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Tag: Bone Health

  • Spinal Cord Injury: Can Brain and Nerve Stimulation Restore Movement?

    Spinal Cord Injury: Can Brain and Nerve Stimulation Restore Movement?

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    Newswise — NEW YORK, NY–A nerve stimulation therapy developed at Columbia University Vagelos College of Physicians and Surgeons is showing promise in animal studies and may eventually allow people with spinal cord injuries to regain function of their arms.

    “The stimulation technique targets the nervous system connections spared by injury,” says Jason Carmel, MD, PhD, a neurologist at Columbia University and NewYork-Presbyterian who is leading the research, “enabling them to take over some of the lost function.”

    The findings were published in December in the journal Brain.

    A personal quest to develop treatments for people with paralysis

    In 1999, when Carmel was a second-year medical student at Columbia, his identical twin brother suffered a spinal cord injury, paralyzing him from the chest down and limiting the use of his hands.

    Carmel’s life changed that day, too. His brother’s injury ultimately led Carmel to become a neurologist and a neuroscientist, with the goal of developing new treatments to restore movement in people living with paralysis.

    In recent years, some high-profile studies of spinal cord electrical stimulation have allowed a few people with incomplete paralysis to begin to stand and take steps again.

    Carmel’s approach is different because it targets the arm and hand and because it pairs brain and spinal cord stimulation, with electrical stimulation of the brain followed by stimulation of the spinal cord. “When the two signals converge at the level of the spinal cord, within about 10 milliseconds of each other, we get the strongest effect,” he says, “and the combination appears to enable the remaining connections in the spinal cord to take control.”

    In his latest study, Carmel tested his technique—called spinal cord associative plasticity (SCAP)—on rats with moderate spinal cord injuries. Ten days after injury, the rats were randomized to receive 30 minutes of SCAP for 10 days or sham stimulation. At the end of the study period, rats that received SCAP targeted to their arms were significantly better at handling food, compared to those in the control group, and had near-normal reflexes.

    “The improvements in both function and physiology persisted for as long as they were measured, up to 50 days,” Carmel says.

    The findings suggest that SCAP causes the synapses (connections between neurons) or the neurons themselves to undergo lasting change. “The paired signals essentially mimic the normal sensory-motor integration that needs to come together to perform skilled movement,” says Carmel. 

    From mice to people

    If the same technique works in people with spinal cord injuries, patients could regain something else they lost in the injury: independence. Many spinal cord stimulation studies focus on walking, but “if you ask people with cervical spinal cord injury, which is the majority, what movement they want to get back, they say hand and arm function,” Carmel says. “Hand and arm function allows people to be more independent, like moving from a bed to a wheelchair or dressing and feeding themselves.”

    Carmel is now testing SCAP on spinal cord injury patients at Columbia, Weill Cornell, and the VA Bronx Healthcare System in a clinical trial sponsored by the National Institute of Neurological Disorders and Stroke. The stimulation will be done either during a clinically indicated surgery or noninvasively, using magnetic stimulation of brain and stimulation of the skin on the front and back of the neck. Both techniques are routinely performed in clinical settings and are known to be safe.

    In the trial, the researchers hope to learn more about how SCAP works and how the timing and strength of the signals affect motor responses in the fingers and hands. This would lay the groundwork for future trials to test the technique’s ability to meaningfully improve hand and arm function.

    Looking farther ahead, the researchers think that the approach could be used to improve movement and sensation in patients with lower-body paralysis.

    In the meantime, Jason Carmel’s twin is working, married, and raising twins of his own. “He has a full life, but I’m hoping we can get more function back for him and other people with similar injuries,” says Carmel.

     

    More information

    The study is titled “Spinal cord associative plasticity improves forelimb sensorimotor function after cervical injury.”

    Other contributors: Ajay Pal, HongGeun Park, Aditya Ramamurthy, Ahmet S. Asan, Thelma Bethea, and Meenu Johnkutty (all at Columbia).

    The study was funded by the National Institute of Neurological Disorders and Stroke (R01NS115470) and the Travis Roy Foundation.

    Jason Carmel is a co-inventor of a patent for the use of softening spinal electrodes. He also has equity in Backstop Neural, which seeks to commercialize the devices for humans. The authors declare no other competing financial interests.

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    Columbia University Irving Medical Center

    Columbia University Irving Medical Center (CUIMC) is a clinical, research, and educational campus located in New York City, and is one of the oldest academic medical centers in the United States. CUIMC is home to four professional colleges and schools (Vagelos College of Physicians and Surgeons, Mailman School of Public Health, College of Dental Medicine, and School of Nursing) that are global leaders in their fields. CUIMC is committed to providing inclusive and equitable health and medical education, scientific research, and patient care, and working together with our local upper Manhattan community—one of New York City’s most diverse neighborhoods. For more information, please visit cuimc.columbia.edu.  

     

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  • Surgery for spinal stenosis linked to lower mortality and costs, compared to nonoperative treatment

    Surgery for spinal stenosis linked to lower mortality and costs, compared to nonoperative treatment

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    Newswise — January 13, 2023 – For patients with spinal stenosis, operative treatment is associated with a lower risk of death and lower costs over two years, compared with nonoperative treatment, suggests a study in the February issue of The Journal of Bone & Joint Surgery. The journal is published in the Lippincott portfolio in partnership with Wolters Kluwer.

    Based on extensive analysis of Medicare data, the study by Raymond Hwang, MD, MEng, MBA, of New England Baptist Hospital and colleagues is one of the first to directly compare the outcomes and costs of operative and nonoperative treatment for patients with spinal stenosis.

    Lower mortality with operative versus nonoperative treatment for spinal stenosis

    Patients with spinal stenosis experience narrowing of the spinal canal and compression of spinal nerves, causing back pain, leg pain, and other symptoms. In some patients, stenosis is related to degenerative spondylolisthesis, referring to “slipped” vertebrae often resulting from spinal degeneration.

    Operative treatment of spinal stenosis can include the use of a laminectomy to decompress the spinal canal, a spinal fusion to stabilize the spine, or a combination of both. Nonoperative treatment can include the use of medications, steroid injections, and physical therapy.

    Spine surgery has been shown to be cost-effective in reducing pain and restoring function. Many patients experience improved quality of life and mobility following surgery – which might promote general health and thus lead to a reduced risk of death. “However, the effect of spine surgery relative to nonsurgical management on these important outcomes has not been well described,” Dr. Hwang and coauthors write.

    The researchers analyzed data on 61,534 Medicare patients with spinal stenosis alone and 83,813 with stenosis and spondylolisthesis. Among these patients, 37% of those with stenosis alone and 52% of those with stenosis and spondylolisthesis were managed operatively; the most common procedures were laminectomy and spinal fusion, respectively. In both groups, the average age was about 73 years.

    Patients undergoing operative versus nonoperative treatment were matched in terms of demographic characteristics and health status (based on Risk Stratification Index). Predicted mortality rates were similar between the operative and nonoperative groups, indicating that the groups were well-matched.

    However, in most comparisons, the actual two-year risk of death was higher in the nonoperative group. For example, among patients with stenosis alone, mortality rates were 3.7% for nonoperative treatment versus 2.5% for laminectomy, as assessed in matched cohorts. For patients with spondylolisthesis, mortality rates were 2.3% for nonoperative treatment versus 1.3% for laminectomy and fusion. In adjusted analyses, the relative risk of death was 28% lower in operatively managed patients.

    Costs vary with diagnosis and type of surgery for spinal stenosis

    Nonoperatively treated patients tended to require more health care, including pain medication, magnetic resonance imaging scans, and physical therapy. Among patients with spinal stenosis and spondylolisthesis, Medicare costs were lower with surgical treatment. For example, the average two-year costs were $47,667 for patients who underwent a laminectomy compared with $68,890 for those who were nonoperatively managed.

    Among patients with stenosis alone, costs were lower in those who underwent laminectomy compared with nonoperative treatment: $34,998 versus $59,071. In contrast, costs were higher in patients who underwent spinal fusion compared with nonoperative treatment: $67,451 versus $60,540.

    Mortality was similar for patients undergoing combined fusion and laminectomy, as compared with either procedure alone. “However,” the researchers write, “laminectomy alone was associated with significantly lower two-year payments when treating stenosis with or without spondylolisthesis.”

    The study provides new evidence linking spine surgery to lower mortality and lower costs among Medicare patients with spinal stenosis. For those without spondylolisthesis, costs are lower with laminectomy and higher with fusion. The researchers point out some limitations of their study, including the possible effects of unrecognized confounding factors.

    These findings may have important implications for clinical practice, especially considering recent increases in the use and costs of lumbar fusion surgery. Based on the observed mortality and cost reductions, “The current study suggests that this trend may be justified within the Medicare population” for well-selected patients, Dr. Hwang and coauthors conclude.

    Read [Surgical Treatment of Single-Level Lumbar Stenosis Is Associated with Lower 2-Year Mortality and Total Cost Compared with Nonsurgical Treatment]

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    About The Journal of Bone & Joint Surgery

    The Journal of Bone & Joint Surgery (JBJS) has been the most valued source of information for orthopaedic surgeons and researchers for over 125 years and is the gold standard in peer-reviewed scientific information in the field. A core journal and essential reading for general as well as specialist orthopaedic surgeons worldwide, The Journal publishes evidence-based research to enhance the quality of care for orthopaedic patients. Standards of excellence and high quality are maintained in everything we do, from the science of the content published to the customer service we provide. JBJS is an independent, non-profit journal.

    About Wolters Kluwer

    Wolters Kluwer (WKL) is a global leader in professional information, software solutions, and services for the clinicians, nurses, accountants, lawyers, and tax, finance, audit, risk, compliance, and regulatory sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with advanced technology and services.

    Wolters Kluwer reported 2021 annual revenues of €4.8 billion. The group serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 20,000 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands.

    Wolters Kluwer provides trusted clinical technology and evidence-based solutions that engage clinicians, patients, researchers and students in effective decision-making and outcomes across healthcare. We support clinical effectiveness, learning and research, clinical surveillance and compliance, as well as data solutions. For more information about our solutions, visit https://www.wolterskluwer.com/en/health and follow us on LinkedIn and Twitter @WKHealth.

    For more information, visit www.wolterskluwer.com, follow us on Twitter, Facebook, LinkedIn, and YouTube.

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    Wolters Kluwer Health: Lippincott

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  • Cat Locomotion Could Unlock Better Human Spinal Cord Injury Treatment

    Cat Locomotion Could Unlock Better Human Spinal Cord Injury Treatment

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    Newswise — Cats always land on their feet, but what makes them so agile? Their unique sense of balance has more in common with humans than it may appear. Researchers at the Georgia Institute of Technology are studying cat locomotion to better understand how the spinal cord works to help humans with partial spinal cord damage walk and maintain balance.

    Using a mix of experimental studies and computational models, the researchers show that somatosensory feedback, or neural signals from specialized sensors throughout a cat’s body, help inform the spinal cord about the ongoing movement and coordinate the four limbs to keep cats from falling when they encounter obstacles. Research suggests that with those motion-related sensory signals the animal can walk even if the connection between the spinal cord and the brain is partially fractured.  

    Understanding the mechanisms of this type of balance control is particularly relevant to older people who often have balance issues and can injure themselves in falls. Eventually, the researchers hope this could bring new understanding to somatosensory feedback’s role in balance control. It could also lead to progress in spinal cord injury treatment because the research suggests activation of somatosensory neurons can improve spinal neural networks’ function below the site of spinal cord damage.

    “We have been interested in the mechanisms that make it possible to reactivate injured networks in the spinal cord,” said School of Biological Sciences Professor Boris Prilutsky. “We know from previous studies that somatosensory feedback from moving legs helps activate spinal networks that control locomotion, enabling stable movement.”

    The researchers presented their findings in “Sensory Perturbations From Hindlimb Cutaneous Afferents Generate Coordinated Functional Responses in All Four Limbs During Locomotion in Intact Cats” in the journal eNeuro.

    Coordinated Cats

    Although genetically modified mouse models have recently become dominant in neural control of locomotion research, the cat model offers an important advantage. When they move, mice remain crouched, meaning they are less likely to have balance problems even if somatosensory feedback fails. Humans and cats, on the other hand, cannot maintain balance or even move if they lose sensory information about limb motion. This suggests that larger species, like cats and humans, might have a different organization of spinal neural network controlling locomotion compared to rodents.

    Georgia Tech partnered with researchers at the University of Sherbrooke in Canada and Drexel University in Philadelphia to better understand how signals from sensory neurons coordinate movements of the four legs. The Sherbrooke lab trained cats to walk on a treadmill at a pace consistent with human gait and then used electrodes to stimulate their sensory nerve.

    The researchers focused on the sensory nerve that transmits touch sensation from the top of the foot to the spinal cord. By electrically stimulating this nerve, researchers mimicked hitting an obstacle and saw how the cats stumbled and corrected their movement in response. Stimulations were applied in four periods of the walking cycle: mid-stance, stance-to-swing transition, mid-swing, and swing-to-stance transition. From this, they learned that mid-swing and the stance-to-swing transition were the most significant periods because the stimulation increased activity in muscles that flex the knee and hip joints, joint flexion and toe height, step length, and step duration of the stimulated limb.

    “In order to maintain balance, the animal must coordinate movement of the other three limbs, otherwise it would fall,” Prilutsky said. “We found that stimulation of this nerve during the swing phase increases the duration of the stance phase of the other limbs and improves stability.”

    In effect, when the cat stumbles during the swing phase, the sensation triggers spinal reflexes that ensure the three other limbs stay on the ground and keep the cat upright and balanced, while the swing limb steps over the obstacle.

    Computational Cats

    With these Canadian lab experiments, the researchers at Georgia Tech and Drexel University are using observations to develop a computational model of the cat’s musculoskeletal and spinal neural control systems. The data gathered are used to compute somatosensory signals related to length, velocity, and produced force of muscles, as well as pressure on the skin in all limbs. This information forms motion sensations in the animal’s spinal cord and contributes to interlimb coordination by the spinal neuronal networks.

    “To help treat any disease, we need to understand how the intact system works,” Prilutsky said. “That was one reason why this study was performed, so we could understand how the spinal networks coordinate limb movements and develop a realistic computational model of spinal control of locomotion. This will help us know better how the spinal cord controls locomotion.”

    CITATION: Merlet AN, Jéhannin P, Mari S, Lecomte CG, Audet J, Harnie J, Rybak IA, Prilutsky BI, Frigon A (2022) Sensory Perturbations from Hindlimb Cutaneous Afferents Generate Coordinated Functional Responses in All Four Limbs during Locomotion in Intact Cats. eNeuro 9: 0178-22.

    DOI: 10.1523/ENEURO.0178-22.2022

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    The Georgia Institute of Technology, or Georgia Tech, is one of the top public research universities in the U.S., developing leaders who advance technology and improve the human condition. The Institute offers business, computing, design, engineering, liberal arts, and sciences degrees. Its more than 46,000 students, representing 50 states and more than 150 countries, study at the main campus in Atlanta, at campuses in France and China, and through distance and online learning. As a leading technological university, Georgia Tech is an engine of economic development for Georgia, the Southeast, and the nation, conducting more than $1 billion in research annually for government, industry, and society. 

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  • January 2023 Issue of Neurosurgical Focus: “Minimally Invasive Surgery of Lumbar Spine”

    January 2023 Issue of Neurosurgical Focus: “Minimally Invasive Surgery of Lumbar Spine”

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    Newswise — Rolling Meadows, IL (January 1, 2023). The January issue of Neurosurgical Focus (Vol. 54, No. 2 [https://thejns.org/focus/view/journals/neurosurg-focus/54/1/neurosurg-focus.54.issue-1.xml]) presents 10 articles on minimally invasive surgery of the lumbar spine.

    Topic Editors: Paul M. Arnold, Dean Chou, Cara L. Sedney, Xu Sun, Timothy F. Witham, Robert F. Heary

    Observing that “the first 2 decades of the new century have seen an explosion of new technology and surgical techniques in spine surgery,” the Topic Editors of the January issue of Neurosurgical Focus present an issue that “highlights several novel techniques that will be of interest to the practicing spine surgeon” as well as points to future developments in the field.

     Contents of the January issue: 

    • “Introduction. The growth of minimally invasive lumbar spine surgery” by Paul M. Arnold et al.
    • “Minimally invasive versus open transforaminal lumbar interbody fusion for grade I lumbar spondylolisthesis: 5-year follow-up from the prospective multicenter Quality Outcomes Database registry” by Andrew K. Chan et al.
    • “Radiographic alignment outcomes after the single-position prone transpsoas approach: a multi-institutional retrospective review of 363 cases” by Luis Diaz-Aguilar et al.
    • “Improvement following minimally invasive transforaminal lumbar interbody fusion in patients aged 70 years or older compared with younger age groups” by Pratyush Shahi et al.
    • “Multilevel tandem spondylolisthesis associated with a reduced ‘safe zone’ for a transpsoas lateral lumbar interbody fusion at L4–5” by Anthony Oyekan et al.
    • “How dimensions can guide surgical planning and training: a systematic review of Kambin’s triangle” by Romaric Waguia Kouam et al.
    • “The impact of cage positioning on lumbar lordosis and disc space restoration following minimally invasive lateral lumbar interbody fusion” by Tariq Ziad Issa et al.
    • “En bloc resection of ligamentum flavum with laminotomy of the caudal lamina in the minimally invasive laminectomy: surgical anatomy and technique” by Luis M. Tumialán
    • “Sacroiliac joint fusion navigation: how accurate is pin placement?” by Shea M. Comadoll et al.
    • “A triple minimally invasive surgery combination for subacute osteoporotic lower lumbar vertebral collapse with neurological compromise: a potential alternative to the vertebral corpectomy/expandable cage strategy” by Yoichi Tani et al.
    • “Does the Global Alignment and Proportion score predict mechanical complications in circumferential minimally invasive surgery for adult spinal deformity?” by David Gendelberg et al.

    Please join us in reading this month’s issue of Neurosurgical Focus.

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    Embargoed Article Access and Author/Expert Interviews:

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    The global leader for cutting-edge neurosurgery research since 1944, the Journal of Neurosurgery (www.thejns.org) is the official journal of the American Association of Neurological Surgeons (AANS) representing over 12,000 members worldwide (www.AANS.org).

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  • Randomized trial finds therapies for spine pain improved disability and quality of life but did not decrease healthcare spending

    Randomized trial finds therapies for spine pain improved disability and quality of life but did not decrease healthcare spending

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    Newswise — Pain in the back or the neck is extremely common and accounts for more healthcare spending than any other health condition. A study led by investigators from Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system, compared two non-invasive interventions for treating spine pain, assessing both how well these methods worked at reducing pain and whether either method reduced spine-related healthcare spending. In a clinical trial of 2,971 participants, patients with spine pain were randomized to receive usual care or one of two interventions. The first intervention used the identify, coordinate and enhance (ICE) model, in which patients receive specialized counseling, physical therapy and a specialist in pain medicine or psychiatry consults with their primary care physician. The second intervention was individualized postural therapy (IPT), a technique that attempts to realign and rebalance spinal muscles to relieve pain. Compared to usual care, both interventions provided a small but significant improvement in pain-related disability after three months. These changes were sustained and clinically meaningful at 12 months, long after the interventions were over.  Both interventions reduced resource utilization (such as diagnostic imaging, procedures, and specialist visits). Overall, the ICE intervention lowered spine-related spending by $139 per person compared to usual care (p=0.04), although this difference was not statically significant at the threshold used in the trial. Spine-related spending for the IPT intervention was significantly higher than usual care.

    “Both methods examined in this clinical trial led to small but meaningful reductions in pain-related disability,” said corresponding author Niteesh Choudhry, MD, PhD, executive director for BWH’s Center for Healthcare Delivery Sciences and a practicing hospitalist. “Given the high cost of spine-related healthcare spending, it is critically important to find cost-effective ways to effectively improve pain management.”

    Read more in JAMA.

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  • Novel Drug Shows Early Promise in Treating Multiple Myeloma

    Novel Drug Shows Early Promise in Treating Multiple Myeloma

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    Newswise — NEW ORLEANS –  A first-of-its-kind drug known as modakafusp alfa has shown early potential in combating multiple myeloma, a form of bone marrow cancer, in a study presented by researchers from the University of Pennsylvania’s Abramson Cancer Center at the 2022 American Society of Hematology (ASH) Annual Meeting (Abstract 565). 

    Patients in the Phase I/II multicenter trial (NCT03215030) receiving 1.5 milligrams of modakafusp every four weeks, 43 percent saw a partial response, or a decrease in their cancer by over 50 percent. Patients enrolled in the study had received at least three prior lines of treatment and had their disease relapsed or stopped responding following the previous therapy. 

    “We are excited by these findings and continue to be optimistic about the potential this treatment holds for patients with multiple myeloma,” said presenting author Dan Vogl, MD, an expert in blood cancers, medical director of the Clinical Research Unit at Penn Medicine’s Abramson Cancer Center, and an associate professor of Hematology-Oncology at the Perelman School of Medicine of the University of Pennsylvania. “We have been working with this new medication at Penn since we gave it to the first patient ever to receive it five years ago. We now see that a substantial number of patients benefit from modakafusp as a single agent, including patients whose myeloma has become resistant to other treatments, which is really impressive.” 

    Modakafusp (developed by Takeda Pharmaceuticals) is fusion protein that targets interferon (a pro-inflammatory hormone that is also used for treating viral infections and other cancers) to cells that have CD38, a surface marker present on myeloma cells and a variety of immune cells. 

    According to the American Cancer Society, about 12,640 deaths from multiple myeloma are expected to occur in the U.S. in 2022. The cancer is uncommon, affecting less than 1 percent of the population. Myeloma is currently not curable, and despite advances in treatment, all patients see their cancers relapse after initial treatment and other early lines of therapy. In this trial, modakafusp made a positive difference in people for whom drugs aimed at the same target, including well-established monoclonal antibodies like daratumumab and isatuximab, were no longer effective. 

    Preliminary results from the study were presented during the 2021 ASH Annual Meeting. The final safety and efficacy results presented this year confirm the drug has a manageable side effects and produces strong anti-myeloma responses. 

    “Modakafusp has a truly novel mechanism of action, delivering a hormonal signal directly to target cells that simultaneously is toxic to cancer cells while stimulating an immune response. We saw responses in patients whose cancer did not respond to or who experienced a relapse after receiving the anti-CD38 antibody drugs that are currently on the market,” Vogl said. “We also saw responses in patients whose myeloma had developed resistance to all currently available effective therapies.” 

    Most patients (87 percent) on the study experienced treatment-related adverse events, as expected for this heavily pre-treated population. The most common side effects among study participants included neutropenia, or a decrease in white blood cells and thrombocytopenia, or low blood platelet count; and about one third of patients had mild reactions after infusion of the medication. 

    Vogl and his colleagues are now enrolling patients in a randomized phase II study, which is designed to identify the optimal dose of modakafusp and provide more information about its effectiveness in people with myeloma. 

    The study was sponsored by Takeda Pharmaceuticals. 

    Editor’s note: Vogl has received consulting fees from Takeda.

     

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    Perelman School of Medicine at the University of Pennsylvania

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  • Study may improve bone and muscle health monitoring during spaceflight

    Study may improve bone and muscle health monitoring during spaceflight

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    Newswise — Bed rest is often used to simulate the effects of microgravity, such as during space flight, on the body’s bones and muscles. New research published in The FASEB Journal examined the effects of 10 days of bed rest on various markers of musculoskeletal health in 10 young male volunteers.

    “During space flight, changes occur over a period of weeks to months, first in the muscle and then in the bone,” the authors wrote. Their experiments over just 10 days suggested a possible early involvement of the molecule irisin in muscle and bone adaptation to microgravity-simulated conditions.

    Results indicated that irisin may help to prevent the onset of atrophy and aging of skeletal muscle, and that low irisin blood levels could represent an early prognostic marker of muscle atrophy in microgravity environments.

    URL upon publication: https://onlinelibrary.wiley.com/doi/10.1096/fj.202201005RR

     

     

    About the Journal

    The FASEB Journal publishes high quality and impactful multidisciplinary research covering biology and biomedical sciences at every level of organization: atomic, molecular, cell, tissue, organ, organismic, and population. The journal’s scope includes the spectrum of biological and biomedical sciences as well as interdisciplinary research cutting across multiple fields and extending in related areas. The FASEB Journal welcomes manuscripts on basic and translational research as well as on pre-clinical and early clinical research.

    About Wiley

    Wiley is one of the world’s largest publishers and a global leader in scientific research and career-connected education. Founded in 1807, Wiley enables discovery, powers education, and shapes workforces. Through its industry-leading content, digital platforms, and knowledge networks, the company delivers on its timeless mission to unlock human potential. Visit us at Wiley.com. Follow us on Facebook, Twitter, LinkedIn and Instagram.

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  • Newer Cementless Knee Replacements Could Last Longer

    Newer Cementless Knee Replacements Could Last Longer

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    Newswise — Newer “Cementless” Knee Replacement Could Last Longer

    Knee replacement surgery is considered one of the most effective and predictable procedures in orthopedic surgery today. Hundreds of thousands of patients opt for the procedure each year to relieve arthritis pain and restore function and mobility.

    The standard knee implant used in joint replacement generally lasts a long time—15 years—but it doesn’t last indefinitely. When the implant wears out or loosens, patients generally need a second knee replacement, known as a revision surgery. Now a newer kind of “cementless” knee replacement could change that, according to Dr. Geoffrey Westrich, research director emeritus in the Adult Reconstruction and Joint Replacement Service at Hospital for Special Surgery.

    CEMENTLESS KNEE REPLACEMENT FOR YOUNGER PATIENTS

    Implant longevity is an important consideration, especially for younger patients with arthritis who opt for joint replacement to maintain their active lifestyle. “Increasing numbers of people in their 50s and even 40s are coming in for joint replacement because they don’t want arthritic knee pain to slow them down. Once they have a knee replacement, these active patients generally put more demands on their joint, causing more wear and tear,” Dr. Westrich explains. “With a conventional cemented prosthesis, chances are they’ll need another surgery down the road. This often has to do with loosening of the implant.”

    In a standard knee replacement, the components of the implant are secured in the joint using bone cement. It’s a tried-and-true technique that has worked well for decades. But eventually, over time, the cement starts to loosen from the bone and/or the implant. “With the new cementless prosthesis, the components are press fit into place for “biologic fixation,” which basically means that the bone will grow into the implant. Perfect positioning of the implant is critical, and we use robotic guidance for pinpoint accuracy,” Dr. Westrich explains.

    ADVANCES IN CEMENTLESS IMPLANT DESIGN AND TECHNOLOGY

    Dr. Westrich believes that with biologic fixation, implant loosening over time will be less likely and a total knee replacement could potentially last much longer, even indefinitely. “Cementless implants have been used in total hip replacement surgery for many years,” he says. “Because of the knee’s particular anatomy, it has been much more challenging to develop a cementless prosthesis that would work well in the knee.”

    Dr. Westrich now believes the time has come. Major advances in design, technology and biomaterials have paved the way for a viable cementless knee implant. The cementless knee system Dr. Westrich utilizes is FDA‐approved for use with the MAKO Robot, combining two of the most recent knee replacement advancements into one high tech procedure that aims to benefit patients.

    Candidates for the cementless procedure are generally patients under 70 with good bone quality to promote biological fixation. In addition to younger patients, Dr. Westrich notes that the cementless implant may also prove to be a good option for very overweight patients who tend to put more stress on their joint replacement.

    To date, Dr. Westrich has seen good results with the cementless prosthesis. However, he says more studies are needed to see how patients with cementless knee replacements do over the long term.

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    Geoffrey Westrich, MD

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  • Weight-Bearing Exercise: 8 Workouts for Strong Bones

    Weight-Bearing Exercise: 8 Workouts for Strong Bones

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    What are the best ways to exercise and improve your bone health when you have osteoporosis? Try weight-bearing workouts to build stronger bones.  Talk to your doctor and make sure the workout you choose is safe for you. Then give these latest trends a try!

    1. Tai Chi

    Tai chi — a form of slow, graceful moves — builds both coordination and strong bones. A study reported in Physician and Sportsmedicine found that tai chi could slow bone loss in postmenopausal women. The women, who did 45 minutes of tai chi a day, 5 days a week for a year, had a rate of bone loss up to 3.5 times slower than those who didn’t do tai chi, according to bone mineral density tests.

    2. Yoga

    A study reported in Yoga Journal found an increase in bone mineral density in the spine for women who did yoga regularly. From the slow, precise Iyengar style to the athletic, vigorous ashtanga, yoga can build bone health in your hips, spine, and wrists — the bones most vulnerable to fracture.

    Standing poses like Warrior I and II work the large bones of the hips and legs, while poses like Downward Dog work the wrists, arms, and shoulders. Both the Cobra and Locust poses, which work the back muscles, may preserve the health of the spine. Yoga also sharpens your balance, coordination, concentration, and body awareness — and thus helps prevent falls.

    3. Brisk Walking

    This classic workout is  great way to boost your bone health. A study of nurses found that walking 4hours a week gave them a 41% lower risk of hip fractures, compared to walking less than an hour a week. Brisk walking is best, but you can adapt your speed to your current fitness level. Walking is free, and you can do it anywhere, anytime, even when you’re traveling.

    4. Golf

    Shouldering that golf bag around 18 holes, and swinging the big clubs to drive the ball long, adds up to a lot of upper-body work. And all that walking, and chasing balls lost in the rough, means plenty of work for your hips and spine. 

    5. Dancing

    Maybe you’ve got two left feet. No problem! Even if you’re not Fred Astaire, you might enjoy social dances such as the waltz, tango, salsa, samba, or East coast swing..Or you might sign up for a gentle adult ballet class or jazz dance class. Or Zumba or another dance-inspired aerobics class at your gym — anything that gets you moving.  A lot of them now combine strength training with dance or step moves — and are also good for your balance.

    6. Hiking

    You’ll get out in nature and get low-impact weight bearing activity on your next hike. The work of weight-bearing — and the impact as your feet hit the ground — can increase bone density, especially in your hips. You’ll get even more impact on those bones if you’re going uphill or downhill. More impact on your feet and legs translates into more bone density.

    And with hiking, boredom is rarely an issue. You can socialize in a hiking club and enjoy new landscapes. 

    7. Racquet Sports

    Pickleball, tennis, squash, and paddle tennis can rally your bone density. You’re stressing your racquet arm, wrist, and shoulder every time you hit the ball, and working your hips and spine with all that running around.

    If you play singles, you’ll get a lot more from your workout in terms of bone health, since you’ll be running around more.

    8. Strength Training

    Lifting weights, using the weight machines at your health club, or doing calisthenics with a resistance band or your own body weight are forms of strength or resistance training. You’re working against some form of resistance  to stress a sequence of muscles and bones. Strength train at least twice a week to stimulate bone growth.

    If you’re not sure how to get started, book a session with a trainer, who can show you simple moves to do safely. 

    Thin Bones Beware

    Take a few exercise precautions if you already have bone thinning:

    • Because your fracture risk is higher than normal, be cautious about trying any exercise with the potential for serious falls, like downhill skiing, ice skating, or inline skating.
    • If you have bone thinning in your spine, you may want to forgo any deep backbends in yoga.
    • Again, check with your doctor before starting any new exercise program, especially if you’re taking medications that slow your coordination or throw off your balance.

    One final tip: Be patient. The bone-building phase in young adults — at its speediest — takes three to four months, and it may take a lot longer if you have osteoporosis or are older. So you won’t be seeing big changes on any bone density tests after your first week of working out. Bones change slowly — but they do change.

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  • Study Examines Total Knee Replacement in Patients Under 21

    Study Examines Total Knee Replacement in Patients Under 21

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    Newswise — A new study from researchers at Hospital for Special Surgery (HSS) has evaluated trends in the use of total knee arthroplasty (TKA) in patients under 21 in the United States. The study was reported at the American College of Rheumatology (ACR) Convergence 2022 meeting (abstract number 08780).

    According to Cynthia A. Kahlenberg, MD, MPH, an orthopedic surgeon at HSS and a coauthor of the study, TKA is rarely performed in patients under 21 years old but may be done in this population due to conditions such as inflammatory arthritis or juvenile idiopathic arthritis (JIA), malignant or non-malignant tumors, or trauma. However, the number of patients under the age of 21 undergoing TKA in the U.S. is unknown. In one of the largest U.S. studies of an institutional arthroplasty registry, only 19 TKAs were performed in patients under the age of 21 out of approximately 30,000 primary TKAs over 34 years—a majority of which were for JIA.

    The researchers retrospectively analyzed the Kids’ Inpatient Database (KID), a national weighted sample of all inpatient hospital admissions of patients under 21 years old in approximately 4,200 hospitals in 46 states. The researchers used International Classification of Diseases, Ninth Revision (ICD-9) and ICD-10 codes to identify patients undergoing TKA from 2000-2016 and determine primary diagnosis. Descriptive statistics such as means and percentages, along with their 95% confidence intervals (95% CI), were calculated using the appropriate sample weights as recommended by the Agency for Healthcare Research and Quality for use with the KID dataset.

    The total weighted number of TKAs performed in patients younger than 21 from 2000-2016 was 1,331; the number of TKAs performed per year in this age group remained relatively stable. The mean age of patients undergoing TKA was 14.8 years (95% CI, 14.4-15.2); 48.8% of the cohort was female. Among tumor patients, a higher proportion identified as Hispanic (22.1%) or other race (12.6%) compared to the non-tumor cohort; 70.3% of TKAs were performed for a primary diagnosis of a tumor; and the number of TKAs for malignant tumors increased slightly over the study period. In contrast, use of TKA for inflammatory arthritis / JIA decreased by more than 70% over the study period, likely due to improvements in medical management of inflammatory arthritis / JIA patients. The majority of TKAs were performed in urban teaching hospitals and in facilities with a large bed size, which likely reflects the complexity and rarity of these procedures.

    “This was one of the first studies to take an in-depth look at TKA in this very young population,” said Dr. Kahlenberg. “Our study was able to confirm that tumors were the most common reason for knee arthroplasty in this population.”

    “I think the biggest takeaway as a rheumatologist is that we are doing a good job treating these patients and over the years the treatments for inflammatory arthritis are really working well in this young population,” said Bella Mehta, MBBS, MS, rheumatologist at HSS and senior study author.

    About HSS

    HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the 13th consecutive year), No. 3 in rheumatology by U.S. News & World Report (2022-2023), and the best pediatric orthopedic hospital in NY, NJ and CT by U.S. News & World Report “Best Children’s Hospitals” list (2022-2023). In a survey of medical professionals in more than 20 countries by Newsweek, HSS is ranked world #1 in orthopedics for a third consecutive year (2023). Founded in 1863, the Hospital has the lowest complication and readmission rates in the nation for orthopedics, and among the lowest infection rates. HSS was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center five consecutive times. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State, as well as in Florida. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Innovation Institute works to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is a trusted leader in advancing musculoskeletal knowledge and research for physicians, nurses, allied health professionals, academic trainees, and consumers in more than 145 countries. The institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally. www.hss.edu.

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  • Chlorhexidine Disinfectant May Perform Best in Killing Bone Tumor Cells After Surgery

    Chlorhexidine Disinfectant May Perform Best in Killing Bone Tumor Cells After Surgery

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    Newswise — October 28, 2022 – The widely used disinfectant chlorhexidine gluconate (CHG) appears to be the most effective irrigation solution for use as part of the surgical treatment of bone tumors, suggests an experimental study in The Journal of Bone & Joint Surgery. The journal is published in the Lippincott portfolio in partnership with Wolters Kluwer.

    Of the various solutions used to eliminate remaining tumor cells after surgery, a 0.05% CHG solution appears to be most effective in killing cultured bone tumor cells, according to the laboratory study by Matthew J. Thompson, MD, of the University of Washington, Seattle, and colleagues.

    CHG shows highest cytotoxicity against chondrosarcoma and giant cell tumors

    Some patients with bone tumors undergo a surgical procedure called intralesional curettage. In this procedure, the tumor is scraped away while preserving as much healthy bone as possible. A common adjuvant treatment is to irrigate the operative area of the bone with some kind of chemical solution. This irrigation is performed to reduce the number of remaining cells that could potentially lead to tumor recurrence and reseeding.

    Several different solutions have been used for irrigation of the tumor bed, including saline, ethanol, and various disinfectants. Dr. Thompson and colleagues performed a series of experiments to determine which of these solutions has the greatest cytotoxic (cell-killing) effects against bone tumor cells.

    The experiments used cultures of two types of bone tumors: giant cell tumor, a benign but aggressive tumor; and chondrosarcoma, a type of bone cancer. Tumor cell cultures were treated with one of six different solutions – sterile water, 0.9% saline, 70% ethanol, 3% hydrogen peroxide, 0.05% CHG, and 0.3% povidone-iodine. Cytotoxicity was compared for the different treatments.

    Of the six treatments, only CHG had cell-killing effectiveness equivalent to a control solution with 100% cytotoxicity, and this outcome was observed regardless of the treatment period (i.e., 2 minutes or 5 minutes).

    None of the other solutions approached the cell-killing effectiveness of CHG. Only two solutions (sterile water and hydrogen peroxide) were superior to a control treatment with low cytotoxicity. The other three solutions tested – saline, ethanol, and povidone-iodine – showed little or no cytotoxicity.

    Chlorhexidine is a familiar disinfectant with various medical uses, including as a topical antiseptic agent before surgery. The researchers write, “[CHG] is commonly used and readily available, with demonstrated in vivo safety in other surgical applications and a lower predicted toxicity compared with some currently used agents.”

    The new study shows that CHG is highly effective in killing bone tumor cells – at least under laboratory conditions. “Therefore, the use of a 0.05% CHG solution clinically could serve as a potential chemical adjuvant during intralesional curettage of chondrosarcoma and [giant cell tumors],” Dr. Thompson and coauthors conclude.

    The researchers emphasize that further studies will be needed to evaluate the outcomes of CHG irrigation in patients undergoing surgery.  Dr. Thompson comments: “We believe it is important to continue to explore better ways to achieve durable local control of benign aggressive tumors like giant cell tumor of bone, which are associated with a high risk of local recurrence when treated with conventional extended intralesional curettage.”

    Read [Cytotoxic Effects of Common Irrigation Solutions on Chondrosarcoma and Giant Cell Tumors of Bone]

    DOI: 10.2106/JBJS.22.00404

    ###

    About The Journal of Bone & Joint Surgery

    The Journal of Bone & Joint Surgery (JBJS) has been the most valued source of information for orthopaedic surgeons and researchers for over 125 years and is the gold standard in peer-reviewed scientific information in the field. A core journal and essential reading for general as well as specialist orthopaedic surgeons worldwide, The Journal publishes evidence-based research to enhance the quality of care for orthopaedic patients. Standards of excellence and high quality are maintained in everything we do, from the science of the content published to the customer service we provide. JBJS is an independent, non-profit journal.

    About Wolters Kluwer

    Wolters Kluwer (WKL) is a global leader in professional information, software solutions, and services for the clinicians, nurses, accountants, lawyers, and tax, finance, audit, risk, compliance, and regulatory sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with advanced technology and services.

    Wolters Kluwer reported 2021 annual revenues of €4.8 billion. The group serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 19,800 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands.

    Wolters Kluwer provides trusted clinical technology and evidence-based solutions that engage clinicians, patients, researchers and students in effective decision-making and outcomes across healthcare. We support clinical effectiveness, learning and research, clinical surveillance and compliance, as well as data solutions. For more information about our solutions, visit https://www.wolterskluwer.com/en/health and follow us on LinkedIn and Twitter @WKHealth.

    For more information, visit www.wolterskluwer.com, follow us on Twitter, Facebook, LinkedIn, and YouTube.

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  • Radiation Therapy for High-Risk, Asymptomatic Bone Metastases May Prevent Pain and Prolong Life

    Radiation Therapy for High-Risk, Asymptomatic Bone Metastases May Prevent Pain and Prolong Life

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    Newswise — SAN ANTONIO, October 23, 2022 — Treating high-risk, asymptomatic bone metastases with radiation may reduce painful complications and hospitalizations and possibly extend overall survival in people whose cancer has spread to multiple sites, a phase II clinical trial suggests. Results of the multicenter, randomized trial (NCT03523351) will be presented today at the American Society for Radiation Oncology (ASTRO) Annual Meeting.

    The clinical trial findings suggest radiation oncologists may play a valuable role in treating widespread bone metastases even in the absence of symptoms. Palliative radiation has historically focused on reducing existing pain and other symptoms when a patient’s cancer is no longer considered curable. Investigators hoped to show that painful complications could be prevented by treating asymptomatic bone metastases with radiation and were surprised to find the benefits may extend beyond comfort.

    “It’s thought-provoking that radiation to prevent pain could potentially prolong life,” said Erin F. Gillespie, MD, lead author of the study and a radiation oncologist at Memorial Sloan Kettering Cancer Center in New York. “It suggests that treating to cure the cancer is not the only thing that can help people live longer.”

    The study arose from the observation that many patients hospitalized for painful bone metastases have evidence of these lesions on imaging scans several months earlier, Dr. Gillespie said. Although external beam radiation therapy is standard-of-care for painful lesions, it has not been used for asymptomatic ones outside of the oligometastatic setting; generally, patients remain on systemic therapy until lesions become symptomatic. Dr. Gillespie and her colleagues wanted to determine “if and when we might intervene before these symptoms occur to prevent hospitalizations and debility from cancer.”

    For the study, researchers identified 78 adults with a metastatic solid tumor malignancy and more than five metastatic lesions, including at least one asymptomatic high-risk bone lesion. Whether a lesion was high-risk was determined by its size (if it was 2 centimeters or more in diameter); its location in the junctional spine; whether it involved the hip or sacroiliac joint; or if it was in one of the long bones of the body, such as those found in arms and legs. Between all enrolled patients, there were a cumulative 122 bone metastases.

    Among study participants, the most common types of primary cancer were lung (27%), breast (24%) and prostate (22%). Participants were randomly assigned to receive standard treatment, which could include systemic treatment (such as chemotherapy or targeted agents) or observation, with or without radiation therapy to treat all of their high-risk bone metastases. Radiation doses varied but were typically low (i.e., not ablative). All patients were followed for at least 12 months or until they succumbed to their disease.

    The primary endpoint was to determine whether treating asymptomatic lesions could prevent skeletal-related events (SREs) – a common and often painful and debilitating complication of bone metastases. SREs include pain, fractures and compression of the spinal cord that requires surgery or radiation. They can contribute to a higher risk of death and higher health care costs.

    Researchers found that treating the asymptomatic lesions with radiation reduced the number SREs and SRE-related hospitalizations and extended overall survival, compared to people who received no radiation. At the end of one year, for patients on the radiation arm, SREs occurred in 1 of 62 lesions (1.6%), compared to 14 of 49 lesions (29%) for those receiving standard care (p<0.001). Significantly fewer patients in the radiation arm were hospitalized for SREs (0 vs. 4, p=0.045).

    After a median 2.4 years of follow-up, overall survival was significantly longer for patients who received radiation therapy, compared to those who did not (hazard ratio 0.50, 95% confidence interval 0.28-0.91, p=0.02). Median overall survival was 1.1 years for the 11 patients who experienced an SRE, compared to 1.5 years for the 67 patients who had no SREs.

    After the first three months, patients in the radiation arm reported less pain than those in the standard care arm (p<0.05), a trend that continued but was no longer statistically significant for the remainder of the study. There were no significant differences in quality of life between the two arms at any point in the study.

    Though it was not in the initial study design, Dr. Gillespie said the team performed an unplanned analysis of which lesions were most likely to cause SREs. While they expected to find those in the long bones might cause more fractures and pain, they found it was metastases in the spine that were most likely to cause subsequent pain, cord compression or fracture. However, the numbers are small and will require further evaluation to confirm.

    Treating those lesions with “even low doses of radiation seemed adequate to prevent the lesion from progressing and causing problems,” Dr. Gillespie said.

    Dr. Gillespie emphasized that because of the study’s small size, its findings, while hypothesis-generating, were not definitive and a larger study is needed to replicate and expand on these analyses. “Our trial results add to a growing field of study examining the potential of early supportive care, but they still need to be confirmed in a larger phase III trial,” she explained.

    She also said future research should seek to answer questions such as: “Does this apply to someone early in the course of their metastatic disease who may not have any symptomatic lesions? At what point would they benefit from intervention with radiation? There are many patients with multiple sites of metastases, but how do we identify those lesions that are most likely to become problematic?”

    “And, once we confirm this is the right thing to do,” she said, “how do we ensure patients who might benefit get access to this treatment?”

    ###

    Attribution to the American Society for Radiation Oncology (ASTRO) Annual Meeting is requested in all coverage. View the meeting press kit at www.astro.org/annualmeetingpress.

    See this study presented:

    • Prophylactic radiation therapy versus standard-of-care for patients with high-risk, asymptomatic bone metastases: A multicenter, randomized phase II trial (Abstract LBA 04)
    • News Briefing: Tuesday, October 25, 9:00 a.m. Central time. Details here.
    • Scientific Presentation: Clinical Trials Session, Sunday, October 23, 10:40 a.m. Central time, Henry B. Gonzalez Convention Center. Details here; email [email protected] for access.

     

    ABOUT ASTRO

    The American Society for Radiation Oncology (ASTRO) is the largest radiation oncology society in the world, with nearly 10,000 members who are physicians, nurses, biologists, physicists, radiation therapists, dosimetrists and other health care professionals who specialize in treating patients with radiation therapies. For information on radiation therapy, visit RTAnswers.org. To learn more about ASTRO, visit our website and media center and follow us on social media.

     

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  • Is ‘frozen shoulder’ a genetic condition? Study finds links to specific genes

    Is ‘frozen shoulder’ a genetic condition? Study finds links to specific genes

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    Newswise — October 14, 2022 – Frozen shoulder, or adhesive capsulitis, is a common cause of shoulder pain and immobility. New findings point to specific genes associated with an increased risk of this condition, reports The Journal of Bone & Joint Surgery. The journal is published in the Lippincott portfolio in partnership with Wolters Kluwer.

    The risk genes are associated with nearly a sixfold increase in the odds of developing frozen shoulder – a stronger association for most known clinical risk factors, according to the new research by Mark T. Langhans, MD, PhD, of Hospital for Specialty Surgery, New York. The authors believe their findings may lend new insights into the causes, prevention, and treatment of adhesive capsulitis.

    Genome-wide association study finds ‘significant loci’ affecting frozen shoulder risk

    Patients with adhesive capsulitis develop painful and progressive loss of shoulder motion with associated pain. Frozen shoulder is one of the most common shoulder conditions, occurring in up to 10% of people at some time in their lives. Although the exact cause is unclear, frozen shoulder sometimes occurs after an injury, surgery, or other condition that reduces shoulder mobility. Loss of motion results from fibrosis (scarring or thickening) of the capsule around the shoulder joint.

    Certain clinical factors are associated with an increased risk of frozen shoulder, including diabetes, thyroid disease, and smoking. Recent studies have suggested that risk is also higher in people with affected relatives – suggesting a possible genetic predisposition. Dr. Langhans and colleagues performed a genome-wide association study to identify specific genes that might be related to the risk of frozen shoulder.

    Data studied from large British database

    The study used data from a large British database, the UK Biobank, which includes genetic and health data on approximately 500,000 patients. The analysis focused on 2,142 patients with adhesive capsulitis compared to those without this diagnosis. Possible genetic associations were adjusted for other factors, including sex, diabetes, thyroid disease, history of shoulder dislocation, and smoking.

    The study identified three significant loci for frozen shoulder. The strongest association was found for gene variants located at a site called WNT7B. This finding was consistent with previous studies that reported a possible link between WNT7B and frozen shoulder, along with several other orthopaedic-related conditions. Weaker associations were also found for two previously unreported genetic loci located near genes for POU1F1 and MAU2.

    All three associations remained significant after adjustment for other factors. Together, the three variants carried nearly a sixfold increase in the odds of developing frozen shoulder. That was greater than the risk associated with diabetes (about four-fold) or thyroid disease (less than two-fold), and second only to smoking (about 11-fold).

    New insights could lead to a new development

    The findings may lend new insights into the development of adhesive capsulitis. In particular, genes located at WNT7B have been shown to be expressed in bone-forming cells (osteoblasts) and to be involved in regulating fibrosis, along with a wide range of other functions. The two newly reported loci, POU1F1 and MAU2, are involved with cell division, which might lend clues into the cellular mechanism by which frozen shoulder develops.

    The researchers note some key limitations of their analysis, including the need for further studies of genetic associations in groups other than the white, British population that predominates in the UK Biobank.

    Meanwhile, the new study identifies several gene loci with the ability to predict a clinically relevant risk of frozen shoulder. Dr. Langhans and colleagues conclude: “Refining the genetic risk metric and including it in a larger clinical model could allow patients at risk for future adhesive capsulitis to be identified, leading to efforts at prevention, early diagnosis, and ultimately improved outcomes.”

    Click here to read “Genome-Wide Association Study of Adhesive Capsulitis Suggests Significant Genetic Risk Factors“

    DOI: 10.2106/JBJS.21.01407

    ###

    About The Journal of Bone & Joint Surgery

    The Journal of Bone & Joint Surgery (JBJS) has been the most valued source of information for orthopaedic surgeons and researchers for over 125 years and is the gold standard in peer-reviewed scientific information in the field. A core journal and essential reading for general as well as specialist orthopaedic surgeons worldwide, The Journal publishes evidence-based research to enhance the quality of care for orthopaedic patients. Standards of excellence and high quality are maintained in everything we do, from the science of the content published to the customer service we provide. JBJS is an independent, non-profit journal.

    About Wolters Kluwer

    Wolters Kluwer (WKL) is a global leader in professional information, software solutions, and services for the clinicians, nurses, accountants, lawyers, and tax, finance, audit, risk, compliance, and regulatory sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with advanced technology and services.

    Wolters Kluwer reported 2021 annual revenues of €4.8 billion. The group serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 19,800 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands.

    Wolters Kluwer provides trusted clinical technology and evidence-based solutions that engage clinicians, patients, researchers and students in effective decision-making and outcomes across healthcare. We support clinical effectiveness, learning and research, clinical surveillance and compliance, as well as data solutions. For more information about our solutions, visit https://www.wolterskluwer.com/en/health and follow us on LinkedIn and Twitter @WKHealth.

    For more information, visit www.wolterskluwer.com, follow us on Twitter, Facebook, LinkedIn, and YouTube.

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  • Landmark Clinical Study Finds Aspirin as Effective as Commonly Used Blood Thinner to Prevent Life-Threatening Blood Clots and Death After Fracture Surgery

    Landmark Clinical Study Finds Aspirin as Effective as Commonly Used Blood Thinner to Prevent Life-Threatening Blood Clots and Death After Fracture Surgery

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    Newswise — Patients who have surgery to repair bone fractures typically receive a type of injectable blood thinner, low-molecular-weight heparin, to prevent life-threatening blood clots, but a new clinical trial found that over-the-counter aspirin is just as effective. The findings, presented today at the Orthopaedic Trauma Association (OTA) annual meeting in Tampa, FL, could cause surgeons to change their practice and administer aspirin instead to these patients.

    The multi-center randomized clinical trial of more than 12,000 patients at 21 trauma centers in the U.S. and Canada, is the largest-ever trial in orthopedic trauma patients. The trial was co-led by the Department of Orthopaedics at the University of Maryland School of Medicine (UMSOM) and the Major Extremity Trauma Research Consortium (METRC) based at the Johns Hopkins Bloomberg School of Public Health.

    “We expect our findings from this large-scale trial to have an important impact on clinical practice, and potentially even change the standard of care,” said the study’s principal investigator Robert V. O’Toole, MD, the Hansjörg Wyss Medical Foundation Endowed Professor in Orthopaedic Trauma at UMSOM and head of the school’s Division of Orthopaedic Traumatology. “Orthopaedic trauma patients are commonly prescribed the blood thinner low-molecular-weight heparin to prevent blood clots for weeks following surgery. Not only does the medication need to be injected, it can also be quite expensive compared to aspirin.”

    Blood clots cause as many as 100,000 deaths in the U.S. each year, according to the U.S. Centers for Disease Control (CDC). Patients who experience fractures that require surgery – an estimated 1 million people in the U.S. annually – are at increased risk of developing blood clots in the veins, including a fatal pulmonary embolism, which is a clot in the lung. Current guidelines recommend prescribing low-molecular-weight heparin (enoxaparin), although research in total joint replacement surgery suggested a potential benefit of aspirin as a less-expensive, widely available option.

    Dr. O’Toole, who is also Chief of Orthopaedics at the R Adams Cowley Shock Trauma Center at the University of Maryland Medical Center (UMMC), presented the results of the landmark clinical trial at the OTA annual meeting. The $12 million study was funded by the Patient-Centered Outcomes Research Institute (PCORI), (PCS-1511-32745), an independent, nonprofit organization that finances research to help patients and clinicians make better-informed healthcare decisions.

    The study enrolled 12,211 patients with leg or arm fractures that necessitated surgery or pelvic fractures regardless of the specific treatment. Half were randomly assigned to receive 30 mg of injectable low-molecular-weight heparin twice daily. The other half received 81 mg of aspirin twice daily. The follow-up period after surgery was 90 days.

    The main finding of the study was that aspirin was “noninferior,” or no worse, than low-molecular-weight heparin in preventing death from any cause – 47 patients in the aspirin group died compared with 45 patients in the heparin group. Secondary outcomes noted no differences in non-fatal pulmonary embolism. The incidence of bleeding complications and all other safety outcomes was similar in both groups.  Of all the outcomes studied, the one potential difference noted was fewer blood clots in the legs in the low-molecular-weight heparin group. This relatively small difference was driven by clots lower in the leg, which are of unclear clinical importance.

    “With data from more than 12,000 patients, this study provides clear evidence that aspirin is a viable option for preventing blood clots in the lung and death in patients who require surgery for orthopaedic trauma,” said Andrew Pollak, MD, the James Lawrence Kernan Professor and Chair of the Department of Orthopedics at UMSOM and Senior Vice President and Chief Clinical Officer for the 11-hospital University of Maryland Medical System (UMMS).

    The trial was called PREVENTion of CLots in Orthopaedic Trauma, or PREVENT CLOT. Patients enrolled in the trial were treated at the R Adams Cowley Shock Trauma Center at UMMC and 20 other trauma centers in 15 other states and two in Canada. Recruitment started in April 2017 and continued through 2021. Deborah Stein, MD, MPH, Professor of Surgery at UMSOM and Director of Adult Critical Care Services at UMMC, and Renan Castillo, PhD, an Associate Professor of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health, are co-principal investigators.

    “This exciting trial, the largest ever conducted in orthopedic trauma patients, provides important guidance to surgeons in helping to prevent potentially fatal blood clots after fracture surgery by using a medication that is both inexpensive and easy to administer,” said Mark T. Gladwin, MD, Vice President for Medical Affairs, University of Maryland, Baltimore, and the John Z. and Akiko K. Bowers Distinguished Professor and Dean, University of Maryland School of Medicine.

     

    About the University of Maryland School of Medicine

    Now in its third century, the University of Maryland School of Medicine was chartered in 1807 as the first public medical school in the United States. It continues today as one of the fastest growing, top-tier biomedical research enterprises in the world — with 46 academic departments, centers, institutes, and programs, and a faculty of more than 3,000 physicians, scientists, and allied health professionals, including members of the National Academy of Medicine and the National Academy of Sciences, and a distinguished two-time winner of the Albert E. Lasker Award in Medical Research. With an operating budget of more than $1.3 billion, the School of Medicine works closely in partnership with the University of Maryland Medical Center and Medical System to provide research-intensive, academic, and clinically based care for nearly 2 million patients each year. The School of Medicine has nearly $600 million in extramural funding, with most of its academic departments highly ranked among all medical schools in the nation in research funding. As one of the seven professional schools that make up the University of Maryland, Baltimore campus, the School of Medicine has a total population of nearly 9,000 faculty and staff, including 2,500 students, trainees, residents, and fellows. The combined School of Medicine and Medical System (“University of Maryland Medicine”) has an annual budget of over $6 billion and an economic impact of nearly $20 billion on the state and local community. The School of Medicine, which ranks as the 8th highest among public medical schools in research productivity (according to the Association of American Medical Colleges profile), is an innovator in translational medicine, with 606 active patents and 52 start-up companies. In the latest U.S. News & World Report ranking of the Best Medical Schools, published in 2021, the UM School of Medicine is ranked #9 among the 92 public medical schools in the U.S., and in the top 15 percent (#27) of all 192 public and private U.S. medical schools. The School of Medicine works locally, nationally, and globally, with research and treatment facilities in 36 countries around the world. Visit medschool.umaryland.edu

     

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  • Study: Novel Imaging Technique Reveals Excellent Biologic Fixation in Cementless Knee Replacement

    Study: Novel Imaging Technique Reveals Excellent Biologic Fixation in Cementless Knee Replacement

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    Newswise — Cementless knee replacement, an alternative approach to the traditional surgery in which bone cement is used, is gaining interest among orthopedic surgeons. Using a novel MRI technique, researchers at Hospital for Special Surgery (HSS) found that a cementless implant demonstrated excellent biologic fixation, and even improved fixation of implant components in some areas in the joint, compared to the standard cemented implant.

    HSS hip and knee surgeon Geoffrey Westrich, MD, and colleagues in the HSS Radiology Department used an advanced imaging technique known as “multi-acquisition variable-resonance image combination selective MRI” to assess fixation in patients who had a cementless knee replacement compared to those whose implant was affixed with bone cement.

    “The purpose of our study was to quantify and compare the fixation of uncemented versus cemented knee replacement components,” said Dr. Westrich, lead investigator. “At an average patient follow-up of 16 months, our study demonstrated robust fixation of the cementless knee replacement components, with results comparable to the cemented total knee replacements. And while there was no clinically significant difference regarding overall fixation in the knee, there were some component areas in which cementless fixation appeared to be superior.” The study was published in the October edition of the journal Arthroplasty Today.  

    The HSS researchers performed MRIs in 20 patients who had a cementless knee replacement. A matched control group of 20 patients with a cemented knee replacement was also evaluated. The images were reviewed by a fellowship-trained musculoskeletal radiologist specializing in the interpretation of joint replacement MRI, including more than 20 years of experience in assessing bony fixation of knee replacement components.

    In a traditional knee replacement, implant components are secured in the joint using bone cement. It’s a tried-and-true technique that has worked well for decades. But eventually, over time, the cement may start to loosen from the bone and/or the implant. This loosening is the leading cause of revision surgery, in which a patient needs a second knee replacement.

    “With the cementless prosthesis, the components are press fit into place for biologic fixation, which basically means that the bone will grow into the implant,” explains Dr. Westrich, who believes a well-designed cementless implant will make loosening over time less likely. This could enable a total knee replacement to last much longer, a particular concern for younger patients.

    “Overall, traditional knee replacement offers excellent outcomes and longevity,” he says. “However, younger patients generally put more demands on their joint, causing more wear and tear and potential loosening. The cemented knee implant used in a traditional joint replacement usually lasts 15 to 20 years.”

    Cementless implants have been used successfully in total hip replacement surgery for many years. It has been much more challenging to develop a cementless prosthesis that would work well in the knee because of its particular anatomy, Dr. Westrich explains.

    “Early generation cementless implants had numerous design flaws resulting in loosening and poor survivorship compared to cemented knee replacements,” he says. “More contemporary cementless knee components such as those used in our study utilize highly porous surfaces to promote biologic fixation of the prosthesis. This should improve outcomes.”

    Candidates for the cementless procedure are generally patients under age 70 with good bone quality to promote biologic fixation. In addition to younger patients, Dr. Westrich notes that the cementless implant may prove to be a good option for very overweight patients who tend to put more stress on their joint replacement.

    “While our study found that early fixation of cementless total knee components are comparable, if not superior, to cemented total knee replacement, further study with a larger number of patients over a lengthier time period is needed to assess long-term durability and fixation.”

    Disclosure: Research support received from Stryker Corporation. 

     

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    Geoffrey Westrich, MD

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