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).
(more…)
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…)
Author Interviews, Opiods, Orthopedics, Pain Research, Pharmacology / 08.05.2015

Hassan R. Mir, MD, MBA Associate professor of Orthopaedics and Rehabilitation Vanderbilt Orthopaedic InstituteMedicalResearch.com Interview with: Hassan R. Mir, MD, MBA Associate professor of Orthopaedics and Rehabilitation Vanderbilt Orthopaedic Institute and and Brent J. Morris, M.D. Shoulder and Elbow Surgery Fellowship Texas Orthopaedic Hospital in affiliation with the University of Texas Houston Health Science Center, Houston, TexasDr. Brent J. Morris, M.D. Shoulder and Elbow Surgery Fellowship Texas Orthopaedic Hospital University of Texas Houston Health Science Center, Houston, Texas Medical Research: What is the background for this study? What are the main findings? Dr. Mir: The past few decades have seen an alarming rise in opioid use in the United States, and the negative consequences are dramatically increasing. The US represents less than 5% of the world's population, yet consumes 80% of the global opioid supply. Management of pain is an important part of patient care, however, the increased usage of opioids for the treatment of pain has led to several unanticipated aftereffects for individual patients and for society at large. Orthopaedic surgeons are the third highest prescribers of opioid prescriptions among physicians in the United States. Orthopaedic patients can experience a tremendous amount of pain with acute injuries and chronic conditions, and the treatment plan may involve opioid prescriptions for relief of discomfort. A significant number of orthopaedic patients and their families are at risk for repercussions from opioid use. We must work together to decrease the use of opioids for musculoskeletal pain. Clinicians should aim to control pain and improve patient satisfaction while avoiding overprescribing opioids. A comprehensive strategy of risk assessment is needed to identify patients who may be at risk for opioid abuse. Objective measures including patient history, recognition of aberrant behavior, urine drug testing, state prescription drug–monitoring programs, and opioid risk-assessment screening tools may be necessary in select cases. (more…)
Author Interviews, Occupational Health, Orthopedics / 06.04.2015

Thomas Karakolis Department of Kinesiology University of Waterloo Waterloo, Ontario, CanadaMedicalResearch.com Interview with: Thomas Karakolis Department of Kinesiology University of Waterloo Waterloo, Ontario, Canada Medical Research: What is the background for this study? What are the main findings? Response: Major League Baseball (MLB) pitchers have an injury rate approaching 1 in 4, depending on the study you look at. As an occupational injury rate, this number is extremely high. In fact, I think you would be hard pressed to find another industry where the injury rate is that high. One way that coaches and managers in MLB are trying to lower the injury rate is to restrict the total 'workload' on pitchers per season. Particularly in young pitchers, many MLB organizations restrict the number of innings a pitcher can pitch based upon the number of innings they pitched the previous year. Essentially, they are using innings pitched as a surrogate for workload. If this is an effective strategy, you would expect a correlation between the increase in number of innings pitched between successive seasons and future injury. Our study found that no such correlation exists. Innings pitched does not appear to be a sensitive enough measure to asses the true workload a pitcher experiences throughout the season. (more…)
Author Interviews, JAMA, Orthopedics, Surgical Research / 11.03.2015

Prof. Amar Rangan Clinical Professor, Trauma & Orthopaedic Surgery School of Medicine & Health, Durham University & Consultant Orthopaedic Surgeon The James Cook University Hospital MiddlesbroughMedicalResearch.com Interview with: Prof. Amar Rangan Clinical Professor, Trauma & Orthopaedic Surgery School of Medicine & Health, Durham University & Consultant Orthopaedic Surgeon The James Cook University Hospital Middlesbrough Medical Research: What is the background for this study? What are the main findings? Prof. Rangan: The majority of fractures of the proximal humerus (broken shoulders) occur in people older than 65 years. Although surgical treatment is being increasingly used for the more serious (displaced) fractures, it has been unclear whether surgical intervention (fracture fixation or humeral head replacement) produces consistently better outcomes than non-surgical treatment (arm-sling); both followed by physiotherapy. Our multicentre randomized controlled trial (ProFHER), funded by the UK National Institute for Health Research’s Health Technology Assessment Programme, recruited 250 patients aged 16 years or older (mean age, 66 years) who presented at the orthopedic departments of 32 acute UK National Health Service hospitals between September 2008 and April 2011 after sustaining the most common types of acute displaced fracture of the proximal humerus. Data for 231 patients (92.4% of 250) included in the primary analysis showed that there was no significant difference between the two treatment groups over two years or at 6, 12 and 24 months follow-up in self-reported pain and function scores. Nor were there significant differences on measures of health-related quality of life, complications related to surgery or shoulder fracture, later surgery or treatment for these complications, and death. (more…)
Author Interviews, Geriatrics, Hip Fractures, Lancet / 06.02.2015

Ingvild Saltvedt PhD Department of Neuroscience, Norwegian University of Science and Technology, Medical Faculty Trondheim, Norway MedicalResearch.com Interview with: Ingvild Saltvedt PhD Department of Neuroscience, Norwegian University of Science and Technology, Medical Faculty Trondheim, Norway Medical Research: What is the background for this study? What are the main findings? Dr. Saltvedt: Hip fracture patients are often old, frail and have many comorbidities. When treated with a traditional orthopaedic approach the outcomes are often poor, and many patients get functionally impaired with reduced ability to walk independently and impairment in daily life activities and with high costs for the society.  In many ways these patients are geriatric patients with hip-fractures. It has previously been shown that acutely sick geriatric patients benefit from treatment in geriatric wards and different kind of  orthogeriatric treatment models where orthopaedic surgeons and geriatricians collaborate have been studied and have shown beneficial results on short term outcomes. In the present study patients home-dwelling hip-fracture patients were randomised to orthogeriatric treatment or traditional orthopaedic treatment from admission to the hospital and during the entire stay except for the surgery that was performed similar in both groups. The study focused on long-term outcomes and also on use of health care services and cost-effectiveness.  Patients in the orthogeriatric group got comprehensive geriatric assessment and treatment performed by an interdisciplinary team that emphasised early mobilisation and rehabilitation and started discharge planning early. In the orthopaedic group traditional treatment according to national and international guidelines was offered. The primary endpoint was mobility at four months, that was better in the orthogeriatric group than in the orthopaedic group, the same difference was also shown at 12 months. In addition there were differences in instrumental activities of daily living and personal activities of daily living, quality of life and fear of falling, all differences were statistically and clinically significant and in favour of the orthoegeriatric group. The length of hospital stay was 1,7 days longer in the geriatric group, while there was no differences in days spent in hospital during one year of follow-up. One of four orthogeriatric patients were discharged directly home as compared to one of ten in the orthopaedic group. The orthopaedic group spent more days in nursing homes and rehabilitation institutions during one year of follow-up. The treatment was cost-effective in favour of the orthogeriatric group. (more…)
Orthopedics, Radiology / 04.12.2014

Frank W. Roemer, MD Associate Professor of Radiology Co-Director, Quantitative Imaging Center (QIC), Department of Radiology Boston University School of Medicine Boston MA 02118MedicalResearch.com Interview with: Frank W. Roemer, MD Associate Professor of Radiology Co-Director, Quantitative Imaging Center (QIC), Department of Radiology Boston University School of Medicine and Associate Professor of Radiology, University of Erlangen-Nuremberg, Germany Medical Research: What is the background for this study? What are the main findings? Dr. Roemer: Meniscal surgery is one of the most common orthopedic procedures performed in order to alleviate pain and improve joint function. However, increasing evidence is emerging that suggests that meniscal resection is detrimental for knee joint preservation including accelerated rates of OA and joint deterioration defined as cartilage loss. Our study focuses on disease onset and shows that structural damage due to surgery might also be observed in these early stages of disease. In light of this the indications for performing meniscal surgery might need to be defined more stringently as is the case today in order to preserve joint structure in the long term. (more…)
Author Interviews, JAMA, Osteoporosis, Pharmacology, Testosterone / 03.12.2014

MedicalResearch.com Interview with: Shabbir M. H. Alibhai, MD, MSc and Husayn Gulamhusein, BHSc Department of Medicine, University Health Network Toronto, Ontario, Canada Medical Research: What is the background for this study? What are the main findings? MedicalResearch: In 2009, we published a research letter in JAMA which examined the rate of bone mineral density (BMD) testing in men starting androgen deprivation therapy (ADT) in the province of Ontario, Canada, between 1995 and 2008. Despite being recommended as a tool to better characterize fracture risk and optimize bone health, use of bone mineral density testing was low throughout the study period. This current study focuses on another aspect of bone health, which is the use of bisphosphonates among men undergoing androgen deprivation therapy for prostate cancer. Bisphosphonates are generally safe and effective medications that can reduce fracture risk particularly in those at higher risk of future fracture. Throughout the 17-year study period, we found that rates of new prescriptions for bisphosphonates remained low. Even when focusing on those men who should be receiving bisphosphonates as per Canadian guidelines due to their high risk for future fracture, i.e. those with a prior fragility fracture or prior diagnosis of osteoporosis, prescription rates remained low. Moreover, in all three groups, new bisphosphonate prescriptions dipped between the 2007-09 and 2010-12 time periods. This may be partly due to recent negative media attention regarding the association of bisphosphonates with rare but serious side effects (i.e. osteonecrosis of the jaw and atypical femoral fracture). (more…)
Author Interviews, CMAJ, Orthopedics, Surgical Research / 27.11.2014

MedicalResearch.com Interview with: NatNathan Evaniew MD Division of Orthopaedics McMaster Universityhan Evaniew MD Division of Orthopaedics McMaster University   Medical Research: What is the background for this study? Dr. Evaniew: Symptomatic cervical and lumbar spinal disc diseases affect at least 5% of the population and they cause a great deal of pain, disability, social burden, and economic impact. For carefully selected patients that fail to improve with nonsurgical management, conventional open discectomy surgery often provides good or excellent results. Minimally invasive techniques for discectomy surgery were introduced as alternatives that are potentially less destructive, but they require specialized equipment and expertise, and they may involve increased risks for technical complications. (more…)
Author Interviews, Orthopedics, Pediatrics, Rheumatology / 06.11.2014

Professor Flavia Cicuttin School of Public Health and Preventive Medicine Monash University and Alfred Hospital Melbourne, AustraliaMedicalResearch.com Interview with: Professor Flavia Cicuttin School of Public Health and Preventive Medicine Monash University and Alfred Hospital Melbourne, Australia Medical Research: What is the background for this study? What are the main findings? Prof. Cicuttin: Previous research found that low birth weight and preterm birth have been linked to hypertension, cardiovascular disease, insulin resistance and reduced bone mass in adulthood.  Given these adverse outcomes related to birth weight and preterm birth we set out to investigate if low birth weight and preterm birth also played a role in increase risk of joint replacement surgery as adults. We found that  low birth weight and preterm birth were associated with a 2-fold increased risk of hip but not knee replacement surgery. (more…)
Author Interviews, BMJ, Orthopedics / 29.10.2014

MedicalResearch.com Interview with: Professor Karl Michaëlsson Professor in Medical Epidemiology, Senior Consultant in Orthopaedic Surgery Uppsala Clinical Research Institute MedicalResearch.com Interview with: Professor Karl Michaëlsson Professor in Medical Epidemiology, Senior Consultant in Orthopaedic Surgery Uppsala Clinical Research Institute Medical Research: What are the main findings of the study? Prof. Michaëlsson: A high milk intake is recommended for the prevention of osteoporotic fractures but milk is also the major dietary source of galactose intake. The addition of galactose by injection or in the diet is an established animal model of aging by induction of oxidative stress and inflammation. Previous research results regarding the importance of milk intake for the prevention of fractures and the influence on mortality rates are conflicting. High milk intake was in our study associated with higher mortality in one cohort of women and in another cohort of men, and with higher fracture incidence in women. In subsamples of two additional cohorts, one in males and one in females, a positive association was seen between milk intake and both urine 8-iso-PGF2α (a biomarker of oxidative stress) and serum interleukin 6 (a main inflammatory biomarker). (more…)
Author Interviews, Orthopedics / 02.10.2014

Dr. Bruce Beynnon McClure Professor of Musculoskeletal Research Dept Orthopedics and Rehabilitation University of Vermont College of Medicine Burlington, VT 05405-0084MedicalResearch.com Interview with: Dr. Bruce Beynnon McClure Professor of Musculoskeletal Research Dept Orthopedics and Rehabilitation University of Vermont College of Medicine Burlington, VT 05405-0084 Medical Research: What are the main findings of the study? Dr. Beynnon: The anterior cruciate ligament (ACL) is an important stabilizer of the joint, and the study investigated how geometry of this ligament and surrounding bone is related to non-contact injury of this ligament. Specifically, the study focused on MRI-based measurements of the size of the ACL, measured as its volume, and the size of the femoral intercondylar notch, or the small space located in the center of the femur in which the ACL resides. Our study revealed that a decrease in the volume of the ACL and a decrease in the size of the intercondylar notch were associated with an increased risk of suffering a non-contact ACL injury in athletes. This finding may be explained by the fact that a smaller ligament is associated with a decrease in its biomechanical properties, such as a smaller ultimate failure load. An alternative explanation is that a decreased femoral intercondylar notch size could result in a greater tendency for the ACL to impinge against the walls of the femoral notch during high demand activities, and increase the risk of injury. The investigation was a longitudinal study with a nested case-control analysis of young, healthy high school and college athletes. The investigation was rigorously designed to control for age, sex, and participation on the same sports team. This enabled us to determine which combination of geometric parameters of the ACL and adjacent bony structures influence risk of suffering a first time non-contact ACL injury. (more…)
Author Interviews, JAMA, Orthopedics, Pain Research / 01.10.2014

MedicalResearch.com Interview with: Ben Metcalf BsC (co-author) on behalf or A/Prof Rana Hinman PhD Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia Medical Research: What are the main findings of the study? Dr. Metcalf: This study investigated whether acupuncture is an effective treatment for people aged more than 50 years with chronic knee pain. Participants in our study were randomly assigned to one of four groups; needle acupuncture, laser acupuncture, sham laser acupuncture or no treatment. The people in the treatment groups received acupuncture treatment from a family physician for 12 weeks. Participants were assessed after treatment and again after one year. There were no significant differences in knee pain or physical function between active and sham laser acupuncture at 12 weeks or at one year. Both needle and laser acupuncture resulted in modest improvements in pain compared with no treatment at 12 weeks that were not maintained at one year. Needle acupuncture improved physical function at 12 weeks compared with no treatment but was not different from sham acupuncture and was not maintained at one year. (more…)