Pub Date : 2022-04-06DOI: 10.2106/JBJS.JOPA.21.00038
W. Curtis, River Fine, Addi N. Moya, R. Blackstone, Richard M Wardell, Gehron P. Treme, D. Richter
Introduction: Many patients within the orthopaedic population experience 1 or more psychosocial issues that may profoundly affect their postoperative outcomes after orthopaedic surgery. Despite the common nature of these factors, there is a paucity of literature describing their effect on orthopaedic outcomes. The purpose of this review was to describe the anecdotal 10 most-encountered psychosocial factors in our patient population, their described influence on orthopaedic outcomes, and how they may be addressed. These factors include expectations, fear of reinjury, socioeconomic status, social support, allergies, addiction, depression and anxiety, resilience, self-efficacy, and other mental health disorders. Methods: A thorough review of the PubMed-indexed literature was conducted using each one of our psychosocial factors described here combined with the key words “orthopaedic outcome.” Study Design: This was a clinical review paper. Level of Evidence: Not applicable. Results: These 10 psychosocial influences have dramatic effects on the recovery and outcomes after orthopaedic procedures. Patients benefit from early recognition and management of these issues before and after surgery. Conclusions: Each of the psychosocial factors reviewed in this paper has a significant influence on outcomes after orthopaedic surgery. A strong understanding of these factors and how to address them will aid orthopaedic surgeons in maximizing postoperative outcomes for their patients. Further research is necessary to improve our treatment strategies for this complex patient population.
{"title":"The “Top 10” Psychosocial Factors Affecting Orthopaedic Outcomes","authors":"W. Curtis, River Fine, Addi N. Moya, R. Blackstone, Richard M Wardell, Gehron P. Treme, D. Richter","doi":"10.2106/JBJS.JOPA.21.00038","DOIUrl":"https://doi.org/10.2106/JBJS.JOPA.21.00038","url":null,"abstract":"Introduction: Many patients within the orthopaedic population experience 1 or more psychosocial issues that may profoundly affect their postoperative outcomes after orthopaedic surgery. Despite the common nature of these factors, there is a paucity of literature describing their effect on orthopaedic outcomes. The purpose of this review was to describe the anecdotal 10 most-encountered psychosocial factors in our patient population, their described influence on orthopaedic outcomes, and how they may be addressed. These factors include expectations, fear of reinjury, socioeconomic status, social support, allergies, addiction, depression and anxiety, resilience, self-efficacy, and other mental health disorders. Methods: A thorough review of the PubMed-indexed literature was conducted using each one of our psychosocial factors described here combined with the key words “orthopaedic outcome.” Study Design: This was a clinical review paper. Level of Evidence: Not applicable. Results: These 10 psychosocial influences have dramatic effects on the recovery and outcomes after orthopaedic procedures. Patients benefit from early recognition and management of these issues before and after surgery. Conclusions: Each of the psychosocial factors reviewed in this paper has a significant influence on outcomes after orthopaedic surgery. A strong understanding of these factors and how to address them will aid orthopaedic surgeons in maximizing postoperative outcomes for their patients. Further research is necessary to improve our treatment strategies for this complex patient population.","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44375486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-10DOI: 10.2106/JBJS.JOPA.21.00034
Erica Trimm
Background: Hyaluronic acid injections for treatment of osteoarthritis of the knee are a widely used yet highly controversial therapy. Many societal guidelines recommend against the use of such injections. Objective: This review aims to investigate efficacy of intra-articular hyaluronic acid injections for treatment of osteoarthritis of the knee. Conclusion: There are many factors impacting the efficacy of intra-articular hyaluronic acid injections. This can include source of hyaluronic acid, dosing regimen, molecular weight of the product, and patient characteristics. Overall, hyaluronic acid injections can be effective in reducing pain and improving physical function in patients with osteoarthritis of the knee. These injections may also prolong time between diagnosis and arthroplasty. Adverse events after injection are rare and can be product-related. Radiologic findings and severity of disease can be predictive of successful treatment outcomes. More consistent research will be necessary to overturn societal guideline recommendations to support treatment with intra-articular hyaluronic acid products.
{"title":"Efficacy of Hyaluronic Acid Injections in the Treatment of Osteoarthritis of the Knee","authors":"Erica Trimm","doi":"10.2106/JBJS.JOPA.21.00034","DOIUrl":"https://doi.org/10.2106/JBJS.JOPA.21.00034","url":null,"abstract":"Background: Hyaluronic acid injections for treatment of osteoarthritis of the knee are a widely used yet highly controversial therapy. Many societal guidelines recommend against the use of such injections. Objective: This review aims to investigate efficacy of intra-articular hyaluronic acid injections for treatment of osteoarthritis of the knee. Conclusion: There are many factors impacting the efficacy of intra-articular hyaluronic acid injections. This can include source of hyaluronic acid, dosing regimen, molecular weight of the product, and patient characteristics. Overall, hyaluronic acid injections can be effective in reducing pain and improving physical function in patients with osteoarthritis of the knee. These injections may also prolong time between diagnosis and arthroplasty. Adverse events after injection are rare and can be product-related. Radiologic findings and severity of disease can be predictive of successful treatment outcomes. More consistent research will be necessary to overturn societal guideline recommendations to support treatment with intra-articular hyaluronic acid products.","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49131461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-10DOI: 10.2106/JBJS.JOPA.21.00001
R. Bryson
Ankle sprains are common injuries in healthy, active adults, especially those engaging in athletics or high-intensity training. Research assessing the effects and sequelae of sustained index ankle sprains demonstrates a high risk of subsequent injuries, leading to chronic ankle instability. Numerous studies have isolated risk factors and mitigation techniques, altering the progression of instability and decreased performance associated with ankle injuries. Enrollment in adequate early rehabilitation programs focused on the restoration of joint biomechanics and sensorineural control is essential in minimizing instability progression. The biomechanics, evaluation, special testing, and progressive spectrum of nonsurgical and surgically invasive treatment options are discussed.
{"title":"Therapeutic Approach in the Reduction of Chronic Ankle Instability Risk in Adults","authors":"R. Bryson","doi":"10.2106/JBJS.JOPA.21.00001","DOIUrl":"https://doi.org/10.2106/JBJS.JOPA.21.00001","url":null,"abstract":"Ankle sprains are common injuries in healthy, active adults, especially those engaging in athletics or high-intensity training. Research assessing the effects and sequelae of sustained index ankle sprains demonstrates a high risk of subsequent injuries, leading to chronic ankle instability. Numerous studies have isolated risk factors and mitigation techniques, altering the progression of instability and decreased performance associated with ankle injuries. Enrollment in adequate early rehabilitation programs focused on the restoration of joint biomechanics and sensorineural control is essential in minimizing instability progression. The biomechanics, evaluation, special testing, and progressive spectrum of nonsurgical and surgically invasive treatment options are discussed.","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":"10 1","pages":"e21.00001"},"PeriodicalIF":0.0,"publicationDate":"2022-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45391347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-02DOI: 10.2106/jbjs.jopa.21.00029
S. Garvick, Nathan Bates, C. T. Jensen, C. Sisson, Aaron Wooten
Glenohumeral arthritis can significantly impact quality of life, most notable in highly active patients. A linear approach to management based on age alone negates factors that impact patient goals such as pain control, joint function, and joint preservation. Diagnostics should use X-ray, computed tomography, and magnetic resonance imaging to provide information about severity of disease and inform treatment plans, including surgical approaches. Although surgical intervention in young adults has previously been controversial, after nonoperative interventions, such as medications, physical therapy, and intra-articular injections, have failed, many studies support arthroplasty to control pain and maximize function throughout their life span.
{"title":"Diagnosis and Management of Glenohumeral Arthritis in the Active Adult","authors":"S. Garvick, Nathan Bates, C. T. Jensen, C. Sisson, Aaron Wooten","doi":"10.2106/jbjs.jopa.21.00029","DOIUrl":"https://doi.org/10.2106/jbjs.jopa.21.00029","url":null,"abstract":"Glenohumeral arthritis can significantly impact quality of life, most notable in highly active patients. A linear approach to management based on age alone negates factors that impact patient goals such as pain control, joint function, and joint preservation. Diagnostics should use X-ray, computed tomography, and magnetic resonance imaging to provide information about severity of disease and inform treatment plans, including surgical approaches. Although surgical intervention in young adults has previously been controversial, after nonoperative interventions, such as medications, physical therapy, and intra-articular injections, have failed, many studies support arthroplasty to control pain and maximize function throughout their life span.","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45460598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-02DOI: 10.2106/JBJS.JOPA.21.00031
Gabriel Palombo, Blake Hoppe
On average, 97% of patients in North America and Europe diagnosed with Guillain-Barré syndrome have a specific subtype known as acute inflammatory demyelinating polyradiculoneuropathy (AIDP). AIDP is suspected to be a result of proinflammatory cytokines causing demyelination, specifically within the peripheral nervous system, in response to stress. Events that precede the onset of AIDP include gastrointestinal or respiratory infections, surgeries, and trauma. AIDP primarily presents with acute ascending paralysis and areflexia. Diagnosis of AIDP is confirmed by nerve conduction studies (NCSs) with electromyography (EMG) and lumbar puncture for cerebral spinal fluid (CSF) analysis. NCS/EMG is used to assess the peripheral nerve function, and serial examinations are often needed. CSF analysis is looking to identify albumino-cytological dissociation. Most commonly, intravenous immunoglobulin is used to treat AIDP with plasmapheresis being the second most common treatment. Prognosis is dependent on the remyelination process but overall is relatively good. More than 80% of patients can walk independently within one year of recovery.
{"title":"Review of Acute Inflammatory Demyelinating Polyradiculoneuropathy","authors":"Gabriel Palombo, Blake Hoppe","doi":"10.2106/JBJS.JOPA.21.00031","DOIUrl":"https://doi.org/10.2106/JBJS.JOPA.21.00031","url":null,"abstract":"On average, 97% of patients in North America and Europe diagnosed with Guillain-Barré syndrome have a specific subtype known as acute inflammatory demyelinating polyradiculoneuropathy (AIDP). AIDP is suspected to be a result of proinflammatory cytokines causing demyelination, specifically within the peripheral nervous system, in response to stress. Events that precede the onset of AIDP include gastrointestinal or respiratory infections, surgeries, and trauma. AIDP primarily presents with acute ascending paralysis and areflexia. Diagnosis of AIDP is confirmed by nerve conduction studies (NCSs) with electromyography (EMG) and lumbar puncture for cerebral spinal fluid (CSF) analysis. NCS/EMG is used to assess the peripheral nerve function, and serial examinations are often needed. CSF analysis is looking to identify albumino-cytological dissociation. Most commonly, intravenous immunoglobulin is used to treat AIDP with plasmapheresis being the second most common treatment. Prognosis is dependent on the remyelination process but overall is relatively good. More than 80% of patients can walk independently within one year of recovery.","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":"10 1","pages":"e21.00031"},"PeriodicalIF":0.0,"publicationDate":"2022-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45434590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-12DOI: 10.2106/JBJS.JOPA.21.00030
C. Bishop, K. Dolan, J. Balch Samora
Background: Timely follow-up for radiographic and clinical evaluation with an orthopaedic specialist is critical in avoiding potential complications after pediatric long bone fractures. At our large, tertiary care, pediatric hospital, the baseline rate of timely follow-up after evaluation of reduced fractures in the emergency department was 74.4%. We tested the hypothesis that we could use quality improvement (QI) methods to increase the rate of timely follow-up and improve patient care. Methods: A multidisciplinary QI program was implemented with education for staff; improvement of procedures; patient and family education; and a method to identify and provide resources for potential barriers to follow-up. Questionnaire results were documented and tabulated. Results: At the end of the QI program, patient rates of timely follow-up were 78.5%, compared with the 74.4% baseline. There was no statistical difference in follow-up between patients who received and completed the questionnaire and those who did not. For patients who did complete the questionnaire, there was no statistical difference between those who identified a barrier to follow-up and those who did not identify any difficulty with follow-up. Conclusions: Minimal improvement was noted on the percentage of timely follow-up in the orthopaedic clinic after reduction of a fracture. Although the interventions fell short of their goals, future opportunities exist for improvement of timely follow-up. Level of Evidence: Level II (prospective cohort study).
{"title":"Increasing Timely Follow-up with Pediatric Orthopaedic Fracture Care","authors":"C. Bishop, K. Dolan, J. Balch Samora","doi":"10.2106/JBJS.JOPA.21.00030","DOIUrl":"https://doi.org/10.2106/JBJS.JOPA.21.00030","url":null,"abstract":"Background: Timely follow-up for radiographic and clinical evaluation with an orthopaedic specialist is critical in avoiding potential complications after pediatric long bone fractures. At our large, tertiary care, pediatric hospital, the baseline rate of timely follow-up after evaluation of reduced fractures in the emergency department was 74.4%. We tested the hypothesis that we could use quality improvement (QI) methods to increase the rate of timely follow-up and improve patient care. Methods: A multidisciplinary QI program was implemented with education for staff; improvement of procedures; patient and family education; and a method to identify and provide resources for potential barriers to follow-up. Questionnaire results were documented and tabulated. Results: At the end of the QI program, patient rates of timely follow-up were 78.5%, compared with the 74.4% baseline. There was no statistical difference in follow-up between patients who received and completed the questionnaire and those who did not. For patients who did complete the questionnaire, there was no statistical difference between those who identified a barrier to follow-up and those who did not identify any difficulty with follow-up. Conclusions: Minimal improvement was noted on the percentage of timely follow-up in the orthopaedic clinic after reduction of a fracture. Although the interventions fell short of their goals, future opportunities exist for improvement of timely follow-up. Level of Evidence: Level II (prospective cohort study).","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44355905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.2106/jbjs.jopa.22.00010
V. Sinkov, Christian M. Klare, K. McAuliffe
{"title":"Spine Roundtable: Sacroiliac Joint Pain","authors":"V. Sinkov, Christian M. Klare, K. McAuliffe","doi":"10.2106/jbjs.jopa.22.00010","DOIUrl":"https://doi.org/10.2106/jbjs.jopa.22.00010","url":null,"abstract":"","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67753839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.2106/jbjs.jopa.21.00025
Joanna Lopez, Melissa Miller, Cynthia Corral
{"title":"Know the Person, Not Just the Disease","authors":"Joanna Lopez, Melissa Miller, Cynthia Corral","doi":"10.2106/jbjs.jopa.21.00025","DOIUrl":"https://doi.org/10.2106/jbjs.jopa.21.00025","url":null,"abstract":"","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67753438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.2106/jbjs.jopa.22.00005
{"title":"JBJS JOPA 2021 Annual Call and Salary Survey","authors":"","doi":"10.2106/jbjs.jopa.22.00005","DOIUrl":"https://doi.org/10.2106/jbjs.jopa.22.00005","url":null,"abstract":"","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67753890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.2106/jbjs.jopa.21.00033
Jessica A. Nelson, Devin A. Maez, Jordan Kump, Mindy A. Trombley, M. Decker, D. Richter
{"title":"Local Application of Vancomycin in Orthopaedic Surgery—A Review","authors":"Jessica A. Nelson, Devin A. Maez, Jordan Kump, Mindy A. Trombley, M. Decker, D. Richter","doi":"10.2106/jbjs.jopa.21.00033","DOIUrl":"https://doi.org/10.2106/jbjs.jopa.21.00033","url":null,"abstract":"","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67752958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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