Author Interviews, Hematology, Surgical Research, Transfusions / 19.03.2018 Interview with: Shawn Anthony, MD, MBA Assistant Professor of Orthopaedics Icahn School of Medicine at Mount Sinai What is the background for this study? What are the main findings?  Response: Rates of total shoulder arthroplasty are increasing, especially with an aging population.  Blood loss requiring transfusion is less common than in total hip or knee replacements but still required in some patients.  Tranexamic acid (TXA) is increasingly used to reduce blood loss in lower extremity arthroplasty but limited data exists for its effectiveness and safety in patients undergoing shoulder arthroplasty. We aimed to utilize national data to assess frequency of use and effectiveness of TXA in shoulder arthroplasty patients. While utilization of TXA has become very common in total hip and knee arthroplasty, TXA is still used in less than 50% of patients undergoing shoulder arthroplasty as of 2016.  TXA use was associated with a 36% decrease in transfusion risk and a 35% decreased risk for combined complications. Moreover, TXA use was associated with 6.2% shorter hospital stay. (more…)
Author Interviews, Cost of Health Care / 12.03.2018 Interview with: Dr. Samuel Cho, MD Associate Professor of Orthopaedics Icahn School of Medicine at Mount Sinai What is the background for this study? What are the main findings? Response: Anterior cervical discectomy and fusion (ACDF), first implemented in 1957, has been considered the “gold standard” for decades for the treatment of cervical degenerative disc disease after conservative options have been exhausted. For patients presenting with neck and radiating arm pain, motor weakness, and sensory loss due to cervical disc herniation or compressive pathologies, ACDF has been shown to be generally well-tolerated and associated with a high clinical success rate. Despite the proven long-term radiographic and clinical success of ACDF, however, our literature has shown the procedure to be associated with certain drawbacks including neurological complications, rapid development of adjacent segment disease, and decreased range of motion owing to solid bony arthrodesis. More recently, cervical disc replacement (CDR) has also become an acceptable surgical option for similar cervical spine pathologies as ACDF. CDR was developed as a motion-sparing alternative to ACDF with purported advantages including minimization of adjacent segment disease and obviation of pseudoarthrosis. Multiple large investigational device exemption (IDE) studies showing the non-inferiority of cervical disc replacement, the cost-effectiveness of this procedure has increasingly become a topic of interest. For this reason, we sought to determine the seven-year cost-effectiveness of single level ACDF versus CDR for the treatment of cervical disc degeneration. (more…)
Author Interviews, Hematology, NEJM, Orthopedics, Thromboembolism / 22.02.2018 Interview with: Dr. David R. Anderson, MD, FRCPC, FACP Faculty of Medicine Dean, Professor Dean, Faculty of Medicine Division of Hematology, Department of Medicine & Nova Scotia Health Authority What is the background for this study? What are the main findings? Response: Blood clots in the lungs (pulmonary embolism) and veins of the legs (deep vein thrombosis) are well recognized complications following total hip and knee arthroplasty surgeries.  Prior to the routine use of antithrombotic prophylaxis, pulmonary embolism was the most common cause of death following these procedures.  Oral anticoagulants such as rivaroxaban are commonly prescribed for the indication of preventing blood clots following total hip or knee arthroplasty.  For maximal benefit these agents are continued following surgery for up to five weeks following total hip arthroplasty and for two weeks following total knee arthroplasty. There is evidence that aspirin has some benefit for the prevention of deep vein thrombosis and pulmonary embolism following total hip or knee arthroplasty.  However there is less evidence for its benefit than for oral anticoagulants.  We reasoned that aspirin would potentially be an attractive alternative for extended out of hospital prophylaxis following total hip or knee arthroplasty for patients who received a short course (5 days )of rivaroxaban following surgery.  Aspirin would be attractive for this indication because of its low cost, ease of use, and low rates of side effects. Our study demonstrated that in a randomized controlled trial involving a large group (over 3400) of patients undergoing total hip or knee arthroplasty that extended therapy with aspirin was comparable to rivaroxaban for the prevention of deep vein thrombosis and pulmonary embolism following surgery.  Low rates of complications (< 1%) were observed with both treatment arms.  We also found that rates of clinically important bleeding complications (the most common side effect with antithrombotic drugs) were uncommon and similar with the two agents. (more…)
Author Interviews, Cancer Research, Orthopedics, Pharmacology / 13.11.2017 Interview with: Charles L.Shapiro MD Professor of Medicine Director of Translational Breast Cancer Research Director of Cancer Survivorship Division of Hematology/Oncology Tisch Cancer Institute New York, NY What is the background for this study? What are the main findings? Response: The new 2017 ASCO guidelines for the use bone-modifying in individuals with bone metastases recently endorsed every 3-month zoledronic, because of high level evidence from three randomized trials, including our trial (published in Jama in Jan 2017, first author Himelstein et al) that giving zoledronic acid every 3-months was non-inferior to the standard of monthly zoledronic. The guidelines also concluded that there was not one preferred bone modifying agent of the other, despite the fact the comparing monthly zoledronic to monthly denosumab in women with bone metastases, denosumab delayed the time to first skeletal-related event (pathological fractures, necessity for radiation or surgery, and spinal cord compression) and subsequent events by 23% (or in absolute terms about 3 months) . Zoledronic acid became generic in 2013, whereas monthly denosumab is still patented until 2022-25. (more…)
Author Interviews, Orthopedics, Rheumatology, Social Issues / 07.11.2017 Interview with: Susan M. Goodman, MD Director of the Integrative Rheumatology and Orthopedics Center of Excellence Hospital for Special Surgery What is the background for this study? What are the main findings? Response: We have previously reported that African Americans who have poorer health outcomes, may be disproportionately impacted by community factors. For African Americans undergoing knee replacement, no difference in pain and function was seen compared to whites in communities with little poverty, while in poor communities, African Americans had poorer outcomes. We wondered if this was generally true or if this only applied to knee replacements. We found similar results; African Americans in richer neighborhoods have comparable outcomes to whites, but as poverty increases- in this study measured as percent with Medicaid coverage- outcomes worsen in a step wise fashion. (more…)
Author Interviews, Exercise - Fitness, NEJM, Orthopedics / 04.10.2017 Interview with: Monika Bayer PhD. Institute of Sports Medicine Copenhagen Bispebjerg Hospital Denmark What is the background for this study? What are the main findings? Response: Acute muscle strain injuries display a major clinical problem with a high incidence rate for both professional and amateur athletes and are associated with substantial risk for recurrence. Common clinical practice advices to follow the RICE (Rest – Ice – Compression – Elevation) principle after strain injuries but it has not been investigated whether patients really benefit from a period of rest or whether an early of loading following the injury would improve recovery. In this study, amateur athletes were divided into two groups: one group started rehabilitation two days after the trauma, the other group waited for one week and began rehabilitation after nine days. All athletes had a clear structural defect of the muscle-connective tissue unit following explosive movements. We found that protraction of rehabilitation onset caused a three-week delay in pain-free recovery. In all athletes included, only one suffered from a re-injury. (more…)
Author Interviews, Columbia, Heart Disease, Orthopedics / 28.09.2017 Interview with: Dr. Mathew Maurer, Medical Director The Hypertrophic Cardiomyopathy Center NewYork-Presbyterian/Columbia University Medical Center. What is the background for this study? Response: Transthryretin cardiac amyloidosis (TTR-CA) is an underdiagnosed type of cardiomyopathy in which TTR (transthyretin, also known as prealbumin), a protein that forms amyloid fibrils, deposits in the heart. The deposits cause thickening of the ventricular wall and diastolic as well as systolic dysfunction. It is usually discovered around age 75 and presents more commonly in men than in women. With advances in non-invasive diagnostic modalities and growing awareness, TTR-CA is being diagnosed increasingly more frequently. Additionally, there are several emerging treatments that are under active investigation. Most of these therapies prevent disease progression and don’t address the amyloid already deposited in the heart. Accordingly, it is imperative that we diagnose TTR-CA before patients develop significant amyloid heart disease. However, this presents a great challenge since there are few known clinical predictors that might alert even the most astute physician that a patient is at such risk. With identification of predictors that may appropriately raise the index of clinical suspicion, clinicians may begin to pick up more subtle (and perhaps not yet clinically significant) forms of TTR-CA and initiate treatment before significant damage occurs. The few known clinical predictors of TTR-CA include bilateral carpal tunnel syndrome and lumbar spinal stenosis, and numerous studies found TTR on biopsies and autopsies of other musculoskeletal sites, particularly in hip and knee joints. (Just last week, and also discussed here on, biceps tendon rupture was also shown to occur more frequently in TTR-CA!) We suspected that patients who ultimately develop TTR-CA may first develop clinically significant hip and knee disease, enough to even warrant a hip (THA) or knee (TKA) replacement. (more…)
Author Interviews, Brigham & Women's - Harvard, Heart Disease, JAMA, Orthopedics / 22.09.2017 Interview with: Avinainder Singh, M.B.B.S. Research Fellow Cardiovascular Medicine Brigham & Women's Hospital Harvard Medical School Boston, MA What is the background for this study? Response: Amyloidosis due to aberrant folding of proteins. These misfolded proteins can deposit in various parts of the body and lead to organ dysfunction. The two most common types of amyloidosis affecting the heart include transthyretin and light chain amyloidosis. Transthyretin is a protein produced by the liver which supports the transport of thyroxine and retinol. Wild-type transthyretin amyloidosis (ATTRwt, previously known as senile amyloidosis) occurs due to deposition of misfolded fibrils derived from transthyretin and primarily affects elderly men. Once considered a rare disease, it is now reported to be responsible for nearly 13% of heart failure with preserved ejected fraction and increased wall thickness. Rupture of the biceps tendon is a rare occurrence in the general population (<1 per 1000). We noticed a ruptured biceps tendon in several patients with wild-type transthyretin amyloidosis and performed this study to further evaluate this finding in a group of patients with wild-type transthyretin amyloidosis and in a control group of age-matched patients with non-amyloid heart failure. (more…)
Author Interviews, Cleveland Clinic, Orthopedics, Pain Research, Surgical Research / 01.08.2017 Interview with: Michael A. Mont, MD Department of Orthopaedic Surgery Cleveland Clinic Cleveland, OH What is the background for this study? What are the main findings? Response: Postoperative pain after total knee arthroplasty (TKA) is a major hurdle for both the patients and the orthopaedists. Many analgesic modalities are currently in use, and can be used alone or in combination in order to augment their effect. Addition of local anesthetic analgesia has been shown to improve pain control and reduce opioid consumption during postoperative period. However, the effects of this analgesia tend to dissipate with time, with the longest duration of action (bupivacaine) of approximately 12 hours. Therefore, long acting local anesthetic (liposomal bupivacaine) has been developed in order to expand the duration of effectiveness of pain relief for up to 96 hours. Many studies evaluated the effectiveness of this anesthetic and demonstrated contradictory results, however, they did not use the same methods and infiltration technique. Therefore, we conducted a prospective, randomized, double-blind, controlled study at 16 hospitals using optimal infiltration techniques. Our study demonstrated significant improvement in pain, decreased opioid consumption, increased time to first opioid rescue, more opioid free patients in liposomal bupivacaine cohort. In addition, there were no unexpected safety concerns. (more…)
Author Interviews, CMAJ, OBGYNE / 05.06.2017 Interview with: Giulia Muraca, MPH, PhD(c) Vanier Canada Graduate Scholar School of Population and Public Health Child & Family Research Institute Faculty of Medicine University of British Columbia What is the background for this study? Response: The rate of cesarean delivery has increased dramatically over the last 30 years. And in an effort to curb the rising trend in caesarean delivery, The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine have recently advocated for increased use of operative vaginal delivery (forceps/vacuum delivery) as a strategy to reduce the cesarean delivery rate. The evaluation of approaches to achieve this end are underway and the current discourse surrounding operative vaginal delivery centers on methods to promote these important skills. But, the truth is, we don’t yet fully understand the balance of risks and benefits to mothers and their babies following operative vaginal delivery compared with caesarean delivery. The preferred choice given these two options relies heavily on how far the baby’s head has descended in the birth canal. If the baby’s head has descended far enough that it is visible and on the perineum, then the use of an instrument has clear advantage. However, when the fetal head is engaged in the maternal pelvis, but has not descended so far down the birth canal, the decision between these modes of delivery becomes much less clear. These deliveries are called midpelvic deliveries. And it’s an increase in these midpelvic deliveries that would have the most potential as a strategy to reduce the cesarean delivery rate, and as a result, it is these deliveries that we were interested in studying. Operative vaginal deliveries are carried out in approximately 14% of all term births in Canada and those that occur when the baby is at midpelvic station account for over 20% of all operative vaginal deliveries. This translates to about 2-3% of all term, singleton deliveries in Canada or about 10,000 deliveries per year overall. The literature on perinatal and maternal outcomes contrasting midpelvic operative vaginal delivery and caesarean delivery is based on studies undertaken 25 to 30 years ago that are no longer reflective of the current obstetric practice.  This was the impetus for our study. We reasoned that before we decide to encourage increased OVD we should first get a sense of the safety of such procedures compared to cesarean delivery as provided by contemporary maternity care providers. (more…)
Author Interviews, Exercise - Fitness, Orthopedics, Pediatrics / 31.05.2017 Interview with: Jacqueline Pasulka, OMS II Des Moines University College of Osteopathic Medicine , Des Moines , IA Division of Pediatric Orthopaedic Surgery & Sports Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago , IL What is the background for this study? What are the main findings? Response: In this study young athletes were recruited from both sports medicine and general practice clinics and were asked to complete surveys reporting on their sports participation, training patterns, and any sports-related injuries they had over the previous six months. We focused this study on the subset of athletes who met the criteria for being a single-sport specialized athlete based on their reported participation in only one sport and training for eight months or more during the year for that sport. Athletes participating in individual sports were more likely to be single-sport specialized than their team sport peers, and they also reported an earlier age at which they began specializing in their sport. Additionally, injury types differed among these two groups as single-sport specialized athletes in individual sport athletes had a greater proportion of overuse injuries, while single-sport specialized athletes in team sport athletes had a greater proportion of acute injuries. (more…)
Author Interviews, Hip Fractures, Mineral Metabolism / 17.04.2017 Interview with: Dr Setor Kunutsor Ba(Legon), MBChB(Legon), MA(Cantab), PhD(Cantab) Research Fellow Musculoskeletal Research Unit University of Bristol What is the background for this study? Response: Bone fractures are one of the leading causes of disability and ill health especially among the ageing population and are a burden to health care systems. There is established evidence that calcium and vitamin D play an important role in bone health. Magnesium is an essential trace element, being the second most abundant intracellular cation after potassium and the fourth most abundant cation in the body. It serves several important functions in the body, which include protein synthesis, nucleic acid synthesis, enzymatic reactions, and has also been shown to be cardio-protective. It is also an important component of bone, with majority (67 percent) of total body magnesium known to be found in the bone tissue. There have been suggestions from both human and animal experiments that magnesium may have a beneficial effect on bone health; however, its relationship with fractures is not very certain. (more…)
Author Interviews, Orthopedics / 11.04.2017 Interview with: Christopher M. Larson, M.D. Minnesota Orthopedic Sports Medicine Institute Twin Cities Orthopedics Edina, MN What is the background for this study? What are the main findings? Response: Until recently Athletic Hip and Pelvis disorders and the appropriate treatment strategies have not received the same attention as other sports related disorders.  There is significant overlap between intra-articular and extra-articular hip disorders that make this a challenging area of sports medicine from a diagnosis and treatment standpoint. (more…)
Author Interviews, NYU, Orthopedics, Pediatrics, Radiology / 10.04.2017 Interview with: Ayesha Rahman, MD Chief Orthopaedic Surgery Resident NYU Langone Medical Center. 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. (more…)
Author Interviews, Dermatology, Orthopedics / 26.03.2017 Interview with: Dr. Jonathan L. Silverberg MD PhD MPH Assistant Professor in Dermatology Medical Social Sciences and Preventive Medicine Northwestern University, Chicago, Illinois Response: Psoriasis is associated with a number of potential risk factors for developing osteoporosis and pathological fractures, including including low vitamin D, chronic inflammation, higher rates of cigarette smoking and systemic corticosteroid usage. We hypothesized that adults with psoriasis have higher rates of osteoporosis and pathological fractures. We examined data from the 2002-2012 National Inpatient Sample, which contains a representative 20% sample of all hospitalizations in the United States. We found that psoriasis was associated with higher odds of osteopenia, osteoporosis, osteomalacia, ankylosing spondylitis, and pathological fractures. In particular, psoriasis was associated with vertebral, pelvic, femoral and tibial/fibular fractures. The associations between psoriasis and pathological fractures were more pronounced in women than men. (more…)
Author Interviews, Orthopedics / 20.03.2017 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 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. (more…)
Author Interviews, Opiods, Pain Research / 19.03.2017 Interview with: Dr. Sommer Hammoud MD ABOS Board Certified Assistant Professor of Orthopedic Surgery Thomas Jefferson University 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. (more…)
Author Interviews, Orthopedics, Outcomes & Safety / 17.03.2017 Interview with: Brad Parsons, MD Associate Professor, Orthopaedics Icahn School of Medicine at Mount Sinai 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. (more…)
Author Interviews, Orthopedics / 16.03.2017 Interview with: Alexander S. McLawhorn, MD, MBA Orthopedic Surgery, Hip and Knee Replacement Hospital for Special Surgery New York, NY 10021 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. (more…)
Author Interviews, Exercise - Fitness, Pediatrics / 16.03.2017 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 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. (more…)
Author Interviews, NYU, Orthopedics / 16.03.2017 Interview with: Dr Aaron J. Buckland Spinal and scoliosis surgeon and Assistant professor Orthopedic surgery NYU Langone Medical Center 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. (more…)
Author Interviews, Vitamin D / 15.03.2017 Interview with: Dr. Sheila Sprague, PhD Assistant Professor, Research Methodologist McMaster University 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). (more…)
Author Interviews, Hip Fractures, NYU, Orthopedics / 09.02.2017 Interview with: Afshin E. Razi MD Clinical Assistant Professor NYU Hospital for Joint Diseases Department of Orthopaedic Surgery New York, N.Y. 10016 What is the background for this study? What are the main findings? Response: We did an extensive literature search and through our two previous seminars on this topic we were able to gather information to aid our colleagues on best ways of differentiating causes of hip and back pain. As an orthopaedic surgeon specializing in spine surgery I encounter many patients who present with concomitant back and hip pain. Many of these patients are also referred to me by surgeons who solely take care of hip problems such as total hip replacement or sport medicine specialist who treat younger patients with hip pain. It can be very difficult to properly diagnose the main issue and as such some patients go on to have unnecessary treatments, including surgery, because of their persistent symptoms. It was our goal to try to educate physicians, including orthopaedic surgeons, on the common differential diagnoses, appropriate clinical history and physical examination, diagnostic tools and their evaluations appropriately, as well as treatment options and priorities of which one to be treated first. More recently, it has been noted that some patients who have undergone total hip replacement with significant curvature of the spine had postoperative dislocation of the hip after reconstruction of the spinal malalignment. This article also talks about this newly seen problem. (more…)
Author Interviews, Cognitive Issues, Gender Differences, Hip Fractures, Orthopedics / 09.02.2017 Interview with: Ann L. Gruber-Baldini, Ph.D. Professor, Division of Gerontology Director, Program in Epidemiology and Human Genetics Department of Epidemiology & Public Health University of Maryland School of Medicine What is the background for this study? Response: While men make up only about 25% of all hip fractures, the number of men who fracture their hip is increasing and we know men are more likely to die than women after a hip fracture. It is also known that those with cognitive impairments, typically due to delirium and Alzheimer's disease and related dementia, are more likely to do more poorly after the fracture. The impact of both sex and cognition on outcomes after hip fracture has not been fully explored. (more…)
Author Interviews, BMJ, Orthopedics, Pain Research, Surgical Research / 08.02.2017 Interview with: Jonas Bloch Thorlund Associate Professor (MSc, PhD) Department of Sports Science and Clinical Biomechanics Research Unit for Musculoskeletal Function and Physiotherapy University of Southern Denmark What is the background for this study? What are the main findings? Response: Arthroscopic partial meniscectomy is a very common knee surgery. Research evidence has seriously questioned the effect of this type of surgery for degenerative meniscal tears in middle-aged and older patients. Most young patients with traumatic meniscal injury (from sports or similar) also undergo this type of surgery. There is a general understanding that young patients with traumatic tears experience larger improvements in patient reported pain, function and quality of life. However, evidence for this presumption is sparse. (more…)
Author Interviews, Cost of Health Care, JAMA, Medicare, Orthopedics, University of Pennsylvania / 06.01.2017 Interview with: Amol Navathe, MD PhD University of Pennsylvania Staff Physician, CHERP, Philadelphia VA Medical Center Assistant Professor of Medicine and Health Policy, Perelman School of Medicine Senior Fellow, Leonard Davis Institute of Health Economics, The Wharton School Co-Editor-in-Chief, HealthCare: the Journal of Delivery Science and Innovation What is the background for this study? Response: Bundled payments pay a fixed price for an episode of services that starts at hospital admission (in this case for joint replacement surgery) and extends 30-90 days post discharge (30 days in this study). This includes physician fees, other provider services (e.g. physical therapy), and additional acute hospital care (hospital admissions) in that 30 day window. (more…)
Author Interviews, Dermatology, Orthopedics / 02.01.2017 Interview with: Hsien-Yi Chiu, MD/ Tsen-Fang Tsai, MD Department of Dermatology, National Taiwan University Hospital Taipei, Taiwan What is the background for this study? What are the main findings? Response: Psoriasis is a chronic, immune-mediated disorder, characterized by red, itchy and scaly skin patches. Over the past several years, accumulating research had shown the effects of psoriasis go far deeper than the skin and psoriasis is associated with multiple comorbidities. Psoriasis shares the inflammatory pathways and several contributing factors with avascular necrosis (AVN), a bone disease presented with death of trabecular bone and collapse of the bony structure. However, previous studies mostly focus on evaluation the increased risk of cardiovascular diseases in patients with psoriasis. No large scale studies have previously explored a potential association between psoriasis and AVN. Our nationwide population-based cohort study investigated this risk in 28268 patients with psoriasis registered in the Taiwan National Health Insurance Research Database. The patients were matched, by age and sex, with 113072 controls without psoriasis. Both the patients and controls were followed to identify those who subsequently diagnosed with an AVN. The results showed that psoriasis was associated with a disease severity–dependent increase in avascular necrosis risk. Moreover, AVN risk was positively associated with male sex, age younger than 30 years, corticosteroid use, severe psoriasis, and concomitant psoriatic arthritis. People with severe psoriasis were 3 times more likely to develop AVN compared with the control group. (more…)
Author Interviews, Heart Disease, Occupational Health, Orthopedics / 31.12.2016 Interview with: Kurt T. Hegmann, M.D., M.P.H. Director, Rocky Mtn. Center for Occupational and Environmental Health Chief, Division of Occupational and Environmental Health The University of Utah Health Care What is the background for this study? Response: This line of work for us began approximately 20 years ago. Normal tendons never rupture, as the weak point when loading the muscle-tendon unit is either the muscle-tendon junction (i.e., a true muscle strain) or bone-tendon junction. Researchers in the 1960s reported there is poor blood supply in the area of rotator cuff tendon tears, providing one of the two main etiological theories of rotator cuff tears. The other main theory is “impingement syndrome” or a biomechanical impingement in the shoulder joint. Though who experience this might find that they need something similar to this shoulder dislocation surgery. Naturally, both theories could co-exist. Next, we noted rotator cuff tendinitis and shoulder risks from tobacco in other studies. We also reported prior research of increased risks with obesity. These led us to the theory that these rotator cuff tears are likely vascular in etiology. The next problem was to show this. (more…)
Author Interviews, Cost of Health Care, Orthopedics / 26.10.2016 Interview with: Kelechi Okoroha, M.D. Orthopaedic Surgery House Officer Henry Ford Health System What is the background for this study? What are the main findings? Response: Historically, patient perceptions of surgeon reimbursement have been exaggerated compared with actual reimbursement. Currently there has been an increased focus or reducing health care cost, increasing access to health care and a shift to tie Medicare and insurance reimbursement to quality outcomes. Among these changes was the reduction in reimbursement payments for orthopedic surgeons. When we polled over 200 of our clinic patients, we found that most patients don’t think an orthopedic surgeon is overpaid but they greatly exaggerate how much a surgeon is reimbursed by Medicare for performing knee surgery. When told of the reimbursement payments, patients found them too be low and said they would be willing to pay more out-of-pocket costs. Patients also believe a surgeon should be compensated more for having fellowship training. • Nearly 90 percent of patients say physicians are not overpaid and their salaries should not be cut. • 61 percent of patients say a surgeon’s salary should not be tied to outcomes. • 79 percent of patients say reimbursement to drug and device companies should be reduced. (more…)
Author Interviews, Lancet, Orthopedics, Stem Cells / 21.10.2016 Interview with: Professor Ivan Martin, PhD Department of Surgery and Department of Biomedicine University Hospital Basel University of Basel Basel, Switzerland What is the background for this study and new use of autologous nasal chondrocytes? Response: We previously demonstrated that nasal chondrocytes, harvested from the nasal septum, have a larger and more reproducible capacity to form new cartilage than articular chondrocytes, harvested from the knee joint. We further established that the cartilage tissue generated by nasal chondrocytes can respond to physical forces (mechanical loads) similar to articular cartilage and has the ‘plasticity’ to adapt to a joint environment, since it efficiently integrated with surrounding articular cartilage when implanted in goat joints. This was the rationale for using nasal chondrocytes for articular cartilage repair. (more…)