Orthopedics (all articles)
RCT: Methotrexate Shows Modest Pain Reduction in Knee Osteoarthritis, More Research Needed – Ann Intern Med
18 Aug, 2024 | 18:01h | UTCStudy Design and Population: This multicenter, randomized, double-blind, placebo-controlled trial evaluated the effects of oral methotrexate on 207 participants with symptomatic knee osteoarthritis (KOA) who had persistent knee pain despite prior treatments. Conducted across 15 musculoskeletal clinics in the UK from June 2014 to October 2017, participants were randomly assigned to receive either methotrexate or placebo over a 12-month period.
Main Findings: At 6 months, methotrexate resulted in a modest reduction in knee pain, with a statistically significant difference of 0.79 points on the NRS compared to placebo (95% CI, 0.08 to 1.51; P = 0.030). Small but statistically significant improvements were also noted in knee stiffness and function. However, the clinical significance of these findings remains uncertain, and potential side effects of methotrexate warrant caution.
Implications for Practice: While methotrexate may offer some symptomatic relief for patients with knee osteoarthritis who do not respond to standard treatments, the modest reduction in pain and improvement in function observed in this study may not justify its routine use given the potential for significant side effects. The small magnitude of benefit suggests that methotrexate should be considered cautiously and only in select patients. Further research is necessary to confirm these findings and to better understand the risk-benefit profile of methotrexate in this population before broader clinical adoption.
RCT: Triple combination of paracetamol, ibuprofen, and dexamethasone reduces morphine use post-hip arthroplasty – Lancet Rheumatol
11 May, 2024 | 14:18h | UTCStudy Design and Population: The RECIPE trial was a randomized, blinded, placebo-controlled multicenter study conducted across nine Danish hospitals to evaluate the effectiveness of non-opioid analgesic combinations in managing postoperative pain following total hip arthroplasty. A total of 1,060 adults scheduled for surgery were enrolled and randomly assigned to one of four treatment groups, receiving combinations of paracetamol, ibuprofen, and dexamethasone. The study’s primary endpoint was the 24-hour intravenous morphine consumption, with a predefined minimal important difference set at 8 mg.
Main Findings: The trial results indicated significant reductions in 24-hour morphine consumption in the group receiving paracetamol, ibuprofen, and dexamethasone combined, compared to other groups, though none reached the minimal important difference. Specifically, this group consumed a median of 15 mg morphine, which was less than the other groups ranging from 16 mg to 24 mg. However, the differences did not meet the study’s threshold for a clinically important effect. Adverse events were lowest in the combined treatment group, suggesting a better safety profile primarily characterized by fewer incidents of nausea, vomiting, and dizziness.
Implications for Practice: The findings support the use of a combined regimen of paracetamol, ibuprofen, and dexamethasone for reducing morphine consumption post-total hip arthroplasty, which could be significant in clinical settings aiming to minimize opioid use. The improved safety profile also highlights the potential benefits of multimodal analgesia. Further research may explore the optimization of dosing schedules and long-term outcomes to enhance patient recovery and satisfaction.
Reference (link to abstract – $ for full-text):
Systematic Review: Diagnostic accuracy of clinical examination for dislocated hips in infants
28 Apr, 2024 | 16:52h | UTCThis systematic review assesses the diagnostic accuracy of clinical examinations in identifying dislocated hips in infants, using data from nine studies that compared clinical examinations to diagnostic ultrasound as the reference. The study involved 37,859 hips with a dislocation prevalence of 0.94%. The Barlow and Ortolani maneuvers showed a sensitivity of 46% and a specificity of 99.1%, with a positive likelihood ratio of 52, highlighting their effectiveness in predicting hip dislocation. Other methods such as limited hip abduction and a clicking sound were found to have minimal diagnostic utility. This evidence supports the clinical utility of specific maneuvers in early detection to prevent long-term complications.
Reference (link to abstract – $ for full-text):
Consensus Paper | Surgical video data use, structure, and exploration (for research in AI, quality improvement, and education)
9 Aug, 2023 | 15:20h | UTC
Cohort Study | Vegetarian diet linked to elevated hip fracture risk; BMI plays a partial role
9 Aug, 2023 | 15:16h | UTC
Podcast | Knee pain pearls
9 Aug, 2023 | 15:08h | UTC#406 Kneedful Things: Knee Pain 201 with Dr. Ted Parks – The Curbsiders
RCT | Ferric derisomaltose plus tranexamic acid may reduce blood transfusion risk by 50% in hip surgery
3 Aug, 2023 | 13:18h | UTCFerric derisomaltose and tranexamic acid, combined or alone, for reducing blood transfusion in patients with hip fracture (the HiFIT trial): a multicentre, 2 × 2 factorial, randomised, double-blind, controlled trial – The Lancet Haematology (link to abstract – $ for full-text)
RCT | Platelet-rich plasma injections lack efficacy in 52-week ankle osteoarthritis study
2 Aug, 2023 | 13:43h | UTC
M-A | Updated evidence supports incisional negative pressure wound therapy for surgical site infection prevention
1 Aug, 2023 | 14:15h | UTC
Guideline | Diagnosis and treatment of fragility fractures of the pelvis
14 Jul, 2023 | 12:39h | UTC
Podcast | Overuse injuries in pediatrics
11 Jul, 2023 | 13:52h | UTC#86: Overuse Injuries – The Leg Bone’s Connected to the Foot Bone! – The Cribsiders
Systematic Review | Ethical perspectives on surgical video recording for patients, surgeons and society
11 Jul, 2023 | 13:44h | UTC
RCT | Opioids not more effective than placebo for acute low back and neck pain
5 Jul, 2023 | 01:15h | UTCOpioid analgesia for acute low back pain and neck pain (the OPAL trial): a randomised placebo-controlled trial – The Lancet (link to abstract – $ for full-text)
News Releases:
Opioids no more effective than placebo for acute back and neck pain – University of Sidney
Opioid pain relievers do not reduce acute lower back and neck pain, study suggests – The Lancet
Commentary from the authors: Opioids don’t relieve acute low back or neck pain – and can result in worse pain, new study finds – The Conversation
M-A | Prophylactic intravenous tranexamic acid and thromboembolism in non-cardiac surgery
29 Jun, 2023 | 14:03h | UTC
RCT | Arthroscopic capsular shift surgery shows no significant pain or functional improvement in atraumatic shoulder instability
29 Jun, 2023 | 13:45h | UTCArthroscopic capsular shift surgery in patients with atraumatic shoulder joint instability: a randomised, placebo-controlled trial – British Journal of Sports Medicine (link to abstract – $ for full-text)
Position Statement | Prehospital hemorrhage control and treatment by clinicians
27 Jun, 2023 | 14:02h | UTC
Cohort Study | Increased revision rates seen in shoulder replacement surgeries by surgeons with less than 10 procedures annually
27 Jun, 2023 | 13:48h | UTCSummary: This prospective cohort study investigated the correlation between surgeon volume and patient outcomes after elective shoulder replacement surgeries. Utilizing data from 39,281 procedures performed by 638 surgeons in UK public and private hospitals between 2012-20, the study focuses on adults aged 18 years or older.
The results indicate a significant connection between a surgeon’s mean annual volume and risk of adverse patient outcomes. Surgeons performing fewer than 10.4 procedures per year demonstrated a significantly increased risk of revision surgery, with the hazard ratio being almost twice as high as that of the lowest risk surgeons. Higher mean annual surgical volume correlated with lower risks of reoperations, fewer serious adverse events, and shorter hospital stays.
These findings suggest the need for strategic resource planning in surgical services, with considerations given to surgeon’s annual procedure volume to improve patient outcomes after shoulder replacement surgery. It should be noted that the study was limited in scope to surgeries performed within the NHS and private hospitals in England. Furthermore, potential confounding factors like patients’ social circumstances, carer availability, or body mass index were not considered.
Editorial: Surgeon volume and patient outcomes in shoulder replacement surgery – The BMJ
News Release: Patients do better when surgeon averages 10 + annual shoulder ops – BMJ Newsroom
RCT | High-dose dual-antibiotic cement doesn’t lower infection rates in hip hemiarthroplasty
26 Jun, 2023 | 00:47h | UTCSummary: This randomized superiority trial studied the effect of high-dose dual-antibiotic loaded cement versus standard care single-antibiotic loaded cement on deep surgical site infection (SSI) rates in hip hemiarthroplasty patients. This large-scale study, conducted in 26 UK hospitals, included people aged 60 and older with a hip fracture.
The trial randomly allocated 4936 participants to either treatment group. The primary outcome was deep SSI at 90 days post-randomisation. Notably, no significant difference was found between the groups. About 1.7% of participants in the single-antibiotic group and 1.2% in the dual-antibiotic group experienced a deep SSI (adjusted odds ratio 1.43; 95% CI 0.87–2.35; p=0.16). This result contradicts previous findings suggesting that high-dose dual-antibiotic cement could reduce infection rates.
News release: Antibiotic bone cement found not to reduce infection after hip replacement – University of Oxford
Review | The antibiotic bead pouch – A useful technique for infection prevention and therapy in trauma surgery
26 Jun, 2023 | 00:35h | UTC
Review | Evaluation and management of diabetes-related foot infections
23 Jun, 2023 | 13:36h | UTCEvaluation and Management of Diabetes-related Foot Infections – Clinical Infectious Diseases
Related: Guideline Series | Prevention and management of diabetes-related foot disease
Review | Nonsurgical management of major hemorrhage
22 Jun, 2023 | 15:16h | UTCNonsurgical management of major hemorrhage – Canadian Medical Association Journal
Editorial | How to become a good surgeon
22 Jun, 2023 | 15:12h | UTCHow to become a good surgeon – Advances in Ophthalmology Practice and Research
RCT | Comparable 1-year outcomes for intramedullary nail vs. sliding hip screw in trochanteric fractures
22 Jun, 2023 | 15:06h | UTCInvited Commentary: A Gap Between Evidence-Based Research and Clinical Practice in Management of Hip Fractures – JAMA Network Open
Commentary on Twitter
INSITE RCT: No significant benefit to using more costly intramedullary devices over sliding hip screws for the majority of patients with trochanteric hip fractures, adding to the body of evidence that the increasing use of these implants is unwarranted. https://t.co/15iJRW5xIS
— JAMA Network Open (@JAMANetworkOpen) June 6, 2023
The foot in diabetes – a reminder of an ever-present risk
21 Jun, 2023 | 13:10h | UTCThe foot in diabetes – a reminder of an ever-present risk – Clinical Medicine Journal
Related: Guideline Series | Prevention and management of diabetes-related foot disease
Systematic Review | Tranexamic acid likely decreases red blood cell transfusion need in hip fracture surgery
16 Jun, 2023 | 14:09h | UTC