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.
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.
Decreasing Variation in Clinical Practice
The current "cost crisis" in health care has resulted in greater emphasis on increasing value in healthcare delivery, particularly in orthopaedics. As orthopaedic practitioners, we are best positioned to streamline musculoskeletal care and to guide changes in practice. Among the many tools that can be used to increase the value of orthopaedic care are Standardized Clinical Assessment and Management Plans (SCAMPs).
New AUC Cover Hip Fracture in the Elderly and Osteochondritis Dissecans
The Academy's roster of Appropriate Use Criteria (AUC) has grown by three, with the addition of two online applications covering management of hip fractures in the elderly (acute treatment and postoperative rehabilitation of low-energy hip fractures) and one for treatment of pediatric patients with osteochondritis dissecans (OCD) of the femoral condyle. The AUC were approved at the December 2015 meeting of the AAOS Board of Directors.
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.
2016 ORS Clinical Research Forum Takes a Twist
Although the Clinical Research Forum has been a part of the Orthopaedic Research Society (ORS) Annual Meeting since 2011, every year brings a new focus for this popular workshop. In 2016, the focus will be Clinical Trials from Early Stage to Large Datasets and Fundamental Challenges. "Each year, we use the forum as an opportunity to shed light on hot topics and what people want to know," explained Forum Chair Kurt M. Spindler, MD.
Fragility Fractures: Risk Factors and Prevention
Wrist fractures may be a sentinel event," stated Tamara D. Rozental, MD, an orthopaedic surgeon at the Beth Israel Deaconess Medical Center and associate professor of medicine at Harvard Medical School. "Fractures of the distal radius are usually the first fragility fracture, so they give us, as orthopaedic surgeons, a unique opportunity to intervene, which might make a difference in preventing future injuries."
AAOS Expands Quality Activities, Updates Position Statements
At their December 2015 meeting, the Board of Directors of the American Association of Orthopaedic Surgeons (AAOS) took several actions that reinforce the AAOS commitment to patient safety, quality care, and advocacy. The Board approved a new clinical practice guideline (CPG) on Surgical Management of Osteoarthritis of the Knee (see "Evidence Bolsters Recommendations in New CPG."