Second Look- Clinical

Obesity and medical costs
Research in the Journal of Health Economics (January) suggests that obesity may account for as much as 21 percent of all U.S. medical costs. The authors drew data from the Medical Expenditure Panel Survey for 2000–2005, and focused on genetic variation in weight to eliminate the impact of other factors—such as back injury—that could affect both weight gain and medical costs. They found that obesity increases one’s annual medical costs by $2,741 (in 2005 dollars) compared to a non-obese person.

Nonsurgical treatment of Legg-Calvé-Perthes disease
A study in the Journal of Bone and Joint Surgery–American (JBJS-A) (Apr. 4) attempts to establish a modern benchmark for long-term outcomes following nonsurgical, weight-bearing treatment of Legg-Calvé-Perthes disease. The prospective study involved 56 patients (58 hips) with the condition who were enrolled in a multicenter trial between 1984 and 1991 and treated with hip range-of-motion exercises or bracing. At mean 20.4-year follow-up, three patients had undergone hip arthroplasty and one had undergone pelvic osteotomy. Of the remaining hips, 14 had no hip osteoarthritis (OA), 16 had Tönnis grade 1 OA, and 24 had grade 2 or 3 moderate or severe OA. Patients had a mean Iowa Hip Score of 74 (range, 43 to 100).

Magnetic growing rods in scoliosis patients
Early data published online in The Lancet suggest that use of a magnetically controlled growing rod (MCGR) procedure can be more cost-effective and offer improved quality of life for scoliosis patients, compared to a traditional growing rod procedure. Of five patients who received the MDGR, two have reached 24 months’ follow-up. The mean degree of scoliosis as measured by Cobb angle was 67 degrees before implantation, and 29 degrees at 24 months. Length of the instrumented segment of the spine increased by a mean of 1.9 mm with each distraction. Throughout follow-up, both patients had no pain, had good functional outcome, and were satisfied with the procedure. No MCGR-related complications occurred.

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