Today’s Top Story

Study: Does Gender Affect Risk Factors for Early TKA Reoperation?

A study published in the June issue of The Journal of Arthroplasty observed gender-related differences on the influence of smoking, low physical activity, and body mass index (BMI) on reoperation risk after total knee arthroplasty (TKA). The single-center study included 1,885 TKA patients; 108 cases (5.8 percent) required early reoperation. More men required early reoperation (8.2 percent; median time to reoperation, 7.5 months) than women (4.4 percent; 2.0 months). Among men, preoperative parameters predictive of reoperation were smoking and obesity (BMI > 30 kg/m 2); among women, they were low physical activity and high BMI.

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In Other News

Study: Regional Anesthesia Timing and Pain Management in Hip Fracture

A study published in the May 20 issue of The Journal of Bone & Joint Surgery found that faster time to block (TTB) was beneficial for hip fracture patients aged 60 years and older. A total of 107 hip fracture patients (mean age, 83.3 years) with a preoperative fascia iliaca nerve block were evaluated. Median TTB was 8.5 hours. Overall, 72 percent of preoperative morphine milligram equivalents (MME) consumption was pre-block placement. Longer TTB was significantly associated with pre-block MME. Patients with faster TTB had lower preoperative opioid consumption and visual analog scale pain scores on postoperative day one, as well as shorter time to discharge.

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Study Compares Nonoperative Management Techniques for Achilles Tendon Rupture

A randomized, controlled trial published online in the British Journal of Sports Medicine compared early controlled motion (ECM) versus immobilization to manage acute Achilles tendon rupture. Final analysis included 64 ECM patients and 58 immobilization patients. One-year post-injury, Achilles tendon Total Rupture Score did not largely differ between the ECM and immobilization groups (74 versus 75). In both groups, the heel-rise work test was 60 percent of the uninjured limb; and elongation was 18 mm and 16 mm, respectively. Six reruptures occurred in the ECM group and seven in the immobilization group.

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Study: Elbow Arthroscopy Complications

A study published in the May issue of Arthroscopy observed a low complication rate among elbow arthroscopies performed in a large community practice. Between 2006 and 2014, 560 consecutive procedures (528 patients; average age, 38.6 years) were performed by 42 surgeons at 14 facilities. The heterotopic ossification rate was 2.5 percent, and 20 cases (3.5 percent) developed transient nerve palsies. Fourteen infections (three deep, 11 superficial) were observed. No vascular injuries, compartment syndrome, deep vein thrombosis, or pulmonary embolism were observed. Diabetes increased the risk for infection. Prior elbow surgery and female sex increased nerve injury risk.

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Study: OR Intervention Rates After Resident-reduced Pediatric Forearm Fractures

A study published in the May/June issue of the Journal of Pediatric Orthopaedics observed no correlation between operating room (OR) intervention rates or reduction quality for pediatric both-bone forearm fractures treated by orthopaedic residents and academic year. A total of 470 reductions were performed, of which 41 fractures (41 patients) required 42 OR interventions. When dividing the academic year into quartiles, the April to June quartile had the highest overall OR intervention percentage (10.6 percent), then July to September (8.6 percent), but percentages of reductions necessitating OR intervention did not significantly differ by quartile.

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Do Bundled Payments Impact Quality and Cost of Care?

With rising healthcare costs and an ever-increasing population in need of medical care, bundled payment models are being evaluated as an alternative to a fee-for-service reimbursement model in orthopaedic surgery. In part one of a three-part series, Gary W. Stewart, MD, FAAOS, interviewed three AAOS fellows and experts in the field to discuss bundled payment models as a way to provide more cost-effective, higher-value care.

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Personalize Your OVT Member Profile

Take five minutes to update your member profile on the newly expanded Orthopaedic Video Theater (OVT). Click on the person icon in the top right corner of the OVT landing page, select “My Profile,” and choose the specialty topics of most interest to you. You can also update your contact information and add an image and brief biography. By keeping your profile current, you get a much more personalized learning experience that addresses your needs, interests, and preferences.

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