Published 2/1/2013

Second Look—Clinical News and Views

SURGIFLO Hemostatic Matrix products recalled
The U.S. Food and Drug Administration (FDA) has announced a Class I recall of Ethicon, Inc., SURGIFLO Hemostatic Matrix and SURGIFLO Hemostatic Matrix Kit Plus FlexTip with Thrombin. The agency states that there is an issue within the packing process, where a cut could potentially breach the double Tyvek® pouch of the packaging. According to FDA, the product may cause serious adverse health consequences, including death. The affected products were manufactured from Sept. 16, 2011, through July 27, 2012, and distributed from Sept. 29, 2011, through Aug. 7, 2012.

Outcomes for obese patients with lumbar disk herniation
A study in the Journal of Bone & Joint Surgery–American (JBJS–A) (Jan. 2, 2013) finds that obese patients may realize less clinical benefit than nonobese patients from treatment of lumbar disk herniation. A data analysis of 336 obese patients and 854 nonobese patients enrolled in the Spine Patient Outcomes Research Trial for the treatment of lumbar disk herniation found that, with one exception (SF-36 pain scores), improvements over baseline in primary outcome measures at 4-year follow-up were significantly less for obese patients compared with nonobese patients in both surgical and nonsurgical treatment groups.

Study: ACP versus HA for gonarthrosis patients
According to data from an Italian study in the American Journal of Sports Medicine (December 2012), autologous conditioned plasma (ACP) may offer better clinical outcomes than hyaluronic acid (HA) for the treatment of gonarthrosis. The randomized, controlled trial involved 120 patients affected by clinically and radiographically documented gonarthrosis. Half received four intra-articular injections of ACP while the other half received four intra-articular injections of HA. Treatment with ACP injections was linked to significant improvement on the Western Ontario and McMaster (WOMAC) score shortly after final infiltration and a continuously improving sustained effect up to 24 weeks, at which point clinical outcomes were better than those achieved with the HA injections.

Safety of bilateral TKA
A study in Clinical Orthopaedics and Related Research (January 2013) finds that, from 1999 through 2008, the unadjusted percent and adjusted incidence of complication per 1,000 inpatient days for bilateral total knee arthroplasty (TKA) patients decreased from 0.42 percent and 0.85 to0.16 percent and 0.39. The unadjusted incidence of pneumonia, pulmonary embolism, and nonmyocardial infarction cardiac complications did not change, but an increase with time was detectible after adjustment for length of stay.

Decreasing inflammation after bilateral TKA
A study in JBJS–A (Dec. 5, 2012) suggests that three doses of hydrocortisone may decrease inflammation after bilateral TKA. The double-blind, randomized, placebo-controlled study involved 34 bilateral TKA patients; half received three doses of intravenous hydrocortisone (100 mg) and half received placebo, 8 hours apart. The level of interleukin-6 increased in both groups, but was significantly higher in the control group, peaking at 24 hours postoperative. Pain scores and presence of fever were significantly lower and range of motion in the knee was significantly greater in the study group, compared to controls, at 24 hours after surgery.

Treating posterior wall fractures
Data in the Journal of Orthopaedic Trauma (January 2013) suggest that posterior wall fractures might be a subset of acetabular fractures that can be treated immediately without increased risk of excessive blood loss. The retrospective review of 49 consecutive posterior wall acetabular fractures treated at a single Level I trauma center found no difference in estimated blood loss between fractures fixed within 24 hours of injury and those fixed later. In addition, no difference was observed when analyzing timing of surgery as a continuous variable or other outcome variable.

IDSA releases guidelines on PJI
The Infectious Diseases Society of America (IDSA) has released a new set of guidelines designed to help healthcare providers diagnose and effectively treat prosthetic joint infections (PJI). Among the areas covered in the guidelines were PJI symptoms, treatment options, antibiotics, and identification of high-risk patients. The guidelines were published online ahead of print in Clinical Infectious Diseases. AAOS advises that the IDSA guidelines are consensus or opinion-based guidelines.

TKA and weight gain
A study in Arthritis Care & Research finds that patients who undergo TKA may be at increased risk of clinically important weight gain following surgery. Patient data from a large U.S.-based knee arthroplasty registry was compared to a population-based control sample from the same geographic region. Among patients in the arthroplasty sample, 30.0 percent gained 5 percent or more of baseline body weight at 5-year follow-up, compared to 19.7 percent of the control sample. Additional arthroplasty procedures during the follow-up period were associated with an increased risk for weight gain relative to controls.

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)