Today’s Top Story
Improper performance of surgery tops reasons for filing orthopaedic medical liability claims.
A report released by medical liability insurer The Doctors Company attempts to identify the most common factors in orthopaedic medical liability cases. The researchers reviewed 1,895 closed claims against orthopaedists and found that improper performance of surgery, improper management of the surgical patient, and diagnosis-related issues, such as failure or delay in diagnosis or wrong diagnosis were the three most common patient allegations. In attempting to determine factors associated with possible injury, the researchers found that the top five factors were technical performance, patient factors, selection and management of therapy, communication between patient or family and provider, and patient assessment issues, such as failure or delay in ordering diagnostic tests. Further, they determined that in 29 percent of cases, patient behaviors such as not following a treatment plain or missing scheduled appointments affected the outcome of care. Read more…
Read the complete report (PDF)…
Other News
Study examines early data on recalled hip system.
A study published online in the journal Clinical Orthopaedics and Related Research (CORR) attempts to evaluate early data from a follow-up study of the recalled Articular Surface Replacement (ASR) hip system. The researchers conducted a prospective study of 288 patients (333 hips) who received DePuy Orthopaedics ASR and ASR XL hip systems and who had a metal artifact reduction sequence magnetic resonance imaging (MIR) scan of the hip performed at a mean time of 6 years after surgery. They identified moderate or severe adverse local tissue reactions (ALTRs) in 79 hips. The direct lateral approach was used in 41 hips and the posterior approach in 38 hips. In patients in whom the lateral approach was used, 83 percent had an anterior ALTR, while 71 percent of patients in the posterior approach group had posterior ALTRs. The researchers noted no differences in patient-reported outcome measures between patients with moderate-to-severe ALTRs and those with no ALTR findings on MRI. In addition, they found that use of ASR XL was an independent risk factor for moderate-to-severe ALTRs, and that patients with ASR XL also had a thicker synovium and larger maximal ALTR diameter compared to patients treated with ASR. Read the abstract…
Study: Smoking linked to increased risk of SSI after ORIF for closed elbow fracture.
Data from a study published online in CORR suggest that cigarette smoking is linked to increased risk of surgical site infection (SSI) after open reduction and internal fixation (ORIF) of a closed elbow fracture. The research team reviewed data on 1,320 adult patients who underwent surgery for elbow fracture. Of those, 1,113 patients had a closed fracture. The research team found that use of plate and screw fixation and use of external fixation prior to surgery were associated with higher infection rates. However, when a subset analysis was performed for closed fractures, only smoking was associated with higher infection rates. The research team writes that plate fixation and temporary external fixation are likely surrogates for more complex injuries; therefore no recommendations should be inferred from the association. Read the abstract…
FDA: Diabetes drug linked to severe joint pain in some patients.
The U.S. Food and Drug Administration (FDA) is warning that the type 2 diabetes medicines sitagliptin, saxagliptin, linagliptin, and alogliptin may cause severe and disabling joint pain. A search of the FDA Adverse Event Reporting System database and the medical literature identified cases of severe joint pain associated with the use of dipeptidyl peptidase-4 (DPP-4) inhibitors. Patients started having symptoms from 1 day to years after they started taking a DPP-4 inhibitor. After the patients discontinued the DPP-4 inhibitor medicine, their symptoms were relieved, usually in less than 1 month. Some patients developed severe joint pain again when they restarted the same medicine or another DPP-4 inhibitor. The agency has added a new Warning and Precaution about this risk to the labels of all DPP-4 inhibitor medications. DPP-4 inhibitors are used along with diet and exercise to lower blood sugar in adults with type 2 diabetes. The agency states that healthcare professionals should consider DPP-4 inhibitors as a possible cause of severe joint pain and discontinue the drug if appropriate. Read more…
Study: Preadmission shower regimen may help reduce surgical wound pathogens prior to elective surgery.
According to a study published online in the journal JAMA Surgery, use of a standardized preadmission shower regimen may inhibit or kill gram-positive or gram-negative surgical wound pathogens prior to elective surgery. The researchers conducted a prospective analysis of 120 healthy volunteers who were randomized to take either two or three showers with 4 percent chlorhexidine gluconate. Cohorts were further divided into three subgroups: no pause, 1-minute pause, or 2-minute pause before rinsing. The researchers found that the mean composite chlorhexidine gluconate concentrations were significantly higher in the 1- and 2-minute pause groups compared against the no-pause groups. Overall, they found no significant difference in concentrations between 2 and 3 showers, or between 1- and 2-minute pauses. Read the complete study…
Study: Patients who undergo THA and TKA may be at increased risk of MI in weeks after surgery.
Data from a study published online in the journal Arthritis & Rheumatology suggest that arthritis patients who undergo total hip or total knee arthroplasty (THA or TKA) may be at increased risk of myocardial infarction (MI). The authors conducted a time-stratified, propensity score-matched, cohort study of 6,063 THA patients and 6,063 non-THA controls, as well as 13,849 TKA patients and 13,849 non-TKA controls. During the first postoperative month, the authors found a significantly increased risk of MI among THA and TKA patients compared to controls who did not undergo joint arthroplasty. Using venous thromboembolism as a positive control outcome, both the first month and overall hazard ratios of MI were substantially increased for THA and TKA. Read more…
Read the abstract…
Are financial conflicts of interest the only ones that matter?
An article in The New York Times looks at the issue of conflicts of interest in medicine. The writer references studies that demonstrate that industry-sponsored studies tend to display more favorable results compared to those sponsored by other sources, and notes that financial conflicts are often disclosed and examined. However, he points out that some experts have suggested that other conflicts such as personal relationships, professional ambition, political ideology, religious or moral beliefs, and personal experiences may also affect how studies are conducted and interpreted. Read more…
Call for volunteers: CME Courses Committee.
Sept. 15 is the last day to submit your application for a position on the CME Courses Committee. This committee plans and organizes the AAOS calendar of continuing medical education (CME) courses and webinars. The following positions are available:
- Pediatric Orthopaedics (one member)
- Shoulder and Elbow (one member)
Applicants for these positions must be active fellows with experience in planning, organizing, presenting, and evaluating CME courses, and a practice emphasis in the relevant topic. Learn more and submit your application…(member login required)
