October 26, 2018
Today’s Top Story

Study Identifies Predictors of Intense Pain Following TSA

Total shoulder arthroplasty (TSA) patients with self-reported allergies, preoperative chronic opioid use, lower American Shoulder and Elbow Surgeons (ASES) score, and depression may be more likely to experience severe postoperative pain, according to a study published online in the Journal of Shoulder and Elbow Surgery. Researchers evaluated preoperative characteristics associated with severe pain, including demographics, emotional health, comorbidities, and ASES score in patients undergoing elective primary TSA. Patients with severe postoperative pain took more opioids (202 versus 84 mg oral morphine equivalents), had longer hospital stays (2.9 versus 2.0 days), used postacute inpatient rehabilitation services more often (28 percent versus 10 percent), and were more likely to be high-cost patients (23 percent versus 5 percent) than patients without severe postoperative pain. Surgery length did not differ between the two groups.

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Other News

Study Links PECO with Minimal Complications

Percutaneous endoscopically assisted calcaneal osteotomy (PECO) may be a safe and less invasive option to correct hindfoot malalignment, according to a study published online in Foot & Ankle International. Researchers assessed outcomes in 41 patients with planovalgus or cavovarus foot deformity who underwent treatment with PECO. At six-month follow-up, no superficial wound infections, lateral calcaneal, or sural nerve dysesthesia had occurred. Six feet had minor complications. The mean postoperative hindfoot correction was 8.3 mm. Visual analog scale for pain, 36-Item Short Form Medical Outcomes Survey, and Foot Function Index scores significantly improved from their preoperative status.

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Study: Post-thrombotic Syndrome in DVT Patients After TKA and THA

A study published online in The Journal of Arthroplasty found a low incidence of post-thrombotic syndrome (PTS) in total knee arthroplasty (TKA) and total hip arthroplasty (THA) patients who developed deep vein thrombosis (DVT). Researchers assessed 187 patients who underwent TKA or THA between April 2010 and March 2017; mean follow-up was 3.6 years. PTS was present in 9.3 percent of patients. Risk factors for PTS included malignancy, previous surgery in ipsilateral lower extremity, and blood transfusion. Researchers recommended preventative measures be taken for high-risk patients.

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Study Analyzes Mortality, Complication, and Fusion Rates in Odontoid Fracture Patients

Age and comorbidities had the biggest impact on mortality and complication rates in odontoid fracture patients—regardless of fracture type—in a prospective study published online in Archives of Orthopaedic and Trauma Surgery. Among the study’s 204 patients, 71 percent (n = 144) were older than 70 years. The most common fracture patterns were type II and oblique-posterior fractures. Slightly more patients received conservative treatment (52.5 percent) than surgical treatment (47.5 percent). Patients older than 70 years had a higher mortality rate than younger patients (16.7 percent versus 3.3 percent, respectively), regardless of fracture type. Older patients had a higher rate of general medical complications. Patients 70 years or younger had fewer fracture fusions than patients older than 70 years (62.5 percent versus 93.5 percent, respectively). Pseudarthrosis was the main complication, occurring most frequently in type II and oblique-posterior fractures after conservative treatment.

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In The States

CMS Gives Governors Authority to Reform State Health Insurance

The Centers for Medicare & Medicaid Services (CMS) released new guidance that provides state governors with more flexibility in meeting standards pertaining to section 1332 of the Affordable Care Act (ACA). Governors will no longer require state legislature approval for waiver plans. State residents can choose short-term insurance coverage as an alternative to ACA plans as long as a similar number of people in the state still have coverage. CMS hopes the change will strengthen the insurance market and expand coverage options. Opponents of the guidance say that even if the same number of people have coverage, access may be worse if beneficiaries choose skimpier plans.

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New Orthopaedic Video Theater Coming to a Screen Near You

AAOS is expanding its Orthopaedic Video Theater (OVT) to include nearly 700 dynamic orthopaedic videos from a variety of experts, as well as new OVT Plus videos. OVT Plus will cover subjects including anatomy, arthroscopy, and cutting-edge techniques. Nearly 250 videos will provide 0.75 CME credits each. Access to the new OVT is free for all AAOS members.

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AAOS Appropriate Use Criteria

AAOS began developing Appropriate Use Criteria (AUC) in 2011 as a tool to implement Evidence-based Clinical Practice Guidelines. AUC are created to inform clinicians when and for whom a procedure should be performed. This involves using clinician expertise and experience, in conjunction with the relevant evidence, to rate the appropriateness of various treatments in a set of hypothetical, but clinically realistic, patient scenarios.

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