 |
By Quanjun "Trey" Cui, MD
VOS Newsletter Editor
Case Reports May Indicate Potential Problems with Dual-Mobility Hip Implants
Two case reports and a commentary in the September 25 issue of the Journal of Bone & Joint Surgery (JBJS) Case Connector raise concerns regarding the use of dual-mobility hip implants. As a result of receiving two or more case reports of early intraprosthetic dislocation associated with the use of such implants, JBJS has identified the intervention as one to “watch.” The author notes that several European studies have confirmed "high levels of implant stability" among dual-mobility designs, but have also reported complications, including several cases of late intraprosthetic dislocation, the most common manifestation of which occurs when the metal femoral head separates from the surrounding polyethylene ball. The case reports in the United States reflect early intraprosthetic dislocation. JBJS states that, although current information regarding potential issues with dual-mobility hip implants may not be statistically conclusive, its "Watch" is intended "to sharpen the focus of clinicians on the potential for similar problems and thereby enhance clinical outcomes and patient safety."
Read more...
________________
Study: Repeat BMD Testing
May Offer Little Benefit to Older Patients
Data from a study published in the September 25 issue of the Journal of the American Medical Association (JAMA) suggest that repeat bone mineral density (BMD) testing may not improve fracture prediction in older patients. The research team conducted a population-based cohort study of 310 men and 492 women (mean age = 74.8 years) who took part in the Framingham Osteoporosis Study between 1987 and 1999. At median 9.6-year follow-up, they found that 76 participants had experienced an incident hip fracture and 113 participants had experienced a major osteoporotic fracture. In receiver operating characteristic (ROC) curve analyses, the addition of BMD change to a model with baseline BMD did not meaningfully improve fracture prediction. Using the net reclassification index, a second BMD measure increased the proportion of participants reclassified as having a high risk of hip fracture by 3.9 percent and decreased the proportion classified as having a low risk of hip fracture by 2.2 percent.
Read more...
________________
Investors Report Projects
Increased Growth in Use of
Ambulatory Surgery Centers
According to HealthLeaders Media, a report from Moody’s Investors Service projects that the use of ambulatory surgery centers (ASCs) will continue to grow as hospital inpatient surgery volumes shrink. The authors state that insurers – possibly driven in part by the economic recession – have increasingly directed patients to ASCs, which are reimbursed on average at about 57 percent of the hospital rate for similar procedures. The investment service states that top financial performers among ASCs are likely to be those that concentrate on higher revenue treatments such as orthopaedics and pain management, although growth in the use of ASCs could be balanced by factors such as reductions in reimbursement, a shift toward bundled payments and value-based care, and hospital acquisition of ASCs.
Read more...
________________
Study: Vitamin D Supplementation
May Not Be As Effective as Calcium
for Post-Menopausal Women
Data from a study published online in the Journal of Clinical Endocrinology & Metabolism suggest that vitamin D alone may do little to protect bone health in postmenopausal women. The researchers conducted a randomized, double-blind, placebo-controlled study of 159 postmenopausal white women at a single center. Each participant was allocated to one of four cohorts: double placebo, calcium (1200 mg daily) plus placebo, vitamin D3 (100 µ g) plus placebo, and vitamin D3 and calcium. When researchers observed patients at baseline and at three- and six-month follow-up, they found that serum cross-linked C-telopeptide (CTX) and procollagen type I N-terminal propeptide declined over time with calcium supplementation, but did not change with increased vitamin D intake. In addition, suppression of parathyroid hormone (PTH) was greater after a calcium load in the vitamin D groups, while a calcium load decreased PTH and CTX and raised urinary calcium.
Read more...
________________
Study: Increased Glenoid Retroversion Linked to Increased Risk for Posterior Shoulder Instability in Young Athletes
According to a study published online in the American Journal of Sports Medicine (AJSM), increased glenoid retroversion is a significant prospective risk factor for posterior shoulder instability among young athletes. The researchers conducted a prospective cohort study of 714 young athletes from June 2006 through May 2010. During the surveillance period, 46 shoulders sustained documented glenohumeral instability events, of which seven were posterior in direction. The researchers found that the following baseline factors were associated with subsequent posterior instability during follow-up: increased glenoid retroversion, increased external rotation strength in adduction and at 45° of abduction, and increased internal rotation strength in adduction.
________________
Concussion Recommendations from Various Sources Show Overlap, Also Point to Lack of Quality Data in Some Areas
An article published online in the Journal of Neurotrauma compares and examines three sets of guidelines for the management of sports concussions, including a position statement from the American Medical Society for Sports Medicine, a summary of evidence-based guidelines from the American Academy of Neurology, and a consensus statement derived from the 4th International Conference on Concussion in Sport, held in Zurich, Switzerland. The authors state that key recommendations agreed upon by all three groups include the following:
- Any athlete suspected of having a concussion should not be allowed to return to play on the day of the injury.
- Concussed athletes should not return to play until they have been evaluated by a licensed healthcare provider.
- After concussion, there should be a gradual, stepwise increase in physical activity.
In addition, the authors note that the groups’ recommendations vary concerning chronic traumatic encephalopathy and chronic neurological impairment, reflecting a lack of sufficient clinical or scientific evidence linking concussion in amateur or professional athletes to specific chronic neurological sequelae.
Read more...
________________
Study: No Significant Difference Between Two-Screw and Four-Screw Constructs
in Reverse Shoulder Arthroplasty
Data from a cadaver study published in the August issue of the Journal of Shoulder and Elbow Surgery finds no statistical difference in baseplate motion between two-screw and four-screw constructs in reverse shoulder arthroplasty glenoid fixation. The research team implanted flat-backed glenoid baseplates with four screw hole options into six matched pairs of cadaver scapulas using standard surgical technique. Within each pair, the baseplates were randomized to two screws or four screws. The research team found no statistical difference in average peak central displacement between fixation with two or four screws.
Read more…
________________
Study: Spine Care Appears to Drift from Published Clinical Guidelines
According to a study published online in the journal JAMA Internal Medicine, management of back pain has relied increasingly on guideline-discordant care, despite the availability of published clinical guidelines. The authors drew data on 22,918 visits for spine problems from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey, and found that use per visit of NSAID or acetaminophen decreased from 36.9 percent in 1999-2000 to 24.5 percent in 2009-2010, while narcotic use increased from 19.3 percent to 29.1 percent during the same period. In addition, although physical therapy referrals remained unchanged at approximately 20 percent, physician referrals increased from 6.8 percent to 14.0 percent. The number of radiographs remained stable at approximately 17 percent, whereas the number of computed tomograms or magnetic resonance images increased from 7.2 percent to 11.3 percent.
Read more...
________________
Physicians Continue to Migrate Away
from Accepting Medicare
An article in the Wall Street Journal looks at the issue of physicians opting out of Medicare. According to CMS data, 9,539 physicians who had accepted Medicare patients in 2011 opted out of the program in 2012, an increase from 3,700 during 2009. Further, the paper reports that many physicians who continue to accept Medicare opt to limit the number of Medicare patients they treat. According to data from the American Academy of Family Physicians, the 81 percent of family physicians who accepted new Medicare patients during 2012 represented a decrease from 83 percent in 2010.
Read more...
________________
Study: Hemiarthroplasty Linked
to Fewer Re-operations than Internal Fixation for Femoral Neck Fracture
According to a study published in the August issue of CORR, hemiarthroplasty may be associated withdecreased likelihood of reoperation compared to internal fixation for femoral neck fracture. The research team reviewed 1,411 records of patients older than 60 years who were treated for femoral neck fracture with internal fixation or hemiarthroplasty between 1998 and 2009. At median 45-month follow-up, they found that internal fixation and displacement were independently associated with increased re-operation rates. In addition, they found that most fractures treated with fixation underwent reoperation within one year, primarily for non-union; most fractures treated with hemiarthroplasty underwent reoperation within three months, primarily for infection.
________________
