Thursday, February 16th, 2012
Skin-derived fibroblasts may be safe for treating Achilles tendinosis
A British study in JBJS–A found that skin-derived fibroblasts offer a safe treatment modality for Achilles tendinosis. In the randomized, double-blind study, patients with unilateral involvement were randomized into the treatment group (12 patients) and the control group (12 patients); eight patients with bilateral involvement were individually randomized into treatment and control groups, with eight Achilles tendons in each group. The Achilles tendons of those in the treatment group were injected with laboratory-expanded, skin-derived fibroblasts and an equal amount of autologous centrifuged plasma under ultrasound guidance. At 6 months, researchers found significant differences in the mean Victorian Institute of Sport Assessment and Visual Analog Scale scores between the treatment and control groups of patients with unilateral involvement (P < 0.001 for both). The researchers note that larger studies with longer follow-up are needed before wider clinical application of this treatment is considered. Read more…
Thursday, February 16th, 2012
Studies support use of viscosupplementation in knees with OA
Three studies presented at the AAOS Annual Meeting support the use of viscosupplementation for patients with osteoarthritis (OA) of the knee. In Scientific Presentation 259, researchers consistently observed pain relief and improvement of function following repeat treatment of symptomatic OA of the knee with hylan G-F 20. In Scientific Presentation 261, patients with OA who were randomized to receive 5 weekly hyaluronic acid injections had significantly less pain as early as 1 week after the first injection, and continuing for at least 6 months. Scientific Presentation 264, a prospective, blinded, longitudinal cohort study, found that viscosupplementation with hylan G-F 20 was an efficacious and safe treatment option for patients with symptomatic knee OA. Read More…
Thursday, February 16th, 2012
Smokers have higher TKA revision rates
A study of patients undergoing total knee arthroplasty (TKA) found that those who smoked had a higher overall revision rate and a higher incidence of other complications. The results are reported in Poster Presentation 198, presented at the AAOS Annual Meeting. At a mean follow-up of 46 months, implant survivorship in smokers was 91 percent, versus 96 percent in nonsmokers. Although all patients who smoked were encouraged to participate in a smoking cessation program, most were noncompliant. Read More…
Thursday, February 16th, 2012
Smoking is a significant risk factor for early failure in complex primary and revision THA
Despite the introduction of ultraporous metal technology in total hip arthroplasty (THA), smoking remains a significant risk factor for early failure in both complex primary and revision THA, according to the results of Scientific Presentation 223 presented at the 2012 AAOS Annual Meeting. Researchers identified 500 patients (535 hips) who had complex primary (160) and revision (375) THAs between 1999 and 2009. At an average of 18 months after surgery, the failure rate was 6.2 percent (33 failures: 15 infections, 13 failures of ingrowth, 3 dislocations, 1 liner fracture, 1 periacetabular fracture). The failure rate in smokers was 11 percent, compared to a failure rate of 5.3 percent in previous smokers, and 3.8 percent in non-smokers. Read More…
Thursday, February 16th, 2012
PRP offers longer lasting improvement for chronic plantar fasciitis
According to Scientific Presentation 051, presented at the 2012 AAOS Annual Meeting, an injection of platelet-rich plasma (PRP) may be more effective and durable than a cortisone injection for the treatment of severe chronic plantar fasciitis. The author conducted a prospective, randomized study of 36 patients with severe chronic plantar fasciitis that did not respond to traditional nonsurgical treatment. Patients treated with a single ultrasound-guided injection of unbuffered autologous PRP saw their American Orthopaedic Foot and Ankle Society (AOFAS) scores improve from a mean of 37 at baseline to a mean of 94 at 12-month follow-up. Mean AOFAS scores for patients treated with a single ultrasound-guided injection of 40 mg methylprednisolone initially improved from 52 to 81 at 3-month follow-up, but mean AOFAS scores dropped to 58 at 12 months. Read More…
Thursday, February 16th, 2012
Neuromuscular training may help prevent ACL injuries
Female adolescent soccer players who participated in a 15-minute neuromuscular warm-up program had a significantly reduced rate of anterior cruciate ligament (ACL) injuries, according to the results of Scientific Presentation 095, presented at the AAOS Annual Meeting. The two-armed, parallel-group cluster randomized trial performed in Sweden involved female soccer players aged 12 to 17 years. Study participants were cluster randomized into an intervention group (n=154) or a control group (n=155). During the 2009 season, those in the intervention group were instructed to complete a twice-weekly, 15-minute neuromuscular warm-up program that consisted of six different exercises focusing on knee control and core stability. Unadjusted Cox regression analysis based on intention-to-treat found a 64 percent reduction of the ACL injury rate in the intervention group (hazard ratio 0.36, 95 percent confidence interval 0.14 to 0.90, P = 0.03). In addition, per-protocol analyses of compliant players (ie, those who carried out a minimum of one exercise session per week) showed preventive effects for ACL injury, severe knee injury, and acute knee injury. Read More…
Thursday, February 16th, 2012
Bearings symposium features international points of view
At a symposium held at the AAOS Annual Meeting, participants shared their opinions on bearing surfaces. “Worldwide Perspectives on Alternate Bearings” was moderated by Henrik Michlau, MD, and featured international experts discussing the current state of alternate bearings for hip replacement. Participants discussed various bearing surfaces such as metal-on-metal, ceramic-on-ceramic, and metal-on-polyethylene.
Read more…
Tuesday, January 24th, 2012
What is the proper interval for osteoporosis testing?
Data published in the Jan. 19 issue of the New England Journal of Medicine suggest that women who are tested and found to have normal bone mineral density (BMD) may not need to be tested again for 15 years. The research team prospectively followed 4,957 women aged 67 years or older with normal BMD or osteopenia and no history of hip or clinical vertebral fractures or treatment for osteoporosis. The researchers defined testing interval as the estimated time it would take 10 percent of women to make the transition to osteoporosis before having a hip or clinical vertebral fracture, after adjustment for estrogen use and clinical risk factors. They found that the estimated BMD testing interval was 16.8 years for women with normal BMD, 17.3 years for women with mild osteopenia, 4.7 years for women with moderate osteopenia, and 1.1 years for women with advanced osteopenia. Researchers note, however, that clinicians may want to recommend a shorter screening interval for individuals with osteopenia who have clinical risk factors for fracture. Read More…
Tuesday, January 24th, 2012
Joint Replacement Patients Face Blood Clot Risk in Hospital
A study published in the Jan. 18 issue of the Journal of the American Medical Association finds that approximately 1 in 100 patients undergoing total or partial knee arthroplasty (TPKA) and approximately 1 in 200 patients undergoing total or partial hip arthroplasty (TPHA) develops symptomatic venous thromboembolism (VTE) prior to hospital discharge—even after undergoing prophylaxis. The authors conducted a meta-analysis of 47 studies covering 44,844 patients who received recommended VTE prophylaxis after undergoing TPHA or TPKA. They found that, for TPKA patients, pooled rates of symptomatic postoperative VTE before hospital discharge were 1.09 percent, pooled rates of symptomatic DVT were 0.63 percent, and pooled rates for pulmonary embolism (PE) were 0.27 percent. For TPHA patients, pooled rates of symptomatic postoperative VTE before hospital discharge were 0.53 percent, pooled rates of symptomatic DVT were 0.26 percent, and pooled rates of PE were 0.14 percent. Read More…
Monday, January 16th, 2012
Resurfacing of humeral head restores intact geometry better than hemiarthroplasty
A study published in the January 4 issue of the Journal of Bone and Joint Surgery—American comparing the biomechanics of the intact glenohumeral joint with those following humeral head resurfacing or hemiarthroplasty finds that humeral resurfacing may permit better function and limit eccentric glenoid wear. The authors used a custom shoulder testing system to assess seven fresh-frozen cadaveric shoulders with the rotator cuff, pectoralis major, and latissimus dorsi musculature loaded with 20 N and the deltoid muscle loaded with 40 N. They found that the geometric center of the humeral head shifted by a mean of 2.2 mm following humeral resurfacing and 4.7 mm following hemiarthroplasty. The apex of the humeral head shifted superiorly at all abduction angles following hemiarthroplasty. In addition, both humeral resurfacing and hemiarthroplasty decreased the glenohumeral contact area and increased peak pressure. Read More…
