Joints Failing Due to Oral Bacteria…Nonoperative Care Trumps Operative Care?…Now Where Did That Needle Go?…“Unprecedented” OA Pain Marker Initiative at Duke…MRSA Vaccine Coming?…and more.
Joints Failing Due to Oral Bacteria?
Case Western University (CWU) researchers say that we may need to look to the mouth to find the source of joint failure. A team from the CWU School of Dental Medicine has found that bacteria from the fluid that lubricates hip and knee joints had bacteria with the same DNA as the plaque from patients with gum disease and in need of a joint replacement. These bacteria cannot be detected using routine lab tests, thus researchers used polymerase chain reactions and DNA sequence analysis of specific genes (16S-23S rRNA) in order to locate the bacteria in the plaque and fluid. The researchers suggest it might be the reason why aseptic loosening or prosthetic wear of the artificial joints fail within 10 years when no infection appears to be present.
Nonoperative Care on the Rise
Brian Cole, M.D., a sports medicine and cartilage restoration orthopedic surgeon at Midwest Orthopaedics at Rush, says that patients are “hungry” for alternatives that are nonsurgical. Dr. Cole, who serves as a clinical trial advisor for one such nonsurgical option, tells OTW, “We are seeing increased patient demand for alternatives to the operating room. Fortunately, there is an emergence of new solutions that may be particularly helpful with high volume problems. One involves the use of electric energy to reduce pain. The technology has been shown to reduce biochemical markers for inflammation, and is now in clinical trials and producing data.”
“Another new technology emanates from the pharmaceutical industry, and provides the ability to take medications currently used and prolong their activity by chemically surrounding them in polymers…essentially prolonging the amount of time in the joint. Additionally, there are some early growth factor studies in the OA arena…ones that are related to disease modification. Why now? Well, on the device side, some of these things have been suppressed because of the economy and the availability of dollars to drive things from conception to manufacturing, etc. Things are changing, however, and in the next five years we should better understand the impact of OA [osteoarthritis] on the general population and hope for it to decrease.”
“Unprecedented” OA Pain Marker Initiative at Duke
Virginia Kraus, M.D., Ph.D., Professor of Medicine in the Division of Rheumatology at Duke University Medical Center is leading a novel effort to validate biochemical markers for osteoarthritis (OA). She tells OTW, “This initiative represents a triumvirate of academics, industry and the Foundation for the National Institutes of Health (FNIH), and is a substantial effort to bring together government and industry funding to tackle a major chronic disease, OA. One of the components of the FNIH is a biomarkers consortium whose goal is to advancebiomarkers for drug development, as well as the advancement of therapies for different diseases. The Foundation had a real success story in the development of biomarkers to monitor harmful effects of drugs on the kidney, so we are using that success as a paradigm for our OA project.”
“At present we are evaluating 600 individuals (who are already part of the NIH funded OA Initiative), using existing blood and urine specimens, X-ray and MRI imaging data, to qualify biochemical and imaging biomarkers for OA indications. We will be evaluating 12 biochemical markers and a host of imaging markers; our hypothesis is that the change in one or more, over 12 to 24 months, will predict pain and structural deterioration of the knee at four years. We plan to evaluate markers of cartilage degradation, inflammation, and cartilage repair. While many of the markers may have capability of predicting progression individually, we think that the combination of many markers will provide the strongest predictive capability.”
“After this study we plan to validate the results in additional cohorts, including clinical trial cohorts to determine whether the biomarkers change in conjunction with clinical improvements in response to the therapy. We are engaging in discussions with the FDA regarding this work and the steps necessary to ultimately gain FDA approval of a set of markers of OA disease progression that could be used in clinical trials. This is an important collaboration for our field that includes major support from industry and donations of kits from biomarker assay manufacturers. All this combined makes for an unprecedented opportunity and a promising project.”
It’s 8am in the OR…Where Exactly is Your Needle?
Robert Stanton, M.D., a former President of the American Orthopaedic Society for Sports Medicine, tells OTW, “We are seeing a trend toward the use of in-office diagnostic ultrasound to help with guided injections. More accuracy is warranted…while orthopedic surgeons are trained to do joint injections, there is no question that mistakes are made when it comes to needle placement. This is not to be used on every single patient, but it is helpful, for example, with heavy patients where the anatomy is less clear.”
“Ultrasound is particularly valuable for use by anesthesiologists placing regional blocks. You can verify that the needle is adjacent to the nerve. For all ultrasound guided procedures, patients are very satisfied because of the visual feedback of seeing exactly where the needle is. Fortunately, most insurers are covering this…and the prices have come down significantly. At the same time, more educational courses are being offered and people are not hesitating to sign up.”
All Aglow in the OR? Radiation and Cone-Beam CT Technology
Jeffrey Lange, M.D., a second-year orthopedic research resident at the University of Massachusetts Medical School, was first author on a study that is garnering much attention. Dr. Lange tells OTW, “In spine specifically there are a lot of intraoperative imaging options that can help us with instrument positioning. These techniques mostly require radiation (X-ray or CT scan). Cone beam CTs are an attempt to make a lower radiation dose CT scan. Our question, which has attracted some interest, was, ‘How much radiation does a patient see from that interoperatively?’”
“These were all estimated dosages because we studied only simulated surgical scenarios. The take home message was that this type of CT scan does not appear to increase exposure to radiation over traditional CT scans in single scan usage. We also wanted to know what happens in a typical spinal surgery (which might use multiple scans). Although it depends on patient- and scenario-specific factors such as weight or number of spinal levels involved, there appear to be many full procedures for which the radiation dose does not exceed that of typical CT. It is especially important when discussing radiation risk to make sure that you’re talking about a risk profile rather than an absolute (safe versus dangerous). This is a widely used tool and people have had great success. The important thing is to be clear as to your goals up front.”
MRSA Vaccine Coming?
A research team from the University of Rochester Medical Center (URMC) will be leading an international consortium of trauma surgeons, infectious disease specialists, and translational scientists…all in an effort to tackle infections from complex orthopedic surgeries. The team, led by Stephen L. Kates, M.D., will be working with $3 million from AOTrauma, which is part of the Switzerland-based AO Foundation. Dr. Kates, Professor of Orthopaedics at URMC, will oversee 8 research projects involving 21 medical centers. The researchers will be focusing on:
- identifying the best ways to prevent infection and create an education template for medical providers everywhere
- develop a diagnostic test to demonstrate a patient’s immunity to Staphylococcusinfections
- develop a novel, MRSA passive immunization (vaccine) to prevent MRSA infections during total joint replacement
- use animal models to study the best ways to deliver antibiotics to deep wounds and to study a possible vaccine against staph
- analyze all current treatment protocols for patients suffering from severe bone and joint infections
- create an international infection registry to help with the study and treatment of infections in a standardized manner
- disseminate study results and discoveries about best clinical practices in a six-part educational series to be available through the AO Trauma Foundation.
R. Barkley Payne New VP at OREF
R. Barkley Payne, former vice president of development for the American College of Healthcare Executives, is the new VP of corporate development and strategic philanthropy for The Orthopaedic Research and Education Foundation (OREF). Payne’s 10+ years of experience in cultivating partnerships for nonprofit health care entities includes the five years he spent as executive director of the American Dental Association Foundation—as well as the five years he spent as senior director of fundraising and development. In 2009, he was awarded honorary fellowships by the American College of Dentists and International Academy of Dental Facial Esthetics, their highest awards for non-DDS professionals. Association Trends Magazine named Payne a 2004 young and aspiring association professional. Payne earned a BA in public relations at Western Kentucky University.
