News in 10

The 10 items below are the most significant elements of recent editions of Headline News Now—the AAOS thrice-weekly, online update of news of interest to orthopaedic surgeons. Check this page regularly for updates.
Updated on September 12, 2014

1. Study: Increased walking linked to better function for patients with knee OA.
Findings published online in the journal Arthritis Care & Research suggest that increased walking may be linked with reduced risk of functional limitation for patients with knee osteoarthritis (OA). The research team evaluated the association of steps/day at baseline with the development of functional limitation 2 years later among 1,788 participants with a mean age of 67 years. They found that each additional 1,000 steps/day was associated with a 16 percent reduction in incident functional limitation by performance-based measures and an 18 percent reduction by self-reported measures. The research team noted that walking at least 6,000 steps/day was the best threshold to distinguish incident functional limitation by performance-based measures.
Read more...

Read the abstract…

2. Study: Both mobile-bearing and fixed-bearing TAA devices improve gait and reduce pain, but in different ways.
A study published in the June 18 issue of The Journal of Bone & Joint Surgery examines differences between mobile-bearing and fixed-bearing total ankle arthroplasty (TAA) devices. The authors observed 90 patients who underwent TAA—49 with mobile-bearing devices and 41 with fixed-bearing devices. At 2-year follow-up, they found no significant difference in ankle motion or step time between implant types or across time. However, they did note a greater increase in peak plantar flexion moment and Short Form-36 total scores across time in the fixed-bearing group compared to the mobile-bearing group. Conversely, patients in the mobile-bearing group exhibited greater improvement in visual analog scale pain scores compared to those in the fixed-bearing group. Independent of time, patients in the fixed-bearing group demonstrated a significant increase in weight-acceptance and propulsion ground reaction forces compared with the mobile-bearing group, while patients in the mobile-bearing group completed the Sit-to-Stand test significantly faster.
Read the abstract…

3. Study: Minority populations receive fewer autologous blood transfusions for elective orthopaedic surgery.
Findings published online in the journal Clinical Orthopaedics and Related Research (CORR) suggest that historically disadvantaged patient populations may be less likely to receive autologous blood transfusions for elective orthopaedic surgery. The authors reviewed information on more than 3,500,000 patients found in the Nationwide Inpatient Sample database who underwent elective orthopaedic surgery. They found that, between 2008 and 2011, 2.4 percent received autologous blood transfusion, while 12 percent received allogeneic blood transfusion. Compared with white patients, Hispanic patients had lower odds of autologous blood use for elective hip and knee arthroplasties, while black patients had lower odds of receiving autologous blood transfusion for hip arthroplasty. In addition, uninsured and publicly insured patients were less likely to receive autologous blood for total joint arthroplasty (TJA) and spinal fusion, compared with privately insured patients, and patients with low and medium income were less likely to receive autologous blood transfusion for TJA and spinal fusion compared to patients at higher income levels. Even at comparable income and insurance levels, the authors found that Hispanic and black patients were less likely to receive autologous blood transfusion, compared to white patients.
Read the abstract…

4. Study: Plain AP pelvic radiographs may have limited sensitivity for children with fractures or dislocations after blunt trauma.
Findings from a study published online in the journal Annals of Emergency Medicine suggest that plain anteroposterior (AP) pelvic radiographs may have limited sensitivity for identifying children with pelvic fractures or dislocations after blunt trauma. The researchers conducted a prospective, multicenter, observational study of children younger than 18 years with blunt torso trauma in the Pediatric Emergency Care Applied Research Network. Of 12,044 patients enrolled in the parent study, 451 (3.7 percent) had pelvic fractures or dislocations. Of those, 65 (14 percent) underwent operative intervention and 21 (4.7 percent) had age-adjusted hypotension on initial presentation. In the emergency department, 382 of the 451 patients underwent plain AP pelvic radiographs, with a sensitivity of 297 of 382 (78 percent) for patients with pelvic fractures or dislocations, 55 of 60 (92 percent) for patients undergoing surgical intervention, and 14 of 17 (82 percent) for patients with hypotension.
Read more...

Read the abstract…

5. Study: Elixhauser model may be more predictive than Charlson for estimating inpatient morbidity after orthopaedic surgery.
According to a study published in the September issue of CORR, the Elixhauser comorbidity method may be more accurate than the Charlson Index for predicting inpatient death after orthopaedic surgery. The authors analyzed data on 14,007,813 patients who underwent orthopaedic surgery between 1990 and 2007, as identified in the National Hospital Discharge Survey. They found that the Elixhauser comorbidity adjustment better predicted in-hospital case mortality, compared against the Charlson model. In terms of relative improvement in predictive performance, Elixhauser performed 60 percent better than Charlson in predicting mortality, and better discriminated inpatient morbidity. However, the authors note that the discriminative ability of the model was poor, and write that the difference in absolute improvement in predictive power between the two models was of "dubious clinical importance." Both comorbidity models exhibited the same degree of discrimination for estimating nonroutine discharge.
Read the abstract…

6. Study suggests that many orthopaedic trauma patients seek multiple narcotic prescription providers.
Data published in the Aug. 6 issue of The Journal of Bone & Joint Surgery suggest that many orthopaedic trauma patients may engage in "postoperative doctor shopping," as they attempt to obtain narcotic prescriptions from multiple providers. The research team conducted a prospective cohort study of 130 eligible patients found in a state-controlled substance monitoring database. They found that 8.5 percent of patients engaged in preoperative narcotic use (defined as three or more narcotic prescriptions within 3 months of admission). Postoperatively, 20.8 percent of patients sought multiple narcotic providers. Overall, patients with a high school education or less were 3.2 times more likely to seek multiple providers, and patients with a history of preoperative narcotic use were 4.5 times more likely to seek multiple providers.
Read more...

Read the abstract…

7. CMS Open Payments site to delay release of about one-third of payment records due to inaccuracies.
ProPublica
reports that the U.S. Centers for Medicare & Medicaid Services (CMS) plans to withhold some physician records when it releases payment data to the public Sept. 30 on the Open Payments (Sunshine Act) website. A spokesperson from CMS states that the agency plans to return about one-third of submitted records to manufacturers and group purchasing organization due to inaccurately attributed data. CMS temporarily suspended the verification system for the Open Payments website after at least one physician discovered that the site had attributed payments to him that actually were made to another physician with the same name. The agency states that the withheld records will be released in the next reporting cycle, during June 2015.
Read more...

Read the CMS press release…

8. Study: Delaying surgery for proximal humeral fracture linked to increased adverse events; length of stay.
Data from a study published in the September issue of the Journal of Shoulder and Elbow Surgery suggest that delaying surgery for proximal humeral fracture may increase the likelihood of adverse events, length of stay, and non-routine discharge. The authors drew data on more than 70,000 patients from the Nationwide Inpatient Sample and found that patients who underwent surgery 3 days or more after admission for proximal humerus fracture had increased inpatient adverse events, prolonged postoperative stay, and increased non-routine discharge. Risk factors for surgery 3 days or more after admission included advanced age, male sex, Elixhauser comorbidity score, polytrauma, Hispanic or black race, no insurance coverage, low household income, and weekend admission. The authors noted that delay of surgery was not linked to increased risk of in-hospital death.
Read the abstract…

9. Study: Sustained care program may help adults quit smoking after discharge.
Data from an NIH-funded study published in the Aug. 20 issue of The Journal of the American Medical Association (JAMA) suggest that use of a post-discharge intervention could help adult smokers quit smoking. The authors conducted a randomized trial of 397 hospitalized daily smokers who wanted to quit smoking after discharge, and who received a tobacco dependence intervention in the hospital. They found that patients assigned to a sustained care program that included automated interactive voice response telephone calls and their choice of free U.S. Food and Drug Administration (FDA)-approved smoking cessation medication were more likely to sustain a biochemically validated 7-day tobacco abstinence at 6 months, compared to patients who received standard care. In addition, sustained care was also associated with higher self-reported continuous abstinence rates for 6 months after discharge.
Read more...

Read the abstract…

10. Study: Residual intra- and extra-articular impingement among common reasons for revision hip preservation surgery.
Findings from a study published online in The American Journal of Sports Medicine suggest that residual intra- and extra-articular impingement are among the most common reasons for revision hip preservation surgery. The authors conducted a cross-sectional study of 147 patients (152 procedures) who underwent revision hip preservation at a single center. The most common reason for revision was residual intra-articular femoroacetabular impingement (74.8 percent), followed by extra-articular impingement (9.5 percent). They noted that 79.8 percent of revision cases could be addressed with arthroscopic surgery, with the exception of extra-articular impingement or residual acetabular dysplasia, which necessitated open approaches. Overall, patients were more likely to undergo revision if they were female, younger in age, or had worse preoperative outcome scores than those in a primary cohort of 1,600 patients (1,898 procedures). The authors note that abnormal femoral version or acetabular coverage were not increased in the revision cohort.
Read the abstract…