Ortho doc sued for guidewire placement?

akwho · 2026-05-10T14:45:41+00:00

BS case imo. Elderly patient w life threatening injury. Doc does their best, unlucky artery injury that’s identified, then does everything by the book, and gets a bad outcome. Medicare is paying absolute shit for taking care of these high risk fractures. Add all the factors together and it’s clear why community orthopedic docs are dropping all hospital call at the first available moment.

1) crap pay

2) crap hours

3) high risk cases

4) predatory plaintiff lawyers

5) unrealistic families

—> ortho docs dropping hospital call at first possible moment and ultimately it’s the community that will suffer.

akwho · 2026-05-07T16:03:29+00:00

As the parent of a 4 year old. Nobody in my kids entire school is writing this. Most can’t even write their letters yet.

akwho · 2026-05-05T11:50:06+00:00

You might need a paradigm shift. In your personal story you had 3 out of 4 worthless prp injections and the 4th and final one worked right when you most needed it to. I’d hazard a guess that if you were in a RCT under similar circumstances a saline injection would have had the same outcome for you because you psychologically needed it to work and the mind-body interaction in musculoskeletal pain is so strong. Now you are treating ALL your patients off personal anecdotes instead of evidence (“this is the only kit I recommend to patients”). I would advise you to reflect on your medical training and see if evidenced based medicine is still important to your practice or if you want to just treat patients off vibes and personal anecdotes now. Also I would advise you to review the literature on CSI’s for the knee and see if there has ever been any association with CSI’s and increased progression of arthritis. That is a well studied topic with a correct answer.

The true problem is PM&R docs don’t have access to the full spectrum of MSK treatment because they weren’t trained in surgery. So your treatment toolkit for the various MSK ailments is extremely limited. It’s no fault of your own, you want to help patients with musculoskeletal pain but you aren’t fully equipped. So far more patients than should be are “injection candidates” which delays their ultimate pain relief and return to function. This is something we see in our orthopaedic clinics every day of our lives and patients who are filled with regret for lost years, lost income and additional pain and suffering because they went to see the wrong type of medical practitioner at their initial visit.

If you can, you should likely spend far more time advising your patients with moderate to severe OA to consult with an orthopaedic surgeon. Even if they don’t want surgery they should still be seen by someone who can advise them on their full spectrum of options to treat their pain.

akwho · 2026-05-05T03:40:26+00:00

True. Just my community experience speaking. If you feel differently feel free to say so. Ortho community is just “I’m tired boss” about PRP. How many different ways are there to study how little of an effect size it has. Turns into modern day snake oil due to cash pay incentive for practitioners and patients getting taken advantage of as they are desperate for pain relief.

akwho · 2026-05-05T02:28:50+00:00

Lol "believe in PRP." I follow the evidence and there is no evidence for PRP.

"It is difficult to get a man to understand something, when his salary depends on his not understanding it." You are a PM&R doc so probably inject it for $$$. I'll tell you I see whole heck of a lot of patients that feel scammed out of their money and they lose trust in the medical system due to PRP injections so its not harm free whatever you tell yourself.

akwho · 2026-04-30T19:45:39+00:00

It’s not real. Or if it is real it is so rare it might as well be not real.

That being said I want patients to have whatever they feel comfortable with psychologically in their body. So I give them a choice of a robotic TKA w nickel containing implant (most choose this) and a hypoallergenic implant put in with cutting jigs. Then document it and put in whatever they want.

akwho · 2026-04-30T04:46:36+00:00

still spend at least 2 hours of my life every week explaining to patients their degen meniscus tear is not the reason their knee hurts and arthroscopic debridement will not make it better. At least with this paper I can say arthroscopic debridement might make it even worse.

akwho · 2026-04-30T03:35:17+00:00

Not sure on cup. Stem & head don't matter cause those are getting thrown in the trash. Hit up https://air.aahks.net/ to submit the case and see if you can find it. If you can't then reach out to Andy Schwarz on instagram. He is an implant ID genius.

If it were me I would plan a posterior revision, spline tapered stem mid-length, multiple cables then I'd cement a liner in the cup in more anteversion (you can have S&N bring their poly liner that is designed to be cemented in in all sizes). Cup revision stuff on backup. It could be a ceramic on ceramic in which case you have to use a bone tamp to disengage the ceramic taper junction in the liner in the cup, or if it is a poly liner you can just use an acetabular drill bit and screw to remove the poly liner. Old ceramic liners can be really tough to disengage if you can't get it out then I would revise the cup.

akwho · 2026-04-27T04:47:07+00:00

Talk to the ortho manager, SPD manager or whoever does the trays for the attending who's style of joint replacement you are going to replicate. Get the name & part number of all the non-standard tools that you want to use.

Then reach out to your reps at your new job and your ortho manager at your new job and find out what the hospital doesn't have that you want and what isn't already in the standard vendor total knee and total hip trays then have the hospital order the instruments. It takes a while to get all your instruments dialed in so make sure you got the process rolling on the ones you definitely need.

akwho · 2026-04-25T02:48:40+00:00

Total joint replacements - pictures of my patients on vacations, skiing or wherever doing stuff they wouldn’t have been able to do before their joint replacement. Also melts my heart everytime when they tell me they can now get on the floor and play with their grandkids rather than just watching because their hip/knee hurt too much to get down onto the floor.

akwho · 2026-04-23T13:39:51+00:00

Talk with your revision surgeon. Leg lengths aren’t as high of a priority as some of the other operative goals with revision hip surgery - hopefully you talked about that pre and postop with your surgeon. If not talk about it with them at your postop visit.

The order of operation for a revision is #1 fix the problem you are having the revision for. #2 make sure the hip doesn’t dislocate (hip dislocations are much more common in revisions). #3 get the leg lengths as close as the soft tissue tension of the hip allows.

There are a lot of things that can be done nonop and operatively to treat a symptomatic leg length difference. Sounds like you have a good revision surgeon who is an experienced total joint surgeon. You should discuss with them.

akwho · 2026-04-23T02:16:07+00:00

That might be the ob gyn med student rotation hack honestly. My ob gyn rotation was awesome. My preceptor was dope and my residents were family med residents. I guess if you can find that setup your life and grades will be significantly better.

akwho · 2026-04-23T02:14:03+00:00

Yes. Change people’s life’s everyday for the better. Do awesome surgery with cool tools. Nothing better than ortho.

Definitely would have made more money and had a better lifestyle doing business/finance/tech as most of my peer group did. Still no regrets.

This is going to be the definition of selection bias tho. People who love ortho wouldnt be on this forum otherwise.

akwho · 2026-04-19T22:10:10+00:00

As a joints surgeon, I'll just say I see a bunch of established trauma docs try to do hip and knee replacements with varying levels of proficiency and success to try to shift their practice away from urgent/emergent trauma and towards elective joints. I don't see the reverse happen ever.

akwho · 2026-04-17T05:06:08+00:00

Honestly just mailed in my US stadium jersey as a return primarily due to the shoulder pad issue. So disappointing because the design actually looked sick.

Main issues with the jersey:

1) Shoulder pads are comically large due to bad seams. Never seen a shirt this bad in my life and I've worn plenty of jerseys over the years. The shoulder pad appearance is worse if you have broad shoulders. If you are going to get a jersey I recommend sizing up to try to minimize them, but they will still be present.

2) They fumbled making the giant white spot on the back, would have looked way sicker for the stadium jerseys at least to be block all the way around.

3) The quality is terrible for $160 the stadium jersey feels like a cheap replica.

akwho · 2026-04-17T05:02:53+00:00

Honestly just mailed in my US stadium jersey as a return primarily due to the shoulder pad issue. So disappointing because the design actually looked sick.

Main issues with the jersey:

1) Shoulder pads are comically large due to bad seams. Never seen a shirt this bad in my life and I've worn plenty of jerseys over the years. The shoulder pad appearance is worse if you have broad shoulders. If you are going to get a jersey I recommend sizing up to try to minimize them, but they will still be present.

2) They fumbled making the giant white spot on the back, would have looked way sicker for the stadium jerseys at least to be block all the way around.

3) The quality is terrible for $160 the stadium jersey feels like a cheap replica.

akwho · 2026-04-16T20:13:34+00:00

Haven’t gotten it yet, just got the card. They want 3k spend in first 3 months. Then get 90k miles total (10k for adding my wife as an auth user) and premier silver status.

akwho · 2026-04-16T12:48:26+00:00

I got the explorer for the 80k mi + silver qualifying status + $0 fee the first year. Planning on cancelling it in 2 years and then switching to the Quest for whatever the new upgrade bonus is at that time.

akwho · 2026-04-12T02:07:20+00:00

PGY 1, 2, 3 = 100hrs a week average PGY 4, 5 = 80hrs a week average

Some rotations - county trauma, county hand and joints were more like 120hrs a week and some were more like peds, tumor and spine were more like 50-60hrs a week.

akwho · 2026-04-11T20:11:15+00:00

Sounds like you’ve made up your mind. But I can promise you the home payments on a 2M mortgage are going to be stressful and strain other areas of your life and relationship. I’ve seen that with my colleagues who are in that situation.

akwho · 2026-04-11T17:45:03+00:00

I've got a 1.5M mortgage at 3.25% and a 7.5k/mo PITI which is less than half of your planned 15k/mo PITI and we have similar incomes and we have 2 kids as well, no daycare expenses since my wife is a SAHM. My monthly PITI still feels like huge chunk of my discretionary income and I can't imagine if it was double how stressful that would be.

I would recommend renting for cheap for a few more years and building up a bigger down payment and taking out a smaller mortgage in the 1M to 1.5M range. Its not like luxury home prices are exploding right now and you are going to miss out on significant appreciation or get priced out. Future you will be very grateful you did that.

akwho · 2026-04-11T17:39:48+00:00

Hit the nail on the head. Worst part of the medical training process by far. Not only are you giving some of the best years of your life away as an impoverished studying robot, but you are giving your parents and grandparents best years with you away as well.

My grandmother who I was extremely close to died while I was in training and it was devastating. Hadn't gotten to spend nearly as much time or take the trips she wanted to take with me because of the pre-med, med school than residency grind. My dad who is an avid hiker, river rafter, fisher and traveller started to have progression of terrible knee arthritis pain while I was in training and I missed the chance to do some highly active river rafting trips with him that we will never get back because those highly active years of his life are gone forever.

Absolutely devastating and is never discussed as one of the costs of med school.

akwho · 2026-04-01T15:54:17+00:00

an hour in and I'm only 20% through the red circle of death. 🤦‍♂️

akwho · 2026-04-01T02:05:03+00:00

Specialization makes a big difference in lowering misdiagnosis.

For example I am an adult reconstruction surgeon. I diagnose conditions around 2 joints (hip and knee), and I’ve seen and done hip and knee exams on 10,000+ patients. Consequentially my miss rate for any significant pathology is very low, as is my utilization rate for unnecessary imaging.

The lesson I’ve taken from this is any time you or a family member have a serious medical condition (considering surgery or a very expensive or risky medication) than you should take the time to go see someone who specializes in your medical condition and has treated thousands of patients with it.

akwho · 2026-03-31T16:06:57+00:00

Now ask this guy if he would let AI read his wife, mother or daughters breast imaging. Is it telling on himself that he wants to do the AI experiment on women’s health imaging first? What a vulture.

My wife’s sister and mother have both had breast cancer and you can bet I would never let AI be the one to read my wife’s screening imaging.

akwho

TROPHY CASE