Hip Fracture Comorbidity Tips; Oxford UKA vs TKA Re-Op Rate; Anand Spine Group to Tackle TOPS
Elizabeth Hofheinz, M.P.H., M.Ed. • Mon, October 9th, 2017
Hip Fracture Comorbidity Tips
Time to unravel the relationship between hip fracture, comorbidities, myocardial infarction, and stroke, said a group of Danish researchers.
Their work, “Hip Fracture, Comorbidity, and the Risk of Myocardial Infarction and Stroke: A Danish Nationwide Cohort Study, 1995–2015,” was published in the September 22, 2017 edition of the Journal of Bone and Mineral Research.
Alma B. Pedersen, D.M.Sc., Ph.D., M.D. with the Department of Clinical Epidemiology at Aarhus University Hospital in Denmark and co-author on the study, commented to OTW, “Mortality following hip fracture is high, which could be related to development of postoperative complications. Cardiovascular events are common and knowledge on the risk of myocardial infarction (MI) and stroke could help preventing these events and potentially reduce mortality.”
“Many hip fracture patients have other comorbid conditions and we wanted to know, how much of MI and stroke risk is due to hip fracture alone and how much could be explain by multi-morbidity.”
“Patients with hip fracture are at increased risk of both MI and stroke up to one year following fracture. We found that risk of stroke, but not of MI, was elevated for up to 10 years post fracture. During the ﬁrst 30 days, up to 76% of MI and stroke risk was attributable to interaction between hip fracture and comorbidity.”
“MI and stroke often starts during surgery or on the first postoperative day due to postoperative hypotension and atrial fibrilation. Thus, more focus on these two issues—with more often measurement of blood pressure and taking electrocardiography day one—could help reduce the risk of MI and stroke. Given the high mortality following MI and stroke, it is clinically important to target preventive treatment to patients with severe comorbidities, in order to achieve even a small reduction in MI and stroke risk and derby reduce mortality.”
“If we want to reduce mortality of hip fracture patients, it is important to focus not only on reoperation risk but also on the risk of other adverse events as well as other conditions patients have at the time of hip fracture. Even closer collaboration with anesthesiologists and geriatrics is necessary.”
Oxford UKA vs TKA Re-Op Rate
UK scientists recently set out to determine how the Oxford unicompartmental knee arthroplasty (UKA) stands up to total knee arthroplasty (TKA).
Their research, “Long-term outcomes of over 8,000 medial Oxford Phase 3 Unicompartmental Knees—a systematic review,” appears in the August 23, 2017 edition of Acta Orthopaedica.
Hasan R. Mohammad, M.D. orthopedic surgeon at the Nuffield Department of Orthopaedics at the University of Oxford and co-author on the study, told OTW, “There is a debate amongst knee surgeons regarding the merits of UKA compared to TKA. Although excellent results with the Oxford UKA have been reported by designer surgeons, concerns have been raised about reproducibility. Therefore, we aimed to address this issue by reviewing all existing studies available in the literature reporting the long-term outcomes of the Oxford Phase 3 UKA in an effort to bring some consensus on the topic.”
“The study design follows the Cochrane search strategy advice as well as including abstracts presenting long term outcomes at any conferences. We ensured that we evaluated the risk of bias of each study included in the analysis and factored this into our discussion. This has allowed us to extensively cover all studies reporting long-term outcomes in the literature fairly.”
“We analysed over 8,500 knees (15 studies) and found good outcomes were achieved by both designer and non-designer surgeons (average 10-year survival 93%, 15-year survival 89%). When the Oxford UKA is compared to TKA the functional outcomes, medical complications, and non-revision re-operation rate were better but the revision rate was higher. When failure is regarded to be all re-operations, then Oxford UKA results were superior to TKA.”
“This study demonstrates that results reported from the designer surgeons are reproducible and can be achieved in other centres. Furthermore, although the Oxford UKA has a higher revision rate than total knee arthroplasty it has a lower overall reoperation rate, better functional outcomes, and fewer medical complications.”
“Therefore, we feel that the Oxford UKA should be considered in all patients with anteromedial osteoarthritis/medial spontaneous osteonecrosis within the recommended indications of the designer surgeons. These include full thickness cartilage loss in the medial compartment with bone-on-bone contact, lateral compartment full thickness cartilage, intact medial collateral and anterior cruciate ligament and no severe lateral patellofemoral osteoarthritis. These indications are satisfied in about 50% of cases needing knee replacement.”
“The Oxford UKA can be used for about half of knees needing knee replacement. Good long-term outcomes are achievable for all Oxford UKA in any centre and that although the revision rates are higher for UKA, its functional outcomes, non-revision reoperations and medical complications are superior to TKA. Furthermore, if implant failure is regarded as any reoperation, then the failure rate of UKA is better than TKA.”
Anand Spine Group to Tackle TOPS
The Anand Spine Group, based in Los Angeles, California, will be a leading center in the national FDA investigational device exemption (IDE) pivotal trial to examine Premia Spine’s TOPS System.
Along with 29 other U.S. spine centers, the Anand Group will be assessing the potential for TOPS to be the first posterior arthroplasty device for the treatment of degenerative Grade I spondylolisthesis and spinal stenosis. Participants will be randomly assigned to either receive the TOPS System or undergo lumbar spinal fusion.
The Anand Spine Group is led by Neel Anand, M.D., M.Ch., Orth., professor of orthopedic surgery and director of spine trauma at Cedars-Sinai Medical Center.
According to the September 28, 2017 news release, “The TOPS System is a mechanical device that is designed to restore motion of the spine in all directions. Instead of permanently locking the two vertebrae with a fusion, the device allows the two vertebrae to continue moving…The new TOPS device, with a 30% smaller footprint and a simpler surgical technique from the original device, has been in commercial use in Europe for over five years.”
“We are very excited to be selected as investigators in the TOPS System study because it offers a unique opportunity for patients who meet the study’s criteria to potentially receive a motion preserving device for the surgical treatment of degenerative spondylolisthesis and spinal stenosis,” said Dr. Anand.
“There are countless numbers of people suffering from debilitating back pain caused by a slipped disc or narrowing of the spine that must either manage the pain through physical therapy and injections or undergo surgery,” added Dr. Anand. “We hope that this study will provide us the scientific data needed to support the continued use of technologies that aim to correct underlying spinal conditions while helping to restore range of motion.”
Dr. Anand told OTW, “This will be a unique opportunity for patients with degenerative spondylolisthesis and/or spinal stenosis to receive a motion preserving device instead of the routine treatment of a spinal fusion. These patients are usually not candidates for an artificial disc replacement and hence the TOPS System is the only viable, available non-fusion system that they could benefit from.”
“For surgeons, similarly, it gives them the opportunity to offer a motion preserving device to treat a condition for which spinal fusion is the routine procedure.”
“The study has been approved at Cedars Sinai Medical Center and we are recruiting patients and offering the opportunity to enter the trial and have a 66.66% chance of getting the device to treat their spinal ailment. This device is only available in the United States through an approved center that is conducting the trial.”