June 13, 2018 | Today’s News

Study: Biomarkers associated with osteolysis could aid in total hip replacement efficacy

Biomarkers may be predictive of osteolysis risk in patients undergoing total hip replacement (THR), according to a study published in the Journal of Orthopaedic Research. Using 24-hour urine samples taken from 26 THR patients between 1989 and 1997—16 of whom contracted osteolysis—researchers examined biomarkers at radiographic diagnosis, annually for six years prior to diagnosis, at the first postoperative sampling point, and preoperatively. Of the seven candidate biomarkers observed, free deoxypyridinoline correlated most strongly with the occurrence of osteolysis as an individual biomarker, with an area under the curve (AUC) in receiver operating characteristic analyses of 0.844 at six years prior to diagnosis. A panel containing connective tissue protein alpha CTX and interleukin‐6 identified patients at risk of osteolysis with an AUC > 0.941 at all postoperative measurements and an AUC of 1.0 preoperatively.

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Study: Reoperation rates for Lisfranc injuries treated via open reduction internal fixation and primary arthrodesis may be similar

A recent study published online in Foot & Ankle International appeared to show that the rate of reoperation in patients with Lisfranc injuries treated by open reduction and internal fixation (ORIF) may not be higher than in those treated by primary arthrodesis (PA). Researchers examined 217 patients who underwent ORIF (n = 163) or PA (n = 54) for isolated Lisfranc injuries between July 1991 and July 2016 with a minimum follow-up of 12 months. The rates of return to the operating room for ORIF and PA were not significantly different (29.5 percent and 29.6 percent, respectively) when excluding operations for hardware removal. Risk factors associated with unplanned return to the operation room included deep infection, delayed wound healing, and high-energy trauma.

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The occurrence of heterotopic ossification after total elbow arthroplasty (TEA) may be more common than previously reported, according to a retrospective study published online in The Bone & Joint Journal. The study included 52 patients (55 elbows) who underwent TEA between June 2007 and December 2015. Among the TEAs, 29 were elective arthroplasty and 26 were related to trauma. At a median clinical follow-up of 3.6 years and a median radiological follow-up of 3.1 years, the overall occurrence of heterotopic ossification was 84 percent (n = 46), and heterotopic ossification incidence was higher in the trauma group (96 percent, n = 25/26) than in the elective group (72 percent, n = 21/29). Elbow range of motion was not significantly affected by the presence of heterotopic ossification.

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Circumferential labral reconstruction with iliotibial band allograft may be an alternative to the traditional labral repair in treating acetabular labral tears, according to a study published online in The American Journal of Sports Medicine. The cohort study included 162 consecutive hips that were operated on between 2014 and 2015, 99 of which were repairs and 63 were reconstructions. Compared to patients who underwent labral repair, those who had labral reconstruction were, on average, older (43.4 years versus 29.5 years), had a slightly higher body mass index (24.6 versus 23.0), had hips with higher Tönnis grade (grade 1 or 2: 25 percent versus 9 percent), had higher preoperative pain scores (49.9 versus 41.5), and had greater pathology in their hips (68 percent versus 5 percent). Each of the hips that did not fail—including 94 repairs and 58 reconstructions—showed statistically significant improvements in patient-reported outcomes, with no significant difference between the groups.

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According to a study published in the June 6 issue of The Journal of Bone & Joint Surgery, the duration of preoperative opioid use could be a strong indicator of continued opioid usage after spinal surgery. Using TRICARE insurance claims data, researchers identified 27,031 patients undergoing spinal surgery between 2006 and 2014. Duration of preoperative opioid use was categorized into four groups: acute exposure, exposed without sustained use, intermediate sustained use, and chronic sustained use. Overall, 2,379 patients (8.8 percent) continued opioid use at six months following surgery. Duration of preoperative opioid use was the most significant indicator of continued use after surgery. Compared to the acute exposure group, cessation of opioid use after six months was 65 percent less likely in the intermediate sustained group, 74 percent less in the chronic sustained group, and 29 percent less likely in the exposed group.

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Considerations for maternal and fetal outcomes in pregnant orthopaedic trauma patients

Trauma affects nearly one in 12 pregnancies, with motor vehicle collisions and intimate partner violence being the most common causes. Aside from pregnancy-related issues, trauma is the leading cause of maternal death. Fetal death secondary to maternal trauma affects 2.3 per 100,000 live births, often stemming from placental abruption. Injuries necessitating trauma activations are associated with increased risk of preterm birth, placental abruption, poor infant condition at birth, as well as infant and maternal death.

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Apply for Trauma Evaluation Committee member position

The AAOS Adult Spine Evaluation Committee has an open member position, a three-year term that runs from Mar. 18, 2019, to Mar. 25, 2022. The committee prepares the Musculoskeletal Trauma Self-Assessment Examination triennially and acts as a resource as requested for providing examination questions for other AAOS educational programs. The last day to submit an application is Aug. 3.

Learn more and submit your application… (member login required)