1. Passage of healthcare refrom legislation. When the healthcare reform act was passed by Congress in March of 2010, the legislation had a profound impact on physicians and medical professionals across the board. Healthcare reform, with its many current and future changes to Medicare payment methodologies and to the “Stark” self-referral and fraud and abuse laws, is creating stricter regulations and new obligations for orthopedic surgeons. The elimination of future physician-owned hospitals, increase in potential patient base, emphasis on evidence-based medicine, lack of tort reform and emphasis on disclosures have presented challenges for orthopedic surgeons across the country. The new legislation will continue to impact orthopedic surgeons in various ways for years to come.
For more coverage, read “7 Healthcare Reform Changes Affecting Orthopedic Surgeons,” and “10 Biggest Concerns Facing Spine Surgeons From Healthcare Reform.”
2. Vertebroplasty. Whether or not vertebroplasty is an effective procedure has been a hot topic among spine surgeons and device companies since the publication of two studies in the New England Journal of Medicine and recently the American Academy of Orthopaedic Surgeons released a guideline recommending against the use of the procedure. The guideline was based on these studies that found vertebroplasty to have the same results as a “sham” procedure. However, many surgeons have experienced success with the procedure in their practices. In the guideline, AAOS moderately recommends calcitonin as pain medication for patients who present within five days of the fracture. All other treatment modalities, including conservative measures, are inconclusive, not recommended or only weakly recommended.
For more coverage, read “4 Reasons Why Spine Surgeons Will Still Perform Vertebroplasty.”
3. Metal-on-metal DePuy Orthopaedics hip replacement recall. Metal-on-metal hip replacements have been used in the United States for several years with studies showing good patient outcomes. However, concerns about the design have recently been raised after the DePuy ASR hip replacement recall occurred in July. For now, there seems to be a trend away from using metal-on-metal hip implants, but industry experts believe this trend won’t last. DePuy Orthopaedics voluntarily recalled the ASR hip implant on July 17 citing the number of patients who required revision surgery. Since then, law firms around the country have filed suit against the company. The recall has caused concern among physicians and patients about the metal-on-metal design that could, at least temporarily, affect the sale and use of metal-on-metal hip implants. To combat the negative press towards metal-on-metal, some companies, such as Wright Medical Group, have issued releases detailing the studies that show the effectiveness of their implant’s design.
For more coverage, read “5 Reasons Why Controversy Surrounds Metal-on-Metal Hip Replacements.”
4. Developments toward a National Joint Replacement Registry. Kaiser Permanente Total Joint Replacement Registry began in 2001 and has so far registered 100,000 implants. Kaiser Permanente researchers recently released a prospective study of 80,000 total joint replacements and 5,000 anterior cruciate ligament reconstruction procedures from the Anterior Cruciate Ligament Reconstruction Registry to examine the patients’ demographics, implants and surgical techniques in relationship with the outcomes for the procedures. The study concluded that the TJR and ACLR was an effective tool in assessing the risk of revision, which could result in a change of procedure, according to a Kaiser Permanente report. There currently isn’t a national joint replacement registry in the United States. However, the Hospital for Special Surgery in New York City announced the creation of the Center for Musculoskeletal Outcomes and Patient Oriented Research in December to translate information collected into studies that will help diagnose and treat musculoskeletal disorders. One of the center’s initial activities will be to lead the development of an International Consortium of Orthopedic Registries as the result of a contract awarded by the FDA. The Hospital for Special Surgery and Kaiser Permanente in Los Angeles are working with the FDA to plan the consortium’s first meeting in spring 2011. The Hospital for Special Surgery currently maintains 30 research registries for conditions, such as ACL injuries and rheumatoid arthritis, and the hospitals total joint replacement registry already contains data from more than 20,000 patients. Research using the registry could lead to publication of peer-reviewed health reports.
For more coverage, read “4 Benefits of a National Joint Replacement Registry.”
5. Concussion management and prevention. Recent studies published in professional journals reveal that NFL players who sustain multiple head injuries are at an increased risk for developing behavioral disorders and degenerative conditions like Parkinson’s and Alzheimer’s. Additional research suggests some concussed athletes don’t experience concussion symptoms and are at risk for sustaining another concussion before the first has healed. Rest is the only treatment currently approved for concussions, which means most sports medicine physicians and team organizations are focused on concussion prevention. Several organizations are taking on the challenges associated with preventing concussions. Researchers with Cleveland Clinic and the Rawlings helmet company have partnered to develop new football helmets intended to decrease the impact of head trauma. Recent developments in assessment tools, such as the ImPACT testing, have made it easier for physicians to detect concussions among individual athletes and examine whether the injuries have fully healed before allowing the athlete back to his or her activity. Many athletic programs around the country are adopting the ImPACT testing, which requires each athlete to perform a series of cognitive and physical tests before the season. Athlets sustaining a hit to the head or suspected concussion are required to repeat the ImPACT testing and achieve baseline performance before returning to play. Several states are now requiring youth athletes to obtain a physician’s written note before returning to play, which is a trend that could catch on in other regions of the country.
For more coverage, read “10 Stories for Team Physicians About Concussion Awareness.”
