September 25, 2019
Today’s Top Story

Study Assesses Use of Dexamethasone for Postoperative TKA Pain

Among patients undergoing total knee arthroplasty (TKA), intravenous dexamethasone relieved postoperative pain between 12 to 21 hours post-surgery, according to a study published online in The Journal of Arthroplasty. The randomized, double blind, placebo-controlled trial included 50 patients undergoing unilateral TKA who received dexamethasone 0.15 mg/kg intravenously or placebo. The dexamethasone cohort had a significantly lower mean visual analog scale (VAS) score both at rest and during motion at 12, 15, 18, and 21 hours postoperatively. At 21 hours post-surgery, the mean difference in pain at rest was –11 points, while the mean difference in pain during motion was –15 points. Those receiving dexamethasone had lower rates of nausea or vomiting and lower mean C-reactive protein level. At three-month follow-up, there were no significant differences in mean morphine consumption by 48 hours, modified Western Ontario and McMaster University Osteoarthritis Index scores, or range of motion of the knee.

Read the abstract…

In Other News

Study Finds RA Population Is Still Not Satisfied with Treatment Options

According to a study published in the September issue of Rheumatology and Therapy, there continues to be an unmet need for rheumatoid arthritis (RA) patients, as three-fourths of study participants said they are not satisfied with treatment. The study included 258 patients (mean age, 54.5 years; 87 percent were women) aged ≥ 21 years who failed one or more disease-modifying antirheumatic drugs (DMARDs) and were receiving current DMARD(s) for six or more months. Using a cross-sectional, web-based survey, participants answered 50 questions about treatment history, RA symptoms, and flares. They completed the Rheumatoid Arthritis Impact of Disease (RAID) questionnaire and the Treatment Satisfaction Questionnaire for Medication (TSQM). Most patients (n = 232, 90 percent) currently or previously used a biologic DMARD. Many patients (43 percent) reported daily or almost daily use of prescription pain medications, and 44 percent reported a current flare. Mean TSQM scores were 59 for effectiveness, 59 for side effects, 72 for convenience, and 65 for global satisfaction (treatment satisfaction was defined as a score of ≥ 80). The mean RAID overall score was 5.1 (on a scale of zero to 10). Just 26 percent (n = 67) of patients reported being satisfied with their RA treatment.

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Study: Biceps Tenotomy versus Tenodesis for Pain Relief

A study published online in Knee Surgery, Sports Traumatology, Arthroscopy observed similar outcomes in patients undergoing biceps tenotomy versus tenodesis; however, the tenotomy group demonstrated greater incidence of cosmetic deformity but an earlier improvement in postoperative pain. The prospective, randomized, single-blinded study included 34 patients (median age, 56 years; 31 were male) who received biceps tenotomy (n = 20) or biceps tenodesis (n = 14). In addition, 56 percent had concomitant rotator cuff repairs. The mean VAS pain score at three months was lower in the tenotomy cohort. Two-year follow-up resulted in no statistically significant differences in VAS, American Shoulder and Elbow Surgeons, or Single Assessment Numeric Evaluation scores Most (75 percent, n = 15) patients in the biceps tenotomy cohort reported no use of pain medication at two weeks postoperatively compared to 33 percent (n = 5) in the biceps tenodesis cohort. Popeye deformity was observed in 25 percent (n = 5) of tenotomy patients and 7 percent (n = 1) of tenodesis patients.

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Study: Open versus Minimally Invasive Cheilectomy

Minimally invasive surgery (MIS) for cheilectomy resulted in an increased risk of further surgery and complications compared to open cheilectomy, according to a study published online in Foot & Ankle International. Researchers conducted a retrospective analysis of 171 cheilectomies performed at their institution between December 2012 and December 2017. Surgical technique was recorded, as well as any subsequent procedures for persistent or recurrent pain and complications. A comparison between open (n = 38) and MIS (n = 133) outcomes was performed. After a mean three-year follow-up, one (2.6 percent) fusion was required in the open group, while 17 (12.8 percent) reoperations occurred in the MIS group. One (2.6 percent) complication occurred in the open group compared to 15 (11.3 percent) in the MIS cohort.

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CMS Issues Final Rule for Medicaid DSH Cuts

The Centers for Medicare & Medicaid Services (CMS) published its final rule describing the methodology behind the $4 billion in Medicaid disproportionate share hospital (DSH) cuts. The five factors taken into consideration were the uninsured factor, Medicaid volume factor, uncompensated care factor, low DSH state factor, and budget neutrality factor. The regulations are set to take effect Nov. 25, and the cuts are set to begin in fiscal year 2020.

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Read the CMS rule…

Read more about Medicaid DSH…


Spine Surgeon Investigates Low-level Laser Therapy

In July, the Food and Drug Administration cleared the Erchonia FX 635, a low-level laser therapy (LLLT) device, for “whole body” pain In part one of a two-part series, Eeric Truumes, MD, chair of the AAOS Now Editorial Board, editor-in-chief of AAOS Now, and an orthopaedic spine surgeon, investigates the use of LLLT in musculoskeletal pain.

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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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