Today’s Top Story

Study Measures Effect of Imaging in Low Back Pain

Imaging in low back pain could result in increased medical costs and healthcare utilization, as well as prolonged time away from work, according to a study published online in the European Spine Journal. Researchers queried PubMed, CINAHL, EMBASE, Cochrane Library, and Web of Science for data from randomized, controlled trials (RCTs) and observational studies comparing imaging to no imaging. One RCT with 421 patients provided moderate-quality evidence supporting a correlation between increased direct costs and X-ray. Three observational studies (n = 9,535) provided low-quality evidence stating that MRI may increase costs. Moderate-quality evidence from one RCT and two observational studies (n = 3,897) associated MRI and CT with increased healthcare utilization. Low-quality evidence from five observational studies (n = 15,493) found a correlation between X-ray or MRI and increased healthcare utilization Moderate-quality evidence (two RCTs, n = 667) found that X-ray and MRI did not prolong absence from work compared to patients who did not undergo imaging, but two observational studies (n = 7,765) provided low-quality evidence for a significant increase in work absence in MRI groups compared to nonimaging groups.

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Other News

Study: What Is the Optimal Treatment for Extensor Tendon Disruption after TKA?

A systematic review published online in The Journal of Arthroplasty evaluated treatment options for patellar and quadriceps tendon ruptures after total knee arthroplasty (TKA). A database search yielded 28 relevant articles. Complication rates were higher in patellar tendon repair (63.16 percent) than quadriceps tendon repair (2537 percent). Complication rates were similar for patellar and quadriceps tendon tears after autograft, allograft, or mesh reconstruction (18.8 percent versus 19.2 percent, respectively). The most common complications were extension lag ≥ 30 degrees (45.33 percent), rerupture (25.33 percent), and infection (22.67 percent). Compared to late injuries, early ruptures had more complications.

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Study Identifies Biochemical Predictors of Post-traumatic Osteomyelitis

High-energy tibial fracture patients with increased perioperative C-reactive protein (CRP) and decreased postoperative albumin may be more likely to sustain acute post-traumatic osteomyelitis (POM), according to a prospective cohort study published online in Injury. A total of 86 patients with high-energy injury to the shin requiring surgery were included; biochemical and immunoinflammatory profile data were collected on admission, first postoperative day (POD1), and fourth postoperative day (POD4). Development of POM was associated with increased CRP on admission and POD1; POM was also associated with decreased albumins on POD4.

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Study: Do Age and Frailty Impact Cost of Care in TJA Patients?

A retrospective review published online in The Journal of Arthroplasty found a correlation between increasing age and frailty and increasing cost of total joint arthroplasty (TJA). Data were reviewed for 1,821 TJA patients at a single institution between 2013 and 2016 who were part of the Bundled Payment Care Improvement initiative. Patients aged 72 years and older and with increasing modified frailty index (mFI) scores had significant increases in cost of care. There was a 0.68 percent increase in cost per incremental age increase; mFI score of 2 or higher was significantly correlated with increased cost.

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Study Evaluates 2D and 3D Intraoperative Imaging and Postoperative CT Scan

A study published in the March issue of the European Journal of Radiology evaluated reduction quality and fixation of calcaneal fractures when using intraoperative fluoroscopic two-dimensional (2D) and three-dimensional (3D) images compared to a postoperative CT scan. A total of 102 patients requiring open reduction and internal fixation of a calcaneal fracture were included. Patients underwent intraoperative 2D and 3D imaging and received a postoperative CT scan one week after surgery. Agreement of 3D imaging and CT scan for reduction quality was fair, better than that of 2D imaging, and for fixation was moderate to good; 2D imaging and CT scan agreement was poor to fair. Image quality and interpretability was best in the 2D imaging group.

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Diagnostic Approaches for PJI Continue to Evolve

“The 2018 Definition of Periprosthetic Hip and Knee Infection: An Evidence-Based and Validated Criteria,” published in The Journal of Arthroplasty, attempts to address the limitations of previous guidelines and aid clinicians and surgeons in navigating this often-difficult diagnosis. The definition of periprosthetic joint infection (PJI) is evolving. With a team of international PJI experts and skilled biostatisticians, Parvizi et al., created the first evidence-based, weight-adjusted, and externally validated scoring system for diagnosing hip and knee PJI.

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Nominate a Colleague for the AAOS Diversity, Humanitarian, or Tipton Leadership Awards

AAOS is now accepting nominations for the 2020 Diversity and Humanitarian Awards and the William W. Tipton Jr, MD, Orthopaedic Leadership Award. These awards are presented at the AAOS Annual Meeting. The respective award recipients are recognized for their endeavors to further encourage diversity or culturally competent care, participation in humanitarian activities, or leadership activities in the orthopaedic profession. The last day to submit nominations for the Humanitarian Award is May 17; the last day to submit nominations for the Diversity and Tipton Awards is June 14.

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