How long do revised knee replacements last?

Revisions of a knee replacements are progressively less successful with each subsequent revision lasting only half the time of the previous one, a UK study has shown.

A retrospective review of more than 33,000 knee replacements with a primary episode found that 20% of first revisions were revised again within 13 years, 21% of second revisions were revised again within five years, and 21% of third revisions were revised again within three years.

The findings, published in Lancet Rheumatology also showed that revision rates for knee replacements were higher in males than females at 10 years (20·0% vs 14·8%) and higher in younger patients. A shorter time between revision episodes was associated with earlier subsequent revision.

ACR cancels 2021 in-person annual meeting

The American College of Rheumatology has cancelled it 2021 in-person congress planned for San Francisco in November and will again run a virtual meeting because of the ongoing problems associated with COVID-19.

The ACR meeting would normally host 16,000 delegates of whom two thirds  are international rheumatologists.

“Despite a strong desire to return to an in-person format, it is unfortunately not viable this year. San Francisco will be unable to host our meeting due to COVID-19’s continued impact to the area and the world,” the ACR announced last week.

Instead, the ACR will run a program that starts with early access to the virtual meeting platform from 1 November, followed by advance programming on November 3–5. offering new features such as a Global Rheumatology Summit, Basic and Clinical Research Conference, and Radiology Bootcamp. The main virtual meeting of ACR Convergence scientific programming and special events will run from 5-9 November.

Better adherence to guidelines needed to prevent fragility fractures in polymyalgia rheumatica

Fewer than half of patients with polymyalgia rheumatica (PMR) are prescribed medications for osteoporosis in spite of the increased risk for fragility fractures associated with extended glucocorticoid use, UK research suggests.

Guidelines recommend the co-prescription of bone protection medication to reduce the rate of bone resorption and hence decrease the risk of developing osteoporosis and fractures,  according to researcher who presented the results at the British Society for Rheumatology’s 2021 Annual Conference on 26-28 April.

The study included 652 people with PMR, of whom 17.2% reported a previous fragility fracture at baseline. Most of the patients who reported a fragility fracture between baseline and month 12 also reported such a fracture at baseline (83.3%); the same was true between months 12 and 24 (79.1%).

The most significant predictor of fragility fracture during the study period was falls before baseline.

In spite of the clear risk for fracture in this cohort, fewer than 50% were prescribed osteoporosis therapy. Being prescribed such therapy, though, was associated with significantly reduced incidence of fragility fracture at 24 months, with an adjusted odds ratio of 0.28 (95% CI, 0.10-0.80), though it was associated with an increased risk in the shorter term at 12 months.