Today’s News | October 10, 2018

Study: Five-year Outcomes for Older Hip Arthroscopy Patients

A prospective study published online in Arthroscopy found patient-reported outcomes (PROs) improved five years after hip arthroscopy in older patients. Researchers assessed 94 hips in patients ≥ 50 years who underwent surgery to treat labral tears and femoroacetabular impingement between February 2008 and January 2012. At a minimum five-year follow-up, the researchers observed improvement in all PROs and visual analog scales (VAS); mean patient satisfaction was 8.4. Nonarthritic Hip Score, Hip Outcome Score-Sports Specific Subscale, and VAS all continued to improve from two to five years’ follow-up. Fifty-one cases (54.3 percent) achieved patient-acceptable symptomatic state for modified Harris Hip Score. Survivorship was 72.3 percent. Risk factors for total hip arthroplasty included higher body mass index, larger alpha angles, and smaller lateral center-edge angles, as well as higher proportions of Tönnis grade 1, acetabular Outerbridge grade ≥ 2, and femoral head Outerbridge grade ≥ 2.

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Study: Degenerative Patellofemoral Joint Defects Associated with Poor Clinical Symptoms

In a study published online in Knee Surgery, Sports Traumatology, Arthroscopy, patients with degenerative isolated cartilage defects in the patellofemoral joint experienced more severe clinical symptoms than patients with trauma-related defects. Researchers collected data on 423 patients registered in the German Cartilage Registry with isolated focal cartilage defects of the patellofemoral joint. Patients with a history of previous ipsilateral knee surgery were excluded. The numeric analog scale (NAS) for pain and the Knee injury and Osteoarthritis Outcome Score (KOOS) were used to measure clinical symptoms. The researchers recorded International Cartilage Repair Society (ICRS) grade, etiology, size, and location of the cartilage defects at baseline. Degenerative defect patients (n = 220) had significantly more trochlear locations than traumatic patients (n = 203) (28 percent versus 18 percent, respectively), fewer ICRS grade 4 lesions (50 percent versus 73 percent, respectively), and a much smaller median defect size. The traumatic defect cohort had better KOOS activities of daily living (77 versus 69, respectively), KOOS pain (69 versus 61, respectively) and NAS (2 versus 4, respectively) scores compared to the degenerative group.

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According to a report from healthcare investment bank Edgemont Capital Partners, the orthopaedic industry may see a surge in outside investment over the next five years. The wide array of ancillary services offerings, increasing outpatient surgical volume, an aging population, and the growing importance of orthopaedics to overall health care led private equity groups nationwide to build a national orthopaedic platform. The orthopaedic industry has grown due, in part, to a large shift in industry procedures to outpatient settings and a rise in poor joint health due to obesity and age-related conditions.

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A study published online in Archives of Osteoporosis found that differences in region-specific lean mass and the specific sport played were most likely to determine one-year changes of areal bone mineral density (aBMD), hip geometry, and trabecular bone score (TBS) in adolescent male athletes. Researchers followed male athletes (n = 104) aged 12 to 14 years at baseline (39 swimmers, 37 footballers [or soccer players], and 28 cyclists). Region-specific lean mass, cycling participation, swimming participation, and moderate to vigorous physical activity were the strongest indicators for aBMD outcomes. Changes in hip geometry estimates were predicted by cycling participation, region-specific lean mass, and cardiorespiratory fitness. Cycling and swimming participation, region-specific lean mass, and stature were most indicative of TBS changes.

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A retrospective analysis published online in the Journal of the American Geriatrics Society found that Medicare beneficiaries who sustained osteoporosis-related fractures faced increased medical costs compared to nonfracture beneficiaries. Respondents of a Health and Retirement Study survey who were aged ≥ 65 years, had at least one fracture risk factor, and experienced a fracture between 1996 and 2008 (n = 689) were included and matched with a control group (n = 689). Among the fracture cohort, total Medicare expenditures increased $13,929 more than the control group from one year prefracture to one year after the index date. Inpatient expenditures contributed most to the increase, costing $12,751 more for fracture cases than the control group. Two and three years after the fractures, growth in expenditures did not vary significantly between groups. Fracture location (hip or other site) did not impact results.

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Avoid Risks During Hip Fracture Management in a Medically Complex Patient

The AAOS Clinical Practice Guideline (CPG) is an evidence-based guide that helps providers navigate multifaceted cases. Because of how common hip fractures are among medically fragile patients, AAOS created a CPG for hip fractures in older patients and those with diminishing bone quality. The CPG includes evidence-based support for interdisciplinary care, early surgical treatment, regional anesthesia, and multimodal regimens to control pain.

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Final Call: Apply for Biomedical Engineering Committee Member Position

The Biomedical Engineering Committee has an open member position, a two-year term that runs from March 17, 2019, through March 21, 2021. The committee monitors and reviews scientific regulatory developments in the field of biomedical engineering as they relate to orthopaedic surgery. The application deadline is Oct. 13.

Learn more and submit your application…(member login required)