Orthopaedic Provider Coding Trends After 2021 Changes to the Current Procedural Terminology Evaluation and Management Coding Guidelines: A Retrospective Cohort Study.

Background: The goal of this study was to determine changes in orthopaedic coding practices between December 2020 and January 2021 after training providers on the 2021 Current Procedural Terminology Evaluation and Management (E&M) Centers for Medicare and Medicaid Services guideline changes.

Methods: Outpatient encounters in December 2020, January 2021, December 2021, and January 2023 were grouped by provider and E&M code level. The codes used for established patients were 99211, 99212, 99213, 99214, and 99215, ordered from low to high-complexity visits.

Ethical Considerations in Selection of Procedure Location: Hospital Versus Surgery Center.

Ambulatory surgery centers (ASCs) are an alternative to hospitals for outpatient orthopedic surgeries. ASCs can offer lower costs, faster turnover times, and lower operative times while maintaining similar safety and readmission rates. However, hospitals can offer more robust care in the perioperative period and are better equipped to handle any complications.

Operative management of Charcot neuropathy of the foot and ankle: A retrospective cohort study of long-term outcomes.

Treatment of Charcot neuroarthropathy (CN) of the foot and ankle remains challenging for both patients and surgeons. Nonoperative treatment with cast/orthosis immobilization has long been the main treatment, but surgical intervention has gained interest to improve poor long-term outcomes. Few long-term outcome studies exist on operative management of CN.

Surgical Outcomes in Charcot Arthropathy.

Treatment of Charcot neuroarthropathy (CN) of the foot and ankle remains challenging for both patients and surgeons. Nonoperative treatment with cast/orthosis immobilization has long been the mainstay of treatment, but surgical intervention has gained interest to improve poor long-term outcomes. A review of existing data on the operative management of CN demonstrates the potential benefits but also the continued risks associated with treatment.

The Differentiation Between Infection and Acute Charcot.

The differentiation between acute Charcot neuroarthropathy and infection in the foot and ankle should be supported by multiple criteria. A detailed history and physical examination should always be completed. Plain radiographs should be performed, though advanced imaging, currently MRI, is more helpful in diagnosis.

Tibiotalocalcaneal Arthrodesis Using Hybrid Plate-Nail Constructs: A Novel Technique for Treatment of Unstable Ankle and Hindfoot Deformities.

Tibiotalocalcaneal (TTC) arthrodesis is a treatment option for several pathologies of the ankle and hindfoot, including acute trauma, posttraumatic arthritis, and Charcot neuroarthropathy. Traditional fixation options for TTC arthrodesis include intramedullary hindfoot nailing or internal fixation with plates and/or screws. In certain patients, either due to poor bone quality, impaired sensation, or concern for noncompliance, more robust fixation may be desired.

The chevron bunionectomy for moderate to severe hallux valgus deformity: Effects of procedural factors on hallux valgus correction.

Background: Effects of procedural factors on chevron bunionectomy outcomes were studied.

Methods: Included were 109 feet with distal chevron osteotomy and preoperative intermetatarsal angle (IMA) greater than 15 degrees. IMA and hallux valgus angles (HVA), release type, fixation, second-digit procedures, and risk factors were evaluated.

Cost Analysis and Reimbursement of Weightbearing Computed Tomography.

Background: Weightbearing computed tomography (WBCT) is becoming a valuable tool in the evaluation of foot and ankle pathology. Currently, cost analyses of WBCT scanners in private practice are lacking in the literature. This study evaluated the costs of acquisition, utilization, and reimbursements for a WBCT at a tertiary referral center, information of particular interest to practices considering obtaining such equipment.

Comparing Rates of Fusion and Time to Fusion in Viable Cellular Allograft and Autograft.

Background: Autograft or allograft frequently are used to enhance bone union in foot and ankle surgery. Viable cellular bone allograft uses viable cells and bone scaffolding in a gel base, but uncertainty remains around allograft's greater efficacy than autograft regarding rates of fusion (ROF) and time to fusion (TTF).

Methods: Autograft, viable cellular allograft, and viable cellular allograft with autograft were compared in 199 forefoot, midfoot, and hindfoot arthrodeses performed over a 6-year period.

A Direct Posterior Approach for Subtalar Distraction Arthrodesis.

Because of soft tissue constraints, definitive management of hindfoot trauma occasionally requires a direct posterior approach via a coronal split of the Achilles tendon. This article and the accompanying video demonstrate a direct posterior approach for subtalar distraction arthrodesis and review treatment decisions involved with management of these complex cases.

Efficacy of Postoperative Oral Antibiotics in Foot and Ankle Surgery.

Background: Preoperative oral antibiotic use in patients undergoing foot and ankle surgery is standard practice, but no consensus has been reached regarding the efficacy of postoperative oral antibiotics. The purpose of this study was to determine whether postoperative oral antibiotics reduce the rate of surgical site infections (SSIs) in patients, with and without comorbidities, undergoing foot and ankle surgery.

Methods: A retrospective chart review was conducted identifying patients who underwent foot and ankle surgery by 4 fellowship-trained, foot and ankle orthopaedic surgeons between January 1, 2015, and January 1, 2019.

Bilateral Charcot Arthropathy Treated with Bolt-Beam Constructs in the Setting of Unilateral Foot Ulcers: A Report of 2 Cases.

Case: Two type-2 diabetic patients presented with bilateral Charcot arthropathy with midfoot collapse and presence of foot ulcerations on one side. The ulcerated extremity in each patient was treated surgically with fusion bolt, beam, and plate constructs in the setting of open ulceration. Bilateral extremities were treated surgically and went on to bony union and wound healing.

Early Failure of the Paragon28 Phantom Hindfoot Fusion Nail: A Case Report.

Case: Tibio-talar-calaneal fusion nails can be used to treat acute ankle fractures in patients with diabetes, Charcot arthropathy, or other comorbidities. Recently, Paragon28 released the Phantom Hindfoot Fusion Nail (Phantom nail) with a unique design feature-a proximal coil. We present a case of an ankle fracture-dislocation in a diabetic patient treated with the Paragon28 nail who experienced early implant failure.

Analysis of Wheeled Knee Walker Use following Foot and Ankle Surgery or Injury.

To determine patient satisfaction and safety with wheeled knee walkers, we performed a retrospective, observational, and descriptive study. Inclusion criteria were age ≥18 years, unilateral foot or ankle surgery, non-weightbearing status, and being given the option of using the knee walker. Surveys were sent to eligible patients, and chart review included only those patients who returned surveys.

Race and Insurance Status Association With Receiving Orthopedic Surgeon-Prescribed Foot Orthoses.

Background: This study looked at the effect of patient demographics, insurance status, education, and patient opinion on whether various orthotic footwear prescribed for a variety of diagnoses were received by the patient. The study also assessed the effect of the orthoses on relief of symptoms.

Methods: Chart review documented patient demographics, diagnoses, and medical comorbidities.

The Current State of the Residency Match.

This article explores the current state of the residency match in 2020 with a focus on orthopedic surgery, analyzing the utility of current applicant screening methods in producing future generations of competent surgeons. Discussed are anticipated changes to the residency application process considering the COVID-19 pandemic and Step 1 becoming pass/fail in January 2022. Also explored are potential changes to improve the process for applicants and residency programs, such as identifying and using predictive factors of resident success in the applicant screening process, finding better ways to match applicants with programs, and increasing female and underrepresented minorities within orthopedics.

Smoking Effects in Foot and Ankle Surgery: An Evidence-Based Review.

Background: The purpose of this article was to review the basic science pertaining to the harmful effects of cigarette smoke, summarize recent clinical outcome studies, and examine the benefits of smoking cessation and the efficacy of current smoking cessation strategies.

Methods: The literature concerning basic science, clinical outcomes, and smoking cessation was reviewed; over half (56%) of the 52 articles reviewed were published in the last 5 years.

Results: Smoking is associated with low bone mineral density, delayed fracture union, peri-implant bone loss, and implant failure.

Cost Comparison of Surgically Treated Ankle Fractures Managed in an Inpatient Versus Outpatient Setting.

Introduction: Although choices physicians make profoundly affect the cost of health care, few surgeons know relative costs associated with the setting in which care is provided. Without valid cost information, surgeons cannot understand how their choices affect the total cost of care.

Methods: Actual costs for all isolated, surgically treated ankle fractures at a level I trauma hospital and affiliated outpatient surgery center were determined using a validated episode of care costing system and analyzed using multivariate regression analysis in this retrospective cohort study.

Early Clinical and Radiographic Outcomes of Trabecular Metal Total Ankle Replacement Using a Transfibular Approach.

Background: In the last 2 decades, total ankle replacement has gained greater acceptance as a treatment option in patients with end-stage ankle osteoarthritis. However, there is a lack of literature on total ankle replacement using a lateral transfibular approach. Therefore, we sought to report early clinical and radiographic results for a patient cohort treated with total ankle replacement using a lateral transfibular approach, performed by a single surgeon.

Distal Femoral Replacement for Acute Distal Femoral Fractures in Elderly Patients.

Objectives: To evaluate outcomes and complications using cemented modular distal femoral replacement in elderly patients with distal femoral fractures.

Design: Retrospective chart review, case series.

Setting: A Level 1 and Level 2 trauma center, both tertiary referral hospitals.

Is Gelsolin a Biomarker for Aseptic Loosening After Total Knee Arthroplasty?

Gelsolin (GSN) has been implicated in inflammatory reactions in asthmatic patients and may be a marker for acute or chronic reactions in synovial tissue. Detection of increased levels of GSN in synovial fluid could differentiate between aseptic loosening (low GSN) and hypersensitivity reaction (high GSN). Synovial fluid from both knees of 7 cadaver specimens with unilateral TKA was analyzed using ELISA for GSN levels.

Effect of Obesity on Outcomes of Forefoot Surgery.

Background: Forefoot surgery typically is elective, so it is important to define risk factors to educate patients on potential complications. The purpose of this study was to determine if obesity is an independent risk factor that contributes to increased complication rates after forefoot surgery.

Methods: Through a retrospective review of records, 633 patients were identified who had forefoot surgery at one institution between 2008 and 2010.

Cigarette smoking increases complication rate in forefoot surgery.

Background: Cigarette smoking is known to increase perioperative complication rates, but no study to date has examined its effect specifically in forefoot surgery. The purpose of this study was to determine whether cigarette smoking increased complications after forefoot surgery.

Methods: The records of 602 patients who had forefoot surgery between 2008 and 2010, and for whom smoking status was known, were reviewed.