Conference Highlights: AAOS 2016

Patient Age & TKA Outcomes

The Particulars: Evidence suggests that increasing life expectancies and obesity rates in the United States have led to a broader age range of patients undergoing total knee arthroplasty (TKA). However, few studies have evaluated the effects of patient age on TKA outcomes.

Data Breakdown: For a retrospective analysis, researchers compared outcomes after TKA among patients younger than 45, aged 45 to 54, aged 55 to 64, aged 65 to 74, and aged 75 and older. All patients experienced improvements with regard to range of motion following TKA, and no significant differences were seen between age groups. Patients aged 75 and older had significantly higher functionality scores at 6 weeks on the Knee Society Scoring system, but all other age groups had higher scores on this test when assessed at 2 and 5 years after surgery. Functional outcomes, which were measured by the Short Form-36 and lower extremity activity scale, were lowest among patients younger than 45 and those aged 75 and older at various time points.

Take Home Pearls: Patients of all ages appear to experience functional improvements and good outcomes following TKA. However, the youngest and oldest TKA patients appear to have better functioning, less pain, and higher activity levels when compared with those aged 45 to 74.

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Patient-Reported Outcomes by THA Approach

The Particulars: Numerous studies have compared total hip arthroplasty (THA) using a direct anterior approach or a posterolateral approach. However, few analyses have specifically compared patient-reported outcomes following each of these approaches.

Data Breakdown: For a study, patients receiving unilateral primary THA from two surgeons who exclusively perform direct anterior approaches were case-matched with similar patients from two additional surgeons who exclusively performed posterolateral approaches. Based on patient-reported outcomes, no significant differences were observed at 6 months between  groups with regard to preoperative, postoperative, or hip disability and osteoarthritis outcomes scores. Rates of complications were also similar with both THA approaches.

Take Home Pearl: The surgical approach to THA appears to have no bearing on patient-reported outcomes.

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Physician Empathy & Satisfaction With Hand Surgery

The Particulars: As healthcare continues to transition toward an outcomes-based model, interest has grown in increasing patient satisfaction rates after medical procedures. However, the drivers of patient satisfaction among hand surgery patients are poorly understood. Identifying what patients value with regard to their care is important for quality improvement purposes and could have clinical and economic implications.

Data Breakdown: New hand surgery patients were surveyed immediately after their first office visit for a study. The authors sought to examine the relationship between physician empathy and patient satisfaction. After controlling for confounding effects, greater physician empathy appeared to increase patient satisfaction (odds ratio [OR], 1.6). Older patient age (OR, 2.4 per 10-year increase) was also independently associated with patient satisfaction. However, no differences were observed between satisfied and dissatisfied patients with regard to:

• Waiting time in the office.
• Duration of the appointment.
• Time from booking until appointment.
• Second opinions.
• Resident or fellow involvement.
• Management or health literacy.

Take Home Pearl: Physician empathy appears to be a strong driver of a patient’s satisfaction with their surgeon among those undergoing hand operations.

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Assessing Lawn Mower Injuries

The Particulars: In 2001, the American Academy of Pediatrics (AAP) Committee on Injury and Poison Prevention released guidelines for the prevention of lawn mower injuries. Few studies have examined the effectiveness of these guidelines in recent years.

Data Breakdown: For a study, data were assessed on 199 patients younger than 17 who sustained a lawn mower-related injury in Pennsylvania from 2002 to 2013. On average, patients were 8 years of age, and 81% of the participants were boys. Injuries to the lower extremity accounted for 64% of cases, and 53% of cases resulted in an amputation either at the time of injury or after surgical intervention. The researchers suggest that at least 69% of cases could have been prevented if the AAP guidelines had been followed.

Take Home Pearls: Non-adherences with AAP guideline recommendations for preventing lawn mower-related injuries appears to account for more than two-thirds of such injuries among children. Educational campaigns are needed to increase awareness among caregivers of the significant effects of lawn mower injuries and to increase adoption of the AAP guideline recommendations.

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Hip Injections Increase Post-THA Infections

The Particulars: Data are inconclusive on the risk of periprosthetic joint infection (PJI) from direct inoculation and/or immune suppression by corticosteroids among patients who receive intraarticular injections prior to undergoing total hip arthroplasty (THA).

Data Breakdown: The effects of preoperative hip injections on the 1-year rate of PJI in patients undergoing primary THA were evaluated for a study. The rates of PJI at 1 year were as follows:

Take Home Pearls: Patients undergoing THA appear to have a higher risk for PJI when an intraarticular hip injection is administered within 12 weeks of their surgery. However, hip injections appear to be safer when performed more than 3 months before THA.