May 22, 2020 | Today’s News

Study: Preoperative Opioid Prescription Predictive of Use After Elbow Arthroscopy

A study published online in Arthroscopy identified preoperative risk factors for prolonged opioid use following elbow arthroscopy. A total of 1,138 eligible patients were identified using a national claims-based database. The preoperative opioid group (n = 245) consisted of patients who filled at least one opioid prescription during the four-month period prior to surgery. In the preoperative opioid group, 61 patients (24.9 percent) were still filling prescriptions 12 months postoperatively. The preoperative opioid group had an increased risk of postoperative opioid prescription filling three, six, nine, and 12 months postoperatively. Fibromyalgia and psychiatric illness were also risk factors for filling postoperative opioid prescriptions. Patients aged younger than 40 years and those who had chronic obstructive pulmonary disease were less likely to have postoperative opioid prescriptions filled at three, six, nine, and 12 months postoperatively.

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Study: Patient Predictors of Return to Driving in TJA

A study published in the May 15 issue of the Journal of the AAOS ® determined specific patient predictors for return to driving following total knee arthroplasty (TKA) and total hip arthroplasty (THA). The study included 554 primary TKA and 490 primary THA patients who completed a survey on return to driving every two weeks. Data collection also included vehicle type, transmission, and involvement in motor vehicle accidents. Of the 1,025 total joint arthroplasty (TJA) patients, most (n = 1,025; 98.2 percent) returned to driving within 12 weeks postoperatively. When stratified by surgery type, TKA and THA patients returned to driving at an average of 4.4 weeks and 3.7 weeks, respectively. Fewer than 1 percent of patients (n = 7) were in a motor vehicle accident within 12 weeks postoperatively; no injuries were reported. In multivariate analysis, baseline return to driving started for TKA patients and THA patients at 10.9 days and 17.1 days, respectively. Factors that added additional time to return to driving after TJA included not feeling safe to drive, limited range of motion (ROM), female sex, limitations due to pain, other limitations, discharge to a rehabilitation facility, right-sided procedures, limited ability to break, preoperative anemia, and preoperative use of a cane.

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A retrospective study published in the May issue of The Journal of Hand Surgery assessed functional patient-reported outcomes following Sauve-Kapandji (SK) procedure. A total of 57 patients who underwent SK in two healthcare systems over a 10-year period were assessed for pre- and postoperative ROM; Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores; and wrist plain film radiographic measurements. QuickDASH scores changed from a mean 52 preoperatively to 28 at 12 months postoperatively; at final follow-up, patients with osteoarthritis and inflammatory arthritis demonstrated significant QuickDASH improvements. Supination improved from 48 degrees preoperatively to 74 degrees postoperatively, but pronation and wrist flexion and extension did not change. Radiographically, ulnar variance and McMurtry’s translation index decreased significantly after surgery. The complication rate was 21 percent; four patients each required revision osteotomy and hardware removal.

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A retrospective study published in the May issue of Foot & Ankle International evaluated patient- and provider-specific risk factors for hammertoe failure. Between Jan. 1, 2011, and Dec. 31, 2013, 152 consecutive patients (311 toes; mean age, 60.8 years) underwent hammertoe surgery at a single urban foot and ankle practice. Mean follow-up was 29.5 months. The following factors were significant predictors of failure: having a larger preoperative transverse plane deviation of the digit, operating on the second toe (versus the third or fourth), using a phalangeal osteotomy to reduce the proximal interphalangeal (PIP) joint, and using less common/conventional operative techniques to reduce the PIP joint. Concomitant performance of first ray surgery reduced the risk of recurrence by 50 percent.

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The Centers for Medicare & Medicaid Services (CMS) finalized changes to its Medicare Advantage (MA) and Part D plans. Among its changes, the final rule will increase telehealth access for seniors enrolled in MA, expand options of supplemental benefits for MA beneficiaries with chronic diseases, support additional MA options for rural-based beneficiaries, and expand MA access for end-stage renal disease patients. AAOS commented on the proposed rule and will compare the finalized provisions against those comments in the coming days.

Read the CMS press release…

Read AAOS’ comments…

Immersive Technologies Offer Short- and Long-term Value

To adapt to the current restrictions related to COVID-19, surgeons and training programs have turned to virtual learning methods. Immersive virtual reality (iVR) has been used by training programs at the Mayo Clinic and University of Connecticut to prevent skill degradation for trainees during COVID-19 restrictions. These experiences during current restrictions can be used to improve future behaviors. A novel, cost-effective, and climate-conscious way of doing this could be incorporating continued virtual meetings and iVR simulations in orthopaedics.

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Take Part in a CPG Workgroup on Transtibial Amputations

AAOS is seeking volunteers to take part in the workgroup for the development of the clinical practice guideline (CPG) on Performing Transtibial Amputations. The deadline to submit applications is May 29.

Learn more and submit your application…