Today’s Top Story
CDC releases guideline for opioid prescribing.
The U.S. Centers for Disease Control and Prevention (CDC) has issued new recommendations for prescribing opioid medications. The guideline aims to improve patient safety by offering recommendations on the use of opioids in treating pain lasting longer than 3 months, excluding cancer, palliative, and end-of-life care. The guideline includes recommendations on:

  • When to initiate or continue opioids for chronic pain
  • Opioid selection, dosage, duration, follow-up, and discontinuation
  • Assessing risk and addressing harms of opioid use

Among other things, the guideline states that clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient, and recommends that clinicians establish treatment goals with patients, including realistic goals for pain and function, along with a plan for discontinuing opioid therapy if the benefits do not outweigh the risks. Read more…
Read the complete guideline…

Other News

MedPAC makes 2017 Medicare payment recommendations to Congress.
The U.S. Medicare Payment Advisory Commission (MedPAC) has released its March 2016 report to the U.S. Congress on Medicare payment policy. The report includes the agency’s analyses of payment adequacy in fee-for-service (FFS) Medicare, and provides a review of Medicare Advantage and Part D. Among other things, MedPAC recommends that 2017 payments be updated by the amount specified in current law for physicians and other health professionals. Further, it recommends no payment update for 2017 for four FFS payment systems: ambulatory surgical centers (ASCs), long-term care hospitals, inpatient rehabilitation facilities, and hospice. Finally, MedPAC recommends that Congress require ASCs to submit cost data. Read more (PDF)…
Read the fact sheet (PDF)…

Study: What factors are linked to revision for PJI following TKA?
Findings from a study conducted in New Zealand and published online in The Bone & Joint Journal looks at factors that may contribute to prosthetic joint infection (PJI) after total knee arthroplasty (TKA), and finds that some modern methods of reducing infection may actually increase infection risk. The researchers obtained data on 64,566 primary TKAs from the New Zealand Joint Registry. At minimum 12-month follow-up, they found that male gender, previous surgery, ligament reconstruction, use of laminar flow, and use of antibiotic-laden cement were significantly associated with revision for PJI. In addition, they noted a trend towards significance with the use of surgical helmet systems at 6-month follow-up. The researchers write that “patient factors remain the most important in terms of predicting early PJI following TKA.” Read the abstract…

Study: Radiographic analysis may help identify femoral stems at risk of anteversion following THA.
A study published online in the Journal of Orthopaedic Research suggests that radiography may be used to detect femoral stems at risk of anteversion for patients undergoing total hip arthroplasty (THA). The authors followed 123 patients undergoing cementless THA using a non-anatomic, non-modular, straight stem. They obtained low centered hip radiographs in two planes preoperatively and three-dimensional computed tomography at 6 weeks postoperatively. They then compared the so-called Isthmus Ratio (iRatio) as the relation between canal isthmus and calcar isthmus in the anteroposterior and Lauenstein view, and compared the iRatio to postoperative 3D-CT stem version measured by an independent, blinded observer. They found that 81 percent (21/26) of retroverted cementless stems had a preoperative iRatio below 0.35, and 91 percent (10/11) of stems with an anteversion exceeding 20° had an iRatio above 0.55. Read the abstract…

Review article looks at research into and treatment of FAI.
A review article published online in the journal Nature Reviews Rheumatology looks at femoroacetabular impingement (FAI). The writers profile imaging techniques, various surgical treatment approaches, and management of soft tissue and hip capsule, and also discuss ongoing trials. They note that arthroscopic treatment has become the preferred method for managing FAI, and that recent research suggests that repair of the labrum may result in improved anatomic correction and outcomes compared with labral debridement. “The majority of the studies that inform clinicians managing patients with FAI are at high risk of bias owing to small sample size and the inherent limitations of observational study designs,” they write. “However, several prospective randomized trials that are currently underway are expected to provide high-quality evidence on the management of hip pathology in young adults.” Read the abstract…

President names Merrick Garland to fill Supreme Court vacancy.
President Obama has named Merrick Garland to fill the vacancy on the U.S. Supreme Court following the death of Justice Antonin Scalia. Judge Garland currently serves as the chief judge on the U.S. Court of Appeals for the District of Columbia Circuit. According to observers, he is seen by some as a “safe choice” with centrist principles. As Justice Scalia was a strong conservative, the person who fills the vacant Supreme Court position could affect court balance for years to come. Republican leaders in the U.S. Senate have announced their intention to block any Supreme Court candidate nominated by President Obama, arguing that the president’s successor should name the nominee. Read more (CNN)…
Read more (NPR)…
Read more (The New York Times [NYT])…

New York.
NYT reports that, beginning March 27, physicians in New York state will be required to submit prescriptions electronically. Physicians will be required to comply with the mandate of face penalties. The shift is linked to the state’s “I-Stop” law, which was enacted to reduce opioid abuse. Phase one of the law’s implementation included an online registry, while phase two is a shift to electronic prescribing to reduce the risk of fraud and errors. Read more…

Call for volunteers: OKU Evaluation Committee.
April 1 is the last day to submit your application for a position on the OKU Evaluation Committee. The OKU Evaluation Committee develops and reviews the Orthopaedic Knowledge Update self-assessment examination (OKU SAE), a 200-question examination that is produced every 3 years. Three openings are available:

  • Hip and Knee Reconstruction
  • Oncology
  • Orthopaedic Basic Science

Applicants for these positions must be active fellows, emeritus fellows, candidate members, or candidate member applicants for fellowship, with a practice emphasis in the relevant topic. Learn more and submit your application…(member login required)