Published 5/1/2011

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.

Chondrolysis of the glenohumeral joint
A study in the Journal of Bone & Joint Surgery—American (JBJS-A) (April 6) examines factors that might be associated with glenohumeral chondrolysis after arthroscopic shoulder surgery. The retrospective cohort study of 375 intra-articular shoulder arthroscopic surgical procedures performed by a single orthopaedic surgeon found a correlation between the occurrence of chondrolysis and the intra-articular infusion of a local anesthetic—either bupivacaine or lidocaine—after surgery. The risk of chondrolysis was greater for patients with one or more suture anchors placed in the glenoid, for younger patients, and for those who had the surgery near the end of the 10-year study period.

Outcomes similar for ACDF or CDA
An analysis of three randomized, prospective trials comparing cervical disk arthroplasty (CDA) with anterior cervical diskectomy and fusion (ACDF) finds that both methods produce good results at 2-year follow-up, but CDA was associated with lower rates of repeat surgery. The three trials covered 1,213 total patients and three different CDA products. Overall, 621 patients received CDA and 592 patients underwent ACDF.

EDs often fail to identify IPV
Victims of intimate partner violence (IPV) are often not identified as such at the emergency department (ED), according to a study published online in the Journal of General Internal Medicine. Of 993 IPV victims who generated 3,426 IPV-related police incidents from 1999 through 2002, 785 (79 percent) generated 4,306 ED visits after the date of a documented IPV assault. Overall, 78.4 percent of ED visits occurring after a documented IPV incident were for medical complaints, and of those, 72 percent were never identified as being associated with victims of abuse. When IPV was identified, ED staff more frequently provided legally useful documentation, police contact, and social worker involvement than safety assessments or referrals to victim services.

Depression increases likelihood of symptomatic knee OA
According to data from a Korean study published in JBJS-A (March 16), depression may be linked to an increased risk of symptomatic knee osteoarthritis (OA). The authors evaluated 660 patients aged 65 years or older; severity of knee OA was assessed based on radiographs and symptoms and depression was assessed based on interviews and patient questionnaires. The presence of a depressive disorder was associated with increased risk of symptomatic knee OA among patients with a radiographic severity of minimal to moderate OA (Kellgren-Lawrence grade 0 to 3).

Combating drug-resistant bacteria
A study in the Archives of Internal Medicine (March 28) found that enhanced intensive care unit cleaning may reduce transmission of both methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococci (VRE). Intervention consisting of targeted feedback using a black-light marker, cleaning cloths saturated with disinfectant via bucket immersion, and increased staff education resulted in a reduction in the acquisition of MRSA from 3.0 percent to 1.5 percent, and of VRE from 3.0 percent to 2.2 percent.

A study in the online journal PLoS One found that the spread of MRSA may be seasonal. Approximately 1.85 times as many community-associated (CA) MRSA infections and 2.94 times as many hospital-associated (HA) MRSA infections occur in the third and fourth quarters of the year than in the first two quarters. For adults only, there were 1.14 times as many CA-MRSA infections in the second two quarters as in the first two quarters, but no seasonal variation in adult HA-MRSA infections was found.

According to a report in Nature Chemistry, researchers have developed a nanoparticle that, in test-tube experiments, can target and destroy antibiotic-resistant bacteria. The biodegradable nanoparticle is designed to inhibit the growth of Gram-positive bacteria, MRSA, and fungi, without inducing significant hemolysis over a wide range of concentrations. The researchers believe that the destruction of the bacteria may render it unable to develop resistance to the nanoparticles, but further research is needed before the drug can be tested in humans.