Published 11/1/2012

Second Look- Clinical News and Views

Obesity issues take center stage
A report released jointly by the Robert Wood Johnson Foundation and Trust for America’s Health estimates that the number of obese adults, along with related disease rates and healthcare costs, will increase dramatically in the United States over the next 20 years. According to “F as in Fat: How Obesity Threatens America’s Future 2012,” by 2030, adult obesity rates in all 50 states would top 44 percent.

The Sept. 19 issue of the Journal of the American Medical Association focused on obesity, with clinical studies and viewpoints on the role of government, the need for research, and risk assessment.

Statins and VTE
A meta-analysis published online in PLOS Medicine finds little evidence for a large protective effect of statins on venous thromboembolic events (VTEs). The analysis of 29 trials covering 146,353 participants found that, in trials of statin versus control, allocation to statin therapy did not significantly reduce the risk of VTE.

NSAIDs for AS patients
According to a study in the Annals of the Rheumatic Diseases (October), use of NSAIDs (celecoxib) may revert the effects of inflammation among some patients with ankylosing spondylitis (AS). The randomized trial of 150 patients who received NSAIDs by request or continuous treatment with NSAIDs found that continuous NSAID therapy was more pronounced in slowing radiologic progression in patients with elevated acute phase reactants.

Smoking and knee surgery
Results of a meta-analysis published online in the American Journal of Sports Medicine suggest that smoking may have a negative influence on the outcomes of certain knee procedures. The systematic review of 14 studies found that basic science and clinical studies exploring the relationship between smoking and knee ligaments found negative molecular, biomechanical, and clinical associations with smoking. Of six studies on the effects of smoking on ligament and cartilage knee surgery, four found a negative influence of smoking on articular cartilage of the knee.

Safer surgeries with RFDS
A study in the Journal of the American College of Surgeons (October) finds that incorporating a radiofrequency detection system (RFDS) into existing laparotomy sponges can help resolve surgical sponge miscounts. The prospective study involved 2,285 consecutive surgery patients from a single center. RFDS detected one near miss and 35 miscounts, for a rate of 1.53 percent. Miscounted items were found in the surgical site, within the surgical suite, and in surgical drapes. Body mass index was not associated with miscounts.

Hip resurfacing implant survivorship
A study published online in The Lancet finds that hip resurfacing may result in inferior implant survivorship compared to other surgical options in many patients. An analysis of data from the National Joint Registry for England and Wales covering 31,932 resurfacings performed between 2003 and 2011 found worse implant survival rates among resurfacing patients than among patients with conventional total hip arthroplasty.

In related news, Smith & Nephew Orthopaedics, Ltd. issued an “urgent field safety notice” regarding the use of the company’s Birmingham Hip Modular Heads. The company is issuing a new standalone set of instructions, which includes updated contraindications, indications, and warnings, for use with the system.

Neurodegenerative mortality among NFL players
A study published online in Neurology finds that the neurodegenerative mortality of National Football League (NFL) players is 3 times higher than that of the general U.S. population. For two subcategories—Alzheimer disease and amyotrophic lateral sclerosis—the neurodegenerative mortality is 4 times higher than the general population.

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)