OrthoJOE

Latest Episodes:

Orthobiologics in Orthopaedics, Part Deux (with special guest Asheesh Bedi) Sep 27, 2021

Show notes

In this episode, Marc and Mo are joined by special guest and world-renowned sports-medicine expert Asheesh Bedi (Director of the Michigan Center for Human Athletic Medicine and Performance, Harold W. and Helen L. Gehring Professor of Orthopaedic Surgery, Chief of Sports Medicine and Shoulder Surgery at the University of Michigan, head orthopaedic surgeon for University of Michigan athletics, and consultant for numerous NBA, NFL, and NHL teams) in a continuation of their previous discussion of orthobiologics, one of the most rapidly evolving areas of orthopaedics. What are the “major players” in this field, and are we there yet? Do PRP and stem cells play a role in the management of patients in 2021? What progress has been made, and what challenges and opportunities remain?

OrthoJOE Mailbag: feedback, comments, and suggestions from our audience can be sent to orthojoe@jbjs.org

Links:

Reider B. Proceed With Caution. The American Journal of Sports Medicine. 2009;37(11):2099-2101. doi:10.1177/0363546509352786. https://journals.sagepub.com/doi/full/10.1177/0363546509352786
Bauer, Thomas W. MD, PhD Stem Cell Therapy for Knee Pain—What Exactly Are We Injecting, and Why?, The Journal of Bone and Joint Surgery: September 21, 2016 - Volume 98 - Issue 18 - p 1509-1510 doi: 10.2106/JBJS.16.00872. https://jbjs.org/reader.php?id=203068&rsuite_id=1261189&native=1&source=The_Journal_of_Bone_and_Joint_Surgery/98/18/1509/fulltext&topics=bs#info

Orthobiologics in Orthopaedics: Essential Questions Sep 13, 2021

Show notes

In this episode, Marc and Mo discuss a number of intriguing questions related to the use of orthobiologics in orthopaedics: How do we set standards for novel biologics? How do we decide what works and what doesn’t? What filter should be used to determine which studies get published? Ultimately, we need to know how these materials are prepared and what is actually in them before we can evaluate their effect on patients. Answering these questions is essential work in order for us to make advances in this field.

OrthoJOE Mailbag: feedback, comments, and suggestions from our audience can be sent to orthojoe@jbjs.org

Links:

Siddiqua A, Bhandari M. Platelet Rich Plasma and Stem Cell Therapy: Setting Standards and Evidence. OrthoEvidence. Article No. 97. August 21, 2021. https://myorthoevidence.com/Insight/Show/97

Murray IR, Safran MR, LaPrade RF. Biologics in orthopaedics. Bone & Joint 360.2018;7(6):2-8. https://online.boneandjoint.org.uk/action/showCitFormats?doi=10.1302%2F2048-0105.76.360648

Cole BJ, Gilat R, DiFiori J, Rodeo SA, Bedi A. The 2020 NBA Orthobiologics Consensus Statement. Orthop J Sports Med. 2021 May 6;9(5):23259671211002296. doi: 10.1177/23259671211002296. PMID: 34017878; PMCID: PMC8114275. https://pubmed.ncbi.nlm.nih.gov/34017878/

Lamplot JD, Rodeo SA, Brophy RH. A Practical Guide for the Current Use of Biologic Therapies in Sports Medicine. Am J Sports Med. 2020 Feb;48(2):488-503. doi: 10.1177/0363546519836090. Epub 2019 Apr 30. PMID: 31038990. https://pubmed.ncbi.nlm.nih.gov/31038990/

Bauer TW. Stem Cell Therapy for Knee Pain-What Exactly Are We Injecting, and Why? J Bone Joint Surg Am. 2016 Sep 21;98(18):1509-10. doi: 10.2106/JBJS.16.00872. PMID: 27655977. https://bit.ly/3Bc2TUz

Rehabilitation Strategies: Evidence is the Oasis Aug 30, 2021

Show notes

In this episode, Marc and Mo discuss the importance of breaking down silos and collaborating with non-surgeon colleagues in the musculoskeletal arena (PTs, OTs, physiatrists) to develop evidence-based recommendations on rehabilitation strategies for the purpose of improving patient outcomes.

OrthoJOE Mailbag: feedback, comments, and suggestions from our audience can be sent to orthojoe@jbjs.org

Links:

Martínez R, Santana F, Pardo A, Torrens C. One Versus 3-Week Immobilization Period for Nonoperatively Treated Proximal Humeral Fractures: A Prospective Randomized Trial. J Bone Joint Surg Am. 2021 Aug 18;103(16):1491-1498. doi: 10.2106/JBJS.20.02137. PMID: 34101691. https://bit.ly/2WhQSh1

Artificial Intelligence, Machine-Learning, and Neural Networks (with special guest Joseph Siburt, PhD) Aug 16, 2021

Show notes

In this episode, Marc and Mo are joined by special guest Joseph Silburt, PhD (Data Scientist at OrthoEvidence) in an informative discussion on the issues related to artificial intelligence, machine-learning, and neural networks, with a specific focus on how these technologies can be applied to preoperative and perioperative planning.

OrthoJOE Mailbag: feedback, comments, and suggestions from our audience can be sent to orthojoe@jbjs.org

Links:

OrthoEvidence. An Overview of Machine Learning Applications for Conducting Systematic Reviews. OE Original. 2021;4(3):2. Available from: https://myorthoevidence.com/Blog/Show/118

OrthoEvidence. Deep neural networks (machine learning) in healthcare. OE Original. 2019;2(6):1. Available from: https://myorthoevidence.com/Blog/Show/33
OrthoEvidence. Rise of the Robots: The robot-assisted orthopaedic surgical Revolution. OE Insight. 2021; 2(1): 1. Available from: https://myorthoevidence.com/Download/51b28028-b6f9-4b2c-8ede-9209dbc642c8

International Consensus in Orthopaedic Care (with special guest Javad Parvizi) Aug 02, 2021

Show notes

In this episode, Marc and Mo are joined by special guest Javad Parvizi (James Edwards Professor of Orthopaedic Surgery at the Sidney Kimmel School of Medicine at the Rothman Institute at Thomas Jefferson University in Philadelphia) in a thought-provoking discussion on the goals and impact of international efforts to achieve consensus and standardization in orthopaedic care, with a specific focus on guidelines related to periprosthetic joint infection and venous thromboembolism.

OrthoJOE Mailbag: feedback, comments, and suggestions from our audience can be sent to orthojoe@jbjs.org

Links:

Second International Consensus Meeting (ICM) on Musculoskeletal Infection. https://icmphilly.com/
Parvizi J, Gehrke T, Chen AF. Proceedings of the International Consensus on Periprosthetic Joint Infection. Bone Joint J. 2013 Nov;95-B(11):1450-2. https://online.boneandjoint.org.uk/doi/full/10.1302/0301-620X.95B11.33135?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org

The Fragility Index: Why is it Important to the Practicing Orthopaedic Surgeon? Jul 19, 2021

Show notes

In this instructive episode, Mo and Marc focus on the concept of the Fragility Index—a method for evaluating the robustness of statistically significant dichotomous outcomes in RCTs—and discuss why this concept is relevant to practicing orthopaedic surgeons, who must routinely make real decisions in the clinic and OR based on their interpretation of the orthopaedic literature.

OrthoJOE Mailbag: feedback, comments, and suggestions from our audience can be sent to orthojoe@jbjs.org

Links:

OrthoEvidence. Fragility Index: How robust are your results? OE Original. 2021;4(5):2. Available from: https://myorthoevidence.com/Blog/Show/127
Ekhtiari S, Gazendam AM, Nucci NW, Kruse CC, Bhandari M. The Fragility of Statistically Significant Findings From Randomized Controlled Trials in Hip and Knee Arthroplasty. J Arthroplasty. 2021 Jun;36(6):2211-2218.e1. doi: 10.1016/j.arth.2020.12.015. Epub 2020 Dec 13. PMID: 33390336. https://pubmed.ncbi.nlm.nih.gov/33390336/

Machine-Learning Algorithms in Orthopaedics Jul 05, 2021

Show notes

In this thought-provoking episode, Marc and Mo highlight a recent single-center study on the use of machine-learning algorithms in orthopaedics and use it as a springboard into a larger discussion of the inherent opportunities and challenges that have always been associated the ongoing process of scientific exploration into new domains, with a focus on the intriguing question: “Is there a day in the future when clinical decision-making will be reduced to these machine-learning algorithms?”

OrthoJOE Mailbag: feedback, comments, and suggestions from our audience can be sent to orthojoe@jbjs.org

Links:

Kunze KN, Polce EM, Clapp I, Nwachukwu BU, Chahla J, Nho SJ. Machine Learning Algorithms Predict Functional Improvement After Hip Arthroscopy for Femoroacetabular Impingement Syndrome in Athletes. J Bone Joint Surg Am. 2021 Jun 16;103(12):1055-1062. doi: 10.2106/JBJS.20.01640. PMID: 33877058. https://jbjs.org/reader.php?id=209282&rsuite_id=2845874&native=1&source=The_Journal_of_Bone_and_Joint_Surgery/103/12/1055/fulltext&topics=sm#info
OrthoBuzz Blog Entry: https://orthobuzz.jbjs.org/2021/06/21/use-of-machine-learning-to-predict-improvement-after-hip-arthroscopy/

Author Insights video: https://www.youtube.com/watch?v=KRT98A2HDn8

Cannabinoids in Orthopaedic Research (with special guest Jason Busse) Jun 21, 2021

Show notes

Orthopaedic patients are increasingly using cannabinoids for pain relief, but there is a lack of evidence-based data on this topic. In this episode, Marc and Mo are joined by special guest Jason Busse (Associate Professor in the Department of Anesthesia at McMaster University, Director of the National Pain Centre, and Associate Director of the Michael G. DeGroote Centre for Medicinal Cannabis Research) in an illuminating discussion on the issues, opportunities, and challenges related to orthopaedic research into the use of cannabinoids. Some of the questions covered during the discussion include:

What are the most popular claims among cannabis proponents? What evidence is there to support these claims?
Is there a causal relationship between cannabinoid use and decreased use of opioids and other prescription medications (i.e., a “substitution effect”)?
Much of the current evidence on cannabinoids is observational and anecdotal. What can we learn from this evidence, and how can such information inform future research?
What are the possible sources of funding for such research?
What legal and regulatory hurdles must be overcome in order to allow us to perform properly designed RCTs into this topic?
What challenges are faced by physicians when asked by patients about cannabinoids?
What research is being done from the patient perspective?
What is the roadmap for the future? How we will obtain quality evidence that will help clinicians and their patients to make decisions that are consistent with their values and preferences?

OrthoJOE Mailbag: feedback, comments, and suggestions from our audience can be sent to orthojoe@jbjs.org

Links:

Yun C, Haleem MS, Jeong S, Oyer MA, Driscoll AJ, Chang KY, Yun J, Paul J, Lubbe RJ, Stock SR, Hsu WK, Hsu EL. Effect of Postoperative Analgesic Exposure to the Cannabinoid Receptor Agonist WIN55 on Osteogenic Differentiation and Spinal Fusion in Rats. J Bone Joint Surg Am. 2021 Jun 2;103(11):984-991. doi: 10.2106/JBJS.20.00573. PMID: 33759484. Link.
Devinsky O, Patel AD, Cross JH, Villanueva V, Wirrell EC, Privitera M, Greenwood SM, Roberts C, Checketts D, VanLandingham KE, Zuberi SM; GWPCARE3 Study Group. Effect of Cannabidiol on Drop Seizures in the Lennox-Gastaut Syndrome. N Engl J Med. 2018 May 17;378(20):1888-1897. doi: 10.1056/NEJMoa1714631. PMID: 29768152. Link.
Devinsky O, Cross JH, Laux L, Marsh E, Miller I, Nabbout R, Scheffer IE, Thiele EA, Wright S; Cannabidiol in Dravet Syndrome Study Group. Trial of Cannabidiol for Drug-Resistant Seizures in the Dravet Syndrome. N Engl J Med. 2017 May 25;376(21):2011-2020. doi: 10.1056/NEJMoa1611618. PMID: 28538134. Link.
Ng JY, Gilotra K, Usman S, Chang Y, Busse JW. Attitudes toward medical cannabis among family physicians practising in Ontario, Canada: a qualitative research study. CMAJ Open. 2021 Apr 13;9(2):E342-E348. doi: 10.9778/cmajo.20200187. PMID: 33849983; PMCID: PMC8084545. Link.
NICE Guidelines on cannabis-based medicinal products: https://www.nice.org.uk/guidance/ng144

Women in Orthopaedics (with special guests Ann Van Heest and Laurie Hiemstra) Jun 07, 2021

Show notes

In this episode, Marc and Mo are joined by special guests Ann Van Heest (Professor and Director of Education in the Department of Orthopaedic Surgery at the University of Minnesota) and Laurie Hiemstra (Orthopaedic Surgeon at Banff Sport Medicine and soon-to-be President-Elect of the Canadian Orthopaedic Association) in an illuminating discussion on the challenges faced by women in the field of orthopaedics—and, more importantly, what can be done to address these challenges. This topic was suggested by one of our listeners (Rostanda Meireles, the first woman in the Brazilian Hip Society) via the OrthoJoe mailbag (orthojoe@jbjs.org). The discussion touched on a number of themes:

What systematic disadvantages do women continue to face in orthopaedics?
How do these institutional barriers impact their careers in terms of meeting the requirements for board certification, becoming successful surgeons, obtaining grants and industry support, performing original research, publishing articles, and so on?
How do cultural differences around the world impact women as they try to become established in the field? How can these issues be addressed locally, nationally, and internationally?
How can we address the root causes of the “pipeline” issue, given the fact that 50% of medical students in the US are female, compared with only 15% of orthopaedic surgeons? What has worked, what hasn’t worked, and where should we be focusing our efforts going forward?
How can we drive cultural change for the purpose of increasing the representation of women in positions of leadership within the field?
How can men and non-minority allies lead the charge in fostering meaningful change and increasing diversity, equity, and inclusion across our organizations?
Major cultural change comes from above, but grassroot change is equally important. How can we all “walk the talk” in order to make the field of orthopaedics better across the board?

OrthoJOE Mailbag: feedback, comments, and suggestions from our audience can be sent to orthojoe@jbjs.org

Links:

Van Heest, Ann E. MD; Agel, Julie MA; Samora, Julie Balch MD, PhD. A 15-Year Report on the Uneven Distribution of Women in Orthopaedic Surgery Residency Training Programs in the United States, JBJS Open Access: April-June 2021 - Volume 6 - Issue 2 - e20.00157. doi: 10.2106/JBJS.OA.20.00157. Link.
Scholl E, Badwall HK, Bhandari M. Equity in Surgery: Being Diverse and Inclusive, Isn’t Enough. OE Insights. Sept. 5, 2020. https://myorthoevidence.com/Download/5ac93c79-38a3-4e9e-b5bc-ce225882ac75.
International Orthopaedic Diversity Alliance: https://www.orthopaedicdiversity.org/.
Women in Orthopaedics Worldwide: https://www.facebook.com/groups/458514672258536/

Innovation (with special guest Ed Harvey) May 24, 2021

Show notes

In this episode, Marc and Mo are joined by special guest Ed Harvey (tenured professor at McGill University and Past-President of the Canadian Orthopaedic Association) in a lively discussion on the topic of innovation in the field of orthopaedic surgery. The discussion touches on a number of related questions:

Invention is often confused with innovation. What is the difference?
What is the phenotype of a surgeon-innovator, and how does such an individual differ from a surgeon-scientist or surgeon-educator?
What are the necessary skills and qualities of the surgeon-innovator? How can we identify individuals with these skills, and how can we motivate individuals to develop them? Are people born with these skills, and can these skills be taught?
When is the right time to innovate? Are you ever too young or too old to innovate?
How does the concept of value relate to the concept of innovation? What are the roles of the “3 Ps” (Patient, Physician, and Payor) in achieving commercialization?
How does a surgeon-innovator define “success”?
Why is it important to have an efficient and effective team during the commercialization process? How does the team change over time?
What kind of expertise is needed to navigate the regulatory issues related to innovation?
What are investors and venture capitalists (VCs) ultimately looking for when evaluating an invention?

OrthoJOE Mailbag: feedback, comments, and suggestions from our audience can be sent to orthojoe@jbjs.org

Links:

Schiffman CJ, Prabhakar P, Hsu JE, Shaffer ML, Miljacic L, Matsen FA 3rd. Assessing the Value to the Patient of New Technologies in Anatomic Total Shoulder Arthroplasty. J Bone Joint Surg Am. 2021 May 5;103(9):761-770. doi: 10.2106/JBJS.20.01853. PMID: 33587515. Link.

Duckworth, A. (2016). Grit: The power of passion and perseverance. Scribner/Simon & Schuster. https://www.amazon.com/Grit-Passion-Perseverance-Angela-Duckworth/dp/1501111108

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