Narcotic Consumption in Opioid-Naïve Patients Undergoing Total Hip and Knee Arthroplasty.

Background: Total knee arthroplasty (TKA) is associated with increased risk of prolonged narcotic requirement compared to total hip arthroplasty (THA). This study aims to compare acute postoperative narcotic consumption between the 2 procedures and quantify amount of narcotics used by opioid prescribed.

Methods: From October 2017 to August 2019, patients were surveyed at 4-week follow-up to determine amount and duration of opioids used and whether they continued to require narcotics.

Narcotic Consumption in Opioid Naïve Patients Undergoing Unicompartmental and Total Knee Arthroplasty.

Background: Total knee arthroplasty (TKA) is associated with increased risk of prolonged narcotic requirement compared to unicompartmental knee arthroplasty (UKA). The purpose of the current study is to compare acute postoperative narcotic consumption between the 2 procedures and quantify narcotic consumption.

Methods: From October 2017 to August 2019 patients were surveyed for four weeks to determine the amount and duration of opioids consumed and requirement for continued narcotics.

Does a "July Effect" Exist for Fellowship Training in Total Hip and Knee Arthroplasty?

Background: The hypothetical association between health-care errors and the transition of the medical academic year has been termed the "July effect." Data supporting its existence are conflicting, particularly in orthopedic surgery, and prior studies have inappropriately grouped fellows with resident trainees. No studies to date have examined whether a training initiation effect exists among surgical fellows in adult reconstructive orthopedics.

Hemiarthroplasty or Total Hip Arthroplasty: Is There a Racial Bias in Treatment Selection for Femoral Neck Fractures?

Introduction: Hip fractures in the elderly individuals are associated with significant morbidity and mortality, and outcomes are directly related to prompt surgical intervention with either total hip arthroplasty (THA) or hemiarthroplasty. Minority hip fracture patients have increased delays to surgical intervention and poorer functional outcomes. This study explored racial biases in the surgical treatment decision between THA and hemiarthroplasty for displaced femoral neck fractures as well as racial disparities in postoperative complications, readmission rates, and 30-day mortality.

Treatment of Hip Flexion Contractures with Psoas Recession Through the Middle Window of the Ilioinguinal Approach.

Introduction: The ilioinguinal approach for psoas recession over the pelvic brim allows for direct visualization and protection of the femoral nerve while preserving hip flexion strength.

Step 1 Patient Positioning Preoperative Assessment And Draping: With the patient supine and anesthetized, perform the Thomas test, administer antibiotics, and drape to provide access to the inferior aspect of the abdomen, ilioinguinal region, and lower limb.

Step 2 Superficial Dissection: Mark the osseous landmarks, draw a line connecting the anterior superior iliac spine to the pubic tubercle, and make a bikini incision along this line.

Evaluation and Management of Failed Hemiarthroplasty.

Hemiarthroplasty is a common procedure for treatment of displaced femoral neck fractures in low-demand patients. As hip fracture incidence continues to increase, the need for revision hemiarthroplasty is also expected to increase. Multiple etiologies can result in a failed hemiarthroplasty, including persistent pain, infection, instability, leg-length discrepancy, and trauma.

Do illness rating systems predict discharge location, length of stay, and cost after total hip arthroplasty?

Background: As procedure rates and expenditures for total hip arthroplasty (THA) rise, hospitals are developing models to predict discharge location, a major determinant of total cost. The predictive value of existing illness rating systems such as the American Society for Anesthesiologists (ASA) Physical Classification System, Severity of Illness (SOI) scoring system, or Mallampati (MP) rating scale on discharge location remains unclear. This study explored the predictive role of ASA, SOI, and MP scores on discharge location, lengths of stay, and total costs for THA patients.

Using Illness Rating Systems to Predict Discharge Location Following Total Knee Arthroplasty.

Purpose: Total knee arthroplasty (TKA) is increasing in frequency and cost. Optimization of discharge location may reduce total expenditure while maximizing patient outcomes. Although preoperative illness rating systems-including the American Society for Anesthesiologists Physical Classification System (ASA), severity of illness scoring system (SOI), and Mallampati rating scale (MP)-are associated with patient morbidity and mortality, their predictive value for discharge location, length of stay (LOS), and total costs remains unclear.

Preoperative Opiate Use Independently Predicts Narcotic Consumption and Complications After Total Joint Arthroplasty.

Background: Multimodal pain protocols have reduced opioid requirements and decreased complications after elective total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, these protocols are not universally effective. The purposes of this study are to determine the risk factors associated with increased opioid requirements and the impact of preoperative narcotic use on the length of stay and inhospital complications after THA or TKA.

Late Complications Following Elective Primary Total Hip and Knee Arthroplasty: Who, When, and How?

Background: Improved pain management and early mobilization protocols have increased interest in the feasibility of short stay (<24 hours) or outpatient total hip (THA) and total knee (TKA) arthroplasty. However, concerns exist regarding patient safety and readmissions. The purposes of this study were to determine the incidence of in-hospital complications following THA/TKA, to create a model to identify comorbidities associated with the risk of developing major complications >24 hours postoperatively, and to validate this model against another consecutive series of patients.

Reliability and Validity of 3 Methods of Assessing Orthopedic Resident Skill in Shoulder Surgery.

Objective: Traditional measures for evaluating resident surgical technical skills (e.g., case logs) assess operative volume but not level of surgical proficiency.

Should All Patients Be Included in Alternative Payment Models for Primary Total Hip Arthroplasty and Total Knee Arthroplasty?

Background: Alternative payment models in total joint replacement incentivize cost effective health care delivery and reward reductions in length of stay (LOS), complications, and readmissions. If not adjusted for patient comorbidities, they may encourage restrictive access to health care.

Methods: We prospectively evaluated 802 consecutive primary total hip arthroplasty and total knee arthroplasty patients evaluating comorbidities associated with increased LOS and readmissions.

The incidence and reporting of sharps exposure among medical students, orthopedic residents, and faculty at one institution.

Objective: To compare the incidence of sharps injuries among medical students, orthopedic residents/fellows, and orthopedic faculty at one institution and to determine the rate of reporting exposures.

Design: Cross-sectional survey. Surveys were completed by 44% (53/120) of medical students, 76% (23/30) of residents/fellows, and 56% (17/30) of full-time faculty.

A crowdsourcing model for creating preclinical medical education study tools.

During their preclinical course work, medical students must memorize and recall substantial amounts of information. Recent trends in medical education emphasize collaboration through team-based learning. In the technology world, the trend toward collaboration has been characterized by the crowdsourcing movement.

Growing rods for the treatment of scoliosis in children with cerebral palsy: a critical assessment.

Study Design: Retrospective analysis.

Objective: To evaluate, in children with cerebral palsy, the following aspects of growing rod (GR) treatment for scoliosis: structural effectiveness, effect of pelvic fixation, hospital stay duration, and complications.

Summary Of Background Data: Children with cerebral palsy frequently develop severe spinal deformity and pelvic obliquity (PO).

The leptin system: a potential target for sepsis induced immune suppression.

Sepsis, which is defined as a systemic inflammatory response syndrome that occurs during infection, is associated with several clinical conditions and high mortality rates. As sepsis progresses immune paralysis can become severe, leaving an already vulnerable patient ill equipped to eradicate primary or secondary infections. At present the predominant treatments for sepsis have not demonstrated convincing efficacy of decreased mortality.

T-cell activation differentially mediates the host response to sepsis.

Survival during sepsis requires both swift control of infectious organisms and tight regulation of the associated inflammatory response. As the role of T cells in sepsis is somewhat controversial, we examined the impact of increasing antigen-dependent activation of CD4 T cells in a murine model of cecal ligation and puncture using T-cell receptor transgenic II (OT-II) mice that are specific for chicken ovalbumin (OVA) in the context of major histocompatibility complex II. Here, we injected OT-II mice with 0, 1, or 100 μg of OVA and demonstrate that increased antigen treatment resulted in increased numbers of activated splenic CD4 T cells.