January 4, 2019
Today’s Top Story

Study Evaluates Risk of Residual Acetabular Dysplasia After Pavlik Method

According to a study published in the November/December issue of the Journal of Pediatric Orthopaedics, patients with dislocated Graf type-IV hips diagnosed at ultrasound who undergo treatment with a Pavlik harness for developmental hip dysplasia have a greater chance of developing residual acetabular dysplasia. Between August 2011 and October 2014, 134 hips (84 patients) were treated by the Pavlik method and followed up at 12 months of age. The hips were 44.8 percent (n = 60) dysplastic, 30.6 percent (n = 41) Barlow, and 24.6 percent (n = 33) Ortolani. At six-month follow-up, 11.7 percent of hips displayed residual dysplasia, and at 12 months, 11.8 percent did. At the 12-month visit, the only factor associated with acetabular index was Graf type. Patients with a normal hip at ultrasound who underwent treatment with the Pavlik method did not have a significant risk of residual acetabular dysplasia.

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Other News

Study Analyzes ATV-related Trauma

A study published online in Injury assessed fracture rates, patterns, and risks associated with all-terrain vehicles (ATVs) across various age groups nationwide. Between 2002 and 2015, the estimated number of ATV-related emergency department visits was 1,862,342. About a quarter (n = 482,501, 25.9 percent) of patients (mean age, 27.5 years; 75.7 percent male) sustained fractures. Of the fracture patients, 28.5 percent were admitted to the hospital, and 57.5 percent were not wearing a helmet; 43.9 percent of fracture incidents took place at home. When analyzed by body part, 51.8 percent involved the upper extremity, 23.6 percent involved the lower extremity, 9.7 percent involved the ribs/sternum, 8.5 percent involved the skull/face, and 6.4 percent involved the spine. In the majority of skull/facial fracture incidents (88 percent), the patient was not wearing a helmet; 87 percent of skull fractures resulted in brain injury. Alcohol use was most likely to be a component in skull (13.2 percent) and spine (13.0 percent) fractures.

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Study: What Are the Risk Factors for Admission After Shoulder Arthroscopy?

A study published online in the Journal of Shoulder and Elbow Surgery identified several predictors of admission in shoulder arthroscopy patients. During a 10-year period, 5,598 consecutive shoulder arthroscopies were performed, of which 233 patients (4.2 percent) required admission. Multivariate analysis identified chronic obstructive pulmonary disease, diabetes, obstructive sleep apnea, age, body mass index, and operative time as risk factors for admission. The absence of general anesthesia decreased admission risk.

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Research Shows Bundled Payments for Joint Replacement Save Money

A two-year evaluation of the Centers for Medicare & Medicaid Services’ (CMS) mandatory bundled payments for joint replacements shows modest savings, according to research published in The New England Journal of Medicine. The Comprehensive Care for Joint Replacement (CJR) program likely saved around 3 percent per procedure—a reduction largely driven by reduced spending on postacute care facilities. Researchers also believe there was no increase in complications.


Although this payment method has helped lower costs, AAOS’ Office of Government Relations (OGR) is concerned about the precedence of CJR over the Bundled Payments for Care Improvement (BPCI) Advanced model. Both models need financial, additional clinical, and socioeconomic risk adjustments for complex patients. Additionally, OGR is advocating that CMS reinstate the financial methodology used in BPCI Classic for BPCI Advanced regarding the cap on physician reimbursement.

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Report: Outpatient Centers on the Rise

The number of nationwide outpatient facilities nearly doubled from 2005 to 2016, jumping from 26,900 to 40,600, according to a report from commercial real estate company CBRE. Outpatient care is more affordable and convenient for patients, said Christopher Bodnar, vice chairman of CBRE Healthcare Capital Markets. For providers, this means decompressing their main campus to allow for more specialty care.

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AAOS Hip Fracture Time-to-surgery Performance Measure Passes First CMS Test

In April 2018, AAOS published a performance measure (PM) encouraging hip fracture surgery within 48 hours of admission in patients aged 65 years and older. The PM is based on AAOS’ 2014 clinical practical guideline on Management of Hip Fractures in the Elderly. This correlates with existing research that older patients who receive early operative treatment have better outcomes. If accepted by CMS, this measure will join the 34 current measures in the CMS Orthopaedic Surgery Specialty Measure Set.

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Hundreds of Surgical Techniques Modules Available Free to AAOS Members

Build your surgical and clinical decision-making skills with unique educational experiences available on the AAOS online learning platform. Explore the surgical instruction interactive learning modules that assess your knowledge, patient management, and clinical decision making. Available free to AAOS members, these microlearning experiences provide quick and exciting lessons for hundreds of procedural techniques. Topics include advanced reconstruction, foot and ankle, hand and wrist, shoulder and elbow, hip and knee, spine, and sports medicine.

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