Study: Factors Associated with Postoperative PROMs in TKA Patients
A study published in the September issue of The Journal of Arthroplasty found a correlation between kinematic factors and postoperative patient-reported outcome measures (PROMs) in total knee arthroplasty (TKA) patients. Researchers simulated deep knee bend kinematics for 96 postoperative TKA patients and measured the Knee Injury and Osteoarthritis Outcome Score (KOOS) 12 months postoperation. They observed significant nonlinear relationships between these scores and rollback and dynamic coronal alignments. The “kinematic safe zone” was determined to be coronal angular change from extension to full flexion between zero and 4 degrees varus and measured rollback ≤ 6 mm without rollforward. The postoperative KOOS score was 10.5 points higher.
The presence of a hip effusion on an MRI screening in a femoral neck fracture may be a risk factor for fracture progression, according to a study published in the Sept. 5 issue of The Journal of Bone & Joint Surgery. Researchers identified 305 patients with femoral neck stress fractures who were treated between 2002 and 2015. At initial MRI, 54.4 percent of patents had edema with a fracture line, and 45.6 percent had isolated edema. At a mean follow-up of six weeks, 194 patients underwent interval MRI, and 13.9 percent of these patients had fracture progression. Among those who required operative treatment, 852 percent had an effusion on the initial MRI compared to 26.3 percent who showed nonoperative resolution at the interval MRI. Patients with a hip effusion were eight times as likely to have fracture progression requiring surgical fixation compared to those without a hip effusion.
Study: Association Between One-year Functional Outcomes in Older Patients and STTGMA Scores
A prospective cohort study published in the September issue of the Journal of Orthopaedic Trauma found that scores for trauma triage in the geriatric and middle-aged (STTGMA) may be indicative of functionality one year after discharge. Researchers assessed data from 685 orthopaedic surgery and trauma surgery consults (> 55 years) in the emergency department between Jan. 10, 2014, and Sept. 30, 2015. At one year, 38.7 percent of patients were successfully contacted (n = 247). The mean STTGMA score was 2.1 percent, and patients had an average 76.4 percent return to presurgery functionality. EQ-5D scores were significant predictors of percent return to baseline.
Study: EMR Systems May Have Adverse Effects on Costs and Provider-patient Interaction
The implementation of an electronic medical records (EMR) system could lead to short-term increased labor costs and long-term reduced physician-patient interaction, according to a study published online in The Journal of Bone & Joint Surgery. Researchers prospectively timed 143 patients throughout their clinic visits prior to hospital-wide implementation of an EMR system and then again two months, six months, and two years after implementation. At two months post-implementation, total labor costs per patient visit increased significantly from $36.88 to $46.04 due to greater lengths of time surgeons spent per patient (from 9.38 minutes to 10.97 minutes, increasing the cost from $21.10 to $27.01) and increased time certified medical assistants spent assessing patients (from 3.4 minutes to 9.1 minutes). Documentation of patient encounters also took twice as long after two months (from 3.3 minutes to 7.6 minutes). Total labor costs returned to similar rates seen prior to implementation at six months (from $36.88 to $38.75) and two years (from $36.88 to $37.73). Encounter documentation remained longer than pre-implementation (from 3.28 minutes to 8.43 minutes) and provider-patient interaction time decreased (from 14.65 minutes to 10.03 minutes).
Virginia to Implement Work Requirements and Premiums for Medicaid Recipients
Virginia may add work rules and premiums to its Medicaid program. If enacted, non-exempt Medicaid beneficiaries would have to participate in 20 hours of work-related activities a month for three months. The number of required hours would increase overtime and eventually hit 80 a month. Medicaid enrollees above the federal poverty level would be required to pay a monthly premium. Those with incomes equal to or 125 percent of the federal poverty level would pay $5/month, and those with incomes between 126 percent and 138 percent of the federal poverty level would pay $10/month. Those aged under 19 years or older than 64 years, post-secondary education students, and those simultaneously enrolled in Medicaid and Medicare would be exempt from the work requirement and the monthly premium.
AAOS AUC Guide Residents’ Decision-making in the Acute Treatment of Distal Radius Fractures
Distal radius fractures (DRFs) are among the most common injuries in orthopaedic practice and account for up to 20 percent of the fractures treated in the emergency department (ED). In 2013, AAOS developed appropriate use criteria (AUC) for DRFs to help orthopaedic providers determine treatment of specific distal radius injury patterns. The criteria were developed with a combination of the best available evidence and clinical expertise. The AAOS AUC for DRFs are a valuable tool that can greatly simplify residents’ decision-making process in the ED and improve patient satisfaction.
Last Call: Apply for the ACGME Review Committee for Orthopaedic Surgery
The Accreditation Council for Graduate Medical Education (ACGME) Review Committee for Orthopaedic Surgery has an open member position, a six-year term that runs from July 1, 2020, to June 30, 2026. Candidates must have expertise or fellowship training in either oncology or spine. The last day to submit an application is Sept. 28.
