Today’s Top Story
Study: How common is myocardial ischemia after orthopaedic surgery?
A study published online in HSS Journal examines rates of myocardial ischemia following orthopaedic surgery. The authors reviewed data on 10,627 inpatient orthopaedic procedures performed at a single center and identified 805 patients as at risk for postoperative myocardial ischemia. Of those patients, they found that 20.6 percent (166 of 805) of the patients had elevated serum cTnI levels (defined as cTnI >0.02 ng/mL), while 1.2 percent had documented postoperative myocardial infarction (10 of 805). Among at risk total knee arthroplasty (TKA), total hip arthroplasty (THA), or posterior spinal fusion (PSF) patients, 19 percent (102 of 532) had elevated cTnI levels and 31 percent (32 of 102) had postoperative cardiac complications. After adjustment for sex, age, body mass index, cardiac risk factors, and medications (statins and ß-blockers), the authors note that PSF patients were significantly more likely to experience myocardial injury compared to TKA and THA patients.
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Other News
Study: More than one-third of adults used opioids in 2015.
Findings from a study published in the Aug. 1 issue of the journal Annals of Internal Medicine suggest that more than one-third of U.S. adults may have taken prescription opioids during 2015. The research team reviewed information on 51,200 participants in the 2015 National Survey on Drug Use and Health. It projects that 91.8 million (37.8 percent) of U.S. civilian, noninstitutionalized adults used prescription opioids, 11.5 million (4.7 percent) misused them, and 1.9 million (0.8 percent) had a use disorder. Among adults taking prescription opioids, 12.5 percent reported misuse, and of those, 16.7 percent reported a prescription opioid use disorder. Misuse and use disorders were most commonly reported in adults who were uninsured, were unemployed, had low income, or had behavioral health problems. Among adults with misuse, 59.9 percent stated that they had used opioids without a prescription and 40.8 percent obtained prescription opioids for free from friends or relatives for their most recent episode of misuse.
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In related news, a systematic review published in the Aug. 2 issue of JAMA Surgery finds that 67 percent to 92 percent of 810 patients surveyed reported unused opioids.
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An interim report from the national Commission on Combating Drug Addiction and the Opioid Crisis recommends among other things that President Trump declare a national emergency to address the opioid crisis, noting that recent data from the U.S. Centers for Disease Control and Prevention suggest that 142 people die of a drug overdose every day.
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Read the commission report (PDF)…
Study: Metal modular radial heads with smooth stems may be linked to fewer complications compared to porous stems.
According to a study published in the August issue of the Journal of Shoulder and Elbow Surgery, metal modular radial heads with smooth stem implants may be associated with reduced risk of complication compared to those with porous stems. The researchers conducted a retrospective cohort study of 57 patients who underwent radial head arthroplasty in the first 4 weeks after trauma, using either smooth stem implants (n = 21) or porous stem implants (n = 36). At mean 6.3-year follow-up, they found that average Disabilities of the Arm, Shoulder, and Hand and Mayo Elbow Performance Index scores were similar across cohorts. However, porous implants were more prone to osteolysis and were linked with a greater loss of elbow flexion and a greater tendency toward overstuffing.
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Study: Long-term use of bisphosphonates associated with more bone mineralization and less fracture toughness.
A study published online in the Proceedings of the National Academy of Sciences examines mechanisms linked to atypical femur fractures (AFFs) among women treated with bisphosphonates. The authors biopsied proximal femoral cortical bone adjacent to the fracture site obtained from postmenopausal women during fracture repair surgery (n = 33) or THA (n = 17). Using vibrational spectroscopy and nanoindentation, they found that tissue from bisphosphonate-treated women with atypical fractures was harder and more mineralized than that of bisphosphonate-treated women with typical osteoporotic fractures. Further, fracture mechanics measurements showed that tissue from patients treated with bisphosphonates had deficits in fracture toughness, with lower crack-initiation toughness and less crack deflection at osteonal boundaries than that of bisphosphonate-naïve patients. The authors write that the data suggest a deficit in intrinsic and extrinsic toughening mechanisms, which may contribute to AFFs in patients treated with long-term bisphosphonates.
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Study: Displaying testing fees in EHR may have little effect on clinician ordering behavior.
Findings from a study published in the July issue of JAMA Internal Medicine suggest that displaying Medicare allowable fees for inpatient laboratory tests in electronic health records (EHRs) may not significantly impact overall clinician ordering behavior or associated fees. The research team reviewed prospective data on 142,921 hospital admissions (98,529 patients) from three centers and found no significant changes in overall test ordering behavior or associated fees after implementation of an intervention in which Medicare allowable fees were randomly displayed in the EHR. However, an exploratory subset analyses noted small but significant differences in tests ordered per patient-day based on patient intensive care unit stay and magnitude of associated fees.
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USBJI videos now available in Spanish.
The United States Bone and Joint Initiative (USBJI) has made available Spanish language edition videos through its Experts in Arthritis and Fit to a T public education programs. Experts in Arthritis is designed to educate patients about current scientific evidence and management strategies in the treatment and care of osteoarthritis, rheumatoid arthritis, and juvenile arthritis. Fit to a T focuses on bone health, osteoporosis, avoiding fragility fractures, and making informed decisions on bone health.
Visit the Experts in Arthritis site…
Visit the Fit to a T site…
Call for volunteers: Practice Management/Rehabilitation Program Committee.
The last day to submit your application for a position on the Practice Management/Rehabilitation Program Committee (one member opening) is Aug. 31. Members of Program Committees grade symposia in May and abstracts in June and July, and may serve as moderators for paper session at the AAOS Annual Meeting. Applicants for this position must be active fellows or international members with a practice emphasis in practice management and rehabilitation.
Learn more and submit your application…(member login required)
