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A Look at Complications After Total Joint Arthroplasty

Results of a meta-analysis suggest that patients with rheumatoid arthritis (RA) appear to be at higher risk for dislocation following total hip arthroplasty than those with osteoarthritis who have these procedures (odds ratio, 2.16). Patients with RA also had a greater risk for infection following total knee arthroplasty. Abstract: Arthritis & Rheumatism, December 2012....

Updating Osteoarthritis Treatment Recommendations

To help clinicians manage the increasing number of patients with osteoarthritis (OA), the American College of Rheumatology (ACR) revised its guidelines for using non-pharmacologic and pharmacologic therapies in OA of the hand, hip, and knee. Published in an issue of Arthritis Care & Research, the guidelines update recommendations from 2000. According to the ACR, management of OA should begin with treatments that are beneficial and have the lowest possible risk. Prior to recommending prescription medication and surgery, low-risk modalities (eg, weight loss and exercise) should be attempted. Treatments with greater risk may be used when simpler treatments fail. Hand Osteoarthritis Potential treatment modalities for hand OA include an assessment of activities of daily living, use of assistive devices, joint protection techniques, thermal agents, and trapeziometacarpal joint splinting. Oral and topical NSAIDs, topical capsaicin, and tramadol are other treatment modalities for hand OA, but opioids and intra-articular therapies are not recommended. Topical NSAIDs are preferred to oral administration in patients aged 75 and older, thus putting an emphasis on using these agents conservatively when possible. “New therapies for OA and additional information on the safety and acceptability of existing therapies have emerged.” Knee Osteoarthritis For knee OA, aerobic or resistance land-based exercise, aquatic exercise, and weight loss are strongly recommended in the guideline update. Conditionally recommended modalities include self-management programs like manual therapy with supervised exercise, tai chi, and wedged insoles. For moderate to severe pain in patients who do not wish to undergo joint replacement, acupuncture and transcutaneous electrical nerve stimulation (TENS) are recommended. Conditionally recommended pharmacologic modalities include acetaminophen, oral and topical NSAIDs, tramadol, and intra-articular corticosteroid injections....

Conference Coverage: American Academy of Orthopaedic Surgeons 2012

The 2012 annual meeting of the American Academy of Orthopaedic Surgeons was held from February 7-11 in San Francisco. The features below highlight just some of the studies that emerged from the meeting. >> Analyzing Deep SSIs in Total Hip Arthroplasty >> Pain Following TKA Tied to Osteoarthritis >> Are Antibiotics Necessary for Clean Soft Tissue Hand Surgery? >> Defensive Medicine Costly in Orthopaedic Surgery >> Trending Lumbar Spinal Stenosis Surgery Analyzing Deep SSIs in Total Hip Arthroplasty The Particulars: Deep surgical site infections (SSIs) are severe complications that may occur in total hip arthroplasty (THA). Few studies have explored patient- and surgical-related risk factors for SSIs associated with THA. Data Breakdown: A prospective cohort study of 30,491 THA procedures found an incidence rate of 0.51% for deep SSIs. Patient factors associated with deep SSI were female gender, BMI of 30 kg/m2 or higher, and American Society of Anesthesiologist risk score of 3 or greater. Patient factors not associated with an increased risk of SSIs were age, arthritis diagnosis, diabetes, and race. Bilateral THA procedures were associated with a 5.32-times increased risk of SSIs when compared with unilateral THA procedures. Surgeon and hospital case volumes, use of antibiotic cement, fixation method, laminar flow, surgical approach, and fellowship training were not associated with SSIs. Take Home Pearl: Female gender, obesity, chronic medical conditions, and bilateral THA procedures appear to be associated with deep SSIs. Pain Following TKA Tied to Osteoarthritis The Particulars: Little is known regarding the association between objective ratings of preoperative osteoarthritis (OA) and pain and dissatisfaction following total knee arthroplasty (TKA). Data Breakdown: In a study, investigators...

The Changing Tide of Knee Arthroscopy in the U.S.

CDC data show that knee arthroscopy is one of the most frequently performed ambulatory orthopedic procedures in the United States. The surgery is now primarily used for the removal of loose bodies, debridement of meniscal tears, debridement and recontouring of cartilage flaps, arthroscopically assisted ligament reconstruction and meniscal transplantation, and synovectomy. In the early 1980s, there was a shift toward performing some surgical procedures on an outpatient basis for a variety of reasons. “Advances in anesthesia and surgical techniques, financial incentives to providers and patients, and enhancements in postoperative pain management were all factors that led to this shift,” explains Richard A. Marder, MD. “It’s well understood that the number of ambulatory surgical procedures is increasing, but there has been little study exploring the frequency and magnitude of these procedures occurring in outpatient settings in the U.S.” Significant 10-Year Trends In the June 1, 2011 Journal of Bone and Joint Surgery, Sunny H. Kim, PhD, Jose Bosque, MD, John P. Meehan, MD, Amir Jamali, MD, and Dr. Marder had a study published that described the changes in demographics and utilization of knee arthroscopy in ambulatory settings between 1996 and 2006 in the U.S. The investigation, which analyzed CDC data from the National Survey of Ambulatory Surgery, also sought out to determine the most common reasons for knee arthroscopy over the past decade. “Our analysis revealed several interesting trends,” says Dr. Marder. “First, between 1996 and 2006, the number of knee arthroscopies increased by 49% (Table 1). The increase in knee arthroscopy procedures was much steeper than the growth of the U.S. population during the same period.” “Clinicians should continue to...
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