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| Today’s Top Story
Study: Rapid Recovery Pathway Reduces Pain, Recovery Time after Adolescent Scoliosis Surgery
A retrospective study published in the March issue of the Journal of the AAOS: Global Research & Reviews ® evaluated a rapid recovery pathway, a novel multimodal postoperative analgesic platform with accelerated rehabilitation, after spine surgery. Forty-four adolescents treated with spinal fusion for idiopathic scoliosis between 2014 and 2016 underwent either rapid (n = 22) or conventional recovery (n = 22) Rapid recovery led to shorter length of stay (3.3 versus 4.4 days), shorter duration of catheter use (1.4 versus 2.3 days), and shorter time to physical therapy clearance (2.2 versus 3.5 days) compared to conventional protocols. Rapid recovery patients also had lower overall and daily pain scores and pain medication use compared to control patients.
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| In Other News
Study: Arthroplasty Risk Due to Post-arthroscopic Subchondral Insufficiency Knee Fracture
A retrospective study published online in Arthroscopy assessed incidence and outcomes of subchondral insufficiency fractures of the knee (SIKF) after arthroscopic meniscectomy and chondroplasty in 28 patients. Mean follow-up was 5.7 years. Medial compartment was the most common SIKF site (89 percent), particularly the medial femoral condyle (75 percent). Fifteen patients (54 percent) had conversion to arthroplasty after a mean 0.72 years. The presence of SIKF in both the femur and tibia in the ipsilateral compartment or in the same compartment as meniscus tear or prior meniscectomy were associated with increased arthroplasty risk. Kellgren and Lawrence osteoarthritis grade was also associated with arthroplasty risk.
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| Commentary: Physician-owned Hospitals May Combat Hospital Consolidation
The 2010 Affordable Care Act included a provision that restricted the expansion and creation of physician-owned hospitals to address concerns about competitive harms to community hospitals. Now, in the face of large-scale hospital mergers and financial distress due to the COVID-19 pandemic, physician-owned hospitals may provide a competitive solution to hospital consolidation. This Health Affairs article, co-authored by AAOS Board of Directors member James Ficke, MD, FAAOS, offers policy recommendations to address concerns regarding physician-owned hospitals. Reversing the ban on physician-owned hospitals is a priority for the AAOS and a tier-one issue on its 2021 Unified Advocacy Agenda.
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| Study: Favorable Outcomes of THA with a 3D Porous Titanium Acetabular Cup
Using a three-dimensional (3D) porous titanium acetabular cup was effective in total hip arthroplasty (THA), according to a study published online in BMC Musculoskeletal Disorders. In total, 73 hips from 65 patients who underwent THA with this approach were evaluated. Mean Japanese Orthopaedic Association scores improved from 52.2 preoperatively to 87.8 postoperatively. No revision surgery was required during the study period. Radiolucent lines occurred in 26 cases (35.6 percent), most frequently appearing at DeLee and Charnley Zone 3. Subject-specific finite element analysis, constructed via computed tomography, showed significantly larger micromotion at DeLee and Charnley Zone 3 compared to Zone 2.
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| Study: Real-world Data Show Cost-effectiveness of TSA
A prospective study published online in the Journal of Shoulder and Elbow Surgery calculated the cost-utility ratio of total shoulder arthroplasty (TSA) in Switzerland. In total, 150 patients were evaluated preoperatively and up to two years postoperatively. Health insurers provided direct medical costs in Swiss francs (CHF). Indirect costs were calculated via work productivity questionnaires. Mean direct costs were 11,771 CHF preoperatively, 34,176 CHF one year postoperatively, and 11,763 CHF after two years. Among 30 working patients, mean productivity losses were 40,574 CHF, 26,114 CHF, and 10,310 CHF, respectively. The incremental cost-effectiveness ratio, accounting for productivity losses was 35,549 CHF per quality-adjusted life year.
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| AAOS Now
Patient Safety Scenario: Protocol Communication Failure
In aviation, there is one accident every 2.4 million flights, whereas medical errors kill between 44,000 and 98,000 patients per year, according to a 1999 Institute of Medicine report. Medicine needs to develop “Black Box Thinking,” defined in a book of the same name as “the willingness and tenacity to investigate the lessons that often exist when we fail. … It is about creating systems and cultures that enable organizations to learn from errors rather than being threatened by them.” This article analyzes a scenario in which improving OR team communication and assessing previous failures allowed for future opportunities to improve patient safety.
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| Your AAOS
Register for Crosstalk Symposium on Osteoarthritis
The Crosstalk Symposium on Osteoarthritis (OA) will take place on April 16 from 8 a.m. to 11:30 a.m. PT. This half-day symposium will be a virtual meeting to convene researchers from institutions across the United States and Europe to recognize OA as a disease of the whole joint. The symposium will discuss the latest discoveries in joint crosstalk in health and disease; complement the conversation in clinical OA research and stimulate translation; recruit and promote new talent within the field, including groups beyond basic musculoskeletal care; and identify priority research areas and strategies to drive progress.
Register for the symposium…
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