Static Non-articulating Knee Spacers Are Associated with a High Degree of Morbidity in Challenging Clinical Scenarios.

The morbidity associated with the use of static non-articulating knee spacers for the treatment of periprosthetic joint infection (PJI) in challenging clinical scenarios has not been well described. From 2011-2019, 63 molded block static spacers were utilized at two academic institutions for the treatment of PJI with associated severe soft tissue compromise (59%), collateral ligament deficiency (49%), extensor mechanism compromise (48%), or type 3 bone defects (44%). Complications and outcomes were assessed. Complications with the use of static spacers were common and included further bone loss (46%), spacer migration (16%), extensor mechanism compromise (16%), cast or related soft tissue injuries (16%), fracture (13%), and spacer breakage (3%). Ultimately, 22% of patients underwent amputation. Patient variables such as age and body mass index were not associated with outcomes. Static knee spacers are associated with substantial morbidity in challenging clinical scenarios and alternatives may need to be considered. (Journal of Surgical Orthopaedic Advances 32(2):122-126, 2023).

Zip Codes May Not Be an Adequate Method to Risk Adjust for Socioeconomic Status Following Total Joint Arthroplasty at the Individual Surgeon Level.

BACKGROUND: Increasing consumerism in healthcare has included a push toward the ranking of individual surgeons. These rankings rely on the adjustment of patient outcomes based on individual patient risk. Socioeconomic status (SES) has been identified as an important variable impacting patient outcomes following total joint arthroplasty, and patient zip code has been proposed as a proxy. Our study attempts to determine if zip code is an acceptable proxy for SES within a single surgeon's practice. METHODS: Using public zip code and Geographic Information Systems (GIS) tax map data, we compared the real estate holdings of 244 patients undergoing total joint arthroplasty from an individual hip and knee arthroplasty surgeon's practice within an academic medical center over a 14-month period. An independent t-test was used to compare GIS data with the average home value within a given zip code. A Pearson correlation coefficient was calculated between GIS values and average home value per zip code. RESULTS: In a sample of 244 patients, mean home value calculated from GIS data was $335,993 (standard deviation [SD] $246,549), and $243,663 with zip code data (SD $84,731). The Pearson correlation coefficient was 0.411 (P < .001). There was a significant difference between mean home values calculated from zip code data and GIS data (P < .001). Using zip code estimates would have mischaracterized home value, as defined as greater than or less than 1 SD, in 15% of patients. CONCLUSION: Although there was some relationship between zip code and real estate holdings, the correlation is only moderate in strength and a substantial number of outliers were present. Given the sample size at the individual surgeon level, we question whether zip code can be used as a proxy for SES risk adjustment for the purposes of surgeon ranking.

The Multisystem effects of Long COVID Syndrome and Potential Benefits of Massage Therapy in Long COVID Care.

Background: A major complication of infection with Severe Acute Respiratory Coronavirus 2 (SARS-CoV-2), the virus responsible for COVID-19, is the potential for Long COVID Syndrome. While the pathophysiology of Long COVID Syndrome has yet to be described, the disease presentation is characterized by long-term symptoms with debilitating effects on human health. A better understanding of Long COVID symptomology may open up new avenues for patient treatment such as massage therapy. Methods: From the PubMed database, cohort studies that examined post-infection COVID sequelae published between January 1st, 2021 and April 30th, 2021 were selected to investigate patient demographics and symptoms. A review of massage therapy literature since 2000 in conjunction with identified Long COVID symptoms was performed. Results: This systematic review identified 17 cohort studies across the world that investigated the symptomatology of patients suffering from post-COVID sequelae in multiple organ systems. We identified the pulmonary and nervous systems to be the organ systems most affected with post-COVID sequelae, with PTSD, fatigue, dyspnea, cough, sleep disturbances, loss of smell, abdominal pain, and decreased appetite as the most common symptoms reported by >20% of Long COVID patients. Massage therapy was historically found to provide benefits to patients experiencing similar symptoms to those identified in Long COVID. Conclusions: Recognizing the need for new approaches to treatment for Long COVID Syndrome, we identify massage therapy as a potential therapeutic treatment to positively impact the organ systems affected by Long COVID, especially the high-incident symptoms, and improve patient quality of life.

Comparison of Patient Satisfaction Between Face-to-Face and Telehealth Modalities in Nephrolithiasis Nutritional Counseling.

INTRODUCTION: Following the COVID-19 pandemic, telehealth usage increased. Virtual visits minimize exposure risk while also addressing barriers to care. Telehealth offers the ability to increase patient access and provider efficiency. However, patient satisfaction with telehealth has not been fully determined. This study evaluated patient-perceived quality and satisfaction of virtual vs face-to-face visits during consultation with a dietician in the management of nephrolithiasis. METHODS: Ninety-six patients with previous diagnosis of nephrolithiasis underwent an initial, in-person nutrition consultation between May 2019 to February 2021. A follow-up with a dietician was randomized to in-person or telehealth. The telehealth group used an application called MDLive. The telehealth group used MDLive on a hospital computer during their follow-up with the urologist, whereas the in-person group had a separate appointment scheduled at a different location. Patient satisfaction following telehealth visits was assessed by the Telemedicine Satisfaction Questionnaire. Patient satisfaction following in-person visits was assessed with an 8-question modified Telemedicine Satisfaction Questionnaire, which lacked technology-related questions. RESULTS: Fifty patients were randomized to in-person follow-up and 46 to virtual follow-up. Within the virtual follow-up group more than 90% "agreed" or "strongly agreed" that they were satisfied with the quality of service provided through telemedicine. Greater than 82% reported intention to use telemedicine services again. There was no significant difference in patient satisfaction between telemedicine and face-to-face visits. Sixty-seven percent of patients in the telemedicine group reported better access to health care services and time saved and 89% reported independence accessing the telehealth system without assistance. CONCLUSIONS: This study supports the idea that telemedicine may be a successful alternative in the follow up of patients undergoing nutritional counseling for stone prevention. Future studies regarding telehealth use should evaluate which other urologic conditions are amenable to virtual management.