CMS announces move to allow drug price negotiations for Medicare
The Centers for Medicare & Medicaid Services (CMS) announced that, for the first time, Medicare Advantage (MA) plans will have the option of negotiating drug prices, as private-sector insurers do, to reduce costs for these beneficiaries. MA plans will have the option of applying step therapy for physician-administered and other Part B drugs. CMS Administrator Seema Verma said, “For too long, MA plans have not had the tools to negotiate a better deal for patients.” In a memo to MA plans, the agency said plans may begin using step therapy on Jan. 1, 2019.
Study: Certain factors may impact ACL failure rates
A retrospective study published in the August 2018 issue of the Journal of Pediatric Orthopaedics found that success rates for anterior cruciate ligament (ACL) reconstruction surgery may depend on age, graft selection, and surgical technique. Researchers studied 561 pediatric patients (age range, 5–19 years) who underwent primary ACL reconstruction surgery between 2002 and 2013. The total failure rate was 9.6 percent (n = 54), and the average time to failure was approximately 13.6 months. The type of graft used was the greatest indicator for failure. Soft-tissue grafts and patellar tendon grafts failed at a 13 percent and 6 percent rate, respectively. Maturity (growth plate status) and surgical technique also affected failure rates. Hamstring grafts and anatomic femoral tunnels appeared to fail earlier. Approximately 8 percent of patients sustained a contralateral ACL injury.
Study: Instability after TKA may be tied to larger joint gap
A study published in the August 2018 issue of The Journal of Arthroplasty found that instability following total knee arthroplasty (TKA) may be related to the size of joint gaps. Between July 2016 and October 2017, researchers reviewed 50 knees of patients with medial osteoarthritis undergoing surgery with a posterior-stabilized implant. Anterior translation was measured while the knee was in 90-degree flexion, using a trial femoral component. Anterior translation was 8.5 mm, on average. Medial gap, medial laxity, and center laxity all correlated with anterior translation, which increased when joint gaps were larger and medial and center laxity were greater. The researchers suggest surgeons avoid excessive medial release when performing TKA.
Study: Kinematically aligned TKA may not impact long-term implant survival
A study published online in The Journal of Arthroplasty found that kinetically aligned (KA) TKA using patient-specific instrumentation (PSI) did not impact 10-year implant survival. Researchers retrospectively assessed 222 knees in 217 patients treated in 2007 with a primary TKA. All patients were treated with KA using PSI without restricting the degree of preoperative deformity and with the restoration of the native joint lines and limb alignment. The implant survivorship rate was 97.5 percent for revision for any reason and 98.4 percent for aseptic failure. The average 10-year Oxford Knee Score and Western Ontario & McMaster Universities Osteoarthritis Index scores were 43 and seven, respectively.
Study: Range of femoral version may not impact clinical presentation of acetabular dysplasia
Data published in the Aug. 1 issue of the Journal of the American Academy of Orthopaedic Surgeons indicate that the range of femoral version may not significantly affect clinical presentation of acetabular dysplasia. Researchers reviewed 314 patients prospectively enrolled in a longitudinal study on periacetabular osteotomy between January 2014 and August 2015. They assessed femoral version, morphologic characteristics of the upper femur and acetabulum, and preoperative clinical outcome scores. On average, femoral version was 19.7 degrees (range, –20 degrees to 50 degrees). There was no correlation between femoral version and radiographic severity of acetabular dysplasia or preoperative symptomatology. Researchers did find a link between femoral version and hip range of motion.
AAOS members will soon receive the print edition of the August issue of AAOS Now, but the electronic edition is already available on the AAOS Now website and on iOS and Android devices through the AAOS Access app. This month’s issue includes information on the advancement and challenges of ACL reconstruction, best practices on treating patients after natural disasters, surgical treatment of athletes, and more.
Apply for Orthopaedic Video Theater Committee member position
The Orthopaedic Video Theater Committee has an open member position, a two-year term that runs through March 21, 2021. The committee evaluates video and multimedia submissions and chooses the programs presented in the Orthopaedic Video Theater at the AAOS Annual Meeting. The last day to submit an application is Aug. 18.
