According to a report published by the Bone and Joint Decade, entitled European action towards better musculoskeletal health (click here to download), an estimated 25% of adults in Europe are affected by longstanding musculoskeletal problems which limit everyday activities. The most common joint disorder is osteoarthritis, accounting for more disability among the elderly than any other disease. The most common inflammatory disease of the joints is rheumatoid arthritis, with a peak age of onset of 32-45 years. Other musculoskeletal problems include back pain and osteoporosis.
Source: European action towards better musculoskeletal health |
Orthopaedic surgeons can now diagnose and treat many types of bone and joint conditions using minimally invasive techniques. Most minimally invasive orthopaedic procedures are carried out using an arthroscope, a specialized thin form of endoscope designed for viewing and treating problems inside a joint. The arthroscope can be inserted into the joint through one or more tiny incisions through the skin and generally, only local anaesthesia is required. The arthroscope is fitted with a miniature imaging system that enables the structures inside the joint to be viewed on a monitor. The surgeon can attach special tools to the end of the arthroscope, or they can be introduced through a second tiny incision to shave, cut or remove problematic cartilage, bone or other tissues.
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As well as joint arthroscopy, procedures that were traditionally more invasive, such as hip and knee replacements and certain trauma procedures, can now be carried out by minimally invasive surgery. For example, by using a new generation instrumentation and techniques, it is possible to conduct a total hip replacement through two small 4cm incisions, or one 6-8cm incision instead of a large 20-30cm cut used in traditional hip replacement. Owing to the less traumatic nature of the surgery, there are benefits in terms of accelerated patient recovery and reduced post-operative pain and discomfort. These types of techniques are now commonplace for knee replacement surgery, and the placement of nails and plates in the treatment of long bone fractures.
Surgical navigation machines, as used routinely in neurosurgical applications, are being adapted for use in orthopaedics, particularly in conjunction with minimally invasive procedures. These devices can present a pre/inter operative image of the site of interest, and provide additional anatomical information to help navigate around the surgical field. This adds to surgeons' confidence as they operate in situations where visibility is less than perfect.
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The latest technology developments in knee replacement have lead to the design and manufacture of total knee replacements specifically for women. Traditional knee replacements are sized and shaped to fit an average of men's and women's knees. As more and more women have knee replacement surgery, it's become apparent that traditional knee replacements, while highly successful in alleviating pain in women, may not feel or move like their natural knee. Women's knees tend to be narrower than men's, and because their hips are wider, their knees move differently. A true gender specific knee is designed to accommodate those differences and is the only knee replacement shaped to fit a woman's anatomy.
The following are the three design features of a gender specific knee that have been developed based upon scientifically-documented differences in a woman's knee:
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In recent years, Louise had to push through her knee pain, serving as a fulltime caregiver for her husband, Joe, who was undergoing cancer treatment. Despite the severity of her ailing knees, she hobbled along. Then came the final straw. "Joe and I found out we were going to be grandparents and I said, 'Forget it, I'm not waiting any longer,'" said Louise. "I wanted to enjoy my new granddaughter." She made an appointment with an orthopaedic surgeon she had heard was using a special knee made for women. He agreed that she was an excellent candidate for a new gender specific knee that was designed to fit women. Louise also benefited from advancements in knee replacement that had occurred in the years since her pain began, such as less-invasive surgery and high-flexion implants. Several months after her 50th birthday, Louise had both knees replaced, and is eager to start exercising, cooking, gardening, shopping, decorating, enjoying family and friends, and "living my life like a 50-year-old." Her only regret? "I wish I would have done it sooner," said Louise. "My advice to people is 'Don't wait.' Why suffer? I had 10 years of pain."
Continued technological advancements in total hip replacement dramatically improve the health and enhance the lifestyles of well over a million hip implant recipients each year, many of whom otherwise experience chronic debilitating pain and physiological limitations, which can lead to severe atrophy and, in extreme cases, potentially premature death. These continuing advancements have led to improved prosthetic designs with greater longevity that are less likely to require costly surgical revision - a burden to both the patient as well as the healthcare industry.
One such advancement is the use of porous hip implants to restore the natural joint movement of the hip joint. Just over two decades ago, the use of non-porous, cemented hip implants was considered the gold standard in hip replacement procedures. As technology has advanced, the use of cemented implants has shifted, with a large percentage of orthopaedic surgeons now using porous hip implants.
With the use of a porous hip implant, the natural head and neck of the femur are replaced with a metal implant that is ultimately fixed to the bone via bone growth into or onto the porous surface of the implant. This means of fixation provides a number of benefits to both the surgeon and the patient including:
In addition, porous implant technology enables minimally invasive procedures, to which many orthopaedic surgeons are turning. During minimally invasive surgery, incisions are smaller and muscles may be spared, which can lead to a faster recovery time for patients. Studies also show that patients are more often discharged to their home rather than to a rehabilitation centre, and can return to work sooner with a minimally invasive procedure compared with a traditional hip replacement.
When performing a minimally invasive hip replacement, most surgeons use porous hip implants. Because the incision is smaller and visualization slightly reduced during an MIS approach, it is difficult to completely remove residual bone cement. Using a porous implant helps eliminate this concern.
Computer Assisted Surgery (CAS) is an exciting example of a medical technology that offers significant benefits to patients. Specifically, it is a method used by surgeons to improve the accuracy of diagnoses and surgical techniques associated with brain, spine, ear-nose-throat (ENT), and a variety of orthopaedic procedures. Advanced technologies provide computerized, three-dimensional viewing so physicians and surgical teams can precisely locate the position of their surgical instruments and any associated medical device implanted in the body.
CAS offers surgeons a broader field of vision and thus enables less invasive surgical techniques. The CAS method requires less blood transfusion, less soft tissue disruption, allowing patients a faster, less painful recovery. By allowing surgeons an improved field of vision and greater accuracy, CAS can produce more consistent, predictable and improved outcomes. This may translate into a faster and smoother recovery time for patients, potentially reducing hospital stays and generating savings for hospitals and the overall health care system. CAS can also support quality initiatives, including its emerging "pay-for-performance" programs in which providers can qualify for higher payments through the delivery of top quality care
CAS also generates electronic documentation of the surgery; which can be used by surgeons in the post-operatively to review and improve techniques and to help support payers' evidence-based medicine aims. Through electronic documentation, CAS may also help mitigate medical liability risk for patients, hospitals and surgeons.
Today the trend in the treatment of bone and joint disorders is increasingly towards convergence of technologies such as advanced materials science, cell and tissue biology, and nanotechnology. Tissue engineered cartilage and bone products may someday replace traditional medical devices in the treatment of certain bone and joint disorders. The most important clinical application of cartilage tissue-engineered products is autologous chondrocyte implantation for traumatic knee joint injuries. A biopsy is performed to obtain healthy chondrocytes from the patient's knee. The cells are expanded and cultivated for three weeks and transferred to the knee in an open surgical procedure. After surgery, two to six months are needed for full regeneration of the cartilage lesion. Another technique is to culture the cells on a three-dimensional biodegradable scaffold. Cut to the required size, the scaffold is then inserted and fixed. This method opens up the possibility of arthroscopic surgery (minimally invasive). Research is being carried out also to extend the application of tissue-engineered cartilage to other joints and to treat arthritis and intervertebral disc damage. If and when these exciting technological advances become available to patients will depend heavily on a supportive regulatory, reimbursement, and tax environment that encourages and rewards continued research and development in these important areas.
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