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American Academy of Orthopaedic Surgeons, March 19-23, 2013

The 2013 Annual Meeting of the American Academy of Orthopaedic Surgeons

The annual meeting of the American Academy of Orthopaedic Surgeons was held from March 19 to 23 in Chicago and attracted approximately 30,000 participants from around the world. The conference highlighted recent advances in the diagnosis and management of musculoskeletal conditions, with presentations focusing on joint fractures, osteoarthritis, and other musculoskeletal injuries as well as factors impacting joint replacement procedure outcomes.

In one study, Caleb J. Behrend, M.D., of the University of Rochester Medical Center in New York, and colleagues evaluated whether or not patients with spinal disorders who quit smoking experience improvements in self-reported axial or radicular pain.

Using a prospectively maintained database of 5,333 patients with axial or radicular pain related to a spinal disorder managed at two academic centers, the investigators examined patients' smoking history, secondary gain factors, and medical history. They sought to examine factors associated with changes in patient self-reported pain on four visual analog scale (VAS) scores at the time of the initial visit compared with the values at the latest follow-up point. Four groups of patients were identified: never smokers (2,634); smokers who quit prior to study entry (1,532); smokers who quit during the time of the study (253); and current smokers (914).

"We found that at the time of entry into the provider's care, never smokers and prior smokers reported significantly less pain than current smokers and those who quit smoking during the course of the study," Behrend said. "The present study supports the addition of smoking cessation programs or counseling as a part of the treatment plan for patients with axial or radicular pain of spinal etiology regardless of the patient's age, given a strong association between improved patient-reported pain and smoking cessation."

Abstract

In a prospective, double blind, randomized, controlled study, Allan Mishra, M.D., of the Menlo Medical Clinic and Stanford Hospitals and Clinics in Menlo Park, Calif., and colleagues evaluated 230 patients with chronic tennis elbow who underwent needling of their elbow tendons with and without platelet-rich plasma (PRP).

"The patients treated with PRP experienced significantly less pain and elbow tenderness compared to those who were in the active control group (needling without PRP). Specifically, at the six-month follow-up visit, we found an 84 percent success rate with PRP, compared to 68 percent in the active control group," said Mishra. "There has now been a decade of data on PRP demonstrating an excellent safety profile and a success rate similar to surgery. In addition, the total cost of treatment with PRP is one-tenth the cost of having a patient undergo surgery. The overall costs vary, but PRP ranges from $800 to $1,200 compared to $8,000 to $12,000 for surgery."

Mishra notes that physicians can now confidently offer this treatment to their patients who have failed other non-operative options, prior to considering surgery.

Abstract

In another study, Alissa Burge, M.D., of the Hospital for Special Surgery in New York City, and colleagues found that magnetic resonance imaging (MRI) may be utilized to identify adverse local tissue reactions (ALTR) in patients with metal-on-metal hip arthroplasties. In particular, MRI may be utilized to identify the hypersensitivity subtype of ALTR reflected in the histologic diagnosis of aseptic lymphocytic vasculitis-associated lesions (ALVAL), which often results in aggressive peri-prosthetic soft tissue damage.

The investigators evaluated a cohort of 68 patients with 70 metal-on-metal hip arthroplasties who underwent preoperative MRI evaluation and subsequent revision surgery. MRI characteristics associated with ALTR were correlated with the histologic ALVAL score as well as with the intraoperative tissue damage score as graded by the operating surgeon at the time of revision arthroplasty.

"The relative predictive value of each of the MRI characteristics was calculated for each of the two outcomes, and was utilized to create an MRI-based predictive model with a sensitivity and specificity of 90 and 86 percent, respectively, for predicting the presence of ALVAL at histology, and a sensitivity and specificity of 94 and 87 percent, respectively, for predicting the gross degree of intraoperative tissue damage," said Burge. "MRI provides a noninvasive means of predicting the degree of soft tissue damage with high sensitivity and specificity, aiding the clinician in proceeding to timely revision surgery in patients with metal-on-metal hip arthroplasties failing secondary to ALTR."

Abstract

AAOS: Knee, Hip Arthroplasty Improves Sexual Function

TUESDAY, March 19 (HealthDay News) -- Patients undergoing total knee (TKA) and total hip arthroplasty (THA) have improved sexual function, while physical activity improves after THA, according to two studies presented at the annual meeting of the American Academy of Orthopaedic Surgeons, held from March 19 to 23 in Chicago.

Abstract - Rathod
Abstract - Lubbeke-Wolff
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AAOS: Most Knee Replacement Patients Return to Same Jobs

TUESDAY, March 19 (HealthDay News) -- Most patients who undergo total knee arthroplasty (TKA) return to work, with the majority successfully returning to the same job, according to a study presented at the annual meeting of the American Academy of Orthopaedic Surgeons, held from March 19 to 23 in Chicago.

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AAOS: Youth Sport/Activity-Related Injuries Dip From 2000

TUESDAY, March 19 (HealthDay News) -- Pediatric sport/activity-related injuries decreased from 2000 to 2005 and 2010 for children aged 5 to 14 years, in contrast to physicians' perceptions that they have increased, according to a study presented at the annual meeting of the American Academy of Orthopaedic Surgeons, held from March 19 to 23 in Chicago.

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