What is Considered a Conflict of Interest or What to Disclose in Lectures and Publications?

Recently our Journal was criticized for allowing a co-author to submit and publish a technical paper when said surgeon is involved in a litigation matter. “I am very surprised indeed that you do not consider being a defendant in legal action concerning the very practice being defended in an article amounts to a conflict of interest.”  This made me think it might be an appropriate time to revisit this issue. First I think it is important to understand some of the history regarding disclosure and conflict of interest

Health Care Regulation Spending Trap

Our health care system has faced many challenges over the past 40 plus years. Now these challenges have forced us into a complicated situation that makes it confusing on how best to proceed. Today third party insurance payers make most health care payments. Our premiums are paid into a risk pool-on medical services for other people. Consumers are disconnected from knowing the cost of goods or services that they are receiving. This commentary reviews the current situation and provides a few common sense approaches for pursuing the best potential policies

Grateful for Medical Advancements

“Grateful” has been described as warmly or deeply appreciative of kindness or benefits received. This commentary will express my personal gratefulness for benefits received by recent Medical Advancements. Most readers are well aware of my orthopaedic career over the past forty-four years and the many benefits that my family and I have received. However, recent benefits received gives me reason to pause and reflect, and to acknowledge their receipt

The Power of One Publication

A simple definition of Peer Review: A process by which a scholarly work (such as a paper or a research proposal) is checked by a group of experts in the same field to make sure it meets the necessary standards before it is published or accepted.1 There has been considerable debate over the years as to the value of publications. This commentary is going to highlight my experience with publications and how the power of one scientific report of two cases has significantly impacted my life and the life of my family. My career of forty-five years in the orthopaedic field with over one hundred and eight publications, 69 citations, sixteen medical device patents, membership in nine professional medical societies prepared me for one significant effort in my personal life “the discipline and experience” to spend nearly two years researching a treatment modality for lymphocytic hypophysitis. Conclusion: This experience demonstrates how the power of one specific paper can influence and play a positive effective role in the direction, treatment and outcome in a rare and uncommon medical condition

Safety Issue of Hip Resurfacing

Hip Resurfacing (HR) development of the 1970s was an attempt to address the failures of conventional cemented stems. Those early HR designs failed because problems with maintaining bone under the resurfaced femoral head, and loosening of the socket with substantial acetabular bone loss. However technology, knowledge and surgical techniques have evolved over the past 45 years. The more recent designs like the Birmingham Hip Resurfacing (BHR) focused on metal to metal bearing surfaces. These devices are under attack and maybe they should be. However, lets not ignore the significant amount of information and potential improvements in both design technology and surgical techniques that have come about over the past few years

Modular Head Mismatch in THA

Modular femoral heads have been used successfully since the mid-1980s in total hip arthroplasty. The use of metallic modular junctions presents a unique set of advantages and problems for use in total hip arthroplasty (THA). The separation of the head from the stem by a Morse taper has provided many benefits on the precision and balancing the reconstructed joint. Historically few complications have been reported for the modular Morse taper connection between the femoral head and trunnion of the stem in metal-on-polyethylene bearings. However, the risks or concerns are a little harder to identify and deal with. Certainly corrosion, and fatigue failure are the two most prevalent concerns but now the specifics of fretting wear and corrosive wear increasing particulate debris and the potential biological response is having an impact on the design and potential longevity of the reconstructed hip. This paper is dealing with a simpler consequence of head/stem modularity. Modular head mismatch to the socket bearing articulation. Two patients by two different surgeons at two different hospitals underwent cementless THA. Both patients were female and both presented with degenerative changes to the hip articulation. Both patients underwent hip replacement via a direct anterior approach using a standard hemispherical porous coated shell. One patient had a ceramic on ceramic bearing and the other had a ceramic head on a polyethylene liner. Both patients had a 32 mm inside diameter liner implanted and both had a 36 mm ceramic femoral head. The ceramic on ceramic mismatch was not recognized until the second office visit at eight weeks. The ceramic poly mismatch was not recognized until first office visit at six weeks. Both underwent correction surgery. These two cases demonstrate human mistakes can be made and steps need to be established to prevent future mistakes of this nature

Experience with Modular Necks for Cemented Total Hip Arthroplasty

This is a retrospective review of two series of using the same stem and modular neck design (R-120™) with the exception that the second series had an improved modular neck construct. Model I, 145 stems implanted between 2002 and 2005. Taper neck problems consisted of two neck trunion fractures at the neck stem junction and one modular neck disassociation at the modular junction. Stem was withdrawn from the market and redesigned to a more robust structure. Model II, 188 stems were implanted between 2007 and 2011 by the senior author utilizing the same surgical technique. There have been no modular neck taper problems. This paper will demonstrate that once a modular junction problem has been identified corrective action can be taken to resolve the problem. We advocate that there is a benefit to a modular neck cemented stem design and all modular junctions are not equal in design or function

Trunnion Corrosion and Early Failure in Monolithic Metal-on-Polyethylene TMZF Femoral Components: A Case Series

We describe four patients who were treated with primary total hip arthroplasty (THA) at two tertiary academic Australian teaching hospitals that experienced premature failure of head-neck trunnions through dissociation of the head-neck taper junction. This retrospective case series have similar clinical presentations and macroscopic pathology with severe head-neck taper junction loss of material, corrosion and early catastrophic failure. It is proposed that the accelerated wear is related to use of varus offset neck in a proprietary beta titanium alloy (Ti-12Mo-6Zr-2Fe  or TMZFÒ Stryker Osteonics, Mahwah NJ, USA) TMZF femoral stem, longer head-neck combination in a relatively active, older, male patient population. In this limited case series presentation was on average 80 months (range 53-92) following index procedure. In three of the four patients, a prodromal period of groin or buttock pain was reported for between 1 week and 2 months prior to acute presentation. Significant metallosis and local tissue damage including gluteal muscle insufficiency was evident. Each stem revised was well fixed. An extended trochanteric osteotomy was required in two of the four cases for stem extraction. We recommend caution and further evaluation on the relationship between TMZF metal alloy and its longevity in higher demand patients with high neck offset, varus stem geometry and large CoCr bearing heads

“Table-less” and “Assistant-less” Direct Anterior Approach to Hip Arthroplasty

In recent years, specialized, non-sterile, traction table systems have facilitated Direct Anterior Approach (DAA) hip arthroplasty. To combat the potential downsides of these traction systems, a sterile, intra-operative retractor option has emerged as a means to access the surgical site more easily, minimize soft-tissue trauma, and reduce the degree of required human assistance. This chapter describes the setup, surgical approach, and early results of a retractor system (the Phantom MIS Anterior Hip Retractor system [TeDan Surgical Innovations, Inc. {TSI}, Houston, Texas, US Patent # 8,808,176 B2]), which uses a standard operating table, allows preparation of both lower extremities free in the surgical field, is compatible with fluoroscopy, and aids in both acetabular and femoral exposure, preparation, and implantation. Early outcome data indicates that this system significantly minimizes the need for surgical assistance, while allowing for safe and effective DAA performance, facilitating the procedure for high-volume surgeons and shortening the learning curve for surgeons new to the procedure