November 26, 2018
Today’s Top Story

Study Evaluates Mechanical Causes of Late Dislocation Following THA

A study published online in The Journal of Bone & Joint Surgery associated spinopelvic abnormalities and abnormal spinopelvic measurements with late dislocation following total hip arthroplasty (THA). Researchers evaluated 20 consecutive THA patients with late dislocation for a mean of 8.3 years. At follow-up, nine patients (45 percent) had anterior dislocations, and 11 (55 percent) had posterior dislocations. Eight of the nine anterior dislocation patients presented spinopelvic abnormalities, including fixed posterior pelvic tilt when standing, increased standing femoral extension, and an increased standing combined sagittal index. Among posterior dislocation patents, 10 of 11 presented abnormal spinopelvic measurements, including decreased spinopelvic motion, increased femoral flexion, and a decreased sitting combined sagittal index. Every one-degree decrease in spinopelvic motion was associated with a 0.9-degree increase in femoral motion, which led to osseous impingement and dislocation in some patients.

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Other News

Study Compares Efficacy of Proximal Humeral Locking Plates for Anatomic and Surgical Neck Fractures

A retrospective study published online in the Journal of Shoulder and Elbow Surgery found that anatomic neck fractures (ANFs) treated with proximal humeral locking plates (PHLPs) had poorer clinical outcomes than surgical neck fractures (SNFs) treated with PHLPs Between May 2013 and April 2015, 31 patients with displaced four-part proximal humeral fractures consecutively treated with PHLPs were classified by ANF and SNF. Researchers assessed parameters including neck-shift angle (NSA) and sum of the screw tip-articular surface distance at three days and one year postoperatively, as well as Constant-Murley scores at three days, one year, and final follow-up. ANF patients tended to be younger and had significantly greater mean operative duration, estimated blood loss, and bone grafting rate. Seven ANF patients and one SNF patient developed full or partial osteonecrosis of the humeral head. Eight screw cutout and/or pullout complications occurred in the ANF group; none occurred in the SNF group. NSA and screw tip-articular surface distance sum changed significantly between three days and one year postoperatively. The tested parameters presented no significant correlations.

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Study: High-altitude TSAs Increase Risk of Postoperative PE

Total shoulder arthroplasties (TSAs) performed at an altitude higher than 4,000 feet above sea level may pose an increased risk of postoperative pulmonary embolism (PE), according to a study published in the December issue of the Journal of Orthopaedics. Researchers performed a retrospective review of patients who underwent primary TSA at an altitude above 4,000 feet between 2005 and 2014. They used the zip codes of the hospitals where the procedures were performed to stratify patients: high altitude—greater than 4,000 feet—and low altitude (control group)—lower than 100 feet. Patients with a history of venous thromboembolisms, deep vein thrombosis, PE, and coagulation disorders were excluded. In 30- and 90-day analyses, the high altitude cohort had a significantly higher rate of PEs compared to matched patients in the low altitude group.

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Study Identifies Risk Factors for Mortality in Periprosthetic Proximal Femoral Fracture Patients

According to a retrospective review published online in Injury, elderly, frail patients with an active malignancy are at the highest risk of mortality following periprosthetic proximal femoral fractures. Researchers queried the Fracture Outcomes Research Database for patients aged older than 60 years with periprosthetic hip fracture between 2007 and 2015. They identified 189 patients, most of whom (61.9 percent) had Vancouver B1 fractures. Most surgeries were cable plating (75.1 percent); 21.2 percent were revision arthroplasties, and 1.6 percent were proximal femoral replacements. Postoperatively, 27.3 percent of patients returned home. There were four (2.1 percent) deaths prior to surgery. The 30-day mortality rate was 2.1 percent, and one-year mortality was 11.6 percent. Older age was associated with increased mortality.

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Study: Effects of Removing TKA from Inpatient-only List

The Centers for Medicare & Medicaid Services’ decision to remove total knee arthroplasty (TKA) from the inpatient-only procedure list in January has created confusion at hospitals, according to a recent study published online in the December issue of The Journal of Arthroplasty. Researchers sent a nine-question survey to active American Association of Hip and Knee Surgeons members. Among the 730 respondents (26.5 percent), 59.5 percent said their hospitals have started scheduling all Medicare TKAs as outpatient procedures. More than three-quarters (76.1 percent) said the change has become an administrative burden. About half (49.8 percent) said patients who were admitted but did not stay a second midnight were treated as outpatients. For patients with stays shorter than two midnights, 43.4 percent of surgeons said that their hospitals will change their status to inpatient, and 40.5 percent said they have received requests to use proscribed documentation in order to make that change; 30.4 percent of respondents reported that their patients have had additional personal costs as a result of their TKA being considered an outpatient procedure. AAOS has requested clarity regarding admission documentation expectations or exemption of TKA from the two-midnight rule.

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Kevin Shea, MD, and Jayson Murray, MA, Shed Light on Appropriate Use Criteria

Appropriate use criteria (AUC) and clinical practice guidelines (CPGs) are produced by the AAOS Committee on Evidence-based Quality and Value (EBQV). In this article, Kevin G. Shea, MD, chair of the AAOS Committee on EBQV, and Jayson N. Murray, MA, director of the Department of Clinical Quality and Value at AAOS, discuss the AUC process, including how they are made and the evidence behind them.

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AAOS Quality Resources

After more than a decade of developing CPGs, AAOS has expanded its reach into the quality space. With the transition to value-based care, AAOS sought to produce quality products that provide the most benefit to the membership AAOS continues to develop CPGs, with 19 published to date, but the Academy now uses them to create AUC and performance measures. These tools help members answer the question, “What does quality care look like?” All AAOS quality resources are free to members.

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