Study Analyzes Effect of Medicare CJR Model on Joint Replacement Patients by Race
A study published online in JAMA Network Open assessed the impact of Medicare’s Comprehensive Care for Joint Replacement (CJR) model on joint replacement patients by race. Medicare claims from 2013 through 2017 on white, Black, and Hispanic joint replacement patients at 67 CJR-participating treatment and 103 control metropolitan statistical areas were retrospectively reviewed. Final analysis incorporated 688,346 patients. Compared to pre-CJR, all three groups saw decreases in discharge to institutional post-acute care. For Black patients, a 3.1 percentage point decrease was observed. CJR decreased the gap between Black and white patients in discharge to institutional post-acute care by 3.4 percentage points.
Study Assesses Impact of Dexamethasone in PNBs on Nerve Function Recovery
A study published online in Foot & Ankle International found that perineural dexamethasone added to peripheral nerve blocks (PNBs) may slow down nerve function recovery in foot and ankle surgery patients. A total of 250 patients from a single foot and ankle surgeon’s practice were retrospectively reviewed; 117 received dexamethasone and 133 received ropivacaine alone. Nerve injury rates did not largely differ between the dexamethasone (62 percent) and ropivacaine-only (59 percent) groups, but the dexamethasone patients were more likely to have persistent symptoms of nerve injury that did not fully recover (65 percent versus 41 percent, respectively).
A study published online in the Orthopaedic Journal of Sports Medicine compared outcomes between total shoulder arthroplasty (TSA) patients with versus without a history of rotator cuff repair (RCR). Among 14 patients (mean age, 65.1 years) who underwent ipsilateral reverse shoulder arthroplasty before TSA, American Shoulder and Elbow Surgeons (ASES) scores improved from 42.9 to 78.5 at two years and 86.6 at five years postoperatively. When RCR patients were matched 1:3 to 42 controls, ASES scores did not largely differ at two (78.5 versus 853) and five years (86.6 versus 90.9).
Study Evaluates Use of Telemedicine After Upper Extremity Surgery
A study published in the September issue of The Journal of Hand Surgery reviewed the implementation of a telemedicine program for postoperative hand and upper extremity surgery care. The study incorporated patients indicated for outpatient surgery over a three-month period. Patient satisfaction was reviewed for the telemedicine and in-person visit. Fifty-seven patients took part in the study. Most patients used a cell phone (89 percent) and were in their own home (88 percent). Four technological complications (7 percent) took place. In-person visits were more than five times longer than telemedicine visits (38 minutes versus 7 minutes). Four clinical complications occurred, and all were identified during the telemedicine visit.
Study Compares Robot-assisted Versus Free-hand Pedicle Screw Placement
A systematic review and meta-analysis published online in The Spine Journal observed good outcomes for robot-assisted pedicle screw placement. A search of electronic databases spanning 1980 through 2020 yielded 19 studies encompassing 1,525 patients (7,379 pedicle screws); 777 patients (51 percent; 3,684 pedicle screws) underwent robot-assisted surgery. Robot-assisted surgery, compared to conventional free-hand, had significantly superior perfect pedicle screw accuracy, as well as clinically acceptable pedicle screw accuracy. Robot-assisted surgery was associated with significantly lower complication rates and proximal-facet joint violation. Intraoperative radiation time and radiation dosage were significantly lower in robot-assisted procedures compared to free-hand. Operative time was significantly longer in robot-assisted procedures.
Marijuana Use Delays Time to Union in Trauma Fractures
A study presented at the virtual Annual Meeting of the Pediatric Orthopaedic Society of North America retrospectively reviewed patients aged 10 to 18 years who were treated for common fractures at a level 1 pediatric trauma center. Among those who were marijuana users, average time to union was markedly higher. In surgically treated patients, marijuana users demonstrated a significantly longer time to union compared to nonusers.
AAOS announced a plan to launch a Fracture & Trauma Registry (FTR) and begin collecting data on five of the more common fractures in the United States. The FTR marks the first AAOS registry built on a synergistic approach where collaborative modules will be available across the RegistryInsights® platform, offering expanded crossover benefits to AAOS Registry Program participants. The FTR will begin with a limited invitation to key sites late this year with full participant enrollment in the spring of 2021.
