March 31, 2015. Over this period of time, 125 sites prospectively collected detailed osteoporosis and bone health-related data points on men and women over the age of 50 who presented with a fragility fracture.

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The recently launched JBJS Knee Spotlight offers highly relevant and potentially practice-changing knee content from the most trusted source of orthopaedic information. Here are the five JBJS articles to which you will have full-text access through the Knee Spotlight during the month of January 2017: Differences in Short-Term Complications Between Unicompartmental and Total Knee Arthroplasty: A Propensity Score Matched Analysis Extensor Mechanism Allograft Reconstruction for Extensor Mechanism Failure Following Total Knee Arthroplasty What’s New in Adult Reconstructive Knee Surgery Bicruciate Substituting Design Does Not Improve Maximal Flexion in Total Knee Arthroplasty: A Randomized Controlled Trial

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As an end-of-year thank-you to the orthopaedic community, we’re offering limited-time full-text access to the five most-read JBJSReviews articles during 2016. The fact that several of these most-read articles were published prior to 2016 is testament to the durable utility of the orthopaedic information published in JBJS Reviews.Treatment of Proximal Humeral Fractures (2016)Arthroscopic Single-Row Versus Double-Row Repair for Full-Thickness Posterosuperior Rotator Cuff TearsTreatment of Proximal Humeral Fractures (2014)The Evaluation and Treatment of Pediatric Tarsal CoalitionsAcute Distal Radioulnar Joint Instability in Adults Share this story: FacebookLinkedInTwitter

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The exact mechanism by which osteochondritis dissecans (OCD) lesions develop is poorly understood. This month’s “Case Connections” spotlights 3 case reports of OCD in young baseball players, 2 of whom developed the condition in the shoulder. A fourth case report details 3 presentations of bilateral OCD of the femoral head that occurred in the same family over 3 generations. The springboard case report, from the December 28, 2016, edition of JBJS Case Connector, describes a 16-year-old Major League Baseball (MLB) pitching prospect in whom an OCD lesion of the shoulder healed radiographically and clinically after 8 months of non-throwing and physical therapy focused on improving range of motion and throwing mechanics.

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As an end-of-year thank-you to the orthopaedic community, we’re offering limited-time full-text access to the five most-read JBJS articles of 2016. The fact that several of these most-read articles were published prior to 2016 is testament to the durable utility of orthopaedic research published in The Journal of Bone & Joint Surgery.Bariatric Orthopaedics: Total Hip Arthroplasty in Super-Obese PatientsAntibiotic-Impregnated Cement Spacers for the Treatment of Infection Associated with Total Hip or Knee ArthroplastyThe Surgical Management of Chronic Tophaceous GoutRotator Cuff Tear Arthropathy: Evaluation, Diagnosis, and TreatmentAn Algorithmic Approach to the Management of Recurrent Lateral Patellar Dislocation

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The Ponseti method is a proven treatment for idiopathic clubfoot, yielding excellent outcomes with minimal pain or disability. However, as many as 40% of patients fail to respond to initial treatment or develop recurrent deformities. On Wednesday, January 25, 2017 at 8:00 PM EST, The Journal of Bone & Joint Surgery will host a complimentary webinar that delves into two recent JBJS studies investigating how to predict which patients are most likely to get subpar results from the Ponseti method, and how best to manage clubfoot relapses if they occur.

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