The reimbursement system can influence the treatment choice and favor joint replacement versus other less invasive solutions in patients affected by osteoarthritis

PURPOSE

The aim of this study was to assess how physicians perceive the role of the reimbursement system and its potential influence in affecting their treatment choice in the management of patients affected by osteoarthritis (OA).

METHODS

A survey was administered to 283 members of SIAGASCOT (Italian Society of Arthroscopy, Knee, Upper Limb, Sport, Cartilage and Orthopaedic Technologies), a National scientific orthopaedic society. The survey presented multiple choice questions on the access allowed by the current Diagnosis-Related Groups (DRG) system to all necessary options to treat patients affected by OA and on the influence toward prosthetic solutions versus other less invasive options.

RESULTS

Almost 70% of the participants consider that the current DRG system does not allow access to all necessary options to best treat patients affected by OA. More than half of the participants thought that the current DRG system favors the choice of prosthetic solutions (55%) and that it can contribute to the increase in prosthetic implantation at the expense of less invasive solutions (54%). The sub-analyses based on different age groups, professional roles, and places of work allowed to evaluate the response in each specific category, confirming the findings for all investigated aspects.

CONCLUSIONS

This survey documented that the majority of physicians consider that the reimbursement system can influence the treatment choice when managing OA patients. The current DRG system was perceived as unbalanced in favor of the choice of the prosthetic solution, which could contribute to the increase in prosthetic implantation at the expense of other less invasive options for OA management.

A complication following ACL reconstruction using bioabsorbable cross-pins

This is a case of a proximal pin migration after ACL reconstruction in medial soft tissue with pain, inflammatory reaction and functional reduction. 33-year-old male presented at our clinic with a complete ACL rupture. Reconstruction with autogenous gracilis and semitendinosus hamstring tendons was performed and graft fixed in the femoral canal with two PLLA bioabsorbable pins (RIGIDFIX® Cross Pin System). Two months postoperatively the patient presented swelling and pain on the medial side of the knee, full range of motion and negative results at the Lachman and Pivot shift tests. MRI examination showed the superior femoral tunnel crossing both the lateral and medial cortex lodging the pin in the knee's medial soft tissue corresponding to the swelling area reported by the patient. The tendon graft was properly positioned. After surgical removal of the pin through a small skin incision, the pain and swelling promptly subsided allowing the patient return to normal activities in few weeks without any pain. In our opinion the painful swelling of the knee was due to a displacement of the pin that had been accidentally lodged in the soft tissues instead of the bone causing a foreign-body reaction resulting in granuloma formation with local inflammation. This dislodgement could have been due to an inappropriately long femoral tunnel.

Use of a non-medicated plaster in shoulder tendinopathies

We assessed 20 shoulders with rotator cuff tendinopathy and partial tendon tears treated with FIT® plasters (far infrared technology). The criteria for inclusion were pain at night and during active shoulder movement. Patients with restricted passive movement (adhesive capsulitis) and complete tendon tears were excluded. Two different types of FIT® plasters were used according to the different power of action. Plasters were replaced after 7 days and dismissed after 15 days. The patients were assessed using the VAS pain scale and the Constant Murley score for function. The use of FIT® plasters have shown a certain effectiveness in activation of the endogenous analgesic action, with a role in alleviate painful symptoms and improve function in rotator cuff tendinopathies, without adverse events. On the base of the safety of this technology and promising results of our study, further studies should be encouraged to confirm its effectiveness, increasing the sample number and follow up so as to demonstrate definitely that the use of technologies, on which FIT® plasters is based, may be a valid alternative as "non-medicated pain relief".

Hip arthroscopy in osteoarthritis consequent to FAI

BACKGROUND

Femoral Acetabular Impingement (FAI) means a set of alterations involving the acetabulum, proximal femur, or both of these components that can results in osteoarthritis. Arthroscopy is a choice for the treatment of initial stages of osteoarthritis (OA) in order to reduce evolution of the degenerative processes; advanced degrees of osteoarthritis are absolute contraindications.

MATERIALS AND METHODS

40 patients affected by osteoarthritis in FAI  underwent hip arthroscopy between May 2010 and March 2015. In all 40 cases OA secondary to FAI was diagnosed. All patients were clinically and instrumentally analyzed pre-operatively and then post-operatively after 3, 6, and 12 months. We evaluated the degree of OA using the Tonnis classification; our study included only patients affected by Tonnis grade 0-2 osteoarthritis.

RESULTS

The mean modified Harris Hip Score showed an evolution from 54.7 points to an average value of 89,1 points after 12 months. The Lower Extremities Functional Scale evolved by 43 points to an average value of 65,28 points.

CONCLUSIONS

Based on the data of this study, supported by the concordance with recent literature reviews, in degrees Tonnis 0 and 1 an arthroscopic treatment is recommended. Instead the therapeutic algorithm in Tonnis grade 2 is still being discussed. We detect a significant response to arthroscopic intervention which leads us to suggest that validation of this method needs further confirmatory studies.