Hip resurfacing: case closed? A bibliometric analysis of the past 10 years.

INTRODUCTION: Hip resurfacing (HR) was introduced as a potential alternative to total hip arthroplasty (THA), indicated predominantly for younger, high demand patients. The modern metal-on-metal implant was popularized in the 1990s and early 2000s and promised greater wear resistance. However, its popularity waned due to increased rates of complications related to metal toxicity including pseudo-tumors as well as the recall of many resurfacing implants. The purpose of this study was to conduct a bibliometric analysis and investigate the current trends in hip resurfacing literature. METHODS: Using the keywords "hip resurfacing," publications between 2012 and 2022 were identified on Web of Science Core Collection of Clarivate Analytics. Results were screened for relevance by three independent reviewers using title, abstract, and full text. The retrieved data were evaluated by the bibliometric method. Included articles were imported into CiteSpace 5.7.R1, 64-bit (Drexel University, Philadelphia, PA, USA), VOSviewer 1.6.15 (Leiden University, Leiden, the Netherlands), and the Online Analysis Platform of Literature Metrology to identify trends in publication. RESULTS: Search terms yielded 1200 results and 724 were included in final analysis. A steady decrease of publications was noted over the past decade with less than 40 articles published in 2020 and 2021. The Journal of Hip Arthroplasty (92), Hip International (74), and Clinical Orthopaedics and Related Research (54) published the most articles. Authors from the United States and the United Kingdom published the most studies. High-frequency keywords in co-occurrence and co-cited cluster analysis were metal-on-metal, metal ions, wear, pseudo-tumor, and revision, demonstrating that long-term concerns have been the focus of most recent studies. CONCLUSION: In conclusion, our bibliometric analysis allowed novel exploration and identification of the current research trends, contributions, and the distribution of publications exploring HR. The understanding of HR and the poor long-term outcomes of some resurfacing implants has improved significantly over the past decade, with the most recent focus on failure rates and long-term complications from metal debris. However, the breadth of literature has steadily declined in the past decade, and ultimately demonstrates the decline of scientific interest and focus on novel areas in hip resurfacing and a potential reached consensus.

The Effect of Preoperative Benzodiazepine Usage on Postoperative Opioid Consumption After Hand Surgery: A Multicenter Analysis.

Background Prescription rates of opioids and benzodiazepines have steadily increased in the last decade with the percentage of prescription opioid overdose deaths involving benzodiazepines more than doubling during that time. Orthopaedic surgery is one of the highest-volume opioid prescribing medical specialties, but the effects of benzodiazepine use on orthopaedic surgery patient outcomes are not well understood. The purpose of the study was to utilize the state Prescription Drug Monitoring Program (PDMP) database to investigate if perioperative benzodiazepine use predisposes patients to prolonged opioid use following hand and upper extremity orthopaedic surgery. Methods This study was retrospective and conducted at three urban academic institutions. All patients who underwent carpal tunnel release, thumb basal joint arthroplasty, and distal radius fracture open reduction internal fixation performed by 14 board-certified, fellowship-trained orthopaedic hand and upper extremity surgeons between April 2018 and August 2019, were collected via a database query. All opioid and benzodiazepine prescriptions were collected from three months preoperatively to six months postoperatively. Results In this study, 634 patients met the inclusion criteria presented to one of the three institutions during the 18-month study period. Patients consisted of 276 carpal tunnel releases, 217 distal radius fracture open reduction internal fixations, and 141 thumb basal joint arthroplasties. Benzodiazepine users were 14.6% more likely to fill an additional opioid prescription (p<0.005) and were 10.8% more likely to experience prolonged three to six-month postoperative opioid use (p<0.005). Conclusion This study found that patients who use benzodiazepines are at a higher risk of filling additional opioid prescriptions and prolonged opioid use following hand and upper extremity surgery. Prescribers should take this into account when prescribing opioids after upper extremity orthopaedic surgery.

Social Media Use Among Hand Surgeons.

Background: Recently social media use within healthcare has increased significantly. Today, it is common for patients to browse the Internet, including physicians' social media pages, to learn about their medical conditions and search for providers. The purpose of this study is to analyze the use of social media among hand surgeons, and to compare this use between academic and private surgeons. Methods: Using the American Society for Surgery of the Hand's (ASSH) online directory, all active members practicing within the ten most populated U.S. cities were identified. Social media presence was determined by an Internet search of platforms. Members were stratified by practice model (academic vs. private). Chi-square and t-tests were used to compare categorical and continuous variables, and a multivariable logistic regression was performed for the binary variable practice model. Results: Two hundred and fifty-six hand surgeons were identified with 150 (59%) in academic and 106 (41%) in private practice. For ResearchGate accounts, 51 (82%) were academic and 11 (18%) were private. Mean PubMed publications was 38 for academic and 9 for private. YouTube presence was 69 (70%) in academic and 29 (30%) in private. On multivariable analysis, the odds of having ResearchGate and YouTube presence were higher for academic practice. There was no statistically significant difference by practice type for Facebook, Twitter, LinkedIn, and Instagram. Conclusions: With the recent social media expansion, surgeons have adopted social media platforms to reach patients. While the literature has shown that private practices are more active in social media, our results show they are not more active than academic practices in the ten most populated U.S. cities. Level of Evidence: IV.

Comparative Cost Analysis of Single-use Sterile versus Reprocessed Distal Radius Volar Plate Sets.

Background: With the rise in distal radius fracture (DRF) incidence and treatment through open reduction internal fixation, there are increasing concerns in the current medical cost containment climate. To help reduce costs, manufacturers are introducing sterile packed kits. The purpose of this study is to compare the costs of the single use kit (SK) against conventional reprocessed DRF surgical sets (RS). Methods: A four-year retrospective review at three surgical centers was performed to determine a company's RS average sterilization and processing costs. RS instrumentation cost was estimated by straight-line depreciation from the original purchase price. RS implant costs were calculated from the list price. SK list cost was obtained from the same company. Incidence of surgical delays was estimated by a survey of 23 hand surgeons and cost of delays was obtained from surgical center reports. Sensitivity analysis on delay frequency was performed to assess a range of overall costs. Results: OR delays were estimated at one out of 100 cases, with an average cost of $11 per case. For RS, average instruments, implants, and sterilization costs per case was $47, $2882, and $39. The total RS cost of $2,978 and the SK was $1,667 with a difference of $1,313 per case. Conclusion: RS was found to cost $1,313 more per case than the SK in an ambulatory surgical setting and potentially more cost effective. Ultimately, pricing is highly variable at each center based on negotiated and contractual pricing.

Larger Perioperative Opioid Prescriptions Lead to Prolonged Opioid Use After Hand and Upper Extremity Surgery: A Multicenter Analysis.

INTRODUCTION: The opioid epidemic remains an ongoing public health crisis. The purpose of this study was to investigate whether surgeons' prescribing patterns of the initial postoperative opioid prescription predispose patients to prolonged opioid use after upper extremity surgery. METHODS: This multicenter retrospective study was done at three academic institutions. Patients who underwent carpal tunnel release, basal joint arthroplasty, and distal radius fracture open reduction and internal fixation over a 1.5-year period were included. Opioid prescription data were obtained from the Pennsylvania Prescription Drug Monitoring Program website. RESULTS: Postoperatively, 30.1% of the patients (191/634) filled ≥1 additional opioid prescription, and 14.0% (89/634) experienced prolonged opioid use 3 to 6 months postoperatively. Patients who filled an additional prescription postoperatively were initially prescribed significantly more pills (P = 0.001), a significantly longer duration prescription (P = 0.009), and a significantly larger prescription in total milligram morphine equivalents (P = 0.002) than patients who did not fill additional prescriptions. Patients who had prolonged opioid use were prescribed a significantly longer duration prescription (P = 0.026) than those without prolonged use. CONCLUSION: Larger and longer duration of initial opioid prescriptions predisposed patients to continued postoperative opioid use. These findings emphasize the importance of safe and evidence-based prescribing practices to prevent the detrimental effects of opioid use after orthopaedic surgery.

Initial Debridement of Dorsal Hand Abscesses in the Operating Room Does Not Improve Outcomes.

Background: Hand infections frequently involve the dorsal aspect of the hand and often develop secondary to some traumatic mechanism. Although Staphylococcus aureus is most commonly isolated, anaerobic and polymicrobial infections are not uncommon. To date, treatment is largely anecdotal, with some surgeons preferring a formal debridement in the operating room, while others opt for an initial debridement at the bedside. The goals of this study were to compare outcomes between treatment modalities and to identify the most common causative organisms. Methods: A 10-year retrospective chart review was conducted to identify adult patients who presented with a dorsal hand infection to a single, level 1, urban trauma center. Demographic data were collected as well as the abscess size, location, duration of symptoms, treatment administered, number of formal debridements, length of hospital stay, and complications. Results: The number of formal debridements was significantly less in the initial bedside debridement group (P < .01), as was the hospital length of stay (P < .01). There was no significant difference in hospital readmissions, complications, or infection due to methicillin-resistant Staphylococcus aureus. There was also no significant difference in abscess size, duration of symptoms, or demographic data including age, sex, comorbidities, intravenous drug use status, and immunocompromised status. Conclusions: An initial debridement of dorsal hand infections at the bedside is at least as effective as formal debridement in the operating room. This decreases number of formal debridements and days in the hospital, without any increase in complications. This permits safe, expeditious, and cost-effective treatment for this common condition.

Orthopaedic Surgery Resident Financial Literacy: An Assessment of Knowledge in Debt, Investment, and Retirement Savings.

Most orthopedic residents carry significant debt and may enter their practice with little knowledge of business management, minimal retirement savings, and overall poor financial literacy. This study aimed to gauge financial literacy, debt, and retirement planning in United States orthopedic surgery residents. Willingness to participate in formalized financial education was also assessed. Eighty-five allopathic orthopedic surgery residents in the United States completed a 14-question anonymous online survey in 2016. The survey assessed demographic data, self-assessed financial knowledge, amount of credit card debt and loans, preparation for retirement, and willingness to participate in formal didactic education on these topics. Most respondents derive their financial knowledge from personal research (51%), whereas only 4 per cent have a formal curriculum. Despite most respondents reporting more than $200,000 in outstanding loans, only 31 per cent create and stick to a budget. Few programs offer retirement advice, and 48 per cent of respondents save $0 toward retirement. Eighty-five per cent of residents expressed interest in learning about personal investment, savings, and retirement planning. Orthopedic surgery residents carry significant debt and do not achieve their high-income potential until disproportionately later in life. Only 4 per cent of residents have formal training in investing, personal finance, or retirement despite a majority who desire such a curriculum. In fact, almost 75 per cent of those surveyed felt less prepared for retirement than their peers outside of medical training. This study suggests a role for formal financial education in the orthopedic curriculum to prepare residents for retirement, improve financial literacy, and enhance debt management.

Arthroscopic Double-Row Suture Anchor Repair of Acute Posterior Bony Bankart Lesion.

The treatment of anterior shoulder instability is well described with various techniques, including arthroscopic double-row repair, an alternative to open stabilization procedures in high-risk groups. The surgical management of posterior instability in high-risk and athletic populations is a less-explored entity. We describe our technique for an all arthroscopic double-row suture anchor repair of a large posterior bony Bankart lesion. We prefer this technique over percutaneous cannulated screw fixation because the double-row suture technique allows for incorporation of capsular plication with bony fixation in an effort to better restore normal anatomy for capsulolabral complex. Double-row repair capsulolabral repair or fixation of the bony Bankart is performed via a suture-bridge technique. Medial row anchors are placed down the glenoid neck and shuttled around the bony fragment and labrum. The lateral-row anchor is placed at the rim of the native glenoid. This repair technique has been shown to increase the surface area for healing and more closely reconstruct the native anatomic capsulolabral complex footprint, improve force distribution, and potentially impart enhanced posterior stability to the glenohumeral joint.

Unrecognized osteoid osteoma of the proximal femur with associated cam impingement.

Femoro-acetabular impingement is a common cause of hip pain in young athletes. Evaluation typically includes radiographs and magnetic resonance imaging. It is important to appreciate uncommon diagnoses and the role of complimentary imaging. This clinical vignette emphasizes the need complete imaging with CT in select case of atypical hip pain. We present a 19-year old soccer player who underwent seemingly successful arthroscopic FAI surgery but returned with pain. Computed tomography (CT) revealed osteoid osteoma of the lesser trochanter. The lesion was successfully treated with percutaneous CT guided radiofrequency ablation.