Physical Education in West Virginia Schools: Are We Doing Enough to Generate Peak Bone Mass and Promote Skeletal Health?

Peak bone mass (PBM) is attained at 25-35 years of age, followed by a lifelong decline in bone strength. The most rapid increase in bone mass occurs between the ages of 12-17. Daily school physical education (PE) programs have been shown to produce measurable increases in PBM, but are not federally mandated. Increases in PBM can decrease the lifelong risk of osteoporosis and fractures; critical for West Virginia prevention programs. Nationally only 1 in 6 schools require PE three days per week, with 4% of elementary schools, 8% of middle schools and 2% of high schools providing daily PE. In 2005, West Virginia passed the Healthy Lifestyles Act that returned physical education to the K-12 curriculum. This law requires only one credit of PE from grades 9-12 and provides only 35% of the recommended PE for grades K-12. This article highlights the relationship of PE to PBM and discusses the potential impact on West Virginia skeletal health

How To Manage Knee Arthritis: Best Practices for Treatment Prior to Orthopaedic Referral

Osteoarthritis (OA) of the knee is a debilitating disease in which degeneration of the joint space cartilage can lead to life-altering pain and stiffness. The prevalence of OA has a strong correlation with age, with evidence of radiographic knee OA found in 37.4% of persons older than 60 years of age. According to the Agency for Healthcare Research and Quality’s (AHRQ) 2013 report, osteoarthritis was ranked the second most expensive condition for Medicare and private insurers, with over 90% of the hospitalizations for OA involving a knee or hip replacement. It is projected that by 2030 the number of primary total knee arthroplasties will increase by 525% and the number of primary hip arthroplasties by 101%. Proper diagnosis and treatment of all stages of osteoarthritis, is essential to increase value and reduce costs for all stakeholders including patients, physicians and payers. In this article, only the non-operative management of knee OA is discussed. We present a simple algorithm that combines expert opinion, the American Academy of Orthopaedic Surgeon’s(AAOS) Clinical Practice Guidelines, and Medicare requirements

Operative Environment

Postoperative SSIs are believed to occur via bacterial inoculation at the time of surgery or as a result of bacterial contamination of the wound via open pathways to the deep tissue layers.1–3 The probability of SSI is reflected by interaction of parameters that can be categorized into three major groups.2 The first group consists of factors related to the ability of bacteria to cause infection and include initial inoculation load and genetically determined virulence factors that are required for adherence, reproduction, toxin production, and bypassing host defense mechanisms. The second group involves those factors related to the defense capacity of the host including local and systemic defense mechanisms. The last group contains environmental determinants of exposure such as size, time, and location of the surgical wound that can provide an opportunity for the bacteria to enter the surgical wound, overcome the local defense system, sustain their presence, and replicate and initiate local as well as systemic inflammatory reactions of the host. The use of iodine impregnated skin incise drapes shows decreased skin bacterial counts but no correlation has been established with SSI. However, no recommendations regarding the use of skin barriers can be made (see this Workgroup, Question 27)

How We Manage Periprosthetic TKA Fractures

Periprosthetic fractures have an incidence of 0.3-2.5% after a primary total knee arthroplasty (TKA) and 1.6-38% following revision TKA. Because the number of TKAs is expected to increase by 673% by 2030, the incidence of this complication is expected to rise as well. Osteoporosis is the single most important contributor to periprosthetic fractures around the knee. The most common mechanism of injury is a fall onto the knee, but other causes include motor vehicle accidents, seizures, and forced manipulation for a stiff knee. The main goal of treatment should be fracture healing, pain-free function, and early functional mobility