BackgroundCompared to the posterior approach, the anterior approach to total hip arthroplasty (THA) offers the potential for an accelerated recovery secondary to less dissection and therefore less pain in the immediate postoperative period. This offers potential financial benefit through a reduction in length of stay. This study retrospectively reviewed 98 anterior approach and 69 posterior approach THA cases (N = 167) to compare perioperative outcomes and cost-effectiveness.MethodsPatients who underwent anterior approach THA were discharged sooner than those who underwent posterior approach THA.ResultsThe anterior approach was also less expensive per patient than the posterior approach. Overall, differences in perioperative outcomes between these approaches to THA are less robust than previously reported. There is a significant difference in operative cost between these surgical approaches.ConclusionsAlthough there are many sources for this difference in cost, the predominant contributor is surgeon implant preference.

Chronic musculoskeletal pain results from a complex interplay of mechanical, biochemical, psychological, and social factors. Effective management is markedly different from that of acute musculoskeletal pain. Understanding the physiology of pain transmission, modulation, and perception is crucial for effective management. Pharmacologic and nonpharmacologic therapies such as psychotherapy and biofeedback exercises can be used to manage chronic pain. Evidence-based treatment recommendations have been made for chronic pain conditions frequently encountered by orthopaedic surgeons, including low back, osteoarthritic, posttraumatic, and neuropathic pain. Extended-release tramadol; select tricyclic antidepressants, serotonin reuptake inhibitors, and anticonvulsants; and topical medications such as lidocaine, diclofenac, and capsaicin are among the most effective treatments. However, drug efficacy varies significantly by indication. Orthopaedic surgeons should be familiar with the widely available safe and effective nonnarcotic options for chronic musculoskeletal pain.

Background:Health literacy is considered the single best predictor of an individual's health status. However, it often is difficult to assess. As such, our group developed the Literacy in Musculoskeletal Problems (LiMP) questionnaire, a musculoskeletal-specific literacy assessment tool. We hypothesized that the degree of inadequate musculoskeletal health literacy would be higher than the rate of inadequate general healthy literacy, as assessed through the Newest Vital Sign (NVS). Methods:Each of the 65 study participants completed a demographic questionnaire, the NVS and the LiMP survey. The NVS and LiMP scores were assessed using contingency table analysis. Categorical outcome variables as a function of demographic parameters also were compared using w 2 tests. Results:More subjects were found to have inadequate musculoskeletal literacy (60%) as compared with general health literacy (48%). Contingency table analysis showed that at LiMP scores of less than 6, the sensitivity and specificity (0.74 and 0.59, respectively) were optimized for predicting limited literacy, as defined by an NVS score of 3 or less. A significantly higher rate of adequate musculoskeletal literacy was observed in Caucasian patients and those who had previously seen a physician for a musculoskeletal complaint. Conclusions:The LiMP's sensitivity and reliability is in line with prior work on disease and specialty-specific literacy, making it a valid and reliable musculoskeletal literacy assessment instrument. It is only with the ability to identify those lacking the skills crucial to making informed decisions regarding their musculoskeletal health that we can accurately target education campaigns, an approach that will ultimately enhance physician-patient interactions and improve clinical outcomes.

Background Traumatic arthrotomy of the wrist is most commonly detected using the saline load test (SLT); however, little data exists on the effectiveness of the SLT to this specific joint. The use of computed tomography (CT) scan has been validated as an alternative method to detect traumatic arthrotomy of the knee, as the presence of intra-articular air can be seen when there is violation of the joint capsule. Question/Purpose The purpose of this study was to determine the ability of CT scan to identify arthrotomy of the wrist capsule and compare the diagnostic performance of CT versus traditional SLT. Materials and Methods Ten fresh frozen cadavers which had undergone transhumeral amputation were initially used in this study. A baseline CT scan was performed to ensure no intra-articular air existed prior to intervention. After baseline CT, an arthrotomy was created at the 6R radiocarpal portal site. The wrists then underwent a postarthrotomy CT to identify the presence or absence of intra-articular air. Following CT, the wrists were subjected to the SLT to detect the presence of extravasation from the arthrotomy. Results Nine cadavers were included following baseline CT scan. Following arthrotomy, intra-articular air was visualized in eight of the nine cadavers in the postarthrotomy CT scan. Air was seen in the radiocarpal joint in eight of the nine wrists; midcarpal joint in seven of the nine wrists; and distal radioulnar joint in six of the nine wrists. All wrists (nine of the nine) demonstrated extravasation during the SLT. The mean volume of extravasation occurred at 3.7 mL (standard deviation = 2.6 mL), with a range of 1 to 7 mL. Conclusion CT scan correctly identified eight of the nine simulated traumatic arthrotomies. Injection of 7 mL during the SLT was necessary to identify 100% of the arthrotomies. Clinical Relevance CT scan is a sensitive modality for detection of traumatic arthrotomy of the wrist in a cadaveric model.

The Institute of Medicine considers limited health literacy a "silent epidemic," as approximately half of Americans lack the competencies necessary for making informed decisions regarding their health. Limited health literacy substantially impedes the effective dissemination and comprehension of relevant health information, and also complicates communication, compromises care, and leads to worse patient outcomes. Poor health, early death, and worse control of chronic conditions have also been associated with limited health literacy. Unfortunately, physicians often struggle to identify those with limited health literacy, which can have adverse effects on the physician-patient relationship. In this article, we discuss the meaning of health literacy,the risk factors for and consequences of limited health literacy, orthopaedic-specific implications and investigations, and the strategies orthopaedic surgeons can utilize to improve health literacy and communication.