November 4, 2019
Today’s Top Story

Study Analyzes Midterm Outcomes for Débridement of Irreparable Rotator Cuff Tears

A retrospective study published online in the Journal of Shoulder and Elbow Surgery observed good midterm outcomes in patients with irreparable rotator cuff tears treated with arthroscopic débridement. Data including demographics, operative reports, and preoperative imaging were gathered on patients treated between 2008 and 2013. Outcome measures including the American Shoulder and Elbow Surgeons (ASES) and visual analog scale (VAS) scores were taken at a minimum of five years of follow-up. Final analysis included 26 patients with a median 98 months of follow-up. Six patients (23 percent) underwent reoperation at a median 11 months; five were revised to reverse shoulder arthroplasty. Significant improvements were observed in median ASES and VAS pain scores postoperatively Patients with lower preoperative forward elevation were more likely to have poorer postoperative ASES scores and require revision surgery. Preoperative radiographic variables were not predictive of reoperation or worse outcome scores.

Read the abstract…

In Other News

Study: Postoperative Effects of Morbid Obesity in Lower Extremity Soft-tissue Sarcoma Resection

In a study published in the Nov. 1 issue of the Journal of the AAOS, morbid obesity was associated with postoperative wound complications and infection in patients undergoing lower extremity soft-tissue sarcoma resection; however, it did not impact oncologic outcomes. The study included 653 patients (mean age, 56 years; 343 were male) with a lower extremity soft-tissue sarcoma. Mean body mass index (BMI) was 271 kg/m 2; 189 patients (29 percent) were obese (BMI ≥ 30 kg/m 2) and 27 (4 percent) were morbidly obese (BMI ≥ 40 kg/m 2). Postoperative complications were observed in 285 patients (40 percent), the most common of which were dehiscence (n = 175, 24 percent) and infection (n = 147, 21 percent). Multivariate analysis presented an association between morbid obesity and wound complications and infection but not local tumor recurrence. Mean Toronto Extremity Salvage Score and Musculoskeletal Tumor Society score did not differ based on morbid obesity status.

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Study: FRAiL Model Identifies Nursing Home Residents Most at Risk for Fracture

The Fracture Risk Assessment in Long term care (FRAiL) model identified nursing home residents who are at the greatest risk for nonvertebral fracture, according to a study published in the November issue of Bone. This retrospective cohort study included most long-stay U.S. nursing home residents (n = 896,840; mean age, 83.8 years; 70.7 percent were women). Hip and nonvertebral fractures were identified using Medicare claims, and the Minimum Data Set was used to identify characteristics from the original FRAiL model. During a mean follow-up of 1.52 years, 41,531 residents (4.6 percent) were hospitalized with nonvertebral fracture, of which 30,356 were hip fractures. In the fully adjusted model, 14 of 15 FRAiL model characteristics were significant predictors of nonvertebral fracture. Female sex, wandering, and falls were strongly associated with nonvertebral fracture rate, while total dependence in activities of daily living was associated with a decrease in nonvertebral fracture rate.

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Study: Why Do Pediatric ACL Reconstruction Patients Return to the OR?

A retrospective cohort study published in the November/December issue of the Journal of Pediatric Orthopaedics described indications aside from graft failure risk for unplanned return to the operating room (RTOR) in young patients who undergo primary anterior cruciate ligament (ACL) reconstruction (ACLR) surgery. Patients underwent primary ACLR at a single institution between 2013 and 2015 and were analyzed based on whether there was a concomitant surgical meniscal procedure with the index ACLR. The main outcome measure was RTOR related to the index ACLR or a possible predilection for knee injury. Final analysis included 419 patients. Three-year RTOR rate for any indication was 16.5 percent; the most common reasons were graft failure and contralateral ACL tear, of which the predicted rates were 10.3 percent and 7.1 percent, respectively. Graft failure constituted less than half of RTOR cases. Patients with a concomitant meniscus procedure were less likely to go back to the operating room (OR).

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CMS Issues Two New Final Rules

On Nov. 1, the Centers for Medicare & Medicaid Services (CMS) issued two final rules. Under the Calendar Year 2020 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule (OPPS/ASC), total knee arthroplasty will be included in the ambulatory surgical center Covered Procedures List, total hip arthroplasty and six spinal surgical procedures will be removed from the inpatient-only list, and site neutrality is promoted between off-campus hospital outpatient departments and physician offices for the same service. The other final rule includes updates for services furnished under the Medicare Physician Fee Schedule (PFS); notably, updates to evaluation and management services will not be extended to the global surgery codes. As a reminder, AAOS submitted formal comments to CMS when both rules were being proposed and will be communicating the impact of these finalized changes to members in the coming weeks and months.

Read about the OPPS/ASC changes…

Read about the changes to the Medicare PFS…


Therapy Billing: Be Sure Your Team Is Doing Things Right

Many orthopaedic surgeons are adding physical and occupational therapy services to their practices. This can be daunting for in-house billing teams, as they may lack experience with the new services, therapy terminology, and associated Current Procedural Terminology codes. This article seeks to educate staff about therapy services and the components required for billing. A small investment of time to clarify the codes and treatment continuum can improve a team’s ability to optimize therapy revenue and prevent billing errors.

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OrthoInfo Helps Doctors Educate Patients

OrthoInfo, the AAOS patient education website, is a free member resource that provides orthopaedic surgeons and patients with authoritative, in-depth information about musculoskeletal health. The website features more than 400 articles, videos, and animations on common orthopaedic problems, surgical procedures, nonsurgical treatments, injury prevention, and healthy living All content is developed and peer reviewed by AAOS members. Written in simple language, OrthoInfo articles can help your patients be better informed and participate more fully in their care and recovery.

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