October 25, 2019
 
Today’s Top Story

Study: Postoperative Opioid Consumption Among Different THA Approaches

A retrospective study published in the November issue of The Journal of Arthroplasty compared postoperative opioid consumption among primary elective total hip arthroplasty (THA) patients treated with an anterior approach (AA), lateral approach (LA), and posterior approach (PA). Patient demographics, American Society of Anesthesiologists grade, opioid naïvety, operative details, pain scores, and hospital length of stay were compared based on the operative approach. Final analysis included 560 patients (335 were female): 179 AA, 178 LA, and 203 PA patients. Average postoperative opioid usage in oral morphine equivalent daily dose (oMEDD) was 63.05 for the AA group, 79.81 for the LA group, and 77.50 for the PA group. The mean difference was 16.8 oMEDD lower in the AA group than the LA group and 14.5 oMEDD lower in the AA group than the PA group.

Read the abstract…

 
 
 
 
In Other News

Study Analyzes Prevalence, Cost of Stem Cell Therapy and PRP for Knee OA

A study published in the Oct. 15 issue of the Journal of the AAOS reviewed available data regarding stem cell therapy (SCT) and platelet-rich plasma (PRP) in the treatment of osteoarthritis (OA) of the knee in Miami-Dade County, Fla. The researchers identified Board-certified orthopaedic surgeons’ offices in the area by their AAOS active membership. They contacted 91 offices and asked about a hypothetical end-stage knee OA patient seeking preoperative SCT or PRP injections. Of those reached, 36 percent offered PRP, and 24.5 percent offered SCT. Regarding cost, 81 percent of offices were transparent on PRP pricing compared to 42 percent on SCT pricing. The practices that did not discuss price said that would be “determined or discussed” at a scheduled visit. The mean cost was significantly greater for SCT injection ($3,100) than PRP injection ($897). The study authors concluded that while these therapies have potential use in nonoperative disease management, data remain lacking and conflicting and should be considered investigational.

Read the abstract…

 
 
 
 
Study Compares Outcomes in Rotator Cuff Repair Treatments

A study published in the October issue of Arthroscopy did not observe significant differences in clinical and imaging outcomes between the suture bridge technique (SB) and medially based single-row technique (medSR) in patients with medium-sized rotator cuff tears. Patients underwent preoperative and 12- and 24-month postoperative evaluations using the modified University of California, Los Angeles (UCLA) scoring system; active range of motion (flexion and external rotation); and the visual analog scale (VAS) score for pain. Postoperative MRI was used to determine healing status. One-year follow-up included clinical and imaging evaluations from 92 patients, and two-year follow-up included 74 patients. At final follow-up, patients in the SB and medSR groups did not exhibit significantly different outcomes: UCLA scores, 33.4 points versus 33.0 points; VAS scores, 6 mm versus 7 mm; active flexion angles, 161 degrees versus 159 degrees; and external rotation angles, 49 degrees versus 52 degrees. The rate of retears was higher in the SB group (6.5 percent) than the medSR group (2.1 percent). Medial cuff failure only presented in the SB group (n = 2, 4.3 percent), and incomplete healing was only observed in the medSR group (n = 4, 8.7 percent). Overall, 93 percent of the medSR cohort presented neo-tendon regeneration.

Read the study…

 
 
 
Study Evaluates Use of Ultrasound in Sciatic Nerve Changes Due to Disk Herniation

According to a study published online in BMC Musculoskeletal Disorders, ultrasound imaging could be helpful in detecting changes in the sciatic nerve attributable to disk herniation. Twenty patients complaining of unilateral sciatica with foraminal stenosis due to one level of lumbar disk herniation (LDH) were age- and sex-matched to 27 controls. A convex array probe was used to examine patients on the axial and longitudinal planes bilaterally at the same level. Compared to the unaffected side and the control group, the sciatic nerve stiffness measured on longitudinal planes of the affected side was much higher. There was a positive correlation between unilateral LDH symptom duration and sciatic nerve stiffness.

Read the study…

 
 
 
Study Analyzes Divergent Intramedullary Nailing to Treat Pediatric Distal Tibial Fractures

Divergent intramedullary nailing (DIN) may be an effective treatment for pediatric distal tibial fractures, according to a retrospective study published in the November/December issue of the Journal of Pediatric Orthopaedics. Patients aged < 16 years with a displaced and/or unstable distal third tibia fracture at a single center were treated with the DIN technique. Preoperative, postoperative, six-week, and six-month X-rays were taken. Final analysis included 13 patients (mean age, 10 years) followed for a mean 32 months. Nail size ranged from 2.5 mm to 4.0 mm. Mean operation time was 54 minutes. Coronal and sagittal angulation was reduced in all 13 fractures, and there were no cases of six-week secondary displacement. By six months, all patients were healed.

Read the abstract…

 
 
 
AAOS Now

Literature Offers Little Direction on the Safety and Efficacy of Low-level Laser Therapy for Back Pain

In July, the Food and Drug Administration cleared the Erchonia FX 635, a low-level laser therapy (LLLT) device, for “whole body” pain In part two of a two-part series, Eeric Truumees, MD, editor-in-chief of AAOS Now and orthopaedic spine surgeon, explores the available literature regarding LLLT for orthopaedic applications.

Read more…

 
 
 
Your AAOS

Final Call: Apply for Volunteer Opportunities

Consider applying for the following positions:

  • Diversity Advisory Board chair position—applications are accepted until Oct. 28
  • Communications Committee chair position—applications are accepted until Oct. 29
  • International Committee chair position—applications are accepted until Nov. 1
  • Practice Management/Rehabilitation Program Committee chair position—applications are accepted until Nov. 1

Learn more and submit applications…(member login required)

 

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