Literature

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

On Thursday, February 23, 2017, at 6:00 pm EST, the Own the Bone initiative will offer a webinar titled “Atypical Fractures and Osteoporosis Medication Considerations” James Goulet, MD, from the University of Michigan, will discuss atypical fractures and other rare outcomes of the use of osteoporosis medication, including what to look for and how to treat these occurrences.  He will also address drug holidays, and how and when to continue treatment on these complex cases. The American Orthopaedic Association (AOA) developed Own the Bone as a quality improvement program to address the osteoporosis treatment gap and prevent subsequent fragility fractures.

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Every month, JBJS publishes a Specialty Update—a review of the most pertinent and impactful studies published in the orthopaedic literature during the previous year in 13 subspecialties. Click here for a collection of all OrthoBuzz Specialty Update summaries. This month, Gwo-Chin Lee, MD, author of the January 18, 2017 Specialty Update on Adult Reconstructive Knee Surgery, selected the five most clinically compelling findings from among the more than 100 studies summarized in the Specialty Update. Nonoperative Knee OA Treatment —Weight loss is one popular nonoperative recommendation for treating symptoms of knee osteoarthritis (OA). An analysis of data from  the Osteoarthritis Initiative found that delayed progression of cartilage degeneration, as revealed on MRI and clinical symptoms, positively correlated with BMI reductions >10% over 48 months.

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OrthoBuzz regularly brings you a current commentary on a “classic” article from The Journal of Bone & Joint Surgery. These articles have been selected by the Editor-in-Chief and Deputy Editors of The Journal because of their long-standing significance to the orthopaedic community and the many citations they receive in the literature. Our OrthoBuzz commentators highlight the impact that these JBJS articles have had on the practice of orthopaedics. Please feel free to join the conversation by clicking on the “Leave a Comment” button in the box to the left.

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OrthoBuzz occasionally receives posts from guest bloggers. This guest post comes from Richard Yoon, MD. With 6 months left in my trauma fellowship, the excitement, anticipation, and sometimes terror around finally beginning my young career continues to build. However, on a flight back from the recent AOTrauma Fellows Course, I also became equally excited (but not so terrified) about the opportunity to start paying it forward. Being surrounded by some of the best minds in orthopaedic trauma, both young and seasoned, was not only a boost for our clinical acumen, but more importantly was also inspirational.

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The February 1, 2017 issue of JBJS contains the fourth of a series of personal essays in which orthopaedic clinicians tell a story about a high-impact lesson they learned that has altered their worldview, enhanced them personally, and positively affected the care they provide as orthopaedic physicians. This “What’s Important” piececomes from Dr. Chad Krueger of the Womack Army Medical Center. In his essay titled “Being Present,” Dr. Krueger emphasizes that family and friends are too easily taken for granted amid clinical and research demands.

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Single-anesthetic bilateral total hip arthroplasty (THA) has had a historically high perioperative complication profile. However, a matched cohort study by Houdek et al. in the January 4, 2017 edition of JBJS comparing single-anesthetic versus staged bilateral THA over four years found no significant differences between the two procedures in terms of:Risks of revision, reoperation, or complications (including DVT/PE, dislocation, periprosthetic fracture, and infection; see graph, where blue line represents single-anesthetic and red line indicates staged)Perioperative mortalityDischarge to home versus rehabThe single-anesthetic group (94 patients, 188 hips) experienced shorter total operating room time and hospital length of stay than the matched cohort, and consequently the single-anesthetic approach lowered the relative total cost of care by 27%.

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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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