knee

Insurers pay twice as much as hospitals for hip and knee implants

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Radiographie Prothse totale de hancheImagine this: You go to buy a car, but you don’t know who makes it, how other customers feel it’s performing, or how its price compares to other cars in its class.

This is exactly the situation facing insurers who reimburse hospitals for orthopedic implants, and a new study in the Journal of the American Medical Association reveals they are paying more than twice what hospitals do for devices inserted into hundreds of thousands of patients every year. This overpayment trickles down to patients in the form of higher premiums, say the study’s authors, but with regards to patient safety, the lack of information about manufacturers means it’s nearly impossible to track the performance of the implants.

By Casey Ross | STAT News

Image Credit: APSTOCK

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3D Printing Orthopedic Solutions — Where are we? An Update.

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1-61bvtpvipel3dtujnbb_zgHealthcare is rapidly changing and by this, I mean that the technology of delivery and care is advancing faster than the providers, the insurers and the patients can keep up. We are going to be seeing a remarkable transformation over the next few decades that will benefit patients most, and much of this is due to advances in 3D printing.

Now, some of this already exists today. There are prototypes built everyday by manufacturers using this technology for research and development but only a handful have fully embraced this technology in medical device implantation for patients. For example, there are cutting jigs that are designed and printed based off the patient’s individual anatomy that act as guides for the surgeon to define bone margins and planned cuts or alignment principles during orthopedic surgery. Commonly, a CT scan of the patient’s bones and joints is visualized with landmarks identified that plot the proposed positions and cuts the surgeon is going to make to accommodate for the proposed implant. This can theoretically and practically simplify complex procedures in to a ‘paint by numbers’ solution.

By Dr. Faisal Mirza | 3DHeals

Photo Credit: Jairo Alzate

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Biology trumps bionics: An alternative to total knee replacement

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alternative-to-knee-replacement-avoid-knee-replacement-biologic-knee-replacementIf you have severe knee pain or chronic knee inflammation and swelling which cannot be improved by minor surgery or physical therapy, a doctor may recommend that you have total knee replacement surgery. For many people, after years of agony, this operation is a godsend. The procedure relieves pain and greatly enhances their quality of life, allowing them to return to work and resume activities that they have not been able to enjoy in years.

But artificial knee replacements are not a perfect solution. Studies have shown that up to 50% of recipients still have some pain after the procedure. Surgeons are reluctant to perform knee replacements on younger people because the parts don’t last. Subsequent replacements are more complex and wear out even faster.

Many of the arthritic patients I see are under 70 years old and have years of playing sports and being active ahead of them. Therefore I like to do everything possible to rebuild their knee joint with biologic tissues rather than artificial materials to help delay the time in which an artificial joint replacement is necessary.

This regenerative approach to healing is the new frontier in modern medicine as researchers all over the world look for ways to rebuild and regenerate tissues and organs, harnessing the body’s natural ability to heal itself. In many cases these solutions are a long way off, but in orthopedics, we have been practicing them for years.

A BioKnee is an alternative to an artificial knee replacement. It combines three key procedures that rebuild, regenerate or biologically replace the damaged parts of the knee.

By Kevin R. Stone, M.D. | Linkedin

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Cutting-Edge Artificial Joints Are Better Than Bionic

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08-im703auckland2014-run-alexanderThree years ago, Michael Rix was taking 250 milligrams of codeine a day and waking up in the middle of the night due to extreme pain in his left hip.

Rix, who was 42 at the time, had taken up marathons and was training around his hometown of Sussex, England. He stubbornly ran through the pain, logging between 100 and 120 miles a week, even as it became more acute. Then he woke up one morning and found himself incapable of reaching down to put on his socks.

He paid a visit to orthopedic surgeon Kerry Acton at the Royal Surrey County Hospital in Guildford, and was told that severe osteoarthritis in his left hip meant that he would need a total hip replacement.

The diagnosis didn’t come as a shock — but he was surprised by what Acton said next.

“I was expecting him to say, after hip replacement, no more running nor more competition,” Rix recalled to Seeker over the phone. “But instead he asked me, what would you like to do? I said, in an ideal world, I’d love to get back to sport — maybe not a marathon, but triathlons. He said, ‘Yeah, we can do that.'”

By Amanda Onion | Seeker

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The 16 Standout North American Sports Knee Surgeons

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orthopedics-this-weekIn the exam room, OR, or the research lab, these are some of the top sports knee surgeons in North America. We sought out leading sports medicine surgeons and asked them to select their peers who stand out.

Here is that list. It isn’t the be-all and end-all list – but a list of who are arguably some of the finest sports knee physicians, teachers, researchers or administrators in the country.

By Elizabeth Hofheinz, M.P.H., M.ED. | Orthopedics This Week

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A single injection of protein harvested from a patient’s own blood may replace the need for knee surgery for osteoarthritis sufferers

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osteoarthritis-knee-painA single injection of protein harvested from a patient’s own blood may replace the need for knee surgery for osteoarthritis sufferers.

The new 20-minute procedure sees blood drawn from the patient’s arm, separated in a centrifuge, after which part of the fluid is then injected into the arthritic knee.

The surgeon who brought the treatment to the UK believes it can stop the need for keyhole surgery for osteoarthritis of the knee altogether.

Osteoarthritis is the most common type of arthritis, particularly affecting people aged 65 and over. The degenerative condition affects the cartilage – the joint’s connective tissue – causing pain, stiffness and inflammation.

A trial study in the Netherlands published earlier this year showed that 85 per cent of patients had little to no pain in their knee six months after new procedure, which is called the NStride Autologous protein injection.

A further, larger, study based on work in Italy, Austria, Belgium and Norway, which has seen similarly positive results, is due to be published later this month.

By Sara Malm | Daily Mail

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Total Joint Arthroplasty in a Stand-alone Ambulatory Surgical Center: Short-term Outcomes

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22knee-1445460477281-superjumboFor decades, the average hospital stay following total joint arthroplasty (TJA) has been getting shorter. The historical standard was several weeks of hospitalization, yet improvements in perioperative care have reduced the average length of stay to a few days. Medicare recognizes a 3-day inpatient stay as the standard of care following hip or knee replacement. Yet continued advances in minimally invasive surgical techniques, short-acting general anesthetics, long-acting local anesthetics, and blood loss management have further improved the safety and recovery for TJA procedures. Thus, further reductions in postoperative hospitalization have been implemented around the country, with surgeons reporting successful same-day protocols, as defined by hospitalization discharge on the day of surgery. Although these studies have presented results of same-day TJA in the hospital setting, this study is the first to report on the perioperative adverse events and early outcomes of 51 consecutive TJA procedures performed in a stand-alone ambulatory surgical center (ASC). The ASC offers an ideal setting to perform such procedures in the properly selected patient population, obviating any form of postoperative hospitalization. Although 16 (31.4%) of 51 patients reported minor adverse events in the postanesthesia care unit, specifically nausea and/or pain, early intervention permitted 50 (98.0%) of 51 patients to be discharged home, on average 176 minutes after surgery, with 1 patient discharged to a rehabilitation facility as arranged prior to surgery. There were no major adverse events in the 90-day perioperative period, and although 1 (2.0%) patient was hospitalized for persistent incisional drainage, none required admission for pain. This study examines the strict eligibility criteria and perioperative analgesia protocols that permit successful outpatient TJA. [Orthopedics. 2016; 39(4):223–228.]

By Bertrand W. Parcells, MD; Dean Giacobbe, MD; David Macknet, BA; Amy Smith, MSN, RN; Mark Schottenfeld, MD; David A. Harwood, MD; Stephen Kayiaros, MD | Helio Orthopedics

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