According to a retrospective study published online in The Knee, total knee arthroplasty (TKA) patients who are older, have a higher body mass index, and do not have hypertension are more likely to be satisfied overall after surgery. However, they may be dissatisfied with their ability to return to recreational activities. Researchers queried an established arthroplasty database to identify 3,324 primary TKA patients. They collected patient demographics, comorbidities, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, and Short Form (SF) 12 scores preoperatively and one year postoperatively. They assessed overall patient satisfaction and satisfaction with recreational activities after one year. The overall satisfaction rate (89.7 percent) was higher than the satisfaction with recreational activities rate (80.4 percent). One-year components and total WOMAC scores significantly indicated recreational activity satisfaction.
A retrospective study published in the Nov. 15 edition of the Journal of the AAOS investigated the timepoints at which routine radiographs are used in postoperative management of lower extremity fracture treatment. Researchers evaluated 485 patients with 586 fractures of the femur, tibia, and ankle. Each fracture underwent an average of 4.8 postoperative radiographs, costing $938,469. The expected postoperative management plan changed in 179 fractures: 93 fractures (31 percent) had a change in management solely due to radiographic findings. This primarily occurred during the period from consideration of advancement to full weight bearing up until confirmation of fracture union (98 percent); in 2 percent of cases, it occurred in the immediate postoperative period.
Patients with symptomatic lumbar degenerative spondylolisthesis (DS) who are treated surgically may have better outcomes than those who receive nonsurgical treatment, according to a study published in the Dec. 1 issue of Spine. Surgical candidates with DS who had at least 12 weeks of symptoms and whose disease was image-confirmed were enrolled in a randomized, controlled trial or observational cohort study. Researchers compared standard decompressive laminectomy (with or without fusion) treatment to standard nonoperative care. Primary outcome measures were the SF-36 bodily pain and physical function scores and the modified Oswestry Disability Index. Outcomes were evaluated at six weeks, three months, six months, and annually for up to eight years. As-treated analyses in both groups showed significantly better outcomes for the surgery group for all primary outcome measures at all time points over the study period. Fusion technique (uninstrumented posterolateral fusion, instrumented posterolateral fusion, and 360-degree fusion) did not impact outcomes.
Patients whose hip fracture surgery was delayed may have an increased postoperative hospital length of stay (LOS) but are not more likely to have adverse outcomes 30 days postoperatively, according to a retrospective review published in the December issue of the Journal of Orthopaedic Trauma. Researchers used the American College of Surgeons National Surgical Quality Improvement Program database to identify 17,459 hip fracture surgery patients at 140 academic and private medical centers between 2006 and 2013. Primary outcomes were 30-day postoperative LOS, readmission rates, reoperation rates, complications, and mortality rates. Of the total cohort, 4,107 patients (23.5 percent) underwent surgery within 24 hours, 8,740 (50.1 percent) within 24–48 hours, and 4,612 (26.5 percent) more than 48 hours following hospital admission. Patients with longer time to surgery had a longer postoperative LOS, but increased time to surgery had no impact on postoperative outcomes.
The Centers for Medicare & Medicaid Services (CMS) launched a new online tool that allows consumers to compare costs for certain procedures that are performed in hospital outpatient departments (HOPDs) and ambulatory surgery centers (ASCs). The Procedure Price Lookup tool displays national averages for the amount Medicare pays and the national average copayment amount a beneficiary with no Medicare supplemental insurance would pay the provider. For example, the average total cost of a total disk arthroplasty with diskectomy is $11,213 at an ASC versus $15,371 at a HOPD; the average total cost of an anterior cervical diskectomy is $7,337 at an ASC versus $10,123 at a HOPD.
While knee arthroscopy is considered a staple of orthopaedic procedures, its use in treating knee osteoarthritis (OA) has been the subject of debate over the past 10 years. AAOS Now presents common questions and recent guidelines pertaining to knee arthroscopy in OA patients.
The Spine Content Committee has an open chair position, a two-year term that runs from March 18, 2019, through March 15, 2021. The candidate should be a spine orthopaedic surgeon with previous Academy experience and knowledge of the current and future states of spine education. Prior experience editing a major print and/or digital publication, as well as familiarity with orthopaedic publishing, would also be helpful. The deadline to apply is Jan. 1, 2019.