Author Interviews, Hospital Readmissions, JAMA, Orthopedics, Surgical Research / 11.03.2016

MedicalResearch.com Interview with: Ronald S. Chamberlain, MD, MPA, FACS Chairman and Surgeon-in-Chief Department of Surgery Saint Barnabas Medical Center Professor of Surgery New Jersey Medical School Rutgers University MedicalResearch.com: What is the background for this study? Dr. Chamberlain:  With the rapidly growing arthritic, aging, and obese population, total hip replacement (THR) has become the most commonly performed orthopedic procedure in the United States (US).  The Affordable Care Act signed by President Barack Obama imposed financial penalties for excess readmissions following certain procedures and diagnoses. While the initial program aimed to reduce readmissions for heart failure, pneumonia, and acute myocardial infarction (AMI), the program expanded to include THR in 2015. With current research estimating a 10%, 30-day readmission rate following a total or partial hip replacement, this study sought to identify factors associated with readmission and to create a scale which could reliably stratify preoperative readmission risk. (more…)
Author Interviews, BMJ, Exercise - Fitness, Orthopedics / 10.03.2016

MedicalResearch.com Interview with: David Morrissey MB PhD FRCS (Tr&Orth) Orthopaedic Specialist Registrar  MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Morrissey: Injury rates in rugby union have increased substantially over the past twenty years, both in the professional and amateur game. The pattern of injury has also changed, reflecting higher grades of trauma. Our institution is a tertiary referral centre for pelvic and acetabular trauma serving a population of 4.5 million. The majority of our cases occur as a result of high velocity trauma such as road traffic accidents. We have not previously seen hip dislocations/acetabular fractures occurring secondary to sporting participation. In the past number of years, however, we have identified four such injuries in three juvenile patients, that occurred during rugby union participation. These injury patterns may have sub-optimal outcomes in up to 30% of patients and can severely affect a young person’s life. The demographic change may be due to changes in the physical development of players as well as an increased emphasis on the tackle/ruck area. In the juvenile game, differing rates of maturation magnify size differences between players, potentially increasing the risk of injury. (more…)
Author Interviews, Cost of Health Care, Medicare, NYU, Orthopedics / 04.03.2016

MedicalResearch.com Interview with: Richard Iorio, MD Dr. William and Susan Jaffe Professor of Orthopaedic Surgery Chief of the Division of Adult Reconstructive Surgery NYU Langone Medical Center  MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Iorio: NYU Langone Medical Center’s Department of Orthopaedic Surgery realized early that alternate payment strategies based on value rather than volume were going to be increasing in prevalence and represent the future of compensation strategies  As leaders in orthopaedics, we knew that we must embrace this change and develop strategies and effective protocols to successfully navigate this alternative payment universe. In 2011, NYU Langone’s Hospital for Joint Diseases was chosen as a pilot site for CMS’s Bundled Payment Care Initiative, focusing on Medicare patients undergoing a total joint replacement. Beginning in 2013, we implemented protocols developed at our hospital focusing on preoperatiive patient selection criteria in an effort to ensure better outcomes for Medicare patients who underwent total joint replacements. Under a bundled payment program, hospitals assume financial responsibility for any complications over the entire episode of care 90 days after surgery, including postsurgical infections and hospital readmissions. We compared year over year outcomes from year 1 to year 3 of this program, and found:
  • Average hospital length of stay decreased from 3.58 days to 2.96 days;
  • Discharges to inpatient rehabilitation or care facilities decreased from 44 percent to 28 percent;
  • Average number of readmissions at 30 days decreased from 7 percent to 5 percent; from 11 percent to 6.1 percent at 60 days; and from 13 percent to 7.7 percent at 90 days;
  • The average cost to CMS of the episode of care decreased from $34,249 to $27,541 from year one to year three of the program.
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Author Interviews, Orthopedics, Transplantation / 25.02.2016

MedicalResearch.com Interview with: Dr. Brett Crist MD FACS Associate Professor of Orthopaedic Surgery Co-Chief, Orthopaedic Trauma Division Associate Director, Joint Preservation Surgery Director, Trauma Orthopaedic Fellowship School of Medicine University of Missouri Health  Medical Research: What is the background for this study? What are the main findings? Dr. Crist: Some young patients have bone and/or cartilage problems on the femoral head due to disease or injury.  Resurfacing the femoral head with donated bone and cartilage tissue is often a better option for these young patients with active lifestyles, who would otherwise require an artificial joint that would limit their activities and eventually wear out. However, there is no standard method for implantation. Our study provides initial clinical evidence that larger, size-matched grafts have the potential to improve outcomes when resurfacing cartilage defects of the femoral head in the hip joint. (more…)
Author Interviews, Exercise - Fitness, Orthopedics / 15.02.2016

MedicalResearch.com Interview with: Pamela S. Hinton, Ph.D. Associate Professor Director of Graduate Studies, Nutritional Sciences Department of Nutrition and Exercise Physiology University of Missouri, Columbia MO 65211 Medical Research: What is the background for this study? What are the main findings? Dr. Hinton: Because bone mass declines with age, maximization of peak bone mass is recommended as the most effective way to prevent osteoporosis. Acquisition of at least 90% of peak bone mass occurs by the age of 18 years, with additional gains of 5% to 10% during young adulthood. Because mechanical loading induces a greater adaptive response in young, compared with old, bone, adolescence and young adulthood constitute a unique window of opportunity to increase bone mass via physical activity. Although physical activity during adolescence and young adulthood is a key determinant of peak bone mass and, therefore, of future bone health, exercise after skeletal maturation can also reduce the risk of osteoporosis and related fractures. Therefore, the objective of the present study was threefold: (a) to examine the relationships between current BMD of the whole body, hip, and lumbar spine and physical activity–associated bone loading during adolescence (13-18 years), young adulthood (19-29 years), and current physical activity–associated bone loading; (b) to investigate the effects of current participation in a high-impact physical activity and/or resistance training on BMD of the whole body, total hip, and lumbar spine in apparently healthy, physically active men; and, (c) to evaluate the effects of continuous participation in high-impact activity throughout the life span on BMD of the whole body, total hip, and lumbar spine. (more…)
Annals Internal Medicine, Author Interviews, Orthopedics / 11.02.2016

MedicalResearch.com Interview with: Teppo L N Järvinen MD PhD Sports Medicine, Orthopedic Surgery, Clinical Trials University of Helsinki, Helsinki MedicalResearch: What is the background for this study? What are the main findings? Dr. Järvinen: When the primary analysis of the FIDELITY trial was published in the New England Journal of Medicine (http://www.nejm.org/doi/full/10.1056/NEJMoa1305189), showing that arthroscopic partial meniscectomy (APM) is no better than sham/placebo surgery in relieving knee pain and improving knee function in patients with a degenerative meniscus tear and no knee OA, the study was met with unprecedented criticism, even hostility. The advocates of APM (which was at the time and probably still is the most common orthopedic procedure in the US and most other “western” countries) argued – despite the fact that our study only confirmed what several other high-quality RCTs had suggested – that  arthroscopic partial meniscectomy is a highly beneficial procedure in the “right” patients. Among the subgroups of patients allegedly having a favourable response to APM, those experiencing “mechanical symptoms” — sensations of knee catching or locking — represented the most obvious group who would benefit from  arthroscopic partial meniscectomy surgery. This assertion is plausible because knee catching or locking is believed to result from a mechanical blocking mechanism in the knee - a piece of the joint structure lodging between the articular surfaces. Because degenerative meniscal tears are very common pathologic alterations found by arthroscopy in the knee joints of patients with degenerative knee disease, trimming the torn meniscus should, in theory at least, improve the apparent mechanical derangement. Against this background, it is somewhat unusual that no study has yet specifically tested whether  arthroscopic partial meniscectomy is effective in alleviating these symptoms. Mechanical symptoms are usually thought to be a solid indication for arthroscopic knee surgery. This is what we set out to examine in our secondary analysis of our sham-surgery controlled FIDELITY trial.

Our key finding: arthroscopic partial meniscectomy (partial resection of a torn meniscus) does not reduce or alleviate mechanical symptoms any better than a sham surgical procedure.

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Author Interviews, Frailty, Hip Fractures, Parkinson's, PLoS / 08.02.2016

MedicalResearch.com Interview with: Helena Nyström MD, PhD Candidate Department of Community Medicine and Rehabilitation Umeå University Umeå, Sweden Medical Research: What is the background for this study? Response: Parkinson’s disease (PD) has an insidious onset and the prodromal phase, preceding the onset of the characteristic PD symptoms, may last for decades. Most prodromal signs previously reported are of non-motor type, such as sleep and mood disorders. However, recent studies have reported balance problems and an increased risk of accidental injuries in the last 3-5 years before diagnosis of Parkinson’s disease , and in a previous study we found a lower muscle strength at military conscription in men who were diagnosed with  Parkinson’s disease three decades later. In this study, we aimed to investigate if such subtle strength deficits may translate into an increased risk of fall-related injuries. Medical Research: What are the main findings? Response: The median study time was 20 years before the diagnosis of  Parkinson’s disease , and during this time more individuals with PD (18%) than controls (11.5%) had at least one fall-related injury. The risk was most increased in the last few years before the diagnosis of  Parkinson’s disease , but a difference between the groups appeared already a decade before the PD diagnosis. The risk of hip fracture was increased during the entire study time of 26 years before the diagnosis of Parkinson’s disease . (more…)
Author Interviews, Hip Fractures, Medical Imaging, Osteoporosis / 25.01.2016

MedicalResearch.com Interview with: Margaret L. Gourlay, MD, MPH Assistant Professor UNC Department of Family Medicine Chapel Hill, NC 27599-7595 Medical Research: What is the background for this study? What are the main findings? Dr. Gourlay: While clinical practice guidelines universally recommend bone density screening for fracture prevention in women aged 65 years and older, minimal data exist to guide bone density screening in older men. We studied how often bone density screening tests should be ordered in men, using data from the Osteoporotic Fractures in Men (MrOS) Study. MrOS is the largest and longest-running (since 2000) US study of bone density and fracture in men aged 65 and older. After peak bone mass is reached in young adulthood, both men and women lose bone density as they get older. Based on our earlier findings in older women, we expected that men aged 65 and older with higher bone density T-score measurements (T-score >-1.50) on a first (baseline) bone density test would have a substantially longer estimated time to develop the lowest level of bone density (osteoporosis) than men with better baseline measurements. Clinicians want to know the time to osteoporosis because they prescribe osteoporosis treatments to prevent future fractures in elderly patients. As expected, we found that the men with higher baseline bone density had a much slower transition to osteoporosis compared to men with lower bone density. In fact, only nine out of 4203 (0.2%) of men with higher baseline bone density developed osteoporosis after an average of 8.7 years of bone density follow-up. That was much lower than we expected and is good news for men who have favorable scores on their first bone density test. Men who had lower baseline bone density measurements developed osteoporosis faster. Unfortunately, maintaining bone density above the osteoporosis range did not guarantee that men remained fracture-free.   Most of the major osteoporotic fractures (broken hip, spine, wrist or upper arm/shoulder) occurred in men who did not have osteoporosis. This might be because they had accidents or injuries that broke their bones despite their bone density being above the thinnest range. (more…)
Author Interviews, Exercise - Fitness, JAMA, Orthopedics, Pain Research / 11.01.2016

Daniel Steffens, Ph.D. The George Institute for Global Health The University of SydneyMedicalResearch.com Interview with: Daniel Steffens, Ph.D. The George Institute for Global Health The University of Sydney Medical Research: What is the background for this study? Dr. Steffens: Back pain is a leading cause of disease burden globally. At present, a variety of interventions, such as getting a mattress that can help with back pain, exercise, education, back belts and shoe insoles, are commonly prescribed to prevent an episode of low back pain. Guidelines lack clear recommendations for prevention of low back pain and the effectiveness of the range of possible prevention strategies for low back pain is not clear. Our study aimed to investigate the effectiveness of these interventions for prevention of low back pain. (more…)
Accidents & Violence, Author Interviews, CDC, Exercise - Fitness, Orthopedics, Pediatrics / 11.12.2015

MedicalResearch.com Interview with: Zachary Y. Kerr, PhD, MPH Sports Injury Epidemiologist Director, NCAA Injury Surveillance Program Datalys Center for Sports Injury Research and Prevention Indianapolis, IN 46202  Medical Research: What is the background for this study? What are the main findings? Dr. Kerr: The NCAA Injury Surveillance Program has been ongoing since 1982, but the Datalys Center for Sports Injury Research and Prevention began management in 2009.  We provide the NCAA sports and medical committees with evidence-based data they can use to make rule and policy decisions aimed at student-athlete health and safety.  However, among the research community, there lacks current injury incidence data across the collegiate student-athlete population. The main findings of this study is that the rate of injury was higher in competitions than in practices.  However, the total number of injuries estimated in practices exceeds that of competition, which suggests that interventions should be aimed at reducing injury incidence in both practices and competitions. (more…)
Author Interviews, Exercise - Fitness, Orthopedics / 01.12.2015

MedicalResearch.com Interview with: Uwe Schütz, M.D. Radiologist and specialist in orthopedics and trauma surgery Department of Diagnostic and Interventional Radiology University Hospital of Ulm Germany Medical Research: What is the background for this study? What are the main findings? Dr. Schütz: In this study, which is a small part of the Trans Europe Foot Race (TEFR) TEFR-project, we investigated the question, what happens to the joints, in detail to the joint cartilage of the lower extremities, when running 4500 km without any day rest for nearly 10 weeks. Is there really a risk for developing an arthrosis when doing this, like some researches and many physicians postulate? Well, what we find when accompanying 44 ultra-athletes with a modern 1.5Tesla MRI mounted on a custom made 38tonnes truck trailer day by day over 64 days on their way throughout whole Europe is, that the joint cartilage is initially altered by this running burden: It shows signals of cartilage matrix degradation beneath the first 1000 to 1500 km of running. But then the situation changes. When further running occurs, then the cartilage shows the ability to partially regenerate under ongoing running burden. This is a pretty new and astonishing finding, first time measured and observed in human joint in vivo. But knowledge of Scandinavian animal studies show the same behavior in dog cartilage. (more…)
Author Interviews, Blood Clots, Orthopedics, PLoS / 16.11.2015

MedicalResearch.com Interview with: Banne Nemeth, MD and  Suzanne C. Cannegieter MD PhD Leiden University Medical Center The Einthoven Laboratory for Experimental Vascular Medicine Clinical Department of Epidemiology and Orthopedic Surgery Medical Research: What is the background for this study? What are the main findings? Dr. Nemeth: Clinicians cannot currently accurately predict who will develop venous thrombosis, but it would be very helpful to be able to identify individuals at high risk for venous thrombosis because the condition can be prevented by giving anticoagulants before a clot forms (thromboprophylaxis). The ability to predict venous thrombosis would be particularly useful in patients who have had a lower limb immobilized in a cast after, for example, breaking a bone. These patients have an increased risk of venous thrombosis compared to patients without cast immobilization. We developed and validated a prediction model to identify patients with plaster cast of the lower extremity who are at high risk to develop venous thrombosis. A clinical risk score named, L-TRIP(cast) score (Leiden Thrombosis Risk Prediction for patients with cast immobilization score), was developed containing 14 clinical risk factors such as age, sex, BMI, use of oral contraceptives and location of plaster cast. Patients that score 9 points or higher are classified as being at high risk for venous thrombosis. Clinicians may decide to prescribe thromboprophylaxis therapy for these patients. (more…)
Author Interviews, Orthopedics, Pediatrics / 30.10.2015

MedicalResearch.com Interview with: Alex L. Gornitzky Medical Student and Theodore J. Ganley, M.D. Director of Sports Medicine, The Children’s Hospital of Philadelphia Associate Professor of Orthopaedic Surgery, The University of Pennsylvania School of Medicine Medical Research: What is the background for this study? Response: Currently, more than half of all high school students participate in organized athletics, and with increasing participation the incidence of ACL injury and subsequent reconstruction are also rising. Furthermore, researchers also know that adolescent and high school athletes have a number of unique risk factors that differentially affect their ACL injury risk profile as compared to older and/or more experienced athletes. To our knowledge, however, no previous studies have described sport-specific seasonal risk for ACL tears in the high school athlete by gender and by sport. More specifically, parents and athletes currently have no available information to more accurately define what their personal risk is for such an important and devastating injury. Therefore, the purpose of our study was to pool data from across the literature in order to objectively quantify an average high school athlete’s risk for ACL injury per season across a variety of varsity-level sports. If a student is injured while playing sports and the school doesn't deal with the injury correctly then it could make the issue worse. This is why it is important for schools to correctly identify is the player has suffered an ACL injury. If you have suffered an injury at school that wasn't properly dealt with then you may want to check out someone like these new york personal injury lawyers to see if you can get compensation. This study will hopefully help students see the risk of them getting an injury meaning they can take measures to prevent one happening to them. Medical Research: What are the main findings? Response: Overall, there is an approximately 1.6 times greater rate of ACL tear per athletic exposure in high school female athletes as compared to males. On a per-season basis, the highest risk sports in females were soccer, basketball and lacrosse at 1.1%, 0.9% and 0.5% risk of ACL tear per athletic season. Comparatively, in males, the highest risk sports were football, lacrosse and soccer at 0.8%, 0.4% and 0.3% risk of ACL tear per athletic season. Looking further at the year-round, multi-sport athlete, this may correspond to either a 2.5% risk per-year or 10% risk per high school career for the female athlete who participates in soccer, basketball and lacrosse, or 1% and 4%, respectively, for the male athlete who plays football, basketball and baseball. (more…)
Anesthesiology, Author Interviews, Orthopedics, Race/Ethnic Diversity / 26.10.2015

MedicalResearch.com Interview with: Jashvant Poeran MD PhD Assistant Professor Dept. of Population Health Science & Policy Icahn School of Medicine at Mount Sinai New York, NY Medical Research: What is the background for this study? Dr. Poeran: Neuraxial anesthesia and peripheral nerve blocks  are two techniques for regional anesthesia for hip and knee replacements. Compared to general anesthesia, these two regional anesthesia techniques are increasingly seen as ‘higher quality care’ as a growing number of studies show that patients have better outcomes after surgery when regional anesthesia is used. However, less is known about the factors that influence the process of anesthetic care. This is important information because the choice for regional anesthesia might affect outcomes after hip and knee replacement surgery. We therefore used a large national database of health claims of hip and knee replacement procedures to study if specific patient subgroups were less likely to receive regional anesthesia. (more…)
Author Interviews, NEJM, Orthopedics / 22.10.2015

MedicalResearch.com Interview with: Søren Thorgaard Skou PT, PhD Postdoc Research Unit for Musculoskeletal Function and Physiotherapy University of Southern Denmark Clinical Nursing Research Unit Aalborg University Hospital  Medical Research: What is the background for this study? What are the main findings? Response: Total knee replacement has been performed for decades. The number of procedures are increasing and is expected to reach 1 million procedures per year in the US alone in the near future, highlighting the associated future economic burden. However, no studies have compared it to non-surgical alternatives, even though this is important to investigate its effectiveness. We found that in patients with knee osteoarthritis eligible for total knee replacement, treatment with total knee replacement followed by non-surgical treatment (exercise, education, dietary advice, use of insoles, and pain medication) were associated with greater pain relief and functional improvement after 12 months than the non-surgical treatment alone. However, both groups had clinically relevant improvements, and patients who underwent total knee replacement had more serious adverse events. Furthermore, most patients who were assigned to receive non-surgical treatment alone did not undergo total knee replacement within the 12 months. (more…)
Author Interviews, JAMA, Orthopedics / 07.10.2015

Dr. Anne Moseley Senior Research Fellow, Musculoskeletal Division The George Institute for Global Health Sydney Australia MedicalResearch.com Interview with: Dr. Anne Moseley Senior Research Fellow, Musculoskeletal Division The George Institute for Global Health Sydney Australia  Medical Research: What is the background for this study? What are the main findings? Dr. Moseley: Ankle fracture is a common injury and is treated with reduction (realignment), sometimes with surgical fixation, followed by a period of immobilization while the fracture heals. Rehabilitation addresses the detrimental effects of the ankle fracture and the subsequent immobilization. Supervised exercise programmes are a common form of rehabilitation traditionally offered to some patients. The benefits of supervised exercise after immobilization for ankle fracture has been unclear. We conducted a clinical trial to determine the effectiveness and cost-effectiveness of a supervised exercise programme and advice about self-management ("rehabilitation" group) compared to advice about self-management alone. Contrary to accepted wisdom, we found that a supervised exercise programme did not offer advantages over physical therapist-prescribed self-management. (more…)
Author Interviews, BMJ, Bone Density, Calcium, Mineral Metabolism, Orthopedics / 03.10.2015

MedicalResearch.com Interview with: Dr. Mark J Bolland Associate professor of medicine Department of Medicine University of Auckland Auckland New Zealand Medical Research: What is the background for this study? Dr. Bolland: Many guidelines advise older people to take at least 1000-1200 mg/day of calcium to improve bone density and prevent fractures. The average calcium intake in most countries is a lot less than these recommendations, and so many people take calcium supplements to increase their calcium intake. However, recent concerns about the safety of calcium supplements have led experts to recommend increasing calcium intake through food rather than by taking supplements, even though the effect of increasing dietary calcium intake on bone health had not been clearly established. Our study was designed to fill this evidence gap. Medical Research: What are the main findings? Dr. Bolland: Firstly, we found that increasing calcium intake either from the diet or by taking calcium supplements led to similar, small, one-off increases in bone density of 1-2%. These increases do not build up over time and are too small to produce significant reductions in the chance of having a fracture. Secondly, the level of dietary calcium intake is not associated with the risk of having a fracture. Thirdly, in clinical trials, calcium supplements have only small, inconsistent benefits on preventing fractures, with no effect on fractures seen in the highest quality trials (more…)
Author Interviews, Exercise - Fitness, Orthopedics, Rheumatology / 14.09.2015

Dr. Kristi Elisabeth Heiberg PhD Post.doc Department of Medical Research Baerum Hospital Vestre Viken Hospital TrustMedicalResearch.com Interview with: Dr. Kristi Elisabeth Heiberg PhD Post.doc Department of Medical Research Baerum Hospital Vestre Viken Hospital Trust Medical Research: What is the background for this study? Dr. Heiberg: This study is a long term follow-up of 60 patients who suffered from hip osteoarthritis and were treated with total hip arthroplasty (THA) approximately 5 years earlier. In a prior study, the patients participated in a RCT study, examining the effects of a supervised walking skill training program on physical functioning, pain and self-efficacy (1). The training program was performed between three and five months after surgery, and it was compared to a control group without supervised physiotherapy in the same time span. The results showed that immediately after the walking skill training intervention was completed, several outcome variables were statistically significant more improved in the training group than in the control group, and at one year after surgery the statistically significant effect on walking capacity (measured by the 6-min walk test) still sustained. Few long-term follow-up of RCTs regarding physical functioning in patients after total hip arthroplasty are previously published. Furthermore in another prior study, we examined the recovery of the total group of the same patients from preoperatively to one year after surgery (2). The results showed that the patients were statistically significant improved in all outcomes of physical functioning, pain and self-efficacy during the first year, but they still did not quite reach the level of healthy peers in walking capacity. In line with this, they also reported one year after surgery that they wanted to further improve their ability to walk and to participate in recreational activities (3). However, it seems that patients’ desires regarding physical activity are poorly understood and have received relatively little evaluation, although regular physical activity is considered to be one of the most important lifestyle behaviors affecting health. Only few prior studies have examined the long term recovery of physical functioning and the impact on physical activity. Therefore, in this present 5-year follow-up study after total hip arthroplasty the aims were threefold.
  • First, to examine the long-term effect from the supervised walking skill training program on physical functioning, pain and self-efficacy;
  • Second, to examine the long-term recovery of physical functioning from one to five years; and
  • Third, to identify predictors of physical activity outcome five years after THA among personal and preoperative variables (4).
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Anesthesiology, Author Interviews, Orthopedics, Surgical Research / 04.09.2015

Dr. Gregory M.T. Hare MD PhD Department of Anesthesia St. Michael's HospitaMedicalResearch.com Interview with: Dr. Gregory M.T. Hare MD PhD Department of Anesthesia St. Michael's Hospital Medical Research: What is the background for this study? What are the main findings? Dr. Hare: While many randomized trials had demonstrated that tranexamic acid (TXA therapy) was effective at reducing surgical blood loss and red blood cell transfusion in patients undergoing hip and knee replacement surgery, our hospital and many other centers in Ontario were not fully utilizing this therapy. Part of the reason was a concern about drug safety and potential side effects. While no serious adverse events had been reported using TXA, we set out to assess the impact of a protocol designed to ensure that we administered TXA (20 mg/kg iv preoperatively) to all eligible patients undergoing hip and knee replacement and determining the effect on our red blood cell transfusion rate and adverse effects including blood clot, stroke, heart attack, kidney injury and death. We excluded patients at high risk of any thrombotic complication. After implementing our protocol, we increased utilization of the drug from 46% to 95% of eligible patients. With this increase in TXA use, we observed a 40% reduction in red blood cell transfusion. The impact was greater in patients with pre-operative anemia, but was also effective in non-anemic patients. The threshold for transfusion was not different after initiating our protocol and patients were discharged with higher red blood cell counts. Length of hospital stay remained constant and the incidence of adverse events did not increase. (more…)
Author Interviews, JAMA, Orthopedics, Surgical Research / 22.08.2015

MedicalResearch.com Interview with: Sandrine Colas, MSc, MPH Department of Epidemiology of Health Products French National Agency for Medicines and Health Products Safety (ANSM) Saint-Denis, France Medical Research: What is the background for this study? What are the main findings? Response: Total hip replacement (THR) is to replace a damaged coxofemoral joint with a prosthetic implant. Primary or secondary degenerative osteoarthritis of the hip joint is the main indication for THR (other indications are essentially trauma, which is more common in the elderly and mostly affects women over 80 years of age). The number of THR has increased in all industrialized countries, particularly on account of the ageng population.Total hip replacement is one of the most common and successful surgical procedures in modern practice. Although results are generally good, revision (consisting in changing one or all components of the implant) is sometimes necessary (about 1% per year). Prosthetic revision is a longer and more complex operation than primary implantation and it has a higher incidence of post-surgical complications. Several prosthetic revision risk factors have been highlighted recently in published studies, but results relating to prosthetic and/or patient characteristics and total hip replacement survivorship tend to vary. The existence of an association between the fixation technique and/or bearing surface and prosthetic survivorship has yet to be established. The main aim of our work was therefore to compare total hip replacement short-term survivorship according to cement type and bearing surface, in a large population of subjects who have undergone total hip replacement for reasons other than trauma (25%) and bone tumor (<0.1%), taking prosthetic revision risk factors (age, gender, comorbidities, concomitant medication, implanting center, etc.) into account. Total hip replacement characteristics are related to early implant survivorship. After 33 months of follow-up, antibiotic-impregnated cemented THRs have a better prognosis. MoM total hip replacemenst have a slightly worse prognosis. (more…)
Author Interviews, Osteoporosis / 17.08.2015

MedicalResearch.com Interview with: Prof. Jonathan M. Hodgson School of Medicine and Pharmacology Royal Perth Hospital University of Western Australia Perth, Australia MedicalResearch What is the background for this study? What are the main findings? Prof. Hodgson: Flavonoids are a class of phytochemicals present at high levels in tea. Observational studies have found that higher tea and flavonoid intakes are associated with higher bone mineral density. However, the relationships of tea and flavonoid intakes with fracture risk are not clear. We therefore examined the relationship of black tea drinking and flavonoid intake with fracture risk in a population of women aged over 75 years followed for 10 years. We found that a higher intake of black tea and particular classes of flavonoids, some of which are derived primarily from tea, were associated with lower risk of fracture-related hospitalizations in these elderly women. (more…)
Author Interviews, Orthopedics, Surgical Research / 08.08.2015

Frank R. Noyes, M.D. President and Medical Director, Noyes Knee Institute and the Cincinnati Sports medicine Research and Education Foundation Cincinnati, OhioMedicalResearch.com Interview with: Frank R. Noyes, M.D. President and Medical Director, Noyes Knee Institute and the Cincinnati Sports medicine Research and Education Foundation Cincinnati, Ohio MedicalResearch: What is the background for this study? Dr. Noyes: Meniscectomy, or removal of the meniscus in the knee, frequently leads to early arthritis – especially in younger active individuals. The meniscus provides a cushion between the femur (thigh bone) and tibia (shin bone) and aids in keeping the knee stable. There are two menisci in the human knee; one on the inner portion (medial) and one on the outer portion (lateral). The problem is that once a meniscus is removed, there are no options for patients who experience knee pain other than a transplant. The operation uses human cadaver menisci from young donors that are implanted intact into the recipient’s knee. This operation has been performed at our Center for 25 years in patients who are typically under the age of 50 and who have some arthritis in their knee and experience pain with activity. There are few long-term clinical studies on meniscus transplantation that provide results in patients who are at least 10 years postoperative. MedicalResearch: What are the main findings? Dr. Noyes: This study reports the long-term results and survival analysis of 40 consecutive meniscus transplants, with a 100% follow-up obtained an average of 11 years postoperatively. The survivor analysis, which included magnetic resonance imaging (MRI) and x-ray criteria in addition to symptoms and clinical examination, revealed transplant survival rates of 68% at 7 years and 48% at 10 years postoperatively. The results of the symptom and activity level analyses in patients without failure of the transplant showed that only 11% experienced pain with daily activities and 72% were able to participate in low-impact athletics many years after surgery. (more…)
Author Interviews, Hip Fractures, JAMA, Menopause, Osteoporosis, Vitamin D / 05.08.2015

MedicalResearch.com Interview with: Karen E. Hansen, M.D., M.S. Associate Professor of Medicine University of Wisconsin School of Medicine and Public Health Madison, WI 53705-2281 Medical Research: What is the background for this study? Dr. Hansen: The USPTF says to older community dwelling adults, "don't bother taking vitamin D", the Endocrine Society says "take 2,000-4,000 IU daily" and the Institute of Medicine gave an RDA of 600-800 IU daily. The Endocrine Society argues that optimal vitamin D levels are 30 ng/mL and higher, while the Institute of Medicine concludes that 20 ng/mL and higher indicates optimal vitamin D status. The disagreement between experts prompted my study. Medical Research: What are the main findings? Dr. Hansen: Among postmenopausal women whose vitamin D level was ~21 ng/mL at baseline, there was no benefit of high-dose or low-dose vitamin D, compared to placebo, on spine/hip/total body bone mineral density, muscle fitness by 5 sit to stand test or Timed Up and Go, or falls. We did see a small 1% increase in calcium absorption in the high-dose vitamin arm, but this small increase did not translate into clinically meaningful changes in bone density or muscle tests. (more…)
Author Interviews, Hip Fractures, Kidney Stones, Menopause, Osteoporosis / 22.07.2015

Monique Bethel, MD Subspecialty Service, Department of Veterans Affairs Medical Center, Department of Medicine, Section of Rheumatology Georgia Regents University Augusta, GAMedicalResearch.com Interview with: Monique Bethel, MD Subspecialty Service, Department of Veterans Affairs Medical Center, Department of Medicine, Section of Rheumatology Georgia Regents University Augusta, GA MedicalResearch: What is the background for this study? Dr. Bethel: Osteoporosis and kidney stones share several risk factors, including elevated calcium in the urine (hypercalciuria), low potassium intake, and possibly, diets high in sodium. Accordingly, several studies have shown a significant relationship between kidney stones and osteoporosis in men. However, it is unclear if this relationship is also true for women. Previous studies examining this association have been small and inconclusive.   With the Women’s Health Initiative, we had data available from approximately 150,000 postmenopausal women in the US. Using this database, we were able to study the relationship between kidney stones and changes in bone mineral density and fractures. MedicalResearch: What are the main findings? Dr. Bethel: We found no association between the presence of kidney stones and changes in bone mineral density over time at the hip, lumbar spine, or the whole body. Also, there was no association between the presence of kidney stones and fractures. We also found that 14% of women who had a history of kidney stones upon entering the studies had another one occur during the course of the study (approximately 8 years). (more…)
Author Interviews, Cannabis, Orthopedics / 20.07.2015

Yankel Gabet, DMD, PhD Department of Anatomy and Anthropology Sackler Faculty of Medicine, Tel Aviv University Tel Aviv IsraelMedicalResearch.com Interview with: Yankel Gabet, DMD, PhD Department of Anatomy and Anthropology Sackler Faculty of Medicine, Tel Aviv University Tel Aviv Israel Medical Research: What is the background for this study? What are the main findings? Dr. Gabet: Cannabis affects the body via specific components that are able to binding to receptors in the brain and other tissues. The components include the well-known ?9-tetrahydrocannabinol (THC) and cannabidiol (CBD), the major constituents of cannabis. The cannabinoid receptors in our body are activated by several molecules (‘endocannabinoids’) synthesized by different sorts of cells under specific conditions. These receptors can be activated by synthetic compounds (cannabinoid ligands) as well as by natural cannabis. The effect of endocannabinoids in bone metabolism has been studied before but this study is the first report on the actions of natural THC and CDB in bone fracture healing. This is particularly important in light of the high incidence of both cannabis use and bone fractures; it is likely that many patients suffering from bone fractures consume cannabis that may have beneficial or adverse effects on the healing process. Another important point is that the non-psychogenic CDB is enough to promote bone healing, so there is no need to be exposed to the euphoric effects of cannabis/THC to get the beneficial functions of CBD on bone. (You can buy cbd oil online to help with other conditions as well such as fibromyalgia and diabetes.) If you are interested in learning more about CBD/THC and its products there are places online where you can find information, for example, from an online cbd store, a CBD Blog and other resources. (more…)
Author Interviews, Orthopedics, Surgical Research / 13.07.2015

Brett D. Owens, MD Professor of Orthopaedic Surgery Brown University Alpert Medical School Providence, RIMedicalResearch.com Interview with: Brett D. Owens, MD Professor of Orthopaedic Surgery Brown University Alpert Medical School Providence, RI Medical Research: What is the background for this study? What are the main findings? Response: Last year at this meeting we presented the results of a prospective multicenter study of collegiate contact athletes who experienced in-season shoulder instability events. While most were able to return to sport within a week, only roughly one quarter were able to successfully return without recurrent instability. We continued to follow this cohort and 39 athletes with additional eligibility the subsequent season. We found that 90% of the 29 who underwent arthroscopic stabilization successfully returned the next season compared with 40% of the 10 underwent nonoperative treatment (more…)
Author Interviews, BMJ, Brigham & Women's - Harvard, Menopause, Orthopedics / 26.06.2015

MedicalResearch.com Interview with: Dr Matthew Miller Department of Health Science Northeastern University Department of Health Policy and Management, Harvard T.H. Chan School of Public Health Harvard University Boston, Massachusetts and Yi-Han Sheu Department of Epidemiology Harvard T.H. Chan School of Public Health Harvard University Boston, Massachusetts Medical Research: What is the background for this study? Response: Selective serotonin reuptake inhibitors (SSRIs) were recently approved by the FDA to treat vasomotor symptoms associated with menopause. No prior study has directly examined whether fracture risk is increased among perimenopausal women who initiate SSRIs or among a population of women without mental disorders more generally.. Medical Research: What are the main findings? Response: We found that SSRIs treatment for non-psychiatric conditions at doses customarily used to treat depression is, all else equal, associated with higher rates of fractures -- an effect that first became evident several months after beginning treatment and, importantly, persisted over the five year study period. (more…)
Author Interviews, BMJ, Osteoporosis, Pediatrics / 12.06.2015

Anne Winther Msc Department of Health and Care Sciences, UiT The Arctic University of Norway Division of Rehabilitation Services, University Hospital of North Norway, Tromsø, NorwayMedicalResearch.com Interview with: Anne Winther Msc Department of Health and Care Sciences, UiT The Arctic University of Norway Division of Rehabilitation Services, University Hospital of North Norway, Tromsø, Norway Medical Research: What is the background for this study? What are the main findings? Response: Norway has one of the highest reported incidences of osteoporotic fractures in the world. Research on fracture risk has primarily focused on bone mass in the elderly. However, there is a growing awareness of the importance of bone mass during growth as a compensation for the inevitable bone loss and prevention of fractures in the elderly . A recent study on Norwegian adolescents´ lifestyle and bone health concluded  that peak bone mass seem to be modifiable by lifestyle factors as higher physical activity levels were strongly associated with bone mass. The other way around; low levels of physical activity may have considerable negative effects on bone health, and increasing sedentary behavior in place of sports and play during growth is worrying. In this study we explored the associations between self-reported hours spent in front of television/computers during weekends along with self reported hours spent on leisure time physical activities and bone mass density (BMD) levels at the hip. This population based study, Fit Futures 1 consisting of 388 girls and 359 boys 15-17 years old was conducted in 2010/2011, and repeated two years later including 66% of the original cohort (Fit Futures 2; 312 girls and 231 boys). Boys spent more time in front of computers and television than girls; approximately 5 and 4 hours, compared with 4 and 3 hours daily in weekends and weekdays, respectively. Physical activity levels were adversely related to leisure time computer use at weekends. However, 20 % of the girls and 25 % of the boys balanced 2-4 hours in front of the screen daily with more than 4 hours of sports and hard training per week. Screen time at weekends was negatively associated with bone mass density levels in boys and positively in girls, after adjustments of several confounders known to affect bone, including age, puberty, physical activity levels and weekday screen time. Moreover; these contrasting patterns persisted two years later. (more…)
Author Interviews, Opiods, Orthopedics, Pain Research, Surgical Research / 02.06.2015

MedicalResearch.com Interview with: Winfried Meissner, M.D. Dep. of Anesthesiology and Intensive Care Jena University Hospital University Hospital Jena, Germany Medical Research: What is the background for this study? Dr. Meissner: Post-operative pain is managed inadequately worldwide. There are probably many reasons for this, one of which may be lack of evidence about outcomes of treatment in the clinical routine. PAIN OUT was established  as a  multi-national research network and quality improvement project offering healthcare providers  validated tools to collect data about pain-related patient reported outcomes and management after surgery. Patients fill in a questionnaire asking for pain intensity, pain interference and side effects of pain management. The questionnaire has now been translated into 20 languages. Data are collected electronically and clinicians are provided with feedback about management of their own patients, compared to similar patients in other hospitals.  Furthermore, the findings are used for outcomes and comparative effectiveness research. PAIN OUT is unique in that  outcomes of postoperative pain management can be examined internationally. PAIN OUT was created in 2009 with funds from the European Commission, within the FP7 framework and  has now been implemented in hospitals in Europe, USA, Africa and SE Asia. The findings allow us to gain insights as to how pain in managed in different settings and countries. For this particular study, we compared management of pain in the US to other countries. We assessed a large group of patients who underwent different types of orthopedic surgery and compared their patient reported outcomes and management regimens. We included 1011 patients from 4 hospitals in the USA  and 28,510 patients from  45  hospitals in 14 countries (“INTERNATIONAL”). Medical Research: What are the main findings? Dr. Meissner: Postoperative pain intensity of US patients was higher than in INTERNATIONAL patients; they felt more often negatively affected by pain-associated anxiety and helplessness, and more US patients stated they wished to have received more pain treatment. However, other patient-reported outcomes like time in severe pain or the level of pain relief did not differ. We found that treatment regiments of American patients differed compared to INTERNATIONAL patients. More US patients received opioids, and their opioid doses were higher compared to INTERNATIONAL patients. In contrast, INTERNATIONAL countries use more nonopioid medications intraoperatively and postoperatively. Thus, under-supply with opioids cannot explain our findings. Mean BMI of US patients was 30.3 while for INTERNATIONAL it was 27.4. However, insufficient evidence exists that this finding might account for differences in pain intensity. Routine pain assessment was performed in almost all US patients, in contrast to about 75% in the INTERNATIONAL group. Obviously, routine pain assessment, as practiced in the United States, fails to result in lower postoperative pain. Perhaps it has the opposite effect by directing patients’ attention to the pain. (more…)