What’s New in Orthopaedic Rehabilitation 2021

Every month, JBJS publishes a review of the most pertinent and impactful studies from the orthopaedic literature during the previous year in 14 subspecialty areas. Click here for a collection of all such OrthoBuzz Guest Editorial summaries. 

This month, co-author Travis L. Cleland, DO selected the 5 most clinically compelling findings from among the studies highlighted in the most recent “What’s New in Orthopaedic Rehabilitation.” 

Shoulder 

–In a recent randomized controlled trial (RCT) including patients with diabetes and adhesive capsulitis, 103 subjects received either 4 sessions of extracorporeal shockwave therapy or a single intra-articular glenohumeral joint ¹. Both groups showed improvement at 12-week follow-up, but the extracorporeal shockwave therapy group demonstrated significantly more improvement in the visual analog scale (VAS) for pain and QuickDASH (the abbreviated version of the Disabilities of the Arm, Shoulder and Hand questionnaire) score compared with the steroid injection group. 

Knee 

–Physical therapy and glucocorticoid injections are commonly used in the treatment of osteoarthritis. In the primary care setting of the U.S. Military Health System, investigators compared the two treatments among a cohort of 156 patients². At 1 year, the mean Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores favored the physical therapy group, and changes in secondary outcome measures also suggested less pain and functional disability for the physical therapy group compared with the glucocorticoid injection group. 

–A recent RCT evaluated the efficacy and safety of cooled radiofrequency ablation (CRFA, 88 patients) compared with a single hyaluronic acid injection (87 patients) for the treatment osteoarthritis-related knee pain³. Significantly better Numeric Rating Scale, WOMAC, and Global Perceived Effect scores were demonstrated for the CRFA group at 6 months (p < 0.0001), and the CRFA group demonstrated significantly improved pain and function compared with the hyaluronic acid group. Neither group experienced any serious adverse events. 

Spine 

– In a Level-II prospective study of 126 patients, investigators assessed the development of facet arthropathy after total disc replacement versus rehabilitation as well as the association between facet arthropathy and clinical outcomes at 8-year follow-up⁴. An increased incidence of facet arthropathy was noted following total disc replacement compared with nonoperative treatment, but this was not associated with differences in the Oswestry Disability Index or back pain. In the total disc replacement group, 4 patients required posterior decompression surgery due to lateral recess stenosis.  

Pain Management 

–Another recent study examined the effect of celecoxib on pain control and opioid use after shoulder procedures; included were 78 patients who underwent total shoulder arthroplasty and 79 patient who underwent rotator cuff repair⁵. Among the patients who were prescribed celecoxib, opioid consumption as assessed by morphine-equivalent dosing (MED) was significantly less (p < 0.01) in both the total population and in patients who underwent total shoulder arthroplasty at 3 and 6 weeks postoperatively. However, there was no significant difference in the group undergoing rotator cuff repair. The authors concluded that analgesia through multimodal pain control, particularly including celecoxib use, may be effective in reducing opioid consumption among shoulder arthroplasty patients.  

References 

1. El Naggar TEDM, Maaty AIE, Mohamed AE. Effectiveness of radial extracorporeal shock-wave therapy versus ultrasound-guided low-dose intra-articular steroid injection in improving shoulder pain, function, and range of motion in diabetic patients with shoulder adhesive capsulitis. J Shoulder Elbow Surg. 2020 Jul;29(7):1300-9. 
2. Deyle GD, Allen CS, Allison SC, Gill NW, Hando BR, Petersen EJ, Dusenberry DI, Rhon DI. Physical therapy versus glucocorticoid injection for osteoarthritis of the knee. N Engl J Med. 2020 Apr 9;382(15):1420-9. 
3. Chen AF, Khalouf F, Zora K, DePalma M, Kohan L, Guirguis M, Beall D, Loudermilk E, Pingree M, Badiola I, Lyman J. Cooled radiofrequency ablation compared with a single injection of hyaluronic acid for chronic knee pain: a multicenter, randomized clinical trial demonstrating greater efficacy and equivalent safety for cooled radiofrequency ablation. J Bone Joint Surg Am. 2020 Sep 2;102(17):1501-10. 
4. Furunes H, Berg L, Espeland A, Thoresen H, Neckelmann G, Brøgger HM, Småstuen MC, Brox JI, Storheim K, Hellum C. Facet arthropathy following disc replacement versus rehabilitation: a prospective study with 8-year follow-up. Spine (Phila Pa 1976). 2020 Nov 1;45(21):1467-75.  
5. Burns KA, Robbins LM, LeMarr AR, Childress AL, Morton DJ, Schroer WC, Wilson ML. Celecoxib significantly reduces opioid use after shoulder arthroplasty. J Shoulder Elbow Surg. 2021 Jan;30(1):1-8.