Today’s Top Story

Study: Does ACL/Meniscus Injury Increase Knee OA Risk?

Patients with an anterior cruciate ligament (ACL) and/or meniscus injury may be more likely to develop osteoarthritis (OA) of the knee, according to a study published online in the British Journal of Sports Medicine. The researchers queried MEDLINE, Embase, SPORTDiscus, CINAHL, and Web of Science through November 2018 for prospective and retrospective studies with at least two years of follow-up on adult patients with ACL and/or meniscal injury. The final review included 53 studies with about 1 million total patients, of whom 185,219 had an ACL injury, 83,267 had a meniscal injury, and 725,362 had a combined injury The odds ratios for knee OA associated with knee injury were 4.2 in the ACL group, 6.3 in the meniscal group, and 6.4 in the combination group.

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Other News

Study Associates Lupus with Postoperative THA Complications

Lupus patients undergoing primary total hip arthroplasty (THA) may have poorer outcomes, according to a study published in the June issue of Lupus. Researchers evaluated data from the 1998–2014 U.S. National Inpatient Sample to evaluate postoperative complications (implant infection, transfusion, THA revision, and mortality) and healthcare utilization outcomes (total hospital charges, discharge to an inpatient facility, and hospital length of stay [LOS] more than three days) after THA. Of 4,116,485 primary THAs, 22,557 (0.5 percent) occurred in lupus patients who tended to be younger and were more likely to be female, black or Hispanic, living in the south, or Medicaid beneficiaries. They also had higher comorbidity rates and lower income. Lupus patients had greater rates of implant infection, transfusion, discharge to an inpatient facility, and higher hospital charges. There was no association between lupus and risk of revision, mortality, or hospital LOS more than three days.

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Study Measures Caprini Score Accuracy in Lower-extremity Fracture Patients

According to a retrospective study published in the June issue of the Journal of Orthopaedic Trauma, the Caprini Score could be a predictor of venous thromboembolism (VTE) events in patients with lower-extremity fracture. A total of 848 patients were stratified into two groups: high (pelvic and acetabular fractures, n = 300) and low risk (isolated foot and ankle fractures, n = 548). Overall, 33 (3.9 percent) VTE events took place, with a higher rate in the high-risk group (8 percent) compared to the low-risk group (1.6 percent). Based on receiver-operating curves, the best cutoff for predicting VTE events was 12 in the high-risk group, 11 in the low-risk group, and 12 overall.

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Study Assesses Risk Factors Associated with Cystic Fibrosis-related Bone Disease

A study published in the June issue of Osteoporosis International evaluated the prevalence of and risk factors associated with cystic fibrosis-related bone disease (CFBD) in CF patients with end-stage respiratory failure undergoing lung transplantation. A total of 42 CF patients (mean age, 34 years) were evaluated for clinical characteristics, bone mineral density (BMD), calcium metabolism parameters (including vitamin D [25OHVitD] levels), and fragility fracture presence. Most patients (81 percent) presented hypovitaminosis D (25OHVitD < 75 nmol/L); the mean 25OHVitD level was 54.9 nmol/L. The median daily calcium intake was 550 mg/day, which is lower than the recommended dose More than half of patients (52.4 percent) had a BMD lower than expected for their age, and 45.2 percent of patients presented at least one fragility fracture; 31 percent of patients presented low BMD and fracture. Patients who had both low BMD and fracture were significantly more likely to have nephrolithiasis.

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Medicare ACOs Will be Able to Take Part in BPCI Advanced Program

Effective Jan. 1, 2020, providers taking part in the Bundled Payments for Care Improvement (BPCI) Advanced program will take priority over Medicare accountable care organizations (ACOs) in the enhanced track. The original rule only allowed BPCI participants to apply the program to basic track beneficiaries, or ACOs in tracks formerly known as Tracks 1, 1+, and 2. BPCI Advanced participation has dropped 16 percent from October 2018 through March.

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Tips and Best Practices for Using Code-X

In part two of a two-part series, Cheryl Toth, MBA, spoke with Madelaine Reese, senior product manager of online learning at AAOS, about tips for getting the most out of Code-X, a coding and compliance tool developed by AAOS.

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Survey Out for Potentially Misvalued Codes 27130 (THA) and 27447 (TKA)

AAOS is participating in the American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC) survey for codes 27130 (THA) and 27447 (total knee arthroplasty [TKA]). The Academy, in concert with the Association of Hip and Knee Surgeons, will survey members who have knowledge of and experience with these services to help determine the work and practice expense values presented to the RUC. If you are contacted to complete a survey, please do so. Your participation will help our societies recommend accurate values for physician work and direct practice expense. Questions regarding the survey can be directed to Joanne Willer, manager of coding and reimbursement resources in the Office of Government Relations, at


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