January 2016

AAOS issues guidance on TKR, hip fracture and rehab, OCD knee in kids

The Rosemont, IL-based American Academy of Orthopaedic Surgeons (AAOS) in December released updated clinical practice guidelines on surgical management of knee osteoarthritis, as well as several appropriate-use criteria (AUC).

“Surgical Management of Osteoarthritis of the Knee” focuses on total knee replacement (TKR). Key recommendations with a “strong” rating include reducing risk factors such as body weight and smoking, administering multimodal anesthesia to decrease pain and opioid use post-TKR, and starting rehabilitation the same day as TKR to shorten hospital stays.

“Appropriate Use Criteria for the Treatment of Hip Fractures in the Elderly” addresses patients  60 years and older with fractures caused by low-impact events.

It includes a preoperative checklist of 12 important care initiatives, including limiting preoperative traction, managing Warfarin, and discussing the patient’s home environment prior to discharge.

“Appropriate Use Criteria for Postoperative Rehabilitation for Low Energy Hip Fractures in the Elderly,” provides universal recovery recommendations for elderly patient populations and a future fracture prevention checklist that includes measures such as participation in a fall prevention program and therapy to improve bone density.

“Appropriate Use Criteria for Management of Osteochondritis Dissecans of the Femoral Con­dyle” covers treatment and rehabilitation of pediatric patients. It rates therapies based on whether they are reasonable and acceptable given the patient’s condition, and are likely to improve outcomes. For example, restricting physical activity that produces impact or pain, and performing physical therapy to regain strength, mobility, and function were rated “appropriate,” and bracing the knee instead of immediate surgical treatment was rated “may be appropriate.”

Access the new clinical guideline and the AUCs at aaos.org.

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