June 2, 2014

Today’s Top Story
1. Study: Immobilization in abduction and external rotation may reduce recurrence risk after primary anterior shoulder dislocation.
Data from a study published in the June issue of the Journal of Shoulder and Elbow Surgery suggest that immobilization with the shoulder joint in abduction and external rotation (stabilizer brace) may reduce the risk of recurrence after primary anterior shoulder dislocations, compared to the more commonly used method of immobilization in adduction and internal rotation (sling and swathe). Of 102 patients with a primary anterior dislocation of the shoulder, 51 were randomized to receive immobilization in adduction and internal rotation using sling and swathe bandage and 51 were treated with immobilization in abduction and external rotation with a stabilizer brace. At 24-month follow-up, they found that 33.3 percent of patients in the sling group had recurrence, compared to 3.9 percent in the brace group. In addition, among patients without recurrence, the anterior apprehension test was positive in 17.6 percent (6 of 34) of the sling group and in 8.2 percent (4 of 49) of the brace group. The authors note that 3 patients in the sling group and 10 patients in the brace group discontinued shoulder immobilization before 3 weeks.
Read the abstract…

Other News
2. Study: Surgeon attitudes may affect reoperation and readmission rates.
According to findings published online in the journal Clinical Orthopaedics and Related Research, surgeon attitudes may affect reoperation and readmission rates. The researchers adjusted validated aviation psychology tools used by the U.S. Federal Aviation Administration to measure pilot attitudes by converting aviation scenarios to analogous situations for surgeons. Based on evaluation of 31 surgeons from a single academic program, they found that 9 (24 percent) had elevated levels of macho attitude thought to be hazardous in pilots. In addition, three (8 percent) of those evaluated had potentially harzardous elevated levels of self-confidence, two (5 percent) had high levels of impusivity, one (3 percent) had a high level of anti-authority, and one (3 percent) reported a high level of worry. Overall, 11 surgeons (30 percent) harbored at least one elevated attitude level. Using a regression model, the researchers determined that macho attitude levels predicted 19 percent of the variation in surgeons’ rates of readmissions and reoperations.
Read the abstract…

3. CMS “Sunshine Act” portal now open for registration.
The “Sunshine Act” provisions of the Affordable Care Act require that the U.S. Centers for Medicare & Medicaid Services (CMS) make data on payments and gifts made to physicians and teaching hospitals by medical device and pharmaceutical companies publicly available on a searchable federal database, starting in September 2014. Before the data is publicly posted, physicians and representatives of teaching hospitals will have the opportunity to review it and dispute any inaccurate or incomplete information—but only if they have registered to do so. The registration portal for the CMS “Open Payments” (Sunshine Act) program is now open for user registration.   Read more…
AAOS has set up a web page to help members connect to resources and recent news about the Open Payments system, and strongly encourages members to register at the CMS portal.   Read more…
View the instructional presentation on steps to complete CMS’ Enterprise Identity Management system registration (PDF)…   Read more…
Register now…

4. Study: Further study needed to explain racial and age disparities in trauma survival.
Data published online in the journal JAMA Surgery suggest that survival after trauma may be affected by racial and age disparities. The research team reviewed records on 1,073,195 patients from the Nationwide Inpatient Sample, and found that the unadjusted odds ratios (ORs) for death in black versus white patients were 1.35 for patients 16 to 64 years of age and 1.00 for patients 65 years or older. After risk adjustment, racial disparities in survival persisted in the younger black group, but were reversed in the older group. The research team suggests that further exploration of the seemingly paradoxical finding may improve understanding of the mechanisms that cause such disparities.
Read the abstract…

5. Last chance for Young Investigators to submit abstracts for musculoskeletal sex differences research symposium.
AAOS is seeking Young Investigator applicants for the Musculoskeletal Sex Differences Throughout the Lifespan Research Symposium, to be held July 30–Aug. 1, 2014, in Rosemont, IL. The symposium, which will be co-chaired by Laura L. Tosi, MD; Karl Jepsen, PhD; John H. Healey, MD; and Nancy Lane, MD, will bring basic scientists and engineers together with clinicians to discuss advances in the understanding of how sex differences in biomechanics, biology, and physiology impact musculoskeletal health and patient outcomes, in order to identify new areas of research related to sex and gender issues over the entire lifecycle. Selected Young Investigators will have the opportunity to present their research during the poster session and learn from experienced mentors in the field. AAOS is seeking abstracts featuring research highlighting sexual dimorphism and sex differences in musculoskeletal health. Selected YIs will receive airfare, lodging, and meals at the event. Applicants must submit a completed application, a poster abstract (one page limit), a current curriculum vitae, and a letter of support from their department chair by June 6, 2014, to Erin L. Ransford, AAOS Manager, Research Development, at  ransford@aaos.org.

Learn more and download the application…

6. New A Nation in Motion® video campaign now online.
In conjunction with the Academy’s national public awareness campaign, A Nation in Motion®, a new resource is now available for members: the “Second Firsts” video, which features poignant stories of patients who have regained mobility and independence thanks to orthopaedic care. The video is available to be shown in a practice’s reception area; shared with patients, caregivers, colleagues, and social media followers; or embedded on a practice’s website.
View or download the video…
Patients are encouraged to share their own stories an the A Nation in Motion® website.
Read more…
Back to top
7. Operation Walk USA releases 2014 guidelines for participation providers.
Operation Walk USA has released its 2014 General Guidelines for Participating Physicians and Hospitals. The mission of Operation Walk USA is to encourage and enable joint replacement surgeons to restore mobility and improve quality of life for uninsured and underinsured patients in the United States who have disabling arthritis of the hip or knee. Each Operation Walk USA participating site provides pro bono total hip and knee replacement surgeries to the economically disadvantaged U.S. citizens or permanent residents. Operation Walk USA will take place Dec. 1-6, 2014.
View the 2014 General Guidelines for Participating Physicians and Hospitals (PDF)…
View the 2013 Operation Walk USA Annual Impact Report (PDF)…

8. Call for volunteers: Musculoskeletal Tumors & Diseases Evaluation Committee.
July 11 is the last day to submit your application for a position on the Musculoskeletal Tumors & Diseases Evaluation Committee (five member openings). Members of this committee write questions for the Musculoskeletal Tumors and Diseases Self-Assessment Examination. Applicants for this position must be active fellows, emeritus fellows, or candidate member applicants for fellowship with a practice emphasis in musculoskeletal tumors and diseases.
Openings also exist on a number of other committees, subcommittees, councils, and cabinets. Visit the Committee Appointment Program website regularly to view new openings and find one that interests you.
Learn more and submit your application…(member login required)

June 4, 2014

Today’s Top Story
1. GAO report finds that orthopaedists buck the trend in self-referral for PT services.
A report from the U.S. Government Accountability Office (GAO) examines physician self-referral and Medicare spending for physical therapy (PT) services, and finds that self-referring orthopaedic surgeons, on average, referred fewer PT services than non–self-referring orthopaedic surgeons. In contrast, self-referring family practice and internal medicine providers in urban areas generally referred more PT services than their counterparts who did not self-refer. From 2004 to 2010, the report finds that non–self-referred PT services increased at a faster rate than self-referred PT services, and over that time, the number of self-referred PT services per 1,000 Medicare fee-for-service beneficiaries held generally flat, while non–self-referred PT services grew by about 41 percent.
In response to the report, Frederick M. Azar, MD, president of AAOS stated, “Physical therapy outcomes are best when a patient’s surgeon and therapist can work closely together. This study confirms the responsible use of in-office ancillary services by orthopaedic surgeons and the importance of maintaining the integration of those services in an orthopaedic surgeon’s office to allow for the continuation of care and to provide the best treatment option for patients.”   Read more…
Read the GAO summary…
Read the complete report (PDF)…
Read the AAOS statement…

Other News
2. Study: BMI most important factor driving increase in TKA.
Data published in the June 4 issue of The Journal of Bone & Joint Surgery suggest that body mass index (BMI) has played the most important role in increasing demand for total knee arthroplasty (TKA) above that of total hip arthroplasty (THA). The authors compiled a minimum of 10 years of data from sources such as the Nationwide Inpatient Sample, the Federal Register, the U.S. Centers for Medicare & Medicaid Services (CMS), the Behavioral Risk Factor Surveillance System, and AAOS. They found that the number of TKAs performed in the United States more than tripled from 1993 to 2009, while the number of THAs approximately doubled. Of all factors examined, the authors noted that BMI played the most substantial role in increasing demand for TKA above that of THA, with younger individuals affected to a greater degree. In addition, growth in TKA volume far outpaced that of THA among the patient population with a body mass index of ≥25 kg/m2, but not among those with a body mass index of <25 kg/m>2.   Read more…
Read the abstract…

3. ACO studies find strong roles for physician leadership, but early ACOs not focusing on surgical care.
Two studies published in the June issue of the journal Health Affairs examine the role of physicians in accountable care organizations (ACOs), which are called for under the Affordable Care Act. In the first study, the research team conducted a survey of public and private ACOs, and found that 51 percent were physician-led, with another 33 percent led jointly by physicians and hospitals. In 78 percent of ACOs surveyed, physicians constituted a majority of the governing board. In addition, 40 percent of responding ACOs were physician-owned.
The authors of the second study combined data from case studies and a survey of 59 Medicare-approved ACOs, and found that the organizations have devoted little attention to surgical care, focusing instead on coordinating care for patients with chronic conditions and reducing unnecessary hospital readmissions and emergency department visits. The authors argue that policy makers, ACO administrators, and surgeons need to be aware of such trends, because they may affect surgical care provided to ACO patients as well as the success of ACOs themselves.   Read more…
Read the abstract of “First National Survey of ACOs Finds That Physicians Are Playing Strong Leadership and Ownership Roles”…
Read the abstract of “Attention to Surgeons and Surgical Care Is Largely Missing from Early Medicare Accountable Care Organizations”…

4. CMS hosts orthopaedics-specific webinar on ICD-10 transition.
CMS has posted a half-hour webinar to assist orthopaedic surgeons with the transition from ICD-9 to ICD-10. The webinar is the first of five planned video presentations, each of which will feature a different medical specialty. Instruction will be provided by an American Health Information Management Association-certified coder and focus on unique ICD-10 clinical documentation needs and hot topics for the relevant specialty. The webinars cover the following topics:

  • Physician perspective and clinical impact of ICD-10
  • Documentation requirements for certain conditions
  • Documentation changes and new concepts
  • Use of “unspecified” in ICD-10

View the webinar…
Visit the CMS “Road to 10” website…
View additional CMS resources…
AAOS also offers a variety of resources to assist with the transition to ICD-10.   Read more…

5. Study: Depression, psychotic disorders, deficiency anaemias, and smoking linked to revision spinal fusion.
A study published in the June issue of The Bone & Joint Journal looks at national trends in revision spinal fusion across the United States. The researchers reviewed data on 410,158 primary spinal fusion discharges and 22,128 revision spinal fusion discharges from the Nationwide Inpatient Sample database. They found that, between 2002 and 2009, primary fusion increased at a higher rate compared with revision fusion. After adjustment, they found that depression, psychotic disorders, deficiency anaemias, and smoking were more likely to be associated with revision spinal fusion discharges than primary fusion discharges. In terms of complications, they noted that dural tears and surgical site infections were more likely to be associated with revision spinal fusion discharges than primary fusion discharges. In addition, the researchers also found that, between 2002 and 2009, primary fusion increased at a higher rate compared with revision fusion.
Read the abstract…

Your AAOS
6. Fellows elect 2015 Nominating Committee.
The members of the 2015 AAOS Nominating Committee have been identified. In May, the AAOS fellowship elected six members of the 2015 Nominating Committee, and the AAOS Board of Directors appointed the chair at its meeting in March. The 2015 Nominating Committee members are:

  • Daniel J. Berry, MD (Minn.), Chair
  • Annunziato (Ned) Amendola, MD (Iowa)
  • Kevin J. Bozic, MD, MBA (Cal.)
  • Amy L. Ladd, MD (Cal.)
  • Vincent D. Pellegrini, Jr., MD (S.C.)
  • Chitranjan S. Ranawat, MD (N.Y.)
  • Roy W. Sanders, MD (Fla.)

Thomas A. Einhorn, MD (Mass.) was elected as the alternate member of the committee.

Of the 23,676 active, inactive, and emeritus fellows who are eligible to vote and who can be contacted, 2,863 (12 percent) cast valid ballots. The 2015 Nominating Committee will present its slate of nominees to the fellowship by Nov. 26, 2014, 120 days prior to the business meeting at the 2015 Annual Meeting. The 2015 Nominating Committee will present a slate of candidates for the following positions:

  • Second vice-president
  • Board member-at-large (no age designation)
  • Board member-at-large (younger than age 45 on March 26, 2015)
  • Four nominees, American Board of Orthopaedic Surgery (ABOS)
  • Member, AAOS National Membership Committee

The 2015 Nominating Committee is actively soliciting suggestions for individuals who might serve in these positions. Please prepare your recommendations, along with a paragraph on your candidates and why you believe they are uniquely qualified for the position for which you are nominating them. Send this information to Daniel J. Berry, MD, Chair, 2015 Nominating Committee, c/o AAOS Office of General Counsel, 6300 N. River Road, Rosemont, Ill. 60018-4202. Candidates will be asked to provide other materials as a condition for consideration, including an abbreviated curriculum vitae and information regarding their relationships with industry.

7. Apply now to take part in the AAOS Leadership Fellows Program.
The AAOS Leadership Fellows Program (LFP) offers an exciting opportunity to all AAOS fellows age 45 and younger as of Jan. 31, 2015. The LFP is a 1-year program, which begins at the AAOS Annual Meeting and combines didactic and experiential leadership training with an ongoing mentoring program. Among the goals of the program are the following:

  • Introduce fellows to the AAOS governance structure
  • Observe AAOS leadership at work
  • Participate in interactive leadership development programs
  • Engage in opportunities for peer-to-peer interactions and learning
  • Experience serving on an AAOS committee

Applications are now available online. This is a year-long commitment with 6 mandatory meetings. Please review the LFP schedule prior to completing the application to ensure you will be able to attend all meetings. The deadline for applications is July 15, 2014.
Learn more and submit your application…
For more information, contact Kristen Erickson at 847-384-4343, or via email at  erickson@aaos.org.

8. Call for volunteers: Upper Extremity Evaluation Committee.
July 11 is the last day to submit your application for a position on the Upper Extremity Evaluation Committee (one member opening). Members of this committee write questions for the Shoulder and Elbow Self-Assessment Examination. Applicants for this position must be active fellows, emeritus fellows, candidate members, or candidate member applicants for fellowship with a practice emphasis in shoulder and elbow.
Openings also exist on a number of other committees, subcommittees, councils, and cabinets. Visit the Committee Appointment Program website regularly to view new openings and find one that interests you.
Learn more and submit your application…(member login required)

June 6, 2014

Today’s Top Story
1. Senate confirms Burwell to head HHS.
The Washington Post reports that, in a bipartisan vote of 78 to 17, the U.S. Senate has confirmed Sylvia Burwell to replace Kathleen Sebelius as secretary of the U.S. Department of Health and Human Services (HHS). Ms. Burwell, who has been serving as the White House budget director, will oversee 11 agencies that make up HHS, including the Centers for Medicare & Medicaid Services, the National Institutes of Health, the Centers for Disease Control and Prevention, and the Food and Drug Administration. Ms. Burwell will also oversee the continued implementation of the Affordable Care Act.   Read more…

Other News
2. Studies look at joint arthroplasty and infection.
Several studies presented at the European Federation of National Associations of Orthopaedics and Traumatology (EFORT) Congress analyze infection and joint arthroplasty. In one, a group of researchers reviewed data on nearly 18,000 patients who underwent primary knee arthroplasty at a single center in New York, and found that younger patients were at higher risk of infection than older patients. A second study, of 3,807 patients in Sweden, finds that fracture patients who receive an artificial hip may be at significantly greater risk of infection than those who undergo surgery due to a degenerative hip disease. Finally, an Australian research team analyzed data from 124 revision arthroplasty procedures (84 patients) and found evidence to suggest that C-reactive protein demonstrates high sensitivity and specificity as a biomarker for diagnosing infections from periprosthetic revision surgery.   Read more…

3. EFORT studies examine link between BMI and knee replacement; complications.
A Northern Ireland-based study presented at the EFORT Congress finds that obese men and women are at increased risk of eventually needing an artificial knee joint. The research team found that over 90 percent of knee arthroplasty patients had a body mass index (BMI) of 25 kg/m2 or higher, compared to 59 percent of Northern Ireland’s general population. An unrelated Swiss study presented at the same meeting analyzed data from nearly 2,500 patients with knee prosthetics, and found that patients with BMI of 35 kg/m2 or greater were at increased risk for reoperation and infection.   Read more…

4. Study: Preoperative opioid use linked to reduced patient-reported outcomes for spine surgery.
Data from a study published in the June 4 issue of The Journal of Bone & Joint Surgery suggest that increased preoperative opioid consumption, Modified Somatic Perception Questionnaire score, and Zung Depression Scale score may predict worse patient-reported outcomes for patients who undergo spine surgery. The authors conducted a prospective cohort study of 583 patients who underwent lumbar, thoracolumbar, or cervical spine surgery to treat a structural lesion. At preoperative evaluation, 326 patients (56 percent) reported at least some opioid use. At 2 and 12 months postoperative, the authors found that preoperative opioid use was a significant predictor of decreased 12-Item Short-Form Health Survey and EuroQol-5D scores, and increased Oswestry Disability Index and Neck Disability Index scores. In addition, every 10 mg increase in daily morphine equivalent taken preoperatively was linked with a 0.03 decrease in the 12-Item Short-Form Health Survey physical component summary and mental component summary scores, a 0.01 decrease in the EuroQol-5D score, and a 0.5 increase in the Oswestry Disability Index and Neck Disability Index score at 12 months postoperative.
Read the abstract…

5. Florida.
According to SaintPetersBlog, the Florida Supreme Court is considering arguments in a case that could determine the retroactive applicability of the state’s medical liability caps. In the relevant case, a plaintiff claimed surgical complications occurred prior to passage of a 2003 tort reform law, but did not file suit until January 2006. The plaintiff subsequently received a jury award of $1.5 million in non-economic damages, which was later reduced to $500,000 due to the caps. The plaintiff’s attorney argued that the caps should not be retroactive to injuries suffered prior to passage of the law. The defendant’s attorney calls non-economic damages “tremendously discretionary,” and argues that retroactive application of the limits did not impact the plaintiff’s rights.   Read more…

6. Pennsylvania.
An advisory released by the Pennsylvania Patient Safety Authority finds that worker fatigue may be a contributing factor in many medical errors. The researchers reviewed data from the Pennsylvania Patient Safety Reporting System, and identified 1,601 events reported from June 2004 to August 2013. Of those, 1,564 events (97.7 percent) were reported as Incidents or near misses that did not result in harm to the patient. Medication errors (n = 995) and errors related to a procedure, treatment or test (n = 422) made up 88.5 percent of all events reported with healthcare worker fatigue as a contributing factor.   Read more…
Read the complete advisory…

7. AAOS seeks public comment on pediatric developmental dysplasia of the hip guideline.
The AAOS guideline on Detection and Nonoperative Management of Pediatric Developmental Dysplasia of the Hip in Infants up to Six Months of Age has completed peer review by specialty organizations, and will be ready for public comments soon. To participate in the commentary, please submit your name, phone number, and email address by Friday, June 27, to Jayson Murray, at  jmurray@aaos.org.

8. Call for volunteers: Committee on Outside Interests.
July 18 is the last day to submit your application for a position on the Committee on Outside Interests (chair, one member opening). The Committee on Outside Interests provides guidance to the Board of Directors and other AAOS bodies regarding conflict of interest issues, and oversees the AAOS Orthopaedic Disclosure Program. Applicants for the chair position must be active fellows. Applicants for the member position must be active or emeritus fellows. All applicants are required to complete the AAOS mandatory enhanced disclosure information, and those who have financial arrangements or conflicts of interest with any orthopaedic device manufacturing company will be required to state how such conflicts would be managed if the individual is selected as a member.
Openings also exist on a number of other committees, subcommittees, councils, and cabinets. Visit the Committee Appointment Program website regularly to view new openings and find one that interests you.
Learn more and submit your application…(member login required)

June 9, 2014

Today’s Top Story
1. Are bundled payments the future of healthcare?
An article in The Wall Street Journal looks at the issue of bundled payments for healthcare. Under a bundled payment pricing program, a single overall price that covers everything involved in a course of treatment is negotiated between payers and providers. The author states that 350 healthcare organizations are currently participating in pilot bundled-payment programs with Medicare, covering 48 health conditions. Supporters argue that bundled payments encourage healthcare providers to work together to keep costs low and quality high. A sidebar to the article uses knee arthroplasty as an example of cost-reduction under a bundled payment system and states that typical unbundled cost for such a procedure may range from $25,000 to $43,000, while bundled payments would total $22,000 to $30,000 for the same level of care.   Read more…
AAOS has released a position statement on bundled payment initiatives and gainsharing arrangements.  Read more…

Other News
2. Study examines risk factors for VTE after spinal fusion.
A study published in the June 4 issue of The Journal of Bone & Joint Surgery assesses risk factors for postoperative venous thromboembolic events (VTEs) after spinal fusion. The authors reviewed data on 710,154 spinal fusion procedures in the Nationwide Inpatient Sample database. Overall, 3,525 patients (0.50%) were recorded as having 3,777 VTEs, consisting of 2,038 deep venous thromboses and 1,739 pulmonary emboli. Compared to patients without VTE, patients with VTE tended to be older, male, and black. In addition, postoperative VTE was associated with a longer hospital stay and higher total hospital charges. The authors note that a number of comorbidities and procedure-related factors were also identified as independent risk factors for VTE.
Read the abstract…

3. Study: Fractures and concussions most common injuries in youth ice hockey.
According to findings published online in the journal Pediatrics, fractures and concussions are the most frequent injuries seen among youth ice hockey players. The research team reviewed records on 168 injuries to 155 children aged 18 years or younger with ice hockey-related injuries who were seen at a single, level 1 pediatric trauma center in Minnesota. Overall, extremity injuries were the most common, followed by traumatic brain injury (TBI), with injuries to the spine, face, and trunk being less common. TBI and injuries to the spine were more common in children aged 14 years and younger and in girls, while injuries to the face were most common in players older than 15 years. The research team noted that 65 patients were admitted to the hospital, including 14 who needed intensive care.  Read more…
Read the abstract…
AAOS has published information on hockey injury prevention on its OrthoInfo website.   Read more…

4. Study: Drug diversion by healthcare personnel linked to infection outbreaks.
Data published online in the journal Mayo Clinic Proceedings suggest that drug diversion by addicted healthcare personnel may be associated with outbreaks of infection. The researchers identified six outbreaks during a 10-year period and found that all occurred in hospital settings and were spread via tampering with injectable controlled substances. Two of the outbreaks involved tampering with opioids administered via patient-controlled analgesia pumps, and resulted in gram-negative bacteremia in 34 patients. The remaining four outbreaks involved tampering with syringes or vials containing fentanyl, through which hepatitis C virus was transmitted to 84 patients. Overall, nearly 30,000 patients were potentially exposed to blood-borne pathogens and targeted for notification advising testing.   Read more…
Read the abstract…

5. ACA may drive some patients to inappropriately seek care at EDs.
An article published in USA Today notes that some hospitals have seen a surge in emergency department (ED) use that may be linked to increased coverage under the Affordable Care Act. According to information from the American College of Emergency Physicians, nearly half of ED physicians recently polled stated that they’ve seen an uptick in visits since Jan. 1, 2014. Observers say the surge may be linked to a variety of factors, including a shortage of primary care physicians, a lack of widespread acceptance of Medicaid patients, work pressure factors that lead poorer patients to seek care after hours, and a segment of the patient population that has become accustomed to using EDs for their primary care needs.   Read more…

6. Last chance to nominate a colleague for the Diversity, Humanitarian, or Tipton Leadership Award!
June 13, 2014, is the last day to submit nominations for the 2015 Humanitarian and Diversity Awards, and the William W. Tipton Jr., MD, Orthopaedic Leadership Award. These awards are presented annually at the AAOS Annual Meeting. Each award recipient is recognized for his or her endeavors to further encourage diversity or culturally competent care, humanitarian activities, or leadership activities in the orthopaedic profession.   Read more…

7. Ebook edition of June AAOS Now now available for download and offline reading.
In addition to being available on the AAOS website, the June 2014 issue of AAOS Now magazine is available for electronic devices and e-readers capable of reading files in ePub format. These include iOS devices such as the iPhone and iPad, Android devices, and desktop computers. (At this time, Amazon Kindle does not recognize ePub files.) To download and view the electronic version of AAOS Now, visit the link below and log in using your AAOS username and password. Instructions for many devices are provided on the site. If you have comments or questions about the ePub version of AAOS Now, please email Peter Pollack, electronic content specialist, at ppollack@aaos.org.
Read the ePub version of AAOS Now(member login required)

8. Call for volunteers: AJRR Board of Directors.
July 25 is the last day to submit your application for a position on the American Joint Replacement Registry (AJRR) Board of Directors (one member-at-large opening). AJRR is a separate entity from the AAOS, with its own board of directors. The initial role of AJRR is to foster a national center for data collection and research on total hip and total knee arthroplasty. Applicants for this position must be active or emeritus fellows, and must be willing to complete the AAOS Mandatory Enhanced Disclosure information required of AAOS Board members.
Openings also exist on a number of other committees, subcommittees, councils, and cabinets. Visit the Committee Appointment Program website regularly to view new openings and find one that interests you.
Learn more and submit your application…(member login required)

June 11, 2014

Today’s Top Story
1. Study: S. aureus-related deep SSI may be transmitted from other body regions.
A study published in the June 4 issue of The Journal of Bone & Joint Surgery finds that deep surgical site infection (SSI) may be caused by Staphylococcus aureus transmitted from the nose, skin surfaces, and other endogenous body regions. The authors reviewed information on all patients admitted to a single institution for elective orthopaedic surgery between 1999 and 2007. They found a large number of genotypes across two patient populations—nasal S. aureus carriers and orthopaedic patients with a deep SSI. Overall, the risk of S. aureus SSI was 5.8 times higher in nasal carriers compared with non-carriers. Of the nasal carriers, 6.3 percent (7 of 111 patients) developed a deep S. aureus SSI, and all but one patient had identical genotypes in the nasal and surgical site infection isolates.
Read the abstract…

Other News
2. Study: miRNAs could serve as biomarkers for severe knee and hip OA.
Findings from a German study presented at the European League Against Rheumatism (EULAR) annual congress suggest that the presence of certain micro RNAs (miRNAs) could serve as a potential biomarker for severe knee or hip osteoarthritis (OA). The researchers followed 816 Caucasian individuals from 1995 to 2010, and assessed joint arthroplasty as a definitive outcome of severe osteoarthritis of the knee and hip. During the study period, 67 participants underwent one or more total joint replacement procedures for severe knee or hip OA. Researchers found that microarray screening identified 12 candidate miRNAs, and further analysis demonstrated that 3 miRNAs were associated with severe knee and hip OA.   Read more…
Read the abstract…

3. Failure to repeal SGR a familiar refrain at AMA meeting.
Modern Healthcare reports that the failure of Congress to repeal the Medicare Sustainable Growth Rate (SGR) formula served as a major theme at the American Medical Association (AMA) House of Delegates meeting this week. “I saw politicians on both sides of the aisle—in the Senate and the House—voice their approval for the legislation,” said AMA President Ardis Dee Hoven, MD, during her opening address. “I saw them look me in the eye and tell me they would get it done. And then, a few weeks later, I saw those same politicians vote that bill down.” A law enacted earlier this year marked the 17th time Congress has delayed cuts mandated by the SGR. Despite wide bipartisan support to replace the SGR, Democrats and Republicans were unable to come to an agreement on how to fund the reduced cost of repeal, and a rider added late in the process that would have delayed by 1 year the individual mandate called for under the Affordable Care Act acted as a dealbreaker for Democrats. A 1-year patch to prevent reimbursement cuts called for under the SGR was enacted in place of full repeal and will expire April 1, 2015.   Read more…

4. Study: PRP may be no more effective than saline for treatment of recently developed epicondylitis.
According to information from a French study presented at the EULAR annual congress, injections of platelet-rich plasma (PRP) containing growth factors may be no more effective in treating recently developed epicondylitis than injections of saline. The research team conducted a prospective, randomized, double-blind trial of 44 patients with recent onset epicondylitis confirmed via magnetic resonance imaging and/or ultrasound and were treated with two ultrasound-guided injections of either PRP or saline solution performed at 4 weeks interval. At 6-month follow-up, they found no statistically significant difference between cohorts for mean relative improvement in pain, or for any secondary criteria (assessment of pain on isometric contraction of the second radial and of the extensor digitorum communis, Roles-Maudsley score, and proportion of asymptomatic patients). The proportion of patients with persistent pain at 12 months was 23.8 percent in both groups. The research team observed no adverse effects. Overall, 34 percent of all patients were asymptomatic at 6 months, and 66 percent of all patients were asymptomatic at 1 year.   Read more…
Read the abstract…

5. Senate subcommittee votes in support of restoring research funding to NIH.
The Hill reports that a Senate Appropriations Committee subcommittee has voted in support of a $605 million funding increase for the National Institutes of Health (NIH). If enacted, the proposal would effectively restore research funding canceled under federal budget sequestration. The subcommittee also voted to more than double funding for the Health Care Fraud and Abuse Control program at the U.S. Centers for Medicare and Medicaid Services (CMS) to $672 million for 2015. Observers say that differences in House and Senate proposals are expected to make the legislation difficult to pass by the Oct. 1 deadline.   Read more…

6. AAOS and HRET seek ASCs to participate in educational and quality improvement program.
AAOS and the Health Research and Educational Trust (HRET) of the American Hospital Association are collaborating on a new educational and quality improvement program for Ambulatory Surgery Centers (ASCs). AAOS and HRET will select 9 to 12 ASCs to take part in the year-long program, which involves an educational component focusing on improving teamwork, communication, infection prevention, and safety, along with data collection and monitoring. Reducing surgical site infections and other complications are important program outcomes. The program is open to any ASC owned by AAOS fellow(s) or operated under a joint venture with another entity, as long as orthopaedic surgeons participate in governance. To qualify for the program, ASCs must meet the following criteria: at least 4,000 cases annually; case mix including arthroscopy patients, arthroplasty patients, and patients undergoing other orthopaedic procedures that require a surgical incision; and orthopaedic surgeon ownership and/or governance. Data collection involves reporting sentinel events including wrong site surgery, wrong patient surgery, surgical site infections, and more. Applications must be submitted by June 30, 2014. Selections will be made by July 31, 2014. The 12-month program is expected to begin during September 2014.   Read more…
Submit your application…
Questions regarding the program can be submitted at  ascorthopaedic@aaos.org.

7. Call for volunteers: CMS Courses Committee.
July 18 is the last day to submit your application for a position on the CME Courses Committee. Members of this committee participate in planning the Academy’s annual continuing medical education (CME) calendar, and act as committee liaisons for relevant Academy courses and webinars. The following positions are available:
Adult Reconstruction Hip and Knee (one member opening)
Spine (one member)
Sports Medicine (one member)
Trauma (one member)
Applicants for these positions must be candidate members, candidate members osteopathic, active fellows, associate members orthopaedic, associate members osteopathic, emeritus fellows, emeritus associate members orthopaedic, or emeritus associate members osteopathic with experience in planning and organizing CME courses and a practice emphasis in the relevant area.
Openings also exist on a number of other committees, subcommittees, councils, and cabinets. Visit the Committee Appointment Program website regularly to view new openings and find one that interests you.
Learn more and submit your application…(member login required)

June 13, 2014

Today’s Top Story
1. NIH task force releases recommendations for clinical research into cLBP.
The National Institutes for Health Task Force on Research Standards for Chronic Low Back Pain (cLBP) has released its report on a set of draft standards to increase the consistency of future clinical research on cLBP. The task force’s recommendations cover:

  • Defining cLBP as pain on at least half the days during the past 6 months
  • Classification of cLBP by “impact,” defined by pain intensity, pain interference with normal activities, and functional status
  • A minimal dataset, including demographics, involvement in workers’ compensation, work status, education, comorbidity, and previous treatment
  • Outcome measures, including a “responder” analysis, in addition to reporting mean scores of outcome measures
  • Recommendations for research on the proposed standards
  • Dissemination of standards to the broad research community upon adoption of recommendations by the NIH Pain Consortium

Read more, with links to supporting materials…

Other News
2. Study: Blood storage time linked to increased likelihood of prosthetic joint infection.
According to findings published online in The Journal of Arthroplasty, longer storage times for blood used in perioperative blood transfusion may increase the likelihood of prosthetic joint infection for patients who undergo total knee arthroplasty (TKA). The researchers followed 1,331 consecutive TKA patients between November 2007 and November 2009. Overall, 32 patients were diagnosed with infection. After adjustment, the researchers found that blood transfusion with red blood cells stored longer than 14 days was the strongest predictor for prosthetic joint infection within 90 days after primary TKA.
Read the abstract…

3. Study: Use of cement for hip hemiarthroplasty for fractured neck of femur may be associated with patient death or other harm.
Data from a United Kingdom study published online in the journal BMJ Open suggest that cement use in hip hemiarthroplasty for fractured neck of femur may be associated with increased likelihood of perioperative death or severe harm. The authors reviewed information on cases of severe acute patient deterioration associated with cement use in hip hemiarthroplasty for fractured neck of femur that were reported to the National Reporting and Learning System (NRLS) between 2005 and 2012. They found that the NRLS received 62 reports that described death or severe harm associated with the use of cement in hip hemiarthroplasty for fractured neck of femur. Overall, they found one such incident for every 2,900 hemiarthroplasties for fractured neck of femur performed during the study period. Of those 62 reports, 41 patients died, 14 were resuscitated from cardiac arrest and 7 from periarrest. In addition, 55 of 62 (89 percent) reports described acute deterioration that occurred during or within a few minutes of cement insertion. Of patient deaths, 33 of 41 (80 percent) occurred on the operating table.   Read more…

4. Study: Increased walking linked to better function for patients with knee OA.
Findings published online in the journal Arthritis Care & Research suggest that increased walking may be linked with reduced risk of functional limitation for patients with knee osteoarthritis (OA). The research team evaluated the association of steps/day at baseline with the development of functional limitation 2 years later among 1,788 participants with a mean age of 67 years. They found that each additional 1,000 steps/day was associated with a 16 percent reduction in incident functional limitation by performance-based measures and an 18 percent reduction by self-reported measures. The research team noted that walking at least 6,000 steps/day was the best threshold to distinguish incident functional limitation by performance-based measures.   Read more…
Read the abstract…

5. Cantor defeat may hurt chances of ACA replacement legislation.
An article in Politico examines potential ramifications for healthcare policy in the wake of House Majority Leader Eric Cantor’s (R-Va.) primary election loss this week. The author argues that the prospect of a Republican alternative to the Affordable Care Act (ACA) being advanced this year is significantly reduced by Rep. Cantor’s defeat. The author notes that Republican lawmakers remain divided on the political wisdom of offering a specific proposal prior to the November general election. Rep. Cantor, however, had sided with those in favor of voting on a replacement plan, and his influence as the number two member of the majority party has been significantly reduced by the primary defeat. In addition, Rep. Cantor has announced his resignation as House Majority Leader, effective July 31.   Read more…

6. Comments requested from active and emeritus fellows on AAOS membership candidates.
July 1 is the last day for active and emeritus fellows to comment on the Class of 2015 Roster of Candidates being considered for AAOS membership. An online comment form has been made available, along with the candidate roster and links to current AAOS Standards of Professionalism (SOPs). Active and emeritus fellows who are aware of a candidate for fellowship or membership whom they believe has violated AAOS SOPs are asked to complete the Report of Concern Form and return it to the Membership Committee by July 1, 2014.  Read more…(member login required)
For more information, please contact Lucy Free, at 847-384-4258, or  free@aaos.org.
Alleged violations of the SOPs involving current fellows or members should proceed through the Professional Compliance Program.
Learn more about the Professional Compliance Program, with links to the AAOS SOPs…

7. Submit papers now for Kappa Delta and OREF Clinical Research Awards.
July 1, 2014, is the deadline for receipt of manuscripts submitted for the 2015 Kappa Delta Awards and the Orthopaedic Research and Education Foundation (OREF) Clinical Research Award. Up to two $20,000 Kappa Delta awards (Elizabeth Winston Lanier Award and Ann Doner Vaughan Award), one $20,000 Kappa Delta Young Investigator award, and one $20,000 OREF award will be bestowed, provided manuscripts of requisite quality are submitted. Manuscripts should represent a large body of cohesive scientific work generally reflecting years of investigation. If the submission reflects a single project, it should be of high significance and impact. Manuscripts must be submitted by members (or candidate members) of the AAOS, Orthopaedic Research Society, Canadian Orthopaedic Association, or Canadian Orthopaedic Research Society. Please note that submissions for the 2015 Kappa Delta and OREF Clinical Research Awards will be accepted in electronic format only. A PDF of the entire submission must be emailed no later than 11:59 p.m. CT on July 1, 2014. Late submissions will not be considered.   Read more…
Please submit your manuscript to  kappadelta@aaos.org.

8. Call for volunteers: Women’s Health Issues Advisory Board.
August 1 is the last day to submit your application for a position on the Women’s Health Issues Advisory Board (one member, one resident member opening). The Women’s Health Issues Advisory Board advocates, advances, and serves as a resource on sex and gender differences in musculoskeletal health. Applicants for the member position must be active fellows, emeritus fellows, or candidate members with in-depth knowledge and experience in women’s musculoskeletal health research issues. Applicants for the resident member position must be PGY-1, 2, or 3, and provide a letter of support from his or her residency program director.
Openings also exist on a number of other committees, subcommittees, councils, and cabinets. Visit the Committee Appointment Program website regularly to view new openings and find one that interests you.
Learn more and submit your application…(member login required)

June 16, 2014

Today’s Top Story
1. Study: MACI may be better than microfracture for treating larger cartilage knee defects.
According to findings published online in The American Journal of Sports Medicine (AJSM), the treatment of symptomatic cartilage knee defects ≥3 cm2 in size may be clinically and statistically significantly better using matrix-applied characterized autologous cultured chondrocytes (MACI), compared against microfracture (MFX), with similar structural repair tissue and safety. The authors conducted a randomized, controlled trial of 137 patients who had at least one symptomatic focal cartilage defect of the femoral condyles or trochlea, with a baseline Knee Injury and Osteoarthritis Outcome Score (KOOS) pain value of <55. At 2-year follow-up, they found significantly greater improvement in mean KOOS pain and function subscores with MACI than with MFX. In addition, patients treated with MACI had significantly improved scores on the KOOS subscales of activities of daily living, knee-related quality of life, and other symptoms, compared to those treated with MFX.>
Read the abstract…

Other News
2. Medtronic to purchase Covidien.
The Albany Business Review reports that Medtronic Inc. has entered an agreement to acquire Covidien for $42.9 billion. The transaction is expected to close in early 2015. Observers say the company will move its legal headquarters from Minnesota to Ireland, but the “operational headquarters” will remain in the United States.   Read more…

3. Study: “Considerable variation” in strength of arthroscopic knots.
Data published online in AJSM suggest that there may be considerable variation in knot strength between arthroscopic knots tied by surgeons, even when the same surgeon ties the same type of knots. The research team conducted a controlled laboratory study in which 73 surgeons each tied five of the same type of their preferred arthroscopic knot and half-hitch locking mechanism. The researchers found that, for an individual surgeon, the standard deviations of the five consecutive knots ranged from 6 to 133 N. When knot strength was used to measure performance, significant differences existed in ultimate load, yet there were no differences in clinical failure load. Surgeons with more than 10 years of practice were able to tie knots more consistently than surgeons who had practiced for less than 10 years, both for ultimate load and clinical failure load.
Read the abstract…

4. California.
The Sacramento Business Journal reports that an appellate court has overturned a lower court decision by ruling that hospitals cannot bill health plans in amounts well in excess of the actual value of services. In the relevant case, a hospital and an insurer were unable to agree on a new contract to set rates for services. The hospital was required by federal law to provide emergency care to the insurer’s beneficiaries. During a 10-month period in which there was no contract, the institution billed the insurer full charges based on the hospital’s “chargemaster,” which lists higher prices that help the hospital shift costs from unprofitable programs and bad payers. The appeals court has ordered a new trial to establish damages that reflect what it calls the “reasonable value” of services.   Read more…

5. Kansas.
According to the Kansas City Business Journal, a case filed in district court alleges that an insurer misled beneficiaries regarding its Affordable Care Act provider network. The plaintiff argues that the insurer marketed its plans as including a specific network of providers, and prior to purchasing a policy, the plaintiff verified that her preferred providers were in-network, based on information on the insurer’s website. However, when she sought care from those physicians, she was billed for out-of-network care.   Read more…

6. AAOS and HRET seek ASCs to participate in educational and quality improvement program.
June 30, 2014 is the deadline for orthopaedic owned or led ambulatory surgery centers (ASCs) to complete their application to participate in an AAOS / Health Research and Educational Trust (HRET) educational and quality improvement program. The program is funded through a contract from the Agency for Healthcare Research and Quality. AAOS and HRET will select 9 to 12 ASCs for the year-long program. The program involves an educational component focusing on improving teamwork, communication, infection prevention, and safety, along with data collection and monitoring. Reducing surgical site infections (SSIs) and other complications are important program outcomes. The program is open to any ASC owned by AAOS fellow(s) or operated under a joint venture with another entity, as long as orthopaedic surgeons participate in governance. ASCs that qualify for the program meet the following criteria: at least 4,000 cases annually, case mix including arthroscopy and arthroplasty patients, and orthopaedic surgeon ownership and/or governance. Data collection involves reporting sentinel events including wrong site surgery, wrong patient surgery, SSIs, and more. Selections will be made by July 31, 2014; the program is expected to begin in September 2014.   Read more…
Submit your application…
Questions regarding the program can be submitted at  ascorthopaedic@aaos.org.

7. Apply now to take part in the AAOS Leadership Fellows Program.
The AAOS Leadership Fellows Program (LFP) offers an exciting opportunity to all AAOS fellows age 45 and younger as of Jan. 31, 2015. The LFP is a 1-year program, which begins at the AAOS Annual Meeting and combines didactic and experiential leadership training with an ongoing mentoring program. Among the goals of the program are the following:

  • Introduce fellows to the AAOS governance structure
  • Observe AAOS leadership at work
  • Participate in interactive leadership development programs
  • Engage in opportunities for peer-to-peer interactions and learning
  • Experience serving on an AAOS committee

Applications are now available online. This is a year-long commitment with 6 mandatory meetings. Please review the LFP schedule prior to completing the application to ensure you will be able to attend all meetings. The deadline for applications is July 15, 2014.
Learn more and submit your application…
For more information, contact Kristen Erickson at 847-384-4343, or via email at  erickson@aaos.org.

8. Call for volunteers: Practice Management Committee.
July 18 is the last day to submit your application for a position on the Practice Management Committee (two member openings). The Practice Management Committee oversees all practice management-related activities of AAOS, including needs assessment, education, and the evaluation and implementation of products and services. Applicants for these positions must be active fellows or associate members osteopathic. One position is reserved for a hospital-employed orthopaedic surgeon.
Openings also exist on a number of other committees, subcommittees, councils, and cabinets. Visit the Committee Appointment Program website regularly to view new openings and find one that interests you.
Learn more and submit your application…(member login required)

June 19, 2014

Today’s Top Story
1. Study: Rotator cuff repair outcomes are similar, with or without acromioplasty.
Findings published in the June issue of The American Journal of Sports Medicine suggest that there may be no significant difference between rotator cuff repairs performed with or without acromioplasty at short-term follow-up. The authors conducted a randomized, controlled trial of 95 patients who underwent arthroscopic repair of full-thickness rotator cuff tears with or without acromioplasty. At 2-year follow-up, they found no significant differences in baseline characteristics, including number of tendons torn, repair configuration, concomitant procedures, and acromion type and angles. Patients in both groups saw significant improvement in all functional outcome scores from baseline to all follow-up time points up to 2 years.
Read the abstract…

Other News
2. Study: Mutations in two genes associated with increased risk of developing severe scoliosis.
Data from a study published online in the journal Human Molecular Genetics suggest that variations in two genes may be associated with increased likelihood of severe adolescent idiopathic scoliosis. The research team sequenced DNA from 91 patients with acute scoliosis and found that the most consistently mutated gene in the group was fibrillin-1, while a related gene, fibrillin-2, was also often mutated. The researchers then sequenced the genes of 852 patients with scoliosis and 669 participants who did not have scoliosis, and found that specific mutations in both fibrillin-1 and fibrillin-2 were associated with a fourfold increase in the likelihood of severe scoliosis.   Read more…
Read the abstract…

3. MedPAC letter calls attention to challenges seen by ACOs.
A letter from the Medicare Payment Advisory Commission (MedPAC) to the U.S. Centers for Medicare & Medicaid Services (CMS) raises several issues of concern for the accountable care organization (ACO) model. The Affordable Care Act called for CMS to implement a program to develop ACOs. The shared savings program developed by CMS enables ACOs to participate in different models, including one-sided risk (the ACO takes no fiscal responsibility for excess costs but collects a smaller share of excess savings) or two-sided risk (the ACO takes some financial responsibility for excess costs and collects a larger share of excess savings). Among other things, MedPAC notes that under the current shared savings program, ACOs say that quality measurement and evaluation are proving to be complex and expensive. In addition, ACOs report finding it difficult to manage the program due to a lack of clarity regarding beneficiaries and financial benchmarks. Regarding longer term concerns, MedPAC argues that the shared savings program should transition to a design in which ACOs take on more two-sided risk and less one-sided risk, ideally in a manner concurrent with a transition to financial targets that are equitable for all participants.
Read the letter (PDF)…

4. Report finds that U.S. healthcare system “underperforms” compared to 11 other industrialized countries.
A report from the Commonwealth Fund calls into question the efficacy of the U.S. healthcare system compared to 11 other industrialized nations. The researchers drew data from the Commonwealth Fund 2011 International Health Policy Survey of Sicker Adults, the Commonwealth Fund 2012 International Health Policy Survey of Primary Care Physicians, and the Commonwealth Fund 2013 International Health Policy Survey, and compared it against data drawn from the Organization for Economic Cooperation and Development and the World Health Organization. They found that the United States ranked high in effective care and patient-centered care, but performed less well in the areas of providing safe or coordinated care. In addition, the researchers ranked the United States last in efficiency, citing time and money spent dealing with insurance administration, lack of communication among healthcare providers, and duplicative medical testing as factors. The United States also ranked last in equity, with 39 percent of adults with below-average incomes reporting a medical problem but no physician visit in the past year because of costs; in the United Kingdom, Sweden, Canada, and Norway, less than 10 percent of adults with below-average incomes reported that problem. Read more…
Read the complete report…

5. Physicians must apply by July 1 for EHR meaningful use hardship exemption.
July 1, 2014, is the deadline for physicians who have been unable to demonstrate meaningful use of electronic health records (EHRs) to apply for a hardship exemption, or face a payment adjustment beginning Jan. 1, 2015. If approved, the exception is valid for one year.  Read more…
Read the CMS Hardship Exception Guidance (PDF)…
Read the CMS tip sheet (PDF)…

6. Opinion: Physicians expected to consider cost of care in wake of pricing transparency movement.
A perspective piece published in the June 18 issue of The Journal of the American Medical Association argues that, with healthcare spending accounting for 18 percent of the U.S. gross domestic product, physicians need to “become better stewards of medical resources.” The author notes that organizations such as the American College of Cardiology, the American Heart Association, and the American Society of Clinical Oncology have announced plans to integrate cost information into their clinical guidelines, and initiatives such as Choosing Wisely “urge physicians to avoid low-value interventions and highlight more cost-effective options.” A spokesperson for the non-profit organization Costs of Care points out that traditional physician training has deemphasized healthcare costs in favor of a paradigm in which “doing more is equated with being thorough.” However, growing price transparency increases the pressure on physicians to act as financial stewards, and physicians will continue to be challenged to “incorporate cost information in care decisions in an ethical and reasonably pragmatic manner.”   Read more…

7. Residents and fellows who end training in 2014 must complete transition form to retain AAOS membership.
Residents and fellows whose training ends in 2014 must complete a short online transition form to retain their AAOS membership. An email was sent to all eligible residents and fellows on May 23. If you did not receive the email containing the transition form link and information, please contact Lucy Free, membership services representative, at  free@aaos.org.
Access the form…(member login required)

8. Call for volunteers: Evaluation Committees.
July 11 is the last day to submit your application for a position on an Evaluation Committee. Members of Evaluation Committees write questions for the various orthopaedic Self-Assessment Examinations. The following positions are available:

  • Anatomy-Imaging
    • Foot and Ankle (one member)
    • Hand and Wrist (two members)
    • Spine (two members)
    • Tumors (two members)
  • Hand & Wrist (chair, nine members)
  • Musculoskeletal Tumors & Diseases (chair, five members)
  • Shoulder & Elbow (three members)

Applicants for a chair position must be active fellows who have served at least one term on the Central Evaluation Committee or an Evaluation Committee, and who have a practice emphasis in the relevant area. Applicants for member positions must be active fellows, emeritus fellows, candidate members, or candidate member applicants for fellowship with a practice emphasis in the relevant area.
Openings also exist on a number of other committees, subcommittees, councils, and cabinets. Visit the Committee Appointment Program website regularly to view new openings and find one that interests you.
Learn more and submit your application…(member login required)


June 20, 2014

Today’s Top Story
1. Study: Both mobile-bearing and fixed-bearing TAA devices improve gait and reduce pain, but in different ways.
A study published in the June 18 issue of The Journal of Bone & Joint Surgery examines differences between mobile-bearing and fixed-bearing total ankle arthroplasty (TAA) devices. The authors observed 90 patients who underwent TAA—49 with mobile-bearing devices and 41 with fixed-bearing devices. At 2-year follow-up, they found no significant difference in ankle motion or step time between implant types or across time. However, they did note a greater increase in peak plantar flexion moment and Short Form-36 total scores across time in the fixed-bearing group compared to the mobile-bearing group. Conversely, patients in the mobile-bearing group exhibited greater improvement in visual analog scale pain scores compared to those in the fixed-bearing group. Independent of time, patients in the fixed-bearing group demonstrated a significant increase in weight-acceptance and propulsion ground reaction forces compared with the mobile-bearing group, while patients in the mobile-bearing group completed the Sit-to-Stand test significantly faster.
Read the abstract…

Other News
2. Bipartisan group of senators proposes that Medicare take patient’s financial status into account when determining readmissions penalties.
Kaiser Health News reports that a bipartisan group of senators has introduced legislation that, if enacted, would force Medicare to take the financial status of hospital patients into account when determining readmissions penalties called for under the Affordable Care Act. Healthcare experts have previously noted that hospitals with large, low-income patient populations are more likely to be penalized, because their patients tend to be sicker and more likely to return after discharge. An advisory committee to Congress has recommended changes to the readmissions program, and the concept of taking socio-economic status into account has been endorsed by a panel convened by the National Quality Forum.   Read more…

3. Study: “Mobilized” stem cells appear to inhibit OA progression in rats.
According to information from a Taiwanese study published online in the journal Cell Transplantation, G-CSF-mobilized peripheral blood stem cells (gm-PBSCs) may stimulate bone marrow to produce stem cells and inhibit osteoarthritis (OA) progression. The researchers evaluated histologic changes in glycosaminoglycan, type II collagen, type X collagen, modified Mankin score, and cell apoptosis rate in the articular cartilage of rat knees. At 3- and 6-week follow-up, they found that gm-PBSCs inhibited progression of papain-induced OA by reducing articular surface irregularity, fibrillation, and erosion, and preventing cellular necrosis and loss of chondrogenic proteins.   Read more…
Read the abstract, with links to an ePub of the complete study…

4. Study: Concussion symptoms may persist for weeks after incident.
A study published online in the journal Pediatrics examines the incidence, duration, and clinical course of post-concussive symptoms in children with concussion. The research team conducted a secondary analysis of a prospective cohort study of patients 11 to 22 years old who presented with an acute concussion.to the emergency department (ED) of a children’s hospital. They found that headache, fatigue, dizziness, and taking longer to think were the most common symptoms encountered at presentation, while sleep disturbance, frustration, forgetfulness, and fatigue were most likely to not be initially present yet develop during the follow-up period. The median duration of symptoms was the longest for irritability (16 days), sleep disturbance (16 days), frustration (14 days), and poor concentration (14 days). Nausea, depression, dizziness, and double-vision abated most quickly. At 1 month after injury, nearly a quarter of children still complained of headache, more than 20 percent suffered from fatigue, and nearly 20 percent reported taking longer to think.
Read the abstract…

5. Does increasing GME funding produce more physicians?
A perspective piece published in the June 19 issue of The New England Journal of Medicine looks at the economics of graduate medical education (GME). The authors explain that education funding consists of direct medical education (DME), which pays the salaries of residents and supervising physicians, and indirect medical education (IME), which subsidizes the higher costs that hospitals incur when operating training programs. They note that conventional wisdom suggests that increasing GME funding is a key to addressing physician shortages. However, the authors suggest that DME does little to offset the cost of training physicians, arguing that residents essentially pay the full cost of their training, while the DME program simply transfers money to recipient hospitals. IME, they say, is more controversial in terms of both reimbursement cost accuracy and the underlying concept, ie, paying institutions more because they spend more, rather than because they provide higher value. “…it is important to recognize that achieving the goals that have been deemed desirable for 21st-century health care will require much more than expanding the GME program under the pretext of solving the physician shortage; we must instead ensure that limited public monies are spent in ways that achieve clearly articulated goals,” the authors write.   Read more…

6. All-payer claims databases: Helpful or wasteful?
An article in USA Today offers background on a growing trend of states setting up all-payer claims databases (APCDs), which require all commercial insurance carriers to submit claims data, including the prices paid. The article notes that 19 states have APCDs in varying stages of development, and at least 21 states are considering laws to create them. Critics argue that such databases are expensive and possibly duplicative, and a national database of all payer data would be more informative and efficient. Supporters respond that states are in the best position to collect claims data from all payers, and that the costs of the databases are low compared to overall healthcare expenditures.   Read more…

7. FDA issues proposed policy to address misinformation on social media.
The U.S. Food and Drug Administration (FDA) has issued draft guidance on how manufacturers and distributors of drugs and medical devices should respond, if they choose to respond, to misinformation about a firm’s products presented on social media. Among other things, FDA argues that firms should offer appropriate corrective action that is relevant and responsive to the misinformation, be non-promotional in nature and tone, be accurate and consistent with FDA labeling for the product, and be posted in conjunction with the misinformation in the same area or forum. In addition, the agency suggests that the person providing the corrective action disclose his or her affiliation with the relevant firm. FDA states that the recommendations are non-binding.   Read more…
FDA has also issued draft guidance for industry on presenting information on internet and social media platforms with character space limitations such as Twitter. Read more…

8. Call for volunteers: Candidate, Resident, and Fellow Committee.
July 31 is the last day to submit your application for a position on the Candidate, Resident, and Fellow Committee (one resident member opening). This committee works with the resident workgroup and is responsible for any and all issues concerning residents and candidate members. Applicants for this position must be PGY-1, PGY-2, or PGY-3 resident members or resident members osteopathic who have an active interest in the development of young orthopaedic professionals.
Openings also exist on a number of other committees, subcommittees, councils, and cabinets. Visit the Committee Appointment Program website regularly to view new openings and find one that interests you.
Learn more and submit your application…(member login required)

June 23, 2014

Today’s Top Story
1. Study: Younger patients and male patients at greater risk for deep infection after primary shoulder arthroplasty.
A study published online in the journal Clinical Orthopaedics and Related Research examines risk factors for deep infection after primary shoulder arthroplasty. The research team conducted a retrospective cohort study of 3,906 patients with mean 2.7-year follow-up. They found that every 1-year increase in age was associated with a 5 percent decrease in risk of infection. Male patients were 2.59 times more likely to experience deep infection than female patients, and patients undergoing primary reverse total shoulder arthroplasty had a 6.11 times greater risk of infection compared with patients having primary unconstrained total shoulder arthroplasty. In addition, patients who underwent traumatic arthroplasties were 2.98 times more likely to have infection develop than patients who underwent elective arthroplasties. Propionibacterium acnes was the most commonly cultured organism, accounting for 31 percent of isolates overall. Body mass index, race, ASA score, and diabetes status were linked to increased risk of infection.
Read the abstract…

Other News
2. Study: SSI rates higher with vancomycin; suggested dosages may be too low.
Data from a study published in the June 18 issue of The Journal of Bone & Joint Surgery (JBJS) question whether the generally accepted recommendations for vancomycin dosage as prophylaxis for surgical site infection (SSI) are too low. The authors conducted a retrospective cohort study of 18,830 elective primary arthroplasties (12,823 knee and 6,007 hip). They found that the overall 30-day SSI rate was 1.4 percent, with unadjusted rates of 2.3 percent with vancomycin only, 1.5 percent with vancomycin plus cefazolin, 1.3 percent with cefazolin only, and 1.1 percent with clindamycin. The authors note that current Surgical Care Improvement Project guidelines address antibiotic timing but not antibiotic dosage, and suggest that their finding of higher SSI rates following prophylaxis with vancomycin may “suggest a failure to use an appropriate dosage rather than an inequality of antibiotic effectiveness.”
Read the abstract…

3. Study: Denosumab treatment associated with reduction in bone turnover among postmenopausal women.
According to information presented at the joint meeting of the International Society of Endocrinology and the Endocrine Society, treatment with denosumab may be associated with persistent reduction of bone turnover, continued increases in bone mineral density (BMD), and low fracture incidence. The researchers drew data from women participating in the ongoing, multinational FREEDOM clinical trial open-label extension. They found that, after 8 years of denosumab treatment in the long-term group, mean BMD continued to increase from the FREEDOM baseline for cumulative gains of 18.4 percent at the lumbar spine and 8.3 percent at the total hip. After 5 years of denosumab treatment in a separate, cross-over group, the mean BMD increase from the extension baseline was 13.1 percent at the lumbar spine and 6.2 percent at the total hip. The incidence of new vertebral and nonvertebral fracture remained low throughout the extension, with hip fracture incidence of 0.2 percent for patients in the long-term cohort and 0.1 percent for patients in the crossover cohort.   Read more…
Read the abstract…

4. Study: All-polyethylene may be as effective as metal-backed tibial components for TKA.
Findings published in the June 18 issue of JBJS suggest that all-polyethylene tibial components may be at least as good as or superior to metal-backed tibial components, with respect to implant survivorship at 10 years in cruciate-retaining total knee arthroplasties (TKAs). The research team identified 27,733 cruciate-retaining TKAs using a press-fit condylar prosthesis with either metal-backed or all-polyethylene tibial components from the Swedish Knee Arthroplasty Register. At median 4.5-year follow-up, they found that all-polyethylene tibial components had slightly superior, unadjusted 10-year survival compared with the metal-backed component. After adjustment, they noted that all-polyethylene components had a reduced risk of revision for any reason and a reduced risk of revision due to infection compared to metal-backed components.
Read the abstract…

5. Report: Nearly 6 in ten ACA enrollees were previously uninsured.
A report released by the Kaiser Family Foundation finds that 57 percent of enrollees who signed up for insurance through Affordable Care Act (ACA) health insurance exchanges were previously uninsured. “Most of this previously uninsured group reports having gone without coverage for two years or more,” the authors write, “and for many the ACA was a motivator in seeking coverage; seven in ten of those who were uninsured prior to purchasing a Marketplace plan say they decided to buy insurance because of the law, while just over a quarter say they would have gotten it anyway.” Among other findings in the report:

  • Enrollees in ACA-compliant plans report somewhat worse health than those in pre-ACA plans.
  • More than four in ten purchasers of ACA plans find it difficult to afford their monthly premiums, and more than six in ten are worried about future affordability.
  • Among plan switchers, as many report paying less as paying more for their new plans, but there is a trend toward narrowing provider networks.
  • People getting subsidies are most likely to feel they have benefited from the ACA, while those most likely to feel negatively impacted are those who had their plans cancelled.

Read more…
Read the complete report (PDF)…

6. California.
The Los Angeles Times reports that officials at the California Department of Managed Health Care are investigating reports that consumers may have been misled by inaccurate provider lists provided by insurers. The agency is looking into two insurance companies that limited their networks under plans provided under the ACA. A number of insurers limited physician networks as a way to obtain lower rates from providers as the new healthcare law was implemented. However, some patients have complained that they received treatment under their ACA plans, only to learn after the fact that their insurer considered the provider to be out of network.   Read more…

7. Please complete your 2014 AAOS Orthopaedic Surgeon Census now!
AAOS is asking all members to participate in the AAOS 2014 census of orthopaedic surgeons. Final fax and email reminders were sent out June 9, with directions on how to submit responses. The census is taken to ensure that AAOS members are accurately represented in advocacy, funding, and reimbursement efforts. The information also helps AAOS tailor programs, products, and services to address professional needs and interests of its members. All individual responses are kept confidential. Please respond by June 30, 2014. For further information, please contact the AAOS research department, at  aaosresearch@aaos.org.
View the report from the 2012 census…

8. Call for volunteers: Diversity Advisory Board.
July 31 is the last day to submit your application for a position on the Diversity Advisory Board (one member-at-large; one resident member opening). The Diversity Advisory Board serves as a resource to all AAOS bodies on issues involving diversity in the orthopaedic community and in the provision of culturally competent musculoskeletal care. Applicants for the member-at-large position must be active fellows, candidate members, candidate members osteopathic, candidate members applicant for fellowship, candidate member applicants for fellowship osteopathic, associate members orthopaedic, or associate members osteopathic. Applicants for the resident member position must be PGY1, PGY2, or PGY3. All applicants should have a high energy level and a strong desire to make a positive difference regarding diversity in orthopaedics.
Openings also exist on a number of other committees, subcommittees, councils, and cabinets. Visit the Committee Appointment Program website regularly to view new openings and find one that interests you.
Learn more and submit your application…(member login required)

June 25, 2014

Today’s Top Story
1. Study: Mortality rates similar for hip fracture patients treated surgically using either regional or general anesthesia.
A study published in the June 25 issue of The Journal of the American Medical Association finds no significant difference in mortality for patients undergoing hip fracture surgery who are treated with regional or general anesthesia. The authors conducted a matched, retrospective cohort study of 56,729 patients aged 50 years or older who underwent surgery for hip fracture at general acute care hospitals between July 1, 2004, and Dec. 31, 2011. Overall, 15,904 patients received regional (spinal or epidural) anesthesia and 40,825 received general anesthesia. Using a near-far instrumental variable match that paired patients who lived at different distances from hospitals that specialized in regional or general anesthesia, the authors found that 5.3 percent of matched patients (583 of 10,757) who lived near a regional anesthesia–specialized hospital died within 30 days, compared to 5.4 percent of matched patients (629 of 10,757) who lived near a general anesthesia–specialized hospital. However, the authors noted that use of regional anesthesia was associated with a 0.2-day shorter length of stay than general anesthesia.   Read more…
Read the complete study…

Other News
2. Studies compare ASC pricing against hospitals and across states.
Two studies from the Workers Compensation Research Institute look at the pricing variation associated with ambulatory surgery centers (ASCs). In the first, a research team analyzed ASC and hospital outpatient facility payments in 23 states for commonly performed knee and shoulder surgeries and found that ASC surgeries were often less expensive than hospital outpatient surgeries. However, in certain states, including Connecticut, Georgia, New Jersey, North Carolina, and Tennessee, all or some ASC surgeries were more expensive. The research team noted that the cost of ASC surgeries appeared to vary based on underlying fee schedule regulations.   Read more…
The second study looked at actual payments across the same 23 states for services associated with common shoulder and knee injury conditions for workers with workers’ compensation claims. The research team found that ASC payments for surgeries performed in higher-cost states were at least three times the payments for similar surgeries performed in lower-cost states. For example, the average ASC payment for knee arthroscopy was less than $2,000 in four study states and more than $6,000 in seven study states. The research team noted that payments for common surgical procedures were more predictable in states with fixed-amount fee schedules and less predictable in states without fixed-amount fee schedules. Read more…

3. Study: Trauma patients may be transferred more often under alternate pay systems.
Data published online in the Journal of Orthopaedic Trauma suggest that changes in the healthcare reimbursement system may affect the likelihood that orthopaedic surgeons would transfer trauma patients to tertiary care centers. The researchers conducted an email survey of 151 orthopaedic surgeons. Overall, 71.1 percent of respondents were in private practice, while 28.3 percent practiced in academic centers. Respondents were polled on three case-based scenarios, with five options for management of each case. Each case was presented in three different settings:

  • The current fee-for-service system
  • A system in which 90-day reoperation or readmission would not be reimbursed
  • A capitated healthcare structure that pays a fixed amount per patient

The researchers found a significant increase in each case in the respondents’ choice to transfer patients to tertiary care centers under both the capitated and penalization systems as compared to the current fee for service model.
Read the abstract…

4. Canadian organizations release guidelines to assist with diagnosis and management of pediatric concussion.
The Children’s Hospital of Eastern Ontario and the Ontario Neurotrauma Foundation have jointly released a set of guidelines for the diagnosis and management of pediatric concussion. The authors state that the guidelines are designed to provide healthcare providers with evidence-based recommendations to standardize the diagnosis and management of concussion in children aged 5 to 18 years old, from initial assessment through recovery. The guidelines include a pocket assessment tool to be used by coaches or parents on the sidelines of sporting events, algorithms for emergency department physicians to guide decision making on whether or not to obtain computed tomography scans, and recommendations for family physicians and other providers regarding symptom management and “return to learn” as well as “return to play.”   Read more…
Read the complete guidelines (PDF)…
View additional information and related links…

5. Final reminder: Physicians must apply now for EHR meaningful use hardship exemption.
July 1, 2014, is the deadline for physicians who have been unable to demonstrate meaningful use of electronic health records (EHRs) to apply for a hardship exemption. Physicians who cannot demonstrate meaningful use of EHRs and do not have a hardship exemption will face a payment adjustment beginning Jan. 1, 2015. If approved, the exception is valid for 1 year.
Read the U.S. Centers for Medicare & Medicaid Services (CMS) Hardship Exception Guidance (PDF)…
Read the CMS tip sheet (PDF)…

6. Colorado.
The Colorado Supreme Court has overturned a lower court ruling in which a patient’s unsafe behavior was discounted from a medical liability determination. In the relevant case, a patient was left in a vegetative state after suffering cardiac and respiratory arrest during a fine-needle biopsy procedure. Later, the patient’s girlfriend asked one of the attending physicians if the patient’s prior cocaine use could have contributed to his injuries. A trial court ruled that the girlfriend’s statement was admissible for the purpose of determining medical liability. An appeals court later overturned the ruling, but the state Supreme Court upheld the trial court’s decision.   Read more…
Read the complete judgment…

7. Your help is needed! Voting reopened on AAOS resolutions and bylaws.
Balloting on AAOS resolutions and bylaw amendments has reopened. A vote of at least 20 percent of fellows is required for an official vote. If you have not voted, please help by casting your ballot to retain or rescind AAOS resolutions or bylaw amendments. The ballot should take no more than 2 minutes of your time.
Cast your ballot…

8. Call for volunteers: Research Development Committee.
August 1 is the last day to submit your application for a position on the Research Development Committee (chair, two members-at-large, one resident member openings). This committee promotes orthopaedic research through advocacy, education, and recognition of excellence. Applicants for the chair position must be active or emeritus fellows with extensive knowledge and experience in orthopaedic basic and clinical research. Applicants for the members-at-large positions must be active fellows or associate member basic science with in-depth knowledge and experience in orthopaedic research. Applicants for the resident member position must be PGY1, PGY2, or PGY3 and provide a letter of support from their residency program director.
Openings also exist on a number of other committees, subcommittees, councils, and cabinets. Visit the Committee Appointment Program website regularly to view new openings and find one that interests you.
Learn more and submit your application…(member login required)

June 27, 2014

Today’s Top Story
1. Study: Primary care follow-up associated with reduced readmissions for high-risk surgery patients with perioperative complications.
Findings published online in the journal JAMA Surgery suggest that early follow-up with a primary care provider (PCP) after high-risk surgery may help reduce hospital readmissions. The research team reviewed data on Medicare beneficiaries discharged to home after open thoracic aortic aneurysm (TAA) repair (n = 12,679; high risk of readmission group) or ventral hernia (VHR) repair (n = 52,807; low risk of readmission group). They found that early follow up with a PCP was associated with a significantly reduced risk of readmission among open TAA patients who experienced perioperative complications, from 35.0 percent to 20.4 percent. The research team noted that PCP follow-up made no significant difference among TAA patients whose hospital course was uncomplicated, nor among patients who underwent VHR repair. After adjustment, the research team found that undergoing open TAA repair in regions with high primary care use was associated with an 18 percent reduced likelihood of 30-day readmission, compared to regions with low primary care use.  Read more…
Read the abstract…

Other News
2. Study: Single-stage TKA revision may offer similar outcomes to two-stage revision.
A study published in the June issue of The Bone & Joint Journal suggests that a single-stage revision following failure of a total knee arthroplasty (TKA) may offer comparable results to a two-stage revision. The authors reviewed data on a consecutive series of 50 single-stage revision TKAs for established deep infection performed between 1979 and 2010. At mean 10.5-year follow-up, they found that only one patient required further revision for recurrent infection, while nine required further revision for aseptic loosening, based on microbiologic testing of biopsies taken at the subsequent surgery. Three additional patients developed a further septic episode but did not require another revision. The authors argue that the data suggest that single-stage revision may produce comparable results to two-stage revision, along with the added benefit of cost reduction and less morbidity and inconvenience for patients.
Read the abstract…

3. Study: Controlled muscular contractions may help strengthen bone.
Data from a rat study published online in the journal Proceedings of the Royal Society B suggest that controlled muscular contractions may be used to strengthen bone in targeted areas. The researchers used implantable stimulators to elicit programmed contractions of the left tibialis anterior (TA) muscle in Wistar rats, with the right TA muscle used as a contralateral control. After contraction of the left TA every 30 seconds for 28 days, the researchers found significant increases in cross-sectional area and bone volume in the stimulated limbs. In addition, the researchers noted a large region of new bone, containing clusters of chondrocytes, indicative of endochondral ossification.   Read more…
Read the abstract…

4. Study looks at trends in FDA warning letters to clinical investigators and review boards.
A study published online in the Journal of Medical Ethics examines 84 first warning letters issued to trial sponsors, lead researchers, and institutional review boards (IRBs) by the U.S. Food and Drug Administration (FDA) from 2005 to 2012. The authors found that 46 warning letters were issued to sponsors, with the most common violations being failure to follow a monitoring schedule (58.69 percent), failure to obtain investigator agreement (34.78 percent), failure to secure investigators’ compliance (30.43 percent), and failure to maintain data records and ship documents to investigators (30.43 percent). The authors also compared recent trends against letters sent earlier in the study period and noted that, between January 2011 and December 2012, failure to protect subject safety and to report adverse events to IRBs was found to be significant compared to prior studies for clinical investigators, while failure to follow standard operating procedures and maintain documentation was significant in warning letters to IRBs. In addition, failure to maintain minutes of meetings and to follow written procedures for continuing review were new substantial violations in warning letters issued to IRBs.   Read more…
Read the complete study…

5. Supreme Court allows Medtronic device lawsuit to proceed.
The Minneapolis StarTribune reports that the U.S. Supreme Court has declined to hear an appeal from Medtronic Inc. to stop a liability lawsuit regarding the alleged malfunction of a device designed to deliver pain drugs to the spinal cord. The company had argued that, under the legal concept of preemption, the device’s approval by FDA severely limited the plaintiff’s ability to sue for injuries. A federal district court judge agreed and threw the suit out, but that decision was overturned on appeal. The Supreme Court decision means the case can proceed.   Read more…

6. Michigan.
An article published on MLive looks at failed efforts in Michigan to improve transparency regarding hospital-acquired infections (HAIs). The author notes that, since 2005, four bills have been introduced in the Michigan Legislature that would have required hospitals to report data on HAIs to the state, and an additional two bills would have created a commission to recommend best practices on eliminating HAIs, but none have made it through the legislature. According to the author, “the [Michigan Health and Hospital Association] and seven major hospital systems collectively spent more than $1 million to influence lawmakers last year, not counting campaign contributions or payments to other lobbying firms.”   Read more…

7. Submit papers now for Kappa Delta and OREF Clinical Research Awards.
July 1, 2014, is the deadline for receipt of manuscripts submitted for the 2015 Kappa Delta Awards and the Orthopaedic Research and Education Foundation (OREF) Clinical Research Award. Up to two $20,000 Kappa Delta awards (Elizabeth Winston Lanier Award and Ann Doner Vaughan Award), one $20,000 Kappa Delta Young Investigator award, and one $20,000 OREF award will be bestowed, provided manuscripts of requisite quality are submitted. Manuscripts should represent a large body of cohesive scientific work generally reflecting years of investigation. If the submission reflects a single project, it should be of high significance and impact. Manuscripts must be submitted by members (or candidate members) of the AAOS, Orthopaedic Research Society, Canadian Orthopaedic Association, or Canadian Orthopaedic Research Society. Please note that submissions for the 2015 Kappa Delta and OREF Clinical Research Awards will be accepted in electronic format only. A PDF of the entire submission must be emailed no later than 11:59 p.m. CT on July 1, 2014. Late submissions will not be considered.   Read more…
Please submit your manuscript to: kappadelta@aaos.org

8. Last call: Committee positions closing soon!
A number of openings on the AAOS Committee Appointment Program website are closing June 30. Act now to apply for the following positions:

  • Committee on Professionalism (two member openings)
  • International Committee (one member, one resident member)
  • Judiciary Committee (chair, one member)

Openings also exist on a number of other committees, subcommittees, councils, and cabinets. Visit the Committee Appointment Program website regularly to view new openings and find one that interests you.
Learn more and submit your application…

June 30, 2014

Today’s Top Story
1. Report suggests continued increasing trend toward hospital physician employment.
A report released by the consulting firm Merritt Hawkins states that fewer than 10 percent of the company’s search assignments conducted from April 1, 2013, to March 31, 2014, were for settings featuring private practice, compared to more than 45 percent of such assignments in 2004. Overall, 64 percent of search assignments were for hospital-employed settings. The report notes that orthopaedic surgery saw the second-highest salary increase by percentage across all specialties, with a 5.1 percent raise from 2013 to 2014. The information is based on 3,158 permanent physician and advanced practitioner search assignments.   Read more…
Read the complete report…(registration may be required)

Other News
2. Study questions the appropriateness of some TKAs.
Findings from a study published online in the journal Arthritis & Rheumatology call into question the appropriateness of many total knee arthroplasty (TKA) procedures performed in the United States. The researchers assessed 205 participants who underwent TKA and were enrolled in the prospective Osteoarthritis Initiative study. Based on a modified version of an appropriateness classification system developed by Escobar et al. and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) Pain and Physical Function scales, they classified 44.0 percent of surgeries as appropriate, 21.7 percent as inconclusive, and 34.3 percent as inappropriate. The researchers argue that the data support the need for consensus development of criteria for patient selection among practitioners who treat potential TKA candidates.   Read more…
Read the abstract…
The AAOS has prepared appropriate use criteria for non-arthroplasty treatment of osteoarthritis of the knee, as well as a web-based app to assist in clinical decision-making.
View the app…

3. Study: Fluoroscopy and navigation may offer similar accuracy for leg length reconstruction in MIS THA.
Data from a study published online in the journal Clinical Orthopaedics and Related Research suggest that intraoperative fluoroscopy and imageless navigation may offer equivalent accuracy for the reconstruction of leg length and global and femoral offset during minimally invasive (MIS) total hip arthroplasty (THA). The authors conducted a prospective study of 125 patients randomized to either navigation-guided or fluoroscopy-controlled THA. They found mean differences of 0.2 mm in leg length restoration, 0.2 mm in global offset, and 1.7 mm in femoral offset between fluoroscopy and navigation. The authors noted that biomechanical reconstruction with a residual leg length less than 5 mm succeeded in 93 percent of the navigation group and 54 percent of the fluoroscopy group; global and femoral offset discrepancy of less than 8 mm succeeded in 98 percent of the navigation group, and 95 percent of the fluoroscopy group.
Read the abstract…

4. Proposed legislation would limit changes to Medicare Advantage physician networks.
The Hartford Courant reports that legislation introduced in both houses of the U.S. Congress would, if enacted, require health insurers to finalize their physician networks for Medicare Advantage plans 60 days before the start of autumn enrollment. In addition, insurance companies that offer Medicare Advantage would be required to disclose the reasons for ending contracts with providers. Supporters of the proposal state that its adoption would prevent patients from having to choose between paying out-of-network costs or changing physicians mid-year.   Read more…

5. Are some readmissions simply not preventable?
The authors of an article published online in the Journal of Hospital Medicine look at the strengths and limitations of metrics used by the U.S. Centers for Medicare & Medicaid Services (CMS) to assess financial penalties for higher-than-expected readmission rates. The authors note that CMS efforts to reduce readmissions assume that a significant number of those readmissions are “reasonably preventable.” However, they write that “there is no consensus in the medical and policy communities on how to define preventable readmissions, which is essential for taking action to reduce them,” and argue that available research suggests that many readmissions may not be preventable. The authors offer a series of suggestions to assist stakeholders with addressing key challenges to measure and reduce preventable readmissions.   Read more…
Read the abstract…

6. Study: MicroRNA miR-34a may suppress osteoclastogenesis and bone resorption.
Research published online in the journal Nature suggests that the microRNA miR-34a may be a key osteoclast suppressor. The research team found that osteoclastic miR-34a-overexpressing transgenic mice exhibited lower bone resorption and higher bone mass, while miR-34a knockout and heterozygous mice exhibited elevated bone resorption and reduced bone mass. The research team suggests that the findings suggest a potential therapeutic strategy to confer skeletal protection and ameliorate bone cancer metastasis.   Read more…
Read the abstract…

7. OKOJ July updates now online!
Check out the new topics and video in the Orthopaedic Knowledge Online Journal (OKOJ) on the AAOS OrthoPortal website. The following topics have been recently added or updated: “Diagnostic Knee Arthroscopy: Surgical Technique,” “Neuromas of the Foot and Ankle,” and “Pathologic Fractures of the Femur and Humerus.” In addition, a new video, “Diagnostic Knee Arthroscopy,” has been made available.
View these topics and more…

8. Call for volunteers: Patient Education Committee.
July 31 is the last day to submit your application for a position on the Patient Education Committee (one member-at-large opening). The Patient Education Committee develops and updates patient education materials designed to assist members in their interactions with patients and improve patient information about orthopaedic diseases and injuries. Applicants for this position must be active fellows with writing and editing skills that target the lay audience.
Openings also exist on a number of other committees, subcommittees, councils, and cabinets. Visit the Committee Appointment Program website regularly to view new openings and find one that interests you.
Learn more and submit your application…(member login required)

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