November 6, 2019
Today’s Top Story

Study Analyzes Use of Computer Adaptive Testing Methods to Assess THA Outcomes

A study published online in The Journal of Arthroplasty assessed the accuracy and validity of computer adaptive testing (CAT) Hip Disability and Osteoarthritis Outcome Score (HOOS) and HOOS Joint Replacement (HOOS-JR) compared to their full versions in total hip arthroplasty (THA) patients. A CAT HOOS and HOOS-JR that was developed previously was applied to 354 HOOS and 1,547 HOOS-JR patient responses. Precision, validity, and accuracy between CAT scores and full-form scores were compared. Modifying the questions to previous responses resulted in a mean 30 percent reduction of questions in the CAT HOOS. The full HOOS and CAT HOOS scores did not largely differ in terms of pain, symptoms, quality of life, activities of daily living, and sports. Strong liner relationships were observed between the CAT and standard questionnaires. When employing the Bland-Altman plot, the researchers reported that CAT HOOS and full HOOS score differences were present, independent of the overall scores.

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In Other News

Study: Trends in Management of Adolescent Tibia Fractures

A retrospective study published in the Nov. 1 issue of the Journal of the AAOS observed an increase in surgical management of tibia fractures among adolescent patients. The researchers gathered data from the Kids’ Inpatient Database on patients aged 10 to 18 years with closed diaphyseal tibia fractures and calculated the frequency of closed reduction and internal fixation (IF). The rate of IF increased by 29.8 percent from 1997 to 2012; the rate of increase in IF patients did not largely differ among patients aged 10 to 12 years, 13 to 15 years, and 16 to 18 years. Large-sized hospitals were more likely than medium- and small-sized hospitals to perform IF. IF patients, compared to closed reduction, had a significantly longer hospital length of stay (3.85 versus 2.44 days) and higher costs ($37,400 versus $15,300).

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Study Evaluates Prediction Tool for Lumbar Spinal Fusion Outcomes

A study published in the European Spine Journal externally validated the Spine Surgical Care and Outcomes Assessment Program/Comparative Effectiveness Translational Network (SCOAP-CERTAIN) model for forecasting outcomes after elective lumbar fusion. The researchers collected data from a prospective registry and evaluated the SCOAP-CERTAIN model’s ability to predict 12-month minimum clinically important difference in Oswestry Disability Index (ODI) and numeric rating scales for back pain (NRS-BP) and leg pain (NRS-LP). Final analysis included 100 patients (average age, 50.4 years). The area under the curve (AUC) for 12-month ODI was 0.71, the calibration intercept was 1.08, and slope was 0.95. For NRS-BP, AUC was 0.72, calibration intercept was 1.02, and slope was 0.74. For NRS-LP, the respective values were 0.83, 1.08, and 0.95. Sensitivity and specificity ranged from 0.64 to 1.00 and from 0.38 to 0.65, respectively. Hosmer-Lemeshow testing yielded a lack of fit among all three models.

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Study: Obesity and Smoking May Not Impact Volar Plate Fixation Outcomes

A retrospective study published online in The Journal of Hand Surgery evaluated outcomes for patients undergoing volar plate fixation of distal radius fracture based on obesity and smoking status. Patients undergoing operative distal radius fracture treatment at two level 1 trauma centers between 2006 and 2017 were stratified into groups based on body mass index (BMI) (obese and nonobese) and cigarette use (current, former, and never smokers). Researchers assessed patient-reported outcomes (PROs) (Quick Disabilities of the Arm, Shoulder, and Hand [QuickDASH]), range of motion (ROM) arc (flexion-extension, pronation-supination), radiographic union (Radiographic Union Scoring System [RUSS] score), and change in radiographic alignment (radial height, radial inclination, volar tilt). Of 200 total patients, 39 had a BMI ≥ 30 kg/m 2 and were classified as obese; at three-month and one-year follow-up, both BMI cohorts had similar and acceptable QuickDASH scores (42 versus 21–24), as well as similar motion, RUSS score, and alignment. Twenty patients were current smokers, 32 were former smokers, and 148 were never smokers; at three-month follow-up, smokers had higher QuickDASH scores and a lower rate of radiographically healed fractures. By final follow-up, PROs differed slightly among smokers (QuickDASH, 18 versus nine to 13); ROM, fracture healing, and complication rates were not significantly different.

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In the States

Insurance Companies Told to Stop Selling Illegal Plans in New Hampshire

New Hampshire’s insurance commissioner John Elias ordered Aliera Healthcare and Trinity Healthcare to stop selling and renewing insurance policies in the state after it was discovered that an estimated 1,400 people had purchased illegal policies. Those who purchased the policies will have to find new coverage. Trinity referred to itself as a healthcare sharing ministry but did not meet the legal requirements to fall under this designation.

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What the OPUS Reveals About Practice Settings and Productivity

This article is the third of a four-part series that discusses results from the 2018 AAOS Census Survey and examines orthopaedic surgeon practice setting and productivity in the United States. This article addresses information on practice setting, productivity, payer mix, payer distribution, work hours, and procedures performed per month.

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Read part one…(member login required)

Read part two…


AAOS Partners with CareCredit to Help Improve the Financial Experience for Orthopaedic Surgeons and Patients

AAOS has entered a new partnership with CareCredit, a leading health, wellness, and personal care credit card business. The partnership is another way the Academy is helping AAOS members deliver the highest quality patient care with tools that offer cost transparency and a convenient payment solution for patients. CareCredit offers payment options that give patients flexibility to pay deductibles, copays, coinsurance, and other out-of-pocket healthcare costs over time.

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