Our Residents Blog on Their AAOS Experience

Here is what members of our 2012 Resident Advisory Board had to say regarding the sessions they have attended at the American Academy of Orthopaedic Surgeons 2012 annual meeting.

I attended both the Adult Reconstruction Knee I: Clinical Outcomes paper presentations and the Adult Reconstruction Hip I: Infection/Venous Thromboembolism paper presentations. Both of these sessions were great and some very interesting studies that were presented. During the first session, a paper from the University of Massachusetts presented their data using a telephone-delivered emotional support system for total knee arthroplasty patients. They instituted a program in which phone calls were made during the weeks pre- and post-operatively to provide support and instructions to patients regarding their rehabilitation, and they found that functional outcomes were significantly increased in patients who were entered into the program- demonstrating the importance of communication and support, and its effect on patient outcomes. The second session presented some interesting data regarding the use of oral factor Xa inhibitors (i.e. Rivaroxaban), and its effectiveness. Two papers demonstrated relatively contrasting results regarding complication rates after its use. However, the take home point for me, which was brought up for discussion by Dr. Javad Parvizi of Jefferson is that currently there is no pharmacologic antidote that is readily available for these factor Xa inhibitors. Thus, in the event of a bleeding complication, it will be very difficult to manage.

— Denis Nam, MD

Orthopaedic Surgery Resident

Hospital for Special Surgery

New York, NY

I attended the Paper Presentation in Trauma I: Bone Healing. I found these two talks to be the best talks in the session:

Michael Palmer and colleagues from Allegheny General Hospital presented a paper entitled “Can We Trust Intraoperative Culture Results in Nonunions”. It evaluated the sensitivity and specificity of OR cultures taken in fracture nonunions and compared it to molecular techniques. The study found that using FISH (fluorescent in situ hybridization) they were able to diagnose infections that would otherwise have been missed by cultures alone in nonunion fractures. This work suggests that intraoperative cultures may not be the gold standard in the diagnosis of bone infections.

Martin Quirno from NYUHospital for Joint Diseases presented a paper entitled “The Role of Progressive ANK in Fracture healing”. He found that progressive ANK stimulates differentiation in osteoblastic precursors in early fracture healing. He explained that using a mouse model they were able to determine that mice deficient in ANK were not able to heal fractures as well as mice who possessed this gene. This finding may provide insight into the molecular cascade of fracture nonunions.

—Richelle Takemoto, MD

Chief Resident

NYU Hospital for Joint Diseases

New York, NY

RVU, CPT, ICD, oh my! Over 500 residents packed in tightly, and many more were turned away at the door at the "Coding Basics for Orthopaedic Residents" course that marked the opening day of the 2012 AAOS meeting. Margaret M. Maley BSN, MS, a former nurse with over 20 years of experience with the business of orthopedics and now an instructor with KarenZupko & Associates, led a nearly 3 hour session explaining coding jargon that dictates how these future practitioners get reimbursed. Some of the highlights included the breakdown of the components of real value units (RVU), correctly utilizing codes and modifiers when performing consultations, and a series of clinical vignettes allowing the audience to participate. There were ample questions asked during the session at the 5 microphones set up throughout the room and many more answered. An opportunity to have a one-on-one interaction with Ms. Maley would have been helpful in clarifying unique questions and some detail that was brushed over during the talk. Nonetheless, this is MUST go for all residents, especially those considering making the leap into running their own practice. And for those turned away at the door, there's always next year in Chicago.

— Thomas John

Chief Resident

Albert Einstein Medical Center

Philadelphia, PA

On the first day of the conference I attended the sports medicine review course. I enjoyed the content on shoulder and knee but I was surprised to see a third of the course cover primary care sports medicine. However, for a resident about to write my final exams it was a great quick review. I also attended the shoulder and elbow presentations on rotator cuff. The talks were interesting and brought about much debate on suprascapular nerve palsy in the setting of a massive rotator cuff. The role of using EMG in diagnosing this unique neuropathy was questioned by various audience members, including Dr. Warner. The highlight of the day for me was the instructional course section on surgical techniques for complex proximal tibial fractures. It was well moderated and covered the management of soft tissues, surgical approaches and reduction and fixation techniques.

—C. Ryan Martin

Chief Orthopaedic Surgery Resident

University of Calgary

Calgary, Alberta, Canada