Published 6/1/2013

Second Look—Clinical News and Views

HA for GH-OA
According to a study in the Journal of Shoulder and Elbow Surgery (May) treating glenohumeral osteoarthritis (GH-OA) with sodium hyaluronate (HA) has little efficacy. The double-blind, randomized, controlled, multicenter trial involved 300 patients with GH-OA who received three weekly injections of either HA (n = 150) or phosphate-buffered saline(n = 150). At 26-week follow-up, both cohorts displayed mean improvement from baseline in visual analog scale, but differences between groups did not reach statistical significance. In a subset of patients with GH-OA and no concomitant shoulder pathologies, differences between groups did reach statistical significance in favor of HA.

Correcting severe hallux valgus deformity
Findings from a study conducted in the United Kingdom and published in the Bone & Joint Journal (April) suggest that distal chevron osteotomy with an associated distal soft-tissue procedure may have efficacy for correcting severe hallux valgus deformity. The prospective, randomized, controlled trial involved 110 consecutive female patients (110 feet) who underwent either a proximal (n = 56) or a distal (n = 54) procedure. At a mean 38.5-month follow-up, both groups had similar outcomes, patient satisfaction levels, and complications.

Predicting acute compartment syndrome
According to a study in the Journal of Bone & Joint Surgery (April 17), continuous intracompartmental pressure monitoring should be considered for patients at risk for acute compartment syndrome. An analysis of prospective data on 850 patients who had sustained a tibial diaphyseal fracture over a 10-year period found that the estimated sensitivity of intracompartmental pressure monitoring for suspected acute compartment syndrome was 94 percent, with an estimated specificity of 98 percent, an estimated positive predictive value of 93 percent, and an estimated negative predictive value of 99 percent.

Impact of sport specialization
According to preliminary findings presented at the annual meeting of the American Medical Society for Sports Medicine, young athletes who specialize in one sport and train intensively may have a significantly higher risk of stress fractures and other severe overuse injuries, compared with those who play a variety of sports. Of 1,206 athletes (ages 8 to 18 years) who had requested sports physicals or obtained treatment at two centers between 2010 and 2013, there were 859 total injuries, including 564 overuse injuries, in cases in which the clinical diagnosis was recorded. Specializing in a single sport increased the risk of overall injury, even when controlling for an athlete’s age and hours per week of sports activity. Study participants were more likely to be injured if they spent more than twice as much time playing organized sports as they spent in unorganized free play.

Knee arthroplasty and weight gain
A study in Arthritis Care & Research (May) finds that patients who undergo knee arthroplasty may be at an increased risk of clinically important weight gain following surgery. A comparison of data on 917 patients in the Mayo Clinic arthroplasty registry against 237 controls from the population-based Rochester Epidemiology Project found that 30 percent of patients in the knee arthroplasty sample had gained 5 percent or more of their baseline weight at 5-year follow-up, compared to 19.7 percent of the control sample.