Uproar Over NEJM Partial Meniscectomy Study // Leslie J. Bisson, M.D. Installed as Mindell Professor, Chair at University of Buffalo // and More!

Uproar Erupts Over NEJM Partial Meniscectomy Study

Neal S. ElAttrache, M.D. is a sports medicine specialist with the Kerlan-Jobe Orthopaedic Clinic in Los Angeles, California. Dr. ElAttrache, the team physician for the LA Dodgers, tells OTW, “In the December edition of the New England Journal of Medicine there was an article implying that partial meniscectomy is not effective. I commend authors of studies such as this that focus on the efficacy of treatment especially in the current health care economic environment. However, I would advise caution in making sweeping general statements—in this case implying that partial meniscectomy is not effective—based on studies that have potential significant unaddressed flaws. There may be significant selection bias in this study. The study sample seems very small compared to the volume of meniscus operations that the contributing authors have been reported to perform. Is this due to applying indications in the clinical setting which are different from what were used for inclusion in the study? Did a very large number of patients refuse to be included in the study, instead opting for surgery? These are some material questions that need to be addressed.”

“Additionally, there are also difficulties that can arise when using a study sample from one homogeneous socioeconomic and national population and attempting to make sweeping efficacy and value of treatment statements which are applied to a very different population. Again, I applaud the authors for conducting an important study such as this. The importance of the implications of the results and conclusions however, requires that the design, methods, data and conduct of the study are clearly understood and have a chance to be debated.”

Leslie J. Bisson, M.D. Installed as Mindell Professor, Chair of Orthopaedics

Leslie J. Bisson, M.D. has been installed as the inaugural June A. and Eugene R. Mindell, M.D. Professor and Chair of the Department of Orthopaedics at the University of Buffalo (UB). Dr. Bisson’s research, education and clinical interests include studying anterior cruciate ligament injuries, maximizing the strength of soft tissue repairs and exploring techniques to optimize rotator cuff healing. Dr. Bisson joined the department in 2007.

Dr. Bisson holds a number of roles, including director of UB’s orthopaedic sports medicine fellowship; medical director and team orthopedic surgeon for the Buffalo Sabres; and team physician and orthopedic consultant for the Buffalo Bills.

John P. Kelly, M.D. Named Top Orthopedic Surgeon

John P. Kelly, M.D., a physician at Orange County Orthopedic Specialists, has been named one of the top orthopedic surgeons in Orange County, according to Orange Coast Magazine’s January 2014 “Top Doctors” issue.

Dr. Kelly specializes in sports medicine, minimally invasive joint replacement surgery, fractures, pediatric orthopedics, hand surgery, spinal disorders, and foot and ankle problems. He has traveled extensively to developing countries throughout Asia and Africa on volunteer surgical missions for the poor and for injured children. He has been recognized and given awards for his volunteer work. Dr. Kelly has published academic papers and has presented at national academic orthopedic meetings.

10, 000 Neutrophil Count – The Number to Remember for TKA Infection

When it comes to infection and total knee replacement, things are different in the early postop period. Craig Della Valle, M.D. is an orthopedic surgeon at Midwest Orthopaedics at Rush and Professor at Rush University Medical Center in Chicago. He tells OTW, “We just published a multicenter retrospective study in the Journal of Bone and Joint Surgery where we evaluated nearly 600 patients who presented within the first two years after primary total knee arthroplasty (TKA) who underwent knee aspiration as part of an evaluation for periprosthetic joint infection. We looked at the progression of the synovial fluid white blood count (WBC), polymorphonuclear cells (PMN) percentage, and total neutrophil count over time and our data suggests that these are excellent indications for the presence of infection but the optimal threshold for the diagnosis of infection changes over time. We have done earlier work on diagnosis of infection in the first six weeks however this most recent work really finishes the story by showing us what happens to these values over the first two years. We assumed that these values decreased but really didn’t have parameters for diagnosing infection after six weeks.”

“Not unexpectedly we found that these parameters do change over time and the appropriate thresholds for diagnosing infection thus change as well. The synovial fluid WBC and differential both decreased the most in the first 90 days post-operatively which is not surprising. What was unexpected, however was that the synovial fluid WBC count and differential changed at different rates over time; the synovial fluid WBC count showing a much more rapid decrease and the PMN percentage demonstrating a more linear change. Hence, we wound up finding that the total neutrophil count (determined by multiplying the synovial fluid WBC count by the percentage of PMN) may provide a better method to identify patients with a periprosthetic joint infection as it combines the two values. Once again, this work really goes hand in hand with prior work we have done on the diagnosis of infection in the early postoperative period showing that if standard cut-off values for diagnosis of infection are utilized, false positive results occur which can lead to operative management when it is not necessary which is a big deal for both surgeons and patients alike. Based on our earlier work and this most recent paper, what we recommend for the diagnosis of infection in the first six weeks is a cut off value for the synovial fluid WBC count of about 12, 000 WBC/uL and a differential showing 90% PMN which works out to a total neutrophil count of about 10, 000 which while an oversimplification of something pretty complex, is an easy number for folks to remember.”

Michael Greller, M.D. Honored With Patients’ Choice Award

Michael Greller, M.D., president of New Jersey-based Advanced Orthopedic and Sports Medicine Institutes, has been honored with the 2013 Patients’ Choice Award. This is an online process that gives patients a chance to rate their physicians on their patient care and expertise.

Dr. Greller, assistant director of the Cartilage Restoration Center of New Jersey, has recently been appointed Team Physician for the NY/NJ Comets, a National Pro Fastpitch women’s softball team and was a team physician for Saint John Vianney High School Football in 2013. He has served as a physician for the U.S. Open Tennis Tournament, Philadelphia High School football, Freehold Borough High School Football and several professional dance companies in New York City. His vast and diverse experience both in the office and on the field allows him to provide the best care to all of his patients.

Dr. Greller specializes in advanced, minimally invasive shoulder, knee, hip, and ankle arthroscopic procedures, including ACL, rotator cuff and meniscus surgery. He also performs minimally-invasive hip, knee, and shoulder replacements.

Pierre Guyot Named to Board of SpineGuard

Pierre Guyot has been appointed to the Board of Directors at the France-based company, SpineGuard. Guyot has served as chief executive officer and board director of Mölnlycke Healthcare since 2007, leading the very successful development of this Swedish corporation both in terms of growth and profitability. Guyot has previously held executive management positions at Becton Dickinson, Johnson & Johnson, and Boston Scientific.