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  • Ankle Replacements of the Future

    Source - Ivanhoe

    It’s a surgery that is becoming increasingly more common. Ankle replacements usually are needed because of a bad accident or arthritis. But artificial ankles have come a long way and not all of them are the same.

    David Sander believes he is a walking medical marvel and told Ivanhoe, “It’s really a miracle.”

    The miracle is that he's walking at all after he slipped on an icy city sidewalk in the middle of winter. Sander said, “I lifted up my leg and my foot was backwards, and I said to myself oh my god.”

    After his initial surgery David knew it would eventually come to a replacement, his cartilage was gone leaving him with painful, debilitating arthritis. But he worried failure rates were high for artificial ankles.

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  • Chronic kidney disease increases prosthetic joint infection rates after TJA

    Source - Healio

    Patients with stage 1, 2 or 3 chronic kidney disease may have a higher rate of prosthetic joint injection after total joint arthroplasty, according to study results.

    Researchers retrospectively reviewed electronic medical records for 377 patients with stage 1 to 2 kidney disease with 402 patients who had stage 3 chronic kidney disease. All patients underwent total hip arthroplasty (THA) or total knee arthroplasty (TKA) between 2004 and 2011.

    Patients with stage 3 chronic kidney disease had a greater rate of overall mortality compared with patients with stage 1 to 2 chronic kidney disease, according to the researchers.

    When adjusted for comorbid disease, the researchers found no significant increases in joint infection, readmission or early revision between patients with stage 1 to 2 chronic kidney disease compared with patients with stage 3 chronic kidney disease.

    Compared with patients with end-stage renal disease, dialysis and kidney transplant, overall incidence of infection was high but much less in chronic kidney disease patients.

    In a subgroup analysis, the significant difference in mortality rate persisted between the stage 1 to 2 group vs. the stage 3 group in patients who had undergone THA, but not in patients who had undergone TKA, according to the researchers.

    Study results showed a slightly lower rate of 90-day readmission in patients with stage 1 to 2 chronic kidney disease who underwent TKA than in patients with stage 3 chronic kidney disease, whereas 90-day readmission was slightly higher in the THA subgroup.

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  • Antibiotic cement during primary TKA may not decrease infection rates

    Source - Healio

    Judicious risk-stratified usage of antibiotic cement during primary total knee arthroplasty may not decrease infection at 1 year, according to study results. Researchers retrospectively reviewed data for 3,292 patients who underwent primary total knee arthroplasty (TKA). Patients were grouped into cohorts based on whether their surgery involved plain or antibiotic cement, or if they were high-risk patients who received antibiotic cement, and infection rates were compared between the cohorts.

    Study results showed a 30-day infection rate of 0.29% in cohort 1, 0.2% in cohort 2 and 0.13% in cohort 3.

    Infection rates in all cohorts increased at all time points, with 6-month rates at 0.39% in cohort 1, 0.54% in cohort 2 and 0.38% in cohort 3, and 1-year rates at 0.78% in cohort 1, 0.61% in cohort 2 and 0.64% in cohort 3. However, no statistically significant between-group differences in infection rates were seen at any of the time intervals studied, according to the researchers.

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  • Older patients still fastest-growing demographic for TKA

    Source - Healio

    Despite total knee arthroplasty becoming more prevalent in patients younger than 65 years of age, the main demographic of growth is still among patients older than 65, according to recent study data.
    Researchers compared 1999 to 2008 U.S. census data for individuals 18 to 44 years old, 45 to 64 years old, and 65 years and older and the number of total knee arthroplasties (TKAs) performed annually in each age group. Per-capita incidence rates were calculated, and the growth rate in all demographics was determined.

    Approximately 305,000 TKAs were performed beyond the number predicted by population growth alone in 2008. Patients older than 65 years of age represented the largest growing cohort, as 151,000 recorded TKA procedures and a per-capita growth rate from 5.2 to 9.1 procedures per 1,000 individuals was observed. Per-capita growth rate also increased from 1.4 to 3.3 procedures per 1,000 individuals among patients 45 to 64 years old.

    TKAs were found to have increased 234% during the span of this study, from 264,000 in 1999 and approximately 616,000 in 2008, with fewer than 48,000 of the additional procedures able to be explained by population increase, according to the researchers.

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  • Multiple predictors of unstable syndesmotic SER ankle fractures identified

    Source - Healio

    Fracture height, medial joint space and bone attenuation were determined to be useful predictors of unstable syndesmotic SER-type ankle fractures, according to a study.

    The retrospective study included 191 patients who underwent surgical fixation of SER-type ankle fractures. Age, sex and mechanism of injury (ie, low- or high-energy trauma), as well as radiographs and CT imaging scans, were reviewed for all patients. Researchers performed binary logistic regression analysis to identify all predictors of unstable syndesmotic injuries.

    Overall, 38 patients (19.9%) had a concurrent unstable syndesmotic injury. Age, sex, mechanism of injury, fracture height, medial joint space and bone attenuation were significantly different between stable or unstable syndesmotic patients, according to the researchers.

    Through binary logistic analysis, the researchers found that fracture height, medial joint space and bone attenuation were significant factors contributing to unstable syndesmotic injuries.

    Cutoff values for predicting unstable syndesmotic injuries on CT scans were fracture height of 3 mm or larger and medial joint space of 4.9 mm or larger; cutoff values on radiograph were fracture height of 7 mm or larger and medial joint space of 4.5 mm or larger.

    Disclosure: The authors have no relevant financial disclosures.

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  • New approach to total knee replacement spares muscle, decreases pain

    Source - The Daily Progress

    Total knee arthroplasty, also known as total knee replacement, is one of the most commonly performed orthopedic procedures. According to the American Academy of Orthopedic Surgeons, as of 2010, more than600,000 total knee replacements were being performed annually in the United States. The number of total knee replacements performed annually in the U.S. is expected to grow by 673 percent to 3.48 million procedures by 2030.

    To start, a rigorous preoperative optimization process is now in place to help minimize the risk of complications after surgery. Patients also attend a joint education class to be advised of what to expect before, during and after the surgery. Studies have shown that these educational classes improve patient outcomes.

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  • Semi-constrained implant improves revision knee arthroplasty outcomes

    Source - OrthoSpineNews

    Use of a semi-constrained implant in revision knee arthroplasty produced acceptable implant survival and functional outcomes during the long-term follow-up period, according to study results.

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  • Identifying risk factors for ACL re-injury

    Source - Medical News Today

    Re-tearing a repaired knee Anterior Cruciate Ligament (ACL) happens all too frequently, however a recent study being presented today at the American Orthopaedic Society for Sports Medicine's (AOSSM) Annual Meeting suggests that identification and patient education regarding modifiable risk factors may minimize the chance of a future ACL tear.

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  • Autografts may improve ACL reconstructions

    Source - Medical News Today

    Anterior Cruciate Ligament (ACL) reconstructions occur more than 200,000 times a year, but the type of material used to create a new ligament may determine how long you stay in the game, say researchers who presented their work at the Annual Meeting of the American Orthopaedic Society of Sports Medicine (AOSSM).

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  • High success rates seen for combined meniscal, ACL repair

    Source - Healio

    Concurrent meniscal and ACL repair has shown high rates of success, according to a presenter here.

    Researchers evaluated 235 patients from the Multicenter Orthopaedic Outcomes Network (MOON) who underwent both unilateral primary ACL reconstructions and concurrent meniscal repair between 2002 and 2004. Of the meniscal repairs, 154 were medial, 72 were lateral and nine underwent both.

    Validated patient-oriented outcome data (KOOS, WOMAC) scores, Marx activity scores and IKDC scores were recorded at 2 and 6 years follow-up. Failure of meniscal repairs was determined by subsequent ipsilateral repair.

    “This represents the largest cohort combining meniscus repair and ACL reconstruction follow-up for a minimum of 6 years,” Robert W. Westermann, MD, said during the American Orthopaedic Society for Sports Medicine Annual Meeting.

    Overall, 86% of meniscal repairs were successful at 6-year follow-up; of these, 86.4% were medial meniscal repair, 86.1% were lateral meniscal repairs and 77.8% were in cases where both were repaired, according to Westermann.

    Of the 33 repair failures, nine (27.3%) were related to revision ACL surgery. On average, medial meniscal repairs failed sooner than lateral repairs (2.1 years vs. 3.7 years).

    KOOS Symptoms, KOOS Pain, KOOS KRQOL, WOMAC Pain, and IKDC values all improved significantly when comparing baseline scores to 6-year follow-up, according to Westermann. Marx Activity levels gradually declined from time of injury to 6-year follow-up. — by Christian Ingram

    Reference:Westermann RW. Paper #44.Presented at: American Orthopaedic Society for Sports Medicine Annual Meeting; July 10-13, 2014; Seattle.
    Disclosure:Westermann has no relevant financial disclosures.

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