American Academy Of Orthopaedic Surgeons Research Articles

Management of prosthetic joint infections: a guidelines comparison.

In the last decade, the number of prosthetic joint replacements has been rising each year and this growing trend is related to the increased number of prosthetic joint infections (PJI). As PJI represent a devastating condition for the patient, physicians must identify the best treatment option for each case. Guidelines are not always clear regarding the most appropriate therapy pathway as they differ in many parameters. Aim of this article is to compare the different indications as reported by four major Academic Societies: the Infectious Disease Society of America, the American Academy of Orthopaedic Surgeons, and the Musculoskeletal Infection Society (MSIS) which published the guideline in partnership with the European Bone And Joint Infection Society. PJI Guidelines differ in many parameters, therefore the choice of treatment for each case does not appear immediate; it would be desirable that, in the next few years, new scientific evidence will help clarify the indications of the most effective therapeutic protocols for PJI to determine the ultimate surgical strategy for every single patient.

Readability of Online Foot & Ankle Patient Resources

Category:OtherIntroduction/Purpose:The internet is a popular source of health information for patients. Professional organizations, such as the American Orthopaedic Foot & Ankle Society (AOFAS) and the American Academy of Orthopaedic Surgeons (AAOS) have created patient-directed websites containing high quality information. However, previous studies have demonstrated that these sites are often written at a level that is too complex for the average reader. We aimed to investigate the current landscape of the readability of these websites.Methods:Online patient resources on foot and ankle topics published by the AOFAS and AAOS were reviewed. Each page was analyzed using the Flesch Kincaid Grade Level (FKGL) and Flesch Reading Ease (FRE) formulas. Sites were noted if they were written at or below an 8th grade reading level, which corresponds to the average US reading level. An independent two-sample t- test or chi-square test, where appropriate, were used to compare resource characteristics between the two professional societies.Results:162 total sites were reviewed, including 113 from the AOFAS and 49 from the AAOS. Overall, the mean FKGL was 9.4 (range, 6.7 - 15.3) and the mean FRE was 56.3 (range, 24.4 - 73.1). Websites written by the AAOS had significantly lower FKGL scores than sites written by the AOFAS (9.0 vs 9.5, p=0.01). 31.3% of all sites were written at or below an 8th grade reading level. Websites published by the AAOS had significantly more sites published at this level than sites published by the AOFAS (44.9% vs 25.7%, p=0.02).Conclusion:Online patient information on foot and ankle topics published by professional organizations are often written at a level that is too complex for the average reader. There was a statistical but not clinically significant difference between sites published by the AAOS and AOFAS. Professional organizations should continue to develop their online patient resources, with emphasis on increasing their readability.

The relationship between the orthopedic job market and sports medicine fellowship applications between 2010 and 2017.

Objectives: More than 90% of graduating orthopedic residents pursue at least one year of fellowship training. There are no studies to date that examine the trends for sports medicine positions in the orthopedic job market. The purpose of this study was to evaluate trends in orthopedic sports medicine positions using postings from four orthopedic journals. Methods: Print advertisements for job positions in three American orthopedic journals (Journal of Bone and Joint Surgery, Journal of the American Academy of Orthopaedic Surgeons, and American Journal of Sports Medicine) between 2010 and 2017 were reviewed. The results were compared to sports medicine fellowship match trends. Results: Between 2010 and 2017, there were a total of 403 postings for orthopedic sports medicine positions, 186 in Journal of Bone and Joint Surgery, 113 in Journal of the American Academy of Orthopaedic Surgeons, and 52 in American Journal of Sports Medicine. There was a 43% decline in print sports medicine advertisements from 2010 to 2015. The number of job advertisements for sports medicine positions remained consistent (approximately 10%) from 2010 to 2015, then dropped to 2.1% (57/2698) and 1.4% (66/4735) in 2016 and 2017, respectively. Conclusion: There is no direct correlation between job positions advertised in orthopedic journals and sports medicine fellowship positions offered. Additionally, there has been an increase in job advertisements requiring fellowship training, indicating an increased demand for sub-specialty trained orthopedic surgeons. Lastly, the drop in total orthopedic advertisements in the years proceedi ng 2015 may serve as a harbinger for the transition to largely online content, and job postings in journals may not be the most reliable source of job opportunities, but further investigation should be done in relation to this topic.

Utilization of Diagnostic Testing for Carpal Tunnel Syndrome: A Survey of the American Society for Surgery of the Hand

In 2016, the American Academy of Orthopaedic Surgeons (AAOS) changed the clinical practice guidelines (CPGs) for the diagnosis of carpal tunnel syndrome, relaxing the recommendation for electrodiagnostic studies (EDS) prior to offering surgery. However, it is unknown how the updated guidelines changed the practice patterns of hand surgeons. A web-based multiple-choice survey was sent to the members of the American Society for Surgery of the Hand. We assessed the current diagnostic practice patterns of hand surgeons. The survey was pretested using expert review with content and survey methodology experts and cognitively tested to ensure readability and understandability. The final cohort consisted of 770 hand surgeons. Approximately 26% of respondents required EDS prior to seeing a patient in consultation, and 56% of members routinely ordered EDS after evaluating a patient with carpal tunnel syndrome if testing was not performed prior to evaluation. The top reasons for obtaining EDS were to provide additional information for unclear diagnoses (97% selected), for patients with worker's compensation (82% selected), for grading the severity (73% selected), and to provide a baseline examination in the event of persistent symptoms (72% selected). However, only 38% of respondents believed that the current AAOS CPGs were appropriate, and 43% of respondents did not know what the guidelines recommended. Despite the change in AAOS CPGs, EDS continues to be ubiquitously used for the diagnosis of carpal tunnel syndrome. Nevertheless, a substantial proportion of hand surgeons are unaware of the recommendations for EDS within the AAOS CPGs. These findings highlight the importance of explicitly defining which patients and which clinical scenarios would benefit from additional diagnostic testing and identifying strategies for more widespread dissemination of guidelines.

An Introduction: Peter S. Rose, MD, FAAOS, New Editor-in-Chief of JAAOS®

Dr. Rose or an immediate family member serves as a board member, owner, officer, or committee member of American Academy of Orthopaedic Surgeons, PARITY Trial, and Sacral Tumor Study Group.

The J. Robert Gladden Orthopaedic Society: Past, Present, and Future.

Officially chartered in 1998, the J. Robert Gladden Orthopaedic Society (JRGOS) is a multicultural society dedicated to improving the diversity of the orthopaedic surgeon workforce and ending disparities in musculoskeletal health care. The purpose of this article is to discuss why an organization such as the JRGOS was needed within the American Academy of Orthopaedic Surgeons and highlight the key figures in orthopaedic history who supported the formation of the JRGOS. It also highlights the present efforts of the JRGOS, which include mentorship of Black, indigenous people of color medical students, residents and fellows in training, and support of research related to disparities in musculoskeletal care. As the JRGOS enters its third decade of existence, additional partnerships with the American Academy of Orthopaedic Surgeons, American Orthopaedic Association, AALOS, Orthopaedic Diversity Leadership Consortium, RJOS, Nth Dimensions, BWOS, and industry will help to realize the dream of making the orthopaedic workforce as diverse as the United States.

Perioperative management of acetabular and pelvic fractures: evidence-based recommendations.

The American Academy of Orthopaedic Surgeons does not currently provide clinical practice guidelines for management of PAF. Accordingly, this article aims to review and consolidate the relevant historical and recent literature in important topics pertaining to perioperative management of PAF. A thorough literature review using PubMed, Cochrane and Embase databases was performed to assess preoperative, intraoperative and postoperative management of PAF fracture. Topics reviewed included: time from injury to definitive fixation, the role of inferior vena cava filters (IVCF), tranexamic acid (TXA) use, intraopoperative cell salvage, incisional negative pressure wound therapy (NPWT), intraoperative antibiotic powder use, heterotopic ossification prophylaxis, and pre- and postoperative venous thromboembolism (VTE) prophylaxis. A total of 126 articles pertaining to the preoperative, intraoperative and postoperative management of PAF were reviewed. Articles reviewed by topic include 13 articles pertaining to time to fixation, 23 on IVCF use, 14 on VTE prophylaxis, 20 on TXA use, 10 on cell salvage, 10 on iNPWT 14 on intraoperative antibiotic powder and 20 on HO prophylaxis. An additional eight articles were reviewed to describe background information. Five articles provided information for two or more treatment modalities and were therefore included in multiple categories when tabulating the number of articles reviewed per topic. The literature supports the use of radiation therapy for HO prophylaxis, early (< 5days from injury) surgical intervention and the routine use of intraoperative TXA. The literature does not support the routine use of iNPWT or IVCF. There is inadequate information to make a recommendation regarding the use of cell salvage and wound infiltration with antibiotic powder. While the routine use of chemical VTE prophylaxis is recommended, there is insufficient evidence to recommend the optimal agent and duration of therapy.

Discrepancies in Work-Family Integration Between Female and Male Orthopaedic Surgeons.

Female surgeons, representing 6.5% of the American Academy of Orthopaedic Surgeons, are particularly vulnerable to work-family conflict. This conflict may deter women from considering orthopaedic surgery as a specialty. The study objective was to identify differences in work-family integration between female and male orthopaedic surgeons in the United States. An anonymous survey collecting data within the domains of work, family, and satisfaction was completed by 347 orthopaedic surgeons (153 female, 194 male). Differences in responses between males and females were identified. Female surgeons were younger than males (mean, 41.1 versus 50.1 years; p < 0.001) and earlier in their careers, with 60.3% of males in practice >10 years compared with 26.1% of females (p < 0.001). Consulting (7.8% versus 31.4%; p < 0.001), course faculty positions (19.0% versus 39.2%; p < 0.001), and academic and leadership titles (30.7% versus 47.4%; p = 0.002) were significantly less common among females. There was a significant income disparity between females (mean yearly income, $300,000 to $400,000) and males (mean, $400,000 to $500,000; p < 0.001). Females were more likely to have never married (12.4% versus 2.6%; p < 0.001), or they married at a later mean age (30.2 ± 4.7 versus 28.3 ± 3.9 years; p < 0.001). Females were more likely to have no children (29.4% versus 7.8%; p < 0.001), require fertility treatment (32.0% versus 11.9%; p < 0.001), and not have children until after completing their medical training (63.0% versus 31.1%; p < 0.001). Female surgeons reported more responsibility in parenting (p < 0.001) and household duties (p < 0.001) than males. Work-family balance satisfaction was 72.3% in females and 82.1% in males (p = 0.081). This study highlights deficiencies in work-family integration that appear to uniquely impact female orthopaedic surgeons. Female surgeons delay starting a family, more frequently require fertility treatments, carry more responsibility at home, have fewer academic and leadership roles, earn lower incomes, and are less satisfied with work-family balance relative to males. The discrepancy in work-family integration must be addressed to attract, support, and retain women as successful orthopaedic surgeons.

Interpretation of 2020 American Academy of Orthopaedic Surgeons (AAOS) on the Management of Glenohumeral Joint Osteoarthritis Evidence-Based Clinical Practice Guideline

Based on peer-reviewed systematic reviews and randomized controlled trials published between January 2000 and June 2019 with regards to the management of glenohumeral joint osteoarthritis (GJO), the American Academy of Orthopaedic Surgeons (AAOS) established the clinical practice guidelines for the treatment of GJO. The guidelines provided practice recommendations including risk factors, non-surgical treatment, surgical treatment, prosthesis selection, and perioperative management for GJO. The recommendations were graded according to different evidence strength. This paper interprets the guidline in order to provide reference for domestic medical workers.

Opioids in primary total joint arthroplasty: Interpretation of 2020 AAHKS/ASRA/AAOS/THS/TKS clinical practice guidelines

In 2020, the American Association of Hip and Knee Surgeons (AAHKS), the American Society of Regional Anesthesia and Pain Medicine (ASRA), the American Academy of Orthopaedic Surgeons (AAOS), the American Hip Society (THS), the American Knee Society (TKS) have worked together to develop clinical practice guidelines on the use of Opioids in primary total joint arthroplasty (TJA). This clinical practice guideline formulates recommendations for common and important questions related to the efficacy and safety of Opioids in primary TJA. This article interprets the guideline to help doctors make clinical decisions.

The Forum, Society for Women Sports Medicine Orthopaedic Surgeons

The Forum is a private, not-for-profit organization for board-certified, fellowship-trained, female orthopaedic surgeons. Founded in 1999, The Forum was conceived as a partnership with women in industry, designed to support women orthopaedic surgeons by providing a place to share research and practice ideas and to stimulate interest and research in arthroscopic surgery. Membership has grown from a handful of founding members to nearly 100 strong in 2021. An annual meeting is held over Martin Luther King, Jr., weekend each year, combining scientific and social programs and highlighted by the Sandy Kirkley Memorial Lecture. The Forum has recently gained notoriety through the work of some of its members in advocating for the protection of athletes from sexual abuse and the publication of the first position statement on the topic, subsequently endorsed by the American Academy of Orthopaedic Surgeons. A recent partnership with the American Orthopaedic Society for Sports Medicine and the Arthroscopy Association of North America to provide concurrent sessions at the 2021 combined annual meeting has increased the visibility of the society and its members.

Risk of complications following surgical fixation of femoral diaphyseal fractures in children aged 4 to 12 years: A systematic review and meta-analysis

Introduction: There is debate regarding the optimal surgical technique for fixing femoral diaphyseal fractures in children aged 4 to 12 years. The National Institute for Health and Care Excellence (NICE) and the American Academy of Orthopaedic Surgeons (AAOS) have issued relevant guidelines, however, there is limited evidence to support these. The aim of this study was to conduct a systematic review and meta-analysis to compare the complication rate following flexible intramedullary nailing (FIN), plate fixation and external fixation (EF) for traumatic femoral diaphyseal fractures in children aged 4 to 12.Methods: We searched MEDLINE, EMBASE and CENTRAL databases for interventional and observational studies. Two independent reviewers screened, assessed quality and extracted data from the identified studies. The primary outcome was the risk of any complication. Secondary outcomes assessed the risk of pre-specified individual complications.Results: Nine randomised controlled trials (RCTs) and 19 observational studies fulfilled the eligibility criteria. Within the RCTs, five analysed FIN (n = 161), two analysed plates (n = 51) and five analysed EF (n = 168). Within the observational studies, 13 analysed FIN (n = 610), seven analysed plates (n = 214) and six analysed EF (n = 153). The overall risk of complications was lower following plate fixation when compared to FIN fixation (RR 0.45, 95% CI 0.28 to 0.73, p = 0.001) in the observational studies. The overall risk of complications was higher following EF when compared to FIN fixation in both RCTs (RR 1.94, 95% CI 1.25 to 3.01, p = 0.003) and observational studies (RR 1.97, 95% CI 1.50 to 2.58, p<0.001). The overall risk of complications was higher following EF when compared to plate fixation in both RCTs (RR 7.42, 95% CI 1.84 to 29.98, p = 0.005) and observational studies (RR 4.39, 95% CI 2.64 to 7.30, p<0.001).Conclusion: Although NICE and the AAOS recommend FIN for femoral diaphyseal fractures in children aged 4 to 12, this study reports a significantly decreased relative risk of complications when these injuries are managed with plates. The overall quality of evidence is low, highlighting the need for a rigorous prospective multicentre randomised trial at low risk of bias due to randomisation and outcome measurement to identify if any fixation technique is superior.

An Evidence-Based Approach to the Treatment of Knee Osteoarthritis

The Journal of Orthopaedic Experience and Innovation editorial (Kirschenbaum 2021) requesting knee osteoarthritis (OA) treatment protocols or algorithms is important. The American Academy of Orthopaedic Surgeons’ (AAOS) Treatment of Osteoarthritis of the Knee Evidence-Based Guideline (2nd Edition) (Jevsevar et al. 2013) provides evidence of the effectiveness of knee OA treatments, but does not provide a treatment algorithm or protocol. Neither does the clinical practice guideline provide a rank ordering of the effectiveness of different treatments or guidance regarding when to initiate or discontinue treatments. Consequently, information must be incorporated from other sources and synthesized into an evidence-based approach. “Approach” is used because the diversity of patients, their co-morbidities, and their responses is not amenable to a defined protocol or algorithm.

Disparities across Diverse Populations in the Health and Treatment of Patients with Osteoarthritis.

The study of disparities across diverse populations regarding the health and treatment of patients with osteoarthritis (OA) is recognized as a priority for investigation and action by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) and the American Academy of Orthopedic Surgeons (AAOS). OA is a common condition that increases with age, but with prevalence generally similar across racial and ethnic groups. However, disparities in the treatment of OA among racial, ethnic, and socioeconomic groups are well-documented and continue to rise and persist. The reasons are complex, likely involving a combination of patient, provider, and healthcare system factors. Treatment disparities among these different populations have an impact on clinical outcomes, healthcare, and productivity, and are projected to increase significantly with the growing diversity of the United States population. The aim of this short review is to summarize studies of racial, ethnic, and socioeconomic disparities among patients with OA in the United States, with a focus on prevalence, treatment utilization, and clinical and economic outcomes.

What Really Matters.

Presented by Dr. Guy as 2021–2022 President of the American Academy of Orthopaedic Surgeons at the Annual Meeting of the American Academy of Orthopaedic Surgeons, San Diego, California, September 2, 2021. Guy or an immediate family member is an employee of Treace Medical Concepts.

Assessing the recognition of female orthopaedic surgeons in Castle Connolly's “America's Top Doctors” from 2000 to 2020

BackgroundThe field of orthopaedic surgery has one of the lowest percentages of practicing female physicians. Studies have shown disparities in various academic societies’ award recipients by sex. Given the recent increased use of physician rating platforms by patients and focus on consumer-driven healthcare, our aim was to assess the recognition of female orthopaedic surgeons. MethodsA twenty-year quantitative analysis was performed comparing the rate of top female orthopaedic surgeons listed on Castle Connolly's “America's Top Doctors” to the percentage of practicing female orthopaedic surgeons as reported by the American Academy of Orthopaedic Surgeons. ResultsFrom 2000 to 2020, there was a statistically significant increase in the percentage of top female orthopaedic surgeons listed on Castle Connolly (1.3%–5.3%), as well as an increase in overall practicing AAOS female members (2.7%–5.8%). When comparing the rate of top female orthopaedic surgeons listed on Castle Connolly to the proportion of practicing female AAOS members from 2000 to 2020, there were no statistically significant differences. ConclusionsThe increase in the rate of top female orthopaedic surgeons recognized by Castle Connolly was proportionate to the increase in percentage of practicing female AAOS members over the past 20 years. This study highlights the persistence of a gender discrepancy in the academic sector of orthopaedic surgery.

CORR Insights®: Is Self-reported Return to Duty an Adequate Indicator of Return to Sport and/or Return to Function in Military Patients?

CORR Insights®: Is Self-reported Return to Duty an Adequate Indicator of Return to Sport and/or Return to Function in Military Patients?

Platelet-rich Plasma and Its Application in Clinical Trial

Platelet-rich Plasma and Its Application in Clinical Trial

Do Orthopaedic In-Training Examination Scores Predict the Likelihood of Passing the American Board of Orthopaedic Surgery Part I Examination? An Update With 2014 to 2018 Data.

Previous research shows a correlation in performance between the Orthopaedic In-Training Examination (OITE) and the American Board of Orthopaedic Surgery (ABOS) Certifying Examination Part I; however, these studies are not current, with the most recent data from 2009. The purpose of this study was to update the relationship between the OITE and ABOS Part I scores with the five most recent nationwide cohorts of Part I scores and their corresponding OITE scores. The American Academy of Orthopaedic Surgeons provided the results for each resident taking the OITE from 2013 to 2017. The ABOS provided the results for each resident taking the Part I examination from 2014 to 2018. These two datasets were matched at the individual level and analyzed. Between 2014 and 2018, 3,502 first-time test-takers were present for the ABOS Part I Examination. A 96.6% pass rate was noted (3,383 of 3,502). A statistically significant correlation between the OITE score and ABOS Part I score was observed at all levels of training: postgraduate year (PGY) 1 r = 0.380, PGY2 r = 0.463, PGY3 r = 0.498, PGY4 r = 0.504, and PGY5 r = 0.504 (P < 0.001 for all correlations). The OITE scores continue to correlate with the ABOS scores and the pass rate for the ABOS with moderate strength correlation. However, although a correlation of the examinations exists when evaluated as a group, the predictive value of the OITE for passing the Part I examination for any specific individual is far from perfect. Individuals with PGY5 OITE percentile scores less than 10 pass the Part I examination, and individuals with PGY5 OITE percentile scores greater than 90 fail the Part I examination.

Industry Payments Among Appropriate Use Criteria Voting Panels: An Open Payments Analysis.

Although multiple studies have consistently demonstrated that orthopaedic surgeons receive greater transfers of value than other specialties, the industry payments of providers who are involved in the formation of practice guidelines have not been thoroughly explored. Therefore, the purpose of our analysis was to evaluate the industry payments of the authors of the Appropriate Use Criteria (AUC) from the American Academy of Orthopaedic Surgeons (AAOS). The publicly available AAOS web portal (OrthoGuidelines.org) was queried for all AUCs that had been released between January 1, 2013, and December 31, 2019, regarding the management of musculoskeletal pathologies. A cross-sectional analysis of the Centers for Medicare & Medicaid Services (CMS) Open Payments database was conducted to determine the number and total value of industry payments to AUC voting committee members during the year of voting for the AUC. Industry payments for each orthopaedic surgeon voting member were compared with payments received by orthopaedic surgeons nationwide who received any payment within the same year. The proportion of orthopaedic surgeon voting members who received any industry payment was compared with the proportion of orthopaedic surgeons nationwide who received payments. Our analysis included a total of 18 different AUCs with 216 voting members, 157 of whom were orthopaedic surgeons. Of the orthopaedic surgeon voting members, 105 (67%) received industry payments, a rate roughly comparable with the national average among orthopaedic surgeons (74%). For 7 of 18 AUCs (39%), the median payment per orthopaedic surgeon voting member was above the median among orthopaedic surgeons receiving payments nationwide that year. Qualitatively, orthopaedic surgeon voting members were more likely to receive payments in the form of royalties, licenses, or speaking fees than orthopaedic surgeons nationwide. AUC voting members receive payments at frequencies and magnitudes that are roughly comparable with orthopaedic surgeons nationwide. Whether voting panel members receiving payments at these rates is ideal or is in the best interest of patients is a policy decision for the AAOS and society at large. Our study confirms that payments are common and, thus, continued vigilance is justified.