AAOS Now, January 2016
Evidence Bolsters Recommendations in New CPG
A new Clinical Practice Guideline (CPG), available on the OrthoGuidelines.org website, provides a wealth of recommendations for Surgical Management of Osteoarthritis of the Knee (SMOAK). Reflecting the improving quality of evidence to guide treatment decisions, the new CPG offers 14 recommendations based on "strong" evidence (Table 1) and 14 with "moderate" evidence. Ten others derive from "limited" evidence. Table 2 lists the complete summary of guidelines.
Second Look—Clinical News and Views
Findings from a study conducted in Canada and published in the Dec. 2 issue of The Journal of Bone & Joint Surgery suggest that use of an intramedullary device (IM) for the management of intertrochanteric fracture may be associated with improved radiographic outcomes, but not improved functional outcomes.
Taking a Second Look at Effectiveness of Viscosupplementation
When the AAOS first issued a clinical practice guideline (CPG) on nonarthroplasty treatment of knee osteoarthritis (OA) in 2009, the evidence on the effectiveness of viscosupplementation (hyaluronic acid [HA] injections) as a treatment option was inconclusive. When the CPG was reviewed and reissued in 2013, the evidence—according to the work group—was undeniable: "We cannot recommend using hyaluronic acid for patients with symptomatic osteoarthritis of the knee," they wrote.
The 80-Hour Week: Impact on Residents
Orthopaedic surgery residency has undergone many changes ranging from limitations on resident work hours and longer orthopaedic surgery rotations during the intern year, to increased documentation requirements for surgical and clinical "milestones." These changes were implemented to improve patient care, provide better resident lifestyles, and reduce resident fatigue. But whether changes in hours and rotations have actually delivered on these claims is an ongoing debate.
Stem Cells Are an Effective Adjunct Therapy for Rotator Cuff Tears
Although arthroscopic rotator cuff repair has become a fairly common surgical procedure, retears can occur. Researchers from Henri Mondor Hospital, Paris University, have found that the use of bone-marrow-derived mesenchymal stem cells (MSCs) during arthroscopy enhances tendon healing and decreases the likelihood of retears.
An Attractive Alternative: Magnetic Growing Rods
"Most orthopaedic surgeons who treat patients with early onset scoliosis use traditional growing rods, which allow for spinal growth and deformity control," said Todd Milbrandt, MD, addressing members of the Scoliosis Research Society during their 2015 annual meeting. "However, such systems require regular surgical lengthening, which may be linked with increased risk of infection and additional stress to the patient.
Reducing Malalignment Rates in Distal Tibia Fractures
A study comparing two intramedullary nail (IMN) insertion techniques in the treatment of distal tibia fractures found that the suprapatellar approach yielded a significantly lower rate of malalignment (3.8 percent) than the infrapatellar approach (26.1 percent). Although use of a locked IMN in an infrapatellar technique "has been shown to enable a successful outcome," according to the authors, "obtaining correct alignment has historically been problematic."
Injections May Increase Infection Risk in TKA Patients
Patients who receive an intra-articular steroid or hyaluronic acid injection in the knee prior to undergoing total knee arthroplasty (TKA) may be at an elevated risk of postsurgical infection, according to Nicholas A. Bedard, MD. Furthermore, infection risk may be time-dependent, increasing when less time has elapsed between injection and undergoing TKA, noted Dr. Bedard during the 2015 annual meeting of the American Association of Hip and Knee Surgeons.
Spine Disability May Negatively Affect TKA Outcomes
Although total knee arthroplasty (TKA) generally results in excellent pain relief, approximately 20 percent of patients have persistent functional deficits that affect their quality of life, noted William C. Schroer, MD, during the 2015 annual meeting of the American Association of Hip and Knee Surgeons. Dr. Schroer reported that lumbar spine problems are a common cause of functional disability in TKA patients.
More News from AAHKS
According to a study presented at the annual meeting of the American Association of Hip and Knee Surgeons (AAHKS), obese patients who undergo bariatric surgery prior to total knee arthroplasty (TKA) will experience fewer complications following the surgery than obese patients who have not had bariatric surgery. Author used a national database to evaluate the complication rates after TKA in patients who have had bariatric surgery.
MIL Caucus Addresses Musculoskeletal Disparities
On Nov. 12–13, 2015, the 6th annual National Caucus on Arthritis and Musculoskeletal Health Disparities, sponsored by Movement Is Life (MIL), was held in Washington, D.C. Since its inception in 2010, MIL has focused on improving the musculoskeletal health outcomes of those disproportionately impacted by knee osteoarthritis: women of all racial/ethnic backgrounds, African-Americans, and Latinos/Hispanics.