Today’s Top Story

Study Assesses TXA Efficacy in Reducing Blood Loss in Pelvic Ring, Acetabulum, and Proximal Femur Fractures

The use of tranexamic acid (TXA) in fractures of the pelvic ring, acetabulum, and proximal femur may reduce total blood loss (TBL) but not transfusion rates, according to a randomized, controlled trial published in the August issue of the Journal of Orthopaedic Trauma. Patients were randomized to study (n = 47) and control (n = 46) groups. Prior to incision, the study group received an initial dose of intravenous TXA 15 mg/kg and the same dose three hours later. The study group had significantly lower TBL (952 mL) compared to the control group (1,325 mL), but total transfusion rates did not largely differ (1.51 versus 1.17, respectively). Inpatient venous thromboembolic event rates were also not significantly different between the groups.

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In Other News

Study: What Factors Predict LOS and Discharge Location in Shoulder Arthroplasty?

A systematic review published in the Aug. 1 issue of the Journal of the AAOS identified predictors of greater length of stay (LOS) and discharge to a facility in shoulder arthroplasty patients. Studies involving hemiarthroplasty, anatomic shoulder arthroplasty, and reverse shoulder arthroplasty (RSA) were included in the review. Final analysis included 22 studies. The following factors were associated with increased LOS and discharge to a facility risk: age > 65 years, female sex, obesity, and RSA. Factors associated with decreased LOS and discharge to a facility risk were greater hospital and surgeon volume. Local injection of liposomal bupivacaine combined with intravenous dexamethasone was also predictive of decreased LOS.

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Study Evaluates Efficacy of Opioid Guidelines in Foot and Ankle Surgery

A study published online in Foot & Ankle International assessed outcomes associated with the implementation of opioid prescribing guidelines in outpatient foot and ankle surgery patients. Opioid prescription and use patterns were observed over the course of one year in 303 consecutive patients. Two- and six-week postoperative visits included pill counts to determine opioid consumption. An average of 37.4 pills were prescribed, and 18.9 pills were used, for a 476 percent utilization rate; 17.2 percent of patients used their entire prescription. After two weeks, 88 percent of patients were no longer using opioids, and only 1.3 percent continued opioid use after the six-week mark. The following risk factors were independently associated with opioid use: younger age, male sex, recent preoperative opioid use, and bony or ankle/hindfoot procedures.

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Study Compares Percutaneous versus Open Hamstring Lengthening in Cerebral Palsy Patients

Percutaneous hamstring lengthening (pHSL) may be as effective as open hamstring lengthening (oHSL) in improving crouch gait and knee function in children with cerebral palsy, according to a retrospective cohort study published in the August issue of the Journal of Pediatric Orthopaedics. Ambulatory cerebral palsy patients who underwent hamstring lengthening and pre- and postoperative gait analysis between 1997 and 2015 were stratified into two groups: oHSL (n = 65; mean age, 8.5 years) and pHSL (n = 22; mean age, 8.3 years). Patients in both groups presented significant improvement in maximum knee extension following surgery (oHSL, Δ8.2 degrees; pHSL, Δ14.4 degrees). In adjusted analysis, there were no significant between-group differences in kinematic variables following surgery. Changes in static range of motion were similar between oHSL and pHSL patients.

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HHS Plan Would Allow International Import of Prescription Drugs

The Department of Health and Human Services (HHS), in conjunction with the Food and Drug Administration, unveiled a Safe Importation Action Plan describing two pathways for the international importing of prescription drugs. According to HHS Secretary Alex Azar, the proposal would safely give Americans access to prescription drugs at a lower cost.

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Read the HHS press release…


Ensure Lasting Career Joy by Aligning Your Work with Your Values

During the fall 2018 in-person meeting of AAOS’ Patient Safety Committee, members addressed the importance of being proactive in maintaining joy in the workplace. David C. Ring, MD, PhD, chair, and committee members discussed the importance of becoming familiar with what matters most and setting up surgical practice to match those values.

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Follow the Office of Government Relations on Twitter

Looking for AAOS advocacy updates on Twitter? Follow the Office of Government Relations for timely news and information. The Association arm of the Academy identifies, analyzes, and directs all health policy activities and initiatives to position AAOS as the trusted leader in advancing musculoskeletal health. Members are encouraged to follow this handle and engage with tweets to help promote the viewpoint of the orthopaedic community.

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