Archive | May 2021

Loss of Supination Force with Partial Distal Biceps Avulsion

In the May 5, 2021 issue of JBJS, Tomizuka et al. report the results of mechanical testing in which they quantified the loss of supination and flexion strength after a series of surgical releases designed to simulate traumatic avulsions of the short and long head of the distal biceps tendon.

Reflecting on the clinical implications of their study, the authors note:

Partial tears of the distal biceps tendon can cause substantial disability, yet the mechanical effect of such ruptures is not fully understood. This study showed that a simulated complete short-head tear significantly decreased (p ≤ 0.043) the supination moment arm by 24% in pronation and 10% in neutral.

A mechanical case can be made for early repair of a partial distal biceps tendon tear when the rupture is ≥75% of the distal insertion site.”

Click here for the full JBJS report.

A JBJS Clinical Summary on distal biceps tendon rupture can be found here.

 

Functional Outcomes of Patients with Schizophrenia After Hip Fracture Surgery

Thirty-eight patients with schizophrenia were compared with 170 geriatric patients without schizophrenia who underwent a surgical procedure for a hip fracture.

Read the full article here.

Introducing the OrthoJOE Podcast: 2 Editors, 2 Coffees, and 2 Times the Evidence

JBJS EditorialPodcasts are an increasingly important mode of communication across many segments of society. Our field was perhaps a bit slow to catch on to this movement, but our attention has been awakened. In the Orthopaedic Forum section of this issue, Jella et al. evaluate the growth of podcasts over the previous 9 years within the field of orthopaedic surgery. Of the 94 podcasts that met the inclusion criteria, 62 remained active in the fall of 2020. The pace of introduction of new podcasts in our field has now reached 1 per month.

In collaboration with OrthoEvidence (www.myorthoevidence.com) and its Editor-in-Chief Mohit Bhandari, JBJS (www.jbjs.org) launched a new podcast in January 2021. We have named the podcast OrthoJOE, with the J coming from JBJS and the OE coming from OrthoEvidence. We find the name to be highly relevant, with both of us enjoying fresh coffee while recording these podcasts together every other Tuesday morning. The format of the podcast is highly conversational; some episodes are topical (for example, we recently discussed how our publications managed the explosion of submissions related to COVID-19), whereas others are based on new articles that have appeared in our own publications. The goal, however, is a simple one: to provide insights derived from evidence on top trending issues in OrthoEvidence and JBJS. Although Jella et al. found that 95.7% of active podcasts employ an audio-only format, we are in the process of creating a video version of the podcast that will be available on the JBJS and OrthoJOE websites. Our target audience is international, and our goal is to discuss topics that will be relevant to the worldwide orthopaedic community. As we evolve, we intend to invite guests to participate in topic-based discussions. We also plan to introduce a “mailbag” feature, during which we will discuss audience feedback regarding the opinions that we have expressed during previous episodes. You can listen to OrthoJOE at http://orthojoe.castos.com/ or subscribe through iTunes or wherever you get your podcasts. We invite you to tune in and are interested in your feedback and ideas for discussion. Many thanks in advance.

Mohit Bhandari, MD, PhD, FRCSC
Editor-in-Chief, OrthoEvidence
Marc Swiontkowski, MD
Editor-in-Chief, JBJS

The Challenges of Post-Treatment Care for Patients with Schizophrenia

The worldwide incidence of mental illness seems to be on the rise—and along with it a widespread recognition that this “epidemic” should receive at least as much attention as other health conditions. At the same time, many societies have transitioned to noninstitutionalized care for patients with severe mental health diagnoses. This parallel phenomenon has resulted in more individuals with mental and emotional challenges being cared for by their families and communities.

Orthopaedic surgeons are often asked what the prognosis is for recovery in a patient with a substantive mental health diagnosis, but only a few scholarly attempts have been made to answer that question. In the May 5, 2021 issue of JBJS, Ng et al. provide meaningful data regarding the concomitant diagnosis of schizophrenia among patients in their early 70s who experienced a hip fracture. One-year post-treatment results from this cohort study showed no differences in mortality or surgical or medical complications between patients with and matched patients without schizophrenia. These good-news findings are largely indicative of the high level of care hip fracture patients receive in the authors’ institution, which includes close collaboration among surgeons, geriatrists, physical therapists, and psychiatric clinicians.

However, the 1-year functional outcomes, as measured with the Modified Barthel Index, were worse in the cohort with schizophrenia. I think this is probably related to the difficulty of encouraging patients to participate in standardized rehabilitation processes, challenges associated with self-care, and potentially less-than-optimal social support.

We certainly need more research into determining the best peri- and post-treatment care for orthopaedic patients with severe mental health issues. Ideally, future investigations of these questions will focus on interactions between mental health professionals and surgical and rehabilitation teams. It is my hope that this study by Ng et al. will stimulate that type of research.

Click here for a downloadable Infographic summarizing this study.

Marc Swiontkowski, MD
JBJS Editor-in-Chief

Reimbursement for Revision TKA Has Not Kept Pace with Inflation

I was once told that if you don’t have any cases with complications, you either aren’t operating enough or aren’t following your patients. Although we in the orthopaedic community make every effort to minimize the occurrence of patient complications, one that remains difficult to eradicate is periprosthetic joint infection (PJI), which is a leading cause of revision total knee arthroplasty (TKA). The welfare of our patients requires successfully addressing this potentially devastating outcome, but reimbursement for these complex cases has decreased over the past decade.

In the upcoming issue of JBJS, Jella et al. offer insight on temporal trends in Medicare physician reimbursement for revision TKA. They queried the Medicare Physician Fee Schedule Look-Up Tool for pricing information corresponding to 1 and 2-stage revision TKAs and used monetary data from Medicare Administrative Contractors to calculate nationally representative means. The authors evaluated aseptic revision of 1 component, 1-stage revision (aseptic or septic), and both the first and second stages of a 2-stage septic revision.

They found that, from 2002 to 2019, there was a mild increase in the physician fee for each CPT code, with the exception of that for second-stage implantation. However, after adjusting for inflation, total Medicare reimbursements declined for both septic and aseptic revision TKAs (between 23% and 33%), with a significantly greater decline observed for septic revision.

The authors also found that Medicare spending on aseptic revision TKA nearly doubled from 2004 to 2017, while spending on septic revision TKA increased only slightly. They note that a main driver of the discrepancy between septic and aseptic revision may be the reimbursement for the second stage of the former procedure using CPT 27447 instead of a revision procedure code (27487).

We know that an increase in revision TKAs (both septic and aseptic) is expected as the number of primary TKA procedures continues to rise. If reimbursement doesn’t keep pace, it is likely to drive certain surgeons away from tackling the sometimes difficult cases, in turn, leaving our patients with fewer available resources when faced with PJI.

Matthew R. Schmitz, MD
JBJS Deputy Editor for Social Media

A New Venue for Dr. Nelson’s Basic Science Tips

Based on page-view data, the monthly basic science posts from Fred Nelson, MD have been hugely popular on OrthoBuzz over the last 4-plus years.

Now, OrthoBuzz readers can sign up to receive Dr. Nelson’s insights on a weekly basis. The “ORS Connects” e-newsletter, a publication of the Orthopaedic Research Society, has kindly agreed to email OrthoBuzz readers Dr. Nelson’s weekly basic science tips. If you are interested, please email Amber Blake at blake@ors.org with your first and last name and email address.

Because Dr. Nelson’s tips are now available to a wider audience on a more frequent basis, we will no longer be including them in OrthoBuzz. The OrthoBuzz team has thoroughly enjoyed engaging with Dr. Nelson and his fascinating basic-science content. We thank him for his outstanding contributions.