December 16, 2019 | Today’s News

Study Compares Arthroplasty versus Hemiarthroplasty for Hip Fracture

Hip fracture patients did not have significantly different outcomes regardless of whether they were treated with total hip arthroplasty (THA) or hemiarthroplasty, according to a randomized trial published online in The New England Journal of Medicine. Displaced femoral neck fracture patients aged 50 years or older were randomized to undergo either THA (n = 718) or hemiarthroplasty (n = 723). The main outcome measure was a secondary hip procedure within 24 months of follow-up; other outcomes included death, serious adverse events (AEs), hip-related complications, health-related quality of life, function (measured with the Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]), and overall health endpoints. Rates of 24-month secondary hip procedure were similar between the THA (n = 57, 7.9 percent) and hemiarthroplasty (n = 60, 8.3 percent) groups. A greater proportion of THA patients sustained hip instability or dislocation (n = 34, 4.7 percent) compared to hemiarthroplasty patients (n = 17, 2.4 percent). WOMAC total, pain, stiffness, and function scores were greater in the THA group than the hemiarthroplasty group. Mortality rates were similar in THA (14.3 percent) and hemiarthroplasty (13.1 percent) patients. More THA patients sustained serious AEs (n = 300, 41.8 percent) than hemiarthroplasty patients (n = 265, 36.7 percent).

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Study: Does Hospital Volume Affect Re-revision Risk in Aseptic Revision TKA?

According to a study published online in The Journal of Arthroplasty, re-revision following aseptic revision total knee arthroplasty (TKA) may be more common at low-volume hospitals. The study included 23,644 aseptic revision TKAs performed between January 2013 and December 2017. Outcomes included 90-day mortality, one-year re-revision, and in-house AEs. High-volume hospitals had lower re-revision rates compared to low-volume hospitals. When the reference group was hospitals with 53 revision TKAs or more, the odds ratios of one-year re-revision were: 12 revision TKAs or fewer, 1.44; 13 to 24 revision TKAs, 1.43; and 25 to 52 revision TKAs, 1.13. As volume decreased, the rates of 90-day mortality and major in-house AEs both increased, but not to the same statistical significance of re-revision.

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A study published online in the Journal of Pediatric Orthopaedics reported the elbow range of motion required in children and adolescents to perform functional and contemporary tasks. Patients performed eight functional and four contemporary tasks. A three-dimensional motion analysis system was used to obtain kinematic data. Elbow kinematics were compared based on age: children, six to 11 years old (n = 14) versus adolescents, 12 to 17 years old (n = 14). Functional tasks required a mean arc of motion of 28 to 146 degrees of elbow extension/flexion and 54 degrees of supination to 65 degrees of pronation. To perform contemporary tasks, 40 to 148 degrees of elbow extension/flexion and 49 degrees of supination to 65 degrees of pronation were utilized. Bringing a cell phone to the ear required a greater supination/pronation arc (107 degrees) and greater elbow flexion (148 degrees). Typing on a keyboard required greater pronation (65 degrees). Children and adolescents presented significant differences in 11 of the 12 tasks; the exception was the use of a fork.

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A study published in the Dec. 15 issue of Spine compared clinical and radiographic outcomes in patients with symptomatic adjacent segment disease previously treated with posterolateral fusion who underwent stand-alone lateral lumbar interbody fusion (LLIF) versus posterolateral fusion (PLF). Between January 2007 and August 2016, 47 consecutive patients underwent either LLIF (n = 23) or PLF (n = 24) following conservative treatment failure. The PLF group had significantly longer operative times and hospital length of stay (LOS), as well as higher intraoperative blood loss. Patient-reported outcomes and radiographic fusion rates were similar between the groups. LLIF was associated with significant improvements in segmental lordosis, total lumbar lordosis, and disk height from preoperatively to immediately postoperatively and at final follow-up The researchers concluded that both techniques may be safe and effective options, although LLIF may be associated with less perioperative morbidity and shorter LOS.

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The Senate confirmed Stephen Hahn, MD, to serve as the next Food and Drug Administration (FDA) commissioner. Dr. Hahn, tapped by President Donald Trump in November, steps into the role after Scott Gottlieb, MD, stepped down in April. Dr. Hahn is a radiation oncologist and currently works at the MD Anderson Cancer Center in Houston.

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Study Favors Nonoperative Management of Clavicle Fractures in Adolescents

A study presented at the Orthopaedic Trauma Society Annual Meeting found that surgery offered no significant advantage over nonoperative management in the major outcome categories assessed in adolescent patients with clavicle fractures. The study’s major findings were: (1) the most common complications associated with nonoperative treatment in adult clavicle fractures affected less than 1 percent of nonoperative adolescents, and (2) when applying matching and regression techniques to specifically compare patient subgroups, two-year function, satisfaction, and activity levels still did not differ between groups.

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AAOS Board of Directors Approves CPG and AUC for Limb Salvage or Early Amputation

The AAOS Board of Directors has approved a new clinical practice guideline (CPG) and appropriate use criteria (AUC) for Limb Salvage or Early Salvation. The CPG and AUC are both the second in a series developed in collaboration with the Major Extremity Trauma Research Consortium and funded by a Department of Defense research grant. The CPG addresses decision factors important to the selection of amputation or limb salvage of adult patients with severe lower-extremity trauma distal to the femur, and the AUC was developed to determine appropriateness of limb salvage and early amputation in patients with high-energy lower-extremity trauma.

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