August 23, 2019
Today’s Top Story

Study: Could Megaprosthesis Be Used in Complex Distal Femur Fractures?

A systematic review published online in Injury found that megaprosthesis may be a safe and effective option for the treatment of complex distal femur fractures (DFFs). Electronic databases were queried to find studies evaluating DFFs treated with a megaprosthesis. Primary outcomes included range of motion (ROM), functional assessment, and complications. Final analysis included 13 studies encompassing 104 patients who were stratified into three groups: supracondylar femur fracture (n = 29), periprosthetic fracture (n = 51), and nonunion of a previous supracondylar fracture (n = 24). Length of follow-up ranged from six months to 58 months. All studies showed positive outcomes pertaining to quality of life, resuming activities of daily living, early mobilization, ROM, and length of hospital stay. Complications were rare; the only ones reported were infection and aseptic loosening.

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In Other News

Study Evaluates the use of THA for Hip Bony Fusion Due to Ankylosing Spondylitis

A study published online in the Journal of Orthopaedic Surgery and Research observed positive outcomes in patients treated with total hip arthroplasty (THA) for bony hip fusion caused by ankylosing spondylitis (AS). The study included 26 patients (31 coxae) with AS who underwent THA and had more than three years of follow-up. Patient age ranged from 19 years to 50 years. The average preoperative Harris Hip Score (HHS) was 19 points. One coxa sustained intraoperative femoral proximal cleavage fracture, which was treated with steel wire cerclage. One coxa sustained postoperative sciatic nerve traction injury that healed after six months. One case of posterior hip dislocation occurred and was treated right away with manual reduction. At final follow-up (average, 46.5 months), the average HHS was 87.1 points, and total average passive ROM and flexion were 215 degrees and 90.8 degrees, respectively—all significant improvements from postoperative averages.

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Study Assesses Efficacy of New Prosthesis in Total Wrist Arthroplasty

A study published online in The Journal of Hand Surgery observed favorable outcomes in total wrist arthroplasty performed using a new semiconstrained wrist prosthesis for patients with severe rheumatoid arthritis (RA) of the wrist. The clinical trial included 20 RA patients (20 wrists). Sixteen wrists had a preoperative Larsen classification of grade IV, while four had a grade V. Patients underwent evaluation pre- and postoperatively at 1.5 years and five years or more after surgery. Assessments included the Figgie wrist score; Japanese version of the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire; and plain radiographs. No patients reported wrist pain at final follow-up. Preoperative flexion-extension arc did not largely differ between preoperative and final follow-up. The Figgie wrist score significantly improved from preoperatively compared to 1.5 years postoperatively and then did not largely differ at final follow-up. The DASH score demonstrated improvement at all three follow-up points. At final follow-up, five wrists presented radiographic evidence of carpal component loosening, but all patients were asymptomatic and did not undergo revision surgery.

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Study Analyzes Factors Associated with Reverse TSA Satisfaction

A study published online in the Journal of Shoulder and Elbow Surgery identified predictors of poor patient outcomes in reverse total shoulder arthroplasty (rTSA). Between 2013 and 2016, 137 patients underwent rTSA performed by a single surgeon and had at least two years of follow-up. The only independent factor associated with poor improvement and outcome was prior shoulder surgery. Of the previous shoulder surgeries, three-quarters were arthroscopic. Patients with preoperative opioid use had poorer outcomes, and higher preoperative American Shoulder and Elbow Surgeons score predicted poor postoperative improvement

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Study: Does Rheumatoid Arthritis Affect Blood Loss in Posterior Lumbar Interbody Fusion on Lumbar Spinal Stenosis?

A study published in the September issue of Spine found that patients with RA who undergo posterior lumbar interbody fusion (PLIF) on lumbar spinal stenosis (LSS) may be more likely to incur hidden blood loss (HBL). A total of 61 LSS patients with RA were matched to 87 non-RA LSS patients. The primary outcomes were intraoperative blood loss, drainage, and HBL. Total blood loss (TBL), intraoperative blood loss, and postoperative drainage did not significantly differ between the groups, but the RA group had higher HBL and proportion of HBL in TBL. Risk factors associated with HBL in RA patients were Steinbroker classification, disease-modifying antirheumatic drugs, change in hemoglobin, and allogenic blood transfusion.

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A Federal Task Force: Another Way to Serve My Country

In this article, John J. McGraw, MD, FAAOS, an emeritus AAOS member and medical director of OrthoTennessee, recalls his experience as a Special Government Employee as part of the Department of Health and Human Services’ Pain Management Best Practices Inter-agency Task Force—an experience he describes as “an opportunity to serve my community, my profession of orthopaedic surgery, and my country.”

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Key Informants Needed for Hip Fractures CPG Project

AAOS is seeking volunteers to take part in a Key Informants Panel for the development of the clinical practice guideline (CPG) on the Management of Hip Fractures in the Elderly. As a key informant, you will serve in an advisory capacity and not be required to attend any in-person meetings. There are no financial conflict of interest restrictions for Key Informal Panel members. If you have any questions, contact Jennifer Rodriguez at The deadline to apply is Sept. 30.

Learn more and submit your application…


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