The 2019 Annual Meeting of the American Academy of Orthopaedic Surgeons

The annual meeting of the American Academy of Orthopaedic Surgeons was held from March 12 to 16 in Las Vegas and attracted approximately 30,000 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, Mary I. O’Connor, M.D., of the Yale School of Medicine and Yale New Haven Hospital in Connecticut, and colleagues found that a telerehabilitation program for patients undergoing hip and knee replacement surgery is effective and delivers high levels of patient satisfaction, comparable clinical outcomes, and lower costs.

“As we recognize the challenges within health care, we need to relentlessly focus on lowering costs while maintaining or preferably improving quality and the patient experience. This is essential as we must always keep the patient at the center of all we do,” O’Connor said. “Therefore, we need modalities that engage patients. We had very high levels of patient satisfaction with our telerehabilitation program.”

The program discharged patients to their home with a telerehabilitation protocol, which still included some traditional face-to-face physical therapy sessions. This protocol intended to extend physical therapy in the home effectively without a physical therapist personally being with the patient for every single therapy session.

“One of the really valuable aspects of this technology is the data. You actually know if your patient is doing their exercises at home or not. For example, if a patient fails to log into the program for two days in a row, the team can reach out to the patient to make sure everything is OK. We also can assess if the patient is progressing with their exercise program because we can see the data,” O’Connor explained. “There are varying degrees of compliance with a home exercise program. We understand that patients often simply do not do their exercises at home as they are supposed to. With this technology, the interactive nature of the program and tracking of progress promotes compliance and actually makes it more fun for the patients.”

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In another study, Frank M. Phillips, M.D., of the Rush University Medical Center in Chicago, and colleagues found that chronic opioid users who stop using opioids for six months prior to orthopedic and spinal surgery have a significantly lower risk for using opioids chronically after surgery.

“I am aggressive about getting patients off opioids prior to surgery and will discuss with patients how chronic opioid use negatively impacts surgical outcomes and how opioid cessation for a period prior to surgery can improve results,” Phillips said. “Clinicians need to take chronic opioid use into consideration prior to surgery and do their best to get patients off them to improve outcomes and avoid postoperative addiction. It is not always easy, but often with management with other drugs, patients can be weaned off opioids prior to surgery.”

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Zaira S. Chaudhry, M.P.H., of the Rothman Orthopaedic Institute in Philadelphia, and colleagues evaluated adolescents and young adults aged 14 to 25 years to determine how long it takes for patients to return to school after surgical intervention for common sports-related injuries.

“For this patient demographic, school is a major part of their lives, and this is a common question encountered in orthopedic practice that is often answered based on anecdotes and not empirical evidence,” Chaudhry said. “Therefore, we sought to provide an evidence-based answer to allow patients to plan appropriately.”

Among patients undergoing common orthopedic sports medicine procedures, the investigators assessed time to return to school after surgery, barriers to returning to school sooner, subjective feelings regarding the impact of surgery on short-term academic performance, and preoperative and postoperative exam failure rates.

“In our study, the average number of days to return to school was 9.6 days for hip arthroscopy, 7.4 days for anterior cruciate ligament reconstruction, 6.6 days for anterior cruciate ligament reconstruction with concomitant meniscal repair, 4.8 days for arthroscopic shoulder labral repair, and 4.3 days for isolated meniscal surgery,” Chaudhry said. “This data can be used by surgeons to counsel patients on how long they should anticipate being absent from school following surgery, which would allow them to plan accordingly.”

The researchers also found that the top three barriers to returning to school sooner were not feeling ready, persistent pain, and restricted mobility.

“Moreover, 13.3 percent of patients felt that the timing of their surgery negatively impacted their academic performance. However, we did not find a statistically significant increase in exam failure rates after surgery,” Chaudhry said. “Given that there is ample literature showing an association between absenteeism and poor academic performance as well as school attrition, it is important for orthopedic surgeons to talk to their patients about the expected number of missed school days and the potential impact surgery may have on short-term academic performance. Our findings allow patients to plan appropriately for absences in order to keep up with their coursework and avoid falling behind.”

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Peter D. Fabricant, M.D., of the Hospital for Special Surgery and Weill Cornell Medical College in New York City, and colleagues found that one-third of adolescents and children have experienced back pain within the previous year, with a significant linear increase seen in back pain for each year of age from 10 to 18 years.

“Among children and adolescents in the United States, there has not been a large-scale epidemiologic study providing insight into the incidence and prevalence of back pain,” Fabricant said.

The investigators found that less than half of children and adolescents sought treatment, and if they did, very few needed any invasive treatments such as injections or surgery.

“Practicing clinicians should understand how common back pain in adolescents and children has become,” Fabricant concluded. “Despite this number being high, back pain in this population is rarely anything serious, and in our study, very infrequently resulted in any invasive or surgical treatment.”

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AAOS: One-Third of U.S. Children Report Back Pain

WEDNESDAY, March 13, 2019 (HealthDay News) — One in three children between the ages of 10 and 18 years said they had back pain in the past year, according to a study presented at the annual meeting of the American Academy of Orthopaedic Surgeons, held from March 12 to 16 in Las Vegas.

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AAOS: Supplement Use Low in Patients With Osteoporosis, Hip Fracture

FRIDAY, March 15, 2019 (HealthDay News) — Of patients diagnosed with osteoporosis who have a history of hip fracture, only 14 percent are receiving appropriate calcium and vitamin D supplementation, according to a study presented at the annual meeting of the American Academy of Orthopaedic Surgeons, held from March 12 to 16 in Las Vegas.

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AAOS: Underweight Status Increases Shoulder Arthroplasty Complications

THURSDAY, March 14, 2019 (HealthDay News) — Underweight patients have a high number of adverse events and postoperative infections after total shoulder arthroplasty, even compared with super morbidly obese patients, according to a study presented at the annual meeting of the American Academy of Orthopaedic Surgeons, held from March 12 to 16 in Las Vegas.

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