December 17, 2018
Today’s Top Story

Study: Long- and Short-term Mortality Risk Elevated in Some Revision TKA Patients

Patients undergoing revision total knee arthroplasty (TKA) for infection or fracture had an increased mortality risk during the early postoperative period, and this risk increased over time, according to a retrospective study published online in The Journal of Arthroplasty. Researchers evaluated data on 4,907 patients who underwent at least one revision TKA between 1985 and 2015, stratifying patients by surgical indications. Patients were followed until death or October 2017. Patients who underwent revision TKA for infection and fracture had significantly higher mortality rates soon after surgery compared to the general population; as time went on, this risk increased. However, patients who required revision TKA due to loosening and/or bearing wear had similar mortality rates compared to the general population. In the early postoperative days, revision TKA patients with aseptic loosening and/or wear and instability had improved mortality, but mortality rates declined in instability patients after five years and in aseptic loosening and/or wear patients after 10 years.

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Other News

Study Compares Predicted and Observed Mortality in Hip Fracture Patients

A retrospective study published online in BMC Anesthesiology found that sex, age, neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein (CRP) at admission did not accurately predict mortality in hip fracture patients. Researchers used receiver operating characteristic curves to evaluate the influence of these factors on mortality in hip fracture patients alone or in combination with the PreOperative Score to predict PostOperative Mortality (POSPOM). The study involved 326 patients who underwent hip fracture surgery between 2010 and 2016. Patients who were younger than 65 years, lacked comorbidities data, and with no CRP or NLR at admission were excluded. No association was found between the identified characteristics and mortality following surgery, and the variables studied did not improve POSPOM performance.

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Study: When Can Surgically Treated Right Ankle Fracture Patients Return to Driving?

A study published in the December issue of the Archives of Orthopaedic and Trauma Surgery found that patients who undergo surgery to treat a right ankle fracture may be able to pass a standard driving test as soon as six weeks postoperatively, even before initiating weight bearing. Researchers included patients aged 23–65 years who had right ankle fracture surgery and a valid driving license. Patients were evaluated at two, six, and 12 weeks postoperatively; they completed a Short Musculoskeletal Function Assessment (SMFA) questionnaire, and a driving simulator measured their brake reaction time. Eligible patients then took an on-road driving test with an instructor and were surveyed after six months to see if they had returned to driving safely. Final analyses included 23 patients (mean age, 42.8 years). At six and 12 weeks postoperatively, SMFA and braking time significantly improved. Most patients (91 percent) passed the six-week on-road driving test before the fracture was healed or weight bearing was initiated. At six-month follow-up, all patients were safely driving again.

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Study: Combo PRFM with β-TCP and BMA Effective for Posterolateral Lumbar Fusion

According to a study published online in the European Spine Journal, combination platelet-rich fibrin matrix (PRFM) with beta-tricalcium phosphate (β-TCP) and bone marrow aspirate (BMA) may be comparable alternatives to iliac crest bone graft for posterolateral lumbar fusion (PLF) procedures. Fifty consecutive one- to three-level PLF patients were included in the study, which included data for 66 operated levels. After one year, nearly all operated levels (92.4 percent, n = 61) achieved radiographic fusion. Visual analog scale scores for leg and back pain both improved significantly. Between baseline and follow-up, the number of patients using opioid analgesics decreased by 38 percent. Among the employed patients, 68 percent returned to work. There were no surgical site infections or revision surgeries at the operated level.

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Study: Lisfranc Joint Radiographic Measurements in Pediatric Patients

In a retrospective review published in the November/December issue of the Journal of Pediatric Orthopaedics, researchers found that the distance between the base of metatarsal 1 and metatarsal 2 (MT1–MT2) and the distance between the medial cuneiform (MC) and the base of metatarsal 2 (MC–MT2) in children approached adult values at six years old. Final analysis included 243 patients younger than 18 years of age who underwent foot radiographs without traumatic injury at a single institution between August 2014 and February 2015. Patients were excluded if they had an anatomic abnormality; fracture; inadequate radiograph; pain at the base of the MT1, MT2, or MC; persisting pain at the outpatient clinic checkup; or no follow-up. Researchers observed a constant measurement between the base of the MT1–MT2 shorter than 3 mm.

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AAOS-led Sports Liability Protection Bill Becomes Law

On Oct. 5, the Sports Medicine Licensure Clarity Act, legislation for which AAOS strongly advocated, was signed into law. The law provides protection for traveling sports medicine physicians and orthopaedic surgeons, as well as ensures injured athletes have timely access to healthcare professionals who are familiar with their medical histories.

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Collaborative Launched to Continue Improvements in Healthcare Quality

Earlier this month, the Core Quality Measures Collaborative (CQMC) was formalized by America’s Health Insurance Plans, the Centers for Medicare & Medicaid Services, and the National Quality Forum to align quality measures. CQMC identifies core measure sets—succinct groups of high-value, evidence-based, and patient-focused measures for consistent use across a broad set of programs. AAOS is proud to have joined other members of the CQMC in this initiative, with Medical Director William O. Shaffer, MD, serving as the program’s orthopaedic lead.

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