Today’s Top Story

Study: Nonoperative Hip Fracture Increases Mortality in Older Patients

Hip fracture patients aged ≥ 65 years who do not undergo operative treatment may increase their mortality risk, according to a study published in the July issue of the Journal of Orthopaedic Trauma. Femoral neck or intertrochanteric fracture (OTA/AO 31A and 31B) patients were stratified into two groups: operative (arthroplasty, cannulated screws, sliding hip screw device, or cephalomedullary nail; n = 154) and nonoperative (n = 77) treatment. The nonoperative group had significantly higher risks of in-hospital, 30-day, and one-year mortality, as well as significantly shorter life expectancy after fracture (221 versus 1,024 days, respectively).

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In Other News

Study Finds Acceptable Outcomes Associated with Contemporary Rotating Hinged TKA

A retrospective study published online in Knee Surgery, Sports Traumatology, Arthroscopy found that contemporary rotating hinged total knee arthroplasty (CRH-TKA) may be associated with satisfactory clinical outcomes. Between 2006 and 2011, 112 primary CRH-TKAs were performed at 14 centers. Mean patient age was 68 years, and most patients were sedentary and had significant comorbidities. Indications for surgery included severe frontal plane deformity (55 percent); inflammatory, constitutional, congenital, or post-trauma arthritis (26 percent); ligament laxity (10 percent); and primary osteoarthritis (9 percent). Evaluations included Knee Society Score (KSS), Oxford score, radiological assessment for implant loosening, and survival and reoperation rates. After a mean seven years of follow-up, the mean KSS and Oxford score were 64 and 33, respectively; both scores improved significantly over time. Most implants (n = 102, 91 percent) were still intact, while seven (6 percent) required revision and an additional three (3 percent) could not undergo revision due to poor overall patient health. Mortality was significantly linked to the presence of comorbidities. There were 28 complications, including infections (n = 12), stiffness (n = 6), aseptic loosening (n = 5), and patellofemoral instabilities (n = 5).

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Study Assesses Long-term Outcomes in Arthroscopic Knotless Suture Bridge Repair of Rotator Cuff Tears

A prospective study published in the July issue of Arthroscopy evaluated five-year outcomes in patients with full-thickness supraspinatus atraumatic chronic tears who underwent arthroscopic knotless suture bridge repair. A total of 68 patients with medium or large tears were included; patients were followed for a mean 68.8 months. At final follow-up, significant improvements were observed in mean visual analog scale (5.5 to 2.1), American Shoulder and Elbow Surgeons (48.2 to 87.4), and Constant (37.8 to 82.8) scores. Anteflexion changed from 99.3 degrees to 1366 degrees, and strength score significantly improved. MRI revealed 88 percent of Sugaya 1–2 repairs, and patients whose rotator cuffs did not heal had poorer functional outcomes compared to the Sugaya 1–2 patients.

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Study: Osteoporosis and Fracture Risk Among Veterans with Thyroid Cancer

According to a case-control study published online in The Oncologist, veterans with thyroid cancer may be at increased risk for osteoporosis but not fracture. Data from 2004–2013 were gathered from the Veterans Health Administration Corporate Data Warehouse; 10,370 thyroid cancer patients were matched 1:1 to healthy controls based on age, sex, weight, and steroid use. In controlled analysis, the thyroid cancer group had a higher rate of osteoporosis than the control group (7.3 percent versus 5.3 percent) but not a higher rate of fracture. Subgroup analysis associated the following risk factors with osteoporosis: lower thyroid‐stimulating hormone (TSH), female sex, older age, and androgen use. There was no correlation between TSH and fracture.

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Improved Readmission Rates in Hip, Knee Surgeries May Be Stalled

A Centers for Medicare & Medicaid Services (CMS) program aimed at reducing readmission rates may not have had as significant of an impact as anticipated in hip and knee surgeries, according to a study published in the July issue of Health Affairs. CMS’ Hospital Readmissions Reduction Program, which kicked off in 2010, was designed to penalize excess readmissions for patients with specific medical conditions; in August 2013, it was expanded to include hip and knee replacements. The study authors suggest that the associated penalties may have reduced readmission rates among surgical patients before the expansion and that readmissions may not be likely to be significantly reduced any further.

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AAOS Advocacy Efforts Address the BPCI Advanced Model

Almost a year ago, CMS launched the Bundled Payments for Care Improvement (BPCI) Advanced model as part of its ongoing bundled payment initiative through the Center for Medicare and Medicaid Innovation (CMMI). The voluntary, episode-based program ties payments to quality performance and requires that participants bear financial risk and use certified electronic health record technology. Participants who meet the requirements can earn an Advanced alternative payment model incentive. Through comments and discussions with both CMMI and Congress, AAOS has pushed for improvements to various aspects of the model’s design.

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Free! Surgical Risk Reduction Toolkit

The best way to improve patient outcomes and help patients have a successful recovery from surgery is to avoid the complications that may lead to increased length of stay, hospital readmission, and multiple operations. Get equipped with quick reference strategies to mitigate preoperative, intraoperative, and postoperative risk factors that may contribute to surgical complications with the free Surgical Risk Reduction Toolkit.

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