Thomas Youm,MD,FRCS
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News Updates

  • Picture emerges of how kids get head injuries

    Source : Science Daily

    A study in which more than 43,000 children were evaluated for head trauma offers an unprecedented picture of how children most frequently suffer head injuries, report physicians. The findings also indicate how often such incidents result in significant brain injuries, computerized tomography (CT) scans to assess head injuries, and neurosurgery to treat them.

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  • Intra-articular tranexamic acid benefitted TKA patients without increased risk of DVT, PE

    Source : Healio

    Among patients who underwent total knee arthroplasty, intra-articular tranexamic acid significantly reduced total blood loss, drainage, reduction of hemoglobin and the need for transfusion without increasing the incidence of deep venous thrombosis and pulmonary embolism, making it safe and efficacious, according to study results.

    Through a search of various databases for relevant randomized, controlled trials, researchers included seven studies comprising 622 patients. The researchers calculated mean difference in total blood loss, risk ratio for transfusion and complication rate in the tranexamic acid-treated group vs. the placebo group.

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  • Bilateral TKA staged at 1-week intervals deemed safe alternative in select patients

    Source : Healio

    For patients with advanced degenerative disease and deformities of both knees who desire a single rehabilitation period, staging total knee arthroplasty in each knee a week apart is a safe alternative, particularly for patients with medical comorbidities precluding a simultaneous operation, according to study results.

    Researchers compared a consecutive series of 234 patients who underwent either a simultaneous or staged bilateral total knee arthroplasty (TKA) to a matched-control group of unilateral TKA.

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  • Divergent trends seen in meniscal and cartilage injuries between primary and revision ACL repair

    Source : Healio

    In a community-based sample, the prevalence of articular cartilage injury increased between primary and revision ACL repair, whereas the prevalence of meniscal injury decreased, according to recent study findings.

    Researchers studied 261 patients who underwent both primary and revision ACL reconstruction (ACLR) between February 2005 and September 2011 via community-based registry. Patient data (sex, age, race and BMI), procedure characteristics and descriptive statistics (medians, interquartile ranges, frequencies and proportions) were the metrics used for evaluation.
    Overall, 256 patients required revision ACLR due to instability, and the remaining five were due to infection.

    Cartilage injuries nearly doubled (14.9% to 31.8%) from primary to revision ACLR, whereas meniscal tears decreased overall from 54.8% at primary ACLR to 43.7% at revision. This trend was also reflected in lateral meniscus tears (32.2% at primary, 18.4% at revision), though medial meniscus tears were observed to be the same (32.6%) at both primary and revision ACLR, according to the researchers.

    A 70.8% prevalence of meniscus tear in revision was observed in patients who had meniscus fixation during primary ACLR.


    Disclosure: The authors have no relevant financial disclosures.

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  • Study reveals shifting trends in the surgical treatment of SLAP lesions

    Source : Healio

    A review of information from the American Board of Orthopaedic Surgery part II database indicates that the rate of SLAP repairs performed for both cases of isolated SLAP lesions and those undergoing concomitant rotator cuff repair has decreased, while the rates of biceps tenodesis and tenotomy for these cases have increased.

    “Practice trends for orthopedic board candidates indicate that the proportion of SLAP repairs has decreased over time, with an increase in biceps tenodesis and tenotomy,” Brendan M. Patterson, MD, MPH, and his colleagues wrote in their study. “Increased patient age correlates with the likelihood of treatment with biceps tenodesis or tenotomy versus SLAP repair.”

    Using the database, the investigators identified 8,963 cases treated for isolated SLAP lesions and 1,540 cases that underwent concomitant rotator cuff repair and treatment for SLAP lesions between 2002 and 2011. Mean patient age was 40.7 years.

    Researchers reviewed surgical logs for the following procedures: SLAP repair, open or arthroscopic biceps tenodesis, biceps tenotomy, and arthroscopic rotator cuff repair with concomitant SLAP repair.

    Patterson and colleagues found the proportion of SLAP repairs decreased from 69.3% to 44.8% for patients with isolated SLAP lesions. The proportion of biceps tenodesis for these cases increased from 1.9% to 18.8% and biceps tenotomy went from 0.4% to 1.7%. Similarly, the investigators found the proportion of SLAP repair decreased in cases undergoing concomitant rotator cuff repair (from 60.2% to 15.3%).

    The proportion of biceps tenodesis or tenotomy for these cases increased from 6.0% to 28.0%. A subanalysis of biceps tenodesis showed that open procedures increased from 1.9% to 9.5% during the total study period, and arthroscopic biceps tenodesis increased in from 0.2% to 9.3% from 2007 to 2011.

    Overall, investigators discovered a significant difference in the mean age of patients who had SLAP repair (37.1 years) compared with those who had biceps tenodesis (47.2 years) and biceps tenotomy (55.7 years).

    Disclosure: This study was paid for by the University of North Carolina at Chapel Hill, Department of Orthopaedic Surgery, Sports Medicine Research Fund.

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  • Higher baseline expectations for TJR improved health-related quality of life, satisfaction

    Source : Healio

    Health-related quality of life and satisfaction improved among patients who had higher expectations for total joint replacement at baseline compared with patients who had lower expectations, according to study results.

    Researchers recruited 892 patients preparing for total joint replacement (TJR) of the knee or hip due to primary osteoarthritis. Before surgery and for 12 months afterward, patients completed questionnaires with five questions about expectations before surgery; an item to measure satisfaction; WOMAC and SF-12; and questions about sociodemographic information. The researchers performed general linear models and logistic regression analysis to determine the association of patients’ expectations at baseline with satisfaction and changes in health-related quality of life (HRQoL) 12 months after surgery.

    Study results showed larger improvements in HRQoL at 12 months among patients who had higher pain relief or ability to walk expectations. WOMAC and SF-12 physical component summary domains also improved more among patients with high expectations regarding the ability to walk, interact with other and psychological wellbeing expectations, according to the researchers.

    Patients with very high expectations on the SF-12 physical component summary regarding their ability to walk and with high or very high pain relief expectations on SF-12 mental component summary experienced better improvement compared with patients with low expectations, the researchers found.

    The researchers also found patients who had high or very high daily activities expectations were more likely to be satisfied.

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  • Antibiotic cement during primary TKA may not decrease infection rates

    Source : Healio

    Judicious risk-stratified usage of antibiotic cement during primary total knee arthroplasty may not decrease infection at 1 year, according to study results. Researchers retrospectively reviewed data for 3,292 patients who underwent primary total knee arthroplasty (TKA). Patients were grouped into cohorts based on whether their surgery involved plain or antibiotic cement, or if they were high-risk patients who received antibiotic cement, and infection rates were compared between the cohorts.

    Study results showed a 30-day infection rate of 0.29% in cohort 1, 0.2% in cohort 2 and 0.13% in cohort 3.

    Infection rates in all cohorts increased at all time points, with 6-month rates at 0.39% in cohort 1, 0.54% in cohort 2 and 0.38% in cohort 3, and 1-year rates at 0.78% in cohort 1, 0.61% in cohort 2 and 0.64% in cohort 3. However, no statistically significant between-group differences in infection rates were seen at any of the time intervals studied, according to the researchers.

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  • No functional differences found between short-, straight-stem THA implants

    Source : Healio

    Recently published study data indicated short-stem and straight-stem implants for total hip arthroplasty exhibited no significant differences in functional outcome measures.

    Researchers conducted a randomized, double-blinded study of 80 patients who underwent total hip arthroplasty (THA). Patients were grouped by whether their THA utilized a short-stem or conventional straight-stem implant. Radiological and functional outcomes were evaluated at 6 weeks postoperatively, and quality of life was quantified via Harris Hip Score, SF-36 and WOMAC scores.

    No significant changes in offset differences were observed in either group from before surgery to after surgery. At final follow-up, no significant differences between groups were found in Harris Hip Score, SF-36 or WOMAC values, according to the researchers.

    Comparison of long-term survival rates among both cohorts will help determine whether short stems are a viable alternative THA solution, the researchers concluded.

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  • Orthopedic surgery generally safe for patients age 80 and older

    Source : MedicalXpress

    Over the past decade, a greater number of patients, age 80 and older, are having elective orthopaedic surgery. A new study appearing in the Journal of Bone and Joint Surgery (JBJS) found that these surgeries are generally safe with mortality rates decreasing for total hip (THR) and total knee (TKR) replacement and spinal fusion surgeries, and complication rates decreasing for total knee replacement and spinal fusion in patients with few or no comorbidities (other conditions or diseases).

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  • Shoulder activity not associated with severity of atraumatic rotator cuff tear

    Source: Healio

    Among patients with atraumatic rotator cuff tears, shoulder activity was not associated with severity of the tear, but was affected by patients’ age, sex and occupation, according to study results.

    Researchers prospectively enrolled patients with an atraumatic rotator cuff tear on MRI in the Multicenter Orthopaedic Outcomes Network shoulder study of nonoperative treatment. Patients were asked to complete a previously validated shoulder activity scale; 434 patients completed the scale and were included in the analysis. Mean patient age was 62.7 years.

    The researchers performed a regression analysis to assess the association of shoulder activity level to rotator cuff tear characteristics, including tendon involvement and traction, as well as patient factors such as age, sex, smoking and occupation.

    Shoulder activity was not associated with severity of the rotator cuff tear, according to the researchers. However, shoulder activity was negatively associated with age and female sex. According to the regression model, 69-year-old patients with rotator cuff tears were 1.5 points less active on the 20-point scale vs. identical 56-year-old patients; female patients were 1.6 points less active vs. similar male patients. Occupation was also a significant predictor of shoulder activity level, with unemployed patients predicted to be 4.8 points less active compared with employed patients.

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