American Academy of Orthopaedic Surgeons 2011 Annual Meeting tip sheet

(Press-News.org) Treating Hip Fractures

Delaying Hip Fracture Surgery Appears Detrimental (Embargo: February 15)
Reduction of wait time encouraged for both economic and humanitarian reasons

Patients who wait more than 36 hours for surgery to correct a hip fracture have a 39 percent rate of medical complication and those who wait 48 hours have a 46 percent complication rate. Patients who receive surgical treatment within 24 hours have a lower complication rate of 25 percent and a shorter hospital stay. Each day the surgery was delayed added an additional two days to hospital stay.

High Rates of Adverse Events Associated With Partial Hip Replacement (Embargo: February 15)
Researchers recommend working to improve patient safety

Like other hip fracture populations, Medicare beneficiaries who underwent a partial hip replacement (clinically known as a hemiarthroplasty) for a hip fracture experienced high rates of adverse events. While in the hospital, 14 percent of patients sustained an adverse event including urinary tract infections, pneumonia, major bleeding or cardiovascular events. Medicare beneficiaries who underwent hemiarthroplasty for hip fracture and experienced an adverse event were more than twice as likely to die during hospitalization. This data demonstrates that employing a chart abstraction technique can help to quantify adverse events in a Medicare population sustaining a hip fracture. This study may help standardize adverse event reporting in this population to improve patient care and to guide national quality of care initiatives.

Treating Children and Adolescent

High School Athletes at Significant Risk of Stress Fracture (Embargo: February 15)
Sport-related stress fractures differ by sex

Female high school athletes have more (61 percent) stress fractures than males (39 percent). Slightly more than half (52 percent) of the stress fractures in females are attributed to track or cross-country, while the fractures in males are caused by track (26 percent), football (23 percent) and cross-country (19 percent). The lower leg is most vulnerable to stress fracture with nearly 60 percent of fractures occurring in the shin bone and the smaller lower leg bone. The feet also are at risk with nearly one in four breaks occurring in either the long bones of the foot or the hindfoot. At the time of fracture, males tend to be older and have a higher body mass index than the female athletes. Males with stress fractures report sleeping more and lifting weights more often than females. In addition, both males and females training at a higher intensity at a younger age, are at an increased risk of stress fractures.

ATV-related Spinal Injuries Have High Disability Rate (Embargo: February 17)
Multiple spinal injuries are common, younger children have more serious injuries

All-terrain vehicle accidents result in high rates of disability and are a danger to children. Children younger than 16 years of age are more prone to lumbar spine injuries, while older adolescents have more thoracic spine injuries. Compression/burst fractures are the most common (31 percent) fracture type. Other injuries included a head injury, abdominal injuries and chest trauma. Some injuries resulted in neurological deficits such as partial and complete paraplegia.

Serving Veterans

Disabling Arthritis Caused by Combat Injuries (Embargo: February 15)
More research recommended to reduce joint degeneration in wounded military personnel

Young, active duty military personnel are developing traumatic arthritis following combat injury. Joint injury resulting in arthritis was commonly caused by explosions, followed by shrapnel and gunshot wounds. An injury to the knee had the highest likelihood of developing post traumatic arthritis. Arthritis was typically diagnosed and recognized as a disabling condition less than two years following injury.

Complex Musculoskeletal Injuries Sustained During Operation Iraqi Freedom (Embargo: February 18)
High incidence of fractures and amputations

The orthopaedic injuries sustained during "The Surge" portion of Operation Iraqi Freedom were complex and often resulted in fractures or major amputation. Of the 4,122 soldiers deployed by the US Army Brigade Combat Team during Operation Iraqi Freedom, 176 soldiers sustained 242 musculoskeletal combat wounds. More than half (55.9 percent) of fractures occurred in the spine, pelvis and long bones. Explosions accounted for most (80.7 percent) of the causalities. Explosions were more likely than gunshots to result in loss of a limb and gunshots were more likely to cause bone fractures, according to the first detailed report of musculoskeletal casualty wounds obtained in combat during a counterinsurgency campaign.

Speeding Surgical Recovery

Immediate Physical Therapy Can Shorten Length of Hospital Stay Following Joint Surgery (Embargo: February 18)
PT on day of surgery speeds recovery

Regardless of the therapy performed, surgical patients visited by a physical therapist on the day of total joint arthroplasty (TJA) go home before patients who do not have day-of-surgery therapy provided by a physical therapist. Patients who have physical therapists work with them on the day of TJA surgery stay in the hospital an average of 2.8 days, while those who receive physical therapy on the day following TJA surgery have longer stays, averaging 3.7 days. Activity with nursing staff alone did not seem to be as beneficial, as patients only assisted to a chair on the day of surgery by nursing staff, average a hospital stay of 3.6 days.

Extended Use of COX-2 Inhibitors Helps Surgical Recovery (Embargo: February 17)
Study follows up on improved perioperative recovery with use of COX-2 inhibitors

Patients taking COX-2 inhibitors for six weeks following total knee arthroplasty have more rapid and less painful recoveries than patients who discontinue COX-2 inhibitor treatment at hospital release. Those who continue taking COX-2 inhibitors require less than half the narcotics and report less pain while resting, sleeping and during activities than those who discontinue therapy at release. Patients who use extended COX-2 inhibitors therapy following surgery have improved knee function measurements at three months as well as improvement in knee flexion on year later.

Access to Care and Conflict of Interest in Medicine

Orthopaedic Surgeons Approaching Retirement: Shortage Expected (Embargo: February 15)
Reduced access to hip and knee reconstruction projected

The number of hip and knee surgeons is predicted to decrease as this group of surgeons draws closer to retirement and fewer trainees are available to carry on reconstructive work. As the economy improves, many surgeons are expected to retire while at the same time Medicare reimbursement rates are predicted to drop. Nearly one in three knee and hip surgeons report changing total joint arthroplasty (TJA) practice due to declining reimbursement. And with physicians dealing with an increasing overhead in maintaining their practice, a decrease in Medicare reimbursement could make it economically impossible for some physicians to continue to perform total joint surgeries. According to the American Association of Hip and Knee Surgeons (AAHKS), a 15 percent to 20 percent drop in Medicare reimbursement for TJA could result in 49 percent to 57 percent of AAHKS members being unable to provide TJA for Medicare patients, leaving an unmet need of between 92,650 to 160,818 patients.

Study finds general public to have a favorable opinion of physician-industry relationships (Embargo: February 17)
However, government and industry representatives not trusted to regulate conflict of interest

Survey respondents did not believe that consulting relationships between surgeons and industry would adversely affect their quality of care. Most respondents (80 percent) felt that consulting for medical device companies was ethical and beneficial or at least non-influential for their personal health care; however, disclosing these relationships was considered to be important. Royalties were deemed appropriate as long as surgeons were not rewarded for devices they implant. Physician-industry relationships and conflict of interest are thought to be best regulated by professional societies (www.aaos.org/disclosure) and physicians with minimal involvement with government and industry.

### With more than 36,000 members, the American Academy of Orthopaedic Surgeons, (www.aaos.org) or (www.orthoinfo.org) is the premier not-for-profit organization that provides education programs for orthopaedic surgeons and allied health professionals, champions the interests of patients and advances the highest quality of musculoskeletal health. Orthopaedic surgeons and the Academy are the authoritative sources of information for patients and the general public on musculoskeletal conditions, treatments and related issues. An advocate for improved care, the Academy is participating in the Bone and Joint Decade (www.usbjd.org) - the global initiative in the years 2002-20011 - to raise awareness of musculoskeletal health, stimulate research and improve people's quality of life. The Academy's 2011 Annual Meeting is being held February 15, 2011 at the San Diego Convention Center in San Diego. Fan AAOS at www.facebook.com/AAOS1 and follow us on Twitter at www.twitter.com/AAOS1