Today’s Top Story

Study: C-reactive Protein/Albumin Ratio Predicts Complications in PJI Revision

A higher preoperative C-reactive protein/albumin ratio (CAR), particularly in combination with serum and synovial fluid markers, is associated with significantly greater risk of infection and 30- and 60-day readmission after revision total joint arthroplasty for periprosthetic joint infection (PJI), according to a study published in the Oct. 15 issue of the Journal of the AAOS ®. In total, 213 patients were analyzed. There was a statistically significant relationship between mean CAR and risk of readmission and reinfection (P <0.01).

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In Other News

Study: Post-TKA Coronal Alignment and Tibial Migration in Varus and Valgus Knees

A systematic review published online in the Journal of Bone and Joint Surgery reported that postoperative coronal alignment did not significantly impact tibial migration at two years after total knee arthroplasty (TKA) in patients with a varus or valgus knee. Ten randomized controlled trials were analyzed. Of 476 TKA implants, 290 had in-range hip-knee-ankle angles and 186 were out-of-range postoperatively. Differences in mean migration at three, 12, and 24 months were not statistically significant (P = 0.07). Uncemented-uncoated implants demonstrated significantly greater migration compared to all other fixation methods (P <0.001).

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Study: Ten-year Clinical Outcomes and Satisfaction after RSA

In a large cohort of patients with a minimum of 10 years of follow-up, reverse shoulder arthroplasty (RSA) demonstrated clinically significant and durable improvements in pain and function. However, the authors noted, rates of complications and revisions were higher than previous reports. This study was published in the Journal of Shoulder and Elbow Surgery. In total, 471 patients were assessed. Function or pain did not deteriorate between mid- and long-term follow-up, according to Single Assessment Numeric Evaluation and pain scores. The prosthesis survival rate was 88 percent at five years and 81 percent at 10 years.

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Study: Hardware Removal after Plate Fixation of Olecranon Fractures

A retrospective study published online in Current Orthopaedic Practice reported a 20.2 percent rate of symptomatic hardware removal after fixation with a plate and screw for isolated olecranon fractures. Eighty-four patients were assessed. Removal occurred at a mean of 326 days postoperatively. Patients requiring removal tended to be younger than those who retained their hardware (mean, 40.0 versus 49.4 years, respectively). Removed hardware was fixated an average of 1.3 mm further from the olecranon tip compared to retained hardware. Plates placed more than 2 mm from the olecranon tip were 8.2 times more likely to require removal.

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Lawmakers Push the Administration to Amend Surprise Billing Policies

Since the release of the second interim final rule regarding the No Surprises Act, intended to address surprise medical billing, lawmakers and physician groups, including AAOS, continue to push the Biden administration to amend its policies before the law takes effect on Jan. 1, 2022. They argue the new regulation does not adhere to the legislation passed in 2020 and incorrectly prioritizes the insurer-formulated median in-network rate over all other factors when adjudicating a payment dispute. Instead, lawmakers assert, the regulation should instruct the arbiter to consider all the factors outlined in the statute equally. AAOS is supportive of efforts by Representatives Tom Suozzi (D-N.Y.) and Brad Wenstrup (R-Ohio), who are leading a letter to the administration making this request, which is currently collecting congressional signatories. AAOS will also send a letter to the administration demanding that the law be correctly implemented.

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Learn more about AAOS advocacy on the issue…

 
 
 
AAOS Now

October Issue of AAOS Now is Now Online

AAOS members will soon receive the print edition of the October issue of AAOS Now, but the electronic edition is already available on the AAOS Now website. This month’s issue discusses the implementation of care pathways using clinical practice guidelines, how the upcoming Medicare pay cuts may impact orthopaedic surgeons, and the imperative to increase diversity in orthopaedics.

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Your AAOS

New AUC on Distal Radius Fractures Builds on Clinical Practice Guideline

The AAOS Board of Directors approved the release of a new set of Appropriate Use Criteria (AUC) on the Treatment of Distal Radius Fractures. As with other AAOS AUC, this resource provides clinician with an algorithm-style tool for choosing treatment pathways based on the patient’s presenting indications as entered by the clinician. The treatment scenarios provided by an AUC arise from the recommendations in a Clinical Practice Guideline (CPG)—in this case, the completely revised CPG on the Management of Distal Radius Fractures approved by the Board in December 2020.

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