August 14, 2019
Today’s Top Story

Study: Does Socioeconomic Status Affect Amputation Risk in TKA?

Patients who are poorer or are Medicaid or Medicare beneficiaries may be more likely to require above-knee amputation (AKA) after periprosthetic joint infection (PJI) resulting from total knee arthroplasty (TKA), according to a cross-sectional study published in the July issue of Clinical Orthopaedics and Related Research. The National Inpatient Sample was queried for data spanning 2010 through 2014. Using the International Classification of Diseases, 9th Revision, Clinical Modification procedure and diagnosis codes, researchers identified 912 AKAs out of 32,907 PJIs of the knee. Males comprised 52 percent of the AKA cohort. Patients in the lowest income quartile by zip code, compared to the wealthiest patients, had a greater AKA risk, as did Medicare and Medicaid beneficiaries compared to those with private insurance. Race and sex did not affect AKA risk.

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In Other News

Study Assesses Low-intensity Pulsed Ultrasound on Spondylolysis in Athletes

According to a case-control study published in the July issue of the Clinical Journal of Sport Medicine, young athletes with early-stage lumbar spondylolysis may benefit from low-intensity pulsed ultrasound (LIPUS). The study took place at an outpatient orthopaedic and sports clinic and included 82 young athletes (mean age, 14.8 years; 80 were boys) with early-stage lumbar spondylolysis. All patients underwent radiographic evaluation and MRI and were stratified to receive standard conservative treatment (including thoracolumbosacral brace, sports modification, and therapeutic exercise) with (n = 35) or without (n = 47) LIPUS. The LIPUS group had a significantly shorter median return to previous sports activities time (61 days) compared to the non-LIPUS group (167 days).

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Study: SSI Care Bundles in the Pediatric Setting

In a study published in the August issue of the Journal of Pediatric Orthopaedics, researchers identified common elements of surgical site infection (SSI) care bundles to help prevent SSIs in pediatric spinal surgery. Pediatric orthopaedic surgeons who requested a copy of the SSI prevention care bundle were asked to respond to a survey. Surgeons were eligible to participate if they had taken part in the 2016 Pediatric Orthopaedic Society of North America Quality, Safety, and Value Initiative challenge; performed pediatric spine surgery; and had a spine SSI bundle. The SSI bundles were stratified into three categories based on frequency of pre-, intra-, and postoperative elements. Final analysis included 16 care bundles from 15 institutions. The following elements were included in at least three-quarters of the evaluated SSI bundles: use of preoperative antibiotics, use of preoperative chlorhexidine wipes, intraoperative use of wound irrigation, and a standardized prescription for the length of postoperative antibiotic.

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Study Evaluates Fracture Patterns by Femoral Stem Fixation

A retrospective study published in the August issue of The Journal of Arthroplasty described fracture patterns in femoral periprosthetic fractures (PPFs) based on femoral stem fixation. A total of 138 femoral PPFs (mean patient age, 78 years; 45.7 percent were male) over a 10-year period were analyzed. In most patients (n = 83), the femoral stem fixation was cemented; more than half (59 percent) of cemented patients presented a comminuted pattern. In the 55 uncemented patients, the most common pattern was a simple oblique fracture pattern (69.1 percent).

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Surprise Bills Becoming More Frequent, Costly

The cost and frequency of surprise, out-of-network (OoN) bills are both increasing, according to a study published online in JAMA Internal Medicine. Researchers evaluated 5,457,981 inpatient and 13,579,006 emergency department (ED) visits between 2010 and 2016. During that time, the rate of OoN billing in the ED increased from 32.3 percent to 42.8 percent, and the mean potential patient liability increased from $220 to $628. For inpatient admissions, incidence went from 26.3 percent to 42.0 percent, while mean potential liability more than doubled, from $804 to $2,040.

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Share Your Content with the Only Video Website Dedicated to Orthopaedics

Did you know that the Orthopaedic Video Theater (OVT) offers a way to submit videos and have them published faster? The new User-submitted Video category gives you the opportunity to share your latest surgical techniques with colleagues and others in the field via fast and timely posting to the OVT website. Videos are now available to an audience of more than 39,000 global AAOS members. Previously, OVT was only accessible by subscription, but the vast and growing collection of more than 800 surgical technique videos is now a free benefit for AAOS members.

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Final Call: Apply for Volunteer Opportunities

Consider applying for the following positions:

  • Foot & Ankle Content Committee member position—applications are accepted until Aug. 18
  • Hand & Wrist Content Committee member position—applications are accepted until Aug. 18
  • Hip & Knee Content Committee chair position—applications are accepted until Aug. 18
  • Hip & Knee Content Committee member position—applications are accepted until Aug. 18
  • Shoulder & Elbow Content Committee chair position—applications are accepted until Aug. 18
  • Shoulder & Elbow Content Committee member position—applications are accepted until Aug. 18

Learn more and submit applications…(member login required)


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