A clinical Round Table discussion on the role of
platelet-rich plasma in connective tissue repair was the most read article
appearing in Orthopedics Today and on the ORTHOSuperSite.com in
The Top-10 article list was generated by an analysis of the number of
times an article was opened on the ORTHOSuperSite.com Web site. The Web site
contains articles from Orthopedics Today, Orthopaedics Today
Europe and the peer-reviewed journal Orthopedics.
The list includes a mix of articles on clinical treatments, health
care reform, and ongoing or dismissed litigation. This is the second
consecutive year that a Round Table discussion was the most-read
“This list of Top 10 read articles represents the broad interest
of our readers in keeping up with our profession and the changes that are
affecting it,” Orthopedics Today Chief Medical Editor Douglas
W. Jackson, MD, said. “It represents the strength of Orthopedics
Today and its broad coverage of the field of orthopedics.”
In terms of the most-accessed article on platelet-rich plasma, Jackson
said, “Our readers have a great interest in treatments for degenerative
articular problems that can be applied directly, via arthroscopy or injected
locally, and have minimal side effects.”
As we look to the future there will be an increased interest in the
issues that affect the business-side of orthopedics.
“I think changing health policy and issues regarding patient care
will be of increasing interest in 2010,” Jackson said.
The following is a list and summaries of the Top 10 articles of 2009
that were compiled by the Orthopedics Today
In a Round Table discussion, orthopedists shared their
experiences using platelet-rich plasma for connective tissue repair.
“There has been a growing interest in the use of
‘biologics’ in orthopedics, and platelet-rich plasma represents an
autologous source of potent bioactive [growth] factors,” Steven P.
Arnoczky, DVM, the moderator of the discussion, told Orthopedics
Today. “While the benefits of growth factors in enhancing cell
proliferation and matrix synthesis have been well documented in numerous in
vitro and in vivo pre-clinical studies, the potential efficacy of platelet-rich
plasma in various clinical applications has yet to be conclusively
demonstrated. I believe the Round Table was able to provide
valuable insight into how several orthopedic thought-leaders currently view
this technology and are applying it in their practices.”
The Round Table participants noted a wide range of
indications for using platelet-rich plasma (PRP) and platelet-rich fibrin
matrix (PRFM), such as rotator cuff repair, knee ligament reconstruction,
treating isolated meniscus tears that are not associated with ACL tears or
reconstructions, and chronic tendinopathy. Compared with control groups, the
participants reported decreased narcotic use, lower rates of tunnel expansion
and osteolysis, and improved pain scores in patients treated with PRP or PRFM.
Of all the articles published at OrthoSupersite.com last year, the
second most accessed concerned the June indictment against Norian Corp, its
parent company Synthes, and four Synthes executives for charges related to
allegedly conducting unauthorized clinical trials.
In July, two of the executives, Michael D. Huggins and John J. Walsh,
entered guilty pleas to the charges against them, according to a media report.
Charges in the case mostly concerned use of Norian XR and Norian SRS
bone cement during testing and surgeries completed from May 2002 until fall
Several felony counts were lodged against Norian, while Synthes was
charged with 44 misdemeanor counts.
In addition to Huggins and Walsh, the two Synthes executives also each
charged with one misdemeanor count of shipping adulterated and misbranded
Norian XR in interstate commerce were Thomas B. Higgins and Richard E. Bohner,
according to a press release from the office of the United States Attorney for
the Eastern District of Pennsylvania.
In the March issue of Orthopedics, Bart I. McKinney, MD,
and colleagues outlined the importance of understanding and properly treating
apophyseal avulsion fractures of the hip and pelvis — injuries that can be
dangerous for an adolescent athlete.
McKinney’s group reported that proper diagnosis and treatment will
usually result in a successful nonsurgical treatment, though they stressed that
these fractures can be easily missed. The key to success with nonoperative
treatment was, according to the study, a five-stage rehabilitation protocol.
Regarding surgical treatment, researchers recommended it be reserved for
painful nonunions and symptomatic exostosis.
The team also covered common complications of the fractures, making note
of painful nonunion and exostosis. Further, they warned, osteonecrosis could
develop in patients with apophyseal fractures of the greater trochanter
regardless of the treatment method used.
In his March commentary, Orthopedics Today Chief Medical
Editor Douglas W. Jackson, MD, expressed his surprise at recent expansions to
health care entitlement programs before the unveiling of the president’s
plans for health care reform in his commentary “Health care reform: It is
happening faster than most of us are aware.”
“I am amazed at how quickly these new entitlement programs have
advanced,” he wrote. “This has occurred without many debates on the
long-term consequences of the undetermined financial costs or on the timing of
the programs during a yet-to-be-defined form of national health
Jackson concluded, “This year we will face imposing challenges as
proposed and enacted economic stimulus and health care reform bills alter the
financing and practice of medicine and, concomitantly, the care of our
The fifth most popular article at ORTHOSupersite.com in 2009 was a
1st on the Web from March about a federal grand jury probe of
Stryker’s biotech division.
In a follow-up piece in October, we covered news that the federal grand
jury of the U.S. Attorney’s Office of the District of Massachusetts
charged Stryker Biotech LLC, its former president and some current sales
managers with fraudulently promoting the improper use of medical devices in
spine and long bone surgeries.
A Dec. 22, 2009 hearing was scheduled.
If convicted on all charges, the division faces fines of more than
$500,000 on each count. The executives face various combinations of
imprisonment and fines if convicted of the charges against them.
The U.S. attorney investigated the Stryker Biotech for submitting false
reports to the FDA, illegally promoting some of its products, and selling
misbranded medical devices, the ORTHOSupersite.com article stated.
Stryker said in a regulatory filing that the investigations are related
to its OP-1 product and Calstrux bone filler.
Arthroscopic hip impingement surgery may lead to pain relief and
restored activity in patients with femoroacetabular impingement.
Dean K. Matsuda, MD, discussed the indications and surgical
considerations for arthroscopic management of femoroacetabular impingement
(FAI) at Orthopedics Today Hawaii 2009.
“I think that FAI is here to stay,” Matsuda said. “If you
are thinking labral tear, think FAI. Isolated labral tears are relatively
uncommon. Both open and arthroscopic procedures [in] short-term studies appear
to be effective at pain relief and activity restoration. [There are] better
outcomes in patients with less cartilage damage, suggesting earlier surgical
intervention may be appropriate.”
While an extensive literature review of studies regarding open and
arthroscopic treatment for hip impingement revealed insufficient evidence to
determine definitive treatment guidelines for FAI, Matsuda and colleagues found
that outcome instruments in these studies showed improved pain relief and
Matsuda noted that arthroscopic treatment may be beneficial for young
athletic patients with symptomatic FAI and may have a role for patients with
mild arthrosis. However, he stated that the procedure does not have a place for
the treatment of patients with advanced arthrosis and noted that it is still
unclear whether the procedure can prevent arthritis.
Dismissal of a highly publicized whistleblower lawsuit against Medtronic
spine surgeons was the seventh most read article published in 2009 at
In March, a federal judge dismissed the lawsuit, filed in 2008 by two
ex-Medtronic employees. It accused spine surgeons, spinal device distributors
and others of accepting kickbacks from Medtronic.
Medtronic was not directly named in the lawsuit, which was dismissed
because it had already been sufficiently aired in the court and media.
The judge blocked the plaintiffs’ motion to file an amended version
of their complaint.
In our 4 Questions interview in October, Douglas W.
Jackson, MD, interviewed Kevin J. Bozic, MD, about revision hip arthroplasty
rates in the United States.
Bozic talked about the increase that has been seen, attributing it
primarily to increased incidences in primary THA procedures, an expansion of
the indications for THA to include younger, more active patients, and finally
limitations in implant longevity.
In 2005, Bozic said, researchers with the American Academy of
Orthopaedic Surgeons (AAOS) and the American Association of Hip and Knee
Surgeons (AAHKS) made a proposal to the Center for Medicare & Medicaid
Services and the National Center for Health Statistics to create a series of
more specific, clinically relevant ICD-9 diagnosis and procedure codes.
These codes were adopted and introduced in October 2005, although Bozic
it is unclear how commonly and appropriately they are being used by surgeons
and administrators. Still, their use could be invaluable.
“Due to changes to THA-related administrative codes that were
introduced in 2005, we now have the ability to use administrative claims data
to evaluate the cause of THA failure and the types of revision THA procedures
that are performed across the entire United States,” Bozic said.
“This information will be valuable in guiding future research, implant
design, and clinical decision making in THA.”
In Orthopedics, a study by Bruce H. Ziran, MD, and
colleagues revealed that differences in the acute rehabilitation
characteristics in patients between the intramedullary hip screw and the
compression hip screw could be noted through the Functional Independence
Ninety-four patients were treated with either intramedullary or
compression hip screws. Bed mobility, bed transfer, gait independence and
distance ambulated were all evaluated.
The intramedullary group performed better with bed transfers, ambulatory
ability at discharge and overall gait distance at discharge. In addition,
skin-to-skin operative time and estimated blood loss were significantly less
for the intramedullary group.
“Hip fractures remain one of the most prevalent fractures in the
elderly population,” Ziran told Orthopedics Today. “Past
debates focused on perioperative issues such as healing, blood loss and
complications. The outcome of such debates found little difference between
existing techniques, so the emerging variables to address include optimization
of recovery and cost efficacy of treatment. This study examined differences in
the rate of recovery using different techniques of fixation and found subtle
differences between intramedullary and extramedullary techniques.”
In the March issue of Orthopedics, Taiwanese researchers
wrote that both medial and lateral plating were functionally successful —
although lateral plating was found to have more advantages and fewer
complications than medial plating.
Yih-Shiunn Lee, MD, and a team of researchers expanded upon the
relatively little existing literature for the use of the lateral approach in
the treatment of distal tibial and fibular fractures while forming the first
reports to compare medial and lateral plating for the treatment of distal
“Both medial and lateral plating for treating distal tibial
fractures achieved good functional outcomes with a low malunion rate; however,
the lateral plating group had a lower complication rate and fewer hardware
problems,” the researchers wrote.
According to the authors, union rate, malunion rate, operative time,
functional score and range of ankle motion were all determined to be similar
between the medial and lateral plating groups.