October 22, 2018
Today’s Top Story

Study Identifies Predictors of Outcomes Following Acetabular Labral Reconstruction

A study published online in The American Journal of Sports Medicine assessed two-year outcomes for acetabular labral reconstruction patients, including risk factors for revision or conversion to total hip arthroplasty (THA). Researchers evaluated 317 labral reconstructions, of which 13.2 percent (n = 42) required THA conversion and 11 percent (n = 35) underwent revision arthroscopic surgery. Older age, two or more previous surgeries, 2 mm or less of joint space, and lateral center edge angle (LCEA) less than 25 degrees were associated with THA. Risk factors for revision were female sex, at least two previous surgeries, and LCEA less than 25 degrees. Patients who did not undergo conversion or revision had significant improvement in Hip Outcome Score (HOS)–Activities of Daily Living, HOS–Sport, Western Ontario and McMaster Universities Osteoarthritis Index, modified Harris Hip Score, and 12-item Short Form Health Survey physical component summary (SF-12) scores; median postoperative satisfaction was nine. Higher preoperative outcome scores were the most significant predictors of improvement after labral reconstruction. Joint space greater than 2 mm and higher preoperative SF-12 scores were associated with higher postoperative patient satisfaction.

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Other News

Study Evaluates PJI Risk in Higher BMI Classes

A retrospective study published in the October issue of Clinical Orthopaedics and Related Research found no body mass index (BMI) cutoff threshold for prosthetic joint infection (PJI) risk in total joint arthroplasty patients, but infection risk may increase in higher obesity classes. Researchers collected data on 18,173 patients who underwent primary total knee arthroplasty (TKA, n = 8,757) or THA (n = 9,416) at a single institution between 2006 and 2015 and identified PJI within 90 days of the index surgery. Only class III obesity (BMI, ≥ 40 kg/m 2) was associated with an increased risk for PJI within 90 days. Overweight (BMI, 25-29.9 kg/m 2), class I obese (BMI, 30-34.9 kg/m 2), class II obese (BMI, 35-39.9 kg/m 2), and underweight (BMI, ≤ 18.4 kg/m 2) patients did not have greater PJI risk. Researchers noted that preoperative weight loss may mitigate infection risks for all patients with an increased BMI.

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Study Associates Shoulder OA with Tendon Degeneration

Shoulder osteoarthritis (OA) patients had a higher incidence of macroscopic degeneration than those without shoulder OA in a study published online in Knee Surgery, Sports Traumatology, Arthroscopy. Patients with shoulder OA (n = 13) or a proximal humerus fracture (control, n = 13) underwent an open biopsy procedure from the biceps and subscapularis tendon in conjunction with shoulder arthroplasty. Fifteen of the 26 specimens in the OA group had macroscopic degeneration compared to seven of 25 in the control group. Total degeneration score did not significantly differ between the groups. The OA group had a greater presence of nonhomogeneous extracellular matrix. Compared to the control group, OA patients had a significantly larger fibril diameter in the biceps tendon but not in the subscapularis tendon.

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Hospitals May Be Putting Knee Replacement Patients in Outpatient Setting to Avoid Audits

According to a Modern Healthcare report, hospital administrators may be placing patients who require joint replacement into the outpatient setting for fear of audits by Medicare contractors. Although the Centers for Medicare & Medicaid Services has forbidden contractors from reviewing TKA surgeries, the agency has reportedly allowed Medicare auditors to ignore the ban. Surgeons are concerned that the shift to the outpatient setting will put frail patients who need joint replacement surgery at risk.

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Douglas W. Lundy, MD, MBA, Elected ABOS President

Douglas W. Lundy, MD, MBA, has been elected president of the American Board of Orthopaedic Surgery (ABOS) for a one-year term. Dr. Lundy, a board-certified orthopaedic trauma surgeon, also serves as the copresident of Atlanta-based Resurgens Orthopaedics. He earned his medical degree at the Medical College of Georgia in Atlanta and his MBA from Auburn University. Dr. Lundy has been an ABOS board member since 2012 and previously served as the treasurer and chair of the ABOS Oral Examinations Committee. He is a member of the AAOS PAC board and an Orthopaedic Trauma Association leader.

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Joy in Practice Impacts Patient Safety

Feelings of exhaustion, depersonalization or detachment, and perceived personal failure all indicate loss of joy in practice, often referred to as “burnout.” When these feelings contribute to errors, physician burnout becomes a patient safety issue. To bring meaning and joy back into practice, the AAOS Patient Safety Committee supports surgeons to address sources of disengagement and depersonalization. By minimizing physician burnout, surgeons can prevent patient harm and lower healthcare costs.

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Annual Meeting News: Preliminary Program Now Available

The preliminary program for the AAOS 2019 Annual Meeting is now available. Browse new and hot topics only offered at the meeting. Member registration opens Oct. 24.

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