Association of State Legislation and Industry Compensation to Orthopaedic Residents: A 3-Year Review of the Centers for Medicare and Medicaid Services Open Payments Database.

BACKGROUND: The Sunshine Act aims to increase the transparency of physicians receiving compensation from pharmaceutical and medical device companies. Nine states have supplementary legislation in addition to the Federal Sunshine Act. The purpose of this study is to assess the characteristics of financial compensation to orthopaedic residents on the Centers for Medicare and Medicaid Services (CMS) Open Payments Database in states with more restrictive regulations compared with those without additional restrictions. METHODS: A complete list of accredited orthopaedic residency programs in the United States was compiled using the Accreditation Council for Graduate Medical Education and American Osteopathic Academy of Orthopedics websites. The website of each orthopaedic residency program was searched to compile a list of residents who attended their program from 2014 to 2016. The CMS Open Payments Database was used to search the residents identified for the corresponding years. All data available on the CMS Open Payments Database were recorded. RESULTS: Over the 3-year period, 3,622 residents were identified from 151 programs. A total of 41% of the residents were reported as receiving compensation from the industry. The percent of residents reported from programs in less restrictive states was 45% versus 28% in more restrictive states (P < 0.001). Residents had a mean of 5.3 transactions per year in less restrictive states and 2.4 transactions per year in more restrictive states (P < 0.001). The mean compensation per resident reported was $2,730 for less restrictive sates versus $1,937 for more restrictive states (P < 0.001). DISCUSSION: Overall, 41% of orthopaedic residents were reported on the CMS Open Payments Database with fewer transactions and less compensation going to residents in states with more restrictive legislature. Potential implications on resident education remain unknown.

Radiographic restoration of native anatomy: a comparison between stemmed and stemless shoulder arthroplasty.

BACKGROUND: Shoulder arthroplasty is a reliable procedure for patients with degenerative glenohumeral disease, and reproduction of native shoulder anatomy leads to superior outcomes. The aim of this study was to compare the ability of stemmed and stemless implants to radiographically restore native glenohumeral anatomy. METHODS: Shoulder arthroplasties were performed in 79 patients, with 58 receiving a stemless implant and 21 receiving a stemmed implant. Preoperative and postoperative radiographs were assessed for humeral head height, humeral head centering, humeral head medial offset, humeral head diameter, humeral neck angle, and lateral humeral offset by 2 independent viewers. Measurements were scored and summed to identify the anatomic reconstruction index (ARI). Radiographic measurements were compared using the Student t test, and significance was set at P < .05 for all statistical analyses. Interobserver agreement of radiographic analyses was assessed using the intraclass correlation coefficient, finding excellent reliability (intraclass correlation coefficient, 0.92). RESULTS: Five of six radiographic measurements along with the calculated ARI demonstrated no differences between stemmed and stemless shoulder implants (humeral head diameter, P = .651; humeral head height, P = .813; humeral head medial offset, P = .592; lateral humeral offset, P = .311; humeral head centering, P = .414; and ARI, P = .862). Stemless implants showed improved restoration of the native humeral neck angle (0° for stemless vs. -3° for stemmed, P = .017). CONCLUSION: Radiographic restoration of anatomy is similar for stemmed and stemless shoulder arthroplasty implants.

Sternoclavicular joint palpation pain: the shoulder's Waddell sign?

BACKGROUND: Pain is a complex and subjective reality and can be magnified by nonorganic or nonanatomic sources. Multiple studies have demonstrated a correlation between psychological factors and patients' perceptions of musculoskeletal pain and disability. In addition, nonorganic findings as part of the physical examination are well and long recognized. The purpose of this study was to analyze the relationship between a shoulder examination test, palpation of the sternoclavicular joint (SCJ), and psychosocial conditions including chronic pain, depression, and anxiety. METHODS: From June until October 2016, all new patients of 2 sports/shoulder fellowship-trained surgeons at an academic practice were screened for study enrollment. After their consent was obtained, patients were given a set of 5 surveys (Pain Catastrophizing Scale; Patient-Health Questionnaire 2; Pain Self-Efficacy Questionnaire; shortened Disabilities of the Arm, Shoulder and Hand questionnaire; and Shoulder Pain and Disability Index) to complete. The physician then completed a comprehensive standardized physical examination, with the examining physician being blinded to the patient's survey responses. Palpation of the SCJ was done with the examiner's thumbs and was accompanied by the question "Does this hurt?" If a positive pain response was given, clarification as to the correct side of the pain was made. RESULTS: A total of 132 patients were enrolled and completed the surveys and physical examination. Of the patients, 26 (19.7%) reported SCJ pain with SCJ palpation. Patients with and without confirmed pain on SCJ palpation had significantly different (P < .001) mean scores for all 5 surveys. A review of the medical histories between the 2 groups identified a significantly increased prevalence of chronic pain and mental health disorders, such as anxiety and depression, in SCJ palpation-positive patients. CONCLUSIONS: Patients who confirmed pain on SCJ palpation had significantly higher scores on various psychological surveys than those who denied pain on palpation, indicating that a portion of their pain was stemming from a nonorganic source. Inclusion of SCJ palpation during a routine shoulder or upper extremity physical examination may improve selection of treatment options for patients.

Readmission Following Revision Total Knee Arthroplasty: An Institutional Cohort.

PURPOSE: Total knee arthroplasty (TKA) is the most common joint replacement surgery performed in the United States. Given the aging and increasingly comorbid patient populations undergoing these procedures, complication rates and the need for subsequent hospital readmission are only expected to rise. It is, therefore, crucial to investigate the risk factors leading to readmission in order to improve patient outcomes. The purpose of this study is to identify significant risk factors for readmission following revision TKA procedures. METHODS: Patients undergoing revision TKA were identified at our institution from 2006-2017. The primary outcome was hospital readmission after revision TKA. Patient demographics, comorbidities, and postoperative complications were recorded and compared between readmitted and non-readmitted patients. RESULTS: Forty-five (26.2%) of the 171 cases were readmitted following revision TKA. The leading diagnoses at readmission varied from arthrofibrosis in 28.9% of patients, implant infection in 22.2% of patients, and implant failure in 20.0% of patients. Male gender was found to be a significant independent variable for readmission. This study also found that 51.1% of all readmitted patients continued to have complaints that required additional hospital readmissions. The average number of total readmissions was 2.1 per readmitted patient. CONCLUSION: This study was successful in identifying variables associated with readmission following revision TKA, as well as presenting information regarding the diagnoses associated with readmission. Our data also showed that if a patient was readmitted after revision TKA, it was likely that they would be admitted again. Due to the increasing prevalence and cost of these procedures, further studies are needed to better understand the risk factors and comorbidities leading to readmission in order to improve the perioperative care of these patients.