Doctors found 2006 AAOS meeting addressed education, information needs

An informal poll of the Orthopedics Today editorial board showed programs on CAOS, cell therapies and basic science most popular.

Issue: April 2006

Douglas W. Jackson, MD [photo]
Douglas W. Jackson

Following last month’s American Academy of Orthopaedic Surgeons Annual Meeting, the staff of Orthopedics Today and its sister publication, Orthopaedics Today International, polled their respective editorial boards for views on the overall trends in orthopedic surgery they distilled from the meeting.

We wanted to know: Was there a particular surgical technique or approach that showed promise based on new data presented during the scientific sessions? What promising new products were introduced in the technical exhibits? And did any recurring subjects come up when talking with colleagues at the meeting?

Here is what they said:

Douglas W. Jackson, MD, Long Beach, Calif. [Chief Medical Editor, Orthopedics Today]: The meeting can be overpowering if I walk around listening to different papers and didactic sessions. I have to plan carefully to meet different educational needs. This year, I spent most of my time focused on three areas:

electronic medical records (I finally made a decision on a system);
less-invasive knee surgery (ie, new instrumentation, prosthetic adaptations and surgical techniques); and
computer-assisted guidance for ACL and PCL surgical applications.

I went to specific scientific presentations and spent considerable time listening to vendors with current and upcoming products in these three areas. In addition, I talked with colleagues from around this country and Europe about their experience with different applications involving the three topics.

Scott D. Boden, MD [photo]
Scott D. Boden

Scott D. Boden, MD, Atlanta: Among the big topics, cell-based therapies have a lot of surgeon interest, but there is relatively little data at this time.

Disc replacements for spine are the hot topic, although the long-term benefit/detriments are years from becoming clear.

Gilberto Luis Camanho, MD, São Paolo, Brazil: In my opinion, the highlight was the CAOS (computer-assisted orthopedic surgery) information.

A. Seth Greenwald, DPhil(Oxon) [photo]
A.Seth Greenwald

A. Seth Greenwald, DPhil(Oxon), Cleveland: Without a doubt, this was the most satisfying and professionally valuable AAOS meeting I have attended since my first one some 34 years ago. The academy pulled a rabbit out of the hat after losing New Orleans to Hurricane Katrina. There was good weather, and it was also one of the largest academies in my memory, with 512 technical exhibitors. The city of Chicago is the home of the academy and should be its future meeting focus.

Joshua J. Jacobs, MD [photo]
Joshua J. Jacobs

[New AAOS President] Richard F. Kyle’s vision for the future — education, research and political action, as well as embracing the specialty societies as participants in the process — set the tone. It was a dramatic reaffirmation of where the academy plans to go.

Joshua J. Jacobs, MD, Chicago, Ill.: I was impressed by the commitment of the leadership of the AAOS to assess the members needs and to develop programs that provide value to the fellows. The AAOS is a model of effectiveness for specialty societies..

Ramon L. Jimenez, MD [photo]
Ramon L. Jimenez

Ramon L. Jimenez, MD, Monterey, Calif.: Highlights for me frm AAOS Annual Meeting-overall the meeting was very successful, as regards attendance, revenue, and enthusiasm. Chicago turned out to be a wonderful venue.

Diversity and Culturally Competent Care has been declared a very important goal that is to be spread and disseminated throughout the whole Academy. Your Orthopaedic Connection is receiving some direct attention and the hope and plan is to expand and improve it.

David Seligson, MD, Louisville, Ky.: [I noticed] plenty of new materials and an increased trend toward elaborate corporate displays, but these may be for investors, not orthopedic surgeons.

Charles Sorbie, MB, ChB, RCS [photo]
Charles Sorbie

Charles Sorbie, MB, ChB, RCS, Kingston, Ontario: I feel that the standards of care are becoming clearer with the advent of clinical evaluation science. That puts an onus on surgeons to meet the standards. For example, a mini symposium on a simple thing like fracture of the clavicle raised the bar considerably. The morbidity of an untreated fracture — one that had ineffective traditional treatment, one where the clavicle was allowed to be 1 cm short and one that left the skin tented up — is significant. Clavicle fractures are often treated in a cavalier fashion, left to the family physician or largely ignored by the orthopedic surgeon. The patients, as the symposium evidence showed, could be left with a poorly functioning shoulder complex for the rest of their lives.

Clinical evaluative science is an essential part of orthopedic surgery, and the standards of care will rise as a result. The paper selectors and the AAOS program organizers have, yet again, done a good job.

The industrial exhibitors put on a dazzling display in spite of the knowledge that two of them have declared recent reduction in share values. So much is packed into three days that it is difficult to spend as much time as one would like in the Exhibit Hall and attend talks, committee meetings, etc. There is no solution to the problem that will suit everyone.

On the downside, I feel the hotels raised the room prices to unfair levels. The AAOS should get a C- for that and perhaps ensure that warnings will be given to hotels that engage in that practice in the future.

Overall it was a great show, and we learned much.

Myron Spector, PhD, Boston [Regarding the Orthopaedic Research Society meeting]: About 25 years ago, a professor at MIT (David Swann) discovered a protein in joint fluid, made by synovial cells, that he said served as the boundary lubricant for joints. He named the protein “lubricin.” Over time, other researchers investigated lubricin and eventually came to the same conclusion.

Myron Spector, PhD [photo]
Myron Spector

About 10 years ago, a cartilage biology group identified a protein made by the superficial cells (ie, the top layer of cells) of articular cartilage; they named the protein superficial zone protein (SZP). Shortly thereafter, amino acid analysis showed that SZP was the same protein as lubricin. This same protein was subsequently found in other tissues, so it has other names as well. A few years ago it was found that these proteins are the product of the gene, PRG4; it is becoming accepted to refer to this protein as PRG4.

This ORS meeting had a substantial increase in the number of studies of PRG4. Of particular importance; the involvement of companies like Wyeth, which are producing PRG4 for study. This scientific work on PRG4 may lead to products for clinical use to augment or replace hyaluronic acid injections for treating osteoarthritis (OA).

Many papers dealt with the processing of mesenchymal stem cells (MSCs) from bone marrow and other tissues. One of presenter noted that a useful “marker” of marrow-derived MSCs is the surface protein CD146. Others reported various supplements to the culture medium that favor the proliferation of MSCs in monolayer culture. Of particular interest was the report of an ongoing clinical trial of MSCs prepared by the company Aastrom (aastrom.com).

My impression is that there are an increasing number of allograft companies. Moreover, I found it interesting that enough hospitals are using allograft material that they collect from their own patients that a company, Clearant Inc. (clearant.com), is marketing a service to sterilize allografts.

It seemed to me that an increasing number of companies are also introducing biomaterial scaffolds and biologics into their product line.

Carol C. Teitz, MD, Seattle:[I saw] a new collagen membrane that one could inject cartilage cells under. That avoids having to harvest a periosteal flap.