The Impact of Injections

Sophia A. Traven, MD; Daniel Brinton, MHA, MAR; Kit N. Simpson, DrPH; Zachary Adkins, MD; Alyssa Althoff, BS; John Palsis, MD; William Ashford, MD; Harris S. Slone, MD

Corticosteroid injections (CSI) are frequently used in the nonsurgical management of rotator cuff tears. According to the authors of Scientific Paper 838 displayed at the AAOS 2018 Annual Meeting, however, individuals who undergo rotator cuff repair (RCR) surgery within a year of receiving a CSI are at much higher risk of needing a revision RCR than those who had not been treated with CSI.

Study: Foot and Ankle Surgical Patients Are Overprescribed Opioids

Terry Stanton

A study presented at the AAOS 2018 Annual Meeting reported that patients who undergo orthopaedic foot and ankle procedures are prescribed narcotic medication by nearly twice the amount that is actually consumed, leading to a significant surplus of narcotics available for potential diversion. The study involved 1,009 patients undergoing outpatient procedures, primary investigator Joseph Daniel, DO, reported.

Preventing Fractures in High-risk Women

Peter Pollack

Dr. Bukata presented her findings in two scientific posters displayed at the AAOS 2018 Annual Meeting. “Abaloparatide is a parathyroid hormone-related protein similar to teriparatide,” Dr. Bukata continued. “One of the notable things about our study is that it directly compares abaloparatide not only to placebo, but to teriparatide as well. There aren’t many osteoporosis studies that offer direct comparison of two treatment options.”

Study: Mixing of Some Surgical Antiseptics May Produce Toxic Products

Terry Stanton

A study observing the reactions that occur when commonly used surgical antiseptics are mixed found that at least two of the reactions tested—chlorhexidine + Dakin’s solution (sodium hypochlorite) and Dakin’s solution + hydrogen peroxide—yielded byproducts that are potentially toxic to human beings. The findings were presented in Scientific Poster 696 at the AAOS 2018 Annual Meeting.

Trends in Carpal Tunnel Syndrome Management Continue to Evolve

Anil Akoon, MD, MBA; C. Liam Dwyer, MD

Carpal tunnel syndrome (CTS) remains the most common compressive neuropathy. The following reviews recent trends in the preoperative evaluation, anesthesia, surgical approaches, and opioid prescribing patterns for patients with CTS. The diagnosis of CTS is made primarily by a physical exam and the patient’s medical history.

‘Tap Test’ May Offer Simple Method for Detecting Intraoperative Syndesmotic Instability

Terry Stanton

Astudy that evaluated a novel intraoperative test for syndesmotic instability of the ankle involving use of a 3.5 mm blunt cortical tap found the technique served as a “simple, reliable, and accurate tool for diagnosis of coronal syndesmotic instability.” Cesar de Cesar Netto, MD, PhD, offered that characterization as he presented the results of a cadaveric investigation during the American Orthopaedic Foot & Ankle Society 2018 Specialty Day.

Experts Offer Suggestions to Manage Transition to Value-based Care

Maureen Leahy

According to Dr. Bozic, delivering better value to patients first requires reorganizing the delivery system around the patient, then honing a strategy for measuring value (outcomes and cost), and finally, optimizing the payment model. The goal, he said, is to “deliver the greatest amount of health we can to patients in a way that reduces the cost of care over time.”

The Crisis in Orthopaedic Technology Puts Evidence-based Medicine at Risk

S. Raymond Golish, MD, PhD, MBA; William M. Mihalko, MD, PhD; J. Tracy Watson, MD

Improvements in orthopaedic patient care are typically connected to improvements in orthopaedic technology. However, the supply of new implants and procedures is not guaranteed. The successful commercialization of truly novel orthopaedic technology currently faces stiff headwinds, including regulatory risk, payer risk, and market risk. This may reduce interest in financing novel technologies within the venture community and among major device manufacturers.

Clinical Trials for Cervical Disk Replacement

S. Raymond Golish, MD, PhD, MBA; Steven M. Kurtz, PhD; Richard D. Guyer, MD

Each of the seven cervical total disk replacements (cTDR) currently available in the United States has undergone a clinical trial providing evidence of safety and efficacy that supports U.S. Food and Drug Administration (FDA) premarket approval.

Providence St. Joseph Health: Surgeons Unify Registry Structure

Karen Metropulos, MBA

The American Joint Replacement Registry (AJRR) is the largest hip and knee replacement registry in the United States and a leader worldwide. Providence St. Joseph Health (PSJH) freely shares highlights of its road to AJRR participation and some of the achievements it attained along the way.

Sexual Dimorphism in Sacroiliac Joint Dysfunction

Laura M. Bruse, MD

The presentation of any patient with sacroiliac (SI) joint pain is complex. The unique nature of the anatomy of the junction of the sacrum and the ilium and surrounding soft-tissue layers, which are attached by strong ligaments, contributes to highly variable symptoms. In addition, SI joint pain may manifest differently in males and females.

Researcher Investigates New Ways to Treat ACL Injuries

Sharon Johnson

In the 1980s, Martha M. Murray, MD, was a graduate student pursuing a degree in materials science and engineering at Stanford University. She learned that a classmate would need surgery and six months of rehabilitation because his torn anterior cruciate ligament (ACL) wouldn’t—or couldn’t—heal. “Everything else in your body heals fine, I thought. Why doesn’t the ACL? Why can’t we sew it back together and get it to restore itself rather than having to replace it?” Dr.