Knee Flexion Angle Measurement Using Virtual Assessment Tools: Correct Procedure and Potential PitfallsVirtual patient assessment will inevitably require smartphone technology to remotely measure knee range of motion. We conducted an experiment to analyze the impact of observer position relative to the flexed knee on the perceived angle measured using an electronic application (Dr. Goniometer) for iPhone. Two observers measured the apparent knee flexion angle from 7 different positions at 3 different heights relative to the center of the knee joint. Intraclass correlations were calculated to evaluate the intraobserver and interobserver variability using two-way mixed-effects models.
The University of Missouri Health Care approach to Comprehensive Care for Joint ReplacementThe University of Missouri Health Care is a 5-hospital academic medical center with 595 beds, located in the central United States. Our system was selected for mandatory participation in the Comprehensive Care for Joint Replacement bundled payment model and participated from April 2016 through December 2017. Using an established improvement model, we implemented several key strategies which resulted in improved quality and lower overall costs.
Patients, pictures, and privacy: managing clinical photographs in the smartphone eraIt is easy to capture and share clinical photographs and x-ray images using modern smartphones. This technology affords health-care providers the ability to rapidly collaborate and facilitate care for their patients. This improvement, however, has increased concerns regarding patient privacy and the safeguarding of protected health information. Health-care providers should understand the deidentification process for patient photographs because this process fundamentally changes the expectations and requirements for how providers are to handle this information.
A state-of-the-art pain protocol for total knee replacementTotal knee replacement is acknowledged as a successful and durable operation, but recovery from this surgery is often lengthy and painful. A great deal of attention has recently been directed at enhancing this recovery, most of which has focused on improvements in perioperative pain control. Various protocols have been suggested. This article discusses a pain management program that uses local infiltrative analgesia with a specific “cocktail” which, when combined with an oral multimodal pain regimen, has led to excellent patient satisfaction and a substantially shorter length of stay.
Trochanteric impingement: is it a source of pain after THR?While uncommon, trochanteric-pelvic impingement may lead to significant lateral hip pain. We defined “impingement distance” as the radiographic distance from the medial aspect of the greater trochanter and the corresponding lateral edge of the acetabular bone or component and compared this to the contralateral normal hip. We present two painful total hip replacement (THR) cases, each featuring a patient with severe lateral hip pain when walking and sitting. Both patients had diminished femoral offset and trochanteric-pelvic clearance, compared to the contralateral normal hip.