Published 11/1/2011

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.

Complication and mortality factors after spine surgery
A study in the Journal of Bone and Joint Surgery—American (JBJS-A) (Sept. 7) finds that patient age, female sex, longer procedural times, and several types of medical comorbidities may increase the likelihood of postoperative complications or mortality after spine surgery. A national database was used to identify 3,475 patients who underwent spine surgery between 2005 and 2008. Overall, 10 patients died after surgery, and 407 complications occurred across 263 patients. Increased patient age and contaminated or infected wounds were found to be independent predictors of mortality, while increased patient age, cardiac disease, preoperative neurologic abnormalities, prior wound infection, corticosteroid use, history of sepsis, American Society of Anesthesiologists classification of > 2, and prolonged operative times were independent predictors for the development of one or more complications.

Professional athletes and septic arthritis
A retrospective analysis in the American Journal of Sports Medicine (AJSM) finds that being a professional athlete and having a combined lateral tenodesis are risk factors for infection after anterior cruciate ligament (ACL) reconstruction. In a consecutive series of 1,957 patients—including 88 professional athletes—who had ACL reconstruction between 2003 and 2008, the prevalence of septic arthritis was 0.37 percent in the nonprofessional group and 5.7 percent in professional athletes. A significant correlation was found between being a professional athlete and having a combined lateral tenodesis, suggesting that one of these variables potentially plays a confounding role.

Patellar tendinopathy in basketball players
According to a study published online in AJSM, low ankle dorsiflexion range is a risk factor for the development of patellar tendinopathy in basketball players. The prospective study of 75 junior elite basketball players found that players with unilateral patellar tendinopathy (12) had a significantly lower mean ankle dorsiflexion range at baseline than healthy players, with a mean difference of –4.7 degrees for the dominant limb and –5.1 degrees for the nondominant limb. The risk of unilateral patellar tendinopathy developing in players with dorsiflexion range less than 36.5 degrees was 18.5 percent to 29.4 percent, compared with 1.8 percent to 2.1 percent risk in players with dorsiflexion range greater than 36.5 degrees.

UK data show high revision rates for MOM hips
A report released by the National Joint Registry of England and Wales finds substantial variation in revision rates for total hip arthroplasty patients, based on prosthesis type. The 7-year revision rates were 3 percent for cemented prostheses, 11.8 percent for resurfacing, and 13.6 percent for stemmed metal-on-metal (MOM) bearing surfaces. The risk of revision appeared to increase sharply at around 6 years after primary surgery for the MOM group, but more data are needed to confirm this finding.