Published 4/1/2011

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.

Hamstring grafts in ACLR
According to data presented by Australian researchers during the American Orthopaedic Society for Sports Medicine (AOSSM) Specialty Day meeting, patients who received a hamstring tendon (HT) graft for anterior cruciate ligament reconstruction (ACLR) were less likely to have pain and mobility issues at long-term follow-up than those who received a patellar tendon (PT) graft. Based on a 15-year follow-up of 180 ACL patients who received either an HT graft or a PT graft, patients in the HT group demonstrated significantly higher activity levels than those in the PT group. The PT group also reported more pain and demonstrated worse outcomes in tests for motion loss and osteoarthritis.

Implants and fractures
According to information presented at the AAOS Annual Meeting, hip and thigh implants may increase the likelihood of fractures in children. The retrospective analysis of 7,584 implants inserted in pediatric patients over a 15-year period found 25 cases of implant-related fracture (IRF) in 22 patients, with a mean age at fracture of 11.8 years and an average of 2.8 years between insertion and fracture. The overall risk of IRF was 3.3 per 1,000 implants, but at the femur and hip, it was 8.9 per 1,000 implants.

Talk about weight
Discussing weight loss with overweight patients may encourage them to have a more realistic view of their own weights and improve their desire to lose weight, according to a study in the Feb. 28 Archives of Internal Medicine. An analysis of data on adults aged 20 to 64 years with a body mass index (BMI) of at least 25.0 found that overweight (BMI of 25 or greater) and obese (BMI of 30 or greater) participants were more likely to perceive themselves as overweight if their physician told them that they were overweight. However, only 45.2 percent of individuals with a BMI of 25 or greater and 66.4 percent of those with a BMI of 30 or greater reported being told by a physician that they were overweight.

Chondroitin sulfate and OA
A Canadian study in the April Annals of the Rheumatic Diseases finds that treatment with chondroitin sulfate (CS) may reduce cartilage volume loss and subchondral bone marrow lesions (BML) in knee osteoarthritis (OA) patients. The randomized, double-blind, multicenter trial involved 69 primary knee OA patients with clinical signs of synovitis who received either CS 800 mg or placebo once daily for 6 months, followed by an open-label phase of 6 months in which patients in both groups received CS 800 mg once daily. At 6- and 12-month follow-up, patients in the CS group displayed significantly less cartilage volume loss than the placebo group for global knee, lateral compartment, and tibial plateaus (p = 0.002). At 12 months, patients in the CS group had significantly lower BML scores in the lateral compartment and the lateral femoral condyle.

Bisphosphonate and mortality in women
An Australian study in the Journal of Clinical Endocrinology and Metabolism finds that bisphosphonate treatment for osteoporosis may reduce mortality risk in women. The prospective cohort study of 1,223 women and 819 men found that mortality rates were lower for women who received bisphosphonates or hormone therapy, but not for those given calcium and vitamin D only or no treatment. In men, lower mortality rates were observed as well, but significance disappeared after adjustment for other factors.

Nitroglycerin ointment and BMD
A Canadian study in the Feb. 23 Journal of the American Medical Association finds that the use of nitroglycerin ointment may modestly increase bone mineral density (BMD) and decrease bone resorption among postmenopausal women. The single-center, double-blind, placebo-controlled randomized trial of 243 postmenopausal women found significant increases in BMD in the area of the lumbar spine, total hip, and femoral neck among women randomized to the nitroglycerin group at 24-month follow-up. Use of the nitroglycerin ointment also increased volumetric trabecular BMD, cortical thickness, periosteal circumference, polar section modulus, and polar moment of inertia at the radius and tibia; and increased bone-specific alkaline phosphatase by 34.8 percent and decreased urine N-telopeptide by 54.0 percent (p < 0.001).

Recurrent VTE among men
The risk of recurrent venous thromboembolism (VTE) is more than twice as great in men compared to women, according to an online study in BMJ. The review of seven prospective studies covering 2,554 patients who had had a first VTE found that the 1-year incidence of recurrent VTE in women was 5.3 percent (95 percent confidence interval, range 4.1 percent to 6.7 percent); in men, the rate was 9.5 percent (7.9 percent to 11.4 percent). The 3-year incidence of recurrence in women was 9.1 percent (7.3 percent to 11.3 percent), but 19.7 percent (16.5 percent to 23.4 percent) in men. Among patients with unprovoked VTE, the risk of recurrence remained higher in men even after adjustment for women with hormone-associated initial VTE.