Home
About
Editorial
Cover Stories
Advertising
Submissions
Contact

Visit Our Advertisers

Article Archive

---

AAOS Celebrates 75 Years

The American Academy of Orthopedic Surgeons drew over 30,000 attendees for the Academy’s annual meeting held March 5-7, 2008 at the Moscone Center in San Francisco.  The event featured 33 symposia, 180 instructional courses, 540 podium presentations, 566 poster presentations, 85 scientific exhibits, and 460 exhibitors.  The meeting also honored the 75^th anniversary of the Academy through presentations, publications, and even an art show outlining the history of orthopaedic advances.  Following are just a few highlights from the meeting.

Sex Matters, From Sports to Health

Saying a person’s sex really does make a difference when it comes to musculoskeletal health, orthopaedic surgeons are calling for increased research and education when it comes to protecting a woman’s musculoskeletal health.

“It is not a question of which sex is defined as normal or prototypical,” said Kim Templeton, MD, associate professor in the department of orthopaedic surgery at the University of Kansas Medical Center, in Kansas City, Kan., and chief of orthopaedic surgery at the Kansas City VA Medical Center. “Men and women are now, and always will be, two different variations on a theme; therefore, it is imperative we understand those differences and have distinctly different options for preventing disease and injury for each sex.”

The number of women athletes with orthopaedic injuries now reflects the number of women who are flooding into both amateur and professional sports. “Although we as orthopaedic surgeons are better able to fix those injuries today,” Dr. Templeton noted, “these women will never be like they were before their injuries, and they are increasing their risk of becoming disabled at an earlier age.” Women already have a higher rate of arthritis just because they are women, but add a sports injury to the mix and the risk of actually developing arthritis shoots way up.

Speaking with the media at the AAOS annual meeting, Laura L. Tossi, MD, director of the Bone Health Program at Children’s National Medical Center in Washington, D.C., asserted that the 170-lb man can no longer be the gold standard when assessing orthopaedic care for women.  Also addressing the media was a panel of orthopaedic surgeons, including Letha Y. Griffin, MD, PhD, professor in the Department of Kinesiology and Health at Georgia State University in Atlanta; Jo A. Hannafin, MD, PhD, professor of orthopaedic surgery at Weill Medical College of Cornell University; and Naomi N. Shields, MD, of Advanced Orthopaedic Associates in Wichita, Kansas. 

Dr. Hannafin pointed out that women are believed to have greater multidirectional instability than men, including the greater ligament laxity and joint laxity in females, which is attributable to a woman’s childbearing potential.  All five surgeons agreed that increased prevention was possible by educating parents and coaches on the differences in the female body and by providing instruction on proper technique and body position for landing a jump, pivoting, cutting, and stopping.

Iraq and Afghanistan: Orthopaedic Surgeons Fighting the Fight Off the Battlefield

The “signature” wounds encountered in the on-going wars in Iraq and Afghanistan are musculoskeletal in nature.

“Modern war produces devastating high energy wounds,” explained Captain D. C. Covey, MD, U.S. Navy chairman of the Department of Orthopaedic Surgery at Naval Medical Center, San Diego.  “Whether due to rocket propelled grenades, bombs or improvised explosive devices, many battlefield wounds are very challenging to treat. The extent and severity of these very injuries is bringing the military and Congress together to discuss dedicating further resources to military trauma wounds.”

“Due to great improvements in body armor, which safeguard the head and torso, military orthopaedic surgeons are seeing a group of extremity wounds that have been infrequently seen in survivors of previous conflicts,” he said. Dr. Covey also noted that musculoskeletal trauma comprises about 7 out of 10 people who sustain battlefield injuries.

The Growing Epidemic of Total Hip Replacement:

Will there be enough orthpaedic total joint surgeons to keep up with demand?

The numbers of hip and knee replacement surgeries have skyrocketed in the last 10 years. The growth and aging of the population, particularly baby boomers, and improved diagnosis and treatment options will continue to critically influence those numbers. “We are preparing for an epidemic of serious proportions,” said Richard Iorio, MD, senior attending orthopaedic surgeon at the Lahey Clinic in Massachusetts.

According to a new study by Dr. Iorio and his colleagues:

• In 2005, 285,000 total hip replacements and 523,000 total knee replacements were performed in the United States.

• By 2030, these two procedures are expected to jump to 572,000 and 3.4 million, respectively.

These figures represent a 101% increase in hip replacements and a 525% increase in knee replacements, but are “just a small slice of the pie,” Dr. Iorio said. “The demand for these procedures will grow rapidly, and the orthopaedic workforce will not be able to keep up. The supply of orthopaedic surgeons will only increase 2% between 2000 and 2020. What we have on our hands is an access problem.”

Orthopaedic surgeons trained in joint replacement (also known as specialists in adult reconstruction) are usually the physicians surgically trained to perform hip or knee replacement. A 2005 survey of more than 23,000 AAOS members revealed that only 7% percent identified themselves as primary surgical specialists for the adult hip and knee.

“Simply put,” Iorio said, “there will be a need for services that overwhelms the supply of physicians who will be able to fill that demand. Patient care is of utmost concern to us. Getting arthritic patients back to the quality of life they once had is always first and foremost. If these projections come to life, the access for a joint replacement will negatively impact patient care.”

What's Next for Stem Cells, Tissue Engineering and Gene Therapy 

The use of stem cells may have the power to transform orthopaedic surgery now and in the future. These “undifferentiated, unspecialized cells” already exist in our bodies and can renew themselves, giving rise to one or more specialized cells that have specific functions within the body. The use of stem cells is a biotechnology that is developing rapidly, offering new hope to patients suffering from musculoskeletal conditions.

Over the past few years, orthopaedic surgeons have successfully used patients’ own stem cells to reverse painful, disabling conditions. In 2007, Thomas Einhorn, MD, chairman of the Department of Orthopaedic Surgery and professor of Orthopaedic Surgery, Biochemistry and Biomedical Engineering at Boston University, performed his first revision hip replacement surgery using the new technology of harvesting his patient’s own stem cells.

“This area of musculoskeletal medicine shows great promise for the use of stem cells, tissue engineering and gene therapy,” Dr. Einhorn stated. “As orthopaedic scientists, researchers and surgeons, we treat bones, joints, tissues and muscles—the exact areas where stem cells are meant to be put to use.”

Adult stem cells are readily available from a number of sources—from fat harvested through liposuction to muscle tissue and bone marrow biopsies. Today, stem cell technology is being used for fracture repair and bony defects. The implications for the not-so-distant future, however, are beyond the imagination.

In 2005, nearly 25 million people visited their physician due to arthritis, according to the American Academy of Orthopaedic Surgeons (AAOS). “Arthritic patients come into our offices and ask what we can do for them,” Dr. Einhorn continued. “One day soon, we may be able to harvest their body’s own stem cells and direct those cells to the damaged and degenerative cartilage, which causes the arthritic pain. This application may restore and regenerate the cartilage to a normal state. Stem cells have the power to become the cells that your body has lost or needs.”

Orthopaedic research scientists are working on stem cell therapies to improve:

• tissue healing

• muscle regeneration

• cartilage repair and bone growth

• orthopaedic diseases and conditions (including osteoarthritis, osteoporosis, osteosarcomas and even muscular dystrophy)

Stem cells could eventually eliminate the need for joint replacement as researchers find ways for cartilage and bone to regenerate in specific areas.

Orthopaedic trauma—including fracture repair and failure of bone healing—represents a significant burden of disease. Patients suffering from orthopaedic trauma may be the greatest beneficiaries of many futuristic cell harvesting techniques. Each year, trauma-related orthopaedic conditions account for 1.9 million hospitalizations and over $30 billion in total charges, according to the AAOS.

Exhibitor News From Local Companies

Game Ready

Alameda-based Game Ready announced the next generation of the Game Ready System, the injury treatment system designed to simultaneously deliver intermittent compression and controllable cold therapy for post-op patients.

Peter Millett, MD, director of shoulder surgery at Steadman Hawkins Clinic in Vail, Colorado prescribed the prior version of the Game Ready System for both his physical therapy and post op patients.  Treating a number of elite athletes, Dr. Millett said that many of his patients liked the cold compression system so much they decide to buy their own system, including the Montreal Canadians hockey team, which bought two. Dr. Millett was especially enthusiast about using the system for post operative recovery.

“[The system] minimizes post operative pain, decreases the need for narcotic pain medicines, and accelerates recovery time by reducing swelling and cooling extremities,” he said. 

 
ALCiS Health

San Jose-based ALCiS announced that their pain cream has become available through national retail outlets.  Previously it was only available through infomercial and direct mail outlets.  According to Brian Berchtold, CEO and president, what sets their topical trolamine salicylate-based pain relief medicine apart is its unique delivery system, allowing medicine to work straight into site of pain without the counter irritants common to other topical relief medications.  ALCiS Pain Relief Cream is currently being sampled at over 6,000 medical clinics across the country. 

“Everyone is trying to get away from pills,” said Greg Quinn, ALCiS manager of Sports Marketing. “[This product] is a nice alternative to aspirin.”

---