Orthopaedic Intervention after Hip Fragility Fractures Yields Successful Treatment for Underlying Osteoporosis

Terry Stanton

A study of patients with hip fractures found that three-quarters of those enrolled in an intervention for osteoporosis management were on the correct treatment four months after hip fracture versus just 6 percent who were assigned to a control group.

Number of Opioids Prescribed after Hip Arthroscopy Does Not Impact Opioid Utilization

Kerri Fitzgerald

There is no standard recommendation for the number of opioids to prescribe after many surgical procedures, and previous studies have found that the number of opioids prescribed influences the number of pills consumed.

Smoking Significantly Increases Complications after Hip Arthroscopy

Kerri Fitzgerald

Tobacco use is associated with significantly increased rates of surgical and medical complications within six months after hip arthroscopy, according to a study presented by Peter Goljan, MD.

Deep Peroneal Neurectomy for Midfoot Arthritis Shows Good Early Outcomes

Terry Stanton

Patients with midfoot arthritis experienced a significant improvement in pain and function after deep peroneal neurectomy, according to a study presented by Glenn G. Shi, MD, of Mayo Clinic in Florida, as part of the Annual Meeting Virtual Experience.

What Are the Driving Factors of Hospital LOS in Knee Arthroplasty?

Kaitlyn D’Onofrio

Hospital length of stay (LOS) following total knee arthroplasty (TKA) varies by patient and is dependent on factors pertaining to the patient, hospital, and surgeon. A study examined which of those three factors play the most significant role in determining a patient’s LOS postoperatively.

This Protocol Reduces SSIs after Pediatric Spinal Surgery

Kerri Fitzgerald

The spine team at Rainbow Babies and Children’s Hospital in Cleveland, implemented a comprehensive, standardized, hospital-wide infection-reduction bundle and observed a statistically significant decrease in the overall rate of SSIs in a pediatric population.

Study Identifies Factors Associated with Increased Opioid Use by Single-admission Trauma Patients

Terry Stanton

A study to determine the factors associated with increased postoperative opioid prescription use after a single admission for a single surgery in orthopaedic trauma patients identified a history of opioid use and longer length of surgery as significant.

Study Reports Large Increase in Hip Prosthesis Dislocations in Past Two Decades

Terry Stanton

A study that was presented as part of the Annual Meeting Virtual Experience reported that the annual volume of prosthetic hip dislocations presenting to U.S. EDs more than tripled between 2000 and 2018.

Immediate Weight Bearing Is Safe after Bony Surgery in Cerebral Palsy Patients

Kerri Fitzgerald

Studies assessing weight bearing following single-event, multilevel surgery have yielded variable findings; however, delayed weight bearing can result in weakness, recurrent contractures, loss of independence, social isolation, depression, and delayed rehabilitation.

Flexor Digitorum Profundus and Flexor Digitorum Superficialis Repair Superior for Zone II Flexor Tendon Repair

Kaitlyn D’Onofrio

A study that was presented as part of the Annual Meeting Virtual Experience compared flexor digitorum profundus (FDP) repair versus FDP and flexor digitorum superficialis (FDS) repair in Hispanic patients with flexor tendon laceration of FDP and FDS in zone II. The researchers concluded that FDP/FDS primary repair was more effective than FDP repair and FDS excision at three months.

Optimization Protocols for TJA Reduce Prosthetic Joint Infection

Terry Stanton

Implementation of preoperative optimization protocols for total joint arthroplasty (TJA) was associated with significant reductions in prosthetic joint infection (PJI), according to a study presented as part of the Annual Meeting Virtual Experience.

Outcome Differences Among THA Approaches Not Clinically Meaningful

Terry Stanton

A study that was presented as part of the Annual Meeting Virtual Experience evaluated outcomes with three major approaches for primary total hip arthroplasty (THA) and found that a surgical approach was a statistically significant factor for pain at one year but did not have a significant effect on physical function or activity scores or on reoperation rates.

Infection Most Common Culprit of Revision TKA Failure

Kaitlyn D'Onofrio

Revision total knee arthroplasty (TKA) is becoming increasingly more common, but data regarding failed procedures are not as robust as those pertaining to primary TKA failures.

Arthroscopic Rotator Cuff Repair Can Be Considered in Older Patients

Kerri Fitzgerald

Risk of degenerative rotator cuff tears increases with older age. Arthroscopic rotator cuff repair can improve function and decrease pain, but retear is a concern for older patients; for that reason, reverse shoulder arthroplasty (RSA) is often performed for large rotator cuff tears without arthritis in this patient population.

Three Biomarkers Predict Postoperative Pain, Osteoarthritis after Knee Injury

Kerri Fitzgerald

Following injury to the articular surface of the knee, measurable changes in the joint microenvironment can occur, including altered expression of proinflammatory cytokines, matrix metalloproteinases, aggrecanases, growth factors, and apoptotic factors

Corticosteroid Injection after TKA Increases Infection Risk

Kaitlyn D’Onofrio

According to the researchers, patients who received an injection had a significantly greater risk of periprosthetic joint infection (PJI) versus patients who did not receive an injection.

Study Finds Ponseti Method Remains an Effective Treatment for Clubfoot, Bracing Is Paramount

Kerri Fitzgerald

A study found that, when performed correctly, the Ponseti method is an effective nonsurgical treatment for clubfoot. Malynda Wynn, MD, of the University of Iowa Hospitals and Clinics, presented the study as part of the Annual Meeting Virtual Experience.

Limiting Pitch Count Reduces Elbow Injuries in Young Pitchers

Kerri Fitzgerald

Limiting pitch count in youth baseball pitchers resulted in decreased elbow injuries, according to a paper that was presented by Tetsuya Matsuura, MD.

Single-screw Fixation During Latarjet Procedure Increases Risk of Complications

Kerri Fitzgerald

Graft- and nerve-related complications are relatively common following the Latarjet procedure. Fixation with only one screw was a significant predictor of graft failure, according to a study that Benjamin A. Hendy, MD, of the Rothman Orthopaedic Institute at Thomas Jefferson University Hospitals in Philadelphia, presented as part of the Annual Meeting Virtual Experience.

Patient Stories Personalize the Need for Research Funding

Erin Lynn Ransford; Stephanie Hazlett

Nearly one in every three Americans has a musculoskeletal condition requiring medical attention. On April 14, orthopaedic surgeons, patients, and researchers visited Capitol Hill to raise awareness about these debilitating and costly diseases and disorders to emphasize the need for research funding. Advocacy teams urged Congress to appropriate $34.

Erika Gandee Shares Behind-the-Scenes Look at OrthoCarolina’s Participation in MIPS

Cindy Bracy; Peter Pollack

On Jan. 1, 2017, the Centers for Medicare & Medicaid Services (CMS) launched the Medicare Quality Payment Program (QPP) with the goal of rewarding high-value, high-quality Medicare clinicians with payment increases, while reducing payments to clinicians who do not meet performance standards. The QPP consists of two tracks: the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).

Evidenced-based Advocacy: The Argument for POHs

Nicholas A. Bonazza, MD

One of the less-discussed provisions of the Affordable Care Act is the ban on the expansion of existing physician-owned hospitals (POHs) and the formation of new ones. The ban was founded on concerns about physician self-referrals and possible conflicts of interest. Similar concerns led to the passage of the Stark Act in 1989, which prevented self-referral of Medicare patients.

North Dakota Community Challenges Selling of Nonautologous Stem Cell Injections

Duncan Ackerman, MD

Regenerative medicine and the utilization of stem cells to treat countless diseases have expanded rapidly over the past several years. Although the science and purpose seem promising, proving the efficacy and determining what types of cells to utilize for particular diseases remain challenging. Although many physicians perform autologous cell transfers for patients, most would agree that this practice is less controversial than nonautologous (e.g., umbilical cord blood) transfers.

BOS Quality and Patient Safety Action Fund Update

Paul Zemaitis, MPH

The healthcare system continues to evolve quickly. Creating and implementing quality and safety tools can help orthopaedic surgeons provide the kind of care their patients have come to expect. In 2014, the AAOS Quality as Advocacy Project Team outlined the importance of specialty society involvement in the development of quality initiatives.

A Meeting of Minds: Town Hall Gives Platform to AAOS, FDA, and Industry

Terry Stanton

A special event at the AAOS 2023 Annual Meeting was billed as a “Town Hall with Key Leaders from AAOS, FDA, and Industry” to address the topic of innovation in orthopaedic medical devices, products, and technology.

Biologics: Hope, Market Pressures, Evidence, Guidelines, and Equipoise

Ronald A. Navarro, MD, FAAOS, FAOA; Gary E. Friedlaender, MD, FAAOS, FAOA, FORS

Through the application of rigorous scientific methodology, evidence-based practice, and advances in safe and effective technology, many important new solutions to serious health issues are being addressed with orthobiologic products.

Evaluating the Evidence for Osteobiologic Efficacy and Cost Value

John Cherf, MD, MPH, MBA

While there is considerable opportunity in the world of biologics to advance the quality of care for our patients, the rapid evolution of these technologies has led to variability in products, cost, and outcomes.

AAOS Biologics Initiative Focuses on Advancing Orthobiologics for Better Outcomes

Ryan Pezold, MA, MBa

In the evolving landscape of patient care, biologics are gaining attention as tools that may improve patient outcomes.

AAOS Biologics Symposium Investigates the Present and Future of Orthobiologic Therapies

Terry Stanton

At AAOS’ third annual Biologics Symposium, titled “The Next Generation of Biologics,” hosted on July 12 in collaboration with the Biologic Association, attendees were able to get a “first look” at the next generation of biologics expected to be available and used in orthopaedics over the next several years.

Understanding Regulatory Pathways for Osteobiologic Use in Orthopaedic Surgery

John Cherf, MD, MPH, MBA, FAAOS

Osteobiologics are a subset of biologics that focus on bone regeneration. An estimated 500,000 bone-grafting procedures are performed in the United States annually, and bone is the second most transplanted tissue, second only to blood transfusions.

AAOS Book on Orthobiologics Provides In-depth Insights into an Emerging Field

AAOS recently released a book on orthobiologics, a fast-growing field that uses biologic materials to enhance tissue repair and regeneration.

Exploring Skeletal Stem Cells: Insights and Challenges in Cartilage Regeneration

Cailin Conner

The third annual Biologics Symposium, titled “The Next Generation of Biologics,” took place on July 12 in Washington, D.C., and featured four sessions on regulatory clarity, autologous tissue processing, personalized blood products, and future biologics trends.

Nerve Blocks Reduce Opioid Use in Children with SCH Fractures

According to a paper presented during the 2016 annual meeting of the Pediatric Orthopaedic Society of North America (POSNA), using a regional nerve block can reduce opioid use in children with supracondylar humerus (SCH) fractures who are treated with closed reduction and percutaneous pinning (CRPP).

Study: Plate Fixation for Clavicle Fractures Reduces Risk of Nonunion, Increases Risk of Complications

Maureen Leahy

A study examining clinical and functional outcomes after internal plate fixation of displaced midshaft clavicle fractures found that although the treatment reduces the risk of nonunion, it is associated with a significant risk of a secondary surgery. Results also revealed that, compared to conservative treatment, plate fixation does not improve shoulder function. Clavicle fractures have traditionally been treated nonsurgically with good results.

Biomechanical Study Supports Early Weight Bearing After Ankle Fracture Fixation

Terry Stanton

A biomechanical analysis of a cadaveric model of early weight bearing in unstable ankle fractures following open reduction and internal fixation (ORIF) found no occurrence of significant fracture displacement, hardware failure, or new fracture. The authors of the study, presented by of the University of Southern California, at the 2016 Specialty Day Meeting of the American Orthopaedic Foot & Ankle Society in Orlando, Fla.

Risk Factors for ACL Re-tears in Athletes

Female athletes, athletes younger than age 25, and athletes with a graft size less than 8 mm are at increased risk for an anterior cruciate ligament (ACL) re-tear after reconstruction, according to study data presented at the 2016 annual meeting of the American Orthopaedic Society for Sports Medicine. "The minimum size required for a successful quadruple hamstring autograft ACL reconstruction remains controversial," the authors write.

Addressing Patient Preferences Appropriately

During a recent meeting of the Patient Safety Committee, Chair David Ring, MD, PhD, facilitated a discussion focused on identifying and responding to patient preferences in treatment. Participating committee members Dwight Burney, MD; Michael Pinzur, MD; Alan Reznik, MD; Andrew Grose, MD; Chris Gaunder, MD; Ramon Jimenez, MD; and Michael R. Marks, MD, MBA, shared strategies. Dr. Ring: The concept of shared decision making has had some impact, but there is still room for improvement.

Hip Fractures: Integrating the AAOS CPG and AUC into a Clinical Care Map

Britton Wells, MD; Carolann Stanek, RN; Jessica Burlile; Kevin G. Shea, MD

Hip fractures in the elderly are life-altering orthopaedic events that are often associated with significant morbidity as well as loss of mobility and independence.

Study Examines Early Weight Bearing After Microfracture Surgery for Talus Lesions

Terry Stanton

Patients managed with early weight bearing (EWB) following arthroscopic microfracture for osteochondral lesions of the talus exhibited significant improvement in early postoperative functional scores compared to those managed with delayed weight bearing (DWB), according to research presented by CPT J. Banks Deal Jr, MD, of Tripler Army Medical Center, Honolulu, Hawaii at the 2016 annual meeting of the Society of Military Orthopaedic Surgeons (SOMOS).

Is Surgical Approach a Risk Factor for Early Failure in THA?

Maureen Leahy

Total hip arthroplasty (THA) is a reliable treatment for reducing pain and improving function in patients with osteoarthritis of the hip. However, the rate of revision THA procedures being performed is on the rise and is expected to continue to increase, according to of OrthoCarolina's Hip & Knee Center. "In order to improve long-term THA survivorship, we need to better understand the etiology and risk factors for early failure in primary total hips," he said.

Study: More Than One-Third of ED Consults for Orthopaedic Injuries Are Inaccurate

Terry Stanton

A study of how orthopaedic conditions are diagnosed and managed by emergency department (ED) personnel at one Level 1 trauma center found that a significant number of them are misdiagnosed and ineffectively managed. The study was presented by CPT Nicholas A. Kusnezov, MD, during the 2016 annual meeting of the Society of Military Orthopaedic Surgeons.

Study Compares Clinical Effects of Hyperosmolar, Isotonic Irrigation Solutions in Shoulder Arthroscopy

Maureen Leahy

Excessive fluid extravasation has been associated with technical difficulties and complications during arthroscopic procedures. According to research presented at the AAOS Annual Meeting, hyperosmolar irrigation solution is a safe and effective method for decreasing periarticular fluid retention associated with arthroscopic rotator cuff surgery.

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.

Preoperative Opioid Use Increases Risk of Postoperative Narcotic Demand Following ACLR

Maureen Leahy

Preoperative use of opioid medications in patients undergoing anterior cruciate ligament reconstruction (ACLR) is a strong predictor of postoperative opioid demand, according to study data presented at the 2017 annual meeting of the American Orthopaedic Society for Sports Medicine. According to the study's authors, the demand for narcotics drops significantly by the third month after surgery for most patients.

Spine Study Identifies Predictors of Chronic Narcotic Use

Terry Stanton

Using a prediction model, researchers were able to identify, with nearly 80 percent accuracy, which patients undergoing thoracolumbar spine surgery would still be taking narcotics two years postoperatively. The prospective, observational study, presented during the North American Spine Society Annual Meeting by Erin Bigney, MA, of Canada East Spine Centre, used the Canadian Spine Outcomes and Research Network data alongside validated psychological measures.

Study Finds Objective Test for Preoperative Pain Predicts Postoperative Opioid Use

A study that used an objective method to measure preoperative pain threshold (PPT) demonstrated that total joint arthroplasty patients with higher preoperative pain tolerance required less narcotic medication after surgery. The study also revealed that one-fifth of the patients received opioid prescriptions from physicians other than their orthopaedic providers in the postoperative period.

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.

Eliminate Adverse Events with Integrated Clinical Pathways

Mark A. Snyder, MD, FAOA

The current healthcare environment is forcing hospitals to face uncertain futures and chart new courses as they shift from volume- to value-based systems and business models. According to Ian Morrison, author of The Second Curve: Managing the Velocity of Change, the second curve is the future—new technologies, new consumers, and new markets—and traditional methods of change are not sufficient to enable companies, including healthcare organizations, to survive.

Study Probes Effect of Tibial Component Positioning in Ankle Arthroplasty

Terry Stanton

Acadaveric study of the role of tibial component position in altering kinematics following total ankle arthroplasty (TAA) with a modern fixed-bearing device found normal joint action in the coronal and sagittal planes. Increased internal rotation in the transverse planes was associated with medial positioning of the tibial component.

Study Examines Medicare Hospital Costs for Spinal Fusion

Terry Stanton

A study seeking to identify cost drivers among Medicare beneficiaries (MBs) undergoing one- or two-level lumbar spinal fusion (1-2-LLSF) identified 22 demographic factors, comorbid conditions, and fusion approaches that increased costs during hospital stays by more than 5 percent. The study, presented at the North American Spine Society Annual Meeting by Kevin J. McGuire, MD, MS, of Dartmouth-Hitchcock Medical Center in Lebanon, N.H., considered all U.S.

Initiative to Decrease Time to Initial Emergency Department Antibiotic Administration for Open Fractures Sustained after Two Years

Terry Stanton

Consensus generally holds that, in patients with open fractures, simple antibiotic prophylaxis can effectively decrease the time to antibiotic administration.

OVT Video Details Posterolateral Approach for Trimalleolar Ankle Fracture

Alexandra E. Page, MD, FAAOS

Anatomic reduction of the posterior malleolus (PM) is a critical factor in ORIF (open reduction—internal fixation) of intra-articular ankle fractures.

The History of Biomechanics and Modern Applications in Orthopaedics

Stuart A. Green, MD, FAAOS

Leonardo da Vinci (1452–1519), one of the first artists to study human cadavers, recognized that mechanical principles provide the basis for human movements.

How Will the Rising Use of GLP-1 Medications Impact Patients and Orthopaedics?

Thomas Fleeter, MD, MBA, FAAOS

It is impossible to avoid the torrent of ads touting glucagon-like peptide-1 medications. The drugs are still relatively new, and more issues may arise with time.

Study: Longer Initial Reduction Time a Risk Factor for Repeat Procedures in Pediatric Forearm Fractures

Terry Stanton

A study to determine what factors may predict instability in pediatric diaphyseal both-bone forearm fractures found that patients requiring lengthy initial reduction times are at greater risk of having a repeat procedure than those with short initial reduction times. Age, initial translation, complete fracture of the radius, and residual translation on follow-up were highly predictive of the need for a second closed reduction and casting or an open surgical stabilization.

Patient-reported HRQL Following Surgical Management of Open Fractures

Maureen Leahy

A study presented at the 2016 Orthopaedic Trauma Association (OTA) annual meeting found that patients who had undergone surgical treatment for open fractures had not yet returned to their pre-injury health-related quality of life (HRQL) at 1 year follow-up. Additionally, HRQL scores were similar regardless of the irrigation solution or irrigation pressure used. The study was based on data from the Fluid Lavage in Open Fracture Wounds (FLOW) trial.

The Relationship Between Tibia-Femur Length Ratio and OA

Maureen Leahy

Results of a study presented at the 2016 AAOS Annual Meeting in Orlando, Fla., revealed that a tibia-femur (T/F) length ratio greater than 0.80 was a significant predictor of osteoarthritis (OA) in the hip and knee. According to Raymond W. Liu, MD, who presented the research findings, this can be important information for orthopaedic surgeons who perform limb-lengthening procedures.

High RTP Rates After Shoulder Surgery

Study data presented at the 2016 American Orthopaedic Society for Sports Medicine annual meeting indicate that return to play (RTP) rates are high for intercollegiate football players following shoulder stabilization surgery. Football athletes from seven programs in the Pacific-12, Southeastern Conference, and Atlantic Coast Conference participated in the IRB-approved study.

Study: No Advantage to Liposomal Bupivacaine for TKA

Terry Stanton

A study comparing the effect of the use of liposomal bupivacaine versus ropivacaine in total knee arthroplasty (TKA), found no increased benefit of liposomal bupivacaine for postoperative pain control. The prospective, double-blind study, was presented by of Ascension Crittenton Medical Center, Rochester Hills, Mich., during the AAOS Annual Meeting. The authors randomized 96 patients undergoing unilateral TKA into two groups.

Researchers Seek to Determine the 'Critical Portions' of Surgical Procedures

Peter Pollack

In 2016, the American College of Surgeons (ACS) released a statement of principles that, among other things, addresses potential surgical scenarios in which the primary attending surgeon may have completed "key or critical" elements of an operation, allowing another qualified practitioner to complete noncritical components.

Study Describes “Game Changer” Technology for Diagnosing Compartment Syndrome

Terry Stanton

Because acute compartment syndrome (ACS) can be such a devastating condition, accurate and timely diagnosis is essential. Improving the process to assess injuries for ACS is imperative across trauma care, but it may have elevated priority in the military setting, where high-energy injuries that are especially associated with ACS may be frequently encountered.

Quality of Recovery Following Anterior THA Not Influenced by Anesthesia Technique

Maureen Leahy

A study presented at the AAOS Annual Meeting compared three different types of commonly used anesthesia techniques in direct anterior approach during total hip arthroplasty (THA). The researchers found that although anesthesia technique did not affect patients' quality of recovery, it did affect several short-term outcomes.

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.

Resource Utilization is High in Patients Undergoing TKA Revision for Infection

Maureen Leahy

A study that examined whether risk adjustment is necessary in value-based reimbursement models for infected total joint replacement found that patients who undergo revision total knee arthroplasty (TKA) for infection utilize more resources in a 30-day episode of care than patients who undergo aseptic revision TKA.

Study Suggests Surgery is a Safe Treatment Option for Pectoralis Major Tendon Ruptures

Maureen Leahy

Pectoralis major tendon ruptures are relatively uncommon and little information exists about the demographics of these injuries or the surgical outcomes of their repair. Study data presented at the 2017 annual meeting of the American Orthopaedic Society for Sports Medicine, however, indicate that surgical repair of acute pectoralis major tendon ruptures is associated with a low rate of re-rupture and a low risk of complications.

Study: Half of Neck Surgery Readmissions Are Not Related to Surgical Site

Terry Stanton

A study presented at the North American Spine Society Annual Meeting in Los Angeles found that among patients undergoing one- or two-level anterior cervical diskectomy and fusion (ACDF), 3 percent were readmitted within 30 days of surgery, and half of those readmissions were unrelated to neck surgery. David C.

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.

Study Follows Up on Skeletally Immature Patients with Osteochondritis Dissecans in the Knee

Terry Stanton

Skeletally immature patients who had osteochondritis dissecans (OCD) in the knee demonstrated “clinically promising outcomes” at 14 years of follow-up, according to a study presented during the American Orthopaedic Society for Sports Medicine Annual Meeting.

Study Details How to Improve RTS Rates in Young Athletes with Shoulder Instability

Maureen Leahy

Managing shoulder instability in athletes younger than 22 years of age can be challenging due to the high failure rates associated with nonoperative treatment and the high recurrence and low return-to-sport (RTS) rates following arthroscopic shoulder stabilization.

Study Indicates Swabbing for MRSA Does Not Lower SSI Rates in Pediatric Spine Patients

Terry Stanton

Presurgical testing for methicillin-resistant Staphylococcus aureus (S. aureus) (MRSA) colonization with intranasal swabs is performed commonly, but a study published in the Sept. 1 issue of the Journal of the AAOS involving pediatric spinal fusion (PSF) patients found that MRSA swab results did not change treatment or outcome. The study comprised 1,200 patients who underwent PSF. Of the participants, 64.3 percent (n = 772) were female, and the average age was 13.8 years (range, 0–21 years).

Consider Several Key Factors When Assessing Robotic Technology

John Cherf, MD, MPH, MBA, FAAOS; Simon Kerr

There is a long history of innovation in supplemental technology for joint arthroplasty procedures, from the early intramedullary cutting jig decades ago to today’s digital soft-tissue balancers, computer navigation, and robotics. Currently, several robotic systems are approved for joint replacement procedures, and more are expected to come to market over the next two years.

Spinal Deformity: Study Focuses on Operative Management of Adult Symptomatic Lumbar Scoliosis

Kerri Fitzgerald

Adult spinal deformity is highly prevalent among the growing older population and can have a large impact on health-related quality of life, including pain, disability, and neurological deficits.

Indications and Techniques for Rotator Cuff Repair Augmentation

Thomas Fleeter, MD, MBA, FAAOS

Editor’s note: The following article is a review of a video available via the AAOS Orthopaedic Video Theater (OVT). AAOS Now will routinely review “OVT Plus” videos, which are vetted by topic experts and offer CME. For more information, visit aaos.org/OVT.

The Biomechanics of Hip and Spine

Huthayfa Kahf, MD; Steven Yang, MD, MBA, FAAOS

Hip-spine biomechanics has become an increasingly popular subject of study over the past several years.

AAOS CPGs Offer Standards for Periprosthetic Joint Infection Prevention

Mohammed K. Alsarraj, MD; Nathanael Adams, MD; Ajay Srivastava, MD, FAAOS

Prosthetic joint infections are a major complication of total joint arthroplasty that can result in significant increases in patient morbidity and mortality and decreased quality of life.

Recertification Examinations That Fit Your Practice

J. Lawrence Marsh, MD; Douglas W. Lundy, MD

The American Board of Orthopaedic Surgery (ABOS) and the American Academy of Orthopaedic Surgeons (AAOS) have a long, successful partnership. Each organization has separate, important missions in improving the practice of orthopaedic surgery. The ABOS establishes educational standards for orthopaedic residents and evaluates the initial and continuing qualifications and competence of orthopaedic surgeons.

International Teams Are Making Advances in Scoliosis Research

Paul D. Sponseller, MD

With more than 1,500 attendees, the 51st annual meeting & course of the Scoliosis Research Society (SRS) was an opportunity to learn about the newest developments in both pediatric and adult deformity. The 3-day meeting, held in the Soviet-era Congress Centre in Prague, Czech Republic, included more than 130 podium presentations by researchers from all parts of the globe.

Low Complication Rate Reported from New Outpatient TJA Facility

Terry Stanton

A study tracking patients who underwent total joint arthroplasty (TJA) at a newly opened outpatient facility reported a low number of adverse events during the facility's first year of operation. The study, presented in a scientific poster at the AAOS Annual Meeting, reported results for 432 patients who underwent either total hip arthroplasty (THA; n = 177) or total knee arthroplasty (TKA; n = 255) in the outpatient surgery center over 13 months.

Treating Septic Arthritis, Knee Instability after ACL Reconstruction

Peter Pollack

Septic arthritis is a rare complication that can occur after anterior cruciate ligament (ACL) reconstruction, with incidence rates estimated to be between 0.14 percent and 1.8 percent of cases. However, the consequences can be devastating, affecting functional outcomes through instability, laxity, chondrolysis, and stiffness.

Improving Transfer of Information to Optimize Patient Safety

Andrew W. Grose, MD

The competing demands of mastering minutiae and working expeditiously create tension for many healthcare providers. Efforts to satisfy both these goals often involve negotiating "efficiency-thoroughness trade-offs," a normal process wherein providers strike a balance between productivity and safety. This is particularly evident when providing patient information during transitions of care.

Study: Few Complications Seen with Peripheral Nerve Block

Terry Stanton

A study on the use of peripheral nerve block (PNB) in foot and ankle surgery revealed an overall low complication rate associated with that anesthetic method. Of postoperative complications that did occur, most were neurological in nature and few were serious or unresolved. The researchers found no clear association in complication rates for popliteal blocks versus ankle blocks.

Can an Algorithm Reduce Mortality for Femoral Neck Fracture Patients?

Peter Pollack

Increased use of total hip arthroplasty (THA) in the treatment of intracapsular proximal femoral fractures has highlighted the need for an improved patient-selection strategy, according to researchers in the United Kingdom. They displayed their findings in a poster presentation at the 2016 AAOS Annual Meeting.

Study: Preoperative PROMIS Scores Can Predict Outcomes for Foot and Ankle Patients

Terry Stanton

A study that examined how well preoperative patient-reported outcome scores would predict postoperative improvement after foot and ankle surgery found that patients with low preoperative function and high preoperative pain experienced outcomes superior to those with relatively high function and lower pain. The authors of the study, which was the 2016 recipient of the J.

Study: Diagnosing PJI after TJA

Maureen Leahy

Study data presented at the AAOS Annual Meeting indicate that a minimum of five periprosthetic samples need to be cultured and held for at least 14 days to reach a diagnosis of periprosthetic joint infection (PJI) following total joint arthroplasty (TJA).

What Is the True Value of the On-call Orthopaedic Resident?

Peter Pollack

"Residents provide a significant amount of care to patients with orthopaedic injuries and musculoskeletal conditions," noted J. Benjamin Jackson, MD. When the attending is not present, much of that care goes unbilled. Currently, resident education is funded by Medicare and the host institution. "The Balanced Budget Act of 1996 froze funding for graduate medical education (GME), so any new resident openings have been funded by individual hospitals.

Preoperative Counseling May Reduce Opioid Use

Peter Pollack

"Although the United States represents less than 5 percent of the world's population, it consumes about 80 percent of all the world's opioid production," said Asif Ilyas, MD, FACS. "And when surveyed, 80 percent of heroin users said they started abuse with prescription opioids, then turned to heroin because it was cheaper and easier to get." Dr.

What are the Benefits of the Perioperative Surgical Home?

Peggy L. Naas, MD, MBA

"Setting [a] goal as cost containment, rather than value improvement, has been devastating to healthcare reform efforts. A focus on value, not just costs, avoids the fallacy of limiting treatments that are discretionary or expensive but truly effective." —Michael Porter, PhD, in "What is the value in health care?

Understanding Patient Perceptions Regarding Unused Opioid Medication

T.K. Miller, MD; Susan Giampalmo, BS; Malek Bouzaher, BS, MS; Joseph T. Moskal, MD

The Virginia Orthopaedic Society (VOS) has an opioid prescribing policy for its membership and works closely with the Medical Society of Virginia to update and promote it. While opioid analgesics play an essential role in the care of acute musculoskeletal injuries and postoperative management of pain, orthopaedic providers must balance this appropriate use with the risks if their patients misuse or divert these medications.

AAHKS and Rheumatologists Team Up to Issue TJA Guideline

Terry Stanton

A newly issued set of clinical recommendations offers surgeons guidance in preventing periprosthetic joint infection (PJI) through medication management in arthroplasty patients who have inflammatory rheumatic diseases. Certain drugs may increase a patient's risk of infection.

Quality Initiative Results in Practice Changes, Cost Savings

A quality improvement project aimed at increasing the use of removable braces instead of casting to treat distal radius buckle fractures (DRBFs) at two pediatric centers changed minds and resulted in significant savings, according to a report presented at the 2017 annual meeting of the American Society for Surgery of the Hand.

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.”

Meta-analysis Evaluates CDC’s Recommendation of a Single, Preoperative Dose of Antibiotics

Sean P. Ryan, MD; Timothy Tan, MD; Thorsten Seyler, MD, PhD

Postoperative infections following orthopaedic procedures that involve placement of metallic implants can be devastating and may result in infected nonunion, removal of hardware and antibiotic spacer placement, prolonged use of antibiotics, or even amputation.

Lumbar Spinal Stenosis Study Associates Surgical Decompression with Improved Low Back Pain

Terry Stanton

A study examining the effect of surgical lumbar decompression on low back pain (LBP) in patients with lumbar spinal stenosis (LSS) found that the surgical intervention significantly improved pain at three months, which was maintained 12 and 24 months after surgery in most patients.

The Biomechanics of Sports Performance Enhancement

David Heath, MD; Jeremy Vail, PT, SCS, OCS, ATC; Thomas Kremen, MD, FAAOS; David McAllister, MD, FAAOS

Modern methods to enhance sports performance incorporate a variety of techniques and technologies.

Pediatric ACL Revision Linked to Suboptimal Results

Peter Pollack

"ACL [anterior cruciate ligament] reconstruction is on the rise in pediatric and adolescent populations," said who presented findings from scientific paper SS-10, "Revision ACL Reconstruction in Children and Adolescents," at the annual meeting of the Arthroscopy Association of North America. "The purpose of our study was to assess demographics, techniques, and outcomes of ACL revision in children and adolescents." Patient profiles Dr.

Keeping the Lifeblood of Orthopaedics Flowing

Sariah Khormaee, MD, PhD

For the past 13 years, the AAOS/Orthopaedic Research and Education Foundation (OREF)/Orthopaedic Research Society (ORS) Clinician Scholar Career Development Program (CSCDP) has brought together promising residents, fellows, and early-career attending surgeons for a 2-day workshop that inspires and prepares them to meet the unique challenges facing clinician scholars. The most recent program (Sept.

Patient Safety Experts to Participate in Summit

William J. Robb III, MD; Paul Zemaitis, MPH

Despite the many technological advances in health care, surgical adverse events leading to patient harm still exist. As a leader in the patient safety movement, AAOS aims to help healthcare organizations work together to address the many issues and challenges involved in providing safe, high-quality care. Together with the American College of Surgeons, AAOS will sponsor the National Surgical Patient Safety Summit (NSPSS), Aug. 4–5, in Rosemont, Ill.

Massive Rotator Cuff Tears Improve with Partial Repair

Peter Pollack

Arthroscopic partial rotator cuff repair may benefit patients with large and massive rotator cuff tears, according to data presented at the annual meeting of the Arthroscopy Association of North America by Stephen C. Weber, MD. Although the results may not approach those of complete arthroscopic repair, the researchers argue that the technique represents a reasonable, low-morbidity, low-cost salvage option for rotator cuff tears that may not be completely repairable.

Study: Optimal Timing of Antibiotic Prophylaxis for Foot and Ankle Surgery Not Clear for SSI Prevention

Terry Stanton

A study aiming to pinpoint the optimal timing of antibiotic administration to prevent surgical site infections (SSIs) following foot and ankle surgery found that timing of intravenous prophylaxis does not appear to significantly affect the risk of SSI. Results demonstrated that host factors and duration of surgery appear to play a much larger role in SSI incidence.

Stopping Biofilms Before They Form

Peter Pollack

Covalent attachment of antibiotics to allograft surfaces could inhibit bacterial colonization and help tumor patients resist infection for a far longer period than most current technologies, according to information from a study conducted by Constantinos Ketonis, MD, PhD, and his colleagues. Dr. Ketonis presented findings from his ongoing work in a scientific paper at the 2016 AAOS Annual Meeting.

Continued Development of Virtual Care Could Improve Musculoskeletal Health

Karl Koenig, MD; David Ring, MD, PhD; Andrea Leyton-Mange, BA

Virtual care and other technologies (such as clinician-to-clinician electronic consults, self-care apps and websites, and bio- and behavioral feedback devices such as activity trackers) will enhance the variety and quality of tools and connections that we, as orthopaedic surgeons, can use to help people seeking better musculoskeletal health.

The Opioid Epidemic and Orthopaedics: Where Do We Stand?

Terry Stanton

Even as the number of prescriptions for opioid pain medication declines from its peak of about 250 million in 2013, the epidemic of opioid use continues to devastate lives. Some 2 million individuals are afflicted with substance use disorders involving opioids, with approximately 500,000 of them addicted to heroin.

New Habits Can Better Serve Patients

During a recent meeting of the Patient Safety Committee, Chair David Ring, MD, PhD, facilitated a discussion on how physicians can deal with the conflict between evidence and experience. Participating committee members Dwight Burney, MD; Michael Pinzur, MD; Alan Reznik, MD; Andrew Grose, MD; and Michael Marks, MD, shared strategies. Dr Ring: As physicians, we all have ways of dealing with the limits of modern medicine—habits we fall back on when we face difficult situations.

Investigators Compare Outcomes of ORIF Versus THA for Femoral Neck Fractures

Terry Stanton

A study comparing outcomes with open reduction and internal fixation (ORIF) versus total hip arthroplasty (THA) for femoral neck fractures in patients younger than age 65 years found that THA was a cost-effective option for healthy patients older than 54 years. THA was also a cost-effective option for patients with mild comorbidity older than 47 years and for patients with multiple comorbidities older than 44 years.

Culture of Safety

David Ring, MD, PhD

This feature is the next installment in a series of dialogues among members of the AAOS Patient Safety Committee. This dialogue focuses on how to establish and maintain a culture of safety within an environment in which everyone is expected to err but also champions the teams and systems that catch errors before they cause harm. Dr. Ring: Let’s talk about ideas for creating a culture of safety. Dr.

Putting Yourself in Your Patient's Place

Identifying a patient's values to appropriately address them during treatment is an important part of medical decision making. In the August issue of AAOS Now, members of the Patient Safety Committee began a discussion focused on identifying and responding to patient preferences in treatment.

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.

Study Compares Tendon Autografts for ACL Reconstruction in Young Females

Maureen Leahy

Research presented during the American Orthopaedic Society for Sports Medicine 2018 Annual Meeting found that the use of bone-patellar tendon-bone (BTB) autograft for anterior cruciate ligament (ACL) reconstruction in females 15–20 years old yielded better outcomes than quadruple hamstring (HS) autograft. The study was presented by Kevin B. Freedman, MD, of Rothman Orthopaedics in Philadelphia. Dr.

Study: Higher Cost of IV Acetaminophen Balanced by Reduction in Opioid Usage and Other Indirect Costs

Terry Stanton

Intravenous (IV) acetaminophen has been demonstrated to be safe and effective, but because of its comparatively high cost, it is prescribed far less to patients after spine surgery than oral (PO) formulations.* During a Best Paper session at the North American Spine Society Annual Meeting, researchers reported that IV acetaminophen may be a better value for use in circumferential lumbar spine surgery due to the reduction in indirect costs and avoidance of potential opioid dependence.

Quantitative Gait Analysis for Clinical Practice

Jeffery W. Rankin, PhD

Originally developed as research tools to better elucidate pathological gait deviations, the tools and techniques associated with quantitative gait analysis have expanded rapidly and are now more accessible than ever as clinical resources.

OVT Video Features Novel MAC-STILA Technique for Analgesia in Hip Fracture Surgery

Leslie Schwindel, MD, FAAOS

Despite advances in technology and perioperative management, postoperative mortality rates remain high. Techniques that decrease perioperative risk are of special interest to surgeons who treat hip fractures.

Hip Arthroscopy—What Happens after Revision?

Peter Pollack

At 2-year follow-up, patients who undergo revision hip arthroscopy may be twice as likely to have undergone either total hip arthroplasty (THA) or hip resurfacing (HR) than those who undergo a primary hip arthroscopy procedure. In addition, patients undergoing primary arthroscopy tend to see improved outcomes compared to those undergoing revision. Parth Lodhia, MD, FRCSC, presented these findings at the annual meeting of the Arthroscopy Association of North America. Dr.

Trends and Recent Research in Hip Arthroscopy

Dean K. Matsuda, MD

It has been 4 years since the last AAOS Now update on advances in hip arthroscopy. Since then, arthroscopic techniques and the field of hip preservation have rapidly evolved. This updated overview explores some of the latest hot topics, technical advancements, and emerging evidence-based studies in hip arthroscopy. As in any evolving field, current information and analysis is subject to change.

Sports Medicine Research at the 2016 AAOS Annual Meeting

Jeremy M. Burnham, MD; Rachel M. Frank, MD

The 2016 AAOS Annual Meeting featured innovative and thought-provoking research in all fields of orthopaedics. Summarized here are some highlights from presentations in sports medicine and arthroscopy. In the April issue, we looked at studies on lower extremity, basic science, and cost-effectiveness. Here we cover selected research on upper extremity and rehabilitation and return to play. Upper extremity In Paper 328, CPT Drew W. Nute, MD, CPT Nicholas A.

TAR and Nicotine

Terry Stanton

A study examining the effects of cigarette smoking on total ankle replacement (TAR) surgery found that active cigarette smokers had a significantly higher risk of wound complications and worse outcome scores compared with nonsmokers and former smokers. The study, presented at the annual meeting of the American Orthopaedic Foot & Ankle Society (AOFAS) in Toronto by Alexander J.

Patients with Ankle Fractures May Be Able to Use Fewer Opioids

Terry Stanton

According to a study published in the July issue of the Journal of the American Academy of Orthopaedic Surgeons, no association exists between opioid intake and disability following surgery for ankle fracture. The study also found no link between opioid intake and satisfaction with treatment or pain management.

Study: Costs of Certain Orthopaedic Procedures Lower at an ASC

According to research recently published in the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), direct costs for select orthopaedic procedures were significantly less when these procedures were performed at an ambulatory surgical center (ASC) rather than at a university-based children's hospital (UH).

Patient-Reported Outcome Measures for Research, Reimbursement, and Point of Care

Thom Walsh, PhD

Patient-reported outcome measures (PROMs) have become more common over the past 30 years. Providers have been exposed to PROMs through the reporting of performance measures for the Physician Quality Reporting System and payment reform efforts such as the Merit-based Incentive Payment System track in the Quality Payment Program (QPP) under the Medicare Access and CHIP Reauthorization Act (MACRA).

After the Error

David Ring, MD, PhD; Robert J. MacArthur, MD

In the January 2017 issue of AAOS Now, my coauthor Robert J. MacArthur, MD, shared a first-person account of how a wrong-side knee procedure could occur in the era of Universal Protocol. I—David Ring, MD, PhD—also have a personal story of medical error. In 2008, I published an account of my wrong procedure—a carpal tunnel release in a patient who should have had a trigger finger release—and later spoke about my error at several meetings across the country.

Identifying Risk Factors for Unplanned Readmissions Following TJA

Terry Stanton

A study that sought to identify trends and risk factors for unplanned readmission following total joint arthroplasty (TJA) found that increasing body mass index (BMI), an American Society of Anesthesiologists (ASA) score of ³3, and discharge to an inpatient rehabilitation facility were independent risk factors for early unplanned readmissions.

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.

The Biomechanics of Metallic Implant Development and Testing

Emmon Johnny Chen, MS

The internal environment of living organisms proves a harsh milieu for manufactured items due to the corrosive ions that break down most materials.

PRP Injections Are an Effective Treatment for Carpometacarpal Joint OA

Maureen Leahy

Results from an ongoing study presented at the AAOS Annual Meeting indicate that platelet rich plasma (PRP) injections may be an effective nonsurgical treatment option for carpometacarpal (CMC) joint osteoarthritis (OA). The study was designed to compare the efficacy of PRP injections vs. the standard treatment of corticosteroid injection(s) for pain relief, functional return, and improved range of motion in patients with CMC joint OA.

Wrong-Side Procedure in the Modern Era

Robert J. MacArthur, MD

Bob MacArthur reached out to me with a compelling story of medical error. People often wonder how a wrong-side procedure can occur in the era of Universal Protocol and two decades of "operate through your initials"/"sign your site." This story will demonstrate how. It's a real lesson in the importance of a culture of safety. Bob and I hope that you will learn from this experience. On Feb.

Safety Program May Help "Turn the Tables on Concussion"

Terry Stanton

A study involving more than 2,500 high school football players in South Carolina found that those on teams that had participated in the USA Football Heads Up safety program had concussion rates 33 percent lower than those on teams that had not. The study was presented at the Game Changers Paper Session at the AAOS Annual Meeting in San Diego by John M. Tokish, MD.

A Closer Look at ACL Tears in Male and Female Athletes Reveals Interesting Data

Kwadwo Owusu-Akyaw, MD

Anterior cruciate ligament (ACL) tears are a dreaded injury for athletes at all levels and are a leading cause of knee instability and dysfunction. For athletes, an ACL tear may mean surgical reconstruction followed by up to 1 year of focused rehabilitation prior to return to sport. Unfortunately, for many athletes, an ACL rupture can affect future athletic performance as well as collegiate and professional opportunities.

The Biomechanics of Reverse Total Shoulder Prosthesis

Christian M. Schmidt II, MD; Mark A. Frankle, MD, FAAOS

Reverse total shoulder arthroplasty (RTSA) addresses the deltoid’s unopposed force by flipping the articulation with a spherical glenoid and a semi-constrained humeral socket, which converts the action of the deltoid from a destabilizing superiorly directed shear force into a stabilizing rotational force that elevates the arm and stabilizes the articulation.

Beyond the Technique: Patient Safety and the Core Competencies

Terry Stanton

In an Annual Meeting symposium focusing on surgical safety core competencies for orthopaedic residents, asked how many residents in the audience had  nontechnical" surgical skills education and whether their programs had an identified safety expert. "Unfortunately," he said, surveying the result, "everyone's hand should be in the air." Dr.

Study: HbA1c Risk Threshold for Infection Identified for Diabetes Patients Undergoing Shoulder Replacement

Terry Stanton

A study, presented at the AAOS Annual Meeting in San Diego, reported, that, in patients with diabetes mellitus undergoing shoulder arthroplasty, the risk of deep postoperative infection rises with increasing hemoglobin A1c (HbA1c) levels. The data also suggested a perioperative HbA1c greater than 8.0 mg/dL might serve as a threshold for a significantly increased risks of postoperative infection.

Study Demonstrates Rapid Method for Detecting P Acnes

Terry Stanton

A study presented at the AAOS Annual Meeting reported on an assay and technique for detecting Propionibacterium acnes (P acnes). This technique was shown to identify the organism in tissue obtained from a shoulder biopsy within 24 hours.

Culturing PJI: How Many Samples; How Long to Grow?

Peter Pollack

"Periprosthetic joint infection [PJI] can be very difficult to diagnose. Isolating the organism is crucial in directed treatment; however, an organism’s virulence may impact the culture growth,” explained Michael M. Kheir, MD, who presented findings from the paper, “Culturing PJI: A 15-year Study of Samples, Growth Duration, Outcomes, and Organisms,” at the 2017 annual meeting of the Musculoskeletal Infection Society (MSIS). With their study, Dr.

Treating Severe Open Tibial Fractures

Terry Stanton

The use of circular hexapod devices was found to provide a safe, minimally invasive surgical alternative method to open reduction and internal fixation (ORIF) in patients with severe open tibial fractures, achieving high bony union rates and excellent limb salvage results, according to research presented in a scientific poster at the 2016 AAOS Annual Meeting. The study, led by Dr.

Study: Study Probes Reimplantation Rates, Complications Following THA Infection

Terry Stanton

A Medicare database study reviewing outcomes for patients who underwent antibiotic spacer placement following removal of total hip arthroplasty (THA) due to infection found that only 60 percent of such patients underwent THA reimplantation. Approximately 6 percent of these patients died within 1 year following removal.

Using Telemedicine for Orthopaedic Follow-Up

Alfred Atanda Jr, MD

My first experience with using telemedicine for orthopaedic follow-up was in August 2014. I had performed an anterior cruciate ligament reconstruction on a 17-year-old male named Tom, who lived about 90 miles from our hospital. A week later, during a casual conversation with his father, I learned that Tom was doing well recovering at home, but was having trouble adjusting his postoperative brace. Tom's dad asked if I could "FaceTime" with Tom and show him how to adjust it.

Study Examines Risk Stratification for Adult Spine Deformity Surgery

Terry Stanton

A program of risk stratification to more judiciously select candidates for adult spinal deformity surgery more selectively can yield reduced complications and increased cost effectiveness, according to Dr. Sethi presented the results of such a program during a 2017 Scoliosis Research Society Specialty Day session. "The number of operative adult scoliosis cases has increased significantly, and we have to find a better way to care for these patients at lower cost," he said.

New Data Underscore the Connection between Nutritional Status and Perioperative Infections

Andrew R. Merwin, MD; Boris A. Zelle, MD, FAAOS, FAOA

Perioperative infections remain a significant concern in orthopaedic surgery, impacting patient outcomes, prolonging hospital stays, and increasing healthcare costs.

Study: Increased Workload After Tommy John Surgery Increases Re-tear Risk

Terry Stanton

A study of 28 Major League Baseball (MLB) pitchers who underwent revision surgery after primary ulnar collateral ligament (UCL) reconstruction (Tommy John surgery) found that they had pitched at or above their pre-primary UCL workload, while pitchers who did not require revision pitched significantly less—below their pre-reconstruction workload. These findings indicate that relative changes in workload may be a risk factor for re-rupture, said Robert A.

Sports Medicine Research at the 2016 AAOS Annual Meeting

Jeremy M. Burnham, MD; Rachel M. Frank, MD

The 2016 Annual Meeting featured innovative and thought-provoking research in all fields of orthopaedics. Summarized here are highlights from sports medicine and arthroscopy presentations covering lower extremity, basic science, and cost-effectiveness. In May, we will feature studies focused on upper extremity, rehabilitation, and return-to-play issues.

Studies on ACL-Deficient Knees, and More Receive Awards

Andrew J. Sheean, MD

The Society of Military Orthopaedic Surgeons (SOMOS) honored research on the use of local antibiotics in contaminated open fractures, as well as on anterior cruciate ligament (ACL) deficiency in knees and chronic exertional compartment syndrome of the lower leg at its 2015 annual meeting, held Dec.7–11, 2014, in St. Petersburg, Fla. The CDR Michael T. Mazurek Clinician Scholar Award and the COL Brian Allgood Memorial Leadership Award were also presented.

Evidence Bolsters Recommendations in New CPG

Terry Stanton

A new Clinical Practice Guideline (CPG), available on the OrthoGuidelines.org website, provides a wealth of recommendations for Surgical Management of Osteoarthritis of the Knee (SMOAK). Reflecting the improving quality of evidence to guide treatment decisions, the new CPG offers 14 recommendations based on "strong" evidence (Table 1) and 14 with "moderate" evidence. Ten others derive from "limited" evidence. Table 2 lists the complete summary of guidelines.

Delay Spells Difficulties for Children with SL Injuries

According to the results of a study presented during the 2016 annual meeting of the American Association for Hand Surgery, early diagnosis and surgical treatment of scapholunate (SL) ligament injuries in patients younger than 18 years results in better outcomes, compared to patients who underwent surgery a year or more after the injury. SL injuries may result from a fall or a sudden load on the wrist. They are not uncommon in athletes, but are rarely diagnosed in pediatric patients.

Preparing the Graft in Cruciate Ligament Reconstruction

Peter Pollack

“The all-inside technique for knee cruciate ligament reconstruction has gained popularity in recent years,” explained Jacqueline M. Brady, MD. “Various techniques for graft preparation have been described, but little research has been conducted to compare those techniques.

The Perioperative Surgical Home: Toward Seamless Patient Care

Brad Waddell, MD; Scott F. M. Duncan, MD, MPH, MBA

In recent years, healthcare reform has taken center stage in both political and medical society debates. As healthcare providers seek a safer, more economical approach to treating their patients, we have begun to implement evidence-based, standardized practices and protocols. At the same time, lawmakers demand high-quality and low-cost solutions. Traditional surgical episodes are fragmented— into the preoperative episode, the operative episode, and the postoperative episode.

THA, Tranexamic Acid, Bupivacaine Papers Receive Awards

Jennie McKee

A study on conversion total hip arthroplasty (THA), the procedure in which a previous hemiarthroplasty or other reconstruction is converted to a total joint replacement, was recognized for outstanding research during the 2015 annual meeting of the American Association of Hip and Knee Surgeons.

Study Finds MCP Arthroplasty Safe, Successful

A promising treatment for patients with inflammatory arthritis, according to a paper presented at the 2016 annual meeting of the American Association of Hand Surgeons, is metacarpophalangeal (MCP) arthroplasty. This study compared the most common implant designs in terms of implant survival rates, finger and hand function, and surgical complications. The researchers, all of whom are from the Mayo Clinic in Rochester, Minn.

Study Focuses on Dual Taper THA and Revision Outcomes

A study of total hip arthroplasty (THA) patients presented at the 2016 AAOS Annual Meeting found that revision surgery of dual taper THA due to taper corrosion had an early increased incidence of postoperative complications (20 percent) and a rerevision rate of 6 percent. According to the study findings, metal ion levels and cobalt chromium ratios declined significantly in all patients after the dual taper was removed.

Stem Cells Are an Effective Adjunct Therapy for Rotator Cuff Tears

Maureen Leahy

Although arthroscopic rotator cuff repair has become a fairly common surgical procedure, retears can occur. Researchers from Henri Mondor Hospital, Paris University, have found that the use of bone-marrow-derived mesenchymal stem cells (MSCs) during arthroscopy enhances tendon healing and decreases the likelihood of retears.

Wide Variation Found in Readmission Rates after TKA

Whether a total knee arthroplasty (TKA) patient is readmitted to the hospital within 30 to 90 days after the procedure may depend, to some extent, on the hospital's geographic location in the United States. Data from a study presented at the 2016 AAOS Annual Meeting found a wide geographic variation in readmission among hospitals across the country, with patients in the Western states having a lower 30- and 90-day readmission (RA) risk than patients in other regions of the country.

An Attractive Alternative: Magnetic Growing Rods

Peter Pollack

"Most orthopaedic surgeons who treat patients with early onset scoliosis use traditional growing rods, which allow for spinal growth and deformity control," said Todd Milbrandt, MD, addressing members of the Scoliosis Research Society during their 2015 annual meeting. "However, such systems require regular surgical lengthening, which may be linked with increased risk of infection and additional stress to the patient.

Decline in HACs Associated with Cost Savings and Fewer Deaths

Julie B. Samora, MD, PhD, MPH; David B. Bumpass, MD

All too often, patients enter a hospital with one condition and acquire others during treatment. These hospital-acquired conditions (HACs), as defined by the Centers for Medicare & Medicaid Services (CMS), are common and costly medical complications that could reasonably have been prevented through the application of evidence-based guidelines.

Reducing Malalignment Rates in Distal Tibia Fractures

Terry Stanton

A study comparing two intramedullary nail (IMN) insertion techniques in the treatment of distal tibia fractures found that the suprapatellar approach yielded a significantly lower rate of malalignment (3.8 percent) than the infrapatellar approach (26.1 percent). Although use of a locked IMN in an infrapatellar technique "has been shown to enable a successful outcome," according to the authors, "obtaining correct alignment has historically been problematic."

Study: Shorter Time Between Injections for Trigger Finger Predictive of Need for Surgical Release

Terry Stanton

Study data indicate that patients who received a second steroid injection for stenosing tenosynovitis—commonly known as trigger finger—within 6 months of the first injection had a significantly higher likelihood of requiring surgical release than patients who received a second injection after 6 months.

Injections May Increase Infection Risk in TKA Patients

Jennie McKee

Patients who receive an intra-articular steroid or hyaluronic acid injection in the knee prior to undergoing total knee arthroplasty (TKA) may be at an elevated risk of postsurgical infection, according to Nicholas A. Bedard, MD. Furthermore, infection risk may be time-dependent, increasing when less time has elapsed between injection and undergoing TKA, noted Dr. Bedard during the 2015 annual meeting of the American Association of Hip and Knee Surgeons.

Spine Disability May Negatively Affect TKA Outcomes

Jennie McKee

Although total knee arthroplasty (TKA) generally results in excellent pain relief, approximately 20 percent of patients have persistent functional deficits that affect their quality of life, noted William C. Schroer, MD, during the 2015 annual meeting of the American Association of Hip and Knee Surgeons. Dr. Schroer reported that lumbar spine problems are a common cause of functional disability in TKA patients.

More News from AAHKS

According to a study presented at the annual meeting of the American Association of Hip and Knee Surgeons (AAHKS), obese patients who undergo bariatric surgery prior to total knee arthroplasty (TKA) will experience fewer complications following the surgery than obese patients who have not had bariatric surgery. Author used a national database to evaluate the complication rates after TKA in patients who have had bariatric surgery.

Advancing Quality and Innovation in Orthopaedics: A Look into AAOS Initiatives

Paul Tornetta III, MD, PhD, FAAOS

With AAOS’ ongoing commitment to enhancing the health of patients with musculoskeletal conditions and promoting innovation in orthopaedics, we continue to evolve the tools and resources available to members.

DAIR, Double DAIR, and DAPRI Procedures: Where Are the Unseen Bacteria?

Daniel R. Schlatterer, DO, MBA, FAAOS

One of the most devasting complications after total knee replacement is periprosthetic joint infection.

Mobility Should Be the New Fifth Vital Sign

Michael S. Sridhar, MD, FAAOS; Michael J. Colello, MD

In its 1999 national pain-management strategy, the Veterans Health Administration identified pain as the fifth vital sign to join the classic four of temperature, heart rate, respiration rate, and blood pressure.

AAOS Board Approves AUC on Antibiotic Use for Dental Procedures

Terry Stanton; Sheryl Cash

At its September meeting, the AAOS Board of Directors approved a suite of appropriate use criteria (AUC) providing guidance on when it may be appropriate to consider antibiotic administration prior to dental procedures in patients with replacement joint implants.

AAOS Puts Patient Safety at the Forefront

Terry Stanton; Paul Zemaitis

Taking a cue from the adage about safety in numbers, more than 150 representatives from more than 75 healthcare organizations came together near AAOS headquarters in August to take part in the inaugural National Surgical Patient Safety Summit (NSPSS).

Abnormal Elbow Findings Identified in Little League Throwers

Terry Stanton

A study of Little League baseball players before and after a season of play found that arm pain and MRI abnormalities of the medial elbow were common even in players who complied with the Little League throwing guidelines, especially those who played year round. Study data also support the conclusion that pain and injury are more closely related to the cumulative number of throws and not necessarily the number of pitches in a given game.

Fighting for Funding

Erin Lynn Ransford

Nearly one of every three Americans will have a musculoskeletal condition in his or her lifetime, costing an estimated $874 billion in annual treatment and lost wages. Yet the federal funding allocated to musculoskeletal research is disproportionate to the economic burden of orthopaedic diseases and disorders. For the past 14 years, the AAOS, in conjunction with multiple specialty societies, has assembled orthopaedic patients, physicians, and researchers in Washington, D.C.

U.S. News & World Report to Publish Hip and Knee Surgeon Ratings

Maureen Leahy

During the 2017 Annual Meeting, orthopaedic surgeons and other stakeholders listened intently as representatives from U.S. News & World Report described the publication's plan to publish individual hip and knee surgeon performance analyses. These score cards are expected to be made available online at USNEWS.com sometime this fall.

HIV and the Orthopaedic Patient

Terry Stanton

Since HIV was first documented in the United States in 1981, great strides have been made in the prevention of transmission and the management and treatment of HIV/AIDS. Still, an estimated 1.2 million persons aged 13 years or older are living with HIV infection in the country. Approximately 156,300 (12.8 percent) are unaware of their infection.

‘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.

S. aureus Infects and Hides in Living Osteocytes in PJIs

Gerald J. Atkins, PhD

Over the past three years, my colleagues and I have studied Staphylococcus aureus (S. aureus) bacteria and their ability to infect and reside inside human living osteocytes. This phenomenon may explain why periprosthetic joint infections (PJIs) are difficult to treat and clear, as well as why they can recur months or years after infection treatment or primary surgery.

U.S. News & World Report Announces Updates to Its Online Physician Profiles

Maureen Leahy

In 2017, during a forum held at the AAOS Annual Meeting, representatives from U.S. News & World Report introduced the publication’s plan to publish individual hip and knee surgeon performance analyses. The purpose, they explained, is to provide patients with decision support and better reflect the quality of care that orthopaedic surgeons provide (see U.S. News & World Report to Publish Hip and Knee Surgeon Ratings, AAOS Now, May 2017).

The Death of Lasers in Spine Surgery?

Matthew S. Galetta, BA; Kris E. Radcliff, MD

In the early 1960s, dermatologists began using ruby lasers to remove port wine stains and melanomas. Since then, lasers have been used in other fields, including cosmetic surgery, genetics, oncology, and ophthalmology. The laser—an acronym for light amplification by stimulated emission of radiation—plays a vital role in numerous medical fields. An intense, focused beam is created from emission of light waves in the same phase and at the same frequency (i.e., coherent).

Wanted: Orthopaedic Surgeon-Scientists!

Roxanne E. Wallace, MD

Orthopaedic innovations come to market in a variety of ways. Sometimes, a researcher will uncover a clue to a new treatment. Then, orthopaedic surgeons will conduct clinical trials to see whether the treatment works. Other times, a clinician will notice a similarity among patients and turn to a researcher to find the reason. And sometimes, the researcher and the clinician are one and the same: the elusive orthopaedic surgeon-scientist.

The Evolving State of TJA Performance Measures

Kent Jason Lowry, MD; Adolph J. Yates Jr, MD

Performance measures, capturing the quality of care provided by surgeons and hospitals, are an increasingly important reality. Performance measures for total joint arthroplasty (TJA) have been an early focus for Medicare and other payers due to the volume of surgeries, the cost, and the potential for reimbursement through alternative payment models (APMs). The most readily applied APM for TJA is an episode of care bundled payment.

Opioids and the Orthopaedic Surgeon

Terry Stanton

Although a flurry of legislative and regulatory activity in response to the opioid crisis has reduced the volume of opioid medications being dispensed, the epidemic of addiction continues to be a serious issue.

New Appropriate Use Criteria Cover Carpal Tunnel, SMOAK

Terry Stanton

The Academy Board of Directors in December approved release of two new sets of Appropriate Use Criteria (AUC), covering Carpal Tunnel Syndrome (CTS) and Surgical Management of Osteoarthritis of the Knee (SMOAK). As with previously issued AUC, these new app-based resources (www.aaos.org/auc) provide clinicians with an algorithm-style tool for choosing management pathways for patients with these conditions.

Addressing the Opioid Epidemic

Manthan Bhatt

Although many patients may benefit from opioid medications, abuse of prescription opioids is a serious problem responsible for nearly 50 deaths a day and thousands of emergency department visits a year. For example, the number of emergencies related to nonmedical use of opioids increased 183 percent between 2004 and 2011. In response, state governments passed nearly 60 laws in 2015 aimed at curbing the opioid epidemic.

Orthopaedic Surgeons and the Quality Conundrum

Elizabeth Fassbender

During the symposium, "The Quality Conundrum: Recognizing and Reckoning with Disparities in Musculoskeletal Health and Health Care," held during the 2017 Annual Meeting in San Diego, presenters reviewed sources of gender, racial, ethnic, and socioeconomic disparities in musculoskeletal care. They also summarized the costs and frameworks required to achieve healthcare equity and provide maximum value for all patients.

Measures to Avoid Complications in TKA

Terry Stanton

Wound complications after total knee arthroplasty (TKA) are rare—with only 0.33 percent of more than 17,000 patients in a Mayo Clinic registry requiring surgical intervention within 30 days. However, when complications do occur, they can be serious and expensive.

New AUC on DDH Offers Guidance for Pediatricians and Orthopaedists

Terry Stanton

At the AAOS 2018 Annual Meeting in New Orleans, the AAOS Board of Directors approved the release of Appropriate Use Criteria covering Management of Developmental Dysplasia of the Hip (DDH) in Infants Up to 6 Months of Age. Based on the Academy’s previously issued Clinical Practice Guideline (CPG) on DDH, this new AUC is noteworthy because it provides a customized version for orthopaedic surgeons as well as generalists/pediatricians.

Study: 'Little If Any' Correlation Between Press Ganey Scores and Functional Outcomes in TJA Patients

Terry Stanton

A study evaluating the corr­elation between patient-reported outcomes and outpatient Press Ganey Scores in patients undergoing total joint arthroplasty (TJA) found little if any correlation between in-clinic satisfaction as expressed in Press Ganey Medical Practice Survey scores and improvement in function, mental health, and pain.

Board Approves Performance Measures for Carpal Tunnel Syndrome, Appropriate Use Criteria for Hip OA

Terry Stanton

During its December 2017 meeting, the AAOS Board of Directors approved the release of two quality-focused products that will provide orthopaedic surgeons with additional evidence-based resources for clinical decision making. The new performance measures for carpal tunnel syndrome are the first set of performance measures that are based on a previously published AAOS Clinical Practice Guideline (CPG). The measures, to be submitted to the U.S.

A Bright Future: AAOS Leadership Addresses NOLC Attendees

Tanya Kenevich

AAOS is making innovative advancements in its strategies, outreach, and educational options. David A. Halsey, MD, AAOS president; Kristy L. Weber, MD, AAOS first vice-president; Joseph A. Bosco III, MD, AAOS second vice-president; M. Bradford Henley, MD, MBA, FACS, AAOS treasurer; and Thomas E. Arend Jr, Esq.

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.”

Studies Find Concerning Rates of Persistent Opioid Use After Common Foot and Ankle Procedures

Terry Stanton

Two studies examining opioid use by patients treated for foot and ankle conditions show that a substantial number of the patients continued to consume opioids persistently after the therapeutic course for pain had concluded. The studies, presented at the American Orthopaedic Foot & Ankle Society annual meeting in Boston, found that in those who underwent surgery for hallux valgus, the rate of new, persistent opioid use was 6.

Academy Issues Two Updated CPGs on PJI and Rotator Cuff Injuries

Terry Stanton; Kaitlyn Sevarino, MBA

The Academy’s Board of Directors met last month during the AAOS 2019 Annual Meeting and approved two completely updated Clinical Practice Guidelines (CPGs): one on periprosthetic joint infection (PJI) and the other on rotator cuff injuries (RCIs). Both CPGs were originally published in 2010, when the available evidence for management of those orthopaedic conditions was relatively limited and the field of evidence-based medicine itself was maturing rapidly.

Are you losing patients to ‘medical tourism’?

Jennie McKee

AAOS Now explores the growing trend of traveling abroad for medical care As U.S. healthcare costs continue to increase, many Americans are facing difficult choices. Should a 61-year-old uninsured waitress who needs bilateral knee replacement wait until she’s eligible for Medicare before having the surgery because she can’t afford the $100,000 total cost?

No easy answers on disk herniation surgery

Mary Ann Porucznik

Initial results from the Spine Patient Outcomes Research Trial (SPORT) study have garnered plenty of publicity—almost as much as speculation about those results before their publication. “So many people were worried about what the results would be and ready to argue with whatever we found,” recalled James N. Weinstein, DO, MS, the study’s primary author.

SPRINT study challenges superiority of reamed nailing

Annie Hayashi

The Study to Prospectively Evaluate Reamed Intramedullary [IM] Nails in Tibial Fractures (SPRINT) found virtually no difference between the results achieved with either reamed or nonreamed IM nailing in tibial shaft fractures, according to a presentation given at the 2007 annual meeting of the Orthopaedic Trauma Association (OTA).

AAOS adopts CTS clinical treatment guidelines

Fareeha Shuttari-Khan, MPH

During its September meeting, the AAOS Board of Directors adopted a new clinical practice guideline on the treatment of carpal tunnel syndrome (CTS). Kristy L. Weber, MD, chair of the Council on Research, Quality Assessment and Technology, presented the guidelines, which were developed by a workgroup appointed by the Guidelines and Technology Oversight Committee. The Guideline Workgroup on the treatment of CTS was chaired by Michael W. Keith, MD, and cochair Victoria Masear, MD.

Massive fraud revelations stun orthopaedics

Annie Hayashi

Fabricated data discredit prominent pain management researcher Revelations about a well-known pain management researcher have hit orthopaedics, anesthesia, and other medical fields, resulting in more than 20 scientific articles being identified as containing fabricated data. Scott S. Reuben, MD, was one of the most prolific investigators in the field of anesthesia and analgesia, particularly for orthopaedic perioperative and postoperative pain management.

AAOS releases first pediatric clinical practice guidelines

Ernest L. Sink, MD

Recommendations focus on treating pediatric diaphyseal femur fractures Pediatric diaphyseal femur fractures account for 1.4 percent to 1.7 percent of all pediatric fractures. Of every 100,000 children who sustain a fracture annually, approximately 19 will have femoral shaft fractures. Many different options for treating femoral shaft fractures exist, and treatment is dictated by patient age, fracture characteristics, and the social situation.

Maintaining the integrity of orthopaedic literature

Maureen Leahy

What do plagiarism and duplicative publishing have to do with orthopaedic surgeons? Plenty, it seems. Instances of these practices in orthopaedic circles have increased in recent years, putting the integrity of the scientific literature at risk.

AAOS adopts clinical practice guidelines on OA Knee

John C. Richmond, MD

Recommendations focus on less invasive treatments Approximately 10 million adults in the United States are estimated to have symptomatic osteoarthritis (OA) of the knee. Although joint replacement remains one of the most cost-effective treatments available for end-stage OA knee, a myriad of treatment alternatives are available for less severe cases. But which are the most effective? Which have the best evidence supporting their use?

National joint registry legislation introduced

Annie Hayashi

Intent is positive, but proposal has drawbacks A bill to create a government-run joint registry program has been introduced in the U.S. House of Representatives. The “National Knee and Hip Replacement Registry Act of 2009,” sponsored by Reps. William Pascrell Jr. (D-N.J.) and Lloyd Doggett (D-Texas), would establish the registry within the Agency for Healthcare Research and Quality.

Keeping master’s athletes in the game

Jennie McKee

Aging may be inevitable, but many people 55 years and older aren’t willing to simply get old. Just look at the success of golfer Tom Watson, who — at age 59 — came within a stroke of winning the 2009 British Open. “Our practices are filled with older patients who want to stay active,” said Vonda J. Wright, MD, director of the Performance and Research Initiative for Master’s Athletes at the University of Pittsburgh.

New CPG on diagnosing periprosthetic infections

Javad Parvizi, MD

At their meeting in June, the AAOS Board of Directors approved a new clinical practice guideline (CPG) on the diagnosis of periprosthetic joint infections. Total joint arthroplasty is an effective means of improving function and decreasing morbidity in patients with degenerative arthritis.

AAOS releases technology overview on hip resurfacing

Brian J. McGrory, MD

During its December 2009 meeting, the AAOS Board of Directors approved a new technology overview (TO) on hip resurfacing (HR). Kristy L. Weber, MD, chair of the Council on Research, Quality Assessment and Technology, presented the document, which was developed by a physician workgroup under the direction of the Guidelines & Technology Oversight Committee.

Closing the TJA gender gap

Jennie McKee

Two patients—one male, one female, both with osteoarthritis of the knee and with identical clinical scenarios of chronic knee pain—visit their primary care provider. The man is referred to an orthopaedist for a possible arthroplasty. The woman is given prescriptions for an analgesic and physiotherapy. Is this appropriate care—or does it demonstrate a gender disparity?

Reverse vs. hemi for 4-part humeral fractures

Maureen Leahy

Hemiarthroplasty (HA) has traditionally been the treatment of choice for elderly patients with four-part proximal humeral fractures. In recent years, however, reverse shoulder arthroplasty (RSA) has been explored as an alternative to HA in these instances.

Treating spinal compression fractures

Robert A. McGuire Jr, MD

At their meeting on Sept. 24, 2010, the AAOS Board of Directors approved a new clinical practice guideline on the treatment of osteoporotic spinal compression fractures (Fig. 1). The new guideline includes 11 recommendations, including one that is strongly supported by good quality evidence and one that is supported by fair quality evidence (see Table 1, PDF).

AAOS endorses back pain guidelines

Michael H. Heggeness, MD, PhD

For the first time ever, the AAOS has endorsed clinical practice guidelines generated by another medical specialty society. At its meeting in June, the AAOS Board of Directors approved the endorsement of the American Pain Society’s Guideline on Management of Low Back Pain.

New Pediatric Guideline on OCD Knee

Kevin G. Shea, MD; Hank G. Chambers, MD; James L. Carey, MD

Osteochondritis dissecans of the knee predominantly affects adolescent and young adult patients. Many of these patients are involved in athletics, and this condition can have a dramatic impact on them. OCD can lead to pain, swelling, mechanical symptoms, and inability to continue to play sports. The affected knee may progress to degenerative arthritis while the patient is still young.

New Guideline on Rotator Cuff Problems

Ken Yamaguchi, MD

Rotator cuff disease ranks among the most prevalent of musculo-skeletal disorders. Previous studies in both cadavers and patient populations have found the prevalence of rotator cuff tears may exceed 50 percent in individuals older than age 65. Given that this age group is the fastest growing segment of the U.S. population, rotator cuff disease is poised to become an even more significant problem in the future.

Making the Case for Orthopaedic Procedures

Madeleine Lovette

The explosive growth in the number of costly orthopaedic procedures—including joint replacements, back surgeries, and other treatments—has attracted the attention of legislators, payers, employers, and experts in both health care and economics. Without scientific evidence to support the effectiveness of these procedures, many of these critics are beginning to ask questions.

PRP an unproven option, agree forum experts

Mary Ann Porucznik

An international group of orthopaedic surgeons, clinician scientists, and researchers agreed that, for many orthopaedic conditions, administration of platelet-rich plasma (PRP) may be an option, but its efficacy is unproven.

New Pediatric Supracondylar Humerus Fractures CPG

Kishore Mulpuri, MD, MBBS, MS (Ortho), MHSc (Epi)

At their meeting on Sept. 24, 2011, the AAOS Board of Directors approved a new clinical practice guideline (CPG) on the treatment of pediatric supracondylar humerus fractures. This is the third CPG to focus on a primarily pediatric condition.

Mobile or fixed bearings for UKA: Which is better?

Mary Ann Porucznik

Do mobile-bearing designs offer a clinical advantage over fixed-bearing designs for unicompartmental knee arthroplasty (UKA)? That was the debate between Craig J. Della Valle, MD, and Richard D. Scott, MD, during the combined Knee Society/American Association of Hip and Knee Surgeons 2011 Specialty Day program.

Ringing the bell on concussion management

Peter Pollack

“Concussion is a significant issue,” said Claude T. Moorman III, MD. “We’ve learned that it is a more significant issue than some of us previously thought.”

Board approves VTED prevention guidelines

Michael A. Mont, MD

Guidelines address identification of at-risk patients and prophylaxis against VTED At their meeting on Sept. 24, 2011, the AAOS Board of Directors approved a new clinical practice guideline (CPG) on the prevention of venous thromboembolic disease (VTED) in patients undergoing elective hip or knee arthroplasty (THA/TKA).

Autograft or Allograft for ACL Reconstruction?

Jennie McKee

Whether to use an autograft or an allograft in anterior cruciate ligament (ACL) reconstruction is still controversial. Although patella tendon autograft has long been considered the gold standard, allograft safety has improved significantly in the last 15 years, making it a viable option in some patients, according to Mark D. Miller, MD, who reported on the latest information on autograft and allograft tissue and offered tips on selecting an allograft tissue bank during the 2012 Arthroscopy Association of North America Specialty Day Program.

AAOS Releases TO on MoM Hip Implants

Kristy L. Weber, MD; Fareeha Shuttari-Khan, MPH

With concerns by patients, clinicians, and regulators about metal-on-metal (MoM) hip implants on the rise, the AAOS Board of Directors commissioned a special technology overview (TO) on the topic.

Grateful Patients Speak to Value of Orthopaedics

Erin Lynn Ransford

Patients advocate during Research Capitol Hill Days Erin Lynn Ransford Debra Shoopman is a passionate cyclist. For 8 years, she has participated in Register’s Annual Great Bicycle Ride Across Iowa (RAGBRAI), a week-long, noncompetitive bicycle ride across the state of Iowa, totaling more than 470 miles. In July 2010, while training for RAGBRAI, Ms. Shoopman dislocated her left shoulder in a bicycle accident. Two months later, she dislocated the same shoulder as she was making her bed.

Ask, Advise, Refer to Improve Surgical Outcomes

Frank B. Kelly, MD

It’s becoming increasingly clear that orthopaedic patients who smoke have worse outcomes than those who don’t. The clinical effects of smoking on bone and wound healing include longer times to union, higher rates of nonunion, and higher rates of infection and wound complications.

Athletes Believe in It—Should You?

Terry Stanton

It started showing up in earnest at the 2008 Olympics in Beijing. Tape on the athletes—not white cloth wound around ankles, but flexible swatches in various hues applied seemingly haphazardly to the body surface, looking like patches on an old inner tube. Among the high-profile users was the U.S.

Will YODA End Debate Over rhBMP-2?

Terry Stanton

The word is in from the Yale Open Data Access (YODA) project: recombinant human bone morphogenetic protein (rhBMP-2), the product marketed as Infuse® by Medtronic, Inc., offers no appreciable benefit over autograft in spinal fusion surgery. The judgment is the result of an unprecedented move by the manufacturer, which turned over all patient data to the YODA project for review.

AAOS, ADA Release CPG for Prophylactic Antibiotics

Leeaht Gross, MPH

At their meeting on Dec. 7, 2012, the AAOS Board of Directors approved a new clinical practice guideline (CPG) on “The Prevention of Orthopaedic Implant Infections in Patients Undergoing Dental Procedures.” The evidence-based CPG, the first to be codeveloped by the AAOS and the American Dental Association (ADA), includes three recommendations (See Table 1) and will replace previous AAOS information statements on the topic. According to David S.

AAOS Approves Updated OA Knee CPG

David S. Jevsevar, MD, MBA

The AAOS, with input from representatives of the American College of Rheumatology, the American Academy of Family Practice, and the American Physical Therapy Association, recently published a collaborative clinical practice guideline (CPG) on the Treatment of Osteoarthritis (OA) of the Knee (Non-Arthroplasty)—2nd Edition.

Obesity Epidemic Has Impact on Specialty Care

Mary Ann Porucznik

The impact of obesity on surgical and nonsurgical treatment outcomes can be seen in every orthopaedic specialty. At the AAOS Now-sponsored forum on “Obesity, Orthopaedics, and Outcomes,” held March 18 in Chicago, orthopaedic surgeons and other experts noted that the problems associated with obesity can begin in childhood and last throughout a person’s life.

Study Takes Close Look at Impact of ACL Surgery

Mary Ann Porucznik; Washington Health Policy Fellows

In the second of a series of studies examining the economic impact of orthopaedic procedures, researchers found that outcomes for patients who had appropriately selected anterior cruciate ligament (ACL) reconstruction were both more effective (short- to intermediate-term) and less costly than rehabilitation alone.

AAOS Approves AUC on Rotator Cuff Tears

Mary Ann Porucznik; Leeaht Gross

The AAOS Board of Directors has approved new appropriate use criteria (AUC) on “Optimizing the Management of Full Thickness Rotator Cuff (RC) Tears.” This is the second AUC released by the AAOS, and it is supported by both a written document and a mobile device app.

What is the Societal Value of TKA?

Peter Pollack

With all the attention on the cost of health care, an important factor is being overlooked: the impact on society resulting from the treatment of a particular condition. Comparing that impact when both surgical and nonsurgical treatments are available is particularly important in a specialty such as orthopaedics, which focuses on restoring mobility and health.

Cell-based Therapies in Sports Medicine

Frank B. Kelly, MD; Mary Ann Porucznik

"Cell-based approaches for soft-tissue regeneration have been around since the 1980s, when autologous chondrocytes were first used to treat cartilage defects,” said Scott A. Rodeo, MD, co-chief, sports medicine and shoulder service, at the Hospital for Special Surgery and professor of orthopaedic surgery at Weill Cornell Medical College in New York City. Speaking at the AAOS Now-sponsored forum on “Stem Cells in Orthopaedics: Myth, Miracle, or Something In-Between,” Dr.

AAOS Introduces OA Knee AUC

Mary Ann Porucznik

When a patient has end-stage osteoarthritis (OA) of the knee, joint replacement is the ultimate treatment. But before a patient reaches that point, clinicians have numerous other treatment options—and many can be very helpful in reducing pain, improving function, and delaying or occasionally even precluding the need for arthroplasty. Determining which of these other treatments would be appropriate—and when—isn’t always clear.

AAOS Moves Forward on Quality Initiatives

During its meeting on Sept. 5, 2014, the AAOS Board of Directors took several steps on quality issues, approving three new clinical practice guidelines (CPGs) and one new appropriate use criteria (AUC). The CPGs and AUC were presented by Kevin J. Bozic, MD, MBA, chair of the AAOS Council on Research and Quality.

Taking a Bite Out of Dental Prophylaxis Guidelines

Mary Ann Porucznik

Could the bacteria released during certain dental procedures result in a periprosthetic joint infection? That question has long plagued patients, their dentists, and their orthopaedists. No one wants to risk an infection, but the medical and monetary impact of the unnecessary use of antibiotics are well-known.

AAOS Quality Efforts Continue

Mary Ann Porucznik

During its June 12–13, 2015, meeting, the AAOS board of directors took the following actions that support and extend quality and advocacy efforts on behalf of orthopaedic surgeons...

Two New ACL AUC, Checklists Now Available

Terry Stanton

"Both prevention and treatment of anterior cruciate ligament (ACL) injuries can be confusing given the diversity of injured patients—from skeletally immature youth to older adults, low- and high-risk athletes playing a variety of sports, and patients with and without arthritis," acknowledged Robert H. Quinn, MD, Appropriate Use Criteria (AUC) Section Leader on the AAOS Committee on Evidence-Based Quality and Value.

PRP: Does It Do Anything?

Robert L. Parisien, MD; David P. Trofa, MD; Jesse Dashe, MD; Scott F.M. Duncan, MD, MPH, MBA

Biologics are becoming increasingly popular in the field of orthopaedics for nonsurgical management or as an adjunct to surgical treatments. Media attention to platelet-rich plasma (PRP)—an autologous blood derivative that isolates high concentrations of platelets and is rich in multiple growth factors and cytokines—has given this treatment a starring role. But does the evidence support the multiple touted uses for PRP?

Looking for life: Xenografts in orthopaedic surgery

Annie Hayashi

A clinician scientist examines this controversial, burgeoning issue Because the demand for all types of organs and tissues far outweighs the supply, medical personnel—including orthopaedic surgeons—are turning to certain animal species with biologic systems that are closely compatible with human systems.

AAOS adopts new clinical practice guidelines

Mary Ann Porucznik

During its May meeting, the AAOS Board of Directors adopted two new clinical practice guidelines—one on the diagnosis of carpal tunnel syndrome and the other on the prevention of symptomatic pulmonary embolism (PE) in patients undergoing total hip or total knee arthroplasty. Joshua J.

Building a national joint replacement registry

Annie Hayashi

Can the United States find its way? Why doesn’t the United States have a national joint registry when other developed countries such as Sweden, Britain, and Australia have one? What are the benefits and risks of such a system? What role should the AAOS play in the formation of a joint registry? Joshua J. Jacobs, MD, chair of the AAOS Council on Research, Quality Assessment, and Technology and a member of the AAOS Now editorial board, discussed the establishment of a U.S.

Where do you stand in the AM vs. TT debate?

Jennie McKee

Controversies abound in anterior cruciate ligament (ACL) reconstruction. Opinions differ on issues such as the most effective type of autograft or allograft to use, whether the single-bundle or double-bundle technique is better, and the optimal timing for surgery.

AAOS takes position on ED orthopaedic care

Mary Ann Porucznik; Lindsay Law

Ensuring access to emergency orthopaedic care in the United States continues to challenge communities, hospitals, orthopaedic surgeons, and patients. At its December 2008 meeting, the AAOS Board of Directors approved a new position statement on Emergency Orthopaedic Care.

Survey: Unlimited low-impact activity ‘OK’ after TJR

Carolyn Rogers

When it comes to physical activity following total hip or total knee arthroplasty, the current standard of care is to recommend unlimited low-impact activity, according to a paper presented at the November 2008 American Association for Hip and Knee Surgeons (AAHKS) Annual Meeting.

AAOS releases new statement on antibiotics after arthroplasty

Mary Ann Porucznik

Comprehensive “information statement” puts patient safety first In February 2009, the AAOS Board of Directors approved the release of the information statement “Antibiotic Prophylaxis for Bacteremia in Patients with Joint Replacements.”

Are orthopaedists trustworthy?

Mary Ann Porucznik

It’s not easy being an orthopaedic surgeon these days. It seems as if the profession, like the rest of medicine, is under a magnifying glass. Last month, a study in the New England Journal of Medicine prompted a reporter to ask the question that headlines this article.

U.S. joint registry gets underway

Jennie McKee

According to Dr. Lewallen, the registry plans to implement a pilot system for data submission this summer and hopes to begin accepting data in the fall. “Then, over the next couple of years, we will work to achieve what has been identified by the international registry group as a true national registry, with more than 90 percent of hospitals reporting nationally,” he said.

Has MOM worn out its welcome?

Recently, the United Kingdom’s Medicines and Healthcare Products Regulatory Agency issued an alert on metal-on-metal (MOM) hip devices. That prompted AAOS Now to contact several prominent joint replacement specialists to discuss the use of MOM in hip resurfacing and hip replacement and how to address the issue with patients.

New TO examines CDA vs. ACDF

Michael R. Zindrick, MD; Fareeha Shuttari-Khan, MPH

Since its introduction in the United States in 2003, the artificial cervical vertebral disk has presented physicians and patients with the prospect of achieving relief of radicular arm and neck pain, while at the same time maintaining spine segmental motion and thus eliminating adjacent segment degeneration.

TO covers synthetic bone void fillers

John S. Kirkpatrick, MD

During its March 2010 meeting, the AAOS Board of Directors approved a new technology overview (TO) on synthetic bone void fillers. Kristy L. Weber, MD, chair of the Council on Research, Quality Assessment, and Technology, presented the document, which was developed by a physician workgroup under the direction of the Guidelines & Technology Oversight Committee.

The 510(k) Process—It’s Not Broken, so Why “Fix” It?

William M. Mihalko, MD, PhD, with Ammar Al-Saraf, Ali Al-Saraf; Katherine Sale

Chances are, if you implanted an orthopaedic device today, it arrived in the marketplace via the U.S. Food and Drug Administration’s (FDA) 510(k) program (Figure 1). Since 2003, more than 99 percent of all medical devices have been cleared through this pathway, compared to less than 1 percent approved through the premarket approval (PMA) process.

Update: PRP in Orthopaedics

Barbara D. Boyan, PhD

Platelet rich plasma (PRP) has been used clinically since the 1970s. Recent advances in methods for PRP preparation and use have made it possible for surgeons to take advantage of this concentrated form of growth factors and cytokines that are naturally present in blood clots. The concept is attractive because the patient’s own blood is used, limiting the potential for disease transmission. This is also a major limitation to the predictability of PRP as a therapeutic modality.

Improving quality with a high-risk spine protocol

Michael R. Murray MD; Michael F. Schafer, MD

High-risk spine surgery refers to a surgical procedure with prolonged duration and large anticipated volume of blood loss, or one who is performed on a patient that has significant medical comorbidity prior to surgery. For example, revision surgery and surgery to correct adult spinal deformity are frequently considered high-risk spine surgeries.

Treating tendons, bones, and cartilage with PRP

Kaye Daugherty; Mary Ann Porucznik

A report from the AAOS Now PRP Forum Versions of platelet-rich plasma (PRP) have been used to treat everything from plantar fasciitis to rotator cuff repair. But its effects differ, depending on the musculoskeletal structure and the composition of the PRP itself. Understanding how PRP affects the healing processes of various musculoskeletal tissues is critical to determining the appropriate type of PRP for specific injuries. The PRP Forum, sponsored by AAOS Now and held on Feb.

Do All Displaced Midshaft Clavicle Fractures Need Surgery?

Jennie McKee

Whether an athlete falls off a bicycle, is tackled in a football game, or is slammed into the side of the hockey rink by another player, the result can be the same: a displaced midshaft clavicle fracture. When this potentially season-ending injury occurs, it’s not always clear whether conservative treatment or surgical fixation will yield the best patient outcomes.

Was rhBMP-2 research tainted?

Terry Stanton

Orthopaedic surgeons took notice in late June when two members of the Senate Finance Committee sent a letter to Medtronic, Inc. (Minneapolis), maker of the recombinant human bone morphogenetic protein-2 (rhBMP-2) product Infuse. Sens. Max Baucus (D-Mont.) and Charles Grassley (R-Iowa) expressed concern about media reports that researchers conducting clinical trials on the product who had financial ties to Medtronic failed to report adverse events, including sterility in men and potentially harmful bone growth.

HHS tightens conflict-of-interest rules for researchers

Terry Stanton

New rules covering conflicts of interest (COI) for researchers receiving federal funding lower the dollar threshold for disclosure of significant financial interests from the current $10,000 to $5,000. The rules, which replace regulations originally issued in 1995, also expand the accessibility of disclosure information to the public.

Evolving Care During a Decade at War

Madeleine Lovette

During the decade since terrorists attacked the World Trade Centers in New York City and the Pentagon in Washington, D.C., more than 32,000 service members have been wounded in action as part of Operations Enduring Freedom (OEF) and Iraqi Freedom (OIF). Although Dec. 15, 2011, marked the end of the military mission in Iraq and current operations in Afghanistan are winding down, the medical mission to treat and rehabilitate those wounded continues.

AAOS Hosts Patient Safety Summit

Mary Ann Porucznik

As a leader in the patient safety movement, the AAOS has consistently been proactive in addressing issues surrounding orthopaedic surgical safety. The Surgical Safety Summit being held this month is just one of the Academy’s efforts to help its members improve orthopaedic surgical safety and reduce complications.

Documenting Medical Necessity for TJR

Mary Ann Porucznik

Although a total hip or total knee arthroplasty is frequently seen as an “elective” procedure, for most patients, it’s also the last step in a long effort to maintain quality of life. Most orthopaedic surgeons won’t recommend a total joint replacement (TJR) until after multiple other options to reduce pain and maintain function have been tried.

FDA Takes Step Forward on Custom Devices

Richard Martin, JD; Julia Williams

The American Association of Orthopaedic Surgeons (AAOS) office of government relations (OGR) has been successful in getting language, which allows greater flexibility in the Food and Drug Administration’s (FDA) Custom Device Exemption, included in the Medical Device User Fee Act (MDUFA) bills in the House and Senate.

Smoking Threatens Orthopaedic Outcomes

S. Terry Canale, MD; Frank B. Kelly, MD; Kaye Daugherty

Although the prevalence of smoking has decreased dramatically in the United States during the past 50 years, this decline has not translated into a decline in the health problems associated with smoking. The deleterious effects of smoking on cardiovascular and pulmonary function are well known, as are the carcinogenic properties, and physicians in these disciplines have been at the forefront of smoking cessation efforts for their patients.

Metal-on-Metal: 2012 Update

Mary Ann Porucznik

On Feb. 10, 2011, the U.S. Food and Drug Administration (FDA) posted a public health communication on metal-on-metal (MoM) hip implants. This was followed by a request, issued on May 9, 2011, to several orthopaedic device makers for postmarket surveillance studies. In particular, the agency expressed interest in information related to adverse events involving these devices that may be associated with increased levels of cobalt and chromium in the bloodstream.

An Insider’s Perspective on the FDA Regulatory Process

Madeleine Lovette

The U.S. Food and Drug Administration (FDA) is integral to ensuring that innovative orthopaedic drugs and devices reach musculoskeletal patients in a safe and timely manner. The FDA Center for Devices and Radiological Health (CDRH) Medical Device Fellowship Program (MDFP) provides opportunities for health professionals, including orthopaedic surgeons, to participate in the FDA regulatory process for medical devices.

Supplements for OA: An Unconvincing Story

Terry Stanton

The glory days for glucosamine began in 1996 with the publication of The Arthritis Cure, by Jason Theodosakis, MD. Millions of people with painful osteoarthritis (OA) flocked to the supplement, along with its common sidekick chondroitin, hopeful that finally something could provide relief for their condition.

AAOS Approves First AUC

Mary Ann Porucznik

The AAOS Board of Directors approved the Academy’s first appropriate use criteria (AUC)—on the treatment of distal radius fractures—at their meeting on March 18, 2013. AUC, explained Kevin J. Bozic, MD, MBA, chair of the Council on Research and Quality, “are another step in ensuring that orthopaedic patients receive high quality, cost-effective, and appropriate musculoskeletal care.”

Sunshine Act Data Collection Begins

Elizabeth Fassbender

As of August 1, medical drug and device manufacturers and group purchasing organizations (GPOs) began collecting data on payments and transfers of value (TOV) made to U.S. healthcare providers. The data collection is required under the Physician Payment Sunshine Act (Sunshine Act), which establishes a publicly accessible database disclosing potential conflicts of interest between physicians and applicable medical drug and device manufacturers.

Rotator Cuff Treatments Pay Off

Mary Ann Porucznik

Shoulder pain associated with an injury to the rotator cuff affects millions of people in the United States and leads to millions of patient visits to physicians. The functional limitations due to these injuries may result in reduced earning for individuals as well as lost productivity and increased costs to society. Two trends contribute to increasing concerns about the appropriate treatment for rotator cuff disease.

Buyer Beware of Foreign Drugs, Devices

John E. Kelly, JD; Matthew M. Curley, JD

Perhaps more than ever before, physicians are being inundated with fax and Internet advertising by foreign pharmacies selling prescription drugs and medical devices. Often, the prices are well below those set by the physician’s usual domestic drug and device suppliers.

Orthopaedic Surgery Helps Keep U.S. Economy Going

Mary Ann Porucznik

As healthcare reform takes shape and healthcare consumers become more cost conscious, evidence-based, cost-effective approaches to what orthopaedic surgeons do can make a big difference in both patient access to care and physician compensation. Looking at just one set of numbers—the projected increase in total knee arthroplasty (TKA) surgeries, for example—might well raise eyebrows among insurers, employers, and legislators for several reasons.

SCIP VTE Measures Changing in 2014

Jennie McKee

Prophylaxis guidelines for venous thromboembolism (VTE) issued by the AAOS and the American College of Chest Physicians (ACCP) have been at odds regarding whether aspirin should qualify as an acceptable prophylactic option. This difference in philosophy has had an impact on the Surgical Care Improvement Project (SCIP) measures, which are based on the ACCP guidelines, because aspirin was not recommended by the ACCP for prophylaxis in total joint arthroplasty patients.

Is Patient-specific Instrumentation for TKA Ready for Prime Time?

Maureen Leahy

Most total knee arthroplasties (TKAs) for end-stage knee arthritis are successfully performed using standard instruments, with patients reporting significant pain relief and enhanced mobility. Newer patient-specific instrumentation (PSI) is designed to further improve TKA by enabling orthopaedic surgeons to customize surgery to a patient’s individual anatomy.

Academy, Specialties Advance Unified Front with Revamped Research Agenda

Terry Stanton

With the ultimate goal of advancing science and research in orthopaedic care through a unified research strategy, the AAOS recently published a revised list of research priorities necessary to improve function and mobility and reduce the socioeconomic burden of musculoskeletal disorders in the United States. This Unified Orthopaedic Research Agenda (URA) had its genesis nearly a decade ago, through a cooperative effort that included the AAOS and orthopaedic specialty societies.

Money, Sex, and Musculoskeletal Infections

Maureen Leahy

Research symposium examines economics, demographics of orthopaedic infections As the U.S. healthcare system transitions from fee-for-service to value-based reimbursements, physicians are increasingly concerned that they might be penalized when adverse events occur over which they may have little control. That concern may be justified, according to Antonia F. Chen, MD, MBA, of the Rothman Institute at Thomas Jefferson University, Philadelphia.

Applying Stem Cells to Orthopaedic Conditions

Frank B. Kelly, MD; Mary Ann Porucznik

The ability of stem cells to divide and become more specialized cells—such as bone, blood, or muscle—makes them attractive agents in many areas of medicine. Additionally, the ability to harvest stem cells from an individual and reimplant them in the same individual, thus potentially reducing or eliminating the risk of infection, makes stem cell therapy appealing to both patients and physicians.

Interest in Using Stem Cells in Spinal Surgery Increasing

Frank B. Kelly, MD; Mary Ann Porucznik

“The world of spinal biologics is very exciting, not only because the spine has so many different tissues to regenerate, but also because the conditions that affect the spine are very different. Cost and regulatory issues, as well as efficacy and safety, are among the considerations that must be addressed,” said Wellington K. Hsu, MD, the Clifford C. Raisbeck Distinguished Professor of Orthopaedic Surgery at Northwestern University’s Feinberg School of Medicine.

Capturing Outcomes in Clinical Practice

Mary Ann Porucznik

Patient-reported outcomes (PROs) are an increasingly important aspect of the healthcare landscape. As the emphasis shifts from volume to value, PROs are seen as critical tools that can help providers assess and improve their treatment strategies.

The Search for Arthroplasty Longevity

Maureen Leahy

Total hip arthroplasty (THA) may be the most effective surgical procedure ever developed, yet it has had problems from the beginning,” said David G. Lewallen, MD, during the AAOS and the Orthopaedic Research Society joint symposium “Articulations in Total Joint Replacement: Have We Lost Our Bearings?” at the 2015 AAOS Annual Meeting in Las Vegas.

Giving Zion Two Hands

Scott F.M. Duncan, MD, MPH, MBA

The surgery made headlines around the world. In June, 8-year-old Zion Harvey became the first child and youngest person ever to receive a bilateral hand transplant. In the hand surgery world, the event was akin to landing a man on the moon—pretty incredible. The surgery was special in many ways—a stunning technical achievement, a unique collaboration among institutions, and a generous humanitarian gesture.

Soft Tissues and PRP: An Uneven Record

Robert L. Parisien, MD; David P. Trofa, MD; Jesse Dashe, MD; Scott F.M. Duncan, MD, MPH, MBA

Proponents of platelet-rich plasma (PRP)—an autologous blood derivative that isolates high concentrations of platelets and is rich in multiple growth factors and cytokines—have touted its use in the treatment of multiple orthopaedic ailments, from fracture healing to tendinopathy. But a closer look at the evidence supporting the use of PRP in soft-tissue injuries shows a more nuanced role for this popular biologic.

Joint supplements: Is there hope behind the hype?

Peter Pollack

“Patented ingredients help support, ease, and rebuild joints….” “Soothe away joint pain and watch as your skin regains a nourished, youthful appearance….” When patients hear and read claims like these, it’s no wonder that they show up in your office with Web page printouts, torn out advertisements, and plenty of questions.

Young athletes have high failure rate with allograft ACL

Annie Hayashi

“With 300,000 anterior cruciate ligament (ACL) reconstructions performed in the United States every year, this procedure has become routine with favorable results. Graft selection, however, continues to be controversial,” said Gene R. Barrett, MD, senior author of “Allograft anterior cruciate ligament reconstruction in the young, active patient.”

OREF named official AAOS fundraiser

At its meeting on Dec. 4, 2009, the AAOS Board of Directors approved an agreement that makes the Orthopaedic Research and Education Foundation (OREF) the official fundraising arm for AAOS orthopaedic education programs. The new agreement strengthens the existing working relationship between the two organizations and broadens the scope of OREF’s fundraising efforts for the Academy. OREF provides similar fundraising support for approximately 40 other orthopaedic organizations.

Younger patients demanding new joints

Jennie McKee

According to a paper presented at the American Association for Hip and Knee Surgeons (AAHKS) 2008 annual meeting, orthopaedists should expect substantial increases in the demand for total joint replacement (TJR) surgery among younger patients in the near future.

AAOS releases technology overview on locking plates

Fareeha Shuttari-Khan

During its December 2008 meeting, the AAOS Board of Directors adopted a new technology overview (TO) on locking plates for extremity fractures. Kristy L. Weber, MD, chair of the Council on Research, Quality Assessment and Technology, presented the document, which was developed by a workgroup overseen by the Guidelines and Technology Oversight Committee (GTOC).

AAOS adopts new clinical guidelines

At its meeting on June 19, 2009, the AAOS Board of Directors adopted new clinical guidelines on the treatment of pediatric diaphyseal femur fractures. The new guidelines are available on the AAOS Web site (www.aaos.org/guidelines). The guidelines were developed by a work group led by Mininder Kocher, MD, and Ernest Sink, MD. AAOS Guideline Oversight chairs William C. Watters III, MD, and Michael Keith, MD, congratulate their efforts.

'Bloody' treatment holds promise

Platelet-rich plasma (PRP) is currently used as an alternative treatment method for several common orthopaedic-related sports medicine conditions. According to a review article in the October 2009 Journal of the American Academy of Orthopaedic Surgeons (JAAOS), early outcomes of PRP appear promising; however, larger clinical studies are still needed to determine the benefits of its use.

Obese patients do well with TAR

Terry Stanton

A Swiss study of obese patients who underwent total ankle replacement (TAR) found that survivorship of prosthesis components at midterm follow-up was comparable to results obtained in nonobese patients. The investigators also observed that approximately 12 percent of the patients had lost weight 1 year after surgery.

Banning the Flames

Terry Stanton

People know that things can go wrong in the operating room. But most would probably not name fire as a potential hazard, especially fire burning on or near a patient. Yet such fires occur approximately 550 to 650 times a year, according to the Food and Drug Administration (FDA) and the ECRI Institute (formerly the Emergency Care Research Institute).

FDA Panel Examines MoM Hip Devices

Katherine Sale; Mary Ann Porucznik

In nearly 23 hours of testimony and deliberations over 2 days in June, the U.S. Food and Drug Administration’s (FDA) Orthopaedic and Rehabilitative Devices Panel (ORDP) considered expert scientific and clinical opinion on the risks and benefits of metal-on-metal (MoM) hip replacement and resurfacing devices.

Obese Patients Present a Weighty Problem

Mary Ann Porucznik

Obesity is a big problem in the United States, where two thirds of the population is either overweight (body mass index [BMI] of 25 to 29.9) or obese (BMI of 30 or higher). That presents an issue—not only for orthopaedists and other medical specialists—but also for policymakers trying to find ways to cut healthcare costs.

AAOS Releases Choosing Wisely® List

Making decisions about which tests, procedures, or protocols to perform is a process that involves both the patient and the physician. But some physicians understandably struggle to talk about appropriate tests and treatments with their patients—and many patients demand care they might not need.

Forum Examines Stem Cells in Orthopaedics

Mary Ann Porucznik

The ability of stem cells to divide and become more specialized cells—such as bone, blood, or muscle—makes them attractive agents in many areas of medicine. Additionally, the ability to harvest stem cells from an individual and reimplant them in the same individual, thus potentially reducing or eliminating the risk of infection, makes stem cell therapy appealing to both patients and physicians.

Newly Released Special Edition of JAAOS ® Features the Latest Research and Guidance for Practicing During the COVID-19 Pandemic

Kate Youdell

The Journal of the AAOS ® (JAAOS ®) will publish a COVID-19 special edition for its June 1 issue. As COVID-19 has become the top priority for researchers and medical professionals alike, the articles are already available online at the JAAOS ® website/

Latest COVID-19 Webinar from Academy Leadership Provides Updates on Advocacy, Return to Surgery, and Research

Kaitlyn D’Onofrio

In a COVID-19 webinar presented on May 13, AAOS’ Presidential Line provided updates on advocacy, return to surgery, COVID-19 member research, patient information, and virtual education. Similar to previous webinars, a question-and-answer session shed some light on members’ top concerns about navigating the COVID-19 pandemic.

Academy Registry Program Now Captures COVID-19 Data

Deanna Killackey; Terry Stanton

The Academy’s Registry Program is now collecting COVID-19 data through the capture of the International Classification of Diseases, 10th revision (ICD-10) code for COVID-19 confirmed diagnosis, U07.1. The new code is enabled across each of the AAOS registries, comprising the American Joint Replacement Registry (AJRR), Shoulder & Elbow Registry, Musculoskeletal Tumor Registry, and American Spine Registry, the latter a collaborative effort between the American Association of Neurological Surgeons and AAOS.

NIH Provides Guidance Summary on the Use of Corticosteroids

Injectable and oral corticosteroids are commonly used to reduce inflammation and manage pain in patients with musculoskeletal disease. Concerns regarding the use of injectable and oral corticosteroids in musculoskeletal care come from guidelines for systemic steroid use in patients being treated for active COVID-19 disease, such as those from the National Institutes of Health (NIH). Within the guidelines, the NIH provides evidence-based recommendations “against the routine use of systemic corticosteroids for the treatment of mechanically ventilated patients with COVID-19 without acute respiratory distress syndrome (ARDS).” For “mechanically ventilated adults with COVID-19 and ARDS, there are insufficient data to recommend either for or against corticosteroid therapy in the absence of another indication.”

AAOS Evidence-Based Quality and Value Committee Launches Evidence-Based Medicine Programs

Stuart J. Fischer, MD, FAAOS

The AAOS Evidence-Based Quality and Value Committee has put together a series of programs that explain the fundamentals of evidence-based medicine.

Deadline: Young Researchers Are Encouraged to Apply for the ABOS-ABMS Visiting Scholars Program

David Elstein

For the seventh consecutive year, the American Board of Orthopaedic Surgery and the American Board of Medical Specialties have partnered to support the ABOS-ABMS Visiting Scholars Program.

Engagement Theater Offers a Lineup of Exciting Topics

Among the many daily activities taking place in Academy Hall is the Engagement Theater.

Posters Offer Attendees Informative, Self-directed Education

The Annual Meeting’s selection of posters is one of the best examples of self-directed education the meeting offers.

Posters and Presentations Highlight AAOS’ Registry Program

The best place to learn more about Registry Program participation is the AAOS Registry Program booth in the Resource Center at Academy Hall, open Tuesday through Friday, 7 a.m. to 5 p.m.

OrthoInfo Helps Physicians Empower Their Patients

An educated patient is an empowered patient, which is why AAOS created OrthoInfo, its website for the general public.

Research Productivity Varies Based on Gender and Academic Rank

Julie Balch Samora, MD, PhD, MPH, FAAOS

Previous studies have identified several factors that contribute to gender disparities in orthopaedics, including lack of early exposure to musculoskeletal medicine, a paucity of female role models, the challenging lifestyle, male dominance in the field, difficulty maintaining work-life balance, and barriers to promotion.

Current Trends in Shoulder Arthroplasty in Germany

Markus Scheibel, MD

Editor’s note: This article is part of a series from 2023 Guest Nation representatives from Germany.

Adjusting Patient Length-of-stay Expectations in Total Hip Arthroplasty Care Pathways

Patrick Daly

According to Michael Tanzer, MD CM, FRCSC, adult hip and knee specialist and professor of surgery at McGill University Health Centre in Montreal, the concurrent implementation of several components of a pathway has obscured the impact of individual care modifications administered before a patient enters one.

Transforming Clinical Practice Initiatives and MIPS

Melissa Kapping, MSN, RN; Craig R. Mahoney, MD

Under the Medicare Access and CHIP Reauthorization Act, The Quality Payment Program (QPP) replaces the sustainable growth rate formula in determining physician reimbursement by Medicare. The QPP replaces three previous programs—the physician quality reporting system, the value-based modifier, and meaningful use. In their stead is one budget-neutral program, the Merit-based Incentive Payment System (MIPS).

Tips for Implementing Previsit Patient-reported Outcomes Collection

Tiffany C. Liu, BA; David Ring, MD, PhD; Karl M. Koenig, MD, MS

Quantifying pain intensity and magnitude of physical limitations using patient-reported outcomes measures (PROMs) can help determine whether and how well specific interventions will lead to meaningful improvements. But routine collection of PROMs is a challenge, as evidenced by the 30 percent to 80 percent response rate generated by joint registries.

Common Misconceptions Continue to Plague Implant-related Hypersensitivity Responses and Testing

Nadim James Hallab, PhD

The terms metal hypersensitivity and metal allergy have been used interchangeably to refer to metal delayed-type hypersensitivity (DTH) responses. DTH, or adaptive, immune responses differ dramatically from normal physiologic responses to metal debris. A normal physiologic response to metal implant debris may be adverse (toxic and/or immunogenic) and increase in proportion to exposure.

Multisensory Patient Education and Informed Consent

Research recently published in the Journal of Bone and Joint Surgery finds that patient education involving the use of multiple senses (sight, hearing, and touch) during a surgeon-patient informed consent discussion improves patients' understanding of anticipated care and possible outcomes. The randomized, controlled trial involved 67 consecutive patients with a new diagnosis of knee osteoarthritis and who were treated with a corticosteroid injection.

PROs in Practice

Joseph P. DeAngelis, MD, MBA; Neha Agrawal, MPH

In the first article of this two-part series on the use of patient-reported outcomes (PROs) (see "Collecting and Using Patient-Reported Outcomes in Everyday Practice," AAOS Now, January 2017), Charles A. Goldfarb, MD, from Washington University in St. Louis, shared his experiences with implementing the Patient-Reported Outcomes Measurement Information System (PROMIS®). In this article, we talk with Bradley J.

Making the Case for Collecting PROMs

Alyssa DelPrete

In a recent American Alliance of Orthopaedic Executives (AAOE) survey, only 35 percent of the participating practices are collecting patient-reported outcomes measures (PROMs). However, most practices indicated they are collecting patient satisfaction surveys (61 percent) and identified quality measures (71 percent) (Fig. 1). Orthopaedic practice executives, particularly those from small practices, may not be shocked by these figures.

Risk Evaluation and Management Strategies for Prescribing Opioids

Stephanie Hazlett

During the AAOS Annual Meeting, experts discussed the epidemic of opioid drug use, misuse, and abuse in the United States, and focused on ways in which orthopaedic surgeons can practice safe and effective pain management for their patients. "Risk Evaluation and Management Strategies for Prescribing Opioids," a symposium moderated by began with a presentation by David H. Sohn, MD, JD, who explored the complicated legal landscape that has developed around physicians' prescribing habits.

Staying out of Trouble Prescribing Controlled Substances

Laurel Beverley, MD, MPH

Physician and public awareness of issues related to opioid use has skyrocketed over the past several years. Prescription drug abusers outnumber those who use all other "street" drugs except marijuana, and twice as many deaths are caused by prescription opioids than heroin. Every state except Missouri now has a Prescription Drug Monitoring Program (PDMP) that tabulates and distributes data about federally controlled substances that are prescribed and dispensed.

Risks in the Age of AI: Protecting Surgeons with Lessons from Financial Service and Cybersecurity

Nkem Egekeze, MD

This article will provide insights on cybersecurity concerns, landmark cybersecurity events, costs of cybersecurity breaches, and cybersecurity challenges for orthopaedics.

Decreasing Variation in Clinical Practice

Susan T. Mahan, MD, MPH; Donald S. Bae, MD; Rachel L. Difazio, RN, PhD; Peter M. Waters, MD

The current "cost crisis" in health care has resulted in greater emphasis on increasing value in healthcare delivery, particularly in orthopaedics. As orthopaedic practitioners, we are best positioned to streamline musculoskeletal care and to guide changes in practice. Among the many tools that can be used to increase the value of orthopaedic care are Standardized Clinical Assessment and Management Plans (SCAMPs).

Orthopaedic Organizations Collaborate to Encourage GME Support

Rhonda Taira

The OMeGA Medical Grants Association (OMeGA) was established to ensure the continued financial support of orthopaedic residency and fellowship programs. Since 2009, it has awarded more than $21 million through nearly 900 fellowship and residency grants.

Cato T. Laurencin, MD, PhD, Brings Science, Engineering, and Medicine to Higher Levels with Establishment of New Institute for Regenerative Engineering

Cailin Conner

The University of Connecticut (UConn) has recently launched the Cato T. Laurencin Institute for Regenerative Engineering, a groundbreaking initiative aimed at advancing the fields of medicine, science, engineering, and technology.

Cost-effectiveness Analysis of Anterior Cervical Diskectomy and Fusions at Physician-owned Versus Nonphysician-owned Hospitals

Kaitlyn D’Onofrio

A new study assessed the impact of sanctions imposed by the Affordable Care Act (ACA) on the creation and expansion of physician-owned hospitals (POHs). The researchers compared safety and cost-effectiveness of elective one- to three-level anterior cervical diskectomy and fusions (ACDFs) performed at physician-owned versus nonphysician-owned hospitals. They concluded that not only do ACDFs performed at POHs yield significant cost savings, they also result in fewer 90-day medical complications and readmissions. The findings of the study were presented as part of the Annual Meeting Virtual Experience.

AI-based Preoperative TKA Plan Is Successful

Kaitlyn D’Onofrio

The use of computer-aided surgery (CAS) in total knee arthroplasty (TKA) has been associated with positive outcomes. However, most manufacturer-provided preoperative plans associated with CAS-based surgeries require revisions, which could take as long as eight minutes. The use of artificial intelligence (AI) could help surgeons cut down on that time.

Study Probes the Effect of CAM Boots on Ankle and Hindfoot Joint Mechanics

Terry Stanton

A study assessing the effect of the tall controlled ankle motion (CAM) boot and short CAM boot on contact pressures of the ankle, subtalar, talonavicular, and calcaneocuboid joints found that immobilization in a tall CAM boot significantly reduced the peak contact pressures of the ankle and hindfoot to a greater degree than the short CAM boot. In addition, the greatest decrease in peak contact pressures was seen in the subtalar and talonavicular joints. The study was presented as part of the Annual Meeting Virtual Experience.

Modified Lapidus Effective in Hallux Valgus for First Ray Pronation

Terry Stanton

A study demonstrated that in patients undergoing hallux valgus surgery, the modified Lapidus procedure can be an effective tool to change pronation of the first ray. The study, presented as part of the Annual Meeting Virtual Experience, also demonstrated that reduction of the sesamoids was not associated with postoperative first metatarsal pronation, and these should be considered as separate deformities in the treatment of hallux valgus.

The Impact of Alternative Payment Models on Quality and Safety of Orthopaedic Care

Ariana Lott, MD

In response to the rise in healthcare spending, the Centers for Medicare & Medicaid Services (CMS) began exploring alternative payment models (APMs) in 2011.

Explainable AI: How Do We Know What AI Is ‘Thinking’?

Alan M. Reznik, MD, MBA, FAAOS

Editor’s note: This is the sixth article in a series on artificial intelligence (AI) applications in orthopaedics and the future of medicine. This article discusses the ability to understand the “thought” process of AI and strategies required to make AI decision­-making more transparent. The prior articles have reviewed the basics of AI, how AI can read an X-ray, natural language processing, medical ethics, and the differences between shallow and deep AI as it applies to the practice of medicine.

First Appropriate Use Criteria Decision Tree Highlights Appropriate Prescription of Dental Prophylaxis in Orthopaedic Patients

Kyle Mullen, MPH; Ryan Pezold, MA

The use of antibiotic prophylaxis for dental procedures in patients with joint replacements has long been debated among orthopaedic surgeons and dental professionals. Appropriate use criteria (AUC) developed jointly by AAOS and the American Dental Association (ADA) and published in 2016 have helped bring direction to an area lacking high-quality literature to support clinical decision-making.

AAOS’ Biologics Initiative Gains Momentum

AAOS’ strategic investment in orthobiologics is well underway, overseen by the Committee on Devices, Biologics, and Technology (DBT) and the Council of Research and Quality, with goals to lay a strong, sustainable foundation in 2020, focusing resources toward creating unbiased, evidence-based content, while providing helpful and meaningful position statements, educational programs, regulatory resources, and symposia.

Patient Cognitive Error and Bias Can Impact Safety and Health

David C. Ring, MD, PhD, FAAOS, led a roundtable discussion to address patient cognitive error and bias and how they can impact illness, such as increasing the intensity of symptoms and creating a greater magnitude of limitations.

Measuring Up: Defining Performance Measures

David R. Chandler, MD

Medical care reimbursement in the United States is currently transitioning from a strictly fee-for-service volume basis to a value-modified volume basis. With the passage of the 2015 Medicare Access and CHIP Reauthorization Act (MACRA), programs such as meaningful use, the Physician Quality Reporting System (PQRS), and Value-based Modifier are being combined into the Merit-based Incentive Payment System (MIPS) and Alternative Payment Methods (APMs).

Turning Obstacles into Opportunities

Lisa Applegate

In his career as a radiologist and clinician scientist, Chao Xie, MD, has often been just as inspired by limitations as by opportunities. Three decades ago, medical technology was very limited in his home country of China. As a first-year medical student, Dr. Xie experienced personal frustration when his father received a late diagnosis of cancer because computed tomography scans were not widely available in China.

Standardizing Patient-reported Outcome Measures

Maureen Leahy

As health care shifts its focus from volume to value, use of performance measures, such as patient-reported outcomes, has become increasingly important. "The question isn't whether or not we need to collect patient-reported outcomes, but rather 'Which measures do we use to collect them?'" said Mark S. Vrahas, MD, Robert W. Lovett Professor of Orthopaedic Surgery, Orthopaedic Trauma Initiative, Harvard Medical School. Dr.

Examining Patient Risk Factors that May Affect Outcomes

Jennie McKee

"There has been more and more published on patient-related issues that may affect outcomes. This is of particular importance as we move forward with the Comprehensive Care for Joint Replacement (CJR) Model and bundled payments," said Samir Mehta, MD, chief of the Orthopaedic Trauma & Fracture Service at the University of Pennsylvania. Dr.

Clinical Quality and the Pathway to Payment

Jackie Ryan

On Tuesday, March 1, 2016, George F. Muschler, MD, vice chair of the Performance Measures Committee (PMC), moderated the symposium "Clinical Quality and the Pathway to Payment" at the 2016 AAOS Annual Meeting. Dr.

Timing Is Everything

Amy Kile

Overall, the more than 600,000 total knee and 300,000 total hip replacements performed in the United States each year lead to positive patient outcomes; however, rare complications such as periprosthetic joint infections (PJIs) can arise.

Improving Arthroplasty for Patients with Diabetes

Mark Crawford

It all started with a clinical observation. Allan L. Bucknell, MD, a professor with the University of Colorado-Denver and the Veterans Affairs (VA) Eastern Colorado Health Care System, was curious about why, after total knee arthroplasty, his diabetic patients did not fare as well as his nondiabetic patients. He wanted to know, for example, why he saw earlier aseptic prosthesis loosening in diabetic patients. "Total knee replacement is not a benign procedure," said Dr. Bucknell.

Stimulating Bone Growth

Mark Crawford

In the United States, fractures cost approximately $20 billion annually to treat and are associated with 100 million days of restricted activity. The surgical treatment for many fractures includes bone grafting. However, performing bone graft harvests has been associated with additional morbidity. Mesenchymal stem cells (MSCs) have been used to treat a variety of musculoskeletal diseases, and researchers are investigating their potential to treat fractures.

Saving Bone

The process of bone remodeling involves a balancing act between two cell types: osteoclasts that resorb bone and osteoblasts that form new bone. Researchers have characterized the molecules primarily responsible for regulating this balance. The mechanism of age-associated bone loss—when osteoclasts outpace the work of osteoblasts—is also generally well defined. And yet, gaps in our understanding remain.

Understanding Shoulder Kinematics in Patients with Asymptomatic RCTs

Mark Crawford

Rotator cuff tears (RCTs) occur in more than 50 percent of people older than 60 years of age. Symptomatic RCTs typically often require surgery; however, associated risks include infection, foreign body reaction, and neurologic injury. "Symptomatic RCTs can be a disabling condition with few treatment options other than surgery, said Phillip N. Williams, MD, assistant professor in the department of orthopaedics at University of Texas Health Science Center at Houston.

Why Are We Ignoring Calcitonin?

Christopher M. Bono, MD

Osteoporotic vertebral compression fractures can hurt—a lot—in a population of patients that does not easily tolerate the usual cocktails of narcotics and nonsteroidal anti-inflammatory medications. Yet, orthopaedic surgeons have largely ignored an effective agent that has been specifically shown to decrease spine–fracture-related pain.

Value of Arthroplasty Registries Recognized

Each year, the Orthopaedic Research and Education Foundation (OREF) recognizes outstanding clinical research related directly to musculoskeletal disease or injury through the OREF Clinical Research Award. This year, the award will be presented to primary investigator. Dr. Malchau's coauthors on the paper, "Arthroplasty Implant Registries Over the Past Five Decades: Development, Current and Future Impact," include Daniel J. Berry, MD; Göran Garellick, MD, PhD; and William H.

Chondrosarcoma: A Black Box Turns Grey

Sharon Johnson

Chondrosarcoma (CHS) remains a devastating primary malignancy of the musculoskeletal system—a black box for clinicians. Locally aggressive and unresponsive to current chemotherapy and radiation therapies, CHS is usually treated with wide surgical excision. Even then, patients often experience local recurrence, metastasis to the lungs, and death.

Rethinking Recovery after Orthopaedic Injury

Jay D. Lenn

Although acute pain is a normal part of recovery after musculoskeletal injury, it is less clear why some patients fully recover while others continue to experience pain and disability months and years after the initial event. A growing body of evidence demonstrates that psychosocial factors explain at least some of the transition from acute pain to chronic pain and disability.

What to Expect for That First Job

Matthew W. Christian, MD; Christopher B. Arena, MD; David A. Hamilton Jr, MD, MBA; Brandon L. Morris, MD; Bishoy V. Gad, MD, MS, MBA

The turnover rate for newly graduated orthopaedic surgeons in their first job is astoundingly high (70 percent to 80 percent), according to some sources. This is challenging not only for the young orthopaedic surgeon who often is forced to uproot his or her family to move for another job, but also for the employers who often invest significant capital in the new orthopaedic practice.

Kappa Delta Lanier Award Honors Work in Wrist Kinematics and Arthroplasty

Terry Stanton

and co-investigator Joseph J. Crisco, PhD, have spent close to three decades working to unravel the mysteries of wrist kinematics, with the ultimate goal of addressing the degenerative condition known as scapholunate advanced collapse (SLAC), which occurs following traumatic disruption of the proximal carpal row. For their work on this challenging condition, Dr. Wolfe, of Hospital for Special Surgery/Weill Medical College of Cornell University, and Dr.

Synovial Sarcoma Treatment Strategies

Jay D. Lenn

Synovial sarcoma is a rare soft-tissue cancer that most often affects children and young adults. Synovial sarcoma is aggressive and difficult to treat, and it presents a significant risk of metastasis, particularly to the lungs. Treatment generally employs multimodal therapies that include surgery, chemotherapy, and radiation.

EWI XII Highlights Joint Learning

Jessica C. Rivera, MD; Mary Ann Spott, PhD; Renee M. Greer, RN; Anthony E. Johnson, MD

The 12th Extremity War Injuries Symposium (EWI)—hosted by the AAOS, the Orthopaedic Trauma Association, the Society of Military Orthopaedic Surgeons, and the Orthopaedic Research Society—was held earlier this year. EWI XII focused on the lessons of war and how the military and civilian trauma communities can move forward together, based on joint learning.

In Search of Long-term TSA Success

Sharon Johnson

Long-term success after total shoulder arthroplasty (TSA) remains elusive for patients with advanced glenohumeral arthritis or severe bone loss. The main culprit is loosening of glenoid implants, which accounts for a 7 percent revision rate within 15 years after primary surgery. In recent years, multiple device manufacturers have introduced augmented glenoid implants to address the problems and the need for revision TSAs.

Xenograft-derived Bone Scaffold Shows Promise

Mark Crawford

Managing segmental bone defects can be a major challenge for orthopaedic surgeons. Of the five million-plus musculoskeletal surgeries performed in the United States every year, nearly half utilize bone grafts. Although autologous bone grafting is considered the best approach for repairing large bone defects, the harvest of autologous bone may be painful and is associated with increased morbidity.

AAOS Tackles Controversies Surrounding the Use of Biologics in Orthopaedic Surgery

Clinical use of biologics to treat orthopaedic problems has greatly outpaced the evidence. This rise is primarily due to widespread use of “minimally manipulated” autologous therapies that are either blood products or have been interpreted as falling within the Public Health Service Act Section 361 pathway, which does not require premarket approval from the U.S. Food and Drug Administration (FDA).

Platelet-rich Plasma: The Path Forward

Terry Stanton

For just about every orthopaedic condition, there is a platelet-rich plasma (PRP) treatment that purports to remedy it. Yet evidence of efficacy for PRP and other blood-derived formulations remains elusive for many applications. During the AAOS 2018 Annual Meeting symposium titled “Use and Misuse of Biologics,” Scott A.

Registry Round-up: A Look Back at a Very Good Year

Terry Stanton

It’s been a year of milestones and trailblazing accomplishments for the AAOS registry program. In its 2018 annual report, having completed its reintegration within AAOS, the American Joint Replacement Registry (AJRR) tallied 1,186,955 procedures from 1,067 institutions from 2012 to 2017, establishing the AJRR as the largest orthopaedic registry by annual procedure count.

Preventing VTE After Elective TJA

Antonia F. Chen, MD, MBA

In the past, medicine was guided by expert opinion. Surgeons would perform procedures, then pass along their wisdom to the next generation. The initial literature in orthopaedics was filled with personal reports and case series. It is rumored that Sir John Charnley injected polyethylene into his own leg and found that it was inert, paving the way for one of the greatest modern medical inventions, low-friction arthroplasty.

AAOS Develops 'Impactful Statements'for Carpal Tunnel Syndrome

Julie Balch Samora, MD, PhD

The AAOS 2016 Management of Carpal Tunnel Syndrome (CTS) evidence-based clinical practice guideline (CPG) has been endorsed by the American Society for Surgery of the Hand (ASSH), the American College of Radiology, and the American College of Surgeons. From this guideline, members of the Evidence-Based Quality and Value Committee, with input from the CPG work group chairs, have developed four “impactful statements.”

TriHealth Good Samaritan Hospital: Registry, EBM, and ICPs

Karen Metropulos, MBA

The American Joint Replacement Registry (AJRR) is the largest hip and knee arthroplasty registry in the United States, exceeding the 1 million procedures milestone in 2017, and is a part of the Academy’s growing family of orthopaedic registries. TriHealth Good Samaritan Hospital (GSH), located in Cincinnati, has been an AJRR subscriber since January 2015.

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.

The Risks and Benefits of Vitamin D Supplementation

Sumeet Jindal, MD, MBA; Scott F.M. Duncan, MD, MPH, MBA

Untitled Document Vitamin D is an essential nutrient for calcium homeostasis and the expression of hundreds of genes. Sufficient serum levels of vitamin D are required, not only for proper bone mineralization but for a host of other factors in musculoskeletal system structure and function.

Building a Better Graft

Jay D. Lenn

Current surgical interventions to repair articular cartilage often result in less than optimal outcomes because the new cartilage does not sufficiently replicate both the structural and functional properties of healthy tissue. The repairs generally fail to restore the gradient composition of the osteochondral tissue. That gradient runs from the smooth surface layer of cartilage, to the transitional layer of calcified cartilage, and into the subchondral bone.

Kevin Shea, MD, and Jayson Murray, MA, Shed Light on Appropriate Use Criteria

Alan M. Reznik, MD, MBA, FAAOS

A lot of buzzwords, abbreviations, and criticisms exist in medicine today. Quality, value, and even standards of care are moving targets based on evolving healthcare trends. Increasingly, we hear about appropriate use criteria (AUC) and clinical practice guidelines (CPGs) as tools that summarize evidence and fill gaps when evidence is unavailable.

Milestone: Academy Launches Shoulder and Elbow Registry

Terry Stanton

October is a milestone month for the Academy’s Registry Program, as it launches the Shoulder and Elbow Registry (SER). Building on the success of the American Joint Replacement Registry (AJRR)—the trailblazer data depository and resource for U.S. knee and hip arthroplasty that last year was reintegrated under the AAOS umbrella—SER will be previewed at the American Shoulder and Elbow Surgeons (ASES) meeting Oct. 11–14 and make its formal debut at the Academy’s Fall Meeting Oct. 25–27.

Understanding the Impact of Artificial Intelligence on Orthopaedic Surgery

Alan M. Reznik, MD, MBA, FAAOS; Kenneth Urish, MD, PhD

This is the first in a series of articles about artificial intelligence and its potential in orthopaedics. It seems we hear daily about advances in artificial intelligence (AI)—from self-driving cars, face recognition, and hacker protection to stock portfolios and more. This article provides a primer for those who have limited knowledge of AI, its history, and the newest possibilities.

Effective Leadership Is Needed to Ensure Quality and Safety in the Workplace

This is the last in a series of roundtable discussions from a September 2017 meeting of the AAOS Patient Safety Committee. In this article, David C. Ring, MD, PhD, chair; and committee members Michael S. Pinzur, MD; Michael R. Marks, MD, MBA; Dwight W. Burney III, MD; Andrew W. Grose, MD; and Alan M. Reznik, MD, MBA, address the importance of leadership in establishing a culture of safety. What is the role of leadership, and how does leadership advance quality and safety?

AAOS Strives to Reduce Surgical Risk with New Online Toolkit

K. Keely Boyle, MD; Alan M. Reznik, MD, MBA; Michael S. Pinzur, MD

Orthopaedic surgeons are involved in routine aspects of surgical planning, such as selecting implants and instructing operating room (OR) support staff on surgical needs. Payers now place more emphasis on the entire episode of care, not just the isolated surgical procedure. The entire episode of care can directly affect how we are judged as surgeons. Most of a patient’s surgical risks are present before we make the decision to operate.

Antimicrobial Stewardship in Orthopaedics

Angie Fouts, PharmD; Patrick Maher, MD

Antimicrobial resistance (AMR) is responsible for two million infections and 23,000 deaths annually in the United States alone. Globally, more than 700,000 people die each year of antibiotic-resistant infections. By the year 2050, AMR infections are predicted to be a larger killer than cancer and heart disease. The primary drivers for resistance are overuse and inappropriate use of antimicrobials. As much as half of all antibiotic use may be misuse.

Natural Language Processing Provides Foundation for AI in Medical Diagnoses

Alan M. Reznik, MD, MBA, FAAOS; Kenneth Urish, MD, PhD

This article is the third installment of an ongoing series about artificial intelligence. The first two installments are available online at www.aaosnow.org. Developing technology could lead to AI-based treatment plans for many common orthopaedic problems The first article in this series (“Understanding the Impact of Artificial Intelligence on Orthopaedic Surgery,” AAOS Now, September 2018) discussed the basic concepts and history of artificial intelligence (AI).

Interpreting Vitamin D Controversies Continue to Pose Challenges

Brandon Naylor, DO; Nathaniel W. Jenkins, MS

Vitamin D has come under public scrutiny in recent years, as articles and studies have explored conflicts of interest (COI) in vitamin D research and questioned the efficacy of the hormone’s use as a supplement. Consequently, those revelations may detract from an important topic in orthopaedics. Here, we attempt to interpret the latest controversies surrounding vitamin D. Fat-soluble vitamin D plays a crucial role in calcium metabolism and bone homeostasis.

Applying the Four Basic Principles of Medical Ethics to Artificial Intelligence

Alan M. Reznik, MD, MBA, FAAOS

Editor’s note: This article is part one of a two-part series on ethics in artificial intelligence (AI). This article explores the underlying four basic principles of medical ethics as they apply to orthopaedic practice and AI.

Study Probes Durability of Smoking Cessation for Elective Surgery

Terry Stanton

Almost half of patients who quit smoking remained nonsmokers after one year A study appearing in the August 15 issue of the Journal of the AAOS found that among patients who complied with a requirement to quit smoking before elective lower-extremity orthopaedic surgery, 48 percent maintained smoking cessation for at least one year postoperatively.

Academy Releases New Appropriate Use Criteria and Tool for Acute Compartment Syndrome

Terry Stanton

Following approval by the Board of Directors in September, the Academy has released appropriate use criteria (AUC) and a corresponding online tool for the Diagnosis and Management of Acute Compartment Syndrome.

Clinical Care Pathways: Incorporating Evidence into Practice

Barbara Krause; Nicole Nelson, MPH

Care pathways, or clinical care pathways, are widely used in numerous U.S. healthcare settings. Pathways are characterized as multidisciplinary management tools, based on evidence-based medicine and input from content experts to guide care for a specified patient population with a specific condition.

New CPG Guides Decision Making for Limb Salvage or Amputation

Terry Stanton

The clinical practice guideline (CPG) for Limb Salvage or Early Amputation, approved by the AAOS Board of Directors in December 2019, advises that initial management decisions for a severely injured lower extremity are dependent on both the assessment of injury itself and the overall health of the patient.

Avoid Patient Harm by Improving Patient Positioning for Surgery

Austin A. Cole, MD

Perioperative positioning may not always get the attention it deserves.

Biologics in the Building

More than a dozen staff and volunteer representatives from orthopaedic subspecialty and research societies, as well as several other medical specialty and auxiliary organizations, met to exchange perspectives and information on the fast-changing field of biologics at the inaugural AAOS Biologics Leadership Symposium, which took place at Academy headquarters in Rosemont, Ill., on Feb. 21.

OVT Debuts Curriculum on Patient Safety and Quality

Julie Balch Samora, MD, PhD, MPH, FAAOS, and Kevin Shea, MD, FAAOS, recognized a need for an educational curriculum around patient safety and quality improvement, a critical area in orthopaedics that is evolving on a daily basis.

Study Details Increase in Dual Mobility Implant Use in THA

Terry Stanton

A study analyzing data from the American Joint Replacement Registry (AJRR) and describing utilization trends of dual mobility (DM) articulations in the United States for primary and revision total hip arthroplasty (THA) found that DM utilization increased year over year during the study period across all age groups.

Presidential Symposium Addresses Quality and Value

Terry Stanton

During the 2020 Presidential Symposium titled, “Successful Musculoskeletal Care in the New Age: It’s All About Value and Outcomes,” 2019–2020 AAOS President Kristy L. Weber, MD, FAAOS, noted that during her past service as chair of the Committee of Research and Quality (CoRQ), she had come to perceive that “quality and value in patient care are at the core of what we do as doctors and surgeons.” This session provided updates and overviews of ways the Academy has progressed in the quality and value movement, along with areas where progress remains to be achieved.

Presidential Symposium Illustrates Academy Registry Successes, Paths to Value

Terry Stanton

At the 2020 Presidential Symposium, titled “Successful MSK Care in the New Age: It’s All About Value and Outcomes,” 2019–2020 President Kristy L. Weber, MD, FAAOS, noted that during her past service as chair of the Committee of Research and Quality, she had come to perceive that “quality and value in patient care are at the core of what we do as doctors and surgeons.”

AAOS Presidential Symposium: The Goal Is Value

Terry Stanton

During the May 27 Presidential Symposium titled “Successful MSK Care in the New Age: It’s All About Value and Outcomes,” Elizabeth Teisberg, PhD, provided a viewpoint from the outside addressing issues facing orthopaedic surgeons.

Big Data and Orthopaedic Surgery

Sagar Chawla, MD, MPH, And James Clemmons

“Big data” has changed the way much of the world operates. From business strategy to health care, leaders are able to make more informed decisions and dramatically impact their productivity.

Osteoporosis Is Not Just a ‘Woman’s Disease’

Nelson Watts, MD; Laura L. Tosi, MD, FAAOS

Osteoporosis is often mischaracterized as a “woman’s disease” because women are at greater risk for developing osteoporosis, but osteoporosis poses a significant burden for men as well.

Tenosynovial Giant Cell Tumor: A New Name and a New Treatment Option for PVNS and GCTTS

Adam S. Levin, MD, FAAOS

Historically, orthopaedic surgeons specializing in sports medicine, adult reconstruction, hand surgery, or foot and ankle surgery have had variable experiences with giant cell tumors of tendon sheath (GCTTS) or pigmented villonodular synovitis (PVNS) (nodular or diffuse).

New CPG Offers Recommendations on Distal Radius Fractures

Terry Stanton

At its December 2020 Board of Directors meeting, AAOS approved a new Clinical Practice Guideline (CPG) on the Management of Distal Radius Fractures.

Patient Safety Scenario: Protocol Communication Failure

David Nelson, MD, FAAOS

A comparison of safety in aviation and medicine is frightening: Aviation disasters are investigated and written up, and every pilot has access to the lessons learned. In medicine, medical errors are investigated, written up, and buried so deeply that no one learns anything.

AAOS Plain Language Summaries Assist with the Shared Decision-making Process

Barbara Krause

To assist in the dissemination of evidence-based information, AAOS has developed Plain Language Summaries of its CPGs to support physician-patient communication and the shared decision-making process.

Off-label Use of Medications, Biologics, and Devices in Orthopaedic Trauma Creates a Bevy of Risks and Challenges

Arun Aneja, MD, PhD; Jonathan Grabau, MD

Following FDA approval, any marketing or promotion of a given medications, biologics, and devices (MBD) is strictly restricted to the approved indication. Discretion on how to use devices on the market for patients is the responsibility of clinicians.

New Protocols for Evaluating Stem Cells in Orthopaedics

Ryan Pezold, MA

The use of MSC injections as regenerative therapy continues to grow as an area of acute interest for many clinicians and patients, despite a lack of high-quality evidence suggesting clinical efficacy.

The Registry Analytics Institute Proves to Be a Valuable Tool

Mita De, PhD; Terry Stanton

The Registry Analytics Institute (RAI) launched in 2019 as a way for researchers to pursue and publish research based on data from the American Joint Replacement Registry (AJRR).

FDA Ends Enforcement Discretion on Biologics and Regenerative Products

S. Raymond Golish, MD, PhD, MBA, FAAOS; Ryan Pezold, MA; David S. Jevsevar, MD, MBA, FAAOS

The FDA has formally ended the “enforcement discretion” of its comprehensive policy framework on biologics and regenerative medicine products.

Basic Science and the Meniscus: Where Are We Now?

Fred R.T. Nelson, MD, FAAOS, FAOA; Alan M. Reznik, MD, MBA, FAAOS

The understanding of the role of meniscus function in knee preservation continues to evolve, and the armamentaria for cartilage preservation in the knee continues to grow.

From Evidence to Implementation: Using Clinical Practice Guidelines to Create Care Pathways

Karl C. Roberts, MD, FAAOS; Matthew Pate, MD

Clinical medicine has been slowly evolving from delivering experience-based care to utilizing evidence-based medicine to guide clinical decision making.

New CPG Updates Guidance on Non-arthroplasty Management of Knee OA

Terry Stanton

At its August meeting, the AAOS Board of Directors approved the 2021 Clinical Practice Guideline (CPG) on Treatment of Osteoarthritis (OA) of the Knee (Non-arthroplasty) Third Edition.

Sound Off: Call It What It Is—It is an Osteoporotic Fracture

Mary Crowe, DO, MPAS, MHSA

For years, orthopaedic surgeons and AAOS have made good-faith efforts to mitigate the costs and morbidities associated with fragility fractures in the United States, which has become an overwhelming task.

Study Shows More than Half of Opioids Prescribed to Young Patients after Orthopaedic Surgery Go Unused

Ariel DeMaio

Adolescents undergoing orthopaedic surgery are commonly prescribed opioid medications for postoperative pain management, but few pediatric patients actually consume the full amount of tablets or liquid doses prescribed, according to a study conducted at Children’s Healthcare of Atlanta.

Shorter Intervals between Knee Arthroscopy and TKA May Increase Risk of Complications

Rebecca Araujo

In a study of timing from knee arthroscopy to total knee arthroplasty (TKA), researchers found a relationship between surgery timing and risk of postoperative complications.

AAOS Board of Directors Approves CPG/AUC on Prevention of Surgical Site Infections after Major Extremity Trauma

Barbara Krause

During their March meeting, the AAOS Board of Directors approved the Clinical Practice Guideline and correlating Appropriate Use Criteria on the Prevention of Surgical Site Infections after Major Extremity Trauma.

Lawrence J. Bonassar, PhD, Receives Kappa Delta Anne Doner Vaughn Award

The 2022 Kappa Delta Anne Doner Vaughn Award was presented to Lawrence J. Bonassar, PhD, for his research on the microscale mechanics and composition of articular cartilage and their relevance to musculoskeletal disease.

Katherine Gerull, MD, Receives Award for OREF’s First National Resident Research Symposium

Katherine Gerull, MD, of Washington University in St. Louis, captured the title of grand champion at the Orthopaedic Research and Education Foundation’s (OREF’s) first-ever National Resident Research Symposium last fall.

Board of Directors Approves CPG/AUC on Prevention of SSI after Major Extremity Trauma

Barbara Krause

During their March meeting, the AAOS Board of Directors approved the Clinical Practice Guideline and correlating Appropriate Use Criteria on the Prevention of Surgical Site Infections after Major Extremity Trauma.

Surgical Treatment for Adult Cervical Deformity: Changes in Approaches and Outcomes since 2013

Rebecca Araujo

In a study presented at the AAOS 2022 Annual Meeting, Peter G. Passias, MD, FAAOS, and colleagues investigated how surgical treatment for adult cervical deformity (ACD) has changed over the past decade.

‘Safe Zones’ Can Reduce Iatrogenic Injury Risk to the Sural Nerve

Brandon May

A team of researchers has identified certain “safe zones” of the ankle which surgeons can use as guides during incision and dissection during common orthopaedic foot and ankle procedures to reduce the risk of iatrogenic injury to the sural nerve.

Updated CPG Details Hip Fractures in Older Patients

Terry Stanton

In December 2021, the AAOS Board of Directors approved a complete update to the Clinical Practice Guideline (CPG) on Management of Hip Fractures in Older Patients.

New Clinical Practice Guideline Covers Prevention of Surgical Site Infection after Major Extremity Trauma

Terry Stanton

During its March meeting, the AAOS Board of Directors approved the Clinical Practice Guideline (CPG) and correlating Appropriate Use Criteria (AUC) on the Prevention of Surgical Site Infections (SSIs) after Major Extremity Trauma.

AAOS Reinforces Its Focus on Patient Safety, Launches New Device Recall Dashboard

Jonathan Dubin, MD, FAAOS; Jason L. Dragoo, MD, FAAOS; Julie Balch Samora, MD, PhD, MPH, FAAOS, FAOA

AAOS leadership and the Committee on Devices, Biologics, and Technology have teamed up with the Patient Safety Committee to publish a quarterly Device Recall Dashboard. The dashboard went live on Sept. 1.

The Presence or Lack of Psychological Safety in Surgery Directly Impacts Team Member Morale and Patient Care

Mary Carnduff, MD, MBA, FAAOS

Orthopaedic surgeons can improve psychological safety in their practices by cultivating skills in three focus areas: communication, conflict, and culture.

AAOS Announces Research Funding for Orthopaedic Specialty Societies

AAOS announced the first recipients of the AAOS Board of Specialty Societies (BOS) Research Support Fund Awards.

Newly Revised CPG Offers Guidance on Managing ACL Injuries

Terry Stanton

The AAOS Board of Directors approved a substantial update to the Clinical Practice Guideline (CPG) for the Management of Anterior Cruciate Ligament (ACL) Injuries, which was first issued in 2014.

Symposium Surveys Current and Future Landscapes of Orthobiologics

Terry Stanton

The full-day symposium “The Next Generation of Biologics: Use of Real-world Evidence” presented by AAOS in Washington, D.C., in November 2022, was an effort to envision and steer a coherent, ethical, and scientifically sound approach to the application of orthobiologic therapies.

Board Approves CPGs for Surgical Management of Knee Osteoarthritis and Treatment of Clavicle Fractures

The AAOS Board of Directors approved an update to the 2015 AAOS Clinical Practice Guideline (CPG) for the Surgical Management of Osteoarthritis of the Knee and a new CPG for the Treatment of Clavicle Fractures.

Immerse Yourself in the Power of Registry Data at AAOS 2023

The AAOS 2023 Annual Meeting offers a range of opportunities for surgeons to engage with data and findings from the AAOS Registry Program.

AAOS Board of Directors Approves Two New Appropriate Use Criteria for Shoulder Pathologies

During its March meeting, the AAOS Board of Directors approved the Appropriate Use Criteria (AUC) on Treatment of Shoulder Osteoarthritis with Intact Rotator Cuff and Severe Glenoid Retention and the AUC on Humeral Component Design during Primary Anatomic Total Shoulder Arthroplasty.

Study Utilizes AJRR Data to Investigate Outcomes of Dual Mobility Articulation in Revision THA

Cailin Conner

The utilization of dual mobility (DM) articulations during revision total hip arthroplasty (THA) to prevent postoperative hip instability has increased in recent years.

Study Finds Second Dexamethasone Dose after Primary TKA Is Associated with Reduced Opioid Use and Pain

Rebecca Araujo

A retrospective study to be presented at the AAOS 2023 Annual Meeting sought to investigate the safety, analgesic effect, and opioid-sparing potential of the administration of a second postoperative dose of dexamethasone in patients undergoing total knee arthroplasty (TKA).

Aspirin versus Low-molecular-weight Heparin for VTE Prophylaxis in Orthopaedic Trauma Care

Alexandra E. Page, MD, FAAOS

Many guidelines for thromboprophylaxis of orthopaedic trauma patients have recommended the use of low-molecular-weight heparin to prevent venous thromboembolism.

Updated CPG Offers Recommendations for Surgical Management of Knee Osteoarthritis

Terry Stanton

Where there is SMOAK, there is ample information in recent literature with which to form updated guidance.

Placement of Anchor in Arthroscopic Suprapectoral Biceps Tenodesis Influences Postoperative Pain

Cailin Conner

A study presented during the AAOS 2023 Annual Meeting found that biceps tenodesis suture anchors that are placed medially and inferiorly were predictors of postoperative biceps pain (BP) following arthroscopic suprapectoral biceps tenodesis (ASPBT).

Pregnancy and Orthopaedic Surgery Practice: Experts Discuss Challenges and Solutions

Cailin Conner

During the AAOS 2023 Annual Meeting in Las Vegas, a panel of female orthopaedic surgeons led a discussion on the challenges associated with pregnancy in the orthopaedic profession.

Health Care Systems Committee Updates Its Strategic Goals after Assessing Its Roles Related to Quality and Advocacy

Karl M. Koenig, MD, MS, FAAOS; Todd Applebaum; Alix Braun

The AAOS Health Care Systems Committee (HCSC) is tasked with staying abreast of the evolving healthcare environment and responding to the impact it has on the AAOS membership and orthopaedic surgery.

Electrocautery Utilization Associated with Potential Inhalation of Carcinogens

Maxwell V. Phillips, MD; Evan Kohler, MD; Alexander Phillips; Ajay Srivastava, MD, FAAOS

The utilization of electrocautery in surgery has been a revolutionary advancement, allowing for quick and effective establishment of hemostasis in the operative setting.

An Opportunity Exists to Better Understand Patient Pain through Patient-reported Outcome Measures

Richard Seiden

As a patient with severe arthritis who has undergone six major joint replacements and recently lumbar spine surgery, I believe that patients need to understand how their own outcomes can be used to further educate other patients, physicians, surgeons, and others in the healthcare-delivery system.

Finding the Right Cell: Using Automation to Select Effective Biologic Therapies

Terry Stanton

The third annual AAOS Biologics Symposium, titled “The Next Generation of Biologics,” featured four sessions on regulatory clarity, autologous tissue processing, personalized blood products, and future biologics trends.

ICL Debunks Urban Legends in Total Shoulder Arthroplasty

Cailin Conner

“Many of the things entrenched in our practice are thought to be based on science but in fact are more urban legend,” Richard J. Friedman, MD, FRCSC, chief of shoulder and elbow surgery and professor of orthopaedic surgery at the Medical University of South Carolina in Charleston, South Carolina, said in his introduction to the Instructional Course Lecture (ICL) titled “Urban Legends versus Evidence-Based Medicine in Total Shoulder Arthroplasty.”.

AAOS and FDA Prioritize Collaboration to Promote Medical Device Safety and Innovation

Ryan Pezold, MA, MBA

AAOS and the FDA both seek to further strengthen their working relationship by encouraging AAOS members who are considering submitting live educational events for the 2025 AAOS Annual Meeting programming to contact representatives from the FDA to discuss their topics and request FDA contributors when a federal regulatory perspective may add to the quality of the content.

AAOS Registry Program Marks Progress and Accomplishments in 2023

Erik Michalesko

The AAOS family of registries continues its growth trajectory, with more than 3.8 million procedures among five orthopaedic registries.

AAOS-FDA Town Hall during AAOS Annual Meeting Highlights Need for Diversity in Real-World Data

Leah Lawrence

During the AAOS 2024 Annual Meeting, AAOS and the FDA co-hosted a Town Hall symposium to examine the need for diversity in the collection of real-world evidence on the use of medical devices.

Research Shows Patient Mental Health Is an Important Aspect of Orthopaedic Outcomes

Leah Lawrence

Research has shown that patients with untreated mental disorders can have worse outcomes following orthopaedic surgery, including decreased function, increased chronic pain, and decreased quality of life.

Newly Revised CPG Provides Guidance on Management of Carpal Tunnel Syndrome

Jennifer Lefkowitz

In May 2024, the AAOS Board of Directors approved the updated Clinical Practice Guideline (CPG) for the Management of Carpal Tunnel Syndrome (CTS) to address the diagnosis and treatment of adult patients aged >18 years presenting with complaints that may be attributed to CTS.

Something to Worry About: Physician Shares Experience Navigating Her Daughter’s Sarcoma Treatment

Susan Blank, MD

One day, Maddie was a fun-loving, athletic 14-year-old picking out a blue polka-dot dress for her eighth-grade graduation and looking forward to a carefree summer of swimming and playing volleyball. The next day, our lives were upended.

Felasfa M. Wodajo, MD, Discusses How MSTS Is Working to Improve Care for Metastatic Bone Disease

Odion Binitie, MD, FAAOS

Felasfa M. Wodajo, MD, FAAOS, orthopaedic oncologist at Virginia Cancer Specialists in Fairfax, Virginia, and chair of the MSTS Skeletal Metastasis Task Force, discusses how the society is working to improve patient care in this area.

Exciting Orthobiologic Products Must Be Viewed through Regulatory and Guideline Lens

Leah Lawrence

Jason L. Dragoo, MD, FAAOS, chair of the AAOS Devices, Biologics, and Technology Committee and vice chair of academic affairs at the University of Colorado, moderated the symposium titled “Optimizing the Care of Your Patients Using Biologics.”

AAOS Registry Program Reaches Milestone of 4.5 Million Procedures in 2024, Collaborates with BCBSA

Molly Todd Rudy

Significant improvements were made to the AAOS Registry Program in 2024. The following article summarizes the most critical achievements.

Daniel B. F. Saris, MD, PhD, Receives Caplan Award for Distinguished Research in Orthobiologics

AAOS announced Daniel B. F. Saris, MD, PhD, as the inaugural recipient of the Arnold I. Caplan Award for Distinguished Research in Orthobiologics (Caplan Award).

Study Identifies Specific Barriers to Osteoarthritis Care for Hispanic and Black Patients

Keightley Amen, BA, ELS

Early diagnosis and treatment for osteoarthritis (OA) can improve symptoms, slow disease progression, and delay the need for joint replacement.

When TAA Fails

Jay D. Lenn

End-stage ankle arthritis results in severe pain, deformity, and functional disability. Although both ankle fusion and total ankle arthroplasty (TAA) are effective treatment options for the condition, TAA has become more common because it preserves mobility in the ankle and may protect surrounding joints from increased wear.

AAOS Featured at 2016 G-I-N Conference

Nicole Nelson, Patrick Donnelly; Nilay Patel

AAOS members and staff from the Academy's department of research, quality, and scientific affairs (RQSA) were among the featured participants at the Guidelines International Network (G-I-N) conference this past September in Philadelphia, an event that drew 511 conference delegates from 36 different countries. G-I-N is an international group that aims to advance the field of guideline development and implementation.

Making the Distinction Between Sex and Gender

Emily Brook, BA; Emily Curry, BA; Elizabeth G. Matzkin, MD

The number of published scientific articles examining male and female differences in orthopaedic medical conditions has increased during the past 25 years due to the National Institutes of Health Revitalization Act of 1993, which ensured the inclusion of women and minorities in clinical research. However, publications have inconsistently used the terms "sex" or "gender" to describe differences between males and females in research.

Acronyms 101: Sifting Through Alphabet Soup, Part 3

Douglas W. Lundy, MD, MBA; Thomas C. Barber, MD

In this third article of our series, we cover acronyms and abbreviations pertaining to quality measures espoused and promulgated by the Centers for Medicare & Medicaid Services (CMS), specifically the Physician Quality Reporting System (PQRS). Because CMS has driven many of these initiatives through Medicare, we begin with a brief discussion of that federal health insurance program.

AJRR Releases Guide on New Patient-Reported Outcome Platform

In late 2015, the American Joint Replacement Registry (AJRR) launched a Level III patient-reported outcome (PRO) platform. As part of an ongoing training and educational series on registry participation, the organization issued a comprehensive patient-reported outcome measures (PROMs) guide for hospitals and other institutions on implementing a PRO program. The guide will help AJRR participants and those interested in starting a PRO program better manage and build their programs.

The ABCs of Biologics

Adam I. Edelstein, MD

The use of biologics is rapidly expanding in the treatment of orthopaedic pathology. Biologics are used to augment healing in various musculoskeletal tissues including bone, tendon, cartilage, and muscle. Biologics include cells, tissues, and nonviable compounds such as growth factors. Residents typically gain exposure to biologics during their surgical training but may have limited formal education on this topic.

Measuring Up: The Making of a Performance Measure

David R. Chandler, MD

At its initial meeting in 2014, the AAOS Performance Measures Committee (PMC), chaired by decided to develop a set of performance measures for management of hip fractures in the elderly.

Measuring Up: The Performance Measure Development Process

David R. Chandler, MD

Performance measure development progresses through the following five phases, as depicted in Fig. 1: conceptualization specification testing implementation use and continuation of maintenance A link to the flow chart of the full process that AAOS implements for development can be found here. In the first phase of measure development, conceptualization, an idea about healthcare quality improvement is proposed.

Academy Announces Plans to Launch JAAOS Global Research & Reviews

The Academy has announced plans for a spring 2017 launch of JAAOS Global Research & Reviews, a new online journal that will serve as an open access companion title to the Journal of the American Academy of Orthopaedic Surgeons (JAAOS). The journal is under the leadership of William N. Levine, MD, editor-in-chief; Jeffrey S. Fischgrund, MD, research editor; and the entire editorial board of JAAOS.

Translating Orthopaedic Innovation to Clinical Use

Suzanne Maher, PhD; Michael Yaszemski, MD, PhD; Erin Lynn Ransford

Despite the wealth of innovation in the orthopaedic sciences, seemingly few technologies translate to clinical use. Federally funded research efforts are largely focused on understanding the mechanisms behind the development and progression of debilitating musculoskeletal diseases. There is a pressing need for researchers and surgeons to figure out how to connect mechanistic knowledge to improved clinical outcomes.

Researcher Evaluates Treatment for PJI Following Lower Extremity TJA

Sharon Johnson

Patients in the United States whose hip or knee replacements have become chronically infected may soon have access to treatment options currently utilized mainly in Europe. With a $500,000 grant from the Orthopaedic Research and Education Foundation (OREF), Thomas K.

Research Uncovers New Treatments for Clubfoot

and Christina Gurnett, MD, PhD, will receive the Kappa Delta Ann Doner Vaughn Award for their paper "Advancing Personalized Medicine for Clubfoot Through Translational Research." The award will be presented in San Diego during the 2017 AAOS Annual Meeting. "Our work leverages scientific advances of the past decades, including human gene sequencing, molecular genetic engineering of mouse models, and magnetic resonance imaging, as well as new treatment technologies," write the authors.

Collecting and Using Patient-Reported Outcomes in Everyday Practice

Joseph P. DeAngelis, MD, MBA; Neha Agrawal, MPH

Current trends in the healthcare landscape are shifting toward more robust, quantitative measurements of patient outcomes and provider performance. Hoping to optimize patient-reported outcomes (PROs), standardize care, and reduce costs, many healthcare providers have led the way in the collection of PROs data. Their experiences in implementing these processes and using the data provide lessons for others. In this, the first of a two-part series, Charles A.

Orthopaedic Practice in the United States

John Cherf, MD, MPH, MBA; Angela Buckley, MPA

Every 2 years, the AAOS research, quality, & scientific affairs department gathers demographic and practice data on orthopaedic surgeons through the Orthopaedic Practice in the United States (OPUS) Survey, also known as the Census Survey. The most recent data comes from the 2016 Census Survey, which had a response rate of 26 percent.

Consensus Performance Standards for Hip, Knee, and Shoulder Arthroplasty Devices

Frederick W. Werner, M Eng; Warren O. Haggard, PhD; William M. Mihalko, MD, PhD; Jack E. Lemons, PhD

Orthopaedic surgeons are often barraged with offers to examine and use a variety of modified or new surgical techniques. These techniques often involve new instruments, new implants, or devices that have new materials associated with them. The selection of a specific surgical device, method, or approach is affected by a number of factors, such as the device's suitability for the procedure and whether it is sufficiently strong, compliant, and biocompatible.

Symposium Explores Lessons Learned from War

Homeland defense has increasingly been at the forefront of national concern, with incidents of domestic and international terrorist activity garnering headlines. The Extremity War Injuries Symposium XII: Homeland Defense as a Translation of War Lessons Learned, held Jan. 31 – Feb. 1, 2017, in Washington, D.C., focused on disaster preparedness, as well as ongoing research efforts to identify knowledge gaps and highlight state-of-the-art treatments for extremity trauma.

New CPG Addresses Hip Osteoarthritis and THA

Terry Stanton; Sheryl Cash

At the 2017 AAOS Annual Meeting in San Diego, the AAOS approved the release of a Clinical Practice Guideline (CPG) on Management of Osteoarthritis (OA) of the Hip. The guideline includes four recommendations classified as "strong," being derived from evidence from two or more "high-quality" studies with consistent findings for recommending for or against an intervention, and eight classified as "moderate."

FDA Guidances on Physician-Directed Use

William M. Mihalko, MD, PhD; Katherine Sale, MPH; ; S. Raymond Golish, MD, PhD, MBA

The U.S. Food and Drug Administration (FDA) has issued several guidances—documents that outline the agency's current thinking about regulatory policy—concerning physician-directed use of medical devices. Before a guidance is finalized, the agency releases a draft guidance to solicit feedback from stakeholders. In January 2017, the FDA issued two new draft guidances, using a question/answer format.

Physician-Directed Use: Leadership from the Orthopaedic Device Forum

William M. Mihalko, MD, PhD; Katherine Sale, MPH; S. Raymond Golish, MD, PhD, MBA

The Orthopaedic Device Forum is a unique venue in which multiple stakeholder groups meet twice annually to debate and shape the future of orthopaedic device technology and policy. Surgeons are represented by the AAOS and its Board of Specialty Societies. Orthopaedic device manufacturers are represented by the Orthopedic Surgical Manufacturers Association (OSMA). Federal agencies are represented by senior officials from the U.S. Food and Drug Administration (FDA).

Complying with the Quality Component of MIPS in 2017

Stephen Mason McCollam, MD; Neha Agrawal, MPH

The Centers for Medicare & Medicaid Services (CMS) Quality Payment Program (QPP) implements the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) legislation, passed in April 2015.

Universal Protocol Is a Team Responsibility

The AAOS Patient Safety Committee continues to address important issues with its series of roundtable discussions. The following roundtable focuses on how to use universal protocol more effectively by including the surgical team as active participants in the process and how doing so can lead to a safer and more efficient operating room (OR). Moderator David Ring, MD, PhD, Patient Safety Committee chair, led the discussion, which included Michael Archdeacon, MD; Dwight W.

Academy Approves Guidelines for SSIs and Imaging Before Referral to an Oncologist

Terry Stanton

The Academy’s Board of Directors has approved two systematic literature reviews (SLRs): Management of Surgical Site Infections (SSIs) and Use of Imaging Prior to Referral to a Musculoskeletal Oncologist. The latter SLR was a product of the Musculoskeletal Tumor Society (MSTS) and was developed through the Academy’s Clinical Practice Guideline (CPG) process by the AAOS Evidence-Based Quality and Value Unit, with funding provided by both organizations.

AAOS Hip Fracture Time-to-surgery Performance Measure Passes First CMS Test

Steve Olson, MD; Quinn Hall, MHA

Hip fractures in older patients have been an increasingly important health concern in the United States, as life expectancy in the country continues to rise. In April, AAOS published a performance measure (PM) to encourage hip fracture surgery within 48 hours of admission for patients 65 years of age or older. The PM stems from the AAOS evidence-based clinical practice guideline (CPG) on Management of Hip Fractures in the Elderly, which was published in 2014.

AAOS Collaborates with DoD and APTA to Develop Quality Products

Kyle Mullen, MPH; Danielle Schulte, MS; Jayson Murray, MA

In recent years, the AAOS research department started offering services to assist in the development of evidence-based medical products, such as clinical practice guidelines (CPGs) and appropriate use criteria (AUC), for interested medical societies and organizations.

Will Biologic Treatments for Cartilage Restoration Become the Standard of Care?

Rivka C. Ihejirika, MD

Prevention of degenerative joint disease and the restoration of articular cartilage through minimally invasive means is a major focus of basic science and orthopaedic sports research. That research has led to advances in technology that enable the long-term storage of cartilage and the replication of “chondroinductive” cells, resulting in cartilage restoration procedures that may potentially set a new standard of care in orthopaedic clinical practice.

MARCQI Demonstrates Value and Impact of Registries

Terry Stanton

In the context of the U.S. government, the nation’s states are sometimes called the “laboratories of democracy.” Ideas often are tested in single states, and results may predict how programs might fare nationally. In orthopaedics, that concept might apply to the context of national registries.

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.

A Watchful Eye Can Prevent Future Harm to Young Patients

Bryan Tompkins, MD

Nonaccidental trauma is one of the leading causes of injury and death for children in the United States, with musculoskeletal injuries as one of the most common manifestations of child abuse. As orthopaedic surgeons, we are well-positioned to recognize and diagnose nonaccidental trauma in our smallest, youngest, and most vulnerable patients. However, the diagnosis of nonaccidental trauma requires proper screening. In 2010, the U.S.

New FDA Guidances Tighten Regulation of Stem Cells

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

Legitimate stem cell research may eventually revolutionize regenerative medicine, and some innovative therapies have already been appropriately studied and commercialized. By comparison, cell and tissue therapies promoted for orthopaedic conditions have often been poorly studied and lightly regulated. Nonetheless, they have proliferated commercially in the medical device market and in so-called stem cell clinics offering autologous, point-of-care interventional procedures.

Communication Breakdown: A Personal Account

Michael R. Marks, MD, MBA

Editor’s note: This article concludes a two-part series on shared decision making and patient-centered care. The previous article, “Communication Skills Are Critical to Improving Patient-centered Care and Shared Decision Making.” In 2018, my wife was involved in a serious skiing accident and had to be taken down the mountain in a sled by the ski patrol and transported by ambulance to a local hospital.

Joy in Practice Impacts Patient Safety

Nina Lightdale-Miric, MD

Loss of joy in practice—often referred to more pessimistically as “burnout”—is characterized by feelings of exhaustion, depersonalization or detachment, and perceived personal failure. Although orthopaedic surgeons have relatively high job satisfaction and reimbursement compared to other clinicians, trends suggest that—consistent with medicine in general—joy in orthopaedic practice is declining.

Binge Drinking Affects Fracture Healing

Sharon Johnson

During his time as a resident at Loyola University’s Stritch School of Medicine in Maywood, Ill., Roman Natoli, MD, PhD, learned that excessive alcohol consumption correlates with nonunions, although the pathophysiology underlying the association was not well understood. “Orthopaedic surgeons have done well in understanding the mechanics behind fracture healing, but the biology is something that [has] been more difficult for us to grasp,” he said.

Use Detailed Operational Benchmarking Data to Drive Increases in Ancillary Revenues

Bradley Coffey, MA, O-CHCP

Durable medical equipment (DME), prosthetics, orthotics, and supplies (DMEPOS) play an important role in musculoskeletal care. Such tools are often used to provide physical support to patients who have undergone surgery. Other types of DME may assist with correcting musculoskeletal deformities, such as scoliosis.

Military and AAOS Collaboration Yields New CPG on Acute Compartment Syndrome

Terry Stanton

During its December 2018 meeting, the AAOS Board of Directors approved a clinical practice guideline (CPG) on Management of Acute Compartment Syndrome (ACS). The CPG is the first of a series of planned guidelines funded by the Department of Defense (DoD) and created by a collaborative effort of military and civilian surgeon members of the Major Extremity Trauma and Rehabilitation Consortium (METRC) and Academy research staff.

Outcome Instrument Tracks Care in Young Throwing Athletes

Mark Crawford

More than 2.6 million emergency department visits annually are due to sports-related injuries in the five- to 24-year-old age group. As more young athletes play organized sports, the rate of pediatric sports injuries continues to rise. Clinical outcome instruments specific to both this patient group and constellation of injuries are needed to objectively evaluate the effect of interventions on recovery from injuries.

Diagnostic Approaches for PJI Continue to Evolve

Brandon Naylor, DO; Gabriel Makar, BS

“The 2018 Definition of Periprosthetic Hip and Knee Infection: An Evidence-Based and Validated Criteria,” published in The Journal of Arthroplasty, attempts to address the limitations of previous guidelines and aid clinicians and surgeons in navigating this often-difficult diagnosis. Javad Parvizi, MD, of the Rothman Institute, is the study’s lead author.

Key Informant Panels Allow for More Content Experts on AAOS CPGs

Kaitlyn Sevarino, MBA

Throughout the history of the AAOS clinical practice guideline (CPG) program, the Academy has received consistent feedback that guidelines need clinical experts, but clinical experts often have conflicts of interest (COI). The Committee on Evidence-based Quality and Value (EBQV) has long agreed with this statement but is charged with balancing the state of medicine with the rigorous methods of the CPG program.

P Value: Purpose, Power, and Potential Pitfalls

Ayoosh Pareek, MD; Chad Parkes, MD; R. Kyle Martin, MD, FRCSC; Lars Engebretsen, MD, PhD; Aaron J. Krych, MD

A P value indicates the probability that an observed result occurred by chance. In most modern literature, this is interpreted in the context of a type 1 error, which is defined as the probability of finding a difference between treatments by chance when a difference does not actually exist (Fig. 1). To reject a null hypothesis, which is the assumption that two groups are the same, it is generally accepted that a P value has to be less than the standard significance level (alpha) of 0.05.

New Checklist Offers Guidance on Securing AAOS Endorsement of a Clinical Practice Guideline

Barbara Krause

The goals and rationale of a clinical practice guideline or systematic review are to improve treatment based on current best evidence, optimize patient care through treatment decisions designed to improve the quality and efficiency of care, and identify areas for future research in which evidence is lacking.

Study Evaluates Lower-cost TKA Prostheses from Physician-owned Distributorships

Terry Stanton

A study comparing results of total knee arthroplasty (TKA) using prostheses provided by a physician-owned distributorship (POD) versus higher-cost implants provided by major commercial manufacturers found no differences in outcomes or complications.

AAOS Launches Strategic Biologics Initiative

Kerri Fitzgerald

In November 2019, AAOS announced the launch of its strategic investment in the field of biologics. Over the next five years, AAOS will prioritize research and development for a biologics-focused competency within the Academy’s existing member benefits, with a focus on creating evidence-based, unbiased information to help shape and guide orthopaedic surgeons who can then educate their patients on this topic.

Looking Back at a Very Good Year for Registries

Terry Stanton

There were welcome new arrivals—beginning with the January 2019 launch of the Musculoskeletal Tumor Registry (MsTR) pilot, followed in March 2019 by the addition of the rotator cuff and elbow arthroplasty modules to the Shoulder and Elbow Registry.

Disparities in Total Joint Replacement: Future Directions

Laura Bruse, MD, FAAOS, FAOA

The charges of the AAOS Research Development Committee (RDC) include the assessment of diversity and unity in all activities.

Direct-to-payer Marketing Attempts to Bypass Orthopaedic Surgeon Decision-making

David Jevsevar, MD, MBA, FAAOS; Kevin Shea, MD, FAAOS

Direct-to-consumer (DTC) marketing campaigns have been a part of the healthcare landscape since their introduction in the early 1980s. Most orthopaedic surgeons have dealt with patients demanding a specific drug or implant they learned about through television, radio, or print ads, as well as, more recently, social media campaigns. Although healthcare professionals advocate for well-informed patients, DTC marketing has also led to untoward outcomes for patients.

Study Supports TXA at Admission for Extracapsular Hip Fractures

Terry Stanton

A study presented by Jennifer R. Sharp, DO, as part of the Annual Meeting Virtual Experience, involving the use of tranexamic acid (TXA) in patients with extracapsular hip fractures found that administration of TXA upon admission led to a statistically significant reduction in the need for blood transfusion.

Anticipate Cognitive Bias to Provide the Best Care

The first article in this series addressed how patient cognitive bias affects health. Cognitive biases are the shortcuts the human mind takes. They are helpful for split-second decisions and are often accurate. But they are sometimes inaccurate in important ways, and managing cognitive bias is an important aspect of helping people get and stay healthy with safety and effectiveness. This article addresses surgeon cognitive bias—and the foundation of techniques used to limit errors and harm from errors in medicine.

True Progress in Orthobiologics Requires That We Police Ourselves and Each Other

Scott P. Bruder, MD, PhD

The orthobiologic product segment now represents 10 percent of the worldwide orthopaedic marketplace, with 2019 sales exceeding $5 billion worldwide. Sadly, however, there are far too many cases where companies have improperly side-stepped the FDA, misguided clinicians, and defrauded not only the surgeon community but also the general public and other federal agencies as well. Fortunately, AAOS is now dedicating more resources and focus to the topic of biologic product development and responsible clinical use. Formation

Lower Speed Limit in Toronto Reduces Vehicle-pedestrian Strikes

Terry Stanton

A Canadian study found that when the speed limit on Toronto streets was reduced from 40 km per hour (25 mph) to 30 km per hour (19 mph), the number of incidents in which pedestrians were struck by cars (passenger-motor vehicle collisions [PMVCs]) decreased by 28 percent.

New AAOS CPG Addresses Metastatic Disease of Femur

Terry Stanton

In June, the Academy Board of Directors approved an AAOS endorsement of a Clinical Practice Guideline (CPG) on the Treatment of Metastatic Carcinoma and Myeloma of the Femur.

AAOS to Launch Fracture & Trauma Registry

Terry Stanton

The Academy Registry Program will welcome a new member to its ranks when the Fracture & Trauma Registry (FTR) launches in the spring of 2021.

AJRR Annual Report Details a Year of Highlights

Terry Stanton

The Annual Report of the Academy’s American Joint Replacement Registry (AJRR), just released at the Annual Meeting of the American Association of Knee and Hip Surgeons (AAHKS), tells the story of a year marked by a multitude of successes and growth for AJRR.

Ten-year Follow-up of Adolescent Idiopathic Scoliosis Patients Confirms Benefits of Surgery

Terry Stanton

The largest study of its kind for adolescent idiopathic scoliosis (AIS), with at least 10-year follow-up of complications and reoperations following spinal fusion for AIS, found an overall complication rate of 12.0 percent and reoperation rate of 6.7 percent in the patients followed.

Rare Disease Research Paves the Way for Registry Studies of the Most Common Orthopaedic Ailments

George T. Calvert, MD, FAAOS

The 2019 launch of the AAOS Musculoskeletal Tumor Registry (MsTR) was a major achievement for the orthopaedic oncology community.

Get to Know the AAOS CPG Evidence to Decision Framework

Danielle Schulte, MS

To ensure that the Clinical Practice Guidelines provide the highest-quality guidance to members, staff and member volunteers follow a systematic process of literature review and recommendation creation.

AAOS PSC Addresses Musculoskeletal Cortisone Injections and COVID-19 Vaccine Administration

The AAOS Patient Safety Committee recommends avoiding musculoskeletal corticosteroid injections for two weeks before and one week after COVID-19 vaccine administration.

AAOS’ $100,000 Pledge to AOSSM Supports Evidence-based Orthopaedic Research and Education

AAOS and the American Orthopaedic Society for Sports Medicine (AOSSM) are proud to announce a major partnership centered on AOSSM’s upcoming historic 50th Anniversary Research Initiative.

Advances in Next-generation Sequencing Will Significantly Impact the Diagnosis of Orthopaedic Infections

Alisina Shahi, MD, PhD; Grace V. Gilbert, BSN; Mike P. Ast, MD, FAAOS

In orthopaedic surgery, research has shown that next-generation sequencing is more sensitive, specific, and cost-effective than traditional culture.

Registry Program Opportunities at the Annual Meeting

The AAOS 2021 Annual Meeting has many offerings for attendees who are participating in the AAOS Registry Program or thinking about participating, including presentations by registry experts, poster submissions, access to knowledgeable staff, and more.

New CPG and AUC Offer Guidance on More than 24 Perioperative Pain Management Interventions

Terry Stanton

In July, the Board of Directors approved a Clinical Practice Guideline (CPG) and an accompanying set of Appropriate Use Criteria (AUC) on Pharmacologic, Physical, and Cognitive Pain Alleviation for Musculoskeletal Extremity/Pelvis Surgery.

AAOS Board of Directors Approves Update to Clinical Practice Guideline for Treatment of Osteoarthritis of the Knee

On Aug. 30, the AAOS Board of Directors approved the full update to the 2013 Clinical Practice Guideline (CPG) for Treatment of Osteoarthritis of the Knee.

Surgeons Trying to Conceive May Suffer Higher Rates of Infertility and Pregnancy Complications

Lindsey C. Valone, MD, MAS; Nina Lightdale-Miric, MD, FAAOS; Maureen A. O’Shaughnessy, MD, FAAOS

A common deterrent to women choosing orthopaedic surgery as a career is the perceived inability to maintain a healthy work-life balance.

New AUC on Distal Radius Fractures Builds on Updated Clinical Practice Guideline

Barbara Krause

At its October meeting, the AAOS Board of Directors approved the publication of a new set of Appropriate Use Criteria (AUC) on the Treatment of Distal Radius Fractures (DRFs).

AAOS Board Approves 2021 Update to CPG on Hip Fracture Management in Older Patients

Barbara Krause

During their December Board meeting, the AAOS Board of Directors approved the 2021 update to the Clinical Practice Guideline (CPG) on Management of Hip Fractures in Older Patients.

(Re)Introducing AAOS Technology Overviews

David Jevsevar, MD, MBA, FAAOS; Ryan Pezold, MA

The AAOS Biologics Initiative, overseen by the Committee on Devices, Biologics, and Technology, has revitalized the Technology Overview program.

Study: Rib Fixation Lowers Mortality but Not Vent-free Days after Flail Chest Injury

Terry Stanton

A study investigating surgical fixation of unstable chest wall and flail chest injury found no improvement in ventilator-free days (VFDs) or other outcomes compared to nonsurgical treatment across the entire patient population.

Alayna E. Loiselle, PhD, Wins 2022 Kappa Delta Young Investigator Award

Alayna E. Loiselle, PhD, was awarded the 2022 Kappa Delta Young Investigator Award for her research on the cell biology of tendons and how different cells contribute to the tendon healing process.

Kappa Delta Elizabeth Winston Lanier Award Presented to L. Scott Levin, MD, for Research in Evolution of Microsurgery

The 2022 Kappa Delta Elizabeth Winston Lanier Award, which recognizes research in musculoskeletal disease or injury with great potential to advance patient care, was awarded to L. Scott Levin, MD, FAAOS, FACS, FAOA.

Posterior Malleolus Repair of Unstable Rotational Ankle Fractures Leads to High Healing Rate

Brandon May

A study to be presented Friday found that direct repair of the posterior malleolus in the prone position in patients with unstable rotational ankle fractures was associated with a high rate of healing and no incidences of readmissions or deep infections.

AAOS Endorses AAHKS CPG on Multimodal Analgesia for Total Joint Arthroplasty: Focus on Oral Medications

Charles P. Hannon, MD, MBA; Yale A. Fillingham, MD, FAAOS

A multidisciplinary group of 35 orthopaedic surgeons and anesthesiologists collaborated on the formation of a clinical practice guideline (CPG) on multimodal analgesia in total joint arthroplasty (TJA).

Study Demonstrates How THA Care Pathways Can Lower Length of Stay for Patients

Patrick Daly

Care pathways in hip arthroplasty programs have effectively lowered the length of stay (LOS) after primary total hip arthroplasty (THA).

Study Characterizes Incidence, Survival Rates for Osteosarcoma

Brandon May

A new study provides improved insights into the incidence and survival rates of osteosarcoma since 1975, with evidence pointing to a relatively recent improvement in survival among patients with metastatic disease but increased incidence in males aged up to 24 years.

Study Questions Whether Strict BMI Cutoffs Yield Meaningful Changes in Post-THA Outcomes

Ariel DeMaio

Obesity is a significant risk factor in the development of osteoarthritis, and as the number of patients with obesity in the United States continues to increase, so does the demand for total hip arthroplasty (THA).

Presentation Illustrates ‘How To Be Your Own COO’

Terry Stanton

At the AAOS 2022 Annual Meeting in Chicago, four experienced orthopaedic surgeons shared their perspectives on “Leadership in Orthopaedics: How to Be Your Own Chief Operations Officer” in an Instructional Course Lecture.

AAOS CPG Infographics Help Surgeons Easily Visualize the Latest Evidence and Treatment Recommendations

Barbara Krause

AAOS recently started presenting its clinical practice guidelines’ strong and moderate-strength evidence recommendations in the format of Guideline Overview Infographics.

AAOS Board of Directors Approves CPG for the Management of ACL Injuries and Two AUC Reissues

The AAOS Board of Directors (BoD) approved an update to the 2014 AAOS Clinical Practice Guideline (CPG) for the Management of Anterior Cruciate Ligament (ACL) Injuries and the reissues of two Appropriate Use Criteria (AUC) for the Management of Developmental Dysplasia of the Hip in Infants up to Six Months of Age: one intended for use by general pediatricians and referring physicians and the second intended for use by orthopaedic surgeons.

AJRR 2022 Annual Report Offers Insight into Trends in Patient-reported Joint Replacement Outcomes

The ninth annual report demonstrates an overall cumulative procedural volume growth of 14 percent compared with the previous year and includes more than 2.8 million hip and knee procedures since 2012 from more than 1,250 hospitals, ambulatory surgery centers, and private practice groups.

AAOS Introduces the Fracture & Trauma Registry, Powered by PatientIQ

AAOS recently announced that the Fracture & Trauma Registry (FTR) will now be powered by PatientIQ.

Antibiotic Prophylaxis for GI Endoscopy: Considerations for Patients with Orthopaedic Prosthesis

Antonia F. Chen, MD, MBA, FAAOS

Orthopaedic patients undergoing gastrointestinal (GI) endoscopy may question infection risk to their prostheses.

The Power of Registry Data Keeps Gaining Momentum: A Look Back on 2022 for the AAOS Registry Program

Erik Michalesko

AAOS has invested significant time and resources to deliver a comprehensive Registry Program and provide a reliable source of actionable data to inform practice decisions and improve care for patients undergoing orthopaedic procedures. Collection and analysis of longitudinal patient information allow participating institutions to access their own real-time dashboards and compare their metrics to national registry benchmarks.

Learn about the Fracture & Trauma Registry Powered by PatientIQ throughout the Annual Meeting

AAOS has partnered with PatientIQ to provide a brand-new registry offering: the Fracture & Trauma Registry (FTR) Powered by PatientIQ.

Study Finds Imageless Navigation during Total Hip Arthroplasty Is Not Associated with Improved Outcomes

Cailin Conner

Given the increasing use of computer navigation during total hip arthroplasty (THA), the degree of the technology’s effectiveness compared with traditional navigational methods has become increasingly important.

Placement of Anchor in Arthroscopic Suprapectoral Biceps Tenodesis Influences Postoperative Pain

Cailin Conner

A study presented during the AAOS 2023 Annual Meeting found that biceps tenodesis suture anchors that are placed medially and inferiorly were predictors of postoperative biceps pain (BP) following arthroscopic suprapectoral biceps tenodesis (ASPBT).

AAOS Board of Directors Approves Two New Appropriate Use Criteria for Shoulder Pathologies

During its March meeting at the AAOS 2023 Annual Meeting, the AAOS Board of Directors approved the Appropriate Use Criteria (AUC) on Treatment of Shoulder Osteoarthritis with Intact Rotator Cuff and Severe Glenoid Retention and the AUC on Humeral Component Design during Primary Anatomic Total Shoulder Arthroplasty.

AAOS CPG Addresses Clavicle Fractures

Terry Stanton

The AAOS Clinical Practice Guideline on Treatment of Clavicle Fractures, issued at the end of 2022, offers a wealth of recommendations and options on the management of these injuries.

Introducing the AAOS PROMs Workgroup: the Why and the Who

Lauren Shapiro, MD, MS, FAAOS; Kurt Spindler, MD, FAAOS

Changes in patient-reported outcomes are arguably among the best measures of the success of orthopaedic procedures.

Are Steroid Injections a Safe Treatment for CTS during Pregnancy?

Timothy Westbrooks, MD; Mahala Walker; Maureen A. O’Shaughnessy, MD, FAAOS

Several studies have demonstrated a high prevalence of carpal tunnel syndrome during pregnancy, with reports of incidence rates ranging from 31 to 62 percent.

Does Antibiotic Prophylaxis Decrease Infection Rate in Pediatric Supracondylar Humerus Fractures?

Cailin Conner

Sumit Gupta, MD, MPH, orthopaedic surgeon from the University of Missouri, presented a prospective, double-blinded, randomized, controlled trial at the 2023 Annual Meeting regarding the efficacy of using antibiotic prophylaxis to prevent infections after CRPP in SCHF patients.

Low-cost Methods Perform Similarly to Virtual Reality at Minimizing Anxiety during Pediatric Cast and Pin Removal

Cailin Conner

Peter D. Fabricant, MD, MPH, FAAOS, and his coauthors conducted a randomized, controlled trial to determine whether virtual reality minimized anxiety among pediatric patients during outpatient cast and pin removal when compared to video distraction.

Study Finds Increased Risk of Periprosthetic Fracture in THA Patients following Bisphosphonate Use

Cailin Conner

A study analyzing the effects that bisphosphonates have on osteoporotic patients undergoing total hip arthroplasty (THA) found that bisphosphonate use prior to THA was an independent risk factor for periprosthetic fracture.

An Explanation of the Categorization of Osteobiologics

John Cherf, MD, MPH, MBA, FAAOS

The ISASS classified alternatives to iliac crest bone graft into six major categories: cellular-based allografts, nonstructural allografts, autologous cellular grafts, synthetic bone grafts, demineralized bone grafts (or demineralized bone matrices), and Class III drug-device combination products.

AAOS Offers Tools for Physicians to Integrate CPGs and Patient Education Resources into Clinical Practice

Barbara Krause

Clinical practice guidelines (CPGs) are systematically developed recommendations intended to assist healthcare professionals in making decisions about appropriate healthcare for specific clinical situations.

Generative AI Could Transform Healthcare

Leah Lawrence

The symposium, titled “Generative Artificial Intelligence—A Technology Set to Transform Musculoskeletal Care?” was an exploration of generative AI and its risks, challenges, and opportunities in the healthcare arena. It included insights from several experts to help attendees navigate these topics.

Unlocking the Power of Patient-Reported Outcomes: Essential Advantages for Orthopaedic Surgeons

Jeffery D. Angel, MD, MFin, FAAOS

The implementation of PROMs has become a pressing issue for the specialty, as the Centers for Medicare & Medicaid Services will soon start penalizing hospitals based on their rate of PROM collection.

Improving Patient Comprehension Should Always Be a Top Priority in Orthopaedic Surgery

John M. Tarazi, MD; Amanda Fantry, MD; Adam D. Bitterman, DO, FAAOS

Patients need a clear understanding of their health conditions and treatment options to manage their health and make informed decisions about their care.

AAOS Offers Tools to Simplify the Implementation of Patient-Reported Outcomes Collection

Lauren Shapiro, MD, MS, FAAOS; Kurt P. Spindler, MD, FAAOS

This article details the current status of PROM collection and utilization in orthopaedics, barriers to utilization in clinical care, resources the PROMs Workgroup has developed, and where the field needs to go next.

AAOS Pens Letter to FDA Calling for Transparency of Biologic Product Data

In the following letter to the FDA, written with expertise from the AAOS Devices, Biologics, and Technology Committee, AAOS encouraged the FDA to require manufacturers to reduce ambiguity and increase publicly available regulatory information as it relates to biologic orthopaedic products.

Musculoskeletal Tumor Registry Fills Void in Understanding Sarcoma and Its Impact on Patients

Molly Todd Rudy

July marks Sarcoma Awareness Month, established to build awareness about this rare type of cancer. For individuals living with and treating sarcomas, increasing awareness about these rare cancers is extremely important.

AAOS Introduces First Clinical Practice Guideline for Management of Acute Isolated Meniscal Pathology

Jennifer Lefkowitz

In June, the AAOS Board of Directors approved the first Clinical Practice Guideline (CPG) for the Management of Acute Isolated Meniscal Pathology.

AJRR Study: Robotic Assistance Does Not Reduce Risk of Revision in Cementless Total Knee Arthroplasty

Rebecca Araujo

A study investigated the benefit of robotic assistance as measured by risk of revision 2 years after total knee arthroplasty with cementless fixation in patients aged 65 years or older, using data from the American Joint Replacement Registry.

AAOS Approves Clinical Practice Guideline on Prevention of PJI in Patients Undergoing Dental Procedures

During their November meeting, the AAOS Board of Directors approved the Clinical Practice Guideline for the Prevention of Total Hip and Knee Arthroplasty Periprosthetic Joint Infection in Patients Undergoing Dental Procedures.

Success Rates Comparable between One-Stage and Two-Stage Treatment for Periprosthetic Joint Infection

Molly Todd Rudy

For periprosthetic joint infections (PJIs) following primary hip or knee arthroplasty, a two-stage approach has been considered the gold standard of treatment in the United States.

AAOS Updates Information Statement on the Use of Structured Communication Tools to Enhance Surgical Safety

AAOS released an updated information statement, “Use of Structured Communication Tools to Improve Surgical Patient Safety,” emphasizing the critical role of effective communication in surgical care.

Updated CPG Addresses PJI Prevention in Patients Undergoing Total Joint Arthroplasty and Dental Procedures

The AAOS Board of Directors approved the updated Clinical Practice Guideline for the Prevention of Total Hip and Knee Arthroplasty Periprosthetic Joint Infection in Patients Undergoing Dental Procedures, which replaces the previous guideline from 2012.

CMS and Performance Measure Implementation: Understanding the Impact of the "2-Year Look Back" and "Capping Out"

Kent Jason Lowry, MD; Adolph J. Yates, MD

As health care changes, performance measures are playing an increasing role in the care provided, how that care is perceived, and how orthopaedic surgeons get reimbursed. The 2015 Medicare Access and CHIP Reauthorization Act (MACRA) did away with the Sustainable Growth Rate formula and the Physician Quality Reporting System (PQRS), but replaced the latter with the Merit-Based Incentive Payment System (MIPS).

BOC Recognizes State Participation in AAOS 2016 Census

Hazel Oreluk, MA

Every 2 years, the AAOS gathers practice data from U.S. orthopaedic surgeons, which it uses to help tailor plans, services, and products for members. This year (2016), the census questionnaire was sent out in April; data collection closed in June. Currently, the data are being cleaned and analyzed by the AAOS department of research, quality, and scientific affairs, and the results will be released in January 2017.

Making Old Bones Young Again

Amber Blake

Researchers at the University of Toronto have been studying mice in the hopes of gaining a better understanding of how bone ages. According to their most recent study, presented at the 2016 Orthopaedic Research Society (ORS) annual meeting, old mice retain the capacity for bone repair when they are exposed to a circulation of youthful blood.

Reminder: Your Input is Requested in the AAOS 2016 Census

There is still time for Academy members to take part in the AAOS 2016 census of orthopaedic surgeons. The census is taken to ensure AAOS members are accurately represented in advocacy, funding, and reimbursement efforts. The information also helps AAOS tailor programs, products, and services to address professional needs and interests of its members. All individual responses are kept confidential. AAOS will be sending reminders to those who have not responded yet.

Periprosthetic Femur Fracture Fixation

Mark Crawford

More than 300,000 total knee arthroplasty (TKA) procedures are performed every year in the United States. With seniors living longer and staying more active, the number of these procedures is expected to double over the next decade. Unfortunately, that means that postoperative complications—especially periprosthetic femur fractures that occur around knee implants—will be of increasing concern.

Turning a CPG into a Care Map

Kevin G. Shea, MD; Charles T. Price, MD

Developmental dysplasia of the hip (DDH) is a relatively common pediatric condition, occurring in 3 to 4 of every 1,000 live births. If left untreated, DDH can have lifelong implications—including disability and total hip replacement at a young age. Even if providers suspect DDH, the early signs of this condition are not always obvious; frank hip dislocation only occurs in approximately 1 of 1,000 newborn infants.

Why Measure Systemic Metal Levels in Orthopaedic Patients?

Nadim James Hallab, PhD; Mitchell C. Weiser, MD

The pursuit of longer lasting, wear-resistant designs in modern total hip arthroplasty (THA) has resulted in the introduction of alternative bearing surfaces (such as metal-on-metal [MoM]) and modularity options (such as modular THA necks). Some of these implant designs have had less-than-optimal performance and have also been correlated with elevated levels of systemic metal ions, highlighting the current usefulness of metal ion blood testing.

Innovation Spotlight: StreaMD

Kevin J. Campbell, MD, chief executive officer and cofounder of StreaMD, was presented the 2017 Orthopaedic Innovator Award at the AAOS/ORS Translating Orthopaedic Technologies into Clinical Practice: Pathways from Novel Idea to Improvements in Standard of Care Research Symposium. Erin Lynn Ransford connected with Dr. Campbell to discuss his product. The questions and his responses follow. Ms. Ransford: What is StreaMD? Dr. Campbell: StreaMD is a health-tech company based in Chicago.

Orthopaedic Organizations Collaborate to Encourage GME Support

Rhonda Taira

The OMeGA Medical Grants Association (OMeGA) was established to ensure the continued financial support of orthopaedic residency and fellowship programs. Since 2009, it has awarded more than $21 million through nearly 900 fellowship and residency grants.

Is Obesity a Modifiable Risk Factor for Elective Orthopaedic Surgery?

Laura M. Bruse, MD

Attention is increasingly being drawn to risk factors that may affect patient outcomes in orthopaedic surgery. Frequently, modifiable risk factors such as smoking, alcohol use, and obesity are discussed and modified prior to elective orthopaedic surgery. Obesity is a recognized medical condition which is increasing in both the adult and child population. The prevalence of obesity has doubled in adults in the past 20 years, with 35 percent of the U.S.

Orthopaedic Opportunities and Hospital Value-Based Payments

Kent Jason Lowry, MD; Peggy L. Naas, MD, MBA

With the shift in health care from volume to value, orthopaedic surgeons have opportunities to improve patient care and leverage aligned financial incentives among providers. The care that orthopaedic surgeons provide directly affects how Medicare payments are allocated to hospitals. It is important, therefore, to understand how hospitals are incentivized.

In Search of a Biologic for Treating Back Pain

Sharon Johnson

Samuel K. Cho, MD, a spine surgeon and research scientist on the faculty at Icahn School of Medicine at Mount Sinai in New York City, is leading an exploration of the molecular biology of notochordal cells. He is particularly interested in what chemical factors they may release or trigger that contribute to healthy disk cells.

Kappa Delta Young Investigator Award to Ankle Researcher

Terry Stanton

Shoes led Robin Queen, PhD, FACSM, to wonder about the ankle and to focus her research career on that joint. For her work so far and for the research efforts she currently leads at Virginia Tech, Dr. Queen will receive the 2017 Kappa Delta Young Investigator Award, to be presented at the AAOS Annual Meeting this month. Dr. Queen’s research is centered on solving mysteries in the interrelationships among ankle osteoarthritis (OA), ankle arthroplasty, and ankle fusion.

Resident Investigators Showcase Their Research

CAPT D. C. Covey, MD, MC, USN (Ret.); LCDR Lucas S. McDonald, MC, USN

Last fall, the fourth annual Orthopaedic Research and Education Foundation (OREF)/Orthopaedic Research Society (ORS) Southwest Region Resident Research Symposium was held in San Diego, California. The event showcased resident researchers from the University of California (UC) San Diego; Stanford University; University of California, UC San Francisco; Naval Medical Center San Diego; and Loma Linda University.

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.

Getting the Most out of AAOS CPGs

Kaitlyn S. Sevarino, MBA

In 2006, the AAOS Board of Directors approved the creation of a Clinical Practice Guideline (CPG) program at the Academy. Since then, the AAOS has been developing and publishing CPGs to serve as educational tools for its membership. The AAOS has allocated resources to the in-house assessment of current published scientific and clinical information, as well as the formation and function of dozens of member volunteer groups.

MRI Safety Update 2018: Is Contrast Safe?

Jacob C. Mandell, MD; Charles H. Cho, MD, MBA

A 41-year-old woman has a rapidly growing wrist mass that does not seem typical for a ganglion. Her orthopaedic surgeon recommends a contrast-enhanced magnetic resonance imaging (MRI) scan to evaluate for a potential mass. However, the patient explains that she does not want to get “gadolinium poisoning.” How do you address her concerns? MRI creates exquisitely detailed images of the body using a combination of a strong magnetic field, radiofrequency excitations, and advanced mathematics.

Board Approves CPG From AAHKS on Tranexamic Acid

In addition to approving the two SLRs on oncology imaging referrals and surgical site infections, the AAOS Board of Directors endorsed a CPG prepared and submitted by the American Association of Hip and Knee Surgeons (AAHKS) in conjunction with the American Society of Regional Anesthesia and Pain Medicine (ASRA) and the Hip and Knee Societies covering use of tranexamic acid (TXA) in total joint arthroplasty (TJA).

NESTcc Announces the First Round of Real-world Evidence Test-cases

The National Evaluation System for Health Technology Coordinating Center (NESTcc), an initiative of the Medical Device Innovation Consortium (MDIC), announced the first round of NESTcc test-cases that address topics of high priority from the medical device industry using real-world data and evidence.

Orthopaedic Surgeons Play Key Role in Device Recalls

Patrick Maher, MD; Chatón T. Turner, Esq.; Kenneth L. Urish, MD, PhD; the AAOS Biomedical Engineering Committee

Orthopaedic surgeons are in a unique position to discover possible issues with orthopaedic devices. Accordingly, the surgeon’s role in ensuring the quality of those devices cannot be overstated. This responsibility requires surgeons to report device failures to the U.S. Food and Drug Administration (FDA) and to understand the hospital’s role in reporting as well. Recent innovations in arthroplasty have resulted in many positive advances for patients.

Debate: Are Ultrasounds Necessary for Routine Knee and Shoulder Injections in the Office?

Holly J. Duck, MD; Alan M. Reznik, MD, MBA

The use of ultrasound guidance for routine knee and shoulder injections in the office is increasing. There is no doubt that ultrasound can improve the accuracy of injections, yet questions remain. How much accuracy is gained and at what cost? Moreover, are patient outcomes negatively affected if ultrasound is not used for these injections? Two respected sports medicine physicians debate the issue.

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.

Knee Arthroscopy and Osteoarthritis: The Numbers Rarely Add Up to 29880

Timothy L. Miller, MD

Knee arthroscopy is one of the most commonly performed procedures in orthopaedics. It is a standard practice for academic sports medicine specialists, and it also is a staple among general, community-based orthopaedic surgery practices. However, over the past decade, the utility of arthroscopy for the treatment of patients with knee osteoarthritis (OA) has become increasingly questioned.

Patient Safety Committee Discusses Using Overutilization as a Quality Measure

When orthopaedic surgeons think of quality and safety, things like medication errors, wrong-site surgery, and hospital-acquired infection often come to mind. To be safe and improve quality, we adopt computerized order entry, utilize the World Health Organization checklist, and wash our hands going into and out of every patient’s room. And we measure our performance. When it comes so-called shared decision making, most of us think, “I do that well.” But do we really?

AAOS AUC Guide Residents’ Decision-making in the Acute Treatment of Distal Radius Fractures

Sravya Vajapey, MD

Distal radius fractures (DRFs) are among the most common injuries in orthopaedic practice and account for up to 20 percent of the fractures treated in the emergency department (ED). In tertiary care centers and academic institutions, the first provider to see a patient after an emergency physician’s evaluation is usually not an orthopaedic surgery attending. It can be a physician’s assistant (PA), a nurse practitioner, a resident, or an ED attending.

The Integrity of Scientific Work Relies on Transparency of Financial Conflicts

Gregory A. Brown, MD, PhD; Kevin G. Shea, MD; Kaitlyn S. Sevarino, MBA

In 2007, Sens. Chuck Grassley (R-Iowa) and Herb Kohl (D-Wis.) introduced the Physician Payments Sunshine Act to increase transparency of the relationships between physicians and medical product manufacturers. Although initial attempts to pass the bill failed, it was enacted as part of the Affordable Care Act in 2010. To further promote transparency in medicine, the Centers for Medicare & Medicaid Services (CMS) began reporting physician payments on its Open Payments website in 2013.

Patient Safety Committee Discusses How Professionalism Can Limit Psychological Harm

The AAOS Patient Safety Committee supports the development, validation, and dissemination of culture and processes that improve orthopaedic surgical safety and inform Academy policy regarding these issues. If you have questions related to the content presented in this roundtable discussion or patient safety in general, please email patientsafety@aaos.org. Many medical errors and harms can be traced to ineffective communication and poor team dynamics, which are issues of professionalism.

AAOS Develops and Approves Position Statement on Development of Musculoskeletal-based PRO-PMs

Kent Jason Lowry, MD

The AAOS Performance Measurement Committee (PMC) has observed that a dizzying array of patient-reported outcome performance measures (PRO-PMs) related to hip and knee joint replacement care were being developed by other stakeholders.

AAOS Patient Safety Committee Considers Ways to Avoid Harm Through Innovations in Quality and Safety

Recently, members of the AAOS Patient Safety Committee—David C. Ring, MD, PhD, chair; Michael R. Marks, MD, MBA; Dwight W. Burney III, MD; Ramon L. Jimenez, MD; Alan M. Reznik, MD, MBA; Michael S. Pinzur, MD; and Nina R. Lightdale-Miric, MD—participated in a roundtable discussion about innovation in quality and safety. : An evolution in the definition of harm was the catalyst for a discussion of innovation in quality and safety.

AAOS Registry Analytics Institute Now Accepting Applications for Registry Science

The AAOS Registry Program collects data within multiple orthopaedic anatomic registries, thereby creating the exciting potential for analytic insights that improve patient outcomes. In February, AAOS launched the AAOS Registry Analytics Institute, bringing that potential closer to reality for many clinicians. The Institute provides clinicians and clinician-scientists the opportunity to submit proposals for analytic insights that are contained within the registries of the AAOS Registry Program.

Study Probes Reasons for Underrepresentation of Minorities in Orthopaedic Residencies

Terry Stanton

A study appearing in the Nov. 1 issue of the Journal of the AAOS explores why members of racial and ethnic minority groups have a lower rate of acceptance into orthopaedic residency programs, resulting in relative underrepresentation in such programs.

Evolution Versus Revolution in AI: Why the Distinction?

Alan M. Reznik, MD, MBA, FAAOS

This is the fifth article in an ongoing series on artificial intelligence (AI) in orthopaedics. Previous articles tackled topics such as the origins of AI, how AI reads X-rays, natural language processing in medical decision-making, and medical ethics related to AI. This article explores the difference between shallow and deep AI, as well as the phenomenon of AI creep. This article explores the difference between shallow and deep AI, as well as the phenomenon of AI creep.

Academy Defines Quality and Value in Musculoskeletal Health Care

Robert H. Quinn, MD, FAAOS; Jayson Murray, MA

When you think of “value-based health care,” what comes to mind? Is it all about cost? It’s far from breaking news that the United States leads the pack in health spending, with an average annual spend of 17.2 percent of gross domestic product (GDP).

Ensure Patient Safety with Proper Documentation of Medication Allergies

Jonathan H. Shaw, MD

The question, “Are you allergic to any medications?” is a critical component of triage and history of an orthopaedic surgery patient.

ASA and AAOS Partner to Launch Pain Alleviation Toolkit

Asokumar Buvanendran, MD; David Ring, MD, PhD, FAAOS

The American Society of Anesthesiologists (ASA) is proud to announce the launch of the Pain Alleviation Toolkit.

AAOS Introduces Presurgical Checklist for Diagnosis of Periprosthetic Joint Infection

Ajay K. Srivastava, MD, FAAOS; Creighton C. Tubb, MD, FAAOS

Periprosthetic joint infections (PJIs) have profound effects on patients and the healthcare system, but they can be very difficult to diagnose.

Higher Facility Costs Do Not Improve THA and TKA Outcomes

Kaitlyn D’Onofrio

Costs associated with total hip arthroplasty (THA) and total knee arthroplasty (TKA) vary significantly at different facilities. A study presented as part of the Annual Meeting Virtual Experience compared short-term outcomes of THAs and TKAs performed at higher- versus lower-cost facilities and observed no significant differences.

An Overview of the FDA Approval Process for Devices

Martha Murray, MD, MS, FAAOS; Jonathan Dubin, MD, FAAOS

In 1976, Congress passed the Medical Device Amendments Act, which granted the Food and Drug Administration (FDA) authority to regulate medical devices. Within the FDA, the Center for Devices and Radiological Health (CDRH) typically oversees the process; however, if a device includes a biologic component, the Center for Biologics Evaluation and Research may oversee its evaluation. At present, the CDRH regulates

New AUC Provides Tool for Screening for Psychosocial Risk Factors After Trauma

Terry Stanton

In June, the AAOS Board of Directors approved the release of a new set of Appropriate Use Criteria (AUC) designed to guide orthopaedic surgeons and other clinicians in determining appropriateness of early screening for psychosocial risk and protective factors in patients with adult orthopaedic trauma.

Osteoporosis and Hip Fracture: Research Directions Based on Sex, Race, and Socioeconomic Status

Laura Bruse, MD, FAAOS, FAOA

Fractures due to osteoporosis are a global and national health burden, taxing the economy and society at large. With the continued changing demographics of the United States and increase in the aging population, the interest in research at the basic science and clinical levels for prevention of osteoporosis, fragility fractures, and specifically hip fractures remains significant.

A Look at Musculoskeletal Outcomes in Males Versus Females

Laura Bruse, MD, FAAOS, FAOA

The continued improvement in the inclusion of females in clinical research trials, with the passage of the National Institutes of Health Revitalization Act, has prompted orthopaedic surgeons to improve the understanding of differences between males and females.

New AUC on Rotator Cuff Builds on Clinical Practice Guideline

Terry Stanton

At its September meeting, the AAOS Board of Directors approved the release of a new set of Appropriate Use Criteria (AUC) on Rotator Cuff Pathology (RCP).

Study Uses PROMs Data from AJRR to Predict TJA Outcomes

Terry Stanton

A study that sought to determine what factors predict total joint arthroplasty (TJA) outcomes at one year found that among patients in the American Joint Replacement Registry (AJRR) for whom patient-reported outcome measures (PROMs) had been recorded, preoperative PROMs, especially physical function subscores, predicted improvement at one year.

Custom Implants Benefit from New 3D Printing Techniques

Samuel Adams, MD, FAAOS

3D printing has given us the ability to create anatomic models; patient-specific instrumentation; and implants ranging from complex, noncustom, “off-theshelf” devices to truly custom implants.

Do We Need to Worry About Methyl Methacrylate Exposure?

Ayesha Abdeen, MD, FAAOS, FRCS(C)

As orthopaedic surgeons, we are exposed to myriad occupational hazards, including ionizing radiation and blood-borne viral infections, as well as the volatile fumes of acrylic bone cement.

Focus on Rehabilitation Needed after Two Decades of Gains in Acute Trauma Care

Brooke C. Hergert; Pedro G. Teixeira, MD; Anthony E. Johnson, MD, FAAOS

Recognizing the military’s trauma care advances, we are now examining other areas of improvement, specifically the rehabilitation of those suffering traumatic amputations.

It Is Time for Spine Surgeons to ‘Own the Bone’

Fred R.T. Nelson, MD, FAAOS, FAOA; Alan M. Reznik, MD, MBA, FAAOS

Approximately one in five patients who undergo spine surgery have osteoporosis.

AAOS Launches Upper Extremity, Shoulder and Elbow Toolkits

AAOS is pleased to announce the addition of two new toolkits to its roster: Upper Extremity Fractures and Shoulder and Elbow.

Sensor-guided Ligament Balancing in TKA Does Not Improve Short-term Outcomes versus Freehand Technique

Rebecca Araujo

In a randomized, controlled trial, sensor-guided ligament balancing during total knee arthroplasty (TKA) was found to be noninferior to freehand balancing but did not lead to improvements in short-term postoperative function or outcomes.

Report Describes Factors That Drive Up Procedure-related Costs of Carpal Tunnel Release

Ariel DeMaio

In an analysis of carpal tunnel release (CTR) procedures performed in a large, diverse patient population, researchers identified several variables that increase the costs of surgery: use of general anesthesia, hospital setting, and the use of antibiotics and opioids.

Position Statement: Potential Hazards of Surgical Smoke and Mitigation Approaches

The following position statement was developed by the Patient Safety Committee and recently approved by the AAOS Board of Directors as an educational tool based on the opinions of the authors.

Panelists Address Sources and Solutions of Physician Burnout

Pamela Stebbins

At the AAOS 2021 Annual Meeting, Alfred Atanda Jr, MD, FAAOS, moderator of a symposium on physician burnout and wellness, opened his presentation with the following scenario: “Imagine a world in which Michael Phelps, a highly trained expert in his craft, also has to test the quality of the water he swims in, clean the pool, and tidy up the stands after fans leave.”.

Committee on Evidence-based Quality and Value Helps Members Thrive in Value-based Environments

Stuart J. Fischer, MD, FAAOS; Karl C. Roberts, MD, FAAOS

The Committee on Evidence-based Quality and Value (EBQV) was established to enable the development of quality programs that reflect AAOS’ commitment to evidence-based medicine.

AAOS Board of Directors Approves Technology Overview for Concentrated Bone Marrow Aspirate for Osteoarthritis of the Knee

On Dec. 3, 2021, the AAOS Board of Directors approved the Technology Overview for Concentrated Bone Marrow Aspirate for Osteoarthritis of the Knee.

Use of Intraoperative Neuromonitoring during Spine Surgery Varies Widely

Rebecca Araujo

A survey of spine surgeons found that use of intraoperative neuromonitoring (IONM) during spine surgery varied depending on the surgical indication.

Martha Murray, MD, Wins 2022 OREF Clinical Research Award

The 2022 Orthopaedic Research and Education Foundation (OREF) Clinical Research Award was presented to Martha Murray, MD, FAAOS, and her collaborators for outstanding clinical research related to musculoskeletal disease or injury.

High Rates of Occupational Physical, Mental Injuries among Orthopaedic Surgeons

Rebecca Araujo

A large study of orthopaedic surgeons, investigated incidence of occupational physical and mental injuries according to subspecialty and other surgeon factors.

Utilizing a Synthetic Bioactive Glass Fiber for Lumbar Posterolateral Spine Fusion

Patrick Daly

In an interim analysis of bone grafting with a synthetic bioactive glass fiber material presented at the AAOS 2022 Annual Meeting, 50 spine patients treated with the resorbable bioactive glass matrix achieved a successful outcome at one year, with an average fusion rate of 94.0 percent and improved clinical outcomes.

AAOS Endorses AAHKS CPG on Multimodal Analgesia for Total Joint Arthroplasty: Focus on Non-oral Therapies

Charles P. Hannon, MD, MBA; Yale A. Fillingham, MD, FAAOS

The second half of the clinical practice guideline (CPG) on multimodal analgesia in total joint arthroplasty (TJA), led by the American Association of Hip and Knee Surgeons (AAHKS), focused on non-oral therapies such as periarticular injection (PAI), regional nerve blocks in total hip arthroplasty (THA) and total knee arthroplasty (TKA), corticosteroids, and ketamine.

Data Show Posterior Malleolus Repair of Unstable Rotational Ankle Fractures Leads to High Healing Rate

Brandon May

A study presented at the AAOS 2022 Annual Meeting found that direct repair of the posterior malleolus in the prone position in patients with unstable rotational ankle fractures was associated with a high rate of healing and no incidences of readmissions or deep infections.

Patient, Surgical Factors Associated with Failed Same-day Discharge after Total Knee Arthroplasty

Rebecca Araujo

A study presented at the AAOS 2022 Annual Meeting identified patient characteristics and surgical factors that were associated with successful planned same-day discharge following total knee arthroplasty.

AAOS Issues Comments to the CDC Regarding Proposed CPG for Prescribing Opioids

Meghan Eigenbrod, MPH

AAOS issued formal comments to the Centers for Disease Control and Prevention (CDC) on the agency’s proposed 2022 Clinical Practice Guidelines (CPG) for Prescribing Opioids.

Older Hip Fracture Patients Often Experience Subsequent Fractures

Brandon May

A study suggests that bone-health evaluations are underutilized for patients following hip fracture, and many patients who experience a hip fracture sustain additional fragility fractures.

Study Questions Whether Prior Bariatric Surgery Improves THA Outcomes

Ariel DeMaio

A study of patients who were scheduled to undergo total hip arthroplasty (THA) found that individuals with morbid obesity who had preoperative bariatric surgery to reduce weight exhibited worse implant survivorship and a higher dislocation rate compared to patients with naturally low or high BMI, according to findings presented at the AAOS 2022 Annual Meeting by Sean P. Ryan, MD.

AAOS Registries Are a Path to Aetna Institutes of Quality ® Designation

Erik Michalesko; Terry Stanton

An orthopaedic program is challenged to stand out when patients have numerous options for their care. Quality certifications and payer distinction designations may be influencing factors but can be burdensome to attain.

Symposium Covers Oncology Fundamentals for Orthopaedics

Terry Stanton

At the symposium “Tumors and Tumor-like Conditions of Which Every Orthopaedist Should Be Aware,” at the AAOS 2022 Annual Meeting in Chicago, Kevin A. Raskin, MD, FAAOS, provided an overview of oncologic principles relevant to orthopaedic surgeons.

CMS Price Transparency Initiative: Are We Still in the Early Phase of Adoption and Enforcement?

Charles A. Bush-Joseph, MD, FAAOS

Editor’s note: This article is part of a new series, Patient Safety Corner, which will highlight the work of the AAOS Patient Safety Committee, whose vision is to optimize musculoskeletal health and eliminate complications.

FDA Clarifies Rules to Foster Innovation within Digital Health and Artificial Intelligence

S. Raymond Golish, MD, PHD, MBA

The potential benefits of digital health, advanced analytics, and artificial intelligence in orthopaedic surgery and healthcare are enormous. With great promise come potential risks as well.

Member-exclusive Event: 2023 AAOS/FDA Town Hall Will Explore Orthopaedic Medical Device Innovation

The upcoming AAOS/FDA Town Hall, taking place during the AAOS 2023 Annual Meeting, is a provocative and interactive forum to rethink how we work together to create innovation in the 21st century. The guiding principles of the inaugural Town Hall are quality, value, registries, artificial intelligence, and real-world evidence. All concepts are on the table in this forum.

AJRR Study: Increased Risk of Periprosthetic Femur Fracture with Cementless Femoral Fixation for THA

Cailin Conner

Postoperative periprosthetic femur fractures (PPFs) are severe complications following total hip arthroplasty (THA) and present both a significant clinical and economic burden.

Antithrombotic Medication Use Does Not Increase Risk of Revision after Wide-awake Hand Surgery

Rebecca Araujo

According to a retrospective study, patients taking prescription anticoagulants or antiplatelets who underwent wide-awake hand surgery did not have an increased risk of revision surgery or postoperative complications.

Less than 100 Percent Glenoid Bone Loss Restored through Latarjet Is Tied to Instability, Graft Complications

Rebecca Araujo

Patients with glenoid bone loss are at risk of recurrent shoulder instability if glenoid width is not properly restored.

Kappa Delta Elizabeth Winston Lanier Award Presented to Major Extremity Trauma Research Consortium

The 2023 Kappa Delta Elizabeth Winston Lanier Award has gone to the Major Extremity Trauma Research Consortium (METRC) for its multidisciplinary research platform addressing challenging issues related to evaluation, treatment, and recovery after severe extremity trauma.

Annual Meeting Attendees Experienced the Power of Data through the AAOS Registry Program

Staff, volunteers, and partners of the AAOS Registry Program had a great experience meeting everyone who stopped by the Registry Zone during the AAOS 2023 Annual Meeting in Las Vegas.

Study Investigates Surgeon Factors Associated with Patient Satisfaction Scores after Orthopaedic Care

Rebecca Araujo

Surgeon age and gender were associated with patient satisfaction after orthopaedic care, according to a study of patients treated within a single hospital system.

Study Finds High Local Recurrence Rate after Unplanned Sarcoma Excision

Terry Stanton

A study investigating outcomes after unplanned excisions of soft-tissue sarcomas found that the rate of local recurrence was higher in such circumstances than after planned excisions.

Study Examines Effects of E-cigarette Use on Bone Healing

Terry Stanton

Little is known concerning the effects on fracture healing of electronic cigarettes (e-cigarettes) that contain nicotine.

Lower Rates of Revision Associated with All-polyethylene Tibial Components in TKA

Rebecca Araujo

An analysis of primary total knee arthroplasty (TKA) cases in patients aged >65 years found a lower all-cause and infection-related revision risk associated with the use of all-polyethylene tibial components (APTCs).

AAOS Endorses Endocrinology Association CPG on Postmenopausal Osteoporosis

Terry Stanton

In December 2023, the AAOS Board of Directors approved an endorsement of a clinical practice guideline (CPG), “Diagnosis and Treatment of Postmenopausal Osteoporosis,” previously issued by the American Association of Clinical Endocrinology (AACE) and the American College of Endocrinology (ACE).

Patient-reported Outcome Measures Play a Role in the Evaluation and Management of Trauma Patients

Clifford B. Jones, MD, FAAOS, FACS; Lauren M. Shapiro, MD, MS, FAAOS; Richard F. Seiden, JD; Kurt Spindler, MD, FAAOS

Because orthopaedic trauma surgeons have occasionally been misperceived as cold-hearted technicians—“bone broke, need fix”—PROMs are a way to help patients feel that they are at the center of their care.

Newly Revised CPG Provides Guidance on Osteoarthritis of the Hip

In December 2023, the AAOS Board of Directors approved a revamped Clinical Practice Guideline (CPG) for the Management of Osteoarthritis (OA) of the Hip.

Distractions in the OR Can Impact Surgical Workflow and Outcomes

Maxwell V. Phillips, MD; Zaid Memon; Alexander Phillips, BS; Ajay Srivastava, MD, FAAOS

Surgery is a complex symphony that requires physicians and the OR team to devote attention to the task at hand.

Apply Today: 2025 Kappa Delta Orthopaedic Awards and OREF Research Award Call for Manuscripts

AAOS is soliciting manuscripts for the 2025 Kappa Delta Orthopaedic Research Awards and the Orthopaedic Research and Education Foundation (OREF) Clinical Research Award.

Adjunctive Dorsal Spanning Plate Fixation for Perilunate Dislocations May Increase Load to Failure

Cailin Conner

The addition of dorsal spanning plate fixation in surgery for perilunate dislocations led to increased load-bearing capacity as well as a decreased change in scapholunate interval at time of failure compared to Kirschner wire (K-wire) fixation alone.

Biologics Dashboard Enhanced for Easier Product Name Search

Ryan Pezold, MA, MBA

Navigating and tracking the wide variety of biologic treatments marketed to orthopaedic surgeons can be daunting tasks.

AAOS Board of Directors Approves Clinical Practice Guideline for Management of Acute Isolated Meniscal Pathology

During its June meeting, the AAOS Board of Directors approved the evidence-based AAOS Clinical Practice Guideline for Acute Isolated Meniscal Pathology.

AJRR, ASR Collaborate with Blue Cross Blue Shield Association to Drive Higher-Quality Patient Care Designation

Jennifer Lefkowitz

Blue Cross Blue Shield Association recently announced a formal collaboration with the American Joint Replacement Registry and the American Spine Registry.

Poster Explores If Metabolic Syndrome Is Associated with Risk of Patellofemoral Arthroplasty Complications

Rebecca Araujo

For patients undergoing patellofemoral arthroplasty, metabolic syndrome is an independent risk factor for postoperative complications, according to a poster study presented at the AAOS 2024 Annual Meeting.

Randomized Trial Investigates Reverse Shoulder Arthroplasty in Older Patients with Complex Proximal Humeral Fractures

Rebecca Araujo

In older patients with complex proximal humeral fractures, reverse shoulder arthroplasty provided a limited benefit compared with nonoperative treatment, according to results from a randomized clinical trial.

Patient Obesity Is an Often-Overlooked Occupational Hazard for Orthopaedic Surgeons

David Hein, MD; Ajay Srivastava, MD, FAAOS

The Centers for Disease Control and Prevention report that more than 40 percent of Americans are obese, a rate that has continued to increase over time.

Study Compares Outcomes, Complications with Plating versus Intramedullary Nailing for Proximal Tibial Fractures

Stuart A. Green, MD, FAAOS

Kevin Monahan, MD, an orthopaedic trauma fellow at Ohio Health Grant Medical Center in Columbus, Ohio, presented findings from a meta-analysis on proximal tibial fractures, comparing locked lateral plating to intramedullary nailing.

American Spine Registry Releases First Annual Report

The American Spine Registry (ASR), an unprecedented partnership between the American Association of Neurological Surgeons (AANS) and AAOS, released its first edition Annual Report today.

AJRR User Group Network Connects Orthopaedic Registry Community

The registry world can be complex, and it can be a challenge to sift through the myriad of materials to find what's important. Guides are helpful, but sometimes it's better just to discuss the situation with someone who's already "been there, done that." That's one reason the American Joint Replacement Registry (AJRR), the national hip and knee arthroplasty registry, maintains a User Group Network.

AJRR Expands TJA Data Collection

Each year, the American Joint Replacement Registry (AJRR) releases its Annual Report on Hip and Knee Arthroplasty Data at the American Association of Hip and Knee Surgeons (AAHKS) Annual Meeting. The AJRR published and distributed its 2016 report on Friday, Nov. 11, at the meeting in Dallas, Tex. The AJRR has seen significant growth in the past year, leading to this year's report being the most comprehensive representation of data from an American orthopaedic registry to date.

Improving Prosthetics for Amputees

Amber Blake

Complications commonly associated with traditional socket prostheses, such as pressure sores and instability, have led to an increased interest in improved methods for attaching prosthetic devices to amputees. One approach gaining popularity is the use of a direct transcutaneous osseointegrated implant that allows for a more stable connection to the skeleton, enabling greater control of the prosthetic limb and heightened sensory feedback.

Research Awards: Call for Papers

July 1, 2016, is the deadline for receipt of manuscripts submitted for the 2017 Kappa Delta Awards and the Orthopaedic Research and Education Foundation (OREF) Clinical Research Award. Up to two $20,000 Kappa Delta awards (Elizabeth Winston Lanier Award and Ann Doner Vaughan Award), one $20,000 Kappa Delta Young Investigator award, and one $20,000 OREF award will be bestowed, provided manuscripts of requisite quality are submitted.

Collecting Patient-Reported Outcomes

Terry Stanton

An AAOS initiative to facilitate collection of outcomes data by orthopaedic surgeons is moving forward with plans to identify the means to collect and review patient-reported outcomes (PROs) in their practices.

AAOS Awarded Research Grant to Support Development of New CPGs and AUCs

On July 26, the U.S. Department of Defense (DOD) approved a $1.5 million grant to AAOS to help develop six clinical practice guidelines (CPGs) and six appropriate use criteria (AUCs) over the next 4 years. The grant was obtained as part of a collaborative effort with the Major Extremity Trauma Research Consortium (METRC), and coordinated through the Data and Research Coordinating Center of the Johns Hopkins Bloomberg School of Public Health.

Bone and Cartilage: Interpreting the Crosstalk

Terry Stanton; Thomas P. Vail, MD; Tamara Alliston, PhD

In electronics, "crosstalk" is the usually undesirable effect of a signal in one channel on another circuit or channel. In orthopaedic research, crosstalk can refer to interactions among tissues, particularly with respect to the onset and development of joint diseases.

Musculoskeletal Effects of Antineoplastic Agents in Women

Izuchukwu K. Ibe, MD; Tara B. Sanft, MD; Tish M. Knobf, PhD, RN, FAAN, AOCN; Theodore Blaine MD, MS, MBA; Karen Sutton, MD

Medical advances in the field of oncology have increased life expectancy and decreased mortality rate for many patients diagnosed with cancer. These improvements are associated with the administration of chemotherapeutic or antineoplastic agents. Unfortunately, these agents can result in side effects that impact the musculoskeletal system.

Visit the AJRR Booth at Annual Meeting

The American Joint Replacement Registry (AJRR) is celebrating a major milestone—the national orthopaedic registry of hip and knee replacement data is now one million procedures strong! To join in the celebration, be sure to visit the AJRR booth at the 2017 AAOS Annual Meeting in San Diego. AJRR staff will be on hand to answer questions about the registry and to demonstrate the newest registry platform enhancements.

AJRR Expands TJA Data Collection

Each year, the American Joint Replacement Registry (AJRR) releases its Annual Report on Hip and Knee Arthroplasty Data at the American Association of Hip and Knee Surgeons (AAHKS) Annual Meeting. The AJRR published and distributed its 2016 report on Friday, Nov. 11, at the AAHKS meeting in Dallas. The AJRR has seen significant growth in the past year, making the report the most comprehensive representation of data from an American orthopaedic registry to date.

No Test Is Too Sensitive, But Those Who Think So Are Almost Correct

S. Raymond Golish, MD, PhD, MBA

Diagnostic tests, especially laboratory tests and imaging, are at the heart of orthopaedic decision-making. Some tests are highly sensitive, generating a lot of true positive results, but also generating a lot of false positive results. For example, the use of broad-range PCR (polymerase chain reaction) testing to detect joint infection may have high sensitivity but has been critiqued for a high rate of false positives.

Improving Standards of Care

Mark Crawford

During his medical and public health studies at the University of Miami, became interested in learning about how disparities in health care and access to care can impact population groups. This drew him to the field of health services research, an area of study he began pursuing while an orthopaedic surgery resident at the Hospital for Special Surgery in New York City. “As a surgeon, you are essentially confined to one patient at a time when you’re in the operating room,” said Dr. Dy.

EWI XII Symposium Focuses on Homeland Defense

James Ficke, MD; David Teague, MD; Erin Ransford

Homeland defense has increasingly been a national concern, with incidents of domestic and international terrorist activity garnering headlines. As a result, physicians and researchers gathered in Washington, D.C., earlier this year to focus on disaster preparedness and response, for both natural disasters and intentional violence.

Form and Function

Jay D. Lenn

The modernist architecture principle "form follows function" promotes the idea that a building design should reflect how it would be used. It's a useful, if imperfect, analogy for understanding cell polarity—a certain cellular form is required for that cell's function. The architecture of growth plates requires well-regulated cell polarity.

Do AAOS ACL Injury Recommendations Impact Patient Care?

Theodore B. Shybut, MD

Anterior cruciate ligament (ACL) tears are high-profile injuries. Every week, they are highlighted on sports TV, radio, and social media. Here in Houston, Texans rookie quarterback Deshaun Watson’s strong campaign for NFL rookie of the year was abruptly halted by an ACL tear. If we look at the sport the rest of the world calls football, the United States women have a stellar record in World Cup competition. However, U.S.

MountainView Regional Medical Center Leverages Registry Data to Earn Joint Commission’s Gold Seal

Karen Metropulos, MBA

MountainView Regional Medical Center (MVRM), located in Las Cruces, N.M., has been an American Joint Replacement Registry (AJRR) subscriber since November 2014. AJRR participation helped Mountainview’s Total Hip and Knee Replacement Center utilize registry benefits to achieve and maintain The Joint Commission’s Gold Seal certification. Other healthcare institutions can learn from the center’s experience in choosing a registry capable of supporting a Joint Commission–certified program.

How Would a Computer Diagnose Arthritis on a Radiograph?

Kenneth Urish, MD, PhD, FAAOS; Alan M. Reznik, MD, MBA, FAAOS

The first article in this series (“Understanding the Impact of Artificial Intelligence on Orthopaedic Surgery,” AAOS Now, September 2018) provided an overview of the history of artificial intelligence (AI) and a few general concepts regarding how AI problems are approached. Inevitably, the question becomes: Is it possible to replace doctors with AI machines?

The Biology of Fracture Healing

Jay D. Lenn

A number of factors influence the risk of delayed union or nonunion after fracture treatment, including the fracture site, severity of injury, patient age, nutrition, tobacco use, and diabetes. Delays or failures to heal result in more intensive medical care, a decline in quality of life, and increased expenses. To improve outcomes in these difficult cases, investigators have been exploring means to identify and alter biologic barriers to healing.

Orthopaedic Leaders Meet with NIH and NIAMS

Erin Ransford; Kurt Sprindler, MD

Representatives and leaders from AAOS, the Orthopaedic Research Society (ORS), and the Orthopaedic Research and Education Foundation (OREF) met with National Institutes of Health (NIH) Director Francis Collins, MD, PhD, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Director Stephen Katz, MD, PhD, and other NIAMS leaders to highlight the impact and value of orthopaedic care.

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.

Communication Skills Are Critical to Improving Patient-centered Care and Shared Decision Making

Michael R. Marks, MD, MBA

This is part one of a two-part series on shared decision making. Part two, which will appear in the November issue of AAOS Now, will present an illustrative case where missing the basic tenets of shared decision making led to an unsatisfactory patient experience. Physicians cannot ignore the nontechnical, soft skills and still be successful In 1998, AAOS conducted an image perception survey, the results of which revealed that the public viewed orthopaedic surgeons as “high-tech and low-touch.”

AAOS’ RegistryInsights™ Platform Delivers Dashboards

The AAOS Registry Program seeks to improve orthopaedic care through the collection, analysis, and reporting of actionable data contributed by hospitals, ambulatory surgical centers, and orthopaedic practices across the United States. With the recent introduction of Surgeon Dashboards, the Registry Program has added a quality-improvement resource, available to individual AAOS surgeon members.

Similar to Aviation, Checklists Have a Place in Surgery

Bilal Sleiman, BS; Zain Sayeed, MD, MHA; Muhammad T. Padela, MD, MSc; Walid K. Yassir, MD, MHCM; Mark Zekaj, MD; Hussein F. Darwiche, MD; ; Khaled J. Saleh, MD, MSc, FRCS(C), MHCM, CPE

Orthopaedics involves a wide variety of invasive and complex procedures, and all surgical endeavors require patient safety. Compared to other industries, such as aviation and nuclear power, surgery is associated with a higher baseline risk for all types of complications. The fatality rate from complications is one per 10,000 surgeries. Comparatively, air travel has a fatality rate of one in 11 million, making it 1,100 times safer.

AAOS and the Musculoskeletal Tumor Society Introduce Musculoskeletal Tumor Registry Pilot

AAOS, in collaboration with the Musculoskeletal Tumor Society (MSTS), announced the launch of a Musculoskeletal Tumor (MsT) Registry feasibility pilot to begin capturing data on orthopaedic oncology bone tumor procedures in a structured and scalable way. Six major U.S.

Kaiser Permanente Northern California Leverages AAOS CPG to Improve Pathways for Possible Knee Replacement and Its Alternatives

Mark Charney, MD

AAOS’ clinical practice guideline (CPG) program has been continually refined since the first evidence-based guidelines were published in 2007. The CPG for knee osteoarthritis (OA) was first published in 2008 and updated in 2013. The third iteration of the guideline is currently underway, with publication expected in early 2020. The guidelines are available for use by orthopaedic surgeons around the world.

AJRR Releases Sixth Annual Report

The American Joint Replacement Registry—the cornerstone of AAOS’ Registry Program—released its 2019 Annual Report on outcomes in hip and knee arthroplasty patients.

Academy Announces Strategic Investment in Biologics Research and Development

The American Academy of Orthopaedic Surgeons announced a strategic investment in the field of biologics. Over the next five years, the AAOS will prioritize research and development for a biologics-focused competency within the Academy’s existing business.

American Spine Registry Goes Live

Terry Stanton

The American Spine Registry, a partnership between the American Association of Neurological Surgeons and the Academy, represents a collaboration to enhance and improve the quality of spine care by providing all North American spine surgeons with access to a shared data-collection program.

AAOS Approves Update to Clinical Practice Guideline on Glenohumeral Joint Osteoarthritis

Barbara Krause; Terry Stanton

At its March 23 meeting, the AAOS Board of Directors approved a comprehensive update to the 2009 clinical practice guideline (CPG) covering the Management of Glenohumeral Joint Osteoarthritis (GJO).

Patient Handouts Available to Convey Information in AAOS CPG for PJI

Barbara Krause

With information more readily available, more patients are turning to the internet or social media to investigate potential surgeries, symptoms, procedures, and associated risk factors.

Allograft MUCL Reconstruction Beneficial Even in Nonathletes

Kerri Fitzgerald

There are vast data on the use of medial ulnar collateral ligament (MUCL) reconstruction in young athletes; however, limited information exists on nonathlete patients seeking functional elbow outcomes.

Most Orthopaedic Surgeons Have a Screw Loose

Fred R.T. Nelson, MD, FAAOS, FAOA; Alan M. Reznik, MD, MBA, FAAOS

Editor’s note: This report is based on the ongoing series called “Basic Science Tips” by Fred R.T. Nelson, MD, FAAOS, FAOA, weekly emails highlighting interesting and clinically relevant orthopaedic basic science research. Initially, the emails were aimed at residents in training, but they have gained a wider readership over time. AAOS Now editorial board member Alan M. Reznik, MD, MBA, FAAOS, worked with Dr. Nelson to select “tips” with current and near-future clinical implications for practicing orthopaedic surgeons.

Two Million and Counting: AJRR Reaches Major Milestone

Lori Boukas; Deanna Killackey

The Academy’s Registry Program celebrated a major marker of progress in June when the American Joint Replacement Registry (AJRR), the cornerstone of AAOS’ Registry Program, reached and surpassed its two millionth hip and knee procedure with the input of data from Mayo Clinic in Rochester, Minn.

Rothman Launches Opioid Foundation

Kaitlyn D’Onofrio

The Rothman Orthopaedic Institute announced the creation of the Foundation for Opioid Research & Education (Rothman Opioid Foundation) in June.

AAOS Registry Data Show SCR Has Gained Popularity

Kerri Fitzgerald

According to data from the AAOS Shoulder & Elbow Registry (SER), superior capsular reconstruction (SCR) has gained significant popularity in the United States since 2015, accounting for approximately 8 percent of rotator cuff procedures reported to the registry.

A Call to Action: High-quality Research Needed

Jonathan Godin, MD, MBA, FAAOS; Jorge Chahla, MD, PhD; Eric Stiefel, MD, FAAOS; Louis McIntyre, MD, FAAOS

One way that AAOS and specialty society members can serve as advocates for our patients and profession is through participation in high-quality clinical research studies. This article is a plea for surgeons to perform these necessary studies going forward.

Cannabinoids after Orthopaedic Surgery?

Caleb M. Yeung, MD; Harold A. Fogel, MD

As legalization of recreational and medicinal marijuana use continues to expand in the United States, cannabinoids are being increasingly studied for use in a wide array of medical applications, including treatment of chronic pain, fibromyalgia, and irritable bowel syndrome.

The Success of Physician-hospital Co-management Agreements

Theodore A. Blaine, MD, FAAOS, FAOA; John Grady-Benson, MD, FAAOS; Stacey Lombardi, MBA; Courtland Lewis, MD, FAAOS

At the end of Hartford Healthcare’s Bone and Joint Institute's (BJI) fifth year of co-management and its third year of operation after opening an award-winning building, BJI has achieved many targets in key performance metrics set by the administrative team

Geographic Variability Seen in Medicare Reimbursement for Joint Replacement

Rebecca Araujo

A study of changes in Medicare reimbursement for arthroplasty procedures in the United States since 2000 found large geographic variability arising over that period.

Racial/Ethnic Disparities Persist in TJA Utilization, Even in Universally Insured Population

Ariel DeMaio

Although previous research has suggested that unequal access to care contributes to the documented racial and ethnic disparities in total joint arthroplasty (TJA) delivery in the United States, a study to be presented today found that, even with universal insurance coverage, minority patients remain 30 to 50 percent less likely to undergo primary TJA than their white counterparts.

Study: Biomechanical Advantage of Metaphyseal Cones and Stems in Addressing Bone Defects in Revision TKA

Rebecca Araujo

Using metallic metaphyseal cones with short cemented stems to address moderate metaphyseal bone defects in revision total knee arthroplasty (TKA) reduced the risk of debonding at the implant-cement interface during activity, compared with short cemented stems without cones.

Mobility Is, Indeed, Life

Claudette M. Lajam, MD, FAAOS, FAOA, FAAHKS

Prevalence of depression and anxiety has increased substantially since the start of the COVID-19 pandemic.

Infographics Improve Readability of AAOS Clinical Practice Guidelines

Barbara Krause

Infographics have long existed within the scientific community as a way to quickly and clearly convey complex information.

When in Doubt, Refer to Avoid Unplanned Resections of Soft-tissue Masses

Terry Stanton

A study presented at the 2021 AAOS Annual Meeting in San Diego found that despite standard educational grounding about initial evaluation and management of soft-tissue masses.

Extended Oral Antibiotic Prophylaxis Protocol Is a Cost-effective Tool for Preventing PJI

Ariel DeMaio

Periprosthetic joint infection (PJI) is a dreaded complication after total knee arthroplasty (TKA) and total hip arthroplasty (THA), particularly for high-risk patients who have increased susceptibility to infection.

Study: Patient Factors and Long-term Outcomes of Operative and Nonoperative Management of Distal Biceps Rupture

Rebecca Araujo

A study presented at the AAOS 2022 Annual Meeting examined the patient profile associated with distal biceps tendon tears and long-term outcomes of treatment for this injury.

Emergency Pediatric Orthopaedic Transfer Criteria Are Needed

Ariel DeMaio

Nearly two-thirds of emergency pediatric orthopaedic transfers are avoidable, according to results of a pilot study by researchers at a level 1 pediatric trauma center.

Reconstructive Microsurgery Pioneer L. Scott Levin, MD, Receives Kappa Delta Elizabeth Winston Lanier Award for Advancing the Field of Orthoplastic Extremity Reconstruction

Jennifer Lefkowitz

L. Scott Levin, MD, FAAOS, FACS, FAOA, was hooked on microvascular surgery even before medical school, finding every opportunity to study and learn from pioneers in the field.

Advanced Age and Bleeding Disorders Predict VTE Risk after Foot and Ankle Fracture Surgery

Brandon May

Advanced age and bleeding disorders are independent risk factors for venous thromboembolism following foot and ankle fracture surgery, a study suggests.

Wide-awake Procedures Are the Future of Hand Surgery

Leah Lawrence

During an Instructional Course Lecture on wide-awake hand surgery, presented at the AAOS 2022 Annual Meeting in Chicago, Andrew Sobel, MD, assistant professor of clinical orthopaedic surgery at the University of Pennsylvania Perelman School of Medicine.

Telemedicine Presentation: Panelists Offer Strategies for Effective Deployment of Virtual Visits

Terry Stanton

The COVID-19 pandemic had a transformational effect across medicine.

Sex and Gender Influence Pain and Pain Management

Yibo (Teresa) Li, MD; Connie B. Newman, MD, MACP; Jessica Patrick-Esteve, MD, MSPH; Kimberly J. Templeton, MD, FAAOS, FAOA, FAMWA

The purpose of this article is to define biological sex and gender, discuss the differences between men and women in relation to responses to pain and opioid medications, and highlight pain-related issues in several specific populations of women.

AAOS to Host Second Annual Biologics Symposium

This year, AAOS will host its second annual biologics symposium, titled “The Next Generation of Biologics: Use of Real-world Evidence,” in Washington, D.C. It is designed to convene experts in science and medicine, industry, as well as regulatory agencies to examine current real-world evidence as it pertains to musculoskeletal medicine.

Study Addresses Cost-effectiveness for Management of Distal Radius Fractures

Terry Stanton

A study investigating the cost-effectiveness of treatments for all distal radius fracture (DRF) types indicated that nonoperative fixation is the optimal cost-effective strategy in general DRF management.

CDC Updates the CPG for Opioid Prescriptions

Alexandra E. Page, MD, FAAOS; Barrett Woods, MD, FAAOS

In November 2022, the Centers for Disease Control and Prevention released an updated Clinical Practice Guideline regarding opioid prescribing.

Analysis of AJRR Data Investigates Trends in TKA Technology Use at Safety-net Hospitals

Rebecca Araujo

A study using data from the AAOS American Joint Replacement Registry (AJRR) identified disparities in the use of premium total knee arthroplasty (TKA) technologies among safety-net hospitals.

Study Evaluates the Efficacy of Serum and Synovial Diagnostic Markers to Diagnosis PJI following Hemiarthroplasty

Cailin Conner

A study presented on Wednesday investigated “the utility and reliability of serum and synovial diagnostic markers for diagnosing periprosthetic joint infection (PJI) in patients following hemiarthroplasty (HA).

Study Maps Postoperative BMI Trends in Ankle Fracture Patients

Terry Stanton

A study examining weight changes in patients after surgery for ankle fracture found that although most did not experience weight and BMI changes in the early postoperative period, after six months, patients recovering from ankle open reduction and internal fixation (ORIF) gained an average of about 10 pounds and 1.5 BMI points.

Kappa Delta Ann Doner Vaughn Award Presented to Michelle Ghert, MD, and the PARITY Investigators

The 2023 Kappa Delta Ann Doner Vaughn Award has gone to Michelle Ghert, MD, FRCSC, on behalf of the Prophylactic Antibiotic Regimens in Tumor Surgery investigators for their research on the prevention of surgical site infections through antibiotic prophylaxis following oncologic reconstruction surgery for bone tumors.

AAOS and FDA Host First-ever Town Hall Meeting to Discuss Innovation in Orthopaedic Medical Devices

On March 7, during the AAOS 2023 Annual Meeting, AAOS hosted its first-ever town hall meeting in partnership with representatives from the FDA and industry leaders to discuss innovation in orthopaedic medical devices.

Study Explores Injury-protection Value of Prophylactic Knee Brace Usage in NFL Offensive Linemen

Cailin Conner

Devon Ackerman recalls that in his days as an offensive lineman for his college football team, he was strongly encouraged to wear bilateral metal knee braces for knee injury prevention.

Researchers Discuss Oncologic Risks for Female Surgeons

Jessica C. Rivera, MD, PhD, FAAOS

Occupational injuries and oncologic hazards are real and present health concerns for orthopaedic surgeons.

The Use of Patient-reported Outcomes Has Evolved across Orthopaedic Subspecialties

Brian P. Cunningham, MD, FAOA; Rebekah M. Kleinsmith, MD; Stephen A. Doxey, DO

Since 1985, the number of publications concerning PROs has increased nearly 30-fold, bringing the number of PROM tools to more than 100 in the field of trauma alone.

Study Probes Role of Mesenchymal Stromal Cells in Nonunion

Terry Stanton

A study compared mesenchymal stromal cells isolated from nonunion tissue with those isolated from uninvolved bone, with an aim to identify the factors contributing to the development of long-bone nonunions and the biological mechanisms behind this clinical entity.

Attending Orthopaedic Surgeons on Call at Night Have Reduced Sleep Quality and Heart-rate Variability

Rebecca Araujo

A study presented at the AAOS 2023 Annual Meeting investigated how orthopaedic call impacted sleep patterns among attending orthopaedic surgeons.

Study of AJRR Data Investigates Trends in TKA Technology Use at Safety-net Hospitals

Rebecca Araujo

An analysis of data from the AAOS American Joint Replacement Registry identified disparities in the use of premium total knee arthroplasty (TKA) technologies among safety-net hospitals.

PROMs Are a Vital Measure of Success in Spine Surgery

Bryce A. Basques, MD

In the context of spine surgery, PROMs encompass a wide range of measurements, including pain, physical function, emotional well-being, and overall satisfaction with the treatment, and they allow spine surgeons to track changes in a patient’s condition over time.

AAOS Board of Directors Approves Three Clinical Practice Guidelines

Barbara Krause

The AAOS Board of Directors (BOD) approved two updates to Clinical Practice Guidelines (CPGs): an update to the 2017 AAOS CPG on the Management of Osteoarthritis of the Hip and a rapid update to the 2010 CPG on the Diagnosis and Treatment of Osteochondritis Dissecans (OCD).

How Do Patient-Reported Outcome Measures Help Patients and Orthopaedic Surgeons Achieve Their Goals?

Jason L. Koh, MD, MBA, FAAOS, FAOA

PROMs can help surgeons focus on patients’ treatment goals in several ways.

Kappa Delta Elizabeth Winston Lanier Award Presented to ANCHOR for Pre-Arthritic Hip Conditions Research

The 2024 Kappa Delta Elizabeth Winston Lanier Award was presented to the Academic Network of Conservative Hip Outcomes Research (ANCHOR) group for 20 years of research to improve the quality of care for adolescent and young adult patients suffering from the three most common pre-arthritic hip conditions: femoroacetabular impingement (FAI), developmental dysplasia of the hip (DDH), and residual Legg-Calve-Perthes disease.

AAOS Board of Directors Approves CPG for the Management of Carpal Tunnel Syndrome

During a recent meeting, the AAOS Board of Directors approved an update to the 2016 AAOS Clinical Practice Guideline for the Management of Carpal Tunnel Syndrome.

AAOS Fracture & Trauma Registry Powered by PatientIQ Results in Increased Data Submission

Molly Todd Ruddy

Data collection and submission can be a cumbersome process for orthopaedic surgeons.

Vigilance in Joint Implant Recalls and Reporting Is Critical to Enhancing Patient Safety

John W. Krumme, MD; Cemil C. Gedik, MD; JONATHAN Dubin, MD, FAAOS

How does a medical device approved by the FDA fail? How can surgeons better protect patients?

Abdominal Pannus Size Is Not Associated with Reoperation Risk after Hip Arthroplasty

Cailin Conner

A study found that, for patients undergoing total hip arthroplasty (THA) via the anterior approach, abdominal pannus size did not affect the risk of delayed wound healing or reoperation within the first 90 days after surgery when compared with THA via the posterior approach.

Data Presented in Poster Show Increased Likelihood of Secondary Surgery after Endoscopic Lumbar Decompression

Rebecca Araujo

A poster study found slightly higher costs and similar complications with endoscopic versus open single-level lumbar decompression; however, endoscopic decompression patients had a significantly higher rate of secondary lumbar surgery within 2 years.

American Joint Replacement Registry Surpasses 4.3 Million Captured Hip and Knee Arthroplasty Procedures

Earlier this year, the American Joint Replacement Registry (AJRR) eclipsed 4.3 million hip and knee arthroplasty procedures in its database, a milestone announced in the 11th edition of its Annual Report released in November.

Study Investigates Timing of Hip Fracture Surgery and Outcomes in Patients Taking Oral Anticoagulants

Stuart A. Green, MD, FAAOS

A significant number of senior citizens take direct oral anticoagulant (DOAC) medications for prophylaxis against strokes, myocardial infarctions, other forms of thromboembolic disease, and numerous other conditions potentially caused by blood clots traveling through their vascular systems.

Rising Incidence of Distal Femur Fractures in Older Patients Is Associated with Increased Costs of Care

Stuart A. Green, MD, FAAOS

Justin Haller, MD, orthopaedic traumatologist at University of Utah Health, and colleagues presented an ePoster revealing a significant increase in the incidence of distal femur fractures over the past decade, particularly in patients aged 60 years or more.

AAOS Announces Research Funding for Orthopaedic Specialty Societies

The AAOS Board of Specialty Societies (BOS) Research Support Fund Award provides $100,000 for evidence-based research in musculoskeletal healthcare.

AAOS to Participate in Guidelines International Network Conference

Ryan Pezold, MA

This fall, when the Guidelines International Network (G-I-N) holds its annual meeting, AAOS will be well-represented, showcasing its exemplary evidence-based program and portfolio. The yearly event is an opportunity to network, learn, and share information with guideline developers, performance measures developers, policy makers, researchers, and others interested in evidence-based research methodology and dissemination.

Searching for Ewing Sarcoma Genetic Triggers

Catherine Rategan

Ewing Sarcoma is the third most common primary malignancy of bone. Most cases occur in patients who are between 10 and 20 years of age. In addition, the disease has a high propensity to metastasize. The cure rate for patients with localized disease is between 60 percent and 70 percent when treated with standard multi-agent chemotherapy protocols and surgical excision or radiation therapy.

OREF Welcomes New Board Members

Sharon K. Mellor, PhD, CAE

The board of trustees of the Orthopaedic Research and Education Foundation (OREF) is pleased to announce these new trustees and executive committee members: began his term as president this year, succeeding John J. Callaghan, MD, who remains on the board as past president. Michael L. Parks, MD, is OREF's new president-elect. Richard F. Kyle, MD, will serve as chair, corporate development, succeeding Thomas P. Schmalzried, MD in that role.

War Injury Experts Chart the Road Ahead

Elizabeth Fassbender

During the last 15 years, while our U.S. Armed Forces have fought in very remote, austere, and hostile environments, combat casualty care as practiced by U.S. Coalition Forces has reached a new pinnacle of success," said Andrew Schmidt, MD, chief of the Department of Orthopedic Surgery at Hennepin County Medical Center in Minneapolis and cochair of the eleventh annual Extremity War Injuries (EWI) Symposium.

AJRR Update

As the official registry of the American Association of Hip and Knee Surgeons (AAHKS), the American Joint Replacement Registry's (AJRR) mission is to collect data on 90 percent of the hip and knee replacement procedures performed in the United States. Under the direction of Paul Haisman, AJRR's first-ever chief technology officer, the national registry has begun making several technological enhancements that will enable it to meet that goal.

The Research Roadmap: Tools and Resources

Kyle Mullen, Ryan Pezold; Jayson Murray

Researchers often seek guidance and tools to ensure that their planned studies can be developed and completed to meet the standards of high-quality clinical research.

New AUCs and CPGs on the Way

Jayson Murray

The AAOS is currently working on the following three clinical practice guidelines (CPGs), one systematic literature review (a product similar to a CPG), and two appropriate use criteria (AUC). This guideline is currently in the public comment stage and is expected to be released in early 2017.

Progress in MOTION

Andrew J. Sheean, MD; Matthew R. Schmitz, MD

In the past decade, efforts to establish nationwide databases to collect "big data" for orthopaedic research have exploded. Goals include learning more about the burden of musculoskeletal disease, improving clinical outcomes, and enhancing efficiencies in the delivery of care.

Decision Aids Enhance Patient-Provider Communication

Danielle Schulte, MS; Nicole Nelson, MPH

“Medical decision science is a field that encompasses several related pursuits,” wrote the authors of the 2008 article “Medical Decision Making: A Physician’s Guide.” “As a normative endeavor, it proposes standards for ideal decision making. As a descriptive endeavor, it seeks to explain how physicians and patients routinely make decisions, and has identified both barriers to, and facilitators of, effective decision making.

A Clinical Pathway for Geriatric Hip Fractures

Ian Broussard, DO

As the elderly population grows, so does the number of geriatric hip fractures, making appropriate management of such fractures increasingly important. The goal is to maximize patient outcomes without increasing healthcare expenditures. One approach is the development of a clinical pathway. A clinical pathway is a sequential plan of care that involves a structured multidisciplinary approach to address a specific healthcare problem according to evidence-based guidelines.

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.

Pediatric SHFs with Vascular Injuries Are Complex

Benjamin J. Shore, MD, MPH, FRCSC

Supracondylar humerus fractures (SHFs) are the most common fractures in children, and the annual rate of SHF presentation is estimated to be 177 per 100,000 children. More than 90 percent exhibit extension or posterior displacement of the distal fracture fragment. This fracture is associated with a high incidence of complications, including neurologic and vascular injury, as well as compartment syndrome. In children, SHF is associated with vascular complications in about 20 percent of cases.

Best Practices Help with Managing Failed Implants

Daniel R. Schlatterer, DO, MS; Richard Schlueter, JD

The first article in this series explored several of the potential liability aspects of failed implants. Although an implant failure in a patient is not malpractice per se, the duty for patient safety continues before, during, and after plaintiff attorneys advertise class action suits.

Failed or Recalled Implants: Is There Surgeon Liability?

Daniel R. Schlatterer, DO, MS; Richard Schlueter, JD

In recent years, catastrophic failures have been associated with several orthopaedic implants. Issues with biologics, such as bone morphogenic protein, also have been reported. This article explores several of the potential liability aspects of failed implants.

Injury Prevention in Young Athletes

Amy Kile

That experience inspired Dr. Each year, high school athletes account for 2 million injuries, 500,000 doctor visits, and 30,000 hospitalizations. And with 70 percent of individuals showing signs of post-traumatic osteoarthritis 15 years after a serious sports-related injury to a lower extremity, the impact lasts long after the initial injury has healed.

Redesigned Clinical Quality and Value Website Links Related Content to Improve Reader Experience

Barbara Krause

Do you find that searching for specific information on a website can be like looking for the needle in the haystack? The AAOS Department of Clinical Quality and Value (CQV) felt that way about its own website. The department fully understood members’ frustrations when they searched for useful information, so the staff made plans for change. The CQV started the project with big ideas.

Academy Announces Strategic Investment in Biologics Research and Development

The American Academy of Orthopaedic Surgeons announced a strategic investment in the field of biologics. Over the next five years, the AAOS will prioritize research and development for a biologics-focused competency within the Academy’s existing business.

New CPG Weighs Psychosocial Factors in Trauma Recovery

Terry Stanton

In December 2019, the AAOS Board of Directors approved the clinical practice guideline (CPG) for Evaluation of Psychosocial Factors Influencing Recovery from Adult Orthopaedic Trauma. The guideline was jointly developed by the Academy and the Major Extremity Trauma and Rehabilitation Consortium.

Board Endorses CPGs from AAHKS and Hematology Society

In addition to the update to the 2009 clinical practice guideline (CPG) for the Management of Glenohumeral Joint Osteoarthritis, the AAOS Board of Directors approved an endorsement of four sets of guidelines issued by the American Association of Hip and Knee Surgeons (AAHKS).

New AAOS Committee on Devices, Biologics, and Technology Springs to Life

David Jevsevar, MD, MBA, FAAOS

As the world’s largest medical association of musculoskeletal specialists, AAOS announced in November 2019 a strategic investment in the field of biologics and future disruptive technologies.

Operative Treatment of Medial Epicondyle Fractures in Pediatric Patients Produces ‘Excellent’ Outcomes

Kerri Fitzgerald

After more than six years of follow-up, researchers observed that operative treatment of medial epicondyle fracture in pediatric patients resulted in “excellent” clinical outcomes.

Tactics to Ensure Device Safety After Approval Are Changing

Jonathan Dubin, MD, FAAOS

Each year, more than 2,000 novel medical devices enter the U.S. market, often representing new technologies and offering significant advantages over older treatment options for our patients.

Secondary Fracture Prevention: Multistakeholder Coalition Shares Recommendations

Paul A. Anderson, MD, FAAOS

A major risk factor for sustaining a fragility fracture is having had a previous fragility fracture. The relative risk increases two to 2.5 times depending on the site of an initial fracture.

Patient Safety Scenario: Leadership Prevails Within the OR

David Nelson, MD, FAAOS; Scott Lifchez, MD, FACS; Julie Adams, MD, FAAOS

A patient was involved in a motor vehicle accident at night and sustained a grade II open radius/ulna fracture and in addition complained of numbness in the median nerve distribution.

The ‘Nightstick Fracture’ Often Signals Intimate Partner Violence

Terry Stanton

A study indicated that up to one-third of women who sustain a fracture to the ulna bone of the forearm may be victims of intimate partner violence (IPV).

Study Probes Role of Depression in Recovery from Ankle Fracture

Terry Stanton

A study exploring the role of depression in functional and pain outcomes for patients treated for an isolated ankle fracture found that all patients have postoperative improvement, but those with no or low-level depressive symptoms improve to a greater extent.

Oral Contraceptive Pills Double VTE Risk after Knee Arthroscopy or ACL Reconstruction

Ariel DeMaio

A study reviewing a large claims database adds the use of combined oral contraceptive pills (COCPs) to the list of risk factors for deep vein thrombosis (DVT) or pulmonary embolism (PE) after knee arthroscopy or anterior cruciate ligament reconstruction (ACLR).

Study Assesses Patient-reported Satisfaction with Foot and Ankle Care via Telemedicine

Terry Stanton

The COVID-19 pandemic wrought numerous effects on the U.S. healthcare system, among them an imperative to quickly adopt methods and technologies to manage a sizeable portion of patient visits via telemedicine.

Augmentation of Fracture Repair: Is Anything Ready for Prime Time?

Pamela Stebbins

Orthopaedic surgeons are frequently required to adapt to changing and challenging circumstances, including complications after fracture fixation.

Vitamin E–Diffused Polyethylene Liners More Resistant to Wear than Highly Cross-linked Polyethylene Liners

Ariel DeMaio

For patients undergoing total hip arthroplasty (THA), vitamin E–diffused polyethylene (VEPE) acetabular liners were found to be noninferior to highly cross-linked polyethylene (XLPE) liners in terms of patient-reported outcome measures (PROMs), according to a study presented at the AAOS 2021 Annual Meeting in San Diego.

2021: A Year of Continued Growth for AAOS Registries

Erik Michalesko

For the AAOS Registry Program, 2021 was a year of significant expansion and noteworthy achievements, as it continued its growth trajectory and introduced several new visual and analytical enhancements.

Vigilance Warranted: The ‘Nightstick Fracture’ Often Signals Intimate Partner Violence

Terry Stanton

A study presented at the 2021 AAOS Annual Meeting in San Diego indicated that up to one-third of women who sustain a fracture to the ulna bone of the forearm may be victims of intimate partner violence.

How Safe and Effective Are COVID-19 Return-to-play Protocols?

Ariel DeMaio

When the World Health Organization (WHO) declared the COVID-19 public health emergency a pandemic on March 11, 2020, and stay-at-home and shelter-in-place orders were imposed across the globe, normal life came to a halt.

Lawrence J. Bonassar, PhD, Is Presented with the Kappa Delta Ann Doner Vaughn Award

Jennifer Lefkowitz

Despite the importance of connective tissues such as articular cartilage, much is still unknown about their unique mechanical functions and biological roles in cartilage health and disease.

Study Explores Pelvic Fractures in Women of Childbearing Age

Brandon May

A study suggests that pelvic fractures in women of childbearing age are associated with increased risks of Cesarean section (C-section), sexual dysfunction, and urinary retention.

Addressing Wellness Early Is Important, But It Is Never Too Late to Start Thinking about Your Mental and Physical Health

Leah Lawrence

Wellness is not just avoiding burnout.

Topical Antibiotics Do Not Increase Nonunion Risk in High-energy Periarticular Tibia Fractures

Brandon May

Topical antibiotics may not increase the risk of nonunion when used in high-energy periarticular tibia fractures, according to study findings presented by Daniel Miles, MD, at the AAOS 2022 Annual Meeting.

ICL Elucidates Regulatory Guidelines on Orthobiologics

Patrick Daly

Scott Bruder, MD, PhD, founder and CEO of Bruder Consulting & Venture Group, was the first presenter in the Instructional Course Lecture (ICL) titled “Orthobiologics Use and Marketing: U.S. Food and Drug Administration, Federal Trade Commission, and Ethical Compliance,” which discussed the complex regulations surrounding the use of orthobiologics.

Study Compares Outcomes by Graft Type in Management of Scaphoid Waist Fractures

Terry Stanton

The scaphoid is the most commonly fractured carpal bone, accounting for 60 percent of all carpal fractures.

Does Antibiotic Prophylaxis Decrease Infection Rate in Pediatric Supracondylar Humerus Fractures?

Cailin Conner

Supracondylar humerus fractures (SCHFs) are often seen in patients aged <10 years.

Study Elucidates Outcomes of Adult Spinal Deformity Surgery in Patients with and without Osteoporosis

Rebecca Araujo

A study presented on Tuesday investigated differences in adult spinal deformity (ASD) surgery outcomes among patients with and without osteoporosis, as well as trends in perioperative osteoporotic treatment among these patients.

Study Examines Safety of Ex-fix In Situ for Staged ORIF of Pilon Fractures

Terry Stanton

A study that sought to evaluate the safety of preparing the external fixator in situ during staged fixation of pilon fractures found that overall patients had relatively high infection (23.3 percent) and unplanned reoperation (11.3 percent) rates.

Christopher J. Dy, MD, Named 2023 Kappa Delta Young Investigator Award Winner

The 2023 Kappa Delta Young Investigator Award has gone to Christopher J. Dy, MD, MPH, FAAOS, FACS, FAOA, for his research on how brachial plexus injuries (BPIs) affect patients’ quality of life.

Study Finds Greater Complications after Elective Orthopaedic Procedures in Older Patients Treated during the COVID-19 Pandemic

Rebecca Araujo

The authors of a study presented at the AAOS 2023 Annual Meeting in Las Vegas sought to identify whether delays, cancellations, and changes to elective orthopaedic procedures during the height of the pandemic increased the incidence of postoperative complications in older patients.

Does Graft Choice Alter Risk of ACLR Revision and Reoperation?

Cailin Conner

Approximately 100,000 anterior cruciate ligament (ACL) reconstructions (ACLRs) are performed each year in the United States, making it one of the most common surgical procedures.

Surgeons Explain Effectiveness of Generic Implant Use in Orthopaedic Trauma and Associated Cost Savings

Brian P. Cunningham, MD, FAAOS, FAOA; Stephen A. Doxey, DO

In 2016, an Orthopaedic Trauma Association (OTA) survey reported that the majority (72 percent) of orthopaedic trauma surgeons knew about generic implants, but incorporation across the trauma community was limited.

Study Elucidates Outcomes of Adult Spinal Deformity Surgery in Patients with and without Osteoporosis

Rebecca Araujo

A study investigated differences in adult spinal deformity surgery outcomes among patients with and without osteoporosis, as well as trends in perioperative osteoporotic treatment among these patients.

Type of Deep Wound Closure Used in PJI Treatment Does Not Impact Likelihood of Treatment Success

Rebecca Araujo

The demand for total joint arthroplasty procedures in the United States is only rising, making it critical to advance and optimize the treatment of prosthetic joint infection when it occurs.

ICL Charts Current and Future Applications of Cannabinoids in Orthopaedics

Cailin Conner

At the AAOS 2023 Annual Meeting in Las Vegas, Harold A. Fogel, MD, FAAOS, and Elizabeth Lord, MD, moderated an Instructional Course Lecture on what cannabinoids are, their current usage in orthopaedics, and what to advise patients who use them.

Registry Study Finds Strong ‘Representativeness’ for AJRR in International Comparison

Terry Stanton

Compared with the United Kingdom National Joint Registry (NJR), hip and knee arthroplasty device-specific survivorship results in the American Joint Replacement Registry (AJRR) were consistent and showed similar trends for comparatively high- and low-performing devices through final follow-up at 8 years.

AAOS Approves Two New Appropriate Use Criteria on ACL Injury and Secondary Hip Fracture

Barbara Krause

The AAOS Board of Directors approved the Appropriate Use Criteria (AUC) titled Return to Play to Pre-Injury Level Following Anterior Cruciate Ligament (ACL) Injury. The AUC is based on evidence from the 2022 AAOS Clinical Practice Guideline (CPG) on the Management of ACL Injuries.

The ‘Weekend Effect’: Are There Worse Outcomes for THAs Performed on Saturdays and Sundays?

Rebecca Araujo

A retrospective study investigated whether there were any differences in postoperative outcomes and healthcare costs associated with total hip arthroplasty procedures performed on weekdays and weekends.

The MOON Shoulder Group Receives Kappa Delta Ann Doner Vaughn Award

The 2024 Kappa Delta Ann Doner Vaughn Award was presented to the Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Group for changing the way physicians treat patients with atraumatic, symptomatic rotator cuff tears.

Recipients of the AAOS BOS Research Support Fund Awards Will Drive New Data and Perspectives on Treatment Options

AAOS announced the recipients of the AAOS Board of Specialty Societies (BOS) Research Support Fund Awards.

Children Have Reduced Hospitalization after Fracture Surgery Performed by Pediatric Orthopaedic Surgeons

Cailin Conner

A study presented at the AAOS 2024 Annual Meeting found that pediatric patients undergoing surgical intervention for a femoral shaft fracture from a non-pediatric–trained orthopaedic surgeon were more likely to require an extended hospital stay (defined as >5.5 days) than patients treated by a pediatric orthopaedic surgeon.

JAAOS® Technology Overview Simplifies cBMA Harvesting and Processing to Improve Fracture Healing

Jennifer Lefkowitz

With the annual number of reported fractures in the United States projected to increase by at least 10 percent over the next decade due to a growing elderly population, it is crucial to optimize fracture healing for patients with delayed or impaired bone union.

ICL Tackles Complication Prevention and Management for Total Hip Arthroplasty via the Anterior Approach

Cailin Conner

Panelists of the Instructional Course Lecture “Complications with the Anterior Approach to Total Hip Arthroplasty: Identification, Prevention, and Management” discussed the unique complications associated with the direct anterior approach to total hip arthroplasty and strategies to reduce and manage them.

Study Supports Simultaneous Fixation for Multiple Long-Bone Fractures

A study comparing cardiopulmonary outcomes following simultaneous versus staged intramedullary nail fixation for multiple lower-extremity long-bone fractures found that simultaneous fixation of multiple fractures was not associated with increased cardiopulmonary events and appeared to expedite time to discharge.

Paper Examines the Accuracy of Surgeons’ Clinical Suspicions of Rotator Cuff Tears at Initial Consultation

Rebecca Araujo

For patients with presumed atraumatic rotator cuff tears, it is common for insurance companies to mandate 6 weeks of conservative physical therapy prior to approval for order of MRIs.

Operative Management of Flail Chest Is Associated with Reduction in Acute Respiratory Distress

Stuart A. Green, MD, FAAOS

Claire Donnelley, MD, orthopaedic surgery resident at Yale School of Medicine, presented a study on plating rib fractures in flail chests.

Volumetric Depression Can Predict Risk of Subsidence in Patients with Tibial Plateau Fractures

Stuart A. Green, MD, FAAOS

An ePoster presented at the AAOS 2024 Annual Meeting by Abhishek Ganta, MD, assistant professor of orthopaedic surgery at NYU Langone Health and director of foot and ankle surgery and codirector of orthopaedic trauma at Jamaica Hospital Medical Center in Queens, New York, found that current measurements of tibial plateau fractures often underestimate trauma severity.

Performance Measures Update: Orthopaedic Preferred Measure Set

The Physician Quality Reporting System (PQRS) began in 2007 as the Physician Quality Reporting Initiative, a voluntary, incentive-based program for practitioners that was designed to better ensure high-quality healthcare services for Medicare beneficiaries. The program as it is known today will sunset on Dec. 31, 2016, as required under the Medicare Access and CHIP (Children's Health Insurance Program) Reauthorization Act of 2015 (MACRA).

Data Collection for the 2016 AAOS Orthopaedic Surgeon Census Has Been Extended

The Academy is asking all members to take part in the AAOS 2016 census of orthopaedic surgeons. The census is taken to ensure AAOS members are accurately represented in advocacy, funding, and reimbursement efforts. The information also helps AAOS tailor programs, products, and services to address professional needs and interests of its members. All individual responses are kept confidential. AAOS will be sending reminders to those who have not answered yet.

AAOS Awarded Research Grant

The AAOS Department of Research, Quality and Scientific Affairs, in collaboration with the Major Extremity Trauma Research Consortium, has been awarded a U.S.

Does Environmental BPA Exposure Affect Fracture Healing?

Sharon Johnson

For years, research scientists in a range of medical specialties have raised questions about the health risks of human and animal exposure to bisphenol A (BPA), a chemical used to manufacture polycarbonate plastics and epoxy resins for products such as water bottles, plastic food containers, and water supply pipes.

Recovery Care Centers Expand the Benefits of Ambulatory Surgery Centers

John C. Steinmann, DO; Alexander Sah, MD; Angela Carlson, MHA; Michael Bergerson; Basil Besh, MD

Prior to 1970, all surgeries were performed in hospitals and were associated with long lengths of stay and high costs. Improved surgical techniques, along with the desire to reduce the costs of simple surgeries in hospitals, have led to the development of ambulatory surgery centers (ASCs). Several surgical cases that were once considered to be inpatient only have migrated to ASCs, with well-documented high rates of patient satisfaction, good outcomes, and cost savings.

Avoid Risks During Hip Fracture Management in a Medically Complex Patient

Andrew Campbell, MD; Thuan Ly, MD; Andrew Glassman, MD, MS

Care in the medically complex patient with a hip fracture can be difficult to organize, inefficient, and fraught with risks of complications. By creating a framework and a collaborative approach guided by the AAOS evidence-based Clinical Practice Guideline (CPG), providers can avoid pitfalls in the care of these challenging cases. A 65-year-old female was referred to her hematologist with profound anemia, hypercalcemia, and a protein gap on serum protein electrophoresis.

Pros and Cons of Emerging Payment Models

Benjamin Kopp, MD, MBA; Kevin Bozic, MD, MBA; Karl Koenig, MD, MS

This is part one in a series about payment models. Part two will appear in the May issue of AAOS Now and will focus on the application of condition-based payment models to the management of musculoskeletal disorders. At the core of the surgeon patient relationship is a shared goal of relieving pain, restoring function, and improving health in the most appropriate, convenient, and efficient way possible for the patient’s condition.

Psychologist Discusses Psychosocial Factors and Recovery after Military or Civilian Trauma

Terry Stanton

To further delve into the issues raised by the clinical practice guideline (CPG) on the Evaluation of Psychosocial Factors Influencing Recovery from Adult Orthopaedic Trauma, AAOS Now conducted an interview with Benjamin Keizer, PhD, psychologist and the military cochair of the development workgroup (the nonmilitary cochair is Steve Wegener, PhD, MA). Dr. Keizer is a licensed psychologist at the Center for the Intrepid, San Antonio Military Medical Center, Fort Sam Houston, Texas.

Data Supplements Offer the Latest on AAOS Registries

Terry Stanton

When the question is, “What’s new with the AAOS Registry Program?” a safe answer is always, “Plenty!” The AAOS Family of Registries is an ever-growing clan, both in numbers of anatomically categorized programs and in the volume and quality of data that continue to pour into these valuable clinical data repositories for orthopaedic procedures.

Preoperative Factors to Consider for Same-day Discharge in TKA

Kaitlyn D’Onofrio

Following Medicare’s removal of total knee arthroplasty (TKA) from the inpatient-only (IPO) list, it has become increasingly important to appropriately select patients who would be viable candidates for same-day discharge (SDD).

Machine Learning in Orthopaedics Is Ready for Prime Time

Ayoosh Pareek, MD; Yining Lu, MD; R. Kyle Martin, MD, FRCSC; Lars Engebretsen, MD, PhD; Aaron Krych, MD, FAAOS

Over the past decade, machine learning (ML) has become an important tool, with promising early results, yet its adoption in orthopaedic surgery has been slow.

AJRR Data Reveal Migration Patterns for Revision TKA

Kerri Fitzgerald

Data from the American Joint Replacement Registry (AJRR) indicate that revision surgery following primary total knee arthroplasty (TKA) takes place at medium and large teaching institutions and migrates away from small, nonteaching institutions.

AAOS Registry Program Looks Back at Another Year of Progress

Terry Stanton

2020 was a year like no other, with the healthcare system completely upended along with the rest of society by COVID-19. But for the AAOS Registry Program, it was nonetheless a year of growth and accomplishment.

AOSSM Million Dollar Drive Raises $2.2 Million

The American Orthopaedic Society of Sports Medicine (AOSSM) launched a major development campaign called the Million Dollar Drive at the conclusion of its Annual Meeting in July 2019, and members stepped up in a major way.

Study: IV Dexamethasone Reduces Persistent Pain after Total Knee Arthroplasty

Rebecca Araujo

A randomized trial found that the use of perioperative IV dexamethasone significantly decreased persistent pain after total knee arthroplasty (TKA) compared to placebo.

Articular Cartilage Injury with Recurrent Patellar Dislocation Is Common, Progresses Quickly

Ariel DeMaio

Nearly half of patients undergoing patellar stabilization surgery for recurrent patellar dislocation experienced articular cartilage injury, according to results from an MRI study of 35 patients.

Study Assesses Foot and Ankle Patient-reported Satisfaction with Telemedicine in the Time of COVID-19

Terry Stanton

The COVID-19 pandemic wrought numerous effects on the U.S. healthcare apparatus, among them was an imperative to adopt quickly methods and technologies to manage a sizeable portion of patient visits via telemedicine.

Study Finds Silver-coated Megaprostheses Cost-effective in Limb Salvage Surgery for Lower-extremity Sarcoma

Terry Stanton

A study presented at the AAOS 2021 Annual Meeting in San Diego demonstrated that the use of silver-coated megaprostheses in reconstruction after wide resection of lower-extremity osteosarcomas remains a cost-effective strategy for mitigating postoperative prosthetic joint infections (PJIs) and associated healthcare costs (Fig. 1).

Arthroscopic Bankart Repair Is More Cost-effective than Nonoperative Management for Anterior Shoulder Dislocation

Ariel DeMaio

Anterior glenohumeral instability represents more than 11 percent of all traumatic shoulder injuries.

Weak Agreement on Radiograph Assessment for Knee OA between Orthopaedic Surgeons and Radiologists

Rebecca Araujo

A study found low levels of agreement between orthopaedic surgeons and radiologists on the radiographic assessment of osteoarthritis (OA) of the knee, including factors such as disease characteristics and recommended treatment.

Study Questions Whether Extended Oral Antibiotic Prophylaxis Effectively Reduces PJI Risk

Ariel DeMaio

In an analysis of 178 aseptic total hip arthroplasty (THA) and total knee arthroplasty (TKA) first-time revisions, extended oral antibiotic (EOA) prophylaxis was associated with a slightly lower risk of periprosthetic joint infection (PJI) compared with standard antibiotic prophylaxis.

Alayna E. Loiselle, PhD, Receives the 2022 Kappa Delta Young Investigator Award after Publishing Research on Tendon Cell Biology and Healing Process

Molly Todd Rudy

Early in her education, Alayna E. Loiselle, PhD, had a vast interest in orthopaedics, thinking she would study to be an orthopaedic surgeon.

High Rates of Occupational Physical, Mental Injuries among Orthopaedic Surgeons

Rebecca Araujo

A large study investigated incidence of occupational physical and mental injuries in orthopaedic surgeons according to subspecialty and other surgeon factors.

In-office Needle Arthroscopy Reduces Pain and Is Widely Accepted by Patients with Anterior Ankle Impingement

Brandon May

In-office needle arthroscopy for anterior ankle impingement led to significant reductions in pain and was associated with low rates of complications and excellent patient-reported outcomes and treatment satisfaction, according to study findings to presented at the AAOS 2022 Annual Meeting by Mohammad Azam of NYU Langone Orthopedic Center.

Dedicated Orthopaedic Trauma Room Improves Surgery Efficiency, Confers Cost Benefits

Brandon May

A dedicated orthopaedic trauma room (DOTR) increased surgical efficiency and resulted in marked cost benefits for centers, according to findings from a Canadian study.

Become an AAOS Registry Surgeon Champion

The growth of the AAOS Registry Program is made possible because members actively engage with one of the five registries: the American Joint Replacement Registry (AJRR); Fracture & Trauma Registry (FTR); Musculoskeletal Tumor Registry; Shoulder & Elbow Registry (SER); and American Spine Registry, a collaboration with the American Association of Neurological Surgeons.

Kappa Delta Ann Doner Vaughn Award Presented to Michelle Ghert, MD, and the PARITY Investigators

The 2023 Kappa Delta Ann Doner Vaughn Award has gone to Michelle Ghert, MD, FRCSC, on behalf of the Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) investigators for their research on the prevention of surgical site infections (SSIs) through antibiotic prophylaxis following oncologic reconstruction surgery for bone tumors.

Low-cost Methods Perform Similarly to Virtual Reality at Minimizing Anxiety during Pediatric Cast and Pin Removal

Cailin Conner

In the orthopaedic outpatient setting, cast and percutaneous pin removal is a generally painless procedure.

Marc J. Philippon, MD, Receives OREF Clinical Research Award for Validating and Advancing Hip Arthroscopy

Marc J. Philippon, MD, FAAOS, was honored with the 2023 Orthopaedic Research and Education Foundation (OREF) Clinical Research Award, which recognizes outstanding clinical research related to musculoskeletal disease or injury.

Major Extremity Trauma Research Consortium Receives Kappa Delta Elizabeth Winston Lanier Award for the Largest Orthopaedic Trauma Research Enterprise

Jennifer Lefkowitz

METRC has conducted 35 studies, enrolled more than 23,000 patients across 82 sites, and published 61 papers, all resulting in increased awareness and funding for extremity trauma care.

PARITY Trial Researchers Earn 2023 Kappa Delta Ann Doner Vaughn Award for First-ever International RCT in Orthopaedic Oncology

Molly Todd Rudy

In 2011, Michelle Ghert, MD, FRCSC, and her colleagues saw a major challenge in patients undergoing limb salvage surgery for bone sarcoma.

Antithrombotic Medication Use Does Not Increase Risk of Revision after Wide-awake Hand Surgery

Rebecca Araujo

According to a retrospective study, patients taking prescription anticoagulants or antiplatelets who underwent wide-awake hand surgery did not have an increased risk of revision surgery or postoperative complications compared to patients who were not taking these medications.

AAOS CPGs Aid Clinicians in Treatment Decisions

Barbara Krause; Danielle Shulte

The primary goals of clinical practice guidelines (CPGs) are to address key decision points, advance practice based on the best available evidence, optimize patient care, and detect areas where future research is needed.

Survey Examines Patterns in PROMs Use in Practice among AAOS Members

Brian P. Cunningham, MD, FAAOS, FAOA; Lauren Shapiro, MD, MS, FAAOS; Jason L. Koh, MD, MBA, FAAOS, FAOA; Stephen A. Doxey, DO; Rebekah M. Kleinsmith, MD

To analyze the use and application of PROMs among orthopaedic surgeons, a recent AAOS survey invited 16,394 members to characterize their PROM usage.

Poor Understanding of Over-the-counter Medications Puts Orthopaedic Patients at Risk

Cailin Conner

A study presented at the 2023 AAOS Annual Meeting found that most patients have a poor understanding of the different classes of OTC medications and their major side effects.

Home Exercise Program Shows Similar 1-year Improvements after Reverse TSA as Physical Therapy Regimen

Rebecca Araujo

The results of a randomized clinical trial, presented at the AAOS 2023 Annual Meeting, found that a home-based rehabilitation program provided similar benefits to supervised physical therapy after reverse total shoulder arthroplasty.

Do PROMs Improve Patient Experience in Foot and Ankle Surgery?

Terry Stanton

A study found that the adoption and application of patient-reported outcome measures (PROMs) by foot and ankle surgeons may not improve patient experience or activation and may, in fact, decrease understanding or patient activation in select populations.

Evaluating an Opiate-Free Multimodal Pain Pathway in Elective Foot and Ankle Surgery

A study of patients undergoing elective outpatient foot and ankle surgery and receiving a comprehensive, opioid-free, multimodal pain-management protocol found that most patients achieved excellent pain control without significant postoperative side effects.

Physician-Led Orthopaedic Hospitals Score Higher on Quality Rankings

Rebecca Araujo

An analysis of the top 200 orthopaedic hospitals in the United States found that physician-led orthopaedic hospitals performed better than hospitals without physician leadership.

Nathaniel A. Dyment, PhD, Receives 2024 Kappa Delta Young Investigator Award

Nathaniel A. Dyment, PhD, was named the recipient of the 2024 Kappa Delta Young Investigator Award for his findings on biophysical and biochemical cues that direct the growth, development, homeostasis, and repair of tendons and ligaments.

Experts Share Tips for Achieving Optimal Outcomes for Patients with Failed ACLRs

Cailin Conner

Anterior cruciate ligament revision surgery has myriad complexities and considerations.

Tibial Stem Extensions May Protect Against Complications in Morbidly Obese Patients Undergoing Total Knee Arthroplasty

Molly Todd Rudy

Morbid obesity (MO; BMI >40 kg/m2) is a known risk factor for complications in patients undergoing total knee arthroplasty (TKA), including increased risk of revisions and poorer outcomes.

Antibiotic Powder Reduces Deep Infection Rate in Lower-Extremity Open Fractures

A study presented at the AAOS 2024 Annual Meeting found that application of antibiotic powder to wounds of patients with lower-extremity open fractures demonstrated efficacy in reducing the incidence of deep surgical site infections.

Injectables Provide Noninvasive Option for Knee Osteoarthritis, Especially for Young Patients

Leah Lawrence

The incidence of osteoarthritis of the knee is increasing steadily, and it is estimated that more than half of people with OA of the knee will undergo total knee arthroplasty during their lifetime.

Nicotine Dependence Is Associated with Complications following Achilles Tendon Repair

A retrospective cohort study found that nicotine-dependent patients who underwent Achilles tendon repair had a significantly higher risk (P <0.05) of postoperative complications over a 20-year period than their non–nicotine-dependent counterparts.

Watchful Waiting versus Physical Therapy for Frozen Shoulder: Randomized Trial Compares Nonoperative Treatment Options

Rebecca Araujo

A watchful waiting approach for management of adhesive capsulitis, or frozen shoulder, delivered similar outcomes at 1 year compared with the use of physical therapy, with a lower cost burden, according to results from a randomized trial.

Improving Wellness: Survey Assesses Burnout Management among Limb-Reconstruction Surgeons

Selina C. Poon, MD, MPH, FAAOS

Fewer than 10 percent of surgeons who specialize in limb lengthening and reconstruction utilize wellness counseling, despite high rates of burnout, according to results of a study presented at the AAOS 2024 Annual Meeting.