April 1, 2020 | Today’s News

Study: Hemiarthroplasty versus Internal Fixation in Nondisplaced Femoral Neck Fractures

A retrospective study published online in Injury compared bipolar hemiarthroplasty (HA) versus internal fixation (IF) with cannulated screws in elderly patients with nondisplaced femoral neck fractures. Patients aged older than 75 years treated at a single institution between January 2010 and December 2015 were compared for outcomes including surgical complications, perioperative parameters, hip joint function, reoperation, and mortality. HA patients had greater blood loss than IF patients (150.0 mL versus 40.5 mL), but blood transfusion rates did not largely differ between the groups. At final follow-up, the severe complication rate was 34.1 percent in the IF group and 10.1 percent in the HA group. Harris Hip Score and visual analog scale (VAS) score did not largely differ between the groups at final follow-up. Reoperation was significantly more common in the IF group than the HA group during follow-up. Mortality rates did not largely differ between the HA and IF groups (39.3 percent versus 34.1 percent).

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Study Assesses Preoperative Opioid Prescription, Reporting Patterns

A study published in the April 1 issue of the Journal of the AAOS ® compared preoperative opioid prescription prevalence by specialty and practice setting, as well as whether patients reported their opioid prescriptions. A total of 461 consecutive patients assessed for arthritic hip or knee were retrospectively reviewed. Patients were stratified based on whether or not they received opioids; opioid receivers were also stratified by whether they reported their opioid prescription. A little under a quarter of patients (n = 105, 22.8 percent) received an opioid before the appointment: 52 patients (11.3 percent) received schedule II or II opioids, 43 (9.3 percent) were given tramadol, and 10 (2.2 percent) were given both. Primary care physicians were most likely to prescribe opioids (59.5 percent), followed by pain medicine specialists (11.3 percent) and orthopaedic surgeons (11.3 percent). Prescriptions were more common in the community setting (63.8 percent) than the academic setting (36.2 percent). About three-quarters of patients (n = 78, 74.3 percent) self-reported their opioid prescriptions; the remaining patients were identified through the Prescription Monitoring Program. Regression analysis identified the following predictors of opioid receipt: higher body mass index (BMI), diagnosis other than osteoarthritis, and benzodiazepine use. Patients who used antidepressants were less likely to self-report their opioid prescriptions

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A retrospective study published in the March issue of Foot & Ankle International assessed the use of the three-stage Masquelet technique and one-stage operation for foot and ankle tuberculosis (TB). Ten consecutive foot and ankle TB patients underwent either the three-stage Masquelet technique (débridement with vacuum sealing drainage, implantation of antibiotic cement spacer, and subsequent reconstruction; n = 5) or a one-stage reconstruction (n = 5). Outcomes measured at final follow-up included the American Orthopaedic Foot & Ankle Society (AOFAS) and VAS pain scores. No patients presented TB reactivation. In the three-stage Masquelet technique group, distal tibia fracture occurred in one patient. The AOFAS score increased from 39.5 preoperatively to 75.3 postoperatively, and the VAS pain score decreased from 6.3 to 1.5. Anti-TB therapy duration was 12 months. In the one-stage operation group, wound necrosis presented in one patient. The AOFAS score increased from 51.8 to 81.8, and the VAS pain score decreased from 5.4 to 1.0. Anti-TB therapy duration was 138 months.

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A retrospective study published online in Arthroscopy identified risk factors for postoperative opioid use in patients undergoing arthroscopic shoulder labral repair. Between August 2013 and November 2017, 340 eligible patients were stratified into three groups based on preoperative opioid use: opioid nonusers, acute users, or chronic users. Factors assessed for the first 12 months postoperatively included patient demographics, injury characteristics, surgical interventions, and postoperative opioid use. The average patient age was 26.3 years, and average BMI was 27.5 kg/m ². Patients who used any number of opioids preoperatively continued receiving opioid medications at extended time points beyond two months post-surgery. Preoperative pain and postoperative opioid prescriptions were higher for patients in whom intraoperative superior labrum anterior and posterior tears were discovered.

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A study published online in the European Spine Journal quantified the Patient Acceptable Symptom State (PASS)-equivalent score for different outcome tools in adult spinal deformity patients. Data were collected from the European Spine Study Group and included the Oswestry Disability Index (ODI) (0–100), Numeric Rating Scales (NRS) (0–10) for back/leg pain, and Scoliosis Research Society (SRS) questionnaire. Responses to the question, “If you had to spend the rest of your life with the symptoms you have now, how would you feel about it?” were measured on a five-point scale; the top two answers (“somewhat satisfied” and “very satisfied”) were considered PASS+, and all other responses were PASS–. Final analysis included 599 operative and 444 nonoperative patients. At 12-month follow-up, 42 percent of patients were PASS+. The receiver operating characteristics areas under the curve ranged from 0.71 to 0.84, with the highest being for the SRS subscore. Outcome measurement scores associated with PASS+ were > 3.5 for SRS subscore (range for SRS subdomains, > 3.3 to 3.8), ≤ 18 for ODI, and ≤ 3 for NRS pain. Cutoffs varied slightly by age, treatment type, etiology, baseline symptoms, and sex.

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AAOS Board Approves New CPG for the Management of Glenohumeral Osteoarthritis

The AAOS Board of Directors has approved an update to the 2009 clinical practice guideline (CPG) for the Treatment of Glenohumeral Joint Osteoarthritis. The 2020 Management of Glenohumeral Joint Osteoarthritis CPG expanded the scope of the original guideline, augmenting the update with prognostic factor recommendations such as BMI, comorbidities, diabetes, age, and smoking. The update also features 13 recommendations, of which 92.3 percent are supported by strong or moderate strength evidence.

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AAOS is seeking volunteers to take part in its Key Informants Panel for the development of the CPG for the Surgical Management of Osteoarthritis of the Knee. The key informant will serve in an advisory capacity and is not required to attend any in-person meetings. There are no financial conflict of interest restrictions for Key Informal Panel members. The deadline to submit an application is April 10.

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