Back from the Orthopaedic Research Society(ORS) and Am Academy of Orthopaedic Surgeons (AAOS)meetings in Chicago and a week of R&R. Damn it was cold. Held here becuz Katrina leveled Nawlins and other Gulf Coast Hotels. Best attendance ever with over 50,000 surgeons, industry folks, researchers, and guests. Was astounded by the Asian influx, big numbers from Japan, and China this year (Easy to fly direct to Chicago). Resturants were great(The Cape Cod Room-Drake Hotel especially the Fresh Flown in Dover Sole, broiled in buerre blanc(sp?) and deboned at the table is an old favorite). A number of new Brazilian/ Argentine resturants with all the meat you can eat on a skewer(Way too much food).
Young research awards went to several with very interesting papers; "Schwann Cell Regulation of Chronic Nerve Injury"(explores the role of chronic nerve injuries and the changes to the nerves themselves), "The Roles of Bone Morphogenic Proteins(BMP's) in Meschymal Stem Cell Differentiation( provides an understanding into cellular and molecular mechanisms underlying BMP activity", and another paper described how Growth Factors blocked Renal Cell Cancer Bone Metastasis.
Joan Rivers was one of several featured speakers (also George Will), describing how Joe Lane at Hospital for Special Surgery stopped her osteoporosis when in her late 40's. Lots of papers on new bone grafting materials, cartilage replication implants, and tendon replacements. Its obvious we are moving towards more biological solutions in both hard and soft tissue repair/replacement. ZMH, DePuy, BMET all showed their versions of specifically designed anatomical knee replacement for females (no they were not pink or in lipstick red). Another big show stopper was minimal invasive implants using surgical navigation technology (Brain Lab AG, Smith & Nephew, MDT to name a few) to go inside a 3 inch incision (both knee and hip joint replacement) instead of a 12-14 in incision previously used. Patients can using become mobile within 24-48 hrs and go home vs 7-14 days. Medicare loves it. ABT's Spinal Concepts display had some strong booth traffic. Keep your eyes on Small Bone Innovations LLC. Nice Upper Extremity Bone Fixation Startup Company, will probably do an IPO in about 2-3 yrs according to the CEO, who I know. Same with a CA (San Luis Obsipo)company FzioMed is in European clinicals on a spinal fusion material sold by DePuy. The gorilla's like STY, DePuy/JNJ, SNN, ZMH, BMET (Big shock CEO Dane Miller resigned-Talk of Acquisition; He started the company) all had good booth traffic. So did some smaller players with some interesting technology; Acumed, Arthrex, ArthroCare, and ISTO Technologies to name a few in the sports med arena. Old friend,Dick Kyle from U. if Minn has become this years AAOS President. Super sharp and well trained in Fracture Management, experiemented with synthetic meniscus replacment material developed in Norway.
Ponte, sorry to learn of your loss. Do wish you well. Its does take some time to recover, but we all do find a way.
Shooting HA in the hip is real tricky. Usually requires an image intensifier to visualize the joint capsule, the a long percutaneous needle is required and the precision to be absolutely in the joint is required. If its not precise, party is over.Interventional Radiologists and some Orthos are doing this, but only in very selective cases on in investigational studies.
Your respone is typical with hyalronic acid compounds. The relief gets better after the 2nd and 3rd series of injections. In Canada it was first tried by Rhuematologists to extend a patients time before they could obtain a TKR, because of the the time it took in the Canadian Medical System to get a replacement. But its still not for everyone. Especially if you are overweight and have worn the cartilage to the point of bone rubbing on bone.
As for Synvisc, yes it does contain some formaldehyde and in some patients has caused reactions such as; pain, swelling, and even effusions.I have heard about the electrical therapy, but do not know that much to comment about it.
As for Persh getting a revision, it all depends on age, weight, and the type of activity levels. The more strain and higher number of stressful articulations (running, golf, tennis) or addded weight, the more stress on the polyethylene (PE) bearing surface. Some of newer ceramic materials and even metal on metal surfaces are reducing this wear. When PE wears small particulates are generated and this often causes loosing in the tibial stem of the knee component; especially if its cemented. This breaks down the bond between the bone-cement-implant interface causing the implant to work loose. This is why they need revision. In todays environment, revision implants are really quite good and depending upon the requirements, may take a little longer to rehab, but once completed patients should function as good if not better than a Primary. Example look at Da Coach, Ditka. Had a gait problem with very early primary put in whne hips were first released, revised a few yrs back, never now know he had a hip done,much less revised.
There have been several notable advancements. One of the newest is to replace the glenoid(the socket) with a ceramic material that helps to reduces wear of this component. Prior to this, molded polyethylene (PE) was most commonly used, but was also subjected to wear between the polished metal head of the humeral component and the PE. This often meant having to undergo a revision to replace these components in typically 8-12 years under normal conditions. However, its only fair to say this issue is not near the problem that its presented that it is in the hip or the knee where weight bearing, gait, and high activity,e.g., golf, tennis, etc increases the wear factor substantially.
Take a look at Biomet's website and you can see the products they have to give you an idea. Another one is Stryker, and you can also look at DePuy. This last one is probably listed under Johnson & Johnson family of company's. Smith & Nephew might also be another spot to look at these components.