October 10, 2018
 
Today’s Top Story

Study Assesses Arthroscopic Partial Meniscectomy Complications

Arthroscopic partial meniscectomy is considered a low-risk procedure, but there is a risk for a few rare yet serious complications, according to a study published online in The Lancet. Researchers searched the national Hospital Episode Statistics for data on arthroscopic partial meniscectomies performed in England between April 1, 1997, and March 31, 2017, excluding simultaneous or staged (within six months) bilateral cases. They included 699,965 total procedures. Within 90 days, complications arose in 2,218 cases (0.317 percent), including 944 infections that required further surgery (0.135 percent) and 546 pulmonary emboli (0.078 percent). Older age, male sex, and more comorbidities were associated with increased complication risk. Mortality risk decreased over time. The general population had a greater risk of mortality, myocardial infarction, and stroke than the study cohort. Researchers estimated that for every 1,390 fewer knee arthroscopies performed, one pulmonary embolism may be avoided, and for every 749 fewer operations, one native knee joint infection may be avoided.

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Other News

Study: Methylphenidate May Lower Risk of Stress Fractures in Young Adults with ADHD

Young adults with attention deficit hyperactivity disorder (ADHD) are at greater risk of stress fractures (SF) than those without ADHD, but chronic treatment with methylphenidate (MP) may reduce this risk, according to a study published online in the journal Bone. Researchers studied 682,110 military recruits (409,175 males) aged 18 to 25 years who served for at least 12 months between 2008 and 2017. Participants were placed in one of five groups: those without ADHD; those with ADHD who were untreated; and those with ADHD who received prescriptions of 1-90, 91-180, or > 181 tablets during the study period. Fractures occurred in 4.4 percent of participants (n = 29,888). Both male and female untreated ADHD participants were at a much higher risk of SF (7.9 percent and 5.4 percent, respectively). ADHD-treated participants had much lower odds of SF compared to healthy controls. After adjusting for confounding factors, the untreated ADHD group remained at an elevated risk for SF. Only those receiving the highest MP dose had a lower risk of fracture than the healthy controls.

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Study Observes Comorbidities Two Years After Elective Hip Surgery

Adverse health effects may occur as late as two years following elective, arthroscopic hip surgery, according to a study published online in The British Journal of Sports Medicine. Researchers identified 1,870 patients (mean age, 32.24 years; 55.5 percent male) from the Military Health System Data Repository who underwent hip arthroscopy between 2004 and 2013. They assessed mental health disorders, chronic pain, substance abuse disorders, cardiovascular disorders, metabolic syndrome, systemic arthropathy, and sleep disorders one year prior to surgery and two years following surgery. Relative to baseline, researchers observed increases in all comorbidities: mental health disorders (84 percent), chronic pain diagnoses (166 percent), substance abuse disorders (57 percent), cardiovascular disorders (71 percent), metabolic syndrome cases (85.9 percent), systemic arthropathy (132 percent), and sleep disorders (111 percent).

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Read the abstract…

 
 
Study: Intraoperative Ropivacaine May Not Offer Long-term Relief for Pediatric Lower Limb Patients

A single-blind study published online in the Journal of Pain Research found that intraoperative epidural infusion of ropivacaine did not relieve pain within 48 hours postoperation in children undergoing extensive lower limb orthopaedic surgery. Forty-seven patients aged three to 12 years randomly received an initial bolus of ropivacaine 0.15 percent 0.2 mL/kg (preemptive group, n = 23) or normal saline (control group, n = 24) and then continuous infusion of 0.15 mL/kg/h throughout surgery. Postoperatively, all patients received patient-controlled epidural analgesia with ropivacaine 0.1 percent. The preemptive group had significantly lower Face, Legs, Activity, Cry, and Consolability pain scores 30 minutes after arriving to the postanesthesia care unit and six hours after surgery (median difference, –1.0, and median difference, –20, respectively). Researchers did not observe significant differences at 12, 24, and 48 hours postoperatively. Epidural ropivacaine consumption and additional analgesic requirements did not significantly differ between the groups throughout the 48-hour postoperative period.

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Study: Overtreatment of Osteoporosis May Be Uncommon

A study published online in Archives of Osteoporosis found that while overtreatment of osteoporosis might be rare, it should still be minimized due to the risk for negligible benefit. Study authors analyzed the results of the randomized, controlled, pragmatic Patient Activation After DXA Receipt Notification trial. The study included 7,749 patients aged ≥ 50 years. Overtreatment was defined as the receipt of osteoporosis pharmacotherapy 12 weeks after dual-energy X-ray absorptiometry (DXA) when treatment was not indicated, per the National Osteoporosis Foundation guidelines. Of the patients who had no indication for osteoporosis treatment (n = 3,602), 8.1 percent (n = 292) received a new prescription for osteoporosis pharmacotherapy or were instructed to continue an existing medication (presumed overtreatment). Overtreatment occurred more frequently in patients with previous DXA history, those who reported a history of osteoporosis or low bone mass, and those who were referred for testing by family medicine providers.

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AAOS Now

Meta-analysis Evaluates CDC’s Recommendation of a Single, Preoperative Dose of Antibiotics

During the Musculoskeletal Infection Society 2018 Annual Meeting, Sean P. Ryan, MD, shared the results of a meta-analysis of the current evidence—specific to orthopaedic procedures with implants—related to the Centers for Disease Control and Prevention (CDC) and World Health Organization’s recommendation for administration of a single preoperative dose of antibiotic prophylaxis. The results suggest that a single dose of antibiotics administered preoperatively offered equivalent infection prophylaxis as multiple perioperative doses. However, concerns about some of the articles resulted in the evidence being deemed poor quality.

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Your AAOS

Apply for the ACGME Review Committee for Orthopaedic Surgery

The Accreditation Council for Graduate Medical Education (ACGME) Review Committee for Orthopaedic Surgery has two open member positions; the six-year terms run from July 1, 2020, to June 30, 2026. Candidates must have expertise or fellowship training in hand. The last day to submit an application is Nov. 1.

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

 

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