Published 2/1/2014

Second Look—Clinical

Impact of rhBMP-2 on fracture healing time
Data in The Journal of Bone & Joint Surgery (JBJS) (Dec. 4, 2013) suggest that the use of recombinant human bone morphogenetic protein-2 (rhBMP-2) in combination with injectable calcium phosphate matrix may not significantly reduce healing time for patients with closed tibial fractures who are treated with reamed intramedullary nailing. The randomized trial of 369 patients was terminated after an interim analysis of 180 patients with 6-month follow-up revealed no shortening in the time to fracture union in any of the active treatment arms compared with the control group.

OA and risk of CVD
Findings from a Canadian study in Arthritis Care & Research (December 2013) suggest that osteoarthritis (OA) may be associated with an increased risk of cardiovascular disease (CVD). The prospective, longitudinal study of 12,745 OA patients and a cohort of matched controls found that OA was a predictor of CVD. Compared to non-OA individuals, OA patients who underwent total joint replacement had a 26 percent increased risk of CVD.

Warfarin protocol for hip fracture patients
Data in the Journal of Orthopaedics and Traumatology (November 2013) suggest that implementation of a perioperative warfarin management protocol may expedite surgery in hip fracture patients. Of 67 hip fracture patients who were on warfarin at the time of admission, the 27 patients admitted before implementation of a warfarin management protocol a median admission-to-operation time of 73 hours, compared to a time of 37.7 hours for the 40 patients admitted postprotocol implementation. No significant differences were found in hospital length of stay or postoperative warfarin recommencement time between groups.

Outcomes for lumbar disk herniation surgery
Data in Spine (Jan. 1) indicate that patients who undergo surgery for lumbar disk herniation may see greater improvement than patients who are treated nonsurgically. The concurrent, prospective randomized (501 participants) and observational (743 participants) cohort studies at 13 U.S. spine clinics found advantages for surgery in intent-to-treat analyses at 4- to 8-year follow-up. The overall comparison of secondary outcomes was significantly greater with surgery in the intent-to-treat analysis, and an as-treated analysis showed significant surgical treatment effects for primary outcome measures.

Treating degenerative medial meniscus tears
Findings from a Finnish study in The New England Journal of Medicine (Dec. 26) suggest that the use of arthroscopic partial meniscectomy may not improve outcomes for patients who do not have knee OA but do have symptoms of degenerative medial meniscus tear. The multicenter, randomized, double-blind, sham-controlled trial of 146 patients 35 to 65 years of age who had knee symptoms consistent with a degenerative medial meniscus tear and no knee OA found no significant differences in primary outcome measures at 12 months. No significant differences were noted in the number of patients who required subsequent knee surgery or the number of serious adverse events.

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)