Rothman Orthopaedic Institute
What role should orthopedic surgeons play in managing their patients’ persistent pain?
Responsible musculoskeletal pain management is up to the orthopedist

Opioids are a main class of pain management drugs that started to be used more often in the U.S. and Canada about 20 years ago, with the HHS now reporting more than 650,000 opioid prescriptions on average dispensed per day in the U.S. However, prescribing opioids and informing patients about opioid misuse issues is just one part of the orthopedic surgeon’s role in pain management. In this Cover Story, orthopedic surgery, trauma, anesthesiology and pain medicine experts discuss responsible pain management and how orthopedic surgeons should approach pain management and better collaborate with other specialties to achieve optimal resolution of their patients’ pain.
Fungal PJI: More than just a prosthetic infection

Management of periprosthetic joint infection is challenging on many accounts. Fungal periprosthetic joint infections are particularly difficult to treat. The problem is the incidence of fungal infections has increased globally in the last few decades. Fungal periprosthetic infections, although rare, are similarly increasing in prevalence. Most case series of patients with fungal periprosthetic joint infections report a disastrous outcome for surgical management of these patients with treatment failure rates of up to 50% at 2-year follow-up. Part of the problem relates to the complex biofilm that fungi can form. Furthermore, patients with fungal periprosthetic joint infection are often immunocompromised with impaired cellular immunity.
Elbow injuries in professional baseball players are most common among pitchers
VIDEO: Formal counseling linked with reduced opioid consumption after hand surgery
SAN FRANCISCO — At the American Society for Surgery of the Hand Annual Meeting, Asif Ilyas, MD, discussed ways in which physicians can manage the opioid crisis specifically for patients who underwent carpal tunnel release. He said formal preoperative counseling was associated with decreased opioid consumption in patients after surgery.
Comparable timing of return to sport between pitchers with vs without revision UCLR
Sleep disturbance continued long-term after rotator cuff repair
Predictive value of infection after TJA improved with alpha-defensin test

SAN DIEGO — When its use is considered in addition to the traditional test results for periprosthetic joint infection, the alpha-defensin test improved the ability to predict positive cultures both when the traditional tests were equivocal or when they were all aligned toward one diagnosis, according to Gregory S. Kazarian, BA.