October 23, 2019
Today’s Top Story

Study Assesses Continuous Popliteal Sciatic Nerve Block in Foot and Ankle Surgery

A systematic review and meta-analysis published online in BMC Musculoskeletal Disorders observed similar safety and efficacy outcomes between continuous popliteal sciatic nerve block (CPSNB) and single-injection popliteal sciatic nerve block. Web of Science, the Cochrane Library, PubMed, and Embase were queried for relevant randomized, controlled trials (RCTs); five RCTs were included. The main outcome measure was visual analog scale (VAS) score at 24, 48, and 72 hours postoperatively. Secondary outcome measures included amount of oral analgesics consumed, overall patient satisfaction, and postoperative admission. The CPSNB group had a lower VAS score 24 and 48 hours postoperatively compared to the single-injection group. No neuropathic symptoms or infection events presented after the nerve block. Minor complications associated with the pump and catheter system were observed, most of which were drug leakage.

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In Other News

Study: Preoperative Factors Associated with Hospital LOS in Same-day and Outpatient TKA

A retrospective study published online in The Journal of Arthroplasty identified preoperative risk factors associated with hospital length of stay (LOS) for same-day discharge (SDD) and inpatient total knee arthroplasty (TKA), defined by Medicare parameters as two midnights. A total of 325 unilateral primary TKAs were identified within a single hospital system, of which 32 (10 percent) were SDD, 189 (58 percent) were next-day discharges, and 104 (32 percent) were inpatients. Lower body mass index (BMI) and fewer self-reported allergies were predictive of SDD. Risk factors for inpatient discharge included older age, higher BMI, lower Risk Assessment and Prediction Tool score, and later surgery start time.

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Study Compares PROMs in Rotator Cuff Repair Patients Based on Workers’ Compensation Status

A study published in the October issue of Arthroscopy found that workers’ compensation (WC) patients undergoing rotator cuff repair (RCR) have poorer preoperative Patient-reported Outcomes Measurement Information System (PROMIS) Upper Extremity Computer Adaptive Test (UE CAT) scores compared to non-WC patients. Isolated arthroscopic RCR patients treated between November 2017 and September 2018 underwent preoperative PROMIS UE CAT alongside legacy patient-reported outcome measures (PROMs). Final analysis included 122 patients (mean age, 53.6 years; 62.3 percent were male): 32 WC and 90 non-WC patients. PROMs pertaining to physical function had a stronger correlation with the PROMIS UE CAT compared to multidomain and mental health PROMs. The PROMIS UE CAT yielded poorer correlative strength relative to shoulder function PROMs among WC patients. WC patients also exhibited relative floor effects for Single Assessment Numerical Evaluation (SANE; 18.8 percent) and Constant-Murley (15.6 percent), as well as relative ceiling effects for the Brief Resilience Scale (531 percent), Short Form-12 mental component score (50.0 percent), and Veterans Rand 12 Mental Component Score (53.1 percent). WC patients had a greater likelihood of reporting the minimum SANE score and maximum Brief Resilience Scale score. There were no absolute or relative floor or ceiling effects observed for the PROMIS UE CAT.

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Study: Progression of Fragility Fractures of the Pelvis Treated Conservatively and Operatively

A study published online in Injury analyzed the natural course of progression of fragility fractures of the pelvis (FFP), as well as the incidence and characteristics of fracture progression (FP). Researchers analyzed medical charts and radiographic data for 148 FFP patients admitted within a three-year period. Patients who presented early after a traumatic event were more likely to have nondisplaced fractures, have fractures with lower FFP type classification, and be treated conservatively. FP presented in 21 cases, of which 20 occurred after conservative treatment; the FP in conservatively treated cases only occurred in female patients. Patients with FP tended to be younger than patients without FP. FP presented in all fracture types but was most common in FFP type I. Among patients with prolonged pain or restricted mobility who underwent a second CT scan, 39.2 percent positively presented with FP.

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Study: Trends in General Payments to Pediatric Orthopaedists

A study published in the November/December issue of the Journal of Pediatric Orthopaedics observed an increase in general payments to the highest paid pediatric orthopaedic surgeons over a three-year period. The researchers used the Open Payments Database to identify general payments made to pediatric orthopaedic surgeons between 2014 and 2017, which were then categorized by median payment, payment subtype, and census region. The number of compensated pediatric orthopaedists increased from 324 to 429 during the study period, but median payment per compensated surgeon did not largely change ($201 to $197). Each year, an average of 71 percent of the total general payment dollars went to the top 5 percent compensated pediatric orthopaedists; this group also saw in increase in median general payment per compensated surgeon from 2014 ($14,624) to 2017 ($32,752). There was a significant increase in median subtype aggregate payment per surgeon in the education and royalty and license subtypes, and a significant decrease in travel and lodging payments. During the entire study period, Midwest pediatric orthopaedists received the highest median payment. Research and ownership payments did not constitute a significant number of payments; four-year aggregate payment totals were $18,151 for research and $3,223,554 for ownership payments.

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Patellofemoral Injury Is Not a ‘Female Disease’

During an Instructional Course Lecture presented at the American Orthopaedic Society for Sports Medicine Annual Meeting, panelists discussed the influence of sex-related factors on treatment outcomes and return to play in sports medicine. This article covers the portion of the presentation focused on patellofemoral injuries and issues, including the prevalence of lateral patella dislocation and redislocation.

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Call for Content: Submit an Article for AAOS Now

Do you have timely research or an interesting story to tell? AAOS Now is seeking editorial submissions from orthopaedic surgeons and orthopaedic- and practice-related product and service providers that qualify as subject matter experts. The magazine features various formats and opportunities to highlight your information or topic. AAOS Now encourages interested authors to contact staff prior to writing in order to review suggestions and provide feedback. Submit an article suggestion online or email AAOS Now Publisher Dennis Coyle at coyle@aaos.org.

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