October 2014

AAOS releases new guidelines for hip fracture, ACL injury, infant hip dysplasia

The American Academy of Orthopaedic Surgeons (AAOS) on September 9 released three new clinical practice guidelines (CPG) featuring evidence-based recommendations for diagnosing and treating hip fractures in patients aged 65 years and older, anterior cruciate ligament (ACL) injuries, and hip dysplasia in infants aged up to 6 months.

“Management of Hip Fractures in the Elderly” includes a number of recommendations aimed at reducing delirium in hip fracture patients, according to W. Timothy Brox, MD, chair of the hip fracture guideline work group. Delirium, or acute confusion, is common among hip fracture patients and studies show patients with postoperative delirium are less likely to return to preinjury levels of function, are more frequently placed in nursing homes, and have increased mortality.

Most notably, the guideline includes a “strong” recommendation for preoperative regional analgesia to reduce pain in hip fracture patients, which is not the standard of care in all hospital settings. Other recommendations include hip fracture surgery within 48 hours of hospital admission; intensive physical therapy following hospital discharge to improve functional outcomes; and an osteoporosis evaluation, as well as vitamin D and calcium supplements, for patients following a hip fracture.

“Management of Anterior Cruciate Ligament Injuries” includes a “moderate” recommendation for reconstructive surgery to occur within five months of an ACL injury to protect the knee joint, and also notes moderate evidence supporting surgical reconstruction in active young adults (aged 18-35 years) with an ACL tear.

It supports the use of autograft or appropriately processed allograft tissue for repairing ACL injuries, but notes that younger or highly active patients have a higher failure rate than their older counterparts after undergoing allograft surgery, according to the AAOS.

“Detection and Nonoperative Management of Pediatric Developmental Dysplasia of the Hip in Infants Up to 6 Months of Age” recommends selective ultrasound screening if an infant has the following risk factors for developmental dysplasia of the hip (DDH): breech presentation at birth, a family history of DDH, or signs or history of hip instability. The CPG does not recommend routine ultrasound screening in infants younger than 6 weeks, even those with risk factors for DDH.

Go to the AAOS website at aaos.org to read the full guidelines.

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