Study: Trends in Opioid Prescriptions by Orthopaedic Surgeons
A study published in the March 1 issue of the Journal of the AAOS ® utilized Medicare Part D prescription data from 2013 to 2016 to assess opioid prescriptions among 241,000 orthopaedic surgeons. The average annual number of prescriptions per prescriber decreased from 157 to 148 and per beneficiary from 2.1 to 1.8. Hydrocodone/acetaminophen and oxycodone/acetaminophen were the most frequently prescribed (47.1 percent and 17.5 percent, respectively). Total prescriptions decreased by 372,045, and nonopioid pain medication prescriptions increased by 269,917. Surgeon characteristics such as male sex, residence in the south, or osteopathic degrees were associated with higher total prescriptions.
New Medicare IPO Policy May Increase Patient Costs
As of Jan. 1, the Centers for Medicare & Medicaid Services (CMS) removed all 266 musculoskeletal-related procedures from the inpatient-only (IPO) list. In theory, the change allows doctors and patients more freedom to account for individual circumstance when choosing a setting of care. However, as CMS pays less for outpatient care, the new policy may mean less reimbursement for these procedures, leaving Medicare patients to pay more out of pocket. “The [inpatient versus outpatient] decision ought to be made by the surgeons in consultation with their patients,” AAOS Past President Joseph A. Bosco III, MD, FAAOS, told The Washington Post. “We don’t need the federal government or health insurance companies interfering in the doctor-patient relationship.”
Study: Outcomes and Complications of Pyrocarbon Interposition Shoulder Arthroplasty
A study published online in the Journal of Shoulder and Elbow Surgery evaluated outcomes and complications of 10 cases of pyrocarbon interposition shoulder arthroplasty. Patients were treated using the InSpyre shoulder prosthesis between 2012 and 2017. Five patients underwent revision to reverse shoulder arthroplasty, all of whom had been initially treated for Walch type B glenoid morphology. Mean time to revision was 60 months. The five patients who did not undergo revision showed improvement in mean Constant Score (30 to 65 points) and Subjective Shoulder Value (32 percent to 87 percent) after a 35-month follow-up.
Study: Most Hemiarthroplasty Complications Are Missed at Standard Follow-up
A study published online in Injury assessed common practice regarding follow-up after hemiarthroplasty for femoral neck fracture repair. A survey was conducted among orthopaedic surgeons from 26 Dutch teaching hospitals, as well as a retrospective review of 1,055 hips treated between 2014 and 2019. Postoperative follow-up was reported as standard care by 89 percent of surgeons. Among the patient cohort, complications occurred in 68 cases, with 31 hips undergoing reoperation. Two of these complications were noted during standard follow-up (0.3 percent). Forty-seven percent of complications were noted at unplanned emergency department visits and 16 percent at outpatient visits.
Study: Impact of Patellar Resurfacing on TKA Outcomes
A randomized study published online in Knee Surgery, Sports Traumatology, Arthroscopy compared total knee arthroplasty (TKA) outcomes with or without patellar resurfacing among 245 patients who received the same total knee “patella-friendly” prosthesis (resurfacing, n = 116 knees; nonresurfacing, n = 105 knees). At 24 months, there was no survival difference between resurfaced compared to nonresurfaced knees (88.3 percent versus 85.3 percent). Functional scores and anterior knee pain were also similar. Resurfacing was associated with less stair pain compared to nonresurfaced knees (8.5 percent versus 17.1 percent). Four nonresurfaced knees (3.6 percent) required secondary resurfacing.
With the vast amount of information available to an orthopaedic resident, sifting through the opinions of your attending surgeon and conflicting articles to help make the best decision in orthopaedic care can be difficult. To assist with your search, AAOS, over the past 20 years, has committed to providing members and residents with the best evidence-based recommendations for specific musculoskeletal topics with Clinical Practice Guidelines (CPGs) and Appropriate Use Criteria (AUCs). This article offers an introduction to the AAOS resources for residents during training and early practice.
Volunteers Needed to Review and Select Kappa Delta and OREF Research Award Winners
AAOS is seeking individuals to promote and recognize excellence in musculoskeletal research by selecting winners for the Kappa Delta Awards and Orthopaedic Research and Education Foundation (OREF) Clinical Research Awards and by increasing the visibility and impact of the annual musculoskeletal research awards. The deadline for applications is March 31. Contact Meghan Eigenbrod at eigenbrod@aaos.org with any questions.
