August 20, 2018 | Today’s News

Study examines upper-extremity surgery in young patients with cerebral palsy

Children and adolescents with cerebral palsy (CP) may benefit from upper-extremity surgery, according to a clinical cohort study published in the Aug. 15 issue of The Journal of Bone & Joint Surgery. Researchers assessed 39 patients (mean age, 14.9 years) who underwent the surgery between July 2011 and May 2017: 87 percent had unilateral CP, and 72 percent were Manual Ability Classification System Level II. Results were positive for patient-specific functional and/or cosmetic goals. Clinically meaningful improvements were seen in patients’ Canadian Occupational Performance Measure (COPM)-Performance (80 percent), COPM-Satisfaction (77 percent), ABILHAND (55 percent), visual analog scale (62 percent), Assisting Hand Assessment (71 percent), and Box and Block Test scores (31 percent). Researchers stated that after careful assessment of eligibility, the surgery could result in clinically relevant improvements in patients.

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Study measures survivorship of cemented straight stem in revision THA

Researchers found positive long-term results using a cemented straight stem in revision total hip arthroplasty (THA), according to an observational study published online in Archives of Orthopaedic and Trauma Surgery. The study included 178 stem revisions conducted between January 1994 and August 2008 using the Virtec straight stem. After 10 years, the cumulative incidence for re-revision due to aseptic loosening of the stem was 5.5 percent. Risk factors associated with loosening included younger age, larger defect size, and larger stem size. In addition, osteolysis was observed in 39 of 80 revision THAs. Researchers concluded that the stem is a valuable, cost-effective option in revision THA.

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A study published in the August issue of Clinical Orthopaedics and Related Research found that instability after reverse total shoulder arthroplasty (rTSA) may be associated with greater superior baseplate inclination. Researchers assessed 97 patients who had undergone rTSA and asked them to rate their postoperative instability symptoms using the American Shoulder and Elbow Surgeons (ASES) functional outcome scores. Thirteen percent of patients (n = 13) reported some instability (grades 2–4). When controlling for confounding factors, the factors associated with instability were greater superior baseplate inclination and greater change into superior inclination from pre- to postoperative. Patients who reported any instability (grades 2–4) had lower ASES scores compared to those with no instability (grade 1).

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In a long-term follow-up study published online in Archives of Orthopaedic and Trauma Surgery, researchers assessed clinical and radiologic outcomes in 43 patients who had undergone hip arthroscopy between 1998 and 2006. Primary endpoints were subsequent total hip arthroplasty (THA) or other hip surgery; secondary endpoints were OA progression and patient-reported outcome measures (PROMs). Overall, 20 patients underwent subsequent surgery, 11 of whom required THA. No significant progression of OA was found in patients who did not undergo THA. Seventy-seven percent of patients (n = 33) said they would undergo hip arthroscopy again in the same situation. The Forgotten Joint Score-12 was the only PROM that differed in patients who had revision surgery and those who did not.

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A retrospective case series published in the July issue of The Spine Journal found that disk type and range of motion (ROM) may be predictive of ossification of the posterior longitudinal ligament (OPLL) progression following laminoplasty. Researchers included data on 34 patients (86 segments) with cervical myelopathy secondary to OPLL. Ossified masses were categorized based on disk space involvement: type 1 (no involvement), type 2 (involving disk space but not crossing), type 3 (crossing disk space but not fused), and type 4 (complete bridging). Severe progression (change in thickness > 2 mm) occurred most often in types 2 (n = 8/29) and 3 (n = 7/16) and was significantly less common in types 1 (n = 1/35) and 4 (n = 0/6). ROM > 5 degrees was associated with severe progression in types 2 and 3 (52 percent versus 8 percent, respectively). Mean OPLL progression was 0.5 mm, 1.3 mm, and 1.5 mm in types 1, 2, and 3, respectively.

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Treatments for osteochondral lesions of the talus continue to evolve

American athletes are becoming bigger, stronger, and faster. The average male in the United States weighs 195 pounds and has a body mass index of 28.6 kg/m ². The increases in mass and velocity translate to increased forces on tendons, ligaments, and joints to accommodate changes in direction and impacts from collisions. The ankle joint is at particular risk of injury in athletes, elite and recreational alike. Some ankle sprains, particularly in chronically unstable ankles, can result in cartilage injury. In fact, it is estimated that as many as 79 percent of severe ankle sprains result in some form of cartilage injury.

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Last call: Apply for Coding, Coverage and Reimbursement Committee member position

The Coding, Coverage and Reimbursement Committee has an opening for a member position. This is a three-year term that runs through March 12, 2021. The committee monitors and makes recommendations regarding Medicare payment and coverage policy issues. The deadline to apply is Aug. 24.

Learn more and submit your application…