News Highlights from the American Academy of Orthopaedic Surgeons
Women Who Break Shoulders at High Risk of Hip Fracture
Golf Places Unexpected Stresses on Artificial Knees
Aspirin Prevents Blood Clots After Knee Surgery
Women Who Break Shoulders Have Five Times Risk of Hip Fracture
Older women who suffer a proximal humerus fracture (sometimes known as a broken shoulder) have a five times greater risk of breaking a hip within the following year, according to a new study presented at the 75th Annual Meeting of the American Academy of Orthopaedic Surgeons. The risk decreased after the first year but still remained elevated.
The study, which followed a group older, Caucasian women for nearly 10 years, found that the strongest risk factor for hip fracture were age and hip bone mineral density. Other factors included:
* self-reported health status
* height at 25 years of age
* history of recent falls
* impaired depth perception
* history of prior fractures
Even when controlling these factors, the researchers still found the increased risk for hip fracture in the first year after a proximal humerus fracture. They say the reasons for this connection are still unclear. “It may be associated medical problems, limited use of the injured shoulder, or there could be something about the treatment for the first fracture—such as narcotic pain medications—which could have caused the patient to fall and break a hip,” says Jeremiah Clinton, MD, co-author of the study and acting clinical instructor at the University of Washington, Department of Orthopaedics. “Now that we are aware of the relationship between these types of fractures, we can take precautions, intervene early and hopefully help to prevent some hip fractures from occurring.” 3/6/08
Golf Places Unexpected Stresses on Artificial Knees
If you’ve had a total knee replacement, you may want to think twice before playing a round of golf. A study using new technology to measure the forces on prosthetic joints shows that golf, generally thought to be a low-impact activity, can cause a great deal of stress on an artificial knee.
Orthopaedic surgeon Clifford W. Colwell Jr., MD, at Scripps Clinic, La Jolla, Calif. implanted four total knee replacement patients with joints equipped to measure forces from inside the implant. A year later, researchers at Scripps’ Shiley Center for Orthopaedic Research and Education took data from the specially designed joints to determine exactly how much force is put on the implant during some common physical activities.
“Some of our findings were expected. For example, we were not surprised to find that jogging and tennis generate a lot of force on the artificial knee joint,” said Darryl D. D’Lima, MD, PhD, primary author of the study. “However, we did not expect to find that golf swings
can be so hard on the knees.”
Most orthopaedic surgeons agree that high-impact activities in any form following a knee replacement have the potential to shorten the life of the artificial joint. However, nearly all previous studies of force from different activities on artificial knees have involved only external measurements or estimates. 3/6/08
Aspirin Prevents Blood Clots After Knee Surgery
Taking aspirin to prevent blood clots after knee surgery may be a safe and effective alternative to currently recommended treatments that are often costlier and riskier, according to preliminary results from a study presented today at the 75th Annual Meeting of the American Academy of Orthopaedic Surgeons. (AAOS).
The study, which examined data from data from more than 93,840 patients who underwent knee replacement surgeries at some 300 hospitals between October 2003 and September 2005, found that patients taking aspirin had less risk of developing blood clots than patients taking other blood-thinning drugs. They also faced a similar risk compared to patients receiving injectable drugs.
Currently, clinical practice guidelines for preventing blood clots after knee replacement do not recommend aspirin use, says Kevin J.Bozic, MD, lead author of the study. But the study suggests they should. “Aspirin is a simple, inexpensive and commonly used drug with few side effects, so it’s a very attractive alternative,” says Dr. Bozic, who is an associate professor in residence at the University of California, San Francisco Department of Orthopaedic Surgery and Philip R. Lee Institute for Health Policy Studies.
The study concludes that more research needs to be conducted to help physicians determine which patient characteristics and treatment factors are best suited for aspirin use to prevent blood clots in knee replacement patients. 3/5/08
Diabetes Complicates Joint Replacement
If you have diabetes and undergo knee or hip replacement surgery, your risk of complications is greater than for those without the disease, according to research presented today at the 75th Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS). Further, if you have type I diabetes your risk is greater than if you have type II.
Because approximately half of people with arthritis also have diabetes, and because joint replacements are performed largely to relieve arthritis pain, it is important to understand the added surgical risks that come with diabetes, says Michael P. Bolognesi, MD, author of the new study. Dr. Bolognesi is the director of adult reconstruction at Duke University Medical Center and an AAOS fellow.
If doctors understand the risks to these patients who undergo hip and knee replacements, better post-surgery outcomes can be expected. Patients can reduce their risk of complications by getting their disease under control before they undergo surgery. “Clearly, with those patients who have good control, there is a decrease in their complications and risks,” Dr. Bolognesi says. 3/5/08
Obesity Impedes Recovery from Total Knee Replacement
If you’re planning knee replacement, but could stand to lose a little – or maybe a lot of – weight, a new study offers added reason to lose those pounds. The study, presented at the 75th Annual Meeting of the American Academy of Orthopaedic Surgeons shows that obesity limits a patient’s range of motion (ROM), prolongs recovery and extends the need for physical therapy after total knee replacement surgery.
Comparing data from 309 patients (400 knee replacements) who underwent total knee
“For anyone considering knee replacement surgery, recovery time is always an important consideration,” Geoffrey Westrich, MD, lead author of the study and an associate professor of orthopaedic surgery at HSS. “Patients often ask me if their pain is going to be relieved and if they will have better range of motion. Our findings will help set more realistic expectations for heavy patients. They need to be counseled that their weight will likely impede their recovery.” 3/5/08
MRI Overused in Diagnosing Osteoarthritis
When it comes to diagnosing osteoarthritis of the knee, weight-bearing X-rays are at least as effective as MRI, but are much less expensive, according to a new study led by Wayne Goldstein, MD, a clinical professor of orthopaedics at the University of Illinois at Chicago College of Medicine and chairman of the Illinois Bone and Joint Institute.
Dr. Goldstein and his colleagues reviewed a random sample of 50 patients who had total knee replacement for osteoarthritis to see if they had an MRI of the knee within the two years before surgery. They found that 32 of the 50 patients did have an MRI which was ordered by their primary-care or orthopaedic physician and that the MRI did not provide any additional diagnostic information that could not be provided by an X-ray.
“MRIs are being used in excess. Many doctors no longer talk to or examine their patients. Instead, they are going right for the technology,” says Dr. Goldstein. He notes that there are some indications for MRI such as suspicion of avascular necrosis [a condition in which blood loss to the area causes bone to break down, something which may not be seen on early X-rays], but that is not a common condition.
“This is another example of over-utilization of the health-care system,” he says. “Many physicians are ordering MRIs for osteoarthritis of the knee, when all they need to make the diagnosis is that X-ray.” 3/5/08
