December 18, 2019 | Today’s News

Study Evaluates Efficacy of Protocol to Lower Opioid Consumption after TJA

According to a study published in the December issue of the Journal of the AAOS: Global Research & Reviews, a standardized reduced opioid prescription protocol successfully reduced opioid consumption in total joint arthroplasty (TJA) patients. TJA patients were stratified into two groups: those who underwent surgery using a standardized opioid prescription protocol (standardized group, n = 97) and those who were treated before the program was implemented (historic group, n = 99). Total knee arthroplasty (TKA) and total hip arthroplasty (THA) patients were evaluated separately. At the one-month postoperative follow-up visit, the number of remaining pills was counted and converted into oral morphine equivalents (OME). In TKA patients, the standardized group had significantly lower mean opioid consumption compared to the historic group (48.5 pills, 432 OME versus 76.2 pills, 903 OME). Half of the standardized group required refills compared to 29 percent of the historic group; average pain scores were 2.3 and 3.2, respectively. In THA patients, the standardized group also had significantly lower mean opioid consumption (19.1 pills, 200 OME) than the historic group (41.3 pills, 504 OME); more patients in the standardized group required refills than the historic group (16 percent versus 8 percent). Average pain scores were similar between the standardized (1.7) and historic (1.8) groups.

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Study: Which Proximal Row Carpectomy and Four-corner Arthrodesis Patients Are Likely to Require Wrist Fusion?

A retrospective chart review published online in The Journal of Hand Surgery evaluated rates and associated risk factors for reoperation and conversion to wrist fusion in patients treated with proximal row carpectomy (PRC) and four-corner arthrodesis (FCA). Between 2002 and 2016, 266 eligible patients underwent PRC or FCA at a single institution. FCA patients were more likely to require reoperation than PRC patients (34 percent versus 11 percent). Multivariable analysis observed a correlation between manual labor and reoperation in FCA patients. Anterior interosseous nerve (AIN) and/or posterior interosseous nerve (PIN) neurectomy was correlated with a lower reoperation risk in PRC patients. Multivariable analysis for wrist arthrodesis observed that intraoperative AIN and/or PIN neurectomy was correlated with a reduced risk of wrist fusion conversion, while smoking increased the risk. In PRC patients, the only factor associated with a reduced risk of wrist arthrodesis conversion was AIN and/or PIN neurectomy.

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A study published online in Foot & Ankle International validated the Diagnostic Ankle Arthroscopy Skills Scoring System, a tool designed to evaluate basic ankle arthroscopy skills among orthopaedic trainees. The system was modeled off validated assessments used in knee arthroscopy and included an oral questionnaire, operative task-specific checklist, and global operative skills rating. Trainees (n = 33) were assessed for their ability to perform a diagnostic ankle arthroscopy on a cadaveric ankle. Educational level significantly corresponded with the global operative skills rating scale, task-specific checklist, and oral questionnaire. An increasing trend was observed between global operative skills scores and training level—the most notable difference being between medical students and senior residents. The most significant year-to-year skill increases were observed between post-graduate year (PGY)-1 and PGY-2, as well as between PGY-2 and PGY-3. Medical students had significantly lower oral questionnaire and task-specific checklist scores than PGY-1 residents. Oral questionnaire scores were significantly better in senior residents than junior residents. The number of self-reported ankle arthroscopy cases was moderately correlated with global operative skills scores.

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A study published online in the Journal of Shoulder and Elbow Surgery assessed the impact of pitch type, velocity, and player characteristics on medial elbow torque in professional baseball pitchers. Professional baseball players (n = 12) wore a gyroscopic sensor with an accelerometer and threw a standard, randomized sequence of fastballs, changeups, and curveballs; elbow torque, arm slot, arm speed, shoulder rotation, and ball velocity were recorded for every pitch. Medial elbow torque was significantly higher in fastballs compared to curveballs. An independent correlation was observed between higher body mass index and decreased elbow torque.

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Congress unveiled the details of a funding deal that would repeal three Affordable Care Act taxes, put Medicaid payment cuts to disproportionate-share hospitals on hold, and prevent brand drug manufacturers from holding back samples required for generic drug manufacturing. Notably, legislation targeting surprise medical bills or reduced prescription drug costs were not included.

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Telemedicine in Orthopaedics: Risks Versus Benefits

This article is part one of a two-part series on telemedicine (TM). This installment provides a historical background and presents TM’s potential role in orthopaedics. TM, which traces back to the 1950s, bridges the physical gap between patients and clinicians. The most illustrative examples are space programs and military installations worldwide, both of which have relied on TM for decades. However, innumerable questions arise when the field of orthopaedics considers TM, including orthopaedic surgeons’ reliance on radiographics and the need for a physical examination.

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Access Fundamental Surgery’s TKA Simulation

AAOS members and residents can now access Fundamental Surgery’s TKA simulation for continuing medical education credits. The newly accredited program offers access to a cutting-edge haptic virtual reality platform to experience and navigate the same visuals, sounds, and feelings they would during a real surgical procedure.

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