The annual meeting of the American Academy of Orthopaedic Surgeons was held from Aug. 31 to Sept. 3 in San Diego and attracted approximately 5,000 participants from around the world. The conference highlighted recent advances in the diagnosis and management of musculoskeletal conditions, with presentations focusing on joint fractures, osteoarthritis, other musculoskeletal injuries, and factors impacting the outcomes of joint replacement procedures.

In one study, Ran Schwarzkopf, M.D., of the New York University Langone Orthopedic Hospital and Hospital for Joint Diseases in New York City, and colleagues found that patients who undergo total knee arthroplasty (TKA) or total hip arthroplasty (THA) who are married or have a supportive structure at home tend to go home upon discharge from the hospital rather than to a rehabilitation facility.

The authors evaluated a few years of outpatient records at NYU Langone Orthopedic Hospital. They used electronic health records for all patients who had undergone TKA or THA, extricating data on social status, whether they lived alone or were married, length of hospital stay, and discharge location. This was not a cause-and-effect study; rather, the goal was to identify associations. The researchers found that patients with supportive care at home were more likely to be discharged to their home environment rather than a rehabilitation or nursing home facility.

“Currently, every patient gets bundled together, and physicians get penalized by sending patients to a rehabilitation center or keeping patients in the hospital longer, even if it is the correct and safe way to treat a patient,” Schwarzkopf said. “If we are penalized on discharge by sending a patient to a nursing home or keeping them in the hospital longer, physicians start cherry picking their patients. This will lead to some patients with more comorbid conditions or lack of support at home to have limited access to care.”

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In another study, Rushabh Vakharia, M.D., of Maimonides Medical Center in Brooklyn, New York, and colleagues found that patients with cannabis use disorder undergoing total joint arthroplasty have prolonged in-hospital stays, elevated rates of medical and prostheses-related complications, and higher costs of care compared with patients not using cannabis.

In a retrospective assessment, the authors used a private database to construct a study cohort of patients with cannabis use disorder, which was matched in a 1:5 ratio with a cohort without cannabis use disorder. Multivariate logistic regression analysis was utilized to determine the association of cannabis use disorder with outcomes. The researchers found cannabis use disorder was associated with higher rates of cardiopulmonary-related complications within the episode-of-care interval compared with the case-matched cohort. In addition, the investigators found that patients with cannabis use disorder also had significantly higher rates of prostheses-related complications (e.g., periprosthetic joint infections) and higher health care expenditures.

“Orthopedists should be vigilant with those patients who have cannabis use disorder undergoing total joint arthroplasty,” Vakharia said. “Working together with mental health professionals such as psychiatrists or substance use disorder professionals can facilitate in potentially reducing the deleterious outcomes associated with the condition.”

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S. Clifton Willimon, M.D., of Children’s Healthcare of Atlanta, and colleagues found that narcotic use in pediatric patients following orthopedic surgery is significantly less than the quantity prescribed, with 56 percent of doses going unused.

In a prospective study, the authors evaluated 342 children and adolescents, aged 5 to 21 years, to track postoperative narcotic use following seven common pediatric orthopedic surgeries. The researchers found that 9,867 narcotic doses were prescribed, and 44 percent of the doses were consumed, which left 56 percent unused. Patients typically used narcotic medications for three to five days following surgery. Nonsteroidal anti-inflammatory drug (NSAID) use was the only factor shown to significantly reduce the total number of narcotic doses consumed and duration of use by 5.1 doses and 1.7 days, respectively, compared with not using NSAIDs for pain relief.

“NSAID use significantly decreased total number of pills consumed and duration of use,” Willimon said. “Patient education decreased duration of narcotic use, highlighting the need for discussion on appropriate indications for use and methods to decrease overall use.”

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Henry B. Ellis, M.D., of the Scottish Rite for Children in Dallas, and colleagues found that training style modifications, decreased training, and increased sleep quantity and quality are positive effects of COVID-19 restrictions on youth athletes, while athletic aspirational changes are undesirable effects.

The authors sent an anonymous survey to youth athletes during the six-week course of heightened restrictions during the COVID-19 pandemic. The researchers found both positive and negative effects in adolescent athletes during social distancing due to COVID-19. Virtual training appeared to be a successful form of safe and healthy training, but sports specialization appeared to predispose youth athletes to signs of depression when compared with multisport athletes during the pandemic.

“Single-sport athletes may be at greater risk for psychological symptoms when their routine is altered,” Ellis said. “During and after COVID-19, healthy habits, including sleep, mental well-being, and optimal practice schedules, will need to be enforced to further educate parents and coaches on taking care of the complete athlete.”

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AAOS: Sports-Related Concussions Up in High School Girls

THURSDAY, Sept. 2, 2021 (HealthDay News) — There was a significant increase in the number of high school-age female patients presenting to the emergency department for sports-related concussions and closed head injuries between 2000 and 2019, according to a study presented at the annual meeting of the American Academy of Orthopaedic Surgeons, held from Aug. 31 to Sept. 3 in San Diego.

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AAOS: Some Seniors May Continue Opioid Use After Hip Fracture Surgery

THURSDAY, Sept. 2, 2021 (HealthDay News) — One out of every six older hip fracture patients is still taking opioid pain medications three to six months after surgery, according to a study presented at the annual meeting of the American Academy of Orthopaedic Surgeons, held from Aug. 31 to Sept. 3 in San Diego.

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AAOS: Knee Replacement Readmissions Higher Among Marijuana Users

TUESDAY, Aug. 31, 2021 (HealthDay News) — Rates for readmission and some short-term complications associated with total knee arthroplasty are higher among patients reporting preoperative marijuana use, according to a study presented at the annual meeting of the American Academy of Orthopaedic Surgeons, held from Aug. 31 to Sept. 3 in San Diego.

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