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Published 3/1/2019

Second Look—Clinical

Hip and Knee

PPIs and hip fracture—Patients who use proton pump inhibitors (PPIs) could be more likely to sustain a hip fracture, according to a study published in Osteoporosis International (online). Researchers queried MEDLINE, EMBASE, Google Scholar, and Web of Science for relevant observational studies with at least 500 patients and at least one year of follow-up between Jan. 1, 1990, and March 31, 2018. The final analysis included 24 studies with a total of 2,103,800 patients (319,568 with hip fracture). Patients using low-, medium-, and high-dose PPIs had an increased risk for hip fracture compared to patients who did not receive PPI therapy, but the risk was more significant in high-dose PPI patients. Patients with both short- and long-term PPI use were more likely to sustain a hip fracture than those who did not receive PPIs.

Intraoperative air decontamination affects TJA outcomes—A retrospective study published in The Journal of Arthroplasty (online) found that patients who underwent total joint arthroplasty (TJA) in the presence of UC-V air decontamination had a decreased risk of periprosthetic joint infection (PJI). Between January 2016 and August 2017, 496 consecutive patients underwent TJA with supplemental UV-C air decontamination technology (n = 231) or standard turbulent heat, ventilation, and air conditioning (n = 265). All patients received the same peri- and postoperative care, and patients had similar demographics, lengths of surgery, and revision status. The turbulent air group had a 1.9 percent PJI rate, whereas the UV-C air decontamination group had no infections.

Short- and long-term outcomes for ACL techniques—A study published in Arthroscopy (January) assessed revision and complication rates in primary anterior cruciate ligament (ACL) reconstruction treatment using anteromedial (AM) and transtibial (TT) femoral drilling hole techniques. Researchers evaluated 8,386 primary ACL reconstruction patients between January 2007 and December 2010, as well as 8,818 patients between January 2012 and December 2015. The 2007–2010 AM group was more likely to undergo revision surgery than the TT group during that time period, but the groups had similar revision rates between 2012 and 2015. During that time, the AM group had a higher postoperative activity level than the TT cohort.

Racial disparities among TJA patients—Black patients may face more complications following TJA, according to a retrospective study published in The Journal of Arthroplasty (online). Between July 2013 and June 2017, 7,208 consecutive patients underwent primary TJA at a single institution; 84.3 percent (n = 6,182) were white and 14 percent (n = 1,206) were black. Black patients tended to be younger and female and had longer lengths of stay, higher incidences of septic complications, and greater manipulation under anesthesia. They also were more likely to be discharged to a facility than to home.

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).