Literature

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

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, James Ninomiya, MD, MS, lead author of the September 21, 2016 Specialty Update on Hip Replacement, selected the five most clinically compelling findings from among the nearly 70 studies summarized in the Specialty Update. Bearing Survivorship –A meta-analysis found no differences in short- and medium-term implant survivorship among the following three bearing combinations used in THA patients younger than 65 years of age: ceramic on ceramic, ceramic on highly cross-linked polyethylene, and metal on highly cross-linked polyethylene.

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The practice of orthopaedic surgery is moving fairly rapidly to the outpatient environment. Advances in less invasive surgical procedures, regional anesthesia, and postoperative pain management have provided the foundation for this transition. The migration to outpatient surgery centers enables surgeons to use surgical teams more focused on orthopaedic technology and practice parameters. The concern that arises in everyone’s mind, though, is the issue of safety. In the October 19, 2016 issue of JBJS,Qin et al. analyzed the NSQIP database and found that the outpatient surgical treatment of patients with a closed ankle fracture and minimal comorbidities resulted in lower risk of pneumonia and no difference in surgical morbidity, reoperations, and readmissions when compared with inpatient surgery.

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The October 5, 2016 issue of JBJS contains the first 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. The first “What’s Important” piece comes from Dr. Terry Light—professor, orthopaedic department chair, and residency program director at Loyola Stritch School of Medicine. In his essay titled “The Unhappy Patient,” Dr. Light stresses the importance of validating patient concerns “with an open ear.” If you would like JBJS to consider your “What’s Important” story for publication, please submit a manuscript via Editorial Manager.

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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 October 2016.What’s New in Adult Reconstructive Knee SurgeryThe Effect of Timing of Manipulation Under Anesthesia to Improve Range of Motion and Functional Outcomes Following Total Knee ArthroplastyNonsurgical or Surgical Treatment of ACL Injuries: Knee Function, Sports Participation, and Knee ReinjuryTopical Intra-Articular Compared with Intravenous Tranexamic Acid to Reduce Blood Loss in Primary Total Knee ReplacementTotal Knee Replacement in Young, Active Patients: Long-Term Follow-up and Functional OutcomeKnee studies offered on the JBJS Knee Spotlight will be updated monthly, so check the site often.

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Excellent communication is critical to helping patients understand medical information—and to achieving truly “informed” consent for invasive and noninvasive interventions. Effective patient-provider communication also results in better information retention and more reasonable expectations of treatment outcome, and it’s one hallmark of a high-quality patient experience. In the October 5, 2016 edition of The Journal, Egekeze et al. report the results of a randomized clinical trial evaluating retention of information provided to patients newly diagnosed with knee osteoarthritis. Each of 67 participants was randomized to receive one of three informed-consent information-delivery protocols, all of which lasted 10 minutes:A one-on-one clinician-delivered lecture about knee arthritis, written at an eighth-grade reading level (auditory input only)The same lecture as above but accompanied by a silent animated knee video (auditory + visual input).

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It is not often that readers of scholarly journals have a “Wow!” moment, a chance to be unexpectedly delighted by a new discovery.1 In the September 14, 2016 edition of JBJS Case Connector, Zhang et al. provide readers of the JBJS family of journals the first of what we hope will be many such moments: the ability to link to and navigate a digital, whole-slide image (WSI) of an entire microscope slide. Figure 1 Illustrating the histology of tumors and the tissue-level details in basic science studies has long been a challenge. Until recently, readers were usually subjected to the few fields of view that the author chose to photograph.

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A substantial number of patients, old and young, who sustain a proximal humeral fracture are managed with Kirschner wires (K-wires). Surgeons are especially likely to opt for wires over other forms of fixation when they need to protect the repair of a concomitant neurovascular injury, or in cases in which the patient cannot tolerate a more invasive surgery. However, there is a somewhat frequent and potentially lethal drawback to using wires about the shoulder girdle. This latest JBJS Case Connector “Watch” looks at several cases in which wires were adequately placed in the shoulder but subsequently moved to other parts of the body.

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Thumbs account for approximately 40% of human hand function, playing a critical role during work, play, and activities of daily living.  Arthritis at the base of the thumb (basilar or trapeziometacarpal joint) is one of the most common forms of hand osteoarthritis, affecting as many as 40 percent of the female population older than 55. This complimentary webinar, hosted jointly by The Journal of Bone & Joint Surgery (JBJS) and the Journal of Orthopaedic & Sports Physical Therapy (JOSPT), will look at the efficacy of both nonoperative and surgical approaches to basilar thumb arthritis.Co-authors Jorge Villafañe, PT, PhD, and Joshua Cleland, PT, PhD, will discuss results from a randomized trial in JOSPTthat compared a multimodal program of exercise and mobilization to a placebo in the management of basilar thumb arthritis.

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This month’s Image Quiz from the JBJS Journal of Orthopaedics for Physician Assistants (JOPA) presents the case of a 74-year-old woman with a 2-month history of left knee pain. She was given an intra-articular knee injection for presumed osteoarthritis, which failed to provide any relief. At a follow-up visit, clinicians obtained the MRI shown here. Pick among five possible diagnoses: secondary osteonecrosis, transient osteoporosis, spontaneous osteonecrosis, osteochondritis dissecans, or bone marrow edema lesion. Share this story: FacebookLinkedInTwitter Like this:

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Sport activity continues to increase in priority in modern society. And with a concomitant increase in single-sport focus early in life and near year-round training, the incidence of knee injuries will also continue to increase.  Among surgeons and patients, there has been some waning of interest in high tibial osteotomy (HTO) for the most common form of unicompartmental arthritis because results from   unicompartmental arthroplasty keep improving, but HTO remains an appropriate choice for patients with very high functional demand. In the September 21, 2016 issue of The Journal, Ekhtiari et al. report on the findings of a well-conducted systematic review on return-to-work and -sport outcomes of HTO.

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