Study: Opioids may not be superior to a nonopioid regimen for chronic back or OA pain
A study published online in The Journal of the American Medical Association suggests that opioids may not be superior to nonopioid medications for moderate to severe chronic back pain or hip or knee osteoarthritis (OA) pain. The authors conducted a pragmatic, randomized trial with masked outcome assessment of 234 patients. Patients in the opioid cohort were first prescribed immediate-release morphine, oxycodone, or hydrocodone/acetaminophen. Patients in the nonopioid cohort were first prescribed acetaminophen or an NSAID. In both cohorts, medications were changed, added, or adjusted based on individual patient response. Over 12 months, the authors found that groups did not significantly differ on pain-related function. However, pain intensity was significantly better in the nonopioid group, while adverse medication-related symptoms were significantly more common in the opioid group.
Study: Anterior tension-band plates may offer advantages over transphyseal screws for knee fixed flexion contracture
Data from Poster P246, on display in Academy Hall B at the AAOS Annual Meeting, suggest that anterior tension-band plates may be superior to transphyseal screws for sagittal plane growth modulation to treat knee fixed flexion contracture. Members of the research team conducted a retrospective review of 20 patients (29 knees) who underwent insertion of either screws-only or tension band plate constructs into the anterior distal femoral hemiphysis to treat fixed flexion contracture. At mean 45-month follow-up (range 10 to 96 months), they found that hardware migration occurred in one of 13 knees treated with a tension band plate and in nine of 16 knees treated with a screws-only construct. The researchers state that improvement in sagittal alignment occurred in both groups.
Study: Many opioids go unused after foot and ankle procedures
Patients are often prescribed more opioids than they need following orthopaedic foot and ankle procedures, opening up the potential for diversion, according to Paper 327, which was presented yesterday at the AAOS Annual Meeting. The researchers conducted a prospective study of 1,009 patients undergoing outpatient procedures and found that participants were prescribed an average of 43 pills (median: 40), but consumed a mean of 22 pills (median: 20), for an overall utilization rate of 51 percent and an estimated 21,196 pills not taken.
What issues surround the use of biologics in orthopaedics?
An article published online in AAOS Now summarizes an AAOS symposium on “Optimizing Clinical Use of Biologics in Orthopaedic Surgery,” which was held Feb. 15-17, 2018. The writer notes that a preponderance of unproven and poorly described stem cell treatments marketed to consumers raises concerns for public health and safety. Among other things, symposium attendees agreed on a need to standardize and clarify terminology, including the definition of the term “stem cell” Participants also formed work groups to recommend candidate biologic targets and clinical outcome metrics to include imaging metrics for treatment of chronic tendon injuries, acute ligament and muscle injuries, knee osteoarthritis, and surgical soft-tissue repair.
A related symposium, “Use and Misuse of Biologics in Orthopaedic Surgery: PRP and Stem Cells,” will be held Friday, March 9, 8:00 a.m. to 10:00 a.m., in the La Nouvelle Ballroom at the Morial Convention Center as part of the 2018 AAOS Annual Meeting.
Your AAOS
Call for volunteers: Program Committees
March 30, 2018, is the last day to submit your application for a position on an AAOS program committee. Members of program committees grade symposia in May and abstracts in June and July and may serve as moderators for paper sessions at the AAOS Annual Meeting. The following openings are available:
Hand & Wrist (one member)
Practice Management/Rehabilitation (one member)
Applicants for these positions must be active fellows or international members with a practice emphasis in the relevant topic.
