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AAOS Now

Published 5/1/2008

Second Look

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.

Efficacy of universal screening for MRSA debated
A study published in the March 18 edition of the journal Annals of Internal Medicine finds that universal screening for methicillin-resistant Staphylococcus aureus (MRSA) may result in decreased MRSA infection rates in hospitals. The observational study, conducted in a 3-hospital, 850-bed organization with approximately 40,000 annual admissions, monitored clinical MRSA rates during and after hospital admission in 3 consecutive periods: baseline (12 months), MRSA surveillance for all admissions to the intensive care unit (ICU) (12 months), and universal MRSA surveillance for all hospital admissions (21 months). Prevalence of MRSA per 10,000 patient-days was 8.9; prevalence dropped to 7.4 cases during ICU surveillance, and to 3.9 cases with universal surveillance. An accompanying commentary pointed out that the screening protocol may have also increased staff compliance with proper hygiene and warned against extensive use of antibiotic ointments, which may promote additional drug resistance.
According to a study in the March 12 issue of the Journal of the American Medical Association (JAMA), however, new findings do not support the idea that MRSA screening of all patients on admission is worthwhile. In the study, “Preventing MRSA Infections: Finding It Is Not Enough,” researchers in Switzerland found that universal screening of patients on hospital admission to find out if they carry MRSA did not significantly reduce hospital-acquired infection rates in surgical patients.

Researchers hope ultra-strong gel may hold key to arthritis cure
According to an article in the Baltimore Sun, researchers at the National Institute of Standards and Technology are investigating a polymer gel that might someday be effective in the treatment of arthritis. The gel, which was developed at Hokkaido University in Japan in 2003, is nearly as strong, flexible, and resistant to friction as the cartilage in the human knee. Scientists say that the gel and others like it may eventually be injected into worn joints to increase the lifespan of these joints.

Small study links alendronate to unusual femur fractures
A letter published in the March 20 issue of the New England Journal of Medicine offers the results of a small retrospective analysis that links alendronate use and low-energy fractures of the femur. The researchers identified 15 postmenopausal women who had been receiving alendronate for a mean of 5.4 years and who presented with atypical low-energy fractures. Of those, 10 were found to share a unique radiographic pattern, defined as a simple transverse or oblique (30 degrees) fracture with beaking of the cortex and diffuse cortical thickening of the proximal femoral shaft. These patients had been using alendronate for an average of 7.3 years)—significantly longer than the five patients without this pattern who had been using the drug for an average of 2.8 years. In light of the limitations of their study, the authors suggest that a prospective study is indicated.

Scaffolding, grafting may hold promise for treating osteonecrosis of the knee
According to a preliminary report to be published in the Journal of Arthroplasty, three patients between the ages of 18 and 21 who were suffering from steroid-induced osteonecrosis had returned to nearly normal activity and knee function with no complications two years after surgery. The attending surgeon removed the dead bone and used scaffolding and osteoprogenitor cellular grafting to fill the space in with new cellular matter from the pelvic area. Based on the success of the surgeries, the author suggests a larger follow-up study is in order.

Study: Medical school drains students’ empathy
A study of medical students released in the March issue of the journal Academic Medicine finds that medical education is associated with a decrease in vicarious empathy, and that female students may be more compassionate than male students. Researchers measured empathic response using the Balanced Emotional Empathy Scale, which was administered to 419 medical students from class years 2001-2004 attending a single school. The authors combined the results from all of the classes, having found no significant differences in students’ empathy scores as they began medical school. Vicarious empathy significantly decreased during medical education, especially after the first and third years. Men choosing core careers initially had empathy exceeding population norms, but their empathy fell to be comparable with that of norms by the end of their third year. Women choosing core careers had empathy scores comparable with those of population norms, but the scores of women choosing non-core careers fell below those of the norms by their second year. The research team states that a significant decrease in vicarious empathy is of concern, because empathy is crucial for a successful physician-patient relationship.

Two studies support efficacy of tocilizumab for treatment of rheumatoid arthritis
A pair of studies published in the March 22 issue of the journal The Lancet find that tocilizumab may have efficacy for patients who suffer from rheumatoid arthritis. In the first study, researchers conducted a double-blind, randomized, placebo-controlled, parallel group phase III study of 623 patients with moderate to severe active rheumatoid arthritis. Subjects were assigned to receive tocilizumab 8 mg/kg (n=205), tocilizumab 4 mg/kg (n=214), or placebo (n=204) intravenously every 4 weeks, with methotrexate at stable pre-study doses (10–25 mg/week). The primary endpoint was the proportion of patients with 20 percent improvement in signs and symptoms of rheumatoid arthritis according to American College of Rheumatology criteria (ACR20 response) after 24 weeks. ACR20 responses were seen in 120 patients (59 percent) in the 8 mg/kg group, 102 (48 percent) in the 4 mg/kg group, and 54 (26 percent) in the placebo group; odds ratio 4·0 [95 percent CI 2·6–6·1], p<0·0001 for 8 mg kg vs placebo; and 2·6 [1·7–3·9], p><0·0001 for 4 mg kg vs placebo). however, those in the tocilizumab groups were more likely to experience an adverse event (143 [69 percent] in the 8 mg kg group; 151 [71 percent] in the 4 mg kg group; and 129 [63 percent] in the placebo group).>
In the second study, researchers performed a phase III study of 56 patients aged 2-19 years with systemic-onset juvenile idiopathic arthritis, whose symptoms had not improved under the standard arthritis treatment regimen. Of the 56 original patients, 43 were selected for inclusion. Of the group receiving tocilizumab, 80 percent (16 out of 20) maintained the ACR Pedi 30 response and a CRP of less than 15 mg/L, while 17 percent achieved this in the placebo group. A 48 week extension phase was entered by 48 patients, and of these, ACR Pedi 30, 50, and 70 responses were achieved by a cumulative 98 percent (47 patients), 94 percent (45 patients), and 90 percent (43 patients) respectively.