August 28, 2019
Today’s Top Story

Johnson & Johnson Held Responsible for $572.1 Million in Opioid Trial

An Oklahoma judge ruled that Johnson & Johnson must pay the state $5721 million for its role in the opioid epidemic, an amount significantly lower than the $17 billion sought in the lawsuit filed by Oklahoma Attorney General Mike Hunter. Johnson & Johnson plans to appeal the decision. The decision could potentially affect more than 2,000 similar pending lawsuits across the country.

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In Other News

Study Evaluates AAOS’ CPG on Pediatric Femoral Shaft Fractures

A study published in the September issue of the Journal of Pediatric Orthopaedics analyzed 10-year data related to AAOS’ 2009 clinical practice guideline (CPG) for the treatment of pediatric femoral shaft fractures. Data spanning 2004 through 2013 from four high-volume, level one pediatric trauma centers were included. Final analysis included 2,646 fractures, of which 1,476 (55.8 percent) were treated nonoperatively and 1,170 were treated operatively. In the operative group, 568 (21.5 percent) patients received flexible intramedullary nails (IMN), while 309 (11.7 percent) received locked intramedullary nails and 188 (7.1 percent) were treated with plating. During the study period, after the CPG’s publication, interlocked IMN use in patients aged younger than 11 years significantly increased (0.5 percent before versus 3.8 percent after); during the same time period, patients aged younger than five years were treated operatively with any technique (6.4 percent versus 8.4 percent, respectively).

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AAOS reissued a 2015 version of this guideline; view the updated CPG…

Study Analyzes Five-year Outcomes for Meniscal Tear Treatments

A study published online in Arthritis & Rheumatology compared five-year outcomes for operative versus nonoperative management of meniscal tear in patients with osteoarthritis. Follow-up data were reviewed from the Meniscal Tear in Osteoarthritis Research Trial of physical therapy (PT) versus arthroscopic partial meniscectomy (APM). Knee Osteoarthritis and Injury Outcome Score (KOOS) pain scale was the primary outcome, while total knee replacement (TKR) was a secondary outcome. Final analysis included 351 patients. In both cohorts, baseline KOOS pain scores in the intent-to-treat (ITT) analysis were about 46. Both groups presented significant 24-month improvement and had KOOS pain scores of about 18; scores remained stable until the 60-month mark. A total of 25 patients underwent TKR. When comparing APM patients to PT patients in the ITT model, the hazard ratio (HR) for TKR was 2.0. The as-treated HR for TKR was 4.9 for APM patients versus PT patients.

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Study: Do Nonmodifiable Patient Factors Affect Satisfaction in the Orthopaedic Clinic?

Certain nonmodifiable patient factors may adversely impact patient satisfaction at the orthopaedic clinic, according to a study published online in Clinical Orthopaedics and Related Research. Press Ganey Survey scores from 3,044 clinic visits for 2,527 patients were analyzed. Visits took place at a single academic medical center in adult reconstructive, sports, and general orthopaedic clinics. When adjusting for covariates, the following patient factors were associated with lower satisfaction: a diagnosis of depression (versus no depression diagnosis), Medicare insurance (versus non-Medicare patients), sports medicine clinic patients (versus general orthopaedic clinic patients), and established patients (versus new patients).

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Study Evaluates Drilling Techniques for Osteochondral Lesions of the Talus

A study published online in Arthroscopy compared anterolateral and posterolateral drilling approaches and varying drilling depths in osteochondral lesions of the talus. A total of 12 tali underwent microCT scanning. In each talus, the talar dome was stratified into nine zones, in which densities were measured at three depths: 0 mm to 5 mm, 5 mm to 10 mm, and 10 mm to 15 mm. The 0 mm to 5 mm depth had the lowest vessel density among the three groups, while the 5 mm to 10 mm and 10 mm to 15 mm depths did not have significant between-group differences. In the 5 mm to 10 mm depth group, the medial talar dome had comparable vessel density to that of adjacent zones, and vessel depth around the lateral dome was higher in the anterior and medial side. There was less vascular damage using the posterolateral approach than the anterolateral approach.

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Patients Over Paperwork Fight Continues

In June, the Centers for Medicare & Medicaid Services released a Request for Information, titled “Reducing Administrative Burden to Put Patients Over Paperwork.” With such broad themes, AAOS took the opportunity to share its position on the issues that are most relevant to its members, including reducing administrative burden, promoting interoperability, and streamlining documentation.

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AAOS Practice Management Resources

The Academy’s numerous free practice management resources provide knowledge, education, clinical tools, and professional support that help you meet the challenges of your chosen specialty and build mastery throughout your career. Access white papers, the Practice Management Advice Center, and webinar recordings, as well as learn about topics such as Medicare Access and CHIP Reauthorization Act delivery reform and the Quality Payment Program.

View AAOS’ practice management resources…


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