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Presented by OrthoEvidence |
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For patients with hip or knee osteoarthritis, the pain is one of the most troublesome symptoms. Controlling it is essential to improving the quality of life for patients.
NSAIDs are recommended by the AAOS for managing pain and improving function. But there is growing evidence that tanezumab, an anti-nerve growth factor monoclonal antibody, could benefit patients. Despite promising results in several papers, the FDA and EMA rejected tanezumab for patients with moderate-severe osteoarthritis unresponsive to other analgesics.
We conducted a systematic review of studies comparing tanezumab and NSAIDs to find out what the current evidence says on this hot topic. After screening 325 studies, we included 6 papers from 4 trials, with a total of 7,422 patients. We compared 2.5mg and 5mg doses of tanezumab separately to NSAIDs.
2.5mg: Compared to NSAIDs, a 2.5mg dose of tanezumab resulted in significantly better pain, function, and global health scores at 4 weeks follow-up compared to NSAIDs. However, patients who received 2.5mg tanezumab had a higher risk of rapidly progressive osteoarthritis and total joint replacement.
5.0mg: Compared to NSAIDs, a 5.0mg dose of tanezumab resulted in significantly better pain, function, and global health scores at both 4 weeks and 16 weeks follow-up compared to NSAIDs. Yet, the risk of adverse events, rapidly progressive osteoarthritis, and abnormal peripheral sensation was higher in the 5.0mg tanezumab group.
Bottom line. Tanezumab, particularly at a 5mg dose, showed potential to reduce pain and improve function for patients with hip or knee osteoarthritis. But with a significantly higher risk of rapidly progressive osteoarthritis and other safety events, it is unclear whether it has a net benefit for osteoarthritis patients.
Read the full OE Original here.
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In the hopes of improving clinical outcomes for patients with Achilles tendon ruptures, early ankle motion and controlled weightbearing have become increasingly popular. Some studies have shown a potential benefit of early ankle motion, but these studies are old and of lower quality. Researchers from Copenhagen, Denmark conducted an RCT to find out whether any benefit exists.
130 patients with non-operatively treated acute Achilles tendon ruptures were randomized to receive 2 weeks of casting with no weightbearing, followed by:
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Early controlled motion of the ankle (n=68)
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Immobilization (n=62)
The primary outcome of interest was the Achilles Tendon Rupture Scores (ATRS). Secondary outcomes included tendon outcomes, the heel-rise work test, incidence of re-rupture, calf perimeter, and return to work and sport. The results demonstrated:
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No significant difference between the two groups in ATRS at 4-, 6- and 12-months post-injury (p>0.05 for all).
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All secondary outcomes were similar between the two groups (p>0.05 for all).
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The rate of re-rupture was similar in the early controlled motion and immobilization group (8.8% vs. 11.3%, p=0.64).
Bottom line. Early controlled ankle motion did not provide any benefit for patients with non-operatively treated Achilles tendon ruptures. That being said, exploring the benefit of early controlled ankle motion in different populations is necessary.
You can check out our full ACE Report here.
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New surgical techniques are risky to introduce into practice.
The InSpace subacromial balloon spacer, used for the treatment of irreparable rotator cuff tears, aims to improve outcomes by reducing friction and improving biomechanics. Despite it being used extensively in Europe and receiving FDA clearance in 2021, evidence on its effectiveness is limited, and there are even reports of poor results. A randomized trial was desperately needed.
Published in the Lancet, this adaptive RCT from the UK randomized 117 patients with irreparable rotator cuff tears to receive arthroscopic debridement of the subacromial space with biceps tenotomy (n=61) or arthroscopic debridement followed by insertion of the InSpace balloon (n=56).
The primary outcome of interest was shoulder-related pain and function, measured with the Oxford Shoulder Score. Secondary outcomes included functional outcomes, quality of life, change in symptoms, resource use, and adverse events. Follow-up was conducted over 12 months.
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Oxford Shoulder Scores were significantly better in the debridement only group at 3-, 6- and 12-months follow-up.
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Constant scores, range of motion in flexion, and abduction strength were significantly in favour of the debridement only group at 12-months follow-up.
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There were no differences in safety events between the two groups.
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This study was stopped early due to futility.
Bottom line. The InSpace subacromial balloon spacer appeared to provide no benefit for patient with irreparable rotator cuff tears and may actually be harmful.
Read our full ACE Report on this important trial here.
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EDITOR’S PICKS |
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Surgeon Feature: Dr. Mohit Bhandari – recently, we sat down with OE’s founder and Editor Dr. Mohit Bhandari for a conversation on success, inspiration, and his career as an orthopaedic surgeon-scientist. He shares his favourite productivity hacks, struggles as a child, and names the most influential people in his career. (Read More) |
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OrthoJoe Podcast: Achilles Tendon Rupture in Athletes – Dr. Bhandari and Dr. Swiontkowski sit down with Dr. Ned Amendola, sports medicine surgeon at Duke University. Achilles tendon ruptures have hit some of our favourite athletes, from Aaron Rodgers to Kevin Durant. They discuss the existing research on operative & non-operative treatment, turf vs. grass fields, and the [missing] data on high-level athletes. (Read More) |
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The Original Shoulder Score – cited over 7000 times, this paper by CR Constant and AH Murley in 1987 detailed a new shoulder function assessment tool, now known as the Constant-Murley score. The Constant-Murley score has become one of the most widely tools in shoulder medicine. (Read More) |
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