A population-based study of ambulatory and surgical services provided by orthopaedic surgeons for musculoskeletal conditions

<p>Abstract</p> <p>Background</p> <p>The ongoing process of population aging is associated with an increase in prevalence of musculoskeletal conditions with a concomitant increase in the demand of orthopaedic services. Shortages of orthopaedic services have been documented in Canada and elsewhere. This population-based study describes the number of patients seen by orthopaedic surgeons in office and hospital settings to set the scene for the development of strategies that could maximize the availability of orthopaedic resources.</p> <p>Methods</p> <p>Administrative data from the Ontario Health Insurance Plan and Canadian Institute for Health Information hospital separation databases for the 2005/06 fiscal year were used to identify individuals accessing orthopaedic services in Ontario, Canada. The number of patients with encounters with orthopaedic surgeons, the number of encounters and the number of surgeries carried out by orthopaedic surgeons were estimated according to condition groups, service location, patient's age and sex.</p> <p>Results</p> <p>In 2005/06, over 520,000 Ontarians (41 per 1,000 population) had over 1.3 million encounters with orthopaedic surgeons. Of those 86% were ambulatory encounters and 14% were in hospital encounters. The majority of ambulatory encounters were for an injury or related condition (44%) followed by arthritis and related conditions (37%). Osteoarthritis accounted for 16% of all ambulatory encounters. Orthopaedic surgeons carried out over 140,000 surgeries in 2005/06: joint replacement accounted for 25% of all orthopaedic surgeries, whereas closed repair accounted for 16% and reductions accounted for 21%. Half of the orthopaedic surgeries were for arthritis and related conditions.</p> <p>Conclusion</p> <p>The large volume of ambulatory care points to the significant contribution of orthopaedic surgeons to the medical management of chronic musculoskeletal conditions including arthritis and injuries. The findings highlight that surgery is only one component of the work of orthopaedic surgeons in the management of these conditions. Policy makers and orthopaedic surgeons need to be creative in developing strategies to accommodate the growing workload of orthopaedic surgeons without sacrificing quality of care of patients with musculoskeletal conditions.</p

Metales trabeculares: Futuras posibilidades en cirugía reconstructiva

El metal trabecular es un biomaterial relativamente nuevo derivado casi siempre del tantalio (Ta), su porosidad es del 80-85% y el tamaño medio de su poro aproximadamente 550 micras. El módulo de elasticidad de su estructura está en un punto intermedio entre el hueso esponjoso y el cortical. Existen abundantes evidencias científicas de que el metal trabecular es muy receptivo al crecimiento óseo y de las partes blandas. Con respecto a la artroplastia de cadera y rodilla el empleo de acetábulos monobloque y componentes tibiales con el polietileno extraído se ha mostrado beneficioso. Para la cirugía de revisión se están desarrollando nuevos prototipos de implantes. El tantalio poroso podría tener propiedades mecánicas favorables para los procedimientos de artroplastia y los estudios iniciales demuestran un crecimiento óseo excepcional. Ello ofrece aplicaciones potenciales interesantes para los casos de revisión cuando exista pérdida ósea. No obstante, la duración a largo plazo, los límites y la posibilidad de revisión de estos implantes no se han establecido todavía

Clinical Review Article The Infected Total Knee Arthroplasty Part 1: Identification and Diagnosis in the Primary Care Setting

Deep infection represents one of the most devastating complications of total knee arthroplasty, imposing heavy emotional and financial tolls on the patient, the physicians involved, and society as a whole. Often, the primary care physician is the first physician a patient sees when problems with total knee arthroplasty arise. Knowledge of the clinical presentation of arthroplasty infection and a high level of suspicion on the part of the primary care physician may speed the diagnosis and treatment of infection and ultimately improve the outcome of a patient with an infected total knee arthroplasty. This is the first in a 2-part series on infected total knee arthroplasty. Part 1 provides an overview of the epidemiology for infection of total knee arthroplasty and discusses evaluation, diagnosis, and classification of infection from a primary care physician’s perspective. Part 2 in the series, to be published in the February 2006 issue of Hospital Physician, discusses management of infected total knee arthroplasty from a surgical perspective

Gait and Stair Function in Total and Resurfacing Hip Arthroplasty: A Pilot Study

Standard total hip arthroplasty (THA) is the established surgical treatment for patients older than 65 years with progressive osteoarthritis but survivorship curves wane in patients younger than 50. Resurfacing hip arthroplasty (RHA) is an alternative for younger, active patients reportedly providing superior range of motion. Quantitative investigation of functional recovery following arthroplasty may elucidate limitations that aid in device selection. Although limited long-term kinematic data are available, the early rate of recovery and gait compensations are not well described. This information may aid in refining rehabilitation protocols based on limitations specific to the implant. We presumed hip motion and forces for subjects receiving RHA are more similar to age-matched controls during physically demanding tasks, such as stair negotiation, at early time points than those for THA. In a pilot study, we quantified walking and stair negotiation preoperatively and 3 months postoperatively for seven patients with RHA (mean age, 49 years), seven patients with standard THA (mean age, 52 years), and seven age-matched control subjects (mean age, 56 years). Although both treatment groups demonstrated trends toward functional recovery, the RHA group had greater improvements in hip extension and abduction moment indicating typical loading of the hip. Further investigation is needed to determine if differences persist long term or are clinically meaningful