According to the orthopaedic surgeon edition of Kantar Media’s Website Usage & Qualitative Evaluation study, JBJS.org ranks hands down as the #1 orthopaedic site that surgeons visit most often and spend the most time on. The Kantar study evaluates the opinions of orthopaedic surgeons on 29 professional websites, including 8 orthopaedic sites. Not only does JBJS.org rank number 1 among the other 7 orthopaedic sites in frequency of visits (4.7 times/month), the website ranks first among all 28 sites evaluated in terms of time per session (20.31 minutes). Additionally, JBJS.org ranks #1 in delivering quality clinical content and keeping surgeons informed of the latest practices and procedures. JBJS ties for first place in the category of information on drugs, devices, or professional services. Also noteworthy is the fact that JBJS Reviews, a new online review journal from JBJS launched in November 2013, has already taken over third place in time spent and number of site visits.
JBJS Webinar Series
JBJS has held multiple live webinar events on a wide variety of topics, and we are pleased to announce the expansion of the JBJS Webinar Series in 2014. Each webinar has proven to be a successful tool in educating, informing and engaging orthopaedic surgeons around the world. In 2014, JBJS is continuing this educational program through a new series of interactive online events.
Our webinars bring together groups of authors to present recently published scientific research and data, and they include commentary from guest experts. Live Q&A sessions follow the author and commentator presentations to provide the audience with the opportunity to further explore the concepts and data presented. Webinars continue to be available on-demand for several months after the event.
AVAILABLE ON-DEMAND (Previously Recorded Events)
Total Knee Arthroplasty Critical Decision Making: Socioeconomic and Clinical Considerations (June 10, 2014) – Moderated by Charles R. Clark, MD
Panelists/Authors: Kevin J. Bozic, MD and Thomas S. Thornhill, MD
Commentators: Daniel J. Berry, MD and Kevin Garvey, MD
Preventing Arthroplasty-Associated Venous Thromboembolism (VTE) (May 12, 2014) – Moderated by Thomas A. Einhorn, MD
Panelists/Authors: Clifford W. Colwell Jr, MD and John T. Schousboe, MD
Commentators: Vincent Pellegrini Jr, MD and Jay Lieberman, MD
Anterior Cruciate Ligament (ACL) Reconstruction (March 5, 2014) – Moderated by Mark Miller, MD
Panelists/Authors: Freddie Fu, MD and Christopher Kaeding, MD
Commentators: Brett Owens, MD and Darren L. Johnson, MD
Adhesive Capsulitis/Frozen Shoulder (December 2013) – Moderated by Andrew Green, MD
Presented in conjunction with the Journal of Orthopaedic & Sports Physical Therapy.
Panelists/Authors: George Murrell, MD, Martin J. Kelley, DPT, Jo Hannafin, MD, PhD, and Philip W. McClure, PT, PhD
Periprosthetic Joint Infection (October 2013) – Moderated by Charles R. Clark, MD
Panelists/Authors: Kevin J. Bozic, MD and Craig J. Della Valle, MD
Commentators: Javad Parvizi, MD, FRCS, and Geoffrey Tsaras, MD, MPH
Measuring Value in Orthopaedic Surgery (September 2013) – Moderated by James Herndon, MD
Panelist/Author: Kevin J. Bozic, MD
Commentators: David Jevsevar, MD and Jon J.P. Warner, MD
Editor, JBJS Reviews: Thomas A. Einhorn, MD
According to a recent survey by JBJS among nearly 100 orthopaedic job seekers, the number-one challenge orthopaedists face each day is finding a balance between work and personal life. The second greatest challenge is the abundance of administrative hassles, such as dealing with insurers, liability issues, and reimbursement. Survey respondents said that when searching for a new job, location is the most important factor followed by job security and career advancement. Responses revealed a strong consensus that a teaching/academic hospital is the preferred type of facility in which to work. The two most compelling drivers that prompt job seekers to find a new job are desire for a better work environment and finding a better community for themselves and their families.
Dr. Brian S. Parsley is President of the American Association of Hip and Knee Surgeons (AAHKS). He was kind enough to answer a few questions for OrthoBuzz.
JBJS: What have been your key goals for AAHKS during your presidency?
Dr. Parsley: AAHKS is a growing organization that has established itself as the premier organization for hip and knee arthroplasty education, advocacy, and support in the United States. Our membership has experienced continued record growth, as has our Annual Meeting. This year will focus on continuing our growth nationally, but we will also focus more on developing international membership and partnerships through educational opportunities. We are blessed with outstanding experts in arthroplasty techniques and innovation, in patient advocacy and legislative and regulatory affairs, and with expertise on how to navigate through this ever-changing healthcare arena to ensure that the patients we serve are well cared for. This requires a constant review and upgrade of our internal organizational systems to manage these priorities effectively and efficiently.
JBJS: How do you think JBJS can best address the needs of the members of AAHKS and other subspecialty organizations?
Dr. Parsley: JBJS continues to be one of the premier resources for quality educational content and serves as a foundation for identifying “Best Practices” recommendations. The expansion of JBJS into alternative methods to communicate with the orthopaedic community through forums such as this and educational webinars indicates an interest in remaining a respected resource.
JBJS: As a specialist in diagnosing and treating arthritis, are there new or emerging approaches to treatment that you see as particularly promising?
Dr. Parsley: The success of total joint arthroplasty today is outstanding, and the quality-of-life improvement this procedure provides is life changing for the vast majority of patients. We continue to focus on new techniques for joint preservation through cartilage research and exploring when early intervention to treat hip or knee abnormalities is indicated to improve function and extend joint preservation. I also see the continued emergence of bicruciate-retaining TKA to potentially provide knee replacements that have a more anatomic stabilization and function and hopefully improved outcomes. Continued refinement of the mechanical functions of the joint implants for both the hip and knee are ongoing; this includes further improvements of the polyethylene articulation, improvements in trunion design for modular hip designs, and improvements in implant geometry that will hopefully extend the life of implants even further.
JBJS: What trends in orthopaedics generally are you most intrigued by?
Dr. Parsley: The delivery of orthopaedic care is undergoing major changes as the fee-for-service model is being challenged and value propositions introduced. This is the most disruptive change in orthopaedics today. The associated changes in the physician practice from the private-sector model to a significant rise in physician employment will potentially have an impact on the patient-physician relationship and our role as patient advocate, and this is a cause for concern. Physicians need to get engaged and lead the way during this time of change.
JBJS: Looking ahead to the next 20 years or so, what do you think might be three significant advances or changes in orthopaedics?
Dr. Parsley: As I mentioned above, the changes in healthcare delivery will be the most significant, but at the same time they will provide opportunities for improvement in the value of the services we provide. Extensive work is being done in the field of orthobiologics and the potential benefits of stem cell research. This field may help us prevent or delay the devastating effects of arthritis. Lastly, the emphasis today on evidence-based medicine will help us refine the care that we provide and decrease the variability of outcomes going forward. This is in the best interest of our patients.
JBJS: What changes do you expect to come as a result of the Affordable Care Act (ACA)?
Dr. Parsley: Continuing on the current path is unsustainable. The passage of the Affordable Care Act has changed the face of medicine and will pose many challenges in the years ahead. The fact is that this is the new law of the land, and the sooner we accept that fact and move forward the better. Still, there is no question the ACA can be modified and improved upon. There are tremendous opportunities for orthopaedics to refocus and take the lead on the management of musculoskeletal care for our patients, and not just as a surgical event within an episode of care. We have not only the surgical skill sets, but we also have the ability to manage the entire episode of care–and we should. There is no one who knows and understands the needs of the patient with an orthopaedic problem better than we do and what care the patient needs. I am very concerned that patients will suffer if the orthopaedic surgeon does not step up and take the lead in this changing healthcare delivery system. We need to maintain the patient–physician relationship and continue to be the patient’s advocate. The most successful early programs since passage of the ACA have all been physician-driven.
In the field of arthroplasty, the evolution of bundled payments is coming and in my opinion, bundled payments will soon be the rule rather than the exception. There is great potential to provide excellent care to patients more effectively and efficiently at a lower cost, resulting in higher value to the patient and the healthcare system. But that requires the physician to be actively engaged in the process.
JBJS: You have participated in several service-oriented activities, including the Houston Haitian Recovery Initiative. How has participating in these activities enriched your medical practice?
Dr. Parsley: I have always felt that the Good Lord gives us all gifts; it is what you do with those gifts that makes a difference. I am blessed to be an orthopaedic surgeon, and I feel that I am doing what was meant to be. Sharing these gifts with others by serving those in need through medical mission work in Guatemala, Haiti, Ecuador, or even in Houston–whether it be with surgical skills, with leadership and volunteer recruitment, or with philanthropy–is life-changing for all involved. I have made more than 45 medical mission trips in the past 18 years, the majority to Guatemala with Faith In Practice. The first of 4 trips I made to Haiti was 6 days following the devastating earthquake several years ago. I am humbled by the patients we treat and the faith that they show in a total stranger such as me. These missions reinvigorate my soul and reinforce the reasons that I went into medicine in the first place. The sanctity of the patient-physician relationship is communicated through the touch of the hand, the smile on their faces, the hugs of gratitude, and the incredible faith they share with you. Everyone should give back in some way as part of this wonderful profession.
JBJS: What is your favorite thing about your profession?
Dr. Parsley: I am truly blessed to be an orthopaedic surgeon and am surrounded by highly motivated and talented people with a can-do attitude and a focus on quality care. The camaraderie, respect, and friendships that develop in the orthopaedic family as we continue to strive to be the best we can be on behalf of the patients we serve is always a motivation and a pleasure.
According to a recent study in the Annals of the Rheumatic Diseases, women who take hormone replacement therapy (HRT) for at least 6 months after a total hip or knee replacement may cut the risk of revision surgery by almost 40%. This potential reduction in revision rate becomes even more impressive when one considers estimates that put the number of knee replacements in the US at close to 3.5 million annually by the year 2030.
The study, which compared joint-replacement outcomes in 2,700 female HRT users with outcomes in 8,100 matched nonusers, found no difference in revision rates relative to HRT use before surgery.
Elena Losina, PhD., JBJS deputy editor for methodology and biostatistics, called this study “well designed and executed” in an article in Arthritis Today. But she was quick to add that “to consider these results more definitively in clinical practice, they need to be confirmed and reproduced in a multicenter randomized controlled trial.”
Among several standout characteristics of the Osteoid cast invented by industrial designer Deniz Karasahin is that it’s made by a 3-D printer using ABS plastic. Loading 3-D CAD data from a scan of a patient’s limb into the printer enables Karasahin to custom fit a medical cast that minimizes itching and odor and is lighter-weight than currently available plaster and plastic designs.
Perhaps more importantly, the Osteoid cast can accommodate a low-intensity pulsed ultrasound bone stimulator (LIPUS) by allowing direct skin contact through the cast’s unique ventilator holes. Using this stimulator for 20 minutes daily can purportedly reduce healing times and increase healing rates in non-union fractures. To find out more see, http://www.pocket-lint.com/news/128658-3d-printed-osteoid-cast-could-heal-broken-bones-40-per-cent-faster.
Kaiser Health News and the Chicago Tribune recently collaborated on a story that led with the following observation: “When America’s joint surgeons were challenged to come up with a list of unnecessary procedures in their field, their selections shared one thing: none significantly impacted their incomes.”
The comment refers to the five items on the AAOS-approved Choosing Wisely list of orthopaedic-related procedures that physicians and patients should discuss and question (see the related OrthoBuzz item from Feb. 26, 2014).
Orthopaedists are not alone in this allegedly income-protecting tactic: “Some of the largest medical associations selected rare services or ones that are done by practitioners in other fields and will not affect their earnings,” the article stated.
For example, the Choosing Wisely list developed by the North American Spine Society (NASS) does not include spinal fusion, a controversial but lucrative procedure. “What we did when we made up the list was to start with more straightforward situations and hopefully expand that later,” said NASS board member F. Todd Wetzel in the article. That explanation makes some sense, considering that the evidence base for many tests and procedures—orthopaedic and otherwise—is equivocal.
Ultimately, the best decisions are made on a patient-by-patient basis, and the patient’s role in the Choosing Wisely campaign can’t be overemphasized. It’s about having a rational and respectful two-way conversation when a patient insists on having a certain test because his or her friend with the same symptoms had that test—or when a physician strongly recommends a certain procedure, the risks and benefits of which the patient doesn’t understand.
While it’s hard not to agree with Morden et al. in their NEJM Perspective piece (Feb. 13, 2014) that “more numerous and more courageous lists should be developed,” patient-education efforts must be ramped up because culling out low-value tests and procedures from the health care system should not and cannot solely be the responsibility of physicians.
In late April, the FDA issued a safety announcement cautioning that corticosteroids delivered by epidural injection to treat back and neck pain may cause “rare but serious adverse events”–including vision loss, stroke, paralysis, and death. The agency is requiring an additional label warning to increase awareness of the risks, which were confirmed after the FDA reviewed cases from its Adverse Event Reporting System. Although anesthesiologists, physiatrists, and specialists other than orthopaedic surgeons often administer such injections, orthopaedists should note that as far as the FDA is concerned, the safety and efficacy of epidural steroid injections for neck and back pain have not been established. The FDA said it plans to convene an advisory committee later this year to “discuss the benefits and risks of epidural corticosteroid injections and to determine if further FDA actions are needed.”
Up against an April 1 deadline that would see Medicare payments to physicians plunge by nearly 24%, a bipartisan group of Congressional negotiators introduced legislation that would repeal Medicare’s sustainable growth rate (SGR) formula and replace it with an annual 0.5% pay increase for five years. The proposed legislation contains additional provisions designed to transition Medicare from a pay-per-procedure system to one that promotes value through alternative payment methods (APMs) and rewards physicians for engaging with APMs. Those provisions include:
- A consolidation of three existing Medicare quality programs into one
- Incentives for care coordination
- Involvement by physicians in developing clinical guidelines, performance measures, and APMs
- Making provider-specific quality and utilization data more publicly accessible
Before we hail this as the epitome of bipartisan success, it should be noted that the legislation in its current form does not detail how Congress would pay for a permanent SGR repeal, which is estimated to cost between $120 billion and $150 billion. That significant detail will be debated if and when the full membership of both chambers considers the bill. Congress has been at similar SGR crossroads before and ended up passing short-term “patches” without permanently revising what everyone agrees is a failed formula.
When it comes to knowing the costs of the devices they implant, orthopaedic surgeons and residents are batting only .210 and. 170, respectively. More than 500 orthopaedic surgeons surveyed at seven US academic medical centers correctly estimated the cost of common orthopaedic devices only 21% of the time. Residents at the same institutions did so only 17% of the time. Many of these respondents (36% of surgeons and 75% of residents) admitted that their knowledge of device costs was “below average” or “poor.” All respondents tended to overestimate the price of low-cost devices and to underestimate the price of high-cost devices. The implication of that tendency, say the authors of the Health Affairs study, is that “physicians may underestimate the amount that could be saved by choosing the lower-cost alternative.” The biggest barrier to physicians knowing device prices is confidentiality clauses in the contracts between device vendors and hospitals. “Widespread dissemination of device prices is not an option at many institutions,” wrote the authors. It remains to be seen whether the proliferation of accountable care organizations, with their emphasis on cost-efficient care, will alter this situation. For more about cost variation in orthopaedic devices, see the JBJS article “Variability in Costs Associated with Total Hip and Knee Replacement Implants.”
In 2009, older patients spent more than $72 billion on products that purportedly slow the aging process. That figure is expected to rise to an estimated $114 billion in 2015. Here are some of the treatments that are touted to help older athletes stay active:
Antioxidants: Examples include vitamins C & E, carotenes, and flavonoids. Antioxidants prevent cell damage that occurs with oxidative reactions, but we don’t know enough to conclude that they can effectively treat or prevent disease.
Human Growth Hormones: Naturally secreted by the pituitary gland, hGH supplements could theoretically reverse age-related physical decline. But hGH hasn’t been proven to improve muscle strength, bone density, or athletic performance.
Testosterone: Testosterone replacement in older men can increase lean muscle mass and bone density and decrease body fat. The most concerning side effect of testosterone replacement is the hormone’s potentially harmful effect on the prostrate. Scientists are exploring testosterone-boosting approaches that sidestep the potential side effects.