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The Journal of Bone and Joint Surgery (American) 83:722-724 (2001)
© 2001 The Journal of Bone and Joint Surgery, Inc.

A Brief Note. Ask Yourself, Why?

A Cost-Effective Look at Routine Pathologic Examination of Specimens Using the Trapezium*

Jeffrey A. Culp, BA, Brian J. Hartigan, MD and Peter J. Stern, MD

Investigation performed at the Department of Orthopaedic Surgery,University of Cincinnati College of Medicine and Hand Surgery Specialists, Cincinnati, Ohio
Jeffrey A. Culp, BA Peter J. Stern, MD Department of Orthopaedic Surgery, College of Medicine, University of Cincinnati Medical Center, P.O. Box 670212, Cincinnati, OH 45267-0212
Brian J. Hartigan, MD Northwestern Center for Orthopaedics, 676 North St. Clair, Suite 450, Chicago, IL 60611
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study.
*Letters regarding a previous Journal article dealing with routine pathologic examination of specimens can be found in the Letters to The Editor section of this issue.


   Introduction
 
Many orthopaedic surgeons never question why they order routine diagnostic tests because it is the way that they were taught or because they believe it to be hospital policy. While hospital policies establish operative guidelines and facilitate standard procedures, sometimes these policies become outdated and need revision. Rising health-care costs have prompted the need for physicians to question the importance and necessity of some routine tests. Studies have shown that routine histologic evaluation of tissues removed during primary hip and knee arthroplasty and routine radiographs of the wrist for patients with carpal tunnel syndrome are not cost-effective because of a low yield of useful information1,2.

Osteoarthritis of the thumb carpometacarpal joint is a common condition, primarily affecting postmenopausal women3. When surgery is indicated, our procedure of choice is trapezial excision and ligament reconstruction with tendon interposition4. For the past ten years, we have routinely submitted excised trapezia to . . . [Full Text of this Article]


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