Thread by @VivekKaliaMD

1/ Musings of an #MSKRad post-#AAOS2018 meeting. Attended nearly the whole meeting – very impressive presentations, exhibitor booths, educational offerings – a vast meeting similar to #RSNA. @UMichRadiology @jjacobsn @morrisonMSK @SoteriosGyft @danortizmd

2/ More MSK Rads should consider this mtg – lots of relevant material and opps for collaboration. Imaging is so central to orthopaedics – we each get better by reviewing this content and conversing. Orthopaedics most frequent referrer for MSK imaging - ajronline.org/doi/abs/10.221…

3/ I attended mostly sports sessions. Some hot topics: Ongoing issues in joint preservation (excellent sessions in both knee and hip joint preservation), orthobiologics, earlier and earlier identification of “cartilage at risk”.

4/ Several vendor-sponsored lunch & learn sessions were available. Vendor presence and sponsorship is felt throughout convention center halls. Impressive vendor booths, as big as those at @RSNA .

5/ Some fav session learning points - Cartilage Restoration Procedures include, broadly: 1 debridement, 2 marrow stimulation (microfx), 3 OC autograft (OATS), 4 ACI/MACI, and 5 OC allograft (OCA). Must treat whole joint, e.g. high tibial osteotomy to unload involved compartment.

6/ Biologic treatments for OA are on the rise – e.g. PRP, stem cells. Focus should be on decreasing inflammatory, catabolic state in joint, with primary endpoint = pain relief.

7/ #Orthobiologics for treatment of chondrosis have progressed in recent times. Now include: various types of #PRP (LP-PRP and LR-PRP), various stem cell injections (bone marrow aspirate concentrate, amniotic, umbilical, adipose-derived, etc).

8/ MSK Rads must keep pace with ortho tx developments to provide best care for patients. Expected post-op radiologic appearance of new procedures must be defined to allow ID of complications (e.g. particulated juvenile cartilage implant looks like what at 1, 3, 6, and 12 months?)

9/ MSK Rads must use identical terminology to orthopaedic surgeons in their reports – e.g. post-operative changes s/p lateral opening wedge high tibial osteotomy (LOWHTO) for valgus alignment correction. Maximize clinical utility of our studies by learning each others’ language.

10/ Notably absent at #AAOS2018 compared to #RSNA2017 is discussion of artificial intelligence relevant to orthopaedics. #AI is poised to bring evolution to nearly all of medical practice in time. Orthopaedic, neurosurgical, interventional rad papers already out to this effect.

11/ Overall a great experience. Much more to learn. Feels good to “stretch” and expand the limits of my knowledge in MSK radiology by trying to understand orthopaedic hardware and procedures at higher level. Most critical is understanding thought processes for treatment choice.