Keeping you up-to-date on recent headlines in orthopedic healthcare:

AAOS creates independent organization: American Joint Replacement Registry ... The American Academy of Orthopaedic Surgeons (AAOS; Rosemont, Illinois) has incorporated the American Joint Replacement Registry (AJRR), a nonprofit organization dedicated to collecting and reporting on hip and knee joint replacement procedures. AAOS believes this proposed option is a patient safety best practice. The goal of a national joint registry is to monitor device performance, thereby allowing early recognition of underperforming processes or devices and supporting continued clinical learning. "In 2009, AAOS has made great strides in bringing the American Joint Replacement Registry to reality. We have now incorporated. And, we currently are in the process of forming project work groups to tackle data, governance and oversight issues." said John Callaghan, MD, first vice president of the AAOS and orthopedic surgeon at the University of Iowa (Iowa City, Iowa). The AAOS has researched and determined the best course of action for starting and administering a national joint registry, one that would include: privacy safeguards for patients; legal protections for device makers and physicians; a plan to begin capturing data as early as 2010; and infrastructure to capture at least 90% of all procedures. In 2006, there were more than 1 million hip and knee replacements performed in the U.S. Of these, about 7.5% were revisions, resulting in 77,000 procedures at a cost of more than $32 billion. A national joint registry will help doctors to more quickly identify poorly performing products and match patient procedures and devices to optimize outcomes. Therefore, the AJRR could help patients and payers save money and could limit the number of revision (or secondary) surgeries necessary. Based on the projected procedures through 2030, the potential savings could exceed $13 billion over 20 years.The AJRR is estimated to cost $20 to $25 million to initiate. "We now have a chance to put best practices, already benefiting patients in other countries, to work here in the U.S. For instance, registries in Sweden, Great Britain, Canada and Australia have seen up to a 10 percent reduction in revision rates. Even with a modest 2 percent decrease in the U.S. revision rate, this proposal would yield a savings of $652 million in one year," said David Lewallen, MD, chair of the AJRR Project Team and orthopedic surgeon at Mayo Clinic (Rochester, Minnesota).

Scientists closer to making implantable bone material ... Scientists are closer to understanding how to grow replacement bones with stem cell technology, thanks to research published in the journal Nature Materials. Many scientists are currently trying to create bone-like materials, derived from stem cells, to implant into patients who have damaged or fractured bones, or who have had parts of diseased bones removed. The idea is that, ultimately, these bone-like materials could be inserted into cavities so that real bone could meld with it and repair the bone. So far, scientists have found they can grow small 'nodules' of what appeared to be bone-like material in the laboratory from different types of bone cells and stem cells. All of these cell types are attracting considerable interest as promising candidates for future implants in people with clinical trials already underway. However, scientists still need to thoroughly explore and understand the in-depth chemical properties and structure of the bone-like materials they are growing. Now, scientists from Imperial College London have compared the 'bone-like' material grown from three different commonly used clinically relevant cell types and have discovered significant differences between the quality of bone-like material that these can form. For example, the researchers have discovered that the 'bone-like' materials that were grown from bone cells from mouse skull and mouse bone marrow stem cells successfully mimicked many of the hallmarks of real bone, which include stiffness. However, they found that the 'bone-like' material grown from mouse embryonic stem cells was much less stiff and less complex in its mineral composition when compared to the other materials. The researchers suggest that further research is now needed to explore the implications of these results for different stem cell therapies. Professor Molly Stevens, from the Department of Materials and the Institute of Biomedical Engineering at Imperial College London, says: "Many patients who have had bone removed because of tumors or accidents live in real pain. By repairing bone defect sites in the body with bone-like material that best mimics the properties of their real bone we could improve their lives immeasurably. Our study provides an important insight into how different cell sources can really influence the quality of bone that we can produce. It brings us one step closer to developing materials that will have the highest chance of success when implanted into patients." To carry out their analysis, researchers used laser-based raman spectroscopy to understand the detailed chemical make-up of live cells as they grew and multivariate statistical analysis techniques, which enabled them to compare and analyse data about the growth of different cell populations. They also used a nano-indenter and high resolution electron microscopy, which allowed the researchers to probe the samples so that they could understand how stiff the bone-like materials were and what their structure was at a microscopic level.

UAB total joint replacement research collaboration supported by NIH funding ... Newly reported National Institutes of Health (NIH) funding will expand the reach of ongoing University of Alabama at Birmingham (UAB) research into a unique nanostructured coating to improve the performance and longevity of total joint replacement components. The broadened UAB research opportunity is funded by a four-year, $790,931 National Institutes of Health (NIH) grant through the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). UAB's research, titled "Bioengineering Research Partnership (BRP) in Total Joint Replacements," will explore next-generation technology to improve the service life of total joint replacements, which UAB researchers believe could dramatically cut the number of recurrent surgical procedures performed each year, said Yogesh Vohra, PhD, the BRP's principal investigator and director of the Center for Nanoscale Materials and Biointegration (CNMB) in the UAB School of Natural Sciences and Mathematics. Vohra said the BRP opportunity will unite his UAB interdisciplinary research team with professionals at Smith and Nephew (S&N; London), an international leader in the development of advanced medical devices. "We have been researching our nanostructured multilayer diamond coating for a number of years inside our UAB facilities but there have been limitations to just how rigorous the testing could be," Vohra said. "The funding to partner with Smith and Nephew expands our research options because it offers us access to the company's resources and talent." Among the benefits, Vohra said, the BRP allows access to S&N's hip and knee simulators, which offer UAB researchers the most realistic testing conditions to date for their coating technology. Working with the multi-million dollar simulators should strongly indicate how well the team's nanostructured multilayer diamond coatings reduce the friction and wear on the metal components of orthopaedic devices, Vohra said. The team also will be able to examine the cellular and tissue responses to the technology and confirm that there is no toxicity effect from any wear debris that is generated. The BRP also helps put the UAB coating technology on the fast track for commercialization, as it will foster the private industry relationship necessary to secure investment and production capacity, Vohra said.

Osteoporosis-linked fractures have risen dramatically ... The hospitalization rate of patients admitted for treatment of hip, pelvis and other fractures associated with osteoporosis increased by 55% between 1995 and 2006, according to the latest News and Numbers from the Agency for Healthcare Research and Quality. An estimated 10 million Americans suffer from osteoporosis, which causes bones to become brittle and weak. Fractures associated with osteoporosis can be slow to heal, and they also can cause debilitating pain, disability, deformities and occasionally death. The federal agency's study also found that fractures associated with osteoporosis: Accounted for one-fourth of the roughly 1 million hospitalizations in 2006 of patients with osteoporosis; Cost hospitals $2.4 billion in 2006; Caused women to be six times more likely to be hospitalized than men; Involved mostly older patients: 90% of hospitalizations were for age 65 and older and 37% for patients age 85 and older; Were highest in the Midwest (107 per 100,000 people) and lowest in the West (68 per 100,000 people). This AHRQ News and Numbers is based on data in U.S. Hospitalizations Involving Osteoporosis and Injury, 2006 (http://www.hcup-us.ahrq.gov/reports/statbriefs/sb76.pdf). The report uses statistics from the 2006 Nationwide Inpatient Sample, a database of hospital inpatient stays that is nationally representative of inpatient stays in all short-term, non-Federal hospitals. The data are drawn from hospitals that comprise 90% of all discharges in the U.S. and include all patients, regardless of insurance type, as well as the uninsured. The report also uses statistics from a special disparities analysis file created from the Healthcare Cost and Utilization Project 2006 State Inpatient Databases.

— Compiled by Holland Johnson, MDD