Today’s Top Story

Study: Continued adalimumab after remission may reduce nonradiographic axial spondyloarthritis flares

Patients with nonradiographic axial spondyloarthritis who maintained remission with adalimumab may benefit from continued therapy, according to a study published online in The Lancet. The multicenter, randomized, double-blind, two-period study was conducted at 107 sites in 20 countries between June 27, 2013, and Oct. 22, 2015. Researchers enrolled 673 adult patients with nonradiographic axial spondyloarthritis who met Assessment of SpondyloArthritis International Society classification material but not modified New York radiologic criterion. Patients showed active inflammation, disease, and no response to at least two nonsteroidal anti-inflammatory drugs. Patients who received adalimumab 40 mg every other week for 28 weeks and had inactive disease (n = 305, 45 percent) were randomized 1:1 to either continue adalimumab (n = 152) or receive placebo (n = 153). A greater proportion of patients who continued adalimumab did not experience a flare up to and including week 68. Among all patients who received adalimumab at any time, 516 (77 percent) reported an adverse event (AE). The most common AEs in both the adalimumab and placebo groups were nasopharyngitis, upper respiratory tract infection, and worsening of axial spondyloarthritis.

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Other News

Study: Standard versus delayed rehabilitation following lateral meniscal allograft transplantation

Delayed rehabilitation showed less coronal graft extrusion and joint space narrowing on weightbearing and reduced progression of arthrosis compared to standard rehabilitation in 53 patients undergoing meniscal allograft transplantation (MAT); however, there were no differences in clinical outcomes between the two rehabilitation methods, according to a study published online in The American Journal of Sports Medicine. Researchers assessed patients who underwent lateral MAT with the keyhole technique between June 2011 and March 2015 and subsequently received standard (n = 25) or delayed (n = 28) rehabilitation. Graft extrusion and relative percentage of extrusion were greater in the standard group, and the percentage of patients with graft extrusion (≥ 3 mm) was 52 percent in the standard group compared to 21.4 percent in the delayed group. There were significant correlations between the coronal graft extrusion and postoperative joint space width on full extension and Rosenberg views, Kellgren-Lawrence grade, and modified Outerbridge grade on MRI.

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Study: ‘Bikini’ incision appears to result in better satisfaction after THA

Use of a short oblique “bikini” skin crease incision appears to be a safe direct anterior approach for total hip arthroplasty (THA), according to a study published online in The Bone & Joint Journal. Researchers administered a follow-up questionnaire to 964 patients two to four years after they underwent THA. Among them, 59 percent received a longitudinal incision and 41 percent received a bikini incision. The questionnaire included the Oxford Hip Score (OHS) and the University of North Carolina “4P” scar scale (UNC4P), as well as two items assessing aesthetics and scar numbness. OHS scores were similar, but the mean UNC4P score was slightly better in the bikini incision group, with more patients reporting aesthetic satisfaction. Reported numbness was higher in the longitudinal incision group. Researchers observed no difference in revision rates, abduction angle of the acetabular component, position of the stem, or rates of heterotopic ossification. However, they noted that the bikini method should only be used by surgeons after they have gained experience with the classic longitudinal incision.

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Study: New technique may create personalized grafts from stem cell–created bone segments

A new technique developed by scientists from the New York Stem Cell Foundation enables researchers to combine bone segments made with stem cells to create personalized grafts for patients with bone disease or injury, according to a paper published online in Scientific Reports. The technique, called Segmental Additive Tissue Engineering (SATE), was used to reconstruct a femoral defect in a rabbit via transverse partitioning to the longitudinal axis to allow effective tissue formation in vitro. A digital model of the rabbit femur was created and used to isolate 14 segments with a thickness of 0.5 cm that were patched to create 3D-printed inserts. The SATE technique allows for reproducible and effective segmental bone graft engineering for personalized reconstructive procedures, according to the researchers.

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Senate confirms Robert Wilkie as new Veterans Affairs secretary

The Senate confirmed Robert Wilkie as secretary of the Department of Veterans Affairs (VA) by a vote of 86-9, making him the first VA secretary who was not unanimously confirmed. The department has been without a permanent secretary since March when David Shulkin, MD, was fired. During his confirmation hearing, Mr. Wilkie said he will prioritize modernizing electronic health records (EHRs), picking up where Dr. Shulkin left off. At the time of his dismissal, Dr. Shulkin was in contract negotiations with Cerner to replace the VA’s legacy EHR.

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AAOS Now

Staff issuing patients blank ABN forms is not acceptable

For many orthopaedic offices, it is standard practice to require Medicare beneficiaries to sign a blank advance beneficiary notice (ABN) at check-in, “just in case” the physician recommends an item or service that may not be covered by Medicare. The rationale is that the team can fill in the blanks later as documentation that the patient was told he or she is responsible for payment. If this is how your team handles ABNs, it is time to reset your systems.

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Your AAOS

Apply for Council on Research and Quality member-at-large position

The Council on Research and Quality has an open member-at-large position, a two-year term that runs from March 18, 2019, to March 12, 2021. The council works to advance the application of scientific knowledge to improve the safety and effectiveness of musculoskeletal care. Some of the council’s responsibilities include promoting policies that are in the best interest of patients with musculoskeletal injuries and diseases, developing and disseminating evidence-based clinical practice guidelines and appropriate use criteria, promoting the development of orthopaedic clinician-scientists, and providing programming to assist orthopaedic researchers to compete for grant funding. The last day to submit an application is Aug. 3.

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

 

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