A poor understanding of cost among healthcare providers may contribute to high healthcare expenditures. Currently, it is unclear whether and how much surgeons know about the costs of implantable medical devices (IMDs).
Emerging Ideas: Instability-induced Periprosthetic Osteolysis Is Not Dependent on the Fibrous Tissue Interface
Stable initial fixation of a total joint arthroplasty implant is critical to avoid the risk of aseptic loosening and premature clinical failure. With implant motion, a fibrous tissue layer forms at the bone-implant interface, leading to implant migration and periprosthetic osteolysis. At the time of implant revision surgery, proresorptive signaling cytokines are expressed in the periimplant fibrous membrane. However, the exact role of this fibrous tissue in causing periprosthetic osteolysis attributable to instability remains unknown.
Dislocation or liner dissociation of a total hip prosthesis usually results in pain and discomfort. Although several reports describe chronic dislocation and its treatment, chronic liner dissociation is an unreported complication.
Historically, physicians as participants in healthcare governance were shunned because of perceived potential for conflict of interest. This maxim is being revisited as health systems begin to appreciate the value presented by physician leaders.
Critical Roles of Orthopaedic Surgeon Leadership in Healthcare Systems to Improve Orthopaedic Surgical Patient Safety
The prevention of medical and surgical harm remains an important public health problem despite increased awareness and implementation of safety programs. Successful introduction and maintenance of surgical safety programs require both surgeon leadership and collaborative surgeon-hospital alignment. Documentation of success of such surgical safety programs in orthopaedic practice is limited.
Orthopaedic surgery practices can provide substantial value to healthcare systems. Increasingly, healthcare administrators are speaking of the need for alignment between physicians and healthcare systems. However, physicians often do not understand what healthcare administrators value and therefore have difficulty articulating the value they create in discussions with their hospital or healthcare organization. Many health systems and hospitals use service lines as an organizational structure to track the relevant data and manage the resources associated with a particular type of care, such as musculoskeletal care. Understanding service lines and their management can be useful for orthopaedic surgeons interested in interacting with their hospital systems.
The relationships between physicians and hospitals are viewed as central to the proposition of delivering high-quality health care at a sustainable cost. Over the last two decades, major changes in the scope, breadth, and complexities of these relationships have emerged. Despite understanding the need for physician-hospital alignment, identification and understanding the incentives and drivers of alignment prove challenging.
Recently, quality, financial, and regulatory demands have driven physicians to seek alignment opportunities with hospitals. The motivation for alignment on the part of physicians and hospitals is now accelerating because the new paradigm under healthcare reform requires an increased focus on improving quality, cost, and efficiency.
The key to successfully aligning hospitals and physicians is financial integration and joint incentives for academic, quality, and clinical productivity. Many physician practices and health systems are moving toward closer integration, but mainly through consolidation and employment strategies.
Developing a high-efficiency operating room (OR) for total joint arthroplasty (TJA) in an academic setting is challenging given the preexisting work cultures, bureaucratic road blocks, and departmental silo mentalities. Also, academic institutions and aligned surgeons must have strategies to become more efficient and productive in the rapidly changing healthcare marketplace to ensure future financial viability.
Physician-hospital alignments are becoming more common in today’s healthcare environment. In the community setting, these relationships can impact quality of care as well as physician and hospital bottom lines. Alignment strategies take many different forms and can be advantageous to both the community orthopaedist and the community hospital, but certain key factors must be present to prevent a failed effort. Both the physician and hospital must be clear about their goals and expectations to overcome barriers and ensure success.
There is broad recognition that the healthcare crisis in the United States is going to require a response and change in clinical practice. The management structure of Geisinger Health System is unique, and this has the potential to change the dynamics of surgeon-administration alignment.
The increasing cost of providing health care is a national concern. Healthcare spending related to providing hospital care is one of the primary drivers of healthcare spending in the United States. Adoption of advanced medical technologies accounts for the largest percentage of growth in healthcare spending in the United States when compared with other developed countries. Within the specialty of orthopaedic surgery, a variety of implants can result in similar outcomes for patients in several areas of clinical care. However, surgeons often do not know the cost of implants used in a specific procedure or how the use of an implant or technology affects the overall cost of the episode of care.
The growth of consumer-directed health plans has sparked increased demand for information regarding the cost and quality of healthcare services, including total joint arthroplasty (TJA). However, the factors that influence patients’ choice of provider when pursuing elective orthopaedic care, such as TJA, are poorly understood.
The future direction of American health care has become increasingly controversial during the last decade. As healthcare costs, quality, and delivery have come under intense scrutiny, physicians play evolving roles as “advocates” for both their profession and patients via healthcare policy. Hospital-physician alignment is critical to the future success of advocacy among orthopaedic surgeons, as both hospitals and physicians are key stakeholders in health care and can work together to influence major health policy decisions.
Percutaneous Release, Open Surgery, or Corticosteroid Injection, Which Is the Best Treatment Method for Trigger Digits?
Percutaneous A1 pulley release surgery for trigger digit (finger or thumb) has gained popularity in recent decades. Although many studies have reported the failure rate and complications of percutaneous release for trigger digit, the best treatment for trigger digit remains unclear.
Since the 18th century, the existence of ulnar nerve innervation of the medial head of the triceps brachii muscle has been controversial. The evidence for or against such innervation has been based on macroscopic dissection, an unsuitable method for studying intraneural topography or intramuscular branching. The study of smaller specimens (embryos or fetuses) by means of serial histologic sections may resolve the controversy.
While “diagrammatic” evaluation of finger joint angles using two folded paper strips as goniometric arms has been proposed and could be an alternative to standard goniometry and a means for self-evaluation, the measurement differences and reliability are unknown.
Is Cervical Disc Arthroplasty Superior to Fusion for Treatment of Symptomatic Cervical Disc Disease? A Meta-Analysis
As the current standard treatment for symptomatic cervical disc disease, anterior cervical decompression and fusion may result in progressive degeneration or disease of the adjacent segments. Cervical disc arthroplasty was theoretically designed to be an ideal substitute for fusion by preserving motion at the operative level and delaying adjacent level degeneration. However, it remains unclear whether arthroplasty achieves that aim.
Cumulative Revision Rate is Higher in Metal-on-Metal THA than Metal-on-Polyethylene THA: Analysis of Survival in a Community Registry
Metal-on-metal (MOM) THA bearing technology has focused on improving the arc of motion and stability and minimizing wear compared with traditional metal-on-polyethylene (MOP) bearing couples. It is unclear whether this more costly technology adds value in terms of improved implant survival.
The effect of the extent of osteonecrosis on the survival of hip resurfacing for osteonecrosis of the femoral head (ONFH) has not been well documented, but is a potentially important variable in the decision to perform resurfacing.
Traumatic posterior hip dislocation in adults is generally understood to be the result of a high-energy trauma. Aside from reduced femoral antetorsion, morphologic risk factors for dislocation are unknown. We previously noticed that some hips with traumatic posterior dislocations had evidence of morphologic features of femoroacetabular impingement (FAI), therefore, we sought to evaluate that possibility more formally.
Wide variation exists in reported prevalence estimates and management standards of developmental dysplasia of the hip (DDH). Discrepancies in diagnosticians’ opinions may explain some of this variation.
In Asia, obesity has reached epidemic proportions and physicians are likely to face a burden of obesity-related disorders, of which osteoarthritis of the knee is one. However, it is unclear whether obesity affects improvement of conventional TKAs in Asian patients.
TKA is one of the most commonly performed procedures in the elderly, yet whether age influences postoperative pain, function, and complication rates is not fully understood for this group. This is because the current literature has limited followup, small sample sizes, and no comparator group.
In studies of TKA, treating each knee as an independent case in patients with bilateral TKAs can lead to errors, because patients with bilateral and unilateral TKAs may achieve different levels of function and because the assumption of statistical independence is violated.
Unloader braces are a nonsurgical approach for predominantly unicompartmental knee arthritis. Although noninvasive, braces are expensive and it is unclear whether clinical factors, if any, will predict regular brace use.
Postoperative pain after TKA is a major concern to patients. The best technique to control pain is still controversial. Intrathecal morphine or periarticular multimodal drug injection are both commonly used and both appear to provide better pain control than placebo, but it is unclear whether one or the other provides better pain control.
Trends in the Surgical Treatment of Pathologic Proximal Femur Fractures Among Musculoskeletal Tumor Society Members
Several strategies for the treatment of pathologic proximal femur fractures are practiced but treatment outcomes have not been rigorously compared.
Surgical Technique: Computer-generated Custom Jigs Improve Accuracy of Wide Resection of Bone Tumors
Manual techniques of reproducing a preoperative plan for primary bone tumor resection using rudimentary devices and imprecise localization techniques can result in compromised margins or unnecessary removal of unaffected tissue. We examined whether a novel technique using computer-generated custom jigs more accurately reproduces a preoperative resection plan than a standard manual technique.
High Infection Rate Outcomes in Long-bone Tumor Surgery with Endoprosthetic Reconstruction in Adults: A Systematic Review
Limb salvage surgery (LSS) with endoprosthetic replacement is the most common method of reconstruction following bone tumor resection in the adult population. The risk of a postoperative infection developing is high when compared with conventional arthroplasty and there are no appropriate guidelines for antibiotic prophylaxis.
Outcomes After Volar Plate Fixation of Low-grade Open and Closed Distal Radius Fractures Are Similar
Low-grade (Gustilo and Anderson Type I or II) open distal radius fractures (DRFs) have been treated by volar locking plate fixation. However, it is unclear whether the outcomes after volar locking plate fixation for low-grade open DRFs are comparable to those for closed DRFs.