New research November 2024

Current research we are reading: November 2024

A September 2024 study analyzed patient obesity on peri-operative complication rates in patients undergoing anterior cervical discectomy with fusion. Pre-operative comorbidities were identified as age, sex, race, smoking status, hypertension requiring medication, diabetes, history of congestive heart failure, history of bleeding disorder, and chronic obstructive pulmonary disease as risk factors. Risk for post-operative side-effects after an ACDF was significantly higher for obese classes I-III compared to non-obese patients.

Goheer HE, Hendrix CG, Samuel LT, Newcomb AH, Carmouche JJ. Obesity is an Independent Risk Factor for Postoperative Pulmonary Embolism after Anterior Cervical Discectomy and Fusion. The Spine Journal. 2024 Sep 26.

An October 2024 paper suggested combining PRP and exercise therapy would show better outcomes on pain, functionality, and quality of life in patients with subacromial impingement syndrome than exercise alone.

In this study, outcomes in 56 patients were assessed, 28 patients in the exercise therapy group and 28 patients in the PRP group. The researchers found statistically significant improvements in pain, functionality, and quality of life outcomes of patients in both the exercise therapy and the PRP groups compared with before the treatment and 6 months after treatment.

This study showed that both isolated exercise therapy and additional PRP application to exercise therapy are effective methods in subacromial impingement syndrome treatment regarding pain, function, and quality of life. Combining exercise therapy with PRP was superior in reducing pain and improving abduction degree and strength.

Ziroglu N, Şahbaz Y. Clinical Effects of Additional Platelet-Rich Plasma Application to Exercise Therapy in Patients with Subacromial Impingement Syndrome: A Double-Blind Randomized Controlled Trial. Orthop J Sports Med. 2024 Oct 8;12(10):23259671241276368.*r

Diabetes mellitus is associated with a high risk of chronic degenerative Achilles and Patellar tendinopathies and ruptures.  A September 2024 study examined whether pre-existent Diabetes mellitus or Impaired Glucose Tolerance could influence the clinical outcome in subjects undergoing PRP treatment.

• Sixty patients with diabetes/pre-diabetes and sixty normal glucose levels patients with proximal insertional patellar tendinopathies and Achilles tendinopathy, treated with PRP therapy, were included in the study and assessed three and six months after treatment.
• Even though the improvement was poor, it was still significant improvement for the patient.
• PRP treatment in Achilles and patellar chronic tendinopathies resulted in less favorable results in subjects with diabetes compared with normal glucose levels subjects.  The patients with patellar chronic tendinopathies showed better results than those with Achilles tendinopathy. Even though the improvement was poor, it was still significant improvement for the patient.

Abate M, Paganelli R, Pellegrino R, Di Iorio A, Salini V. Platelet Rich Plasma Therapy in Achilles and Patellar Tendinopathies: Outcomes in Subjects with Diabetes (A Retrospective Case-Control Study). Journal of Clinical Medicine. 2024 Sep 13;13(18):5443.*r

What is Tandem Stenosis? As the name implies, tandem stenosis is a spinal stenosis occurring in different segments of the spine at the same time. Typically this occurs simultaneously in the lumbar and cervical spines, however doctors are now looking into the greater prevalence of cervical and thoracic spine tandem stenosis. An August 2024 study suggests that tandem stenosis of the cervical and thoracic spine may be missed by clinicians and potentially lead to missed and delayed diagnosis. In their review of 23 published studies, the authors here found “a missed diagnosis rate of 7.2% in tandem cervical-thoracic stenosis, with the thoracic stenosis emerging as the predominant area susceptible to oversight.”

Lin Y, Xu G, Sun Y, Zhou J, Feng F. Tandem stenosis of the cervical and thoracic spine: a systematic review. BMC Musculoskeletal Disorders. 2024 Aug 14;25(1):640.

Knee osteoarthritis

A December 2024 paper assessed the association of low muscle mass index and sarcopenic obesity (muscle loss and obesity) with knee osteoarthritis. The researchers write: “Sarcopenia and knee osteoarthritis are common age-related diseases. . . Few studies have reported the association between muscle mass loss and knee osteoarthritis. In reviewing previously published data of 12 studies, low-quality evidence indicated that low muscle mass index and sarcopenic obesity increase the odds of knee osteoarthritis. However, no association was observed between general sarcopenia or low muscle mass with knee osteoarthritis.

Wu Q, Xu Z, Ma X, Li J, Du J, Ji J, Ling X, Kan J, Zhao M. Association of low muscle mass index and sarcopenic obesity with knee osteoarthritis: a systematic review and meta-analysis. Journal of the International Society of Sports Nutrition. 2024 Dec 31;21(1):2352393.

A July 2024 study aimed to evaluate whether a combination of platelet-rich plasma (PRP) and hyaluronic acid is more effective and safer than either injection alone for treating knee osteoarthritis. Ten studies involving 943 patients were included in the analysis.

• The statistical findings did not differ between the treatment of PRP + hyaluronic acid and PRP alone.
• However PRP + hyaluronic acid treatment efficacy was observed when compared to hyaluronic acid alone in self-reported pain and function patient scores.

Gao J, Ma Y, Tang J, Zhang J, Zuo J. Efficacy and safety of platelet-rich plasma and hyaluronic acid combination therapy for knee osteoarthritis: a systematic review and meta-analysis. Archives of Orthopaedic and Trauma Surgery. 2024 Jul 7:1-21. *

Osteoporosis and hip replacement

A July 2024 paper provides an updated analysis for patients with osteoporosis following total hip replacement.

• Osteoarthritis patients who suffer from alcohol abuse, chronic kidney disease, cerebrovascular disease, obesity, and rheumatoid arthritis continue to be significant risk factors for periprosthetic femur fracture  and aseptic loosening. Further, the patient population with severe osteoporosis may have higher risks for aseptic loosening and periprosthetic femur fracture  than previously recognized.

Layson JT, Hameed D, Dubin JA, Moore MC, Mont M, Scuderi GR. Patients with Osteoporosis Are at Higher Risk for Periprosthetic Femoral Fractures and Aseptic Loosening Following Total Hip Arthroplasty. Orthopedic Clinics. 2024 Mar 23.

A December 2024 study (x) wrote that while patient satisfaction is high and functional ability improves after total hip replacement, residual impairment and pain are common. Degenerative changes in tendons and muscles are probable causes. The researchers suggest degeneration in the gluteus medius tendon and muscle strength in the muscles acting around the hip in patients with hip osteoarthritis, before and after total hip replacement is occurring. Pre and post-surgery muscle strengthening exercises should be explored.

Juhlin J, Sernert N, Åhlund K. Pre-operative gluteus medius tendon degeneration and its impact on strength and functional ability one year after total hip replacement. Annals of Medicine. 2024 Dec 31;56(1):2388701.

Prolotherapy

An October 2024 study found both dextrose prolotherapy and trigger point wet needling with bupivacaine, a local anesthetic, in reducing pain in the short term. At 24 months, a single-dose prolotherapy was more effective than the wet needling with bupivacaine. The changes were noted in the improved pain scores, disability index, and improved quality of life. According to the researchers: “The wet needling with bupivacaine is, in general, a destructive process that introduces focal macro-trauma to induce healing. The dextrose prolotherapy produces focal-controlled inflammation with agents designed to promote healing. This is why the dextrose prolotherapy showed better results than the wet needling in the long-term follow-up.”

Jacob NK, Sankaran R. A Prospective Nonrandomized Comparison of Wet Needling Versus Prolotherapy in Myofascial Pain. Cureus. 2024 Oct 14;16(10):e71427.

Tennis Elbow

An October 2024 study compared the effectiveness of autologous blood injection (reinjecting a patient’s blood) and local steroid injection in providing pain relief for patients with lateral epicondylitis (tennis elbow) using the visual analog scale (VAS 0 – 10 pain score) over 12 weeks.

• A total of 396 patients (almost 70% male) with tennis elbow, aged 20 to 50 years, were included (198 in each group).
  • Group I (average patent age 36) received an injection of 40 mg of methylprednisolone acetate with 1 ml of 2% lignocaine solution.
  • Group II (average patent age 37) received an injection of 2 ml of autologous venous blood. The final outcome was assessed at 12 weeks.
• Both groups mean baseline VAS score was 6.99 (considered very severe)
  • Group I (steroid) had a mean post-therapy VAS score of 3.11 (Mild pain)
  • Group II had (blood injection) had a mean score of 2.48 (Milder pain).
  • About 118 (59.60%) individuals in Group I and 156 (78.79%) patients in Group II experienced pain alleviation from lateral epicondylitis.

This study found that autologous blood injection significantly reduces pain in patients with lateral epicondylitis compared to steroid injection. Pain relief was more frequent in the autologous blood group (78.79%) than in the steroid group (59.60%). These findings suggest that autologous blood injections may offer a more effective treatment, reducing the need for repeat procedures and improving patient outcomes.

Mannan M, Eisha S, Afridi A, Mazari MI. Comparison of the Effectiveness of Autologous Blood Injection and Steroid Injection in Managing Tennis Elbow. Cureus. 2024 Oct 14;16(10):e71419.