January 2, 2019
Today’s Top Story

Study Examines Factors Associated with Postoperative Pain in THA Patients

A study published in the December issue of Archives of Orthopaedic and Trauma Surgery analyzed factors that influence pain in the first four weeks following total hip arthroplasty (THA). Researchers evaluated 103 THA patients who used a numerical rating scale (NRS) to describe their pain. Mean NRS scores decreased constantly during the first postoperative week, from 3.1 on day one to 2.3 on day eight; a perpetual increase was observed for three days, with a mean NRS of 2.6 observed on day nine compared to 2.3 on day 12. Pain levels then decreased continuously, with a mean NRS score of 0.9 on day 29. Patients with preoperative pain reported higher levels of postoperative pain. Researchers attributed the three-day perpetual pain increase to more extensive mobilization and physiotherapy in the rehabilitation unit.

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Other News

Study: Opioid Use in DRF Patients Treated with Volar Locked Plating

A prospective study published online in Injury found that distal radius fracture (DRF) patients may be more likely to use tramadol after receiving volar locked plating if they do not require postoperative immobilization. Following surgery, eligible DRF patients randomly received either a short forearm splint and no early mobilization (splint) or conventional bandage with early wrist mobilization (no splint). Of 39 patients scheduled for volar plate fixation, 36 completed follow-up. Researchers evaluated pain scores using a 10-point scale; tramadol usage; Disabilities of the Arm, Shoulder, and Hand score; wrist range of motion; patient satisfaction; and complication rates. All patients had similar pain scores throughout their hospital stay and up to six-month follow-up. During the hospital stay, the no splint group was more likely to use tramadol (no splint, 65 percent; splint, 47 percent) and had higher intake doses (no splint, 218 mg; splint, 167 mg). The no splint group also had higher doses after discharge (second day = no splint, 112 mg; splint, 75 mg). Use of immobilization did not impact functional and complication rates.

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Study Evaluates Association Between Creatinine Ratio and Fracture Risk in Diabetic Patients

A study published in the December issue of Diabetes Research and Clinical Practice found that type 2 diabetes patients with a lower serum creatinine to cystatin C (Cr/CysC) ratio may have an increased risk of fracture. Researchers followed 1,911 postmenopausal women and 2,689 men with type 2 diabetes (mean age, 66 years) for a median of 5.3 years. Patients were divided into Cr/CysC ratio quartiles by sex. Among these patients, 192 sustained fragility fractures and 645 sustained any fracture. Compared to the reference group (quartile 4 [Q4]), multivariate-adjusted hazard ratios (HRs) for fragility fractures for postmenopausal women were 2.15 (Q1), 1.63 (Q2), and 1.34 (Q3). Also using Q4 as a reference, HRs for fragility fractures in men were 1.75 (Q1), 2.09 (Q2), and 1.56 (Q3). The risk of any fracture was 1.46 (Q1), 1.33 (Q2), and 1.40 (Q3) for women and 2.33 (Q1), 2.02 (Q2), and 1.13 (Q3) for men, with both groups using Q4 as a reference.

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Study Analyzes MRI Accuracy to Detect Subscapularis Tendon Tears

A systematic review published online in the Archives of Orthopaedic and Trauma Surgery found that although MRI can accurately diagnose subscapularis tendon tears, its accuracy is lower than that of overall rotator cuff tears. Researchers queried PubMed, EMBASE, and MEDLINE databases through April 2017 for relevant studies on the sensitivity and specificity of MRI compared to arthroscopic surgical findings for subscapularis tendon tear. Fourteen eligible studies were chosen for final analysis, which included 1,858 shoulders with 613 subscapularis tears. Sensitivity and specificity for overall subscapularis tears were 0.68 and 0.90, respectively. Sensitivity for full-thickness tears and partial tears was 0.93 and 0.74, respectively, and specificity was 0.97 and 0.88, respectively.

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Study: Procedure Value Index Highlights Shoulder Arthroplasty Value Differences

A retrospective study published online in the Journal of Shoulder and Elbow Surgery introduced the procedure value index (PVI) and applied it to shoulder arthroplasty. The goal of PVI is to quantify value-driven care by measuring minimal clinically important differences (MCIDs). Researchers compared PVIs for primary anatomic total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA) in 534 shoulder arthroplasty patients with a minimum two-year follow-up. Patients’ Simple Shoulder Test (SST) score, American Shoulder and Elbow Surgeons (ASES) score, visual analog scale (VAS) score for pain, and Single Assessment Numeric Evaluation (SANE) score were used to identify MCIDs. Total hospitalization costs, total charges, and total reimbursements accounted for cost data. Researchers calculated the PVI as the ratio of outcome improvement in MCID units over the cost of care. Improvements in MCID units did not significantly differ between TSA and RSA patients for the SST, VAS pain, and SANE scores, but ASES scores differed. RSA was associated with significantly higher total hospitalization costs and charges. PVIs based on total hospitalization costs and total charges were significantly greater for TSA.

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Study: Half of Neck Surgery Readmissions Are Not Related to Surgical Site

Although only 3 percent of one- or two-level anterior cervical diskectomy and fusion patients are readmitted within 30 days of surgery, half of them are readmitted for reasons unrelated to neck surgery, according to a study presented at the North American Spine Society Annual Meeting. Pneumonia is the most common complication unrelated to surgery.

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Pennsylvania E-prescribing Bill Signed Into Law

The Pennsylvania Orthopaedic Society (POS) recently succeeded in getting H.B. 353 passed by the Pennsylvania State Legislature and signed into law. It will help eliminate a major source of drug diversion due to written prescriptions being lost, stolen, altered, or sold. POS hopes the law will pave the way for effective communication among all players in the healthcare delivery system, including patients, physicians, hospitals, pharmacies, insurers, and governmental entities, to continue battling the crisis. Long-term, POS strives to demonstrate to lawmakers that the opioid addiction crisis is not a “bad doctor” issue, but a complicated crisis with many actors at fault and that orthopaedic surgeons are part of the solution, not the problem.

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