September 16, 2019
Today’s Top Story

Study: Inpatient Admission Following Proximal Humeral Fracture Increases Mortality Risk in Older Patients

Older patients who require inpatient admission after a proximal humeral fracture may be at a greater risk of death, according to a study published online in the Journal of Shoulder and Elbow Surgery. Researchers identified 288 consecutive patients who were admitted after sustaining a proximal humeral fracture between January 2007 and January 2011. They retrospectively collected data on demographic characteristics, comorbidities, anemia, physical and social independence, inpatient length of stay (LOS), management, and mortality. Among this cohort, 13 (4.5 percent) died at one month, 28 (9.7 percent) died at three months, 46 (16.0 percent) died at one year, and 117 (40.6 percent) died at five years. Male sex, comorbidities, unemployment or retirement, and nonoperative management were independent predictors of five-year mortality.

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In Other News

Study: Can a Patient-specific Instrument Improve Accuracy of UKA?

In a study published online in The Knee, researchers assessed whether a novel patient-specific instrument (PSI) design could deliver the same level of accuracy as a robotic one in patients undergoing unicompartmental knee arthroplasty (UKA). The results indicated that a PSI in the hands of an expert surgeon can safely deliver comparable accuracy to a robotic system and was significantly faster than conventional instruments. The study included 30 patients undergoing medial UKA by one surgeon using a PSI. Tibial component position was planned using a low-dose CT scan and compared to a day one postoperative CT scan to determine the difference between the planned and achieved positions. The mean absolute difference between planned and achieved tibial implant positions using PSI was 2.0 degrees in the coronal plane, 1.8 degrees in the sagittal plane, and 4.5 degrees in the axial plane. These outcomes were not significantly different from the 13 historical robotic cases (mean difference, 0.5 degrees, 0.5 degrees, and 1.7 degrees, respectively). PSI mean operating time was an average of 62 minutes shorter than the robotic group and 40 minutes shorter than the conventional instrument group. There were no reported complications.

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Study: Postoperative Pain after Ankle Arthroplasty Predicts Risk for Revision Surgery

A study published online in Foot & Ankle International found that persistent postoperative pain and poor function after ankle arthrodesis and total ankle arthroplasty (TAA) were associated with higher risk of revision surgery. Researchers conducted a retrospective analysis of a longitudinal cohort of 336 ankle arthrodesis and TAA patients (348 ankles) who were recruited at a single center between 2003 and 2013 and had at least four years of follow-up. Patients completed the Ankle Osteoarthritis Scale (AOS) preoperatively and annually post-surgery. Median follow-up for revisions was 8.2 years, and 46 patients underwent revision. Higher postoperative AOS scores were associated with a higher likelihood of revision. Ankle arthrodesis was associated with a reduced risk of revision compared to ankle fusion.

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Study: Tranexamic Acid May be Beneficial for Patients with Hemophilia Undergoing THA or TKA

Patients with hemophilia who underwent total hip arthroplasty (THA) or total knee arthroplasty (TKA) and were treated with tranexamic acid had improved outcomes, according to a study published online in BMC Musculoskeletal Disorders. The retrospective study included prospectively collected data on 34 patients with hemophilia A undergoing TKA (n = 24) and THA (n = 18) at a single center between January 2008 and August 2017. Patients were categorized as those who did (12 knees and 10 hips) and did not (12 knees and eight hips) receive tranexamic acid. After a mean follow-up of 68 months, the tranexamic acid group had less perioperative blood loss, hidden blood loss, transfusion rate, a lower ratio of postoperative knee swelling, less postoperative joint pain, lower levels of inflammatory biomarkers, and better joint function.

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Study: Width of Surgical Margin Impacts Recurrence in Pelvic Chondrosarcomas

A study published online in Clinical Orthopaedics and Related Research found that the width of the surgical margin after surgical treatment of a peripheral pelvic chondrosarcoma impacted the local recurrence rate. Researchers retrospectively reviewed records from three international collaborating hospitals between 1983 and 2017. The final analysis included 50 patients (median age, 37 years; range, 29–54 years) with peripheral chondrosarcomas of the pelvis who had an osteochondroma-like lesion at the base of the tumor and a cartilage cap with malignant cells in resected specimens. The ilium was the most frequently affected bone (n = 30, 72 percent). Ten-year disease-specific survival and local recurrence-free survival (RFS) rates were 90 percent and 69 percent, respectively. A surgical margin ≥ 1 mm (n = 16) was associated with a better local RFS rate than a surgical margin < 1 mm (n = 17) or 0 mm (n = 11). No patients with a surgical margin ≥ 1 mm had local recurrence, metastasis, or disease-related death. Patients with local recurrence (n = 13) showed worse disease-specific survival than those without local recurrence (n = 37). The most common post-surgery complication was local recurrence (n = 13, 26 percent). Deep infection was the most frequent nononcologic complication (n = 4).

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Are We Paid Too Much?

In a two-part Editor’s Message, Eeric Truumees, MD, considers the criticism that physicians are paid too much, comparing salaries to international physicians and other professions. He concludes, however, that physicians are not the major cause of increased healthcare costs in the United States.

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Nominate a Story for the 2020 Media Orthopaedic Reporting Excellence (MORE) Awards

Have you been quoted in a news article or interviewed by a consumer radio or television outlet? Did you know the Academy recognizes members of the media for accurate orthopaedic reporting via its MORE Awards? This program recognizes journalists and media outlets for stories published between Oct. 1, 2018, and Oct. 1, 2019, that effectively report on musculoskeletal health issues, healthy behaviors, high-quality care, and prevention and treatment of orthopaedic issues or injuries. Send a link to the story to and staff will follow up. The last day to submit nominations is Oct. 8, at 5 p.m. C.T.

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