The annual meeting of the American Academy of Orthopaedic Surgeons was held from Feb. 15 to 19 in San Diego and attracted approximately 30,000 participants from around the world. The conference highlighted recent advances in the diagnosis and management of musculoskeletal conditions, with presentations focusing on joint fractures, osteoarthritis, and other musculoskeletal injuries as well as factors impacting joint replacement procedure outcomes.
In one study, John Patrick Meehan, M.D., of the University of California at Davis, and colleagues found that performing simultaneous knee replacements as compared to staged knee replacement procedures was associated with significantly fewer prosthetic joint infections and revision knee operations within one year after surgery. The investigators evaluated 11,445 patients who underwent simultaneous bilateral knee replacement and 23,715 patients who had both knees replaced in two stages several months apart.
"One unexpected finding was that the risk of death was not significantly different between simultaneous bilateral knee replacement surgeries as compared with staged knee replacement surgeries," Meehan said. "Consistent with previous findings, we found that the risk-adjusted odds of cardiovascular events and pulmonary embolism [were] higher with simultaneous bilateral knee replacement surgery as compared with staged surgeries. A surprising finding was that the risk of infection and knee revision surgery was two times lower among those who underwent simultaneous knee replacement surgery as compared to those who underwent staged surgeries. We hope this study will lead to future research which helps to preoperatively identify the cardiac risk factors which may assist physicians with the decision of whether or not to perform simultaneous or staged bilateral knee replacements."
In another study, Iftach Hetsroni, M.D., of the Meir General Hospital in Kfar Saba, Israel, and colleagues found that the incidence of symptomatic pulmonary embolism after outpatient knee arthroscopy was very low. The investigators evaluated data from the 374,033 patients undergoing 418,323 outpatient arthroscopic knee procedures between 1997 and 2006 included in the New York State Department of Health Statewide Planning and Research Cooperative System administrative database. The rate of readmission with a pulmonary embolism diagnosis within 90 days was .028 percent.
"Risk factors which were demonstrated to significantly increase the risk of pulmonary embolism included age, operating room time, female sex, and history of cancer," Hetsroni said.
Other potential risk factors evaluated included complexity of the surgery, comorbidities, and type of anesthesia. However, not one of these was found to be associated with an increased risk of pulmonary embolism.
"We believe, once patients and surgeons are aware of these findings, that this information can improve the accuracy of informed consent prior to what is considered a very common and safe procedure, and provide a basis for thromboprophylaxis decision making immediately after surgery in patients where several of these factors coexist," Hetsroni added.
Jasvinder Singh, M.D., of the University of Alabama in Birmingham, and colleagues found that both prior and current smokers had a higher risk of adverse outcomes after undergoing elective total hip replacement or total knee replacement as compared to never smokers.
"We found that smoking at the time of surgery is a risk factor for complications, including infection at the surgical site, pneumonia, pulmonary complications, and cardiovascular events. Current smokers also had a higher risk of dying one year after surgery compared to nonsmokers," Singh said. "Increase in the risk of some complications was also seen in prior smokers. It is possible that starting a smoking-cessation program may lower the risk of complications among individuals undergoing elective hip and knee surgeries."
The investigators evaluated data from 33,336 patients from the VA Surgical Quality Improvement Program who underwent elective primary joint replacement procedures between October 2001 and September 2008.
"Our estimates can be used to inform the discussions during the informed consent at the time of surgery. Our study should also encourage discussions between patients and surgeons and consideration of a smoking-cessation program," Singh added.
In another study, Carlos J. Lavernia, M.D., of the Orthopedic Institute in Miami, and colleagues found that type 2 diabetes patients with poor blood sugar control had worse outcomes after total joint replacement surgery as compared to those with normal blood sugar levels. The investigators performed 121 consecutive primary total joint replacements on type 2 diabetes patients and assessed preoperative hemoglobin A1c levels.
"We demonstrated that good control of diabetes will probably provide earlier return to a higher quality of life among those who underwent elective surgery and also improved outcomes," Lavernia said. "Surgeons considering elective surgery among patients with diabetes should check for control in the last three months, and if the patient's control is not optimal, they should consider getting the patient under control for three months prior to surgery."
AAOS: Stretching Before Run Does Not Cause Injury
FRIDAY, Feb. 18 (HealthDay News) -- Stretching before running does not appear to either prevent or cause injury, according to research presented at the annual meeting of the American Academy of Orthopaedic Surgeons, held from Feb. 15 to 19 in San Diego.
AAOS: In Long Term, Outcomes Improve After Arthroplasty
THURSDAY, Feb. 17 (HealthDay News) -- Patients who undergo total knee replacement (TKR) appear to demonstrate improved functional outcomes over the long term, even 20 years after surgery, according to research presented at the annual meeting of the American Academy of Orthopaedic Surgeons, held from Feb. 15 to 19 in San Diego.
AAOS: Stress Fractures Fairly Common in Young Athletes
TUESDAY, Feb. 15 (HealthDay News) -- Significant gender differences may contribute to stress fractures among adolescent athletes, with the level of participation also playing a role in these types of fractures, according to research being presented at the annual meeting of the American Academy of Orthopaedic Surgeons, held from Feb. 15 to 19 in San Diego.
AAOS: Defensive Orthopedic Imaging Prevalent and Costly
TUESDAY, Feb. 15 (HealthDay News) -- Nearly 35 percent of all imaging costs associated with orthopedic patient encounters in Pennsylvania appear to be for defensive medicine purposes, according to research being presented at the annual meeting of the American Academy of Orthopaedic Surgeons, held from Feb. 15 to 19 in San Diego.
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