Today’s Top Story

Study: Does Pubertal Timing in Boys Affect Adult Fracture Risk?

Boys with late pubertal timing may have a greater risk of fracture as men, according to a study published online in PLoS Medicine. Height and weight data for 31,971 Swedish men born between Jan. 1, 1945, and Dec. 31, 1961, were collected. The researchers calculated the age at peak height velocity (PHV) using a modified infancy-childhood-puberty model; fracture data were gathered from the Swedish National Patient Register. Mean age at PHV was 14.1 years. A total of 5,872 patients (18.4 percent) sustained at least one fracture after age 20; during a mean follow-up of 37.3 years, 5,731 (17.9 percent) sustained a nonvertebral fracture after age 20. Patients in the highest tertile for age at PHV (older than 14.5 years)—compared to those in the lowest tertile (13.6 years or younger)—had an increased all-fracture risk, as well as nonvertebral fracture risk. Adjusting for birthweight, body mass index during childhood, adult educational level, and young adult height did not reduce the correlation between PHV age and adult fracture risk.

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In Other News

Study Explores Reasons for Revision after Noncemented THA

A study published in the Dec. 15 issue of the Journal of the AAOS analyzed failure etiologies of primary, noncemented total hip arthroplasty (THA). Data spanning 2000 through 2012 for 4,555 primary, noncemented THAs performed at a single institution were collected. The estimated 10-year survival rate without THA revision surgery was 982 percent; survival free from modular implant revision was 98.1 percent, and survival free from nonmodular implant revision was 96.3 percent. Nearly half of revision surgeries were attributed to wound-related complications (49 percent); a quarter were due to periprosthetic fracture, and 18 percent were due to pain. More than half of revision procedures with isolated exchange of at least one modular implant were performed due to hip instability (53 percent), while 26 percent were because of acute periprosthetic joint infection. Replacement or removal of nonmodular implant was performed primarily due to periprosthetic fracture (32 percent), aseptic loosening (22 percent), and adverse tissue reaction (17 percent).

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Study Examines Relationship between Radiographic Lateral Ankle Instability and Osteochondral Lesions of the Talus in Ankle Inversion Injuries

A study published in the December issue of Foot & Ankle International observed an inverse relationship between lateral ankle instability and the development of osteochondral lesions of the talus (OLT) in patients with ankle inversion injury. The study included 195 patients (mean age, 38.7 years; 113 were male) with a history of ankle inversion injuries who underwent MRI and stress radiography. Radiographic lateral ankle instability was defined as tibiotalar tilt angle of 10 degrees or greater. MRI was used to confirm OLT. Using the chi-squared test, researchers observed an inverse relationship between radiographic lateral ankle instability and OLT. Multiple regression analysis demonstrated an association between increased tibiotalar tilt angle and lower OLT incidence; binary logistic regression analysis showed that OLT was correlated with a decreased tibiotalar tilt angle.

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Study: Correlation between Age and Postoperative Outcomes after Lumbar Fusion

A retrospective cohort study published online in The Spine Journal analyzed whether age affects clinical and radiographic outcomes after lumbar spinal fusion. Between 2011 and 2018, 850 eligible patients underwent posterolateral lumbar fusion; patients were stratified into three age groups: young (18–54 years; n = 330), middle-aged (55–69 years; n = 317), and senior (older than 70 years; n = 203). Seniors had a longer postoperative length of stay compared to younger patients. Final Oswestry Disability Index scores were worse in the younger group compared to the middle-aged group. Achievement of minimal clinically important difference did not vary among the groups.

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House Committee Proposes Fix to Surprise Medical Billing, Calls to Delay Legislative Action

Leaders of the House Ways & Means Committee proposed a solution for surprise medical billing and requested that legislative action be put on hold until 2020. The proposal comes days after the House Energy & Commerce Committee unveiled a deal of their own.

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Improving the Odds: OTA Session Addresses Pelvic Ring Fractures

During the Orthopaedic Trauma Association (OTA) Annual Meeting symposium titled, “A Multidisciplinary Approach to Hemodynamically Unstable Pelvic Ring Injuries,” David J. Hak, MD, MBA, FAAOS, FACS, of Hughston Clinic Orthopaedics in Sanford, Fla., addressed challenges in acute pelvic stabilization, including the use of binders and sheeting and external fixation and C clamps, use and misuse of fluoroscopy, and physiologic stabilization.

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Action Alert: Make Your Voice Heard on Surprise Medical Billing

Congress has released two new legislative proposals to prevent patients from receiving surprise medical bills. The approach proposed by the Senate HELP Committee and the House Energy and Commerce Committee would ban balance billing for emergent procedures and set the payment rate at a geographic area’s median in-network rate. AAOS responded warning that this would harm patient access to care and urged Congress to instead incorporate proven solutions like the fair market independent dispute resolution standard employed successfully in New York. Details of the House Ways and Means Committee proposal are still forthcoming, but the committee has expressed concern over Congress taking the time to get it right. AAOS members have actively engaged on the issue throughout 2019 but more work remains to be done. Congress may move on surprise medical billing before the end of this year, so now is the time to make your voice heard. Contact your legislators today using AAOS’ Advocacy Action Center.

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AAOS statement on the new proposal…