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…)
Author Interviews, BMJ, Orthopedics / 17.09.2014

Marc Nieuwenhuijse MD Research fellow ICOR and FDA Weill Cornell Medical College New York CityMedicalResearch.com Interview with: Marc Nieuwenhuijse MD Research fellow ICOR and FDA Weill Cornell Medical College New York City   Medical Research: Why did you decide to study this topic? Dr. Nieuwenhuijse : The introduction of new orthopaedic implants and related technologies has been the focus of major scientific and policy discussions since the failures of articular surface replacement and large head size metal-on-metal articulations in total hip replacement were brought to light. However, scientists and policy makers seem to “run out of steam,” and the momentum for change generated by these recent high profile failures is waning. The consequences of uncontrolled device introduction worldwide may not be fully recognised by the scientific community and there is a high likelihood that current practice regarding device innovations will not change much. As such, there is a need to investigate whether the problems associated with the articular surface replacement and large head size metal-on-metal articulation are isolated events or if there is a systemic problem affecting the introduction of a much wider range of implantable devices. In this study, we systematically evaluate the evidence concerning the introduction of five substantial, innovative, relatively recent, and already widely implemented device technologies used in major total joint replacement to determine the evidence of effectiveness and safety for introduction of five recent and ostensibly high value implantable devices in major joint replacement to illustrate the need for change and inform guidance on evidence based introduction of new implants into healthcare. (more…)
Annals Internal Medicine, Author Interviews, Orthopedics, UCLA / 09.09.2014

Carolyn J. Crandall, MD, MS Professor of Medicine David Geffen School of Medicine at University of California, Los Angeles UCLA Medicine/GIM Los Angeles, CA 90024MedicalResearch.com Interview with: Carolyn J. Crandall, MD, MS Professor of Medicine David Geffen School of Medicine at University of California, Los Angeles   Medical Research: What are the main findings of the study? Dr. Crandall: 1.        We found high-strength evidence that several medications decrease fracture risk when used by persons with bone density in the osteoporotic range and/or with pre-existing hip or vertebral fracture.  While many of the medications (alendronate, risedronate, zoledronic acid, ibandronate, denosumab, teriparatide, and raloxifene) reduce vertebral fractures, a reduction in the risk of hip fracture is not demonstrated for all of the medications.  In particular, hip fracture reduction is only demonstrated for alendronate, risedronate, zoledronic acid, and denosumab.  Unfortunately, due to a lack of head-to-head trials, the comparative effectiveness of the medications is unclear. 2.       The adverse effects of the medications vary.  For example, raloxifene is associated with an increased risk of thromboembolic events, whereas denosumab and the bisphosphonate medications have been associated with increased risk of osteonecrosis of the jaw and atypical subtrochanteric femoral fractures. (more…)
Author Interviews, Health Care Systems, Orthopedics / 05.08.2014

M. Susan Ridgely, JD Senior Policy Analyst RAND Corporation Santa Monica, CaliforniaMedicalResearch.com: Interview with: M. Susan Ridgely, JD Senior Policy Analyst RAND Corporation Santa Monica, California   Medical Research: What are the main findings of the study? Answer: We evaluated a three-year effort, coordinated by the Integrated Healthcare Association, to determine whether bundled payment could be an effective payment model for California. The pilot focused on bundled payment for orthopedic procedures for commercially insured adults under age 65. Bundled payment is a much-touted strategy that pays doctors and hospitals one fee for performing a procedure or caring for an illness. The strategy is seen as one of the most-promising ways to curb health care spending. Unfortunately, the project failed to meet its goals, succumbing to recruitment challenges, regulatory uncertainty, administrative burden and concerns about financial risk. At the outset of the project, participants included six of the state’s largest health plans, eight hospitals and an independent practice association. Eventually, two insurers dropped out because they believed the bundled payment model in this project would not lead to a redesign of care or lower costs. Another decided that bundled payment was incompatible with its primary type of business (health maintenance organization). Just two hospitals eventually signed contracts with the three remaining health plans to use bundled payments. Hospitals that dropped out cited concerns about the time and effort involved. The project was hurt by a lack of consensus about what types of cases to include and which services belonged in the bundle. In the end, most stakeholders agreed that the bundle definitions were probably too narrow to capture enough procedures to make bundled payment viable. (more…)
Orthopedics / 12.07.2014

Christoher C. Kaeding M.D. Judson Wilson Professor, Department of Orthopaedics Executive Director, Sports Medicine Center Head Team Physician, Department of Athletics The Ohio State UniversityMedicalResearch.com Interview with: Christoher C. Kaeding M.D. Judson Wilson Professor, Department of Orthopaedics Executive Director, Sports Medicine Center Head Team Physician, Department of Athletics The Ohio State University MedicalResearch: What are the main findings of the study? Dr. Kaeding:
  • Younger age and high activity level were predictors off another ACL injury after an ACL Reconstruction.
  • Allograft use in younger more active patients Had an increased risk of re-injury.
(more…)
Author Interviews, CMAJ, Cost of Health Care, Orthopedics / 23.04.2014

MedicalResearch.com Interview with: Susan Jaglal, PhD Senior Scientist Toronto Rehabilitation Institute University of Toronto, Toronto, Ontario MedicalResearch.com: What are the main findings of the study? Dr. Jaglal: Bone Mineral Density (BMD) tests are used to both diagnose osteoporosis and assess and individual’s risk of fracture. While the tests play an important role in bone health, they are sometimes ordered inappropriately. For example, while women age 40-44 are typically not at risk of fragility fracture or in need of Bone Mineral Density testing, these individuals received almost half the Bone Mineral Density tests performed in Ontario in 2007/2008. Policy changes have been made in recent years in an effort to curb unnecessary testing of low risk individuals in both the United States and Canada. Policy efforts in Ontario included a 2008 fee schedule change that limited repeated testing among low-risk patients and included a new fee code for a “baseline” tests. Patients were limited to 1 baseline test in their lifetime. The goal of the present study was to determine the impact of this fee schedule change on Bone Mineral Density testing rates. The study was based on an analysis of provincial administrative data including physician billings, hospital discharges, and emergency department visits. Results demonstrated that while fee schedule changes were associated with a decrease in BMD testing rates, the decreases affected both low and high-risk patients. Most decreases were seen in testing rates of low-risk women. However, the associated decrease in testing among high-risk patients (e.g., those over 65 or with a recent fracture) is concerning, as high-risk patients benefit from screening and monitoring of Bone Mineral Density. (more…)
Exercise - Fitness, Orthopedics, Pediatrics / 19.04.2014

MedicalResearch.com Interview with: Neeru Jayanthi, MD Associate Professor Medical Director, Primary Care Sports Medicine Loyola University Medical Center study MedicalResearch.com: What are the main findings of the study? Dr. Jayanthi: We surveyed a cohort of 1,190 athletes ages 7 to 18, including 1,121 for whom insurance status could be determined. Our main findings were: 1. The rate of serious overuse injuries in athletes who come from families that can afford private insurance is 68 percent higher than the rate in lower-income athletes who are on public insurance (Medicaid). 2. Privately insured young athletes are twice as likely as publicly insured athletes to be highly specialized in one sport. MedicalResearch.com: Were any of the findings unexpected? Dr. Jayanthi: The findings confirmed our hypothesis that higher-income students would be more likely to specialize in one sport, and also more likely to suffer serious overuse injuries. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Jayanthi: Specializing in one sport at an early age increases the risk of serious overuse injuries. Here are evidence-based tips to reduce the risk of overuse injuries: • Increase the amount of unstructured free play, while limiting the amount of time spent in organized sports and specialized training. Do not spend more than twice as much time playing organized sports as you spend in unstructured play. • Do not spend more hours per week than your age playing sports. For example, a 10-year-old should not spend more than 10 hours per week playing sports. • Do not specialize in one sport before late adolescence. • Do not play sports competitively year round. Take a break from competition for one to three months each year (not necessarily consecutively). • Take at least one day off per week from sports training. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Jayanthi: We are doing a pilot study this summer comparing parent/child dyads of high competitive young athletes and recreationally active children with parent dyad to see differences based on sports participation of child and adult, as well as based on socioeconomic status. This may lead to a much larger study. Citation: Abstract presented at the American Medical Society for Sports Medicine Annual Meeting in New Orleans, LA.MedicalResearch.com Interview with: Neeru Jayanthi, MD Associate Professor Medical Director, Primary Care Sports Medicine Loyola University Medical Center study MedicalResearch.com: What are the main findings of the study? Dr. Jayanthi: We surveyed a cohort of 1,190 athletes ages 7 to 18, including 1,121 for whom insurance status could be determined. Our main findings were: 1. The rate of serious overuse injuries in athletes who come from families that can afford private insurance is 68 percent higher than the rate in lower-income athletes who are on public insurance (Medicaid). 2. Privately insured young athletes are twice as likely as publicly insured athletes to be highly specialized in one sport. (more…)
Author Interviews, Gender Differences, Orthopedics, Race/Ethnic Diversity, UCLA / 08.04.2014

Dr. Carolyn Crandall, M.D. Division of General Internal Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA, 90024, USAMedicalResearch.com Interview with: Dr. Carolyn Crandall, M.D. Division of General Internal Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA, 90024, USA MedicalResearch.com: What are the main findings of the study? Dr. Crandall: We found that higher social class was linked with a lower risk of fractures among non-Caucasian women.  Compared with non-Caucasian women who had no more than a high school education, those with at least some postgraduate education had nearly 90% lower rates of non-traumatic fracture.  These results were present even after we accounted for income. (more…)
Heart Disease, Orthopedics / 16.03.2014

Bheeshma Ravi, MDMedicalResearch.com Interview with: Bheeshma Ravi, MD Orthopedic Surgery University of Toronto Medical Center   MedicalResearch.com: What are the main findings of the study? Dr. Ravi:  This study suggests that in persons with moderate-severe osteoarthritis of the hip or knee, total joint replacement is associated with a significant reduction in the risks for serious cardiovascular events. (more…)
Addiction, Opiods, Orthopedics, Pharmacology, Surgical Research / 11.03.2014

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, TexasMedicalResearch.com Interview with: 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, Texas MedicalResearch.com: What are the main findings of the study?

 Dr. Morris: There are concerns that an increasing percentage of patients are receiving narcotics by “doctor shopping” or seeking narcotics from multiple providers. One in five of our postoperative orthopedic trauma patients received narcotics from one or more additional providers other than the treating surgeon. Patients that doctor-shopped postoperatively had a significant increase in narcotic prescriptions, duration of narcotics, and morphine equivalent dose per day. (more…)
Author Interviews, BMJ, Orthopedics / 26.01.2014

MedicalResearch.com Interview with: Keijo T Mäkelä Associate professor Department of Orthopaedics and Traumatology Turku University Hospital, Rauhankatu Turku, FI-20100, Finland MedicalResearch.com: What are the main findings of the study? Answer: • The implant survival of cemented total hip replacement was higher than that of uncemented total hip replacement in patients aged 65 years and older in our multinational register study with a comprehensive patient population. • The proportion of uncemented total hip replacement is rapidly increasing in Nordic countries. The increased use of uncemented total hip replacement group is not supported by these data. (more…)
Author Interviews, BMJ, Hip Fractures, Hormone Therapy, Orthopedics / 25.01.2014

Professor Nigel Arden Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences Botnar Research Centre Windmill Road Oxford OX3 7LDMedicalResearch.com Interview with: Professor Nigel Arden Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences Botnar Research Centre Oxford  OX3 7LD MedicalResearch.com: What are the main findings of the study? Professor Arden: We found that in a cohort of women who had used hormone replacement therapy (HRT) and underwent knee or hip replacement their risk of implant revision was reduced by about 40% compared to non-users of HRT. (more…)
Author Interviews, Menopause, NEJM, Osteoporosis / 04.01.2014

Michael McClung, MD Founding Director, Oregon Osteoporosis Center 5050 NE Hoyt Street, Suite 626 Portland, OR 97213MedicalResearch.com Interview with Michael McClung, MD Founding Director, Oregon Osteoporosis Center 5050 NE Hoyt Street, Suite 626 Portland, OR 97213 MedicalResearch.com: What are the main findings of the study? Dr. McClung: In this Phase 2 trial, each of five romosozumab dose regimens significantly increased BMD compared with pooled placebo groups at the lumbar spine, total hip and femoral neck regions (all p<0.001). The largest increases were observed with the romosozumab 210 mg once-monthly dose, with mean increases, compared with baseline, of 11.3 percent at the lumbar spine, 4.1 percent at the total hip and 3.7 percent at the femoral neck. (more…)
Author Interviews, NEJM, Orthopedics, Surgical Research / 26.12.2013

MedicalResearch.com Interview with: Raine Sihvonen, M.D. From the Department of Orthopedics and Traumatology Hatanpää City Hospital, Tampere Finland MedicalResearch.com: What are the main findings of the study? Dr. Järvinen: The main finding of the study is that arthroscopic partial meniscectomy is not superior over sham-surgery (placebo) when treated patients with knee pain attributable to degenerative  meniscus tear, even in the `best-case-scenario, that is patients with no knee OA. (more…)