Today’s Top Story

Study Compares Posterior Stabilizing to Constrained Condylar Knee Articulations in Revision TKA

In a retrospective study published online in The Journal of Arthroplasty, researchers evaluated outcomes associated with posterior stabilizing (PS) to constrained condylar knee (CCK) articulations in revision total knee arthroplasty (TKA). The study included 106 PS patients and 147 CCK patients. Outcomes included complications, aseptic loosening, and re-revision. PS articulation was associated with better postoperative knee flexion and The Knee Society Score-functional component, and lower re-revision risk. CCK revision articulations had a worse survivorship rate when using all-cause re-revision as the primary endpoint. Implant articulation did not influence complications or aseptic loosening.

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In Other News

Study Assesses Opioid Prescribing in Orthopaedics by Country

A study published in the July 17 issue of The Journal of Bone & Joint Surgery found that opioid prescribing habits in orthopaedics may vary significantly in different countries. Orthopaedic residents from academic centers in Haiti, the Netherlands, and the United States responded to questionnaires asking what they would prescribe for post-discharge analgesia. Opioid prescriptions were converted to morphine milligram equivalents (MMEs). The overall mean total MMEs per case was significantly higher among U.S. residents (383 MMEs) compared to residents from the Netherlands (229 MMEs) and Haiti (101 MMEs); the same was true in injury-specific analysis: femur (U.S., 452 MMEs; Netherlands, 315 MMEs; Haiti, 103 MMEs), tibial plateau (459 MMEs, 280 MMEs, and 114 MMEs, respectively), tibial shaft (440 MMEs, 294 MMEs, and 141 MMEs, respectively), wrist (239 MMEs, 78 MMEs, and 63 MMEs, respectively), and ankle (331 MMEs, 190 MMEs, and 85 MMEs, respectively). In the U.S., residents prescribed significantly more MMEs to patients aged < 40 years (432 MMEs) compared to those aged > 70 years (327 MMEs).

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Study Finds Similar Short-term Outcomes for Rotator Cuff Tear Repair Options

Short-term functional outcomes may not largely differ between patients with large and massive rotator cuff tears who undergo load-sharing rip-stop (LSRS) or single-row (SR) repair, according to a retrospective study published online in Arthroscopy. During a one-year period, 17 patients with limited tendon mobility underwent repair with an LSRS technique, and during the following one-year period, 18 patients with similar injury underwent SR repair. Patients underwent six-month postoperative ultrasound to assess healing, and functional outcome was evaluated after at least 24 months. There were no significant between-group differences in range of motion or visual analog scale pain, American Shoulder and Elbow Surgeons, Simple Shoulder Test, or Single Assessment Numeric Evaluation scores. More patients in the LSRS group achieved complete rotator cuff healing compared to the SR group (53 percent versus 11 percent, respectively).

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Study: Hook Plate Fixation Comparable to Other Treatments for Distal Clavicle Fracture

A systematic review published in the August issue of the Journal of Orthopaedic Trauma observed similar outcomes in hook plate fixation compared to other operative techniques for the treatment of acute unstable distal clavicle fracture. PubMed, Medline, Embase, and Cochrane databases were queried in July 2018 for relevant studies. Eligible English-language studies compared hook plate fixation outcomes to those associated with other surgical techniques in adult patients. The primary outcome was functional result, and the secondary outcomes were rates of union and complication. Final analysis included 11 studies with 634 total patients (397 were male). Functional outcome and union rates did not largely differ between hook plate fixation, coracoclavicular (CC) stabilization, and locking plate fixation. Compared to tension band wiring (TBW), hook plate fixation was associated with a higher Constant-Murley score. Hook plate fixation was associated with a lower complication rate than TBW but a higher complication rate than CC stabilization.

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Orthopaedic Surgeon Appealing Malpractice Verdict, Sparks Overlapping Surgeries Debate

Brett Greenky, MD, will be appealing a $2 million malpractice verdict handed down by the state Supreme Court in Syracuse, N.Y., regarding a hip replacement surgery performed six years ago. According to the patient, Dr. Greenky’s operation left her permanently injured after her femur was fractured during surgery. Dr. Greenky claims the fracture did not occur during surgery. On the day in question, Dr. Greenky performed 14 surgeries in 14 hours, including overlapping surgeries.

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Seven Common Questions in Foot and Ankle Coding

A previous article published in the March issue of AAOS Now (“How to Avoid Common Mistakes When Coding Hand Procedures”) identified common coding issues for hand procedures. This article presents seven coding conundrums and frequently asked questions pertaining to foot and ankle procedures.

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Read “How to Avoid Common Mistakes When Coding Hand Procedures”…(member login required)


Final Call: Apply for Volunteer Opportunities

Consider applying for the following positions:

  • Liaison Activities member position (Accreditation Council for Graduate Medical Education—Residency Review Committee for Orthopaedic Surgery)—applications are accepted until Aug. 6
  • Pediatric Evaluation Committee member position (six open positions)—applications are accepted until Aug. 7
  • Committee on Evidence-based Quality and Value section leader position (Clinical Practice Guideline section leader)—applications are accepted until Aug. 8
  • Committee on Evidence-based Quality and Value chair position—applications are accepted until Aug. 8
  • Council on Research and Quality member-at-large position—applications are accepted until Aug. 12
  • Sports Medicine Content Committee member position—applications are accepted until Aug. 15

Learn more and submit applications…(member login required)


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