Afleveringen
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Lower extremity joint replacement is the second largest inpatient expense to U.S. Centers for Medicaid & Medicare Services (CMS), prompting value-based care experimentation most recently seen in the Bundled Payment for Care Improvement Advanced Model (BPCI-A). BPCI-A tested a new target pricing methodology and welcomed acute care hospital, physician group practice (PGP), and convener participants.
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The recording of The Journal of Orthopaedic Experience & Innovation Zoom "Open Mic" featuring Scott Mabry, MD, Robert Sershon, MD, Charles Taunt, DO, and Ira Kirschenbaum, MD (Moderator).
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Zijn er afleveringen die ontbreken?
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Medial patellar instability is a potentially severe ligamentous condition that significantly impairs normal knee function, with most cases due to iatrogenic injury to the lateral soft tissue restraints. Idiopathic causes are exceedingly rare. We present a unique case of a 32-year-old woman with chronic idiopathic medial patellar instability managed with LPFL reconstruction using a semitendinosus allograft. This report contributes to the limited literature on non-iatrogenic medial patellar instability and supports LPFL reconstruction as a viable treatment option.
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Peptide therapies have rapidly entered musculoskeletal and orthopaedic care through direct-to-consumer performance clinics and widespread online promotion. Agents such as BPC-157 and thymosin beta-4 derivatives (TB-500) are increasingly used by patients seeking accelerated recovery, despite uncertain efficacy and limited perioperative safety data.
This scoping review aimed to characterize the available evidence regarding commonly used peptide therapies relevant to musculoskeletal pathology and to examine safety considerations and perioperative implications for orthopaedic surgical patients, with emphasis on total joint arthroplasty (TJA). -
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly prescribed for both glycemic control and weight loss, particularly in patients undergoing total joint arthroplasty. While studies on total hip and knee arthroplasty suggest potential perioperative benefits, the impact of GLP-1 RA use on outcomes following total shoulder arthroplasty (TSA) is unclear. Given the unique biomechanical demands of TSA, rising TSA volumes, and increasing GLP-1 RA use, this systematic review aims to evaluate the current literature on the impact of GLP-1 RA therapy on postoperative outcomes in TSA patients.
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Total knee arthroplasty (TKA) is a treatment option for individuals with symptomatic osteoarthritis who have failed conservative therapy. In this manuscript the authors describe the pathophysiology of post-operative edema and explore the patient dependent factors potentially contributing to lymphatic dysfunction and thus directly influencing the TKA postoperative course. A proposed multimodal perioperative protocol is presented that focuses on identifying limb edema/lymphedema preoperatively, intraoperative technique changes that may decrease swelling post-TKA.
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Thumb carpometacarpal (tCMC) arthritis is a common and debilitating condition for aging people worldwide. Conservative treatments including activity modification, bracing, anti-inflammatory medications, and steroid injections remain the initial treatment of choice. Given the size of the tCMC joint, intra-articular image-guided injections (IGI) may provide more consistent and superior outcomes with comparison to peri-articular anatomic landmark injections (ALI). This study systematically reviews the accuracy and efficacy of intra-articular IGA versus ALI.
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Since the removal of total hip arthroplasty (THA) from the Medicare Inpatient‑Only (IPO) list in 2020, there has been a growing trend towards outpatient procedures. Recent studies have demonstrated equivalent complications and patient-reported outcome measures (PROMs) among inpatient and outpatient THA patients, but existing selection tools primarily emphasize medical comorbidities. This study assessed the value of incorporating preoperative PROMs into clinical-decision making tools to adequately identify patients most suitable for outpatient THA.
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Complex acetabular defects with associated infection as well as multiple revision procedures remain a significant reconstructive challenge due to compromised bone stock, altered anatomy, and increased risk of recurrent infection. Custom triflange implants have been used to restore pelvic stability in severe bone loss; however, conventional metallic constructs may present limitations in previously infected environments, including challenges with imaging assessment and biomechanical load transfer. Patient-specific implants manufactured from Poly Ether Ketone Ketone (PEKK), a high-performance polymer with mechanical properties closer to cortical bone, may offer an alternative reconstructive strategy.
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Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are some of the most commonly performed surgical procedures. Due to the soft tissue damage sustained intraoperatively, pain is a common occurrence which is frequently treated with opioid analgesics. Conventional wisdom still espouses large numbers of opioids for post-op pain relief. However, opioid related adverse events such as addiction, mental status changes, fall risk, and sedation remain a problem. Suzetrigine is a novel non-addictive FDA approved medication to treat acute pain. Lowering opioid use in the early phases of recovery has been shown to reduce long-term opioid use for patients.
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The purpose of this study was to identify pre- and post-operative radiographic measurements in patients who achieved excellent range of motion to optimize implant positioning in patients undergoing rTSA. We hypothesized that restoring the lateral humeral offset to closely align with the patient’s pre-operative anatomy, along with achieving optimal lateralization and distalization shoulder angles as outlined in the literature, would correlate with excellent clinical outcomes.
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The recording of The Journal of Orthopaedic Experience & Innovation Zoom "Open Mic" featuring Nathanael Heckmann, MD (moderator), James Baker, MD, & Chris Hoedt, MD.
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Computer navigation (CN), with or without the use of robotics, is increasingly utilized in primary total joint arthroplasty (TJA). Although evidence supporting its clinical benefit remains limited, its role in the revision setting is even less defined. This study evaluates national utilization trends and compares 2-year implant-related complications of CN and conventional revision total hip (rTHA) and knee arthroplasty (rTKA).
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This study identifies a 20.1% overall citation error rate in orthopaedic surgery literature, with nearly 10% classified as major errors. A new classification system for citation accuracy is introduced, revealing significant pre-existing inaccuracies. The research also shows that current AI tools, like ChatGPT, cannot reliably verify citations due to limited access and the rubric used.
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A retrospective study compared a novel antimicrobial surgical irrigant, XPerience (XP), to standard povidone-iodine rinse in 1,295 hip/knee arthroplasty patients. The XP group had no periprosthetic joint infections (0/471), while the control group had a 0.5% infection rate (4/824). Although differences weren't statistically significant, findings suggest XP may lower infection.
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This systematic review analyzed 26 studies on cognitive deficits in athletes after sports-related concussions, involving 4,534 participants. Findings revealed impairments in attention, memory, processing speed, and executive function across acute, intermediate, and long-term periods. While most deficits resolve within weeks, severe cases may persist.
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This study analyzes 250 pelvic fracture patients treated with sacroiliac or transiliac-transsacral screw fixation over 12 years. Painful hardware was reported by 18.4% of patients, leading to implant removal at an average of 6.7 months post-surgery. All patients who underwent removal experienced significant pain reduction, with no complications recorded.
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The relationship between patient health literacy and surgical outcomes is an increasingly popular topic within healthcare circles. To our knowledge, no specific assessment of shoulder health literacy has been validated in the literature, and the role that health literacy has in the outcomes of shoulder-arthroplasty patients is unclear.
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