Articles related to Surgery, Orthopedic

Use of Carnett sign, greater trochanter palpation, and a simple extension to typical joint examination can reduce imaging and orthopedic referrals by primary care physicians and bring faster effective treatment to the patient.

In a study of more than 800 rural-living men and women with knee osteoarthritis, an 18-month program of diet and exercise versus attention control yielded an average 14-pound greater weight loss in the test group – but not much difference in pain magnitude.

Gabapentin has been increasingly used as part of a multimodal analgesia regimen to reduce opioid use in perioperative pain management. In this cohort study of 237,872 adults aged 65 years or older, perioperative gabapentin users had significantly increased risk of delirium, new antipsychotic use, and pneumonia compared with nonusers after major surgery.

The VITAL trial enrolled more than 25,000 men and women over age 50. Supplemental vitamin D showed no significant benefit vs. placebo in preventing the common fractures of osteoporosis.

The knee arthritis meta-analysis reviewed 169 trials involving 21,163 patients, with the evidence demonstrating viscosupplementation is associated with a clinically irrelevant reduction in pain intensity and with an increased risk of serious adverse events compared with placebo. For the meniscus study, the commentary may sum it up best: “Multiple studies, including several with sham surgeries as a control have shown repeatedly over the previous 2 decades that surgery is not superior to physical therapy, yet the issue and use of surgery persist.”

The review, which we covered previously, concluded that “oral, synthetic cannabis products with high THC-to-CBD ratios and sublingual, extracted cannabis products with comparable THC-to-CBD ratios may be associated with short-term improvements in chronic pain and increased risk for dizziness and sedation.”