August 30, 2019
Today’s Top Story

Study: TJA Outcomes in Morbidly Obese Patients

Morbidly obese patients with moderate/severe osteoarthritis (OA) of the hip or knee may have lower orthopaedic retention rates than patients with a lower body mass index (BMI), according to a retrospective study published online in The Journal of Arthroplasty. A total of 158 patients with a BMI of 40 kg/m 2 or higher with moderate/severe hip or knee OA were analyzed. Researchers compared demographics, comorbidity profiles, and weight loss between patients that did and did not undergo total joint arthroplasty (TJA). TJA patients (n = 1,473) from 2016 through 2018 were identified. More than half (51.3 percent) of new morbidly obese patients with OA did not attend a follow-up clinic visit; among those who did return, 42.9 percent underwent TJA. Single-visit patients had a higher mean BMI compared to multiple-visit patients (49.5 kg/m 2 versus 46.3 kg/m 2). Patients who elected to undergo TJA had a lower mean BMI compared to those who did not undergo surgery (44.5 kg/m 2 versus 47.6 kg/m 2). Overall complications did not largely differ between patients with a BMI of 40 kg/m 2 or higher versus lower, but high-BMI hip arthroplasty patients had a higher rate of surgical site infections.

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In Other News

Study Observes Decline in Postoperative Ankle Fracture Opioid Use

Over a 10-year period, opioid use after surgical treatment of ankle fracture in the United States may be lower than expected, according to a retrospective study published in the July/August issue of Current Orthopaedic Practice. Opioid-naïve operative ankle fracture patients treated between 2007 and 2015 were identified using a private payer database. Annual opioid prescriptions were stratified into two periods: the immediate postoperative (zero to six months from surgery) and prolonged (six to 12 months from surgery) periods. The study included 20,992 patients; the proportion of patients filling opioid prescriptions during the immediate postoperative period declined from 28.5 percent to 21.2 percent. During the prolonged period, the rate dropped from 2.9 percent to 2.3 percent.

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Study Assesses Iontophoresis Efficacy in Lateral Epicondylitis

The use of iontophoresis in patients with lateral epicondylitis may reduce pain and improve strength and function, according to a randomized clinical trial published in the September issue of the Journal of Shoulder and Elbow Surgery. A total of 24 patients were randomized to two groups: The iontophoresis group was given a dexamethasone solution and gel lidocaine on the negative electrode and a base gel solution on the positive electrode. The galvanic cohort underwent the same treatment but received a base gel solution on both electrodes. All patients presented significant improvements in pain, handgrip strength in elbow extension and flexion, and function (measured by the Patient-rated Tennis Elbow Evaluation Scale). Pain and functional outcomes were better in the iontophoresis group compared to the galvanic group.

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Study Measures Accuracy of Computer-aided Cobb Angle Measurement and Scoliosis Diagnosis

A study published online in the European Spine Journal evaluated the accuracy and reliability of a computer-aided technique to measure the Cobb angle and diagnose scoliosis on chest X-rays. The core of the technique was two Mask R-CNN models, which were used to separately detect and segment the spine and all vertebral bodies on chest X-ray. The output of these models was used to measure the Cobb angle of the spinal curve. A total of 248 chest X-rays from lung cancer screening were measured using the computer-aided technique and by two experienced radiologists. The intraclass correlation coefficient (ICC) of intraobserver reliability analysis for manual measurement of the Cobb angle was 0.941 and for interobserver reliability analysis was 0.887, with mean absolute differences less than 3.5 degrees. The ICC between the computer-aided technique versus manual measurements was 0.854, with a mean absolute difference of 3.32 degrees, indicating high reliability for the computer-aided technique. The computer-aided technique had an 89.59 percent sensitivity level and 70.37 percent specificity level for diagnosing scoliosis on chest X-rays

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Medicare Paying Twice for Same Hospice Drugs May be Costing Millions

According to a report from the Department of Health and Human Services’ Office of Inspector General (OIG), Medicare Part D spent $160.8 million on drugs that should have been already covered by Medicare Part A’s hospice benefit in 2016. While hospices claimed that they should not have been responsible for the $261.9 million remaining from the total $422.7 million total cost, an analysis of communications between the Centers for Medicare & Medicaid Services and hospices and sponsors found that “hospice organizations or hospice beneficiaries likely should have paid for many of these drugs, not Part D,” according to the report.

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Read the OIG report…


Study Illustrates Self-reported Low Pain Tolerance Linked to Increased Opioid Consumption after Foot and Ankle Surgery

Patients who viewed themselves as having a low pain threshold took more opioid medication after foot and ankle surgery than those with a self-reported high pain threshold, according to a study presented at the American Orthopaedic Foot & Ankle Society Specialty Day during the AAOS 2019 Annual Meeting. Lead study investigator Rachel Shakked, MD, said of the study’s significance, “In light of the current opioid crisis, orthopaedic surgeons are attempting to find a balance between appropriately treating patients’ pain while minimizing narcotic prescriptions.”

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Final Call: Act Now to Nominate AAOS Leadership

The 2020 Nominating Committee is actively soliciting nominees for individuals to serve on the Board of Directors in the following positions:

  • Second Vice President
  • Board Member-at-Large (over age 45 on March 30, 2020)
  • Board Member-at-Large (younger than age 45 on March 30, 2020)

Nominations close today, Aug. 30. Members can review the position descriptions—including information about responsibilities, desired experience, and time commitments—as well as submit nomination(s) online.

Learn more and submit your nomination…(member login required)


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