Pub Date : 2021-08-17DOI: 10.2106/JBJS.JOPA.21.00008
A. Sciulli
Joint arthroplasty remains one of the most common elective surgeries in the United States. Orthopaedic hardware can contribute either as the primary source or as a secondary seeding site in hematogenously spread infections. Arthroplasty status should remain a focal point of history taking in both surgical and medical settings. This case details a 76-year-old woman who experienced bilateral knee arthroplasty infections after presenting with both a lumbar epidural abscess and vertebral osteomyelitis secondary to infected lumbar hardware.
{"title":"Bilateral Knee Arthroplasty Infections in the Setting of Infected Spinal Hardware","authors":"A. Sciulli","doi":"10.2106/JBJS.JOPA.21.00008","DOIUrl":"https://doi.org/10.2106/JBJS.JOPA.21.00008","url":null,"abstract":"Joint arthroplasty remains one of the most common elective surgeries in the United States. Orthopaedic hardware can contribute either as the primary source or as a secondary seeding site in hematogenously spread infections. Arthroplasty status should remain a focal point of history taking in both surgical and medical settings. This case details a 76-year-old woman who experienced bilateral knee arthroplasty infections after presenting with both a lumbar epidural abscess and vertebral osteomyelitis secondary to infected lumbar hardware.","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42955957","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 : 2021-08-13DOI: 10.2106/JBJS.JOPA.21.00012
Wesley Lykins
Purpose: This article aims to review the treatment options for osteoarthritis and discuss the potential efficacy of cannabidiol (CBD) as an alternative treatment. Method: A PubMed literature search was conducted with search terms osteoarthritis (OA), cannabidiol, and CBD. Sixteen pertinent articles were retrieved and served as the basis for this clinical review. Three additional citations were used to provide supplementary information. Results: The ability of CBD to reduce acute OA synovitis, reduce neuropathic joint pain, and prevent the progression of OA pain has resulted in increased interest in CBD as an alternative treatment for arthritis. Clinical studies with systemic CBD administration showed no evidence of adverse side effects in animals. Preliminary studies show promising results on pain relief and functional activity in rats. Conclusion: The use of alternative treatments of OA may provide symptomatic relief with limited associated risk. CBD is a non–euphoria-producing compound retrieved from the hemp plant that has shown less severe adverse effects than other analgesic medications. We must continue developing and using new treatment options to alleviate the pain related to OA and increase the patient's quality of life where surgical treatment is not indicated. The Food and Drug Administration has not approved CBD products for treatment of OA, and no human trials are available at this time. Futures studies are needed to compare the efficacy of CBD to nonsteroidal anti-inflammatory drugs or corticosteroid injections, to determine the efficacy and safety profile on human subjects, and to determine the mode of CBD administration that is most effective.
{"title":"Efficacy of Cannabidiol in Treating Osteoarthritis","authors":"Wesley Lykins","doi":"10.2106/JBJS.JOPA.21.00012","DOIUrl":"https://doi.org/10.2106/JBJS.JOPA.21.00012","url":null,"abstract":"Purpose: This article aims to review the treatment options for osteoarthritis and discuss the potential efficacy of cannabidiol (CBD) as an alternative treatment. Method: A PubMed literature search was conducted with search terms osteoarthritis (OA), cannabidiol, and CBD. Sixteen pertinent articles were retrieved and served as the basis for this clinical review. Three additional citations were used to provide supplementary information. Results: The ability of CBD to reduce acute OA synovitis, reduce neuropathic joint pain, and prevent the progression of OA pain has resulted in increased interest in CBD as an alternative treatment for arthritis. Clinical studies with systemic CBD administration showed no evidence of adverse side effects in animals. Preliminary studies show promising results on pain relief and functional activity in rats. Conclusion: The use of alternative treatments of OA may provide symptomatic relief with limited associated risk. CBD is a non–euphoria-producing compound retrieved from the hemp plant that has shown less severe adverse effects than other analgesic medications. We must continue developing and using new treatment options to alleviate the pain related to OA and increase the patient's quality of life where surgical treatment is not indicated. The Food and Drug Administration has not approved CBD products for treatment of OA, and no human trials are available at this time. Futures studies are needed to compare the efficacy of CBD to nonsteroidal anti-inflammatory drugs or corticosteroid injections, to determine the efficacy and safety profile on human subjects, and to determine the mode of CBD administration that is most effective.","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49339523","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 : 2021-08-05DOI: 10.2106/JBJS.JOPA.21.00011
Jessica D. Bianculli
Idiopathic scoliosis (IS) is a spinal deformity of unknown etiology, and it is the most common spinal deformity in the pediatric population. The treatment of IS is multifactorial but is determined in part by curve magnitude and remaining skeletal growth. The goal of nonoperative treatment of IS is to prevent curve progression during growth, but if curve magnitude continues to progress, the goal of operative treatment becomes curve correction and stabilization. The current gold standard of treatment for progressive IS is a posterior spinal fusion; however, anterior vertebral body tethering (AVBT) is a newer surgical technique which has emerged as a nonfusion option for the treatment of progressive IS in skeletally immature patients. Many recent clinical studies have garnered evidence that AVBT may be a viable treatment option and an alternative to posterior spinal fusion in patients with remaining growth.
{"title":"Anterior Vertebral Body Tethering: A Nonfusion Surgery for Idiopathic Scoliosis","authors":"Jessica D. Bianculli","doi":"10.2106/JBJS.JOPA.21.00011","DOIUrl":"https://doi.org/10.2106/JBJS.JOPA.21.00011","url":null,"abstract":"Idiopathic scoliosis (IS) is a spinal deformity of unknown etiology, and it is the most common spinal deformity in the pediatric population. The treatment of IS is multifactorial but is determined in part by curve magnitude and remaining skeletal growth. The goal of nonoperative treatment of IS is to prevent curve progression during growth, but if curve magnitude continues to progress, the goal of operative treatment becomes curve correction and stabilization. The current gold standard of treatment for progressive IS is a posterior spinal fusion; however, anterior vertebral body tethering (AVBT) is a newer surgical technique which has emerged as a nonfusion option for the treatment of progressive IS in skeletally immature patients. Many recent clinical studies have garnered evidence that AVBT may be a viable treatment option and an alternative to posterior spinal fusion in patients with remaining growth.","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42737643","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 : 2021-07-30DOI: 10.2106/JBJS.JOPA.21.00004
K. Dimino
Hip osteoarthritis is the process of chondral degeneration leading to synovial inflammation, which in turn advances the articular degradation in a cyclical manner. The impact of hip arthritis is increasing with an aging population and obesity. Conservative treatments include activity modification, physical therapy, steroid injections, oral nonsteroidal anti-inflammatory drugs, and opioids. Intra-articular injections of hyaluronic acid or platelet-rich plasma (PRP) are also options for temporary pain relief. In the past decade, there has been a trend toward the use of biologics for limiting the pain of hip arthritis. PRP is one biologic showing promise. Using biologics such as PRP is a simple, less expensive, and minimally invasive procedure compared with surgery.
{"title":"The Efficacy of Platelet-Rich Plasma in Reducing Pain in Hip Osteoarthritis","authors":"K. Dimino","doi":"10.2106/JBJS.JOPA.21.00004","DOIUrl":"https://doi.org/10.2106/JBJS.JOPA.21.00004","url":null,"abstract":"Hip osteoarthritis is the process of chondral degeneration leading to synovial inflammation, which in turn advances the articular degradation in a cyclical manner. The impact of hip arthritis is increasing with an aging population and obesity. Conservative treatments include activity modification, physical therapy, steroid injections, oral nonsteroidal anti-inflammatory drugs, and opioids. Intra-articular injections of hyaluronic acid or platelet-rich plasma (PRP) are also options for temporary pain relief. In the past decade, there has been a trend toward the use of biologics for limiting the pain of hip arthritis. PRP is one biologic showing promise. Using biologics such as PRP is a simple, less expensive, and minimally invasive procedure compared with surgery.","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41497431","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 : 2021-07-29DOI: 10.2106/jbjs.jopa.21.00010
Cody A. Sasek
Clinical doctorate and other doctoral-level degrees have been increasingly considered by practicing physician assistants (PAs). Although doctoral programs and degrees vary, there are common factors that are helpful to consider when exploring doctoral education. This article outlines 5 key considerations for the PA who is exploring doctoral education.
{"title":"To What Degree? Considerations for the Pursuit of a Doctoral Degree by Clinical Physician Assistants","authors":"Cody A. Sasek","doi":"10.2106/jbjs.jopa.21.00010","DOIUrl":"https://doi.org/10.2106/jbjs.jopa.21.00010","url":null,"abstract":"Clinical doctorate and other doctoral-level degrees have been increasingly considered by practicing physician assistants (PAs). Although doctoral programs and degrees vary, there are common factors that are helpful to consider when exploring doctoral education. This article outlines 5 key considerations for the PA who is exploring doctoral education.","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41492383","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 : 2021-07-23DOI: 10.2106/JBJS.JOPA.20.00047
J. Weis
The patient in this case presented with a malignant psoas syndrome secondary to a primary psoas muscle sarcoma. A malignant psoas syndrome is characterized by the presence of lumbar plexopathy, ipsilateral hip flexion, and severe pain with attempted hip extension. The presence of severe, atraumatic joint pain with fevers and other associated systemic symptoms should raise the clinical index of suspicion for a diagnosis requiring urgent attention including infection and malignancy.
{"title":"Malignant Psoas Syndrome","authors":"J. Weis","doi":"10.2106/JBJS.JOPA.20.00047","DOIUrl":"https://doi.org/10.2106/JBJS.JOPA.20.00047","url":null,"abstract":"The patient in this case presented with a malignant psoas syndrome secondary to a primary psoas muscle sarcoma. A malignant psoas syndrome is characterized by the presence of lumbar plexopathy, ipsilateral hip flexion, and severe pain with attempted hip extension. The presence of severe, atraumatic joint pain with fevers and other associated systemic symptoms should raise the clinical index of suspicion for a diagnosis requiring urgent attention including infection and malignancy.","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48598185","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 : 2021-07-23DOI: 10.2106/JBJS.JOPA.20.00040
P. Smith, Eric T. Johnson
Purpose: The purpose of the article is to review the treatment of comminuted distal femur fractures and examine the risks and benefits of distal femoral replacement/arthroplasty (DFA) for the treatment of complicated osteopenic supracondylar femur fractures. Method: An OVID MEDLINE, PubMed, and Cochrane Database of Systematic Reviews literature search was conducted with search terms distal femur fracture, distal femoral replacement, osteoporosis, fixation, and functional outcomes. Forty-six articles pertinent to the topic were retrieved. These articles serve as the basis for the clinical review portion of the article. A patient representing the clinical question was selected for inclusion in the case study. Verbal consent was obtained, consistent with the guidelines from the Journal of Orthopaedics for Physician Assistants. Results: There is a paucity of evidence-based literature to justify the use of distal femoral replacement/DFA for the management of comminuted supracondylar distal femur fractures. Further study is needed to document the role of DFA for frail, elderly patients. Conclusion: Open reduction internal fixation has been used to treat distal femur fractures. The techniques of locked plating (with or without variable angle construct), percutaneous fixation, and intramedullary nailing are well established for the treatment of fractures of the distal femur. The use of distal femoral replacement/DFA has been shown to decrease weight-bearing limitations, decrease immobility, minimize the use of a brace, and maximize function after complicated fractures with osteoporosis. Further research is needed to identify the role of DFA for the treatment of comminuted distal femur fractures in the elderly population.
{"title":"Distal Femoral Arthroplasty Versus Open Reduction Internal Fixation for Comminuted Osteoporotic Supracondylar Distal Femur Fractures","authors":"P. Smith, Eric T. Johnson","doi":"10.2106/JBJS.JOPA.20.00040","DOIUrl":"https://doi.org/10.2106/JBJS.JOPA.20.00040","url":null,"abstract":"Purpose: The purpose of the article is to review the treatment of comminuted distal femur fractures and examine the risks and benefits of distal femoral replacement/arthroplasty (DFA) for the treatment of complicated osteopenic supracondylar femur fractures. Method: An OVID MEDLINE, PubMed, and Cochrane Database of Systematic Reviews literature search was conducted with search terms distal femur fracture, distal femoral replacement, osteoporosis, fixation, and functional outcomes. Forty-six articles pertinent to the topic were retrieved. These articles serve as the basis for the clinical review portion of the article. A patient representing the clinical question was selected for inclusion in the case study. Verbal consent was obtained, consistent with the guidelines from the Journal of Orthopaedics for Physician Assistants. Results: There is a paucity of evidence-based literature to justify the use of distal femoral replacement/DFA for the management of comminuted supracondylar distal femur fractures. Further study is needed to document the role of DFA for frail, elderly patients. Conclusion: Open reduction internal fixation has been used to treat distal femur fractures. The techniques of locked plating (with or without variable angle construct), percutaneous fixation, and intramedullary nailing are well established for the treatment of fractures of the distal femur. The use of distal femoral replacement/DFA has been shown to decrease weight-bearing limitations, decrease immobility, minimize the use of a brace, and maximize function after complicated fractures with osteoporosis. Further research is needed to identify the role of DFA for the treatment of comminuted distal femur fractures in the elderly population.","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46822564","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 : 2021-01-01DOI: 10.2106/jbjs.jopa.20.00022
Blake Hoppe, David LeVan
{"title":"Hand Atrophy","authors":"Blake Hoppe, David LeVan","doi":"10.2106/jbjs.jopa.20.00022","DOIUrl":"https://doi.org/10.2106/jbjs.jopa.20.00022","url":null,"abstract":"","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67753138","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 : 2021-01-01DOI: 10.2106/jbjs.jopa.21.00019
D. Cloutier, Larry Collins, C. Dowell, Sean M. Hazzard, B. Downie
{"title":"Sports Medicine Roundtable: Identifying and Treating Shoulder Instability from a Deficient Glenoid","authors":"D. Cloutier, Larry Collins, C. Dowell, Sean M. Hazzard, B. Downie","doi":"10.2106/jbjs.jopa.21.00019","DOIUrl":"https://doi.org/10.2106/jbjs.jopa.21.00019","url":null,"abstract":"","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67753317","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 : 2021-01-01DOI: 10.2106/jbjs.jopa.21.00003
{"title":"JBJS JOPA 2020 Annual Call and Salary Survey","authors":"","doi":"10.2106/jbjs.jopa.21.00003","DOIUrl":"https://doi.org/10.2106/jbjs.jopa.21.00003","url":null,"abstract":"","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67753368","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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