Today’s Top Story

Study Examines Influence of Preoperative Characteristics on Post-TKA Pain

Preoperative predictors of pain following total knee arthroplasty (TKA) may differ between men and women, according to a study published online in Arthritis Care & Research. The study included 477 patients (279 women, 198 men) undergoing TKA for osteoarthritis. Patients completed questionnaires preoperatively and three months after surgery. Women reported significantly worse preoperative knee pain, joint count, depressive symptoms, and postoperative knee pain. When adjusting for covariates, sex had no impact on pain, but sex did influence the effects of comorbidities (worse for women), low back pain (worse for men), and depressive symptoms (worse for men) on postoperative pain. Both men and women with worse preoperative pain had worse postoperative pain.

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In Other News

Study: Does Delayed Surgery for Hip Periprosthetic Fracture Increase Mortality or Morbidity Risk?

A study published online in The Journal of Arthroplasty evaluated the impact of time to surgery on 30-day complications in operative hip periprosthetic fracture patients A total of 857 patients were stratified into two groups based on time from hospital admission to surgery: ≤ 24 hours (expedited, n = 402) or > 24 hours (nonexpedited, n = 455). The average time to surgery in the nonexpedited group was 2.4 days. In multivariate analysis, nonexpedited patients had higher rates of overall complications and, specifically, respiratory complications, urinary tract infections, nonhome discharge, and blood transfusions, as well as longer total and postoperative length of stay (LOS). Mortality did not significantly differ between the two groups.

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Study Evaluates Operative Treatment of Fibroadipose Vascular Anomaly

Certain patients may be good candidates for surgical management of fibroadipose vascular anomaly (FAVA), according to a retrospective study published in the June 7 issue of the Journal of Pediatric Orthopaedics. The study included 35 patients (mean age, 12.3 years; 71 percent female) who underwent lower-extremity FAVA excision at a single institution between 2007 and 2016. Mean postoperative follow-up was 35 months. FAVA was most often located in the calf (49 percent) or thigh (40 percent), and most cases involved the gastrocnemius (29 percent) or quadriceps (26 percent) muscles. At final follow-up, significant improvement was observed in the proportion of patients with pain at rest (63 percent versus 29 percent), pain with activity (100 percent versus 60 percent), and analgesia use (94 percent versus 37 percent). Further treatment was required in 14 patients (40 percent) due to symptomatic residual disease or FAVA recurrence. Additional surgery was performed in six patients (17 percent), radiologic intervention was required in six patients (17 percent), and three patients (9 percent) underwent amputation for intractable pain and loss of function. Direct nerve involvement was associated with worse outcomes, including persistent neuropathic symptoms at final follow-up and symptomatic residual disease and/or FAVA recurrence.

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Study Uses Modified Frailty Index to Predict TSA Outcomes

The five-factor modified frailty index (mFI-5) could be a useful tool to predict complications, increased LOS, discharge to a facility, hospital readmission, and mortality in total shoulder arthroplasty (TSA) patients, according to a retrospective study published online in the Journal of Shoulder and Elbow Surgery. The National Surgical Quality Improvement Program database was used to gather data on 18,957 TSA patients who underwent surgery between 2005 and 2017. The mFI-5 score was the strongest predictor of mortality. It also strongly predicted serious medical complications (cardiac arrest, myocardial infarction, septic shock, pulmonary embolism, postoperative dialysis, reintubation, and prolonged ventilator requirement), discharge to a facility, readmission, and LOS.

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Drug Shortages Cost Hospitals Nearly $360 Million Annually

According to a Vizient survey of more than 6,000 U.S. hospitals, drug shortages cost facilities at least $359 million a year, as well as about 8.6 million additional personnel hours. Hidden costs associated with drug shortages include additional staffing, lost profit from delayed and canceled procedures, overtime, and updating technology. All hospitals surveyed said they are affected by drug shortages.

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Feedback and Coaching Are Vital Elements of Workplace Culture and Success

During the fall 2018 in-person meeting of AAOS’ Patient Safety Committee, members discussed methods for creating a culture of safety and enjoyment in orthopaedic surgery. David C. Ring, MD, PhD, chair, and committee members addressed the value of feedback and coaching to enhance individual and team performance as well as contentment and fulfillment at work.

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Apply for the AAOS Now Deputy Editor Position

AAOS Now has a new open deputy editor position. Over the course of a one-year term, which is renewable for up to three years, the deputy editor will serve as a backup for the editor-in-chief. The deputy editor is responsible for generating article ideas; seeking potential authors and subject matters; and identifying potential event coverage from the AAOS Annual Meeting, AAOS National Orthopaedic Leadership Conference, AAOS Fall Meeting, and other meetings. The application deadline is July 8.

Learn more and submit your application…(member login required)


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