September 4, 2019
Today’s Top Story

Study: Impact of Steroids at Different Postoperative Time Points in TKA

A randomized, controlled study published online in The Journal of Arthroplasty measured the efficacy of systemic steroid administration on pain and nausea one day postoperatively in total knee arthroplasty (TKA) patients. TKA patients were randomized to receive normal saline injection (control group), dexamethasone 10 mg intravenously (IV) one hour preoperatively (group 1), dexamethasone 0.1 mg/kg IV 24 hours postoperatively (group 2), or dexamethasone 0.2 mg/kg IV 24 hours postoperatively (group 3). Each group included 44 to 46 patients. Postoperative pain and nausea at 48 hours remained high. Visual analog scale (VAS) scores for pain and nausea were lower in group 1 than in the control group, but only for 24 hours postoperatively; 48 hours postoperatively, groups 2 and 3 had lower VAS scores for pain and nausea than both group 1 and controls. Groups 2 and 3 had substantially lower analgesic and antiemetic administration than the control cohort during the first 48 hours postoperatively. C-reactive protein level, range of motion, and complications did not largely differ among the groups.

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In Other News

Study Identifies Risk Factors for Failure of Articulating Polymethylmethacrylate Spacers in Revision THA

Younger age and chronic infection may be risk factors for mechanical failure of articulating polymethylmethacrylate spacers in two-stage revision total hip arthroplasty (rTHA) for periprosthetic joint infection (PJI), according to a study published online in BMC Musculoskeletal Disorders. Between January 2014 and December 2015, 31 patients (19 were male) underwent rTHA for hip PJIs; 14 patients sustained mechanical complications during the interim period. The Harris Hip Score (HHS) was used to establish hip functional outcome. The most significant risk factors for spacer complications were younger age and chronic PJI Those who experienced complications also had a lower median HHS prior to reimplantation compared to the group that did not sustain complications (37 versus 60, respectively); scores were similar after reimplantation (90 versus 89, respectively). After two years, the treatment success rates were 846 percent in those with complications and 87.5 percent in those who did not experience complications.

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Study Evaluates Clinical Usefulness of Cervical Sensorimotor Control Tests

According to a study published online in the Journal of Orthopaedic & Sports Physical Therapy, recommended tests to determine cervical sensorimotor control may not be able to differentiate between patients with chronic idiopathic neck pain versus asymptomatic patients. Patients with chronic idiopathic neck pain (n = 50) were age- and sex-matched to asymptomatic controls (n = 50). All patients completed joint position error, joint position error torsion, postural balance, subjective visual vertical, head tilt response, The Fly, smooth pursuit neck torsion, and head steadiness tests. For all seven tests, there were no between-group differences in cervical sensorimotor outcomes. Outcomes for all tests included “poor performers” from both cohorts. The associations between tests and levels of neck pain and neck disability were weak.

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Study Determines Safe Time to Resume Driving in TAA

Total ankle arthroplasty (TAA) patients may be able to drive six weeks postoperatively, according to a study published online in Clinical Orthopaedics and Related Research. Patients undergoing right TAA were prospectively recruited. At six weeks, patients underwent brake-reaction time testing and repeated the test weekly until they passed. Using a control group of patients without right lower-extremity pain or stiffness, the passing brake-reaction time was set at 0.850 seconds. Age, American Orthopaedic Foot and Ankle Society (AOFAS)-Hindfoot assessment score, VAS pain score, and ankle plantarflexion and dorsiflexion were considered. Six weeks after surgery, 92 percent of patients passed the brake-reaction time test, and after nine weeks, all patients who completed the study passed. Poorer VAS pain score and diminished ankle plantarflexion were associated with worse brake-reaction time.

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Study: Does High-dose Vitamin D Affect Bone Health?

According to a randomized study published online in JAMA, high-dose vitamin D may not improve bone mineral density (BMD) or bone strength. Patients were randomized to receive daily vitamin D for three years at doses of 400 IU (n = 109), 4,000 IU (n = 100), or 10,000 IU (n = 102), as well as calcium supplementation if their intake was < 1,200 mg per day. Of the 311 randomized patients, 287 completed the trial. Baseline, three-month, and three-year levels of 25-hydroxyvitamin D were 76.3 nmol/L, 76.7 nmol/L, and 77.4 nmol/L, respectively, in the 400 IU group; 81.3 nmol/L, 115.3 nmol/L, and 132.2 nmol/L, respectively, in the 4,000 IU group; and 78.4 nmol/L, 188.0 nmol/L, and 144.4 nmol/L, respectively, in the 10,000 IU group. At final follow-up, the 4,000 IU and 10,000 IU groups had lower radial volumetric BMD than the 400 IU group. Failure load did not significantly change.

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Gabapentin Reduces Opioid Use after Foot and Ankle Surgery

A study presented at the American Orthopaedic Foot & Ankle Society Specialty Day during the AAOS 2019 Annual Meeting found that in patients who had foot and ankle surgery, acute postoperative pain was significantly better among those receiving gabapentin compared to those who were not. By two weeks post-surgery, those taking gabapentin required less opioids for postoperative pain than those who did not receive gabapentin.

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OrthoInfo Helps Doctors Educate Patients

OrthoInfo, the AAOS patient education website, is a free member resource that provides orthopaedic surgeons and patients with authoritative, in-depth information about musculoskeletal health. The website features more than 400 articles, videos, and animations on common orthopaedic problems, surgical procedures, nonsurgical treatments, injury prevention, and healthy living All content is developed and peer reviewed by AAOS members. Written in simple language, OrthoInfo articles can help your patients be better informed and participate more fully in their care and recovery.

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