Other Articles

Biologics for Spine: Where We Are Now
Dr. Jeffrey Wang, Chief of the UCLA Spine Service and Director of the UCLA Spine Surgery Fellowship, discusses the exciting happenings in spine biologics, including growth factors, the use of different genes, and injecting stem cells into the disc. And then there are the challenges, namely the disc environment and the funding environment.

Physician Medicare Payments: Grandma vs. Docs
The fight over Medicare physician payments in Congress has been reduced to a fight over limited public dollars between Grandma and her physician. Is this a prelude to how public health care policy will be decided in the future? Read about the tussle here.

Spine Niche! Opportunity in the Spinal Deformity Market
Given the myriad of start-up companies pursuing the same patients, product differentiation and solutions for specific target markets could be the key in the future. Using the PearlDiver Patient Records Database we estimate procedure volumes for posterior fusion as a treatment for scoliosis—followed by the results of a study identifying complications associated with instrumented posterior thoracic fusion in treating scoliosis.

AAOS Political Action Committee
Active players in the orthopedic field know the importance of the AAOS Political Action Committee (PAC). On the cusp of hot topics affecting physicians and patients, the AAOS PAC works diligently to provide data to members of Congress and improve the present and future of orthopedics.

Who ARE These Guys?
Every 60 seconds or so a surgeon tears the cover off an Integra LifeSciences package. Quietly, this company has become the seventh largest medical implant manufacturer serving orthopedic surgeons in the world. Where to now? Would you believe $1 billion in two years? How about $2 billion by 2015?

Redemption in a Mechanism of Failure: The TOPS™ Story
Impliant’s TOPS™ System had a “squeaker” in its clinical study. After a voluntary suspension of the study by the company and finding the mechanism of failure, the FDA has approved a resumption of the study. What insider lessons were learned? Class starts here.

Who is Numero Uno in the PearlDiver Database!! Are You Surprised?
The answer may surprise you. Is it sore backs, aching hips, sore knees, fingers? PearlDiver details 3.8 million spine related complaints—complete with demographic information and charging information. But that’s not #1. PearlDiver also lists 3.5 million large joint complaints. Sorry, still not #1. What could the most common orthopedic complaint possibly be? To get the surprising answer…read on.

What the Knees Need: Baby Boomers and Their Options
Knee patients often show up at the doctor’s office with recurrent mechanical symptoms. It is up to the orthopedist, says Dr. Giles R. Scuderi, Director and orthopedic surgeon with the Insall, Scott & Kelly Institute in Manhattan, to thoroughly assess the patient and then determine if nonoperative treatment will do, or if the person needs a unicompartmental or total knee procedure.

Physician: Report Thyself
The government says its healthcare anti-fraud efforts are working and it wants to encourage physicians to self-report possible fraud. How well did the government do in 2007 and what about those deferred-prosecution deals with undisclosed evidence? Read about it here.

Revising the Statistics
The word that orthopedic patients least want to hear is “revision.” Who, in the universe of large joint patients, do we expect to see on the receiving end of this news? If you guessed “the elderly” you would have been wrong. The reality of who is hearing “revision” may come as a surprise. Read what we found when probing PearlDiver’s database.

Where Is Ben Now? Trends in Venture Capital
What is being funded by VCs and why? First of all, spine is having to share the spotlight, says Gary Stevenson, Managing Partner at MB Venture Partners, LLC. Here Stevenson outlines what constitutes an attractive investment…he also highlights issues that are affecting the distribution of VC funding.

The Hounds of Wall Street
Conventional wisdom on Wall Street is that ArthroCare is in a bare-knuckle fight to the finish with short sellers. Which leaves us with the dominating question: If ArthroCare is essentially a “lame duck” growth stock, then why are sales, earnings, and the stock price contradicting the short seller’s dire predictions and even outperforming consensus analyst forecasts? We have the answer.

The Era of “Tell Me Right Now” Dawns at FDA
The FDA wants the next phase of post-market oversight to change from self reporting to proactive surveillance. How? Through the Sentinel Initiative. Read what it means to device manufacturers here.

The Day After Tomorrow: Complication Rates and Instrumentation Trends in Posterior Lumbar Fusion
Could PearlDiver be the Nostradamus of spinal instrumentation? This most commonly performed surgery on the lumbar region of the spine increases fusion rates and improves spinal stability—but what about complications? Using PearlDiver’s database we find the answers. Are you ready for some quatrains about what happens next?

You Try It. No You Try It First: New Technology Adoption
What are the forces working for and against new technology adoption? Youth versus age, risk taking versus conservatism, and the economic realities of the day, says Dr. Rick Guyer, President of the Texas Back Institute.

Cheaper, Thinner, Faster, Stronger
In this, the second of our series of three articles on innovation, we tackle the question: How do you measure medical technology innovation? While difficult, measuring innovation is NOT impossible. Why? Well to start, and in the immortal words of Supreme Court Justice Potter Stewart, “We know it when we see it.”

SAS Crosses the Rubicon in Miami Beach
The SAS 8th Annual Global Symposium in Miami Beach may have crossed the Rubicon. How? Read about the Society’s opportunities for growth and collaboration as its new President lays out a vision for the future.

It's 6:30 p.m. You're cooking the evening meal. Your attention turns to the television, where reporters are discussing the latest roadside bomb in Iraq. Maybe you shake your head and think, "It's the same thing every night."

Says Lt. Col. John Thomas Friedland, M.D., an orthopedic surgeon and dedicated member of the U.S. Army, "I see that the war in Iraq is no longer on the forefront of people's minds. We are still fighting, although for a lot of people the war doesn't register anymore. I think it has almost lost its media appeal."

But, emphasizes Army Reserve Lt. Col. Paul Phillips III, M.D., people need to know what is happening. "The average American hears about the deaths, but not the injuries and not the long-term care that is required. Some soldiers are now in prostheses. An extraordinary amount of physical and mental effort is required to manage these injuries. Think about how much these individuals' lives have changed because they took a risk for their country."

And how does the Army provide medical care for the soldiers? "I am stationed at Landstuhl Regional Medical Center in Germany," says Colonel Friedland. "Landstuhl is well-located for our needs. If we had to fly wounded soldiers from Iraq or Afghanistan to the U.S., it would require refueling, thus delaying treatment. Approximately 24 to 48 hours after a soldier is wounded, he or she arrives at Landstuhl. They stay with us an average of four days, during which time we work to stabilize their condition. We typically get one plane in per day, resulting in approximately four to ten orthopedic patients a day. Once the patient is stable, he or she can be flown out to the U.S. on one of our three weekly flights."

States Colonel Phillips, an orthopedic surgeon in private practice who donates time to the Army Reserves and recently returned from a deployment to Germany, "Our unit is mobilized to support the active component of the war. As Reservists, we go to tertiary U.S. facilities, such as Landstuhl Regional Medical Center, where we get flights from both Iraq and Afghanistan. We have a doctor, nurses, techs, medics, physical therapists, and pharmacists. It's truly an emotional experience. Particularly difficult to witness is that not all patients are able to return to the same life they had previously."

As to the environment of wartime medicine, the doctors say that normal operating procedures usually don't apply. Colonel Friedland: "We primarily see injuries from Improvised Explosive Devices (IEDs). These patients require constant reevaluation because injuries that may have initially seemed less serious could worsen. The extent of soft tissue injuries is always greater in this environment. Debridement is standard treatment; unfortunately, in this environment, after your initial debridement, 24 hours later the amount of dead tissue has often increased."

Adds Colonel Phillips, "In private practice there are very few high-energy injuries. You see some orthopedic trauma injuries in the inner city, but these are guns, not bombs or the blast effects of shrapnel such as bolts or metal. In combat we see large open wounds and fractures. I've also had to do a lot of tendon reconstruction and small bone reconstruction in Baghdad and at Landstuhl. What we can do in the field versus what is possible in Baghdad varies, of course. For example, if a soldier has an open fracture of the tibia, we could not repair this in the field because of the risk of infection. We would remove the dead tissue, use an external fixator, and if the patient is stable, transport them to Baghdad or Landstuhl for further care. Overall, it's a progression of treatment life, limb, function."

These physicians know better than most people the gravity of the soldiers' sufferings. They are grateful, however, that these men and women have survived. "Body armor works and saves lives," says an adamant Colonel Phillips. "It covers the torso, chest, back, and a small portion of the neck. Although rare, spinal injuries can occur because body armor doesn?t fully cover the sides. The Army is currently developing armor with more coverage. Unfortunately, not every soldier wears body armor. And, despite what some may think, there is no safe environment out there."

While the young men and women are lying in a hospital recuperating, they have ample time to think. Says an impressed Colonel Friedland, "They are injured and yet they are thinking about their friends out in the field. When can I go back is the question I hear most often from these soldiers. They are worried about the mission and about leaving their friends behind. They are also proud of the work they are doing to help the Iraqis, such as building schools and improving communication systems."

Upholding their oath to preserve life, these surgeons also provide care to those who view life from the other side. "We treat Iraqis and Afghans, be they civilians or insurgents. These people often come in with penetrating wounds to the chest and abdomen, as well as head wounds. We know they are hurting and do what we can to provide them with good medical care."

So what of the support from non-military orthopedic surgeons and the industry as a whole states Colonel Phillips, "many orthopedic surgeons were formerly in the military, either in a combat unit or the Reserves. They have a good idea of the challenges we face every day."

Adds Colonel Friedland, "the orthopedic industry has been very supportive of our efforts. They have been quite generous with resources and training. As far as my colleagues in the U.S., they are not critical of the work we do on the patients we send to them. They are not in an ivory tower. Regarding how orthopedists in the U.S. could help, I would ask that the chairs of orthopedic departments challenge their trainees to consider a military posting, if only for a short period of time. They would be making a significant contribution to their country and our citizens."

And, says Colonel Phillips, military medicine is different. "The things you get to experience really expand the complexity of injuries that you learn to treat."

Colonel Phillips' last comment: "I've chosen to be a Reservist, despite the fact that it interrupts my daily work and personal life. We need reminders that to live the type of life we do, to have our children not be fearful, requires men and women to step up to the plate. That's why I stay."

Colonel Friedland's final message: "Our generation is equal to the task of protecting us. I am honored to work with them."

Thank you, from Orthopedics This Week, to the men and women of the U.S. military.