Nonsurgical Management of Osteoarthritis of the Knee: What You Should Be Injecting Now and in the Future.

Osteoarthritis of the knee affects many Americans. With the aging of the population and increasing comorbidities (eg, obesity, diabetes, hypertension, heart disease), the use of oral or topical NSAIDs is often contraindicated. Injectable treatment options are advantageous because of the ability to decrease or avoid the unwanted systematic adverse effects of NSAIDs.

Editorial Commentary: Release of the Medial Collateral During Arthroscopic Meniscectomy Should Be Encouraged, Not Feared!

In patients having arthroscopic medial meniscectomy, percutaneous pie crust or intra-articular release of the proximal medial collateral ligament is preferable to iatrogenic damage to the cartilage of the medial femoral condyle. In patients with tight medial compartments, release is recommended. Release of the medial collateral ligament during arthroscopic partial medial meniscectomy does not result in morbidity and should be encouraged, not feared.

The Conservative Treatment of Osteoarthritis of the Knee.

Osteoarthritis has one of the highest associations for all-cause mortality in the United States. Comorbidities are common in patients with end-stage disease. In most cases, it is critical to exhaust conservative modalities of care before resorting to surgical intervention.

Editorial Commentary: Knee Meniscus and Hip Labrum: The Dilemma of Degenerative Tears.

The dilemma for orthopaedic surgeons attempting to solve the problem of treating a knee meniscal tear in an older patient has always been whether or not a conservative approach is of value and if a surgical approach will provide benefit to the patient. Today, the same might be said of hip labral tears. Physical therapy is a wonderful tool to strengthen muscles, but it does not correct underlying pathology, which is often the source of joint pain.

Employment Contracts: The Good, the Bad, and the Ugly.

Recent trends indicate that a greater number of orthopaedic surgeons who complete their residency and/or fellowship training are accepting employment positions at hospitals. Moreover, established orthopaedic surgeons with successful private practices have begun to consider whether aligning with hospitals and larger health systems can be effectively accomplished. A comprehensive evaluation of institution-based employment opportunities is essential for orthopaedic surgeons considering hospital-based employment.

Outpatient Total Joint Arthroplasty.

Purpose Of Review: Outpatient total joint arthroplasty (OTJA) allows for a safe, cost effective pathway for appropriately selected patients. With current pressures on arthroplasty surgeons and their associated institutions to reduce costs per episode of care, it is important to define the steps and challenges associated with establishing an outpatient arthroplasty program.

Recent Findings: Several studies have outlined techniques of selecting patients suitable for this type of postoperative pathway.

First, Do No Harm: Protect the Articular Cartilage When Performing Arthroscopic Knee Surgery!

It is not uncommon to damage the articular surface when performing routine arthroscopic surgical procedures of the knee. The article reviews the background, literature, and technique of performing a partial medial collateral ligament release in a tight knee when attempting to access the posterior medial compartment.

Getting Ready for ICD-10 and Meaningful Use Stage 2.

For the past 24 years, most developed countries have used the International Classification of Diseases, Tenth Revision (ICD-10) to report physician services. In the United States, physicians have continued to use the American Medical Association Current Procedural Terminology, Fourth Edition and the Healthcare Common Procedure Coding System. The ICD-10-Clinical Modification (CM) has approximately 4.

Abandoning microfracture of the knee: has the time come?

Marrow stimulation has been performed for more than 45 years beginning with the simple drilling of bony surfaces, burring or "abrading" the sclerotic lesion, and more recently using awls to penetrate eburnated bone to promote blood flow to the bony surface. Multiple authors have promoted these procedures as "helpful," but others have confirmed only short-term relief with destruction of the subchondral surface. Unfortunately, proponents do not compare their marrow stimulation results to a control group that had debridement alone.

Nonoperative treatment of unicompartmental arthritis: from bracing to injection.

The published recommendations for the nonoperative treatment of osteoarthritis (OA) of the knee include weight loss, physical therapy to strengthen lower-extremity musculature, nonsteroidal antiinflammatories, nutritional supplements, topical treatments, and steroid injections. Evidenced-based results have been mixed using these treatment modalities. The results using unloader braces and viscosupplementation have also been variable.

The pros and cons of hospital employment.

The pros and cons of hospital employment vary significantly in today's economic environment. This chapter summarizes the advantages and disadvantages of hospital employment with an emphasis on the critical aspect of formalizing an agreement with the hospital employer to prevent future salary reductions and/or termination.

Management of infections after arthroscopy.

Management and evaluations of infections after arthroscopy of the knee and shoulder can be difficult and fraught with complications, both medical and legal. This article reviews the literature regarding arthroscopic infections from a historical perspective and discusses the treatment of knee and shoulder infections as well as the complications associated with delayed treatment. It is critical to make the diagnosis as soon as possible subsequent to the initial procedure to avoid postoperative sequelae consisting of stiffness and a decrease in function.

Treatment of OA of the knee in the middle-aged athlete: the role of arthroscopy.

Knee arthroscopy for patients with osteoarthritis remains controversial. The outcome of arthroscopic debridement in a patient with symptomatic arthritis, and in the absence of mechanical symptoms, is inconsistent and short lived. However, in carefully selected patients with mild or moderate arthritis on standing radiographs, with the acute onset of symptoms, well-localized joint line pain, and painful mechanical symptoms, improved knee function can be expected.

Interscalene block for shoulder surgery in physician-owned community ambulatory surgery centers.

Purpose: To retrospectively report on a series of patients who had interscalene block regional anesthesia performed for outpatient open and arthroscopic shoulder surgical procedures in a community-based ambulatory surgery center setting.

Methods: We reviewed the cases of 1,945 patients who had interscalene block regional anesthesia performed during an 8-year period.

Results: The complication rate was 0.

Viscosupplementation with hylan g-f 20 in patients with osteoarthrosis of the knee.

Viscosupplementation (VIS) is one of several treatment modalities for osteoarthritis of the knee. It is useful in the treatment of osteoarthritis when other methods of conservative care have failed and it may be a safer method of treatment than oral chemical therapy which can have significant side effects with even short-term usage. The biochemical effects of hyaluronic acid are incompletely understood, however there are several accepted modes of action which result in a positive clinical effect on the function of the knee joint.

Current strategies for nonsurgical, arthroscopic, and minimally invasive surgical treatment of knee cartilage pathology.

The current approaches to treating articular cartilage defects in the knee comprise a spectrum from pharmacologic therapies to total knee arthroplasty. Nonsurgical treatment can include anti-inflammatory medications, bracing, and physical therapy. Surgical treatments include reconstructive repair of a small or large defect using microfracture, osteochondral autograft transplantation, autologous chrondrocyte transplantation, or osteochondral allograft transplantation; realignment procedures including osteotomies; and unicompartmental arthroplasty.

The use of hyaluronan after arthroscopic surgery of the knee.

Viscosupplementation is defined as the use of intra-articular hyaluronan therapy for symptomatic osteoarthritis (OA). Originally used for the treatment of ophthalmic disorders, viscosupplementation has been available for over a decade in the United States for the treatment of pain secondary to OA of the knee in patients who have not responded adequately to conservative oral pharmaceuticals including nonsteroidal anti-inflammatories and simple analgesics. The majority of patients with symptomatic knee OA will have evidence of meniscal and/or articular surface pathology, and most orthopaedic surgeons include arthroscopic surgery as a possible treatment modality for the symptomatic patient.

Venous thromboembolism in lower extremity arthroscopy.

Venous thromboembolism (VTE) is a relatively rare complication of arthroscopic surgery of the lower extremity, but it does have the potential to result in significant morbidity and possible mortality. VTE has been reported to occur with knee arthroscopy, and guidelines for VTE prophylaxis before and after knee arthroscopy have been proposed. There are much fewer data regarding the incidence of VTE occurring after arthroscopy of the ankle and the hip.

Putting it all together: the efficient, profitable orthopedic practice.

In today's complex practice environment, the orthopedic surgeon is faced with multiple stressful practice decisions. To achieve a surgeon's personal practice goals of quality of care, quality of life, and improvement in quality of practice, the physician must commit himself or herself to a certain amount of restructuring of his or her practice. This article describes the elements necessary for successful restructuring.