Qualitative inquiry with persons with obesity about weight management in primary care and referrals.

Introduction: Referrals to evidence-based weight management in the community-commercial sector are aligned with clinical recommendations but underutilized. Methods: This qualitative study explored patients' perceptions and expectations about obesity treatment in primary care and referral to community-commercial sector programs. Individual semi-structured interviews were conducted with a sample of US persons with obesity via telephone. Audiotape transcripts, interviewer notes, and independent review of data by two investigators allowed for data and investigator triangulation. Transcripts were analyzed using thematic analysis. Results: Data saturation was reached with 30 participants who had a mean age of 41.6 years (SD 9.4), 37% male, 20% Black/African American and 17% Hispanic, 57% college educated, and 50% were employed full-time. Three primary themes emerged: (1) frustration with weight management in primary care; (2) patients expect providers to be better informed of and offer treatment options; and (3) opportunities and challenges with referrals to community-commercial programs. Discussion: Patients expect that providers offer personalized treatment options and referrals to effective community-commercial programs are an acceptable option. If patient-level data are shared between clinical and community entities to facilitate referrals, then privacy and security issues need attention. Future research is needed to determine feasibility of implementing clinical to community-commercial referrals for obesity treatment in the United States.

The Variable Effects of NSAIDs on Osteotomy Healing and Opioid Consumption.

In an effort to fight the opioid epidemic, an NSAID pain protocol was created for osteotomy patients. The study asked if NSAIDs negatively affect bone healing or reduce the need for opioids. Methods: This was a retrospective review of 155 limbs that underwent osteotomy of a long bone with fixation. Patients received an NSAID-free protocol or an NSAID protocol. Time to union and bone healing index were recorded. Results: There was not a significant difference in the time to union (P = 0.89) or bone healing index (P = 0.07). In the deformity correction group, the total milligrams of morphine equivalents prescribed after discharge was significantly less in patients receiving NSAIDs (P < 0.001). Conclusions: The use of NSAIDs after osteotomy surgery did not negatively affect bone healing and resulted in a dramatic decrease in narcotic consumption for deformity correction patients. Level of Evidence: Level III retrospective cohort study.

Ankle Distraction Arthroplasty for Ankle Osteoarthritis: A Survival Analysis.

AIM: The treatment algorithm for end-stage ankle arthritis is imperfect. Young or active patients are challenging to treat as fusion and replacement carry predictable consequences. Ankle distraction arthroplasty is a less commonly utilized surgical procedure for the treatment of osteoarthritis of the ankle. The purpose of this study was to report intermediate-term survival of ankle distraction and to identify factors associated with earlier time to failure. MATERIALS AND METHODS: A single-centre, multi-surgeon cohort of 258 cases of ankle arthritis, treated with ankle distraction or ankle distraction with supramalleolar osteotomy (SMO), was identified. Patients were contacted by phone to determine the status of the ankle (natural vs fused/replaced). Data were collected through chart review. This included patient demographics, medical comorbidities, surgical procedure, and X-ray characteristics including pattern and severity. A Cox regression model was used to determine factors associated with failure during 10 years of follow-up. Risk factors were analysed as hazard ratios (HRs) and 95% confidence intervals (CIs). Time to failure was illustrated with Kaplan-Meier (KM) curves. RESULTS: In total, 144 cases were successfully contacted with median follow-up of 4.57 years. In total, 16.7% of ankles failed (24/144). The 5-year survival was 84% (95% CI: 78-91%). In adjusted Cox regression, female sex (HR = 2.68, p = 0.049) and avascular necrosis (AVN) of the talus (HR = 3.77, p = 0.041) were significantly associated with failure risk. CONCLUSION: Avascular necrosis of the talus and male/female gender differences in survival were found to be significant. Our experience shows that ankle distraction is a valid and effective operation for the treatment of end-stage ankle arthritis. CLINICAL SIGNIFICANCE: This work is clinically significant in that it demonstrates excellent intermediate-term survival data for hinged ankle distraction for treatment of osteoarthritis of the ankle. Additionally, it evaluated patient and disease characteristics allowing improved patient counselling with regard to survival longevity. LEVEL OF EVIDENCE: IV cohort study. HOW TO CITE THIS ARTICLE: Greenfield S, Matta KM, McCoy TH, et al. Ankle Distraction Arthroplasty for Ankle Osteoarthritis: A Survival Analysis. Strategies Trauma Limb Reconstr 2019;14(2):65-71.