Study: How Much Preoperative THA and TKA Work Is Unaddressed in RUC Methodology?
A study published in the September issue of The Journal of Arthroplasty measured how much preoperative work in total hip arthroplasty (THA) and total knee arthroplasty (TKA) cases is unaccounted for in current Relative Value Scale Update Committee (RUC) methodology. A total of 438 primary THAs and TKAs performed by one of five surgeons were assessed. The current RUC review includes 40 minutes of preservice time on the day of surgery; however, surgeons work for an average additional 43.2 minutes and physician assistants and nurse practitioners an additional 97.9 minutes per patient preoperatively; ancillary medical staff spent a mean 110.2 minutes per patient.
Study Analyzes Nerve Lesions Following Traumatic Shoulder Dislocations
A study published in the September issue of Archives of Orthopaedic and Trauma Surgery assessed characteristics of shoulder dislocation and concomitant nerve surgery. Final analysis included 60 patients (mean age, 60 years; 32 patients were male). Most patients (n = 51) sustained their injury due to a trivial fall on the outstretched arm. In 61.6 percent of patients, the dislocation direction was anterior-caudal. About three-quarters of patients had an injured brachial plexus; 23.3 percent of patients had isolated nerve damage. Just over a third of patients (38.3 percent) underwent electroneurographic examinations.
Study: Autogenous Bone Graft with K-wire Fixation in Scaphoid Nonunion
According to a study published in the September issue of the Journal of Pediatric Orthopaedics, autogenous bone graft with Kirschner wire (K-wire) fixation may be an option for adolescents with scaphoid nonunion. Twelve patients (mean age, 15.4 years) were retrospectively reviewed. All patients achieved stable bony union. At three years postoperatively, the mean active range of motion of the injured wrist was 215 degrees. The K-wire was removed from all patients at 12 weeks postoperatively. Intermittent pain following heavy work was reported by three patients.
Study Assesses Benefit of Exercise for Intervertebral Disk
A randomized, controlled trial published in the August issue of the European Spine Journal observed no benefit of exercise for the intervertebral disk (IVD) in patients with nonspecific low back pain. Final analysis included 17 patients who progressively loaded their lumbar IVDs (exercise) and 15 patients who performed motor control training and manual therapy (control). Group-by-time differences in T2 time of the entire IVD did not differ between the groups. The exercise group had shorter six-month T2 time in the posterior annulus, and at three months, higher L5/S1 apparent diffusion coefficients and decreased IVD height. In adjusted analyses, differences were not statistically significant.
Study Evaluates Correlation Between Age and First Metatarsophalangeal Arthrodesis Outcomes in Hallux Rigidus
A study published online in Foot & Ankle International observed acceptable outcomes for older patients who underwent first metatarsophalangeal arthrodesis for hallux rigidus. Patients treated at a single center were stratified by age: < 65 years (n = 79) and ≥ 65 years (n = 64). The older group had more female patients than the younger group (95.3 percent versus 77.2 percent), as well as higher rates of hypertension (73.4 percent versus 50.6 percent) and coronary artery disease (9.4 percent versus 0.0 percent). Postoperative wound complications requiring operative irrigation and débridement, deep vein thrombosis, deformity recurrence, and revision surgery rates were similar between the groups.
Tackling Difficult Problems in Orthopaedics: Guidance from a Bioethicist
Casey Jo Humbyrd, MD, MBE, FAAOS, is an orthopaedic foot and ankle surgeon with extensive knowledge of and interest in medical ethics. She pursued a medical ethics fellowship at Oxford University, received a master’s degree in bioethics, and has published dozens of articles on various medical ethics topics. Julie Balch Samora, MD, PhD, MPH, FAAOS, spoke with Dr. Humbyrd about various scenarios in orthopaedics that are sometimes difficult to navigate in order to glean some insights on best approaches.
AAOS members across the United States are engaging with members of Congress this month as part of the monthlong In-District Advocacy Event. One of the issues they are raising with policymakers is the need to reform the burdensome prior authorization process, which is challenging practices already operating with reduced staff and backlogged cases during the COVID-19 crisis The bipartisan Improving Seniors’ Timely Access to Care Act of 2019 (H.R. 3107) would reduce unnecessary delays in care by streamlining and standardizing prior authorization under the Medicare Advantage program, providing oversight and transparency for health insurance. Join AAOS members in taking action on the issue and follow the In-District Advocacy Event on social media with the hashtag #OrthoAdvocacyinAction.
