COVID-19 Updates

AAOS Releases Clinical Considerations for Navigating COVID-19

As the COVID-19 pandemic continues to spread across the country, AAOS has issued some important clinical considerations for orthopaedic surgeons when making the decision to reopen facilities for elective surgery. Its five guiding principles are: (1) the safety of patients is and must be of the highest priority; (2) the safety of healthcare personnel and staff should be of the next highest priority; (3) adhere to relevant Centers for Disease Control and Prevention and relevant federal, state, and local public health guidance and recommendations; (4) make locally-based decisions, including incidence, prevalence, patient and staff risk factors, community needs, and resource availability; and (5) follow legal restrictions, including adhering to local shutdowns and stay-at-home orders.

Read AAOS’ clinical considerations…

White House Issues Plan to Reopen America, Including Return to Elective Surgery

President Donald J. Trump released Guidelines for Opening Up America Again, a three-phase plan to help state and local officials in reopening their economies and getting people back to work. Phase one allows elective surgeries to resume on an outpatient basis at facilities that follow guidelines set forth by the Centers for Medicare & Medicaid Services (CMS). Phase two allows elective surgeries to resume on an outpatient and inpatient basis at facilities compliant with CMS guidelines.

Read the Guidelines for Opening Up America Again…

In Other News

Study: Correlation Between Financial Incentives in Medicare Program and Hospital Readmission Performance

A study published online in JAMA Network Open evaluated the correlation between hospitals’ condition-specific incentives and readmission performance and assessed their responsiveness to condition-specific incentives compared to aggregate penalty amounts. Medicare readmissions data from 2,823 hospitals participating in Medicare’s Hospital Readmissions Reduction Program (HRRP) were retrospectively reviewed to compare three-year follow-up readmission performance per tertiles of hospitals’ baseline marginal incentives for five HRRP-targeted conditions, one of which was hip and/or knee surgery. Most hospitals (n = 2,280, 81 percent) had more than one excess readmission for at least one of the five conditions. The mean financial incentive to reduce readmissions for incentivized hospitals ranged from $8,762 to $58,158 per one avoided remission. Decreases in readmissions were greater among hospitals with greater readmission avoidance incentives compared to those with smaller incentives (40 percent for hip and/or knee surgery). Hospitals without incentives had an increase in excess readmission of 7.1 percent for hip and/or knee surgery. For every $5,000 increase in the incentive amount, excess readmissions decreased by 0.6 percentage points to 1.3 percentage points.

Read the study…

Study: Anterior Cervical Corpectomy and Fusion versus Vertebral Body Sliding Osteotomy

A study published in the April 15 issue of the Journal of the AAOS ® compared safety and efficacy between standard anterior cervical corpectomy and fusion (ACCF) versus novel vertebral body sliding osteotomy (VBSO) for cervical ossification of the posterior longitudinal ligament (OPLL). Cervical OPLL patients who underwent VBSO (n = 24) or ACCF (n = 38) were reviewed for operating time, estimated blood loss, neurologic outcomes, complications, and radiographic parameters. The VBSO group had a shorter mean operating time and less estimated blood loss, as well as fewer complications. Complications in the ACCF group (n = 16) included neurologic deficit (two patients), cerebrospinal fluid leakage (four patients), graft migration (three patients), and pseudarthrosis (seven patients) compared to only pseudarthrosis in the VBSO group (two patients).

Read the abstract…

Study: Operative Management of Nail Bed Injuries Combined with Soft Tissue Defects

A study published online in The Journal of Hand Surgery presented a surgical procedure to treat a nail bed injury combined with a soft tissue defect and reported good safety outcomes. Records were reviewed for eight patients treated at a single hospital between 2015 and 2018. Per the Allen classification, five patients were considered type 2, and three were type 3; two patients presented partial distal phalanx defects. The nail bed injury was reconstructed with a split-thickness nail bed flap of the great toe. All nails and flaps survived, with the nail completely attached to the nail bed. No complications or deformities were reported; nail plate appearance was close to normal. One patient had an unsatisfactory nail appearance. One year postoperatively, three patients had two-point discrimination of 6 mm or less. All patients were satisfied with postoperative function per the Michigan Hand Outcomes Questionnaire.

Read the abstract…


First Appropriate Use Criteria Decision Tree Highlights Appropriate Prescription of Dental Prophylaxis in Orthopaedic Patients

The use of antibiotic prophylaxis for dental procedures in patients with joint replacements has long been debated among orthopaedic surgeons and dental professionals. Appropriate use criteria (AUC) developed jointly by AAOS and the American Dental Association and published in 2016 have helped bring direction to an area lacking high-quality literature to support clinical decision-making. To increase utilization and ease of use, including an interactive web-based tool, the content from the AUC has been converted to an at-a-glance decision tree highlighting the key takeaways for printable access and ease of reference.

Read more…


AAOS Registries Release New Data and Access to Virtual Annual Meeting

In 2019, AAOS’ Family of Registries continued to build participation and engagement for its cornerstone registry, the American Joint Replacement Registry, while also growing the Registry Program (Shoulder & Elbow Registry, Musculoskeletal Tumor Registry, and the American Spine Registry) in new directions. Click here for the latest Registry Program updates and press announcements. Additional research as submitted for inclusion in the AAOS 2020 Annual Meeting Virtual Education Experience includes: