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Key issues of 2012 may concern orthopaedic surgeons in 2013 and beyond
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Orthopaedics Today Europe begins a new era with this digital newspaper, which was published as a print newspaper six times a year since 1998. As a digital publication, there will be 10 issues annually that can be accessed by a computer or a digital device.
This change is both a logical and natural one since many of us now receive much of our orthopaedic education and updates in a digital format. We also use other forms of electronic media much more often, such as social media or YouTube to access training videos.
With a focus on current trends, this Commentary discusses the most viewed articles of 2012 in Orthopaedics Today Europe from our website Healio.com/orthopaedics. I highlight the topics our readers found most interesting and informative last year. I think the same topics serve as a guidepost to the issues that will prove important to orthopaedic surgeons and our patients in 2013 as well.
Interest in navigation declines
In 2012, European orthopaedic surgeons found they used computer navigated surgery — mostly for major lower limb joint replacement — less than before and many were less interested in this technology than in previous years. There are several reasons for this trend, but basically it comes down to the fact that the studies with longer term computer navigation results now being presented show no significant improvement in survival of implants placed with navigation. Also navigation increases the time in surgery for each case, even in the hands of experienced surgeons, and the instruments and systems come with a high price tag.
Without evidence of economic or clinical benefits, it is logical to me to leave navigation technology in its current state and look to the newer, more user-friendly technical set-ups being developed.
Patient-specific instruments and implants were another hot topic in 2012 — one that is driven by several key orthopaedic colleagues and industry. This method of joint arthroplasty may well deliver a more reliable way of templating prior to these procedures, leading to more exact-fitting instruments and implants and improved functional outcomes and survival. However, we need clearer data on its safety and cost before techniques are released more extensively. I believe our industrial partners can have a major impact on the use of this technology by assisting in its stepwise introduction.
Metal-on-metal implant controversy
But without question, the most described and hotly debated topic in orthopaedic surgery worldwide in 2012 was the status of metal-on-metal (MoM) bearings in hip arthroplasty. Interest and concern about the issues surrounding MoM hip implants, including various implant recalls, was slowly building before last year, but it exploded in 2012.
The topic was also met with intense interest from health authorities in Europe and North America, as well as the media. In several nations, including my own country of Denmark, the government got involved in the ongoing debate about MoM arthroplasty and solving the problems that patients and health care systems now face.
The MoM debate has not been positive for the orthopaedic world. I expect that at this juncture using prostheses and orthopaedic devices that are unproven or not fully tested implants is out of the question in the minds of many physicians, countries and health authorities. Due to the ongoing MoM debate, we can also expect to see stricter regulations about the use of all types of implants in patients going forward.
However, the factual “disaster” with MoM implants still needs to be carefully analyzed. As more specific data are published, I am sure we will all become a little more confused about what the real lessons learned from this situation are since no linear relationship currently seems to exist between MoM bearings and whole blood metal ion levels, soft tissue lesions, such as pseudotumors, and other clinical symptoms. This lack of data actually makes it more difficult and complicated when we try to reliably advise our patients whether a revision procedure is indicated, and support our colleagues with guidance on what to do and not do as a next step in these cases.
Finally, it is important to note that some of the issues related to the bearing surface in MoM hip arthroplasty can occur with other procedures. They have been associated with the taper junction between the neck and head in the trunnion in total hip arthroplasty. Some data in total knee replacement show elevated chromium and cobalt levels in the blood serum of patients.
One thing is certain in my mind. In 2013, we will all learn much more about these topics surrounding MoM arthroplasty. I sincerely hope what we all take away from this process is a much clearer understanding of all the issues, which will ultimately help us advise our patients.
- For more information:
- Per Kjaersgaard-Andersen, MD, is the Chief Medical Editor of Orthopaedics Today Europe. He can be reached at Orthopaedics Today Europe, 6900 Grove Road, Thorofare, NJ 08086, USA; email: orthopaedics@healio.com.