November 2, 2018
Today’s Top Story

Study Compares Best Methods for Pain Relief Following TKA

According to a meta-analysis published in the November issue of The Clinical Journal of Pain, continuous femoral nerve block (cFNB) is the superior treatment of postoperative pain in total knee arthroplasty (TKA) patients. Researchers used Embase and PubMed to collect data from 58 studies that included 3,501 patients. All treatments improved pain score compared to placebo in six to eight hours except for patient-controlled epidural analgesia plus femoral nerve block (FNB) and sciatic nerve block. At 24 hours, continuous FNB (cFNB), periarticular infiltration, periarticular infiltration plus FNB, single-dose FNB, and sciatic nerve block plus FNB outperformed the control group. Only cFNB and intra-articular infiltration yielded better results than the control group for pain score 48 hours postoperatively. With respect to morphine consumption two days postoperatively, only cFNB outperformed the control group.

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Other News

Study Identifies Risk Factors of Kidney Injury in Gentamicin Recipients

A retrospective chart review published in the November issue of the Journal of Orthopaedic Trauma identified female sex and higher weight as risk factors for kidney dysfunction in open fracture patients receiving gentamicin. Researchers assessed 371 open fracture patients treated with antibiotics between January 2008 and December 2012. Patients were classified by normal kidney function (74.9 percent) and abnormal kidney function (25.1 percent). Abnormal kidney function patients had lower baseline creatine and higher injury severity scores than the normal kidney function cohort and were more likely to be admitted to the intensive care unit (ICU). Female sex, higher weight, ICU admission, CT contrasted imaging use, and older age were all independently linked to abnormal kidney function.

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Study Finds Implant Position Has Minimal Effect on Reoperation Risk in Femoral Neck Fracture

According to a study published online in the Journal of Bone & Joint Surgery, risk factors for reoperation following osteosynthesis in patients treated for femoral neck fractures were insufficient fracture reduction, varus position of the implants, and femoral head perforation. Researchers used the Danish Fracture Database to identify 1,206 consecutive surgeries for primary femoral neck fracture treated with parallel implants between December 2011 and November 2015. Pre- and postoperative radiographs measured fracture displacement, posterior tilt, the number of implants, posterior distance, calcar distance, tip-cartilage distance, and angulation of implants. In 997 cases, two implants were used, and in 209 cases, three implants were used. In 157 cases, the patient required reoperation within a year, and in 228 cases, the patient died within a year. Younger patients (< 70 years) were more likely than older patients to require revision surgery (18 percent versus 9.8 percent, respectively) but less likely to die (7.4 percent versus 26.3 percent, respectively). Posterior distance, calcar distance, tip-caput distance, and parallel implants had no impact on the need for reoperation.

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CMS Releases 2019 MPFS

The Centers for Medicare & Medicaid Services (CMS) issued its final Medicare Physician Fee Schedule for 2019. Changes included modifications to Part B drug payments and telehealth services. Clinicians will now be paid for making use of “communication technology-based services.” Part B drug payments will reduce seniors’ out-of-pocket spending by reducing reimbursement for physicians from wholesale acquisition cost +6 percent to +3 percent. CMS also finalized evaluation and management (E/M) documentation burden reduction proposals but did not finalize any coding proposals, including a single collapsed E/M rate and add-on G-codes.

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In The States

Wisconsin Approved to Impose Medicaid Work Requirements

CMS granted Wisconsin permission to impose work requirements on Medicaid beneficiaries, as well as a time limit for enrollment, but rejected the state’s request to mandate drug testing for recipients. Medicaid recipients in Wisconsin are required to document at least 80 hours a month of volunteering or work-related activities to maintain their benefits. Those who wish to enroll have a four-year nonconsecutive time limit to apply, after which enrollees will forfeit coverage for six months. People with disabilities, those with mental illness, sole primary caregivers, and children are exempt from the new requirements.

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Answers to Five Common Coding Questions

AAOS Now provides insight on hot topics surgeons and their staff want to know more about. Questions include when not to take documentation advice from vendors, arthroscopic fracture treatment codes, and precertified TKA stays.

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New JAAOS CME Series Now Available with Lippincott CMEConnection

AAOS and Wolters Kluwer announced the launch of a new JAAOS CME series. Based on existing JAAOS issues and articles, the site boasts more than 30 American Medical Association Physician’s Recognition Award category 1 credit(s) in 25 CME modules. Beginning in January 2019, two new JAAOS CME articles will be posted monthly. Try a new activity with an exclusive one-time JAAOS CME coupon. Log in to Lippincott CMEConnection or create an account to take advantage of this special offer. Type in the special offer code JAAOSFREE, then read the CME article and complete a CME quiz and evaluation.

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