Today’s Top Story

Study: Which THA Patients Are at Risk for Postoperative Fracture?

A study published online in The Journal of Arthroplasty identified anatomic and patient factors predictive of postoperative periprosthetic hip fracture after total hip arthroplasty (THA). Between 2008 and 2018, 16,254 primary THAs were performed at a single institution. Within 90 days of the initial surgery, 48 were revised for periprosthetic fracture. Osteoarthritis (OA) patients undergoing THA were randomly selected as a control group (n = 193). Significant risk factors for fracture included older age and female gender. In age- and sex-adjusted analyses, a correlation was observed between absence of contralateral OA and increased fracture risk relative to patients with contralateral OA. Having a contralateral THA in place was also a fracture risk factor. Fracture risk was not influenced by the neck shaft angle, femoral offset, and the Dorr classification.

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In Other News

Study Surveys Use of Personality Assessments in Residency Programs

According to a study published in the March/April issue of Current Orthopaedic Practice, personality assessments are not widely used in orthopaedic residency programs. Orthopaedic residency program directors were invited to complete a survey regarding the use of personality assessment tools in each residency program, as well as their own sentiments on the utility of personality assessments. A total of 47 program directors responded, of whom 42 said their residency program does not include any personality assessment. Among the five who did use them, reasons included to identify potential problems, as well as mentorship selection and investigational purposes. One director said the assessment is used to evaluate residency applicants. No one reported using it to choose clinical service teams. Most directors expressed familiarity with the Myers-Briggs personality inventory.

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Study Reviews Proximal Humeral Allograft-prosthetic Composite Procedures

A retrospective review published online in the Journal of Shoulder and Elbow Surgery assessed the use of proximal humeral allograft-prosthetic composites (APCs) in reconstruction surgery for large bone deficits. Between 1970 and 2018, 115 proximal humeral APC procedures were performed at two institutions, of which 14 (eight patients were female) required revision due to nonunion (n = 7), glenohumeral instability (n = 5), and allograft fracture (n = 2). Patients were stratified into three groups based on the amount of usable allograft retained at revision surgery: type A, complete allograft retention (n = 6); type B, partial retention (n = 3); and type C, no retention (n = 5). Revision surgeries were performed at a mean 22.8 months. The following associations were observed by case: type A, nonunion with a well-fixed stem; type B, instability and conversion from a hemiarthroplasty to a reverse total shoulder arthroplasty; and type C, allograft fracture or nonunion with a loose humeral component.

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Study: Does Preoperative Opioid Use Predict Postoperative Use after Transforaminal Lumbar Interbody Fusion?

According to a retrospective cohort study published online in the European Spine Journal, patients with a history of opioid use undergoing transforaminal lumbar interbody fusion (TLIF) are more likely to use opioids postoperatively in the long term. One- and two-level TLIF patients treated at a single institution between 2014 and 2017 were assessed for total inpatient oral morphine milligram equivalents (MMEs) use. Prolonged postoperative opioid use was associated with the following risk factors: a psychiatric or chronic pain diagnosis, preoperative opioid use, American Society of Anesthesiologists class, and inpatient total MME. Inpatient muscle relaxant use was correlated with a decreased risk for prolonged opioid use. Patients who used opioids preoperatively were significantly more likely to use them at six weeks, three months, and six months.

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ONC Issues Health Information Technology Goals

The Office of the National Coordinator (ONC) for Health Information Technology (IT) released its strategy to align research- and data-related needs of clinicians and medical researchers. Nine priorities are outlined, including improving access to interoperable electronic health data, leveraging health IT systems to increase education and participation, and integrating knowledge at the point of care.

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A Focus on Members: Mission Critical!

AAOS President Kristy L. Weber, MD, FAAOS, introduces the newly formed Membership Council, which will work closely with other councils to enhance the member experience by improving access to even more educational materials on the new learning platform; clinical practice guidelines, appropriate use criteria, and performance measures via website or smartphone; and real-time updates on critical legislative and regulatory advocacy issues that affect patients and practices.

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Apply for Volunteer Opportunities

Consider applying for the following positions:

  • Education Assessments and Examinations Committee member position (spine)—applications are accepted until April 15
  • Education Assessments and Examinations Committee member position (sports medicine)—applications are accepted until April 15
  • Liaison Activities member position (American College of Radiology Appropriateness Criteria Panels)—applications are accepted until April 15

Learn more and submit applications…(member login required)