Prior COVID-19 Diagnosis Increases Risk of VTE in TJA Patients Aged >65 Years
According to a study in the Journal of Arthroplasty, prior COVID-19 diagnosis was associated with increased risk of venous thromboembolism (VTE) in patients aged >65 years undergoing total joint arthroplasty (TJA). Incidence of VTE, deep vein thrombosis (DVT), and pulmonary embolism (PE) were assessed from a national dataset spanning 2016 to 2021. There were 2,422,051 total hip (THA) and knee arthroplasty (TKA) cases analyzed. VTE prevalence decreased from 2.2 to 1.9 percent (THA) and 2.5 to 2.2 percent (TKA). Prior COVID-19 was associated with significantly increased odds of VTE in TKA patients, but not DVT or PE.
Significant Loss of Skeletal Muscle Mass after Femoral Fragility Fracture
The Journal of Bone and Joint Surgery published a prospective study that examined the change in skeletal muscle mass and relationship with malnutrition and physical function in patients aged ≥65 years after femoral fragility fracture. Skeletal muscle mass was assessed within 72 hours of admission and at 6 weeks, 3 months, and 6 months. Physical function was measured using the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function domain. Age >75 years was associated with lower skeletal muscle mass. A 1-kg decrease in skeletal muscle mass was associated with an 8-point decrease in the Physical Function score.
Study Investigates Prevalence of Knee Instability in Patients with ACL Injury and Concomitant Lateral Meniscus Tear
According to a case-cohort study in the Journal of Knee Surgery, lateral meniscus tear (LMT) comorbid with ACL injury was associated with increased residual rotatory knee instability (RKI) one year after ACL reconstruction (ACLR). A total of 327 patients were divided into three groups: intact lateral meniscus (LM), unrepaired LMT, and repaired LMT. RKI was observed more in the LMT group (13.8 percent) versus the intact LM group (8.1 percent). Furthermore, the prevalence of RKI was significantly higher in the repaired LMT than in the intact LM group (17.7 percent versus 8.1 percent)
Study: Longer Instrumented Levels Are a Risk Factor for Distal Junctional Problems
Orthopaedic Surgery published a retrospective study that sought to identify risk factors associated with distal junctional problems (DJPs) following long construct-based treatment for degenerative lumbar scoliosis (DLS). A total of 182 patients with DLS were analyzed. Of these patients, 13.2 percent experienced a DJP postoperatively, and the reoperation rate was 88 percent. Longer instrumented levels, preoperative sagittal vertical axis, and a smaller pelvic tilt were found to be strongly associated with the presence of DJPs.
The Center for Medicare & Medicaid Services’ Quality Payment Program’s Merit-Based Incentive Payment System (MIPS) program once again requires an application be submitted to qualify for the Extreme and Uncontrollable Circumstances (EUC) Exception. This change applies for the 2023 performance year. While COVID-19 can still be used as an exception, an application must be submitted by Jan. 2, 2024. This applies to clinicians, groups, virtual groups, and Alternative Payment Model (APM) entities requesting a reweighting of the MIPS performance categories because of COVID-19 impacts. The application is open to participating clinicians reporting traditional MIPS, MIPS Value Pathways, or the APM Performance Pathway.
The Use of Patient-reported Outcomes Has Evolved across Orthopaedic Subspecialties
In a time of value-based healthcare, patient-reported outcomes (PROs) are becoming the standard for outcome evaluation among many surgical subspecialties. PROs are quantifications of patient characteristics such as functional status, quality of life, and overall patient health that come directly from the patient (or a qualified proxy). This article explores trends in the use of these measures across orthopaedic subspecialties and looks to the way these tools may be utilized in the future as the landscape of value-based care expands.
AAOS is gearing up to initiate work on two brand-new Clinical Practice Guidelines (CPGs): “The Management of Shoulder Instability” and “The Management of Osteoarthritis of the Ankle.” AAOS is actively looking for dedicated volunteers to join the development work groups. Work group participants will be responsible for crafting PICO (patient/population, intervention, comparison, outcome) questions, reviewing literature, and drafting recommendations, among other tasks. If you are interested in contributing to either of these significant projects, you are invited to apply. Applications will be reviewed and approved on a first come, first served basis.
Whether you are a resident, early in your career, or a seasoned surgeon, it is important to stay current with the latest in coding. Listen in to the two-part podcast “Coding Matters: Understanding the Ever-Evolving Landscape,” featuring host Daniel Cognetti, MD, and orthopaedic coding expert Shannon DeConda. They discuss the general principles of coding and some of the more common errors. You will also get an update on new rules and the latest developments in coding.
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