November 30, 2018
Today’s Top Story

Study Identifies Risk Factors for Postoperative Valgus Malalignment in Mobile-bearing UKA

Smaller lateral distal femoral angle (LDFA), femorotibial facet angle (FTFA), larger medial proximal tibial angle (MPTA), and less medial tibial cut thickness may predict valgus malalignment following mobile-bearing medial unicompartmental knee arthroplasty (UKA), according to a study published online in Archives of Orthopaedic Trauma and Surgery. Researchers retrospectively evaluated 122 consecutive Oxford phase 3 UKAs, which were classified as valgus with hip-knee-ankle angle (HKAA) > 180 degrees (n = 24) or nonvalgus with HKAA ≤ 180 degrees (n = 98). They collected data on preoperative LDFA, MPTA, FTFA, thickness of polyethylene bearing insert, tibial prothesis size, femoral prothesis size, medial tibial cut thickness, thickness of distal femoral mill, prothesis angle of coronal, and sagittal plane. Mean mechanical HKAA increased from 174.39 degrees preoperatively to 178.18 degrees postoperatively. The valgus group had a mean postoperative HKAA of 183.45 degrees compared to 176.88 degrees in the nonvalgus group. Multivariate analysis revealed that tibial cut, LDFA, MPTA, and FTFA were significant risk factors for predicting postoperative valgus malalignment after mobile-bearing UKA.

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Other News

Study Identifies THA Conversion Risk Factors Following Acetabular Fractures with Posterior Wall Involvement

According to a retrospective study published in the December issue of the Journal of Orthopaedic Trauma, conversion to total hip arthroplasty (THA) after acetabular fractures involving the posterior wall is more likely if reduction is not near-anatomic. The study included patients with acetabular fractures with posterior wall involvement treated with open reduction and internal fixation who were at least four years out from surgery. Researchers evaluated pre- and postoperative CT scans to assess injury characteristics and reduction quality. Patients were contacted via phone to inquire about reoperations and functional outcomes. THA conversion rates at two, five, and nine years were 5 percent, 14 percent, and 17 percent, respectively. Five specific radiographic features were correlated with a 50 percent THA conversion rate compared to an 11 percent rate if fewer than five features were present. No patients with less than 1 mm of diastasis/step-off on postoperative CT scan were converted to THA; patients with 1–4 mm had a 10 percent conversion rate, and 54 percent of patients with 4 mm or more of malreduction converted to THA. Short Form-8 and modified Merle d’Aubigne scores did not differ regardless of THA status.

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Study Evaluates Correlation Among Overactive Bladder, Falls, Fractures

Symptoms of overactive bladder (OAB) may be risk factors for falls and fractures, according to a study published in the November issue of Advances in Therapy. Researchers identified 15 observational studies on OAB from Medline, EMBASE, the Cumulative Index to Nursing and Allied Health Literature, and Scopus; non-OAB comparison sample data were also included when possible. OAB patients with at least one fall over the course of one year ranged from 18.9 percent to 50 percent; the rate of recurrent or serious falls in OAB patients ranged from 10.2 percent to 56.0 percent. Studies that included non-OAB comparison data found that OAB patients were at a higher risk of falls than patients without OAB. The adjusted OAB-associated fall risk ranged from 1.3- to 2.3-fold; unadjusted percent attributable risk of falls for OAB patients ranged from 3.7 percent to 15.5 percent Women and patients aged 65 years and older were at an increased risk of falls. Analysis of fractures could not determine a statistically significant difference between OAB and non-OAB groups.

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Study: Patient-reported Experience in Fracture Patients with Chronic Kidney Disease

Patients with chronic kidney disease (CKD) who sustain a fracture may be less likely than other fracture patients to have improved patient-reported experience measures, according to a prospective study published in the December issue of the Archives of Osteoporosis. Researchers evaluated 593 patients with hip (37.3 percent) and vertebral (62.7 percent) fractures, of whom 18 percent had CKD at baseline. At follow-up, patients reported improvement in self-care (32 percent), daily activity (27 percent), and pain severity (43 percent). CKD led to worse self-care ability and daily activity. In multivariate logistic regression analyses, baseline CKD predicted lower odds of improved daily activity and pain severity; self-care ability improvement did not significantly change.

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Study: TDR Surgery May be Declining in Popularity

According to a study published online in International Orthopaedics, problems with anterior surgery, imbursement policy, and potential problems with salvage surgery have led to a decrease in total disk replacement (TDR) surgeries. Researchers reviewed 80 studies: 23 literature reviews, 41 studies accepted by “importance criteria” from the internet, and 16 articles published in 2018. Three papers discussed problems associated with state nonimbursement; seven papers discussed salvage surgery, which was considered rare but extremely problematic. According to 16 papers, the anterior approach is a challenging surgery. One paper associated it with a 38.5 percent transient complication rate, another associated it with a 6.6 percent vascular injury rate, one correlated it with a 1.8 percent rate of retrograde ejaculations, and two said an access surgeon was required.

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AAOS Past-president Bernard Rineberg, MD, Remembered as a Caring, Thoughtful Leader

Bernard A. Rineberg, MD, AAOS president from 1993–1994, passed away on Sept. 30 in his Little Silver, N.J., home at 83 years old, surrounded by family. Dr. Rineberg is remembered for his various AAOS leadership roles, as well as his active work in other organizations. His advice for young orthopaedic surgeons: “Get involved!”

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Visit the AAOS Career Center

Jump start your search for the right position at the AAOS Career Center, a free benefit for AAOS members. The Career Center houses resources and support to enhance your job success, including flexible capabilities for sorting, refining, and saving job searches, as well as salary statistics, interview tips, and more. You can also visit the AAOS Career Center onsite at the AAOS 2019 Annual Meeting, March 12–16, in Las Vegas, to schedule face-to-face interviews with employers, view available job opportunities, and network with physician recruiters.

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