The Physician as the Provider at Risk: Rolling the Dice.

Background: There is significant need for physician innovation and leadership in health care as we adapt to bundled payment models of health care delivery.

Methods: We engaged a collective of 16 different private company orthopedic physician groups to apply to become episode initiators under BPCI models 2 and 3. The application process itself provided historical cost data, enabling each group to independently decide whether or not to proceed with the BPCI initiative.

Importance of Proper Utilization of International Classification of Diseases 10th Revision and Clinical Documentation in Modern Payment Models.

Background: Health care payment models are changing rapidly, and the measurement of outcomes and costs is increasing.

Methods: With the implementation of International Classification of Diseases 10th revision (ICD-10) codes, providers now have the ability to introduce a precise array of diagnoses for their patients.

Results: More specific diagnostic codes do not eliminate the potential for vague application, as was seen with the utility of ICD-9.

Factors in Surgical Decision Making for Thoracolumbar/Lumbar AIS: It's About More Than Just the Curve Magnitude.

Study Design: A retrospective review of prospective data OBJECTIVE:: The purpose of this study was to compare operative and nonoperative patients with similar curve magnitudes to determine motivating factors associated with surgical correction in "smaller" curves.

Summary Of Background Data: Despite traditional treatment recommendations on major curve angle measurements, many patients with thoracolumbar/lumbar (TH/L) curves of smaller magnitudes are unhappy and desire correction.

Methods: A prospectively enrolled multicenter adolescent idiopathic scoliosis database was queried.

Reoperation rates in minimally invasive, hybrid and open surgical treatment for adult spinal deformity with minimum 2-year follow-up.

Introduction: Minimally invasive surgical (MIS) techniques are gaining popularity in the treatment of adult spinal deformity (ASD). The premise is that MIS techniques will lead to equivalent outcomes and a reduction in perioperative complications when compared with open techniques. Potential issues with MIS techniques are a limited capacity to correct lumbar lordosis, unknown long-term efficacy, and the potential need for revision surgery.

Long-term results of total knee arthroplasty in young and active patients with posterior stabilized design.

Background: The aim of this study was to evaluate long-term quality and performance of cemented posterior-stabilized (PS) total knee arthroplasty (TKA) in young and active patients with gap balancing technique.

Methods: Between January 2000 and October 2001, 55 TKAs (21 rotating platform [RP] and 34 fixed bearing [FB]) in 41 patients, 60 years and younger, with University of California Los Angeles (UCLA) activity score of five and above were included in this study and prospectively followed. Clinical assessments included Western Ontario and McMaster Universities (WOMAC), Knee Society, UCLA activity score, and Patient Administered Questionnaire (PAQ).

A Comparison of Two Different Dosing Protocols for Tranexamic Acid in Posterior Spinal Fusion for Spinal Deformity: A Prospective, Randomized Trial.

Background: Multilevel spinal fusions have typically been associated with significant blood loss. Previous studies have shown a reduction in blood loss with antifibrinolytics in both adolescent and adult spinal deformity patients. While this has been mirrored in other subspecialties as well, the dosing of TXA remains highly variable.

Effect of Spinal Deformity on Pelvic Orientation from Standing to Sitting Position.

Background: The effect of fixed spinal deformities on a functional pelvis from standing to sitting is not fully understood. We aimed to assess the change in preoperative sagittal pelvic tilt angle (SPTA) from standing to sitting in patients undergoing total hip arthroplasty, comparing flexible and fixed spinal deformities.

Methods: Between July 2011 and October 2011, 68 consecutive unilateral total hip arthroplasties were implanted in 68 patients with a mean age of 71 ± 6 years.

Cytokine preconditioning of engineered cartilage provides protection against interleukin-1 insult.

Background: During osteoarthritis and following surgical procedures, the environment of the knee is rich in proinflammatory cytokines such as IL-1. Introduction of tissue-engineered cartilage constructs to a chemically harsh milieu may limit the functionality of the implanted tissue over long periods. A chemical preconditioning scheme (application of low doses of IL-1) was tested as a method to prepare developing engineered tissue to withstand exposure to a higher concentration of the cytokine, known to elicit proteolysis as well as rapid degeneration of cartilage.

Healthcare Resource Use and Direct Costs in Patients with Ankylosing Spondylitis and Psoriatic Arthritis in a Large US Cohort.

Objective: Direct costs of ankylosing spondylitis (AS) and psoriatic arthritis (PsA) have not been well characterized in the United States. This study assessed healthcare resource use and direct cost of AS and PsA, and identified predictors of all-cause medical and pharmacy costs.

Methods: Adults aged ≥ 18 with a diagnosis of AS and PsA were identified in the MarketScan databases between October 1, 2011, and September 30, 2012.

Treatment of systemic lupus erythematosus patients with the BAFF antagonist "peptibody" blisibimod (AMG 623/A-623): results from randomized, double-blind phase 1a and phase 1b trials.

Introduction: Blisibimod is a potent B cell-activating factor (BAFF) antagonist that binds to both cell membrane-expressed and soluble BAFF. The goal of these first-in-human studies was to characterize the safety, tolerability, and pharmacokinetic and pharmacodynamic profiles of blisibimod in subjects with systemic lupus erythematosus (SLE).

Methods: SLE subjects with mild disease that was stable/inactive at baseline received either a single dose of blisibimod (0.

Performance of Non-Cemented, Hemispherical, Rim-Fit, Hydroxyapatite Coated Acetabular Component.

The purpose of this study was to assess the durability of a non-cemented, hemispherical rim-fit, hydroxyapatite coated cup with a highly cross-linked polyethylene in 223 total hip arthroplasties. At 6-years follow-up (range, 5-9), there were no cup revisions for osteolysis or loosening. Radiologic evidence of osseointegration was based on presence of Stress Induced Reactive Cancellous Bone and radial trabeculae, seen in 47% and 93% of cups, respectively; both were most prevalent in Zone 1.

Clinical and stereoradiographic analysis of adult spinal deformity with and without rotatory subluxation.

Introduction: In degenerative adult spinal deformity (ASD), sagittal malalignment and rotatory subluxation (RS) correlate with clinical symptomatology. RS is defined as axial rotation with lateral listhesis. Stereoradiography, recently developed for medical applications, provides full-body standing radiographs and 3D reconstruction of the spine, with low radiation dose.

Mechanism of Injury Differentiates Risk Factors for Mortality in Geriatric Trauma Patients.

Objectives: To evaluate the relationship between mechanism of injury and mortality in geriatric trauma patients and the ability of existing injury severity indices (ISIs) to assess mortality.

Design: Retrospective review.

Setting: Urban level 1 trauma center.

Does Syndesmotic Injury Have a Negative Effect on Functional Outcome? A Multicenter Prospective Evaluation.

Objective: To evaluate the effect of syndesmotic disruption on the functional outcomes of Weber B, SE4 ankle fractures treated operatively.

Setting: Multicenter trauma hospitals.

Patients: Data were prospectively gathered during a previous, multicenter randomized trial including 242 patients (136 women, 106 men) from 9 trauma centers with operatively treated Weber B SE4 ankle fractures.

Safety and efficacy of continuous femoral nerve catheter with single shot sciatic nerve block vs epidural catheter anesthesia for same-day bilateral total knee arthroplasty.

In a retrospective analysis, we evaluated the safety and efficacy of peripheral nerve blocks (PNB) compared to epidural anesthesia in 221 consecutive patients undergoing same-day bilateral total knee arthroplasty (TKA). Primary outcome measures included: hypotension requiring physician intervention, number of blood transfusions, perioperative hespan and crystalloid consumption, incidences of respiratory desaturation, pruritis, urinary retention, and nausea/vomiting. The incidences of hypotension, urinary retention, and pruritis were all higher in the epidural group, compared to PNB.

Fear-avoidance beliefs-a moderator of treatment efficacy in patients with low back pain: a systematic review.

Background Context: Psychological factors are believed to influence the development of chronic low back pain. To date, it is not known how fear-avoidance beliefs (FABs) influence the treatment efficacy in low back pain.

Purpose: To summarize the evidence examining the influence of FABs measured with the Fear-Avoidance Belief Questionnaire or the Tampa Scale of Kinesiophobia on treatment outcomes in patients with low back pain.

Fourth-generation spinal instrumentation: experience with adolescent idiopathic scoliosis at a tertiary care hospital in Pakistan.

Objective: To evaluate the radiological and functional outcome of surgical treatment of adolescent idiopathic scoliosis using fourth-generation posterior spinal instrumentation at The Aga Khan University, Karachi, Pakistan.

Design: Case series.

Place And Duration Of Study: The Aga Khan University Hospital after a minimum of 2 years postoperatively.

Back pain in adolescent athletes.

Back pain in the young athlete is a common complaint and often perceived as a challenging problem. A well-directed approach will usually provide the practitioner with a higher comfort zone. The etiology of back pain in the pediatric and adolescent population is different from that of the adult population due to the presence of open physes and increased linear growth velocity.

Advances in magnetic resonance imaging of articular cartilage.

The pathology, assessment, and management of articular cartilage lesions of the hip and knee have been the subject of considerable attention in the recent orthopaedic literature. MRI has long been an important tool in the diagnosis and management of articular cartilage pathology, but detecting and interpreting early cartilaginous degeneration with this technology has been difficult. Biochemical-based MRI has been advocated to detect early cartilaginous degenerative changes and assess cartilage repair.

Orthopaedic manifestations of neurofibromatosis type 1.

Neurofibromatosis type 1 (NF-1) is an autosomal dominant disease that affects 1 in 3,000 persons worldwide. Café-au-lait macules and peripheral nerve sheath tumors (ie, neurofibromas) are the most commonly recognized manifestations of NF-1. However, NF-1 affects multiple organ systems, and a multidisciplinary approach to treatment is required.

Wrist osteoarthritis.

Osteoarthritis of the wrist is one of the commonest conditions encountered in clinical orthopaedic practice. This article looks at our approach to this problem including clinical assessment, radiographic analysis and the management of wrist osteoarthritis.

Erythrocyte sedimentation rate and C-reactive protein levels are poorly correlated with clinical measures of disease activity in rheumatoid arthritis, systemic lupus erythematosus and osteoarthritis patients.

Objective: To determine the patterns and correlation of elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels with outcome measures in rheumatoid arthritis (RA), and compare it to systemic lupus erythematosus (SLE) and osteoarthritis (OA) patients.

Methods: Brooklyn Outcomes Arthritis Registry Database (BOARD) was analyzed to determine both first visit and mean values of ESR and CRP, along with disease activity measures in each patient. Data were analyzed with descriptive statistics and correlations.

Olympic fencers: adaptations in cortical and trabecular bone determined by quantitative computed tomography.

Unlabelled: We investigated how cortical bone, trabecular bone, and muscle adapt in US Olympic Fencing Team members. These athletes demonstrate femoral cortical bone expansion, greater distal femoral trabecular bone density, and greater muscle mass compared to controls. This is the first study to investigate musculoskeletal adaptations in Olympic fencers.

Femoroacetabular impingement: can the alpha angle be estimated?

Objective: Femoroacetabular impingement is an important entity with well-described radiographic findings. One of the criteria of the cam type of femoroacetabular impingement is femoral head-neck dysplasia, denoted mathematically as the "alpha angle." Several observers have reported that direct measurement of the angle may not be necessary because subjective appraisal may yield similar results.

Adaptations in trabecular bone microarchitecture in Olympic athletes determined by 7T MRI.

Purpose: To produce in vivo high-resolution images of the knee and to determine the feasibility of using 7T MR to detect changes in trabecular bone microarchitecture in elite athletes (Olympic fencers) who undergo high impact activity.

Materials And Methods: The dominant knees of four males from the U.S.