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OTW Presents
The Great CCJR Debates

Gehrke v. Haidukewych: Mega Prosthesis for Distal Femoral Peri-Prosthetic Fx’s

OK, it’s a distal femoral peri-prosthetic fracture. Do you reach for the locking plates, the screws or the intramedullary nails? Or do you opt for a mega prosthesis? This week’s Orthopaedic Crossfire® debate tackles this excellent subject with ENDO-Klinik’s Gehrke choosing the big implant and Orlando Health’s Haidukewych going ORIF. Who wins? You judge.

Thienpont v. Ranawat—UKA: The Gold Standard for Medial Compartment Disease

Unicompartmental Knee or Total Knee? What’s not to like about preserving natural kinematics, lower infection rate and good post op range of motion? But can the patient live with higher revision rates? Dr. Thienpont argues for Uni while Dr. Ranawat takes the counter position. Great and timely debate this week.

Berend v. Dunbar: Outpatient TJA: “Drive-Thru” Surgery

Same day total knee arthroplasty is the siren song of large joint reconstruction. Michael Berend has performed over 2, 000 knee arthroplasties with 98% of these folks going home the same day and recommends it strongly. Michael Dunbar points out that these are select patients in a tightly controlled environment. Hard to duplicate especially with heavier, more diabetic and older patients. Read this very interesting debate here.

Lee v. Schmalzried: Ceramic-Ceramic THA in Patients <60: A New Standard

Is the use of ceramic-on-ceramic in young patients the new standard of care? Yes, says Lee. In fact c-on-c has better wear, is more reliable and provides more options. Not so fast says Schmalzried. Survivorship and function are no better, there is a squeaking and fracture risk. Who wins this debate? You be the judge.

Hozack v. Haddad: The Anterior Approach: Better, Faster, Cheaper

Anterior hip arthroplasty. Is it really better, faster and cheaper or is that mere marketing hype? This week’s debate pits William J. Hozack, M.D. against Fares Haddad, M.B., F.R.C.S. with Paul Lachiewicz moderating on this hot topic. Who wins this most entertaining debate? You be the judge.

Murphy v Maloney: Ceramic on Ceramic THA in Patients <60: A New Standard

Does a patient’s age determine whether to use ceramic-on-ceramic THA? As we saw with the excellent 2013 CCJR debate regarding ceramic-on-ceramic, this is a popular topic. This year Stephen Murphy reminds us that “ceramic-on-ceramic bearings have excellent results” while William Maloney points out that they are not a standard of care and can squeak. Lieberman moderates yet another terrific CCJR debate.

Beaule v Maloney: The Anterior Tabled Approach: First Among Equals

“Are you doing the anterior approach?” According to Bill Maloney, that’s the most common patient question he gets. But not everyone should follow the anterior siren song. Paul Beaule makes a strong case for the benefits of the anterior approach while Dr. Maloney reminds us that the learning curve is steep. This may be one of the most important debates of the year.

MacDonald v Meneghini: Femoral Head Materials: No Difference in Outcomes

Cobalt chrome or ceramic heads? Steven MacDonald takes the position that there is NO difference between the two in outcomes while Michael Meneghini is very persuasive saying that outcomes are clearly better with cobalt chrome. Who wins this outstanding debate? With mounting evidence of corrosion from cobalt chrome, this is a timely debate.

Barrack v Pagnano: Patient Specific Cutting Blocks: Of Unproven Value

Patient Specific Instrumentation (PSI), unproven value or next new thing for knee replacement surgery? Dr. Barrack says he’s tried it and it didn’t improve outcomes or value. Dr. Pagnano counters by saying that in his experience PSI lowers stress in the OR and is valuable for certain hospitals. Another timely and important debate from CCJR.

Patella Resurfacing: Rarely, if Ever Necessary

According to Robert Barrack, M.D.” There are about five things that can happen when you resurface a patella and four of them are bad.” Not so, says Wayne Paprosky, M.D. in this spirited CCJR debate. “I say resurface the patella” With modern techniques and instruments “Just go ahead and resurface the patella. Why not finish the job?” Who wins this debate? You be the judge.

Kwong vs Pagnano — The Cementless TKA: Lifetime Guarantee on Parts & Labor

“I believe that we are on the threshold of the cementless total knee coming of age, ” says Louis Kwong. Not so fast counters Mark Pagnano, “It’s my contention that in 2015 cemented fixation remains the gold-standard for total knee arthroplasty fixation.” Who’s right? In this spirited debate it’s truly hard to tell.

Measured Resection Trumps Gap Balancing in TKA

Them’s fighting words! Measured resection or gap balancing in total knee arthroplasty. Aaron Hofmann M.D. makes a strong case for measured resection but Bryan Springer M.D. counters effectively for gap balancing. Who earns an “A”? You be the judge.

Reverse Shoulder or Not? Crosby and Gobezie Debate Contained Cuff Arthropathy

Lynn Crosby: “When treating cuff tear arthropathy with loss of acromial-humeral distance; pain with or without activity; good deltoid tone and strength, reverse is the best option. Not so fast, says Reuben Gobezie: “Don’t do these reverse replacements on patients who have these types of tears because they have pre-op range of motion greater than 90. It is not a good outcome.” Who wins this great debate? You decide.

Cement That Shoulder? John W. Sperling and William H Seitz, Jr. Debate

In the Crossfire this week is a very sticky topic—cementing that shoulder replacement. Says John W. Sperling “If we look over all the literature one can see that cement fixation is frankly not necessary.” Not so fast says William H. Seitz, Jr., “Cement has become the gold standard and there are new designs and new techniques and we also have new techniques for cementing as well.” It’s a lively and informative debate, for sure.

Burkhead vs. Romeo Over Hill-Sachs Lesion for Shoulder Repair

To Surface Replace or Not to Surface Replace. That is the question. Buz Burkhead and Anthony Romeo debate fiercely the advisability of shoulder surface replacements when there is a Hills-Sachs lesion. It’s a spirited intellectual tussle which we think you’ll enjoy immensely.

Two Aarons Square Off Over Cementless Fixation: Hofmann v. Rosenberg

“Twenty-five years of implant retrieval has shown that we definitely have a solid attachment with cementless devices, ” argues Aaron Hofmann. Aaron Rosenberg counters, “The literature and registries clearly show that it sometimes is just silly not to cement (patients with osteopenia, patients with significant bone defects, the elderly).”

Parvizi, Scott Debate Simultaneous Bilateral TKA

“There are higher complications and mortality with simultaneous bilateral total knee surgery (SBTKA), ” argues Jay Parvizi, “it is for a select group of patients.” Richard Scott counters, “SBTKA is indicated in 10-15% of patients, patient and family satisfaction is high, and recent reports indicate a cost savings and the overall morbidity is less compared to staged procedures.”

Minas, Lachiewicz Debate Patient Specific TKA

“Patient specific TKA—especially in large patients or very small patients—gives a precise fit. It’s easy for the OR staff, the jigs are accurate, and you get excellent intraoperative stability, ” argues Tom Minas. Paul Lachiewicz counters, “Ask yourself three questions: Does it provide better outcomes and decreased revisions for patients? Is it less expensive? Is it easier for the surgeon? For patient specific instrumentation the answer is ‘NO’ to all three.”

Lewallen, Thornhill Debate All Poly Tibias

“Modular platforms are more expensive, unproven, and you have a rigid implant along with bone stress shielding, ” argues David Lewallen. But Tom Thornhill counters, “You have fewer options with an all poly tibia, including the fact that you can’t go without cement. And if you cemented an all poly tibia you can sometimes miss the fact that there is cement left towards the back.”

Spooks, Phishing and Cyberattacks Cripple Hospitals

Spook technology stolen from U.S. spy agencies was used by hackers in a phishing cyberattack that crippled Britain’s National Health Service and computers worldwide. Outdated healthcare computer systems make healthcare systems easy targets. Read about this attack and see what you can do to keep patients safe.

Systemic Bias in Clinical Research

Orthopedics This Week calls for a change in the economic framework for the clinical study process globally. The current system is undermined by systemic bias, lack of reproducibility and scalability. The causes come from multiple factors, many of which are non-corporate. It is time to address these issues.

The Last Men Standing

Once upon a time lumbar arthroplasty was the most innovative and exciting development in spine surgery. Thirteen years ago the procedure hit a reimbursement wall. That was then, this is now. The resurrection of TOPS is the latest sign that lumbar arthroplasty has a second wind.

A Cry for Help? FDA Bares Concerns in NEJM

The most senior FDA executives went public with their worries, frustration even, we suspect, impotence regarding the plethora of stem cells therapies in the market last November. And that article, which appeared in the New England Journal of Medicine just keeps growing in influence. Here is what Celia Whitten, Peter Marks and Robert Califf said.

All Aboard the Opioid Tax BOAT

A bill is pending to amend the Internal Revenue Code’s Public Health Service Act (PHSA). The Budgeting for Opioid Addiction Treatment Act (BOAT) potentially places a one penny per milligram excise tax on most opioid prescriptions, with the revenue earmarked for opioid treatment programs.

HCAHPS Report Card: A+ or C-?

Millions of patients have evaluated their hospital, physician and nurse experience by way of the HCAHPS survey. Patients seem happy. But CMS isn’t. And poorer hospitals are calling foul. We checked with the expert about all this and read a handful of new studies. Conclusion: HCAHPS is a very good, albeit not perfect, thing.

The Case of Brazil’s “Prosthetic Mafia”

A private Brazilian insurance group claims U.S. orthopedic and other implant device makers and the U.S. government allegedly violated the Foreign Corruption Act. In numerous private lawsuits, the group alleges a “Prosthetic Mafia” gorged payers.

The $1,000 Infection Tax

In this new era of cost containment in medicine, adding over $1,000 to the cost of a procedure sounds fiscally irresponsible. A group of new studies about post op infection rates provide new insights into this critical issue as contributing commentator, Jay Mabrey, M.D., MBA, CPE explains.

New Evidence: Mild Concussions Related to ALS

A new concussion model developed by Gretchen Thomsen, Ph.D., of the Regenerative Medicine Institute at Cedars-Sinai Medical Center in Los Angeles and colleagues triggered earlier onset of familial Amyotrophic Lateral Sclerosis symptoms. The researchers hope that the model can be used to develop novel therapies.

12 Leading North American Hand Surgeons

According to their colleagues, these are the leading orthopedic hand surgeons in North America. Whether handling the wrist, elbow, or hand, these exemplary physicians have reached the pinnacle of their profession.

Peachtree Orthopedics Massive Hack Affects 500,000+ Patients

Peachtree Orthopedics is the second orthopedic clinic in Atlanta to fall victim to TheDarkOverlord hacking group in 2016. With over half a million patient records held at ransom, with sensitive information leaked in a teaser threat, Peachtree is working with the FBI to prevent patient identity theft

Judge Backs DOJ Effort to Stop Aetna-Humana Merger

Seven months after the DOJ filed a lawsuit to stop the $37B Aetna-Humana merger, along with a complementary Anthem-Cigna merger, a district judge rules in favor of the DOJ—but Aetna promises a quick appeal. What does a potential merger mean for the millions of Medicare Advantage customers who rely on these mega insurers for coverage?

Zimmer Biomet Finally Settles for $30.5 Million

A decade-long legal battle between Zimmer Biomet, the Department of Justice (DOJ), and Securities and Exchange Commission (SEC) ended in a grand finale with a $30.5 million settlement. Allegations include violations of the U.S> Foreign Corrupt Practices Act (FCPA) and improprieties in Brazil and Mexico.

$31 Million Lawsuit: Orthopedic Surgeon Seeks Justice After Attack

Renowned orthopedic surgeon Dr. Jamie Alexandra Dale is seeking justice and $31 million after she was attacked and left for dead by her ex-boyfriend and former NFL player Curtis Jordan. Her permanent injuries have left her unable to continue her surgery practice. Her story is not only heartbreaking but an indication of the economic toll this attack represented.

10 Surprising 2017 Shoulder and Foot/Ankle Market Insights

Which companies will increase shoulder and foot/ankle market share in 2017. In mid-December we received a flashlight into the opaque future of those two dynamic extremity markets. The early Xmas gift came courtesy of top global medical technology analyst, Glenn Novarro. Here is what we learned.

Drinking the Kool Aid in DT’s D.C.

It’s Donald Trump’s world in Washington. The Boss is driving agendas now and here’s the absolutely very latest. The ACA is first up. But there is also a spate of other year-end developments—primarily new digital healthcare initiatives—that should be noted.

Untwisting the Obamacare Rubik’s Cube

Orthopedic surgeon Dr. Tom Price is in charge of implementing President-elect Trump’s promise to repeal and replace Obamacare. He faces a 2, 000 page long law and a Rubik’s Cube of rules and regulations. But he is the right guy for the job having led the Republican effort over the last couple of years to design an alternative plan. Can Obamacare be untwisted? What does it mean for orthopedics? We find out.

3D Print This!

It’s not a revolution, but it is changing orthopedics. 3D printing produced the fastest new product launch in Stryker Spine’s history. It also represented 20% of the winning spine technologies for 2016. Stryker’s rousing success with Tritanium has lessons for everyone. Here they are.

NASS Issues Major Spine Stim Coverage Recommendations

NASS new guidance document regarding bone growth stimulators for spine fusion brings clarity to an often confusing gaggle of products and indications. Bottom line, the evidence supports some bone stimulators and not others in spine fusion. Here’s the story.

The Ten Best New Spine Technologies for 2016

Robots, 3D printing and clever strategies for navigating the spinal anatomy dominated this year’s winning technologies. Clearly we are in an environment where risk reduction rules. And so our panel selected impressively clever technologies which make every surgeon even more perfect…and awesome. Congratulations to each and every winner!

New Spine Surgeon Survey: 10 Surprising Answers

RBC’s excellent spine surgeon survey, now in its eighth year, was released a couple of weeks ago and it provided many insightful, even surprising, results. Which products are spine surgeons most excited about? What do they think is happening with reimbursement? Is their business growing or declining? Here are RBC’s answers.

Game Changer for Large Joint Patients and Their Rehab

A new, data driven tool which cuts patient assessment time from weeks to, literally, 30 seconds is the hot new technology for professional athletes. Eventually, maybe sooner, it will be coming to a large joint clinic near you. Maybe your clinic. This innovation feels like a game changer. It measures muscle health and therefore rehab milestones and progress.

Did Zimmer Biomet Just Pull a ‘Soft’ Turn With Vanguard?

The hype surrounding Zimmer Biomet’s Vanguard ID had us double checking with our surgeon friends. They told us this is actually a particularly interesting innovation in total knee arthroplasty. Apparently, the venerable Vanguard knee is still capable of a few new tricks. Here’s what we learned.

Will a $95 Million Deal Bring Chemonucleolysis Back?

Is chemonucleolysis for painful lower back disc herniation returning? In the 1980s chymopapain achieved fairly wide spread use as a chemonucleolysis agent. Outcomes were highly technique and patient selection dependent. It eventually left the market. Now two large firms have inked a deal to bring a new chemonucleolysis approach to market. Will this one work?

With 1.2 Million Medical Marijuana Users, Orthopods in Crosshairs

Medical marijuana is the law in 23 states, 1.2 million marijuana cards have been issued and the two most common reasons for getting a medical marijuana card are back and arthritis pain. How should orthopedists in those states deal with the phenomenon of medical marijuana? We have some answers.