AAOS Now, AAOS Now Special Edition 2020
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Orthopaedic Intervention after Hip Fragility Fractures Yields Successful Treatment for Underlying Osteoporosis
A study of patients with hip fractures found that three-quarters of those enrolled in an intervention for osteoporosis management were on the correct treatment four months after hip fracture versus just 6 percent who were assigned to a control group.
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Number of Opioids Prescribed after Hip Arthroscopy Does Not Impact Opioid Utilization
There is no standard recommendation for the number of opioids to prescribe after many surgical procedures, and previous studies have found that the number of opioids prescribed influences the number of pills consumed.
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Smoking Significantly Increases Complications after Hip Arthroscopy
Tobacco use is associated with significantly increased rates of surgical and medical complications within six months after hip arthroscopy, according to a study presented by Peter Goljan, MD.
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Deep Peroneal Neurectomy for Midfoot Arthritis Shows Good Early Outcomes
Patients with midfoot arthritis experienced a significant improvement in pain and function after deep peroneal neurectomy, according to a study presented by Glenn G. Shi, MD, of Mayo Clinic in Florida, as part of the Annual Meeting Virtual Experience.
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What Are the Driving Factors of Hospital LOS in Knee Arthroplasty?
Hospital length of stay (LOS) following total knee arthroplasty (TKA) varies by patient and is dependent on factors pertaining to the patient, hospital, and surgeon. A study examined which of those three factors play the most significant role in determining a patient’s LOS postoperatively.
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This Protocol Reduces SSIs after Pediatric Spinal Surgery
The spine team at Rainbow Babies and Children’s Hospital in Cleveland, implemented a comprehensive, standardized, hospital-wide infection-reduction bundle and observed a statistically significant decrease in the overall rate of SSIs in a pediatric population.
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Study Identifies Factors Associated with Increased Opioid Use by Single-admission Trauma Patients
A study to determine the factors associated with increased postoperative opioid prescription use after a single admission for a single surgery in orthopaedic trauma patients identified a history of opioid use and longer length of surgery as significant.
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Study Reports Large Increase in Hip Prosthesis Dislocations in Past Two Decades
A study that was presented as part of the Annual Meeting Virtual Experience reported that the annual volume of prosthetic hip dislocations presenting to U.S. EDs more than tripled between 2000 and 2018.
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Immediate Weight Bearing Is Safe after Bony Surgery in Cerebral Palsy Patients
Studies assessing weight bearing following single-event, multilevel surgery have yielded variable findings; however, delayed weight bearing can result in weakness, recurrent contractures, loss of independence, social isolation, depression, and delayed rehabilitation.
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Flexor Digitorum Profundus and Flexor Digitorum Superficialis Repair Superior for Zone II Flexor Tendon Repair
A study that was presented as part of the Annual Meeting Virtual Experience compared flexor digitorum profundus (FDP) repair versus FDP and flexor digitorum superficialis (FDS) repair in Hispanic patients with flexor tendon laceration of FDP and FDS in zone II. The researchers concluded that FDP/FDS primary repair was more effective than FDP repair and FDS excision at three months.
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Optimization Protocols for TJA Reduce Prosthetic Joint Infection
Implementation of preoperative optimization protocols for total joint arthroplasty (TJA) was associated with significant reductions in prosthetic joint infection (PJI), according to a study presented as part of the Annual Meeting Virtual Experience.
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Outcome Differences Among THA Approaches Not Clinically Meaningful
A study that was presented as part of the Annual Meeting Virtual Experience evaluated outcomes with three major approaches for primary total hip arthroplasty (THA) and found that a surgical approach was a statistically significant factor for pain at one year but did not have a significant effect on physical function or activity scores or on reoperation rates.
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Infection Most Common Culprit of Revision TKA Failure
Revision total knee arthroplasty (TKA) is becoming increasingly more common, but data regarding failed procedures are not as robust as those pertaining to primary TKA failures.
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Arthroscopic Rotator Cuff Repair Can Be Considered in Older Patients
Risk of degenerative rotator cuff tears increases with older age. Arthroscopic rotator cuff repair can improve function and decrease pain, but retear is a concern for older patients; for that reason, reverse shoulder arthroplasty (RSA) is often performed for large rotator cuff tears without arthritis in this patient population.
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Three Biomarkers Predict Postoperative Pain, Osteoarthritis after Knee Injury
Following injury to the articular surface of the knee, measurable changes in the joint microenvironment can occur, including altered expression of proinflammatory cytokines, matrix metalloproteinases, aggrecanases, growth factors, and apoptotic factors
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Corticosteroid Injection after TKA Increases Infection Risk
According to the researchers, patients who received an injection had a significantly greater risk of periprosthetic joint infection (PJI) versus patients who did not receive an injection.
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Study Finds Ponseti Method Remains an Effective Treatment for Clubfoot, Bracing Is Paramount
A study found that, when performed correctly, the Ponseti method is an effective nonsurgical treatment for clubfoot. Malynda Wynn, MD, of the University of Iowa Hospitals and Clinics, presented the study as part of the Annual Meeting Virtual Experience.
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Limiting Pitch Count Reduces Elbow Injuries in Young Pitchers
Limiting pitch count in youth baseball pitchers resulted in decreased elbow injuries, according to a paper that was presented by Tetsuya Matsuura, MD.
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Single-screw Fixation During Latarjet Procedure Increases Risk of Complications
Graft- and nerve-related complications are relatively common following the Latarjet procedure. Fixation with only one screw was a significant predictor of graft failure, according to a study that Benjamin A. Hendy, MD, of the Rothman Orthopaedic Institute at Thomas Jefferson University Hospitals in Philadelphia, presented as part of the Annual Meeting Virtual Experience.
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Cost-effectiveness Analysis of Anterior Cervical Diskectomy and Fusions at Physician-owned Versus Nonphysician-owned Hospitals
A new study assessed the impact of sanctions imposed by the Affordable Care Act (ACA) on the creation and expansion of physician-owned hospitals (POHs). The researchers compared safety and cost-effectiveness of elective one- to three-level anterior cervical diskectomy and fusions (ACDFs) performed at physician-owned versus nonphysician-owned hospitals. They concluded that not only do ACDFs performed at POHs yield significant cost savings, they also result in fewer 90-day medical complications and readmissions. The findings of the study were presented as part of the Annual Meeting Virtual Experience.
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AI-based Preoperative TKA Plan Is Successful
The use of computer-aided surgery (CAS) in total knee arthroplasty (TKA) has been associated with positive outcomes. However, most manufacturer-provided preoperative plans associated with CAS-based surgeries require revisions, which could take as long as eight minutes. The use of artificial intelligence (AI) could help surgeons cut down on that time.
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Study Probes the Effect of CAM Boots on Ankle and Hindfoot Joint Mechanics
A study assessing the effect of the tall controlled ankle motion (CAM) boot and short CAM boot on contact pressures of the ankle, subtalar, talonavicular, and calcaneocuboid joints found that immobilization in a tall CAM boot significantly reduced the peak contact pressures of the ankle and hindfoot to a greater degree than the short CAM boot. In addition, the greatest decrease in peak contact pressures was seen in the subtalar and talonavicular joints. The study was presented as part of the Annual Meeting Virtual Experience.
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Modified Lapidus Effective in Hallux Valgus for First Ray Pronation
A study demonstrated that in patients undergoing hallux valgus surgery, the modified Lapidus procedure can be an effective tool to change pronation of the first ray. The study, presented as part of the Annual Meeting Virtual Experience, also demonstrated that reduction of the sesamoids was not associated with postoperative first metatarsal pronation, and these should be considered as separate deformities in the treatment of hallux valgus.
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Study Details Increase in Dual Mobility Implant Use in THA
A study analyzing data from the American Joint Replacement Registry (AJRR) and describing utilization trends of dual mobility (DM) articulations in the United States for primary and revision total hip arthroplasty (THA) found that DM utilization increased year over year during the study period across all age groups.
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Study Supports TXA at Admission for Extracapsular Hip Fractures
A study presented by Jennifer R. Sharp, DO, as part of the Annual Meeting Virtual Experience, involving the use of tranexamic acid (TXA) in patients with extracapsular hip fractures found that administration of TXA upon admission led to a statistically significant reduction in the need for blood transfusion.
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Higher Facility Costs Do Not Improve THA and TKA Outcomes
Costs associated with total hip arthroplasty (THA) and total knee arthroplasty (TKA) vary significantly at different facilities. A study presented as part of the Annual Meeting Virtual Experience compared short-term outcomes of THAs and TKAs performed at higher- versus lower-cost facilities and observed no significant differences.
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Allograft MUCL Reconstruction Beneficial Even in Nonathletes
There are vast data on the use of medial ulnar collateral ligament (MUCL) reconstruction in young athletes; however, limited information exists on nonathlete patients seeking functional elbow outcomes.
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Operative Treatment of Medial Epicondyle Fractures in Pediatric Patients Produces ‘Excellent’ Outcomes
After more than six years of follow-up, researchers observed that operative treatment of medial epicondyle fracture in pediatric patients resulted in “excellent” clinical outcomes.
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Preoperative Factors to Consider for Same-day Discharge in TKA
Following Medicare’s removal of total knee arthroplasty (TKA) from the inpatient-only (IPO) list, it has become increasingly important to appropriately select patients who would be viable candidates for same-day discharge (SDD).
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AJRR Data Reveal Migration Patterns in Revision THA
A study based on data from the American Joint Replacement Registry (AJRR), presented as part of the Annual Meeting Virtual Experience by Richard Illgen, MD, of the University of Wisconsin, found significant differences in migration rate and destination in patients treated for periprosthetic fracture (PPF) after total hip arthroplasty (THA), with the highest percentage of patients migrating from small nonacademic centers to large or medium academic centers.
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Simulated Training Technique Helps Residents Improve Arthroscopic Partial Meniscectomy Abilities
A study assessed the use of a simulated training technique for arthroscopic partial meniscectomy for orthopaedic residents and found that it improved simulated proficiency.
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Hip Fractures: Medicare ‘Paid Less for Doing More’
A study that evaluated actual Medicare reimbursement to hospitals for care of hip fracture patients utilizing the three hip fracture admission types from 2011 to 2016 found that the mean episodic Medicare reimbursement to hospitals decreased by nearly 10 percent and more than $2,000 per episode for hip fracture patients with major medical comorbidities.
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Repair of Pectoralis Major Tendon Tears Yields Good Outcomes
A study found that military patients who underwent primary repair of a chronic pectoralis major tear had excellent clinical outcomes, low risk of complications, and a high return to preoperative levels of recreational and military job activities.
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Surgical Site Infections Are More Common When Primary TKA Is Preceded by Knee Arthroscopy
A study found that patients who have knee arthroscopy then primary total knee arthroplasty (TKA) in the same knee are at a greater risk of developing surgical site infections (SSIs).
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Maximal Pain Reduction, Functional Gains Typically Occur Within Six Months of RTSA
A study found that patients undergoing reverse total shoulder arthroplasty (RTSA) experience the most significant pain reduction and functional gains within the first six months after surgery, followed by a plateau by 12 months after surgery.
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A Dedicated Trauma Operating Room Improves Outcomes for Pediatric Supracondylar Humerus Fractures
The use of a dedicated orthopaedic trauma operating room (OR) improved post-surgical outcomes and reduced costs for pediatric patients with supracondylar humerus fractures, according to a study that Rachel Y. Goldstein, MD, MPH, FAAOS, director of hip preservation at Children’s Hospital Los Angeles, presented as part of the Annual Meeting Virtual Experience.
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Study Shows Decline in Opioid Prescribing for Pediatric Fractures, But Demographic Discrepancies Persist
A study observed a significant overall decline in opioid prescription rates during the past 14 years among children and adolescents with minor fractures and dislocations.
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Goal Awareness May Improve Patient Experience
A prospective cohort study that was presented as part of the Annual Meeting Virtual Experience explored patient- reported goals for outpatient orthopaedic and spine care visits, as well as the impact of patient-healthcare professional goal awareness on patient satisfaction.
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Study Reports Greater Radiographic Failure Rate After Reverse Total Shoulder Arthroplasty with Bone Grafting
Reverse total shoulder arthroplasty (RTSA) with structural bone grafting for glenoid bone loss improved range of motion and function, but researchers observed a larger than previously reported rate of radiographic baseplate loosening in the early postoperative period.
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Many NFL Rookies Incur Achilles Tears, But Only in Preseason
A retrospective study that was presented as part of the Annual Meeting Virtual Experience assessed Achilles tendon (AT) tears in National Football League (NFL) players and found that a relatively large percentage of injuries occurred in rookie players during the preseason, whereas AT tears during the regular season occurred only in veteran players.
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RCT Compares Ankle Arthrodesis with Total Arthroplasty
A first-of-its-kind, multicenter, randomized, controlled trial (RCT) compared the clinical outcomes of ankle arthrodesis (AA) versus total ankle arthroplasty (TAA) in managing end-stage ankle arthritis and demonstrated statistically significant improvements in all Ankle Osteoarthritis Scale (AOS) scores from baseline to time of last follow-up independently for both TAA and AA, with large effect sizes.
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Immediate Pain Relief Following Steroid Injection Not Predictive of Need for Future Surgery
Immediate relief of pain after a fluoroscopic-guided glenohumeral injection for idiopathic adhesive capsulitis of the shoulder is not predictive of eventual need for manipulation under anesthesia (MUA) and/or lysis of adhesions (LOA), according to a study that was presented by Brian C. Werner, MD, an assistant professor of orthopaedic surgery at the University of Virginia Health System, as part of the Annual Meeting Virtual Experience.
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Direct-to-consumer Advertising of Stem Cell Therapy Is Subpar
More healthcare practices are offering stem cell therapy (SCT) as part of their services for musculoskeletal treatments.
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Value of Bundled TJR: A Perspectives Analysis
A study that was presented as part of the Annual Meeting Virtual Experience assessed how the value of bundled total joint replacement (TJR) differs among patients, payers/employers, and hospitals/providers.
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Study Gauges Impact of Age and Graft Type on Fusion Following Ankle and Hindfoot Arthrodesis
A study presented as part of the Annual Meeting Virtual Experience indicates that age is an identifiable and concerning risk factor for hindfoot or ankle arthrodesis nonunion, a finding the authors say is “in contrast to wider perception of the surgeon community.” .
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British Registry Data Support Regional Anesthesia for THA
Regional anesthesia was associated with reduced length of stay (LOS) and lower risk of readmissions and complications following total hip arthroplasty (THA) compared to general anesthesia, according to a study presented by Andrew Judge, MSc, PhD, as part of the Annual Meeting Virtual Experience.