Published 8/1/2008

Second Look – Clinical News and Views

If you missed these Headline News Now items the first time around, AAOS Now gives you a second chance to review them. Headline News Now—the AAOS thrice-weekly, e-mail update of news of interest to orthopaedic surgeons—brings you the latest on clinical, socioeconomic, and political issues, as well as important announcements from AAOS.

Age doesn’t negate benefits of THA
A survey published in the Journal of the American Geriatrics Society finds that total hip arthroplasty (THA) can be as beneficial to patients in their 80s or 90s as it is for those in their 60s. Researchers interviewed 131 osteoarthritis (OA) patients who received THA between 1992 and 2003, and 257 OA patients who did not. THA was associated with significant improvements in two of three levels of physical functioning. Further, patients who were disabled at the time of surgery had transitioned out of disability within 1 year of the procedure. THA is cost-effective because reimbursement for the procedure is less costly than the long-term cost of health care for the disabled.

Duloxetine HCl may reduce knee OA pain
Duloxetine HCl may reduce pain among patients with OA of the knee, according to a study presented at the 2008 Annual Congress of the European League Against Rheumatism (EULAR). Researchers randomly assigned 111 patients to receive 60 mg per day of duloxetine and 120 patients to receive placebo. After 7 weeks, patients in the experimental group were randomized again to receive either 60 mg or 120 mg duloxetine per day. Among patients taking duloxetine, 59 percent experienced a 30 percent improvement in pain, and 47 percent experienced a 50 percent improvement, compared to 45 percent and 29 percent, respectively, of patients taking placebo.

Fewer osteoporotic hip fractures reported
Another 2008 EULAR Congress study found that the number of hospitalizations for nontraumatic osteoporotic hip fractures in the United States declined significantly from 1988 to 2005, despite a general aging of the population and an increase in overall hospitalizations during the same period. Although the proportion of the U.S. population age 50 years or older increased from 25.6 percent to 29.4 percent, the prevalence of nontraumatic hip fracture hospitalizations in this population decreased 25 percent. Hospitalizations directly related to nontraumatic hip fractures also decreased.

Femoral stress fracture linked to osteoporosis drug
According to a study in the Journal of Orthopaedic Trauma, prolonged use of alendronate may be associated with suppression of bone metabolism, leading to low-energy fractures of the femoral shaft and hypertrophy of the diaphyseal cortex. A retrospective review of the medical records of 59 female and 11 male patients (average age: 74.7 years) who had femoral shaft fractures and were admitted to a Level 1 trauma center between January 2002 and March 2007 revealed that 25 patients (36 percent) were being treated with alendronate. Of these patients, 19 (76 percent) had a simple, transverse fracture with a unicortical break in an area of cortical hypertrophy. Only 1 patient (2 percent) in the control group had the same fracture. The authors conclude that alendronate use is a significant risk factor for the fracture pattern.

CA-MRSA linked to pediatric bone infections
Researchers reviewing the medical records of 290 children with acute osteomyelitis admitted to Children’s Medical Center Dallas between January 1999 and December 2003 note that an increasing number of cases may be linked to community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA). The median age at diagnosis was 6 years old. Overall, 37 percent of blood cultures were positive, and a bacterial isolate was obtained in 55 percent of cases. The bacteria most frequently isolated included methicillin-sensitive S. aureus, MRSA, Streptococcus pyogenes, and Pseudomonas aeruginosa. The study appeared in the Journal of Pediatric Orthopaedics.

Device fragment danger
MSNBC reported on incidences of “unretrieved device fragments” (UDFs)—potentially dangerous debris from medical devices that have broken or malfunctioned. Since 2003, 72 deaths and 4,675 injuries associated with UDFs have been reported. One expert states that government estimates on the number of incidents may be low, as the problem tends to be underreported.

Little difference in polished, rough cemented implants
A study published in the Journal of Bone and Joint Surgery finds no significant differences between polished and precoated roughened cemented femoral components with similar geometry. Researchers conducted a prospective, randomized study of 201 patients (219 hips) treated with THA during a 5-year period. Overall, 113 procedures were performed using polished cemented femoral components, while 106 used precoated roughened components with similar geometry. Patients were followed for a mean of 5.3 years. No significant difference in survival was found, nor were any significant differences between the groups found with regard to Harris hip scores, clinical results, or the presence or number of bone-cement radio­lucent lines.

Joint Commission updates National Safety Goals
The Joint Commission 2009 National Safety Goals include three new hospital and critical access hospital requirements related to preventing deadly healthcare-associated infections due to multiple drug-resistant organisms, central line-associated bloodstream infections, and surgical site infections.

The new requirements related to central line-associated bloodstream infections also will apply to ambulatory care facilities, office-based surgery practices, and home care and long-term care organizations. Preventing surgical site infections will be a new requirement for ambulatory care facilities and office-based surgery practices. The new infection-related requirements will be phased in during the year.