July 6, 2018 | Today’s News

Robotic-arm assisted TKA may improve outcomes

Robotic-arm assisted total knee arthroplasty (TKA) may be associated with better outcomes compared to conventional jig-based TKA, according to a study published online in The Journal of Bone & Joint Journal. The prospective cohort study included 40 consecutive patients who underwent conventional jig-based TKA followed by 40 consecutive patients receiving robotic-arm assisted TKA. A single surgeon performed all surgical procedures using the medial parapatellar approach with identical implant designs and standardized postoperative inpatient rehabilitation. Robotic-arm assisted TKA was associated with reduced postoperative pain, decreased analgesia requirements, decreased reduction in postoperative hemoglobin levels, shorter time to straight leg raise, decreased number of physiotherapy sessions, and improved maximum knee flexion at discharge. The median time to hospital discharge was 77 hours for the robotic-arm assisted TKA cohort compared to 105 hours for the conventional jig-based TKA group.

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USPSTF report recommends screening to prevent osteoporotic fractures

A report from the U.S. Preventative Task Force (USPSTF) published in the June issue of JAMA indicates that screening women may prevent osteoporotic fractures. Researchers conducted a literature review of PubMed, the Cochrane Library, EMBASE, and trial registries between Nov. 1, 2009, and Oct. 1, 2016, as well as surveillance of the literature through March 23, 2018. They identified 168 articles pertaining to osteoporotic fractures. One randomized, controlled trial that included 12,843 patients found that the fracture rate was lower in those who underwent screening (2.6 percent) than in those who did not (3.5 percent). In women, lower rates of vertebral fractures were associated with parathyroid hormone, bisphosphonates, denosumab, and raloxifene. Denosumab was correlated with reduced risk of nonvertebral fractures. Bisphosphonates showed no significant association with hip fractures, and little evidence was found for men.

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A report from the American College of Surgeons (ACS) indicates that there is a lack of incentive for healthcare systems to limit surgeons’ work hours. The number of hours a surgeon can work should be capped to reduce harmful mistakes caused by exhaustion and burnout, according to an editorial published online in the Journal of ISAKOS. The editorial also notes that airline pilots and train drivers are carefully monitored in terms of hours worked and tested for drugs and alcohol abuse. ACS argued for “a coordinated and systematic approach to the issue of surgical sleep deprivation.” Previous studies have also shown there are more heavy drinkers among physicians than in the general population, a trait the ACS credits to a sense of “invulnerability” that may be prevalent in surgeons. Coupled with excessive workload, this alcohol abuse is likely to lead to feelings of “burnout and depression,” according to Krista Kaups, previous chair of ACS’ Governor’s Committee on Physician Competency and Health.

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Fracture type and morphology appears to significantly influence nonunion risk and time to union following intramedullary nailing for tibial fracture, according to a retrospective review published in the July issue of the Journal of Orthopaedic Trauma. Researchers used data from a Scottish trauma center to identify 1,003 adult tibial fractures treated via intramedullary nailing between 1985 and 2007. They assessed risk factors such as observed nonunion, final union time, age, fracture type, American Orthopaedic Trauma Association/Arbeitsgemeinschaft für Osteosynthesefragen (OTA/AO) classification, and smoking status. The overall nonunion rate was 12 percent, with a median healing time of 18 weeks. Age had a significant influence on nonunion, with the highest risk found in middle-aged adults. Fracture type and OTA/AO classification had a strong influence on nonunion rate and time to union, with OTA/AO type B having a nonunion rate of 15 percent in closed injuries and type C having a rate of 61 percent in open injuries. Compartment syndrome and smoking status significantly extended time to union.

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CMS denies Massachusetts’ request to choose Medicaid-covered drugs

The Centers for Medicare & Medicaid Services (CMS) denied Massachusetts’ request to determine which drugs will be covered by its Medicaid program. The state filed a federal waiver request to establish its own drug formulary and would have become the first state to do so, if accepted. CMS said it would have considered the waiver if it was framed as a pilot or demonstration project; in addition, the program would have to forgo rebates and negotiate prices directly with manufacturers for CMS to consider sign-off. The state’s proposed program was an effort to contain Medicaid drug costs, which have risen 13 percent each year since 2010. Massachusetts’ Medicaid spending increased 20 percent, from $6.4 billion in 2013 to $7.7 billion in 2016.

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July AAOS Now is available online

AAOS members will soon receive the print edition of the July issue of AAOS Now, but the electronic edition is already available on the AAOS Now website and on iOS and Android devices through the AAOS Access app. This month’s issue includes coverage from the National Orthopaedic Leadership Conference, as well as information on advance beneficiary notice forms, supracondylar humerus fracture in children, and more.

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Apply for Medical Liability Committee member position

The Medical Liability Committee has an open member position, a two-year term that runs from March 18, 2019, to March 12, 2021. The committee monitors trends regarding professional liability and tort reform and develops and prioritizes AAOS activities related to the medical liability crisis. The last day to submit an application is Aug. 3.

Learn more and submit your application… (member login required)