Today’s Top Story

Study: PJI History Significantly Increases Risk After TKA

Patients with a previous prosthetic joint infection (PJI) in another joint after total knee arthroplasty (TKA) or total hip arthroplasty (THA) may have a nearly threefold risk of developing PJI following a subsequent TKA in a different joint, according to a retrospective review published in the July issue of The Bone & Joint Journal. The study included 95 patients (102 primary TKAs) who underwent surgery between 2000 and 2014 who had sustained a PJI after a previous THA or TKA. Patients were followed for a mean six years and matched 1:3 to 306 primary TKA patients who had a previous THA or TKA in another joint and did not develop PJI. At 10 years, patients with a prior PJI were significantly more likely to sustain one following the current surgery compared to those with no PJI history (6.1 percent versus 2.6 percent, respectively). Chronic suppression was a risk factor for PJI, while host grade was not.

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In Other News

Study Evaluates Long-term THA Outcomes with Dual-offset Uncemented Femoral Stem

A study published online in The Journal of Arthroplasty observed good 15-year outcomes in THA using a proximal porous-coated, dual-offset, tapered titanium alloy uncemented stem. Between 1996 and 1999, 210 THAs were performed in 193 patients with an average follow-up of 16 years (range, 15.0–17.7 years). At final follow-up, the cumulative survival rate was 99.5 percent. Compared to preoperatively, there were significant improvements in the Harris Hip Score, Western Ontario and McMaster University Arthritis Index score, and Short Form Health Survey-12 score at final follow-up. Fourteen hips (6.6 percent) displayed minor osteolysis when observed proximally, but no osteolysis presented distal to the porous coating.

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Study Identifies Factors Related to HRQoL in Cerebral Palsy Patients

A retrospective study published online in the Journal of Pediatric Orthopaedics assessed factors that contribute to improved health-related quality of life (HRQoL) in nonambulatory cerebral palsy patients who underwent spinal fusion surgery. Baseline and two-year outcomes were assessed using radiographs and the Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD) questionnaire. Meaningful CPCHILD improvement was defined as at least a 10-point improvement from baseline to two years. Of the 157 patients, 57 (36.3 percent) had meaningful two-year improvement in CPCHILD scores. Predictors of significant postoperative improvement were preoperative comfort, emotions, and behavior domain of the CPCHILD.

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Study: Does Artificial Soccer Turf Reduce Injury Risk?

Injury rates do not significantly differ in soccer players when they play on artificial turf versus natural grass, according to a cohort study published online in The American Journal of Sports Medicine. Injury data were compared over the course of four Major League Soccer seasons (2013–2016) based on the venue’s playing surface. Of the 2,174 in-game injuries recorded, injury rates were 1.54 per game on artificial turf and 1.49 per game on natural grass. In subgroup analyses, there was a greater incidence of overall ankle injury, Achilles injury, and ankle fracture on artificial turf, but there were no significant between-group differences in overall foot, forefoot, and knee injuries.

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House Votes to Repeal ACA’s Cadillac Tax

The House of Representatives voted 419–6 to repeal the Affordable Care Act’s (ACA) Cadillac Tax. Although it never went into effect, the Cadillac Tax would have imposed a 40 percent tax on the most expensive employer health plans. The Senate has not yet voted. Repealing the policy would cost an estimated $200 billion.

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AAOS Now

Determining Return to Activity Isn’t Easy, but There Is Help

Orthopaedic surgeons often are asked by patients, athletic departments, employers, insurance companies, and the Social Security Administration to complete forms that are designed to describe patients’ activity abilities, restrictions, or impairments. Activity ability (return to sports or work) is easy to determine when a patient wants to return to the activity and the controlling source (athletic department or employer) wants the patient back. In determining how to fill out such a form, a physician should consider risk of re-injury and whether the patient has the capacity to return to the activity (sports or work).

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