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

Bariatric surgery increases fracture risk ... Mayo Clinic (Rochester, Minnesota) researchers are reporting that persons who undergo bariatric surgery may have a greater chance of experiencing broken bones, especially in their hands and feet. The study is based on a review of nearly 100 surgical cases at Mayo spanning 21 years and presented at the Endocrinology Society annual meeting in Washington. "We knew there was a dramatic and extensive bone turnover and loss of bone density after bariatric surgery," says Jackie Clowes, MD, PhD, a Mayo rheumatologist and senior author on the study. "But we didn't know what that meant in terms of fractures." The research team worked with Rochester Epidemiology Project records to develop the chart review of 97 of the 292 patients who underwent the bariatric procedure between 1984 and 2004. The findings, adjusted for age and gender factors, showed 21 individuals experienced 31 fractures within an average of seven years after surgery. Fractures were reported in the hip, spine and humerus (upper arm bone), with the majority of fractures in the hands and feet. "We've shown that risk of fractures after this type of weight loss surgery is clinically significant," says Elizabeth Chittilapilly Haglind, MD, Mayo endocrinologist and lead author. "More research is needed to confirm our findings and understand the specific risk factors and mechanisms involved."

New alternatives for bone imaging on the horizon ... On June 4, the Centers for Medicare & Medicaid Services (CMS) reported that it is considering a pathway for coverage of Sodium Fluoride (NaF-18) for PET bone imaging as an alternative to Technetium-99m imaging. Currently, Tc-99m bone imaging is one of the more commonly performed procedures using this radioisotope. Technetium-99m is in scant supply because of ongoing production outages, resulting in serious delays in patient imaging studies for many medical problems, including oncologic, cardiac and neurologic conditions. Because of the severity of the radioisotope supply crisis and the long-term duration of the anticipated outage, CMS has opened the PET National Coverage Determination (NCD) to evaluate the effectiveness of the radiotracer Sodium Fluoride (NaF-18) for PET bone imaging. PET bone imaging is a nuclear medicine procedure that is sensitive for the detection of the spread of many common cancers – such as breast, lung and prostate – to the bone. It also can be used to detect fractures when X rays do not provide a definitive diagnosis, particularly in pediatric patients. Currently, about 80% of the world's nuclear medicine scans are performed using Technetium-99m. However, the medical community depends on only six nuclear reactors in the world for more than 30 million nuclear medicine tests performed annually with this critical isotope. A shutdown last month at one of these reactors in Chalk River, Canada, has already left thousands of hospitals in the U.S. and Canada without access to this medical isotope. "The medical community is in crisis right now," said Robert Atcher, PhD, president of the Society of Nuclear Medicine (Reston, Virginia). and chair of the society's isotope task force. "Physicians can't get access to essential isotopes for common nuclear medicine procedures. As a consequence, patients are being denied tests, or have to be diagnosed with procedures that involve more radiation dose, less accuracy, more cost or more invasive techniques." While F-18 as fluorodeoxyglucose (FDG) has been approved by the FDA, CMS does not currently reimburse for F-18 fluoride PET bone imaging procedures for the many Americans who would be eligible for coverage as Medicare recipients. "This is very good news," said Barry Siegel, MD, chief of nuclear medicine at the Mallinckrodt Institute of Radiology (St. Louis), and co-chair of the NOPR working group. "With the potential for a coverage opening, physicians will be able to provide the evidence necessary to build the case that F-18 fluoride is a viable alternative to Tc-99m in this situation – a case the preliminary evidence suggests will be readily made." Source: Society of Nuclear Medicine.

Surgeons successfully integrate stem cell procedure for spine surgeries ... A new breakthrough in adult stem cell technology has three Texarkana neurosurgeons leading their industry by utilizing concentrated stem cells for spine surgery. The innovative technique is improving the desired results of surgical interventions for back pain. Leading researchers in the orthopedic and spine industry are predicting the latest developments in this field of medicine will become mainstream practice and, potentially, a standard of care for surgical treatments of severe back pain. Lee Buono,MD, Freddie Contreras, MD, and J. Brett Dietze, MD, of Texarkana Neurological Associates (Texarkana, Texas) are utilizing the new procedure that harnesses the healing potential of adult stem cells from a patient's own body. During surgeries for the neck and back, bone marrow is extracted from the hip through a small incision. The marrow is processed by an FDA-approved device and the living cells are delivered back to the surgeon in a concentrated dose to be implanted back into a patient to promote healing. "The concentrations of endothelial progenitor cells, hematopoietic stem cells, and mesenchymal stem cells have adhesion properties that ensure the cells remain localized where we need them to promote tissue growth and healing. Surprisingly, the process takes only 15-20 minutes without adding time to the surgery," said Dietze. As the population ages, incidents of spinal degeneration will likely continue to increase. The potential of stem cells and regenerative medicine is virtually limitless for treatments of degenerative diseases since adult stem cells have the remarkable potential to differentiate and become new tissues such as bone, tendon, cartilage and heart muscle. Source: Texarkana Neurological Associates

Arthroscopic surgery shown effective for massive rotator cuff repair ... Arthroscopic shoulder surgery has advanced in recent years as orthopedic surgeons have proven its effectiveness for the treatment of rotator cuff tears and the pain that accompanies such injuries. But as with many other orthopaedic procedures, the approach and skill at which arthroscopic shoulder surgery is performed makes tremendous difference, especially when treating large cuff tears. In a retrospective study performed at two orthopedic centers in Rome, researchers studied 457 patients who underwent arthroscopic repair of their rotator cuff tear. All of the surgeries were performed between 2000 and 2007, and 93 patients exhibited complete massive cuff tears, he said. The surgeons performed arthroscopic cuff repair using either a posterior-superior approach or a posterior-superior-anterior technique. Investigators analyzed the preoperative and postoperative outcomes using the Constant Score (CS), Simple Shoulder Test (SST) and a single-question patient satisfaction questionnaire. Patients were 55 to 74 years old on average, and the average time from onset of symptoms to surgery was 16.7 months. Results showed that the CS improved from an average score of 42 prior to arthroscopic surgery to 84 postoperatively. The SST scores improved from an average preoperative score of 4 to 8.5 postoperatively, according to Andrea Vitullo, MD, who presented the results at the 10th EFORT Congress held in Vienna. "There were no big differences between the posterior-superior and posterior-superior-anterior groups," he said. However, there were poor results in approximately 10% of cases, including seven posterior-superior cases and three posterior-superior-anterior cases. Investigators did not compare the results with patients who underwent an open procedure. Baldini said the patients with rotator cuff tears who are the best candidates for an arthroscopic procedure include those who demonstrate no fatty infiltration on nuclear magnetic resonance images and no superior dislocation of the humeral head.

— Compiled by Holland Johnson, MDD