Today’s Top Story

Study Evaluates Operating Times in THR and TKR

A study published in the July issue of Health Affairs found that self-reported service times for total hip replacement (THR) and total knee replacement (TKR) may be inaccurate. Actual service times were assessed for THRs and TKRs at two academic hospitals between Jan. 1, 2013, and Oct. 1, 2016. Electronic health record time-stamp data were compared to the Medicare Physician Fee Schedule and Relative Value Scale Update Committee’s most recent recommendations. Service times for primary THRs and TKRs were overestimated by 18 percent and 23 percent, respectively. Revision THRs and TKRs were overestimated by 61 percent and 48 percent, respectively. There was no correlation between faster operating time and complications or intensive care unit admissions.

Read the abstract…

In Other News

Study: Does Adding Fusion to Decompression Improve Outcomes in Neurogenic Claudication Secondary to Lumbar Stenosis?

A study published online in The Spine Journal compared three-, 12-, and 24-month clinical outcomes in patients with neurogenic claudication secondary to lumbar stenosis without spondylolisthesis or deformity who underwent decompression alone versus decompression plus fusion. Researchers queried the Canadian Spine Outcomes and Research Network prospective database for relevant data spanning from October 2012 to January 2018. The fusion group had significantly longer operative time and length of hospital stay, as well as more blood loss and a higher rate of perioperative complications. Both cohorts experienced clinically meaningful changes in generic and disease-specific patient-reported outcome measures at three and 24 months. There were no significant between-group differences.

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Study Analyzes Secondary Subtalar Joint OA After Total Ankle Replacement

In a study published online in Foot & Ankle International, secondary subtalar joint fusion was low among total ankle replacement (TAR) patients. Between 2000 and 2016, 941 patients underwent primary TAR. Subtalar joint osteoarthritis (OA) progression was assessed through degenerative subtalar joint changes in 671 patients preoperatively and at final follow-up. Four percent of patients (n = 37) required a secondary subtalar joint fusion, most commonly for symptomatic OA (51 percent, n = 19). Other indications included hindfoot instability (27 percent, n = 10), osteonecrosis of the talus (19 percent, n = 7), and cystic changes of the talus (3 percent, n = 1). When the indication was progressive OA, the time from primary TAR to joint fusion was five years compared to 1.6 years for other indications. Most patients (68 percent, n = 456) did not exhibit progression of subtalar joint OA.

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Study Reviews Outcomes in Flail Chest Injuries

A retrospective study published in the July issue of the Journal of Orthopaedic Trauma observed good outcomes in flail chest injury patients who underwent locking plate and screw fixation constructs with muscle-sparing approaches. A total of 52 patients underwent treatment and were followed for at least one year. All patients achieved union. Within three months postoperatively, mean periscapular strength was greater than 90 percent of the noninjured side and within six months was a mean 95 percent of the noninjured side. Significant improvements in glenohumeral range of motion were also observed during this time. Complication rates were similar to those observed in previous studies.

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Bipartisan Legislation Seeks to Lower Drug Costs for Medicare Patients

Senators Chuck Grassley (R-Iowa) and Ron Wyden (D-Ore.) revealed new legislation that would reduce the cost of prescription drugs for Medicare beneficiaries, as well as save money for federal and state healthcare programs. Effective in 2020, the legislation would cap annual out-of-pocket costs at $3,100 for Medicare Part D patients.

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In an Effort to Cut Costs, Domestic Medical Tourism Takes Off

Medical tourism refers to patient travel specifically for medical wellness services. Historically, travel recommendations for rare or complex conditions often came from local treating physicians. More recently, payers seeking to cut costs have selected preferred providers or centers of excellence for elective orthopaedic procedures such as joint arthroplasty and spinal fusion. Typically, they will cover travel costs for the patient and a family member. This is part two in a two-part series.

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Read part one…


Apply for Volunteer Opportunities

Consider applying for the following positions:

  • Hip, Knee & Adult Reconstruction Evaluation Committee chair position—applications are accepted until July 31
  • Hand & Wrist Evaluation Committee member position—applications are accepted until Aug. 2
  • Hip, Knee & Adult Reconstruction Evaluation Committee member position—applications are accepted until Aug. 2
  • Orthopaedic Knowledge Update (OKU) Evaluation Committee member position (hip & knee reconstruction item writer)—applications are accepted until Aug. 2
  • OKU Evaluation Committee member position (sports medicine item writer)—applications are accepted until Aug. 2
  • OKU Evaluation Committee member position (orthopaedic basic science item writer)—applications are accepted until Aug. 2

Learn more and submit applications…(member login required)


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