November 12, 2021 | Today’s News

Study: Elevated Preoperative HbA1c Is Associated with Increased Episodic Costs in TJA

Hemoglobin A1c (HbA1c) levels above 7.5 percent are associated with increased episode-of-care costs, complications, and readmissions after total joint arthroplasty (TJA), according to a study published in the Nov. 15 issue of the Journal of the AAOS ®. In total, 9,511 TJA cases were retrospectively reviewed. Diabetic patients had higher episodic costs than patients without diabetes ($20,577 versus $19,414; P <0.001). Higher HbA1c levels were associated with increasing mean episode-of-care costs, and HbA1c >7.5 percent was associated with higher costs and increased rate of complications and readmissions compared with patients with lower HbA1c.

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Study: High Risk of Implant Impingement, Notching with Thick Femoral Neck Implants in Ceramic-on-ceramic THA

A retrospective study published in Clinical Orthopaedics and Related Research reported a high rate of neck–ceramic impingement and ceramic component fracture after use of a thick-neck stem design implant in ceramic-on-ceramic total hip arthroplasty (THA). In total, 456 patients with ≥10 years of follow-up were included. Eleven percent of patients demonstrated stem neck notching. Notching was more common in implants with a 28 mm head rather than a 32 mm head. Nine implants had ceramic head fracture, all with 28 mm heads. At 13 years, survivorship free from revision was 97 percent and free from reoperation for any cause was 96 percent.

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A small proportion of young athletes who undergo ACL reconstruction (ACLR) met Knee Injury and Osteoarthritis Outcome Score (KOOS) functional recovery target values derived from uninjured counterparts, according to a study published online in Knee Surgery, Sports Traumatology, Arthroscopy. Using registry data, investigators derived recovery targets from KOOS outcomes among 56 uninjured athletes aged around 17 years. For 166 ACLR patients, at return to sport clearance, 63 percent met Pain target values, 42 percent met Symptoms, 80 percent met Activities of Daily Living, 45 percent met Sports, and 24 percent met Quality of Life target values. Younger age, hamstring graft, pediatric ACLR, and limb symmetry were significant predictors of overall functional recovery.

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A study published online in the Journal of Hand Surgery investigated patient concerns regarding Wide-awake Local Anesthetic No Tourniquet (WALANT) hand surgery. Fifteen patients with diagnoses of carpal tunnel syndrome, trigger finger, or De Quervain’s tenosynovitis were interviewed. Eight patients reported concerns with being “knocked out” and/or emerging from anesthesia Patient-surgeon trust was a recurring theme regarding anesthesia use. Participants reported not wanting to feel, see, or hear the procedure, or preferring distracting music or conversation. Patients interested in WALANT valued the decreased time commitment and the avoidance of side effects.

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In response to the ongoing COVID-19 public health emergency, the Centers for Medicare & Medicaid Services (CMS) announced this week that it will automatically apply the extreme and uncontrollable circumstances policy to all Merit-based Incentive Payment System (MIPS)–eligible clinicians reporting individually for performance year 2021. Notably the policy does not apply to groups, virtual groups, or Alternative Payment Model (APM) Entities. The automatic policy reweights all performance categories to 0 percent so the clinician will receive a final score equal to the performance threshold and therefore avoid a negative payment adjustment for the 2023 payment year. Additionally, individual clinicians will receive a neutral payment adjustment unless they either submit data in two or more performance categories, or have a higher final score from group or APM Entity participation.

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Two Studies Presented at Annual Meeting Draw on Shoulder & Elbow Registry Data to Analyze Arthroplasty Trends

Two studies presented at the AAOS 2021 Annual Meeting in San Diego demonstrated that, in its relatively brief history, the AAOS Shoulder & Elbow Registry (SER) already has yielded valuable findings from its data. One of the studies, by Joaquin Sanchez-Sotelo, MD, PhD, and colleagues, addressed the current comparative use of anatomic and reverse shoulder arthroplasty in the United States. The other, by John E. Kuhn, MD, MS, and colleagues, explored off-label use of reverse shoulder arthroplasty.

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AJRR Releases 2021 Annual Report, Showing Increase in Number of Hip and Knee Procedures Despite Pause Due to COVID-19

The American Joint Replacement Registry (AJRR), the cornerstone of the AAOS Registry Program, released its 2021 Annual Report on hip and knee arthroplasty procedural trends and patient outcomes today at the American Association of Hip and Knee Surgeons’ 2021 Annual Meeting in Dallas. Despite the disruption to the delivery of joint replacement care during the initial impact of the COVID-19 pandemic (most markedly, March through May 2020), procedures rebounded to historic averages by June 2020. Even with the temporary decline in procedures, the report demonstrates an overall cumulative procedural volume growth of 18.3 percent compared with the previous year and includes findings from 2,244,587 hip and knee arthroplasty procedures performed between 2012 and 2020.

Download the AJRR 2021 Annual Report…