December 14, 2018
Today’s Top Story

Study: Longer TKA Surgeries Associated with Increased Infection Risk

Primary total knee arthroplasty (TKA) patients with longer operative times may be more likely to develop prosthetic joint infections (PJIs) and surgical site infections (SSIs), according to a study published online in The Journal of Arthroplasty. Researchers evaluated 11,849 primary TKAs performed between Jan. 1, 2014, and Dec. 31, 2017, with a mean two-year follow-up. Procedures exceeding 121 minutes were classified as long cases Younger patients (mean age, 67 years) and those with a higher body mass index (mean, 34 kg/m 2) were more likely to have longer cases. Longer cases had a 1.4 percent PJI rate compared to 0.3 percent for cases shorter than 85 minutes Longer cases also had the highest SSI rate (3.8 percent). Patients whose cases were complicated by PJIs ultimately had longer mean operative times (135 minutes) compared to those who did not develop a PJI (105 minutes); the same trend was observed for SSIs. In adjusted analyses, every 15-minute increase in operative time increased the risk of PJIs and SSIs by 18 percent and 11 percent, respectively.

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Other News

Study Evaluates Risk Factors Associated with Readmission After Hip Fracture Surgery

A study published online in Injury identified several factors that put a patient at increased risk of hospital readmission after undergoing operative hip fracture treatment, including some preexisting conditions. Researchers queried a nationwide database with 68,800 patients who underwent hip fracture surgery between 1991 and 2011. The postoperative readmission rate after three months was 4.6 percent. High-risk patients were those with heavy alcoholism, Parkinson’s disease, preexisting osteoarthritis, rheumatic disease, femur neck fracture, depression, a psychotic disorder, an operative delay of at least three days, or prior total hip arthroplasty.

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Study: Elevated Ankle Joint Temperatures in Arthroscopic Surgery Associated with Radio Frequency Ablation

In a study published online in BMC Musculoskeletal Disorders, researchers analyzed factors associated with increased temperatures in arthroscopic ankle joint surgery when a radio frequency device is used. Using six formalin-fixed cadaver ankle specimens, researchers recorded intra-articular temperatures every second for 120 seconds at 3 mm, 5 mm, and 10 mm from the tip of the radiofrequency device. The irrigation flow was controlled using the inlet pressures with 10 mmHg, 25 mmHg, 50 mmHg, and 100 mmHg; controller unit voltage was set to 1, 5, and 9. With the exception of a pressure setting of 100 mmHg, all combinations of parameters resulted in maximum temperatures exceeding 122 degrees Fahrenheit. Researchers identified the pressure setting as the main critical variable, while controller unit voltage had no impact on temperature. An irrigation flow of 10 mmHg resulted in the highest recorded temperature: 215.6 degrees Fahrenheit.

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Study Evaluates Importance of Socioeconomic Factors in PROs Following LSS

A study published online in the European Spine Journal measured socioeconomic and clinical factors predictive of patient-reported outcomes (PROs) in lumbar spinal stenosis (LSS) patients. Data were collected using several registries, including the national quality registry for spine surgery (Swespine). Length of sick leave, Global Assessment (GA) of leg pain, and the Oswestry Disability Index (ODI) were all evaluated postoperatively. Clinical and socioeconomic factors both impacted GA and ODI outcomes. Being born in the European Union, no baseline back pain, and high disposable income and education level were all associated with a good ODI outcome. Indicators of a poor outcome were prior surgery; a history of back pain for more than two years; having comorbidities; and being a smoker, on social welfare, or unemployed.

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Study: No Significant Differences in Use of Opioids versus Nonopioids After Hand Surgery

Patients may find similar postoperative pain relief with ibuprofen or hydrocodone in combination with acetaminophen after elective, soft-tissue hand surgery, according to a study published online in The Journal of Hand Surgery. Researchers randomized 60 patients to receive acetaminophen/hydrocodone 325/5 mg (AH, n = 30) or acetaminophen/ibuprofen 500/400 mg (AIBU, n = 30). Patients were followed for two weeks postoperatively and evaluated for daily pain intensity based on their visual analog scale (VAS) score, medication pain relief (Likert pain relief score), need for rescue opioid prescription at one week, and days until pain-free. Both groups had a similar mean VAS score and number of days until pain-free (AH group, five days; AIBU group, three days). In both groups, two patients needed rescue opioid medication. The AIBU group had greater pain relief, but the difference was not significant. The AH group had a higher rate of side effects (23 percent) than the AIBU group (3 percent), but none of the side effects were severe.

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Is In-office Needle Arthroscopy Worth Another Look?

In 2015, knee pain was the ninth most common reason for ambulatory medical office visits in the United States. MRI often is required to arrive at a diagnosis; however, it does have limitations. Over the past three decades, a new imaging modality, in-office needle arthroscopy, has emerged as a tool to aid in the diagnosis of intra-articular pathology.

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Academy Releases 2018 Work Environment and Culture Survey Summary

Earlier this year, AAOS, on behalf of a collaborative body of multiple orthopaedic societies, conducted a survey on the orthopaedic work environment and culture related to bullying, discrimination, and harassment. After analyzing the results, AAOS released an executive summary. The AAOS Diversity Advisory Board will assume responsibility for future surveys to track progress, as well as propose ideas to enhance surgeons’ work environments.

Read the executive summary…(member login required)

Read the AAOS Now article…


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