February 21, 2020 | Today’s News

Study Reviews Primary and Revision THA Outcomes with Highly Porous Coated Titanium Acetabular Cup

According to a systematic review published online in The Journal of Arthroplasty, highly porous coated titanium acetabular cup use in primary and revision total hip arthroplasty (THA) was associated with satisfactory short- and midterm clinical outcomes. The U.S. National Library of Medicine (PubMed/MEDLINE), Embase, and the Cochrane Database of Systematic Reviews were searched using the following keywords: “titanium” or “highly-porous” and “titanium” or “acetabular” and “trabecular” and “titanium.” Final analysis included 16 studies encompassing 11,366 cases (60 percent were female) with a mean two to seven years of follow-up. In primary THA cases including highly porous titanium acetabular components, the overall survival rate was 99.3 percent, with a 0.1 percent rate of aseptic loosening. In revision THA cases, the overall survival rate was 93.5 percent, with a 2.1 percent aseptic loosening rate.

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Study Identifies Preoperative Expectations Predictive of Postoperative Dissatisfaction in TKA

A study published in the Feb. 15 issue of the Journal of the AAOS established preoperative expectations correlated with postoperative dissatisfaction among total knee arthroplasty (TKA) patients. Primary unilateral TKA patients in the researchers’ institutional registry with a body mass index (BMI) < 40 kg/m ² and at least two years of follow-up were eligible for inclusion. Preoperative assessments included the 19-item Hospital for Special Surgery Expectations Survey, Short Form-12, Knee Injury and Osteoarthritis Outcomes Score, and EuroQol 5-D; five domains were used to assess dissatisfaction two years postoperatively. A total of 2,279 eligible TKA patients (mean age, 65.3 years; mean BMI, 30.2 kg/m ²) were identified. Expectations that were predictive of dissatisfaction on multiple domains included kneeling ability, leg straightening, and participation in recreation and sports.

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According to a retrospective study published in the February issue of Foot & Ankle International, preoperative patient-reported outcome measures (PROMs) predicted postoperative improvement in end-stage ankle arthritis patients. Data including demographics, comorbidities, Ankle Osteoarthritis Scale (AOS), Ankle Arthritis Score (AAS), Short Form-36 (SF-36) physical components score (PCS) and mental components score (MCS), and five-year follow-up were available for 427 patients. The minimal clinically important difference (MCID) was measured, and receiver operating characteristic (ROC) analysis was employed. Poorer preoperative scores were associated with the most significant improvements in function and pain relief; these patients were most likely to achieve postoperative MCID. ROC curves identified a correlation between AOS, AAS, and SF-36 PCS and MCS outcomes and postoperative improvements in physical and mental function. The probability of achieving an MCID with a preoperative AOS score greater than 45.7 was 83.0 percent, and with a preoperative AAS score greater than 25.7 was 78.0 percent. A preoperative SF-36 PCS score below 31.0 was correlated with a 62.0 percent probability of achieving an MCID, and a preoperative SF-36 MCS below 52.7 was correlated with a 47.0 percent probability.

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A retrospective study published online in Injury assessed outcomes for complex elbow dislocations treated with radial head arthroplasty versus resection. Patients with complex elbow dislocations associating comminuted fractures of the radial head were stratified into two groups: radial head prosthesis (n = 20) and resection (n = 12). The Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder, and Hand (DASH) score were used to assess functional outcomes. The two groups did not present significant differences on the MEPS scale. The resection group had a significantly higher mean DASH score than the arthroplasty group (29.8 versus 10.3). The radial head excision group had a significantly higher rate of reinterventions and heterotopic ossifications. The prosthesis group had a 45 percent rate of specific radiological complications.

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The Centers for Medicare & Medicaid Services (CMS) proposed a three-year extension and changes pertaining to episode definition and pricing to its Comprehensive Care for Joint Replacement (CJR) model. The proposed changes would incorporate outpatient hip and knee replacements into the episode of care definition, as well as change the reconciliation process, the beneficiary notice requirements, gainsharing caps, and the appeals process. The CJR model three-year extension would provide time to assess the changes in practice.

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Five Coding Tips for Dealing with Third-party Billing Entities

Whether due to the complexities of hiring billing staff or a result of hospital employment and practice acquisition, many orthopaedic practices are moving their billing operations to a third-party entity or centralized billing office. This process is part of what institutions call revenue cycle management. If you find yourself in this situation, these best practices will help improve coding accuracy.

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Apply for Volunteer Opportunities

Consider applying for the following positions:

• 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

Learn more and submit applications…(member login required)