Today’s Top Story

Study offers definition for diagnosis of hip and knee PJI

A study published in the May issue of The Journal of Arthroplasty offers an evidence-based definition for the diagnosis of hip and knee periprosthetic joint infection (PJI). The authors conducted a multi-institutional study of 684 cases of PJI (based on Musculoskeletal Infection Society definition) and 820 aseptic cases that underwent one-stage revision for a noninfective indication and did not fail within two years, followed by validation using an external cohort of 222 patients with PJI who subsequently failed with reinfection and 200 aseptic patients. The authors weighted a variety of factors, including but not limited to:

  • elevated serum C-reactive protein >1 mg/dL (2 points)
  • D-dimer >860 ng/mL (2 points)
  • erythrocyte sedimentation rate >30 mm/h (1 point)
  • elevated synovial fluid white blood cell count >3000 cells/μL (3 points)
  • alpha-defensin signal-to-cutoff ratio >1 (3 points)

The authors determined that patients with an aggregate score of ≥6 were considered infected, while a score between 2 and 5 required the inclusion of intraoperative findings for confirming or refuting the diagnosis of PJI.

Read the abstract…

Other News

AAOS, AMA, and other associations urge reduction of MIPS reporting period

In a letter to the U.S. Centers for Medicare & Medicaid Services (CMS), the American Association of Orthopaedic Surgeons, the American Medical Association, and 47 other medical organizations urge CMS to reduce the 2018 Merit-based Incentive Payment System (MIPS) quality measure reporting period from one calendar year to a minimum of 90 consecutive days, “due to the lack of timely and direct notification by CMS on whether a physician is considered MIPS eligible, as well as a severe delay by CMS in updating the Quality Payment Program (QPP) interactive website with 2018 information.”

Read the letter (PDF)…

FDA: Cantrell Drug Company agrees to cease manufacturing and distribution until facility is compliant

A U.S. district court has entered a consent decree that prohibits Cantrell Drug Company of Little Rock, Ark., from manufacturing, processing, packing, holding, or distributing drugs until it complies with Federal Food, Drug, and Cosmetic Act and U.S. Food and Drug Administration (FDA) regulations. The complaint filed with the consent decree alleges that the company manufactured and distributed purportedly sterile drug products, including injectable opioids and antibiotics, that were made under unsanitary conditions and in violation of current good manufacturing practice requirements. The consent decree requires the company to cease operations until it completes corrective actions, including hiring a qualified independent expert to inspect its facility to ensure compliance of federal requirements.

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HHS proposes 2019 start for ‘Common Rule’ compliance

Politco Pro reports that the U.S. Department of Health & Human Services (HHS) proposed a delay in general compliance with the so-called “Common Rule,” which governs research performed on human subjects. The proposed rule sets a general compliance date of Jan. 21, 2019. Studies launched at that time will be required to comply with the new regulatory requirements.

Read the proposed rule…

Learn more about BCPI Advanced

An early online release article from the May issue of AAOS Now offers an in-depth look at the Medicare Bundled Payments for Care Improvement Advanced (BPCI Advanced) model, a voluntary episode-based payment model designed to test bundled payments for 32 clinical episodes, many of which are relevant to orthopaedic surgeons. BPCI Advanced will operate under a total-cost-of-care concept, in which the total Medicare fee-for-service spending on all items and services furnished to a beneficiary during a clinical episode, including outlier payments, will be part of the clinical episode expenditures for purposes of the target price and reconciliation calculations, unless specifically excluded. The model is scheduled to begin Oct. 1 and will run through Dec. 31, 2023. CMS will provide a second application opportunity in January 2020.

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In the States


The Milwaukee Journal Sentinel reports that the Wisconsin Supreme Court is considering a case that could strike down the state’s $750,000 cap on non-economic damages in medical liability suits. A lower court jury previously awarded the plaintiffs $25.3 million, including $16.5 million in non-economic damages, because a hospital had failed to inform a patient that an antibiotic could be used to treat severe abdominal pain that later was discovered to have been caused by a Streptococcus A infection. The patient’s condition worsened, leading to sepsis, organ failure, coma, and amputation of all four limbs. An appellate court found the cap to be unconstitutional. The high court is expected to rule on the case in the coming months.

Read more…


Call for volunteers: Research Development Committee

May 4 is the last day to submit applications for a position on the Research Development Committee (one member-at-large opening). This committee oversees annual research symposia, the Kappa Delta orthopaedic research awards, the Clinician Scholar Career Development Program, and the Unified Orthopaedic Research Agenda, and is the Academy’s liaison group to the National Institutes of Health. Applicants for this position must be active fellows or associate members basic science.

Learn more and submit your application…  (member login required)

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