August 19, 2019
Today’s Top Story

Study Assesses Outcomes Associated with Undersedation in THA Dislocations

A retrospective review published online in The Journal of Arthroplasty found that undersedation may result in poorer outcomes for total hip arthroplasty (THA) dislocation patients. Patients who underwent closed reduction of THA dislocations in the emergency department (ED) between 2013 and 2019 were included in the study. Undersedation was defined as a dose of propofol < 0.45 mg/kg/dose of conscious sedation. Final analysis included 79 THAs (mean age, 65.5 years); 37 (46.8 percent) patients previously required revision surgery and 44 (55.7 percent) had a prior dislocation. The 39 undersedated patients had significantly longer sedation time, more re-doses, greater total dose, and a higher risk for failed ED closed reduction. One skin tear from countertraction occurred in an undersedated patient.

Read the study…

In Other News

Study: Minority Women May be Less Likely to Undergo TKA

A prospective study published online in Osteoarthritis and Cartilage found racial disparities in total knee arthroplasty (TKA) utilization among women. Postmenopausal women aged 50 to 79 years from the Women’s Health Initiative were stratified by race/ethnicity: white (n = 90,420), black (n = 8,942), and Hispanic (n = 3,405). Multivariable hazards models adjusted for factors including age, arthritis, joint pain, mobility disability, body mass index, number of comorbidities, income, education, neighborhood socioeconomic status (SES), and geographic region. White women were more likely to utilize TKA (10.7/1,000 person-years) than black (8.5/1,000 person-years) and Hispanic (7.6/1,000 person-years) women. When analyzing women with arthritis, joint pain, and mobility disability, age-adjusted analysis found that black and Hispanic women were significantly less likely to undergo TKA than white women. When adjusting for SES, the disparity remained but was not as significant.

Read the abstract…

Study Evaluates Role of Posterior and Inferior Glenosphere Position in Reverse TSA

A study published in the August issue of the Journal of Shoulder and Elbow Surgery analyzed how the posterior and inferior glenosphere support the anterior and lateral deltoid muscles in reverse total shoulder arthroplasty (rTSA). The researchers altered a biomechanical shoulder model to host a reverse shoulder prosthesis, and they designed the glenoid baseplate to allow inferior, lateral, and posterior center-of-rotation (COR) offsets. They tracked rope excursion mimicking several shoulder muscles during three planes of motion: humeral abduction, elevation, and flexion. There was a significant correlation between the inferior offset of the COR in rTSA and an increase in deltoid moment arm during all three planes of motion; posterior offset of the COR primarily supported humeral flexion.

Read the abstract…

Study Tests Pain Reduction Efficacy of Virtual Reality in Orthopaedic Disorders

According to a systematic review and meta-analysis published online in Physical Therapy, virtual reality may benefit patients in orthopaedic rehabilitation. Researchers queried PubMed, CINAHL, Embase, PEDro, REHABDATA, and Sage publications, as well as conducted manual searching and snowballing using Scopus and Web of Science, through September 2018. Relevant articles were stratified into two groups: general or region-specific (upper limbs, lower limbs, and spine) orthopaedic disorders. Final analysis included 19 studies, most of which were of moderate quality. When comparing virtual reality to exercises, 14 studies saw no between-group differences. Compared to no treatment, five studies found virtual reality provided better outcomes, while three saw no significant differences. The authors concluded that virtual reality was effective in patients with chronic neck pain and shoulder impingement syndrome but did not yield any significant benefits compared to exercises in cases of rheumatoid arthritis, knee arthritis, ankle instability, and post-anterior cruciate reconstruction.

Read the abstract…

Medical Groups Push for More Changes to CMS’ Patients Over Paperwork Initiative

The American Medical Group Association (AMGA) and Medical Group Management Association (MGMA) called on the Centers for Medicare & Medicaid Services (CMS) to make additional changes to its Patients Over Paperwork initiative, which is intended to reduce physicians’ administrative burden. In a letter addressed to CMS Administrator Seema Verma, AMGA said it would like to see a transition from fee-for-service payments to value-based reimbursement. In its own letter to Ms. Verma, MGMA recommended altering the Quality Payment Program so it correlates with the Medicare Access and CHIP Reauthorization Act.

Read more…

Read AMGA’s letter…

Read MGMA’s letter…


Study Probes Durability of Smoking Cessation for Elective Surgery

A study appearing in the Aug. 15 issue of the Journal of the AAOS (JAAOS) found that among patients who complied with a requirement to quit smoking before elective lower-extremity orthopaedic surgery, 48 percent maintained smoking cessation for at least one year postoperatively. Of the patients who relapsed, 55 percent stated that they did not resume smoking until at least three months postoperatively, suggesting that the period after surgery may be an important time for intensified smoking cessation counseling.

Read more…

Read the JAAOS abstract…


Final Call: Apply for Volunteer Opportunities

Consider applying for the following positions:

  • Foot & Ankle Content Committee member position—applications are accepted until Aug. 20
  • Education Assessments and Examinations Committee member position (spine)—applications are accepted until Aug. 20
  • Patient Safety Committee chair position—applications are accepted until Aug. 21
  • Council on Education Video and Multimedia chair position—applications are accepted until Aug. 22
  • Adult Reconstruction Hip Program Committee member position—applications are accepted until Aug. 23
  • Adult Reconstruction Knee Program Committee member position—applications are accepted until Aug. 23
  • Membership Council chair position—applications are accepted until Aug. 23

Learn more and submit applications…(member login required)


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