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American Journal of Orthopedics

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https://www.readbyqxmd.com/read/28005125/the-role-of-liposomal-bupivacaine-in-value-based-care
#1
Richard Iorio
Multimodal pain control strategies are crucial in reducing opioid use and delivering effective pain management to facilitate improved surgical outcomes. The utility of liposomal bupivacaine in enabling effective pain control in multimodal strategies has been demonstrated in several studies, but others have found the value of liposomal bupivacaine in such approaches to be insignificant. At New York University Langone Medical Center, liposomal bupivacaine injection and femoral nerve block were compared in their delivery of efficacious and cost-effective multimodal analgesia among patients undergoing total joint arthroplasty (TJA)...
November 2016: American Journal of Orthopedics
https://www.readbyqxmd.com/read/28005124/comprehensive-care-for-joint-replacement-cjr-bundle-expense-in-perioperative-pain-management
#2
Susan D Bear
The implementaion of the Comprehensive Care for Joint Replacement (CJR) model has necessitated value-focused care for a 90-day period. Pain management in joint arthroplasty therefore represents a focused opportunity to achieve lasting change in the delivery of care. To be successful, orthopedic surgeons must integrate approaches that take into account administration route and therapy duration, and various combinations thereof, to achieve improved longer term outcomes for joint arthroplasty patients. In addition, pain management choices must be based on value and not on simple costs, as patient satisfaction scores affect CJR repayments...
November 2016: American Journal of Orthopedics
https://www.readbyqxmd.com/read/28005123/addressing-the-opioid-epidemic-with-multimodal-pain-management
#3
Michael A Kelly
The opioid epidemic has become a national public health and safety problem affecting both adults and adolescents. There is little doubt that this epidemic is rooted in the need for pain control after surgery and that orthopedic surgeons have in part contributed to opioid overprescription. Indeed, opioid abuse, misuse, and diversion are associated with increased hospitalizations, emergency department visits, and associated health care costs. In addition, postoperative exposure to opioids correlates with long-term use and abuse...
November 2016: American Journal of Orthopedics
https://www.readbyqxmd.com/read/28005122/opioid-sparing-pain-control-in-outpatient-total-joint-arthroplasty
#4
John W Barrington
Postoperative pain management is vital to promoting recovery and improving clinical outcomes. Although improved understanding of pain pathways has led to the development of varied approaches for controlling pain after surgery, some approaches are associated with potentially harmful side effects. Several lines of evidence have demonstrated that opioid analgesics can have unwanted adverse effects on patients having surgery. Similarly, risks associated with femoral nerve blocks have outweighed the benefits. Liposomal bupivacaine has shown efficacy in reducing the need for opioid analgesics and nerve blocks...
November 2016: American Journal of Orthopedics
https://www.readbyqxmd.com/read/28005121/limited-incision-knotless-achilles-tendon-repair
#5
Andrew R Hsu
Acute midsubstance Achilles tendon ruptures, which are increasingly common among athletes, can result in significant functional limitations and decreased quality of life when not managed appropriately. The various surgical techniques for treating Achilles ruptures include open repair with Krackow locking sutures, percutaneous repair, and limited-incision repair with suture-passing jigs. Less invasive techniques have been developed to optimize the functional benefits of surgery while reducing delayed wound healing, infection, and other postoperative complications...
November 2016: American Journal of Orthopedics
https://www.readbyqxmd.com/read/28005120/surgical-simulation-in-orthopedic-surgery-residency
#6
Daniel B Gibbs
No abstract text is available yet for this article.
November 2016: American Journal of Orthopedics
https://www.readbyqxmd.com/read/28005119/an-overview-of-the-history-of-orthopedic-surgery
#7
Ishaan Swarup, Joseph F O'Donnell
Orthopedic surgery has a long and rich history. While the modern term orthopedics was coined in the 1700s, orthopedic principles were beginning to be developed and used during primitive times. The Egyptians continued these practices, and described ways to recognize and manage common orthopedic conditions. The Greeks and Romans subsequently began to study medicine in a systematic manner, and greatly improved our understanding of orthopedic anatomy and surgical technique. After a period of little progress during the Middle Ages, rapid advancement was noted during the Renaissance, including the description of various injuries, improvements in surgical technique, and development of orthopedic hospitals...
November 2016: American Journal of Orthopedics
https://www.readbyqxmd.com/read/28005118/application-of-amniotic-tissue-in-orthopedic-surgery
#8
Nathanael Heckmann, Richard Auran, Raffy Mirzayan
The use of amniotic tissue in orthopedic surgery has increased in recent years. While more studies are needed to fully understand the therapeutic potential and define the appropriate applications of these tissues, basic science and clinical studies are available that indicate promising results. This review will highlight these studies as they relate to the musculoskeletal system.
November 2016: American Journal of Orthopedics
https://www.readbyqxmd.com/read/28005117/tenotomy-tenodesis-transfer-a-review-of-treatment-options-for-biceps-labrum-complex-disease
#9
Elizabeth B Gausden, Samuel A Taylor, Prem Ramkumar, Benedict U Nwachukwu, Keith Corpus, Brian J Rebolledo, Alexander White, Stephen J O'Brien
Biceps-labrum complex (BLC) disease is a well recognized source of shoulder pain. The BLC can be divided into 3 anatomical zones: inside, junction, and bicipital tunnel. Despite our evolving understanding, diagnosis of BLC pathology through physical examination, standard imaging techniques, and standard diagnostic glenohumeral arthroscopy can be challenging. Selection of the most appropriate surgical technique in refractory cases should take into account decompression of the extra-articular bicipital tunnel...
November 2016: American Journal of Orthopedics
https://www.readbyqxmd.com/read/28005116/arthroscopic-transosseous-and-transosseous-equivalent-rotator-cuff-repair-an-analysis-of-cost-operative-time-and-clinical-outcomes
#10
Adam J Seidl, Nicholas J Lombardi, Mark D Lazarus, Eric M Black, Mitchell G Maltenfort, Matthew D Pepe, Luke S Austin
The incidence of arthroscopic rotator cuff repair (RCR) continues to rise. Given the changing healthcare climate, it is becoming increasingly important to critically evaluate current practice and attempt to make modifications that decrease costs without compromising patient outcomes. We conducted a study of the costs associated with arthroscopic anchorless (transosseous [TO]) RCR and those associated with the more commonly performed anchor-based TO-equivalent (TOE) method to determine whether there are any cost savings with the TO-RCR method...
November 2016: American Journal of Orthopedics
https://www.readbyqxmd.com/read/28005115/robotic-technology-produces-more-conservative-tibial-resection-than-conventional-techniques-in-uka
#11
Danielle Y Ponzio, Jess H Lonner
Conversion of unicompartmental knee arthroplasty (UKA) to total knee arthroplasty (TKA) may be relatively simple when tibial resection is conservative during the index UKA. However, with greater tibial resection, conversion to TKA may be complicated by osseous insufficiency, requiring stems and augments, and potentially compromising patient outcomes and TKA durability. Robotic assistance in UKA is shown to enhance the bone preparation accuracy. In our retrospective comparison of polyethylene insert sizes, 8-mm or 9-mm polyethylene inserts were used in 93...
November 2016: American Journal of Orthopedics
https://www.readbyqxmd.com/read/28005114/an-update-on-management-of-syndesmosis-injury-a-national-us-database-study
#12
James C Carr, Brian C Werner, Seth R Yarboro
We conducted a study to determine the incidence of syndesmotic injury and stabilization within various ankle fracture patterns along with the rate of syndesmotic implant removal. All data were obtained from a publicly available for-fee healthcare database, the PearlDiver Patient Records Database. Current Procedural Terminology (CPT) codes were used to search the database for cases of fixation of lateral malleolus, bimalleolar, and trimalleolar fractures in addition to syndesmotic fixation and implant removal...
November 2016: American Journal of Orthopedics
https://www.readbyqxmd.com/read/28005113/patient-reported-outcome-measures-how-do-digital-tablets-stack-up-to-paper-forms-a-randomized-controlled-study
#13
Kalpit N Shah, Martin R Hofmann, Ran Schwarzkopf, Deeba Pourmand, Nitin N Bhatia, Gregory Rafijah, S Samuel Bederman
Patient-reported outcomes (PROs) are essential to assessing the effectiveness of care, and many general-health and disease-specific PROs have been developed. Until recently, data were collected predominantly with pen-and-paper questionnaires. Now, though, there is a potential role for electronic medical records in data collection. In this study, patients were randomly assigned to complete either tablet or paper questionnaires. They were surveyed on patient demographics, patterns of electronic device use, general-health and disease-specific PROs, and satisfaction...
November 2016: American Journal of Orthopedics
https://www.readbyqxmd.com/read/28005112/can-a-total-knee-arthroplasty-perioperative-surgical-home-close-the-gap-between-primary-and-revision-tka-outcomes
#14
Chijioke Iwuchukwu, David Wright, Anna Sofine, Ran Schwarzkopf
Given the steady increase in the number of primary and revision total knee arthroplasties (TKAs) performed in the United States, we wanted to determine if an evidence-based TKA perioperative surgical home could close the perioperative morbidity gap between primary and revision TKAs. We conducted a prospective cross-sectional cohort study comparing outcomes of patients who had primary TKA (n = 235) with outcomes of patients who had revision TKA (n = 50). We measured several perioperative outcomes: length of stay, discharge disposition, 30-day readmission rate, and 30-day reoperation rate...
November 2016: American Journal of Orthopedics
https://www.readbyqxmd.com/read/28005111/instability-after-reverse-total-shoulder-arthroplasty-which-patients-dislocate
#15
Eric M Padegimas, Benjamin M Zmistowski, Camilo Restrepo, Joseph A Abboud, Mark D Lazarus, Matthew L Ramsey, Gerald R Williams, Surena Namdari
Given the increasing use of reverse total shoulder arthroplasty (RTSA), it is important to study the complications associated with this procedure. We conducted a study of the incidence, predisposing factors, and treatment of RTSA dislocations. Using our institutional database, we retrospectively searched for RTSAs performed between September 27, 2010 and December 31, 2013 and identified postoperative dislocations. Four hundred eighty-seven patients underwent 510 RTSAs (393 primary, 117 revision). Fourteen patients had 15 dislocations (5 in primary RTSAs, 10 in revision RTSAs)...
November 2016: American Journal of Orthopedics
https://www.readbyqxmd.com/read/28005110/biomechanics-of-polyhydroxyalkanoate-mesh-augmented-single-row-rotator-cuff-repairs
#16
Robert Z Tashjian, Christopher W Kolz, Thomas Suter, Heath B Henninger
Polyhydroxyalkanoate (PHA) mesh is a bioresorbable scaffold used to reinforce the suture-tendon interface in rotator cuff repairs (RCRs). We conducted a study of cyclic and ultimate failure properties of PHA mesh-augmented single-row RCRs and nonaugmented RCRs. Eight pairs of fresh-frozen cadaver humeri (6 male, 2 female) were tested. Mean (SD) age was 61 (9) years. The supraspinatus tendon was resected and reattached in a single-row configuration using 2 triple-loaded suture anchors and 6 simple stitches. The opposite humerus underwent RCR augmented with 2 strips of 13-mm × 23-mm PHA mesh...
November 2016: American Journal of Orthopedics
https://www.readbyqxmd.com/read/28005109/perceived-leg-length-discrepancy-after-primary-total-knee-arthroplasty-does-knee-alignment-play-a-role
#17
Zachary H Goldstein, Paul H Yi, Brian Batko, Sean Kearns, Matthew W Tetreault, Brett R Levine, Craig J Della Valle, Scott M Sporer
Leg length discrepancy (LLD) is common after total knee arthroplasty (TKA) although its incidence has not been well documented. The purpose of this study was to determine the incidence of perceived LLD before and after primary total knee arthroplasty as well as to determine the correlation between mechanical axis of the knee and perceived LLD. The incidence and time frame of resolution of postoperative LLD was also assessed. Seventy-three patients were prospectively enrolled. Evaluation included patient surveys regarding perceived LLD preoperatively, and at 3- to 6-week, 3-month, 6-month, and 1-year visits...
November 2016: American Journal of Orthopedics
https://www.readbyqxmd.com/read/28005108/comparing-cost-efficacy-and-safety-of-intravenous-and-topical-tranexamic-acid-in-total-hip-and-knee-arthroplasty
#18
Joseph F DiBlasi, Ross P Smith, Jeffrey Garavaglia, Jeffrey Quedado, Benjamin M Frye, Matthew J Dietz
We conducted a study to compare the cost, efficacy, and safety of intravenous (IV) tranexamic acid (TXA) and topical TXA in primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). We retrospectively reviewed the cases of 291 patients who received either IV TXA or topical TXA before and after surgery. Significant differences favored topical TXA in reducing the postoperative decrease in hemoglobin levels in THA (P = .031) and TKA (P = .015) and calculated blood loss in TKA (P = .019). The groups did not differ in transfusion requirements for either THA or TKA...
November 2016: American Journal of Orthopedics
https://www.readbyqxmd.com/read/28005107/prevalence-of-low-vitamin-d-levels-in-patients-with-orthopedic-trauma
#19
Michael A Hood, Yvonne M Murtha, Gregory J Della Rocca, James P Stannard, David A Volgas, Brett D Crist
Low levels of serum vitamin D have been linked to numerous musculoskeletal and nonmusculoskeletal conditions. Vitamin D deficiency appears relatively high among various patient subpopulations, including patients with fracture nonunion. We conducted a retrospective study to determine the prevalence of vitamin D deficiency and insufficiency in a large population of patients with orthopedic trauma. The study included all patients who were over age 18 years, had no risk factors for vitamin D deficiency, and were treated for an acute fracture at a Level 1 trauma center...
November 2016: American Journal of Orthopedics
https://www.readbyqxmd.com/read/28005106/mycotic-septic-arthritis-of-the-ankle-joint
#20
Adam Tucker, Scott Matthews, Alister Wilson
Septic arthritis is a debilitating acute orthopedic emergency. Unfortunately, the diagnosis can be delayed or missed in immunocompromised patients with diabetes mellitus, and the result can be catastrophic. These patients are also at risk for atypical infections, including mycotic subtypes, which are more insidious than their more aggressive, more common Staphylococcus counterparts. The result is increased morbidity. In this article, we report a case of Candida albicans septic arthritis in a patient with diabetes mellitus and rheumatoid arthritis...
November 2016: American Journal of Orthopedics
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