Today’s Top Story

Study Assesses Birth Outcomes for Women After THR

Women who give birth after total hip replacement (THR) may be more likely to experience adverse outcomes, according to a cohort study published in the July issue of the European Journal of Obstetrics & Gynecology and Reproductive Biology. Researchers gathered nationwide registry data in Finland on women who underwent THR between 1980 and 2007 (patient group; n = 2,429) and each patient was matched to three women who did not undergo THR (control group; n = 7,276). The patient group was more likely to experience a stillbirth compared to the control group (2 percent versus 0.6 percent) and more likely to require emergency cesarean section (28.9 percent versus 11.6 percent). Infants born to mothers in the patient group were more likely to be born preterm, be small for their gestational age, and have low birthweight. Women who gave birth after THR were more likely to have adverse outcomes than women who underwent THR after giving birth.

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Other News

Study: TKA Safe, Beneficial for Older Patients

Older patients undergoing total knee arthroplasty (TKA) have similar outcomes compared to younger patients, according to a retrospective study published online in The Journal of Arthroplasty. A total of 644 TKA patients aged > 80 years were matched to a cohort deemed average age. Both cohorts had low revision rates and similar 10-year implant survivorship and surgical complications. The older patient group had higher mortality and general complication rates. At final follow-up, patient-reported outcomes were 4 percent lower in the older group.

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Study Evaluates Efficacy of Dextrose in Failed Back Surgery Syndrome

Patients with failed back surgery syndrome (FBSS) could experience an improvement in symptoms with dextrose injections, according to a consecutive case series published online in the European Spine Journal. The study involved 79 patients with FBSS for at least six months and did not respond to conservative treatment for three months. Patients received prolotherapy injections in posterior and lateral approaches. The visual analog scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate patients pre- and postoperatively. VAS and ODI significantly improved after dextrose injections.

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Study Compares Operative Fracture Care Rates in Medicaid Versus Otherwise-insured Patients

According to a retrospective study published in the June issue of the Journal of Orthopaedic Trauma, fewer hospitals in four large states provide operative fracture care to Medicaid patients than to patients with other types of insurance. A total of 240,376 patients underwent open reduction and internal fixation of the radius/ulna, tibia/fibula, or humerus at 1,075 hospitals in California, Florida, New York, and Texas. Outcomes varied based on emergent status. In nonemergent settings, between 7 percent and 16 percent fewer hospitals treated Medicaid patients compared to otherwise-insured patients. In emergent settings, the only state with a gap greater than 5 percent was Texas (11 percent to 14 percent). Medicaid and Medicare patients also traveled longer distances in the nonemergent setting compared to those in the emergent setting.

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Prices Predicted to Drive up 2020 Medical Costs

According to a report from PricewaterHouse’s Health Research Institute (HRI), medical costs are expected to increase by 6 percent in 2020—an increase from the 5.7 percent increase observed in 2018 and 2019. The HRI report attributes the forecasted increase to rising medical prices, which are outpacing general inflation. Healthcare inflators include drug spending, chronic diseases, and mental health.

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Is Anatomic TSA Still a Good Treatment Option for Instability Arthropathy After a Coracoid Transfer?

Some in the medical community have expressed concern about performing total shoulder arthroplasty (TSA) for instability arthropathy in patients who have undergone a prior coracoid transfer procedure, due to the distorted anatomy, scarring, and concerns about early failure or poor outcomes. Some have advocated for reverse TSA in all such patients; however, researchers recently compared outcomes for patients who underwent TSA after coracoid transfer versus patients who had TSA for primary osteoarthritis and found no significant differences in outcomes. The study compared anatomic TSA patients with prior coracoid transfer to patients who underwent anatomic TSA for primary osteoarthritis. At final follow-up, both groups had significant improvements in American Shoulder and Elbow Surgeons score and reported high satisfaction.

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Apply for the Committee on Evidence-based Quality and Value Open Positions

The Committee on Evidence-based Quality and Value (EBQV) has three open positions: EBQV chair, EBQV clinical practice guideline (CPG) section leader, and EBQV resident member. These three positions are all two-year terms that run from March 30, 2020, through March 25, 2022. Committee members plan, organize, direct, and evaluate evidence-based initiatives, including CPGs, appropriate use criteria, systematic reviews, and performance measures, as well as oversee related education, dissemination, validation, and implementation activities. Applicants should have experience with evidence-based practice principles. The application deadline is Aug. 8.

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