Rothman Orthopaedic Institute

The holiday season is a time to celebrate with people who are important to us and to be grateful for blessings received. However, for many, the meaning of these holidays has turned into consumerism focused on the acquisition of belongings and sharing the joy of newly acquired possessions.

Preoperative medical optimization of patients is an approach orthopedic surgeons can use to reduce postoperative complications and improve the overall safety of procedures they perform.

An 81-year-old woman presented to our clinic with a chief complaint of left hip pain and inability to bear weight. She had undergone left total hip arthroplasty revision surgery 6 weeks previously to address polyethylene wear of her index THA performed 20 years prior to presentation. The patient was noted to have a protrusio prior to her revision surgery with violation of the medial wall, however her revision surgeon was able to perform an appropriate acetabular revision by using a multi-hole shell. During her rehabilitation from that surgery, the patient sustained a fall and subsequently developed severe left hip pain with any attempt at weight-bearing. She was subsequently referred to our practice for further evaluation and management.

The final consensus documents that resulted from the International Consensus Meeting on Musculoskeletal Infection, which was held July 25-27, 2018, in Philadelphia, are now available at the meeting’s website, which is ICMPhilly.com, and via the ICMPhilly app, according to Javad Parvizi, MD, FRCS, of Philadelphia, who co-chaired the meeting with Thorsten Gehrke, MD, of Hamburg, Germany.

Each year, one of the most important components of the EFORT Congress is the presence of an outstanding orthopaedic surgeon with international reputation who contributes to our scientific program by giving the Erwin Morscher Honorary Lecture. This plenary session is scheduled for Thursday, 6 June 2019, just before the lunch break, to gather the biggest audience of all the scientific sessions. This year, EFORT is pleased to welcome Javad Parvizi, MD, FRCS, a native of Azerbaijan, Iran, who is currently practicing at Rothman Orthopaedic Institute in Philadelphia, United States. Parvizi will share with the orthopaedics and trauma community his broad knowledge on handling musculoskeletal infections via a presentation on the evolution of periprosthetic joint infection (PJI) diagnosis and treatment used in recent years.

Orthopedics lost a preeminent leader when Richard H. Rothman, MD, PhD, died on Oct. 21. He was one of the most well-known surgeons in the world, frequently invited to share his thoughts and expertise worldwide.

Patients who received interscalene brachial plexus block plus soft tissue infiltration with Exparel when undergoing primary shoulder arthroplasty used significantly more narcotics postoperatively and had no significant reduction in pain scores in the early postoperative period compared with patients who received interscalene brachial plexus block alone, according to results published in The Journal of Bone and Joint Surgery.

Despite efforts to control the price of procedures, implants and physician reimbursement, health care costs continue to increase. According to 2016-2025 Projections of National Health Expenditures Data from CMS, the U.S. spends $3.4 trillion on health care. This has now reached 17.8% of gross domestic product, which is projected to increase to 19.9% by 2025. There is constant pressure on all components of health care to control cost.

Musculoskeletal and infection professionals from 98 countries convened July 25-27, 2018 at the International Consensus Meeting on Musculoskeletal Infection in Philadelphia to discuss how to improve the prevention and treatment of musculoskeletal infections. Of the topics presented, delegates strongly debated whether antibiotic-loaded bone cement should be used in primary total joint arthroplasty to prevent periprosthetic joint infection.

A 63-year-old woman developed persistent, insidious, atraumatic low back and right posterior thigh pain. She was seen by her primary care physician and, in the absence of red flag symptoms, was diagnosed as having sustained a herniated lumbar disc with associated radiculopathy/sciatica. Plain radiographs of the lumbar spine were negative and given her lack of motor or sensory findings, no advanced imaging was ordered. She was treated with NSAIDs and prescribed a course of physical therapy. Despite compliance with treatment, her symptoms failed to resolve. She was subsequently treated with an escalating course of oral steroids, anti-spasmodic medication, and lidocaine patches. After at least 2 months of such treatment, her symptoms were severe enough to warrant a visit to the ED, although she was discharged home after evaluation by the emergency physician.