May 6, 2020 | Today’s News

Governing Bodies Vote to Approve Bylaws Amendments

The needs of AAOS members in different stages of their careers are changing. To maintain its relevance, AAOS must also change to meet members’ evolving needs. This year’s proposed bylaws amendments align with and support AAOS’ new Governance Principles. Bylaws amendments Nos. 1 and 2 are an effort to improve the current Academy and Association bylaws that are antiquated, cumbersome, confusing, and redundant. Bylaws amendment No. 3 relates to the composition of the AAOS Nominating Committee. In a recent AAOS Now article, AAOS President Joseph A. Bosco III, MD, FAAOS, summarized: “We recommend that the AAOS Fellowship carefully review the three bylaws amendments. We encourage each Fellow to cast their ballot and participate in this important process for their Academy. It is vital that each of your voices are heard.” AAOS First Vice President Daniel K. Guy, MD, FAAOS, shared his perspective on the proposed bylaws amendments during a recent webinar.

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Study Examines Aspirin for VTE Prevention in Revision THA

A retrospective study published online in The Journal of Arthroplasty observed favorable safety and efficacy outcomes for the use of aspirin to prevent venous thromboembolism (VTE) in patients undergoing revision total hip arthroplasty (THA). Between 2011 and 2019, 1,361 consecutive revision THAs were performed at a large academic medical center. The institution implemented a new protocol for VTE prophylaxis in standard-risk arthroplasty patients in 2017. The old protocol called for aspirin 325 mg twice daily (BID) (n = 973), while the new protocol called for aspirin 81 mg BID (n = 388). Among the surgeries performed under the old protocol, 13 cases of VTE were diagnosed (1.34 percent); three (077 percent) were diagnosed under the new protocol. No significant between-group differences were observed in postoperative pulmonary embolism (PE), deep vein thrombosis (DVT), PE and DVT, and total VTE. Bleeding complications, infection rate, and mortality also did not largely differ.

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A study published in the April issue of JAAOS: Global Research and Reviews ® examined recent trends in various payments for common orthopaedic procedures. The investigators explored: (1) total net payments (for episode of care), (2) payments to hospitals, (3) payments to physicians, (4) payments to physicians as a percentage of total net payments, and (5) regional variation in hospital and physician payments for four common orthopaedic procedures, which included primary THA (n = 128,269), total knee arthroplasty (TKA) (n = 223,319), one-level anterior cervical diskectomy and fusion (ACDF) (n = 51,477), and one-level lumbar-instrumented posterior spinal fusion (PSF) (n = 45,680). Inflation-adjusted total net payments for the episode of care increased per year the most for ACDF (5.2 percent), followed by PSF (3.2 percent), TKA (2.9 percent), and THA (2.6 percent). For all four procedures, significant increases were observed in annual inflation-adjusted hospital payments; however, annual inflation-adjusted physician payments per year decreased for all four procedures: PSF, –2.2 percent; TKA, –1.5 percent; THA, –1.1 percent; and ACDF, –0.4 percent. Physician payments as a percentage of total net payments significantly decreased for ACDF (–4.6 percent), PSF (–3.1 percent), TKA (–2.1 percent), and THA (–1.8 percent).

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A study published in the May issue of the Journal of Shoulder and Elbow Surgery used MRI to assess medial joint opening and ulnar collateral ligament (UCL) injury severity and compared the injured versus uninjured elbow with valgus stress radiography. Two raters independently took medial joint space measurements in 74 patients experiencing throwing-related medial elbow pain. UCL injury severity was determined using available imaging into intact UCLs, partial-thickness tears of the anterior bundle, or full-thickness tears of the anterior bundle. There was a correlation between joint gapping and UCL injury severity; a difference was observed among tear severity groups. The relationship between excess opening and UCL injury severity was not significant. Overall, 22 percent of patients presented a negative excess opening, but there were no significant factors corroborating guarding or a mechanical explanation for a decreased medial joint opening of the injured elbow versus the uninjured elbow.

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A study published in the April issue of Foot & Ankle International analyzed return to weight-bearing and high-impact activities after Jones fracture intramedullary screw fixation. A single surgeon treated 32 consecutive Jones fracture patients. The main outcomes included times to return to full weight-bearing, radiographic union, and resumption of high-impact or restriction-free activities. All fractures healed with no significant events; at a mean follow-up of 24.2 months, patient satisfaction was 100 percent. The following mean postoperative outcomes were reported: return to full weight-bearing, 3.7 weeks; radiographic union, 10.8 weeks; and resumption of restriction-free activities, 13.0 weeks.

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A retrospective study published in the May issue of The Journal of Hand Surgery assessed the use of a silicone implant after failure of primary trapeziometacarpal (TMC) surgery. Between January 2005 and December 2015, 22 Tie-in silicone implants were performed after failed TMC surgery. Analysis included time from implantation to date of diagnosis of the failed revision procedure (rupture, major wear, dislocation, poor clinical tolerance). Median survival was 2.15 years; all but three patients did not show wear, and one of the no-wear patients was lost to follow-up after one year. Implant rupture was observed in 10 cases, implant instability (subluxation or dislocation) in five, abnormal wear in three, and residual pain in one; 42 percent of failures were correlated with silicone synovitis.

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AAOS Develops Resource to Guide Members Through the COVID-19 Pandemic

Unprecedented times call for unprecedented actions. AAOS has sought to provide guidance to its members during these challenging and uncertain times. On April 17, the Academy released “AAOS Clinical Considerations During the COVID-19 Pandemic” as a useful guide to assist members navigating the COVID-19 pandemic. The guidance covers topics such as general considerations, resumption of clinical care with risk stratification of services (e.g., telehealth; in-person, socially distant services; in-person, nonsocially distant services; and elective surgery), patient safety, staff safety, and clinical “need” and “benefit” considerations, as well as velocity of return to site-of-care guidance.

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