American Academy of Orthopaedic Surgeons, March 22-26

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The annual meeting of the American Academy of Orthopaedic Surgeons was held from March 22 to 26 in Chicago 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, Cordelia W. Carter, M.D., of the NYU Langone's Hassenfeld Children's Hospital in New York City, and colleagues found that wearing a surgical mask while exercising is safe and can be done without significant changes in physiologic parameters, such as heart rate and respiratory rate.

The authors conducted a systematic review of the existing literature performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The researchers found that for the general population, wearing a surgical mask while exercising was safe and did not impair athletic performance.

"These findings were reported for a variety of populations, including children and pregnant women," Carter said. "The caveat to this conclusion is that several studies that looked specifically at N95 respirator use during exercise performed to exhaustion did demonstrate small elevations in heart rate during heavy work and decrements in peak performance (faster time to exhaustion and decreased maximum power output)."

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In another study, Keith B. Diamond, M.D., of Maimonides Medical Center in Brooklyn, New York, and colleagues found that depressive disorder is associated with adverse outcomes following primary reverse shoulder arthroplasty for the treatment of glenohumeral osteoarthritis.

The authors performed a retrospective query of a national insurance administrative claims database to identify patients with a diagnosis of glenohumeral osteoarthritis and reverse shoulder arthroplasty, with and without depressive disorder as a secondary diagnosis. For patients with depressive disorder, the researchers observed increased length of stay (three versus two days), increased medical complications (47.4 versus 14.7 percent), and increased 90-day episode-of-care costs ($19,363.10 versus $17,927.55).

"Depressive disorders can negatively impact patients undergoing primary reverse shoulder arthroplasty for the treatment of glenohumeral osteoarthritis," Diamond said. "Practitioners should be aware of the increased risk for adverse events, as well as include psychiatric screening as part of their preoperative medical clearance for patients undergoing reverse shoulder arthroplasty. Patients should be properly educated about their medical and psychiatric comorbidities when considering this proven-successful treatment option."

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Assem Sultan, M.D., of the Cleveland Clinic, and colleagues found that telemedicine is appropriate and feasible for most pediatric orthopedic conditions and provides a value-add for all parties, including less time away from school and work, a familiar environment for small children, and less overhead for providers and health systems.

The authors surveyed patients and parents using a validated survey tool that encompassed several domains of patient satisfaction. Data were prospectively collected between March 2020 and March 2021 for patients who underwent virtual as well as in-person clinic visits. A total of 1,686 individual responses were received (226 virtual and 1,460 in-office). Using bivariate analysis, the researchers found that satisfaction rates were similar for virtual visits and office visits. Multivariable regression models were used to assess the association between type of visit and attaining good/excellent satisfaction scores in each domain after accounting for multiple baseline characteristics among patients. The researchers found that virtual visits had similar satisfaction scores for most of the proposed questions examining different domains from the patient perspective.

"Telemedicine can be a powerful tool to boost efficiency in daily pediatric orthopedic practice. We showed that it is highly beneficial and convenient for patients, families, and clinicians," Sultan said. "With good coordination and incorporation into the scheme of the outpatient clinic schedule, it can boost the efficiency and quality of care delivery."

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Priscilla P. Varghese, M.D., candidate at The State University of New York Downstate College of Medicine in Brooklyn, New York, and colleagues found that patients older than 80 years of age (octogenarians), experience a longer length of stay and greater readmission rates compared with nonoctogenarians following total knee arthroscopy (TKA).

The authors identified 1,775,460 patients who underwent primary TKA from 2005 to 2014. Patients aged 80 years and older represented the study cohort and patients 65 to 79 years represented the control cohort. Study group patients were matched to controls in a 1:5 ratio according to gender and comorbidities. While the researchers found that octogenarians tend to have longer lengths of stay and readmission rates following TKA, they also found that these older patients had similar rates of 90 different medical complications and lower rates of hardware complications compared with their younger counterparts.

"Surprisingly, we found rates of 90-day medical complications to be similar to those of the younger aged cohort, which was not expected. This could be due to the advancements which are being made within the orthopedic specialty through the use of robotics, high-volume surgeons, introduction of tranexamic acid, and other novel innovations," Varghese said. "Given the increasing life expectancy of patients within the United States and older populations considering total knee arthroplasty, these findings are important to share with orthopedic surgeons and other health care professionals to educate octogenarian patients who are considering TKA and provide reassurance that their risk of adverse events is similar to that of younger cohorts."

Varghese conducted this research at Maimonides Medical Center during a summer research program for first-year medical students. The Maimonides Orthopedic Research Experience program was founded by Afshin Razi, M.D., and Rushabh M. Vakharia, M.D.

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