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NEWS - Orthopedics

Graduated compression stockings for prevention of deep vein thrombosis – Cochrane Library (free)

Summary: Graduated compression stockings for prevention of deep vein thrombosis during a hospital stay – Cochrane Library (free)

“There is high-quality evidence that GCS are effective in reducing the risk of DVT in hospitalised patients who have undergone general and orthopaedic surgery”

 


Deep neural network improves fracture detection by clinicians – Proceedings of the National Academy of Sciences (free)

“How to reduce emergency doctor misinterpretation of wrist X-rays for fracture by nearly 50%? Deep learning AI, of course” (via @EricTopol see Tweet)

 


The clinical and cost-effectiveness of corticosteroid injection versus night splints for carpal tunnel syndrome (INSTINCTS trial): an open-label, parallel group, randomised controlled trial – The Lancet (free)

Invited Commentary: Steroid injection or wrist splint for first-time carpal tunnel syndrome? (free)

“A single corticosteroid injection shows superior clinical effectiveness at 6 weeks compared with night-resting splints, making it the treatment of choice for rapid symptom response in mild or moderate carpal tunnel syndrome presenting in primary care.”

 


Should You Have Knee Replacement Surgery? – The New York Times (10 articles per month are free)

“Some experts question whether the surgery is being done too often or too soon on patients who have not adequately explored less invasive approaches.”

 


Effect of Early Surgery vs Physical Therapy on Knee Function Among Patients With Nonobstructive Meniscal Tears: The ESCAPE Randomized Clinical Trial – JAMA (free for a limited period)

Commentary: PT an Alternative to Surgery for Some Meniscal Tears – Physician’s First Watch (free)

Related: Adverse Outcomes After Arthroscopic Partial Meniscectomy (free study, commentary and guideline on the subject)

“Our Dutch multi center RCT demonstrates noninferiority of physical therapy compared with early surgery with arthroscopic partial meniscectomy for improving self-reported knee function in patients with nonobstructive meniscal tears.” (via @RudolfPoolman see Tweet)

 


Guideline for the management of hip and knee osteoarthritis – Royal Australian College of General Practitioners (free PDF)

News Release: Updated osteoarthritis guideline designed to reduce unnecessary imaging and surgery (free)

Commentary: Australia hopes to reduce unnecessary imaging, surgery with updated osteoarthritis guidelines – Health Imaging (free)

““The Guideline for the management of knee and hip osteoarthritis,” offer up exercise and weight loss as a first line defense, and warn against costly treatments using glucosamine, opioids and arthroscopic surgery, said David Hunter, co-chair of the RACGP group responsible for the update.” (from Health Imaging)

 


Effect of Negative Pressure Wound Therapy vs Standard Wound Management on 12-Month Disability Among Adults With Severe Open Fracture of the Lower Limb: The WOLLF Randomized Clinical Trial – JAMA (free for a limited period)

Commentaries: High-tech treatment of open leg wounds no better than using regular dressings – University of Warwick (free) AND Negative-Pressure Therapy No Better for Open Fractures – Medscape (free registration required)

“Negative pressure wound therapy did not improve 12-month disability for patients with severe open fracture of the lower limb compared with standard wound dressing”

 


Percutaneous vertebroplasty for osteoporotic vertebral compression fracture – Cochrane Library (link to abstract – $ for full-text)

Summary: Featured Review: Vertebroplasty for treating spinal fractures due to osteoporosis – Cochrane Library (free)

High quality evidence shows that vertebroplasty does not provide more clinically important benefits than placebo but may cause people harm”.

 


Opioid Wisely – Choosing Wisely Canada (free)

Related Guideline: Guideline for opioid therapy and chronic noncancer pain – Canadian Medical Association Journal (free)

See complete lists from Choosing Wisely U.S. / Choosing Wisely UKChoosing Wisely Australia AND Choosing Wisely Canada

This campaign encourages thoughtful conversation between clinicians and patients to reduce harms associated with opioid prescribing, with recommendations relevant to different specialties.

 


Surgery for trigger finger – Cochrane Library (link to abstract – $ for full-text)

 


Aspirin or Rivaroxaban for VTE Prophylaxis after Hip or Knee Arthroplasty – New England Journal of Medicine (link to abstract – $ for full-text)

Quick Take Video Summary: Preventing VTE after Hip or Knee Arthroplasty (free)

“Among patients who received 5 days of rivaroxaban prophylaxis after total hip or total knee arthroplasty, extended prophylaxis with aspirin was not significantly different from rivaroxaban in the prevention of symptomatic venous thromboembolism”.

 


Sham surgery versus labral repair or biceps tenodesis for type II SLAP lesions of the shoulder: a three-armed randomised clinical trial – British Journal of Sports Medicine (free)

“Neither labral repair nor biceps tenodesis had any significant clinical benefit over sham surgery for patients with SLAP II lesions in the population studied”.

 


Weekend Surgical Care and Postoperative Mortality: A Systematic Review and Meta-Analysis of Cohort Studies (free)

Commentary: Evidence Supports ‘Weekend Effect’ for Mortality after Surgery – Wolters Kluwer, via NewsWise (free)

“The odds of postoperative mortality were 27 percent higher for patients admitted to the hospital on Saturday or Sunday, compared to those hospitalized on a weekday” (from NewsWise).

 


Postsurgical prescriptions for opioid naive patients and association with overdose and misuse: retrospective cohort study – The BMJ (free)

“The duration of treatment rather than dose is more strongly associated with opioid misuse after surgery, concludes this study” (via @bmj_latest see Tweet)

 


Choice of implant combinations in total hip replacement: systematic review and network meta-analysis – The BMJ (free)

Commentary: What is the most effective type of hip implant combination for patients undergoing a hip replacement? – University of Bristol (free)

“…there is no evidence that any of the newer hip implant combinations, such as ceramic or uncemented, are better than the widely used small head metal-on-plastic cemented hip combination, which has been commonly used since the 1960s”.

 


Local nerve blocks can improve outcomes for people with hip fracture – NIHR Signal (free)

Original article: Peripheral nerve blocks for hip fractures – Cochrane Library (link to abstract – $ for full-text)

“One case of pneumonia prevented for every 7 hip fracture patients given pain relief with nerve block” (RT @NIHR_DC see Tweet)

 


Comprehensive assessment may reduce risk of delirium after hip fracture – NIHR Signal (free)

Original article: Comprehensive Geriatric Assessment for Prevention of Delirium After Hip Fracture: A Systematic Review of Randomized Controlled Trials – Journal of The American Geriatrics society (link to abstract – $ for full-text)

“Comprehensive geriatric assessment reduced the risk of delirium by 20% in patients having hip fracture surgery” (RT @NIHR_DC see Tweet)

 


Osteoarthritis of the Knee Clical Care Standard – Australian Commission on Safety and Quality in Health Care (PDF Guideline and other resources)

Source: Research Review Australia (free resource to find articles of interest)

 


Low molecular weight heparin for prevention of venous thromboembolism in patients with lower-limb immobilization – Cochrane Library (link to abstract – $ for full-text)

“Moderate-quality evidence showed that the use of LMWH in outpatients reduced DVT when immobilization of the lower limb was required, when compared with no prophylaxis or placebo”.

 


Long-Term Effects of Repeated Injections of Local Anesthetic With or Without Corticosteroid for Lumbar Spinal Stenosis: A Randomized Trial – Archives of Physical Medicine and Rehabilitation (free)

Source: ACP Journal Wise ($)

“Epidural injections of corticosteroid plus lidocaine offered no benefits from 6 weeks to 12 months beyond that of injections of lidocaine alone”

 


When surgery is just a stitch-up – The Guardian (RT @Onisillos  see Tweet)

Related article: Use of placebo controls in the evaluation of surgery: systematic review – The BMJ (free)

“With evidence mounting that many minor operations owe their success to the placebo effect, is it time to call a halt to some routine procedures?”

 


A comprehensive guide to the new science of treating lower back pain – VOX (free)

“Mainstream medicine has failed people with chronic back pain”

 


New National Guideline Clearinghouse (NGC) Summaries in Low back, Cervical and Thoracic Spine Disorders with focus on occupational health.

Low Back Disorders – American College of Occupational and Environmental Medicine (free summary from NGC – $ see original guideline in ACOEM website)

Cervical and thoracic spine disorders – American College of Occupational and Environmental Medicine (free summary from NGC – $ see original guideline in ACOEM website)

 


Effectiveness of non-steroidal anti-inflammatory drugs for the treatment of pain in knee and hip osteoarthritis: a network meta-analysis – The Lancet (link to abstract – $ for full-text)

Diclofenac 150 mg/day is the most effective NSAID available at present (are the cardiac and renal risks worth it?) and Paracetamol does not seem to work for this condition.

 


Is cyclobenzaprine useful for pain? – Therapeutics Initiative (free)

“…cyclobenzaprine is a long-acting sedative, not a muscle relaxant, and questioning whether any potential benefits are worth the side effects”. (from TI Newsletter). “If prescribed, a dose of 5 mg at bedtime should be tried first.  Evidence suggests titration based on response and tolerability to a maximum dose of 15 mg/day, for no longer than one week”.

 


Viewpoint: The Evolving Story of Overlapping Surgery – JAMA (free) (RT @pash22 see Tweet)

Commentary: 3 steps to restore patient trust in overlapping surgeries – FierceHealthcare (free)

This interesting viewpoint discusses the practice of scheduling overlapping surgeries, in which a qualified practitioner finishes noncritical parts of the first operation while the primary surgeon moves to the next surgery.

 


Implant Survival After Minimally Invasive Anterior or Anterolateral Vs. Conventional Posterior or Direct Lateral Approach: An Analysis of 21,860 Total Hip Arthroplasties from the Norwegian Arthroplasty Register (2008 to 2013) – The Journal of Bone and Joint Surgery (link to abstract – $ for full-text)

Commentary: Implant survival for minimally invasive vs. open hip surgery: 4 key notes – Spine Review (free)

Source: EvidenceAlerts (free resource to find articles of interest in all specialties)

“There were no significant differences among the surgical approaches with regard to the 2 and 5-year survival rates or RR of revision due to any cause”

 


Venous Thromboembolism Prophylaxis in Major Orthopedic Surgery: Systematic Review Update. Comparative Effectiveness Review – Agency for Healthcare Research and Quality (free report and summary)

See also: Executive summary (free PDF)

Source: ACP Journal Wise ($ resource to find articles of interest)

Comprehensive review on the evidence regarding thromboembolism prophylaxis in major orthopedic surgery.

 


What I Wish I’d Known About My Knees – The New York Times (10 articles per month are free)

Related guideline: Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline – The BMJ (free)

“There’s little evidence to support many of the procedures people undergo in the hopes of avoiding a knee replacement”. (RT @NYTHealth see Tweet)

 



A Meta-analysis of the Impact of Aspirin, Clopidogrel, and Dual Antiplatelet Therapy on Bleeding Complications in Noncardiac Surgery – Annals of Surgery (link to abstract – $ for full-text)

Source: EvidenceAlerts (free resource to find articles of interest)

“Antiplatelet therapy at the time of noncardiac surgery confers minimal bleeding risk with no difference in thrombotic complications. In many cases, it is safe to continue antiplatelet therapy in patients with important indications for their use”

 


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