Today’s Top Story

Study Measures Success Rate of Latissimus Dorsi Transfer for Revision Massive Rotator Cuff Tears

A retrospective chart review published in the January issue of Arthroscopy found a low clinical success rate for latissimus dorsi transfer in the treatment of revision massive rotator cuff tears. Data were collected from an institutional shoulder outcome registry for latissimus dorsi transfer patients with a history of failed rotator cuff repair and at least one year of follow-up. Final analysis included 22 patients (mean age, 53 years). Close to two-thirds of patients (n = 14) had at least two previous failed rotator cuff repairs. American Shoulder and Elbow Surgeons, Simple Shoulder Test, and pain scores significantly improved from pre- to postoperatively. The postoperative complication rate was 27 percent. After a mean 2.7 years, 13.6 percent of patients (n = 3) required revision to reverse total shoulder arthroplasty. At final follow-up, the clinical failure rate was 41 percent. Preoperative predictors of clinical failure included an acromiohumeral interval of less than 7 mm and high-grade fatty infiltration.

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In Other News

Study Examines Timeliness of Knee Replacement for OA

A study published online in The Journal of Bone & Joint Surgery found that many patients either undergo total knee replacement (TKR) prematurely or wait too long for surgery and do not receive the full possible benefits. Data were collected from two multicenter cohort studies on patients who either had or were at high-risk for knee osteoarthritis (OA). Patients were stratified into three groups: timely, potentially appropriate but knee not replaced, and premature. Final analysis included 3,417 knees: 290 knees (8 percent of the total and 9 percent of the knees for which replacement was potentially appropriate) were timely, 2,833 knees (83 percent of the total and 91 percent of those for which replacement was potentially appropriate) were potentially appropriate but not replaced, and 294 knees (9 percent of the total and 26 percent of the 1,114 TKRs performed) were premature. Of potentially appropriate knees that did not undergo surgery, 42.5 percent (n = 1,204) had severe symptoms.

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Study: Outcomes Associated with Cross-screw Intermediate Cuneiform Construct for First Tarsometatarsal Joint Arthrodesis

A study published online in Foot & Ankle International examined correction maintenance of the first and second intermetatarsal angle, hallux valgus angle, and tibial sesamoid position following first tarsometatarsal joint arthrodesis with a cross-screw intermediate cuneiform construct. Hallux valgus patients received a first tarsometatarsal joint arthrodesis with a cross-screw intermediate cuneiform construct. Three observers assessed preoperative weight bearing, first weight bearing, and final weight bearing. Final analysis included 62 patients (mean follow-up, 9.3 months). Most patients (n = 62, 96.7 percent) achieved bony union, and two underwent revision surgery due to recurrence. The intermetatarsal angle (IMA) improved by a mean 6.8 degrees, hallux valgus angle by 14.8 degrees, and tibial sesamoid position by 2.4 positions. Mean loss of IMA correction was 1.5 degrees, hallux valgus angle was 2.9 degrees, and tibial sesamoid position was 0.8.

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Study: Intraoperative Ischemic Stroke Risk Factors in Spine Surgery Patients

A retrospective study published in the Jan. 15 issue of Spine examined incidence, risk factors, complications, and early postoperative outcomes associated with intraoperative ischemic stroke in elective spine surgery patients. Electronic health records for patients who received elective spine surgery between January 2016 and November 2018 were analyzed. Data collection included patient demographics, pre- and postoperative neurological status, surgical treatment and time, blood loss, intraoperative abnormalities, risk factors, stroke history, medical treatment, diagnostics, hospital stay, complications, and mortality. Among 5,029 patients, seven who developed intraoperative ischemic stroke were identified, six of whom were female. Two patients sustained ischemic pontine stroke. Intraoperative ischemic stroke risk factors were hypertension, diabetes, smoking, dyslipidemia, and possible major intraoperative cerebrospinal fluid leak. Three patients presented neurological deficits that did not improve in the hospital. Two patients made a full recovery and two died, resulting in a 29 percent in-hospital mortality rate in this patient subset.

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Decline in Racial Gap in Uninsured Patients Has Stalled

Although the Affordable Care Act initially contributed to a decline in uninsured rates among black and Hispanic patients, this trend has stalled as the overall uninsured rate increases, according to a report from The Commonwealth Fund. The report states that the uninsured rate among black adults has increased by 0.7 percentage points since 2016 compared to a half percentage point decrease in white adults; Hispanic adults still have significantly higher uninsured rates compared to both groups.

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Prior Authorization: Controlling Costs or Hurting Patients?

The term prior authorization (PA) elicits an almost instant sigh from physicians. What started as a way for insurers to manage the utilization of physician services in the early 1970s has morphed into something entirely different. The time and energy associated with PA have grown exponentially in the past decade, delaying medically necessary care for patients and forcing physicians to devote significant resources to completing requests. AAOS has been active in advocating for needed reforms to the current system of PA, working to reduce the time it takes to get patients the care they need. With renewed efforts to reform PA in the House of Representatives, states, and federal agencies, there is increasing focus on changing this burdensome system.

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Take Part in a CPG Workgroup

AAOS is seeking volunteers to take part in the workgroup for the development of the clinical practice guideline (CPG) for the Surgical Management of Osteoarthritis of the Knee. The deadline to submit an application is Jan. 31.

Learn more and submit your application…