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

Scientists discover way to jumpstart bone's healing process .... Rarely will physicians use the word "miraculous" when discussing patient recoveries. But that's the very phrase orthopedic physicians and scientists are using in upstate New York to describe their emerging stem cell research that could have a profound impact on the treatment of bone injuries. Results from preliminary work being released, patients confined to wheelchairs were able to walk or live independently again because their broken bones finally healed. At the heart of the research is the drug teriparatide, or Forteo, which was approved by the FDA in 2002 for the treatment of osteoporosis. Astute observations led a team of clinicians and researchers to uncover how this drug can also boost our bodies' bone stem cell production to the point that adults' bones appear to have the ability to heal at a rate typically seen when they were young kids. Baseline research presented in February at the Orthopaedic Research Society meeting revealed that of 145 patients who had an unhealed bone fracture half of them for six months or longer 93% showed significant healing and pain control after being on teriparatide for only eight to 12 weeks. These findings were enough to convince the National Institutes of Health to fund a clinical trial underway at the University of Rochester Medical Center (Rochester, New York), and if the preliminary data are any indication, researchers may have discovered a new, in-the-body stem cell therapy that can jumpstart the body's natural healing process in bones. The clinical implication is significant, as orthopedists can soon have a new tool at their disposable to deal with many common, painful bone ailments including the tens of thousands of painful fractures for which there is no treatment (pelvic fractures, vertebral compression fractures, clavicle fractures), fractures that won't heal, fractures in patients that are either too sick to have surgery or chose not to have surgery, and even reduce the size of a incision in some surgeries.

Source: University of Rochester Medical Center

New plain language guide on treatments for osteoarthritis of the knee .... A new pair of plain-language guides from the Agency for Healthcare Research and Quality (AHRQ) examines the effectiveness, safety, and adverse effects of various treatments for osteoarthritis of the knee, including glucosamine and chondroitin, fluid injections, arthroscopic surgery, pain medications and other approaches. Separate guides are available for patients and clinicians.The guides summarize the results of a new report that addresses several questions: How effective are glucosamine and chondroitin for osteoarthritis of the knee? Will losing weight and staying active help the condition? Are there side effects and risks associated with shots or arthroscopic surgery? AHRQ's new consumer guide, Osteoarthritis of the Knee A Guide for Adults:

(http://effectivehealthcare.ahrq.gov/healthInfo.cfm?infotype=sg&DocID=132&ProcessID=89) defines the chronic and often debilitating condition. It is written to assist patients who seek answers to basic questions, and to guide them when they discuss treatment options with their clinicians. The clinician guide, Three Treatments for Osteoarthritis of the Knee: Evidence Shows Lack of Benefit (http://effectivehealthcare.ahrq.gov/healthInfo.cfm?infotype=sg&DocID=134&ProcessID=89), includes the same information but has been designed for people with a clinical background. The clinician guide includes a confidence scale that rates the available evidence.
Among the guides' conclusions: Evidence shows that some common treatments for osteoarthritis of the knee are not helpful and may have side effects. Glucosamine and chondroitin, for example, were not shown to offer improvement and can cause upset stomach, diarrhea, and headache. Fluid injections don't reduce pain or improve movement and can cause swelling, minor infection, and pain. Arthroscopic Surgery does little to reduce the pain of knee osteoarthritis and can result in more pain, swelling, infection, and blood clots in the legs. Some prescription and over-the-counter medications, including NSAIDs, have been found to help relieve the pain of knee osteoarthritis. Source: Agency for Healthcare Research and Quality (AHRQ)

Link between widely used osteoporosis drugs and heart problems probed .... New research at Wake Forest University School of Medicine (Winston-Salem, North Carolina) evaluated the link between a common class of drugs used to prevent bone fractures in osteoporosis patients and the development of irregular heartbeat. Researchers found that bisphosphonate use was associated with a significant increase in the incidence of "serious" heart rhythm disturbances, classified by hospitalization, disability or death resulting from the condition. However, when they included "non-serious" cases in their analysis, they found no overall increased risk of atrial fibrillation, the study shows. The study's findings appear in the current issue of Drug Safety, a publication of the International Society of Pharmacovigilance covering the safe and proper use of medicines. "Bisphosphonates, found in prescription drugs including Boniva, Fosomax, Reclast and Actonel, inhibit the breakdown of bones, which reduces the risk of fractures, especially those of the spine and hips in older patients. The first such drugs were approved for use in the mid-1990s. Early studies indicated that the use of bisphosphonates might cause problems with heart rhythm, or atrial fibrillation, which increases the risk for stroke or heart attack. For the study published this month, researchers analyzed the data from previous observational studies and clinical trials to determine the link between bisphosphonate therapy and irregular heart beat.

Source: Wake Forest University Baptist Medical Center

Study assesses new surgical procedure for regenerating cartilage in damaged knee joints .... Rush University Medical Center (Chicago) is testing a new procedure for regenerating damaged articular cartilage in the knee joint to relieve the pain of osteoarthritis. Rush is the only center in Illinois participating in the CAIS Phase III clinical trial. The procedure, called the Cartilage Autograft Implantation System (CAIS), involves extracting cartilage from the healthy tissue that remains in the knee, breaking it into tiny fragments to enable it to grow and expand, fixing it onto a biologically reabsorbable scaffold, and then implanting the scaffold with the cartilage cells back into the damaged area all in a single surgery. Earlier laboratory studies at Rush had indicated that the procedure can yield the tougher hyaline cartilage that naturally occurs in the joint, unlike the most popular surgical treatment currently for regenerating cartilage, called microfracture. Up to 40 centers in North America are participating in the clinical trial after a pilot study in 2006 demonstrated the procedure was safe. Investigators now are determining whether the procedure is as at least effective as microfracture, and possibly better. Approximately 300 patients will be enrolled in the trial, including both men and women ages 18 to 65 who have one or two lesions in their knee, but not significant arthritis that might require a knee replacement. Participants will be followed for 48 months. Results will be compared with outcomes for microfracture, in which the surgeon creates tiny fractures in the bone underlying the damaged cartilage with a tiny pick-like tool. Blood and marrow, which contains stem cells, leak out of the fractures, forming a blood clot with cartilage-building cells. Source: Rush University Medical Center

Temple podiatrists use research to design a new shoe line ....
Temple University (Philadelphia) podiatrists James McGuire and Kendrick Whitney recently joined the shoe design business with the release of their R'n'R - rest and recovery - shoe, the first commercially available shoe to be designed by university-backed researchers. The R'n'R is a product of Creative Footwear Technology, a venture between the two doctors and local entrepreneur Richard Posoff that uses the latest in foot and ankle research to produce a foot-friendly therapeutic shoe. "Most shoes on the market today are designed by artists and not scientists who know something about how the foot works," said McGuire. "Our goal was to enhance the way shoes are designed, by looking at research-based findings and put out a better shoe, one that's designed with both function and form in mind." Commercially available shoes tend to place the most support on the arch of the foot, which throws off the body's center of gravity and keeps the foot from functioning normally. McGuire and Whitney say that the R'n'R offers an entirely new way to support the arch, and it dissipates the shock and stress experienced at the two most stressful parts of the gait cycle: heel strike and pushoff. As a result, the shoes provide a more natural gait, reduce shock and shear forces, and support the foot while still allowing a natural use of the muscles and bones. Source: Temple University

— Compiled by Holland Johnson, Medical Device Daily

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