Published 9/1/2008

Second Look – Clinical

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.

FDA issues notification regarding CT scans
The U.S. Food and Drug Administration (FDA) has issued a preliminary public health notification linking a risk of possible malfunction of electronic medical devices with computed tomography (CT) scanning. The agency has received a small number of reports of adverse events in which CT scans may have interfered with devices such as pacemakers, defibrillators, neurostimulators, and implanted or externally worn drug infusion pumps. FDA is investigating the issue and asks that healthcare professionals who suspect a reportable adverse event was related to the use of CT equipment follow the reporting procedure established by their facilities.

Prophylactic antibiotics in pediatric spinal fusions
A study published in the Pediatric Infectious Disease Journal finds that pediatric patients undergoing spinal fusion should be given preoperative antibiotic prophylaxis within 60 minutes before incision to reduce the risk of surgical site infection (SSI). Based on a case-control study, significant risk factors for deep SSI included inappropriate timing of preoperative antibiotic prophylaxis, previous spine surgery, presence of a complex underlying medical condition, age, fewer than 10 vertebrae fused, and an increased estimated blood loss per kilogram of body weight. After controlling for previous spine surgery, number of vertebrae fused, and complex underlying medical condition, inappropriate timing of preoperative antibiotic prophylaxis administration was a significant independent risk factor for deep SSI.

Tommy John patients getting younger
A study released at the annual meeting of the American Ortho­paedic Society for Sports Medicine finds that 83 percent of athletes who underwent ulnar collateral ligament (UCL) reconstruction (“Tommy John”) surgery were able to return to the same or better level of play. The average time from surgery to full competition was 11.6 months. The authors, however, say they are troubled by a rising trend of young athletes requiring the surgery. In 2005 alone, 62 of the 188 operations performed were on high school athletes.

Joint replacement in elderly yields good outcomes
A study published in the journal Archives of Internal Medicine (AIM) finds that older patients who underwent hip or knee replacements for severe osteoarthritis (OA) took several weeks to recover, but experienced excellent outcomes. A prospective cohort study examined decision making and clinical outcomes for 174 patients age 65 years or older who had symptoms inadequately controlled with conservative treatments. At 12-month follow-up, 29 percent had TJR. Patients could walk independently after surgery at a median of 12 days and perform household chores at a median of 49 days. Among patients who did not have surgery, 45 percent reported that surgery was not offered as a treatment option.

Durom cup pulled from market
According to the New York Times, sales of the Durom cup—an artificial hip component manufactured by Zimmer, Inc.—were voluntarily suspended by the company in response to complaints by physicians that the device has a high failure rate. The company plans to resume sales of the device after implementing a specialized training program for physicians.

Pseudotumors tied to hip resurfacing
A study published in the Journal of Bone and Joint Surgery—British estimates that pseudotumors may develop in about 1 percent of patients who undergo metal-on-metal hip resurfacing within 5 years. The authors report that 17 patients (20 hips) who had metal-on-metal hip resurfacing procedures later presented with various symptoms and a soft-tissue mass that the researchers termed a pseudotumor. All the patients were women and the most common symptom was discomfort in the region of the hip. Other symptoms included spontaneous dislocation, nerve palsy, a noticeable mass, or a rash. Common histologic features were extensive necrosis and lymphocytic infiltration.

Study: Allograft with osteoprogenitor cells as successful as autograft
A prospective, multicenter study presented at the International Meeting on Advanced Spine Techniques finds that allograft processed with osteoprogenitor cells may produce lumbar spinal fusion rates comparable to autograft, yet without the morbidity of iliac crest harvest. The researchers followed 51 patients undergoing lumbar fusion at one to three levels. Of those, 44 patients were followed up at an average of 21 months. The fusion rate was found to be 94 percent, and mental and physical functioning scores improved by 7 percent and 40 per­cent, respectively. In this specific study, osteoprogenitor cells retained on the allograft matrix represented a 3.6-fold increase over those in unprocessed aspirate.

Patients less trusting of physicians
According to the New York Times, reports suggest a growing lack of trust between patients and physicians. A study previously published in the journal Medicine found that about 25 percent of patients believe that their physician may expose them to unnecessary risk, and two recent studies show that a patient’s trust in the physician has a strong influence on whether the patient follows medication instructions. Factors cited as possibly contribut­ing to this shift include the decreas­ing amount of time that physicians are spending with each patient due to reduced reimbursement; news reports about medical errors and drug industry influence; and a rise in direct-to-consumer drug advertising and medical Web sites.

SSTI rates increasing
A study published in the journal Archives of Internal Medicine finds that the incidence of skin and soft-tissue infections (SSTIs) has rapidly increased across the United States since 1997 and appears to disproportionately affect certain population groups. The authors used the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey to examine records of visits by patients with SSTIs to various healthcare providers between 1997 and 2005. During that period, overall rate of visits for SSTIs increased from 32.1 to 48.1 visits per 1,000 population, reaching 14.2 million by 2005. The largest relative increases occurred in emergency departments, among black patients, and among patients younger than age 18.