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JBJS Case Connector: Celebrating 10 Years  

JBJS is pleased to note that this year marks the 10th anniversary of JBJS Case Connector. Over the past decade, Case Connector has seen rapid growth toward its goal of establishing a sizable inventory of high-quality, peer-reviewed case reports—enriched by a collection of keywords and search functionality that will allow healthcare providers to recognize commonalities between cases, benefit from the experience of their peers, identify trends, and distinguish between truly rare cases and repeated single instances of a larger problem.  

Insight into Case Connector’s journey and mission can be found in a recent editorial by Co-Editors Dr. Tom Bauer and Dr. Ron Lindsey and Editor-in-Chief Dr. Marc Swiontkowski. 

From just over 200 manuscripts submitted from 28 countries in 2011, with 13 articles published that first year, Case Connector received more than 1,000 case report submissions from 54 countries, with 320 articles published, in 2020. Reports have been authored by academic scientists, private practitioners, residents, physical therapists, medical students, and other healthcare professionals.  

JBJS extends its thanks to all who have contributed to Case Connector’s success to date. Authors interested in submitting an article to Case Connector are encouraged to visit the Author Resource Center for additional information and guidance.  

A Real-World Economic Evaluation: TSA vs Hemiarthroplasty

In a new study reported in JBJS, Lapner et al. conducted a cost-utility analysis of total shoulder arthroplasty (TSA) versus hemiarthroplasty from the perspective of Canada’s publicly funded health-care system. They used a Markov model to simulate the costs and quality-adjusted life-years (QALYs) for patients undergoing either TSA or hemiarthroplasty over a lifetime horizon to account for costs and medically important events over the patient lifetime. Subgroup analyses by age groups (≤50 or >50 years) were also performed.

Discussing their findings, the authors note:

Our analysis demonstrated that TSA was more cost-effective compared with hemiarthroplasty. This study involved a large cohort of patients (5,777) who underwent TSA or hemiarthroplasty. The data demonstrate that, despite the additional initial cost of TSA implants, health-care utilization postoperatively was greater for hemiarthroplasty compared with TSA and utility scores for hemiarthroplasty were inferior. Our findings can help inform both clinical decision-making as well as health-care policy with respect to these treatments.”

Click here for the full JBJS report.

JBJS Author Insights: Dr. Jeremy Smith

Co-author Jeremy Smith, MD discusses the new JBJS study “Correlation Between Patient-Reported Outcome Measures and Health Insurance Provider Types in Patients with Hip Osteoarthritis.” Watch the video below.

Read the full report here.

JBJS OA Participates in Research4Life Program

JBJS Open Access (JBJS OA) is an international, peer-reviewed, open-access journal from the publishers of The Journal of Bone & Joint Surgery. The mission of this continuously published online journal is to provide a steady flow of comprehensive, objective, and evidence-based basic-science and clinical studies that have the potential to impact orthopaedic care worldwide.

JBJS OA welcomes original articles that contribute to orthopaedic knowledge from all sources in all countries, with the goal of improving the quality of care of orthopaedic patients. To this end, JBJS OA is pleased to participate in the Research4Life waiver program and offers full or partial equitable waivers for accepted articles from low-income and middle-income economies. Eligibility is based on the Research4Life eligibility criteria, which can be found here. Countries listed in Group A are eligible for the full waiver and countries listed in Group B are eligible for the partial (50%) waiver. The waiver is automatically applied based on the Corresponding Author’s country information provided during submission.

For more information about JBJS OA submission guidelines and author instructions, please visit the JBJS OA Author Resource Center.

Video Summary: Prevalence and Outcomes of Unexpected Positive Intraoperative Cultures in Presumed Aseptic Revision Hip Arthroplasty

A new JBJS video summary is available now. View the video below, and read the full article here.

Patient Perspectives in Orthopaedic Care: JBJS “What’s Important” Series 

Last year, JBJS expanded its popular “What’s Important” article series to include personal essays on what’s important to orthopaedic patients. Since its launch, the Patient Perspective series has included essays spanning a variety of topics—from what it’s like experiencing claustrophobia during an MRI for a shoulder injury, to confronting age-related bias in knee care, to learning to play the role of a “recovery partner” for a spouse following rotator cuff surgery. The importance of communication, compassion, and empathy have stood out among themes of these patient-focused essays. 

In the recently published “What’s Important: A Resilience Found in Running,” author Louise A. Atadja, BA shares her personal story as a longtime athlete who persevered despite the painful challenges of hip dysplasia and femoroacetabular impingement, and who went from orthopaedic patient to medical student inspired to become an orthopaedic surgeon.  

In her essay, she writes,

I would not have been able to get through this recovery without my family, coaches, and close friends, whose support kept me smiling through difficult days. I’m also grateful for the multidisciplinary team that was unwilling to give up on me. … In an age in which medicine is becoming more impersonal, I strongly encourage physicians to continue to find ways to truly connect with patients and not to overlook the whole person in their care.” 

Members of the orthopaedic community are invited to work with patients to submit an essay offering their insights, or to share their own experience “walking in the shoes” of a patient. Manuscripts can be submitted here, and additional guidance on submitting an article can be found at our Instructions for Authors. We remain inspired by the words of wisdom shared in the series to date. 

Decrease in Inflation-Adjusted Medicare Reimbursement for Revision THA 

In a study now reported in JBJS, Acuña et al. analyzed Medicare reimbursements associated with revision total hip arthroplasty (THA) procedures. After adjusting for inflation, they found that the mean physician fee reimbursement for revision THA due to aseptic complications declined by a mean of 27% for femoral component revision, 27% for acetabular component revision, and 28% for both-component revision from 2002 to 2019. For 2-stage revision due to infection, they found that mean reimbursement fell by 19% and 24% for the explantation and reimplantation stages, respectively.  

The total decline in reimbursement for revision THA due to infection ($1,020.64 ± $233.72) was significantly greater than that for revision due to aseptic complications ($580.72 ± $107.22) (p < 0.00001). 

Reflecting on their investigation, the authors note: 

In light of persistent cost pressures and discussions surrounding the future of total hip arthroplasty reimbursement, our study explores temporal trends in the Centers for Medicare & Medicaid Services (CMS) physician fee schedule for revision THA procedures. Our findings, showing a significantly larger decline for septic revision THA reimbursements compared to their aseptic counterpart, may have important implications for ongoing discussions surrounding the CMS physician fee schedule.” 

They conclude in their study that, “continuation of this trend [of decreased reimbursement] could create substantial disincentives for physicians to perform such procedures and limit access to care at the population level.” 

Click here for the full JBJS report. 

A recent OrthoBuzz post on reimbursement for revision TKA can be found here. 


Contralateral Limb Function Before THA: An Indicator of Postop Gait Speed 

In a prospective case-control study reported in JBJS, Ohmori et al. evaluated factors related to postoperative gait speed in patients with osteoarthritis undergoing total hip arthroplasty. They found that the preoperative, contralateral-side OLST (one-leg standing time) was a significant factor (p < 0.001) for postoperative comfortable gait speed. They also found that preoperative, contralateral-side knee extensor strength was a significant factor (p = 0.018) for postoperative maximum gait speed. 

Reflecting on their findings, the authors note: 

THA is a procedure that typically has a good a postoperative prognosis. However, some patients do not have sufficient satisfaction. Investigating reasons for this, we found that the functional status of the nonoperative lower limb is an important factor. 

Surgical intervention before lower-limb function on the contralateral side declines, or a preoperative rehabilitation intervention on the contralateral side, may improve the THA outcome.” 

Click here for the full JBJS report. 

Cross-Cultural Mentorship in Orthopaedic Surgery

Source: Association of American Medical Colleges (AAMC).

In a new JBJS “What’s Important” article, Dr. David N. Bernstein and Dr. Addisu Mesfin discuss cross-cultural mentorship in orthopaedics, offering their personal reflections as a Black mentor and White mentee.

As the authors state, “Recent events in the United States have magnified our society’s continued struggle to effectively address structural racism. While many within the medical community have pledged to tackle race-related injustices, much of the measurable progress will take time to quantify accurately. However, one of the ways in which positive change may happen, and happen more expeditiously, is through active efforts to recruit Black learners into medical school and residency programs so that the country’s physician workforce is truly more representative of the populations it serves. Indeed, many in medicine, including leaders within orthopaedic surgery, have turned their attention toward this critical mission… It is no secret that mentorship is crucial to the professional and personal development of physicians and scientists, especially as a means to improve real diversity and inclusion, not just the appearance of it…” Read the full article here.