Today’s Top Story

Study Identifies Predictors of SSI in TJR Patients

Among total joint replacement (TJR) patients, those undergoing revision surgery and those who have certain comorbidities may have an increased risk for surgical site infection (SSI), according to a retrospective study published online in the American Journal of Infection Control. Primary and revision TJR patients were identified using the IBM MarketScan and Medicare databases and were assessed for 34 comorbidities. Final analysis covered 335,134 total knee replacements (TKRs) and 163,547 total hip replacements (THRs). SSI rates were higher after revision TKR (15.6 percent) and revision THR (8.6 percent) compared to primary TKR (2.1 percent) and primary THR (2.1 percent). In all TJRs, the following comorbidities were most significantly associated with SSI: AIDS, paralysis, coagulopathy, metastatic cancer, and congestive heart failure.

Read the abstract…

Other News

Study Evaluates Intraoperative Frozen Section During Open Bone Biopsy

A retrospective review published in the June 1 issue of the Journal of the AAOS found that frozen section analysis could assist in intraoperative decision making during open bone biopsy. A total of 485 open biopsies (474 patients) of osseous lesions were included in the study. Frozen section analysis accuracy rates were determined using pathology reports, operative notes, and prebiopsy imaging. The open bone biopsy overall diagnostic yield was 95.3 percent. Frozen section analysis had a 54.2 percent accuracy rate. It was equivocal positive and equivocal negative in 21.2 percent and 21.0 percent, respectively, of cases, and incorrect in 3.5 percent of cases.

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Researchers Create Algorithm for Managing Periprosthetic Ankle Fracture

A retrospective study published in the June issue of Foot & Ankle International described an algorithm researchers developed to assist in the management of periprosthetic fractures occurring with total ankle replacement (TAR). The study involved patients who underwent TAR between 2007 and 2017 and sustained periprosthetic fracture more than four weeks from index surgery. Of the 32 patients identified, most (62.5 percent) had a fracture located about the medial malleolus. Three-quarters of fractures were considered to have stable implants. For talus fractures, implants were always unstable and revision surgery was always required. At an average of three years, patient-reported outcomes did not differ between stable and unstable fractures. Multivariate analysis identified the following as predictors of unstable implants: fracture location (talus), less time to fracture, and implant type.

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Study: Fusion Length Linked with Lung Volume Decrease in AIS Surgery

A longer fusion area in patients with adolescent idiopathic scoliosis (AIS) undergoing posterior spinal fusion with instrumentation (PSF) may be a risk factor for decreased lung volume (LV), according to a retrospective study published online in the European Spine Journal. A total of 111 consecutive AIS patients (aged 10–20 years) underwent PSF at a single facility. At two-year follow-up, the mean total LV had increased, although with marginal significance, and there was a significant increase in the left LV but not the right LV. Overall, 18 percent of patients (n = 20) had a postoperative reduction in total LV. Univariable and multivariable analyses revealed a significant relationship between fusion levels  ≥ 11 and postoperative LV reduction, and the authors concluded that avoidance of those longer levels may be advisable for preserving LV.

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Trauma Tips for the Orthopaedic Surgeon

During the AAOS 2019 Annual Meeting, Michael J. Weaver, MD, presented an Instructional Course Lecture titled “Orthopaedic Disaster Management: Preparing for Your Worst Moment in the Operating Room,” offering guidance and tips for managing three clinical trauma scenarios: mangled extremity, compartment syndrome, and pelvic fracture. When feasible, patients with such injuries and associated complications should be transported to a Level 1 trauma center, but orthopaedic surgeons in other settings may find themselves handling these challenges.

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Urge Your Senators to Oppose the Surprise Billing Provisions of the Lower Health Care Costs Act

This week, the Senate HELP committee is expected to advance the Lower Health Care Costs Act (S.1895), which includes a provision that would benchmark all out-of-network reimbursements to a median commercial in-network rate for the geographic area. Under the guise of protecting patients from surprise medical bills, Congress is pursuing an unprecedented transfer of market power to insurers by sanctioning government-mandated price setting. AAOS strongly opposes this legislation and is working to advance a solution that maintains specialty access and protects patients while preserving physicians’ ability to fairly negotiate with insurers. The Association urges members to contact their Senators and implore them to oppose this misguided, heavy-handed government price setting.

Take action…

Read AAOS’s opposition statement…

Fellows Elect 2020 Nominating Committee

The members of the 2020 AAOS Nominating Committee have been identified. The AAOS Board of Directors appointed the chair of the AAOS Nominating Committee at its meeting in March. In June, the AAOS fellowship elected the five members of the 2020 Nominating Committee. One additional member was jointly elected by the Board of Councilors (BOC) and the Board of Specialty Societies (BOS) at the National Orthopaedic Leadership Conference. The 2020 Nominating Committee will present its slate of nominees to the fellowship by Nov. 27, 120 days prior to the business meeting at the AAOS 2020 Annual Meeting The 2020 Nominating Committee members are Gerald R. Williams, Jr., MD (Pa), Chair; Stephen S. Burkhart, MD (Texas); Jesse B. Jupiter, MD (Mass.); CAPT (Ret) Matthew T. Provencher, MD (Colo.); Anthony A. Romeo, MD (N.Y.); Jennifer M. Wolf, MD (Ill.); and Lisa K. Cannada, MD (Fla.), BOC/BOS representative. Richard H. Gelberman, MD (Mo.), was elected as the alternate member of the committee.


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