December 10, 2018
 
Today’s Top Story

Study Identifies High-risk Patients for Early TKA Conversion After Opening Wedge HTO

Female sex and older age may be risk factors for conversion to total knee arthroplasty (TKA) in opening wedge high tibial osteotomy (HTO) patients, according to a study published online in The Knee. Between 1994 and 2011, 111 opening wedge HTOs (mean patient age, 45 years; 84 percent male) were performed at a single center. Mean follow-up was 12 years. Failure was defined as conversion to TKA. At a mean of 6.3 years, 40 (36.0 percent) HTOs failed. After five, 10, and 15 years, the Kaplan-Meier survival rates were 84 percent, 65 percent, and 55 percent, respectively. Researchers identified age older than 47 years and female sex as independent predictors of failure.

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Other News

Study Evaluates Impact of Anesthesia on Postoperative Delirium in Older Hip Fracture Surgery Patients

In a study published in the November issue of JAMA Surgery, researchers found that reducing anesthesia in elderly hip fracture surgery patients with low comorbidity rates may help reduce postoperative delirium. The double-blind, randomized STRIDE (A Strategy to Reduce the Incidence of Postoperative Delirium in Elderly Patients) trial took place between Nov. 18, 2011, and May 19, 2016, at a single academic medical center. Researchers evaluated 200 patients (mean age, 82 years; 73 percent female) undergoing nonelective hip fracture repair. Patients were followed for the first five days after surgery or until hospital discharge. Mean Charlson comorbidity index (CCI) was 1.5. Patients were randomized to receive lighter (n = 100) or heavier (n = 100) sedation levels. Among all patients, the incident delirium risk was 36.5 percent (n = 73); in the lighter and heavier sedation groups, rates were 39 percent (n = 39) and 34 percent (n = 34), respectively. Patients with a CCI of zero had double the risk of delirium when heavily sedated. However, sedation levels did not impact risk of delirium in patients with a CCI greater than zero.

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Study: Survival Rates for Short-stemmed Humeral Component in Shoulder Arthroplasty

In a study published online in the Journal of Shoulder and Elbow Surgery, researchers studied survival rates when using a press-fit convertible short-stemmed humeral component in total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA). They radiographically evaluated 150 anatomic TSAs (group 1) and 77 RSAs (group 2), and patients were followed for a minimum of two years postoperatively. No radiographic changes were observed in 49 percent of group 1 and 65 percent of group 2 after two years. In both groups, 83 percent of radiographic changes were low bone adaptations, and 17 percent were high adaptations. Patients in both groups were more likely to demonstrate high radiographic adaptations in the presence of larger stem sizes with higher filling ratios. Group 2 had a greater instance of overall filling ratios.

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Study Reviews Characteristics of Pilot RCTs in Orthopaedic Surgery Literature

A systematic review of orthopaedic surgery literature published online in BMC Musculoskeletal Disorders found that while most pilot randomized, controlled trials (RCTs) could be considered feasibility trials, most published pilot RCTs do not result in definitive trials. EMBASE, MEDLINE, and PubMed were queried for orthopaedic RCTs published in English that included the evaluation of at least one orthopaedic surgical intervention in humans. Researchers searched for associated definitive trials. Feasibility outcomes included efficacy, cost, and timeliness of a large-scale clinical trial that included surgical intervention. Final analysis included 49 articles, of which 73.5 percent (n = 36) were considered feasibility trials. Of the feasibility trials, researchers identified five (10.2 percent) corresponding definitive trials—four published and one ongoing. According to author responses, reasons for a lack of a definitive RCT following the pilot trial were not enough money, insufficient recruitment, and the belief that the pilot RCT answered the hypothesis.

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Study Evaluates RAPT Score Efficacy in Extended LOS Patients Based on Risk Level

The Risk Assessment and Prediction Tool (RAPT) for discharge disposition may not be as effective in extended length of stay (LOS) patients following total joint arthroplasty (TJA), according to a study published online in The Journal of Arthroplasty. Patients who underwent TJA between 2014 and 2016 (n = 260) whose LOS was longer than three days were evaluated They were classified by their RAPT score: low-risk (9–12), medium-risk (6–9), and high-risk (1–6) for discharge to a facility. RAPT predicted discharge disposition in more of the low- (76.5 percent to home) and high-risk (62.9 percent to facility) patients compared to medium-risk patients (56.5 percent to home). Male sex, ambulation without walking aids or a single-point cane, less than one community support visit per week preoperatively, and having support from someone at home were significantly correlated with discharge to the home.

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AAOS Now

AAOS Lobbies for Student Loan Repayment Reform

The AAOS Office of Government Relations, along with 15 other medical specialties, has given its support to legislation that would help relieve interns and residents of student loan debt. The bill (H.R. 5734), introduced by Rep. Brian Babin, DDS (R-Texas), would allow medical or dental interns or residents to defer their loans, interest-free.

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Your AAOS

OrthoInfo Helps Doctors Educate Patients

OrthoInfo, the AAOS patient education website, is a free member resource that provides orthopaedic surgeons and patients with authoritative, in-depth information about musculoskeletal health. The website features more than 400 articles, videos, and animations on common orthopaedic problems, surgical procedures, nonsurgical treatments, injury prevention, and healthy living. All content is developed and peer reviewed by AAOS members. Written in simple language, OrthoInfo articles can help your patients be better informed and participate more fully in their care and recovery.

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