Today’s Top Story

Study: Most TJA patients may not receive opioid prescriptions from orthopaedists

According to a study published online in The Journal of Arthroplasty, patients appear to receive opioid prescriptions from various physicians before and after total joint arthroplasty (TJA), the majority of which are not provided by their orthopaedic surgeon. Researchers evaluated patients undergoing total hip and knee arthroplasty between 2008 and 2012 and used the Total Joint Replacement Registry and pharmacy data to identify opioid prescriptions among this cohort. Primary care and internal medicine providers were the highest prescribers in the year prior to and after TJA. Among patients undergoing knee arthroplasty, orthopaedists prescribed 9 percent of the opioids in the year prior to surgery, 47 percent in the first 90 days after surgery, and 14 percent in days 271 to 360 after surgery. In patients undergoing hip arthroplasty, orthopaedists prescribed 14 percent of the opioids in the year prior to surgery, 40 percent in the first 90 days after surgery, and 14 percent in days 271 to 360 after surgery.

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Other News

Study: Costs of THA appear to remain steady, transparency not improving

Despite industry interest in improving price transparency, a study published online in JAMA found no evidence of this between 2012 and 2016 among total hip arthroplasties (THAs) at 120 hospitals. Researchers surveyed this group of hospitals in 2011 and again in 2016 to see if there was a change in price reporting for THAs. Investigators called each hospital posing as a granddaughter seeking information on the cost of a primary hip replacement for her 62-year-old grandmother, specifically looking for the lowest “cash” bundled price. Only eight hospitals (6.7 percent) gave a bundled price; 20.8 percent (n = 25) provided a complete price, 28.3 percent (n = 34) provided a partial price, and 44.2 percent (n = 53) could not provide any pricing information. The percentage of hospitals able to provide a bundled price declined from 15.8 percent in 2012 to 6.7 percent in 2016. The mean bundled/complete price did not change—it was $44,300 in 2012 and $37,900 in 2016.

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Study: Baseball players with symptomatic femoroacetabular impingement may be able to return to play following hip arthroscopy

A study published online in The American Journal of Sports Medicine found that professional baseball players who underwent hip arthroscopy for femoroacetabular impingement (FAI) returned to the sport with similar performance. Researchers assessed career length, performance, and return-to-play rates in 44 professional baseball players (51 hips) undergoing hip arthroscopy for FAI between 2000 and 2015 by a single surgeon. Almost all players (95 percent; n = 42) were able to return to professional baseball after hip arthroscopy and had a mean career length of 9.5 years. There were no differences in performance measures between preinjury and postoperative values.

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Study: In-office diagnostic arthroscopy may be safe and effective

In-office needle-based diagnostic imaging appears to be statistically equivalent to surgical diagnostic arthroscopy in patients with knee pain, according to an article published online in Arthroscopy. The prospective, blinded, multicenter trial included 110 consecutive patients aged 18–75 years who presented with knee pain between April 2012 and April 2013. Each patient underwent a physical examination, MRI, in-office diagnostic imaging, and a diagnostic arthroscopic examination in the operating room. Two blinded, unaffiliated experts reviewed the in-office arthroscopic images and MRI images using the surgical diagnostic arthroscopy images as the “control” group. The accuracy, sensitivity, and specificity of in-office arthroscopy was equivalent to surgical diagnostic arthroscopy and more accurate than MRI. There were no patient- or device-related complications with in-office arthroscopy.

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Study: Preoperative mechanical symptoms may be linked to greater improvements following meniscal surgery

In an observational study published online in Osteoarthritis and Cartilage, younger patients with preoperative mechanical symptoms appeared to have improved patient-reported outcomes following arthroscopic meniscal surgery. Investigators assessed younger (≤ 40 years) and older (> 40 years) patients from the Knee Arthroscopy Cohort Southern Denmark undergoing arthroscopic surgery for meniscal tear. Patients (n = 150) completed an online questionnaire preoperatively and at 12 and 52 weeks post-surgery. Those with mechanical symptoms generally had worse self-reported outcomes prior to surgery. At 52 weeks, younger patients with mechanical symptoms had more improvement in the Knee Injury and Osteoarthritis Outcome Score (KOOS 4) than younger patients without these preoperative symptoms; however, they did not exceed the absolute postoperative KOOS 4 score compared to those without mechanical symptoms. There did not appear to be a difference in outcomes in the older cohort between those with and without mechanical symptoms.

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Experts offer suggestions to manage transition to value-based care

As health care shifts from volume to value, some orthopaedic surgeons may be concerned about how to effectively manage the transition. During a symposium held at the AAOS 2018 Annual Meeting, moderator Kevin J. Bozic, MD, MBA, of the Dell Medical School at the University of Texas at Austin, and other experts explored a variety of different principles and pathways for implementing value-based care.

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Apply for member position of Membership and Leader Development Committee

The AAOS Membership and Leader Development Committee has an open position for member for the Mar. 15, 2019, through Mar. 20, 2021 term. The committee oversees the AAOS membership admissions process, makes recommendations on membership issues to the Board of Directors, and oversees leadership development and mentoring of members. The last day to submit an application is Aug 11, 2018.

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