Today’s Top Story

Study: Revision rates may be lower when failed TKA is treated with knee arthrodesis

A retrospective cohort study published online in the Archives of Orthopaedic and Trauma Surgery found that knee arthrodesis may be an alternative to revision surgery for patients with failed, infected total knee arthroplasty (TKA). Researchers gathered data for 81 patients with periprosthetic joint infection of the knee who were treated between 2008 and 2014. Thirty-six patients were treated with a modular intramedullary arthrodesis nail, and 45 received two-stage revision TKA. The arthrodesis group had higher infection-free rates (n = 32, 88.9 percent) than the revision TKA group (n = 36, 80.0 percent). Oxford knee score scores were slightly higher for arthrodesis patients (38.7) than revision TKA patients (36.5). Mean visual analogue scale pain scores were similar between both groups (arthrodesis = 3.2; revision TKA = 3.1). Revision rates were lower among arthrodesis patients (1.2) than revision TKA patients (2.8). Researchers concluded that arthrodesis may be a good option for certain patients when other options have been exhausted.

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Other News

Study: OA therapy exposure may not be linked to knee replacement

A nested, case-control study published online in Arthritis Research & Therapy did not find a link between common oral osteoarthritis (OA) therapies and the occurrence of knee replacement (KR). Using the Osteoarthritis Initiative database, researchers studied 218 patients who had a KR and matched them to 540 controls. They assessed use of oral OA therapies (including acetaminophen, nonsteroidal anti-inflammatory drugs, cyclooxygenase-2 inhibitors, narcotics, and glucosamine/chondroitin sulfate) three years before KR and did not find a significant association between KR and exposure to the OA therapies. KR was significantly more common in Caucasian participants, as well as those with a body mass index (BMI) ≥ 27 kg/m 2. Researchers concluded that the greatest risk factors for KR were disease severity, symptoms, and high BMI.

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Study: XPLE hip implants may lower risk of revision surgery

An observational study published online in The Journal of Bone & Joint Surgery found that the likelihood for revision surgery following a total hip arthroplasty (THA) may be reduced when cross-linked polyethylene (XPLE) implants are used compared to conventional noncross-linked polyethylene (CPE). Researchers analyzed 240,302 THAs (CPE = 41,171; XPLE = 199,131) performed to treat OA between 1999 and 2016. The 16-year cumulative percentage of primary THA revisions was 11.7 percent in the CPE group and 6.2 percent in the XPLE group. The researchers said that the improved longevity in THA means younger patients may be able to undergo the surgery with reduced risk of revision surgery in the future.

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Study assesses bone union rates after opening wedge high tibial osteotomy

Patients who underwent opening wedge high tibial osteotomy (OWHTO) with no bone graft (NBG) showed better incorporation rates at different periods of follow-up compared to those with synthetic bone graft (SBG), according to a study published online in the journal Arthroscopy. The retrospective study assessed OWHTOs performed in 71 knees between 2012 and 2015, including those performed with SBG (n = 33) and those without (n = 38). The NBG group showed much greater union rates after six months, one year, and two years. At two years, 100 percent of NBG patients and 93.9 percent of SBG patients displayed incorporation in union zone three.

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Study compares two standard skin antiseptic solutions for posterior spine surgeries

A prospective comparative study published in the August issue of Clinical Spine Surgery found chlorhexidine-gluconate (CHG) and povidone-iodine (PD-I) to be equally effective in eliminating bacterial pathogens from surgical sites prior to posterior spine operations. Researchers assessed 190 patients who were treated with 0.5 percent CHG in ethanol (n = 98) or 10 percent PV-I (n = 92). The researchers found no differences in bacteria growth among the cultures for the two groups pre- and postoperatively. After the surgical site was sealed, the CHG group had lower positive culture rates (5.1 percent) than the PD-I group (14.1 percent).

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Recovery care centers expand the benefits of ambulatory surgery centers

Several surgical cases that were once considered to be inpatient only have migrated to ambulatory surgery centers (ASCs), with well-documented high rates of patient satisfaction, good outcomes, and cost savings. From 2012 to 2015, elective total joint replacement surgeries in the outpatient setting increased by nearly 50 percent. Patients, employers, and insurers are very interested in finding ways to safely migrate procedures to ASCs. One solution is to responsibly extend pain management and monitoring beyond ASCs’ 24 hours.

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Apply for Resident Bowl Question Workgroup member position

The Resident Bowl Question Workgroup has an open member position, a five-month term that runs from Oct. 1 to March 8, 2019. Members of this workgroup will develop questions and answers for the Resident Bowl, an event that enables residents to compete against one another in a quiz-bowl setting for a chance to win grand and runner-up prizes. The last day to submit an application is Sept. 15.

Learn more and submit your application…(member login required)