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Published 12/1/2008

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, online 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.

Prevalence of arthritis pain
The U.S. Agency for Healthcare Research and Quality reports that during 2005, about 9.5 percent of American adults 18 and older either visited or called a physician for a prescription to reduce arthritis pain. Women sought treatment more often than men; 10.5 percent of non-Hispanic white adults reported arthritis symptoms, compared with 9.7 percent of non-Hispanic black adults, 5.9 percent of Hispanic adults, and 4.3 percent of non-Hispanic Asian adults. About $32 billion was spent for arthritis treatments.

Clubfoot linked to gene
Researchers have linked a human gene to the development of clubfoot. DNA analysis of 35 extended family members of an infant born with clubfoot in both feet, duplicated first toes, and a missing tibia in the right leg found that 13 family members were affected with conditions such as clubfoot, underdeveloped patella, and flatfoot. In all affected family members, the PITX1 gene was identified as mutated. PITX1 is critical for early development of lower limbs. The study (registration required) appeared in the American Journal of Human Genetics.

Link between rofecoxib and cardiovascular events
The use of the COX-2 inhibitor rofecoxib substantially increases the risk of stroke, heart attack, and death compared with placebo, according to a study published in The Lancet. In a multicenter, randomized, placebo-controlled, double-blind trial of 2,587 patients with a history of colorectal adenomas, researchers found that 59 individuals in the rofecoxib group had an endpoint based on the combined incidence of nonfatal myocardial infarction; nonfatal stroke; and death from cardiovascular, hemorrhagic, and unknown causes, compared with 34 in the placebo group.

One in 75 THA, TKA needs revision in 3 years
According to the results of a British retrospective review of 76,576 patients with a primary total hip arthroplasty (THA) and 80,697 with a primary total knee arthroplasty (TKA), 1 in 75 patients needed revision surgery within 3 years. In THA patients with a cemented prosthesis, the 3-year revision rate was 0.9 percent; the 3-year revision rate for cementless THAs was 2.0 percent. Hybrid THAs had a 3-year revision rate of 1.5 percent; patients who had undergone hip resurfacing had a 3-year revision rate of 2.6 percent. Women had higher revision rates after hip resurfacing than men. Three-year revision rates for TKA patients were 1.4 percent for cemented prostheses, 1.5 percent for cementless prostheses, and 2.8 percent for unicondylar prostheses. Patients younger than 55 years at the time of the primary TKA had the highest revision rate; those older than 75 years had the lowest revision rate. The study appeared online in PLoS Medicine.

Combine treatments for DVT
A retrospective analysis of 11 trials involving 7,431 patients found that a “belt-and-braces” approach that combines short periods of leg compression with medications such as heparin may reduce the risk of DVT from 4 in 100 to less than 1 in 100 compared with either anticoagulants or compression alone. More studies are needed to determine whether the combined approach is also useful in preventing pulmonary embolism.

DVT diagnosis methods equivalent
A study in the Journal of the American Medical Association finds that 2-point ultrasonography and whole-leg ultrasonography are equivalent when used for the management of symptomatic outpatients with suspected deep vein thrombosis (DVT) of the lower extremities. Researchers conducted a prospective, randomized, multicenter study of 2,098 symptomatic outpatients with a first episode of suspected DVT of the lower extremities. They found that symptomatic DVT occurred in 7 of 801 patients in the 2-point strategy group and in 9 of 763 patients in the whole-leg strategy group. This met the established criterion for equivalence.