October 24, 2018
 
Today’s Top Story

Study: Twenty-year Outcomes for Isolated Supraspinatus Tendon Tear Repair

Two decades after operative treatment for isolated supraspinatus tears, clinical outcomes still greatly surpassed preoperative conditions, according to a retrospective study published online in the Journal of Shoulder and Elbow Surgery. The study included 137 patients, six of whom (4.3 percent) died from unrelated causes, 52 (38 percent) were lost to follow-up, and 13 (9.5 percent) had undergone reoperations. Among the remaining 66 patients available for clinical evaluation, 45 patients underwent radiography and MRI to assess osteoarthritis, tendon healing, fatty infiltration (FI), and muscle atrophy. The Constant Score went from 51.5 points preoperatively to 71 points at follow-up. Tendon discontinuity presented in 42 percent of patients (n = 19), advanced FI of the supraspinatus in 27 percent (n = 12), FI of the infraspinatus muscle in 35 percent (n = 16), supraspinatus atrophy in 28 percent (n = 12), and cut tear arthropathy in 30 percent (n = 12). Six patients had advanced arthritis. Infraspinatus FI was the most influential factor of long-term clinical outcome.

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Other News

Study Observes Impact of Group Exercise Program Following Hip and Knee Replacement

An outpatient rehabilitation group exercise program for hip and knee joint replacement patients increased physical activity levels only during the program’s duration, according to a study published online in Clinical Rheumatology. Patients took part in a six-week outpatient orthopaedic exercise group after total hip or total knee replacement surgery and were evaluated based on the International Physical Activity Questionnaire short form. Researchers used the Osteoarthritis Research Society International recommended performance-based tests (30-second Chair Stand Test, 40-minute Fast Pace Walk Test, Stair Climb Test, Timed Up and Go Test, and 6 Minute Walk Test) to evaluate physical function. Fifty-four patients underwent assessments at admission, discharge, and six weeks after group discharge. At group discharge, researchers observed a significant improvement in self-reported activity levels and performance-based measures. Self-reported activity did not improve at six-week follow-up, but fast-paced walking and 6 Minute Walk Test measures continued to improve.

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Study Evaluates Indicators of Fracture in Geriatric Patients

A study published online in Heart found that elevated pro-adrenomedullin (MR-proADM) and pro-atrial natriuretic peptide (MR-proANP) levels may predict fragility in older patients. Researchers followed 5,415 patients (mean age, 68.9 years) enrolled in the Malmö Preventive Project over 8.1 years and evaluated the correlation between C-terminal pro-arginine vasopressin, C-terminal endothelin-1 precursor fragment, MR-proADM, and MR-proANP, and incident vertebral, pelvic, and extremity fractures. Vertebral, pelvic, or extremity fracture occurred in 19 percent of patients (n = 1,030). Risk factors included older age, female sex, low body mass index, decreased diastolic blood pressure, antihypertensive treatment, and history of fracture. Elevated MR-proADM and MR-proANP levels were independently associated with increased risk of any fracture. Patients in the top quartile of all four measured biomarkers were at a two- to threefold increase in risk of fracture at any site.

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Healthcare Executives Not Effectively Cutting Costs

Fewer than one out of five healthcare executives successfully reduced costs by more than 5 percent in a priority area, according to a report from Kaufman Hall titled, “2018 State of Cost Transformation in U.S. Hospitals and Health Systems: Time for Big Steps .” According to the report, 72 percent of executives named “labor cost/productivity” and “supply chain/other nonlabor costs” as their main targets for cutting costs. However, regarding key focuses for physician enterprise and service line initiatives, the report noted:

  • 71 percent do not cite service rationalization
  • 55 percent do not cite physician enterprise management
  • 52 percent do not cite service line efficiency

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Study: Older Patients Depend on Physician Advocacy

A study published online in Clinical Interventions in Aging found that older patients may prefer to be less involved in healthcare decisions, instead relying on their physicians to serve as the decision-makers. Researchers interviewed 802 adults (mean age, 77.82 years). Patients’ age and functional limitations were negatively correlated with their satisfaction of their physicians. When controlling for confounding factors, increased emotional support and willingness to act as an advocate were both associated with a more positive physician-patient relationship. Among the total participants, 87 percent said their physicians serve as advocates on their behalf.

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AAOS Now

Advocacy Council’s John J. McGraw, MD, Appointed to HHS Pain Task Force

Earlier this year, John J. McGraw, MD, was appointed to a 30-member Pain Management Best Practices Inter-Agency Task Force. He is the only surgeon on the task force, which the Department of Health and Human Services (HHS) oversees. Dr. McGraw brings to the position a combined 34 years of commissioned service in the Air Force and Army, as well as more than three decades of private practice. His military service earned him multiple honors, including the Meritorious Service Award. He currently serves as medical director of OrthoTennessee in eastern Tennessee.

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Your AAOS

Apply for the ACGME Review Committee for Orthopaedic Surgery

The Accreditation Council for Graduate Medical Education (ACGME) Review Committee for Orthopaedic Surgery has two open member positions; the six-year terms run from July 1, 2020, to June 30, 2026. Candidates must have expertise or fellowship training in hand. The last day to submit an application is Nov. 1.

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