COVID-19 Presidential Update from Joseph A. Bosco III, MD, FAAOS

In his latest COVID-19 update, AAOS President Joseph A. Bosco III, MD, FAAOS, acknowledged the two very different COVID-19 narratives across the country, with some places seeing increased burdens and others slowly relaxing their rules. He also discussed the Federal Reserve’s Main Street Lending Program, which opened for registration on June 15. Information about this and all of the COVID-19 loan and grant programs can be found at the AAOS COVID-19 Member Resource Center. On the Congressional front, the AAOS-endorsed Improving Seniors’ Timely Access to Care Act has gained majority support from the House of Representatives and would reform burdensome prior authorization processes for Medicare Advantage Plans.

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In Other News

Study: Two-stage TKA with Articulating Spacers

A study published online in Knee Surgery, Sports Traumatology, Arthroscopy assessed the use of two-stage total knee arthroplasty (TKA) using an articulating spacer in infected arthritic knees. Sixteen consecutive patients with advanced osteoarthritis (OA) and infection were included. In all patients, the infection was eradicated, and no cases of recurrence were reported. Pain and functional outcomes significantly improved. Knee flexion improved from 95 degrees preoperatively to 109 degrees after spacer implantation and to 119 degrees after TKA implantation. Mean visual analog scale score decreased from 65 preoperatively to 2 after spacer implantation and 1 after TKA implantation.

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Study Compares BST-CarGel Treatment Versus Microfracture in Acetabular Chondral Defects

A study published online in The American Journal of Sports Medicine compared outcomes between patients treated arthroscopically for acetabular chondral defects with BST-CarGel (CarGel) versus microfracture (MF). Eighty hip arthroscopy patients were identified (54 CarGel and 26 MF); three patients were lost to follow-up. Average defect size in the MF group was 3.63 cm 2 versus 4.97 cm 2 in the CarGel group. Both groups presented significant improvements in the International Hip Outcome Tool–33 and Hip Outcome Score–Activities of Daily Living; when adjusting for covariates, outcome scores did not largely differ between the groups. A higher proportion of MF cases than CarGel cases were converted to total hip arthroplasty.

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Study: Microfracture After Distraction Ankle Arthroplasty

A study published in the June issue of Foot & Ankle International evaluated the use of microfracture (MFX) after distraction arthroplasty (DA) of the ankle joint. Seventy-eight patients with post-traumatic OA were stratified into four groups: DA plus MFX (n = 8), DA plus MFX plus concentrated bone marrow aspirate (CBMA) (n = 35), DA plus CBMA (n = 22), and DA alone (n = 13). Patients who received DA plus MFX, with or without CBMA, had significantly worse motion than the DA alone group. Postoperative joint space, time to return to activity, and Foot and Ankle Outcome Score were significantly worse for patients who received MFX.

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Study: Anatomical Abnormalities of Extrinsic Tendons in Type IIIa Hypoplastic Thumbs

A study published in the June issue of The Journal of Hand Surgery analyzed variations in extrinsic tendons of the thumb in type IIIa hypoplastic thumbs. Seventy-nine thumbs (67 patients) underwent opponensplasty, stabilizing of the thumb metacarpophalangeal joint, and widening of the first web space; anatomical abnormalities of the thumbs’ extrinsic tendons were noted at the time of surgery. An interconnection between the flexor pollicis longus (FPL) and the extensor pollicis longus (EPL) tendons was observed in 50 thumbs (63 percent). A third of thumbs (n = 26) had bifurcations; all but one bifurcated from the FPL. Twenty-five FPL abnormalities and seven EPL abnormalities were observed.

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Study Assesses Patient-specific and Off-the-shelf 3D-printed Spine Surgery Implants

A systematic review published in the June issue of the European Spine Journal evaluated clinical evidence pertaining to three-dimensional (3D)-printed patient-specific and off-the-shelf spine surgery implants. The review included 22 peer-reviewed articles and one book chapter. The published literature included case reports and case series largely focused on patient-specific designs made from titanium alloys for surgical reconstruction in significantly complex cases affected by neoplasia, infection, trauma, or degenerative processes. Overall, patient- and surgeon-reported outcomes were positive. However, the researchers stated there is a need for more high-powered studies and longer follow-up times in future research.

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Famed Peloton Instructor Discusses Exercise and Self-care

Christine D’Ercole is one of the original spin instructors with Peloton—an indoor cycling experience that brings people together via a virtual community. Ms. D’Ercole is also a Masters World and national champion cyclist. She still races at the age of 48 years, and she continues to make it to the podium. Karen M. Sutton, MD, FAAOS, and Jennifer M. Weiss, MD, FAAOS, spoke with Ms. D’Ercole on behalf of AAOS Now about the magic of group fitness and the “adult” athlete among the orthopaedic community, as well as about using fitness to manage stress during the COVID-19 pandemic.

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