Orthopaedic News

It's your health care...Know what's at stake

As Congressional leaders work on a deal to reform health care, you should know what reform means to your health care options.

Complete article: Read More

ACL Injuries continue to increase

ACL injuries on the rise; readmission increases with age and other factors.

In a review of 70,547 anterior cruciate ligament (ACL) reconstructions performed between 1997 and 2006 in New York State , a research team found that the number of ACL reconstructions performed in a year increased from 6,178 in 1997 to 7,507 in 2006. The team found that readmission within 90 days occurred at a 2.3 percent rate, and subsequent surgery on either knee within 1 year occurred at a 6.5 percent rate. Patients older than 40 years of age, with a preexisting comorbidity, who were male, or who were operated on by a lower-volume surgeon were at increased risk for readmission within 90 days. Predictors of subsequent knee surgery included being female, having concomitant knee surgery, and being operated on by a lower-volume surgeon. Predictors of a subsequent anterior cruciate ligament reconstruction included being younger than 40 years old, concomitant meniscectomy or other knee surgery, and surgery in a lower-volume hospital. The study was published in the October 1 issue of JBJS-A.

Attribution: AAOS Headline News Now - October 21, 2009 (www.aaos.org)

References:  For more, click on this link: http://www.sciencedaily.com/releases/2009/10/091001164054.htm

Weight loss helps arthritis

Losing weight reduces risk of knee osteoarthritis.
A study presented at the scientific meeting of the American College of Rheumatology finds that weight loss may be an effective strategy to reduce the risk of incident radiographic osteoarthritis of the knee (rOAKnee). Researchers reviewed data from a longitudinal study of 1,480 African-Americans and Whites aged 45 years and older in Johnston County , N.C. from 1990-1998 to 1999- 2003. Overall, 63.2 percent were female and 25.9 percent were African-American with mean age of 59.4 (standard deviation [SD] 9.4) years and body mass index of 28.6 (SD 5.5) kg/m2. Over a mean follow-up of 5.9 (SD 1.3) years, rOAKnee developed in 415 of 2,788 knees (14.9 percent). Compared to those who gained weight (31.4 percent), patients who maintained weight (32.8 percent) were no less likely to develop incident rOAKnee [HR=1.02 (95 percent CI=0.77, 1.35)]. Patients who lost weight (16.7 percent) were at reduced risk for development of incident rKOA [0.71 (0.49, 1.01).

Attribution: AAOS Headline News Now - October 05, 2009 (www.aaos.org)

References:  For more, click on this link: http://acr.confex.com/acr/2009/webprogram/Paper16229.html

Surgery works for Carpal Tunnel Syndrome

Better clinical outcomes after carpal tunnel surgery.
For patients with carpal tunnel syndrome without denervation, surgical treatment may provide a modestly better clinical outcome than non-surgical treatment, according to a study published in the September 26 issue of the journal The Lancet. The authors conducted a parallel-group randomized controlled trial of 116 patients from eight academic and private practice institutions. Overall, 57 patients were assigned to carpal tunnel surgery, while 59 were assigned a well-defined, non-surgical treatment, including hand therapy and ultrasound. At 12 month follow-up, 101 patients (87 percent) were analyzed (49 of 57 in the surgery group and 52 of 59 in the non-surgery group. Patients in the surgery group displayed a significant 12-month adjusted advantage for surgery in function (Carpal Tunnel Syndrome Assessment Questionnaire [CTSAQ] function score: Δ -0.40, 95 percent confidence interval, 0.11—0.70, p=0.0081) and symptoms (CTSAQ symptom score: 0.34, 0.02—0.65, p=0.0357). There were no clinically important adverse events and no surgical complications.

Attribution: AAOS Headline News Now - September 25, 2009 (www.aaos.org)

References:  For more, click on this link: http://www.medicalnewstoday.com/articles/165166.php

For shoulder pain, exercise preferred over ECSW

Exercise may be more effective than shockwave treatment for subacromial shoulder pain.
A study published in the September 15 issue of the British Medical Journal finds that supervised exercises may be more effective than radial extracorporeal shockwave treatment for short-term improvement among patients with subacromial shoulder pain. The authors randomized 104 patients with subacromial shoulder pain lasting at least 3 months to receive either a weekly session of radial extracorporeal shockwave treatment for 4 to 6 weeks, or two 45-minute supervised exercise sessions for up to 12 weeks. They found that a significantly higher proportion of patients in the group treated with supervised exercises improved (odds ratio 3.2 [range 1.3 to 7.8]) on the Shoulder Pain and Disability Index, and the treatment effect favored supervised exercises at 6, 12, and 18 weeks. Adjusted treatment effect was –8.4 (95 percent confidence interval [range –16.5 to –0.6 points]). Patients in the shockwave treatment group were more likely to receive additional treatment between 12 and 18 weeks (odds ratio 5.5 [range 1.3 to 26.4]).

Attribution: AAOS Headline News Now - September 16, 2009 (www.aaos.org)

References:  For more, click on this link: http://www.bmj.com/cgi/content/abstract/339/sep15_1/b3360

Running not so bad after all

An article in Skeletal Radiology, a well-respected journal, created something of a sensation in Europe last year. It reported that researchers from Danube Hospital in Austria examined the knees of marathon runners using M.R.I. imaging, before and after the 1997 Vienna marathon. Ten years later, they scanned the same runners’ knees again. The results were striking. “No major new internal damage in the knee joints of marathon runners was found after a 10-year interval,” the researchers reported.

Attribution:NY Times, Health, By Gretchen Reynolds, Tuesday August 18, 2009

References:  For more, click on this link: http://well.blogs.nytimes.com/2009/...running&st=cse

Delayed ACL repair in young patients linked to other injuries.

Delaying repair of the anterior cruciate ligament (ACL) in younger athletes can increase the risk of other damage, including meniscus tears, chondral injuries, and patellotrochlear injuries, according to data presented at the annual meeting of the American Orthopaedic Society for Sports Medicine (AOSSM). The research team analyzed the records of 69 patients younger than age 14 who had undergone ACL reconstruction between 1991 and 2005. All patients who elected to delay treatment were instructed to wear a custom ACL brace, and all patients who underwent the surgery received a soft tissue graft with anatomically placed tunnels and fixation devices that did not cross the growth plate. Researchers found that a delay in treatment of more than 12 weeks was associated with a 4-fold increase in irreparable medial meniscus tears, an 11-fold increase in lateral compartment chondral injuries, and a 3-fold increase in patellotrochlear injuries. Additionally, those who delayed treatment had significantly more issues with instability in the knee.

Attribution: AAOS Headline News Now - July 13, 2009 (www.aaos.org)

Tags: ACL, Knee, Reconstruction, Cartilage, Injury

References:  For more, click on this link: http://www.sportsmed.org/tabs/newsroom/AOSSMPressReleaseDetails.aspx?DID=612

Training in proprioception may decrease recurrent ankle sprains

A study published online in the British Medical Journal finds that a proprioceptive training program may help prevent self-reported recurrences of ankle sprain. The authors conducted a randomized, controlled trial of 522 athletes (aged 12-70 yrs) who sustained lateral ankle sprains. Athletes assigned to the intervention group (n=256) received an 8-week home-based proprioceptive training program, while those in the control group (n=266) did not. At 1-year follow-up, 145 athletes reported a recurrent ankle sprain: 56 (22 percent) in the intervention group and 89 (33 percent) in the control group. Patients in the intervention program had a 35 percent reduction in risk of recurrence. The researchers found no significant differences among athletes in either group who received medical treatment for their injury, although athletes in the intervention group who were not medically treated had a significantly lower risk of recurrence than controls who were not medically treated.

Attribution: AAOS Headline News Now - July 13, 2009 (www.aaos.org)

Tags: Ankle, Sprain, Recurrent Injury, proprioception

References:  To learn more, click on this link for abstract: http://www.bmj.com/cgi/content/abstract/339/jul09_1/b2684

Tennis elbow may respond to exercise

A randomized study of 21 patients with lateral epicondylitis or so-called tennis elbow finds that use of a simple bar and strengthening exercise may help alleviate pain. Patients were divided into two groups, both of whom were treated using wrist extensor stretching, ultrasound, cross-friction massage, heat and ice for treatment. The standard treatment group (10 patients) performed isotonic wrist strengthening exercises, while the eccentric training group (11 patients) performed isolated eccentric wrist extensor strengthening using a rubber bar (three sets of 15 repetitions daily and with increasing intensity over time). A variety of pain and movement scales were used to determine progress. Patients in the eccentric exercise group had better results on all pain and movement scales used; groups did not differ in duration of symptoms, physical therapy visits, or treatment duration.

Attribution: AAOS Headline News Now - July 13, 2009 (www.aaos.org)

Tags: Tennis Elbow, Elbow, Epicondylitis, Exercise

References:  To read more, click on this link: http://www.sportsmed.org/tabs/newsroom/AOSSMPressReleaseDetails.aspx?DID=613

Good news after shoulder replacement: You can remain active in sports

A study presented at the annual meeting of the American Orthopaedic Society for Sports Medicine (AOSSM) finds that older individuals who receive a total shoulder arthroplasty (TSA) may be able to return to full participation in sports within approximately 6 months. The research team interviewed via questionnaire 165 patients (average age=68.5 years, range=47-93 years) who received unconstrained TSAs from a single surgeon between July 1, 2004, and Sept. 30, 2007. Overall, 87 patients regularly participated in sports prior to surgery. The researchers found that approximately 94 percent of those patients were able to return to sports, and 85 percent were able to return to the type-specific sport they played before surgery.

Attribution: AAOS Headline News Now - July 10, 2009 (www.aaos.org)

Tags: Shoulder, Replacement, Arthroplasty, Arthritis, Sports

References: For more, click on this link: http://www.sportsmed.org/tabs/newsroom/AOSSMPressReleaseDetails.aspx?DID=617

Sports injuries common cause of kids' visits to Emergency Room

According to data released by the U.S. Agency for Healthcare Research and Quality, sports-related injuries such as broken bones, bruises, and scrapes accounted for 22 percent of hospital emergency department (ED) visits for children ages 5 to 17 in 2006. Other findings include:

•   81 percent of all ED visits were for bruises, sprains and strains, arm fractures, or cuts and scrapes to the head, neck, or chest

•   1.3 percent of visits resulted in hospital admissions, mostly for leg and arm fractures

•   Teens were 5 times more likely than children to be treated for sports injuries in EDs

The data was drawn from the agency's Sports Injuries in Children Requiring Hospital Emergency Care, 2006 report, which uses statistics from the 2006 Nationwide Inpatient Sample-a nationally representative database of hospital inpatient stays in all short-term, non-federal hospitals.

Attribution: AAOS Headline News Now - July 6, 2009 (www.aaos.org)

Tags: Sports, Injury, Children, Emergency Room

References: For more information, click on this link:  http://www.ahrq.gov/news/nn/nn070109.htm

Political News

Kill the bills. Do health reform right

The United States has the best health care in the world -- but because of its inefficiencies, also the most expensive. The fundamental problem with the 2,074-page Senate health-care bill (as with its 2,014-page House counterpart) is that it wildly compounds the complexity by adding hundreds of new provisions, regulations, mandates, committees and other arbitrary bureaucratic inventions.

Worse, they are packed into a monstrous package without any regard to each other. The only thing linking these changes -- such as the 118 new boards, commissions and programs -- is political expediency. Each must be able to garner just enough votes to pass. There is not even a pretense of a unifying vision or conceptual harmony.

The result is an overregulated, overbureaucratized system of surpassing arbitrariness and inefficiency. Throw a dart at the Senate tome:

• You'll find mandates with financial penalties -- the amounts picked out of a hat.
• You'll find insurance companies (which live and die by their actuarial skills) told exactly what weight to give risk factors, such as age. Currently insurance premiums for 20-somethings are about one-sixth the premiums for 60-somethings. The House bill dictates the young shall now pay at minimum one-half; the Senate bill, one-third -- numbers picked out of a hat.
• You'll find sliding scales for health-insurance subsidies -- percentages picked out of a hat -- that will radically raise marginal income tax rates for middle-class recipients, among other crazy unintended consequences.

The bill is irredeemable. It should not only be defeated. It should be immolated, its ashes scattered over the Senate swimming pool.

Then do health care the right way -- one reform at a time, each simple and simplifying, aimed at reducing complexity, arbitrariness and inefficiency.

First, tort reform. This is money -- the low-end estimate is about half a trillion per decade -- wasted in two ways. Part is simply hemorrhaged into the legal system to benefit a few jackpot lawsuit winners and an army of extravagantly rich malpractice lawyers such as John Edwards.

The rest is wasted within the medical system in the millions of unnecessary tests, procedures and referrals undertaken solely to fend off lawsuits -- resources wasted on patients who don't need them and that could be redirected to the uninsured who really do.

In the 4,000-plus pages of the two bills, there is no tort reform. Indeed, the House bill actually penalizes states that dare "limit attorneys' fees or impose caps on damages." Why? Because, as Howard Dean has openly acknowledged, Democrats don't want "to take on the trial lawyers." What he didn't say -- he didn't need to -- is that they give millions to the Democrats for precisely this kind of protection.

Second, even more simple and simplifying, abolish the prohibition against buying health insurance across state lines.

Some states have very few health insurers. Rates are high. So why not allow interstate competition? After all, you can buy oranges across state lines. If you couldn't, oranges would be extremely expensive in Wisconsin, especially in winter.

And the answer to the resulting high Wisconsin orange prices wouldn't be the establishment of a public option -- a federally run orange-growing company in Wisconsin -- to introduce "competition." It would be to allow Wisconsin residents to buy Florida oranges.

But neither bill lifts the prohibition on interstate competition for health insurance. Because this would obviate the need -- the excuse -- for the public option, which the left wing of the Democratic Party sees (correctly) as the royal road to fully socialized medicine.

Third, tax employer-provided health insurance. This is an accrued inefficiency of 65 years, an accident of World War II wage controls. It creates a $250 billion annual loss of federal revenue -- the largest tax break for individuals in the entire federal budget.

This reform is the most difficult to enact, for two reasons. The unions oppose it. And Barack Obama savaged the idea when John McCain proposed it during last year's campaign.

Insuring the uninsured is a moral imperative. The problem is that the Democrats have chosen the worst possible method -- a $1 trillion new entitlement of stupefying arbitrariness and inefficiency.

The better choice is targeted measures that attack the inefficiencies of the current system one by one -- tort reform, interstate purchasing and taxing employee benefits. It would take 20 pages to write such a bill, not 2,000 -- and provide the funds to cover the uninsured without wrecking both U.S. health care and the U.S. Treasury.

Attribution: The Washington Post

Medicare for physicians will remain broken

Bill to reset SGR falls in Senate.
MedPage Today reports that a bill designed to permanently eliminate the Medicare Sustainable Growth Rate (SGR) formula has failed a key vote in the U.S. Senate. Legislators voted 53-47 against cloture on S.1776, which would have cut off debate and allowed the bill to proceed. All 40 Republican senators and 13 Democrats voted against the motion. Some critics of the bill stated that they were opposed because it did not contain a budget offset for the bill’s $247 billion cost. Senate Majority Leader Harry Reid, D-Nev., said that the Senate might come back to the bill after addressing broader healthcare reform legislation, but in the interim the Senate will consider another one-year fix. The SGR currently calls for a 21 percent reduction in physician reimbursement in 2010.

Attribution: AAOS Headline News Now - October 21, 2009 (www.aaos.org)

The American Academy of Orthopaedic Surgeons view on Healthcare Reform

AAOS Now examines healthcare reform issues.
An early-release AAOS Now article outlining the response of the AAOS to healthcare reform proposals currently being considered in the U.S. Congress is now available on the AAOS Web site. Significant differences exist between House and Senate versions of various reform bills, and with hundreds of proposed amendments, it is not known which components of the various proposals and amendments will appear in the final legislation that both houses of Congress will consider. President Obama has committed to pressing forward with healthcare reform legislation this year, however, and AAOS will continue to seek out opportunities to engage legislators and other stakeholders in dialogue and action to shape the final bill.

Attribution: AAOS Headline News Now - October 5, 2009 (www.aaos.org)

For more, see: http://www.aaos.org/news/aaosnow/oct09/cover1.asp

Even the public knows this one

Poll finds strong public support for medical tort reform.
A national poll conducted by the nonpartisan reform coalition Clarus Research Group and the non-profit Committee for Economic Development finds that 83 percent of U.S. voters want Congress to address reform of the medical liability system as part of healthcare reform efforts, and 72 percent believe the fear of being sued often changes the way physicians deal with patients. Americans are also aware of the impact of medical liability on the practice of defensive medicine and medical costs. When asked "Do you think the fear of being sued is causing doctors to order unnecessary medical tests and procedures just to protect themselves from possible lawsuits?" 74 percent of respondents answered yes, and more than half of those who responded in the affirmative identified such defensive medical practices as a "major cause" of increased healthcare costs. The poll was conducted via live telephone interviews August 14-18, 2009, with a sample of 1,003 registered voters and a margin of error of +/- 3.1 percent.

Attribution: AAOS Headline News Now - September 16, 2009 (www.aaos.org)

For more, see: http://www.philipkhoward.com/images/uploads/CommonGood_PPT_Clarus-poll-sept10-09_ppt.pdf

Orthopedists take on healthcare misinformation

During a recent New Hampshire "town hall" meeting on healthcare reform, President Obama stated, "If a family care physician works with his or her [diabetic] patient to help them lose weight, modify diet, monitors whether they're taking their medications in a timely fashion, they might get reimbursed a pittance. But if that same diabetic ends up getting their foot amputated, that's $30,000, $40,000, $50,000—immediately the surgeon is reimbursed." The AAOS has voiced its vigorous opposition to this statement by sending a letter to the president, emphasizing the value orthopaedic surgeons provide in the U.S. healthcare system and clarifying that Medicare reimbursement to physicians for foot amputations ranges from approximately $700 to $1,200, including follow-up care provided by the surgeon for up to 90 days after the operation. The letter also notes that, along with numerous other organizations, AAOS has testified before the U.S. Congress that delays in reimbursement by Medicare and other payors create additional administrative burdens that make it more difficult to provide access to care for patients. The letter affirms that AAOS is committed to improving the American health care delivery system and increasing health care coverage and states that the most expedient way to accomplish health care reform is to ensure that the debate is based in fact and reflects the value of the services that all physicians, including orthopaedic surgeons, provide.

Read the AAOS letter to President Obama (PDF)… http://www6.aaos.org/headline_news_now/potus.pdf

Attribution: AAOS Headline News Now - August 14 2009 (www.aaos.org)

References:  Read the transcript of the president’s remarks:

http://www.whitehouse.gov/the_press_office/...Reform-in-Portsmouth-New-Hampshire/

Orthopaedsts fight for their patients rights: "AAOS Act" introduced into U.S. Senate.

The Access to America's Orthopaedic Services (AAOS) Act (S. 1548) has been introduced in the U.S. Senate as S.1548. Sponsored by Sen. Benjamin L. Cardin (D-Md.) and cosponsored by Sen. Richard M. Burr (R-N.C.), the legislation aims to improve knowledge about the public health effects of musculoskeletal diseases and conditions. The bill has been referred to the Senate Committee on Health, Education, Labor, and Pensions. The bill was previously introduced in the U.S. House of Representatives as H.R. 1021.
Attribution: AAOS Headline News Now - July 31, 2009 (www.aaos.org)

Tags: Healthcare, Reform, Congress, AAOS

References:  Read more, including the text of the House version of the bill, by clicking on this link: http://www.aaos.org/govern/public/aaos_bill/aaosact.asp

Alternative Medicines not so cheap after all (AND largely unproven)

According to a report released by the U.S. National Center for Complimentary and Alternative Medicine, Americans spent $33.9 billion out-of-pocket on complementary and alternative medicine (CAM) during 2007, accounting for about 1.5 percent of total healthcare expenditures and 11.2 percent of total out-of-pocket expenditures in the United States. Of the $33.9 billion, an estimated $22.0 billion was spent on self-care items, mostly on the purchase of non-vitamin, non-mineral, natural products ($14.8 billion) such as fish oil, glucosamine and Echinacea. U.S. adults also spent approximately $11.9 billion on an estimated 354.2 million visits to CAM practitioners such as acupuncturists, chiropractors, and massage therapists.

Attribution: AAOS Headline News Now - July 31, 2009 (www.aaos.org)

Tags: Complementary medicine, alternative medicine

References:  For more, go to this link: http://nccam.nih.gov/news/camstats/costs/

Senate to delay vote on healthcare reform until after recess

According to the Boston Globe, the Senate will not try to hold a vote on healthcare reform before the August recess. Although the Senate Finance Committee is expected to act on a measure before the break, that bill will have to be reconciled with a previous bill passed by the Senate Health, Education, Labor, and Pensions Committee. The compromise measure will then be presented for a vote. President Obama, who had pushed for an early vote, accepted the delay, saying "That's OK...I just want it done by fall."

Attribution: AAOS Headline News Now - July 27, 2009 (www.aaos.org)

Tags: Healthcare, Reform, Senate

References:  To read more, click on this link: http://www.boston.com/.../senate_democrats_give_up_plan_for_healthcare_vote_before_recess/

House healthcare plans pass two committees, but concerns remain

Bloomberg reports that two committees in the U.S. House of Representatives have approved their portions of a plan to revamp the U.S. healthcare system. The Ways and Means Committee voted 23-18 in favor of its part of the legislation, HR 3200: America's Affordable Health Choices Act of 2009. The Education and Labor Committee followed with a supporting vote of 26-22. Both approvals were largely along party lines. The legislation must now be voted on by the Energy and Commerce Committee, which has already begun debate. According to Reuters, President Obama is seeking the support of Republican legislators for the plan, although a handful of Democrats in the House have opposed it as well. In related news, the Washington Post reports that the director of the Congressional Budget Office, in testimony before the Senate Budget Committee, said that bills crafted by House leaders and the Senate health committee fall short of the "fundamental changes" needed to control the rising cost of government health programs.

Attribution: AAOS Headline News Now - July 17, 2009 (www.aaos.org)

Tags: Healthcare, Reform, Congress, Orthopaedics

References:  For more, link to: http://www.bloomberg.com/apps/news?pid=20601087&sid=aBFO3BCTYiuA

From the Washington Post: http://www.washingtonpost.com/wp-dyn/content/article/2009/07/16/AR2009071602242.html

House Democrats slow down to take a good look at reform details

Politico reports that several Democratic legislators in the U.S. House of Representatives have demanded changes to healthcare reform legislation, which could delay an informal timetable proposed by House leadership. In a letter addressed to House Speaker Nancy Pelosi and Majority Leader Steny Hoyer, 40 members of the so-called "Blue Dog Coalition" stated that they have "strong reservations about the process and direction" of an early preview of a bill put forth by several House leaders. Additionally, 22 Democratic representatives state that they would prefer that government-sponsored health coverage piggyback on Medicare's pre-existing network, despite earlier opposition to the idea from caucus leaders. A group of 20 rural and Western Democrats argue that the bill should fix inequities in reimbursement rates Medicare pays to healthcare providers in "low-cost, high-quality" states. House leadership had previously stated that they hoped to move the legislation out of the House before a planned break in August, but some experts say that timeline appears in doubt.

Attribution: AAOS Headline News Now - July 10, 2009 (www.aaos.org)

Tags: Healthcare, Reform, Congress, Orthopaedics

References:  To read more, click on this link: http://www.politico.com/news/stories/0709/24756.html

Read copy of the letter from the Bluedog democrats; http://wonkroom.thinkprogress.org/wp-content/uploads/2009/07/bluedogletter.pdf