News From ACFAS

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The HUB is back for ACFAS 2021 to be your one-stop shop for practical learning for practically everyone. With a fresh lineup of topics aimed to give attendees real-world advice, you won’t want to miss it.

New this year, all HUB sessions delivered on-site will also be recorded and made available on your ACFAS 2021 digital portal. This way you can make it your own—engage with your peers on a variety of topics you might not find elsewhere, or participate from the safety of your home or hotel room.

This year’s HUB topics include:

• Let’s Talk—Lessons Learned from Your Complicated Cases
• The Fellowship Experience: Is Advanced Training Right for You?
• Telemedicine
• Working with Industry—Pros and Cons
• Office Emergencies
• and more!

Visit acfas.org/LasVegas to get a closer look at this year's HUB schedule and for more information on ACFAS 2021! ACFAS’ Arthroscopy of the Foot and Ankle Surgical Skills Course is back in-person for 2021! Join us for one of the upcoming dates to get the latest techniques, didactic lectures and surgical demonstrations at the Orthpaedic Learning Center (OLC) in Rosemont, Illinois.

March 20-21, 2021
April 17-18, 2021
August 14-15, 2021
October 2-3, 2021
December 11-12, 2021

Visit acfas.org/Skills for more information and to secure your spot at one of these popular, highly interactive course’s upcoming dates. Join us tomorrow, February 18 at 7pm CT for the next ACFAS Virtual Journal Club. Flatfoot Reconstruction will be hosted by the Reconstructive Rearfoot and Ankle Surgical Fellowship in Youngstown, OH and presented by Henry D. Spingola III, DPM, AACFAS.

Visit acfas.org/JournalClub to register for this installment and stay tuned for March's Journal Club hosted by the Pediatric Foot & Ankle Fellowship in Cedar Knolls, NJ. You can also access archived Journal Club sessions using your membership login at acfas.org/JournalClub.

Foot and Ankle Surgery

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The study assessed the intra- and inter-reader reliability of both Charcot neuroarthropathy classifcations (Sanders/Frykberg and Brodsky/Trepman), as well as Eichenholtz staging. Digital radiographic images were presented without clinical information. Five reviewers reviewed 55 cases of Charcot neuroarthropathy and five normal cases and rated them according to each system. The 95 percent confidence interval of the intraclass correlation coefficient estimate for Sanders/Frykberg was 0.9601 to 0.9833 at week zero and 0.9579 to 0.9814 at week eight, which can be regarded as “excellent” reliability. For Trepman/Brodsky, the 95 percent confidence interval of the intraclass correlation coefficient estimate was 0.8463 to 0.9327 at week zero and 0.8129 to 0.9226 at week eight, which can be regarded as “good” to “excellent” reliability. For Eichenholtz, that interval was 0.6841 to 0.8640 and 0.6931 to 0.8730 at weeks zero and eight, respectively, which can be regarded as “moderate” to “good” reliability.


The study compared clinical outcomes after total ankle arthroplasty (TAA) between patients with osteoarthritis and rheumatoid arthritis. Forty-five patients with end-stage osteoarthritis (OA group) and 19 with rheumatoid arthritis (RA group) were followed for more than three years after three component mobile-bearing TAA. Perioperative anti-rheumatic medications were modified using an established guideline used in total hip and knee arthroplasty. Clinical evaluations consisted of American Orthopaedic Foot and Ankle Society (AOFAS) scores, Foot and Ankle Outcome Score (FAOS) and Foot and Ankle Ability Measure (FAAM). There were no significant differences in AOFAS, FAOS and FAAM scores between the two groups. However, the OA group showed significantly better scores in FAOS sports and leisure and in FAAM sports activity subscales than those in the RA group. There were no significant differences in perioperative complication and revision rates between the two groups.


This population-based cohort study sough to identify risk factors associated with failure of total ankle arthroplasty (TAA). The study included 2,914 subjects who underwent primary TAA between 2010 and 2016, utilizing the database of the Korean National Health Insurance Service. Failure of TAA was defined as revision TAA or arthrodesis procedures. An increased risk of TAA failure was observed in those under 65 compared to those aged 75 or older. The risk of TAA failure was increased in the severely obese group, with a body mass index (BMI) greater than 30, compared to the normal BMI group.

Practice Management

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Physicians can take several steps to prioritize bedside manner despite the stresses of the COVID-19 pandemic. This includes taking a few moments to confirm how to pronounce a patient's name and discuss patient history notes from staff, helping the patient feel a genuine connection. Body language is a bit different in light of COVID-19 restrictions, and physicians need to adjust their physical cues accordingly. Smiling can still go a long way, as patients can see and hear it in their physicians' eyes and voice. Wearing a name badge with an identification photo can also help remind patients of the person helping them. Moreover, physicians should try not to appear rushed to the patient, as this can lead to medical errors. Providers can show engagement with a patient by sitting down to be at eye level, uncrossing arms and making eye contact.


The pandemic resulted in many people missing or delaying medical care, leading to more serious disease and more costly treatment. However, experts say the pandemic is also revealing ways healthcare can become less expensive, more efficient and more effective at protecting people's health. For instance, Dr. Amol S. Navathe at the University of Pennsylvania says the pandemic demonstrated how convenient and effective it can be to use telemedicine for many routine medical problems. Experts also note that along with the elderly, people with preventable health conditions are more vulnerable to COVID-19. However, most physicians are unable to influence the behaviors that accelerate these conditions. Dr. William H. Shrank at Humana suggests that instead of instantly turning to surgery for certain conditions, patients can undergo physical therapy, home exercises or use topical remedies to achieve relief.


A recent survey by The Joint Commission gathered comments from more than 2,000 healthcare workers on what is causing their burnout during the COVID-19 pandemic. The top causes of burnout identified were fear of the unknown, fear of getting sick, fear of binging the virus home and staffing issues. The Joint Commission makes a number of recommendations on ways to support healthcare workers. These include fostering open communication, eliminating barriers keeping healthcare workers from seeking mental health services, protecting worker safety, identifying tasks that can be completed from home and providing workers with chances to collaborate.

Health Policy and Reimbursement

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The Biden administration has told the US Supreme Court that it believes the entire Affordable Care Act should be upheld. The US Justice Department issued a letter to the Supreme Court "to notify the Court that the United States no longer adheres to the conclusions in the previously filed brief." The healthcare case was argued a week after the election in November. The case centers on whether a 2017 change in a provision of the law known as the individual mandate rendered it unconstitutional. Congress eliminated the penalty for not having health insurance. The US Justice Department says the mandate remains constitutional, but that even if the court decides otherwise, the rest of the law should be left alone.


Groups representing hospitals, doctors, insurance companies and employers have joined forces to urge Congress to embrace President Joe Biden's broad vision of building on the Affordable Care Act to achieve universal coverage. The coalition of eight groups released a detailed set of proposals that included an increase in federal subsidies available to help people afford coverage and a three-year re-establishment of the generous match in federal funding to states to entice more of them to expand their Medicaid programs. The coalition also urged the government to spend more money on enrolling people in plans offered by the insurance markets established under the law. The groups said the decision to work together was fueled by the COVID-19 pandemic and by the need to address "longstanding inequities in healthcare access and disparities in health outcomes."


Several states have passed laws requiring commercial insurance plans to permanently cover more telehealth services. Of these states, 14 require insurers to pay the same amount for telehealth visits as in-person visits. In Arizona, a new law mandates that commercial insurers cover remote patient monitoring and asynchronous visits, such as when a patient's primary care physician share an X-ray or lab reports with a specialist. In some states, patients may be able to submit questions and self-assessments to a provider. With the exception of Tennessee, states also have lifted restrictions on patients' originating site, which would have required them to be in a specific clinical setting for virtual visits to be covered. However, parity requirements don't address remote patient monitoring or the use of devices such as connected blood pressure monitors or glucometers to keep track of patients' health at home.

Medicine, Drugs and Devices

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Researchers at Pennsylvania State College of Medicine have identified the cellular pathway that leads to osteoarthritis and found that paroxetine, a common antidepressant, inhibits this pathway. The team found that paroxetine slows down cartilage degeneration and also promotes cartilage health in both mice and human cartilage in vitro. In other experiments with cultured human osteoarthritic cartilage, obtained from patients undergoing knee replacement surgery, the team also confirmed the ability of paroxetine to mitigate chondrocyte hypertrophy and cartilage degradation. The results were published in Science Translational Medicine.


In recent months, US investigators have failed to identify counterfeit 3M respirators whose quality, experts say, is not significantly worse than the real thing. N95 masks are essential for health providers because they filter out 95 percent of the particles that cause COVID-19. The Cleveland Clinic recently acknowledged that since November, it accidentally distributed 3M counterfeit masks to hospital staffers. 3M, the leading American maker of N95s, says more than 10 million fake masks have been seized since the pandemic began, and the company has fielded 10,500 questions about the authenticity of N95s.


As the COVID-19 pandemic began last March, opioid prescriptions under Medicare Part D dipped, according to a report from the Office of Inspector General (OIG) at the US Department of Health and Human Services. Data from January–August 2020 showed that an estimated 1.1 million beneficiaries received a short-term opioid prescription, on par with the previous year. In April, however, the pace slowed by about one-third to 727,505 beneficiaries. "The decline is likely due to elective surgeries being postponed during the early months of the pandemic," the OIG concluded.