Rothman Orthopaedic Institute

A popular bearing surface from the 1990s to the mid-2000s, published literature estimated more than 1 million metal-on-metal total hip arthroplasties were performed since the design’s introduction, with 80% remaining in situ. However, metal-on-metal hip implant use decreased 10 years after its peak due to revisions related to adverse reaction to metal debris, infection and aseptic loosening.

In the 1970s, American psychologists defined clear differences in the definition of gender vs. sex. The term “gender” was introduced in the 1970s to define characteristics and socially developed traits that were attributed to male and female patients. “Sex” was defined as the biological and genetic mechanisms that separate male and female patients, such as the chromosomes, genes, hormones and areas of cerebral development or other genetic-based physical attributes. Gender can be selected and modified. Sex is what one is born. The physical characteristics of sex can be modified, but this does not determine gender, which is the behavior, cultural and psychological traits of being a man or woman.

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The last decade of health care has seen incredible changes, beginning with the passage of the Affordable Care Act in 2010. The law has been challenged, altered and amended numerous times. Yet, it still has many unsettled issues and the cost of health care continues to increase.

Since the 1990s, the American Association of Orthopaedic Surgeons has engaged in health policy and advocacy activities for patients and the orthopedic surgery profession. Orthopedic subspecialty groups, such as the American Shoulder and Elbow Surgeons, the American Association of Hip and Knee Surgeons, the American Orthopaedic Society for Sports Medicine and the Orthopaedic Trauma Association, have also joined the cause. With the many opportunities today to improve the delivery of health care, sources who spoke with Orthopedics Today said that, because they are the experts in the specialty, orthopedic surgeons should be the ones who manage how health care reform impacts orthopedic surgery.

As we reflect on 2019, we should be grateful for the people who support our work and appreciate how our relationships with patients, friends and family provide the foundation for a meaningful life. It is also important to remember the importance of integrity to do what is right, especially when it is not the easiest path to follow.

There are two areas in orthopedic surgery where robotics has been employed successfully: joint arthroplasty and pedicle screw instrumentation in spine surgery. In joint arthroplasty, robotics is used to aid the accuracy of bone cuts in total knee arthroplasty and the accurate placement of the acetabular component in total hip arthroplasty. Many cadaveric and retrospective clinical studies have demonstrated high accuracy with bone cuts in arthroplasty leading to improved overall implant alignment and increased accuracy of screw placement in pedicle instrumentation. Despite these advantages, however, it is unclear whether robotic assistance results in improved outcomes that justify its added costs. For example, the advantages gained from robotics must outweigh the added costs of the robotic system itself, the annual service and maintenance fees of the system, as well as the cost of disposables. One also has to factor in the possible increased anesthesia and operative time in the beginning of the learning curve for the surgeon, as well as the cost of preoperative advanced imaging or the use of intraoperative CT/fluoroscopy to register the patient to be tracked by the navigational system. One area where robotic surgery may improve cost-effectiveness is by decreasing the revision rates of joint arthroplasty and spine surgery. Some studies suggest a decreased need for revision surgery with robotic assistance; however, these studies, at present, are generally retrospective studies with implicit bias. Robotics in orthopedic surgery is here to stay and will help surgeons in particularly complex cases; however, more evidence is needed to determine whether outcomes truly outweigh the costs in more routine surgical procedures.

In the past few years, physicians and staff at Rothman Orthopaedic Institute have begun to implement a series of preoperative, intraoperative and postoperative protocols to decrease the opioid prescribing, consumption and refill rates.

In 2018, WHO reported musculoskeletal conditions accounted for a greater proportion of persistent pain, with more than 150 diagnoses that affect the locomotor system. Although there are approved medications to treat musculoskeletal pain, sources who spoke with Orthopedics Today said these medications may not work or be suitable for all patients, especially for long term use, depending on their medical status.

Social determinants of health are environmental factors that can be modified to improve a patient’s ability to manage musculoskeletal disease and intervention. Where a person lives, works and accesses health care can affect outcomes of surgical care. While many environmental factors are quickly glossed over in preoperative assessments, often with the thought that not much can be done to change them, overall outcomes can be affected, thus leading to conclusions that costly interventions are not valuable to patients and overall population health.