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BACKGROUND: Osteoarthritis is a chronic musculoskeletal condition that frequently affects the hip and knee joints. Given the burden associated with surgical intervention for hip and knee osteoarthritis, patients continue to search for potential non-operative treatments. One biologic therapy with mixed clinical and basic science evidence for treating osteoarthritis is platelet-rich plasma injections into the affected joint. We used the Google Trends tool to provide a quantitative analysis of national interest in platelet-rich plasma injections for hip and knee osteoarthritis. METHODS: Google Trends parameters were selected to obtain search data from January 2009 to December 2019. Various combinations of ‘arthritis’, ‘osteoarthritis’, ‘PRP’, ‘platelet-rich plasma’, ‘knee’, and ‘hip’ were entered into the Google Trends tool and trend analyses were performed. RESULTS: Three linear models were generated to display search volume trends in the United States for platelet-rich plasma and osteoarthritis, hip osteoarthritis, and knee osteoarthritis, respectively. All models showed increased Google queries as time progressed (p < 0.001), with R(2) ranging from 0.837 to 0.940. Seasonal, income-related, and geographic variations in public interest in platelet-rich plasma for osteoarthritis were noted. CONCLUSION: Our results demonstrate a significant rise in Google queries related to platelet-rich plasma injections for osteoarthritis of the hip and knee since 2009. Surgeons treating hip and knee osteoarthritis patients can expect continued interest in platelet-rich plasma, despite inconclusive clinical and basic science data. Trends in public interest may inform patient counseling, shared decision-making, and directions for future clinical research.

BACKGROUND: Single position (SP) lateral transpsoas lumbar interbody fusion (LLIF) with posterior pedicle screw fixation (PPSF) reduces operative time compared to dual positioning. However, the learning curve has not yet been described. The purpose of this study was to define the learning curve SP LLIF with PPSF. METHODS: This retrospective case series included the first 161 consecutive patients who underwent SP LLIF and PPSF with the senior author. Primary analysis of operative time versus case number included single level cases without adjacent level procedures. Secondary analyses included 1−3 level cases without adjacent level procedures. Operative time for 2 and 3 level procedures was normalized to single-level cases. The learning curve was assessed with linear regression, which was found to fit the data better than logarithmic regression as judged by R(2) values and data visualization. Perioperative outcomes as a function of case number were analyzed by least squares linear regression and Mann Whitney U-tests. RESULTS: For single level surgeries without adjacent procedures (n=87), operative time decreased by a total of 28.7 (95% CI, 9.6, 47.9) minutes over the series (P

Background “Interpersonal and Communication Skills” (ICS) is a core competency set forth by the ACGME. No structured curriculum exists to train orthopedics residents in ICS. Methods Twenty-four out of thirty-five orthopedics residents completed the survey (69%). The survey had the following domains: [1] Demographics, [2] Communication Needs/Goals, and [3] Communication Barriers. Results Eighty-three percent of respondents wanted to improve their communication skills and their patient's experience. Interns-PGY4s wanted to improve on similar specific communication skills. All residents desired training in conflict management. Conclusion There is a need among orthopedics residents for a communication skills curriculum early in residency training, specifically in conflict management., Highlights • In procedural training programs (including Orthopedics), there is less focus on non-technical skills acquisition. • When surveyed, 83% of orthopedic trainees perceived a need to improve their communication skills. • All orthopedic trainees wanted training in conflict management.

Objective To determine the accuracy of International Classification of Disease Version 10 (ICD-10) coding for ankle fracture injury patterns. Design Retrospective cohort study Patients 97 adult patients with fractures about the ankle (rotational ankle fracture or distal tibia fracture) from 2016 to 2020, selected by stratified random sampling. Intervention Assignment of an ICD-10 code representative of a rotational ankle fracture, pilon fracture, or unspecified fracture of the lower leg. Outcome measurements Injury radiographs were reviewed by three authors to determine the correct code. Agreement between the correct code and the electronic medical record (EMR) assigned code was determined using kappa's statistic in the aggregate as well as percent agreement, sensitivity, specificity, and positive predictive value (PPV) between individual codes. Results 59 of 97 cases (60.8%) demonstrated discordance between the existing EMR and surgeon-assigned codes. Aggregate agreement between all codes was fair (K = 0.26). Lateral malleolus fracture codes demonstrated the highest PPV (0.91, 95% CI 0.72–0.99), while the lowest PPV was found for “other fractures of the lower leg” (0.05, 95% CI 0.0–0.24) and “other fracture of the fibula” (0.0, 95% CI 0.0–0.15). Generalized “other fracture” codes comprised 45% of EMR codes compared to only 6% of assigned codes (p Conclusion There is substantial discordance between existing EMR and surgeon-assigned ICD-10 codes for ankle fractures. Database research that relies on ICD-10 coding as a surrogate for primary clinical data should be interpreted with caution and institutions should make efforts to increase the accuracy of their coding.

Background Google Trends (GT) is a free tool that provides analysis of search traffic for specified terms entered into the Google search engine. In this study, we evaluate the association between public interest in hand osteoarthritis (OA) as determined by GT search volumes and healthcare usage related to hand OA. Methodology We compiled GT data from 2010 to 2017 for the following group of hand OA-related search terms: “hand osteoarthritis,” “hand arthritis,” “hand swelling,” “hand stiffness,” and “chronic hand pain.” Claims associated with hand OA codes were obtained from an administrative database (14.8 million patients) using International Classification of Diseases codes from 2010 to 2017. We performed trend analysis using univariate linear regression of GT data and hand OA claims. A month-by-month analysis of variation from yearly GT means was conducted for hand OA-related search terms. Results There was increased public interest in hand OA-related search terms from January 2010 to December 2017. Univariate linear regression of GT data for hand OA-related search terms compared with hand OA claims demonstrated a significant positive correlation (p < 0.001, r = 0.707). Peak public interest in hand OA-related search terms was observed in July, May, and June. Conclusions This study demonstrates the ability of GT to track healthcare use related to hand OA. Our data also add to the evidence for monthly variations in public interest related to hand OA. Clinics and surgery centers can employ GT data to anticipate resource utilization by hand OA patients.