Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Published in
Clinical Orthopaedics and Related Research®
Volume 468 | Issue 10 | Oct, 2010

The Internet and the Physician-Patient Relationship

Randale C. Sechrest MD

Since the emergence of the public Internet in the early 1990s, the healthcare industry has been struggling to understand how best to utilize this resource. During the last decade there has been an increase in both the interest and participation by healthcare providers in the Internet space, but many observers continue to push for more development of healthcare resources to better support the provider-patient relationship.

Assessing Readability of Patient Education Materials: Current Role in Orthopaedics

Sameer Badarudeen MD, Sanjeev Sabharwal MD

Health literacy is the single best predictor of an individual’s health status. It is important to customize health-related education material to the individual patient’s level of reading skills. Readability of a given text is the objective measurement of the reading skills one should possess to understand the written material.

The Potential Research Impact of Patient Reported Outcomes on Osteogenesis Imperfecta

Catherine A. Brownstein MPH, PhD, Paul Wicks PhD

Osteogenesis imperfecta (OI) is an inherited connective tissue disorder with many phenotypic presentations ranging from mild to severe. It is often called “brittle bone disease.” Treatment consists of physical therapy, surgical interventions, medications and, in some cases, experimental therapies. Because treatment is not standardized and is often experimental, information on the success of different methods is usually not available or well documented.

Virtual Reality in Orthopaedics: Is It a Reality?

Jay D. Mabrey MD, Karl D. Reinig PhD, W. Dilworth Cannon MD

Virtual reality (VR) simulation has been a requirement for airline and military pilots for decades and is only now being integrated into surgical training programs. Thus far, orthopaedic training programs have been slow to adopt VR training.

The Role of SIGN in the Development of a Global Orthopaedic Trauma Database

John F. Clough MD, DPhil, Lewis G. Zirkle MD, Robert J. Schmitt

The global burden of injury is receiving recognition as a major public health problem but inadequate information delays many proposed solutions. Many attempts to collect reliable data on orthopaedic trauma have been unsuccessful. The Surgical Implant Generation Network (SIGN) database is one of the largest collections of fracture cases from lower and middle income countries.

Low-income Countries’ Orthopaedic Information Needs: Challenges and Opportunities

Kathryn Doughty MD, MPH, MS, Linda Rothman BscOT, MHSc, Luke Johnston BSc Student, Kim Le MPH, Joanna Wu BSc, Andrew Howard MD, MSc, FRCSC

The Internet should, in theory, facilitate access to peer-reviewed scientific articles for orthopaedic surgeons in low-income countries (LIC). However, there are major barriers to access, and most full-text journal articles are available only on a subscription basis, which many in LIC cannot afford. Various models exist to remove such barriers. We set out to examine the potential, and reality, of journal article access for surgeons in LIC by studying readership patterns and journal access through a number of Internet-based initiatives, including an open access journal (“PLoS Medicine”), and programs from the University of Toronto (The Ptolemy Project) and World Health Organization (WHO) (Health InterNetwork Access to Research Initiative [HINARI]).

Improving Web Site Performance Using Commercially Available Analytical Tools

James A. Ogle MSc, MBA

It is easy to accurately measure web site usage and to quantify key parameters such as page views, site visits, and more complex variables using commercially available tools that analyze web site log files and search engine use. This information can be used strategically to guide the design or redesign of a web site (templates, look-and-feel, and navigation infrastructure) to improve overall usability. The data can also be used tactically to assess the popularity and use of new pages and modules that are added and to rectify problems that surface.

Computational Ontologies in Orthopaedic Surgery

Ricardo Pietrobon MD, PhD, MBA, Amrapali Zaveri MSc, Luciana Cofiel PT, PhD, Jacson Barros MSc, Jatin Shah BAMS, PDCR

Information Technology (IT) plays an important role in storing and collating the vast amounts of healthcare data. However, analyzing and integrating this data to extract useful information is difficult due to the heterogeneous, siloed, disparate, and unstructured nature of the data.

Orthopaedic Literature and MeSH

Stuart J. Nelson MD, FACMI, Jacque-Lynne Schulman MA, MLS

Since 1916 there has been a recognized demand for a method of classification of orthopaedic literature inclusive enough to permit the proper collection and retrieval of all literature on the subject. Today, MEDLINE, available through the PubMed interface, has become the de facto standard for organization and retrieval of medical literature. The Medical Subject Headings (MeSH), used to provide indexing and assist in searching, are partly responsible for this standard. Understanding how MeSH is built and maintained may lead the user to a better understanding of how to use MEDLINE, and what to expect from the indexing of an article.

Utilizing Information Technology to Mitigate the Handoff Risks Caused by Resident Work Hour Restrictions

Joseph Bernstein MD, Duncan C. MacCourt JD, MD, Dan M. Jacob BA, Samir Mehta MD

Resident duty hours have been restricted to 80 per week, a limitation thought to increase patient safety by allowing adequate sleep. Yet decreasing work hours increases the number of patient exchanges (so-called “handoff”) at the end of shifts.

Should We Be Teaching Information Management Instead of Evidence-based Medicine?

Shepard R. Hurwitz MD, David C. Slawson MD

To encourage high-quality patient care guided by the best evidence, many medical schools and residencies are teaching techniques for critically evaluating the medical literature. While a large step forward in many regards, these skills of evidence-based medicine are necessary but not sufficient for the practice of contemporary medicine and surgery. Incorporating the best evidence into the real world of busy clinical practice requires the applied science of information management. Clinicians must learn the techniques and skills to focus on finding, evaluating, and using information at the point of care. This information must be both relevant to themselves and their patients and be valid.

Private Practice Outcomes: Validated Outcomes Data Collection in Private Practice

Jack Goldstein MD

Improved patient care is related to validated outcome measures requiring the collection of three distinct data types: (1) demographics; (2) patient outcome measures; and (3) physician treatment. Previous impediments to widespread data collection have been: cost, office disruption, personnel requirements, physician motivation, data integration, and security. There are currently few means to collect data to be used for collaborative analysis.

Kaiser Permanente National Total Joint Replacement Registry: Aligning Operations With Information Technology

Elizabeth W. Paxton MA, Maria C. S. Inacio MS, Monti Khatod MD, Eric J. Yue MD, Robert S. Namba MD

A Total Joint Replacement Registry was developed in a large community-based practice to track implant utilization, monitor revisions and complications, identify patients during recalls and advisories, and provide feedback on clinical practices.

Electronic Data Capture for Registries and Clinical Trials in Orthopaedic Surgery: Open Source versus Commercial Systems

Jatin Shah BAMS, PDCR, Dimple Rajgor MSc, Shreyasee Pradhan MSc, Mariana McCready BS, Amrapali Zaveri MSc, Ricardo Pietrobon MD, PhD, MBA

Collection and analysis of clinical data can help orthopaedic surgeons to practice evidence based medicine. Spreadsheets and offline relational databases are prevalent, but not flexible, secure, workflow friendly and do not support the generation of standardized and interoperable data. Additionally these data collection applications usually do not follow a structured and planned approach which may result in failure to achieve the intended goal.

Ethical Choice in the Medical Applications of Information Theory

Scott V. Haig MD

Alongside advances in medical information technology (IT), there is mounting physician and patient dissatisfaction with present-day clinical practice. The effect of introducing increasingly complex medical IT on the ethical dimension of the clinical physician’s primary task (identified as direct patient care) can be scrutinized through analysis of the EMR software platform.

Pain Relief, Motion, and Function after Rotator Cuff Repair or Reconstruction May Not Persist after 16 Years

Niclas Borgmästars MD, Mika Paavola MD, PhD, Ville Remes MD, PhD, Martina Lohman MD, PhD, Martti Vastamäki MD, PhD

Short- to medium-term rotator cuff repair reportedly relieves pain in 82% to 97% of patients and provides normal or almost normal shoulder function in 82% to 92%. However, it is unknown whether pain relief and function persist long term.

Is Closed-suction Drainage Necessary for Single-level Lumbar Decompression?: Review of 560 Cases

Masahiro Kanayama MD, Fumihiro Oha MD, Daisuke Togawa MD, Keiichi Shigenobu MD, Tomoyuki Hashimoto MD

Closed-suction drainage is commonly used for prevention of postoperative hematoma and associated neurologic compromise after lumbar decompression, but it remains unclear whether suction drainage reduces postoperative complications.

In Vivo and In Vitro Analysis of Rat Lumbar Spine Mechanics

Matthew E. Cunningham MD, PhD, Jocelyn M. Beach BS, Serkan Bilgic MD, Oheneba Boachie-Adjei MD, Marjolein C. H. Meulen PhD, Chisa Hidaka MD

Rodent lumbar and caudal (tail) spine segments provide useful in vivo and in vitro models for human disc research. In vivo caudal models allow characterization of the effect of static and dynamic loads on disc mechanics of individual animals with time, but the lumbar models have required sacrifice of the animals for in vitro mechanical testing.

Second-generation Highly Cross-linked X3™ Polyethylene Wear: A Preliminary Radiostereometric Analysis Study

David G. Campbell BM, BS, FRACS, PhD, John R. Field MSc, BVSc, DVSc, PhD, Stuart A. Callary BAppSc

First-generation highly cross-linked polyethylene liners have reduced the incidence of wear particle-induced osteolysis. However, failed acetabular liners have shown evidence of surface cracking, mechanical failure, and oxidative damage. This has led to the development of second-generation highly cross-linked polyethylene, which has improved wear and mechanical properties and resistance to oxidation in vitro. Owing to its recent introduction, there are no publications describing its clinical performance.

Radiographic Prevalence of Femoroacetabular Impingement in a Young Population with Hip Complaints Is High

Leah M. Ochoa MD, Laura Dawson DO, Jeanne C. Patzkowski MD, Joseph R. Hsu MD

Femoroacetabular impingement (FAI) is reportedly a prearthritic condition in young adults that can progress to osteoarthritis. However, the prevalence of FAI is unknown in the young, active population presenting with hip complaints.

Nationwide Epidemiologic Survey of Idiopathic Osteonecrosis of the Femoral Head

Wakaba Fukushima MD, PhD, Mikihiro Fujioka MD, PhD, Toshikazu Kubo MD, PhD, Akiko Tamakoshi MD, PhD, Masaki Nagai MD, PhD, MSc, Yoshio Hirota MD, PhD

Although numerous studies describe the clinical characteristics of idiopathic osteonecrosis of the femoral head (ONFH) in specific study populations, these have not been confirmed in countrywide studies.

Shed Blood-derived Cells from Total Hip Arthroplasty Have Osteoinductive Potential: A Pilot Study

Tomokazu Yoshida MD, Masakazu Ishikawa MD, PhD, Yuji Yasunaga MD, PhD, Takuma Yamasaki MD, PhD, Mitsuo Ochi MD, PhD

Cell therapy using autologous cells has been used in the treatment of various medical conditions. The mononuclear cell (MNC) fraction of bone marrow (BM) contains stem/progenitor cells that could contribute to osteogenesis and angiogenesis.

Rotational References for Total Knee Arthroplasty Tibial Components Change with Level of Resection

Bradley P. Graw MD, Alexander H. Harris PhD, Krishna R. Tripuraneni MD, Nicholas J. Giori MD, PhD

Various landmarks can guide tibial component rotational alignment in routine TKA, but with the deeper tibial resection levels common in complex primary and revision TKAs, it is unknown whether these landmarks remain reliable.

Do Porous Tantalum Implants Help Preserve Bone?: Evaluation of Tibial Bone Density Surrounding Tantalum Tibial Implants in TKA

Alicia K. Harrison MD, Terence J. Gioe MD, Christine Simonelli MD, Penny J. Tatman MPH, Mary C. Schoeller RT(R), CDT

TKA with conventional metal-backed tibial implants subjects the tibial metaphysis to stress shielding, with resultant loss of bone density.

Total Ankle Replacement Compatible with Ligament Function Produces Mobility, Good Clinical Scores, and Low Complication Rates: An Early Clinical Assessment

Sandro Giannini MD, Matteo Romagnoli MD, John J. O’Connor PhD, Francesco Malerba MD, Alberto Leardini DPhil

A three-part ankle replacement was developed to achieve compatibility with the natural ligaments by allowing fibers on the medial and lateral sides to remain isometric during passive motion. Unlike all current prostheses, the new design uses nonanatomically shaped components on the tibia and talus and a fully conforming interposed meniscal bearing.

Multiplanar Osteotomy with Limited Wide Margins: A Tissue Preserving Surgical Technique for High-grade Bone Sarcomas

Raffi S. Avedian MD, Rex C. Haydon MD, PhD, Terrance D. Peabody MD

Limb-salvage surgery has been used during the last several decades to treat patients with high-grade bone sarcomas. In the short- and intermediate-term these surgeries have been associated with relatively good function and low revision rates. However, long-term studies show a high rate of soft tissue, implant, and bone-related complications. Multiplanar osteotomy with limited wide margins uses angled bone cuts to resect bone tumors with the goal of complete tumor removal while sparing host tissue although its impact on local recurrence is not known.

Curettage and Cryosurgery for Low-grade Cartilage Tumors Is Associated with Low Recurrence and High Function

David G. Mohler MD, Richard Chiu MS, David A. McCall MD, Raffi S. Avedian MD

Chondrosarcomas of bone traditionally have been treated by wide or radical excision, procedures that may result in considerable lifelong disability. Grade 1 chondrosarcomas have little or no metastatic potential and are often difficult to distinguish from painful benign enchondromas. Curettage with adjuvant cryosurgery has been proposed as an alternative therapy for Grade 1 chondrosarcomas given the generally better function after the procedure. However, because it is an intralesional procedure, curettage and cryosurgery may be associated with higher rates of recurrence.

Office-based Core Needle Biopsy of Bone and Soft Tissue Malignancies: An Accurate Alternative to Open Biopsy with Infrequent Complications

Sheila C. Adams MD, Benjamin K. Potter MD, David J. Pitcher MD, H. Thomas Temple MD

Biopsy is a critical step in the diagnosis of musculoskeletal malignancy. As an alternative to open biopsy, percutaneous core needle biopsy techniques have been developed. As many studies combine office-based, image-guided, and operative biopsies, the accuracy of office-based core needle biopsy is not well documented.

Osseointegrated Titanium Implants for Limb Prostheses Attachments: Infectious Complications

Jonatan Tillander MD, Kerstin Hagberg RPT, PhD, Lars Hagberg MD, PhD, Rickard Brånemark MD, PhD

The concept of osseointegration involves direct contact between titanium implant and bone. This transcutaneous prosthetic system for amputees is intended to assure stable long-term fixation. Most metal transcutaneous implants have failed, primarily owing to infection.

Maggot Excretions Inhibit Biofilm Formation on Biomaterials

Gwendolyn Cazander MD, Mariëlle C. Veerdonk, Christina M. J. E. Vandenbroucke-Grauls MD, PhD, Marco W. J. Schreurs PhD, Gerrolt N. Jukema MD, PhD

Biofilm-associated infections in trauma surgery are difficult to treat with conventional therapies. Therefore, it is important to develop new treatment modalities. Maggots in captured bags, which are permeable for larval excretions/secretions, aid in healing severe, infected wounds, suspect for biofilm formation. Therefore we presumed maggot excretions/secretions would reduce biofilm formation.

Do Scores of the USMLE Step 1 and OITE Correlate with the ABOS Part I Certifying Examination?: A Multicenter Study

Paul J. Dougherty MD, Norman Walter MD, Peter Schilling MD, Soheil Najibi MD, PhD, Harry Herkowitz MD

The US Medical Licensing Examination (USMLE) and Orthopaedic In-Training Examination (OITE) are commonly used to select medical students or residents, respectively. Knowing how well these examinations predict performance on the American Board of Orthopaedic Surgery (ABOS) Part I certifying examination is important to provide evaluations for medical students and residents. Previous studies comparing the OITE scores with the ABOS Part 1 scores have been limited to one program.

Editorial: Self-citation in Publishing

Andreas F. Mavrogenis MD, Pietro Ruggieri MD, PhD, Panayiotis J. Papagelopoulos MD, DSc

Case Report: Hemosiderotic Fibrohistiocytic Lipomatous Lesion: A Clinicopathologic Characterization

Vincent M. Moretti MD, John S. J. Brooks MD, Christian M. Ogilvie MD

A hemosiderotic fibrohistiocytic lipomatous lesion, also called hemosiderotic fibrolipomatous tumor, is a rare and recently described fibrolipomatous entity. Initially considered the result of a reactive inflammatory process from trauma or vascular disease, newer evidence suggests it may be neoplastic in origin.

Case Report: Calcific Tendinitis of the Rectus Femoris: A Rare Cause of Snapping Hip

Luca Pierannunzii MD, Filippo Tramontana MD, Mauro Gallazzi MD

Internal snapping hip is a syndrome caused by recurrent subluxation of the iliopsoas tendon. There is little agreement regarding the impinging sites responsible for the jerky motion of the tendon. Thus far, the lesser trochanter, anterior capsule, and iliopectineal eminence are considered the most likely catching sites.

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