October 28, 2019
Today’s Top Story

Study: Ideal Anterior Retractor Placement in THA

A study published in the Nov. 1 issue of the Journal of the AAOS identified safe zones for the placement of anterior acetabular retractors in direct anterior total hip arthroplasty (THA) This study included 22 hips of 15 cadavers that underwent direct anterior THA. Anterior acetabular retractors were placed in line with the femoral neck over the anterior acetabular wall. Kirschner wires marked the areas where retractors were reinserted: right hip, superior; and right hip, inferior The distance between retractor tip positions and neurovascular structures were determined with a digital caliper. Retractor tip movement was significant from lateral to the femoral nerve when placement was in the superior position (mean, 2.8 mm) to medial to the femoral nerve in the middle and inferior locations (mean, –2.3 mm and –4.8 mm, respectively). Significant medial movement toward the external iliac artery was observed when retractor placement was changed from superior to inferior positions (mean, 15.3 mm and 6.6 mm, respectively).

Read the abstract…

In Other News

Study Compares Ankle Fracture Treatment Strategies

A study published online in BMC Musculoskeletal Disorders analyzed clinical outcomes in supination-external rotation type IV (SER IV) ankle fractures treated with open reduction and internal fixation (ORIF) with deltoid ligament repair (DLR) versus transarticular external fixation (TEF). The study included SER IV ankle fracture patients diagnosed between January 2012 and December 2015 treated with ORIF and TEF without DLR (group 1, n = 20) or ORIF and DLR (group 2, n = 23). Patients underwent pre- and postoperative radiographic examinations; other outcomes included the American Orthopaedic Foot & Ankle Society ankle-hindfoot score, the visual analog scale score, the Medical Outcomes Short Form 36-item questionnaire score, and ankle range of motion (ROM). Both groups had significant improvements postoperatively, and outcomes did not largely differ between the groups. Six weeks postoperatively, ankle ROM was better in group 2 than group 1, but this difference was not observed 12 months postoperatively. Neither group presented any cases of bone nonunion or post-traumatic arthritis. Time to fracture union was shorter in group 1 than group 2.

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Study Analyzes Linked and Unlinked Total Elbow Arthroplasty to Treat RA

A study published in the November issue of the Journal of Shoulder and Elbow Surgery observed no significant differences between linked versus unlinked total elbow arthroplasty (TEA) using a convertible system to treat patients with rheumatoid arthritis (RA). RA patients treated with TEA at a single center who had two years of follow-up (mean, six years) were included in the study; 27 received unlinked TEA, and 55 received linked TEA. Mean age at surgery was 61 years. ROM did not largely differ between the groups, and neither did elbow strength, except pronation strength (unlinked, 74 percent versus linked, 100 percent). Rates of reoperation (17 percent versus 24 percent, respectively), complications (32 percent versus 31 percent, respectively), and revisions (13 percent versus 17 percent, respectively) did not largely differ between the groups. Four unlinked patients with instability underwent revision to a linked design, and four linked design patients underwent revision for aseptic loosening of smooth short-stem ulnar components.

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Study: Inpatient versus Ambulatory Anterior Cervical Disk Replacement

A study published in the October issue of Clinical Spine Surgery observed similar clinical outcomes and cost between anterior cervical disk replacement performed in the inpatient versus ambulatory settings. Researchers retrospectively analyzed elective anterior cervical disk replacement cases in state inpatient and ambulatory databases representing California, Florida, and New York from 2009 to 2011. Final analysis included 1,789 inpatient and 370 ambulatory procedures. The rate of 30-day emergency department (ED) presentation was 5.14 percent in the ambulatory cohort compared to 4.20 percent in the inpatient group. The rate of 30-day readmission was 1.0 percent in the ambulatory group and 2.2 percent in the inpatient group. Six unique patients in the inpatient group required 30-day reoperation compared to zero in the ambulatory group. ED visit rate, inpatient readmission rate, and reoperation rates within 30 days of the index procedure between outpatient versus inpatient procedure did not significantly differ. The outpatient group had significantly lower direct costs compared to the inpatient group ($11,059 versus $17,033), as well as lower 90-day cumulative charges ($46,404.03 versus $80,055.00).

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CMS Wants to Use AI to Fight Fraud

The Centers for Medicare & Medicaid Services (CMS) issued a Request for Information (RFI) calling for input on how new technology, including artificial intelligence (AI), could aid in the fight against fraud. CMS hopes to implement AI in order to ensure proper claims payment, ease provider burden, and streamline program integrity activities.

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Read the RFI…


Sports Course Instructors Talk Trends, Biologics, and More

The 21st Annual Sports Medicine Course will include expert faculty-led discussions about upper- and lower-extremity sports-related injuries, injury-specific treatment, and rehabilitation guidelines for all patients. Jeff Dugas, MD, recently led a roundtable discussion with the course codirectors, Brian J. Cole, MD, MBA; CAPT (Ret.) Matthew T. Provencher, MD, MC USNR; and Kevin E. Wilk, DPT, PT, FAPTA, to discuss current and developing practices to make return-to-play decisions and reduce reinjury. The course, presented by AAOS, the American Orthopaedic Society for Sports Medicine, and the Arthroscopy Association of North America, will take place Feb. 23–27, 2020, in Park City, Utah.

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Follow the Office of Government Relations on Twitter

Looking for AAOS advocacy updates on Twitter? Follow the Office of Government Relations for timely news and information. The Association arm of the Academy identifies, analyzes, and directs all health policy activities and initiatives to position AAOS as the trusted leader in advancing musculoskeletal health. Members are encouraged to follow this handle and engage with tweets to help promote the viewpoint of the orthopaedic community.

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