Radiation Exposure in the Pediatric Patient: What Every Orthopaedist Should Know

MedicalResearch.com Interview with:
Ayesha Rahman, MD

Chief Orthopaedic Surgery Resident
NYU Langone Medical Center.

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Children are more vulnerable and susceptible to lifetime adverse events from radiation exposure, caused by imaging . We reviewed literature and found certain pediatric orthopaedic patients are at greater risk for radiation exposure, namely those who have surgery for hip dysplasia, scoliosis, and leg length discrepancy, as they are among those most likely to undergo CT imaging. After reviewing all types of imaging studies performed in orthopedics and how much radiation is involved in each test, we developed several recommendations that pediatric orthopaedic surgeons should follow.

Among those recommendations are: utilize low-dose CT protocols or technology that uses less imaging (like EOS), limit CT scans of the spine and pelvis, know that female patients are more susceptible to adverse risk and plan accordingly, and follow the the “as low as reasonably achievable,”principle to limit exposure to parts of the body that are necessary for diagnosis.

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Patients Can Expect To Return To Normal Function Relatively Quickly After Knee Arthroscopy

MedicalResearch.com Interview with:

Patients Can Expect To Return To Normal Function Relatively Quickly After Knee Arthroscopy MedicalResearch.com Interview with: Alexis Colvin, MD Associate Professor, Orthopaedics Icahn School of Medicine at Mount Sinai James N. Gladstone, MD Co-Chief, Sports Medicine Service, The Mount Sinai Hospital Associate Professor, Orthopaedics, Icahn School of Medicine at Mount Sinai MedicalResearch.com: What is the background for this study? Response: Knee arthroscopy is one of the most commonly performed procedures in the U.S. There is minimal literature on when patients can expect to return to daily activity. We sought to help patients understand when they could expect to return to a number of basic activities, specifically in an urban environment where patients need to be mobile early. MedicalResearch.com: What are the main findings? Response: Our findings included: • Patients are off narcotics within 7 days, • Patients stop use of a cane/crutches at 8 days • Patients can drive after 14 days • Patients can go up subway stairs at 20 days • Patients sit on a toilet comfortably at 14 days • Patients return to work at 15 days MedicalResearch.com: What should readers take away from your report? Response: Patients can expect to return to relatively normal function within a short amount of time. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Response: We will also be looking at what other factors, such as age, BMI, medical co-morbidities, etc. can also influence how fast patients recover from this very common surgery. MedicalResearch.com: Is there anything else you would like to add? Response: MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community. Citation: 2017 AAOS abstract Return to Daily Life After Meniscectomy Alexis C. Colvin, MD, New York, NY James Dieterich, BA, New York, NY James N. Gladstone, MD, New York, NY Diana Patterson, MD, New York, NY Arthroscopic meniscectomy is a frequently performed procedure, but minimal guidelines exist for counseling patients on functionality during the recovery period or time to return to daily activities. http://www.aaos.org/uploadedFiles/2017%20Final%20Program_compressed.pdf Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions. More Medical Research Interviews on MedicalResearch.com

Dr. Colvin

Alexis Colvin, MD
Associate Professor, Orthopaedics
Icahn School of Medicine at Mount Sinai

James N. Gladstone, MD Co-Chief, Sports Medicine Service, The Mount Sinai Hospital Associate Professor, Orthopaedics, Icahn School of Medicine at Mount Sinai

Dr. Gladstone

James N. Gladstone, MD
Co-Chief, Sports Medicine Service, The Mount Sinai Hospital
Associate Professor, Orthopaedics, Icahn School of Medicine at Mount Sinai

MedicalResearch.com: What is the background for this study?

Response: Knee arthroscopy is one of the most commonly performed procedures in the U.S. There is minimal literature on when patients can expect to return to daily activity.

We sought to help patients understand when they could expect to return to a number of basic activities, specifically in an urban environment where patients need to be mobile early.

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Tennis Elbow: Is the Problem the Joint or the Tendon?

MedicalResearch.com Interview with:

Michael Hausman, MD Chief, Hand and Upper Extremity Surgery, Mount Sinai Health System; Professor, Orthopaedics, Icahn School of Medicine at Mount Sinai

Dr. Michael Hausman

Michael Hausman, MD
Chief, Hand and Upper Extremity Surgery
Mount Sinai Health System
Professor, Orthopaedics
Icahn School of Medicine at Mount Sinai

MedicalResearch.com: What is the background for this study? What are the main findings?


Response
: Lateral epicondylitis has traditionally been thought of as a tendon problem, but tendon pathology has not been well documented. Our study supports our hypothesis that the problem lies within the elbow joint, rather than in the tendon outside the joint.

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The Opioid Epidemic and Orthopaedic Pain Management

MedicalResearch.com Interview with:

Dr. Hammoud

Dr. Sommer Hammoud

Dr. Sommer Hammoud MD
ABOS Board Certified Assistant Professor of Orthopedic Surgery
Thomas Jefferson University 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The background for this exhibit stemmed from the growing problem of prescription opioid abuse in the United States.  As we saw this issue developing, we aimed to investigate the history behind this epidemic, what information we have now to fight it, and what information we need in the future to improve care our patients.

Our main findings for each of those aims are the following:

1) It would appear that a large push at the end of the last century led to a lower threshold to prescribe opiates in the effort to control pain, leading to the current opioid epidemic
2) Mulitmodal methods of pain control and the expanding skill of regional anesthesia can be used to help decrease narcotic use and thus limit exposure to narcotics, and
3) Future research needs to focus on the psychologic aspect of patients’ ability to manage pain and we should strive to be able to categorize patients in order to create an individualized pain management protocol which will most effectively manage pain.

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Evolution of Surgery for Adolescent Idiopathic Scoliosis over 20 Years

MedicalResearch.com Interview with:

Dr. Baron Lonner MD Professor of Orthopaedic Surgery Mount Sinai Medical Center

Dr. Baron Lonner

Dr. Baron Lonner MD
Professor of Orthopaedic Surgery
Mount Sinai Medical Center

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Adolescent idiopathic scoliosis is the most common form of scoliosis, lateral curvature of the spine, in the pediatric population. 2-3% of adolescents are affected and approximately 10% of patients require surgery. Operative treatment has traditionally involved a spinal fusion with the use of metallic implants. I personally have been practicing spine surgery with an emphasis on the treatment of the pediatric patient with scoliosis for over twenty years. During the course of my own practice, I have seen significant changes in the way my colleagues and I operatively manage adolescent idiopathic scoliosis (AIS). Being part of a group of surgeons from around the world who contribute clinical data on patients with AIS, with a database of nearly 3000 patients, a group called the Harms Study Group after Professor Jurgen Harms of Germany, an innovator in this area, and housed within the larger Setting Scoliosis Straight Foundation, I felt, now, as we reached the twenty year mark of data collection in January 2015, was the moment to look at trends in our collective experience.

Our goal was to evaluate changes in the surgical approach to AIS over this time span and to assess whether or not these changes have been associated with improvements in outcomes for the patient including decreases in complication rates. Perhaps we could learn lessons from this data, contributed by leaders in the treatment of AIS, that might inform future innovations and to be confirmatory of the trajectory of our approach to these patients.

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Patients Who Quit Smoking Had Fewer Adverse Events After Knee Replacement

MedicalResearch.com Interview with:
Amy Wasterlain, MD

Fourth-year orthopaedic surgery resident
NYU Langone Medical Center who led the study with Dr. Richard Iorio 

MedicalResearch.com: What is the background for this study?

Response:  We looked at smoking habits and outcomes for 539 smokers undergoing primary total hip or knee arthroplasty, 73 of whom participated in a pre-operative smoking cessation program. Patients who participated in program were 4.3 times more likely to quit than smokers who tried to quit on their own. Program participants also reduced their tobacco intake dramatically (10.6 fewer cigarettes/day) compared to smokers who didn’t participate (2.3 fewer cigarettes/day), even if they weren’t able to quit completely. Patients who completed the program before undergoing total knee arthroplasty had about 24% fewer adverse events (readmission, venous thromboembolism, stroke, urinary tract infection, pneumonia, and surgical site infection) than smokers who didn’t participate in the program.

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Risk Factors For Adverse Events After Total Shoulder Replacement

MedicalResearch.com Interview with:

Brad Parsons, MD Associate Professor, Orthopaedics Icahn School of Medicine at Mount Sinai

Dr. Parsons

Brad Parsons, MD
Associate Professor, Orthopaedics
Icahn School of Medicine at Mount Sinai

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: As bundled payment initiatives increase in order to contain health care costs, total shoulder arthroplasty (TSA) is a likely future target.

Understanding modifiable drivers of complications and unplanned readmission as well as identifying when such events occur will be critical for orthopedic surgeons and hospitals to improve outcomes and to make fixed-price payment models feasible for TSA.

Utilizing the American College of Surgeons National Surgical Quality Improvement Program we identified 5801 patients that underwent TSA with a 2.7% readmission rate and 2.5% severe adverse event rate. Patients with 3 or more risk factors were found to have a significantly increased risk of readmission and severe adverse events within the first two weeks postoperatively.

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The Short Form KOOS, Jr Is Valid for Revision Knee Arthroplasty

MedicalResearch.com Interview with:

Alexander S. McLawhorn, MD, MBA Orthopedic Surgery, Hip and Knee Replacement Hospital for Special Surgery New York, NY 10021

Dr. McLawhorn

Alexander S. McLawhorn, MD, MBA
Orthopedic Surgery, Hip and Knee Replacement
Hospital for Special Surgery
New York, NY 10021

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Hospital for Special Surgery (HSS) researchers saw the need for a shorter, more patient friendly outcome survey for revision knee replacement surgery. This is an area where patient-reported outcomes data are essential to improving quality of care. In fact, knee replacement revisions, which are more complex and heterogeneous than primary knee surgery, are under-studied in this regard.

A commonly used knee replacement survey, the KOOS (Knee Injury and Osteoarthritis Outcome Score), is 42 questions and often leaves physicians with partial and unusable information secondary to patient burden and fatigue. Previously, researchers at HSS created the KOOS, JR, which is a shorter, 7-question survey that accurately measures “knee health”, meaning it reflects aspects of pain, symptom severity, and activities of daily living relevant and difficult for patients with knee arthritis. The current research presented at AAOS showed that the KOOS, JR can be extended to knee replacement revision patients and that it is a valid and efficient tool for assessing knee health in this challenging patient population.

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High School Students Increasingly Specializing in One Sport

MedicalResearch.com Interview with:

Michael G. Ciccotti, MD Professor of Orthopaedic Surgery Rothman Institute Chief of Sports Medicine, and Director of the Sports Medicine Fellowship Thomas Jefferson University

Dr. Michael Ciccotti

Michael G. Ciccotti, MD
Professor of Orthopaedic Surgery
Rothman Institute
Chief of Sports Medicine, and
Director of the Sports Medicine Fellowship
Thomas Jefferson University

MedicalResearch.com: What is the background for this study? 

Response: No doubt sports plays a huge role in the United States and all over world with millions of young people between the ages 6 and 18 participating in an organized sport on a regular basis.

Over the past decade, there has been a tremendous focus on youth single sport specialization (SSS), with pressure from coaches, parents and the athletes themselves to participate in one sport year round. Many participants, coaches and parents believe that early specialization may allow the young athlete to become better and progress more quickly in their sport, perhaps allowing them a greater chance of becoming a professional athlete. This drive toward early specialization has been fueled by popular icons i.e. Tiger Woods (golf) and Lionel “Leo” Messi (soccer) as well as by media hits such as Friday Night Tykes (young football players) and The Short Game (7-year old golfers). The pop-psych writer, Malcolm Gladwell, whose The 10,000 Hour Rule (in his book Outliers) holds that 10,000 hours of “deliberate practice” are needed to become world-class in any field may have also encouraged the specialization trend.

There is little doubt that youth sports may encourage a lifelong interest in a healthy lifestyle as well as improved self-esteem and social relationships. The flip side is that extreme training and singular focus on a sport can lead to stress on the developing musculo-skeletal system, a pressure to succeed at all costs, reduced fun, burnout and sometimes social isolation.

The dilemma we are beginning to scratch the surface of is does single sport specialization enhance the likelihood of getting to an elite level and does it increase the risk of injury? There is a growing sense in the medical community that SSS raises injury risk without enhancing progression to a higher level.

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How Does Spinal Deformity Impact Hip Stability?

MedicalResearch.com Interview with:

Dr Aaron J. Buckland Spinal and scoliosis surgeon and assistant professor Orthopedic surgery NYU Langone Medical Center

Dr. Aaron Buckland

Dr Aaron J. Buckland
Spinal and scoliosis surgeon and
Assistant professor
Orthopedic surgery
NYU Langone Medical Center

MedicalResearch.com: What is the background for this study?

Response: For decades, surgeons performing hip replacements have placed the acetabular component adjacent to the pelvis in a “safe zone” which has been shown to reduce dislocation risk. However, beginning in residency, I would notice that several of my patients with spinal deformities or lumbar fusions, would experience dislocations despite the safe zone placement of these implants. Our initial research demonstrated that there was an increased dislocation risk in patients with lumbar fusions, particularly if they underwent spinal realignment. We investigated this phenomenon further by retrospectively reviewing 107 patients who met the criteria for sagittal spinal deformity, including 139 hip replacements collectively.

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Female Soccer Players Have High Risk of Concussion

MedicalResearch.com Interview with:

Wellington K. Hsu, MD Clifford C. Raisbeck, MD, Professor of Orthopaedic Surgery Associate Professor of Orthopaedic Surgery Northwestern University Chicago, IL

Dr. Hsu

Wellington K. Hsu, MD
Clifford C. Raisbeck, MD, Professor of Orthopaedic Surgery
Associate Professor of Orthopaedic Surgery
Northwestern University
Chicago, IL

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Concussions remains a significant problem in youth sports. The recent enactment of Traumatic brain injury laws have certainly heightened awareness regarding this problem. Our study looked at publicly available data regarding diagnosis of concussion in high school athletes. We found that females are more likely to be diagnosed with a concussion than males. We also concluded that girl soccer players and boys football players are at highest risk for a diagnosis of concussion. Since the neck meant of the Traumatic brain injury state laws, the diagnosis of concussion in this patient group increased significantly past decade.

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Despite Guidelines, Low Proportion of Elderly Hip Fracture Patients Are Consistently Taking Vitamin D

MedicalResearch.com Interview with:

Dr. Sheila Sprague, PhD Assistant Professor, Research Methodologist McMaster University

Dr. Sheila Sprague

Dr. Sheila Sprague, PhD
Assistant Professor, Research Methodologist
McMaster University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Previous research has found that daily administration of vitamin D is important for maintaining bone homeostasis. There has been an increased interest among the orthopaedic community regarding vitamin D supplementation and patient outcomes following fractures. Using data from the FAITH trial (NCT01908751), a multicenter randomized controlled trial that compared cancellous screws versus sliding hip screws in patients over the age of 50 with femoral neck fractures, we:

1) determined the proportion of patients consistently taking vitamin D following hip fracture surgery and
2) determined if supplementation was associated with improved health related quality of life and reduced re-operation.

Patients enrolled in the FAITH trial were recruited from 81 clinical sites in 8 countries over a 6-year span. We asked a subset of them about vitamin D supplementation and categorized them as consistent users, inconsistent users, or non-users.

The final analysis included 573 patients and we found that a surprisingly low proportion of elderly hip fracture patients are consistently taking vitamin D (18.7% of patients reported never taking vitamin D, 35.6% reported inconsistent use, and 45.7% reported consistent use). We also found that vitamin D was associated with a statistically (p=0.033), but not clinically, significant improvement in health-related quality of life following a hip fracture. Lastly, supplementation was discovered to not be associated with reduced re-operation (p=0.386).

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