NSAID use in orthopedic surgery: A review of current evidence and clinical practice guidelines.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a valuable class of medications for orthopedic surgeons and often play a pivotal role in pain control. However, there are many common stipulations resulting in avoidance of its use in the treatment of musculoskeletal disease. This review summarizes the mechanism of action of NSAIDs as well as provides an overview of commonly used NSAIDs and the differences between them.

Resilience correlates with patient-reported outcome measures at a minimum of 2 years after arthroscopic rotator cuff repair.

Aims: We aimed to evaluate the correlation between preoperative and postoperative resilience scores and postoperative outcomes at minimum 2-year follow-up after arthroscopic rotator cuff repair.

Methods: We prospectively enrolled 98 patients who underwent rotator cuff repair. We assessed resilience using the Brief Resilience Scale.

Low rate of secondary surgery and implant removal following superior, precontoured plating of midshaft clavicle fractures.

Background: Surgical fixation of midshaft clavicle fractures with a single 3.5 mm superior clavicular plate has been associated with a high rate of hardware removal due to symptomatic hardware. Because of this, dual-plating techniques with lower-profile implants have been proposed.

A Systematic Review of Satisfaction Measures in Hand and Wrist Surgery.

Purpose: Patient-reported experience measures (quantifying satisfaction, trust, perceived clinician empathy, and communication effectiveness) may not be developed with the same rigor as patient-reported outcome measures (quantifying comfort and capability). We systematically reviewed the use of measures used to evaluate satisfaction with hand surgery by comparing recent (2017-2019) and remote (2000-2002) publications to assess the use of satisfaction measures and areas for potential improvement.

Methods: An initial search yielded 6,159 studies, 278 of which met the eligibility criteria.

Impact of patient resilience on early recovery from rotator cuff repair.

Aims: We sought to evaluate early recovery from rotator cuff repair by assessing the correlation between patient resilience and postoperative shoulder pain and function, and physical and mental health.

Methods: Patients scheduled to undergo arthroscopic rotator cuff repair were prospectively enrolled. Resilience was assessed using the Brief Resilience Scale (BRS), pain and function was measured by American Society of Shoulder and Elbow Surgeons (ASES) shoulder scores, and physical and mental health was measured by the Patient-Reported Outcome Measurement Information System Global Health-10 (PROMIS-10).

Social Media Use by Hand Surgery Fellowship Programs.

Introduction: Social media has emerged as a useful tool in the fellowship recruitment process. We aimed to assess the prevalence of social media use among hand surgery fellowships, to analyze social media posts according to content, and to evaluate the level of engagement generated by specific content.

Methods: We used a list of accredited hand surgery fellowships from the American Society for Surgery of the Hand Fellowship Directory to identify all hand surgery fellowship profiles on Facebook, Twitter, and Instagram.

Junior doctor-led quality improvement project to improve safety and visibility of an interspecialty referral system.

Interspecialty referrals for increasingly complex hospital inpatients are common and miscommunication often leads to delays in patient care. In a district general hospital, a web-based system generated an email referral, which lacked visibility and tracking/audit of the process, with no record generated automatically in paper inpatient notes or electronic patient records (EPR). We aimed to improve the visibility and safety of the interspecialty referral system.

Clinical Pathways of Patients Denied Total Knee Arthroplasty Due to an Institutional BMI Cutoff.

Out of concern for the increased risk of complications with morbid obesity, institutional body mass index (BMI) cutoffs for total knee arthroplasty (TKA) have become commonplace. We sought to answer the questions: what percentage of morbidly obese patients with knee osteoarthritis who present to an arthroplasty clinic will, within 2 years, undergo TKA at (1) a BMI less than 40 kg/m or (2) at a BMI greater than 40 kg/m? Of those who do not undergo surgery, (3) what percentage lose enough weight to become TKA-eligible, and (4) what percentage do not? We performed an observational study of 288 patients, of which 256 had complete follow-up. Institutional electronic medical record review and patient follow-up by telephone were conducted to determine which patients underwent surgery, and at what BMI.

Intraoperative navigation and preoperative templating software are associated with increased glenoid baseplate screw length and use of augmented baseplates in reverse total shoulder arthroplasty.

Background: Preoperative templating software and intraoperative navigation have the potential to impact baseplate augmentation utilization and increase screw length for baseplate fixation in reverse total shoulder arthroplasty (rTSA). We aimed to assess their impact on the (1) baseplate screw length, (2) number of screws used, and (3) frequency of augmented baseplate use in navigated rTSA.

Methods: We compared 51 patients who underwent navigated rTSA with 63 controls who underwent conventional rTSA at a single institution.

Adolescent vertebral osteomyelitis mimicking a neoplasm.

A 14-year-old previously healthy girl presented with atraumatic onset of low back and flank pain and mildly elevated inflammatory markers. Magnetic resonance imaging disclosed an L5 superior endplate fracture, and cultures grew methicillin-susceptible S. We discuss the variable presentations and appropriate treatments of adolescent vertebral osteomyelitis.

Shared Decision-making in Orthopaedic Surgery.

Shared decision-making (SDM) is the process by which the physician and the patient collaborate to arrive at the evidence-based treatment that best aligns with the patient's individual goals of care. The implementation of SDM practices is especially important when an invasive surgical procedure is among the treatment options. Ideally, the variation in the patient treatment choice would mirror the variability in patient goals rather than variation in a physician's ability to communicate effectively.

What role does metal allergy sensitization play in total knee arthroplasty revision?

Background: Clinicians are often faced with the decision whether to revise a painful total knee replacement in patients who have chronic vague pain with no apparent explanation. A sensitive metal testing assay called the lymphocyte stimulation test has been used to detect nickel sensitization in patients with orthopedic implants. We hypothesize that nickel sensitization plays a role in the pathology of failed joint arthroplasty in patients with unexplained dissatisfaction.