March 2, 2020 | Today’s News

AAOS Annual Meeting: An Update on COVID-19

The AAOS 2020 Annual Meeting is proceeding as planned in Orlando, Fla., at the Orange County Convention Center March 24–28. The Academy will continue to monitor the Coronavirus Disease (COVID-19). As the event nears, the Academy will be guided by information from the Centers for Disease Control and Prevention website, the World Health Organization’s Travel Advice, and the Florida Department of Health.

AAOS remains committed to hosting a meeting experience focused on innovation, education, and collaboration, while creating a safe, exciting, and customized experience for all attendees, partners, and colleagues.

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Study: How Long Should Patients Wait between Surgeries in Planned Staged Bilateral TJA?

A retrospective study published online in The Journal of Arthroplasty compared outcomes for staged bilateral total joint arthroplasty (TJA) patients by how much time they waited to undergo the second surgery. Between 2010 and 2016, 670 primary staged bilateral TJAs were performed by two surgeons at a single institution. Demographics, length of stay (LOS), discharge disposition, adverse events (AEs), and transfusion rates were recorded. The 335 second surgeries were evaluated across three different thresholds: (1) ≤ 90 days versus > 90 days, (2) ≤ 180 days versus > 180 days, and (3) ≤ 365 days versus > 365 days. Outcomes did not largely differ between groups in the 90- and 180-day threshold analyses, but when using the 365-day thresholds, the ≤ 365 days group had poorer outcomes than the > 365 days group, including mean LOS (2.21 days versus 1.92 days), rates of AEs (26.0 percent versus 15.3 percent), total transfusion (7.4 percent versus 1.5 percent), and allogeneic transfusion (6.9 percent versus 1.5 percent).

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A retrospective study published in the February issue of The Bone & Joint Journal assessed how the degree of injury to the medial collateral ligaments (MCL) and lateral collateral ligaments (LCL) corresponds with fractures in patients with a posterolateral elbow dislocation. Between March 2009 and March 2018, 64 eligible patients with posterolateral elbow dislocation underwent CT to assess fractures of the radial head, coronoid process, and medial and lateral humeral epicondyles, as well as MRI to determine bone contusion and collateral ligament injuries by tear. At least one fracture was present in 54 patients (some had multiple fractures); 25 had radial head fractures, and 42 had coronoid fractures. Eight and six patients presented lateral and medial humeral epicondylar fractures, respectively. All patients presented rupture of the LCL (partial, n = 8; complete, n = 56). Complete MCL rupture was observed in 37 patients and partial rupture in 19 patients; eight patients did not present rupture evidence. LCL tear was not associated with fracture. Patients with a radial head fracture also presented complete MCL rupture.

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According to a study published online in Foot & Ankle International, treating large and cystic talar dome osteochondral lesions (OCLs) by transferring structural autograft bone from the distal tibia to the talus may yield good patient-reported outcomes (PROs). A total of 32 patients (average age, 48.6 years) were treated and evaluated using subjective patient-centered tools and objective clinical outcomes. From baseline to final follow-up, significant improvements were observed in American Orthopaedic Foot & Ankle Society (65.4 to 86.9), Foot Function Index (48.9 to 21.1), visual analog scale for pain (4.7 to 1.4), and Patient-reported Outcomes Measurement Information System (PROMIS) physical function (40.4 to 45.5) scores. PROMIS pain interference did not improve (54.7 to 52.4). Surgery satisfaction was 8.4 out of 10.0; 96 percent of patients said they would undergo the procedure again, and 94 percent returned to work and/or activities. One patient presented deep vein thrombosis six weeks postoperatively; one patient required ankle fusion 18 months postoperatively.

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A study published online in JAMA Surgery found that the Enhanced Recovery After Surgery (ERAS) care protocol may reduce the risk of postoperative complications in total hip arthroplasty (THA) and total knee arthroplasty (TKA). Elective THA and TKA patients were recruited from 131 centers in Spain and stratified into groups based on where they were treated: in a self-designated ERAS center (ERAS group) or a non-ERAS center (non-ERAS group). Final analysis included 6,146 patients, of whom 680 presented with postoperative complications. The rate of patients with overall postoperative complications did not differ between ERAS and non-ERAS patients, but the ERAS group had fewer patients with moderate to severe complications. The adherence rate with the ERAS protocol was 68.8 percent for ERAS facilities and 50.0 percent for non-ERAS facilities. When assessing patients with the highest and lowest quartiles of ERAS adherence, those with the highest adherence had a lower risk for overall and moderate to severe postoperative complications, as well as shorter median hospital LOS.

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ABOS Utilizes Patient-reported Outcomes with Candidates

The American Board of Orthopaedic Surgery (ABOS) began to utilize PRO measures (PROMs) in 2017 and has gradually expanded its program since that time In 2017, the ABOS asked Board Certification Candidates submitting their Case Lists for the 2018 ABOS Part II Oral Examination to solicit email addresses from patients as they scheduled surgeries. The full ABOS Case Collection period extends six months from April through September each year. In the first year of the ABOS PROs program, Candidates collected patient email addresses for PROM distribution for two of the six months. PROs collection has expanded each year so that Candidates now ask all patients from the entire six-month collection period to participate.

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OrthoInfo Helps Doctors Educate Patients

OrthoInfo, the AAOS patient education website, is a free member resource that provides orthopaedic surgeons and patients with authoritative, in-depth information about musculoskeletal health. The website features more than 400 articles, videos, and animations on common orthopaedic problems, surgical procedures, nonsurgical treatments, injury prevention, and healthy living. All content is developed and peer reviewed by AAOS members. Written in simple language, OrthoInfo articles can help your patients be better informed and participate more fully in their care and recovery.

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