A black-shouldered kite just after a meal, a beautiful picture that is CC and made by David Jenkins.
Although I’m not a shoulder surgeon, I find the rotator cuff injuries fascinating. The rotator cuff is a group of muscles that surround the shoulder, providing motion and stability. Out of the four muscles, the top one is usually the most troublesome, the supraspinatus. It has a sensitive tendon that can both become irritated and cause pain and be a vital part of a rotator cuff rupture. In this post I’m going to focus on the rupture part, also commonly known as a rotator cuff tear. Note, this is not a complete review of this vast subject, more my personal reflections.
The most common symptom that an orthopaedic surgeon treats is pain, while simple in concept it turns out to be surprisingly difficult to pin down the cause. The picture is a bed of nails, CC by Ormando Madoery
Degenerative meniscal tears in the knee are a truly elusive problem for orthopaedic surgeons. As I have previously posted, degenerative meniscal tears are a common MRI finding in the healthy population above 40 years of age, and fail to correlate with actual knee symptoms, such as pain. As a surgeon it is tempting to try surgery for these injuries, but there is an increasing pile of evidence against this. This post is a comment on the most recent evidence, a NEJM study by Katz et al. Continue reading
Sticking to the old, proven concepts have often turned out to be a good strategy in orthopaedics. Switching hip implants can be both cumbersome and hazardous. The image is CC by Trey Ratcliff.
In my research I focus on patient factors and their impact on re-operation rates after total hip arthroplasties. While they do matter, the implant itself seems to be even more important. One of the most successful implant in the Swedish Hip Arthroplasty Registry is the Link Lubinus SP II implant, while some may argue that it’s an awesome design, I would argue that the tools that it comes with are awesome, thus limiting surgeon’s mistakes. This importance of skill is nicely illustrated in Peltola et al’s recent study, where they found an increased risk for revision during the first 3 years when introducing new implants, hazard ratio was 1.3 (95% CI 1.1 to 1.5) for the first 15 arthroplasties. This increased risk early on is commonly referred to as the learning curve, and may vary between implants. Continue reading
Can the promise of the new life after a total hip arthroplasty becom shattered by a stroke? The image is CC by Andreas Levers.
A recent study from Denmark by Lalmohamed et al. looked at stroke risk after total hip replacements. It is interesting as this is a severe disease that can have a major impact on the life after a total hip arthroplasty. Even if it’s a rare event, the rates are similar to other serious negative outcomes such as early infections (less than 1%), and therefore just as valid endpoint to study. Continue reading
When is it appropriate to return to driving? The image is CC by K嘛.
As an orthopaedic surgeon I’m often confronted by patients asking me when they can return to driving. While this is a natural question, the answer is surprisingly difficult for us doctors. It is therefore nice to read MacLeod et al.’s and Fleury et al.’s excellent reviews on this subject, and yes: I’ve thankfully been in line with the evidence. Continue reading
Many of us orthopaedic surgeons have been frustrated by waiting for the anesthesiologist to finish with the spinal anesthesia. It is therefore of great relief that Pugely et al. write that this frustration is not in vain. Patients that receive spinal anesthesia seem to have fewer complications after a total knee arthroplasty than those with general anesthesia. A conclusion based on a large registry study with 14 000 patients although the overall odds ratio was though not that alarming, 1.3. Continue reading
The gap between regular health care and research can sometimes be overwhelming. The researchers have the tools, the hospital change routines all the time, but they almost never meet. I’m therefore pleased to see Åstrand et al’s simple article, a follow-up of a screening program for osteoporosis that showed a decrease fracture risk about 50 %. Continue reading
Do tourniquets leave a sour aftertaste? The image is CC by Capsicina.
Total knee arthroplasties are common procedures, about 12-13 000 primary procedures are performed each year in Sweden (population 9 million). Since over 90 % of Swedish surgeons operate in a bloodless field (applying a tourniquet to the leg prior to incision), it is interesting to see research questioning our use. Could 2013 be the beginning of the end for the tourniquet in knee arthroplasties? Continue reading
Squash is one of my favorite sports, although unfortunately plagued by frequent achilles tendon ruptures as all racket sports. The image is CC by penguincakes.
A recent meta-analysis comparing treatments for achilles tendon ruptures caught my eye. This is probably one of the most commonly debated injuries among young orthopaedic surgeons; “what would you do if you’re achilles ruptured?”. After a few beers we can keep at it for hours… Maybe we can finally move to more interesting topics after Soroceanu et al’s excellent article. Continue reading