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 Chad Krueger, MD, in response to an article at MedCityNews.com that announced a 3-D printing alliance between Johnson & Johnson and HP. There’s much focus lately on healthcare concepts in which each patient’s treatment is tailored to his or her specific condition, anatomy, and, in some cases, genetic make-up. Within that realm of so-called “personalized medicine,” surgeons are becoming increasingly interested in tailoring procedures and implants to specific individuals. The MedCity News article discusses how Johnson & Johnson has partnered with HP to further develop 3-D printing capabilities, with a goal of giving surgeons more patient-specific options.

Read more ...

Orthopaedists frequently treat knee osteoarthritis with hyaluronic acid (HA) or corticosteroid injections, but which works better? The 99 patients in a double-blinded randomized controlled trial by Tammachote et al. in the June 1, 2016 Journal of Bone & Joint Surgery received a single intra-articular injection of either 6 mL of hylan G-F 20, or 1 mL of 40-mg triamcinolone acetonide plus 5 mL of 1% lidocaine. At the six-month follow-up, both groups experienced significant and similar improvements in knee pain, function, and range of motion, without complications. But there were short-term distinctions:  Triamcinolone relieved pain better and faster in the first week, after which the effect became similar to that of HA.

Read more ...

I think it’s safe to say that the anterior cruciate ligament (ACL) is the most-studied anatomic structure in the musculoskeletal system.  Yet more than a century ago, French surgeon Paul Segond identified a lesser structure in the knee, the anterolateral ligament (ALL), presuming it to be an important stabilizer of that joint. More recent research has associated this ligament with the anterolateral joint line capsular avulsion fragments associated with some ACL ruptures. A “fashionable” interest in the ALL has re-emerged in that cyclic way orthopaedic surgical techniques and indications are prone to. Some surgeons are designing reconstruction procedures in which the ALL is addressed in addition to the ACL.

Read more ...

Ample research has revealed that a patient’s psychological status influences the outcomes of many medical interventions. While orthopaedists treating patients with multiple-system orthopaedic trauma might not think first of the patient’s mental health, they should definitely take it into account, according to a prognostic study by Weinberg et al. in the March 2, 2016 Journal of Bone & Joint Surgery. The study found that depression was an independent predictor of increased complications among 130 polytrauma patients who had preexisting psychiatric disorders. The authors also found that, relative to patients managed by a general trauma surgery service, those managed by an orthopaedic surgery service were less likely to receive their home psychiatric medications while hospitalized and were less likely to receive instructions for mental-health follow-up upon discharge.

Read more ...

Whether and when to surgically treat injuries to the anterior cruciate ligament (ACL) remain difficult questions for patients, doctors, and physical therapists to answer. On Wednesday, March 30, 2016 at 12:30 pm EDT, a complimentary webinar, hosted jointly by JBJS and the Journal of Orthopaedic & Sports Physical Therapy (JOSPT), will arm orthopaedists and physical therapists with up-to-date information to help ensure the best possible clinical decisions for patients with ACL injuries. Hege Grindem, PT PhD, will present the JBJS paper, “Nonsurgical or Surgical Treatment of ACL Injuries,” and Vincent Eggerding, MD, will present the JOSPT systematic review, “Factors Related to the Need for Surgical Reconstruction After ACL Rupture.

Read more ...

In the March 2, 2016 edition of JBJS, Rongen et al. air some dirty laundry regarding the orthopaedic community’s registering and reporting on randomized controlled trials (RCTs). According to the authors, only 25% of 362 RCTs published in the top-ten orthopaedic journals between January 2010 and December 2014 were reported as having been registered. Furthermore, of those 25%, only 47% were registered before the end of the trial, and only 38% of those 25% were registered before the enrollment of the first patient, as specified by the International Committee of Medical Journal Editors (ICMJE). Additionally disheartening is the finding that among the 26 trial reports that the authors deemed eligible for evaluation of consistency between the registered outcome measure(s) and outcomes reported in the published article, 14 (54%) were found to have one or more outcome-measure discrepancies.

Read more ...

Increasingly, the care of patients with musculoskeletal problems is being provided by teams of providers with varied professional backgrounds and diverse types of experience. On March 1, 2016, JBJS Reviews presented its inaugural “team approach” article, entitled “Treatment of Head and Neck Injuries in the Helmeted Athlete,” by Diduch et al. The article summarizes updated recommendations for on-field and in-hospital injury evaluation, spine-boarding, and equipment removal. Throughout, the authors stress that initial and follow-up steps in the process are a team effort that may involve the athletic trainer, team physician, EMS provider, and emergency, orthopaedic, and primary-care physicians. Insisting that team collaboration should begin prior to any athletic competition or event, the authors strongly recommend preseason training and pregame time-outs for all members of the sidelines medical team to clarify roles, responsibilities, and communication strategies.

Read more ...

As new advances in medical technology lead to treatments for injuries and diseases, one concept that has emerged is the importance of genetic predisposition to health, sickness, and functional recovery after trauma. Indeed, as the future of medicine will most likely concentrate on health as opposed to health care, understanding the genetic predisposition to medical conditions will become paramount. In the February 2016 issue of JBJS Reviews,Prodromidis and Charalambous focus on the role of genetics in the development and treatment of frozen shoulder. This article represents a careful analysis of the relationship between genetics and disease. Frozen shoulder, or adhesive capsulitis, is a common condition that leads to functional loss and impairment of activities of daily living.

Read more ...

When it comes to acetabular cup positioning during total hip arthroplasty (THA), precision really matters. Malpositioned cups increase the risk of dislocation, early wear, and loosening, among other unwanted outcomes. In the January 20, 2016 issue of The Journal of Bone & Joint Surgery, Sariali et al. report on results of a randomized trial that compared cup positioning guided by three-dimensional (3-D) visualization tools used intraoperatively (28 patients) with freehand cup placement (28 patients). Cup anteversion was more accurate in the 3-D planning group, and the percentage of anteversion outliers according to the Lewinnek safe zone was lower in the 3-D planning group.

Read more ...

“First do no harm.” Patients undergo operative procedures with the inherent belief that their surgeon will perform the operation in a safe and effective manner, and, certainly, on the correct organ or body part. However, recent data suggest that in orthopaedic surgery alone, 21% of hand surgeons, 50% of spine surgeons, and 8.3% of knee surgeons have performed wrong-site surgery at least once during their career. These are astonishing numbers! Orthopaedic surgeons are at increased risk of performing wrong-site surgery, mainly because of the inherent nature of the musculoskeletal system. Anatomic factors such as laterality, multiple digits, and different spinal levels predispose to wrong-site surgery.

Read more ...

Submit Community Content

If you have orthopedic information that you would like to share with the Orthogate Community, please register/login and submit your news, event, job, article, case or workshop from the Submit Content menu under the My Account area. Learn more!