If you missed these news items the first time around, AAOS Now gives you a second chance to review them. Headline News Now, the AAOS thrice-weekly, online update of news of interest to orthopaedic surgeons, brings you the latest on clinical, socioeconomic, and political issues, as well as important announcements from AAOS.

Best, worst state tort systems identified
The not-for-profit Pacific Research Institute has ranked the best and worst state tort systems in the United States. The report valuated the tort laws, tort costs, and litigation risks of each state. North Dakota had the lowest tort costs, but lack of strong tort reform laws could make the state a target for trial lawyers in the future. Conversely, Florida ranked the worst in terms of tort cost and litigation risk, but recent reforms have resulted in some of the best tort laws. The best overall tort rules were in Colorado, Texas, Ohio, Georgia, Indiana, Florida, and Michigan. States considered to have the worst tort rules were Pennsylvania, Illinois, Maryland, New York, Vermont, and Rhode Island.

Integrated assessment better for determining risk of fracture
A study published in the February issue of the Journal of Bone and Joint Surgery (JBJS) analyzing risk factors in patients with recent clinical fractures found that an integrated bone- and fall-related risk-factor assessment may be preferable to a simple diagnosis of osteoporosis in identifying elderly individuals at risk for fractures. Dutch researchers studied 568 patients at a single institution and found that prevalence of fall-related risk factors (75 percent) and prevalence of bone-related risk factors (53 percent) at the time of fracture were higher than the prevalence of osteoporosis (35 percent). Half of the patients had an overlap between bone- and fall-related risk factors. Risk factors were found to be overlapping, heterogeneous, and found in multiple combinations, regardless of the patient’s age, fracture location, or gender.

Potential test for infection in prosthetic joints
According to a study published in the March issue of JBJS, researchers are developing a test that could help confirm or rule out the presence of infection-causing bacteria in prosthetic joints requiring surgical revision. The researchers obtained synovial fluid samples from 12 patients presenting with knee pain and effusion but no evidence of infection, and inoculated the samples with various bacteria species to simulate septic arthritis. All inoculated synovial fluid samples were able to be identified compared to controls using real-time quantitative reverse transcription polymerase chain reaction; there were no false-negative results.

SPORT study finds surgical treatment more helpful for lumbar spinal stenosis
According to the results of the Spine Patients Outcomes Research Trial (SPORT) study, patients who underwent surgery for lumbar spinal stenosis showed significant improvement compared to those who were treated nonsurgically. Researchers followed 289 patients enrolled in a randomized cohort and 365 patients enrolled in an observational cohort at 13 U.S. spine clinics. All patients had a history of at least 12 weeks of symptoms and spinal stenosis without spondylolisthesis; patients were treated with either decompressive surgery or nonsurgical care. At 2 years, 67 percent of patients who were randomly assigned to surgery had undergone surgery, and 43 percent of those assigned to receive nonsurgical care had also undergone surgery. Despite the high level of nonadherence, the intention-to-treat analysis of the randomized cohort showed a significant treatment effect favoring surgery on the SF-36 scale for bodily pain, and the as-treated analysis showed a significant advantage for surgery by 3 months for all primary outcomes. There was no significant difference in scores on physical function or on the Oswestry Disability Index.