October 7, 2019
 
Today’s Top Story

Study: Impact of PCL Resection on Flexion-extension Gaps, Mediolateral Soft-tissue Laxity, Fixed Flexion Deformity, and Limb Alignment During Posterior-stabilized TKA

A prospective study published in the October issue of The Bone & Joint Journal observed that posterior cruciate ligament (PCL) resection during posterior-stabilized total knee arthroplasty (TKA) led to flexion-extension mismatch because the flexion gap increased more than the extension gap. A total of 110 patients with symptomatic knee osteoarthritis underwent primary robot-assisted posterior-stabilized TKA. Gaps before and after PCL resection in extension and 90-degree knee flexion were analyzed using optical motion capture technology. Measurements were taken after anterior cruciate ligament excision and before bone resection. PCL resection increased the mean flexion gap significantly more than the extension gap in both compartments. After PCL resection, the mean gap differences presented significant mediolateral laxity in flexion but not extension. The mean fixed flexion deformity (FFD) improved significantly after surgery. Preoperative FFD and postoperative change in FFD were positively correlated.

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In Other News

Study Compares Dupuytren Contractures Treatments

A retrospective study published online in The Journal of Hand Surgery assessed rates and predictors of reinterventions, as well as direct costs, of three treatments of Dupuytren contracture. A total of 848 interventions (350 patients) for Dupuytren contracture performed by a single surgeon were included: needle aponeurotomy (NA, n = 444), collagenase injection (n = 272), and open fasciectomy (n = 132). Across all groups, the most commonly affected digit was the fifth finger (NA, 43 percent; collagenase, 60 percent; and fasciectomy, 45 percent). Two-year reintervention rates following each procedure were 24 percent in the NA, 41 percent in the collagenase, and 4 percent in the fasciectomy groups; five-year rates were 61 percent, 55 percent, and 4 percent, respectively In the NA and collagenase groups, younger age and preintervention proximal interphalangeal joint contracture severity were predictors of reintervention. Standardized direct costs were cheapest in the NA group ($624), followed by the collagenase ($4,189) and fasciectomy ($5,291) groups; cumulative five-year costs (including interventions) were $1,540, $5,952, and $5,507, respectively.

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Study: Risk Factors for Complications in ORIF of the Ankle

A study published online in Injury identified specific risk factors and comorbidities that could increase the risk for complication in patients undergoing open reduction and internal fixation (ORIF) of the ankle. A chart review was performed including patients aged ≥ 18 years who underwent ORIF at a single institution between 2008 and 2018. Relative risks for adverse outcomes were compared by patient age: < 50 years versus ≥ 50 years. Of 886 total patients, 375 (42.3 percent) were older than 50 years. Hypertension was associated with increased infection risk in both groups, but the risk was greater among older patients. In the younger cohort, risk factors significantly associated with dehiscence included tobacco use, substance use, and congestive heart failure (CHF). In the younger group, implant failure was more likely in patients with HIV, CHF, and chronic kidney disease; in older patients, implant failure risk factors included CHF, tobacco use, and hypertension.

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Study Compares Open versus Arthroscopic Procedures to Treat Post-traumatic Stiffness after Elbow Fracture

According to a study published in the October issue of the Journal of Shoulder and Elbow Surgery, arthroscopic osteocapsular arthroplasty had similar outcomes to its corresponding open procedure for patients with post-traumatic stiffness after elbow fracture. Patients were stratified into two groups: open procedure (OPEN) and arthroscopic procedure (ARTHRO). Outcome measures included range of motion (ROM), Mayo Elbow Performance Score (MEPS), and visual analog scale (VAS) score. Patients were further analyzed by whether their initial fracture was an intra-articular (I) or extra-articular (E) fracture. ARTHRO and OPEN patients showed improvements in ROM, VAS score, and MEPS. VAS scores in the OPEN group improved from 6.6 preoperatively to 2.2, and in the ARTHRO group from 6.5 to 2.1. Preoperative flexion was 88 degrees in the OPEN group and improved to 113 degrees compared to a change from 102 degrees to 122 degrees in the ARTHRO group; preoperative extension improved from 36 degrees to 17 degrees and 30 degrees to 15 degrees, respectively. MEPS improved from 48.9 preoperatively to 800 in the OPEN group and from 52.3 to 80.8 in the ARTHRO group. The I group had worse outcomes in all clinical values than the E group.

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Study: Long-term Outcomes for Posterior Facet versus Pedicle Screw Fixation

A study published online in the European Spine Journal compared clinical and economic outcomes associated with facet versus pedicle screw instrumentation for single-level circumferential lumbar spine fusion. Researchers compared self-assessment of back and leg pain, pain drawing, Oswestry Disability Index (ODI), pain medication usage, and procedure success. Ten-year data were used to conduct a cost-effectiveness analysis (CEA); costs included index surgery and subsequent procedures, outpatient/emergency department visits, and medications. ODI scores were used to predict Short Form Six-dimension utilities in establishing quality-adjusted life years (QALYs). Both groups presented significant clinical improvement from preoperatively to 10-year follow-up. The facet group had significantly better outcomes for back pain and ODI at all follow-up periods after one year. In the CEA base-case, compared to pedicle screws, facets had more QALYs and lower costs.

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AAOS Now

Much Has Changed With ABOS’ Computer-Based Recertification Examinations

In the spring, more than 9,500 Diplomates of the American Board of Orthopaedic Surgery (ABOS) took part in the inaugural Web-Based Longitudinal Assessment Program. It was a successful launch, and the ABOS looks forward to its growth. However, many ABOS Diplomates want to take only one assessment every decade and are happy with the numerous options offered with an ABOS Computer-Based Recertification Examination. The ABOS has made several improvements to the Examinations over the past four years, which are outlined in this article.

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Your AAOS

Final Call: Take Part in an AUC Workgroup

AAOS is seeking volunteers to take part as writing panelists in the development of the appropriate use criteria (AUC) for The Management of Rotator Cuff Injuries. There are no financial conflict of interest restrictions for writing panel members. The deadline to submit an application for this project is Oct. 9.

Learn more and submit your application…

 

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