Orthopedics

23 Apr

Posted at 22:41h in Author Interviews, CMAJ, Cost of Health Care, Orthopedics
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.

19 Apr

Posted at 12:18h in Exercise - Fitness, Orthopedics, Pediatrics
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.

08 Apr

Posted at 23:57h in Author Interviews, Gender Differences, Orthopedics, Race/Ethnic Diversity, UCLA
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.

16 Mar

Posted at 19:13h in Heart Disease, Orthopedics
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.

11 Mar

Posted at 23:33h in Addiction, Opiods, Orthopedics, Pharmacology, Surgical Research
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.

26 Jan

Posted at 20:22h in Author Interviews, BMJ, Orthopedics
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.

25 Jan

Posted at 13:33h in Author Interviews, BMJ, Hip Fractures, Hormone Therapy, Orthopedics
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.

04 Jan

Posted at 00:57h in Author Interviews, Menopause, NEJM, Osteoporosis
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.

26 Dec

Posted at 18:56h in Author Interviews, Orthopedics

MedicalResearch.com Interview with: Arief Lalmohamed, PharmD Utrecht Area, Netherlands MedicalResearch.com: What are the main findings of the study? Dr. Lalmohamed: In a nationwide cohort study, short-term survival following elective hip and knee replacement surgery has greatly improved since the early 90s. Between 1989 and 2007, risk of death within 60 days has decreased by 60% for...

26 Dec

Posted at 13:15h in Author Interviews, NEJM, Orthopedics, Surgical Research
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.

28 Nov

Posted at 02:10h in Author Interviews, Exercise - Fitness, Hip Fractures, Orthopedics
Ida C. Svege
 PhD student / Physical Therapist 
NAR Norwegian research centre for Active Rehabilitation
Department of Orthopaedics Oslo University Hospital / NIMI / Norwegian School of Sports Sciences
MedicalResearch.com Interview with: Ida C. Svege
 PhD student / Physical Therapist 
NAR Norwegian research centre for Active Rehabilitation
Department of Orthopaedics, Oslo University Hospital / NIMI / Norwegian School of Sports Sciences MedicalResearch.com: What are the main findings of the study? Answer: The main finding of the study was that exercise therapy in addition to patient education resulted in significantly higher 6-year cumulative survival of the native hip to total hip replacement compared with patient education only. Over the 6 year follow-up period the need for total hip replacement was reduced by 44% in the group who received both exercise therpay and patient education. Also, better self-reported physical function was demonstrated in the group who received exercise therapy and patient education, suggesting that the lower surgery rate in this group were due to better hip function, with or without the presence of pain.

05 Nov

Posted at 00:42h in Author Interviews, Orthopedics
Dr. Geoffrey S. Marecek, MD Department of Orthopaedic Surgery University of Southern California Keck School of Medicine Los Angeles, CAMedicalResearch.com Interview with: Dr. Geoffrey S. Marecek, MD Department of Orthopaedic Surgery University of Southern California Keck School of Medicine Los Angeles, CA MedicalResearch.com: What are the main findings of the study? Dr. Marecek: There were several main findings: 1. It is not safe to drive while wearing a sling or splint on the upper extremities 2. It is not safe to drive while wearing a brace, cast, or boot on the lower extremities 3. Braking function does not return to normal for at least 4 weeks after knee arthroscopy, total knee arthroplasty (TKA) and total hip arthroplasty (THA), for 9 weeks after ankle fracture repair, and for 6 weeks after weight bearing begins for a fracture (up to 18 weeks for articular fractures).

29 Oct

Posted at 02:31h in Hip Fractures
MedicalResearch.com Interview with: Stefano Volpato MD MPH Department of Medical Sciences, University of Ferrara Ferrara, Italy MedicalResearch.com: What are the main findings of the study? Dr. Volpato: In this study we evaluated clinical value of handgrip strength  assessment in older patients admitted to the hospital for hip fracture. We observed 504 older patients admitted to 4 Italian hospitals for hip surgery, able of walking independently before fracture, and we found a strong, graded and independent association of grip strength, assessed before hip surgery, and the likelihood of functional recovery over the one-year follow-up. The findings reported in our manuscript can be summarized as: a. handgrip strength significantly correlated with several prognostic factors traditionally considered in clinical practice, such as age, gender, neuro-psychological and functional status, comorbidity level, vitamin D plasma levels, and time before the surgical procedure; b. logistic regression models showed that handgrip strength was directly associated with higher probability of walking recovery, both at any follow-up (incident walking recovery), and for at least 2 consecutive follow-ups (persistent walking recovery); b. Kaplan-Meier survival estimates showed that lower grip strength was related to increased mortality after hip surgery; c. the association between grip performance and walking recovery was clinically relevant and statistically independent of potential confounders.

25 Sep

Posted at 13:54h in Author Interviews, Hip Fractures, JAMA, Orthopedics
Sarah D. Berry MD MPH Institute for Aging Research, Hebrew Senior Life Boston, MassachusettsMedicalResearch.com Interview with: Sarah D. Berry MD MPH Institute for Aging Research, Hebrew Senior Life Boston, Massachusetts   MedicalResearch.com: What are the main findings of the study? Dr. Berry: Repeating a bone mineral density (BMD) screening test in 4 years provided little additional value beyond baseline BMD when assessing fracture risk. Also, the second BMD measure resulted in little change in risk classification that is commonly used in clinical management of osteoporosis.

25 Sep

Posted at 11:05h in Author Interviews, Genetic Research, Hip Fractures, Weight Research
Professor Tuan V. Nguyen Osteoporosis and Bone Biology Program Garvan Institute of Medical Research 384 Victoria Street, Darlinghurst NSW 2010 AustraliaMedicalResearch.com Interview with: Professor Tuan V. Nguyen Osteoporosis and Bone Biology Program Garvan Institute of Medical Research 384 Victoria Street, Darlinghurst NSW 2010 Australia MedicalResearch.com: What are the main findings of the study? Dr. Nguyen: We analyzed polymorphisms of the FTO (fat mass and obesity) gene in 934 elderly women of Caucasian background, and found that carriers of minor genotype (AA) of the SNP rs1121980 had a two-fold increase in the risk of hip fracture compared with carriers of major genotype (GG). Approximately 20% of women are carriers of the AA genotype. We estimate that about 17% of hip fracture cases could be attributed to the variation within the gene.

19 Sep

Posted at 00:59h in Author Interviews, CMAJ, Orthopedics, Pain Research, University of Michigan
Chad M. Brummett, M.D. Assistant Professor, University of Michigan Health System Department of Anesthesiology Division of Pain Medicine 1500 East Medical Center Drive, 1H247 UH, Box 5048 Ann Arbor, MI 48109MedicalResearch.com Interview with: Chad M. Brummett, M.D. Assistant Professor, University of Michigan Health System Department of Anesthesiology Division of Pain Medicine 1500 East Medical Center Drive, 1H247 UH, Box 5048 Ann Arbor, MI 48109 MedicalResearch.com:  What are the main findings of the study? Dr. Brummett: The study found that 42% of new patients presenting to a tertiary care pain clinic with a primary spine pain diagnosis met the American College of Rheumatology (ACR) survey criteria for fibromyalgia, which is a measure of widespread body pain and comorbid symptoms (e.g. trouble thinking, fatigue, mood symptoms, etc.).  Patients categorized as fibromyalgia-positive using the survey measure were distinctly different from those not meeting criteria.  In a multivariate regression model, independent predictors of being categorized as fibromyalgia-positive were female sex, higher neuropathic pain scores, anxiety, and lower physical function.

18 Sep

Posted at 20:22h in CMAJ, Cost of Health Care, Duke, MRI, Orthopedics
Matthew P. Lungren, MD Duke University Medical CenterMedicalResearch.com Interview with: Matthew P. Lungren, MD Duke University Medical Center MedicalResearch.com: What are the main findings of the study? Dr. Lungren: In the single center study, knee MRIs are more likely to be normal when the referring doctor has a financial stake in the imaging center or the equipment used; these data suggest that some of these examinations may be unnecessary.

04 Sep

Posted at 20:06h in Author Interviews, Orthopedics, PLoS
Assistant Professor School of Biological & Population Health Sciences, Exercise & Sport Science Program College of Public Health and Human Sciences Oregon State University Corvallis, OR 97331Marc F. Norcross, PhD, ATC Assistant Professor School of Biological & Population Health Sciences, Exercise & Sport Science Program College of Public Health and Human Sciences Oregon State University Corvallis, OR 97331 MedicalResearch.com: What are the main findings of the study? Dr. Norcross: In the scientific community, there remains considerable disagreement over which direction of knee loading is most responsible for causing an anterior cruciate ligament (ACL) injury event.  Many researchers tend to fall into one of three “camps” in which they believe quadriceps loading (sagittal plane), “knock-kneed” landing (frontal plane), or twisting (transverse plane) is the essential factor in the injury mechanism.  However, we know from cadaver studies that combined loading from all of these different planes puts the most strain on the ACL.  We found that men and women are equally likely to use a sagittal plane landing strategy that we believe increases the risk for ACL injury.  However, females were about 3.6 times more likely than males to use a higher risk frontal plane landing strategy.  This suggests that the increased likelihood of greater frontal plane loading in women coupled with the equal likelihood of using a high-risk sagittal plane strategy is likely at least partly responsible for women’s 2-6 times greater risk for ACL injury.

27 Aug

Posted at 02:47h in Author Interviews, Biomarkers, Orthopedics
MedicalResearch.com Interview with: Anna Eriksson MD, PhD Centre for Bone and Arthritis Research Institute of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden MedicalResearch.com: What are the main findings of the study? Answer: The main findings of the study are that low-grade inflammation as measured by high sensitive CRP (hsCRP) is a risk factor for fractures in men, and that this is mainly driven by an increased risk for vertebral fractures. Previous epidemiological research has shown that higher levels of hsCRP is associated with an increased risk for fractures in women but until now it has not been known whether this applies also to men. The associations between hsCRP and fracture risk remained also after controlling for a wide range of known risk factors for fractures. There were no associations between hsCRP and BMD in our study. This implies that low-grade inflammation is an independent risk factor for fractures.

03 Aug

Posted at 13:19h in Author Interviews, Hip Fractures, Orthopedics
MedicalResearch.com Interview with: Pim A de Jong Heidelberglaan 100, E01.1A32, 3508 GA Utrecht, the Netherlands MedicalResearch.com: What are the main findings of the study? Answer: We observed that patients with a vertebral fracture on a routine clinical chest computed tomography exam had a tripled risk of future hip fracture after adjustment for age and gender.

25 Jul

Posted at 13:30h in Author Interviews, Coffee, Nutrition, Orthopedics, Osteoporosis
Helena Hallström Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, OrthopaedicsMedicalResearch.com Interview with: Helena Hallström Ph.D., M.Sc. (Toxicology) Department of Surgical Sciences, Section of Orthopedics Uppsala University, Uppsala, Sweden and Risk and Benefit Assessment Department National Food Agency, Uppsala, Sweden.   MedicalResearch.com: What are the main findings of the study? Answer: The aim of the study was to investigate whether high consumption of coffee is associated with osteoporosis and development of osteoporotic fractures, since results from previous fracture studies regarding potential associations between coffee drinking and fracture risk are inconsistent. The longitudinal population-based Swedish Mammography Cohort, including 61,433 women born between 1914 and 1948, was followed from 1987 through 2008. Coffee consumption was assessed with repeated food frequency questionnaires. During follow-up, 14,738 women experienced any type of fracture and of these 3,871 had a hip fracture. In a sub-cohort (n=5,022), bone density was measured and osteoporosis was determined (n=1,012). There was no evidence of a higher rate of any fracture or hip fracture with increasing coffee consumption. However, a high coffee intake (≥4 cups) in comparison with a low intake (<1 cup) was associated with a 2-4% reduction in bone mineral density (BMD), depending on site (p<0.001), but the odds ratio of osteoporosis was only 1.28 (95% confidence interval: 0.88, 1.87). Thus, high coffee consumption was associated with a small reduction in bone density that did not translate into an increased risk of fracture.

12 Jul

Posted at 11:56h in Author Interviews, Orthopedics
obesity and living kidney donationMedicalResearch.com Interview with: Mark V. Paterno PT, PhD, MBA, SCS, ATC Coordinator of Orthopaedic and Sports Physical Therapy Associate Professor, Sports Medicine Biodynamics Center Acting Scientific Director, Division of Occupational Therapy and Physical Therapy Cincinnati Children's Hospital Medical Center 3333 Burnet Ave. MLC 10001 Cincinnati, OH 45229-3039 MedicalResearch.com: What are the main findings of the study? Dr. Paterno: Our study suggests that young patients (average age 16 y/o) who return to pivoting and cutting sports after Anterior cruciate ligament (ACL) reconstruction are 6 times more likely to suffer a second ACL injury than an individual with no prior history of ACL injury.  In addition, females after ACL reconstruction may be more likely to injury their opposite limb than actually re-injure the same limb they initially hurt.  Finally, when you look at the results of this 2 year outcome study in conjunction with the 1 year outcomes we published last year, it would appear that the greatest risk of suffering a second ACL injury is within the first several months after returning to sports.

17 Apr

Posted at 00:35h in Author Interviews, CT Scanning, Mayo Clinic, Medical Imaging, Orthopedics
MedicalResearch.com:  Katrina N. Glazebrook, MB, ChB Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 MedicalResearch.com:  Why did you do the study? Dr. Glazebrook: We felt CT was being underutilized for evaluation of knee injuries. The utility of CT has been well documented in the assessment of fractures, but little attention has been made on soft tissue evaluation. CT now has high spatial resolution with very thin reconstructions in any desirable plane, and we have previously noted that this allowed injured soft tissue structures such as cruciate ligaments to be well visualized [presented at Society of Skeletal Radiology meeting March 2013]. We had determined in that prior study that the best reconstruction plane to evaluate both normal and torn anterior cruciate ligaments was the oblique sagittal plane parallel to the lateral femoral condyle as routinely used in MRI imaging of the knee The soft tissue window, single energy bone removal and Dual energy bone removal were the best reconstructions to determine the presence or absence of ACL disruption The bone removal techniques removed the distracting bone so the soft tissue structures were more apparent.