New Study: 95% Meniscal Allograft Survival Rate!
Failure is far from a given for those who undergo meniscal allograft transplantation (MAT). In what is the largest series in the literature, Brian Cole, M.D. and colleagues have just this week published information indicating positive results for those undergoing meniscal allograft transplantation. Dr. Cole, Professor in the Departments of Orthopaedic Surgery and Anatomy & Cell Biology at Rush University Medical Center, told OTW, “We looked at 200 patients who underwent MAT, 172 of whom were evaluated at 59 months with a minimum two year follow-up. Sixty-percent of these patients had a combined MAT with a concomitant articular cartilage procedure such as an osteochondral allograft. Our goal was to determine the indications for a second surgery after a meniscal transplant, as well as what would be likely to happen if people required a second surgery. Thirty-two percent required a second operation (due to scar tissue and/or persistent symptoms).”
“There was a 95% allograft survival rate at five years; even those who had to undergo a second surgery fared well with an 88% survival rate (however they were at a slight increased risk of failure). This news helps us as far as educating people in this complicated patient group. These are typically individuals who have undergone multiple operations; our study helps us to better understand what the future looks like for these patients. We can now say to patients, ‘Even if you undergo a meniscal allograft transplant—with or without a subsequent arthroscopic surgery—it doesn’t mean it is going to fail.”
ACDF Non-Fusion Rate Higher Than Expected
That bone is fused, right? Look again, says Dan Riew, M.D. Dr. Riew is the Mildred B. Simon Professor of Orthopedic Surgery, Professor of Neurological Surgery, and the Chief of the Cervical Spine Service for Washington University Orthopedics and Director of the Orthopedic Cervical Spine Institute. He told OTW, “While non-unions following ACDFs are rare, because of the sheer volume of such procedures done in the U.S., many patients return post-operatively, saying that they are still experiencing pain. ‘Impossible, ’ says the surgeon. You are fused.’ But the surgeon is not looking carefully enough.”
“Along with my colleague, Dr. K.S. Song, I recently published a paper on this topic, where we found that in order to properly diagnose a fusion on a CT scan following arthrodesis with a cage, you must look for bridging bone formation outside of the cage. If you just look inside, you will often see what appears to be bridging bone in patients who are not fused. This is the largest study in the literature with intra-operative confirmation of fusion status and conclusively shows that ‘bridging bone’ inside the cage is an unreliable sign of fusion. Doctors should learn how to diagnosis this because it is so easy to surgically fix non-unions and patients are so happy afterwards.”
Revolutionary, Infection-Fighting Balls
Little balls packed with antibiotics just might be the wave of the future for infection prevention, say researchers from the University of Texas Health Science Center at Houston (UT Health). Terry Clyburn, M.D., and Catherine Ambrose, Ph.D., have found that by coating porous metal implants with antibiotic-containing microspheres they could prevent infections in grossly contaminated wounds in a rabbit model. Dr. Ambrose told OTW, “Orthopaedic infections lead to extra surgeries and weeks or even months of antibiotic treatment. In addition, antibiotics that are taken systemically do not penetrate well into infected bone, and thus high doses of antibiotics are required, which can have serious side effects. Local delivery of antibiotics directly to the infected bone tissue is optimal, but when we started this research the methods for local delivery were limited. We wanted a local delivery system that was biodegradable and could deliver near linear doses of the antibiotic for the required length of time (at least six weeks). We anticipated that this type of drug delivery system would reduce the number of surgeries, decrease medical costs, and improve the effectiveness of antibiotics. Delivering the antibiotic in this way successfully prevented infection in 100% of the cases studied, resulting in an increase in implant integration.”
Dr. Clyburn noted, “We sought to develop a means to deliver effective doses of antibiotics to the local tissues for a more effective duration, while not interfering with soft tissue or bone healing and without requirement of further surgery to remove the delivery agent.”
Dr. Ambrose commented, “We were surprised to learn that a relative simple system worked well for this application. Our microspheres are actually only made from a few ingredients, and all of the ingredients are already approved by the FDA for use in humans. In addition, we discovered that if we create microspheres of the right size, then healthy bone would grow right around them to heal the patient’s wound.”
“The most unpredictable result, ” said Dr. Clyburn, “was that even when we directly contaminated a metal implant with Staph Aureus, that the antibiotic microspheres protected 100% of these implants from infection and allowed excellent ingrowth of bone into the implant. We certainly hope that we can show a similar result in protecting human implants from such infections!”
Dr. Ambrose stated, “Our work is unique as we have optimized the size and composition of the microspheres to cure bone infections and to allow the microspheres to be used around total joint replacements.”
“Several researchers have sought solutions to this challenging issue, ” added Dr. Clyburn. “Most researchers have worked on applying a coating of antibiotics or bactericidal agents to implants which release over a very short duration. We feel that a more prolonged period of protection may be more beneficial.”
“Getting approval from the FDA for investigation in human trials is the next step, ” says Dr. Ambrose. “Although each individual ingredient in the microspheres is already FDA-approved, the combine product still must undergo investigation.”
Dr. Clyburn added, “We are exploring possibilities overseas where such studies are more easily performed.”
Simon Lee, M.D. Presented With Award
Simon, Lee, M.D. of Midwest Orthopaedics at Rush has been presented with the Community Leadership Award by the Chicago Health Executives Forum (CHEF) for his work with “Soles4Souls.” Award recipients have worked to bridge the gap in the fragmentation of health care and delivery of services and have promoted education as a measure to strengthen communities.
In 2007, Dr. Lee helped to establish the Chicago-area chapter of Soles4Souls, a Nashville-based charity founded by a fellow foot and ankle specialist, that collects donated shoes from the warehouses of footwear companies to distribute to people in need. Every year since 2007, Dr. Lee has organized Chicago’s annual year-end event called “Our Hearts to Your Soles, ” providing medical foot screenings for Chicago-area homeless men and women at the Franciscan House of Mary and Joseph on Chicago’s west side.
Employees from Midwest Orthopaedics at Rush, as well as orthopedic surgery residents and medical students from Rush University, work under the supervision of Dr. Lee and his colleagues to examine and treat the feet of the overnight clients. This program provides homeless Chicagoans with relief for cold, wet, uncomfortable feet as well as a new pair of shoes and socks. It also educates the medical students and residents about the issues faced by the homeless and how they as medical professionals can help.
George Kalliolias, M.D., Ph.D. Awarded Sontag Fellowship
George Kalliolias, M.D., Ph.D., a physician-scientist in the Division of Rheumatology at Hospital for Special Surgery, will be honored with this year’s coveted Sontag Fellowship in recognition of his advancement of promising research in rheumatoid arthritis. Dr. Kalliolias was chosen as this year’s Fellow from a class of 15 researchers who will be receiving grants from the Arthritis National Research Foundation (ANRF), in partnership with The Sontag Foundation.
Dr. Kalliolias’ research is focused on inhibiting the joint destruction that is caused by inflammation in rheumatoid arthritis. Specifically, he is investigating the role of joint fibroblasts, important but little-studied players that represent a new and exciting potential therapeutic target for rheumatoid arthritis.
