Tip Sheet: Johns Hopkins Researchers Present at Orthopaedic Meeting

03/16/2019

What: American Academy of Orthopaedic Surgeons 2019 Annual Meeting

When: Tuesday, March 12–Saturday, March 16, 2019

Where: Venetian / Sands Expo, 201 Sands Avenue, Las Vegas, Nevada 89169  

Lower Cutoffs for Blood Transfusions for Higher-Value Care

When: Tuesday, March 12, 8:06–8:12 a.m., PST; Thursday, March 14, 3:06–3:12 p.m., PST (6:06-6:12 p.m., EST)
Where: Palazzo Ballroom J; Room 2102
Session: Trauma I (016-030, 879): Geriatric Trauma, Paper 017; Adult Reconstruction Hip V (574-588): Outcomes measures, Paper 586

Patients with hip fractures often receive blood transfusions during their time in the hospital for surgery; however, blood transfusions can result in infection and other adverse outcomes, including major complications and even death. To avoid overusing transfusions, Raj Amin, orthopaedic surgery resident at the Johns Hopkins University School of Medicine, and team investigated whether making the standards stricter for when to give blood transfusions to patients with hip fractures could improve patient outcomes.

According to the Centers for Disease Control and Prevention, 300,000 people over 65 in the U.S. are hospitalized for hip fractures. This population may be frail, and the risks for them to have complications such as blood clots, heart attacks and infections after surgery are higher if they receive a blood transfusion. Currently, both the American Academy of Orthopaedic Surgeons and American Association of Blood Banks recommend patients receive a blood transfusion if they have a hemoglobin—a protein used to measure red blood cell counts—concentration lower than 8 grams per deciliter. By analyzing medical records of 498 patients with hip fractures admitted to The Johns Hopkins Hospital between January 2013 and May 2017, Amin and team found that reducing the cutoff to 7 grams per deciliter was safe for patients and could cut the number of transfusions by more than half, saving $70,840 over the study period for the hospital.

In a related study, Amin’s team investigated how a blood management program can influence transfusion rates among patients undergoing hip or knee replacements. The program used the lowered cutoff for blood transfusions, individualized provider feedback with monthly summaries on how many patients they transfused and other efforts. This reduced the transfusion rate by 86.1 percent, saving $32,000–$92,000 for the hospital over the study period, depending on which hospital unit gives the transfusion.
 

Obesity Linked with Worse Knee Disorders in Adolescents

When: Wednesday, March 13, 2019, 11:24–11:30 a.m., PST (2:24-2:30 p.m., EST)

Where: Room 4303
Session: Pediatrics II, Paper 340

For an adolescent active in sports, nothing is more frustrating than having a condition that substantially limits his or her ability to move and participate in activities. Davis Rogers, a medical student at the Johns Hopkins University School of Medicine, was diagnosed with a joint disorder in high school. The condition, osteochondritis dissecans, is a joint disorder that most often affects children and adolescents, especially those active in sports. It causes pain and sometimes swelling of the affected joint, and can progress to catching and locking when moving. His own difficulty brought on by the condition led Rogers to investigate risk factors that could contribute to more severe symptoms, especially obesity, which continues to become an increasing concern for pediatric patients.

After reviewing medical records of 77 adolescents treated for this joint disorder, researchers showed that adolescents whose body mass indexes were in the highest 20 percent among the study participants had a 30 to 150 percent higher chance of showing severe symptoms such as fluid buildup around the osteochondritis dissecans and advanced bone and cartilage disease. Researchers say that clinicians should let children know that they can have a more severe osteochondritis dissecans at the time of presentation if they are obese or overweight, and therefore encourage them to work toward a healthy weight with an appropriate diet and exercise plan.

              

Replacing Opioids with Common OTC Pain Meds Doesn’t Impede Bone Healing in Children

When: Friday, March 15, 2019, 4:12–4:18 p.m., PST (7:12-7:18 p.m., EST)
Where: Room 3401
Session: Practice Management/Rehabilitation IV (841-855)

Non-steroidal anti-inflammatory drugs (NSAIDs) such as naproxen and ibuprofen are commonly used to treat pain after fractures. However, some clinicians worry that NSAIDs may harm the healing of bone fractures in children, and prescribe opioids instead. Given the ongoing national opioid crisis and the wish to reduce opioid prescriptions, Gregory Toci, a medical student at the Johns Hopkins University School of Medicine, and team wanted to see whether NSAIDs could treat pain in simple fractures in children just as well as opioids without delaying healing.

To do this, researchers screened records of children with simple fractures. They compared medications prescribed in 28 children whose fractures healed well with 56 children whose fractures didn’t heal well, and didn’t find any differences. Their study suggests that the outcomes of fractures in children weren’t affected by choice of pain reliever. Researchers hope this research will encourage clinicians to prescribe common, anti-inflammatory drugs to children and refrain from prescribing opioids.

 

Assessing Unstable Kneecaps with Eyes Alone Not Reliable

When: Saturday, March 16, 2019, 12:46–12:51 p.m., PST (3:46-3:51 p.m., EST)

Where: Venetian/Sands Expo, Palazzo Ballroom F
Session: AOSSM/AANA Specialty Day

Unstable kneecaps, or patellar tracking disorder, happens when the kneecaps shift out of place as the leg bends or straightens. Most clinicians assess patients’ knees by a general examination during an office visit, and only a few medical centers have access to dynamic 4D CT scans for evaluation. Matthew Best, resident in orthopaedic surgery at the Johns Hopkins University School of Medicine, and team did the first study to investigate whether physicians’ evaluations by eyes alone are reliable to accurately detect the presence and severity of kneecap instability, which can help guide treatment.

After comparing the visual assessments of physicians, including specialists of this condition, with the more accurate results from a 4D CT scan, researchers showed that assessments varied significantly between physicians. Experts could only point out two-thirds of the cases with kneecap instability, and could only accurately determine severity of the condition in half the cases. Researchers say that their study suggests that clinicians shouldn’t assess patients’ kneecap movement by their eyes alone and should use objective imaging to improve assessments. They say that inaccurate diagnosis can result in persistent symptoms or may lead to inappropriate treatment.