Today’s Top Story
Study: Comorbidity indices may offer little predictive value for discharge setting and readmission after TKA, THA.
A study published online in the journal Arthritis Care & Research suggests that various comorbidity indices offer weak discrimination for the prediction of post-acute discharge settings and hospital readmission for patients following joint arthroplasty. The authors retrospectively reviewed data on 607,349 Medicare beneficiaries who underwent total knee arthroplasty (TKA) or total hip arthroplasty (THA). They found that 30-, 60-, and 90-day unplanned hospital readmission rates were 5.3 percent, 7.2 percent, and 8.5 percent respectively. The authors note that the C-statistic for the base model in predicting post-acute discharge setting and 30-, 60-, and 90-day readmission in TKA and THA were between 0.63 and 0.67. “Adding Charlson, Elixhauser, or the U.S. Centers for Medicare & Medicaid Services (CMS) risk adjustment model Hierarchical Condition Category increased the C-statistic minimally from the base model for predicting both discharge settings and hospital readmission,” they write. Conditions most frequently associated with hospital readmission were diabetes, pulmonary disease, arrhythmias, and heart disease. Read more…
Read the abstract…

Other News

Study: How important is CSA in predicting progression of rotator cuff disease?
Findings published online in the journal Clinical Orthopaedics and Related Research cast doubt on the relationship of critical shoulder angle (CSA) to rotator cuff disease. The researchers retrospectively compared data on 313 patients with asymptomatic rotator cuff tear who underwent ultrasonography and standardized anteroposterior radiographs at enrollment and yearly thereafter during a median of 4 years. Of 1,552 radiographs evaluated, they found that 326 (21 percent) were of sufficient quality to measure CSA. The researchers noted that CSA was higher among patients with cuff tears than control patients, but CSA did not correlate with baseline tear length or width, and CSA was not different between tears that enlarged and those that were stable. In addition, CSA did not change over time. Read the abstract…

Study: Endoscopy may return athletes more quickly than open treatment of PAIS.
A study published online in The American Journal of Sports Medicine (AJSM) compares open surgery and endoscopy for the treatment of posterior ankle impingement syndrome (PAIS). The research team conducted a randomized, controlled trial of 52 athletes who underwent a symptomatic os trigonum excision, and who underwent an open procedure (n = 26) or an endoscopic procedure (n = 26). Compared to those in the open procedure cohort, they found that patients in the endoscopy cohort demonstrated significant improvement of American Orthopaedic Foot and Ankle Society hindfoot score, and the mean time to return to training was 4.58 weeks in the endoscopy group and 9.58 weeks in the open group. In addition, the time to return to previous sports level was 7.12 weeks among endoscopy patients and 11.54 weeks among open patients. Finally, the overall complication rate was 3.8 percent in the endoscopy cohort and 23 percent in the open cohort. The research team found no significant difference in postoperative Visual Analog Score–Foot and Ankle scores between the two groups. Read the abstract…

Study: Many patients with AIIS and subspinous hip impingement may be asymptomatic.
Data from a study published online in AJSM suggest that a large number of patients with anterior inferior iliac spine (AIIS) morphology associated with subspinous hip impingement may be asymptomatic. The authors conducted a cross-sectional study of 449 hips without a history of hip pain or hip impingement and 59 hips with a diagnosis of hip impingement, in which three blinded assessors classified the AIIS for each hip twice. The authors found that morphological distribution between symptomatic and asymptomatic patients was similar, with 75 percent of patients in the asymptomatic group and 80 percent of patients in the symptomatic group having a type 2 or type 3 AIIS. After matching for age, sex, and affected side, they found no significant difference in assessed classification type between the cohorts. Overall, the positive predictive value of a type 2 or type 3 AIIS classification for hip impingement symptoms was 10 percent and the negative predictive value was 91 percent. Read the abstract…

JAMA articles look at ACA replacement proposals.
An article in the Jan. 24/31 issue of The Journal of the American Medical Association (JAMA) looks at proposed Affordable Care Act (ACA) replacement plans. They include:

  • A proposal from U.S. House Speaker Paul Ryan (R-Wis.) that would include high-risk pools, insurance guarantees regardless of health status, and price guarantees for consumers with continuous coverage, and Medicaid block grants.
  • A proposal from U.S. Department of Health and Human Services Secretary-nominee Tom Price, MD (R-Ga.), that includes high-risk pools, guaranteed insurance, tax credits based on age, and repeal of ACA Medicaid expansion.
  • A proposal from Sen. Ted Cruz (R-Texas) that retains the ACA Medicaid expansion; dismantles much of the ACA, including insurance exchanges, the individual mandate, guaranteed insurance, and subsidies, and would encourage the sale of medical insurance across state lines.
  • A proposal from the American Enterprise Institute that would eliminate essential benefits from healthcare plans, automatically enroll consumers in low-cost plans if they didn’t sign up on their own, retain the ACA exchanges, and move Medicaid to a block-grant program.

The writer notes that President Trump has outlined his thoughts on healthcare reform, which include increased use of health savings accounts, high-risk pools, selling insurance across state lines, and offering states more flexibility with Medicaid. Read more…
A related commentary article in JAMA Forum also looks at potential ACA replacements.

Jan. 31 is the last day to register for Education Tracks; receive course discounts for 2017 AAOS Annual Meeting!
AAOS Members who register for Annual Meeting courses by Tuesday, Jan. 31 will save $20 on each Instructional Course and $100 on the Orthopaedic Review Course. Jan. 31 is also the final day to register to participate in the new Education Tracks, the cost of which includes one free Instructional Course Lecture in each track! The 2017 AAOS Annual Meeting will be held March 14-18 in San Diego, Calif. Register now…

Call for volunteers: ACR Appropriateness Criteria Expert Panel on Musculoskeletal Imaging.
AAOS seeks to nominate two members to the American College of Radiology (ACR) Appropriateness Criteria Expert Panels on Musculoskeletal Imaging. The criteria are evidence-based guidelines designed to assist providers in making the most appropriate imaging decision for a specific clinical condition. Applicants for this position must be active fellows. In addition, all applicants must provide the following: an online AAOS CAP application, a current curriculum vitae; a 100-word biosketch, and a letter of interest highlighting his or her expertise in the subject area. All supporting materials must be submitted by Febr. 7, 2017 at 11:59 p.m. (CT), to Kyle Shah at:
Learn more and submit your application…(member login required)