News June 2007 Issue

In The News: 06/07

Shoulder Surgery Risks A Myth?

If you’ve been putting off shoulder surgery because of the cost or the specter of surgical risks, a major study in the journal

Clinical Orthopaedics may put your concerns to rest. Researchers found that patients with chronic arthritis pain who undergo shoulder

arthroplasty (placement of an artificial joint similar to that used in hip and knee surgery) can expect fewer complications, shorter hospital stays, and fewer costs than patients who undergo hip or knee replacement. Patient information from the Maryland Health Services Cost Review Commission for the period 1994-2001 revealed details on 15,414 hip surgeries, 34,471 knee procedures, and 625 shoulder surgeries. After examining how the patients fared, researchers determined that shoulder surgery was just as safe and effective as other joint-replacement procedures. The shoulder patients had fewer post-surgical complications (7.5 percent) compared with those who had knees and hips replaced (15.5 percent and 14.7 percent), and the average time a patient remained in the hospital following shoulder surgery was 2.42 days vs. more than four days for those who had knees or hips replaced. The cost was also less: an average $10,351 compared to hip replacement ($15,442) or knee arthroplasty ($14,674).

New Once-A-Year Drug Promises Reduced Risk Of Fractures

A new treatment on the horizon may reduce osteoporosis fractures with a single annual infusion. Zolendronic acid (Reclast) is a member of a class of drugs called bisphosphonates, which are designed to curb bone loss. If approved by the U.S. Food and Drug

Administration (which is expected this year), the drug will give people with osteoporosis the option of being treated with a single yearly infusion, which takes 15 minutes. Other osteoporosis drugs are taken orally once weekly (Fosamax, Actonel) or once monthly (Boniva, also available as an intravenous infusion every three months).

In a study of 7,736 women (average age 73) who also took calcium and vitamin D, zolendronic acid reduced the risk of spine fractures by 70 percent and hip fractures by 40 percent. When compared to Fosamax, a third of the women taking Reclast reported side effects (primarily headache, pain, or fatigue) within the first three days of treatment; only a fifth of those on Fosamax reported side effects. Three days after treatment, side-effect rates were similar for both drugs.


Methotrexate Plus Infliximab Move RA Patients Into Drug-Free Remission

Results from a study of 508 rheumatoid-arthritis patients conducted in the Netherlands suggest that early therapy with infliximab (Remicade) combined with methotrexate (Rheumatrex, Trexall) can often bring about remission of the disease.

Participants (average age 54) were separated into four groups and given a variety of standard RA treatments, using combinations of prednisone, sulfasalazine, infliximab, and methotrexate. After three years, 55 percent of patients in the infliximab/methotrexate group were in remission and had discontinued infliximab. In addition, 15 percent of patients remained in remission without any drug therapy.


Antibiotics Not Needed Before Knee Surgery

Although antibiotics are traditionally administered to prevent infection prior to arthroscopic knee surgery, one study has found there is no need for them. After reviewing 3,231 arthroscopic knee surgeries over three years, investigators found that 30 percent of

patients had received intravenous antibiotics before undergoing surgery. The infection rate was .15 percent in patients receiving antibiotics and .16 percent in those who did not receive antibiotics. Researchers claim that most orthopaedic surgeons continue to use antibiotics for routine arthroscopic surgeries—primarily due to fear of litigation if the patient were to develop an infection—despite a lack of evidence supporting their use. "Although there is a culture of using pre-op antibiotics in orthopaedic procedures," says Brian Donley, vice chairman of Cleveland Clinic’s Department of Orthopaedic Surgery, "this study shows that it is not needed for this type of surgery. And in addition to being unnecessary, it will save money not to use them."