Keeping you up-to-date on recent headlines in orthopedic healthcare:
Proposed legislation calls for a national hip and knee registry ...Legislators introduced a new bill in the U.S. House of Representatives to establish a national hip and knee joint replacement registry. If approved, the Knee and Hip Replacement Act of 2009 would create a national registry within the Agency for Health care Research and Quality at the Department of Health and Human Services to collect and analyze data on patients with hip and knee replacements. The bill calls for data collection to begin no later than 5 years after it is enacted. The co-sponsors of the bill, Reps. Bill Pascrell Jr. (D-New Jersey) and Lloyd Doggett (D-Texas), say the proposed legislation would improve the quality of patient care and cut unnecessary Medicare costs. "The Knee and Hip Replacement Act would help ensure that only the best and most effective medical devices are made available to American patients," Pascrell said in a press release. "It would reduce the number of costly and complicated do-over surgeries and save taxpayers billions of dollars. It is outrageous that medical devices are being made available in America that are so lousy they have been withdrawn in markets overseas. As Congress seeks to reform healthcare and reduce Medicare costs, bringing higher standards to the medical device industry would be a good place to start."
TKR appears cost-effective in older adults . . . Total knee replacement (arthroplasty) appears to be a cost-effective procedure for older adults with advanced osteoarthritis, according to a report in the June 22 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. The procedure appears to be cost-effective across all patient risk groups, and appeared more costly and less effective in low-volume centers than in high-volume centers. About 12% of adults older than 60 have symptoms of knee osteoarthritis, and their direct medical costs are estimated to range from $1,000 to $4,100 per person per year, according to background information in the article. "Total knee arthroplasty is a frequently performed and effective procedure that relieves pain and improves functional status in patients with end-stage knee osteoarthritis," the authors write. Elena Losina, PhD, of Brigham and Women's Hospital and the Boston University School of Public Health (both Boston), and colleagues developed a computer simulation model and populated it with Medicare claims data and cost and outcomes data from national and multinational sources. They then projected lifetime costs and quality-adjusted life expectancy-or the number of years remaining of good health-for patients at different levels of risk and receiving total knee arthroplasty at high-volume or low-volume facilities. Overall, having a total knee arthroplasty increased quality-adjusted life expectancy of the Medicare population (average age 74) from 6.822 to 7.957 quality-adjusted life years (years of life in perfect health). Total costs increased from $37,100 among individuals not receiving total knee arthroplasty to $57,900 per person undergoing total knee arthroplasty, resulting in a cost-effectiveness ratio of $18,300 per quality-adjusted life year. Therefore, total knee arthroplasty is a highly cost-effective procedure for the management of end-stage knee osteoarthritis compared with non-surgical treatments and is within the range of accepted cost-effectiveness for other musculoskeletal procedures, the authors note. "Clinicians, patients and policy makers should consider the relative cost-effectiveness of total knee arthroplasty in making decisions about who should undergo total knee arthroplasty, where and when," they conclude.
Study stresses importance of exercise on bone health ...Exercise has many benefits from improving cardiovascular capacity to reducing weight, and now a new research review published in the July/August issue of Sports Health highlights that weight bearing exercises especially those that include higher levels of strain such as running or jumping, can be effective in enhancing bone health and preventing future diseases and injury such as osteoporosis and fractures. "There are many facets related to maintaining bone health, including genetic, intrinsic, and environmental factors, but physical activity is by far one of the strongest means to develop and maintain healthy bone mass," said study author, Ron Zernicke, PhD, DSc, Director of the Bone & Joint Injury Prevention & Rehabilitation Center at the University of Michigan. The study reviewed research from 1961 through today by searching Pubmed, Web of Science, and relevant edited books. The study found that three factors – strain magnitude, strain rate, and strain frequency – are important to the impact exercise has on bone health. "Because a high number of older women experience osteoporosis, postmenopausal women may receive the most benefits from improving bone mineral density (BMD) through weight bearing exercise. Research clearly illustrates, however, that a critical time to develop BMD is during the pre- and early-pubertal periods. Making sure young children exercise regularly is key to developing healthy bone structures and long-term injury prevention. Regardless of age, weight bearing exercises are extremely beneficial," said Zernicke. While most exercises provide an increase in bone density there are a few in particular that are the most beneficial according to the study. For instance, those that put a larger strain on the body (gymnastics, dance and power sports, such as weightlifting), those that have a higher strain rate (e.g., jumping activities), and those that have a higher strain frequency (e.g., running) also appear to increase bone density. The research also noted previous studies in which the benefits of exercise were achieved with less-time-consuming programs (such as 12 minutes, three days a week). Interval training – short rests in between continuous movement were also found to make a difference to BMD levels. "There still isn't a 'gold-standard' for the best blend of these three facets of exercise – strain magnitude, strain rate, and strain frequency – but, we do know that exercise is directly linked to bone health and can help prevent bone loss and possible fractures. In the end, weight bearing exercise – even for just 20 minutes per day – can strengthen your skeleton significantly," stresses Zernicke.
BioElectronics sponsors study on musculoskeletal disorders ... BioElectronics (Fredrick, Maryland), a maker of disposable drug-free anti-inflammatory devices, reported its sponsorship of what it terms a "groundbreaking" clinical study on musculoskeletal disorders. The randomized, double blinded and placebo-controlled study will be supervised by a primary investigator, Sheena Kong, MD of San Francisco, in conjunction with several other physicians. "This is a very exciting field of research and we are looking forward to determining the safety and efficacy of BioElectronics' ActiPatch for the treatment of many different types of musculoskeletal complaints," said Kong. "Since my days studying at Harvard University I have been very interested in treatments such as Pulsed Electromagnetic Field therapy as an alternative to pharmaceuticals. We are currently in process of working with our Independent Review Board and registering the study with the National Institutes of Health. Patient recruitment is expected to begin over the next few weeks. We believe this will be one of the largest studies ever completed on the subject of general muscular skeletal complaints." BioElectronics CEO Andrew Whelan added, "The sponsorship and completion of the study are significant events for our company. While we are seeing success within the plastic surgery market and in our international distribution channels, we believe the U.S. markets for back, knee, foot/ankle, and elbow pain are our biggest opportunities. This study is specifically designed to allow us to apply to the FDA for an indication for pain relief for general muscular skeletal complaints. With the many concerns over the dangers of taking medications such as acetaminophen and NSAIDs, we believe U.S. consumers are looking for safer and more effective pain relief options. We believe our unique and patented drug-free technologies will effectively fill this need."
— Compiled by Holland Johnson, MDD