Friday, January 13, 2017

Patient Selection Crucial for Success of Unicompartmental Knee Replacement

Makoplasty Medial Compartment
20 year survival rates of unicompartmental knee replacement approach 75 % or better.  Implant design and Makoplasty surgical technique (robot technology) are important contributing factors.

Berlin surgeons performed a medical study evaluating 5 year survival of German patients from 2006 to 2012.  This was published in the JBJS in October of 2016.

Risk factors associated with failure of the implant in the first 5 years after implantation are:

1.  age younger than 55

2.  Obesity (BMI > 30)

3.  Diabetes, complicated

4.  Depression

5.  Low volume facility (less than 10 cases per year)

Sunday, January 8, 2017

Optimal Delivery of Total Knee Replacement Surgery - Surgeon Experience Improves Outcomes

High volume Total Knee surgeons working at high volume facilities deliver the best outcomes for patients undergoing knee replacement surgery.

The Hospital for Special Surgery in New York published data on meaningful surgeon and hospital volume threshholds in the October, 2016 Journal of Bone and Joint Surgery.

Here are the key numbers.  

Surgeon volume of 60 or more cases per year had the best 90 day complication and 2 year revision rates. Choose a surgeon that performs 5 or more knee joint replacement surgeries per month.

Facility volume of 236 cases per year had lower 90 complication rates.  Mortality rates were lowest for facilities performing more than 645 cases per year.  

Thursday, December 22, 2016

MRI to Evaluate Knee Pain in Patients Over 40

MRI of the knee is a accurate test to identify injuries and diseases of the knee.  Unnecessary testing leads to unnecessary procedures. Guidelines as to when to order a knee MRI is valuable.

Research published by Washington University Department of Orthopedics found that plain xrays should be evaluated prior to ordering an MRI scan in patients over the age of 40.  When xrays reveal > 50 % joint space narrowing MRI is unnecessary 95 % of the time.  

Nearly 50 % of the MRI knee scans ordered in this study of 600 patients was considered unnecessary.  That is a lot of wasted health care dollars.  

Saturday, September 24, 2016

Obesity Linked to Cancer/Death

In 2013, there were an estimated 4.5 million deaths worldwide attributable to overweight and obesity.  Longevity and wellness is linked to body weight.  The absence of excess body fatness reduces the risk of cancers.
A summary was published online August 25 in the New England Journal of Medicine.
These 13 cancers are linked to obesity ― colorectal, esophageal (adenocarcinoma), renal cell carcinoma, breast cancer in postmenopausal women, uterine endometrial cancer, stomach (gastric cardia), liver, gall bladder, pancreas, ovarian, thyroid, meningioma, and multiple myeloma.
Several mechanisms linking excess body fat with carcinogenesis were identified, including chronic inflammation and dysregulation of the metabolism of sex hormones, the IARC notes.
The identification of new obesity-related cancer sites will add to the number of deaths worldwide attributable to obesity. 
Worldwide Obesity Epidemic
Worldwide, an estimated 640 million adults were obese in 2014, which is a sixfold increase since 1975. There were 110 million obese children and adolescents in 2013 (a twofold increase since 1975).
What to Do?  Prevention is the Answer:
Obviously, the best way forward would be to prevent people from becoming overweight (defined as having a body mass index [BMI] ≥ 25 kg/m2) and obese (BMI ≥ 30 kg/m2) in the first place.
But once people have excess body fat, does reducing it also reduce the increased risk for cancer? Here, there is evidence from animal studies, but not yet from studies in humans.

Saturday, September 10, 2016

School Aged Athletes With ACL Revision Surgery: Be Aware of Sub Optimal Results

If your son or daughter is under the age of 18, has undergone ACL reconstruction surgery and suffers a second ACL tear in the same knee, one should strongly consider stopping Level One sports activities (cutting, pivoting, ACL at risk sports).

MRI of healthy ACL
Research presented by Melissa Christino, MD at the AANA meeting in 2016 found that the risks for poor outcomes are too great to recommend returning to competitive sports after revision ACL surgery in young adults and adolescents.  This is an impressive study on a topic relevant to many young athletes.

Here are the facts:

Graft retear risk after a second ACL surgery is 20 % at less than 2 years (rate after one ACL surgery is < 2%).

Return to the operating room for a third surgery occured in 25 % of these patients.

33 % of patients that tore their revision ACL also tore the ACL in their opposite knee.

Only 55 % of revision ACL patients could even compete at their previous level of play.

This is sobering information.  We have been empowered with knowledge, now let us be intelligent enough to heed the advice.  Hopefully parents, school aged athletes and surgeons will consider these facts for young athletes that fail primary ACL reconstruction.