Disclosure Consultant: Smith & Nephew Stock: Johnson & - - PowerPoint PPT Presentation

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Disclosure Consultant: Smith & Nephew Stock: Johnson & - - PowerPoint PPT Presentation

Nov 07, 2023 192 likes •353 views

O rthopaedic Summit 2017: Evolving Techniques Las Vegas, Nevada USA Injections are Cost Effective: I inject everyone prior to any arthroscopy! Allston J. Stubbs, M.D., M.B.A. Medical Director Hip Arthroscopy & Associate Professor

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SLIDE 1

Orthopaedic Summit 2017: Evolving Techniques

Las Vegas, Nevada USA Allston J. Stubbs, M.D., M.B.A.

Medical Director Hip Arthroscopy & Associate Professor Department of Orthopaedic Surgery December 5-9, 2017

Injections are Cost Effective: I inject everyone prior to any arthroscopy!

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SLIDE 2

Disclosure

  • Consultant: Smith & Nephew
  • Stock: Johnson & Johnson
  • Research Support: Bauerfeind
  • Department-Division Support: Smith & Nephew, DePuy-Mitek, Arthex
  • Boards/Committees: AAOS, ABOS, AOSSM, ISHA, AANA, MASH, ISAKOS, Journal
  • f Hip Preservation Surgery
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SLIDE 3

Do the Right Thing

  • Spike Lee

Is more than a diagnostic tool, it’s a lifestyle

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SLIDE 4

Plenty of Injection Champions

  • John Sekiya

– AJR Am Journ Roentgenol 2012

  • Thomas Byrd

– Am J Sports Med 2004

  • Carlos Guanche

Combined over 50 years of experience!

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SLIDE 5

Why Inject?

  • Diagnostic

– Intraarticular vs Extraarticular – Organic vs Supratentorial – One needs a gold standard test: sensitivity and specificity – MRIs are now ~90% abnormal: high false positive rate

  • Therapeutic

– Expanding options for treatment (not just steroids): local anesthetics, steroids, hyaluronic acid, PRP/ACP, Bone Marrow Aspirate, Amniotic – Patient Satisfaction: Improve treatment timeline – In office imaging: fluoroscopy, ultrasound, nanoscopy, open MRI

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SLIDE 6

What’s the Success Rate of Hip Preservation Surgery?

  • ~80-85% Good to Excellent in the best of

hands

  • Why not gain every percent you can for your

patient?!

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SLIDE 7

The Competition

  • If you don’t offer injection therapy, someone

close to you will or not so close

Turner & Knoepfler Cell Stem Cell June 2016

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SLIDE 8

But I hate shots!

Needle vs Knife

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Winning Technique

  • Skin desensitization
  • 27G anesthetic
  • No pin cushion
  • Know osteology
  • Don’t over-fill
  • Instant cold pack technology
  • Proactive anti-inflammatory po
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SLIDE 10

Limitations . . .

  • Time & Organization of work flow
  • Low wRVU
  • False negatives
  • Inflammatory response (Gadolinium worst
  • ffender especially with MRI-A)
  • Infection risk
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SLIDE 11

Best time to initiate

  • Avoid MRI imaging within 6 weeks
  • Typically have imaging established before

injections

  • Space out injections 4-6 weeks
  • Avoid intraarticular injections within 3 months
  • f surgery [Wang Arthroscopy 2017]
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SLIDE 12

Where to put them

Our Favorites

  • Intracapsular
  • Iliopsoas bursa
  • Greater trochanteric bursa
  • Ischiofemoral space
  • Obturator internus muscle-tendon junction
  • Pudendal nerve
  • Lateral femoral cutaneous nerve
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SLIDE 13

In Summary Don’t Left Be Holding the Bag

  • Make the best decision possible . . .based on

injection management

  • Utilize technology
  • Inject every time!
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SLIDE 14

Cool Future Hip Meetings

Melbourne October 2018 www.isha.net

Cancun May 2019 www.isakos.org