Published 11/1/2013

Second Look—Clinical News and Views

Return to military after TJA
Data presented in The Journal of Arthroplasty (September) suggest that total joint arthroplasty (TJA) may have efficacy when appropriately indicated among young, active patients who seek to continue their military careers. The research team surveyed 42 service members (average age 45 years) who had undergone major joint arthroplasty at a mean follow-up of 4½ years. They found that 86 percent of patients had returned to duty or remained on active duty through full military retirement. Of those who remained on active duty at least 18 months from surgery, 70 percent were able to deploy to a combat zone and complete a full tour of duty.

BrAIST study results
Data published in the New England Journal of Medicine (Sept. 19) suggest that bracing may significantly decrease the progression of high-risk curves to the threshold for surgery in patients with adolescent idiopathic scoliosis. The multicenter Bracing in Adolescent Idiopathic Scoliosis Trial (BrAist) study involved 242 patients with typical indications for bracing, 116 of whom were randomly assigned to bracing or observation, and 126 who chose between bracing and observation. Patients in the bracing group were instructed to wear the brace at least 18 hours per day. The primary outcomes were curve progression to 50 degrees or more (treatment failure) and skeletal maturity without this degree of curve progression (treatment success). The rate of treatment success across both cohorts was 72 percent after bracing, compared with 48 percent after observation, and the trial was stopped early due to the efficacy of bracing.

Physical therapy for atraumatic full-thickness rotator cuff tears
A multicenter prospective cohort study published in the Journal of Shoulder and Elbow Surgery (October) finds that physical therapy was an effective treatment in 75 percent of patients with full-thickness rotator cuff tears who were followed up for 2 years. Of 452 patients who underwent a physical therapy program developed from a systematic review of the literature and returned for evaluation at 6 weeks and 12 weeks, fewer than 25 percent of patients chose to undergo surgery.

Surgical decompression for cervical spondylotic myelopathy
Data presented in The Journal of Bone & Joint Surgery (Sept. 18) suggest that the use of surgical decompression for the treatment of cervical spondylotic myelopathy may be associated with improved outcomes at 1-year follow-up. The AOSpine North America prospective multicenter study involved 278 patients with symptomatic cervical spondylotic myelopathy and magnetic resonance imaging evidence of spinal cord compression who underwent surgical decompression. At baseline, 85 patients were classified as having mild disease, 110 as moderate, and 83 as severe. Among 222 patients available at 1-year follow-up, significant improvements were seen in outcome scores. Overall, 52 patients (18.7 percent) experienced complications, with no significant differences among the severity groups.

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)