Rothman Orthopaedic Institute

A 5-year-old boy from Cypress presented with a few months of progressive upper and lower extremity paresthesias, weakness and ataxia. His mother contributed to the pertinent history. She denied any significant trauma but said her son had been falling a lot recently. The boy described numbness and tingling in his hands and feet. He also had a lot more trouble playing with his toys and seemed to drop objects frequently. The patient’s mother denied any episodes of bowel or bladder incontinence.

Patient satisfaction assessment has become critical to determine quality and value in medical care. The patient’s perspective is important to understand and assess so improvements are patient-centric. The movement toward patient satisfaction assessment is not new, but its importance in health care has escalated as it is now tethered to reimbursement and other financial incentives.

A 21-year-old man presented with a 3-year history of intermittent 8/10 lateral right knee pain. He failed two prior surgical procedures done at outside hospitals. The patient initially sustained a jumping injury while playing basketball and recalled feeling a pop at the time. At presentation, his knee pain was associated with a catching sensation and swelling. He tried viscosupplementation injections and physical therapy without resolution of symptoms. Two years ago, he underwent arthroscopic partial lateral meniscectomy and chondroplasty at an outside hospital without improvement in symptoms. One year ago, he underwent arthroscopy and microfracture at a different outside hospital. His symptoms persisted and continued to be aggravated by playing basketball and other impact activities.

Orthopedic surgery is a highly demanding profession. More than one-third of orthopedic surgeons work 60 hours per week, not including call responsibilities or after-hours academic or leadership work. Fortunately, for many, we have found a rewarding profession. However, the ego gratification can be addictive and lead to excessive hours away from family and friends.

The patient is a 76-year-old man with a history of coronary artery ectasia on Coumadin (warfarin, Bristol-Myers Squibb), hyperlipidemia, hypertension and gout, who sustained a right Achilles tendon rupture 5 months prior to evaluation. He was managed non-surgically by another practice using cast immobilization in equinus with gradual dorsiflexion for about 6 to 8 weeks, during which time he was non-weight-bearing. He was transitioned to boot immobilization with a conservative, graduated physical therapy until he was weaned from the boot. At presentation, his shoe wear is normal, but he complains of persistent limitations in his gait, strength, and ability to return to prior activities despite 2 months of physical therapy.

WAIKOLOA, Hawaii — Anthony A. Romeo, MD, summarized the hot topics of this year’s Orthopedics Today Hawaii meeting.

Achilles tendon ruptures treated surgically had a low risk of infection and re-rupture, but these risks were greater in the presence of certain patient and surgical factors, according to study results.

Modifiable patient factors, such as BMI, vitamin D levels and diabetes, can be optimized preoperatively to reduce the risk of infection and other postoperative complications. However, sometimes patient risk factors — and how to modify them — are not as clear cut.

Education continues to evolve. New ideas on how adults comprehend information combined with innovative technology has led to a greater understanding of the complexity and individuality of learning, which has had a significant effect on the education of orthopedic surgeons. Changes in training curriculum and CME have improved the ability of surgeons and surgeons-in-training to understand musculoskeletal diseases and provide care resulting in the best possible outcomes.

WAIKOLOA, Hawaii — To have a successful total shoulder arthroplasty, orthopedic surgeons need to make sure the humeral head implant is the correct size, according to a presentation at Orthopedics Today Hawaii.