Literature

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

JBJS is helping celebrate Peer Review Week 2016 by formally recognizing some of its top reviewers for their contributions. Each day during Peer Review Week 2016, JBJS will profile three different top reviewers on OrthoBuzz. The week will culminate with a listing of our current Elite Reviewers. Today, let’s meet Harry McKellop, Gordon Groh, and Philipp Moroder: Harry McKellop, PhD UCLA What do you like best about reviewing for JBJS? It helps to keep me informed of the latest accomplishments in research; I usually am able to suggest ways for the authors to improve their manuscripts; in the end, it is a benefit to the orthopaedic community and the patients. How do you find time to review for JBJS? I am a “retired” emeritus professor; but I always considered reviewing for JBJS as an enjoyable way for giving  back to the profession. What do you see as JBJS’ role in shaping the future of orthopaedics? The research and clinical papers provide valuable information and guidelines for improving the quality of care to the patients. Gordon Groh, MD Mission Health What do you like best about reviewing for JBJS? Reviewing offers me the opportunity to “make a bigger impact.

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Data published in the September issue of the Journal of Orthopaedic Research emphasize a need for care in performing subacromial lidocaine injections to treat rotator cuff tears. 

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OrthoBuzz occasionally receives posts from guest bloggers. This guest post comes from Brett A. Freedman, MD, in response to a study published in JAMA about a new agent to prevent fractures in postmenopausal women with osteoporosis. The August 16, 2016 issue of JAMA published the results of the ACTIVE (Abaloparatide Comparator Trial In Vertebral Endpoints) trial.  This 28-site randomized trial allocated postmenopausal women with low bone mineral density (BMD) and/or a prior fragility fracture into one of three arms:  abaloparatide (80 µg subcutaneously, daily ) vs. daily placebo injection vs. teriparatide (20 µg subcutaneously, daily).  The primary end point was new vertebral fracture over the 18-month trial.

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Total hip arthroplasty made its debut about 60 years ago. As with most new technologies, it was anticipated that advances and improvements would occur. However, the improvements have been incremental and in some cases have led to problems, particularly with regard to interchangeable parts, modularity, and the materials used for articulating surfaces. Some still believe that total hip arthroplasty was close to being optimized at the time that it was introduced. Some may view these comments as somewhat provocative, but I would not be surprised if a lot of surgeons agree. The issue of trunnion wear is one example of these problems.

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The answer to that question depends largely on how much the 90-day episode of care actually costs. Virk et al., in the August 17, 2016 edition of JBJS, provide benchmark data that could help policymakers design bundled payments for cervical fusions that are economically viable for providers. The authors analyzed the Medicare 5% National Sample Administrative Database and found that 4,506 patients in that cohort underwent a one to two-level anterior cervical discectomy and fusion (ACDF) for cervical radiculopathy from 2005 to 2012. The mean cost per patient of the procedure plus the 90-day postoperative period was $15,417.

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In addition to the recently announced JBJS Journal of Orthopaedics for Physician Assistants (JOPA) writing awards, JBJS is offering two additional $1,000 awards for the following:Best Physical Exam Video by a certified, practicing PA or NP (suggested length of 10 to 15 minutes)Best Injection Technique Video by a certified, practicing PA or NP (e.g., subacromial, knee, or trigger finger injection)Please submit videos without accompanying text, except for the title and author(s). Submit your video via the JOPA Editorial Manager submission site, and please include a signed Video License Agreement. For complete information on submitting video to JOPA, including sample videos, click here.

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One key question for orthopaedic surgeons regarding revision total knee arthroplasty (TKA) is how best to affix femoral and tibial stems. The August 17, 2016 edition of the Journal of Bone & Joint Surgery contains findings from a Level I randomized trial by  Heesterbeek et al . that addresses this clinical conundrum. Thirty-two patients with Type-I or II bone defects who needed a revision TKA received the same basic implant, with the femoral components and tibial baseplates being cemented in all cases. However, in half the patients the femoral and tibial stems were cemented, and in the other half the stems were press-fit (so-called hybrid fixation).

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Orthopaedic surgery is generally a discipline where functional restoration and pain relief take precedence over esthetics. However, all practicing surgeons know that how incisions appear is important to many patients and their families. This is especially true in pediatric orthopaedics, where parents feel a responsibility to limit any adverse experiences their child may have. In the August 17, 2016 edition of The Journal, Davids et al. provide our community with an important contribution regarding some basic principles of scar management in children—in this case, kids with cerebral palsy who had a second surgery to remove an implant. The take-home message is that scars that are acceptably thin with minimal discoloration are safe to treat and do well cosmetically with a repeat incision through the original scar.

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A therapeutic Level II study by DiGiovanni et al.  in the August 3, 2016 edition of The Journal of Bone & Joint Surgery examined the relationship between successful foot/ankle fusions and the amount of graft material used. The authors found that among 573 procedures in which graft material (either autograft or AUGMENT bone graft) occupied ≥50% of the cross-sectional fusion space at nine weeks, 81% were successfully fused at 24 weeks. However, among 101 procedures with <50% of the graft space filled, only 21% were successfully fused at 24 weeks. The authors determined both graft-fill percentages at nine weeks and fusion success at 24 weeks using CT scans.

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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 about these classics by clicking on the “Leave a Comment” button in the box to the left. One of the hallmarks of a great journal article is whether it changes practice.

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