Today’s Top Story

Study Assesses 10-year THA Trends in Operative Time

A study published online in The Journal of Arthroplasty analyzed changes over the last decade in operative times for total hip arthroplasty (THA). Data on 157,574 THA patients treated between 2008 and 2018 were collected from the American College of Surgeons–National Surgical Quality Improvement Program database, including operative time, demographics, and comorbidities. Median operative time was 87 minutes and remained stable across the study period; all calculated annual values were within five minutes of the median. Factors that influenced operative time were age, body mass index, resident involvement, modified Charlson Comorbidity Index, and preoperative laboratory values. During the study period, length of stay, readmission, superficial wound infection, and sepsis all decreased. Operative times were longer for nonelective procedures compared to elective surgeries.

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In Other News

Study: How Common Are Incidental Findings on Orthopaedic Radiographs?

A study published in the April 15 issue of the Journal of the AAOS ® measured the one-year rate of incidental findings on orthopaedic radiographs ordered in an academic orthopaedic multispecialty group. A total of 13,948 radiographs from a single institution over a 12-month period were retrospectively analyzed. Incidental findings were stratified based on whether they raised concern for possible malignancy versus likely benign conditions. Possible malignancies were further stratified by bone or lung, and benign findings were stratified by etiology and anatomic location. There were 289 incidental findings, for a rate of 2.07 percent; the study categories with the highest rates of incidental findings were spine (3.96 percent), leg length alignment (3.94 percent), and pelvic and hip radiographs (2.81 percent). The most prevalent types of incidental findings were for possible malignancy or metastases in bone (30.10 percent), benign bone disease (24.90 percent), and gastrointestinal conditions (6.57 percent). Less than half of incidental findings (n = 122; 42.2 percent) were recommended for follow-up.

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Study: Does Femoral Tunnel Location Affect Postoperative Tunnel Widening After ACL Reconstruction?

A study published in the April issue of Arthroscopy compared postoperative tunnel widening following hamstring anterior cruciate ligament (ACL) reconstruction between anatomic versus nonanatomic femoral tunnels. Hamstring ACL reconstruction patients who were treated with an adjustable-loop cortical suspension device, received three-dimensional CT the day after surgery, and had at least two years of follow-up were stratified into two groups: anatomic (n = 37) and nonanatomic (n = 52). Femoral tunnel angles and postoperative tunnel widening did not largely differ between the groups. An association was observed between a higher position and femoral tunnel widening at two years postoperatively. After two years, knee stability and patient-reported outcomes were not significantly different.

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Study Assesses Failure Risk for Posterior Shoulder Instability in Adolescence

A study published in the April issue of The American Journal of Sports Medicine analyzed outcomes among children who underwent operative treatment for posterior shoulder instability Between 2011 and 2018, 48 children (23 were girls) aged younger than 18 years received arthroscopic shoulder surgery at a single institution. Mean follow-up was 3.75 years. About a third of patients (n = 15; 31.3 percent) sustained a complication, including 12.5 percent with surgical failures. In major complication cases, successful treatment varied between boys (96 percent) and girls (78 percent). Factors associated with complications were younger age and presentation type. Single Assessment Numeric Evaluation scores significantly varied by presentation type (trauma, 52; recurrent instability, 94; and pain, 81), as did Disabilities of the Arm, Shoulder, and Hand (DASH) scores (37, 9, and 11, respectively).

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Study: Effect of Partial and Complete Trapezoid Excision on Outcomes After Abductor Pollicis Longus Suspensionplasty

A study published in the April issue of The Journal of Hand Surgery assessed outcomes associated with adding complete or partial trapezoid excision versus a simple trapeziectomy and abductor pollicis longus suspensionplasty. The study included 69 patients (79 hands; mean age, 64 years; 87 percent were female) with abductor pollicis longus suspensionplasty. Patients with scaphotrapezium-trapezoid arthritis received an additional proximal trapezoid excision (PT; n = 21 hands) or complete trapezoid resection (CT; n = 22 hands); 36 hands did not receive trapezoid excision. The main outcome was final radiolunate (RL) extension of at least 15 degrees observed on lateral radiographs. Patients were followed for a median 92 months. CT was correlated with the greatest increase in RL angle, but PT had a higher incidence of final RL angle of 15 degrees or greater than CT (29 percent versus 26 percent). When hands were stratified into groups by final RL greater or less than 15 degrees, the former had poorer outcomes including Patient-rated Wrist Evaluation and Quick DASH scores. Symptomatic index metacarpal migration was considered indicative of failure and presented in 18 percent of CT wrists and 10 percent of PT wrists

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Supply Chain Knowledge Is Important to Orthopaedic Physicians

Why is supply chain knowledge important for orthopaedic surgeons? Health care is undergoing a transformational change in which the primary focus will shift from business to business (hospital to payer) to business to consumer. An increasingly patient-centered model will require health systems to build their service-delivery models around patients’ needs. In this article, Steve Kiewiet, CMRP, FAHRMM, FACHE, discusses the significance of supply chain knowledge in the orthopaedic world.

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Take Part in a CPG Workgroup on SSI Prevention

AAOS is seeking volunteers to take part in the workgroup for the development of the clinical practice guideline (CPG) for The Prevention of Surgical Site Infections (SSI) Following Major Extremity Trauma. The deadline to submit an application is April 24.

Learn more and submit your application…