Clinical Orthopaedics & Related Research最新文献

{"title":"Erratum to: Do Skills Acquired from Training with a Wire Navigation Simulator Transfer to a Mock Operating Room Environment?","authors":"Steven A. Long, G. Thomas, M. Karam, D. Anderson","doi":"10.1097/CORR.0000000000000958","DOIUrl":"https://doi.org/10.1097/CORR.0000000000000958","url":null,"abstract":"BACKGROUND Skills training and simulation play an increasingly important role in orthopaedic surgical education. The intent of simulation is to improve performance in the operating room (OR), a trait known as transfer validity. No prior studies have explored how simulator-based wire navigation training can transfer to higher-level tasks. Additionally, there is a lack of knowledge on the format in which wire navigation training should be deployed. QUESTIONS/PURPOSES (1) Which training methods (didactic content, deliberate practice, or proficiency-based practice) lead to the greatest improvement in performing a wire navigation task? (2) Does a resident's performance using a wire navigation simulator correlate with his or her performance on a higher-level simulation task in a mock OR involving a C-arm, a radiopaque femur model, and a large soft tissue surrogate surrounding the femur? METHODS Fifty-five residents from four different medical centers participated in this study over the course of 2 years. The residents were divided into three groups: traditional training (included first-year residents from the University of Iowa, University of Minnesota, and the Mayo Clinic), deliberate practice (included first-year residents from the University of Nebraska and the University of Minnesota), and proficiency training (included first-year residents from the University of Minnesota and the Mayo Clinic). Residents in each group received a didactic introduction covering the task of placing a wire to treat an intertrochanteric fracture, and this was considered traditional training. Deliberate practice involved training on a radiation-free simulator that provided specific feedback throughout the practice sessions. Proficiency training used the same simulator to train on specific components of wire navigation, like finding the correct starting point, to proficiency before moving to assessment. The wire navigation simulator uses a camera system to track the wire and provide computer-generated fluoroscopy. After training, task performance was assessed in a mock OR. Residents from each group were assessed in the mock OR based on their use of fluoroscopy, total time, and tip-apex distance. Correlation analysis was performed to examine the relationship between resident performance on the simulator and in the mock OR. RESULTS Residents in the two simulation-based training groups had a lower tip-apex distance than those in the traditional training group (didactic training tip-apex distance: 24 ± 7 mm, 95% CI, 20-27; deliberate practice tip-apex distance: 16 ± 5 mm, 95% CI, 13-19, p = 0.001; proficiency training tip-apex distance: 15 ± 4 mm, 95% CI, 13-18, p < 0.001). Residents in the proficiency training group used more images than those in the other groups (didactic training: 22 ± 12 images, p = 0.041; deliberate practice: 19 ± 8 images; p = 0.012, proficiency training: 31 ± 14 images). In the two simulation-based training groups, resident performance on the simulator","PeriodicalId":10465,"journal":{"name":"Clinical Orthopaedics & Related Research","volume":"52 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72722540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medicolegal Sidebar: Getting Sued By Someone Else's Patient-When Does a Curbside Consultation Carry Medicolegal Jeopardy?","authors":"B. S. Bal, W. Teo, Lawrence H. Brenner","doi":"10.1097/CORR.0000000000000941","DOIUrl":"https://doi.org/10.1097/CORR.0000000000000941","url":null,"abstract":"Surgeons know that staying current on surgical techniques is important; they may not realize that medicolegal principles evolve just as quickly. In 2018, it was reasonable to believe that one might be sued for malpractice by a patient; in 2019, a Minnesota Supreme Court decision found that a physician-patient relationship is not a necessary element in a medical malpractice claim [8]. In the ruling, the Court ruled that during the time that a physician acts in a professional capacity, if it is reasonably foreseeable that a third-party will rely on the physician’s medical decisionmaking that may ultimately harm the patient, then a physician duty of care toward that patient arises, even absent a physician-patient relationship [8]. Modern medical practice is increasingly democratized by team-based approaches to medical care, information disclosure and dissemination, and shared decision-making. But the Minnesota court ruling is a reminder that courts still hold a traditional view that the physician is ultimately responsible for the patient, even for medical advice and decisionmaking done without establishing a physician-patient relationship.","PeriodicalId":10465,"journal":{"name":"Clinical Orthopaedics & Related Research","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79859134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial: The Shortcomings and Harms of Using Hard Cutoffs for BMI, Hemoglobin A1C, and Smoking Cessation as Conditions for Elective Orthopaedic Surgery.","authors":"S. Leopold","doi":"10.1097/CORR.0000000000000979","DOIUrl":"https://doi.org/10.1097/CORR.0000000000000979","url":null,"abstract":"Most orthopaedic surgeons I know pride themselves on engaging with their patients as individuals. Many bridle at the idea that trendy, shared decision-making models are somehow something new, as they feel they’ve been sharing decisions with their patients all along; I believe many of them are right about this. And yet some of those same surgeons adopt heavy-handed approaches that seem to misunderstand how surgical risk really works when they insist on binary cutoffs for parameters like BMI, hemoglobin A1C, and cigarette smoking as a condition to offer elective surgery to their patients. When a surgeon unilaterally defines and applies such cutoffs in practice, by definition shared decision-making cannot take place. When the risk factors only seem modifiable, but in fact are not (or when they are only minimally modifiable), the use of rigid thresholds may become coercive. For these and other reasons, orthopaedic surgeons should stop using hard cutoffs for parameters like BMI, hemoglobin A1C, and smoking in the context of deciding whether to offer a patient elective surgery. The idea of using surgery as a “carrot” to nudge patients towards healthier behaviors—with the endpoint of offering an elective procedure the patient seeks as the inducement for efforts made—is entirely reasonable. When done with care and sensitivity, it can be one portion of a healthcare partnership in which both parties take some responsibility for achieving a result that both will be pleased with. But surgeons don’t have to operate on anyone we don’t want to treat, and increasingly we’re being held to financial account for the complications that result from our elective procedures. I believe this combination can result in surgeons setting unrealistic or impossible health goals for patients who seek particular interventions, and withholding those interventions from patients when they inevitably (or nearly inevitably) fall short [9]. This strikes me as potentially coercive. It’s also not well-supported by the available evidence.","PeriodicalId":10465,"journal":{"name":"Clinical Orthopaedics & Related Research","volume":"14 12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78388917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CORR Insights®: Orthopaedic Physician Attire Influences Patient Perceptions in an Urban Inpatient Setting.","authors":"R. J. Mistovich","doi":"10.1097/CORR.0000000000000895","DOIUrl":"https://doi.org/10.1097/CORR.0000000000000895","url":null,"abstract":"While preferences and knowledge have changed over time, the role of uniforms and even clothing colors remains important for all vocations [7]. Indeed, one’s personal presentation is a modifiable component of a first impression [3]. From the military, to the clergy, to the physician wearing scrubs on daytime television, society still has expectations regarding the appearance of professionals. However, unlike many other vocations, doctors have historically adopted a uniform that was not only culturally appropriate, but also functional. The traditional role of the physician uniform has been to promote the eradication of disease and minimize its spread through the best current evidence. From the plague doctor’s protective suit and beak filled with herbs and straw, to advancements like sterile gloves, scrubs, and masks; form has followed function in terms of the physician uniform. Physician attire must facilitate (or at least not impair) best medical practices, allow for the physical demands of our field, and mitigate (or at least not worsen) disease propagation. Physician attire must also meet patients’ social expectations, which may be culture-bound, and may change over time. And although we cannot control patients’ biases with respect to physician age, ethnicity, or gender, we should promote a uniform that conveys professionalism. The ideal physician uniform should seek to offset any biases patients may have, and help identify the individual as a physician, and not a nurse, medical student, or hospital administrator. Research conducted in an urban outpatient orthopaedic setting [4] suggests that patients have expectations regarding how doctors should present themselves; specifically, it appears that in that setting, patients prefer orthopaedic surgeons to wear either a white coat or scrubs. The current study by Jennings and colleagues [5] extends what we know on this topic; it found that in the inpatient setting, patients preferred both male and female orthopaedic surgeons to wear a white coat with scrubs or white coat with business attire most frequently, then, respectively, ranked scrubs alone, business attire, and least preferred casual attire. Prior work by Jennings and colleagues [4] studied patient preferences for orthopaedic surgeons in the outpatient setting. At that time, they did note some variations in patient preference based on the sex of the surgeon, with male physicians preferred to be in a white coat over business attire. However, there was no difference in confidence ranking of male surgeons in scrubs alone versus a white coat over business attire, and no differences in any category between scrubs alone and business attire. For women surgeons, there was an equal preference for a white coat over business attire or scrubs alone, and scrubs alone evoked a greater rating of confidence than business attire. Regardless of gender, patients still disliked surgeons in casual attire. This CORR Insights is a commentary on the article “Orthopa","PeriodicalId":10465,"journal":{"name":"Clinical Orthopaedics & Related Research","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75781124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and Molecular Analysis of Pathologic Fracture-associated Osteosarcoma: MicroRNA profile Is Different and Correlates with Prognosis.","authors":"Santiago A. Lozano Calderón, C. Garbutt, Jason Kim, Christopher E Lietz, Yen-Lin E Chen, K. Bernstein, I. Chebib, G. Nielsen, V. Deshpande, Renee Rubio, Yaoyu E. Wang, John Quackenbush, T. Delaney, K. Raskin, J. Schwab, G. Cote, D. Spentzos","doi":"10.1097/CORR.0000000000000867","DOIUrl":"https://doi.org/10.1097/CORR.0000000000000867","url":null,"abstract":"BACKGROUND\u0000MicroRNAs are small, noncoding RNAs that regulate the expression of posttranslational genes. The presence of some specific microRNAs has been associated with increased risk of both local recurrence and metastasis and worse survival in patients with osteosarcoma. Pathologic fractures in osteosarcoma are considered to be more the manifestation of a neoplasm with a more aggressive biological behavior than the cause itself of worse prognosis. However, this has not been proved at the biological or molecular level. Currently, there has not been a microRNA profiling study of patients who have osteosarcoma with and without pathologic fractures that has described differences in terms of microRNA profiling between these two groups and their correlation with biologic behavior.\u0000\u0000\u0000QUESTIONS/PURPOSES\u0000(1) In patients with osteosarcoma of the extremities, how do the microRNA profiles of those with and without pathologic fractures compare? (2) What relationship do microRNAs have with local recurrence, risk of metastasis, disease-specific survival, and overall survival in osteosarcoma patients with pathologic fractures?\u0000\u0000\u0000METHODS\u0000Between 1994 and 2013, 217 patients were diagnosed and treated at our institution for osteosarcoma of the extremities. Patients were excluded if (1) they underwent oncologic resection of the osteosarcoma at an outside institution (two patients) or (2) they were diagnosed with an extraskeletal osteosarcoma (29 patients) or (3) they had less than 1 year of clinical follow-up and no oncologic outcome (local recurrence, metastasis, or death) (four patients). A total of 182 patients were eligible. Of those, 143 were high-grade osteosarcomas. After evaluation of tumor samples before chemotherapy treatment, a total of 80 consecutive samples were selected for sequencing. Demographic and clinical comparison between the sequenced and non-sequenced patients did not demonstrate any differences, confirming that both groups were comparable. Diagnostic samples from the extremities of 80 patients with high-grade extremity osteosarcomas who had not yet received chemotherapy underwent microRNA sequencing for an ongoing large-scale osteosarcoma genome profiling project at our institution. Six samples were removed after a second look by a musculoskeletal pathologist who verified cellularity and quality of samples to be sequenced, leaving a total of 74 patients. Of these, two samples were removed as they were confirmed to be pelvic tumors in a second check after sequencing. The final study sample was 72 patients (11 patients with pathologic fractures and 61 without). Sequencing data were correlated with fractures and local recurrence, risk of metastasis, disease-specific survival, and overall survival through Kaplan-Meier analyses.\u0000\u0000\u0000RESULTS\u0000Several microRNAs were expressed differently between the two groups. Among the markers with the highest differential expression (edgeR and DESeq algorithms), Hsa-mIR 656-3p, hsa-miR 493-5p, and hsa-miR 381-3p w","PeriodicalId":10465,"journal":{"name":"Clinical Orthopaedics & Related Research","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91370756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ArtiFacts: Gottfried \"Götz\" von Berlichingen-The \"Iron Hand\" of the Renaissance.","authors":"K. Ashmore, S. Cialdella, A. Giuffrida, E. Kon, M. Marcacci, B. Di Matteo","doi":"10.1097/CORR.0000000000000917","DOIUrl":"https://doi.org/10.1097/CORR.0000000000000917","url":null,"abstract":"From the column editor, The Renaissance-era German mercenary Gottfried “Götz” von Berlichingen defied the odds by surviving both a significant battle wound to his right arm and an upper extremity amputation at a time when few survived either. Ambroise Paré’s discovery that surgical patients were more likely to survive their operation without cauterization would not occur for another 30 years. The invention of the tourniquet did not occur for another century. However, von Berlichingen did survive, only to be confronted with a problem that is still relevant 500 years later. Indeed, despite 21st century silicone chip microprocessors, miniature electric motors, sensors, and myoelectric controls, developing an upper extremity prosthesis with suitable functionality remains a remarkably difficult problem to solve. But in the guest ArtiFacts column that follows, Berardo Di Matteo and his research group from Milan, Italy use their established expertise in the field of orthopaedic history [3, 4] to detail how, with the help of a local blacksmith, von Berlichingen managed to successfully wear and operate a functional iron prosthesis capable of wielding a sword in multiple battles, earning him the nickname “Götz of the Iron Hand.” — Alan J. Hawk BA The Renaissance contributed more than just art and architecture, and more even than the science of Kepler and Galileo. Then [1] as now [6], war and bloodshed advance the art and science of medicine, and wars were a part of life during the Renaissance. An innovation arising from one of those wars—a genuine representation both of the artistic and medical ingenuity of the time—is the extraordinary case of the “iron hand” of the 16 century German knight and mercenary Gottfried “Götz” von Berlichingen. Born into a wealthy German family in 1480, von Berlichingen was drawn to the battlefield at an early age. Before his 17th birthday, he enlisted into the Brandenburg-Ansbach army, where he served the Holy Roman Empire, before leaving to form his own mercenary squad at the age of 20 [7]. A skilled and fierce mercenary and commander, von Berlichingen’s impressive 47-year military career [7] spanned numerous German civil wars, including the German peasants’ war (1524 to 1525), as well as bloody European battles against the French and the Ottomans [1, 10]. While invading the city of Landshut as a mercenary in 1504 [11], enemy cannon fire jolted von Berlichingen’s blade against himself, maiming his right arm at the elbow. German doctors A note from the Editor-in-Chief: We are pleased to present the next installment of ArtiFacts. In this month’s guest column, Berardo Di Matteo and his research group explore the life of Renaissance-era German mercenary Gottfried “Götz” von Berlichingen, who had his right arm amputated from the elbow following a battle in 1504. Rather than transition into civilian life, the brutal mercenary and commander commissioned a local blacksmith to create an iron right arm prosthesis that he could wear in ","PeriodicalId":10465,"journal":{"name":"Clinical Orthopaedics & Related Research","volume":"95 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85292067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CORR Insights®: The Pediatric Toronto Extremity Salvage Score (pTESS): Validation of a Self-reported Functional Outcomes Tool for Children with Extremity Tumors.","authors":"D. Davidson","doi":"10.1097/CORR.0000000000000816","DOIUrl":"https://doi.org/10.1097/CORR.0000000000000816","url":null,"abstract":"Outcomes following treatment can be determined with the use of disease-specific outcomes tools like theWOMAC for hip and knee osteoarthritis or, if one seeks a moreholistic view of the patient’s overall well-being, then the use of broader functional outcomes and/or healthrelated quality of life measures may be more appropriate. While subspecialists may tend to focus ondisease or even jointspecific scales, the understanding of a patient’s overall outcome is likely to be incomplete if function and health-related quality of life are not measured [1]. Most oncology studies now include function and health-related quality of life measures, and perhaps because of this, some have delivered important findings [3, 5, 7]. For example, one study found that anxiety and depression was the domain with the greatest change between the time of diagnosis of adult soft-tissue sarcoma and 1-year following completion of treatment [3]. Another study found that body image issues and mobility concerns are common among survivors of sarcoma and these individuals may be reluctant to share these concerns with their providers [7]. Finally, a study on Ewing’s sarcoma survivors reported mild-to-moderate disability and impairments in 32% of patients, with older patients, females, and those with a pelvic site of disease to be at greatest risk of long-term issues [5]. These studies exemplify the importance of a more comprehensive outcome measurement compared to disease-specific or functional outcomes alone. Standardization of health-related quality of life tools and interpretation among children, adolescents, and young adult populations has been recommended on the basis of results from a systematic review [6], in order to improve the information provided by these measures. Before including either functional or health-related quality of life outcome measures in a study, the measurement tool must be validated in the specific population in which it is intended to be used. Absent this information, it is not possible to know whether the outcome tool measures what it intends to measure or does so accurately or in a valid way. In the current study, Piscione and colleagues [4] accomplished this critical task for the pediatric population with benign and malignant bone tumors. By developing and subsequently validating a measure of physical function specific to this patient population, they have contributed a means by which to determine patient reported physical function amongst children and adolescents.","PeriodicalId":10465,"journal":{"name":"Clinical Orthopaedics & Related Research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88631044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Residency Diary: Intern Year Part 2 (April-June)-Teams in Residency.","authors":"D. Lebrun","doi":"10.1097/CORR.0000000000000904","DOIUrl":"https://doi.org/10.1097/CORR.0000000000000904","url":null,"abstract":"","PeriodicalId":10465,"journal":{"name":"Clinical Orthopaedics & Related Research","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91320877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Your Best Life: When Mindfulness is Not the Answer-Alternative Approaches to Managing Anger and Conflict.","authors":"J. Kelly","doi":"10.1097/CORR.0000000000000906","DOIUrl":"https://doi.org/10.1097/CORR.0000000000000906","url":null,"abstract":"","PeriodicalId":10465,"journal":{"name":"Clinical Orthopaedics & Related Research","volume":"438 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85537698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editor's Spotlight/Take 5: Misconceptions and the Acceptance of Evidence-based Nonsurgical Interventions for Knee Osteoarthritis. A Qualitative Study.","authors":"S. Leopold","doi":"10.1097/CORR.0000000000000910","DOIUrl":"https://doi.org/10.1097/CORR.0000000000000910","url":null,"abstract":"Many surgeons dislike or distrust methods-intensive research approaches like meta-analyses [14], and even experienced readers—including seasoned peer reviewers—head for the hills when it takes heavy computing power to grind data into answers [15], as is the case for studies using machine learning. So, let’s take a break this month from all that math, and luxuriate in the glow of some great qualitative research in this month’s Spotlight. Nary a decimal point or p value in sight. Did I hear someone say, “What’s qualitative research?” I’m not surprised. As far as I can recall, we’ve published only two papers [10, 12] in Clinical Orthopaedics and Related Research using qualitative or interview-based methods in the 7 years since I joined the team, and I’ve seen similarly sporadic deployment of these approaches in other leading generalinterest journals of our specialty [6, 8]. That’s too bad. The kinds of quantitative approaches that clinicians (and readers of clinical research) are most familiar with—case series, historically controlled studies, and even randomized trials—can tell us the what and the when, but they fall short on the why and the how. Specifically, they provide little or no insight into why our patients make the decisions they make, and how those patients perceive (and sometimes misunderstand) important facts about their own bodies. Facts that, in principle, their doctors have tried to explain. For these reasons, I’m excited to share a wonderful example of the genre in this month’s CORR from Dr. Jo-Anne Manski-Nankervis’s study group in Melbourne, Australia, which offers a number of penetrating insights into common misperceptions patients have about knee arthritis [2]. The authors, including first author, Samantha Bunzli PhD, performed indepth interviews with more than two dozen patients who were on a surgical waiting list to ascertain patients’ beliefs about what osteoarthritis is, what causes it, what may happen to it if left untreated, and how the condition can best be controlled or managed. The sample size—a question, no doubt, on every reader’s mind who is accustomed to seeing a larger number there—was determined by an a priori analytic approach that resulted in recruitment until no new themes emerged during these conversations. Some of the misunderstandings were staggering. Many patients’ (mis)understandings about the causes of their arthritis, their anticipation of worsening pain with time, and their beliefs about potential harms associated with choosing a non-surgical course, in particular, cannot be substantiated by any interpretation of the evidence on the topic of which I am aware. More importantly, those serious misapprehensions seem A note from the Editor-In-Chief: In “Editor’s Spotlight,” one of our editors provides brief commentary on a paper we believe is especially important and worthy of general interest. Following the explanation of our choice, we present “Take 5,” in which the editor goes behind the discovery with a ","PeriodicalId":10465,"journal":{"name":"Clinical Orthopaedics & Related Research","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73769169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}