Archive | May 2014

Orthopaedists Led the Pack in 2013 Specialist Compensation

Among 25 medical specialties, orthopaedic surgery ranked highest on payscale, according to Medscape’s 2014 Compensation Study (registration/login required). With an average annual salary of $413,000 in 2013, orthopaedists were followed by cardiologists with an average salary of $351,000 and urologists and gastroenterologists (tied at $348,000). The lowest-earning specialists were HIV/ID physicians, family- and internal-medicine doctors, and pediatricians, all making less than $200,000. Relative to 2012, orthopaedists experienced an increase of nearly 2%, while rheumatologists reaped the biggest year-to-year increase in pay, with a jump of 15%. A gender gap remained, with the average salary for male orthopaedic surgeons at $418,000, compared to female surgeons at $354,000. Geography also impacts salaries. The highest-paid orthopedists live in the Northwest and the Great Lakes regions. When asked whether they would choose the same specialty if given the chance to start over, 64% of orthopaedists said they would. However, despite the high salaries, Medscape’s study placed orthopaedists in the middle of the pack for overall career satisfaction.

JBJS Webinar: Experts Call for Better Outcome Measures in ACL Studies

Changes in and current “best practices” for anterior cruciate ligament (ACL) reconstruction were the subject of a recent JBJS webinar that is available for free viewing until March 5, 2015.

The webinar focused on the procedural and outcome differences between nonanatomic transtibial tunnel drilling and more anatomic anteromedial portal drilling. Drs. Freddie Fu and Christopher Kaeding summarized their recent JBJS papers on ACL tunnel drilling, and Drs. Brett Owens and Darren Johnson commented on the authors’ findings. Dr. Mark Miller moderated the webinar.

One of several points the four ACL experts agreed upon during the webinar was the need for more objective outcome measures to help surgeons distinguish success from failure. For example, Dr. Fu argued for measuring outcomes with biomarkers and advanced imaging such as dynamic stereoradiography and 3-D computed tomography. As important as patient-centered outcomes are, Dr. Fu cited their subjectivity as a downside. “Getting back to sport in 6 months may not be so good if your ACL isn’t reconstructed anatomically,” he said.

Dr. Kaeding’s study found no KOOS-score differences between the two drilling techniques, but the transtibial group had a nearly 2.5-fold increased risk of subsequent ipsilateral knee surgery when compared to the anteromedial group. Commenting on that study, Dr. Johnson lauded the six-year follow-up and outcome metric of subsequent same-knee surgery. But he stressed that a combination of clinical outcomes–including patient satisfaction, knee stability, re-tear rates, and subsequent arthritis–would help surgeons make more informed decisions. He expressed hope that the patients in Dr. Kaeding’s study will continue to be followed so longer-term clinical data can been obtained.

To view the webinar in its entirety, free of charge, go to

https://vts.inxpo.com/Launch/QReg.htm?ShowKey=18001

You can also read a JBJS Reviews critical analysis of ACL tunnel placement here.

Editor’s Choice – May 5, 2014

The article “Declining Rates of Osteoporosis Management Following Fragility Fractures in the U.S., 2000 through 2009” by Balasubramanian, et al. in the April 2, 2014 JBJS is a bit discouraging, but it will hopefully serve as a wake-up call for orthopaedic surgeons to re-engage with our patients to diagnose and treat previously undetected osteoporosis.

Fragility fractures–which primarily affect the vertebrae, hip, distal radius, or proximal humerus–are often the initial indication of osteoporosis in older individuals. For more than a decade, orthopaedic surgeons treating these fractures have been strongly encouraged to evaluate patients in this age group for the osteoporosis generally associated with these fractures. The American Orthopaedic Association (AOA) in 2005 began developing the Own the Bone program, specifically addressing the need to evaluate and treat osteoporosis, as well as the fracture, in these patients. The AOA has formed liaisons with several other national organizations to advance this program, and by late 2013, 44 states had hospitals implementing Own the Bone at their local institutions.

This article is sobering. Despite concerted efforts to link care of fragility fractures to evaluation and treatment of co-existing osteoporosis, these authors report an actual decrease in the rate of osteoporosis management for these patients. Only one-third of the women and one-sixth of the men in this retrospective cohort study were evaluated and treated according to current clinical guidelines.

This is an important public health issue. Despite the fact osteoporosis management involves non-operative treatment, it is essential that orthopaedic surgeons become more cognizant of the association between fragility fractures and osteoporosis treatment, and put in place a protocol to ensure that these patients are evaluated and treated for osteoporosis, as well as for the fracture. Osteoporosis may not be under the direct guidance of the orthopaedic surgeon, but the recognition of this potential problem is squarely within the practice scope of orthopaedists, who are well positioned to initiate secondary prevention measures for these older individuals.