Friday, November 20, 2015

Blood Clot Risk Lurks At Hospital

In USA Today snapshots recently:

60 % of all potentially deadly venous thromboembolism (VTE) cases are linked to recent hospitalization.

VTE is a know risk that occurs after knee surgery.  At Advanced Knee Care we follow national guidelines and employ measures to mitigate these risks including aspirin 325 mg orally twice daily following major knee surgery as well as sequential home compression for a month after total and partial knee replacement.

Friday, October 30, 2015

Physical Activity Could Help Prevent Knee Osteoarthritis

Surface damage to articular cartilage in a knee 
Research suggesting that physical activity could help prevent Knee Osteoarthritis has been presented this week at the AVS 62nd International Symposium and Exhibition, in San Jose, CA.

Researchers including Dr. Burris at the University of Delaware found that as the sliding speed increased toward typical walking speeds cartilage thinning was reversed.  At slow sliding speeds (less than would occur in a joint at typical walking speeds) cartilage thinning and an increase in friction occurred over time. This may explain why walking or cycling can mitigate knee pain in patients with osteoarthritis of the knee.  
A healthy joint surface is composed of 80 % synovial fluid (water and proteins).  To investigate whether hydrodynamic pressurization could refill deflated cartilage, the researchers placed larger-than-average cartilage samples against a glass flat to ensure that there would be a wedge.   Pressure forced fluid back into the articular cartilage stopping the joint surface from deflating.  If movement occurs faster than the fluid can diffuse then continuous knee movement could prevent deflation.  
Articular Cartilage is a firm, porous, rubbery material covering the ends of the bones in the knee joint. It reduces friction in the joint and acts as a "shock absorber."  Loss of synovial fluid occurs when articular cartilage is damaged or diseased.  Osteoarthritis is a degenerative disease resulting from a reduction in the articular cartilage thickness, leading to an increase in friction, inflammation, pain and deformity of legs.
When cartilage becomes damaged or deteriorates, it limits the knee's normal movement and can cause significant pain, and eventually the need for knee replacement surgery

Sunday, October 25, 2015

ACL Surgery Graft Choice - Autograft or Allograft ?

Rick Wright, MD of Washington University presented at an ACL workshop.

A summary of his opinions:

1.  Study results appear to favor autograft over allograft by measures of stability and abnormal laxity.

2.  Studies performed show age differences - younger patients have much higher success rates with autograft (their own tissue) while patients over 40 have 97 % success rate with allograft (donor tissue) which should be considered for this population.

3.  Other considerations when choosing a graft include cost (allograft > $1000),  biologic safety (disease transmission with allograft) and graft harvest complications in autograft.
ACL Reconstruction with Hamstring Graft and preservation of native ACL tibial fibers

Friday, October 16, 2015

Consumer Patients Choose Ambulatory Surgery Centers When Costs Revealed

Freestanding ASC (ambulatory surgery centers) saved the consumer patient 17 % compared to the hospital outpatient department.

A California price study found hospital cost $6640 and ASC cost $4795 for knee arthroscopy.

Consumer patients became sensitive to price differences when transparent pricing was revealed.  Patients respond strongly to pricing incentives.

Dr. Tarlow supports and practices transparent pricing on his website.

Consumers need to be accorded a greater decision making role when accessing the health care system.  They should be provided information on price and quality.

Friday, October 9, 2015

Meniscal Transplant in the Knee: Results

An article recently published in JBJS by Dr. Noyes of Cinncinnati reported on their meniscal transplant experience.

Long term survivorship is 88% at 5 years, 63 % at 10 years, and falls to 40 % at 15 years after transplant.

While meniscal transplants fail over the long term the benefit of symptom resolution and functional improvment in the 5-10 year range justify the procedure in younger patients.

Orthopedic Surgeons are still searching for a long term biological solution for patients that suffer a serious meniscal injury to the knee.  At this time, many will go on to develop premature knee arthritis, pain and limited knee function and there is little we as health care providers can do for them.