Today’s Top Story

Study Compares Adductor Canal Blockade Administered by Surgeon versus Anesthesiologist in TKA

According to a study published in the May issue of The Journal of Arthroplasty, single-shot adductor canal blockade (ACB) administered intraoperatively by a surgeon during total knee arthroplasty (TKA) was not inferior to ACB administered by an anesthesiologist. Primary TKA patients were randomized to ACB using 15 mL of ropivacaine 0.5 percent administered by either an anesthesiologist (group one; n = 34) or surgeon (group two; n = 29). The main outcomes were visual analog scale pain score, range of motion (ROM), and opioid consumption. On postoperative days (PODs) zero, one, and two, there were no between-group differences in opioid equivalents consumed. On POD zero, group one had statistically less pain, but the difference did not reach clinical significance, and there was no longer a difference at PODs one and two. On POD one, group one had significantly increased active flexion, but there were no significant differences on POD zero or six weeks postoperatively. Patient satisfaction with pain control or short-term functional outcomes did not differ between the groups.

Read the abstract…

In Other News

Study Measures Effect of Pelvic Tilt and ROM in FAI Syndrome

A study published in the May 15 issue of the Journal of the AAOS ® assessed how changes in pelvic tilt and hip adduction influence ROM in hips with femoroacetabular impingement (FAI) syndrome. Impingement was simulated in 10 FAI hips at 20 degrees (IR) with 100 degrees flexion and 10 degrees adduction and at 40 degrees IR with 35 degrees flexion and 10 degrees adduction. The IR amount was measured at the bony impingement point or to the defined limit. Both simulations were conducted at neutral and five degrees and 10 degrees anterior and posterior pelvic tilt. All simulations were then repeated with the hip in 10 degrees of abduction. Impingement was observed at 4.3 degrees of IR at the high-flexion position with neutral pelvic tilt. Increased anterior pelvic tilt was correlated with lost IR, and increased posterior pelvic tilt was associated with increased IR. Abduction provided more IR before impingement at the high-flexion position. When the hip was in abduction and the pelvis was posteriorly tilted, IR increased relative to the neutrally tiled pelvis. None of the pelvic tilt and hip abduction or adduction combinations influenced the ROM in the mid-flexion position.

Read the study…

Study Evaluates Timing of Antibiotic Administration and SSI in Open Fractures

Delayed antibiotic administration may increase the risk of surgical site infection (SSI) in open fractures, according to a study published online in Injury. Between 2013 and 2017, 230 consecutive open fracture patients with at least 30 days of follow-up were treated at a level 1 trauma center. The main endpoint was 90-day SSI incidence. Overall, 10 percent of patients sustained an SSI. A trend was observed for patients who did not develop an SSI to receive antibiotics earlier compared to those who developed an SSI. Patients who received intravenous antibiotics after two hours of open fracture presentation to the emergency department were significantly more likely to develop an SSI.

Read the abstract…

CMS’ IPPS Proposed Rule Targets Price Transparency Through Increased Reporting

The Centers for Medicare & Medicaid Services’ (CMS) fiscal year 2021 Inpatient Prospective Payment System (IPPS) proposed rule would add additional reporting requirements for hospitals’ Medicare cost reports. Under the new rule, the report would be required to include: (1) the median payer-specific charge that the hospital has negotiated with all Medicare Advantage (MA) organizations (also referred to as MA organizations), by Medicare Severity-diagnosis Related Group (MS-DRG); and (2) the median payer-specific charge the hospital has negotiated with all third-party payers, which would include MA organizations, by MS-DRG. CMS believes the new rule would be less burdensome for hospitals because hospitals are already obligated to report payer-specific negotiated charges. AAOS is analyzing the rule and will provide comments.

Read more…

COVID-19 Updates

Webinar: Dinsmore & Shohl LLP on Strategies for AAOS Members to Reopen After COVID-19

Tune in on Monday, May 18 at 7:15 p.m. C.T., for a one-hour webinar titled, “AAOS COVID-19 Impact on Orthopaedic Surgeons: Preparing to Reopen and Strategies for Mitigating the Financial Impact.” Firm partners at Dinsmore & Shohl LLP will provide guidance on how practices can reopen or ramp up operations safely to increase volumes as quickly as possible. Topics to be covered include government funding opportunities for physician organizations, financial risk management, and restructuring financial obligations. Registration is free, and the webinar will be recorded and made available to watch again after the event.

Register for the webinar…


Sound Off: Rapid Restructuring of Large Subspecialty Pediatric Orthopaedic Department During Pandemic

The rapid acceleration of COVID-19 called for significant and rapid restructuring of many facets of care. This can be likened to rapidly rerouting a large cargo ship moving along with significant momentum—a difficult task many departments and practices are currently facing. The authors’ goal in sharing their recent experience is to offer ideas, as different parts of the country must rapidly adapt, and to stimulate discussion of ideas. This article analyzes the infrastructure changes of a large subspecialty pediatric orthopaedic department, including restructuring of clinical workflow, triage/rescheduling, communication, education, and more.

Read more…


AAOS Expands Choosing Wisely ® List

AAOS expanded a list of specific tests and procedures that orthopaedic surgeons and patients should question as part of the Choosing Wisely ® campaign, an initiative of the American Board of Internal Medicine Foundation. The Choosing Wisely ® campaign promotes conversations between clinicians and patients about utilizing the most appropriate, evidence-based tests and treatments and avoiding care in which harm may outweigh the benefits.

Read more…

Learn more about Choosing Wisely ®…