Today’s Top Story

Study: Risk factors for PJI-related revision in hip replacement patients

A study published online in The Lancet Infectious Diseases found that modifiable and nonmodifiable factors may play a role in prosthetic joint infection (PJI) in total hip replacement patients. The prospective, observational cohort study included 2,705 primary hip procedures that were revised due to PJI between 2003 and 2014. The following were associated with an increased need for PJI-related revision: male sex, younger age (< 60 years old), elevated body mass index (≥ 30 kg/m 2), diabetes, dementia, previous septic arthritis, fractured neck of femur, and use of the lateral surgical approach. Use of ceramic rather than metal bearings was associated with a decreased risk of revision. Researchers noted that most factors had time-specific effects. The grade of the operating surgeon, absence of a consultant surgeon during surgery, and volume of procedures performed by the hospital had little to no impact on PJI risk.

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Other News

Study associates perioperative statin use with lower delirium following TKA

A retrospective study published online in The Journal of Arthroplasty found that total knee arthroplasty (TKA) patients under spinal anesthesia who receive continuous perioperative statin may be at a decreased risk of postoperative delirium (POD). Of 6,020 procedures that took place at a single tertiary care hospital between January 2005 and October 2017, statins were used perioperatively in 16.4 percent (n = 992), and just 5 percent of patients experienced POD (n = 304). Patients receiving statins had a 1.7 percent significant lower incidence of POD (n = 35, 3.5 percent) than those who did not receive statins (n = 1,420/5,028, 5.4 percent). POD incidence was 34 percent lower in the statin group. The use of atorvastatin and simvastatin decreased the presence of POD by 37 percent and 79 percent, respectively.

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Insurers stop covering OxyContin

Blue Cross Blue Shield of Tennessee, the state’s largest insurer, announced it will no longer cover prescriptions for OxyContin beginning Jan. 1, 2019. The company, according to a report, will encourage doctors to prescribe alternative pain relievers that are more difficult to abuse. Purdue Pharma, the drug’s manufacturer, said it has taken steps to make OxyContin more difficult to misuse. Blue Cross Blue Shield of Tennessee’s decision follows Cigna and UnitedHealthcare, which both stopped covering OxyContin last year, and Florida Blue, which ended coverage at the start of 2018.

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Study: Effects of osteotomy with lateral soft-tissue release for hallux valgus

A meta-analysis published online in Foot and Ankle Surgery found that patients treated for hallux valgus may benefit from transection of the lateral sesamoido-metatarsal ligament (LSML). Researchers analyzed six comparative clinical studies that included 425 patients (549 feet). Patients were divided into two groups: those with osteotomy alone and those with osteotomy with lateral soft-tissue release (LSTR). Patients experienced significantly better hallux valgus angle correction when the LSML was released. Intermetatarsal angle difference was also positively correlated with LSTR.

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Study: Costs and collections for trauma patients who undergo fracture surgery

A retrospective study published in the September issue of the Journal of Orthopaedic Trauma assessed initial inpatient management costs for 440 consecutive adult trauma patients (mean age, 41 years) undergoing fracture surgery. Patients were mostly white (63.2 percent) and male (74.3 percent), with a mean injury severity score of 18.5. Thirty-five percent of patients were uninsured (self-pay), and 34.5 percent were unemployed. Total professional charges were $12,382,028 ($28,140/patient), and technical charges were $39,682,225 ($90,187/patient). Initial charges were associated with injury severity score, longer lengths of stay, and the presence of a complication. Total professional collections were $2,418,096 ($5,496/patient) and technical collections were $16,921,959 ($38,459/patient). Collections were predicted in female, employed, and insured patients. Among the self-pay group, 34.4 percent did not have collections, leading to $2,513,988 in potential lost revenue.

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Study indicates swabbing for MRSA does not lower SSI rates in pediatric spine patients

Presurgical testing for methicillin-resistant Staphylococcus aureus (S. aureus) (MRSA) colonization with intranasal swabs is performed commonly, but a study published in the Sept. 1 issue of the Journal of the AAOS involving pediatric spinal fusion patients found that MRSA swab results did not change treatment or outcome. Despite mixed outcomes for the overall surgical site infection (SSI) rate, the studies all demonstrated successful reduction of endogenous S. aureus SSI in MRSA-colonized patients treated with intranasal mupirocin.

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ResStudy provides residents with more than 3,700 questions to advance learning

ResStudy now offers more exclusive content for residents, with questions from six years of Orthopaedic In-Training Examinations, Orthopaedic Knowledge Update (OKU) self-assessment examinations, and multiple Special Interest Exams across 11 topics. Residents have access to more than 3,700 questions from AAOS self-assessment exams exclusively available on ResStudy, which is now accessed on the new AAOS online learning platform, with a mobile-friendly and highly visual interface.

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