April 10, 2020 | Today’s News

Study Compares Cost-effectiveness of Patellofemoral Arthroplasty versus TKA

A randomized clinical trial published in the April issue of The Bone & Joint Journal compared the short-term cost-effectiveness of patellofemoral arthroplasty (PFA) versus total knee arthroplasty (TKA) for isolated patellofemoral osteoarthritis (OA). Isolated patellofemoral OA patients (n = 100) were randomized to receive either PFA or TKA and preoperatively filled out the EuroQol five-dimension questionnaire (EQ-5D) and Six-item Short-form Health Survey questionnaire; outcomes were completed again six weeks and three, six, and nine months postoperatively, as well as one and two years postoperatively and annually. The incremental 12-month EQ-5D gain in the PFA group was 0.056, and the incremental 12-month cost was –€328. The authors concluded that PFA provided better and cheaper outcomes compared to TKA.

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Study Assesses Orthopaedic Management in Emergency Setting

A study published in the March/April issue of Current Orthopaedic Practice analyzed outcomes associated with management of orthopaedic conditions in an emergency setting. Orthopaedic consults conducted by emergency medicine providers at a level 1 trauma center between May 1, 2016, and June 30, 2016, were assessed for the accuracy of the initial diagnosis, effectiveness of management by the emergency medicine physician, and consult appropriateness. Direct orthopaedic transfers and general surgery trauma consults were not included in the study. Final analysis included 239 consecutive consults, of which 38.5 percent were inaccurate due to nonspecific consults, incomplete information with missed injuries, grossly incorrect diagnosis, or use of incorrect terminology. About three-quarters of patients (n = 68) ultimately had a significant change in orthopaedic management due to inaccurate diagnoses. Thirteen open injuries were documented, of which four (30.8 percent) were incorrectly labeled “closed.” In about a quarter of patients (n = 61; 25.5 percent), initial work-up was incomplete, which affected management in 44.3 percent (n = 27) of cases. More than half of consults (n = 136; 56.9 percent) required acute orthopaedic intervention in the emergency setting.

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A study published online in Injury assessed the incidence of complications during the first 120 days following hip fracture. Patients aged 60 years and older who received operative hip fracture treatment (n = 8,673) were followed for complications until hospital discharge and at 120 days postoperatively. Factors associated with increased risk for complications during the first 120 days included chest infection (6.3 percent), blood loss requiring transfusion (6.1 percent), urinary tract infection (5.0 percent), signs of wound infection (3.1 percent), deep vein thrombosis/pulmonary embolus (1.8 percent), acute kidney injury (1.3 percent), overall revision surgery (0.9 percent), acute coronary syndrome/myocardial infarction (0.6 percent), cerebrovascular accident (0.6 percent), failure of fixation (0.6 percent), dislocation (0.5 percent), and periprosthetic fracture (0.3 percent).

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A retrospective study published in the April issue of The Journal of Hand Surgery evaluated the outcomes of proximal interphalangeal (PIP) joint denervation using a volar approach to treat PIP joint OA. Eleven cases were identified through a single institution’s registry. Data collection included demographics; comorbidities; preoperative and postoperative visual analog scale (VAS) score for pain; and Disorders of the Arm, Shoulder, and Hand (DASH) questionnaire score. The most commonly treated finger was the ring finger. VAS pain score improved from 7.8 to 1.4, and DASH score improved from 43.6 to 8.7. PIP joint active range of motion improved from 52 degrees to 79 degrees. Postoperative digital paresthesia presented in two patients and resolved spontaneously. No major complications were recorded.

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A study published online in BMJ Open analyzed days on sick leave and factors associated with return to work after surgery for type II superior labral tear from anterior to posterior of the shoulder. A total of 114 patients underwent labral repair, biceps tenodesis, or sham surgery. During the two-year postoperative period, the mean total number of work days on sick leave was 148; 22 percent of the patients took more than 80 percent of the sick leave days. Most sick leave days (80 percent) were shoulder related. Across treatment groups, the mean total number of days on sick leave the year after surgery doubled. Biceps tenodesis patients had more postoperative sickness absence days than the sham surgery and labral repair groups, but the difference was not significant when adjusting for sick leave days the year before surgery. The following factors were associated with return to work two years postoperatively: no sick leave and moderate anxiety or depression symptoms at inclusion.

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Orthopaedics Must Take Action to Combat Assault on Athletes

We cannot forget the days in 2018 when 150 survivors—former and current gymnasts—entered a Michigan courtroom to confront their abuser, most with vivid, emotional testimonies of their experiences. The abuser was not just anybody—he was a man they were expected to trust. He was their physician. Larry Nassar, MD, held a unique role in their lives. As members of the profession that unknowingly subjected those young girls to abuse, it is not enough merely to acknowledge what happened. We must take steps to correct those wrongdoings and protect our future patients, athletes, children, and communities from similar situations.

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Call for Abstracts for 2021 Annual Meeting Postponed

The Academy remains committed to bringing world-class education to the orthopaedic community. With many orthopaedic surgeons on the frontlines, AAOS has decided to postpone the Call for Abstracts for the 2021 Annual Meeting to begin on June 1. AAOS strives to offer the highest level of unbiased scientific and clinical content and adjusting the timeframe will allow the Academy to do so.

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