Two-stage Exchange Arthroplasty and the Antibiotic Holiday

Maureen Leahy

Study results presented at the Musculoskeletal Infection Society (MSIS) annual meeting indicate that the duration of the antibiotic-free period often associated with two-stage exchange arthroplasty—the current gold standard for treating periprosthetic joint infection (PJI) following total joint arthroplasty—does not significantly affect reinfection rates following reimplantation.

Next-generation Sequencing: The Next Step in Identifying Infections?

Next-generation sequencing (NGS) is a DNA-sequencing technology that has revolutionized genomic research, reducing both the time and costs involved. "The cost to sequence one gigabase of DNA in 2000 was $230; to sequence the same amount of DNA today costs just $1," said Javad Parvizi, MD, FRCS, during his presentation at the 2017 annual meeting of the Musculoskeletal Infection Society. Dr.

#ILookLikeASurgeon Promotes Women in Orthopaedics

Erin Morrison; Peter Pollack

After many years of planning and collaboration, EPOSNA, a combined conference sponsored by the Pediatric Orthopaedic Society of North America (POSNA) and the European Paediatric Orthopaedic Society (EPOS), took place May 3-6, 2017, in Barcelona, Spain. With more than 2,000 attendees, the largest pediatric orthopaedic meeting in history fostered global pediatric orthopaedic education and scholarly exchange.

Second Look – Clinical News and Views

These items originally appeared in AAOS Headline News Now, a thrice-weekly enewsletter that keeps AAOS members up to date on clinical, socioeconomic, and political issues, with links to more detailed information. Subscribe at www.aaos.org/news/news.asp (member login required).

Reducing Opioid Use after Hand Surgery

Peter Pollack

The use of written guidelines and educational handouts can lead to a significant reduction in the quantity of opioids prescribed, while maintaining high patient satisfaction and a low refill rate, according to study data presented at the annual meeting of the American Society for Surgery of the Hand. "Opioid abuse has become a recognized national epidemic in recent years," noted C. Liam Dwyer, MD.

Orthopaedists Respond

The Atlantic hurricane season has been unusually intense this year, spawning five major hurricanes. Hurricanes Harvey, Irma, and Maria, in particular, were especially destructive due to their intensity, duration, and sheer physical size. Although so many different geographic regions were severely impacted by devastating winds and flooding, the hurricanes did not cause high numbers of musculoskeletal injuries.

Las Vegas Crisis: Preparation Saves Lives

On Oct. 1, 2017, 59 people were killed and nearly 500 more were injured at a Las Vegas concert in what is classified as the deadliest mass shooting in U.S. history. The tragic event tested the resolve and capacity of the entire healthcare community in Las Vegas. Fortunately, the medical system had prepared for a chaotic, mass-casualty event, and was able to respond to the Route 91 Harvest Festival shooting with an organized, coordinated effort.

Hip Fracture Guidelines: Evidence Over Experience

Karl C. Roberts, MD

One way or another, we as orthopaedic surgeons all practice EBM. The question for each of us is whether the "E" represents Evidence-based or Experience-based Medicine. Some of us may be dogmatic in our approach, rigidly adhering to experienced-based medicine; others of us are neophytes looking for guidance. Regardless of our personal situation, familiarity with clinical practice guidelines (CPGs) and appropriate use criteria (AUCs) can benefit us as surgeons and our patients as well.

Tales from the Hurricane Front

Terry Stanton

It's not that the healthcare system in Houston wasn't prepared for Hurricane Harvey. Having seen the devastation in New Orleans after Hurricane Katrina in 2005 and, before that, tropical storm Allison, which inundated Houston in 2001, the city's hospitals and medical network were ready as Harvey bore down on the Texas coast. As ready as anyone can be for a once-in-five-lifetimes storm.

On the Water Front

On Sunday, as waters were rising on streets near his Memorial neighborhood in Houston, Stefan Kreuzer, MD, MSc, and friend Brian Dominguez, ventured out in a large truck to salvage food from Brian's house, which had lost electricity. On the way, Dr. Kreuzer sent a text to one of his patients—a woman for whom he had done a hip replacement about a month prior to Hurricane Harvey. She replied with a photo showing water halfway up her front door.

On Duty

It was the water of Hurricane Harvey, not the wind, that caused most of the billions of dollars in destruction, and the experiences reported by orthopaedic and other medical personnel speak to that fact. At the Memorial Hermann trauma center at Texas Medical Center—one of two Level 1 facilities in the region—the days of the storm were mostly quiet, even uneventful for what by some measures is described as the nation's busiest trauma center.

In the Firehouse

Amy Cockerham is a nurse practitioner who works in orthopaedic trauma with Joshua Gary, MD, at Memorial Hermann's Level 1 trauma center in Houston and lives in Friends­wood, a bedroom community south of the city. With the rising waters paralyzing transportation around her, Ms. Cockerham stayed in Friendswood to serve as a medical coordinator at an emergency operations center established at the fire station.

On Call

Taggart Gauvain, MD, an orthopaedic surgeon, proved his versatility when he joined Houston's improvised version of the "Cajun Navy" —the volunteer rescue force of Louisiana-based boaters that assembled after Hurricane Katrina and then towed their armada to Houston—to help in the Harvey flooding. Dr. Gauvain related how much of the informal rescue efforts in Houston coalesced organically through text messages and social media.

Inside the Shelter

Camden Tissue, MD, is a recently minted orthopaedic trauma surgeon practicing at Memorial Hermann Southwest in Houston. As a lifelong Houstonian, he returned to the area after completing his training in New York. "My wife and I looked at each other as Hurricane Harvey was bearing down the coast and said, 'Why did we leave New York again?'" he said. Dr. Tissue noted that as a wind event, Harvey was underwhelming.

Post-Hurricane Maria: Many Ask, 'How Can I help?'

On Sept. 28, 2017, Hurricane Maria unleashed its Category 4 strength on Puerto Rico and unbridled devastation ensued, leaving much of the island in ruin. Now, a widescale humanitarian effort is managing the aftermath of the storm. As a U.S. territory, Puerto Rico is similar yet unique when compared to the states. Nearly 3.5 million U.S. citizens live in Puerto Rico. As U.S. citizens, Puerto Ricans can travel without a passport to and from the continental United States.

Medical Community Unifies in Response to Shooting

Terry Stanton

When a gunman perched on the 32nd floor of the Mandalay Bay hotel in Las Vegas rained gunfire on the crowd attending a Sunday night country music concert, the scores of wounded began flooding the city's emergency departments. Orthopaedic surgeons stepped up to provide care for the injured. Amid the chaos and the carnage, the patients arrived at area hospital, sometimes five to a vehicle, in ambulances, limousines, and pickup trucks pressed into service, many driven by valiant civilians.