2013 HOA Symposium Syllabus - AAOS Error Page

50 Pages·2013·0.57 MB·English

28th Annual
Combined Orthopaedic
Spring Symposium
April 26-27, 2013
Hawaii Prince Hotel - Honolulu
Welcome from HOA President
Welcome to the 28th Annual Combined Orthopaedic Spring 2013 HOA
Symposium. This event provides a great opportunity for the Officers
orthopaedic community throughout Hawaii to learn about the
2007 HOA Officers
latest advances in orthopaedic surgery and to network with fellow
President
specialists. The symposium will provide an outstanding forum for Byron Izuka, MD
discussions among HOA members, residents, medical students and
Vice-President
allied health professionals from across our state. It also provides
Elizabeth Ignacio, MD
University of Hawaii and Tripler Army Medical Center residents
the opportunity to present and discuss their research. Our social Secretary/Treasurer
Arabella Leet, MD
program includes the Allen B. Richardson Memorial Golf
Tournament on Thursday afternoon, a cocktail reception on Friday
Immediate Past President
afternoon and the awards banquet Saturday evening. The bottom Joseph Orchowski, MD
line is that this symposium is a great opportunity to gain
Board of Councilors
knowledge, participate in discussions and catch-up with our local
Linda Rasmussen, MD
orthopaedic ohana. Much thanks to Cathy Iwai for all of her
assistance with the coordination of this meeting. Here's hoping Executive Director
Cathy Iwai
you have a wonderful time!
Byron Izuka, M.D.
HOA Membership Information
Contact HOA Executive Director Cathy Iwai at 808-630-1586 or [email protected] if
you are interested in becoming a member of the Hawaii Orthopaedic Association.
Hawaii Orthopaedic Association
P.O. Box 61207
Honolulu, HI 96839
Fax: [phone].
Americans with Disability Act (ADA)
Participants with special needs should contact Cathy Iwai at 808-630-1586 or [email protected] to
discuss desired accommodation(s).
Learning Objectives
The goal of the Symposium is to maintain, develop, and increase the knowledge and professional performance of
health care providers in the evaluation and treatment of patients with musculoskeletal conditions and the systems
approach to musculoskeletal health care delivery through personal professional development education and clinical
and basic science research. At the conclusion of this educational activity, participants will be able to:
1. Identify current advances in order to provide state of the art care to individuals with orthopedic conditions.
2. Understand current clinical and basic science research that is being performed in Hawaii.
3. Understand recent changes in healthcare reform and how they may impact the practice of orthopedics.
CME Credits
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accredi-
tation Council for Continuing Medical Education through the joint sponsorship of the Hawaii Consortium for CME and
Hawaii Orthopaedic Association. The Hawaii Consortium for CME is accredited by the ACCME to provide continu-
ing medical education to physicians. The Hawaii Consortium for CME designates this educational activity for a
maximum of 10.75 AMA PRA Category 1 Credit(s)TM. Physicians should only claim credit commensurate with the
extent of their participation in the activity.
Disclosure Declaration
The following have no relevant financial relationships with any commercial interest:
Planners Resident Presentations Adam C. Hines, MD
Robert Atkinson, MD Susan Andrews Megan Kuba, MD
Elizabeth Ignacio, MD Bryan Armitage, MD Jeff Levy, MD
Cathy Iwai Drew Brown IV, MD James Shaha, MD
Byron Izuka, MD J. Matthew Cage, MD Daniel Song, MD
Arabella Leet, MD Jay Cook, MD Joseph Varcadipane, MD
Craig Ono, MD Kim Driftmier, MD
Joseph Orchowski, MD Justin Ernat, MD Guest Faculty
Linda Rasmussen, MD Kelly Fitzpatrick, MD Peter Mandell, MD
Joseph Varcadipane, MD Dana T. Hensley, MD J. Lee Pace, MD
The following have relevant financial relationships to disclose:
Jorge L. Orbay, MD Skeletal Dynamics LLC – Stock Shareholder
David L. Skaggs, MD OREF paid to Columbia University – Grant/Research Support
Biomet, Medtronic, Beachbody, LLC – Consultant
Biomet, Medtronic, Stryker – Speakers’Bureau
POSNA, Growing Spine Study Group, SRS,
Growing Spine Foundation – Advisory Committee/Board
Medtronic, Biomet – Royalties
Kelly Vince, MD Zimmer - Consultant
Kristy Weber, MD Wolters-Kluwer Publishing Royalties of $521 in 2012 for a masters text
on tumor surgery (Co-Editor) – Other Financial or Material Support
This Symposium is jointly sponsored by HOA and The Hawaii Consortium for Continuing Medical Education.
1
Best Resident Paper Awards
Richardson Awards: The Richardson Fund was established in 1982 to honor the memory of B. Allen
Richardson, MD. Dr. Richardson was one of the first Board-Certified Orthopaedic Surgeons in Honolulu,
where he practiced for nearly 30 years. He was an active member of the teaching staff of the University of
Hawaii Orthopaedic Residency Training Program from its inception in the mid-1960s, and was a staunch
supporter for the creation of the John A. Burns School of Medicine. The proceeds of the Richardson Fund are
used to award first, second and third place prizes for the best resident papers presented at the Annual Com-
bined Orthopaedic Spring Symposium.
Shriners Award: The Shriners Award is presented annually and was established to honor an orthopaedic
resident who has completed a rotation at the Shriners Hospital for Children in Honolulu. Residents present their
completed papers to medical staff and allied health professionals at the Shriners Hospital's patient care confer-
ence. The paper must be written to meet standards for publishing in clinical publications.
Acknowledgements
Thank you for the Support of all of Our Exhibitors...
Aloha Care Medtronic
Arthrocare MTF
Automated Healthcare Systems Ortho Development
Biomet Hawaii OsteoMed LLC
DePuy Synthes Joint Reconstruction Sanofi Biosurgery
DePuy Synthes Spine Skeletal Dynamics
DePuy Synthes Trauma Smith & Nephew
DJO Global Stryker Orthopaedics
Ferring Pharmaceuticals Unique Pharmaceuticals
Globus Medical Wealth Strategy Partners
InVision Imaging Wright Medical Technology
Medshape/Integra Zimmer
Special Thanks to...
Shriners Hospital for Children Orthopaedic Residency Program
Tripler Army Medical Center Orthopaedic Residency Program
University of Hawaii Orthopaedic Residency Program
...and a Big Mahalo to...
HOA Executive Director Cathy Iwai, the glue that holds our organization together.
Thank you for all of your work and for another successful year!
2
28th Annual Combined Orthopaedic Spring Symposium
Friday, April 26, 2013
7:00 Registration, continental breakfast, exhibits
7:30 Opening remarks & announcements - Byron Izuka, MD
7:45 AAOS Update - Peter Mandell, MD
8:15 The Role of Orthopaedic Evidence in the National Quality Movement - Kristy Weber, MD
8:45 ACL Reconstruction in the Skeletally Immature Patient - J. Lee Pace, MD
9:15 Return to an Active Lifestyle Following Osteochondral Allograft Transplantation of the Knee
- CPT James Shaha, MD
9:30 The Utility of CT Arthrograms in Evaluating Osteochondral Allograft Transplants of the Distal Femur
- CPT Jay Cook, MD
9:45 Increased Rates of Posterior Shoulder Instability in Young Active Patients - CPT Adam Hines, MD
10:00 Discussion - J. Lee Pace, MD
10:10 Break / PLEASE VISIT EXHIBITS
11:00 Perilous Pitfalls in Pediatric Trauma - David Skaggs, MD
11:30 Outcomes of Immediate Long Arm Cast Versus Double Sugar Tong Splinting of Acute Pediatric
Distal Radius and Both Bone Forearm Fractures - CPT Jeffrey Levy, MD
11:45 One Visit, One Splint: Patient and Parent Satisfaction After Treatment for Pediatric
Distal Radius Buckle Fractures - Megan Kuba, MD
12:00 Short Leg Casting for Isolated Fractures of the Pediatric Tibial Shaft - Drew Brown, MD
12:15 Septic Arthritis of the Shoulder in a Pediatric Population - CPT Kelly Fitzpatrick, MD
12:30 Discussion - David Skaggs, MD
12:40 Lunch / Quickbooks Update - Joseph Varcadipane, MD / HOA Advocacy - Byron Izuka, MD
/ PLEASE VISIT EXHIBITS
2:00 Why Not Work For a Hospital? - David Skaggs, MD
2:10 Arthroplasty Endgame: When There Are Very Few Pieces Left on the Board - Kelly Vince, MD
2:40 Early Aseptic Failure in Total Knee Arthroplasty Using Uncemented Trabecular Metal Tibial Components
- Joseph Varcadipane, MD
2:55 Anterior to Posterior Pelvic Radiographs for Measuring Anterversion in Pelvic Acetabular Components
- Bryan Armitage, MD
3:10 A Novel Approach to Pre-Total Knee Arthroplasty Alignment and Surgical Decisions - Samantha Andrews
3:25 Discussion - Kelly Vince, MD
3:35 End
3:45 Welcome Reception in Hotel Foyer
3
28th Annual Combined Orthopaedic Spring Symposium
Saturday, April 27, 2013
7:00 Registration/Continental Breakfast/Exhibits
7:30 Affordable Care Act in 2013 and Beyond - Peter Mandell, MD
8:00 Metastatic Bone Disease: The Bench & the Bedside - Kristy Weber, MD
8:30 Mobile Computing as a Tool in Orthopaedic Residency Training - Joseph Varcadipane, MD
8:45 Surgical Salvage of Failed XLIF - Kim Driftmier, MD
9:00 Clinical Outcome Following Single Level Cervical Disk Arthroplasty in a Military Population
- CPT Matthew Cage, MD
9:15 Discussion - Joseph Orchowski, MD
9:25 Break / PLEASE VISIT EXHIBITS
10:00 Update in Distal Radius Fractures - Jorge Orbay, MD
10:30 Arthroscopic Treatment of FAI - J. Lee Pace, MD
11:00 Return to Military Duty After Mini-Open Arthroscopic Assisted Treatment of FAI in an
Active Duty Military Population - CPT Justin Ernat, MD
11:15 Mental Health Medication Use Correlated With Poor Outcomes After Femoroacetabular
Impingement Syndrome - CPT Daniel Song, MD
11:30 Discussion - J. Lee Pace, MD
11:40 Lunch / BOC Update - Linda Rasmussen, MD / PLEASE VISIT EXHIBITS
12:30 Improving Outcomes and Lowering Costs in the Treatment of Scoliosis - David Skaggs, MD
1:00 Pediatric Access to Care - A Look at Orthopaedic Access in Hawaii - Megan Kuba, MD
1:15 The Effects of Restraint Type on Pattern of Spine Injury in Children - CPT Dana Hensley, MD
1:30 Discussion - David Skaggs, MD
1:40 The State of Revision TKA: The Unwitting Conspiracies That Hold Us Back - Kelly Vince, MD
2:10 Periarticular Raft Constructs and Fracture Stability in Split-Depression Tibial Plateau Fractures
- Bryan Armitage, MD
2:25 Progression of Knee Adduction Moment After Total Knee Arthroplasty - Samantha Andrews
2:40 Discussion - Kelly Vince, MD
2:50 Closing Statements - Byron Izuka, MD
3:00 End
6:00 Banquet in the Hawaii Prince Hotel's Captain's Room
4
GUEST SPEAKERS
Peter Mandell, MD
* General Orthopaedic Practice on the San Francisco Peninsula since 1975
* Assistant Clinical Professor of Orthopaedic Surgery, University of California, San Francisco
Jorge Orbay, MD
* Founder & Medical Director, The Miami Hand and Upper Extremity Institute
* Clinical Associate Professor of Orthopedic Surgery, Herbert Wertheim School of Medicine,
Florida International University, Miami
J. Lee Pace, MD
* Director, Pediatric Sports Medicine Program, Children's Hospital Los Angeles
* Assistant Professor, Department of Orthopaedic Surgery, University of Southern California
Keck School of Medicine
David Skaggs, MD
* Chief of Orthopaedic Surgery & Director of Spine Surgery, Children's Hospital Los Angeles
* Professor with Tenure, Department of Orthopaedic Surgery, University of Southern California
Keck School of Medicine
Kelly Vince, MD
* Consultant Orthopedic Surgeon, Department of Orthopaedic Surgery, Whangarei Regional Hospital,
Whangarei, New Zealand
* Founding Editor, American Journal of Knee Surgery
Kristy Weber, MD
* Vice Chair of Faculty Affairs & Chief of the Division of Orthopaedic Oncology
Department of Orthopaedics
University of Pennsylvania
* Director, Sarcoma Program
Abramson Cancer Center
University of Pennsylvania
###
5
AAOS Update
Peter Mandell, MD
Major initiatives for 2013
§ New Headquarters Building
§ Dues increase
§ Professional Compliance Program
§ Medicare Administrative Contractor and Recovery Audit Contractor activities
6
Council on Advocacy activities
2
l § Medical Liability Reform
i
pr § Coding Coverage and Reimbursement
A § Political Action Cmte

,
y Council on Research and Quality activities
a § Appropriate Use Criteria
d
§ Clinical Practice Guidelines
i
r
F Council on Education Activities

-
Communications Cabinet activities
s
t
c
a
r
t
s
b
A

m
u
i
s
o
p
m
y
S
###
6
The Role of Orthopaedic Evidence in the National Quality Movement
Kristy Weber, MD
A) Sources of Compiled Orthopaedic Evidence
1. Professional societies
2. Government (AHRQ)
3. Insurance companies
4. Other
B) State of the Orthopaedic Evidence
6
1. Eminence vs Evidence
2
l 2. Journal article trends
i
r C) Brief overview of AAOS Quality Efforts
p
A 1. Evidence-based Clinical Practice Guidelines
2. Technology Overviews
,
y 3. Performance Measures (via PCPI)
a 4. American Joint Replacement Registry
d
5. Appropriate Use Criteria: Filling in the Guidelines Evidence Gap
i
D) Role of Guidelines in Orthopaedic Practice
r
F Must be user-friendly
Credible
-
Patient-focused
s
t One of many tools to make decisions
c
E) Role of Appropriate Use Criteria in Orthopaedic Practice
a
Rationale
r
t Orthopedics is in the spotlight for high volume/high cost procedures
s
High level evidence or sufficiently detailed data often not available
b
Examples of value-based insurance delivery
A
Large variations in care/escalation of numbers of specific procedures (Dartmouth)

m Appropriate vs inappropriate use
Disparities in care
u
i Definition
s
AUC specify when it is appropriate to perform a procedure/service
o
Physicians must decide when to use/not use a procedure despite lack of evidence
p
Largely guideline-based along with clinical scenarios
m
Evaluate relative risks/benefits of a procedure/service for a specific indication
y
“Reasonable to do”
S
(continued on next page)
7
The Role of Orthopaedic Evidence in the National Quality Movement
(continued from previous page)
Methods
RAND/UCLA Method with modified Delphi process
Combines best evidence with collective judgment of experts to develop a statement
re/appropriateness of performing a procedure based on patient sx, medical history,
test results
3 panels
6 Writing Group – develops vignettes/scenarios (need volunteers)
2
Review Group

l
i Technical Rating Panel (minimize bias)
r
p
Ranking of Indications
A
7-9: Appropriate procedure for specific indication

, 4-6: Uncertain/unclear if appropriate for specific indication
y
1-3: Inappropriate test for specific indication
a
Benefits
d
i Provide clear and public demonstration of how ortho community works for pts
r
Give AAOS a stronger voice with payers and healthcare purchasers
F
May result in guaranteed reimbursement and reduced paperwork for those who

- practice in accordance with these criteria

s
t
F) Third Party Interests in Orthopaedic Evidence and Quality
c
a 1. Purchasor/payer groups
r Interests align with patients
t
s Little data available
b International data suggests high variability
A
US practice driven by technology, marketing, reimbursement vs outcomes/
continuous feedback
m
*Example: 2008 vs 2010 reimbursement of fixation for intertoch/
u
subtroch fx fixation
i
s Geographic variation
o CPT codes
p
m
2. PQRI Measures Applicable to Orthopedics
y Clinical and Administrative measures
S
3. Orthopaedic Quality Institute (2011)
*Rationale – AAOS is behind in quality arena, lack of true partnership with govt/
payors/etc
*Goal: Identify opportunities/barriers to improving quality care
Build the bench of liaisons to National Quality organizations from
orthopaedics
###
8