Today’s Top Story
NCHS data brief notes rise in the number of THAs.
A data brief released by the U.S. National Center for Health Statistics examines a rise in the number of total hip arthroplasties (THAs) performed in the United States over a decade. The report finds that the number of THAs among inpatients aged 45 and older increased from 138,700 in 2000 to 310,800 in 2010, driving the rate of THAs per 100,000 population from 142.2 to 257.0 during the same span. In addition, the age distribution of inpatients who underwent THA shifted significantly between 2000 and 2010, with the percentage of THAs increasing for younger age groups and decreasing for older age groups. However, inpatients aged 45 years and older still accounted for 95 percent of all THAs during 2010. Read the complete data brief…

Other News

Study: Worsening outcomes over time associated with radiological findings after OLD.
Findings published in the February issue of the Journal of Neurosurgery: Spine suggest that long-term worsening of clinical outcomes may be correlated with radiological findings of degeneration at the operated segment for patients who have undergone open lumbar diskectomy (OLD). The authors conducted a retrospective study of 79 patients who had undergone OLD and were followed for a minimum of 10 years. Overall, the authors state that OLD was associated with reduced pain and disability scores. They noted a significant correlation between numeric radiological findings and visual analog scale scores of back pain. Clinical outcomes tended to be most favorable among the group of patients with shorter follow-up (10 to 14 years), and outcomes tended to deteriorate across groups with longer-term follow-up, indicating some worsening over time. Read the abstract…

Study: Bilateral total wrist arthrodesis may be viable option for patients with severe bilateral disease.
According to data from a small study published in the February issue of The Journal of Hand Surgery, bilateral total wrist arthrodesis may be a viable salvage option for patients with severe bilateral disease. The research team reviewed data on all living patients (n = 13; 26 wrists) who underwent bilateral wrist arthrodeses from 1980 to 2010 within a single institution. At mean 14-year follow-up, they found significant improvement in postoperative grip strength and pain levels. Increasing age, preoperative steroid usage, and concomitant shoulder or elbow disorders were associated with worse outcomes. Overall, 12 patients (93 percent) were satisfied and would repeat the surgery, and 9 returned to full-time work. The research team noted that the major functional limitation was turning a doorknob or tight jar lid. Seven patients underwent additional surgery including 5 revision arthrodeses and 2 plate removals, with revision surgeries more common in patients with prior surgeries or preoperative steroid usage, as well as in women, smokers, those with ipsilateral elbow dysfunction, and those with fixation with a dorsal locking plate. Read the abstract…

Interstate licensure effort proposal under consideration in 12 states.
An article in HealthLeaders Media examines efforts to streamline the licensing process for physicians who want to practice medicine in multiple states. The writer notes that the Interstate Medical Licensure Compact—an interstate licensure proposal—has been introduced in 12 state legislatures. Under terms of a draft of the compact, healthcare professionals could designate a “state of principal license,” and register for licensure through participating state authorities. Read more…

Medical organizations offer guidance on preventing neurologic complications after ESI.
The journal Anesthesiology has published a consensus statement on steps to prevent neurologic complications after epidural steroid injections (ESIs). The statement incorporates input from 13 medical organizations and covers 17 clinical considerations, including the following:

  • All lumbar interlaminar ESIs should be performed using image guidance, with appropriate anteriorposterior, lateral, or contralateral oblique views and a test dose of contrast medium.
  • No cervical interlaminar ESI should be undertaken without reviewing prior imaging studies that show adequate epidural space for needle placement at the target level.
  • Particulate steroids should not be used in therapeutic cervical trasforaminal injections.

The authors write that adherence to specific recommended practices when performing epidural corticosteroid injections should lead to a reduction in incidence of neurologic injuries. Read more…
Read more, with links to the complete statement…

FDA issues draft documents for regulation of compounding pharmacies.
The U.S. Food and Drug Administration (FDA) has issued five draft documents related to drug compounding and repackaging. In the wake of a 2013 outbreak of fungal meningitis linked to contaminated sterile compounded drug products, the U.S. Congress created the new regulatory category of “outsourcing facilities.” The agency states that some drugs produced by registered outsourcing facilities may be entitled to exemptions from certain provisions of the Federal Food, Drug, and Cosmetic Act (FD&C Act), but they are subject to current good manufacturing practice requirements and FDA inspection. In addition, drugs produced by compounders that are not registered as outsourcing facilities must meet certain other conditions described in the FD&C Act, or be subject to all requirements applicable to drugs produced by conventional drug manufacturers. The draft documents are available for public comment for 90 days. In addition, the public has 120 days to comment on the draft memorandum of understanding. Read more, with related links…

WSB-TV (Atlanta) reports on the effect on medical costs when hospitals purchase physician practices. The report cites data from a recent study that reported that patients generally pay 10 percent more at hospital-owned practices, compared to physician-owned practices, and notes that Medicare and other insurers generally reimburse hospitals more than private practices for certain services. The reporter states that a few patients have seen their medical bills double after practice mergers. Supporters of consolidation argue that mergers improve care coordination among providers. Read more…

Call for volunteers: Evaluation Committees.
April 3 is the last day to submit your application for a position on an AAOS Evaluation Committee. Members of evaluation committees write questions for the self-assessment examinations. The following openings are available:

  • Anatomy-Imaging (two members—hand and wrist; two members—tumors)
  • Hip, Knee & Adult Reconstruction (four members)
  • Shoulder & Elbow (one member)

Applicants for these positions must be active fellows, emeritus fellows, or candidate member applicant for fellowship with a practice emphasis in the relevant area. Learn more and submit your application…(member login required)