Today’s Top Story

Study Compares TKA Versus High Tibial Osteotomy Revision Rates

High tibial osteotomy (HTO) patients may be more likely to require revision than total knee arthroplasty (TKA) patients, according to a retrospective study published online in The Journal of Bone & Joint Surgery. Information from the South Korean National Health Insurance claims database spanning from Jan. 1, 2009, to Aug. 31, 2017, was reviewed for patients aged ≥ 41 years who underwent either primary HTO or TKA. Final analysis included 436,538 TKA patients and 452,724 HTO patients. Compared to TKA patients, HTO patients had a significantly higher risk for revision. Risk factors associated with revision in HTO patients were age > 60 years, female sex, receiving medical aid program benefits, hyperlipidemia, diabetes, and osteoporosis.

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Other News

Study Finds Association Between COPD Disease Severity and Hip Fracture Mortality

According to a study published online in Injury, the presence and severity of chronic obstructive pulmonary disease (COPD) may affect mortality risk in older hip fracture patients. Between 2004 and 2017, 1,294 patients (1,294 hips) underwent surgery for unilateral femoral neck or intertrochanteric fractures at two hospitals. Patients were stratified by COPD (n = 441 [mild to moderate, n = 354; severe to very severe, n = 87]) and non-COPD (n = 853). In the non-COPD group, 30-day, 60-day, three-month, six-month, and one-year postoperative cumulative mortality rates were 1.3 percent, 2.5 percent, 3.5 percent, 6.6 percent, and 10.7 percent, respectively; for COPD patients, mortality rates were 2.9 percent, 5.7 percent, 7.7 percent, 11.8 percent, and 16.6 percent, respectively. In subgroup analyses, 30-day, 60-day, three-month, six-month, and one-year postoperative cumulative mortality rates for patients with severe to very severe COPD were 4.6 percent, 6.9 percent, 11.5 percent, 20.7 percent, and 26.4 percent, respectively.

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Study Evaluates BPCI’s Impact on Healthcare System

The Bundled Payments for Care Improvement (BPCI) initiative may have helped drive down costs and readmissions in the healthcare system, according to a study published online in The Journal of Arthroplasty. Researchers analyzed data for one high-volume hospital and four low-volume hospitals participating in the BPCI Major Joint Replacement of the Lower Extremity Model 2. They evaluated changes in cost during the one-year period prior to BPCI participation versus the first 16 months of BPCI participation. Compared to the prior one-year period, after enrolling in BPCI, the mean episode of care cost decreased by 111 percent (from $21,324 to $18,953) at the high-volume hospital and by 8.3 percent (from $25,724 to $23,584) at the low-volume hospitals, which was attributed to less inpatient rehabilitation use, reduced lengths of stay at skilled nursing facilities, and declining readmission rates. The high-volume hospital did incur a $490 per episode penalty, while the low-volume facilities were rewarded a mean $315 per episode.

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Study: Foot Orthoses Versus Corticosteroid Injection for Heel Pain

A randomized trial published online in the Journal of Orthopaedic & Sports Physical Therapy evaluated the effectiveness of foot orthoses and corticosteroid injection for plantar heel pain. A total of 103 patients were randomized to receive prefabricated, arch-contouring foot orthoses or a single ultrasound-guided corticosteroid injection. The Foot Health Status Questionnaire foot pain subscale was assessed at four and 12 weeks; the minimal important difference value was 12.5 points. At week four, corticosteroid injection was more effective than the foot orthoses (adjusted mean difference, 8.2 points), but by week 12, the orthoses were more effective (adjusted mean difference, 8.5 points). The difference did not meet the previously established minimal important difference value, but the findings were still considered statistically significant; however, the researchers noted that patients may not notice a clinically significant difference between the treatment methods.

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Insys Therapeutics Pleads Guilty in Opioid Bribery Case

Opioid manufacturer Insys Therapeutics, Inc., pleaded guilty and agreed to a $225 million settlement in an opioid bribery case. The company was accused of paying doctors to speak at phony events where they were asked to promote its fentanyl spray Subsys. In reality, the doctors were being paid to prescribe the company’s medication to their patients. John Kapoor, the company’s founder, was found guilty of racketeering conspiracy in May.

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Read the AAOS Pain Relief Toolkit…


State and Federal Solutions to ‘Surprise Billing’

Since the passage of the Affordable Care Act, insurers have increasingly offered products with narrow, inadequate, and nontransparent networks. For those purchasing or electing coverage, a given product’s limitations in access to covered care are not well understood. For example, the nuances of highly profitable, narrow network coverage are rarely understood by customers until they receive a “surprise” bill. In such cases, uninformed patients receive out-of-network care and incur substantial out-of-pocket costs.

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Final Call: Cast Your Ballot! AAOS 2020 Nominating Committee, 2019 Resolutions and Bylaws Amendments

Active, emeritus, and inactive Fellows: Ballots must be cast by June 12. Cast your ballot to elect five members for the 2020 AAOS Nominating Committee and to determine action on two AAOS resolutions and three AAOS bylaws amendments. Balloting is quick, secure, and confidential. For the resolutions and bylaws amendments, at least 5 percent of the total Fellowship must cast ballots for the voting to be valid. An AAOS member ID is required to vote.

Learn more and cast your ballot…(member login required)


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