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| News in Brief - January 2010 Brief items of the latest industry news... |
| Readers Comments Unedited readers comments about Orthopaedic Product News ... |
| Spinal Cement may Provide Real Support for Cancer Patients New technologies used to repair spinal fractures could soon... |
| Arthritis Drug RoActemra Approved for Scots Patients A powerful arthritis drug, judged too expensive for patients in England and... |
| Hip Fracture Surgery Delay Increases Risk for Adverse Outcomes A study in Italy has shown that delaying hip fracture surgery increases... |
| NHS ‘Could Save Millions’ by Flying Patients to India Tens of millions of pounds would be saved and waiting lists slashed if some... |
| Campbell’s Operative Orthopaedics: Core Techniques Now on App Store Modality, Inc. announced that Campbell’s Operative Orthopaedics:... |
| Mandatory Blood Clot Prevention will make “Real Impact” Reducing 25,000 Aviodable Annual Death Toll The APPTG has welcomed the DOH decision to mandate VT prevention in... |
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News In Brief
 Two animated films enabling patients to watch their procedures in advance of their operations are now available to hospitals, in the UK and overseas.
Developed in conjunction with Health Enterprise East (HEE), the regional NHS Innovation Hub, the short films were created with input from doctors at The Princess Alexandra Hospital NHS Trust in Harlow, Essex and co-funded by The Rivers Hospital in Sawbridgeworth.
The two procedures now available for purchase are Total Knee Replacement and Total Hip Replacement.
The animations are designed to tell patients in a clear and informative way what their forthcoming procedure will involve and provide a helpful insight into what happens both during and after the operation.
Darren Leech, Executive Director of Delivery at the Trust said: “Research shows that patients who receive high quality pre-operative information have reduced anxiety and therefore make a swifter recovery. These animations illustrate to patients the possible implications of their surgery so they come in prepared. We hope that by informing patients in this way will lead to an earlier discharge from hospital”.
HEE helped The Princess Alexandra Hospital NHS Trust to negotiate a licence agreement allowing the Indian-based production company, ComartOne, to sell the films to other hospitals, with a percentage of revenue coming back to the Trust.
Plans are in the pipeline to expand the DVD film library in due course, including other surgical procedures and treatments.A new research program at The Methodist Hospital in Houston, USA is the nation’s first dedicated solely to advancing nanotechnology in orthopedics and spine surgery.
Dr. Bradley Weiner, chief of spinal surgery at Methodist, is the director of the Spine Advanced Technology Laboratory (SATL) said. “The use of nanotechnologies to treat disease or repair damaged tissues might allow physicians to intervene more efficiently and safely than currently possible.”
Researchers in the lab will be looking at various ways nanotechnology can improve the treatment of musculoskeletal disease.
“Using nanotechnology, we hope to be able to deliver drugs directly to the affected area thereby limiting exposure to other tissues. In the future, we hope to give an injection into the vein and, with sophisticated mapping, send it directly to specific musculoskeletal tissues, including the spine, and release the medication exactly where it is needed,” Weiner said. “We are exploring many avenues of intervention such as the delivery of proteins to help bone formation when doing fusions and ways of delivering anti-inflammatory drugs and pain medications to help decrease musculoskeletal pain.”After the surge in U.S. troops heading to Afghanistan, there will be an influx of injured veterans returning, so the U.S. Department of Defence has recruited its own “soldiers” in the battle against war casualties: a consortium of researchers who are improving care to wounded soldiers as well as the general public.
Some of the orthopaedic researchers involved will lead a workshop about the program at the 56th annual meeting of the Orthopaedic Research Society in New Orleans.
The Armed Forces Institute of Regenerative Medicine (AFIRM) is improving reconstructive and trauma care to the war wounded.
“AFIRM has focused the attention of some of the most innovative biomedical engineering laboratories in the country on understanding and addressing the unique needs of today’s injured warrior,” says Dr. Muschler MD, director of the Orthopaedic Research Center at the Cleveland Clinic. “AFIRM has primarily selected technologies and strategies that can make the greatest difference in the shortest period of time, particularly methods that can be used in the clinic or brought to clinical trials now or within two to three years.”
Patients are already being recruited for clinical trials, testing new techniques for transplanting lost facial tissue and upper limbs.
Source: Newswise Orthopaedic surgeons from Hospital for Special Surgery in New York, led by Chitranjan S. Ranawat, M.D., organised the 8th winter meeting of “Advances and Techniques in Joint Replacement Surgery”, bringing world class orthopaedic surgery education to India. Four hundred Indian orthopaedic surgeons attended the meeting in Kolkata, India in January.
Joining Dr. Chitranjan Ranawat at the meeting are his sons, Amar S. Ranawat, M.D., who presented on topics including complications of total hip arthroplasty, and Anil S. Ranawat, M.D., who presented on the future direction of robotic surgery.
Douglas E. Padgett, M.D., chief of the Adult Reconstruction and Joint Replacement Division and chief of the Hip Service at Hospital for Special Surgery, moderated the session on Imaging and presented on trends in infection treatment, among other topics. Hospital for Special Surgery has one of the lowest infection rates in the country.
Since 1986, the Ranawat Orthopaedic Research Foundation has supported orthopaedic research and education in the United States and Asia. With Dr. Chitranjan S. Ranawat as chairman, the foundation has united physicians and scientists in the goal of providing innovative clinical care. A recent study, published in the January issue of Mayo Clinic Proceedings, demonstrates that in elderly patients undergoing hip fracture repair under spinal anaesthesia with propofol sedation, the prevalence of delirium can be decreased by 50 percent with light sedation, compared to deep sedation.
“These data show that, for every 3.5 to 4.7 patients treated in this manner, one incident of delirium will be prevented,” says Frederick Sieber, M.D., primary investigator of the study from the Department of Anaesthesiology and Critical Care Medicine, Johns Hopkins Medicine in Baltimore. “Therefore, interventions capable of reducing the occurrence of postoperative delirium would be important from a public health perspective.”
Several demographic and perioperative variables are associated with postoperative delirium in elderly patients after hip fracture repair. The most important is preoperative dementia.
Although postoperative delirium usually resolves within 48 hours of onset, delirium can persist and is associated with poor functional recovery, increased length of stay in hospitals, higher costs, and greater likelihood of placement in an assisted-living facility after surgery.
In addition to decreasing the prevalence of delirium, lighter sedation in this group of elderly surgical patients was associated with a reduction in delirium that averaged almost one day for each patient in the light sedation group.
Source: www.sciencecentric.comSpinal Cement may Provide Real Support for Cancer Patients New technologies used to repair spinal fractures could soon be helping patients suffering from the bone marrow cancer multiple myeloma. A research project led by engineers at the University of Leeds will focus on the disease – an incurable cancer of the bone marrow that causes destructive lesions in bones and makes them more susceptible to fracture. The study will analyse whether techniques such as injecting cements into the spine to stabilise the bone, or using plates to fix fractures can be adapted for affected patients.  Although incurable, improvements in treatment mean that patients with multiple myeloma are surviving for longer, with up to a third surviving for at least five years. However, a better prognosis means that secondary symptoms, such as painful bone deterioration, have more time to take effect.
“Our aim is to give people suffering from this disease a better quality of life. If the spine becomes weakened or fractures, patients can do little more than stay in bed and try to deal with the pain,” said Professor of Spinal Biomechanics, Richard Hall, who is leading the research at Leeds’ Faculty of Engineering. “The majority of multiple myeloma patients are in their sixties or older, but even simple things that we take for granted, such as sitting your grandchild on your knee, can become impossible for them.”
The work will combine laboratory experiments with computer modelling to predict the impacts of various treatments on patients.
Professor Hall will be collaborating with researchers at the Sunnybrook Health Sciences Centre, housed at one of Canada’s largest hospitals in Toronto, and clinicians from Leeds Teaching Hospitals NHS Trust.
The project team includes Mr Jake Timothy, Consultant Neurosurgeon in Leeds, who has developed an award winning clinical vertebroplasty and kyphoplasty service that can help to fix painful vertebrae and spinal compression fractures associated with osteoporosis. He has seen the dramatic improvement that such procedures can have on the pain scores of patients affected by vertebral myeloma.
“There is still so much unknown about the positive and negative effects of these procedures,” he says. “This money will undoubtedly aid our understanding and help us select which patients will benefit the most from these procedures, improving their quality of life even further.”
The £600,000 project has been funded through the Engineering and Physical Sciences Research Council (EPSRC) and will run for four years. The work is part of the £50 million research portfolio led by the Institute of Medical and Biological Engineering (iMBE) aimed at giving people ‘50 active years after 50’.
Professor Hall is also leading a €3 million EU-funded research project involving academic and industrial partners from Germany and Austria, looking at new ways of diagnosing and treating spinal fracture caused not only by disease, but by age and trauma.
Arthritis Drug RoActemra Approved for Scots Patients A powerful arthritis drug, judged too expensive for patients in England and Wales, has been approved in Scotland. The National Institute for Health and Clinical Excellence (NICE) has ruled that Tocilizumab was too costly for NHS patients south of the border. However, the body’s Scottish equivalent has recommended patients in Scotland be treated with the drug. The treatment, marketed under the name RoActemra, targets an inflammatory signalling molecule to reduce symptoms. Used in combination with standard anti-inflammatory drug methotrexate (MTX), researchers have found that RoActemra can improve remission rates for those with rheumatoid arthiritis six-fold. NICE has indicated in its draft guidance that the treatment, which costs £9,000 per patient per year, is too expensive to justify its use on the NHS. In December 2009, the organisation issued a statement saying its final decision could be swayed by sufficiently persuasive new evidence. It challenged the drug’s makers Roche to prove that its product really was cost-effective. Meanwhile, the current position in England and Wales is that NHS funding bodies do not feel obliged to pay for Tocilizumab. Sufferers of rheumatoid arthritis who do not respond to other therapies already have access to the drug in most of continental Europe. The new guidance, by the Scottish Medicines Consortium (SMC), recommends Tocilizumab in combination with MTX for moderate to severe rheumatoid arthritis when other treatment options have run out. Leading rheumatologist Professor John Isaacs, from the Institute of Cellular Medicine at the University of Newcastle, said: “This is fantastic news for people in Scotland who suffer from this disabling, life-long disease. “However, it also highlights the disparities in accessing treatment between Scotland and the rest of the UK.” Ailsa Bosworth, chief executive of the National Rheumatoid Arthritis Society, which receives support from pharmaceutical companies including Roche, said: “The SMC’s decision provides people with rheumatoid arthritis in Scotland who face a life of pain and potential disability another chance of combating their disease. “We strongly hope that NICE will revise its draft guidance to ensure that people with rheumatoid arthritis across the country are able to benefit from RoActemra.” Source: BBC News Hip Fracture Surgery Delay Increases Risk for Adverse Outcomes A study in Italy has shown that delaying hip fracture surgery increases the risk for mortality and disability in the first 6 months after injury, say researchers who also found that osteoporosis treatment can improve outcomes. Stefania Maggi (Institute of Neuroscience, Padova, Italy) and co-workers highlight the risks associated with surgery 48 hours or more after hip fracture, noting that 60% of the patients surveyed at nine Italian hospitals experienced a delay of at least this length.  The team prospectively examined the relationship between delayed hip fracture surgery and adverse outcomes in 3288 patients aged 50 years and older with fragility fractures who were followed-up for 6 months after discharge. The patients underwent surgery an average of 3.8 days after fracture and stayed in hospital for an average of 14.5 days.
In all, 61% of patients were followed-up for 6 months, with 815 cases lost to follow-up, while 102 patients died before discharge and 361 patients died in the first 6 months after discharge. Nearly one-third (32%) received osteoporosis treatment at discharge.
Analysis showed that death was predicted significantly by increasing age, comorbidity, functional disability before fracture, and receipt of surgery more than 48 hours after fracture.
Patients with higher levels of functional ability at 6-month follow-up were significantly more likely to have received surgery within 24 hours of fracture and osteoporosis treatment on discharge.
Patients were most likely to have a walking disability after 6 months if they were older, had comorbid diseases, were disabled before hip fracture, and if they received surgery more than 24 hours after fracture.
Noting the significant impact of osteoporosis treatment on function, the team says clinical risk-assessment did not differ between treated and untreated patients, indicating no selection bias.
“We know that the risk of subsequent fractures is particularly high in the 6 months after a first fracture and that some antiresorptive treatments are very effective in reducing the risk in this time frame, so we can suggest a true protection derived from the therapy,” Maggi et al comment in the journal Osteoporosis International.
Observing that hip fracture surgery delay is mostly caused by administrative rather than clinical factors, they conclude: “Considering that such delays are responsible for increased mortality and walking disability, avoidable administrative and organizational problems need to be carefully considered.”
Source: Medwire news
NHS ‘Could Save Millions’ by Flying Patients to India Tens of millions of pounds would be saved and waiting lists slashed if some NHS patients were treated abroad, according to figures. Thousands of patients waiting for operations such as hip replacements could be treated more cheaply and quickly if the Government set up formal agreements with countries such as India. The NHS can currently pay for patients who meet strict criteria to receive treatment in Europe, but only if the flight is under three hours. This means patients are denied access to scores of internationally renowned hospitals outside the continent. Global health experts at the London School of Hygiene and Tropical Medicine (LSHTM) and the Indian Institute of Management in Bangalore have been exploring the potential for bilateral agreements to trade health services between the UK and India. Their preliminary findings from the year-long study suggest a two-way agreement would benefit both countries while alleviating many of the concerns about medical tourism. At least £120 million could be saved if NHS patients currently waiting for just five different operations went to India, with a companion, for treatment in an accredited hospital, according to health economists’ calculations. A two-way agreement would make it easier to guarantee high-quality treatment, good follow-up care and deal with malpractice or clinical negligence. It could also help to counter the brain-drain from developing countries as health professionals may choose to stay if given better conditions and higher salaries in international hospitals. English is universally spoken among educated Indians and the health and education systems share many similarities. And Britons are used to Indian doctors. These factors could make India an acceptable destination for some people awaiting NHS treatment. Hundreds of thousands of people worldwide already travel abroad to buy quicker, cheaper or better healthcare. This includes growing numbers of British Indians who pay privately for operations and health checks in India every year, often combining medical tourism with holidays or visits to relatives. Source: The Independent Campbell’s Operative Orthopaedics: Core Techniques Now on App Store Modality, Inc. announced that Campbell’s Operative Orthopaedics: Core Techniques is now available on the App Store. This app works with iPhone and iPod touch and encompasses 242 of the most important and frequently referenced techniques in Campbell’s Operative Orthopaedics, Eleventh Edition, authored by Drs. S. Terry Canale and James H. Beaty. This app condenses 242 of the most important and frequently referenced orthopaedic techniques. “Campbell’s Operative is the hallmark resource for orthopaedic healthcare practitioners,” according to S. Terry Canale, MD. “With this new app, the vast amount of clinical reference material provided by the authors can be searched, bookmarked and reviewed quickly to create an engaging user experience on iPhone and iPod touch.” “Patient diagnosis and treatment is greatly enhanced when the right reference tools are at the clinician’s fingertips,” said Nate O’Keefe, director of publishing for Modality. “This product allows critical information to be accessed within a matter of seconds, without need for a network connection.” The application is available for $99.99 from the App Store on iPhone and iPod touch. Mandatory Blood Clot Prevention will make “Real Impact” Reducing 25,000 Aviodable Annual Death Toll The All-Party Parliamentary Thrombosis Group (APPTG) has welcomed the Department of Health’s (DH) decision to mandate venous thromboembolism (VTE) prevention in the Operating Framework for the NHS in 2010/11. The All Party Group has been campaigning for its inclusion as a key step in reducing up to 25,000 annual avoidable deaths and saving the NHS over half a billion pounds a year. The APPTG has been working alongside the Department of Health to prioritise VTE prevention in recent years. It has frequently demonstrated that mandating best practice is the most effective way to increase the quality of patient care and achieve significant cost savings for the NHS. The announcement follows the publication last week of the APPTG annual survey of all acute Trusts in England. It found that only 41% of Trusts are able to demonstrate that all hospital inpatients are being risk assessed and are receiving appropriate preventative treatment as recommended by the Chief Medical Officer and NICE. Crucially, the move to mandate VTE prevention was supported by over three quarters of Trusts - 77% thought this would be the most effective way to drive compliance with VTE prevention policies at the ward level. The decision will apply to all Strategic Health Authorities who will be able to recoup money paid to hospitals for procedures, where it transpires patients have not been risk assessed for VTE. Professor Beverley Hunt, Medical Director, Lifeblood: The Thrombosis Charity said, “Our campaign for reducing deaths from hospital acquired VTE has always recognised that mandating VTE prevention is critical to ensuring all patients are risk-assessed and given appropriate prophylaxis. We are pleased VTE has finally been given the priority it deserves, and we can now begin to make a real impact in reducing estimated 25,000 unnecessary deaths that occur from the condition each year.” Dr Richard Taylor MP, Vice-Chair of the All-Party Parliamentary Thrombosis Group, said, “We are delighted the Government has responded to the growing momentum of the medical profession in its support for mandating VTE prevention. The challenge will now be to ensure that mandatory policies are audited by a meaningful indicator, so that compliance with risk-assessment and thromboprophylaxis policies are measured on a national scale.” |
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