Physician's Weekly Surgery Edition Article - Conference Highlights: The AAOS 2009 Annual Meeting

       The American Academy of Orthopaedic Surgeons held its 2009 Annual Meeting from February 25 to February 28 in Las Vegas. The features below highlight just some of the news emerging from the meeting. For more information on these items and other research that was presented, go to www.aaos.org/.

      TKA Benefits Octogenarians

      The Particulars: Use of total knee arthroplasty (TKA) in patients older than 80 has been shown to carry many risks, including cardiovascular and neurologic complications. However, patients are living longer, and there is an increasing demand for sustaining quality of life (QOL) in the elderly population. Insufficient data compare the gains of TKA with the potential complications. Researchers compared preoperative QOL to postoperative QOL in patients older than 80 who underwent TKA.

      Data Breakdown: Data from 145 primary total knee replacements in 128 patients were reviewed. Two QOL scales, the Short Form-36 and Oxford Knee Score, were used to measure physical pain, social functioning, vitality, and physical functioning. A dramatic increase was observed in postoperative scores for health-related QOL dimensions and social-related QOL dimensions as early as 6 months postoperatively in TKA recipients. Scores were maintained at 2 years follow-up.

      Take Home Pearl: The advent of new technologies and techniques in both orthopedics and geriatric medicine has led to significant gains in pain and function in elderly patients who undergo TKA.

      Is an Orthopedic Surgeon Shortage Looming?

      The Particulars: Currently, over 700,000 total hip arthroplasties (THAs) and total knee arthroplasties (TKAs) are performed in the United States each year. The demand for arthroplasty is predicted to double in the next 10 years. This estimate, combined with a decreased interest in arthroplasty by residents and the retirement of arthroplasty surgeons, may threaten patient access to surgeons who are trained to perform these procedures.

      Data Breakdown: The estimated arthroplasty surgeon workforce in 2016 was determined by creating an economic supply and demand model. Investigators estimated that 400 hip and knee specialists and 1,594 generalists will enter the workforce between 2008 and 2016, and 963 specialists and 3,568 generalists will retire. By 2016, it is expected that the 427,500 THAs and 1,046,000 TKAs will be performed. Considering this data, the current workforce trend will lead to a shortfall of 46% and 72% THAs and TKAs, respectively, in 2016.

      Take Home Pearls: Demand for THA and TKA will significantly outpace the number of orthopedic surgeons able to perform these total joint replacements. Action must be taken to address the decreasing workforce.

      Leading the Way Toward Fewer Hip Fractures

      The Particulars: Osteoporosis-related hip fractures are a major health burden in the United States. Over 74 million baby boomers are approaching an age that increases their risk for osteoporosis and disease-related fractures. Managing bone health with screening and treatment may help to reduce fracture rates.

      Data Breakdown: Researchers examined the effectiveness of an osteoporosis management program—primarily consisting of medication treatment and osteoporosis management—on the incidence of hip fractures. The incidence of hip fractures was analyzed in over 500,000 patients aged 60 or older. Medication treatment reduced the risk of hip fracture by 45%. Screening for osteoporosis reduced risk by 82%.

      Take Home Pearl: Implementation of an osteoporosis management program may significantly reduce the risk of hip fractures in elderly patients.

      Orthopedic Injuries & Pregnancy

      The Particulars: Pelvic injuries carry the highest risk on pregnancy outcomes because they are associated with abdominal injuries. Few studies, however, have evaluated the effect of all trauma-related orthopedic injuries on pregnancy. Investigators evaluated pregnancy outcomes in women who delivered during or after their trauma admission.

      Data Breakdown: Over 1,600 pregnant women, 65 of which had an orthopedic trauma injury, were studied. Women who had orthopedic trauma injuries had an increased risk of pre-term delivery (23% vs 5%), placenta abruption (8% vs 1%), and perinatal mortality (8% vs 1%) when compared with those who did not have an orthopedic injury. Furthermore, infants had an increased risk of ICU nursery admission (15% vs 3%) and time spent on a ventilator (14% vs 3%).

      Take Home Pearl: Pregnant trauma patients with orthopedic injury have significantly greater risks for complications during pregnancy compared with women who did not experience such injuries.

      Analyzing ACL Surgery in Athletes

      The Particulars: Insufficient data exist on the ability of athletes to return to sports after anterior cruciate ligament (ACL) reconstruction. Researchers evaluated the timing and competition level of high school female and male athletes who returned to compete in basketball and soccer following ACL surgery.

      Data Breakdown: Follow-up data was obtained for more than 400 patients who were younger than 17 at the time of their first ACL surgery. For basketball, 87% of girls and boys returned to compete after surgery, of which 21% of women and 17% of men continued to compete in college. The mean time to return to full participation was 5.2 ± 2.1 months for women and 5.3 ± 2.2 months for men. For soccer, 93% of women and 80% of men returned to compete after surgery, and 33% of women and 24% of men continued to compete in college. The mean time to return to full participation was 5.1 ± 1.9 months for women and 5.1 ± 2.0 months for men.

      Take Home Pearl: Both male and female athletes who undergo ACL reconstruction when they are younger than 17 appear to return to competing in basketball and soccer at the same rate and the same level of sport after surgery.

      Assessing Disparities in Orthopedic Surgery

      The Particulars: The potential for gender and racial disparities continues to be an issue in orthopedic surgery. Researchers evaluated the relationship between gender, race, and preoperative function in a diverse patient population undergoing hip and knee replacement.

      Data Breakdown: Investigators evaluated preoperative function of over 3,500 hip and knee replacement patients using the Harris Hip and Knee Society scores. African-American and Hispanic patients demonstrated lower preoperative hip and knee function, with an average Harris Hip score of 8.77 points lower and 4.9 points lower than Caucasian patients, respectively. Poorer preoperative hip function was found in Hispanic men and African American and Hispanic women prior to hip replacement than Caucasian women. Hispanic men had significantly worse function prior to knee and hip replacement than African American and Caucasian men.

      Take Home Pearls: Hispanic and African-American patients appear to have poorer preoperative hip and knee function prior to arthroplasty compared to Caucasians. Future efforts should be made to understand the cause of gender and racial disparities in orthopedics.

      For more information on the annual meeting news emerging from the American Academy of Orthopaedic Surgeons, as well as further data on the studies presented in this feature story, go to www.aaos.org/.