June 18, 2018 | Today’s News

Study: Knee osteoarthritis disease severity may be linked to depression

In patients with knee osteoarthritis (OA), greater structural disease severity and pain, as well as decreased physical performance may increase the risk of depression, according to a study presented at the Annual European Congress of Rheumatology. Researchers included 1,652 patients aged 45 to 79 years from the Osteoarthritis Initiative who had radiographic disease but did not have depression at enrollment. They assessed OA disease severity at baseline and at three annual follow-ups. The odds ratios comparing highest to lowest severity quintiles in order of increasing magnitude were 1.80 for gait speed, 2.10 for joint space width, and 2.21 for pain.

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Study observes decreasing arthroplasty procedures in patients with RA

Despite an overall increasing rate of rheumatoid arthritis (RA), there appears to be a reduction in arthroplasty surgery in this patient population over a 13-year period, according to a retrospective cohort study presented at the Annual European Congress of Rheumatology. Researchers used administrative healthcare data from approximately 1 million people with access to universal health care between 1997 and 2010. Each patient was matched by age and sex to four randomly selected controls. The prevalence of RA cases increased from 3,913 (0.42 percent) to 4,911 (0.52 percent) during that time; however, there was a 51.9 percent reduction in arthroplasty among patients with RA. In the control cohort, the frequency of arthroplasty procedures increased by 31.9 percent, except for hip arthroplasty.

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According to the multicenter, randomized WOLLF (Wound Management of Open Lower Limb Fractures) study published in the June 12 issue of JAMA, negative pressure wound therapy (NPWT) did not improve self-rated disability at 12 months compared to standard wound dressing in patients with severe open fracture of the lower limb. Researchers used data from the UK Major Trauma Network to enroll 460 patients (≥ 16 years) with a severe open fracture of the lower limb between July 2012 and December 2015. They assessed NPWT (n = 226) in which an open-cell solid foam or gauze was placed over the surface of the wound and connected to a suction pump, creating a partial vacuum over the dressing versus standard dressings not involving application of negative pressure (n = 234). There were no statistically significant differences in Disability Rating Index, number of deep surgical site infections, or quality of life between treatment groups. The researchers concluded that these findings do not support the use of NPWT for severe open fractures.

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According to a study published in the June 6 issue of Journal of Bone & Joint Surgery, elderly patients may be unable to maintain weight-bearing restrictions following treatment for hip fracture. Researchers used an insole force sensor to measure postoperative weight-bearing in patients aged 75 years or older who were treated for hip fracture (n = 16) compared to patients aged 18 to 40 years who were treated for ankle fracture (n = 18). Both groups were instructed to maintain partial weight-bearing on the affected limb (≤ 20 kg) postoperatively. No patients in the elderly cohort could comply with the weight-bearing restriction, and 69 percent (n = 11) of patients exceeded the specified load by more than two-fold. Significantly more patients in the control group (> 75 percent, n = 14) achieved almost the entire weight-bearing restriction. One older patient complied with the predetermined weight-bearing restriction, but only for a short period. Significantly more patients in the control group (89 percent, n = 16) maintained the partial load for nearly the entire time. “As early mobilization of geriatric trauma patients is an important element for a successful rehabilitation, the directive of postoperative partial weight-bearing for these patients should be abandoned,” the researchers concluded.

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In patients with idiopathic early-onset scoliosis, traditional growing rods (TGRs) may lead to better outcomes than vertically expandable titanium ribs (VEPTRs), according to a study published online in the Journal of Pediatric Orthopaedics. Researchers used two multicenter early-onset scoliosis databases to identify patients with idiopathic spine abnormalities treated with TGR (n = 50) or VEPTR (n = 22) who underwent at least four lengthenings and had at least five years of follow-up. Patients who underwent TGR experienced greater curve correction (50 percent) than VEPTR patients (27 percent) and achieved a greater percentage of thoracic height gain (24 percent versus 12 percent, respectively). TGR patients had better maintenance of curve correction, less kyphosis, and 15 percent greater absolute gain in thoracic height than VEPTR patients.

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Researcher investigates new ways to treat ACL injuries

In the 1980s, Martha M. Murray, MD, was a graduate student pursuing a degree in materials science and engineering at Stanford University. She learned that a classmate would need surgery and six months of rehabilitation because his torn anterior cruciate ligament (ACL) wouldn’t—or couldn’t—heal. “Everything else in your body heals fine, I thought. Why doesn’t the ACL? Why can’t we sew it back together and get it to restore itself rather than having to replace it?” Dr. Murray recalled asking herself. Those two questions redirected her academic career, from engineering to orthopaedic surgery, and launched what has become a decades-long search for a new treatment for ACL rupture.

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AAOS Board of Directors approves new systematic literature review on the management of surgical site infections

AAOS developed a systematic literature review to provide the most up-to-date recommendations for the management of surgical site infections following orthopaedic surgery. The systematic review includes recommendations regarding diagnostic criteria and associated risk factors, as well as antibiotic protocols and rifampin use. This review is intended for use by orthopaedic surgeons, infectious disease specialists, and other providers who manage orthopaedic surgical site infections. The review was developed by a 12-member multidisciplinary work group with representatives from seven societies. Systematic reviews are developed using the same methods as AAOS Clinical Practice Guidelines but focus on smaller topics that may have less available literature.

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