March 16, 2020 | Today’s News

CMS Issues FAQs on COVID-19 Coverage Benefits

The Centers for Medicare & Medicaid Services (CMS) published frequently asked questions (FAQs) on essential health benefits (EHB) coverage as it pertains to the COVID-19 outbreak. The FAQs detail which services, such as testing, isolation/quarantine, and vaccination, are covered as EHBs through individual and small-group insurance markets.

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Study: Does Perioperative Clindamycin Increase Complication Risk in Penicillin Allergic Shoulder Arthroplasty Patients?

According to a study published in the March 15 issue of the Journal of the AAOS ®, shoulder arthroplasty patients who were allergic to penicillin and received perioperative clindamycin had a higher risk of postoperative infection. Between 2005 and 2016, 7,140 primary shoulder arthroplasties were performed. Deep surgical site infection risk was compared between patients who received perioperative vancomycin alone (6.2 percent; n = 444) or clindamycin alone (7.1 percent; n = 508) for penicillin allergy versus patients who received cefazolin alone without penicillin allergy (86.7 percent; n = 6,188). The five-year cumulative incidence of deep infection was 1.2 percent. Infection risk did not largely differ between patients treated with cefazolin versus vancomycin, but patients treated with clindamycin alone had a higher risk of infection.

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A study published online in Injury examined how much fluid is required and the sensitivity of the saline load test to diagnose intra-articular ankle arthrotomy. A total of 20 thawed, fresh-frozen below knee cadavers were stratified into four groups by arthrotomy location. Arthrotomies were made with a 4 mm trochar at the anteromedial, anterolateral, posteromedial, and posterolateral sites. Required saline levels to reach extravasation ranged from 3.0 mL to 11.0 mL, with a mean required volume of 5.3 mL. The required volume of saline to achieve 90 percent sensitivity was 8 mL; 10 mL was required to reach 95 percent sensitivity and 11 mL to reach 99 percent sensitivity. In site-specific analyses, the mean saline volume required to detect a traumatic arthrotomy was 5.2 mL for anterolateral, 6.2 mL for anteromedial, 5.0 mL for posteromedial, and 4.8 mL for posterolateral. The saline volume required to detect arthrotomies did not largely differ among the groups.

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A retrospective study published in the March issue of The Lancet Infectious Diseases assessed short- and long-term mortality and adverse joint outcomes following septic arthritis of the native knee. The Hospital Episode Statistics database was queried for patients treated with arthroscopic knee washout for septic arthritis between April 1, 1997, and March 31, 2017. Outcomes were 90-day mortality; one-year rates of arthrodesis, amputation, and arthroplasty; and 15-year arthroplasty. Final analysis included 12,132 patients (mean age, 56.6 years; 36.0 percent were female). There were 10,195 patients who had septic arthritis as their primary admitting diagnosis; in this group, 90-day mortality was 7.05 percent, and it increased to 22.69 percent in patients aged older than 79 years. Patients with secondary septic arthritis, compared to those with a primary diagnosis, had an adjusted odds ratio for mortality of 2.10. Of 11,393 patients with at least one year of follow-up, the one-year rates of arthrodesis, amputation, and arthroplasty were 0.13 percent, 0.40 percent, and 1.33 percent, respectively. Of 1,816 patients with 15-year follow-up, 8.76 percent received arthroplasty.

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A randomized clinical trial published in the March issue of The Journal of Hand Surgery compared the use of two-dimensional (2D) versus three-dimensional (3D) fluoroscopy intraoperatively in distal radius fracture patients. The multicenter study randomized 206 patients to receive or not receive intraoperative 3D fluoroscopy. The revision surgery rate was 31 percent in the 2D group and 24 percent in the 3D group. In the 3D group, 11 percent of fractures required additional intraoperative corrections.

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Study Confirms Improvements in Pain and Function Following Implant Removal in Fracture Patients

A recent study sought to determine preoperative factors predictive of improvements in pain and function following elective implant removal. Removal in patients with healed fractures led to significant improvements in pain and function. The degree of improvement in Patient-reported Outcomes Measurement Information System physical function and pain interference scores was greater than the minimal clinically important difference.

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Take Part in a CPG Workgroup

AAOS is seeking volunteers to take part in the workgroup for the development of the clinical practice guideline (CPG) for the Surgical Management of Osteoarthritis of the Knee. The deadline to submit an application is March 20.

Learn more and submit your application…