February 7, 2020 | Today’s News

Study Reviews Available RCT Data for TKA

A study published online in The Journal of Arthroplasty reviewed available data from randomized, controlled trials (RCTs) on total knee arthroplasty (TKA). The researchers queried the Cochrane Central Register of Controlled Trials, Ovid MEDLINE, and Embase databases for relevant studies. Nonrandomized trials, those focused on unicompartmental knee arthroplasty or revision surgery, systematic reviews, and meta-analyses were excluded. Final analysis included 403 RCTs encompassing 47,675 patients. Studies were stratified by surgical approach (n = 34), tourniquet (n = 31), minimally invasive surgery (n = 13), patient-specific instrumentation (n = 30), knee design (n = 37), fixation (n = 27), mobile bearing (n = 47), navigation (n = 50), polyethylene (n = 19), technique (n = 27), patella resurfacing (n = 26), drain (n = 19), closure (n = 16), and “other” (n = 27). Significant differences between the intervention and control groups were reported in less than 10 percent of RCTs (n = 33, 8.2 percent). The researchers concluded that, in most cases, a standard, conventional TKA performed by an experienced surgeon with well-established components, with or without tourniquet, and without surgical drain resulted in acceptable long-term clinical results.

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Study Measures Effect of Osteoporosis on Anatomic and Reverse TSA Outcomes

A significant proportion of anatomic and reverse total shoulder arthroplasty (TSA) patients have osteoporosis, which may be an independent risk factor for fracture and revision surgery, according to a study published in the Feb. 1 issue of the Journal of the AAOS. Anatomic and reverse TSA patients with osteoporosis were evaluated separately for rates of two-year complications, including loosening/osteolysis, periprosthetic fracture, periprosthetic dislocation, and revision shoulder arthroplasty. At the time of surgery, 14.3 percent of anatomic TSA and 26.2 percent of reverse TSA patients had an osteoporosis diagnosis. Patients with osteoporosis in the anatomic and reverse TSA groups both had a significantly increased risk for periprosthetic fracture and revision shoulder arthroplasty within two years of surgery compared to their respective matched controls without osteoporosis.

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A study published online in BMC Musculoskeletal Disorders assessed patient-reported outcome measures (PROMs) pre- and postoperatively in those with trapeziometacarpal joint arthritis treated with trapeziectomy with or without ligament reconstruction and tendon interposition. Swedish quality registry for hand surgery data for 1,850 patients (mean age, 63 years; 79 percent were female) were evaluated preoperatively and at three months and one year postoperatively. At one-year follow-up, mean pain at rest (assessed on a 100-point scale) was reduced from 50 to 12. Pain on load and weakness did not significantly change from preoperatively to one year postoperatively (mean, 30 versus 34). Mean PROM improvements were not affected by age or gender. The majority of patients (86 percent) received trapeziectomy with ligament reconstruction and tendon interposition; outcomes did not significantly differ between these patients and those who underwent simple trapeziectomy.

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A retrospective study published online in The Spine Journal assessed risk factors and costs associated with postoperative urinary retention (POUR) in elective lumbar laminectomy patients. Data were evaluated on patients who underwent surgery between April 2014 and December 2016. Patient (age, gender, body mass index [BMI], and comorbidities) and surgical (surgical time, intraoperative fluid volume requirements, anesthesia type, and levels involved) factors were collected; additional factors included length of stay (LOS), discharge disposition, 30-day all-cause readmission and emergency department (ED) visits, 90-day complications, and variable direct costs. Among 203 one-level and 130 two-level laminectomies, the overall POUR incidence was 17.4 percent. Risk factors for POUR included age, male gender, urinary history retention, and increased surgical time. Anesthesia, BMI, intraoperative fluid requirements, readmission, ED visit, complication rates, and other study comorbidities did not largely affect POUR risk. POUR patients, compared to non-POUR patients, tended to have significantly longer LOS, were more likely to be discharged to acute rehabilitation facilities, and had higher average variable direct cost than non-POUR patients.

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Many reputable hospitals will receive less money from Medicare depending on the proportion of their patients who sustained infections or injuries during their inpatient stay. The penalties, which will reportedly affect 786 hospitals, fall under the Hospital-acquired Conditions Reduction Program and are designed to improve the quality of care in hospitals without completely cutting Medicare and Medicaid funding for hospitals.

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Health Care Is the Family Business

Heather Gulish-Melton, MD, FAAOS, grew up with a father who was an orthopaedic surgeon and a mother who was a nurse. Dr. Gulish-Melton went on to become an orthopaedic surgeon herself, and each of her four siblings also made a career in health care. Her father, Eugene Gulish, MD, FAAOS, established Henry County Orthopaedic Surgery and Sports Medicine in Paris, Tenn., in 1994; Dr. Gulish-Melton joined the practice in 2003, where they practiced together for 13 years. During an interview with AAOS Now, Dr. Gulish; Dr. Gulish-Melton; and her mother, Chris Gulish, discussed the family’s lifelong commitment to health care.

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Apply for Volunteer Opportunities

Consider applying for the following positions:

• 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)