Regenerative Medicine and Cell Therapy in Orthopedics—Health Policy, Regulatory and Clinical Development, and Market Access
Orthopedic indications collectively represent a large clinical and economic burden, especially given the aging world population. To meet this area of unmet need, a wave of regenerative medicine therapies, including stem cells and other cell-based therapies, is currently in clinical development and anticipated to inundate the global market over the next few years. Although intended to be transformative, orthopedic cell therapies face several practical opportunities and challenges. Such therapies could reduce the health care burden, in part by replacing traditional drug therapies and highly-invasive surgical interventions wi...
Source: Techniques in Orthopaedics - November 15, 2019 Category: Orthopaedics Tags: Symposium Source Type: research
The Promises and Challenges of Stem Cells Use for Orthopedic Applications: A New and Exciting Era in Biological Treatments
No abstract available (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - November 15, 2019 Category: Orthopaedics Tags: Preface Source Type: research
Revision Total Knee Arthroplasty With Ipsilateral Below Knee Amputation Positioned Over a Radiolucent Triangle
Positioning for primary and revision total knee arthroplasty in patients with ipsilateral below knee amputation requires special consideration. Prior case reports have described various strategies, each having their own limitations. Here we describe a novel technique flexing the amputated extremity over a radiolucent triangle. All equipment for this technique is readily available in most operating rooms and does not require the need for a second assistant to help stabilize the extremity during the procedure. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - August 27, 2019 Category: Orthopaedics Tags: Special Technical Article Source Type: research
Comparing Conventional and Navigation-assisted Techniques for Lateral Opening-wedge Femoral Varus Osteotomy
Conclusions:
Duration of surgery and tourniquet time were longer in the NAV osteotomy group. The use of NAV for femoral varus osteotomy did not result in any significant difference in final alignment. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - August 27, 2019 Category: Orthopaedics Tags: Novel Research Methods and Models Source Type: research
Consensus on Reducing Risk in Total Joint Arthroplasty: Revision Surgery
Rates of revision hip and knee arthroplasty continue to increase. Patients undergoing revision hip and knee arthroplasty face a different set of challenges than those undergoing primary arthroplasties, with increased rates of medical and surgical complications. Specifically, patients undergoing revision arthroplasty have higher rates transfusion, more unplanned readmissions, greater cardiac and renal complications, and more frequent surgical complications including surgical site infections and need for reoperation and revision surgery. Multiple strategies may be used in an effort to lower these risks, including shifting th...
Source: Techniques in Orthopaedics - August 27, 2019 Category: Orthopaedics Tags: Symposium Source Type: research
Soft Tissue Issues and Considerations in Total Knee Arthroplasty
Total knee arthroplasty is projected to increase beyond substantial numbers due to an aging population. An important factor to avoid common complications is meticulous attention to soft tissue and skin healing. Comprehensive knowledge of wound healing and vascular anatomy provides a stable foundation for the physician and surgeon. This is complimented by updated information on common complications and preoperative optimization of undesirable factors that could hinder the success of a total knee arthroplasty. The need for prophylactic intervention may be determined during the preoperative evaluation and is recommended in pa...
Source: Techniques in Orthopaedics - August 27, 2019 Category: Orthopaedics Tags: Symposium Source Type: research
Reducing Risk in Bilateral Total Knee Arthroplasty
As the utilization of total knee arthroplasty increases and the population ages, the number of patients who require surgical treatment of both knees is rising. These procedures may be conducted simultaneously or sequentially; the simultaneous bilateral approach is increasingly considered the preferred option because it permits a symmetric recovery while avoiding risks associated with an additional operation, anesthetic, hospitalization, and recovery period while reducing the costs associated with sequential procedures. Despite these advantages, concerns have been raised regarding increased risks for deep vein thrombosis, p...
Source: Techniques in Orthopaedics - August 27, 2019 Category: Orthopaedics Tags: Symposium Source Type: research
Reducing Risk in Total Joint Arthroplasty: Vascular Status
This article will provide a brief update on the literature and consensus recommendations regarding (1) patients with increased bleeding risk and increased venous thromboembolic event risk, (2) patients with a history of peripheral vascular disease, and (3) patients with lymphedema. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - August 27, 2019 Category: Orthopaedics Tags: Symposium Source Type: research
Reducing Risk in Total Joint Arthroplasty: Assessing Mental Health, Mood, and Movement Disorders
Preoperative and postoperative mental health status (MHS) of total joint arthroplasty patients can affect immediate and long-term outcomes following surgery. Alterations in MHS can be acute or chronic. The most common etiologies include acute changes due to (1) delirium or stroke, (2) movement disorders (Alzheimer dementia, Parkinson disease, multiple sclerosis, epilepsy), and (3) mood/behavior disorders (major depressive disorder, anxiety, bipolar disorder, schizophrenia). Across etiologies, alterations in MHS are associated with worse clinical/patient-reported outcomes and greater total cost of care. Prevention via pharm...
Source: Techniques in Orthopaedics - August 27, 2019 Category: Orthopaedics Tags: Symposium Source Type: research
Consensus on Reducing Risk in Total Joint Arthroplasty: Narcotic Use
Because of the potential adverse events associated with opioid use, the purpose of this consensus was to provide guidelines to help reduce the risks when performing lower extremity joint arthroplasty. Specifically, the authors addressed: (1) the use of nonopioid pain management; (2) national and state guidelines; (3) the role of pain management specialists; and (4) multimodal pain management options for total hip and knee arthroplasty. A literature search was performed utilizing the PubMed database focused on total hip and knee arthroplasty pain managed with opioids. The authors recommend that patients be started with nono...
Source: Techniques in Orthopaedics - August 27, 2019 Category: Orthopaedics Tags: Symposium Source Type: research
The Effects of Smoking on Postoperative Complications After Total Joint Arthroplasty
The evidence that preoperative smoking cessation provides decreased postoperative morbidity and complications is continuing to develop and offer stronger results. Although the intensity of the intervention required for a long-term positive impact remains unknown, direct communication between the physician and their patient in combination with nicotine replacement therapy seems to offer the greatest reduction in postoperative morbidity. With many institutions now implementing group classes to prepare patients for their upcoming surgery, adding a smoking cessation group therapy component may further offer patients mutual sup...
Source: Techniques in Orthopaedics - August 27, 2019 Category: Orthopaedics Tags: Symposium Source Type: research
Reducing Risk in Total Joint Arthroplasty: Immunocompromised Patients
Immunodeficiency limits the body’s natural ability to fight infection, thus increasing the patient’s risk of postoperative complications. Moreover, rates of immunosuppression in the United States are on a steady climb secondary to the duality of greater life expectancy of the immunosuppressed and expanding indications for immunosuppressant use. Taken together, these 2 factors foreshadow the growing challenge orthopedic surgeons will face, as higher rates of immunocompromised patients will inevitably present for procedures in the decade ahead. These patients present with the 3-fold effect of a weakened ability to heal, ...
Source: Techniques in Orthopaedics - August 27, 2019 Category: Orthopaedics Tags: Symposium Source Type: research
Acute and Chronic Renal Insufficiency in the Total Joint Arthroplasty Patient
With the projected increase in joint replacement in the next few decades, along with the increased prevalence of renal insufficiency, arthroplasty surgeons must have a good understanding of the routine management of renal impairment in the perioperative setting. Multiple studies have demonstrated significant effect on arthroplasty outcomes, morbidity, and mortality. We highlight several key strategies in the perioperative management of both acute and chronic renal insufficiency. A multidisciplinary approach should be pursued in the perioperative management of renal disease, with important considerations for cardiovascular,...
Source: Techniques in Orthopaedics - August 27, 2019 Category: Orthopaedics Tags: Symposium Source Type: research
Perioperative Management of Diabetes for Total Joint Arthoplasty: A Consensus Article
Diabetes mellitus (DM) is an increasingly prevalent comorbidity among patients undergoing total joint arthroplasty. Uncontrolled DM is a known risk factor for a multitude of postoperative complications, the most dreaded of which is periprosthetic joint infection, but also includes wound complications, deep venous thrombosis, and worse functional outcomes. Given that uncontrolled DM is a modifiable risk factor, it would be prudent for the surgeon to do all that is possible to minimize perioperative risks related to DM while also avoiding unnecessary surgical delays. In this article, we review risk mitigating measures includ...
Source: Techniques in Orthopaedics - August 27, 2019 Category: Orthopaedics Tags: Symposium Source Type: research
New York Arthroplasty Council (NYAC) Consensus on Reducing Risk in Total Joint Arthroplasty: Obesity
This article reviews the literature related to these topics, and focuses on the reduction of risk in TJA in relation to obesity in general. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - August 27, 2019 Category: Orthopaedics Tags: Symposium Source Type: research
