Literature

Evidence based literature that is truly important to your orthopaedic clinical practice.

Every month, JBJS publishes a Specialty Update—a review of the most pertinent and impactful studies published in the orthopaedic literature during the previous year in 13 subspecialties. Click here for a collection of all OrthoBuzz Specialty Update summaries. This month, OrthoBuzz asked Theodore Choma, MD and Darrel Brodke, MD, co-authors of the June 15, 2016 Specialty Update on spine surgery, to select the five most clinically compelling findings from among the more than 40 studies they cited. Antifibrinolytics –A Level-I meta-analysis of 11 RCTs showed that tranexamic acid significantly lowered perioperative blood loss and transfusion requirements during spine surgery, with no associated increased incidence of heart attack or pulmonary embolism.

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OrthoBuzz regularly brings you a current commentary on a “classic” article from The Journal of Bone & Joint Surgery. These articles have been selected by the Editor-in-Chief and Deputy Editors of The Journal because of their long-standing significance to the orthopaedic community and the many citations they receive in the literature. Our OrthoBuzz commentators highlight the impact that these JBJS articles have had on the practice of orthopaedics. Please feel free to join the conversation about these classics by clicking on the “Leave a Comment” button in the box to the left. When Walter Putnam Blount, MD described “Tibia Vara: Osteochondrosis Deformans Tibiae” in the January 1937 issue of The Journal of Bone & Joint Surgery, he probably did not realize that this mouthful of a term would become known simply as “Blount disease.

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The July 6, 2016, edition of The Journal of Bone & Joint Surgery features a large case-cohort study that may help older patients and clinicians decide whether to use bone morphogenetic protein (BMP) as an adjunct to lumbar arthrodesis. Among Medicare patients aged 65 years and older, Beachler et al. found that BMP use was not associated with the following:Overall cancer riskIncreased risk of individual cancer typesIncreased risk of cancer in people who had cancer prior to undergoing lumbar arthrodesisIncreased mortality after a cancer diagnosisBMP was used in 30.7% of >3,600 lumbar-arthrodesis patients analyzed, and the lack of association between BMP use and cancer held whether patients received the growth factor as part of an FDA-approved anterior lumbar interbody fusion or as an off-label application.

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Articular cartilage is a unique and complex tissue. The interactions among chondrocytes, water, and matrix macromolecules provide articular cartilage with its special properties, including the absorption and distribution of compressive loads and low-friction articulation of synovial joints. However, this complex, unique, and sophisticated tissue does not repair itself well and cartilage repair recently has become the target of numerous investigations. Indeed, the natural history of articular cartilage defects is not well defined and thus the development of treatment strategies has been limited. One technique that has gained some success is microfracture. Microfracture is a commonly employed operative technique that is considered to be safe, relatively inexpensive, and minimally invasive as a first-line treatment for small, contained articular cartilage defects.

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The Orthopaedic Trauma Association (OTA) just launched a page on its website devoted to disaster-preparedness resources for surgeons and first responders. Titled “Get Prepared,” the page includes:A 93-slide PowerPoint presentation on orthopaedic blast injuriesCourses from the National Disaster Life Support Foundation and the American College of Surgeons’ Committee on TraumaA bibliography with links to the JBJS Reviews article “Disaster Response Management Protocol for Departments of Orthopaedic Surgery” and the JBJS/JOSPT Special Report It Takes a Team—The 2013 Boston Marathon.See related OrthoBuzz post. Share this story: TwitterFacebookLinkedIn

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Maybe—but only if larger, longer-term studies replicate the findings from a randomized trial of 144 patients (mean age = 66 years) published recently in the Annals of the Rheumatic Diseases. Subjects with knee osteoarthritis (OA) in the double-blind Annals study received either placebo or up to 25 mg per week of oral methotrexate over a 28-week period. At 28 weeks, researchers found greater reductions in knee pain and larger improvements in scores of physical function and activities of daily living in the methotrexate group than in the placebo group. The authors also noted a significantly greater reduction in synovitis, measured both clinically and with ultrasound, in the methotrexate group relative to the placebo group.

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OrthoBuzz regularly brings you a current commentary on a “classic” article from The Journal of Bone & Joint Surgery. These articles have been selected by the Editor-in-Chief and Deputy Editors of The Journal because of their long-standing significance to the orthopaedic community and the many citations they receive in the literature. Our OrthoBuzz commentators highlight the impact that these JBJS articles have had on the practice of orthopaedics. Please feel free to join the conversation about these classics by clicking on the “Leave a Comment” button in the box to the left. Austin Moore’s article “The Self-Locking Metal Hip Prosthesis” was published in The Journal of Bone & Joint Surgery in 1957.

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This month’s Image Quizfrom the JBJS Journal of Orthopaedics for Physician Assistants (JOPA) highlights the case of an 8-year-old boy who presents with a 3-month history of in-toeing. Anteroposterior pelvic and bilateral frog-leg radiographs are included, along with measurements of the foot progression angle, medial rotation of the hip, and the thigh-foot axis. The Image Quiz reviews the natural history of lower-extremity rotational deformities in children, and describes in detail how to make the physical-examination measurements that helped answer the clinical question of whether this patient’s in-toeing was benign or a sign of a more serious deformity.

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About one-third of lower-limb amputees have problems with the socket connecting their residuum to a prosthetic limb. This has led to the development of osseointegrated implants, which consist of a press-fit intramedullary implant that protrudes through the skin to accommodate an abutment to which the prosthetic limb is rigidly attached. Concerns about ascending infection and related complications with such constructs led Al Muderis et al. to conduct a multicenter prospective cohort study on the safety of osseointegrated implants, published in the June 1, 2016 JBJS. The authors found that mild infection and irritation of soft tissue were common, but that “these complications can be managed with simple measures,” such as outpatient antibiotic treatment.

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The first 2016 JBJS Quarterly CME Exam—based on articles published in January, February, and March—is now available. Starting now and going forward, each interactive quarterly CME experience from JBJS contains 100 questions and is approved for a maximum of 10 AMA PRA Category 1 CreditsTM. Even better, the ABOS has approved the JBJS Quarterly Exams for 10 Self-Assessment Exam (SAE) credits—half of the 20 SAE credits per three-year cycle that you need for Maintenance of Certification (MOC). So you can meet several continuing-education requirements with a single JBJS-vetted learning experience. Take JBJS Quarterly Exams online anytime, anywhere, with each exam available for one year from time of initial posting.

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