Impact of smoking on patient-reported outcome measures after arthroscopic rotator cuff repair: a 2-year comparative cohort study.

BACKGROUND AND HYPOTHESIS: Smoking is a well-established risk factor for tendon healing. The purpose of this study was to evaluate the differences in patient-reported outcome measures between smokers and nonsmokers who have undergone arthroscopic rotator cuff repair. It was hypothesized that smokers would have worse self-reported outcomes at 1 and 2 years postoperatively. METHODS: A total of 560 consecutive patients who underwent arthroscopic rotator cuff repair were divided into 2 groups: group I (smokers) n = 25 and group II (nonsmokers) n = 535. All participants were administered preoperative and postoperative surveys consisting of the following outcome-measuring tools: (i) visual analog scale, (ii) Veterans Rand 12-Item Health Survey, (iii) American Shoulder and Elbow Surgeons shoulder score, (iv) standard preoperative form consisting of 4 questions regarding their expectations of recovery, (v) Single Assessment Numeric Evaluation shoulder score, and (vi) Simple Shoulder Test. RESULTS: At 1 and 2 years postoperative, nonsmokers reported statistically significant differences in Veterans Rand 12-Item Health Survey mental scores (56.2 vs. 51.9, P = .0162 and 56.3 vs. 49.5, P = .0004, respectively). American Shoulder and Elbow Surgeons Shoulder scores showed no differences until the 2-year mark, at which time nonsmokers reported higher scores than smokers (87.9 vs. 79.0, P = .0212). Single Assessment Numeric Evaluation scores also remained similar up until 2-year follow-up, at which time nonsmokers reported statistically significant improvement (80.0 vs. 68.5, P = .0339). Nonsmokers reported higher Simple Shoulder Test scores at baseline and at 2-year follow-up (43.3 vs. 37.0, P = .0417 and 83.7 vs. 68.1, P = .0046, respectively). CONCLUSION: At 2 years postoperatively, nonsmokers had significantly higher patient-reported outcome measure scores than smokers. In elective surgery, smoking status should be considered as a risk factor for poorer patient-reported outcomes after arthroscopic rotator cuff repair. However, smokers continue to report a clinical benefit at 2 years postoperatively.

Long-term Outcomes of Silastic Arthroplasty of the Thumb Metacarpophalangeal Joint.

Background: Silastic metacarpophalangeal arthroplasty (SMPA) has proven to be a durable option for end-stage arthritis in the non-thumb digits, while fusion has been the mainstay procedure for the thumb metacarpophalangeal joint (MP). Few studies exist to comment on the viability of thumb MP arthroplasty. This study reports both survival and objective outcomes following SMPA of the thumb. Methods: In an institutional review board-approved retrospective study, we identified 18 patients who underwent thumb SMPA at a tertiary academic center by 3 board-certified hand surgeons. Primary outcome measures were implant survival and post-operative complications. Secondary outcomes measures were quick Disabilities of the Arm, Shoulder, and Hand (quickDASH) scores, brief Michigan Hand Questionnaire (bMHQ), and postoperative pain as rated by the numerical rating scale. Results: Mean quickDASH and bMHQ scores at final follow-up were 35.6 and 70.6, respectively. The most common short-term complication was clinical deformity, followed by instability. The sole long-term complication was an implant dislocation in a previously asymptomatic patient. All patients reported reduction in pain. Three patients were indicated for revision surgery, 2 for persistent instability, and 1 for implant dislocation. Primary survivorship was 83% at mean follow-up of 5.8 years. Conclusions: Thumb SMPA is a viable option for end-stage arthritis. Pain relief in our series was unanimous. Among those that reported persistent symptoms or required revision, a majority had one or more key preoperative risk factors for failure as currently reported in literature. Larger, prospective series are needed to prove superior longevity and functional outcomes of thumb SMPA versus fusion.

Descending Geniculate Artery Pseudoaneurysm Following Tibial Plateau Fracture.

Pseudoaneurysms are uncommon in patients with trauma, but can cause diagnostic difficulty and result in significant morbidity. Etiologies range from penetrating and nonpenetrating trauma to operative injury during fracture fixation, arthroscopy, total joint arthroplasty, and hardware loosening and removal. Pseudoaneurysms can conspicuously present as a pulsatile mass with an audible bruit, or as a subtly expanding hematoma. In either case, the complications can be serious if diagnosed late. The authors report a case of a pseudoaneurysm arising from the descending geniculate artery following a tibial plateau fracture. This was suspected following a slowly expanding hematoma and persistent anemia refractory to transfusion. Computed tomography angiography was used for confirmation. Successful treatment was accomplished with embolization, surgical evacuation of the hematoma, delayed skin grafting, and fracture fixation. The postoperative outcome was satisfactory, with complete wound healing, functional but decreased range of motion, normal perfusion distal to the injury, and the sole report of mild intermittent knee pain. [Orthopedics. 2017; 40(1):e188-e191.].

Osteoporosis Diagnosis and Management in Long-Term Care Facility.

BACKGROUND: Contemporary estimates of the prevalence of diagnosed osteoporosis among long-term care facility residents are limited. METHODS: This chart review collected data between April 1, 2012 and August 31, 2013 for adult (age ≥ 30 years) residents of 11 long-term care facilities affiliated with the Louisiana State University Health Sciences Center in the New Orleans metropolitan area. Data (demographics; comorbidities; osteoporosis diagnosis, risk factors, diagnostic assessments, treatments; fracture history; fall risk; activities of daily living) were summarized. Data for residents with and without diagnosed osteoporosis were compared using χ tests and t tests. RESULTS: The study included 746 residents (69% women, mean [SD] age: 76.3 [13.9] years, median length of stay approximately 18.5 months). An osteoporosis diagnosis was recorded for 132 residents (18%), 30% of whom received a pharmacologic osteoporosis therapy. Fewer than 2% of residents had bone mineral density assessments; 10% had previous fracture. Calcium and vitamin D use was more prevalent in residents with diagnosed osteoporosis compared with other residents (calcium: 49% versus 12%, vitamin D: 52% versus 28%; both P < 0.001). Over half (304/545) of assessed residents had a high fall risk. Activities of daily living were similarly limited regardless of osteoporosis status. CONCLUSIONS: The prevalence of diagnosed osteoporosis was higher than previously reported for long-term care residents, but lower than epidemiologic estimates of osteoporosis prevalence for the noninstitutional U.S. POPULATION: In our sample, osteoporosis diagnostic testing was rare and treatment rates were low. Our results suggest that osteoporosis may be underdiagnosed and undertreated in long-term care settings.

Theories and mechanisms of aging.

This article discusses various theories of aging and their relative plausibility related to the human aging process. Structural and physiologic changes of aging are discussed in detail by organ system. Each of the organ systems is discussed when applicable to the various theories of aging. Normal versus abnormal aging is discussed in the context of specific aging processes, with atypical presentations of disease and general links to life expectancy. Life expectancy and lifespan are discussed in the context of advances in medical science and the potential ultimate link to human life span.

Salvaging a geriatric medicine academic program in disaster mode-the LSU training program post-Katrina.

Formal training in geriatric medicine in Louisiana is in its infancy. This article portrays the struggle of the sole functioning geriatric medicine training program and its trials and tribulations in a survival mode, opportunities that come with disaster as well as lessons learned post-Katrina.

A second course of hylan G-F 20 for the treatment of osteoarthritic knee pain: 12-month patient follow-up.

This prospective open-label study evaluated the efficacy and tolerability of a second course of hylan G-F 20 for the treatment of osteoarthritic knee pain over a 12-month period in patients who previously experienced a beneficial initial course of therapy. Men or women aged > or = 40 years with knee osteoarthritis received 3 weekly injections of hylan G-F 20. Consecutive patients requesting a second course of therapy were enrolled from October 2000 to January 2001. The mean time between the first and second courses of hylan G-F 20 was 19.6 months. All efficacy parameters significantly improved (P<.001) from baseline at weeks 1, 2, 4, 8, 12, 26, and 52. Improvements from baseline to weeks 26 and 52 for the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) index question A1, WOMAC domain C, and total WOMAC were 1.39+/-0.11 and 1.1+/-0.12, 18.50+/-1.43 and 13.69+/-1.54, and 26.77+/-1.97 and 19.8+/-2.13, respectively. Significant improvements from baseline were maintained for patient and physician VAS to week 26 (patient: 48.66+/-2.52; investigator: 51.51+/-2.34) and week 52 (patient: 46.10+/-2.73; investigator: 47.23+/-2.52). A second course of hylan G-F 20 therapy was generally well-tolerated; the types of local events observed in this study were not qualitatively different from those in the current product information and published literature. For continued relief of osteoarthritic knee pain, this study supports repeat use of hylan G-F 20 in patients who had a previous successful course of therapy.

Is bone mineral density predictive of fracture risk reduction?

Bone mineral density (BMD) measurement is a widely available noninvasive means of identifying individuals with osteoporosis and, possibly, those at high risk for fracture. This nonsystematic review examines the relationship between BMD increase and fracture risk reduction in clinical trials evaluating osteoporosis therapy. The trials examined here are predominantly in postmenopausal women. BMD increase correlates poorly with fracture risk reduction in clinical trials of osteoporosis therapy conducted in postmenopausal women. Although BMD may increase with therapy, the increase is not measurable until later, and the overall increase is too small to account for the timing and magnitude of fracture risk reduction. BMD is only one of many contributors to bone strength and fracture risk reduction. Bone strength is derived from bone quantity, which consists of density and size, and bone quality, which, in turn, consists of structure (micro- and macroarchitecture), material properties, and turnover. Data are beginning to accrue suggesting that changes in bone turnover markers may be an accurate predictor of fracture risk reduction. Future research will elucidate the link between changes in bone turnover markers and bone architecture as a measure of osteoporosis treatment efficacy. Until then, physicians will continue to rely on fracture risk reduction data from well-designed clinical trials when judging the efficacy of different treatments for osteoporosis.

An open-label study of a second course of hylan G-F 20 for the treatment of pain associated with knee osteoarthritis.

OBJECTIVE: To evaluate the efficacy and tolerability of a second course of hylan G-F 20 for the treatment of osteoarthritic knee pain in patients who experienced a clinical benefit with an initial course of therapy. RESEARCH DESIGN AND METHODS: In this prospective, open-label study, men or women (>/=40 years of age) with knee osteoarthritis (OA) received three weekly injections of hylan G-F 20. Consecutive patients who requested a second course of hylan G-F 20 therapy due to OA knee pain subsequent to pain relief with a first course of therapy were enrolled between October 26, 2000 and January 18, 2001. MAIN OUTCOME MEASURES: Pain while walking on a flat surface (Western Ontario and McMaster's Universities Osteoarthritis Index, WOMAC, question A1), WOMAC domain C (physical functioning), full WOMAC, and patient and investigator overall visual analog scales (VAS). Efficacy variables were measured at baseline and at weeks 1, 2, 4, 8, 12 and 26. An analgesic washout was required before all efficacy evaluations. RESULTS: Patients receiving at least one injection of hylan G-F 20 (n = 71) were predominantly Caucasian (84.5%) and female (64.8%), with a mean age of 65.5 years and mean weight of 200.1 pounds. The mean time between the first and second courses of hylan G-F 20 was 19.6 months (median 17.6 months). With hylan G-F 20, pain while walking on a flat surface was significantly lower (p < 0.001) than baseline at all time points up to week 26 (mean +/- SEM: -1.40 +/- 0.10 at week 26). Actual scores decreased from 2.4 +/- 0.10 at baseline to 0.97 +/- 0.11 at week 26. Scores for the WOMAC domain C, full WOMAC and patient and investigator overall VAS also significantly improved (p < 0.001) at all time points. A second course of hylan G-F 20 was generally well-tolerated, based on the low incidence of local adverse events (AEs) - only one patient (1.4%) experienced a severe event, the types of AEs, and the fact that no patients discontinued the study due to these AEs. The types of related AEs observed were not qualitatively different from those listed in the current product information and published literature. CONCLUSION: A second course of hylan G-F 20 therapy is an appropriate therapy for the treatment of OA knee pain in patients who had a previous favorable clinical response. For continued relief of osteoarthritis knee pain, this study supports repeat use of hylan G-F 20 in these patients.

Geriatric medical education in Louisiana: current status and future needs.

Despite the impending explosion in the size of American's elderly population, physicians remain undertrained in geriatric medicine. In Louisiana, this training is especially important for the family physician and internist, many of whom practice primarily in rural areas and carry the bulk of nursing home patient care on their shoulders. Louisiana's medical schools offer little in the way of training in geriatric medicine, despite the author's finding that there is a strong interest for such training among practitioners and residents. Meanwhile, at the national level, leaders in geriatric medicine are working to develop new ways to encourage participation in geriatric educational opportunities.