Below are highlights of new review articles appearing in the June 2012 issue of the JAAOS, as well as the full table of contents. Each news highlight, and listed title in the table of contents, includes a link to the abstract.
Effects of Smoking on Bone and Joint Health
During cigarette use, hazardous gases and chemicals that can cause genetic mutations and the development of cancer are released into the bloodstream. One of these chemicals, nicotine, also can cause and/or exacerbate many smoking-related diseases and harm a patient's bone and joint health prior to, during and post-surgical procedure.
Smoking and the carbon monoxide found in tobacco has been shown to decrease blood flow to healing tissues, which may delay and/or impair the healing of fractures or fusion of the joints, increase chances of surgical site infection, and negatively affect bone density by decreasing the production and metabolism of estrogen and other bone-protecting hormones.
Smokers also have higher rates of postoperative complications than nonsmokers, and have a six times greater chance than nonsmokers to develop infections. However, patients who undergo a 4-week preoperative counseling and nicotine replacement program can decrease their risk of complications to only one third of those who continue to smoke.
Intervention with smokers prior to elective surgery or following traumatic injury can minimize other smoking-related chronic diseases—the potential health benefits of early intervention can be successful and likely substantial.
Treatment of the Stiff Big Toe (Hallux Rigidus)
The most common form of osteoarthritis affecting the foot is called hallux rigidus, a degenerative arthritis of the base of the first metatarsophalangeal (MTP, also known as the "big toe") joint. Left untreated, the condition may cause notable limitations in gait (manner of walking or moving on foot), activity level, and daily function.
Hallux rigidus usually develops in adults between the ages of 30 and 60 years—it is not known why the condition appears in some people and not others—and is not associated with trauma, shoe wear, or Achilles tendon tightness. However, wearing shoes with heels often increase symptoms.
Nonsurgical treatments such as use of pain relievers and anti-inflammatory medications such as ibuprofen may help reduce the swelling and ease the pain, and wearing shoes with large toe boxes or stiff, flat-soles can alleviate pressure on the big toe.
Surgical treatment options can include joint-sparing procedures for middle or moderate damage to remove bone spurs as well as a portion of the foot bone so that the toe has more room to bend. In more severe cases of hallux rigidus, arthrodesis (completely fusing the bones of the joint to make one continuous bone) is the current standard of care and can include a wide variety of fixation options to help alleviate pain and enhance functional and mechanical stability so that the patient may return to moderate activities.
June 2012 Full JAAOS Table of Contents
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