Hmmm.....Can Anyone Else Relate Too??

Doctor Who? Are Patients Making Clinical Decisions?
ScienceDaily (Feb. 12, 2008) — Doctors are adjusting their bedside manner as better informed patients make ever-increasing demands and expect to be listened to, and fully involved, in clinical decisions that directly affect their care. In a study just published in Clinical Orthopaedics and Related Research, Dr. J. Bohannon Mason of the Orthocarolina Hip and Knee Center inCharlotte, NC, USA, looks at the changes in society, the population and technology that are influencing the way patients view their orthopaedic surgeons. As patients gain knowledge, their attitude to medicine changes: They no longer show their doctors absolute and unquestionable respect.
Demographic change, education, affluence, availability of information via the Internet, patient mobility, direct-to-consumer marketing, patient age, patient activity demands, cost pressures and physician accountability are converging to present the practitioner with a patient who is more informed and has higher expectations than any prior generation of patients.
Today's patients do not simply have a medical complaint, they desire a particular operation and sometimes even a particular implant. The doctor is no longer the sole source of medical information. Patients have enough snippets of information to stimulate a dialogue and clearly express their expectations for a particular outcome and technique to achieve that outcome. They are also demanding quicker recovery, return to higher-level sport activity and earlier discharge from the hospital.
"Patients have come to expect miracles in medicine as the norm, yet these miracles are not without inherent risk," cautions Mason.
Providing true patient-centered care relies on doctors' ability to supply patients with accurate, evidence-based information and to improve communication. However, patients are not necessarily motivated by evidence-based medicine. They are often willing to adopt the promises of direct-to- consumer marketing.
In Mason's view, the doctor's responsibility is "to maintain control of validated information sources and of the exchange of information with the patient. [Doctors] need to be interpreters and balancers of scientific information to help guide [their] patients through the maze of medical hyperbole. [They] need to discuss new treatments and technologies openly and honestly."
And crucially, they must also understand that although patients' demands are changing, the surgeon's accountability and responsibility for their patient's safety and care have not.
Journal reference: Mason JB (2008). The new demands by patients in the modern era of total joint arthroplasty. Clin Orthop Relat Res (DOI 10.1007/s11999-007-0009-2)
Adapted from materials provided by Springer.

On a Nerdiness Scale of 1-10, I have reached an 11

Today, as both kids napped, I picked up a PT journal (this is not where the nerdiness ended). I began reading an article:
"Manual Therapy Intervention for a Patient With a Total Hip Arthroplasty Revision "
J Orthop Sports Phys Ther 2007;37(12):763-768.
doi:10.2519/jospt.2007.2437

It was about rehabbing a patient with a revision total hip replacement. As I reached the end, the authors quoted another article:
Marc J. Philippon, Mara L. Schenker, Karen K. Briggs, David A. Kuppersmith, R. Brian Maxwell, and Allston J. StubbsRevision Hip ArthroscopyAm. J. Sports Med., Nov 2007; 35: 1918 - 1921

The first article quoted the second article saying that the authors found that the primary reason for revision hip ARTHROPLASTY (i.e total hip replacement) is impingement. As I was reading, I said, out loud, WTF??? That is not what that article says, I know that article like the back of my hand and they don't speak anywhere about arthroplasty, only arthroscopy. Yes, we all know that the primary reason for a revision ARTHROSCOPY is impingement. The authors misquoted Philippon et. al. My husband thinks i have gone off the deep end...again, he can't believe I caught that, and that I plan on emailing the authors regarding their mistake!

Another Interesting Article

Radiologic and Intraoperative Findings in Revision Hip Arthroscopy

Original Article
Radiologic and Intraoperative Findings in Revision Hip Arthroscopy

Presented at the Annual Meeting of the American Academy of Orthopaedic Surgeons, San Diego, California, February 2007.

Benton E. Heyworth M.D., a, , Michael K. Shindle M.D.a, James E. Voos M.D.a, Jonas R. Rudzki M.D.a and Bryan T. Kelly M.D.a
aHospital for Special Surgery, New York, New York, U.S.A.

Available online 5 December 2007.



Purpose: The purpose of this study was to identify possible causes of failure of hip arthroscopy by reviewing the intraoperative and radiologic findings in a series of patients requiring revision hip arthroscopy. Methods: We retrospectively reviewed 24 revision hip arthroscopy cases performed in 23 patients (14 female and 9 male; mean age, 33.6 years; 1 bilateral). The review included indications for surgery, intraoperative findings, and arthroscopic interventions for both the primary and revision surgeries. Imaging studies, including radiography, magnetic resonance imaging, and 3-dimensionally reconstructed computed tomography scans, were analyzed for the presence of preoperative bony impingement lesions (e.g., femoral head-neck junction “cam” lesions or anterosuperior acetabular “pincer” lesions). Results: The mean interval between previous hip arthroscopy and recurrence of symptoms was 6.1 months. In 13 of 24 cases (54%), patients had no significant improvement at any point after the primary hip arthroscopy. The mean interval between the previous hip arthroscopy and revision surgery was 25.6 months. Unaddressed or undertreated bony impingement lesions were found in 19 of 24 cases (79%) and were identified on imaging studies before revision hip arthroscopy. A tight psoas tendon and corresponding labral impingement lesion were identified by arthroscopic visualization in 7 of 24 cases, for which partial psoas tendon release was performed. Eight cases of failed labral repair were addressed with labral debridement and removal of suture material. Of these 8 cases, 6 also had bony impingement, which was also addressed at the time of the revision surgery. Conclusions: Failure to address bony impingement lesions of the hip and a tight psoas tendon are key factors in unsuccessful hip arthroscopy and may require revision surgery. Furthermore, failure of labral repairs may be the result of unrecognized bony impingement at the time of initial surgery. Level of Evidence: Level IV, prognostic case series.

Article Review

I have been frantically trying to get my hands on an article from this month's AJSM because there is an article titled "Revision Hip Arthroscopy". I finally got it today. It found that the most common reason for a revision is persistent impingement.
Of 37 cases reported, 36 had impingement that was either not previously addressed, or inadequately addressed. 32 had labral lesions, 26 had a chondral defect, 22 had unaddressed FAI, 22 required lysis of adhesions, 13 for unaddressed instability, 12 for repeat treatment of FAI.

Just some food for thought! I feel better that most did have a labral lesion, not that I hope that for anyone...but you know what I mean!!!