Today’s Top Story

Study Measures Effect of Bariatric Surgery on Arthroplasty Outcomes

In a study published online in The Journal of Arthroplasty, patients who underwent bariatric surgery prior to total knee arthroplasty (TKA) or total hip arthroplasty (THA) had reduced pulmonary complications and length of stay (LOS) but increased anemia and blood transfusion rates. The Nationwide Inpatient Sample was queried for data from 2006 to 2014; morbidly obese TKA and THA patients were matched to TKA and THA patients who underwent previous bariatric surgery. There was an increasing trend in morbid obesity among arthroplasty patients; bariatric surgery rates among morbidly obese TKA and THA patients did not change after 2007. Among TKA patients, those with previous bariatric surgery had reduced risks for pulmonary embolism (PE), respiratory complications, and death, as well as shorter LOS but increased risks for blood transfusion and anemia. Among THA patients, PE and LOS were reduced in the bariatric surgery group but blood transfusion and anemia risks were greater.

Read the study…

In Other News

Study Compares Operative versus Nonoperative Management of Humerus Fractures in Older Patients

A study published in the July issue of the Journal of Orthopaedic Trauma found that patients aged ≥ 60 years may have better outcomes if they undergo surgical treatment for proximal humerus (PH) or distal humerus (DH) fractures. PH and DH fracture patients were identified using the New York Statewide Planning and Research Cooperative System database. Patients were stratified based on operative versus nonoperative management; seven-day, 30-day, and one-year mortality rates were compared. Final analysis included 42,511 PH and 7,654 DH fractures; 76.2 percent of PH fractures and 53.0 percent of DH fractures received nonoperative treatment. In both cohorts, nonoperative treatment was associated with more comorbid conditions; longer LOS; and higher seven-day, 30-day, and one-year mortality. In controlled analyses, mortality rates did not differ between PH and DH fractures, but operative patients had lower mortality rates compared to nonoperative patients.

Read the abstract…

Study: Constrained Implant Arthroplasty for Distal Radioulnar Joint Arthrosis

Patients may undergo several reconstructive surgeries prior to distal radioulnar joint (DRUJ) implant arthroplasty, according to a retrospective study published in the July issue of The Journal of Hand Surgery. The study included 50 DRUJ implant arthroplasties (49 patients; average age, 47.8 years) performed during a 10-year period. Average follow-up was 35.8 months. Prior to DRUJ arthroplasty, 46 patients underwent several other surgeries. Patients demonstrated significant improvements in pronosupination range of motion, grip strength, and visual analog scale pain scores following arthroplasty. Eleven arthroplasties had wound-healing problems, but all healed without further surgery. Patients with a history of rheumatoid arthritis or immunosuppression were more likely to experience wound-healing problems. Complications led to 18 operations in eight patients, most commonly due to extensor tendinopathy.

Read the abstract…

Study Evaluates Financial Worry, Stress Among Orthopaedic Trauma Patients

Even with insurance, orthopaedic trauma patients may incur a significant amount of financial stress and worry, according to a study published in the July 17 issue of The Journal of Bone & Joint Surgery. A total of 236 patients (mean age, 56.3 years) who completed treatment for a musculoskeletal injury at one of two centers completed a survey. Researchers evaluated the financial burden composite score (0–6; “0” indicated “low” and “6” indicated “high”). While 97.9 percent of patients had medical insurance, the mean financial burden composite score was 2.4. A quarter of patients reported high levels of worry about financial problems directly related to their injury, 57 percent said they had to cut expenses in general to pay their associated bills, 54 percent used money from their savings, 23 percent borrowed money or took out a loan, and 23 percent missed other bill payments. Risk factors for increased financial hardship were high-deductible health plan insurance, Medicaid insurance, failure to complete high school, increased number of surgical procedures, and prior medical or student loans.

Read the abstract…

CMS Releases 2020 Payment Rules

On July 29, the Centers for Medicare & Medicaid Services (CMS) released two proposed rules, which include payment updates for outpatient and physician services, as well as expanded price transparency initiatives. The Outpatient Prospective Payment System (OPPS) proposed rule includes TKA potentially being added to the ambulatory surgical center covered surgical procedures list and THA potentially being removed from the inpatient-only list. The Medicare Physician Fee Schedule (MPFS) proposed rule includes potentially retaining five levels of coding for established patients, collapsing to four levels for new patients, and increasing payment for office/outpatient evaluation and management visits. AAOS will share more details in its forthcoming Executive Summary and looks forward to formally commenting on the proposed rules before they are finalized.

Read the OPPS fact sheet…

Read the MPFS fact sheet…


Good or Bad: Every Organization has a Culture

Every organization has a culture. The size, scope, location, makeup, or identity of an organization makes no difference, but the larger the organization, the more likely that additional subcultures will occur among departments. Culture is created and cultivated—whether actively or unconsciously influenced and whether positively or adversely inspired. Culture can be described as “the way things are done around here,” but creating and sustaining a healthy culture is an august goal worth pursuing.

Read more…


Act Now to Nominate AAOS Leadership

The 2020 Nominating Committee is actively soliciting nominees for individuals to serve on the Board of Directors in the following positions:

  • Second Vice President
  • Board Member-at-Large (over age 45 on March 30, 2020)
  • Board Member-at-Large (younger than age 45 on March 30, 2020)

Nominations close on Aug. 30. Members can review the position descriptions—including information about responsibilities, desired experience, and time commitments—as well as submit nomination(s) online.

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


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