Today’s Top Story

AAOS 2019 Annual Meeting Paper Presentation: IV Acetaminophen Does Not Reduce Pain after Total Hip Replacement

A double-blind, controlled trial that will be presented today at the AAOS 2019 Annual Meeting found that intravenous (IV) acetaminophen did not result in a significant difference in pain scores, opioid consumption, or opioid-related adverse events (AEs) compared to oral acetaminophen in total hip arthroplasty (THA) patients. A total of 154 patients undergoing THA were randomized to receive postoperative oral acetaminophen with an IV placebo or IV acetaminophen with an oral placebo. Both cohorts had low pain scores with activity, low burden of opioid-related AEs, and modest opioid intake.

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Other News

Study: Local Infiltration Analgesia with or Without Liposomal Bupivacaine in TKA Patients

According to a study published online in The Journal of Arthroplasty, total knee arthroplasty (TKA) patients may have better outcomes when they receive local infiltration analgesia (LIA) with liposomal bupivacaine (LB). TKA patients with osteoarthritis of the knee were randomized 1:1 to receive LIA with LB 266 mg/20 mL with bupivacaine hydrochloride (HCl) 0.5 percent 20 mL (n = 70) or bupivacaine HCl alone (n = 69). During the 24-hour postoperative period, patients who received LIA with LB were less likely to need opioid rescue compared to the bupivacaine HCl alone group (1.4 percent versus 17.1 percent). LIA with LB patients had a 91 percent opioid consumption reduction and 19 percent pain intensity reduction. LIA with LB patients were more likely to be ready to discharge after 24 hours (42.9 percent versus 27.5 percent) and reported higher pain treatment satisfaction (84.6 percent versus 69.2 percent).

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AAOS 2019 Annual Meeting Paper Presentation: Shoulder Surgery in an ASC Is a Safe Alternative for Some Patients

A study that will be presented today at the AAOS 2019 Annual Meeting found that outpatient shoulder surgery performed at an ambulatory surgical center (ASC) could be a low-risk alternative to inpatient surgery for certain patients. Researchers used a claims database to gather information on all patients who had orthopaedic shoulder surgery (n = 84,658) in the hospital-based outpatient department (HOPD) (n = 56,819) or an ASC (n = 28,730). Outcomes included unexpected postoperative admission, readmission, deep vein thrombosis (DVT), pulmonary embolism (PE), and 90-day wound infection. Compared to the ASC cohort, HOPD patients had a slightly increased risk of unexpected admission, readmission, DVT, PE, and wound infection.

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Study: Is a Rehabilitation Program Feasible after Lumbar Fusion Surgery?

A randomized, controlled trial published online in the European Spine Journal evaluated a theoretically informed rehabilitation program after lumbar fusion surgery (REFS). Patients were randomized to REFS or usual care. REFS consisted of 10 consecutive weekly group rehabilitation sessions that included education; low-tech cardiovascular, limb, and spine strengthening exercises; and peer support. The primary outcome was feasibility in terms of recruitment and engagement. REFS engagement was greater than 95 percent. The REFS cohort had a significant reduction in mean short-term disability, which was not observed in the usual care group. Long-term disability reduction was much more significant in the REFS group.

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Study: Low Back Pain in LSS Patients Treated with ULBD

Lumbar spinal stenosis (LSS) patients with low back pain (LBP) may benefit from unilateral laminectomy for bilateral decompression (ULBD), according to a study published online in BMC Musculoskeletal Disorders. Researchers used a detailed visual analog scale (VAS) (100 mm) score of LBP in three different postural positions—motion, standing, and sitting—and measured bilateral VAS score (approached side versus opposite side) of LBP, lower extremity pain, and lower extremity numbness. Among the 50 patients included in the study, preoperative LBP VAS scores were 51.5 in motion, 63.0 while standing, and 37.8 while sitting. Postoperative LBP while standing significantly improved; LBP levels in all three positions became almost equal with Oswestry Disability Index improvement. Both sides equally showed significant improvement in bilateral VAS scores.

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New Guidance Attempts to Resolve Confusion Regarding the Removal of TKA from IPO List

On Jan. 8, the Centers for Medicare & Medicaid Services (CMS) issued unprecedented guidance to help resolve confusion regarding the removal of TKA from the Medicare inpatient-only (IPO) list. The 2018 Medicare Outpatient Prospective Payment System Final Rule included a policy change allowing for payment of TKA procedures in either the hospital inpatient or outpatient setting. Unfortunately, the policy change precipitated considerable confusion and differences in interpretation among various stakeholders. The new guidance, prompted by ongoing communication between CMS and the AAOS Office of Government Relations, aims to clarify CMS’ intent.

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AAOS Board of Directors Approves Two Updated Clinical Practice Guidelines

On Monday, the AAOS Board of Directors approved the complete updates of both the Management of Rotator Cuff Injuries and the Management of Periprosthetic Joint Infections Clinical Practice Guidelines (CPGs). Both CPGs were originally published in 2010, during a time when the available evidence for orthopaedic surgery was limited and the field of evidence-based medicine was still maturing at a rapid pace.

Learn more about the Management of Rotator Cuff Injuries CPG…

Learn more about the Management of Periprosthetic Joint Infections CPG…


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