Today’s Top Story

Study: Do TKA Expectations Differ Between RA and OA Patients?

A retrospective cohort study published online in The Journal of Arthroplasty found that rheumatoid arthritis (RA) patients have lower baseline expectations for total knee arthroplasty (TKA) compared to osteoarthritis (OA) patients. A total of 76 RA patients were matched 1:2 with 152 OA patients by age, sex, American Society of Anesthesiologists score, and Charlson Comorbidity Index (CCI). Researchers assessed outcomes including visual analog scale (VAS) for pain and Knee Injury and Osteoarthritis Outcome Score (KOOS) at baseline and two years postoperatively. Preoperatively, the RA group had lower expectations and worse VAS pain scores, as well as KOOS-pain, KOOS-symptoms, and KOOS-activities of daily living. After two years, the RA patients demonstrated significant improvement in VAS pain scores and all KOOS subscales, making them more comparable to OA patients. Both cohorts reported similar satisfaction levels with their TKA (RA group, 86.1 percent; OA group, 87.1 percent).

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In Other News

Study Evaluates Association Between Intraoperative Hemodynamic Events and Postoperative Delirium in Hip Fracture Patients

A prospective study published online in Injury evaluated the association between a single episode of intraoperative hyper-/hypotension, blood pressure (BP) fluctuation (ΔMAP), and pulse pressure (PP) and postoperative delirium (PD) in hip fracture patients aged > 60 years. Researchers used the Confusion Assessment Method to determine perioperative delirium and recorded the development of PD and whether it was hyper- or hypoactive. The Short Portable Mental Status Questionnaire (SPMSQ) was used to measure cognitive function. Anesthesia charts were used to determine patients’ lowest and highest BP values. Just over half of patients (n = 148, 53 percent) experienced PD within the first week after surgery, of whom three-quarters were diagnosed with hypoactive PD. The following factors were associated with developing any type of PD: older age, lower body mass index, increased SPMSQ and CCI scores, more severe systemic diseases, lowest intraoperative BP, higher ΔMAP, lower PP, higher postoperative pain score, taking more drugs, and receiving intraoperative blood transfusion.

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Study Finds High Complication Rate in Wrist Arthrodesis Patients

Patients undergoing arthrodesis of the wrist for noninflammatory arthritis may have a higher complication risk than previously believed, according to a study published in the July issue of The Bone & Joint Journal. Of 76 wrist arthrodesis patients (mean age, 50 years), 63 completed questionnaires and 57 underwent clinical and radiological assessments after a mean 11 years. In total, 60.5 percent of patients experienced complications, and 65 reoperations were performed. Among the patients who filled out the questionnaires, the mean Quick Disabilities of Arm, Shoulder and Hand and Patient-rated Wrist and Hand Evaluation scores were 36 and 40, respectively; only 22 percent of patients reported no wrist pain. Compared to the contralateral forearm, there were significant reductions in grip and pinch strength, pronation, and supination. At the time of the study’s publication, 13 patients were still awaiting reoperations, for a 63 percent total reoperation rate.

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Study Assesses Intermediate-term TAA Outcomes Based on Age

Patients aged < 55 years with end-stage ankle arthritis may have similar clinical and radiographic outcomes after total ankle arthroplasty (TAA) compared to older patients, according to a study published in the July issue of Foot & Ankle International. Primary TAA patients with a mean follow-up of 78 months were stratified by age: < 55 years (38 ankles; mean age, 45 years) and > 55 years (85 ankles; mean age, 65 years). There were no significant between-group differences in Ankle Osteoarthritis Scale pain and disability, American Orthopaedic Foot & Ankle Society ankle-hindfoot, Short Form–36 Physical Component Summary and Mental Component Summary, and VAS scores, nor in complication and survivorship rates at final follow-up.

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Medicare May Cover Acupuncture for Back Pain in Approved Studies

The Centers for Medicare & Medicaid Services (CMS) proposed a decision that would grant Medicare beneficiaries access to acupuncture if the treatment is part of an approved study. Acupuncture is not currently covered by Medicare and is being considered as an alternative to opioid use.

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OTA Presentations Detail When to Operate on Talus and Femoral Neck Fractures

During the AAOS 2019 Annual Meeting, a session at the Orthopaedic Trauma Association (OTA) Specialty Day included two presentations that offered guidance on timing issues in the management of talus fractures and of femoral neck fractures in younger adults.

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New AAOS Courses OnDemand: Learn Like You Were There

Grab your front-row virtual seat at recorded AAOS courses with on demand video programs that bring the finished events to you. Self-directed programs offer the flexibility to engage with trusted AAOS content at your convenience, across your devices. Watch and listen to the experts and their presentation slides, patient case discussions, and surgical demonstration videos. Content is segmented by topic, so you can select lectures you prefer to watch, pick up where you left off, and earn continuing medical education credit at your own pace. Explore the growing collection today.

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