In a retrospective chart review published in the October issue of the Journal of Pediatric Orthopaedics, researchers used MRI scans, plain radiographs, and arthrograms to observe hip dysplasia pathology in nine mucopolysaccharidosis type-1H (MPS-1H) patients. The mean acetabular index (AI) was 36.2 degrees on radiographs and 39.3 on MRI. The mean migration percentage was 59 percent on the plain radiographs, but the MRI scans showed a lower percentage. All patients had a negative center-edge angle, with the radiographs showing a mean of −16.8 degrees compared to −19.6 degrees per the MRI scans. The cartilaginous AI was 22.4 degrees and the labral AI was 13.5 degrees. Six arthrograms showed stability.
Study: Patients Report Similar Improvements for Nonobstructive Meniscal Tear with PT and Early Surgery
Physical therapy (PT) may not be inferior to early operative treatment of arthroscopic partial meniscectomy (APM) for improving knee functionality in patients with nonobstructive meniscal tears, according to a study published online in JAMA. The randomized clinical trial included 321 patients with nonobstructive meniscal tears aged 45 to 70 years who were treated at nine hospitals in the Netherlands between July 17, 2013, and Nov. 4, 2015. Patients were treated with APM (n = 159) or a predefined PT protocol (n = 162) that included 16 exercise therapy sessions over eight weeks. PT sessions focused on coordination and closed kinetic chain strength exercises. At 24-month follow-up, knee functionality in the PT group improved by 20.4 points compared to 26.2 points in the APM group. The difference did not exceed the noninferiority margin.
Study Observes Better Outcomes for Shoulder OA Patients Treated by an Orthopaedic Specialist
In a retrospective study published online in BMC Musculoskeletal Disorders, shoulder osteoarthritis (OA) patients received faster and more invasive treatment when they received a new diagnosis from an orthopaedic specialist (OS) versus a nonorthopaedic physician (NOP). Patients with shoulder OA (n = 572) received care from either an OS (n = 474) or NOP (n = 98) on the date of their index shoulder visit OS patients received their first treatment significantly quicker than the NOP cohort (16.3 days versus 32.3 days, respectively). The OS group also had higher rates of operative treatment within one year following their initial visit.
Study: Association Between Cataract and Risks of Osteoporosis, Fracture
A retrospective cohort study published online in the Journal of American Geriatrics Society found a correlation between cataracts and incidence of osteoporosis and fracture. Researchers matched 57,972 cataract patients who had been treated either surgically or nonsurgically with healthy controls. Overall, during follow-up (mean, 6.4 years), cataract patients were more likely to develop osteoporosis or fractures than the control group (n = 17,450 versus n = 12,627, respectively). Specifically, diagnosis of cataracts was associated with increased risks of osteoporosis (43 percent), hip fracture (16 percent), vertebral fracture (25 percent), and other fractures (24 percent). Cataract patients who underwent cataract surgery were at significantly lower risk of developing osteoporosis or fracture than those who did not have surgery.
Study Evaluates Link Between BMI and SSI in Trauma and Nontrauma PCIF Patients
A retrospective cohort study published online in The Spine Journal found that trauma and nontrauma patients have the same rate of surgical site infection (SSI) after posterior cervical instrumented fusion (PCIF), and all patients with increased body mass index (BMI) are at a higher risk for SSI. Researchers assessed data for 1,143 patients who underwent PCIF for traumatic (n = 688) and nontraumatic injuries (n = 454) between April 2011 and October 2017. SSI incidence among all patients was 3.9 percent, with no significant difference in SSI rate between the trauma and nontrauma groups. Diabetic patients and those with BMI ≥ 30 kg/m 2 had an increased SSI risk. Patients with both diabetes and higher BMI had an even greater likelihood of developing SSI after PCIF.
Patient Safety Committee Discusses Using Overutilization as a Quality Measure
Communication is vital in order to avoid misdiagnosing patient treatment preferences, but patients rate orthopaedic surgeons’ communication effectiveness significantly lower than that of other specialists. AAOS Patient Safety Committee (PSC) members recently gathered and discussed the use of overutilization (low-value care) as a quality measure to minimize misdiagnosis of patient preferences. The PSC said it would like to expand the definition of quality and patient safety.
The AAOS 2019 Annual Meeting will take place March 12–16 in Las Vegas. Early bird registration for members opens Oct. 24. Members must possess an AAOS Member ID and password and will receive access to one complimentary family badge.
