Total Knee Tips & Pearls From Dr. Adam Rosen (A Virtual Total Knee Fellowship Podcast)

Hip fractures are a frequent admission at hospitals.  Here I will go over things that are helpful in getting patients to the OR safely and timely.

It is not important for the medical team to attempt to classify the type of fracture, leave that up to the orthopedic team.  Simply refer to it as a right or left hip fracture.  Occasionally, the ER or radiologist is wrong and all you do is propagate the mistake in the medical record.

Blood loss, VTE, prophylaxis, pain management as well as discharge planning is discussed.

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I hate the word clearance, but prefer a pre-op eval or stratification.

Here I will go into detail of the things I look for when a patient is referred to their PCP prior to elective orthopedic surgery.  I will go over not only what, by why each item is important.  For each test I will explain what peri-operative complications could occur and why we may want to correct certain things prior to surgery.

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Here I am going to try to go through hip pain in the office setting in patients over 50.  Think about location, is it in the groin, laterally or in the buttock.  Take a good history and physical exam.  Xray are beneficial but need to be WEIGHT BEARING to adequately assess for arthritis.  

Although MRI are useful for tumors, infections and osteonecrosis or fractures not seen on xray, the MRI is not as helpful in older individuals for certain diagnoses.  Most patients over 50 and almost all with arthritis have labral tears so an MRI is not necessary for those patients - wastes resources.

Lateral hip pain syndrome can include ITB syndrome, bursitis and tendinitis.  Buttock pain and radiculopathy can be from the back in individuals who have back disease.

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Here I will review the 3 common achilles problems - achilles tendinitis, achilles tendinosis and achilles tendon rupture.  I will discuss the plantaris tendon rupture which can be mistaken for an achilles injury.

I will briefly describe the symptoms, exam and workup for these diagnoses.

I will explain why MRI's are not needed for the diagnosis of an achilles tendon rupture - the have been shown to be a waste of time and money and can delay care.

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In season 3 I am going to try to pass on some orthopedic knowledge to non-orthopedic health care providers.

It has been shown that the MSK knowledge coming out of medical school is poor, yet a high number of visits in the office and ER are for orthopedic problems.

Here I am starting with non-traumatic knee pain in patients over 50.  I will attempt to cover other common presenting diagnoses in future episodes.

The recommended xrays:
1. Standing (Weight Bearing) AP
2. Rosenberg view (Standing flexed knee PA)
3. Lateral
4. Merchant or sunrise view of the patella

The AAOS Knee exercise guide:
https://orthoinfo.aaos.org/globalassets/pdfs/2017-rehab_knee.pdf

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It looks like things will be virtual for now.  I am going to offer my thoughts on what I was looking for when I applied for a fellowship.  I'll review things I think are important such as number and type of cases, office hours and education.  Briefly, I touch on things I discuss as an overview of the fellowship I am involved in.  Disclaimer: I work where I did my fellowship so there may be some bias.

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After medical school, residency and probably fellowship it is time to find a practice.  Here I will try to offer my two cents on what to think about and what to look for when you start looking for that first job out of training.

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TKA's are complicated and the femoral preparation is complicated.  We are concerned about bone resection, rotation, sizing and more.  If the implant is wide or gaps tight you may need to downsize.  The initial referencing can be anterior or posterior.  Each has its pro's and con's.  Here I will try my best to explain the basic similarities and differences of anterior and posterior referencing.

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I am not a coding expert.  I know that through med school, residency and fellowship I received little to no education on coding.  Here I want to offer my simple overview of new versus established, level 3 vs level 4 and how to code based on time.  I hope this offers an introduction and helps you dig further by asking questions and possibly taking a coding course.

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Being in practice for 15 years has allowed me to see and be involved in many improvements in patient care.  Here I will outline ten things that have evolved to improve outcomes.  In addition they have helped control cost, which is beneficial to the health care system.

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