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| Today’s Top Story
Study Assesses Impact of Corticosteroid Injections Before and After Rotator Cuff Repair
A study published online in Arthroscopy observed an increased risk of revision surgery in primary rotator cuff repair patients who receive preoperative corticosteroid injections. The Cochrane Database of Systematic Reviews, Central Register of Controlled Trials, PubMed, Embase, and MEDLINE databases were searched for relevant studies reporting on adverse events associated with corticosteroid injection use before or after primary rotator cuff repair. Ten studies encompassing 240,976 total patients were included. Of 48,235 patients who received a corticosteroid injection, about two-thirds (66.2 percent) did preoperatively, and 33.8 percent of patients received it postoperatively; 78 patients received pre- and postoperative injections. Among the three studies reporting on preoperative corticosteroid injection influence on revision surgery, the incidence ranged from 3.8 percent to 10.5 percent with the injection compared to 3.2 percent to 3.4 percent for controls. In the five studies evaluating the association between postoperative corticosteroid injections and retears, the incidence for injection patients ranged from 5.7 percent to 19.0 percent compared to 10.8 percent to 18.4 percent for controls.
Read the abstract… |
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| In Other News
Study Examines Long-term Postoperative Opioid Prescription Patterns
A study published in the January issue of the Journal of the AAOS: Global Research & Reviews assessed trends in postoperative prescribing of opioids to manage acute postoperative pain over a two-decade period. A large commercial claims dataset was queried for postoperative opioid prescribing data spanning 1994 to 2014. The mean postoperative morphine milligram equivalents (MME) was calculated for each procedure and year to determine the proportion of patients who filled a high-dose prescription, defined as 350 MME or greater. A total of 1,321,254 adult patients were identified. During the study period, 80.3 percent of patients filled a postoperative opioid prescription. From 1994 to 2014, the mean MME filled increased by 145 percent for lumbar laminectomy/laminotomy, 84 percent for total knee arthroplasty, and 85 percent for total hip arthroplasty. Orthopaedic procedures were the most significantly associated with a high-dose opioid fill. Patients with postoperative long-acting formulation opioid prescriptions were the most likely to fill a high-dose prescription.
Read the study… |
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| Study: PROMIS versus International Knee Documentation Committee Score for Pediatric Knee Pain
A study published online in the Journal of Pediatric Orthopaedics compared the Pediatric International Knee Documentation Committee (Pedi-IKDC) scores versus Patient-reported Outcomes Measurement Information System (PROMIS) computer-adaptive testing scores. Scores for both measurement systems were prospectively collected from 100 consecutive pediatric patients (average age, 14 years; 53 percent were female) with new knee pain. PROMIS domains examined included mobility, pain interference, and upper extremity (control). The PROMIS tests had a higher completion rate than the Pedi-IKDC questionnaire (100 percent versus 70 percent). The average Pedi-IKDC score was 48.8, while mean scores for the PROMIS mobility, pain interference, and upper extremity domains were 38.4, 53.5, and 49.7, respectively. The Pedi-IKDC had 22 questions—about twice that of the PROMIS pain interference and mobility tests combined (11.9 questions). Pedi-IKDC scores were correlated with PROMIS mobility and pain interference domains; mobility and pain interference correlations improved when seven highly functional patients with significant pain symptoms were excluded from analyses.
Read the abstract… |
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| Study: Does Chronic Ankle Instability Affect Evertor Strength and Muscle Activity?
A study published online in Foot & Ankle International assessed ankle evertor strength and muscle activity during eversion with and without toe flexion (TF) in patients with chronic ankle instability (CAI). The researchers measured isometric ankle evertor strength and muscle activity of the peroneus longus (PL), peroneus brevis (PB), and extensor digitorum longus (EDL) during eversion with and without TF in 15 patients with CAI and 15 healthy controls. A significant interaction effect was observed in evertor strength, but not in electromyography of the PL, PB, and EDL. PL and PB muscle activity measurements between eversion with and without TF were significantly different in the CAI group but did not largely differ for the healthy controls.
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| Study Assesses Dysphagia Risk Between One- versus Two-level Anterior Cervical Diskectomy and Fusion
According to a retrospective review published online in The Spine Journal, the risk of postoperative dysphagia was not significantly different between patients who received one- versus two-level anterior cervical diskectomy and fusion (ACDF). Patients underwent either one- (n = 22) or two-level (n = 36) ACDF performed by a single surgeon at a single, high-volume institution. Outcomes included the Neck Disability Index, visual analog scale for neck and arm pain, 12-Item Short Form Health Survey physical and mental health components, and Swallowing Quality of Life (SWAL-QOL) Questionnaire. The two-level group was older than the one-level group (54.17 years versus 48.06 years) and had longer operative times (69.08 minutes versus 53.50 minutes). Twelve-week PROMs significantly improved in both cohorts compared to preoperative data, with no significant differences in PROMs or dysphagia outcomes. Risk factors for six-week dysphagia included younger age, male sex, longer operative times, and worse preoperative SWAL-QOL; the only risk factor for 12-week dysphagia was preoperative SWAL-QOL.
Read the abstract… |
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| AAOS Now
Avoid Patient Harm by Improving Patient Positioning for Surgery
Perioperative positioning may not always get the attention it deserves. Surgeons often delegate positioning responsibility to circulating nurses, scrub technicians, and physician assistants (and in teaching hospitals, residents). In many institutions, the status quo includes complacency regarding patient positioning. Given the preventable risk of patient harm due to poor positioning, intentional individual and hospital strategies about positioning can reduce that risk of harm.
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| Your AAOS
Apply for Volunteer Opportunities
Consider applying for the following positions:
- Liaison Activities member position (American College of Radiology Appropriateness Criteria Panels)—applications are accepted until Feb. 19
- Liaison Activities member position (Agency for Healthcare Research and Quality U.S. Preventative Service Task Force)—applications are accepted until March 2
- Social Media Ambassador Program chair position—applications are accepted until March 3
- Education Assessments and Examinations Committee member position (spine)—applications are accepted until April 15
- Education Assessments and Examinations Committee member position (sports medicine)—applications are accepted until April 15
- Orthopaedic Knowledge Update Evaluation Committee member position (orthopaedic basic science item writer)—applications are accepted until April 15
Learn more and submit applications…(member login required) |
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