February 1, 2019
Today’s Top Story

Study: What’s the Best Time to Detect Hyperglycemia After TJA?

The optimal time to evaluate total joint arthroplasty (TJA) patients for postoperative hyperglycemia may be 9:00 p.m. on the night of surgery, according to a retrospective study published online in The Journal of Arthroplasty. The study involved 314 patients who underwent hip or knee arthroplasty between September 2017 and September 2018 Their blood glucose levels were measured immediately preoperatively, immediately postoperatively, at 5:00 p.m. on day of surgery (DOS), at 9:00 p.m. on DOS, and the morning of postoperative day one. Hyperglycemia was evaluated at strict (≥ 126 mg/dL), intermediate (≥ 137 mg/dL), and lenient (≥ 180 mg/dL) thresholds. The mean glucose values were significantly higher at 5:00 p.m. DOS (138.6 mg/dL) and 9:00 p.m. DOS (142.9 mg/dL) compared to the other times in both diabetic and nondiabetic patients. Across all three hyperglycemia thresholds, most patients were hyperglycemic at 9:00 p.m. DOS.

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Other News

Study: Is Echocardiography Beneficial for Surgical Hip Fracture Patients?

In a retrospective study published in the February issue of Anesthesia & Analgesia, preoperative echocardiography screening did not improve outcomes in hip fracture patients undergoing surgical treatment. Using a nationwide administrative database, researchers identified 66,620 patients who underwent surgery to treat hip fracture between April 1, 2008, and Dec. 31, 2016. After propensity-score matching, researchers compared 25,205 pairs of screened and nonscreened patients. Both groups had similar in-hospital mortality rates (screened versus nonscreened: 417 [1.65 percent] versus 439 [1.74 percent]). The screened group did not have reduced postoperative complications or intensive care unit admission rates.

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Study Evaluates X-ray and CT for Detecting Pedicle Screw Loosening

X-ray and CT may both have high specificity to detect loose pedicle screws, but they have low sensitivities, according to a study published online in the Journal of Orthopaedic Surgery and Research. Two years after their primary surgery and prior to their current operation, 33 pedicle screw removal surgery patients were evaluated by CT and X-ray for fixation stability A total of 236 screws were removed. A loosened screw was defined by a used torque force of less than 1.02 Nm. Overall, the loosening rate was 33 percent. X-ray sensitivity and specificity were 24 percent and 98 percent, respectively; CT sensitivity and specificity were 22 percent and 96 percent, respectively.

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Study: Positive Clinical Outcomes Following Elbow Hemiarthroplasty

In a study published online in the Journal of Shoulder and Elbow Surgery, elbow hemiarthroplasty (EHA) was a reliable treatment option for active patients with acute distal humeral fractures (DHFs). Over six years, 24 active patients (mean age, 65 years) with acute intra-articular and multifragmentary DHFs underwent EHA. At a median follow-up of 20 months, the median Oxford Elbow Score was 40 points; 21 patients had “good to excellent results,” two patients had “fair” results, and one patient had a “poor” outcome. The median Mayo Elbow Performance Score was 85 points, with similar outcomes: 19 patients had “good to excellent” outcomes, four had “fair” results, and one had a “poor” outcome. Seven patients had complications, of whom three underwent reoperation due to stiffness.

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Medicare Advantage Enrollment Falls Short of Industry Expectations

Medicare Advantage membership growth has slowed compared to previous years, federal data show, which is surprising to some industry experts. Enrollees increased by 6.8 percent from January 2018 to January 2019. By comparison, from January 2016 to January 2017 and January 2017 to January 2018, the Advantage program grew by 8.04 percent and 7.70 percent, respectively. Some Advantage organizations saw higher growth percentages than the national rate, however.

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Advance Your Career with Exceptional Learning Opportunities at the AAOS 2019 Annual Meeting

The upcoming AAOS 2019 Annual Meeting will provide a variety of Career Development Courses, including “Hot Marketing Topics to Build your Practice,” “Writing a Competitive Grant Application,” and “Managing Residents in 2019.” Career services will include successful job search tips, interview preparation tools, and more.

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Register for the Annual Meeting…


Education and Networking Opportunities Await at AAOS CME Courses

Experience the highest quality continuing medical education (CME) on the latest clinical topics at AAOS courses offered year-round. Exceptional world-class faculty are dedicated to delivering unbiased, unparalleled, peer-reviewed programs to meet your lifelong learning and practice needs. Refine your surgical skills with hands-on labs, prepare for certification with review courses at all stages, or take a deep dive into comprehensive topics with dynamic programming. Save on your registration fees with discounts for AAOS members and residents.

Plan to attend your next CME event…


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