Today’s Top Story

Study Evaluates Outcomes in Computer-assisted Kinematic TKA

In a study published online in The Bone & Joint Journal, researchers assessed medial and lateral gap laxity differential outcomes in computer-assisted kinematic total knee arthroplasty (TKA) patients. The study included 192 computer-assisted kinematic TKAs performed by a single surgeon; mean follow-up was 3.5 years. Most patients (n = 116, 60 percent) were male, and mean age was 65 years. Postoperative limb alignment had no impact on results; only the standing hip-knee-ankle (HKA) angle positively predicted the joint line convergence angle (JCLA). Patients with greater lateral flexion gap laxity had better outcomes, but this was not associated with HKA angle, JCLA, or lateral extension gap laxity. About 33 percent of patients required minor releases.

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Other News

Study: Predictors of Stiffness Following Arthroscopic Rotator Cuff Repair

A study published in the April 1 issue of the Journal of the AAOS identified patient-related risk factors associated with stiffness requiring operation following arthroscopic rotator cuff repair (RCR). Researchers queried the PearlDiver database to obtain information on isolated arthroscopic RCR patients from 2007 to 2015. Of 19,229 patients, 232 (1.2 percent) required a postoperative manipulation under anesthesia and/or lysis of adhesions within the first nine months following RCR. The most significant risk factors were age younger than 50 years, female sex, type 1 diabetes mellitus (but not type 2 diabetes mellitus), hypothyroidism, and systemic lupus erythematosus.

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Study: Postoperative THA Pain Treatments Yield Similar Outcomes

A study published online in Acta Anaesthesiologica Scandinavica found that various analgesic treatment routines at different hospitals following total hip arthroplasty (THA) did not have largely differing results. A total of 501 THA patients were treated at five Danish hospitals from April 2014 to April 2016. The two primary outcomes were pain during mobilization six hours postoperatively (numeric rating scale [NRS] zero to 10) and morphine consumption within the first 24 hours postoperatively. No two hospitals used the same basic analgesic regimen. Across the five hospitals, the NRS pain level during six-hour mobilization was five, and the 24-hour intravenous morphine consumption was 25 mg. Pain levels tended to be low to moderate at rest and moderate during mobilization. Some hospitals exhibited differences in morphine use, but researchers did not identify a nonopioid analgesic regimen that was consistently clinically superior.

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Study Finds Increased Cervical and Lumbar Spine Pain in Obese Patients

Obese patients who were eligible for bariatric surgery had worse pain in the cervical and lumbar spine compared to nonobese patients, according to a study published online in the European Spine Journal. Researchers compared body mass index, visual analog scale (VAS) cervical and lumbar spine pain, Neck Disability Index (NDI), Oswestry Disability Index (ODI), and radiographic spine and pelvis parameters in 30 obese patients and 25 nonobese controls. Cervical and lumbar VAS, NDI, and ODI were significantly worse in the obese cohort. Obese patients also had higher variance in the cervical sagittal vertical axis, as well as a more diminished cervical lordosis compared to the control group. There were no significant differences in thoracic kyphosis, lumbar lordosis, and pelvic parameters.

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Study: Are After-hours Calls Beneficial in a Joint Replacement Practice?

A study published online in The Journal of Arthroplasty evaluated the effectiveness of an after-hours contact phone number for total joint replacement patients to contact a surgical team member after discharge. Researchers collected data on phone calls from July 3, 2017, through Oct. 3, 2017, that took place after 4 pm., during weekends, and on holidays. They documented the duration, chief complaint, and resolution of all phone calls. The phone number provided access to a surgeon or midlevel provider on the Hip and Knee Reconstruction Service. During the study period, 325 cases were performed, and a total of 68 phone calls were placed by 55 patients; 26 went to surgeons, and 42 went to midlevel providers. Calls lasted an average of 3.9 minutes and were made an average of 17.5 days after surgery. Poor health literacy was correlated with increased calls during the first postoperative week; there was an association between pain as the chief complaint and primary versus revision surgery. The researchers concluded that an after-hours call option may provide reassurance for some patients.

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Are You Ready to Change your Practice?

Are you thinking about tapering your surgical practice or retiring from surgery altogether? Are you tired of the electronic medical records, insurance denials, and constant administrative changes? Do you worry about malpractice exposure, despite practicing a good standard of medicine? Does the adrenaline no longer surge when you are performing emergency cases? Eugene Pepper Toomey, MD, described his personal account of changing practice and common issues a physician may face when making this paradigm shift.

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Nominate a Colleague for the AAOS Diversity, Humanitarian, or Tipton Leadership Awards

AAOS is now accepting nominations for the 2020 Diversity and Humanitarian Awards and the William W. Tipton Jr, MD, Orthopaedic Leadership Award. These awards are presented at the AAOS Annual Meeting. The respective award recipients are recognized for their endeavors to further encourage diversity or culturally competent care, participation in humanitarian activities, or leadership activities in the orthopaedic profession. The last day to submit nominations for the Humanitarian Award is May 17; the last day to submit nominations for the Diversity and Tipton Awards is June 14.

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