Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Published in
Clinical Orthopaedics and Related Research®
Volume 473 | Issue 8 | Aug, 2015

Disability After Deployment Injury: Are Women and Men Service Members Different?

Jessica C. Rivera MD, Christina M. Hylden MD, Anthony E. Johnson MD

Civilian trauma literature suggests sexual dimorphism in outcomes after trauma. Because women represent an increasing demographic among veterans, the question remains if war trauma outcomes, like civilian trauma outcomes, differ between genders.

Does Patient Sex Affect the Rate of Mortality and Complications After Spine Surgery? A Systematic Review

Andrew J. Schoenfeld MD, MSc, Elyse N. Reamer BS, Emily I. Wynkoop BS, Hwajung Choi PhD, Christopher M. Bono MD

Available studies disagree regarding the influence of patient sex on mortality and complications after spine surgery. We sought to conduct a systematic review and pool the results of existing research to better understand this issue.

Sex Differences in Cartilage Topography and Orientation of the Developing Acetabulum: Implications for Hip Preservation Surgery

Jonathan B. Peterson MD, Josh Doan MEng, James D. Bomar MPH, Dennis R. Wenger MD, Andrew T. Pennock MD, Vidyadhar V. Upasani MD

Increased attention is being placed on hip preservation surgery in the early adolescent. An understanding of three-dimensional (3-D) acetabular development as children approach maturity is essential. Changes in acetabular orientation and cartilage topography have not previously been quantified as the adolescent acetabulum completes development.

β-Ecdysone Augments Peak Bone Mass in Mice of Both Sexes

Weiwei Dai PhD, HongLiang Zhang MD, PhD, Zhendong A. Zhong PhD, Li Jiang MD, Haiyan Chen MS, Yu-An Evan Lay MS, Alexander Kot BS, Robert O. Ritchie PhD, Nancy E. Lane MD, Wei Yao MD

One of the strongest predictors for osteoporosis is peak bone mass. Interventions to augment peak bone mass have yet to be developed. β-Ecdysone (βEcd), a natural steroid-like compound produced by arthropods to initiate metamorphosis, is believed to have androgenic effects and so may be used to augment bone mass.

Functional Impairment Is a Risk Factor for Knee Replacement in the Multicenter Osteoarthritis Study

Barton L. Wise MD, MSc, Jingbo Niu DSc, David T. Felson MD, MPH, Jean Hietpas LCSW, Alesia Sadosky PhD, MPH, MBA, James Torner PhD, MS, Cora E. Lewis MD, MSPH, Michael Nevitt PhD, MPH

Debilitating pain associated with knee osteoarthritis (OA) often leads patients to seek and complete total knee arthroplasty (TKA). To date, few studies have evaluated the relation of functional impairment to the risk of TKA, despite the fact that OA is associated with functional impairment.

Do Sex Differences Exist in Rates of Falls and Fractures in Hutterite, Rural, and Nonrural Populations, Aged 20 to 66 Years?

Lee Weidauer PhD, Teresa Binkley PhD, Tianna Beare BS, Maggie Minett MS, Lacey McCormack PhD, Andrew Wey PhD, Bonny Specker PhD

Falls and fractures are a major public health concern with an economic impact of more than USD 19 billion per year. Extensive research into the risk of falls and fractures in elderly populations has been performed; however, little is known about fall or fracture risk in younger populations. Additionally, sex- and population-specific (rural versus nonrural) fall and fracture risk may be important in identifying groups most at risk in an effort to develop preventive measures.

Do Complication Rates Differ by Gender After Metal-on-metal Hip Resurfacing Arthroplasty? A Systematic Review

Bryan D. Haughom MD, Brandon J. Erickson MD, Michael D. Hellman MD, Joshua J. Jacobs MD

Although metal-on-metal (MoM) bearing surfaces provide low rates of volumetric wear and increased stability, evidence suggests that certain MoM hip arthroplasties have high rates of complication and failure. Some evidence indicates that women have higher rates of failure compared with men; however, the orthopaedic literature as a whole has poorly reported such complications stratified by gender.

Women Build Long Bones With Less Cortical Mass Relative to Body Size and Bone Size Compared With Men

Karl J. Jepsen PhD, Erin M. R. Bigelow MS, Stephen H. Schlecht PhD

The twofold greater lifetime risk of fracturing a bone for white women compared with white men and black women has been attributed in part to differences in how the skeletal system accumulates bone mass during growth. On average, women build more slender long bones with less cortical area compared with men. Although slender bones are known to have a naturally lower cortical area compared with wider bones, it remains unclear whether the relatively lower cortical area of women is consistent with their increased slenderness or is reduced beyond that expected for the sex-specific differences in bone size and body size. Whether this sexual dimorphism is consistent with ethnic background and is recapitulated in the widely used mouse model also remains unclear.

How Does Bone Strength Compare Across Sex, Site, and Ethnicity?

Stephen H. Schlecht PhD, Erin M. R. Bigelow MS, Karl J. Jepsen PhD

The risk of fragility fractures in the United States is approximately 2.5 times greater among black and white women compared with their male counterparts. On average, men of both ethnicities have wider bones of greater cortical mass compared with the narrower bones of lower cortical mass among women. However, it remains uncertain whether the low cortical area observed in the long bones of women is consistent with their narrower bone diameter or if their cortical area is reduced beyond that which is expected for the sex differences in body size and external bone size.

Are There Sex Differences in Knee Cartilage Composition and Walking Mechanics in Healthy and Osteoarthritis Populations?

Deepak Kumar PT, PhD, Richard B. Souza PT, PhD, Karupppasamy Subburaj PhD, Toran D. MacLeod PT, PhD, Justin Singh BS, Nathaniel E. Calixto BS, Lorenzo Nardo MD, Thomas M. Link MD, Xiaojuan Li PhD, Nancy E. Lane MD, Sharmila Majumdar PhD

Women are at a greater risk for knee osteoarthritis (OA), but reasons for this greater risk in women are not well understood. It may be possible that differences in cartilage composition and walking mechanics are related to greater OA risk in women.

Do Secular Trends in Skeletal Maturity Occur Equally in Both Sexes?

Dana L. Duren PhD, Ramzi W. Nahhas PhD, Richard J. Sherwood PhD

Skeletal maturity assessment provides information on a child’s physical development and expectations based on chronological age. Given recently recognized trends for earlier maturity in a variety of systems, most notably puberty, examination of sex-specific secular trends in skeletal maturation is important. For the orthopaedist, recent trends and changes in developmental timing can affect clinical management (eg, treatment timing) if they are currently based on outdated sources.

Sex Differences in Arm Muscle Fatigability With Cognitive Demand in Older Adults

Hugo M. Pereira MSc, Vincent C. Spears BSc, Bonnie Schlinder-Delap MA, Tejin Yoon PhD, April Harkins PhD, Kristy A. Nielson PhD, Marie Hoeger Bement PhD, Sandra K. Hunter PhD

Muscle fatigability can increase when a stressful, cognitively demanding task is imposed during a low-force fatiguing contraction with the arm muscles, especially in women. Whether this occurs among older adults (> 60 years) is currently unknown.

Femoroacetabular Impingement: Prevalent and Often Asymptomatic in Older Men: The Osteoporotic Fractures in Men Study

Lorenzo Nardo MD, Neeta Parimi MS, Felix Liu MS, Sonia Lee MD, Pia M. Jungmann MD, Michael C. Nevitt PhD, Thomas M. Link MD, PhD, Nancy E. Lane MD

The epidemiology of femoroacetabular impingement (FAI) is important but incompletely understood, because most reports arise from symptomatic populations. Investigating the prevalence of FAI in a community-based cohort could help us better understand its epidemiology and in particular the degree to which it might or might not be associated with hip pain.

Are Changes in Composition in Response to Treatment of a Mouse Model of Osteogenesis Imperfecta Sex-dependent?

Adele L. Boskey PhD, Josephine Marino MPh, Lyudmila Spevak MS, Nancy Pleshko PhD, Stephen Doty PhD, Erin M. Carter MS, Cathleen L. Raggio MD

Osteogenesis imperfecta (OI) is a genetic disease characterized by skeletal fragility and deformity. There is extensive debate regarding treatment options in adults with OI. Antiresorptive treatment reduces the number of fractures in growingmice, an animal model that reproducibly mimics the moderate-to-severe form of OI in humans. Effects of long-term treatments with antiresorptive agents, considered for treatment of older patients with OI with similar presentation (moderate-to-severe OI) are, to date, unknown.

Biomechanical Outcomes of Bridge-enhanced Anterior Cruciate Ligament Repair Are Influenced by Sex in a Preclinical Model

Ata M. Kiapour PhD, Braden C. Fleming PhD, Martha M. Murray MD

Despite the well-established role of sex on the anterior cruciate ligament (ACL) injury risk, its effects on ACL surgical outcomes remain controversial. This is particularly critical when developing novel surgical techniques to treat the injury because there are limited data existing on how these procedures will respond in each sex. One such approach is bridge-enhanced ACL repair, in which primary suture repair of the ACL is augmented with a bioactive scaffold saturated with autologous blood. It has shown comparable biomechanical outcomes to ACL reconstruction in preclinical models.

Does Combined Intra- and Extraarticular ACL Reconstruction Improve Function and Stability? A Meta-analysis

Fernando Cury Rezende MD, Vinicius Ynoe Moraes MD, Ana Luiza Cabrera Martimbianco Bsc, Marcus Vinícius Luzo PhD, Carlos Eduardo Silveira Franciozi PhD, João Carlos Belloti PhD

ACL reconstruction aims to restore knee function and stability; however, rotational stability may not be completely restored by use of standard intraarticular reconstruction alone. Although individual studies have not shown the superiority of combined ACL reconstruction compared with isolated intraarticular reconstruction in terms of function and stability, biomechanical principles suggest a combined approach may be helpful, therefore pooling (meta-analyzing) the available randomized clinical studies may be enlightening.

Morbid Obesity: Increased Risk of Failure After Aseptic Revision TKA

Chad D. Watts MD, Eric R. Wagner MD, Matthew T. Houdek MD, David G. Lewallen MD, Tad M. Mabry MD

Patients with obesity are known to have a higher risk of complications after primary TKA; however, there is a paucity of data regarding the effects of obesity with revision TKAs.

Do Psychological Factors Predict Poor Outcome in Patients Undergoing TKA? A Systematic Review

Yasser Khatib MBBS, MSports Med, FRACS(Orth), Aman Madan BSc(Med), MBBS, Justine M. Naylor PhD, BAppSc(Phty), Ian A. Harris MBBS, MMed(Clin Epi), PhD, FRACS(Orth)

A subgroup of patients undergoing TKA is unhappy with the outcome of surgery and preoperative psychological factors may play a role in their dissatisfaction.

Does Tranexamic Acid Reduce Blood Loss and Transfusion Requirements Associated With the Periacetabular Osteotomy?

Scott A. Wingerter MD, Angela D. Keith MS, Perry L. Schoenecker MD, Geneva R. Baca BA, John C. Clohisy MD

Tranexamic acid (TXA) has shown safety and efficacy in reducing blood loss associated with various surgical procedures. However, to our knowledge there are no studies evaluating the effect of TXA on blood loss and transfusion requirements associated with periacetabular osteotomy (PAO).

Cartilage Thickness and Cyst Volume Are Unchanged 10 Years After Periacetabular Osteotomy in Patients Without Hip Symptoms

Inger Mechlenburg PhD, Jens Randel Nyengaard DMSc, John Gelineck MD, Kjeld Soballe DMSc

Periacetabular osteotomy (PAO) may affect cartilage thickness and cyst volume in patients with hip dysplasia. However, as no studies randomizing patients to either PAO or conservative treatment have been performed, to our knowledge, it is unknown if PAO directly affects the development or progression of osteoarthritis in patients with hip dysplasia.

Scapular Bracing is Effective in Some Patients but Symptoms Persist in Many Despite Bracing

Martti Vastamäki MD, PhD, Veera Pikkarainen MD, Heidi Vastamäki MD, Leena Ristolainen PT, DSc

A scapular-protecting brace is one option for treating patients with a winging scapula in isolated serratus palsy. However, outcomes after brace treatment have been reported in only a few studies, and to our knowledge, none has results reported at long-term beyond 10 years.

Developmental Dislocation of the Hip Successfully Treated by Preoperative Traction and Medial Open Reduction: A 22-year Mean Followup

P. Farsetti MD, R. Caterini MD, V. Potenza MD, E. Ippolito MD

During the last 35 years, the medial approach has been reported more frequently than the anterior approach for open reduction of developmental dislocation of the hip (DDH), however, few studies have followed children treated by medial open reduction to adulthood.

Does Arthroplasty Provide Better Outcomes Than Internal Fixation At Mid- and Long-term Followup? A Meta-analysis

Jin Jiang MD, PhD, Chen-hui Yang MD, Qiao Lin MD, Xiang-dong Yun MD, PhD, Ya-yi Xia MD, PhD

Arthroplasty has been shown to be superior regarding low risk of reoperation and better function score to internal fixation for treatment of displaced femoral neck fractures at short-term followup. However, there are unanswered questions regarding the efficacy of arthroplasty in the longer term compared with internal fixation.

Does Blast Medium Affect Heterotopic Ossification in a Blast-amputation Model?

David E. Jaffe MD, David Yoo MS, Jason Blevins BA, Gregory Gasbarro MS, Tyler Hughes BA, Ebrahim Paryavi MD, MPH, Thao Nguyen MD, William L. Fourney PhD, Vincent D. Pellegrini MD

Heterotopic ossification (HO) develops after nearly 2/3 of traumatic blast amputations in the contemporary battlefield. This phenomenon has potentially devastating consequences for servicemen and women and its pathophysiology warrants further investigation using a previously developed animal blast model.

Higher Preoperative Patient Activation Associated With Better Patient-reported Outcomes After Total Joint Arthroplasty

John Andrawis MD, MBA, Sina Akhavan BA, Vanessa Chan MPH, Mandeep Lehil MD, Dana Pong MPH, Kevin J. Bozic MD, MBA

Despite widely reported success associated with hip and knee replacements, some patients remain dissatisfied with their outcomes. Patient activation, an individual’s propensity to engage in adaptive health behaviors, has been measured as a potentially important factor contributing to health outcomes, cost, and patient experience of care. However, to our knowledge, it has not been studied in patients undergoing total joint arthroplasties (TJAs).

What Host Factors Affect Aseptic Loosening After THA and TKA?

Jeffrey J. Cherian DO, Julio J. Jauregui MD, Samik Banerjee MD, Todd Pierce MD, Michael A. Mont MD

Aseptic loosening is the most common cause for revisions after lower-extremity total joint arthroplasties, however studies differ regarding the degree to which host factors influence loosening.

Delayed Slipped Capital Femoral Epiphysis After Treatment of Femoral Neck Fracture in Children

Hai Li MD, PhD, Li Zhao MD, PhD, Luyu Huang MD, PhD, Ken N Kuo MD

Slipped capital femoral epiphysis (SCFE) after the treatment of femoral neck fracture is a rare entity in children that poses important treatment challenges.

Erratum to: Sex Differences in Cartilage Topography and Orientation of the Developing Acetabulum: Implications for Hip Preservation Surgery

Jonathan B. Peterson MD, Josh Doan MEng, James D. Bomar MPH, Dennis R. Wenger MD, Andrew T. Pennock MD, Vidyadhar V. Upasani MD

Statistics in Brief: An Introduction to the Use of Propensity Scores

Maria C. S. Inacio PhD, Yuexin Chen BS, Elizabeth W. Paxton MA, Robert S. Namba MD, Steven M. Kurtz PhD, Guy Cafri PhD, MStat
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