April 9, 2018 | Today’s News

Study: Adding peripheral nerve blocks to PAI may reduce pain and opioid consumption for TKA patients

Data presented at the annual meeting of the American Society of Regional Anesthesia and Pain Medicine (ASRA) suggest that adding peripheral nerve blocks to periarticular injection (PAI) for total knee arthroplasty (TKA) may help reduce postoperative pain and opioid consumption. The authors conducted a double-blind, randomized, controlled trial of 86 TKA patients who received either a periarticular injection (n = 43) or an interspace between the popliteal artery and capsule of the posterior knee (IPACK) block with an adductor canal block (ACB) and a “modified” PAI. On postoperative days 1 and 2, they found that patients in the intervention cohort reported lower numeric rating scale (NRS) pain scores on ambulation compared to patients in the control cohort. In addition, patients in the intervention group were more satisfied, had significantly less pain, less interference from pain when walking, slept better, and were in severe pain less often in a 24-hour period. Further, compared to controls, they had less opioid consumption, less intravenous opioids, and less intravenous patient-controlled analgesia.

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Study: Soft cast may be appropriate for pediatric patients with nondisplaced supracondylar humeral fracture

A study published in the April issue of the Journal of Pediatric Orthopaedics suggests that a removable long-arm soft cast may be appropriate for children with nondisplaced supracondylar humeral fracture. Members of the research team conducted a randomized, controlled trial of 100 consecutive pediatric patients who presented with a closed, nondisplaced, type I supracondylar humeral fracture or an occult, closed, acute elbow injury. Among the 100 patients, 50 were treated with a long-arm, traditional (hard) fiberglass cast and 50 were treated with a long-arm, soft fiberglass cast. At latest follow-up, patients in both groups displayed similar mean arc of motion and had achieved similar relative arc of motion to that of the contralateral side. The researchers write that pain scores were low and comparable across cohorts over the study period, and all patients in both groups reported the highest rate of satisfaction at eight-week follow-up.

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According to findings published online in The American Journal of Sports Medicine, alterations in tibiofemoral contact location, contact area, and bone shape may contribute to long-term degeneration after anterior cruciate ligament (ACL) reconstruction. The researchers determined dynamic tibiofemoral kinematic values for 43 patients at six and 24 months after ACL reconstruction. At both follow-ups, they found that lateral compartment congruency in the ACL-reconstructed knee was greater than in the contralateral knee. The researchers write that, from six to 24 months after surgery, dynamic congruency decreased in the medial compartment and increased in the lateral compartment in the reconstructed knee. In the lateral compartment, they found that side-to-side difference (SSD) in joint congruency related to contact location and femur global curvature, while in the medial compartment, SSD in joint congruency was related to contact area.

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Modern Healthcare reports that the U.S. Medicare Payment Advisory Commission (MedPAC) plans to recommend to the U.S. Congress a 30 percent reduction in Medicare reimbursement rates to off-campus stand-alone emergency departments (EDs) that are within six miles of an on-campus hospital ED. The agency states that off-campus facilities have lower overall expenses than on-campus EDs, but typically receive equal Medicare payments. If adopted by the U.S. Congress, MedPAC estimates the move could save $250 million per year. Critics argue that the pay cut could reduce access to care.

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According to The New York Times, under a proposal from President Donald J. Trump, a variety of medical devices may face a 25 percent tariff on goods manufactured in China, including some joint arthroplasty products. The publication notes that several companies have orthopaedic device factories in China that export goods to the United States. A report released by RBC Capital Markets estimates that if the proposed 25 percent tariffs take effect, the move could cost the medical device industry up to $1.5 billion each year.

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California

The California Medical Association reports that, beginning Oct. 2, 2018, physicians in the state must consult the Controlled Substance Utilization and Evaluation System (CURES) prior to prescribing Schedule II, III, or IV controlled substances to a patient for the first time, and at least once every four months thereafter if the substance remains part of the patient’s treatment. The organization notes several exceptions to the requirement, including situations in which access to CURES is not reasonably possible or when patients are under hospice care.

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Call for volunteers: CMS panel on Elective THA and TKA Hospital-Level Performance

AAOS seeks to nominate members to the CMS Technical Expert Panel on Patient-Reported Outcomes Following Elective Total Hip and/or Total Knee Arthroplasty. The primary objective of this project is to develop one to two patient-reported outcome performance measures for Medicare beneficiaries aged 65 years or older who undergo an elective total hip or total knee arthroplasty (THA or TKA). Applicants for this position must be active fellows, candidate members, candidate members osteopathic, candidate member applicants for fellowship, or candidate member applicants for fellowship osteopathic. In addition, all applicants must provide the following: an online AAOS CAP application, a current curriculum vitae, a 100-word biography, a letter of interest highlighting his or her expertise in the subject area, and a signed CMS nomination form. All supporting materials must be submitted by April 12, 2018, at 11:59 p.m. CT, to:

trivedi@aaos.org

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

Learn more and obtain the CMS nomination form…