Publications by authors named "David Pedowitz"
Article Synopsis
- - The study examined trends in pickleball-related Achilles tendon injuries over the past decade, particularly among the aging population, due to the sport’s growing popularity.
- - Researchers identified 43 cases of Achilles tendon ruptures related to pickleball from a larger pool of 2,684 injuries, noting an increase since 2016, with a significant dip in 2020 likely due to COVID-19.
- - Findings showed older players (average age 64.5) had these injuries and were more likely to require surgery (67.4%) compared to the general population with Achilles injuries.
Background: Resiliency is the ability to recover from stressful events and has been shown to correlate with patient outcomes following certain orthopaedic procedures. The purpose of this study was to determine the relationship between resiliency and outcomes following TAA.
Methods: A retrospective analysis of patients undergoing primary TAA between April 2015 and September 2022 was performed (N = 83).
Surgical augmentation methods have been introduced to the Modified Broström (MB) technique to support native anterior talo-fibular ligament (ATFL) healing and function. This study aimed to investigate the isolated biomechanical performance of common MB augmentation elements, including allograft, suture tape, and copolymer, compared to native ATFL. Six cadaveric feet were dissected, isolating the ATFL from all surrounding soft tissue.
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- This study compared foot and ankle patient education materials generated by AI chatbots (ChatGPT, Google Bard, and Bing AI) to the American Orthopaedic Foot and Ankle Society's recommended site, FootCareMD.org.
- The AI-generated content for 10 common foot and ankle conditions was analyzed for accuracy, scoring below 60% across all categories compared to the AOFAS website.
- Overall, the AI platforms provided limited accuracy, with ChatGPT averaging 46.2% accurate information, while Google Bard and Bing AI scored 36.5% and 28.0%, respectively.
Background: The decision regarding total ankle replacement (TAR) is challenging in patients with inflammatory arthritis (IA) regarding more inferior bone quality, large bone cysts, and increased risk of infections. This systematic review and meta-analysis aimed to compare the functional outcome, revision rate, complication rate, and survival rate of TAR between IA (including rheumatoid arthritis [RA]) and noninflammatory arthritis (NIA) (primary and posttraumatic).
Methods: After reviewing the full texts, 30 articles fulfilled all inclusion criteria from 1985 until 2021, comparing TAR results.
Introduction Diversion of unused prescription opioids is a common source of opioid sensitization in the community. Educating patients about safe opioid use has been shown to be effective in decreasing opioid use. However, decreasing diversion will also require educating patients on proper opioid disposal.
View Article and Find Full Text PDFNationwide perspectives on cannabis have changed dramatically over recent decades. Although cannabis remains illegal at the federal level, medical cannabis (MC) is now legal in most states, and research has continued to show its effectiveness in a variety of medical conditions. However, both perception and acceptance of MC by the general public are evolving and remain poorly understood.
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- A study examined the occurrence of incidental torn plantar plates in both symptomatic and asymptomatic patients undergoing foot MRIs from 2019 to 2020.
- Out of 218 patients, 28% of symptomatic individuals had torn plantar plates, compared to only 2% in asymptomatic patients, indicating a significant difference in findings.
- The research concluded that the likelihood of a false-positive plantar plate tear in asymptomatic patients is very low, suggesting MRIs are reliable in identifying true occurrences of the tear.
Article Synopsis
- The study investigates if closed suction drains used after total ankle arthroplasty (TAA) lead to fewer wound complications in the first year post-surgery compared to no drains.
- A total of 324 TAA cases were analyzed, comparing outcomes in 144 patients without drains to 180 patients with drains over various follow-up periods.
- Results indicated that while drains were associated with a higher rate of complications in the first 2 weeks, no significant differences were observed in complications or reoperations in the following months, leading to a cautious recommendation regarding drain use.
Article Synopsis
- There is a lack of comprehensive research on adverse events (AEs) following outpatient orthopedic surgeries, and existing detection methods primarily use billing data and self-reports, which often miss a significant number of AEs.
- The trigger method, which identifies specific "triggers" as indicators for further investigation, is gaining traction as a more effective way to detect AEs compared to traditional methods.
- This study focuses on analyzing six EHR-based triggers to predict AEs after outpatient surgeries and emphasizes the need for further research to better implement these triggers for improving post-surgery outcomes.
Background: Total ankle arthroplasty (TAA) is an increasingly popular option for the operative treatment of ankle arthritis. The Cadence TAA entered clinical use in 2016 and was designed to address common failure modes of prior systems. We report early complications and radiographic and clinical outcomes of this total ankle system at a minimum of 2 years of follow-up.
View Article and Find Full Text PDFThe objective of this study was to investigate the effect of standardized preoperative opioid counseling on postoperative opioid consumption for patients undergoing outpatient lower extremity orthopaedic surgery. Participating patients undergoing elective outpatient lower extremity orthopaedic surgery were randomized to either receive preoperative opioid counseling or not receive counseling (control group). Counseling was delivered via a five-minute pre-recorded standardized video preoperatively.
View Article and Find Full Text PDFIntroduction: Previous literature has demonstrated an association between acute opioid exposure and the risk of long-term opioid use. Here, the investigators assess immediate postoperative opioid consumption patterns as well as the incidence of prolonged opioid use among opioid-naïve patients following ankle fracture surgery.
Methods: Included patients underwent outpatient open reduction and internal fixation of an ankle or tibial plafond fracture over a 1-year period.
Article Synopsis
- The study investigates the relationship between patients' self-reported pain tolerance and their use of prescription opioids after foot and ankle surgery.
- A total of 700 patients provided data on pain tolerance and opioid consumption, revealing that higher pain tolerance scores correlated with lower opioid use.
- The findings suggest that assessing patients' pain thresholds pre-surgery could help surgeons develop better postoperative pain management strategies.
The goal of training in orthopedic residency is to produce surgeons who are proficient in all aspects of the practice of orthopedic surgery; however, most residents receive either inadequate or no training in medical coding. The purpose of this study was to determine how well orthopedic residents code when compared with practicing surgeons and to identify whether coding education improves accuracy in medical coding. A mock coding survey was developed using commonly encountered orthopedic clinical scenarios.
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- Despite achieving normal alignment after hallux valgus correction surgery, many patients still experience pain, potentially linked to arthritic changes at the metatarsal head where it meets the sesamoids.* -
- A study involving 200 feet showed that over 50% had severe arthritis in the metatarsal head area, with age and intermetatarsal angle being significant risk factors for these changes.* -
- The findings indicate a high prevalence of arthritis during surgery, but these changes did not significantly impact patients’ preoperative pain or functional levels.*
Background: Ankle and lower leg injuries are very common in sports, and numerous studies have discussed their diagnosis and management. Our study differs in that we report lower leg injuries in professional baseball players spanning the 2011-2016 seasons by utilizing a comprehensive injury surveillance system developed by Major League Baseball (MLB).
Purpose: To determine the injury characteristics of ankle and lower leg injuries in professional baseball players during the 2011-2016 seasons by utilizing the MLB injury surveillance system.
Postoperative management of hallux valgus varies widely. Setting preoperative expectations is an important aspect of attaining a successful outcome, but this is not routinely reviewed in the literature. This chapter offers suggestions on successfully navigating this area of patient care.
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- Brake reaction time (BRT) testing is crucial for determining safe return-to-driving guidelines after orthopedic surgery, but no effective clinical tool exists for assessing driver safety during recovery.
- A new validated survey was developed to help predict safe driving readiness after specific foot and ankle surgeries, involving 171 patients who responded to a 4-question survey and completed a BRT test at 6 weeks post-surgery.
- Findings showed that 95% of patients passed the BRT within about 7.6 weeks, and a score of 10/15 or higher on the survey could predict a passing BRT with 99% accuracy.
Background: The investigation of nonnarcotic drug regimens for postoperative pain management is important in addressing the opioid epidemic. NSAIDs can be a powerful adjunct in managing postoperative pain, but the possibility of delayed bone healing is a major concern for orthopaedic surgeons. Our recent retrospective study on ketorolac administration demonstrated that the NSAID is not associated with an increased risk of delayed union or nonunion after ankle fracture surgery.
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- With the rise in total ankle arthroplasties (TAA), understanding when patients can safely return to driving is crucial, as ankle movement plays a key role in braking.
- The study aimed to determine if brake-reaction time returns to safe levels within 6 weeks post-TAA and what factors might delay this recovery.
- Results showed that at 6 weeks, 92% of patients passed the brake-reaction test, indicating that most could drive safely again shortly after surgery.
Recommendation: Overall, the approach to a potentially infected total ankle arthroplasty (TAA) does not change compared to other periprosthetic joint infections (PJIs). There are no novel or unique diagnostic procedures for TAA infection, specifically. Joint aspiration or intraoperative tissue/synovial biopsies with microbiological cultures are the most important diagnostic tests for suspected TAA infections.
View Article and Find Full Text PDFRecommendation: The optimal antibiotic treatment after foot/ankle fractures or fusion should be determined based on the result of culture. In the absence of culture results, administered antibiotics should include coverage against common pathogens such as .
Level Of Evidence: Strong.
Recommendation: Debridement, antibiotics, and implant retention (DAIR) in acute total ankle arthroplasty (TAA) infections may be an acceptable treatment option. If performed, DAIR should be done meticulously, ensuring that all necrotic or infected tissues are removed and modular parts of the prosthesis, if any, exchanged. The infected joint should also be irrigated with antiseptic solutions.
View Article and Find Full Text PDFBackground: Postoperative pain management following orthopedic surgeries can be challenging, and the opioid epidemic has made it essential to better individualize opioid prescriptions by patient and procedure. The purpose of this subgroup analysis of a prospective study was to investigate immediate postoperative opioid pill consumption and prolonged use in patients undergoing operative correction of hallux valgus (HV).
Methods: Patients undergoing outpatient HV correction procedures with 5 fellowship-trained foot and ankle surgeons over a 1-year period were included.