November 7, 2018
Today’s Top Story

Study: Risk Factors for Subsequent Joint Replacement of Contralateral Joint or Different Joint Following Index Procedure

A study published online in the Journal of Bone & Joint Surgery found that patients have a high risk of contralateral joint replacement following an initial joint replacement surgery but a low risk of replacement of a different joint after an index total hip arthroplasty (THA), total knee arthroplasty (TKA), or total shoulder arthroplasty (TSA) for osteoarthritis (OA). Using the Healthcare Cost and Utilization State Inpatient Database of New York, researchers identified 85,616 primary THA, TKA, and TSA patients, of whom 20,223 (23.6 percent) required a subsequent replacement of the contralateral joint within five to eight years of the index procedure. Obese patients were more likely to require subsequent replacement surgery of the same joint, as were index TKA patients compared to THA patients. Within five to eight years of the index surgery, 3,197 patients (3.7 percent) underwent replacement surgery of a different joint. Risk factors included obesity and index TSA compared to THA.

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Other News

Study Analyzes Socioeconomic and Racial Disparities in THA Outcomes

A study published in the Nov. 1 issue of the Journal of the AAOS found disparities in THA outcomes between black and white patients in areas of high deprivation. Researchers used a large institutional THA registry to compare race and percent of the population with Medicaid coverage and its association with two-year patient-reported outcomes. At baseline and follow-up, black patients undergoing THA reported worse pain and function scores compared to white patients. Census tract Medicaid coverage and living below the poverty line were strongly associated with increased pain for black patients. Two-year Western Ontario and McMaster Universities Osteoarthritis Index function scores were predicted to be –5.54 points lower for black patients living in highly deprived areas than black patients living in less deprived communities. This difference was not observed in white patients.

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Study: Prevalence of Concurrent Intercuneiform Ligament Injuries in Athletes with Subtle Lisfranc Instability

A study published online in Foot & Ankle International assessed injuries and injury patterns associated with unstable Lisfranc injury in competitive athletes. Injuries were categorized as traditional dislocation (TRAD, first to second tarsometatarsal [TMT] ligament tear), medial column dislocation (MCD, second TMT, and medial-middle cuneiform ligament tear), and proximal extension dislocation (PE, first, second, and medial-middle cuneiform ligament tear) in 82 patients (64 males) who were injured during sport. Injury patterns were determined at time of surgery. The most common injury was TRAD (n = 40), followed by PE (n = 23) and MCD (n = 17). The most common sport being played at time of injury was football (n = 48). Basketball players (n = 13) were younger than other athletes and had a faster return to sport. Wakeboard athletes (n = 5) tended to be older and were more likely to have MCD tears. MCD injuries indicated a longer time to returning to sport.

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Study Observes Increased Risk of OA in Older Patients Who Delay ACL Reconstruction

A prospective comparative study published online in the journal Arthroscopy found that older age and delayed time to surgery were risk factors for developing OA 16 years after anterior cruciate ligament (ACL) reconstruction. Researchers determined patient-acceptable symptom state (PASS) in the International Knee Documentation Committee and OA development defined as a Kellgren-Lawrence grade ≥ 2 for 147 patients (63.7 percent male; average age at time of surgery, 27.9 years). The International Knee Documentation Committee evaluation system score surpassed the PASS cutoff in half the patients. Patients with a concomitant injury at surgery and greater preoperative anteroposterior laxity were more likely to achieve PASS. At 16.4-year mean follow-up, older patients and those who waited more than a year between injury and surgery had a higher risk of developing OA.

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New CMS Rules Increase 340B Drug Program Cuts, Implement Site Neutral Payments

The Centers for Medicare & Medicaid Services (CMS) released its Hospital Outpatient Prospective Payment and Ambulatory Surgical Center (ASC) Payment Systems rules, effective Jan. 1, 2019. The updated rules aim to lower hospital outpatient visit costs so that prices are similar to those in a physician’s office. The agency estimates this shift will save Medicare $380 million in 2019. CMS’ new rule also makes additional cuts to the 340B Drug Program, expanding inclusion to off-campus outpatient sites. Hospital groups criticized the decision and threatened to take legal action.

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Orthopaedic Practices Must Adapt Patient-acquisition Strategies

New referral patterns and updates to consumer technology have created a need for orthopaedic practices to use digital, direct-to-patient marketing efforts to reach new patients. How can practices develop an online presence that will stand out for this generation’s technically savvy patients? Strategies include a mobile-optimized website, Google AdWords, social media, and a return on investment strategy.

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Call for Resident Advocacy Fellowship Applications

The AAOS Office of Government Relations (OGR) is accepting applications for its 2019 Resident Advocacy Fellowship program. The program is directed by Stuart L. Weinstein, MD, former chairman of the AAOS Political Action Committee. The fellowship seeks to foster the development of orthopaedic surgeons interested in health policy and advocacy who are willing to become key members of the AAOS advocacy team. Interested applicants must apply no later than Nov. 15, and two fellows will be selected. For more information, contact Julie Williams, senior manager in the AAOS OGR, at

Read the program description and application instructions…


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