OrthoJOE

Latest Episodes:

Knee Arthroscopy May 10, 2021

Show notes

In this episode, Marc and Mo highlight a recent large database study from The Hospital for Special Surgery and use it as a springboard to discuss a number of issues related to the appropriateness, timing, and investigation of knee arthroscopy in patients with degenerative disease.

What is the relationship between the timing of knee arthroscopy and the rates of revisions and complications following TKA? Is there a recommended time interval between knee arthroscopy and TKA that can be used to inform clinical decision-making?
Is the use of arthroscopy in the presence of knee OA even evidence-based to begin with? What would be the specific situations in which arthroscopy would definitely be indicated?
What are the weaknesses of the insurance database approach to studying this topic? How should we advise residents or young academic faculty with regard to the issues that are associated with this study design? What confounders must be considered in the interpretation of the results?
If the goal is to delay TKA for as long as possible, what are the top 3 evidence-based interventions that we have in our armamentarium today?

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

Links:

Gu A, Fassihi SC, Wessel LE, Kahlenberg C, Ast MP, Sculco PK, Nunley RM. Comparison of Revision Risk Based on Timing of Knee Arthroscopy Prior to Total Knee Arthroplasty. J Bone Joint Surg Am. 2021 Apr 21;103(8):660-667. doi: 10.2106/JBJS.20.00218. PMID: 33849048. Link

Jones MH. Indications for Knee Arthroscopy in Patients with Osteoarthritis: Commentary on an article by Alex Gu, MD, et al.: "Comparison of Revision Risk Based on Timing of Knee Arthroscopy Prior to Total Knee Arthroplasty". J Bone Joint Surg Am. 2021 Apr 21;103(8):e33. doi: 10.2106/JBJS.21.00074. PMID: 33849051. Link

Richardson SS, Schairer WW, Sculco TP, Sculco PK. Comparison of Infection Risk with Corticosteroid or Hyaluronic Acid Injection Prior to Total Knee Arthroplasty. J Bone Joint Surg Am. 2019 Jan 16;101(2):112-118. doi: 10.2106/JBJS.18.00454. PMID: 30653040. Link

OARSI Guidelines: https://oarsi.org/education/oarsi-guidelines-0

Perioperative and Transitional Care Apr 26, 2021

Show notes

In this episode, Marc and Mo are joined by special guest P.J. Devereaux, Director of the Division of Perioperative Care at McMaster University, in an informative discussion on the future of perioperative and transitional care. With much of the world still dealing with a third wave of the Covid pandemic, and with hospital access continuing to be a challenge because of high rates of ER visits and hospital readmissions, how can we optimize the safety and care of patients both intraoperatively and postoperatively?

How has Covid helped us to rethink how we might improve care for our patients in the future?
How can we most effectively monitor patients after they leave the orthopaedic surgical suite?
What measures can we take to send patients home both sooner and safer?
What are the roles of technology, personnel, data monitoring, and established protocols in ensuring timely and improved patient care after discharge?
What are the cost considerations associated with technology and technology support? How do these costs compare with those of ER visits and rehospitalizations?
How might the development of a new discipline of perioperative and transitional care help to save lives, provide better patient experiences, improve outcomes, and avoid overloading our ERs and hospitals?

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

Links:

Prada C, Chang Y, Poolman R, Johal H, Bhandari M. Best practices for surgeons. COV/0-19 Evidence-Based Scoping Review. https://myoe.blob.core.windows.net/docs/OE-Best-Practices-for-Surgeons-COVID-19-Evidence-Based-Scoping-Review.pdf

Prvu Bettger J, Green CL, Holmes DN, Chokshi A, Mather RC 3rd, Hoch BT, de Leon AJ, Aluisio F, Seyler TM, Del Gaizo DJ, Chiavetta J, Webb L, Miller V, Smith JM, Peterson ED. Effects of Virtual Exercise Rehabilitation In-Home Therapy Compared with Traditional Care After Total Knee Arthroplasty: VERITAS, a Randomized Controlled Trial. J Bone Joint Surg Am. 2020 Jan 15;102(2):101-109. doi: 10.2106/JBJS.19.00695. PMID: 31743238. link

Total Ankle Replacement Apr 12, 2021

Show notes

In this episode, Marc and Mo are joined by special guest Bruce Sangeorzan—Professor of Orthopaedics at the University of Washington and world-renowned foot and ankle researcher—in a lively discussion on the past, present, and future of ankle replacement.

Approximately 700,000 knee replacements are performed each year, compared with just 10,000-20,000 ankle replacements, leading to a number of questions:
- How does this factor affect the number of clinicians who are as skillful and comfortable in performing ankle replacement as compared with shoulder, knee, and hip replacement?
- How do better-designed alignment devices, improved implants, and better training affect the numbers of ankle replacements being performed each year?
- How soon can we reach 40,000 ankle replacements each year?
What are the challenges in performing RCTs of ankle arthroplasty? Is an RCT even the right study design for this topic?
What design elements seem to be most successful, especially given the space limitations in the ankle region?
How do factors such as degenerative disease, BMI, activity level, and adjacent osteotomy affect the results of ankle replacement and arthrodesis?

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

Resources/Links:

Veljkovic AN, Daniels TR, Glazebrook MA, Dryden PJ, Penner MJ, Wing KJ, Younger ASE. Outcomes of Total Ankle Replacement, Arthroscopic Ankle Arthrodesis, and Open Ankle Arthrodesis for Isolated Non-Deformed End-Stage Ankle Arthritis. J Bone Joint Surg Am. 2019 Sep 4;101(17):1523-1529. doi: 10.2106/JBJS.18.01012. PMID: 31483394. https://jbjs.org/reader.php?id=205473&rsuite\_id=2159103&native=1&source=The\_Journal\_of\_Bone\_and\_Joint\_Surgery/101/17/1523/fulltext&topics=fa#info
Muller P, Skene SS, Chowdhury K, Cro S, Goldberg AJ, Doré CJ; TARVA Study Group. A randomised, multi-centre trial of total ankle replacement versus ankle arthrodesis in the treatment of patients with end stage ankle osteoarthritis (TARVA): statistical analysis plan. Trials. 2020 Feb 18;21(1):197. doi: 10.1186/s13063-019-3973-4. PMID: 32070409; PMCID: PMC7029552. https://pubmed.ncbi.nlm.nih.gov/32070409/
The Canadian Foot and Ankle Society (COFAS): https://coa-aco.org/foot-ankle-cofas/

Brought to you by Mohit Bhandari and Marc Swiontkowski of OrthoJOE.

Diversity, Equity, and Inclusion Mar 29, 2021

Show notes

How do diversity, equity, and inclusion contribute to excellence, creativity, competitive advantage, and relevance in both orthopaedic surgery and scientific publishing? How can we achieve greater diversity among authors, editors, and reviewers at top journals? What specific steps can individuals and organizations take to create a more diverse, inclusive, and equitable environment that provides greater opportunities for under-represented groups?

We have a mailbag! If you have any feedback or comments about the latest episode or other relevant topics, feel free to send us a line at the OrthoJOE Mailbag: orthojoe@jbjs.org.

Talking Points:

Equity and inequality in surgery
“Getting to excellence” and “being diverse and inclusive” are key targets
How can we be more inclusive in the publishing industry and within our fields of expertise?
The orthopaedic gender gap
What more should we be doing?
Rallying the voices of others
Being aware of what’s happening in your office
Thinking broadly about change

Resources/Links:

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.
Okike K, Liu B, Lin YB, Torpey JL, Kocher MS, Mehlman CT, Bhandari M, Biermann JS. The orthopedic gender gap: trends in authorship and editorial board representation over the past 4 decades. Am J Orthop (Belle Mead NJ). 2012 Jul;41(7):304-10. https://pubmed.ncbi.nlm.nih.gov/22893880/
Hiller KP, Boulos A, Tran MM, Cruz AI Jr. What Are the Rates and Trends of Women Authors in Three High-impact Orthopaedic Journals from 2006-2017? Clin Orthop Relat Res. 2020 Jul;478(7):1553-1560. doi: 10.1097/CORR.0000000000001043. https://pubmed.ncbi.nlm.nih.gov/31688211/
Ray GS, Lechtig A, Rozental TD, Bernstein DN, Merchan N, Johnson AH. Gender Disparities in Financial Relationships Between Industry and Orthopaedic Surgeons. J Bone Joint Surg Am. 2020 Feb 19;102(4):e12. doi: 10.2106/JBJS.19.00669. https://jbjs.org/reader.php?id=205772&rsuite_id=2266005&native=1&source=The_Journal_of_Bone_and_Joint_Surgery/102/4/e12/abstract&topics=oe#info

Distal Radial Fractures Mar 15, 2021

Show notes

Welcome to the OrthoJOE podcast with Dr. Marc Swiontkowski and Dr. Mohit Bhandari. In this episode of OrthoJOE, Marc and Mo discuss the RCTs (or randomized control trials) on common injuries like distal radial fractures. There is a huge amount of work involved in these. Should our focus be elsewhere? Is there such a thing as too many RCTs on the same topic?

Marc and Mo also talk about the data and their findings in recent scientific journals, including their own JBJS and Orthoevidence articles. "Cost-effectiveness studies'' are increasingly popular, with submissions doubling every 18 months. Orthopaedic surgeons must "own the bone" when treating distal radial fractures, which should be seen as a sentinel event for investigating overall bone health.

If you have any comments, questions, or topics you would like us to cover, please feel free to reach out so we can read your messages and possibly answer your questions during the next episode of OrthoJOE. We are currently working on a better mailbag system. However, in the meantime, you can contact us through our respective websites (MyOrthoEvidence and JBJS).

Talking Points:

RCTs on distal radial fractures
The cost-effectiveness of certain studies
Getting the appropriate dialogue going
The upsides and downsides to “expertise-based trials”
Novel angles for future trials
The AOA’s “Own the Bone” Program and focusing on poor bone quality

Resources/Links:

Ludvigsen T, Matre K, Gudmundsdottir RS, Krukhaug Y, Dybvik EH, Fevang JM. Surgical Treatment of Distal Radial Fractures with External Fixation Versus Volar Locking Plate: A Multicenter Randomized Controlled Trial. J Bone Joint Surg Am. 2021 Mar 3;103(5):405-414. doi: 10.2106/JBJS.20.00275. PMID: 33369985. https://pubmed.ncbi.nlm.nih.gov/33369985/
Rajan PV, Qudsi RA, Dyer GSM, Losina E. The Cost-Effectiveness of Surgical Fixation of Distal Radial Fractures: A Computer Model-Based Evaluation of Three Operative Modalities. J Bone Joint Surg Am. 2018 Feb 7;100(3):e13. doi: 10.2106/JBJS.17.00181. PMID: 29406347; PMCID: PMC6819022. https://pubmed.ncbi.nlm.nih.gov/29406347/

How is Data Redefining Surgery? Mar 01, 2021

Show notes

Welcome to the OrthoJOE podcast with Dr. Marc Swiontkowski and Dr. Mohit Bhandari. In this episode of OrthoJOE, Marc and Mo explore both the challenges and opportunities that have risen from the new abundance of online information and what this means for our pursuit of evidence-based medicine in surgery.

If you have any comments, questions, or topics you would like us to cover, please feel free to reach out so we can read your messages and possibly answer your questions during the next episode of OrthoJOE. You can contact us through our respective websites (MyOrthoEvidence and JBJS). We intend on having a mailbag portion of the show where we answer questions posed by our listeners.

Talking Points:

Traditional textbooks and journal articles in digital form look and operate similar to the printed version
Application of machine learning to scientific research and clinical practice
Future scientific paper: computational notebooks creating opportunity for a "living journal”
Point-of-care, data-driven tools of the future

Resources/Links:

OrthoEvidence, (February 19, 2021- No 42) OrthoEvidence. The Digital Enterprise: Redefining How Data is Changing Surgery. OE Insight. 2021;2(2):3. Available from: https://myorthoevidence.com/Download/9a6a3a4e-405f-4e40-8970-9ffa1f77480b
JBJS, Vaid S, Cakan C, Bhandari M. Using Machine Learning to Estimate Unobserved COVID-19 Infections in North America. J Bone Joint Surg Am. 2020 Jul 1;102(13):e70. doi: 10.2106/JBJS.20.00715. PMID: 32618918; PMCID: PMC7396213. https://pubmed.ncbi.nlm.nih.gov/32618918/

Machine Learning Consortium, on behalf of the SPRINT and FLOW Investigators. A Machine Learning Algorithm to Identify Patients with Tibial Shaft Fractures at Risk for Infection After Operative Treatment. J Bone Joint Surg Am. 2020 Dec 29;Publish Ahead of Print. doi: 10.2106/JBJS.20.00903. Epub ahead of print. PMID: 33394819. https://pubmed.ncbi.nlm.nih.gov/33394819/

Femoral Neck Fracture Evidence Feb 15, 2021

Show notes

Welcome to the OrthoJOE podcast with Dr. Marc Swiontkowski and Dr. Mohit Bhandari. In this episode of OrthoJOE, Marc and Mo are talking about the choice of a unipolar or bipolar prosthesis design for displaced femoral neck fractures which are treated with hemiarthroplasty. They discuss randomized clinical trials (scientific approach to control bias) vs registry data (real world). They also have a lively discourse about revision rates.

Talking Points:

Orthoevidence article: “Unipolar vs bipolar hemiarthroplasty similar in elderly displaced femoral neck fractures in elderly individuals”
Lessons from Mo’s large random control trial concerning fractures
- The debate about total versus hemiarthroplasty
- The advantage of a total hip replacement
- The statistics of the trial
The need for a repository of data
Clinical decision-making about cementification and revision

Resources/Links:

Farey JE, Cuthbert AR, Adie S, Harris IA. “Revision Risk After Unipolar or Bipolar Hemiarthroplasty for Femoral Neck Fractures: An Instrumental Variable Analysis of 62,875 Procedures from the Australian Orthopaedic Association National Joint Replacement Registry.” J Bone Joint Surg Am. 2021 Feb 3;103(3):195-204. doi: 10.2106/JBJS.20.00486. PMID: 33208595. https://europepmc.org/article/med/33208595

HEALTH Investigators, Bhandari M, Einhorn TA, Guyatt G, Schemitsch EH, Zura RD, Sprague S, Frihagen F, Guerra-Farfán E, Kleinlugtenbelt YV, Poolman RW, Rangan A, Bzovsky S, Heels-Ansdell D, Thabane L, Walter SD, Devereaux PJ. Total Hip Arthroplasty or Hemiarthroplasty for Hip Fracture. N Engl J Med. 2019 Dec 5;381(23):2199-2208. doi: 10.1056/NEJMoa1906190. Epub 2019 Sep 26. PMID: 31557429. https://pubmed.ncbi.nlm.nih.gov/31557429/

Orthoevidence: “Unipolar vs bipolar hemiarthroplasty similar in elderly displaced femoral neck fractures in elderly individuals” https://myorthoevidence.com/AceReports/Report/8399

Robotics in Orthopaedics Feb 01, 2021

Show notes

Welcome to the OrthoJOE podcast with Dr. Marc Swiontkowski and Dr. Mohit Bhandari. In this episode of OrthoJOE, Drs. Bhandari and Swionkowski discuss the future of robotics in orthopaedic surgery. Why all of the investment? What are the costs vs. benefits? How about the marketing incentives for institutions? Is there a promise of better outcomes?

Talking Points:

Facts about robotics in the medical industry
Why robotics? Are we fixing the problem?
What is the long-term value of robotics in surgery?
Expertise bias in robotics
Is the initial cost going to be outweighed quickly?
- Two-year outcome study
- Quicker, less invasive surgeries?
- Marketing using the latest technology
Robotics as an enabler technology that allows us to rethink our views on surgery
What is needed in order to integrate and use robots well

Resources/Links:

“Robotic-Assisted Total Hip Arthroplasty: A Meta-analysis of Randomized Controlled Trials,” OrthoEvidence

“Robotic Technology in Orthopaedic Surgery,” JBJS.org

“Robotic-Assisted Pedicle Screw Placement During Spine Surgery,” JBJS.org

The Journal of Bone and Joint Surgery

Orthoevidence

Cov-19 Crisis and Impact on Orthopaedic Publishing Jan 25, 2021

Show notes

Welcome to the OrthoJOE podcast with Dr. Marc Swiontkowski and Dr. Mohit Bhandari. In this episode of OrthoJOE, we’ll be talking about the Journal of Bone and Joint Surgery (JBJS) as well as Orthoevidence, our two publications which both have the goals of synthesizing information and making it digestible for the public and professionals in the industry. Today we’re also talking about the impact of COVID-19 on orthopaedic surgery, the speed at which information was disseminated, as well as the publishing standards on this information as it was released to the public.

Talking Points:

The history and mission statement for Orthoevidence
The early days of COVID-19
Infodemic
The speed at which information was disseminated
How publishing standards have evolved
Preprint servers and associated use during crisis

Resources/Links:

The Journal of Bone and Joint Surgery

Orthoevidence

JBJS Covid-19 Collection

The "Infodemic" of Journal Publication Associated with the Novel Coronavirus Disease

Sham Surgery as the Surgical “Placebo” in Orthopedic Trials Jan 17, 2021

Show notes

Welcome to the OrthoJOE podcast with Dr. Marc Swiontkowski and Dr. Mohit Bhandari. In this episode of OrthoJOE, we’ll be talking about sham surgeries. What is sham surgery and why do we need it? Is it morally ethical to use sham controls? We talk about avoiding bias and the feasibility of using sham controls. What are the benefits? Do they outweigh the moral ramifications?

Talking Points: