October 19, 2018 | Today’s News

Study Evaluates Short- and Long-term Mortality Rates in Hip Arthroplasty Patients Based on BMI

Underweight hip arthroplasty patients may have an increased mortality rate one year after surgery, according to a study published online in Age and Ageing. The study included 3,627 hip arthroplasty patients who underwent surgery between 2010 and 2013. Researchers used Cox regression analysis to observe any correlation between body mass index (BMI) and mortality from 30 days, 31–365 days, and from the first day of surgery to death during the study. Compared to those with a normal BMI, underweight patients (BMI, < 18.5 kg/m ²) had a significantly higher risk of death. Short-term analyses showed that within 30 days of operation, underweight and obese (BMI, 25–29.9 kg/m ²) patients had an increased mortality rate.

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Study Measures Impact of Patient-Institution Relationship in Choosing PJI Treatment

In a study published online in The Journal of Arthroplasty, primary arthroplasty patients who sustained a prosthetic joint infection (PJI) were more likely to have their hardware removed when treated at a different hospital than patients who received treatment at the investigating institution. Researchers analyzed 270 patients with primary total hip and total knee arthroplasty infections. When controlling for confounding factors, they found that patients whose index procedures were performed at outside hospitals were more likely to choose prosthetic removal for treatment than patients who underwent total arthroplasty at the investigating institution. Researchers suggest that institutional protocols be put in place to guide the decision-making process and avoid bias.

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Isolated upper limb (IUL) injection of 75 mg of ceftriaxone and systemic (ST) 1 g injections may be equally effective in upper limb surgeries under tourniquet, according to a study published online in the Journal of Anesthesiology Clinical Pharmacology. Patients undergoing upper limb orthopaedic surgery (n = 25) were divided into two groups: ST (n = 5) and IUL (n = 20). ST patients received 1 g of ceftriaxone 20 minutes before tourniquet inflation, and the IUL group received a dose of 200 mg (n = 5), 100 mg (n = 5), 75 mg (n = 5), and 50 mg (n = 5) diluted in 50 mL of normal saline distally after tourniquet inflation. The groups did not demonstrate significant differences in peak bone marrow concentration after ST 1 g injection and IUL injection with 75 mg (155.8 versus 158.5 μg/mL, respectively). The ST group had a significantly lower area under curve than the IUL 75 mg group (1,285 versus 784.4 μg/mL/h, respectively) and a greater half-life (5.2 versus 4.7 hours, respectively).

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Adding dexmedetomidine to 0.75 percent ropivacaine in ultrasound-guided supraclavicular brachial plexus block greatly prolonged analgesia length in a double-blind study published online in the Journal of Anesthesiology Clinical Pharmacology. Researchers divided 90 adult patients set to undergo elective upper limb surgery under ultrasound-guided supraclavicular brachial plexus block into two groups; group A received 2 mL 0.9 percent normal saline (n = 43), and group B received dexmedetomidine 1 μg/kg body weight (n = 44). All patients were given 20 mL 0.75 percent ropivacaine. Patients in group B experienced longer sensory and motor block durations (613.34 and 572.7 minutes, respectively) than those in group A (543.7 and 503.26 minutes, respectively), as well as longer analgesia duration (704.8 versus 593.19 minutes, respectively).

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Composite fixation may help treat nonunions in proximal tibia fractures, according to a study published online in the American Journal of Orthopedics. Between January 2014 and July 2016, three proximal tibial nonunion patients (mean age, 61 years old; all female) were treated with composite fixation. All patients were primarily treated with open reduction and internal fixation. No postoperative complications occurred, and patients were hospitalized for a mean of five days. They developed no clinically significant pin site infections. All patients achieved union at an average of 5.2 months, and they all achieved deformity correction. Average range of motion (ROM) arc was 100 degrees, and knee ROM returned to preinjury levels in all patients.

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AOFAS Surveys the Field

Many aspiring foot and ankle orthopaedic surgeons may have a misconception that their field of choice will limit them exclusively to foot and ankle cases and prevent them from providing general orthopaedic treatment. Particularly, residents may believe that they will deal primarily with diabetic foot care. Leaders of the American Orthopaedic Foot & Ankle Society (AOFAS) recently conducted a survey to address these concerns, hoping the information collected may be beneficial for residents as well as their mentors.

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Call for Volunteers: Ambulatory Surgery Center and Hospital Outpatient Measurement Information Gathering Project

AAOS seeks to nominate two members to the Ambulatory Surgery Center and Hospital Outpatient Measurement Information Gathering (AHMI) Project. Through the AHMI Project, the Centers for Medicare & Medicaid Services will gather stakeholder input to develop new measure concepts in several ambulatory and outpatient healthcare settings. Applicants for this position must be active fellows, candidate members, candidate members osteopathic, candidate member applicants for fellowship, or candidate member applicants for fellowship osteopathic.

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