September 20, 2019
Today’s Top Story

Study: How Prevalent is Hip Dislocation Following Primary THR?

Postoperative hip dislocation in primary total hip replacement (THR) patients may have declined over time, according to a systematic review and meta-analysis published online in The Lancet Rheumatology. Researchers queried Medline, Embase, Web of Science, and the Cochrane Library for relevant articles published through March 8. Final analysis included 149 articles on 125 studies covering 4,633,935 THRs and 35,264 dislocations. Dislocation incidence ranged from 0.12 percent to 16.13 percent; overall pooled incidence was 2.1 percent over a weighted mean follow-up period of six years. Dislocation rates significantly declined from 1971 to 2015. Sex did not affect dislocation risk. Patients aged < 70 years (compared to older patients) and from high income groups (compared to low income) were less likely to sustain dislocation. Risk factors for dislocation included white ethnicity (only when compared to Asian ethnicity), drug use disorder, social deprivation, and body mass index (BMI) ≥ 30 kg/m 2 (compared to BMI < 30 kg/m 2).

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In Other News

Study Compares Treatment Options for End-stage Ankle Arthritis

Arthroscopic ankle arthrodesis (AAA) and open ankle arthrodesis (OAA) may have comparable outcomes to total ankle replacement (TAR) in patients with isolated, nondeformed end-stage ankle arthritis, according to a retrospective review published in the Sept. 4 issue of The Journal of Bone and Joint Surgery. Patients who underwent TAR, AAA, or OAA and had at least two years of follow-up were identified using the Canadian Orthopaedic Foot and Ankle Society (COFAS) Prospective Ankle Reconstruction Database. All patients were aged ≥ 18 years and had symptomatic COFAS type-1 nondeformed end-stage ankle arthritis. Final analysis included 238 ankles (TAR, n = 88; AAA, n = 50; OAA, n = 100). Preoperative Ankle Osteoarthritis Scale (AOS) pain, disability, and total scores, as well as pre- and postoperative Short Form-36 physical and mental component summary scores were similar across groups. AOS total and disability scores improved more in the TAR (34.4 and 36.7, respectively) and AAA (38.3 and 40.5, respectively) groups than the OAA group (25.8 and 26.0, respectively), but these improvements were not clinically significant. Reoperation rates were higher in the TAR group than the AAA and OAA groups, and all three groups had similar revision rates.

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Study Evaluates Trends in Electronic Motorized Scooter Injuries

A retrospective study published online in Trauma Surgery & Acute Care Open observed an increase in trauma related to the use of electronic motorized scooters (eScooters). Multicenter data from Sept. 1, 2017, to Oct. 31, 2018, including demographics, drug and alcohol use, helmet use, admission vitals, injuries, procedures, hospital and intensive care unit length of stay (LOS), death, and disposition, were evaluated. During the study period, 103 patients (mean age, 37.1 years; 65 percent were male) were admitted for eScooter-related trauma. Most (98 percent) patients were not wearing a helmet, and median LOS was one day. Of the 79 percent of patients tested for alcohol, 48 percent had a blood alcohol level > 80 mg/dL; of the 60 percent of patients who underwent a urine toxicology screen, 52 percent were positive. The most common injuries were extremity fractures (42 percent), facial fractures (26 percent), and intracranial hemorrhage (18 percent); a third of patients underwent surgery, primarily open fixations of extremity and facial fractures. There were no deaths, and 86 percent of patients were discharged home.

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Study: Is Trapeziometacarpal Joint Arthritis Revision Surgery Successful?

A study published in the September issue of The Journal of Hand Surgery observed poor outcomes in revision surgery for failed trapeziometacarpal joint arthritis surgery compared to primary surgery. Between 1995 and 2015, 83 patients (86 hands) underwent revision trapeziometacarpal surgery; 25 patients (27 hands) were available for follow-up with a phone survey or clinical examination, and 58 patients (59 hands) were available for just chart review. The phone survey and clinical examination used the visual analog scale (VAS) score; Disabilities of the Arm, Shoulder, and Hand (DASH) score; and Conolly-Rath evaluation method to evaluate outcomes. The clinical examination also included an evaluation of grip strength, pinch strength, and radiographs. During a median 8.5 years of follow-up, postoperative complications occurred in 20 percent of patients, most of which were pin problems (7 percent). The average VAS was 28.2, and the average DASH was 32.0. Using the Conolly-Rath criteria, 10 patients had a good outcome, 10 were poor, and seven were fair. Of the 13 patients who underwent physical examination, average adduction in the affected side was 42 degrees compared to 51 degrees in the nonaffected side. Radial abduction was 58 degrees versus 65 degrees, respectively. Palmar abduction was 53 degrees versus 85 degrees, respectively. Tip finger pinch in the affected hand was 3.4 kg compared to 4.0 kg in the nonaffected hand; key pinch was 4.7 kg versus 5.5 kg, respectively, and grip strength was 22.1 kg versus 27.6 kg, respectively, when adjusted for dominance.

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Study Assesses Safety of Cervical Transforaminal Epidural Steroid Injections

Cervical transforaminal epidural steroid injections (CTFESIs) may be safe and cost-effective, according to a study published online in the European Spine Journal. The single-center study included CTFESI patients from January 2008 through August 2018. Final analysis included 527 patients who underwent 1,047 procedures (1,753 individual cervical levels injected); 1,011 procedures were performed with particulate steroid (triamcinolone acetonide) and 36 were performed with nonparticulate (dexamethasone). Six complications occurred, all of which resolved on their own.

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Senate Candidate Manny Sethi, MD, Promises To Make a ‘Different Kind of Difference’

Orthopaedic surgeon Manny Sethi, MD, announced his campaign for Tennessee’s open U.S. Senate seat on June 3 and has been endorsed by AAOS’ Orthopaedic Political Action Committee. AAOS First Vice President Joseph A. Bosco III, MD, FAAOS, conducted an interview with Dr. Sethi during a fundraiser on June 25.

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Take Part in an AUC Workgroup

AAOS is seeking volunteers to take part in a workgroup for the development of appropriate use criteria (AUC) for The Early Screening for Psychosocial Risk and Protective Factors. The deadline to submit an application for this project is Oct. 4.

Learn more and submit your application…


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