воскресенье, 23 октября 2011 г.

SUFE (Slipped Upper Femoral Epiphysis) - Delay In Diagnosing "Can Be Devastating"

Delayed diagnosis of slipped upper femoral epiphysis (SUFE) can result in
lifelong disability and medicolegal claims of more than ВЈ100,000, according
to a report in the latest (Spring 2008) edition of Summons, the magazine of
MDDUS, The Medical and Dental Defence Union of Scotland.


The condition occurs in up to seven individuals per 100,000 and, as such, is
likely to be encountered once or twice in any one GP's career, says Jamie
MacLean, who as lead consultant at Tayside Children's Orthopaedic Service
provides expert reports for MDDUS.


A 2.5 fold increase in the incidence of SUFE has been recently reported,
with a suggested link to the growing problem of childhood obesity, says Mr
MacLean.


SUFE persists as a regular source of medicolegal claims, often in excess of
ВЈ100,000, adds Dr Rob Hendry, a medicolegal adviser at MDDUS. Claims are
unusual but regularly encountered. "Every year we usually see one or two
cases. Where the outcome can be so devastating, it's one or two too many.


"In the practice of medicine there are relatively few conditions in which an
early diagnosis can make a radical difference to the outcome for a patient.
SUFE is one of them. Miss it, and both patient and doctor can live to regret
it. GPs should have a high index of suspicion when it comes to SUFE-like
symptoms."


SUFE occurs typically among children aged between 10 and 16, in twice as
many boys as girls. However, there has been an increase in children as young
as eight presenting with SUFE, and when it occurs at this age, bilateral
disease is more common. SUFE tends to affect obese children, but may also
occur in tall thin individuals.


Conditions associated with increased risk of SUFE in children include a
previous slip on the other side, hypothyroidism, hypogonadism,
panhypopituitarism, primary and secondary hyperparathyroidism and growth
hormone deficiency. Children on steroids, or undergoing chemotherapy or
radiotherapy, may also be at increased risk of SUFE.


SUFE can be 'silent' and painless with deformity developing slowly over
months. Usually the onset of symptoms is insidious. When they follow sport
they can easily be incorrectly attributed to muscle strain.


Most patients have hip or groin pain, but a fifth of patients report
isolated knee or thigh pain, and these are particularly at risk of
misdiagnosis.


"SUFE is a condition that progresses and so it's important to recognise any
increase in the severity of symptoms or signs," says Mr MacLean.


Pain on weight bearing is an important symptom. In five to 10 per cent of
cases the condition can become rapidly progressive, as reflected by an
inability to weightbear. Such cases represent a genuine surgical emergency.
The outcome in this subgroup is invariably very poor unless referred for
treatment immediately.


"Unfortunately, delay in diagnosis occurs both in general practice and
hospital and can have a devastating effect on the outcome - a disabled
adolescent being the end result," says Mr MacLean. Early diagnosis enables
uncomplicated surgical intervention with the expectation of a near to normal
outcome. If misdiagnosed, "individual cases make sad reading, with major
impacts on patients' lives and, indeed, attitudes to life and work," says Mr
MacLean.


Common pitfalls leading to claims include failure to consider the diagnosis,
failure to examine the hip, being falsely reassured by a previous "normal"
X-ray and failing to appreciate the urgency of referral. In this age group
hip, groin, distal thigh or knee pain should always be regarded as a
potential SUFE. Indeed, any child complaining of knee pain in whom the knee
examination is normal should be regarded as a case of SUFE until proven
otherwise.


The loss of earnings potential in patients who cannot pursue their intended
careers subsequent to SUFE accounts for those cases which settle for over
ВЈ100,000, whilst those involving pain and cosmetic problems - invariably
with an increased risk of osteoarthritis - settle at around ВЈ10,000-ВЈ60,000.


MDDUS is a medical defence organisation providing access to
professional indemnity and expert medicolegal advice for doctors, dentists
and other healthcare professionals throughout the UK.


mddus

четверг, 20 октября 2011 г.

Depuy Orthopaedics Launches Significant Enhancements To Its Sigma(R) Knee Product Portfolio

DePuy Orthopaedics, Inc., a global leader in
devices for joint replacement, announced the launch of new products in its portfolio of
Sigma® Knee products that offer surgeons the ability to select from a wide range of instruments
and implants based on a spectrum of patient needs and their own surgical preferences.


"The launch of these new Sigma Knee products signals a new wave of innovation that will have
significant effects on patient care," said David Floyd, President, DePuy Orthopaedics, Inc.
"These significant enhancements to the Sigma Knee group are the beginning of a new era of
products and solutions designed to offer high performance instrumentation, customization,
quicker recovery, and longer-term durability for the wide range of patients seeking knee
replacement today."


DePuy Orthopaedics made the announcement at the 75th Annual Meeting of the American Academy
of Orthopaedic Surgeons (AAOS), where it will showcase these new products, including Sigma
High Performance instruments, a new line of instruments designed to enhance procedure efficiency,
surgical precision and flexibility. Designed for contemporary knee surgery, the High Performance
Instruments adapt to a surgeon's specific surgical technique, including computer assisted surgery
and manual surgery, with both minimally invasive and traditional open approaches. Sigma High
Performance instruments were developed with a compact design to allow for smaller incisions and
are soft-tissue friendly to reduce surgical trauma. This is DePuy Orthopaedics' largest introduction
of instrumentation in a decade.


"Sigma High Performance Instruments are the most advanced instrumentation we have ever
developed, and the initial feedback from surgeons who've already used the instruments is
extremely positive. These instruments will further contribute to the excellent results seen with
our Sigma Knee implants," said Tom Lavery, Vice-President Marketing, Knees.
Also at AAOS DePuy Orthopaedics is introducing into the Sigma Knee product group the Sigma
CR Porocoat Femur, a cement-less fixation femoral component that contains a porous coating
conducive to deep bone ingrowth and better long-term fixation of the implant and the Sigma PS
Femur, designed to provide today's high demand patients with enhanced function from gait to
deep flexion activities, and the next generation in computer assisted knee software, Ci™ Essential
Knee.


DePuy will introduce additional Sigma Knee products and services over the next 18 months.
The Sigma Knee will also be part of a consumer education campaign called Sigma -- My knee.
My life™. This campaign will encourage patients to talk with their surgeons about which Sigma
knee replacement system will best fit their lifestyle and activity level. For more information visit
kneereplacement.


About Knee Replacement















According to the AAOS more than 500,000 total knee replacements are performed in the U.S.1
The AAOS notes that more joint replacement surgeries are performed on the knee than on any
other joint. In a total knee replacement, the knee is replaced by prostheses made of metal alloys,
high-grade plastics and polymeric materials. Most of the other structures of the knee remain
intact. Knee replacement surgery is generally recommended for patients with severe knee pain
and disability caused by damage to cartilage from rheumatoid arthritis, osteoarthritis or trauma.
It is highly successful in relieving pain and restoring joint function.
The performance of knee replacements depends on age, weight, activity level, and other factors.
There are potential risks and recovery takes time. People with conditions limiting rehabilitation
should not have this surgery. Only an orthopaedic surgeon can tell if knee replacement is right
for a patient.


About DePuy Orthopaedics, Inc.


DePuy Orthopaedics, Inc., a Johnson & Johnson company, is advancing the standard of
orthopaedic patient care, with a focused commitment to help surgeons achieve excellence in
surgical practice. The company designs, manufactures and distributes orthopaedic devices and
supplies including hip, knee, extremity, trauma, cement, orthobiologics, and operating room
products. As a global leader in joint replacement products, DePuy Orthopaedics is committed to
Restoring the Joy of Motion® for patients whose mobility is restricted by severe osteoarthritis or
other debilitating injury. For more information about DePuy Orthopaedics, Inc., visit the
company's Web site depuyorthopaedics.


This press release contains "forward-looking statements" as defined in the Private Securities
Litigation Reform Act of 1995. These statements are based on current expectations of future
events. If underlying assumptions prove inaccurate or unknown risks or uncertainties materialize,
actual results could vary materially from Johnson & Johnson's expectations and projections.
Risks and uncertainties include general industry conditions and competition; economic
conditions, such as interest rate and currency exchange rate fluctuations; technological advances
and patents attained by competitors; challenges inherent in new product development, including
obtaining regulatory approvals; domestic and foreign health care reforms and governmental laws
and regulations; and trends toward health care cost containment. A further list and description of
these risks, uncertainties and other factors can be found in Exhibit 99 of the Company's Annual
Report on Form 10-K for the fiscal year ended December 30, 2007. Copies of this Form 10-K, as
well as subsequent filings, are available online at sec, jnj or on request from
Johnson & Johnson. Johnson & Johnson does not undertake to update any forward-looking
statements as a result of new information or future events or developments.


Reference:


"Facts on Knee Replacements," American Academy of Orthopaedic Surgeons, 2005.


DePuy Orthopaedics

понедельник, 17 октября 2011 г.

Wyeth Receives Approvable Letter From FDA For Bazedoxifene For The Treatment Of Postmenopausal Osteoporosis

Wyeth Pharmaceuticals, a
division of Wyeth (NYSE: WYE), announced that the U.S. Food and Drug
Administration (FDA) issued an approvable letter on May 21 for
bazedoxifene, a selective estrogen receptor modulator, for the treatment of
postmenopausal osteoporosis. In the letter, the FDA requested information
similar to that outlined in its approvable letter for bazedoxifene's New
Drug Application (NDA) for the prevention of postmenopausal osteoporosis
issued in December 2007. This included further analyses concerning the
incidence of stroke and venous thrombotic events. The Agency also
identified specific questions concerning data collection and reporting and
requested additional source documents.



"Today's action is in line with our expectations," says Gary L. Stiles,
M.D., Executive Vice President, Chief Medical Officer, Wyeth
Pharmaceuticals. "In our conference with the Agency earlier this year, they
stated their desire to convene an advisory committee to review the pending
new drug applications for both treatment and prevention of postmenopausal
osteoporosis. We have been working closely with the FDA to address their
questions and we are preparing a complete response which we expect to file
by end of 2008. We remain committed to pursuing bazedoxifene as an
important new option for the millions of postmenopausal women at risk for
osteoporotic fracture."



About Osteoporosis



Osteoporosis is a disease characterized by low bone mass and structural
deterioration of bone tissue, leading to bone fragility and an increased
risk of fractures. According to the National Osteoporosis Foundation, the
number of women of menopausal age who have osteoporosis or are at risk for
developing the disease will increase from almost 30 million in 2002 to
nearly 41 million in 2020. Up to 20 percent of a woman's expected lifetime
bone loss can occur in the years immediately following menopause. The
treatment of postmenopausal osteoporosis could lead to significant
improvement in the overall health for millions of women worldwide as well
as reduce costs associated with postmenopausal osteoporosis-related
fractures.



About Wyeth Pharmaceuticals



Wyeth Pharmaceuticals, a division of Wyeth, has leading products in the
areas of women's health care, infectious disease, gastrointestinal health,
central nervous system, inflammation, transplantation, hemophilia,
oncology, vaccines and nutritional products.



Wyeth is one of the world's largest research-driven pharmaceutical and
health care products companies. It is a leader in the discovery,
development, manufacturing and marketing of pharmaceuticals, vaccines,
biotechnology products, nutritionals and non-prescription medicines that
improve the quality of life for people worldwide. The Company's major
divisions include Wyeth Pharmaceuticals, Wyeth Consumer Healthcare and Fort
Dodge Animal Health.
















The statements in this press release that are not historical facts are
forward-looking statements that are subject to risks and uncertainties that
could cause actual results to differ materially from those expressed or
implied by such statements. These risks and uncertainties include, without
limitation, the inherent uncertainty of the timing and success of, and
expense associated with, research, development, regulatory approval and
commercialization of our products and pipeline products (including that
there can be no assurance that our pending new drug applications for
bazedoxifene will be approved or that the product will ever be successfully
commercialized); government cost-containment initiatives; restrictions on
third-party payments for our products; substantial competition in our
industry, including from branded and generic products; emerging data on our
products and pipeline products; the importance of strong performance from
our principal products and our anticipated new product introductions; the
highly regulated nature of our business; product liability, intellectual
property and other litigation risks and environmental liabilities;
uncertainty regarding our intellectual property rights and those of others;
difficulties associated with, and regulatory compliance with respect to,
manufacturing of our products; risks associated with our strategic
relationships; economic conditions including interest and currency exchange
rate fluctuations; changes in generally accepted accounting principles;
trade buying patterns; the impact of legislation and regulatory compliance;
risks and uncertainties associated with global operations and sales; and
other risks and uncertainties, including those detailed from time to time
in our periodic reports filed with the Securities and Exchange Commission,
including our current reports on Form 8-K, quarterly reports on Form 10-Q
and annual report on Form 10-K, particularly the discussion under the
caption "Item 1A, Risk Factors" in our Annual Report on Form 10-K for the
year ended December 31, 2007, which was filed with the Securities and
Exchange Commission on February 29, 2008. The forward-looking statements in
this press release are qualified by these risk factors. We assume no
obligation to publicly update any forward-looking statements, whether as a
result of new information, future developments or otherwise.


Wyeth Pharmaceuticals

wyeth

пятница, 14 октября 2011 г.

New Prospective Multicenter Long-Term Balloon Kyphoplasty Study To Be Featured On American Health Radio

Kyphon Inc. (Nasdaq: KYPH) announced today that Richard Mott, Kyphon's president and
chief executive officer, and Dr. Rudolph Buckley, orthopaedic spine surgeon
from Slocum Dickson Medical Group in Utica, New York, will be interviewed
on American Health Radio, the nationally-syndicated health radio program
hosted by Scott Broder. Dr. Buckley is co-author of the first-ever
prospective multicenter long-term clinical study evaluating the benefits of
balloon kyphoplasty treatment of osteoporotic spinal fractures. This study
was recently published in the September 1, 2006 issue of Spine, the leading
subspecialty, peer-reviewed journal reporting on spinal disorders.



The program will air live today, Monday, October 2, 2006 at 6:00 p.m.
Central Time and can be accessed at wrmn1410. A replay of
the program will be available on Wednesday, October 4 at 8:00 p.m. Central
Time and on Friday, October 6 at 6:00 p.m. Central Time at
healthradionetwork.



This latest study in the growing body of evidence for balloon
kyphoplasty showed that patients experienced rapid and sustained
improvement in back pain, back function and quality of life for two years
post-procedure. In addition, the study documented improvements in restoring
vertebral height and high patient satisfaction with the procedure. To view
a Multimedia News Release, which reveals details about the study, please
visit prnewswire/mnr/kyphon/25116.



Spinal Fractures and Balloon Kyphoplasty



The majority of spinal fractures are caused by osteoporosis, a
progressive disease that causes bones to become brittle, weak and
susceptible to painful, debilitating fractures. According to the National
Osteoporosis Foundation, one-in-two women and one-in-four men over the age
of 50 in the U.S. will experience a spinal fracture, with two-thirds going
undiagnosed. Cancer, including multiple myeloma and the metastasis of other
tumors to bone, can also affect bone quality and lead to spinal fracture.
In cases of multiple spinal fractures, a loss of height and stooped posture
-- known as kyphosis -- can occur, which affects the ability to stand
upright and walk, and can make simple tasks like lifting a bag of groceries
or getting dressed difficult. Left untreated, each additional fracture
increases future fracture risk, accelerating the effects of the spinal
deformity. Increasing kyphosis is associated with decreased respiratory
function, reduced ability to walk, decreased quality of life, and an
increased risk of early mortality.



Supplemental calcium with vitamin D and prescription medications are
often used to slow down bone loss and treat the underlying osteoporosis.
Medical management, however, does not always prevent fracture. Despite the
advances in drug therapy, spinal fractures continue to occur and may
require surgical intervention. First performed in 1998, balloon kyphoplasty
is a minimally invasive procedure which can treat the fracture, reduce
pain, restore quality of life, and repair some or all of the associated
deformity. To date, over 275,000 spinal fractures have been treated using
balloon kyphoplasty worldwide.



To request a full copy of the study, go to
kyphon/professionals/pcpnewsletterrequests.cfm.



To find a Spine Specialist who performs Balloon Kyphoplasty in your
area, go to kyphon/phys_Locator.cfm.



For additional downloadable media materials, go to
kyphon/media.cfm.



About Kyphon Inc



Kyphon develops and markets medical devices designed to restore spinal
function using minimally invasive technologies. The company's KyphX line of
products is used in balloon kyphoplasty, a minimally invasive procedure to
treat spinal fractures caused by osteoporosis or cancer. For more
information, visit Kyphon's Web site at kyphon.



Kyphon and KyphX are registered trademarks of Kyphon Inc


Kyphon Inc

kyphon

вторник, 11 октября 2011 г.

UC San Diego Bioengineer's Sticky Insights Published In Journal Science

Sticky is good. A University of California, San Diego bioengineer is the first author on an article in the journal Science that provides insights on the "stickiness of life." The big idea is that cells, tissues and organisms hailing from all limbs of the tree of life respond to stimuli using basic biological "modules." For example, the researchers outlined similar strategies across biology for fulfilling the tasks of "sticking together" (cell-cell interactions), "sticking to their surroundings" (cell-extracellular matrix [ECM] interactions), and responding to forces.



Adam Engler, a bioengineering assistant professor from UC San Diego's Jacobs School of Engineering, is the first author of the Review article entitled "Multiscale Modeling of Form and Function" published in the 10 April issue of the journal Science. According to Engler, there is something inherent in the nature of the ever-present tasks of sticking together and responding to forces that causes common form and function to emerge. For example, even though the cells within bacteria, fungi, sponges, nematodes and humans do not use exactly the same proteins to stick together, all of these organisms rely on fundamental components of cell-cell adhesions for survival. For this reason, the capacity to form complex multilayer organisms through cell-cell interactions is likely based on the evolutionary advantage to adhere to new environments and survive in potentially hostile environments, the authors say.



The team also described a universal need for cells, tissues, organs and organisms to respond to forces. Two examples of very different biological structures that nevertheless rely on responsiveness to forces for proper function are leg bones and breast acini. Breast acini are hollow spherical objects at the ends of breast ducts that are made of a layer of cells that secrete milk proteins. Breast acini form hollow spheres, according to Engler, because this form maximizes the surface to volume ratio. When pressure builds up, acini can hold more and more volume until they need to push the milk proteins down the duct.



"This kind of structure is conserved in a variety of dissimilar systems that respond to forces in a manner similar," said Engler. The long bones of the human skeleton are another example, where their elongated and cylindrical form optimizes the distribution of body weight while remaining very light.



Thinking Wide



Engler hopes that the observations and connections he and his coauthors make regarding the ubiquitous need for vastly different cells, tissues, organs and organisms to use common biological modules will encourage other scientists and engineers to think beyond their specific areas of specialization.



"In our Science paper, I think we have arrived at an interesting way to describe known biological processes and bring concepts together that are traditionally not considered," said Engler. "I hope this paper will encourage researchers to interact with disciplines previously assumed to be dissimilar and foster new interdisciplinary interactions like we have here at UCSD with the Institute for Engineering in Medicine."
















Engler's primary appointment is in the Department of Bioengineering at UC San Diego's Jacobs School of Engineering. The Department of Bioengineering ranks 2nd in the nation for biomedical engineering, according to the latest US News rankings. The bioengineering department has ranked among the top five programs in the nation every year for the past decade.



Engler has secondary appointments in Material Science and Biomedical Sciences. He is a member of the UCSD Stem Cell Institute and the UCSD Institute for Engineering in Medicine.



Engler is a bioengineer and mechanical engineer by training. He earned a Ph.D. in mechanical engineering from the University of Pennsylvania, and went on to a post doctoral fellowship in molecular biology at Princeton University before coming to UC San Diego in 2008. He is already involved in a number of interdisciplinary collaborations at UC San Diego.



One collaboration involves Engler, Shu Chien, who is University Professor of Bioengineering and Medicine, and Director of UC San Diego's Institute of Engineering in Medicine (IEM), and materials science professor Sungho Jin from the Jacobs School of Engineering's Mechanical and Aerospace Engineering (MAE) and NanoEngineering departments. In a January 2009 paper in the journal PNAS, researchers led by this team unveiled a new way to help accelerate bone growth through the use of nanotubes and stem cells. This new finding could lead to quicker and better recovery, for example, for patients who undergo orthopedic surgery.



Engler's lab recently began a collaboration with Rick Lieber, Ph.D., Professor and Vice Chair of UC San Diego's Department of Orthopedic Surgery and Director of the National Center for Skeletal Muscle Rehabilitation Research, based at UC San Diego. Lieber is also Senior Research Career Scientist at the Veterans Affairs San Diego Health System. The team is trying to uncover the cause of unexplained lower back pain in patients with no obvious disk degeneration, pinched nerves or other known causes of lower back pain.



"No matter what your area of expertise, there is someone that has a complementary area of expertise that can really help you ask new and interesting questions," said Engler.



Interdisciplinary Research



Mathematicians, engineers and stem cell biologists have not traditionally worked together, but these kinds of interdisciplinary collaborations have been the key to developing new techniques and new disciplines, explained Engler, who told a story of how his own dabbling into interdisciplinary research led to fruitful results.



As a graduate student, Engler helped put an experimental stem-cell-based surgical technique into a more appropriate mechanical context. The project began when he was approached by a surgeon puzzled by the results he was getting after injecting stem cells into damaged rat heart tissue in hopes of regenerating healthy heart tissue.



"As a matrix biologist and a mechanical engineer I said, 'Perhaps we need to look at what the host tissue is actually doing. What is being damaged and what is changing within the tissue due to the lack of oxygen?'" Engler and his collaborators found the cells in the damaged heart tissue were excreting collagen and making stiff scar tissue. "The engineer in me then analyzed the mechanical properties of the tissue and found out it was three to four times more rigid than the background healthy muscle. The biologist in me then characterized the cells in vitro and was able to show that these cells do respond to the mechanical properties of their environment."



Engler published his findings in 2006 in the high profile journal Cell and in the American Journal of Physiology. (Read New Scientist's description of Engler's findings.) One idea for improving such cell-based therapies, according to Engler, could involve injecting "smarter stem cells" that have been programmed to respond to some environmental stimuli but ignore other stimuli.


Notes:


"Multiscale Modeling of Form and Function, by Adam J. Engler from the University of California, San Diego; Patrick O. Humbert from Peter MacCallum Cancer Center; Bernhard Wehrle-Haller from Centre Medical Universitaire; and Valerie M. Weaver from University of California, San Francisco.



Source:
Daniel Kane


University of California - San Diego

суббота, 8 октября 2011 г.

Actemra Is First Biologic Agent To Show Better Efficacy Than Methotrexate In RA

PARIS: The interleukin-6 receptor inhibitor Actemra (tocilizumab) achieves significantly greater reduction in the signs and symptoms of rheumatoid arthritis (RA) than the current standard of care, methotrexate, according to two international clinical trials reported this week at EULAR 2008, the Annual European Congress of Rheumatology.


The phase III AMBITION (Actemra versus Methotrexate double-Blind Investigative Trial In mONotherapy) trial randomised 673 patients with active moderate to severe RA, including a high proportion of patients with early disease, to Actemra (8mg/kg) or methotrexate.


Results showed significantly greater reduction in the signs and symptoms of RA at six months in patients treated with Actemra than in those given methotrexate. Nearly three-quarters (70%) of patients treated with Actemra achieved a 20% reduction in their symptoms (ACR20) after 24 weeks, compared to 53% of those treated with methotrexate. No previous biologic therapy has demonstrated superior efficacy to methotrexate in this key measure of RA symptoms by six months.


Nearly three times as many patients treated with the Actemra achieved remission of their RA - defined by the globally recognised measure of Disease Activity Score (DAS) 28 < 2.6 - compared to those taking methotrexate (34% vs 12%). Remission is the ultimate goal in the treatment of RA.


Reporting the results, Professor Graeme Jones, Professor of Rheumatology, University of Tasmania, Hobart, Australia and lead investigator of the study, said: "Tocilizumab demonstrated superior efficacy to methotrexate across a range of measures of RA signs and symptoms. It is the first and only biologic agent that has demonstrated clinical superiority compared to methotrexate as monotherapy."


Asked what treatment he would want to take if diagnosed with RA, Professor Jones said: "Last year, I would have said methotrexate plus an anti-TNF agent, starting on day one. But based on the new data with tocilizumab showing that, as monotherapy, it achieves equivalent efficacy, I wouldn't mind taking this from day one." He added that it had been easy to tell which patients were on Actemra in the trial, as their improvements in RA symptoms were so rapid and dramatic.


Results from a second major study with Actemra showed that the IL-6 receptor inhibitor was also highly effective in difficult-to-treat RA patients who had previously had an inadequate response to anti-tumour necrosis factor drugs (anti-TNFs).


The RADIATE (Research on Actemra Determining effIcacy after Anti-TNF FailurEs) randomised 499 patients with moderate to severe active RA and an inadequate response to at least one anti-TNF drug to Actemra (8 or 4mg/kg) or placebo, in combination with 10-25mg methotrexate.


Half (50%) of patients treated with Actemra (8mg/kg) plus methotrexate achieved an ACR20, compared with 10% of those in the control group. Disease remission (DAS28

среда, 5 октября 2011 г.

How Often Do Hip And Knee Replacements Need Revision?

A comprehensive study using nationwide data on hip and knee replacements in England has found that one in seventy-five patients require a revision of
their joint replacement after three years. Although this compares favourably with the rest of the world, the study published in this week's PLoS
Medicine reinforces concerns about the new surgical techniques of hip resurfacing and unicondylar knee replacement.



Hip and knee replacements are amongst the most frequent surgical operations performed, with around 160,000 carried out in England and Wales in 2006.
However, there is little evidence to compare the patient outcomes of hip and knee replacement with the many types of surgical techniques and
prostheses used to replace the joint. Jan van der Meulen and colleagues from the Royal College of Surgeons used records from the National Joint
Registry (NJR) for England and Wales to address this lack of evidence; the NJR being the largest national joint registry of any in the world. Since it
was established in April 2003 the NJR has collected data available immediately following surgery, including patient characteristics, the type of
prostheses and the surgical technique used to replace the joint, with the aim of providing patients, healthcare professionals and regulators with
evidence to assess these prostheses and techniques.



In order to identify the revision rates - how often the hip or knee replacement had to be re-done - the researchers linked the NJR records with
another database: the Hospital Episodes Statistics (HES), which contains information on all admissions to National Health Service (NHS) hospitals in
England. They considered revisions for any reason in the three years following a hip or knee replacement. They also paid particular attention to hip
resurfacing and unicondylar knee replacement, two techniques that are increasingly used but about which there is little evidence of their performance.
Hip resurfacing was introduced in the 1990s for younger patients or those with less severe disease. Rather than replacing the head of the femur, as
happens in total hip replacement, the diseased surface of the joint is replaced with a metal component. In unicondylar knee replacement only the
damaged part of the knee is replaced and it also results in shorter recovery time.



Of the 167,076 procedures that could be linked between the two databases between April 2003 and September 2006 - about half of all such operations
carried out in England in this period - one in seventy-five patients required a revision of their joint replacement, which is considered to be low. As
expected the patients who had cemented prostheses - cement being used to position the metal implant in place in the original replacement surgery - had
the lowest revision rates. For hip replacements the highest revision rates were experienced by women who had undergone hip resurfacing rather than
total joint replacement. Of patients who had undergone knee replacement operations, those who had unicondylar prostheses had the highest revision
rates. According to the study there appears to be no connection between a patient's age and revision rates for hip replacements, whereas revision
rates after knee replacement decreased strongly with age.
















The study demonstrates what can be achieved by linking together the two databases and it shows convincing success rates of knee and hip replacement
surgery, with few patients requiring a revision. However, on the basis of the data, the researchers suggest that "consideration should be given to
using hip resurfacing only in male patients and unicondylar knee replacement only in elderly patients." They point out that different patterns may
emerge over a longer follow-up period, so it is not possible to directly draw conclusions on the long-term efficacy of the different procedures.
However, this first national study on joint replacement does provide benchmark data for the further research that is needed to evaluate the
performance of different procedures and types of implant.



Revision rates after primary hip and knee replacement in England between 2003 and 2006.
Sibanda N, Copley LP, Lewsey JD, Borroff M, Gregg P, et al. (2008)

PLoS Med 5(8): e179. doi:10.1371/journal.pmed.0050179

Click here to view article online.


About PLoS Medicine



PLoS Medicine is an open access, freely available international medical journal. It publishes original research that enhances our understanding of
human health and disease, together with commentary and analysis of important global health issues.


PLoS Medicine



About the Public Library of Science



The Public Library of Science (PLoS) is a non-profit organization of scientists and physicians committed to making the world's scientific and medical
literature a freely available public resource.

Public Library of Science