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Surgeon Autonomy and Implant Choice
A multitude of factors influence implant choice in total joint replacement surgeries, including surgeon choice. Attempts at limiting health care costs by restricting implant choice have become commonplace. A spectrum of strategies exists including price transparency, patient demand matching, capitation pricing, and limited vendor agreements. The benefits and drawbacks of these various strategies in optimizing costs must be considered along with physician autonomy and independence in performing the surgeries. (Source: Orthopedic Clinics of North America)
Source: Orthopedic Clinics of North America - February 24, 2024 Category: Orthopaedics Authors: Nicholas M. Brown, Nithya Lingampalli, Daniel Schmitt Source Type: research

Considerations Regarding Vitamin D in Foot and Ankle Treatment and Surgery
Although the impact that vitamin D has on bone healing is uncertain in foot and ankle (F&A) surgery, there is support for vitamin D supplementation (2000 IU/day) with calcium (1  g/day) to promote bone healing. Although orthopedic F&A surgeons are frequently the first provider to detect the harbingers of osteoporosis by the occurrence of fragility fractures, this should trigger referral to the appropriate specialist for assessment and treatment. There is circumstantial evidence suggesting a role of hypovitaminosis D in bone marrow edema syndrome and possibly osteochondritis dissecans. There should be a low threshold for a...
Source: Orthopedic Clinics of North America - February 19, 2024 Category: Orthopaedics Authors: James D. Michelson Source Type: research

Treatment Strategies in the Osteoporotic Spine
This article reviews the appropriate assessment and management of osteoporotic compression fractures and discusses the implications of osteoporosis on initial patient evaluation, medical optimization for surgery, selection of instrumentation, and surgical technique. Adverse outcomes associated with osteoporosis are discussed. Failure to appropriately evaluate, optimize, and treat spine patients with osteoporotic bone can lead to disastrous complications. Weakened bone can lead to implant failure through cage subsidence and screw pullout, as well as, peri-implant fractures, failure of deformity correction, and proximal kyph...
Source: Orthopedic Clinics of North America - January 23, 2024 Category: Orthopaedics Authors: Daniel Gelvez, Katherine Dong, Nathan Redlich, Jestin Williams, Amit Bhandutia, Berje Shamassian Source Type: research

A Systematic Review of Patient Selection Criteria for Outpatient Total Shoulder Arthroplasty
The utilization of total shoulder arthroplasty (TSA) is increasing, driving associated annual health care costs higher. Opting for outpatient over inpatient TSA may provide a solution by reducing costs. However, there is no single set of accepted patient selection criteria for outpatient TSA. Here, the authors identify and systematically review 14 articles to propose evidence-based criteria that merit postoperative admission. Together, the studies suggest that patients with limited ability to abmluate independently or a history of congestive heart failure may benefit from postoperative at least one night of hospital based ...
Source: Orthopedic Clinics of North America - January 10, 2024 Category: Orthopaedics Authors: Kevin T. Root, Keegan M. Hones, Kevin A. Hao, Tyler J. Brolin, Jonathan O. Wright, Joseph J. King, Thomas W. Wright, Bradley S. Schoch Source Type: research

Ethics in Pediatric Decision-Making and Application Process
Decision-making capacity in pediatric health care is crucial for upholding ethical practices and protecting patient autonomy. It involves a patient ’s ability to understand the benefits, risks, and alternatives of a proposed treatment or intervention, demonstrate understanding, appreciate the consequences, reason clearly, and communicate their wishes. Informed consent and assent are essential concepts in pediatric decision-making, ensuring th at patients, including children, clearly understand their treatment options, and voluntarily agree to them. The involvement of children in medical decisions should be proportional t...
Source: Orthopedic Clinics of North America - January 6, 2024 Category: Orthopaedics Authors: Ayse Kurtoglu, Berna Arda Source Type: research

Infections
Postoperative infections are becoming more prevalent, as the number of total joint arthroplasties (TJA) continues to rise worldwide, increasing readmissions and health care costs. This issue of Orthopedic Clinics of North America focuses on the challenges that such infections present and explores how to best deal with them to achieve optimal outcomes for patients. (Source: Orthopedic Clinics of North America)
Source: Orthopedic Clinics of North America - December 16, 2023 Category: Orthopaedics Authors: Frederick M. Azar Tags: Preface Source Type: research

Management of the Septic Wrist
Septic arthritis of the wrist can have severe deleterious effects on cartilage and bone if not promptly addressed. Expedient diagnosis and early medical intervention are important. The most effective strategy involves immediate arthrocentesis of the infected joint, enabling precise antibiotic selection based on joint fluid analysis. Diagnostic imaging is important in excluding fractures and identifying abscesses. This review explores the etiologic factors underlying septic wrist joint, identifying risk factors, and delineating optimal diagnosis and treatment approaches. The overarching goal is to impart valuable insights a...
Source: Orthopedic Clinics of North America - December 9, 2023 Category: Orthopaedics Authors: Heather L. Mercer, Diego Rodriguez, Rhiana Rivas, Elizabeth Rivenbark, Elizabeth Mikola, Deana Mercer Source Type: research

Perioperative Evaluation and Management of Children with Osteoporosis and Low Bone Mineral Density
As medical and surgical treatment options for children with osteoporosis expand, multidisciplinary strategies for bone health optimization become more important. Each patient ’s bone mineral density and fracture history should be interpreted in context. Off-label bisphosphonate use is a standard pharmacologic intervention for children with osteoporosis for optimal bone accrual. It is possible to continue this therapy perioperatively under certain circumstances. The rar e side effects (osteonecrosis of the jaw and atypical femur fractures) seem less common in children. Physical therapy, vitamin D supplementation, and othe...
Source: Orthopedic Clinics of North America - December 6, 2023 Category: Orthopaedics Authors: Jordan D. Ross, Alicia Diaz-Thomas Source Type: research

Surgical Outcomes in Charcot Arthropathy
Treatment of Charcot neuroarthropathy (CN) of the foot and ankle remains challenging for both patients and surgeons. Nonoperative treatment with cast/orthosis immobilization has long been the mainstay of treatment, but surgical intervention has gained interest to improve poor long-term outcomes. A review of existing data on the operative management of CN demonstrates the potential benefits but also the continued risks associated with treatment. Additionally, a retrospective review of cohorts managed with limited surgical interventions (wound debridements, exostectomies, and other surgical procedures) compared to reconstruc...
Source: Orthopedic Clinics of North America - November 20, 2023 Category: Orthopaedics Authors: William C. Skinner, Naveen Pattisapu, Jane Yeoh, Benjamin J. Grear, David R. Richardson, Garnett A. Murphy, Clayton C. Bettin Source Type: research

Orthopedic Clinics of North America
www.orthopedic.theclinics.com (Source: Orthopedic Clinics of North America)
Source: Orthopedic Clinics of North America - November 17, 2023 Category: Orthopaedics Authors: Frederick M. Azar Source Type: research

Copyright
ELSEVIER (Source: Orthopedic Clinics of North America)
Source: Orthopedic Clinics of North America - November 17, 2023 Category: Orthopaedics Source Type: research

Editorial Board
Orthopedic Clinics of North America, Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center, Memphis, Tennessee (Source: Orthopedic Clinics of North America)
Source: Orthopedic Clinics of North America - November 17, 2023 Category: Orthopaedics Source Type: research

Contributors
FREDERICK M. AZAR, MD (Source: Orthopedic Clinics of North America)
Source: Orthopedic Clinics of North America - November 17, 2023 Category: Orthopaedics Source Type: research

Contents
Frederick M. Azar (Source: Orthopedic Clinics of North America)
Source: Orthopedic Clinics of North America - November 17, 2023 Category: Orthopaedics Source Type: research

Forthcoming Issues
April 2024 (Source: Orthopedic Clinics of North America)
Source: Orthopedic Clinics of North America - November 17, 2023 Category: Orthopaedics Source Type: research