The edition · Orthopaedics
Brisk walking, at the right dose, is the bone prescription with evidence behind it
A 124-trial network meta-analysis puts numbers on the exercise advice every clinic gives: about 600 METs-minutes a week, walking or jogging, with mixed aerobic work the only modality showing a fracture signal. Plus why cementless versus cemented robotic knees remains an open question.
The edition in brief
Today's orthopaedics desk leads with the evidence on fixation in robotic-assisted total knee arthroplasty: ten comparative studies of cementless against cemented knees, with every pooled outcome rated very low certainty. Mid-term all-cause revision gave a risk ratio of 0.63 with a 95% confidence interval from 0.09 to 4.53 — an interval so wide it excludes nothing — and manipulation under anaesthesia 1.03 (0.09 to 11.74). The suggested operative-time saving of 12.91 minutes was both imprecise and highly heterogeneous (I squared 94.4 per cent). A single-centre non-inferiority trial randomised 316 older patients having knee or hip arthroplasty to intranasal dexmedetomidine the night before surgery or intravenous dexmedetomidine before induction: delirium within three days occurred in 9.5 per cent and 7.6 per cent respectively, a difference of 0.02 (95% CI −0.04 to 0.08) that met the non-inferiority margin, with better preoperative sleep, less anxiety and fewer adverse events on the intranasal route. A propensity-matched comparison of 98 hips found competitive athletes treated with contemporary hip arthroscopy — capsular repair and knotless labral repair or reconstruction — returned to sport at 97.6 per cent against 81.0 per cent with early techniques. The practice-changer is a hierarchical Bayesian network meta-analysis of 124 randomised trials and 18,429 adults over 40, which found brisk walking or jogging and combined aerobic-resistance training improved bone mineral density, with an inverted-U dose response peaking near 600 METs-minutes per week and fracture reduction seen only for mixed aerobic and mind-body exercise.
Cementless or cemented in a robotic knee: the evidence cannot say
Choose fixation in a robotic knee the same way you would in a manual one — the comparative evidence is too weak to favour either.
Dexmedetomidine up the nose the night before, instead of a drip on the day
Intranasal dexmedetomidine the night before arthroplasty was no worse than an infusion on the day for delirium, and gave better sleep with fewer adverse events.
Capsular repair and knotless labral work, and where the athletes went
Where hip arthroscopy is offered to a competitive athlete, capsular repair with knotless labral fixation is the technique these outcomes support.
Ask what the patient can no longer do, then measure that
Write down two activities the patient wants back and review those at every visit, alongside whatever score your audit requires.
About 600 METs-minutes a week, and walking counts
Give the bone-health patient a dose, not advice: about 600 METs-minutes a week — two to three hours of brisk walking — with combined aerobic and resistance work as the alternative.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this one is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for orthopaedics, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free