Today’s Top Story
Study: Patients often continue to use opioids 6 months after arthroplasty.
Data from a study published in the June issue of the journal Pain suggest that many patients continue to use opioids for months after undergoing an arthroplasty procedure. The authors conducted a prospective study of 574 total knee arthroplasty (TKA) and total hip arthroplasty (THA) patients who completed validated, self-reported measures of pain, functioning, and mood and who were longitudinally assessed for 6 months following surgery. They found that 53.3 percent of TKA patients and 34.7 percent of THA patients who reported opioid use on the day of surgery continued to use opioids at 6 months. Additionally, among patients who were opioid naïve on the day of surgery, 8.2 percent of TKA patients and 4.3 percent of THA patients were using opioids at 6-month follow-up. For opioid-naïve patients, day of surgery predictors for 6-month opioid use included greater overall body pain, greater affected joint pain, and greater catastrophizing. For both patient cohorts, decreases in overall body pain from baseline to 6 months were associated with decreased likelihood of being on opioids at 6 months. However, the authors note that change in affected joint pain was not predictive of opioid use at 6 months.
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Study: Triamcinolone acetonide and hyaluronic acid may offer similar improvement in pain and function for knee OA patients.
According to a study published in the June 1 issue of The Journal of Bone & Joint Surgery, triamcinolone acetonide and hyaluronic acid may offer similar improvement in pain and function for patients with knee osteoarthritis (OA). The research team conducted a prospective, randomized, double-blind trial of 99 patients with knee OA who were treated with a single-shot, intra-articular injection of either 6 mL of hylan G-F 20 (hyaluronic acid) or 6 mL of a solution comprising 1 mL of 40-mg triamcinolone acetonide and 5 mL of 1 percent lidocaine with epinephrine. At 6-month follow-up, the research team noted similar improvements in knee pain, knee function, and range of motion across both cohorts. However, patients in the triamcinolone acetonide cohort displayed better pain improvement from 24 hours until 1 week after injection, and 2 weeks after injection, patients who took triamcinolone acetonide also had better knee functional improvement.
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Study: PRP may help improve outcomes for patients with large rotator cuff tears.
A study published online in The Journal of Shoulder and Elbow Surgery suggests that application of moderately concentrated platelet-rich plasma (PRP) may improve outcomes for patients with large rotator cuff tears. The authors conducted a randomized trial of 102 patients who underwent arthroscopic repair of medium-sized or large degenerative posterosuperior tears and who were treated with either PRP (n = 52) or served as a control group (n = 50). At 1-, 3-, and 6-month follow-ups, they found that visual analog scale scores were significantly lower in the PRP group than in the control cohort. Furthermore, at 6- and 12-month follow-ups, University of California–Los Angeles scores were significantly higher in the PRP cohort, while Constant-Murley scores were significantly better in the PRP group compared with controls at 12- and 24-month follow-ups. The authors note that American Shoulder and Elbow Surgeons scores were comparable across cohorts at all follow-up points. At 24 months, the authors found a significantly lower retear rate in the PRP group compared to controls, but the difference was significant only for large tears.
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Study: Does THA bearing surface affect risk of PJI?
Findings published online in the journal Clinical Orthopaedics and Related Research suggest that the type of bearing surface used in patients undergoing THA may affect the risk of periprosthetic joint infection (PJI). The researchers drew data on 84,894 hips from a national arthroplasty registry to assess whether the choice of bearings—metal-on-polyethylene (MoP), ceramic-on-polyethylene (CoP), ceramic-on-ceramic (CoC), or metal-on-metal (MoM)—may be associated with differences in risk of revision for deep infection. Overall, there were 54,409 MoP (64 percent), 16,503 CoP (19 percent), 9,051 CoC (11 percent), and 4,931 MoM (6 percent) hip arthroplasties in the study cohort, and 401 hips were revised for deep infection. The researchers found that the rate of early (<6 months) PJI did not differ by bearing surface. However, when the whole observation period was considered (median 9 years; range 1–15 years), they noted that CoC hips were associated with a lower risk of revision for deep infection compared with CoP, MoP, and MoM bearings. The researchers write that they “caution readers against attributing all of the observed difference to the bearing surface.” They also note that “it is possible that some or all of the observed difference associated with bearing type may have been driven by other factors such as [American Society of Anesthesiologists class] and [body mass index], which could not be included in our multivariate analysis, and so future registry studies on this topic must assess those variables carefully.”
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The Associated Press reports that a bill under consideration in the New York State Legislature would, if enacted, greatly extend the term during which a patient can file a medical liability claim. Current law requires patients to file within 2.5 years of an alleged misdiagnosis or harm. Under the proposed legislation, that period would be extended to 2.5 years after a patient first realizes he or she may have been misdiagnosed or harmed by a medical professional, with a maximum 10-year limit to file a suit. Supporters say that patients with complex conditions may take several years before they realize they may have been misdiagnosed or mistreated. Critics say the bill goes too far, by allowing date-of-discovery cases to be filed as long as 10 years after the original incident in a state that already has some of the highest rates for medical liability insurance and no cap on non-economic damages.
Submit papers now for 2017 Kappa Delta and OREF Clinical Research Awards.
July 1, 2016 is the deadline for receipt of manuscripts submitted for the 2017 Kappa Delta Awards and the Orthopaedic Research and Education Foundation (OREF) Clinical Research Award. Up to two $20,000 Kappa Delta awards (Elizabeth Winston Lanier Award and Ann Doner Vaughan Award), one $20,000 Kappa Delta Young Investigator award, and one $20,000 OREF award will be bestowed, provided manuscripts of requisite quality are submitted. Manuscripts should represent a large body of cohesive scientific work, generally reflecting years of investigation. If the submission reflects a single project, it should be of high significance and impact. Manuscripts must be submitted by members (or candidate members) of the AAOS, Orthopaedic Research Society, Canadian Orthopaedic Association, or Canadian Orthopaedic Research Society. Submissions for the 2017 Kappa Delta and OREF Clinical Research Awards will be accepted in electronic format only. A PDF of the entire submission must be emailed no later than 11:59 p.m. CT on July 1, 2016. Late submissions will not be considered.
Submit your manuscript to firstname.lastname@example.org.
Call for volunteers: Diversity Advisory Board.
July 31 is the last day to submit your application for a position on the Diversity Advisory Board (one resident member opening). The Diversity Advisory Board serves as a resource to all AAOS bodies on issues involving diversity in the orthopaedic community and in the provision of culturally competent musculoskeletal care. Applicants for this position must be PGY1, PGY2, or PGY3 resident members, and must provide a letter from their residency program director indicating the residency program’s support of the resident applicant to fully participate in the board, including attendance at all meetings and conference calls.
Learn more and submit your application…(member login required)