September 23, 2019
Today’s Top Story

Study: Do Psychological Factors Impact Age of Onset for Hip Dysplasia?

Psychological factors were not associated with age of onset in dysplasia of the hip (DDH) or femoroacetabular impingement syndrome (FAIS); however, functional impairment did affect age of onset, according to a study published online in BMC Musculoskeletal Disorders. Researchers collected demographic, clinical, and radiographic data for 56 DDH and 84 FAIS patients from the University of Texas Southwestern Medical Center between November 2016 and April 2018. Pain catastrophizing (PCS) and the hospital anxiety and depression scale were assessed. Pain catastrophizing, anxiety, and depression were not significantly related to age of DDH or FAIS onset. However, alpha Dunn angle, Tönnis grade, prior hip surgery, Western Ontario and McMaster Universities Arthritis Index pain score, and International Hip Outcome Tool total score were associated with age of FAIS onset. Lateral center edge angle, alpha frog angle, Tönnis grade, Short Form 12 physical functioning, and body mass index were associated with age of DDH onset.

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In Other News

Study: Shoes Affect Lower-extremity Injury in U.S. Military Members

Shoes with mild to moderate lateral torsional stiffness may reduce the risk of lower-extremity injury in U.S. military academy cadets, according to a study published online in The American Journal of Sports Medicine. The cohort study included 1,025 incoming cadets. Shoe torsional stiffness and heel height were calculated and recorded, and lower-extremity injuries sustained during a nine-week period of cadet basic training were documented via the Armed Forces Health Longitudinal Technology Application and the Cadet Illness and Injury Tracking System. Approximately 18.1 percent of participants experienced a lower-extremity injury. Cadets wearing shoes with moderate lateral torsional stiffness were 49 percent less likely to experience any type of lower-extremity injury and 52 percent less likely to experience an overuse lower-extremity injury compared to those wearing shoes with minimal lateral torsional stiffness. Injury risk was similar in both shoe cohorts.

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Study Compares Total Elbow Arthroplasty for Distal Humerus Fracture as Primary Versus Salvage Procedure

Total elbow arthroplasty (TEA) for distal humerus facture resulted in similar outcomes when performed as a primary procedure and as salvage after previous internal fixation, according to a study published online in the Journal of Orthopaedic Trauma. The retrospective, observational study included patients from the Mayo Clinic in Rochester, Minn., between 1998 and 2016: 22 received primary TEA and 66 received TEA after prior internal fixation. The mean time between internal fixation and arthroplasty was 7.3 years, and the most common reasons for salvage TEA were nonunion (36 percent) and post-traumatic osteoarthritis (32 percent). The primary and salvage cohorts differed in age (74 years versus 60 years) and tobacco use (0 percent versus 23 percent). TEA resulted in similar outcomes in both cohorts for Mayo Elbow Performance Score and motion. Reoperation rates were also similar in the primary and salvage groups (36 percent versus 39 percent, respectively). In both the primary and salvage cohorts, the most common complications were aseptic loosening (n = 2 versus n = 8) and deep infection (n = 2 versus n = 7).

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Study: Is a ‘Drug Holiday’ Needed in Patients with Osteoporosis Taking Bisphosphonates and Denosumab?

According to a study published in the September issue of Osteoporosis International, it is not always necessary to recommend a “drug holiday” from bisphosphonates and denosumab in patients with osteoporosis. Researchers conducted a systematic review of the literature to assess therapeutic intervention of these anti-osteoporosis drugs. Different pharmacokinetic properties for different therapies require different strategies to manage drug intermission, according to the findings. Prospective and retrospective analyses showed that the risk of new clinical fractures was 20 percent to 40 percent higher in patients who stopped bisphosphonate treatment, and vertebral fracture risk approximately doubled. Rapid bone loss has been well described after denosumab discontinuation with an incidence of multiple vertebral fractures around 5 percent. Studies have not identified risk factors for fracture after stopping treatment other than those that provide an indication for treatment (e.g., prior fracture and low bone mineral density). Studies that considered long-term continuation did not observe an increased fracture risk and reported low rates of adverse skeletal events such as atypical femoral fracture.

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Study: What Muscles Impact Shoulder Stiffness?

A study published online in the Journal of Shoulder and Elbow Surgery found that the infraspinatus and lower trapezius could be key muscles in posterior shoulder tightness. The study included 21 college baseball players who volunteered to participate. Passive range of motion (ROM) for shoulder abduction and horizontal adduction were measured using a goniometer. Participants were grouped based on the differences between bilateral shoulder ROMs: STIFF+ and STIFF− Thickness and elasticity of the posterior and inferior shoulder muscles were assessed using ultrasound. There were significant differences in shoulder abduction ROM on the throwing side: 114.5 degrees in the STIFF+ group and 131.3 degrees in the STIFF− group. There were also significant differences in horizontal adduction ROM on the throwing side: 96.6 degrees and 110.9 degrees, respectively. The elasticity of infraspinatus and lower trapezius in the STIFF+ group was significantly greater than that in the STIFF− group.

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Not Just for Research Anymore: The Usefulness of PROMs in Clinical Practice

The utilization of patient-reported outcome measures (PROMs) has been driven by a growing interest in understanding patients’ perceptions of their physical and psychosocial health and outcomes of treatment. Although most agree with this general direction, the institutional uptake of PROMs at the point of care is highly variable, with a range of logistical, cultural, and clinical barriers to adoption. Nevertheless, PROMs may be useful in evaluating health-related outcomes from the individual’s perspective across a variety of conditions within musculoskeletal medicine.

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Reminder: Free Webinar on Becoming an Advocacy Leader

As a reminder, tune in to this free, one-hour webinar on Sept. 25 at 7:15 p.m. CT to discover effective advocacy techniques and tips for building long-lasting relationships with members of Congress. Constituent advocacy is a strong way to influence public policy, and AAOS Congressional Ambassadors and PAC Donors are at the forefront of the AAOS advocacy effort. Hosted by Advocacy Resources Committee Chair Claudette Lajam, MD, with special guest and OrthoPAC Chair John T. Gill, MD, this webinar will cover topics including key advocacy issues in orthopaedics, advocacy strategies, in-district congressional advocacy, as well as attending and hosting PAC events.

Register for the webinar…


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