Published 7/1/2012

Second Look-Clinical News and Views

Smith & Nephew withdraws metal hip liner
MedPage Today
reported that Smith & Nephew has initiated a voluntary market withdrawal of the optional metal liner component of the company’s R3 Acetabular System. The company states that the withdrawal was implemented after a review of the product and a finding that the company was “not satisfied with the clinical results.” The company says that the withdrawal does not impact other R3 System liners and asks anyone experiencing unusual symptoms to contact his or her surgeon. The withdrawal does not change the current practice for patient follow-up care for this component.

Study: High-impact activity and implant wear
High-impact sports are associated with increased wear and reduced implant durability after total hip arthroplasty (THA), according to a study in Clinical Orthopaedics and Related Research (CORR). The retrospective study of 70 patients who engaged in high-impact sports and 140 with low activity levels from among 843 THA patients in a prospectively collected database found that, at 10-year follow-up, the mean Hip Osteoarthritis Outcome Score was higher in the high-impact group for three of five subscales. In addition, mean linear wear was higher in the high-impact group than in the low-activities group, and the likelihood of revision was greater among patients in the high-activity group.

Study: Trauma centers better for trauma patients
According to an Australian study in Annals of Surgery, patients with major trauma who were managed at Level 1 trauma centers demonstrated better functional outcomes compared to those managed at other hospitals. The study was based on data from the Victorian State Trauma Registry for 3,824 patients age 18 years or older who experienced major trauma between October 2006 and June 2009. Cases managed at major trauma centers achieved better functional outcomes, while female gender, older age, and lower levels of education were associated with lower odds of better outcome.

Study: Meniscal allograft fixation techniques
A study in the American Journal of Sports Medicine (AJSM) finds that meniscal allografts fixed with the suture-only technique displayed a greater degree of extruded meniscal body than allografts fixed with the bony fixation method. The prospective series of 88 meniscal allograft transplants used the suture-only technique in 33 cases and the bone plug method in 55 cases. The average percentage of meniscal tissue extruded in the suture-only group was 36.3 percent, compared to 28.13 percent in the bony fixation group. No association was seen between degree of meniscal extrusion and functional score.

Study: Obese patients and complications
According to a study in Spine (May 15), morbidly obese patients have nearly twice the risk of complications after spinal fusion surgery than normal weight patients. Based on data from the Healthcare Cost and Utilization Project’s California State Inpatient Databases, 1,455 of 84,607 patients who underwent spinal fusion (anterior cervical, posterior cervical, anterior lumbar, and posterior lumbar) in California between 2003 and 2007 were morbidly obese. The in-hospital complication rate for morbidly obese patients was nearly double that for normal patients (13.6 percent vs. 6.9 percent) across nearly all types of complications. Mortality, length of hospital stay, and average hospital costs were also significantly higher for the morbidly obese patients.

Study: Short-term NSAID regimen safe following fracture
A study in the Journal of Bone and Joint Surgery—American (May 2) found that short-term use of NSAIDs following a fracture is a safe and effective supplement to other modes of pain control. A review of 316 published papers on the influence of NSAIDs on fracture healing found no robust evidence attesting to a significant and appreciable patient detriment as the result of short-term NSAID use.

Study: Bisphosphonates and fracture trends
A Swiss study in Archives of Internal Medicine finds that bisphosphonate use is associated with atypical femoral fractures, and longer duration of treatment is linked to a higher risk. However, the absolute number of such fractures is low. The case-control study of 477 patients aged 50 years or older with a fracture of the subtrochanteric or femoral shaft area who were admitted to a single center between Jan. 1, 1999, and Dec. 31, 2010, found 39 patients with atypical fractures and 438 patients with classic fractures. Of patients with atypical fractures, 32 (82.1 percent) had been treated with bisphosphonates. In the classic fractures group, 28 patients (6.4 percent) had been treated with bisphosphonates.

Study: Anticlotting drugs for pediatric fractures
According to data from a study in the Journal of Pediatric Orthopaedics (June), children with big-bone fractures may only rarely require anticlotting drugs. The review of 1,782 pediatric patients with pelvic or femoral fractures admitted to a single center between 1990 and 2009 found three (0.17 percent) diagnoses of deep vein thrombosis (DVT), no diagnoses of pulmonary embolism, and no related mortality. Among a subset of 948 patients with electronically searchable medication and device records, 83 patients (8.8 percent) received some type of thromboprophylaxis. None of the three children in whom DVT developed had a central venous catheter.

Study: Readmissions and HIAs
A study in Infection Control and Hospital Epidemiology (June) finds that patients with healthcare-associated infections (HAIs) may be at increased risk of hospital readmission. The retrospective cohort study of 136,513 adults admitted to an academic, tertiary care referral center from Jan. 1, 2001, to Dec. 31, 2008, found that 35 percent of patients were readmitted to the index hospital within 365 days. Median time to readmission among patients with a positive clinical culture was 27 days, compared with 59 days for patients without a positive clinical culture result. In addition, the incidence of 30-day readmission among patients with a positive clinical culture result was 25 percent, compared with 15 percent for patients with a negative result or no clinical culture.

Study: Wide variations in TKA outcomes
A study in Health Affairs finds wide variation in operating time, hospital length-of-stay, discharge disposition, and in-hospital complication rates for patients undergoing primary total knee arthroplasty (TKA). The authors reviewed data on patients ages 18 to 89 years old who underwent primary TKA at five healthcare systems belonging to the High Value Healthcare Collaborative consortium. Longer length-of-stay was associated with surgeons who perform fewer TKAs, longer operating time, and surgery performed later in the week. In addition, operating time varied across organizations, and surgeon caseload was associated with a lower complication rate during the index admission.

Study: Return to play after Type II SLAP repair
According to a study in CORR (June), most patients return to previous levels of sports participation after repair of Type II superior labral anterior-posterior (SLAP) tears. The review of data from 14 studies covering 506 patients with Type II SLAP tears found 327 patients with SLAP lesions repaired by anchor, 169 by tacks, and 10 by staples. For the entire patient population, 83 percent had “good-to-excellent” patient satisfaction and 73 percent returned to previous levels of play. However, only 63 percent of patients classified as “overhead athletes” returned to previous levels of play; in overhead athletes, anchor repair resulted in higher patient satisfaction and a slightly higher return to play rate, compared with tack repair.

Study: Sex, age may affect concussion recovery
A study of 296 concussed high school and college athletes in AJSM found that female athletes had worse symptoms and scored lower on visual memory tests than male athletes after sustaining a concussion. Participating athletes completed the Immediate Post-Concussion Assessment and Cognitive Test, the Post-Concussion Symptom Scale at baseline and at 2, 7, and 14 days after concussion, and the Balance Error Scoring System (BESS) at 1, 2, and 3 days after concussion. High-school athletes fared worse on visual and memory tests and took longer to recover, compared to college athletes. Although high school male athletes scored worse on the BESS than their collegiate counterparts, the reverse was true among female athletes (college athletes scored worse than high school athletes).

Study: Rising rates of RA may be linked to obesity
Results of a study in Arthritis Care & Research suggest that obese patients (body mass index = 30 kg/m2) are at increased risk of having rheumatoid arthritis (RA) develop, especially if they smoke. The population-based study also found that a history of obesity was significantly associated with development of RA. Obesity could account for more than half of the increase in the incidence of RA from 1985 to 2007.

These items originally appeared in AAOS Headline News Now, a thrice-weekly enewsletter that keeps AAOS members up to date on clinical, socioeconomic, and political issues, with links to more detailed information. Subscribe at www.aaos.org/news/news.asp (member login required)