Study: Preoperative Opioid Use Increases TJA Costs
A study published in the April 1 issue of the Journal of the AAOS ® calculated increased costs for total joint arthroplasty (TJA) associated with preoperative opioid use. Using Medicare data, researchers identified 3,211 patients who underwent TJA between 2015 and 2018. In total, 569 patients (17.7 percent) used preoperative opioids, of whom 242 (42.5 percent) only used tramadol. Episode-of-care costs were significantly higher among users of preoperative opioids and tramadol ($19,229 and $19,403, respectively) compared to those who did not ($17,572). Opioid and tramadol use were associated with a $789 and $430 increase in episode-of-care costs, respectively.
Study: Impact of Patella Grafting on Pain and Knee Mobility after BPTB ACL Reconstruction
A systematic review published online in Arthroscopy measured how patellar defect bone grafting influences outcomes of bone-patellar tendon-bone (BPTB) autograft ACL reconstruction. Thirty-nine studies were included, comprising 1,955 patients treated between 2000 and 2020. Of these, 1,159 had patella grafting (PG) and 796 patients had no patella grafting (NPG). Knee pain occurred more frequently in the NPG group compared to the PG group (19–81 percent versus 15–32 percent). Moderate to severe pain occurred in 22 percent to 57 percent of the NPG group and 10 percent of patients who underwent ACL with PG. Extension loss of ≥ 3 degrees occurred in 4 percent to 43 percent of the NPG patients and 2 percent to 11 percent of the PG patients.
Study: Favorable Outcomes with SCOI Row Method for RCR of Full-thickness Tears
A retrospective study published online in BMC Musculoskeletal Disorders evaluated outcomes and tendon-to-bone healing after arthroscopic rotator cuff repair (RCR) of full-thickness tears using the Southern California Orthopedic Institute (SCOI) row method. Eighty-nine patients aged < 55 years received preoperative and three- and six-month postoperative MRI. Overall, patients experienced improvements in functional and pain scores and range of motion after six months. Six-month MRIs also showed intact repairs in patients’ shoulders, including footprint regeneration, indicating satisfactory tendon-to-bone healing. Mean regeneration tissue thickness was 7.35 ± 0.76 mm and 7.75 ± 0.79 mm at three months and six months, respectively. The rate of patients who reported feeling satisfied with the procedure was 93.3 percent.
Study: Risk Factors of Treatment Failure for Infections after Fracture Fixation
A retrospective study published online in Injury determined risk factors of treatment failure after operative management of deep surgical site infection following fracture fixation. A total of 451 patients treated between 2006 and 2015 were included in the study and were followed for an average of 2.3 years. The initial surgical management failure rate was 35 percent (n = 156). Risk factors for treatment failure included initial cultures positive for polymicrobial organisms, removal of implants, or Gustilo-Anderson Classification type IIIB/IIIC injuries. Having a higher BMI and meeting criteria for a methicillin-resistant Staphylococcus aureus nasal swab screening also showed a trend toward increased risk of treatment failure.
Study: Improvements in Mental Health after Spine Surgery
Health-related improvements after spine surgery led to greater scores on mental health scales, according to a study published online in The Spine Journal. Utilizing the Canadian Spine Outcome Research Network, researchers evaluated pre- and postoperative mental health outcomes among 3,222 patients who underwent surgery for degenerative lumbar disease Lower Oswestry Disability Index (ODI), European Quality of Life Healthstate, and Short Form (SF)-12 Physical Component Score indices correlated with worse SF-12 Mental Component Scores (MCS). Back and leg pain also were associated with decreased mental health scores. Patients showed MCS improvements within three months postoperatively, and these benefits remained for 24 months. Major depression incidence decreased by up to 48 percent following surgery. Higher ODI scores correlated with greater improvements in MCS.
Focus on Rehabilitation Needed after Two Decades of Gains in Acute Trauma Care
Acute trauma care has made significant gains since the turn of the 21st century, many of which can be attributed to tactical combat casualty care methodologies learned on the battlefields of Iraq and Afghanistan. As with battlefield care, civilian acute care trauma teams have been able to resuscitate and save the lives of individuals with more severe injuries than in the past. The question remains whether the post-acute care period has also realized gains comparable to those in trauma care, as patients are surviving with more severe injuries in need of post-acute rehabilitation.
AAOS Fracture & Trauma Registry Adds Orthopaedic Trauma Association as Partner
AAOS is pleased to announce the Orthopaedic Trauma Association (OTA) as a partner of the Fracture & Trauma Registry (FTR), which opens this spring with a limited invitation to key sites followed by a full participant enrollment in the summer. Full support from OTA creates an even stronger foundation for the FTR to collect quality data that can drive improved patient outcomes.
