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American Academy Of Orthopaedic Surgeons 2009 Annual Meeting 'Highlights and Hot Topics'

LAS VEGAS, Feb. 25 /PRNewswire-USNewswire/ -- The following was issued today by the American Academy of Orthopaedic Surgeons:

Hip Replacement


  • Hip Resurfacing Disappoints Those Who Expect a "Bionic" Hip Replacement

Using a common mechanism to score activity levels after hip surgery, researchers found that the majority of patients who underwent a procedure to resurface arthritic hip bones consented to surgery with unrealistic expectations regarding outcome. While many patients hoped to return to skiing, jogging, ballet or tennis after surgery, most instead continued to experience limits on activities due to pain and stiffness. They were, however, able to regain the ability to participate in low-impact activities that increased their quality of life. The researchers recommend pre-surgical counseling to set expectations.

Pro Athletes and Knee Surgeries


  • Unlike Meniscectomy, ACL Reconstruction Not Detrimental to Sports Career

Football players who underwent knee repair surgery in college prior to joining the NFL had shorter professional careers if they underwent a meniscectomy, or knee meniscus repair, instead of surgical reconstruction of the anterior cruciate ligament (ACL). Common athletic pivoting and contact injuries often require surgery. It appears that those who undergo meniscectomy are likely to have a shorter career than uninjured athletes. Conversely, ACL reconstruction does not appear to have a significant effect on career longevity. Those athletes unfortunate enough to have undergone both ACL reconstruction and meniscectomy are statistically more likely to have a shorter career than if they had undergone only one or the other surgery.

Broken Bones as Indicators of Child Abuse


  • Clear Relationship Seen Between Types of Orthopaedic Injury and Abuse

In a study of nearly 1,500 pediatric patients classified as either confirmed victims of child abuse or sufferers of accidental trauma, clear relationships between injury type, child age and the presence of abuse became apparent. One significant indicator found by researchers was age; children who were victims of abuse were treated at the emergency room for bone trauma at a younger age (12 months) than those who were not victims (22 months). Patients younger than 18 months with orthopaedic injuries appear to have a stronger chance of suffering from abuse than those older than 18 months. Specific types of injuries were markers as well. A child with broken ribs appeared to be 14 times more likely to be a victim of abuse (24 times more likely if younger than 18 months of age) than their peers. Children with broken arms and legs who were older than age 18 months were likely to have suffered accidents, but the presence of these same fractures on children under the age 18 months was instead a strong indicator of abuse. Sex of the child did not appear to be a reliable predictor of abuse.

Shoulder Injuries May Have Genetic Link


  • Relations as Distant as Third-Cousin Appear to Increase Likelihood

There is evidence that a patient who suffers a shoulder injury is likely to have a family history of such injuries. Family members, even distant relatives who have suffered tears to the rotator cuff, the muscles and tendons that hold the top of the upper arm bone in place, appear to create an increased risk for others on the same family tree to also develop a torn rotator cuff. This risk extends out to third-cousin relationships (Third cousins are the great-great-grandchildren of one's great-great-grandparents). Researchers found that if any relative, even distant, suffered a rotator cuff injury, there was a greater likelihood of suffering a rotator cuff injury before age 40.

Botox Used To Treat Spasms After Hip Replacement


  • "Remarkable" Drug Shows Success in Hard-To-Treat Patients

Patients who undergo hip replacement surgery often complain of stiffness and occasionally suffer severe muscle spasms, limiting surgical recovery and lowering post-surgical quality-of-life. Physical therapy alone does not appear effective for these patients, but when botox is injected into spasming or stiff muscles around the hip, all of the trial patients showed increased hip range of motion, decreased pain, fewer (or zero) muscle spasms and were able to walk more normally with little or no limp. Researchers chose to investigate botox after reading of similar success the drug showed in knee replacement surgery.

Fracture Repair Treatment Using Balloons Appears Effective for Osteoporosis Fractures


  • Balloons inserted to correct spinal deformity, followed with bone paste injections, are shown to add improved activity for osteoporosis patients

People with osteoporosis often endure spinal fractures that are painful and limit mobility. Treatment is generally limited to bed rest and pain medication. Repeated fractures often result, leading to stooped backs, limited mobility and depression. By inserting and inflating balloons on each affected vertebrae, surgeons are able to straighten the spine. The new shape is held in place with bone-paste, which leads to a permanent repair. Researchers indicated that this repair can lead to reduced hospital stays, increased mobility, a normal daily life and fewer complications. Patients reported 60 days of improved daily activity compared with untreated peers.

Driving After ACL Surgery


  • Reduced Reaction Times Become Normal After Six Weeks
  • Cadaver Tissue vs. Tissue Obtained From Patient's Body Show Difference

The "safe to return to driving", call by physicians offering guidance after anterior cruciate ligament (ACL) surgery on the right (driving) knee might vary by type of surgery according to a recent study. Patients who had their ligament repaired with tissue obtained from a cadaver trended toward normal brake reaction times at three weeks, versus the six week interval for those patients who were grafted with tissue obtained from their own body. In all patients, significantly slower reaction times were shown to occur immediately (7-10 days) after surgery but generally resolved by the six-week point. A six-week driving restriction appears appropriate after any ACL surgery, with allowances for individual rehabilitation.

ACL Repair Still Effective at 20-Year Mark


  • Rare Long-Term Study Shows No New Knee Disability Even Long After Surgery

Patients who were older than 40 and as old as 60 when they underwent ACL surgery reported long-term "excellent function" and "high activity" levels as many as 20 years after the reconstructive surgery. Most reported being able to perform normal activities and reported an ability to lead as normal a lifestyle as those who had never undergone knee surgery.

Wheelchair Users and Rotator Cuff Injuries


  • 50 percent Report Disabling Pain, Women at Higher Risk

Unlike the able-bodied population, where age is the major risk factor for "shoulder girdle" problems such as rotator cuff tears in the shoulder and bursitis, paraplegic patients show additional risk factors for shoulder injuries. The duration of paraplegia and the amount of athletic activity are strong indicators for future shoulder injuries among the paralyzed. Wheelchair dependence significantly affects the possibility of shoulder damage diagnosis, as well as the sex of the paraplegic patient. Paraplegic women were found to be at much higher risk of painful shoulder problems than paraplegic men.

Stress Fractures as Indicators of Underlying Bone Health


  • Microscopic Breaks in Young Women Can Forecast Future Osteoporosis Diagnosis

There is little bone growth or development after a person reaches the mid-20s in age. The presence of bone fractures from repeated stress offers insight into future bone health problems, especially among young women. Measurement of bone-density can be important for young, at-risk women, but often does not occur because such measurements are traditionally performed only on older patients.

Young women who may be at risk of osteoporosis often show symptoms as early as the college years that can predict future problems. An examination of sites where small fractures take place from bones being subjected to repeated stress, which happen in activities such as running and gymnastics, show that bones often suffer significant and identifiable fractures at the microscopic level. These microscopic fractures appear to correlate with the status of bone health in young women. "At risk" patients can be determined by the identification of such stress fractures, which appear to indicate a strong risk of a future osteoporosis diagnosis. These "at risk" patients should undergo a thorough evaluation, so that appropriate osteoporosis prevention and treatment strategies can be implemented.

Shoulder Surgery can be complicated by Sudden Cartilage Loss


  • The Infusion of Local Anesthetics after Shoulder Arthroscopy Can Lead to Devastating Loss

After arthroscopic shoulder surgery, local anesthetics may be infused into the joint for post surgical pain management. This infusion has been associated with chondrolysis of the shoulder, a condition that results in complete loss of cartilage and secondary arthritis. A new study of a large number of previously unreported cases examines the risk factors for chondrolysis. The study found that chondrolysis can complicate a wider range of arthroscopic shoulder surgeries than previously thought and that this complication is not limited to young patients. Chondrolysis can follow the infusion of lidocaine as well as bupivacaine, the only medication previously thought to be involved. Additionally, chondrolysis can occur without the use of radiofrequency within the joint. Surgeons and patients are cautioned about combining shoulder arthroscopy with the post-surgical infusion of local anesthetics due to the possible risk of chondrolysis.

Orthopaedic Biologics Hold Promise


  • Symposium Address New Therapies for Bone and Soft Tissue Health

6.2 million bone fractures occur annually in the United States and as many as 10% of these fractures show delayed healing or do not heal completely. Recently research has focused on solving this medical problem through biologically based medications, and a number of exciting technologies that hold great promise for the future of bone and soft tissue health are now surfacing. Growth factor combinations such as bone morphogenetic protein, platelet rich plasma, and platelet derived growth factor and other potential therapeutic agents are now being explored. Many of these new biologics are focused at stimulating bone growth and bone fusion. Advances also have been made in tendon and ligaments reconstructions with soft tissue aides.

Ankle Sprains


  • Symposium Addresses Difficult to Treat Ankle Sprains

In the United States, the incidence of ankle sprains is roughly 2,300 a day, almost 100 every hour. Although the majority of acute ankle sprains heal without surgery, approximately 15 to 20 percent of patients have persistent ankle symptoms. Failure of the ankle to heal may be due to cartilage injuries, subtle ankle fractures, tendon tears, development of scar tissue, or abnormalities unmasked by an ankle sprain. A panel of foot and ankle specialists will use a case-based approach to describe their experiences with diagnosing and treating many of the conditions that are responsible for persistent pain and loss of function after ankle sprain. In addition to a review of conventional treatment methods, the panelists will highlight state-of-the-art techniques of rehabilitation, minimally invasive surgery, and arthroscopy.

    For more information, contact:

    Catherine Dolf  C (847) 894-9112 or O (847) 384-4034
    Lauren L. Pearson  C (224) 374-8610 or O (847) 384-4031

SOURCE American Academy of Orthopaedic Surgeons
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