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Jonathan Cluett, M.D.

Orthopedics Blog


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5 Tests You Don't Need

Tuesday April 22, 2014

Some orthopedic tests are valuable.  They can help determine the cause of pain or the reason for lost function.  But other tests may not be so helpful.

Tests may be unnecessary, they may be misleading, or they may even lead to a potentially harmful treatment.

It's important to have the right test to guide proper treatment, but sometimes the right thing is not to have a test.  Here are a 5 tests that may not be necessary....

Ultrasound Being Used for Injections: Do You Need It?

Saturday April 19, 2014

Injections are among the most common treatments used in an orthopedists office.  Injections can be used for arthritis, tendonitis, bursitis and other conditions.

In order to ensure the injection is as effective as possible, it is important to ensure the injection is given in the proper location.  If your doctor doesn't get the injection to the right spot, it may not work as well to relieve symptoms.

Using ultrasound to "guide" the injection is increasingly common, but is it necessary?  Some doctors insist the injections should be given with ultrasound, while others believe it is a waster of money.  Learn about the use of ultrasound to guide injections...

Price for a New Hip

Monday April 14, 2014

Well, according to a recent survey of hospitals throughout the United States, many don't know!

And those hospitals that could offer a price, offer from a range of just over $10,000, to well over $100,000.  So why the discrepancy?

Most hospitals are used to dealing with insurance companies and Medicare, not consumers.  Most hospitals don't think much about price competition for services.  Therefore, charges are often arbitrary, and don't make much sense.

In this survey, a caller asked for the price of a hip replacement.  She said on the phone that her grandmother needed a new hip, and was willing to pay out of pocket.  She just wanted to know how much?  Many hospitals couldn't provide an answer, and those that could provided quite a range.

The truth is, that there is little variation in what is done to perform a hip replacement.  Some hospitals may have more cost associated with their service, but the differences should be minimal.  But the differences in price were anything but minimal!

In order to control the cost of healthcare, there must be pressure to compete on price.  That pressure cannot impact the quality of care, but there has never been any evidence to show that a hospital that charges 10 times the amount for a hip replacement does a better job.

Over time, I would guess that this information becomes more widespread, and consumers will be asked to pay attention to the price of the service they are being offered.

Leave your comments below...

Source: Price for a New Hip? Many Hospitals Are Stumped

Study Shows ACL Grafts Best When Your Own

Saturday April 12, 2014

ACL reconstruction surgery is often the best treatment for an ACL tear.  When reconstructing the torn ligament, a new ligament needs to be made.  Unfortunately, the ACL cannot be repaired, and therefore the reconstruction is the best option.

Surgeons have debated for decades about the best option for the ACL graft.  Options include either using tissue from somewhere in your body (commonly the patellar tendon or hamstring tendon), or using tissue from a donor (cadaver tissue).  Recent research has clearly shown that your own tissue is better.  In fact, a recent analysis of all the best studies on this subject found patellar tendon autografts (your own tissue) had all of the following advantages when compared to donor graft:

  • Less repeat ruptures (tears of the graft)
  • Stronger ACL (less laxity)
  • Improved knee function (measured by single-leg hop test)
  • More satisfied patients

While there may be some reasons to perform ACL reconstruction with donor tissue, more evidence is pointing towards use of your own tissue.

Related: Safety of Donor Grafts

Source: Bone-Patellar Tendon-Bone Autograft Versus Allograft in Outcomes of Anterior Cruciate Ligament Reconstruction

Choosing the Right Anesthesia

Saturday April 5, 2014

For many types of orthopedic surgery, there are options for anesthesia.  Choosing the right option for your surgery may depend on personal preference, medical issues, or surgical considerations.

Recent studies have shown that with joint replacement surgery, specifically hip and knee replacement, spinal anesthesia is the best option if it is determined to be safe for the patient.  While personal preference is an important consideration, getting the best outcome from surgery is also important.  If the surgery can have better results, patients should know about the best choice of anesthesia.

Bad Orthopedic Travel Advice

Thursday April 3, 2014

I read a column on the Internet recently advocating patients with implanted metal bring x-rays to the airport to assist the TSA in screening. My opinion: Bad idea.

Many patients with implanted metal will set off airport metal detectors. Implants including plates, screws, rods, and joint replacements can all set off airport metal detectors. However, the TSA is staffed by security specialists, not doctors. Taking x-rays to the security personnel is a waste of your time and effort. Here are the problems:

  • Identity Issues
    Security personnel cannot (and should not) assume that an x-ray belongs to the person holding it. If that were the case, anyone could simply bring an x-ray of a metal implant as their reason for setting off the metal detector.
  • Hospital Records
    X-rays are part of your hospital record, and removing them makes your record less complete. If those x-rays get lost on your trip it could affect your medical care down the road. Sometimes having previous x-rays for comparisons is essential, especially when dealing with implants.
  • Cost
    Every time an x-ray is taken, and printed, medical costs go up. If patients are constantly getting extra x-rays taken and printed for travel purposes, this wastes medical resources.

I think this column has great tips for travel security--except the advice to bring your x-rays to the airport. Instead, use the advice of the TSA, and leave your x-rays at your doctor's office.

Related: Do metal implants cause metal detectors to go off? | TSA Recommendations

Found the Right Surgeon?

Thursday March 27, 2014

Wondering if you have found the right surgeon to help you with your condition?  Here are a few resources and ideas to help you learn more about the person you are trusting to fix your condition.

Having surgery is one of the most important decisions you will make, and finding the right surgeon can mean the difference between a great outcome and a long list of problems.  Learn a few ways to find the right person to perform your surgery!

ACL Surgery in Children Leads to Early Arthritis

Monday March 24, 2014

It's something most surgeons have suspected, but recent research has confirmed: people who undergo ACL reconstruction are more likely to develop arthritis of the knee later in life.

The study looked at ACL reconstruction in kids, and followed their knees for 10-20 years.  After time had past, many of the patients had developed arthritis (65% of those that had undergone ACL surgery), compared to a relatively small number of patients who didn't sustain ACL injuries (14%).

Surgeons hope that performing ACL surgery will help to restore normal knee mechanics, and prevent the development of arthritis, but this study shows that even having the surgery will not be enough.

Source: "Knee Surgery May Put Kids at Higher Risk for Future Arthritis"

Prevent Complications of Knee Arthroscopy

Thursday March 20, 2014

Complications after arthroscopic knee surgery are rare, but they can occur.  The most common complications include blood clot, infection, and the possible need for additional surgery.  The chance of these complications occurring is between 1-2%.

A recent study looked at why some people are more likely to sustain these complicating issues with their knee arthroscopy.  The study found the following patients had the highest risk of surgery:

  • Patients over 40 years old
  • Patients whose surgery lasts more than 90 minutes
  • Patients who have had other recent surgical procedures (within 30 days)

Not much you can do about your age, but your surgeon can control the duration of surgery, and not recommend elective knee arthroscopy within 30 days of another surgery.

Source: Study Examines Complication Incidence, Morbidity Risks Following Knee Arthroscopy

Protocol Prevents Hip Replacement Infection

Monday March 17, 2014

Infections of joint replacement implants are serious problems that typically require additional surgery and significant morbidity.  Patients who have infections can have much worse results from surgery compared to patients who don't have this complication.  Because of this, every effort to limit the chance of infection is taken.

Researchers are continually trying to determine which steps are most helpful to prevent surgical infections of joint replacements.  A recent study found the following combination lowered the chance of infections of hip replacements:

  • Using nasal mupirocin ointment before surgery
  • Using chlorohexidine (antibacterial) wipes on the surgical site before surgery
  • Using multiple antibiotics at the time of surgery (vancomycin and cefazolin)
  • Sterilizing the skin with a combination of solutions (chlorohexidine, alcohol, and iodine)

While this is encouraging, it is important to note that the risk of complication is still not zero, and some patients still experienced an infection.  Further research is needed to determine how to eliminate this possible problem.

Source: "Aseptic Protocol Decreases Surgical Site Infection After Hip Arthroplasty"

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