Keeping current with orthopaedic science and research. A podcast from JBJS and OrthoEvidence, featuring Mohit Bhandari, MD and Marc Swiontkowski, MD.

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Latest Episodes

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June 07, 2021

Women in Orthopaedics (with special guests Ann Van Heest and Laurie Hiemstra)

In this episode, Marc and Mo are joined by special guests Ann Van Heest (Professor and Director of Education in the Department of Orthopaedic Surgery at the University of Minnesota) and Laurie Hiemstra (Orthopaedic Surgeon at Banff Sport Medicine and soon-to-be President-Elect of the Canadian Orthopaedic Association) in an illuminating discussion on the challenges faced by women in the field of orthopaedics—and, more importantly, what can be done to address these challenges. This topic was suggested by one of our listeners (Rostanda Meireles, the first woman in the Brazilian Hip Society) via the OrthoJoe mailbag ([email protected]). The discussion touched on a number of themes:  What systematic disadvantages do women continue to face in orthopaedics?  How do these institutional barriers impact their careers in terms of meeting the requirements for board certification, becoming successful surgeons, obtaining grants and industry support, performing original research, publishing articles, and so on?  How do cultural differences around the world impact women as they try to become established in the field? How can these issues be addressed locally, nationally, and internationally? How can we address the root causes of the “pipeline” issue, given the fact that 50% of medical students in the US are female, compared with only 15% of orthopaedic surgeons? What has worked, what hasn’t worked, and where should we be focusing our efforts going forward? How can we drive cultural change for the purpose of increasing the representation of women in positions of leadership within the field?  How can men ...



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May 24, 2021

Innovation (with special guest Ed Harvey)

In this episode, Marc and Mo are joined by special guest Ed Harvey (tenured professor at McGill University and Past-President of the Canadian Orthopaedic Association) in a lively discussion on the topic of innovation in the field of orthopaedic surgery. The discussion touches on a number of related questions: Invention is often confused with innovation. What is the difference?  What is the phenotype of a surgeon-innovator, and how does such an individual differ from a surgeon-scientist or surgeon-educator? What are the necessary skills and qualities of the surgeon-innovator? How can we identify individuals with these skills, and how can we motivate individuals to develop them? Are people born with these skills, and can these skills be taught?  When is the right time to innovate? Are you ever too young or too old to innovate? How does the concept of value relate to the concept of innovation? What are the roles of the “3 Ps” (Patient, Physician, and Payor) in achieving commercialization? How does a surgeon-innovator define “success”?  Why is it important to have an efficient and effective team during the commercialization process? How does the team change over time? What kind of expertise is needed to navigate the regulatory issues related to innovation? What are investors and venture capitalists (VCs) ultimately looking for when evaluating an invention?  OrthoJOE Mailbag: feedback, comments, and suggestions from our audience can be sent to [email protected] Links: Schiffman CJ, Prabhakar P, ...



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May 10, 2021

Knee Arthroscopy

In this episode, Marc and Mo highlight a recent large database study from The Hospital for Special Surgery and use it as a springboard to discuss a number of issues related to the appropriateness, timing, and investigation of knee arthroscopy in patients with degenerative disease.  What is the relationship between the timing of knee arthroscopy and the rates of revisions and complications following TKA? Is there a recommended time interval between knee arthroscopy and TKA that can be used to inform clinical decision-making?  Is the use of arthroscopy in the presence of knee OA even evidence-based to begin with? What would be the specific situations in which arthroscopy would definitely be indicated?  What are the weaknesses of the insurance database approach to studying this topic? How should we advise residents or young academic faculty with regard to the issues that are associated with this study design? What confounders must be considered in the interpretation of the results?  If the goal is to delay TKA for as long as possible, what are the top 3 evidence-based interventions that we have in our armamentarium today? OrthoJOE Mailbag: feedback, comments, and suggestions from our audience can be sent to [email protected] Links: Gu A, Fassihi SC, Wessel LE, Kahlenberg C, Ast MP, Sculco PK, Nunley RM. Comparison of Revision Risk Based on Timing of Knee Arthroscopy Prior to Total Knee Arthroplasty. J Bone Joint Surg Am. 2021 Apr 21;103(8):660-667. doi: 10.2106/JBJS.20.00218. PMID: 33849048. Link Jones MH. Indications for Knee Arthroscopy ...



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April 26, 2021

Perioperative and Transitional Care

In this episode, Marc and Mo are joined by special guest P.J. Devereaux, Director of the Division of Perioperative Care at McMaster University, in an informative discussion on the future of perioperative and transitional care. With much of the world still dealing with a third wave of the Covid pandemic, and with hospital access continuing to be a challenge because of high rates of ER visits and hospital readmissions, how can we optimize the safety and care of patients both intraoperatively and postoperatively?   How has Covid helped us to rethink how we might improve care for our patients in the future? How can we most effectively monitor patients after they leave the orthopaedic surgical suite?  What measures can we take to send patients home both sooner and safer? What are the roles of technology, personnel, data monitoring, and established protocols in ensuring timely and improved patient care after discharge?  What are the cost considerations associated with technology and technology support? How do these costs compare with those of ER visits and rehospitalizations?  How might the development of a new discipline of perioperative and transitional care help to save lives, provide better patient experiences, improve outcomes, and avoid overloading our ERs and hospitals?    OrthoJOE Mailbag: feedback, comments, and suggestions from our audience can be sent to [email protected]   Links:   Prada C, Chang Y, Poolman R, Johal H, Bhandari M. Best practices for surgeons. COV/0-19 Evidence-Based Scoping Review. https://myoe.blob.core.windows.net/docs/OE-Best-Practices-for-Surgeons-COVID-19-Evidence-Based-Scoping-Review.pdf   ...



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April 12, 2021

Total Ankle Replacement

In this episode, Marc and Mo are joined by special guest Bruce Sangeorzan—Professor of Orthopaedics at the University of Washington and world-renowned foot and ankle researcher—in a lively discussion on the past, present, and future of ankle replacement.   Approximately 700,000 knee replacements are performed each year, compared with just 10,000-20,000 ankle replacements, leading to a number of questions: How does this factor affect the number of clinicians who are as skillful and comfortable in performing ankle replacement as compared with shoulder, knee, and hip replacement? How do better-designed alignment devices, improved implants, and better training affect the numbers of ankle replacements being performed each year? How soon can we reach 40,000 ankle replacements each year? What are the challenges in performing RCTs of ankle arthroplasty? Is an RCT even the right study design for this topic? What design elements seem to be most successful, especially given the space limitations in the ankle region? How do factors such as degenerative disease, BMI, activity level, and adjacent osteotomy affect the results of ankle replacement and arthrodesis?  OrthoJOE Mailbag: feedback, comments, and suggestions from our audience can be sent to [email protected] Resources/Links: Veljkovic AN, Daniels TR, Glazebrook MA, Dryden PJ, Penner MJ, Wing KJ, Younger ASE. Outcomes of Total Ankle Replacement, Arthroscopic Ankle Arthrodesis, and Open Ankle Arthrodesis for Isolated Non-Deformed End-Stage Ankle Arthritis. J Bone Joint Surg Am. 2019 Sep 4;101(17):1523-1529. doi: 10.2106/JBJS.18.01012. PMID: 31483394. https://jbjs.org/reader.php?id=205473&rsuite\_id=2159103&native=1&source=The\_Journal\_of\_Bone\_and\_Joint\_Surgery/101/17/1523/fulltext&topics=fa#info   Muller P, Skene SS, Chowdhury K, Cro S, Goldberg AJ, Doré CJ; TARVA Study Group. A randomised, multi-centre trial of total ankle replacement versus ankle arthrodesis in the treatment of patients with end stage ankle osteoarthritis ...



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March 29, 2021

Diversity, Equity, and Inclusion

How do diversity, equity, and inclusion contribute to excellence, creativity, competitive advantage, and relevance in both orthopaedic surgery and scientific publishing? How can we achieve greater diversity among authors, editors, and reviewers at top journals? What specific steps can individuals and organizations take to create a more diverse, inclusive, and equitable environment that provides greater opportunities for under-represented groups?  We have a mailbag! If you have any feedback or comments about the latest episode or other relevant topics, feel free to send us a line at the OrthoJOE Mailbag: [email protected]   Talking Points: Equity and inequality in surgery “Getting to excellence” and “being diverse and inclusive” are key targets How can we be more inclusive in the publishing industry and within our fields of expertise? The orthopaedic gender gap What more should we be doing? Rallying the voices of others Being aware of what’s happening in your office Thinking broadly about change Resources/Links: Scholl E, Badwall HK, Bhandari M. Equity in Surgery: Being Diverse and Inclusive, Isn’t Enough. OE Insights. Sept. 5, 2020. https://myorthoevidence.com/Download/5ac93c79-38a3-4e9e-b5bc-ce225882ac75.  Okike K, Liu B, Lin YB, Torpey JL, Kocher MS, Mehlman CT, Bhandari M, Biermann JS. The orthopedic gender gap: trends in authorship and editorial board representation over the past 4 decades. Am J Orthop (Belle Mead NJ). 2012 Jul;41(7):304-10. https://pubmed.ncbi.nlm.nih.gov/22893880/ Hiller KP, Boulos A, Tran MM, Cruz AI Jr. What Are the Rates and Trends of Women Authors in ...