Today’s Top Story

Study: Use of LMWH Following THR or TKR Surgery Does Not Pose Additional Risks

A study published online in BMC Musculoskeletal Disorders compared outcomes for total hip replacement (THR) and total knee replacement (TKR) patients who receive low-molecular-weight heparin (LMWH) versus other anticoagulants, direct thrombin inhibitors, or placebo. Researchers conducted a review of Medline, Cochrane, EMBASE, and Google Scholar to identify 21 randomized, controlled trials published before June 30, 2017. They found that THR patients who received LMWH had a lower risk of venous thromboembolism (VTE) and deep vein thrombosis (DVT) than the placebo group; however, rates of pulmonary embolism (PE) risk were similar between the groups. TKR patients who received LMWH had a higher risk of VTE than those receiving factor Xa inhibitors. Among THR and TKR patients, LMWH was associated with greater DVT risk than factor Xa inhibitors, but major bleeding and PE risks were similar. For both THR and TKR, risks were similar between the LMWH and direct thrombin inhibitors cohorts for VTE, DVT, and PE. Major bleeding was lower for THR patients in the LMWH group but similar for TKR patients.

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Other News

Newer Surgeons Appear to Prefer Percutaneous Fixation over Open Surgery for Posterior Pelvic Ring Injuries

Early-career orthopaedic surgeons are performing more percutaneous fixations than open surgeries on the posterior pelvic ring, according to a study published online in the Journal of Orthopaedic Trauma. Researchers evaluated case log data from 2003 to 2015 from the trauma subspecialty for part II of the American Board of Orthopaedic Surgery examination. Among 377 candidates, 2,095 posterior ring stabilization procedures were performed (1,626 percutaneous, 469 open). Percutaneous procedures increased from 49 percent in 2003 to 79 percent in 2015. There was a significant decrease in open cases per candidate.

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Study: Arthroscopic Elbow Contracture Release is an Effective Treatment Alternative in Young Patients

According to a retrospective study published in the October issue of the Journal of Pediatric Orthopaedics, arthroscopic elbow contracture release can be a comparable, less-invasive alternative to open contracture release in pediatric patients. Researchers identified 25 patients 18 years old and younger who underwent 29 arthroscopic elbow contracture releases. The flexion-extension arc of motion improved by 35.2 degrees, from 93.0 degrees to 128.0 degrees. The pronation-supination arc of motion improved by 122 degrees, from 141.0 degrees to 153.0 degrees. There were seven complications. The authors concluded that the procedure restores range of motion with an acceptable safety profile.

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Study Finds Correlation Between Low Back and Knee Pain in Young Baseball Players

A cross-sectional study published online in Knee Surgery, Sports Traumatology, Arthroscopy found that young baseball players with knee pain may also be more likely to report low back pain (LBP). The study used a self-reported questionnaire and included 1,609 participants aged 6 to 15 years. The point prevalence of LBP was 8.4 percent and the prevalence of knee pain was 13.1 percent. Researchers found a significant association between knee pain and LBP. When compared to players who did not have knee pain, the odds ratio for LBP for those with knee pain was 5.83. The authors recommend clinicians pay attention to knee complaints in these patients, as they may be able to prevent and treat LBP.

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TAA Patients Who Receive a Two-compartment Prosthesis May Require Early Revision

Total ankle arthroplasty (TAA) patients who received the two-component INFINITY prosthesis demonstrated higher early revision rates due to tibial component loosening compared to patients who received other implant systems, according to a study published online in Foot & Ankle International. Patients from two prospectively collected databases were screened for inclusion. Two orthopaedic foot and ankle surgeons performed TAA using the INFINITY prothesis on 159 ankles. At a mean 13 months following surgery, 10 percent of the ankles underwent revision (n = 16), most commonly for symptomatic tibial component loosening (n = 6) and deep infection (n = 6). Eight of the 108 ankles with retained components and at least one year of radiographic follow-up presented with tibial component global lucency that was suggestive of loosening.

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Is There a Clear Solution for Recurrent Disk Herniations?

Recurrent disk herniation is one of the most common reasons for reoperation in microdiskectomy patients. In an analysis of data collected from the Spine Patient Outcomes Research Trial, disk herniations were divided into four groups: fragment-fissure herniations, fragment-defect herniations, fragment-contained disks, and absence of fragment-contained herniations. Fragment-fissure herniations had the best outcomes, including the lowest reherniation and reoperative rates (each 1 percent). Absence of fragment-contained herniations were associated with the worst outcomes.

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Clinical Practice Guidelines

AAOS Evidence-Based Clinical Practice Guidelines (CPGs) are based on a systematic literature review of published studies. Multidisciplinary guideline development groups construct Evidence-Based CPGs to serve as an educational tool based on an assessment of the current published scientific and clinical information and accepted approaches to treatment. AAOS CPGs meet all the Institute of Medicine standards for developing trustworthy CPGs. The process involves many steps to limit the risk of bias, incorporating a large number of experts on the topic under study via clinician work groups and peer review and public commentary stages.

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