Today’s Top Story

Study compares costs of THA versus nonsurgical management based on BMI

Total hip arthroplasty (THA) may be more cost-effective than nonoperative management (NM) regardless of patients’ body mass index (BMI), according to a long-term study published online in The Journal of Arthroplasty. Researchers used a state-transition Markov model that included direct medical costs, but not indirect societal costs, to compare the THA and NM cohorts among six BMI groups in patients > 15 years old. The two highest BMI groups had higher incremental costs and quality-adjusted life years (QALY), but THA was still considered cost-effective among these cohorts. The incremental cost-effectiveness ratios (ICER) for the six BMI groups were:

1.    normal weight (BMI, 18.5–24.9 kg/m2): $6,043/QALY

2.    overweight (25–29.9 kg/m2): $5,770/QALY

3.    obese (30–34.9 kg/m2): $5,425/QALY

4.    severely obese (35–39.9 kg/m2): $7,382/QALY

5.    morbidly obese (40–49.9 kg/m2): $8,338/QALY

6.    super obese (≥ 50 kg/m2): $16,651/QALY

With an ICER threshold of $50,000/QALY, researchers said that THA was more cost-effective than NM in 100 percent of normal weight, overweight, obese, severely obese, and morbidly obese simulations, and in 99.95 percent of super obese simulations. Researchers theorized that BMI cutoffs for THA may contribute to unnecessary loss of healthcare access.

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Other News

Study: Long-term survival, functionality of cementless Oxford unicompartmental knee replacement

A cohort study published online in the journal The Knee found that the cementless Oxford unicompartmental knee replacement (OUKR) may be a safe alternative to unicompartmental knee replacements with cement. Researchers measured clinical outcomes and survival among the first 1,000 consecutive cementless medial OUKRs implanted at one independent and one designer center. The 10-year survival was 97 percent, and only 25 knees required revision. The most common reason for revision was progression of arthritis laterally (n = 9), followed by primary dislocation of the bearing (n = 6). After a seven-year mean follow-up, the mean Oxford Knee Score went from 23 to 42. Survivorship and clinical outcomes were not significantly different between the two centers.

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Study identifies genetic factors that influence bone mineral density

A large–scale meta-analysis of genome-wide association studies published online in The BMJ identified 15 genetic determinants associated with increased fracture risk. The study included 37,857 fracture cases in patients older than 18 years and 227,116 controls. All 15 fracture-associated loci were also associated with bone density, the only clinical risk factor that showed a major causal effect on fracture. Hand grip strength was insignificantly associated with fracture risk. No other risk factors, including lower levels of vitamin D and estimated calcium intake from dairy sources, were linked to fracture risk. Researchers concluded that increasing bone density may be the most clinically effective intervention to decrease fracture risk.

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Study: Assessment of three treatment options for large and massive rotator cuff tears

A prospective comparative study published in the September issue of the Journal of Shoulder and Elbow Surgery found that surgery may be a better option than patch augmentation or débridement and biceps tenotomy to repair large-to-massive rotator cuff tears. Thirty-two patients diagnosed with large-to-massive rotator cuff tears were evaluated pre- and postoperatively at three, six, 12, and 24 months using the Constant-Murley score Three treatments were used: arthroscopic complete repair (repair group), open repair and xenograft patch augmentation (patch group), and arthroscopic débridement and tenotomy of the long head of the biceps (débridement group). Mean improvements in the Constant-Murley score were +29.1 for the repair group, +32.2 for the patch group, and +20.1 for the débridement group. Five complications occurred in 11 patients in the patch group. There was one complication in the repair group and none in the débridement group.

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Study: PROs following ATR vary depending on time to operation

Surgery for acute Achilles tendon rupture (ATR) within 48 hours of injury was associated with better patient-reported outcomes (PROs) compared to patients who waited 72 hours, according to research published online in The American Journal of Sports Medicine. The cohort study retrospectively assessed 228 patients with ATR who were treated with uniform anesthetic and surgical techniques within 10 days of injury. Patients were divided into three cohorts: short time from injury to surgery (TTS) (< 48 hours), intermediate TTS (48–72 hours), and long TTS (> 72 hours). PROs were assessed at one-year follow-up using a 100-point scale Achilles tendon Total Rupture Score; a score > 80 points indicated a good outcome. Seventy-one percent of patients in the short TTS cohort had a good outcome compared to 63 percent of the intermediate TTS and 44 percent of the long TTS groups. Short TTS patients were significantly less likely to experience adverse events (1.4 percent) than intermediate TTS (11 percent) and long TTS (14.8 percent) patients. The risk of deep vein thrombosis was not significantly different among the groups.

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U.S. News & World Report announces updates to its online physician profiles

In 2017, during a forum held at the AAOS Annual Meeting, representatives from U.S. News & World Report introduced the publication’s plan to publish individual hip and knee surgeon performance analyses. The purpose, they explained, is to provide patients with decision support and better reflect the quality of care that orthopaedic surgeons provide. Recently, the publication shared with AAOS two additional updates to its physician-level public reporting activities.

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Apply for Biomedical Engineering Committee member position

The Biomedical Engineering Committee has an open member position, a two-year term that runs from March 17, 2019, through March 21, 2021. The committee monitors and reviews scientific regulatory developments in the field of biomedical engineering as they relate to orthopaedic surgery. The deadline to apply is Oct. 13.

Learn more and submit your application…(member login required)