Today’s Top Story
Study: Similar mid-term outcomes for patients who undergo ACLR using titanium or PLLA-HA screws.
A study published in the August issue of The American Journal of Sports Medicine finds similar mid-term clinical outcomes among patients who undergo anterior cruciate ligament reconstruction (ACLR) using either titanium or bioabsorbable poly-L-lactic acid with hydroxyapatite (PLLA-HA) screws. The authors conducted a randomized, controlled trial of 40 ACLR patients who received either PLLA-HA or titanium screws. At both 2- and 5-year follow-up, they found no significant difference between cohorts in IKDC (International Knee Documentation Committee) and Lysholm knee score, KT-1000 arthrometer, and single-legged hop test. At 2 years, the authors noted that magnetic resonance imaging revealed that the femoral tunnel was smaller in the PLLA-HA group compared to the titanium group; however, at 5 years that distinction had disappeared. Read the abstract…

Other News

MedPAC outlines areas of concern with CMS CCJR model.
In a letter to Andrew Slavitt, acting administrator of the U.S. Centers for Medicare & Medicaid Services (CMS), the U.S Medicare Payment Advisory Commission (MedPAC) has offered comments on a proposal to bundle payment and quality measures for hip and knee arthroplasty at hospitals in 75 geographic areas. Under the Comprehensive Care for Joint Replacement (CCJR) model, hospitals will be at financial risk for care provided during the initial hospital stay plus 90 days after discharge. “By putting hospitals at risk,” the agency writes, “beneficiary care could improve because hospitals will have an incentive to increase care coordination, invest in infrastructure and care processes that increase quality and efficiency, and use high-value care throughout the 90-day episode.” However, the agency notes that the bundled payment structure could “create an incentive to furnish fewer services than medically necessary, to use low-cost settings even if another setting is more appropriate, to delay care until after the bundle is over, and to the increase the number of bundles.” The agency suggested that CMS monitor unintended impacts in the following ways:

  • Tracking readmission and complication rates
  • Monitoring spending during the 30 days after the 90-day bundles
  • Comparing rates of joint replacement in both included and excluded markets
  • Tracking the mix of cases and the severity of illness of the cases treated

Read more…
Read the proposed rule (PDF)…
Read more about CCJR in AAOS Now…

Study: Use of plastic multilayered closure technique may reduce infection rates for operative treatment of nonidiopathic scoliosis.
Findings from a study published online in the Journal of Pediatric Orthopaedics suggest that use of a plastic multilayered closure technique may reduce the likelihood of postoperative wound complication for patients who undergo posterior spinal fusion for nonidiopathic scoliosis. The researchers reviewed data on 76 patients with a primary diagnosis of scoliosis associated with a syndrome or neuromuscular disease, and who underwent posterior spinal fusion using either nonstandardized wound closure performed by an orthopaedic surgical team (n = 42) or a plastic multilayered closure technique and rotational flap coverage when needed performed by a plastic surgeon (n = 34). They found that the wound complication rate in the nonstandardized closure group was 19 percent compared with 0 percent in the plastic multilayered closure group. In addition, the researchers found that unanticipated return to the operating room rate was 11.9 percent for nonstandardized closure patients and 0 percent for plastic multilayered closure patients. Read the abstract…

Study: Delivery of vitamin D3 to older, homebound patients may reduce likelihood of falls.
According to a study published online in the Journal of the American Geriatrics Society, delivery of vitamin D3 to seniors via a “meals on wheels” program may reduce the likelihood of falls for such patients. The research team conducted a single-blind, cluster randomized trial of 68 community-dwelling homebound adults aged 65 years or older, who received either 100,000 IU/month of 25-hydroxyvitamin D (n = 38) or 400 IU vitamin E/month (n = 30). At 5-months after start of the intervention, the research team found that one of 34 participants randomized to vitamin D3 had 25(OH)D concentrations less than 20 ng/mL, compared with 18 of 25 participants randomized to placebo. After adjustment for sex, race, season of year, baseline 25(OH)D status, and history of falls, they found that participants in the vitamin D3 cohort had a lower rate of falling than those in the control cohort. Read more…
Read the abstract…

Medicare fraud crosses international borders.
An article in Bloomberg Business reports on Medicare fraud perpetrated in foreign countries. In two related schemes, institutions in Nicaragua and the Dominican Republic billed Medicare for non-American patients who provided mailing addresses in the United States. Observers say CMS paid out about $25 million between 2011 and 2014 for medical care received by patients who signed up using post office boxes, mail-forwarding services, or the addresses of friends or relatives in the United States. Read more…

Presidential Innovation Fellows program seeks stakeholders to help improve government.
The White House has announced an update to the Presidential Innovation Fellows (PIF) program, which seeks successful entrepreneurs, executives, and innovators to develop meaningful solutions with the goals of saving lives and taxpayer money, fuel job creation, and to improve how the federal government serves its citizens. The PIF program is administered as a partnership between the U.S. Office of Science and Technology Policy, the U.S. Office of Management and Budget, and the U.S. General Services Administration. Among other things, PIF plans to seek expanded adoption of Blue Button, which enables consumers to securely download electronic copies of their own health information. Fellowships last 12 months, during which fellows are embedded within a federal agency to collaborate on challenges with innovators inside government. Fellows must be based in Washington D.C. for the duration of their fellowship, and are considered full-time employees of the federal government. Fellows operate with wide latitude for individual initiative in planning and executing solutions to problem, and spend a significant portion of their time co-working and collaborating with other fellows. Throughout the program, fellows receive support from partners in the White House and change-agents across various federal agencies. Read more…
Learn more and submit your application…

AAOS Members only: Housing now open for the 2016 AAOS Annual Meeting.
Now is the best time to reserve a room for the 2016 AAOS Annual Meeting, to be held March 1 – 5 in Orlando, Fla. All official AAOS hotels not within walking distance will offer free shuttle bus service to the Orange County Convention Center. Housing is currently open for AAOS members only. Learn more about the AAOS Annual Meeting…
Reserve your room…

Last call: Committee on Outside Interests.
Aug. 25 is the last day to submit your application for a position on the Committee on Outside Interests (two member openings). The Committee on Outside Interests advises the Board of Directors and other AAOS bodies regarding conflict of interest issues, and oversees the AAOS Orthopaedic Disclosure Program. Applicants for this position must be active or emeritus fellows and will be required to complete the AAOS mandatory enhanced disclosure information form. Learn more and submit your application…(member login required)