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Gender Differences in Total Hip Arthroplasty

Gender Differences in Total Hip Arthroplasty

Research has shown that total hip arthroplasty (THA) can significantly improve function and quality of life and reduce pain. THA has yielded excellent results when assessed at 5 to 7 years after the procedure. Despite these successes, there is still ongoing debate about how certain factors relating to patients, implants, surgeons, procedures, and volume affect THA outcomes. The contribution of each of these types of factors is difficult to evaluate independently. The FDA recently provided guidance for the enrollment of women and for conducting sex-specific analyses in device studies, with an emphasis on transparency. “This is an important issue in orthopedics,” explains Monti Khatod, MD. Sex differences in THA are substantial, and industry has already started developing sex-specific devices. Furthermore, THA is more often performed in women than men. Sex-specific risk factors and outcomes have been investigated for most other major surgical procedures, but Dr. Khatod says it is even more important to understand these differences in THA, especially with the location of the femoral head center, size and shape of the femoral canal, and trabecular patterns. “It’s still unclear how anatomical sex differences can influence functional outcomes and implant survivorship,” he says. “While some studies suggest that men have higher perioperative complication and failure rates, others have observed similar failure rates and functional outcomes among men and women.” Taking a Closer Look At Joint Replacement In a study published in JAMA Internal Medicine, Dr. Khatod and colleagues used a large total joint replacement registry cohort of elective primary THA in 46 hospitals within the United States. The purpose of the analysis was to determine whether sex was associated...
Guideline Recommendations for Prosthetic Joint Infections

Guideline Recommendations for Prosthetic Joint Infections

Research shows that as many as 20,000 of the nearly 1 million total hip arthroplasty (THA) and total knee arthroplasty (TKA) procedures performed in the United States result in a prosthetic joint infection (PJI) over the lifetime of the device. PJIs remain one of the most serious complications of prosthetic joint implantation. According to recent estimates, roughly 4 million THAs and TKAs will be performed each year in the U.S. by 2030, due largely to the rapidly increasing elderly population. Diagnosing PJIs is often challenging for physicians and frequently necessitates multiple modalities. Management of these infections typically requires surgical interventions and lengthy courses of intravenous (IV) and oral antibiotics. Although much research has been conducted in this area, questions about optimal diagnosis and management strategies for PJIs remain. The Infectious Diseases Society of America (IDSA) recently released updated guidelines that are intended to help clinicians by offering optimal strategies to improve the diagnosis and management of these infections. Using a Team Approach A key point that the IDSA guidelines emphasize is that using a multidisciplinary team approach is essential for managing PJIs. “A strong collaboration is required from all medical specialists who are involved in the care of patients with PJIs,” explains Douglas R. Osmon, MD, who served as lead author of the IDSA guidelines. “This team most often includes an orthopedist and an infectious diseases specialist. Other specialists should be involved on a case-by-case basis, such as plastic surgeons, general internists, nurses, mid-level providers, and microbiologists.”   Patients requiring THA or TKA procedures tend to be elderly, meaning they are more likely than others to have multiple comorbidities,...

Conference Highlights: American Academy of Orthopaedic Surgeons 2010

The American Academy of Orthopaedic Surgeons, or AAOS, held its 2010 annual meeting from March 9 to 12 in New Orleans. The features below highlight some of the news emerging from the meeting. For more information on these items and other research that was presented, go to www.aaos.org. Improving Healing After Rotator Cuff Surgery The Particulars: Rotator cuff tears are common sports injuries that lead to pain and restricted motion. Surgery to repair the damage can help reduce pain, but poor healing can still occur, leading to an incomplete recovery of function. Studies have indicated that less than 70% of rotator cuff repairs are completely healed when evaluated 2 years after surgery. Teriparatide (Forteo, Eli Lilly), an FDA-approved therapy for osteoporosis that has been shown to stimulate bone growth and slow the rate of bone loss, might enhance the healing process after rotator cuff surgery. Data Breakdown: Using a rat model, researchers performed rotator cuff surgery and then administered teriparatide injections in amounts comparable to human doses. At 2 weeks after surgery, the repair was not as strong in the rats who received teriparatide injections. However, at weeks 4 through 8, the tendon to bone interface appeared much more like normal tissue. Closer examination showed that the rats receiving teriparatide injections produced more bone and cartilage cells. The organization of the tissue was also better, more closely resembling normal tissue. The tendon was also significantly stiffer, a sign of proper healing, at 8 weeks. Take Home Pearls: Teriparatide injections appear to be a promising strategy to promote improved healing and function in patients undergoing rotator cuff surgery. The agent...
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