Today’s Top Story

Presidential Update from Joseph A. Bosco III, MD, FAAOS

In his latest message, AAOS President Joseph A. Bosco III, MD, FAAOS, highlighted three major steps that the Consolidated Appropriations Act, 2021 (HR. 133) took to mitigate the impact of planned cuts in the 2021 Medicare Physician Fee Schedule final rule. The legislation increased Medicare payments across all specialties by 3.75 percent for one year, suspended implementation of the G2211 add-on code for complex visits until 2024, and delayed the scheduled 2 percent Medicare sequestration cut until March 31. Legislative action could not protect against the egregious attack on total hip arthroplasty (THA) and total knee arthroplasty (THA) codes but provided some relief on the overall reimbursement of these procedures. Dr. Bosco assured members that AAOS will advocate against further reductions to the value of orthopaedic care in 2022 and beyond.

Read Dr. Bosco’s message…

In Other News

Study: What Is the Return to Work Rate Following Rotator Cuff Repair?

A systematic review and meta-analysis published online in The American Journal of Sports Medicine found that most patients who underwent primary rotator cuff repair returned to work eight months later. The study consisted of 13 retrospective studies encompassing 1,224 total patients. An overall weighted average of 62.3 percent of patients returned to work at a mean 8.15 months postoperatively. Return to previous work rates were higher among those with decreasing work intensity. Return to work did not largely differ between open and arthroscopic repair technique or workers’ compensation and nonworkers’ compensation patients.

Read the abstract…

Study Compared Bundled Payment Costs After Joint Arthroplasty by Race

A study published in the January issue of The Journal of Arthroplasty compared episode-of-care costs between Black versus white patients undergoing TKA or THA. Using Medicare claims data, 7,310 primary TKA and THA patients were identified. Black patients were younger than white patients but had higher rates of pulmonary disease, diabetes, and discharge to a rehabilitation facility. Black patients, compared to white patients, had higher subacute rehabilitation ($1,909 versus $1,284), home health ($819 versus $698), post-acute care ($5,656 versus $4,961), and overall 90-day episode-of-care costs ($19,457 versus $18,694).

Read the abstract…

Study Evaluates Effect of Surgical Management of Intramuscular Venous Malformations

According to a study published in the January issue of the Journal of Pediatric Orthopaedics, surgery as a first-line treatment for intramuscular venous malformations may be appropriate and relieve pain. Fifty-four cases of vascular anomalies from January 2004 through December 2018 were retrospectively reviewed; 40 underwent surgery. After surgery, nearly all patients with preoperative pain experienced improved pain (n = 36/39), and three-quarters were pain-free. In the 13 cases where whole muscle excision was required, all patients had improved pain postoperatively, and 10 of them were pain-free. A trend was observed between previous intervention with surgery or sclerotherapy and less successful operative outcomes.

Read the abstract…

Study Compares Treatments for Pain in Chronic Plantar Fasciitis

A retrospective study published in the January issue of Foot & Ankle International compared corticosteroid injection (CSI), extracorporeal shock wave therapy (ESWT), and radiofrequency thermal lesioning (RTL) treatments in cases of chronic plantar heel pain where conservative treatments were ineffective. A total of 217 patients underwent CSI (n = 73), ESWT (n = 75), and RTL (n = 69). Outcomes were assessed at six months. All patients experienced significant improvements in pain, but CSI and RTL were more effective than ESWT. No complications were observed in any of the cohorts.

Read the abstract…


MICRA Will Be Tested Again in 2022

In 1975, the Medical Injury Compensation Reform Act (MICRA) was enacted during a special session of the California legislature as a comprehensive plan to support physicians and limit the cost of medical liability premiums. MICRA has withstood multiple legal, legislative, and ballot initiative challenges since its inception and is once again being challenged. The most threatening aspect of the new ballot initiative, which is scheduled to be on the ballot for the General Election in 2022, is the creation of a new “catastrophic” category of injury, which completely eliminates the cap on noneconomic damages in cases deemed “catastrophic.” It is anticipated, should the initiative pass, that most medical malpractice cases would be filed as catastrophic cases.

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AAOS Approves the Management of Distal Radius Fractures Evidence-based CPG

The AAOS Board of Directors has approved the Management of Distal Radius Fractures Evidence-based Clinical Practice Guideline (CPG). This guideline contains six recommendations, of which 66 percent are of strong or moderate strength, for orthopaedic surgeons and all quality physicians managing patients with acute distal radius fractures. This CPG was jointly developed between AAOS and the American Society for Surgery of the Hand.

View the new CPG…