May 28, 2021 | Today’s News

Study Finds HIV Is a Risk Factor for VTE after TJA

A retrospective study published online in the Journal of the AAOS ® compared rates of venous thromboembolism (VTE) in patients with HIV who have undergone total joint arthroplasty (TJA). The researchers evaluated 110 patients with HIV and 240 control subjects without HIV who received TJA between 2000 and 2018. VTE occurred in 3.6 percent of patients with HIV and 0.4 percent of controls. Median time to VTE was 40 days in the HIV-positive group, compared to three days postoperatively in the control group. Adjusted multivariable analysis found HIV was an independent predictor of VTE. All HIV-positive patients with VTE received treatment with warfarin.

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Study: Complications in Conversion TKA with Periarticular ORIF versus Primary TKA

A study published online in The Journal of Arthroplasty compared two-year incidence of complications and revision in primary total knee arthroplasty (TKA) or conversion TKA after prior periarticular ORIF (open reduction internal fixation) of the ipsilateral knee. Using insurance claims data, the investigators evaluated 823 patients with conversion TKA and 1,640 patients with primary TKA. Conversion TKA was associated with higher incidence of revision (5.47 percent versus 2.47 percent), periprosthetic joint infection (4.74 percent versus 134 percent), and intra- or postoperative periprosthetic fracture (1.58 percent versus 0.55 percent) compared to primary TKA. There was also a nonsignificant trend toward increased aseptic loosening in the conversion TKA group.

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A study published online in BMC Musculoskeletal Disorders evaluated how carpal tunnel syndrome (CTS) impacts gliding abilities of the median nerve and flexor tendon of the wrist. Forty-nine patients with CTS and 48 control subjects completed the Boston CTS questionnaire, physical examinations, nerve conduction studies, and ultrasonography. Compared with controls, patients with CTS had reduced median nerve excursion, with increased excursion at 30-degree wrist extension, and significantly lower ratios of median nerve to flexor tendon excursion in neutral and 30-degree extended positions. This ratio had mild to moderate correlations with answers on the Boston CTS Questionnaire and nerve conduction study results.

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A study published online in The Journal of Bone and Joint Surgery assessed four-year outcomes of total ankle arthroplasty (TAA) versus ankle arthrodesis (AA). In total, 517 patients were enrolled (TAA, n = 414; AA, n = 103). Outcomes were determined via Foot and Ankle Ability Measure scores, the Short Form-36 scores, and pain scores at 12, 24, 36, and 48 months postoperatively. Both groups showed significant improvement in all measures, with patients in the TAA group showing higher mean improvement in all measures compared to the AA group. However, these differences were reduced by 48 months. Improvements in both groups at 24 months were maintained at 48 months.

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A study published online in the Journal of Orthopaedic Trauma investigated risk factors for posttraumatic stress disorder (PTSD) in a cohort of 452 patients treated for traumatic injuries. Patients were administered the DSM-5 PTSD checklist within 15 months of their injury. Overall, 26 percent (n = 103) screened positive for PTSD after a mean of 86 days postinjury. Age younger than 45 years and mechanism of injury were risk factors of PTSD. Patients who were struck by motor vehicles, were in motorcycle or all-terrain vehicle crashes, or were victims of crime were at increased risk of PTSD.

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Female Orthopaedic Residents Discuss Barriers to Entry

Although women constitute 50 percent of medical students, only 14 percent of orthopaedic residents are women, and only 7 percent of AAOS members are women. Studies have shown that reasons for these disparities are likely multifactorial, including limited exposure to the musculoskeletal system, negative stereotypes about the field, minimal exposure to female mentors, and worries about work-life balance. In this article, Ayane Rossano, a third-year medical student, and Brooke Hergert, a fourth-year medical student, both of Dell Medical School, discuss perceived barriers to entry by female orthopaedic surgeons or aspiring orthopaedic surgeons.

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Take Part in the Development of a Clinical Practice Guideline

AAOS is seeking volunteers to take part on the work group for the development of the Treatment of Clavicle Fractures Clinical Practice Guideline. Due to limited space, applications will be reviewed and approved on a first come, first served basis.

Learn more and submit your application…