November 18, 2019
 
Today’s Top Story

Study: Does RA Increase Complication Risks After TKA?

According to a study published online in The Journal of Arthroplasty, patients with rheumatoid arthritis (RA) who underwent primary total knee arthroplasty (TKA) had significantly higher rates of venous thromboembolisms (VTEs), readmission rates, and costs. Primary TKA patients with RA were matched 1:5 to controls without RA based on age, sex, and comorbidities. Patients with a history of VTEs and hypercoagulable states were excluded. Compared to patients without RA, RA patients had higher incidence rates of VTEs (1.9 percent versus 1.3 percent), deep vein thromboses (1.6 percent versus 1.1 percent), pulmonary embolisms (0.4 percent versus 0.3 percent), and readmission (21.6 percent versus 14.1 percent), as well as higher cost of surgery ($12,475.17 versus $11,428.96) and 90-day costs of care ($15,937.34 versus $13,678.85).

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In Other News

Study Measures Usefulness of Computer-assisted Surgery in Hip Resurfacing Arthroplasty

A randomized, controlled trial published online in BMC Musculoskeletal Disorders observed no benefit from the use of computer-assisted surgery (CAS) compared to manually implanted femoral components to evaluate femoral component positioning in hip resurfacing arthroplasty in terms of femoral placement accuracy or patient-reported outcome measures (PROMs). A total of 122 patients were stratified into two groups. The CAS group (n = 61) received the femoral component with imageless navigation, and the control group (n = 61) received the femoral component manually. The main outcome was a maximum of three-degree variance between the postoperative and preplanned Stem Shaft Angle (SSA); secondary outcomes included the Hip Disability and Osteoarthritis Outcome Scale score, Harris Hip Score, and visual analog scale score for pain. Accuracy of femoral implant position did not significantly differ between the two groups. The mean difference between postoperative and preplanned SSA was –2.26 degrees in the CAS group versus –1.75 degrees in the control group. Both groups presented significant improvements in all PROMs compared to baseline.

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Study: Prevalence and Effect of Endplate Defect on Lumbar MRI

Endplate defects may be common on adult lumbar MRIs and could be a risk factor for back pain, according to a study published online in The Spine Journal. Randomly selected patients from a Chinese community were interviewed about current back pain status, as well as four-week, 12-month, and lifetime history. Lumbar MRIs were evaluated for endplate defects, modic changes (MCs), and disk degeneration. Additional factors evaluated included age, sex, body mass index, smoking history, riding in motorized vehicles and associated vibration, and job-related physical demands. Final analysis included 478 patients (mean age, 53.3 years); endplate defects were observed in 301 patients and 842 endplates. An association was observed between the presence of endplate defects and lifetime back pain, but MCs and disk degeneration were not associated with lifetime back pain. All three defect types were correlated with intensity of 12-month worst back pain ever, and focal and erosive endplate defects were correlated with lifetime back pain history.

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Study Assesses Outcomes After Hemiarthroplasty Revision to Reverse Shoulder Arthroplasty

A study published online in the Journal of Shoulder and Elbow Surgery compared outcomes for hemiarthroplasty patients revised to reverse shoulder arthroplasty (RSA) based on initial pathology. Between January 2004 and January 2017, 207 shoulder hemiarthroplasty, bipolar prosthesis, and humeral resurfacing cases were revised to RSA. Outcomes included shoulder motion, American Shoulder and Elbow Surgeons (ASES) score, and Simple Shoulder Test (SST) score. Each revised RSA was matched 1:4 based on age, sex, and minimum two-year follow-up. The mean time between initial hemiarthroplasty and RSA was 3.6 years. Overall, 114 patients had at least two years of follow-up. The most common indications for initial hemiarthroplasty were fracture (n = 72), cuff tear arthropathy (CTA, n = 22), and osteoarthritis (OA, n = 20). Mean ASES score was 59, mean SST score was 4, and forward flexion and abduction were a mean 106 degrees and 95 degrees, respectively. Compared to fracture, CTA cases had better forward flexion and abduction, and OA cases had better SST and abduction. At a mean 31 months, the rerevision rate was 7.7 percent and was most common in fracture cases (n = 10/16). The most common failure mechanism was humeral loosening, presenting in half of cases (n = 8/16); larger gleonsphere sizes were more likely to require revision.

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Study: Does Preoperative Alignment in the Coronal Plane Affect Ankle Implant Survival?

A systematic review published online in Foot & Ankle International observed that preoperative tibiotalar valgus alignment in the coronal plane could adversely impact implant survival in total ankle replacement (TAR) patients but not varus alignment. Medline and Embase were queried for relevant studies published through September 2018. A total of 17 studies comprising 1,627 patients (1,692 TARs) were included in the review. TARs were stratified into three groups based on preoperative alignment: neutral (n = 711), varus (n = 545), and valgus (n = 332). Revisions were required in 52 TARs in the neutral group, 37 in the varus group, and 36 in the valgus group; revisions per 100 observed component years were 1.6, 1.7, and 2.5, respectively. Overall, 129 complications and 447 additional procedures occurred in 601 TARs.

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AAOS Now

Instagram Chat Group Drives Surprise Billing Awareness with Viral Video

In this article, Daniel E. Choi, MD, shares how he leveraged the power of social media to spread awareness about surprise medical billing legislation He created an Instagram chat group with 23 physicians from various specialties around the country who participated in a video and created the hashtag campaign: #PatientsOverProfits.

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Your AAOS

Call for Content: Submit an Article for AAOS Now

Do you have timely research or an interesting story to tell? AAOS Now is seeking editorial submissions from orthopaedic surgeons and orthopaedic- and practice-related product and service providers that qualify as subject matter experts. The magazine features various formats and opportunities to highlight your information or topic. AAOS Now encourages interested authors to contact staff prior to writing in order to review suggestions and provide feedback. Submit an article suggestion online or email AAOS Now Publisher Dennis Coyle at coyle@aaos.org.

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