David G. Deckey, MD; Matthew K. Doan, BS, Jeffrey D. Hassebrock, MD; Karan A. Patel, MD, Kostas Economopolous, MD, John M. Tokish, MD; Joshua S. Bingham, MD; Anikar Chhabra, MD, MS
Mayo Clinic Arizona, Department of Orthopaedic Surgery; Phoenix, AZ
INTRODUCTION: Cannabinoid (CBD) products are a widely available, non-FDA approved supplements, that are increasingly being used to treat musculoskeletal pain. While there is some evidence that these products may provide a therapeutic effect, little is known about the usage patterns or their prevalence of use in the orthopedic sports medicine patient. The purpose of this descriptive epidemiological study was to report the prevalence and perceived self-efficacy of CBD products in patients presenting to an orthopaedic sports medicine clinic.
METHODS: Institutional review board approval was obtained prior to start of study, and consent was obtained from all patients. All new patients presenting to an orthopaedic surgery sports medicine clinic for consultation with a surgeon at a large academic center were surveyed. Utilizing single-assessment numeric evaluation (SANE) scores, numerical rating scale for pain (NRS), the survey questions assessed perceived pain and effectiveness of CBD products and other non-surgical treatment modalities. Chart review provided demographic factors. Descriptive statistics were used to characterize the data.
RESULTS SECTION: Of the eight hundred twenty-three patients who completed the survey (285 shoulders, 44 elbows, 76 hips, 276 knees, 58 ankles, 77 “other”), 45.4% were female, the average age was 51 years (range 18-88), and average BMI was 28.9. Nineteen percent (19%, 152/823) of patients endorsed the use of CBD products prior to their presentation. The average affected joint presenting SANE score (range 0-100) for non-CBD users was 53 compared to 50 among CBD utilizers (p=0.256), and average presenting NRS was 5.6 for non-CBD users, and 6.1 for CBD utilizers (p=0.029). CBD utilizers were significantly more likely to have tried other non-operative modalities compared to non-users, including non-steroidal anti-inflammatories (79.6% v. 69.8%, p=0.032), bracing (44.7% v. 34.6%, p=0.024), steroid injections (38.8% v. 21.6%, p<0.001), and physical therapy (54% v. 36.1%, p<0.001). Additionally, 30.9% of CBD utilizers reported marijuana use compared to 2.8% of non-users (p<0.001) for management of their pain.
DISCUSSION: There was a 19% incidence of CBD usage among patients presenting to a busy orthopedic surgery sports medicine practice. Patients who reported CBD use had higher degrees of pain and were more likely to have tried other modalities for their pain. Sports medicine providers should be aware of this high incidence of usage, and the potential interactions they may have with other treatment modalities.
SIGNIFICANCE/CLINICAL RELEVANCE: The incidence of CBD use in sports medicine patients is unknown, as there is a paucity in the literature regarding both its use, perceived, as well as actual efficacy. This study is the first to date to describe the incidence and perceived efficacy of CBD products in sports medicine patients.
David G. Deckey, MD; Jens T. Verhey, BS, Christian S. Rosenow, BS, Matthew K. Doan, BS, Adam J. Schwartz, MD, Henry D. Clarke, MD, Joshua S. Bingham, MD
Mayo Clinic Arizona, Department of Orthopaedic Surgery; Phoenix, AZ
INTRODUCTION: Robot-assisted total knee arthroplasty (RA-TKA) has been hypothesized to improve precision, accuracy, and post-operative outcomes relative to manual total knee arthroplasty (M-TKA), though it may increase operative times. Resident impact on surgical time is an important consideration in the academic setting, as increased procedural time can lead to infection, decreased efficiency, increased cost, and limits overall case volume. We sought to evaluate whether RA-TKAs were longer than M-TKAs and whether the time differential was accentuated by trainee participation.
METHODS: Institutional review board approval was obtained prior to start of study, and consent was obtained from all patients. 194 consecutive, primary TKAs (99 M-TKA and 95 RA-TKA) performed by a single attending surgeon with a trainee/fellow or physician assistant (PA) as first-assist were reviewed. Surgical time was measured from the surgical time-out to the closure of the incision, while tourniquet time was measured from inflation immediately prior to skin incision to placement of the final polyethylene insert. PAs were used as controls for trainee procedures, as they perform a similar range of tasks but are not responsible for learning or performing critical components of the procedure.
RESULTS SECTION: Overall surgical and tourniquet time was significantly longer for RA-TKAs in comparison to M-TKAs (238 minutes v. 211 minutes, 99 minutes v. 89 minutes, respectively). There was also a significant difference in surgical time between trainees and PAs, as trainee cases were 12 minutes longer on average (229 v. 217). While RA-TKAs took longer than M-TKAs in general, RA-TKAs with trainees did not take significantly longer than those with PAs. Similarly, there were no significant differences in tourniquet times of trainee- vs. PA-assisted M-TKA compared to RA-TKA.
DISCUSSION: While the use of robotics in TKA increased overall surgical times, trainee presence was not associated with an increase in operative time. Minimizing trainee impact on surgical times could help to improve patient outcomes while supporting greater trainee involvement in total knee arthroplasty.
SIGNIFICANCE/CLINICAL RELEVANCE: Trainee involvement and teaching during robotic assisted total knee arthroplasty does not increase operative time when compared to manual total knee arthroplasty. This demonstrates that trainees can be educated in the use of robotic technology without compromising surgical efficiency or increasing patient risk due to an increase in surgical time.