January 6, 2020 | Today’s News

Study: Risk Factors for Extended LOS and Nonhome Discharge after TKA

A study published online in The Journal of Arthroplasty examined predictors of extended hospital length of stay (LOS) and nonhome discharge following total knee arthroplasty (TKA). Data were collected from the Illinois Hospital and Health Systems Association COMPdata administrative hospital discharge database on unilateral TKAs performed at 151 nonfederal hospitals in Illinois between January 2016 and June 2018. Extended LOS was defined as longer than two days, and very extended LOS was longer than four days. Final analysis included 72,359 admissions; 25.0 percent had a nonhome discharge, 41.1 percent had extended LOS, and 4.0 percent had very extended LOS. The following risk factors for extended LOS, very extended LOS, and/or nonhome discharge were identified: female sex; age 75 years or older (versus age 65 to 74 years); non-Hispanic black, Hispanic, and Asian race (versus non-Hispanic white race); Medicaid/no insurance (versus private insurance); obesity; Charlson Comorbidity Index greater than zero; and receiving treatment at a low-volume hospital (fewer than 200 TKAs per year versus more than 600 TKAs per year).

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Study Compares Two Devices for Warming Body Temperature in Shoulder Arthroscopy

A randomized, controlled trial published online in Arthroscopy analyzed differences in core body temperature (CBT) between the Bair Hugger (BH) and Inditherm (IT) warming devices in arthroscopic shoulder surgery patients. The BH was the indicative forced-air warming device, and the IT was the indicative resistive heating system. The minimal clinically significant difference was 0.6 degrees Celsius. Patients’ intraoperative CBT was measured every five minutes. Final analysis included 47 BH patients and 44 IT patients. Both groups sustained a steady decline in CBT up to 30 minutes after anesthesia induction. After the 30-minute mark, CBT gradually increased in the BH group but continued declining in the IT group. Beginning at the 60-minute mark, CBT significantly differed between the groups, and the difference continued increasing up to 90 minutes. The IT group never exhibited an increase in CBT. Overall, 13 BH patients and 32 IT patients sustained hypothermia.

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A retrospective study published online in Injury identified factors associated with adverse events (AEs) among patients undergoing distal tibiofibular syndesmosis fixation. The study included 849 patients who received either screw or suture button fixation to treat syndesmotic instability with associated fibula fracture without open wound between January 2000 and May 2015. One year postoperatively, 10.7 percent of patients (n = 91) suffered an infectious complication, and 22.0 percent (n = 187) required unplanned reoperation. The following factors were correlated with infectious complications: increased duration of hospital admission, use of an external fixator device before open reduction and internal fixation, peripheral vascular disease, and osteoporosis. Patients whose body mass index was lower than 30 kg/m ² had a greater risk of unplanned hardware removal.

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A study published online in the European Spine Journal analyzed the accuracy and feasibility of navigated percutaneous paraspinal pedicle screw implantation (PPSI) in the thoracolumbar sacral spine using intraoperative CT (iCT) and robotic cone-beam CT (CBCT) imaging. A total of 465 percutaneous paraspinal pedicle screws were placed in 75 patients with either iCT- (n = 198) or CBCT-based (n = 32) spinal navigation; 230 screws were connected to rod reducers. PPSI patients were compared to a case-matched cohort of 75 patients who received 481 pedicle screws with an open midline approach. CBCT and iCT both provided reliable analysis of all screws. Overall correct placement accuracy was similar between PPSI (96.6 percent) and open surgery patients (94.2 percent). PPSI presented better outcomes for complete placement within the pedicle (90.1 percent versus 75.1 percent, respectively), as well as regional placement accuracy in the lumbar (97.8 percent versus 91.5 percent, respectively) and lumbar-sacral spine (100.0 percent versus 81.2 percent, respectively).

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Start-up company FossiLabs claims it is engineering first-of-its-kind three-dimensional (3D) printed PolyEther Ether Ketone porous medical implants. According to FossiLabs founder and president Todd Reith, “Using 3D printing technology makes it possible to create a porous structure that would not be possible using traditional methods. The increased surface area and the full porosity encourage new bone on-growth and in-growth of the implant, leading to greater integration strength.”

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Evolution Versus Revolution in AI: Why the Distinction?

This is the fifth article in an ongoing series on artificial intelligence (AI) in orthopaedics and explores the difference between shallow and deep AI, as well as the phenomenon of AI creep. The more familiar AI becomes, the less we think of it as AI. Hence, the phenomenon of AI creep: The simpler the device that performs the AI task, the more we rely on it, and the less it seems like the device is doing a significant brain task.

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OrthoPAC and RJOS Announce New Health STAR Fellowship

The Orthopaedic Political Action Committee (OrthoPAC), in partnership with the Ruth Jackson Orthopaedic Society (RJOS), recently created the Health Strategy and Advocacy Research (Health STAR) Fellowship. The program is designed to further RJOS participation in, and understanding of, orthopaedic advocacy and health policy. Health STAR Fellows will be paired with an advocacy mentor from AAOS and required to regularly communicate and work together on a fellowship project. They will also be required to attend several leadership meetings, participate in state society programs, and guest cohost at least one show on SIRIUS XM Business Radio’s “The Orthopaedics Show” or “The Sports Medicine Show.” The deadline for applications is Jan. 8.

Apply for the fellowship…