Author Interviews, Cleveland Clinic, Orthopedics, Pain Research, Surgical Research / 01.08.2017

MedicalResearch.com Interview with: [caption id="attachment_36247" align="alignleft" width="159"]Michael A. Mont, MD Department of Orthopaedic Surgery Cleveland Clinic Cleveland, OH Dr. Mont[/caption] Michael A. Mont, MD Department of Orthopaedic Surgery Cleveland Clinic Cleveland, OH  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Postoperative pain after total knee arthroplasty (TKA) is a major hurdle for both the patients and the orthopaedists. Many analgesic modalities are currently in use, and can be used alone or in combination in order to augment their effect. Addition of local anesthetic analgesia has been shown to improve pain control and reduce opioid consumption during postoperative period. However, the effects of this analgesia tend to dissipate with time, with the longest duration of action (bupivacaine) of approximately 12 hours. Therefore, long acting local anesthetic (liposomal bupivacaine) has been developed in order to expand the duration of effectiveness of pain relief for up to 96 hours. Many studies evaluated the effectiveness of this anesthetic and demonstrated contradictory results, however, they did not use the same methods and infiltration technique. Therefore, we conducted a prospective, randomized, double-blind, controlled study at 16 hospitals using optimal infiltration techniques. Our study demonstrated significant improvement in pain, decreased opioid consumption, increased time to first opioid rescue, more opioid free patients in liposomal bupivacaine cohort. In addition, there were no unexpected safety concerns.
Author Interviews, JAMA, Orthopedics / 11.07.2017

MedicalResearch.com Interview with: [caption id="attachment_35801" align="alignleft" width="193"]2009 Presspicture, Mattias Lorentzon for free publication. (Photographer: Magnus Gotander,Bilduppdraget,Sweden) Prof. Lorentzon[/caption] Mattias Lorentzon, PhD Professor, Senior Physician Head of Geriatric Medicine, Institute of Medicine, Sahlgrenska Academy Sahlgrenska University Hospital, Mölndal Mölndal, Sweden MedicalResearch.com: What is the background for this study? What are the main findings? Response: It was previously known that alendronate reduces the risk of vertebral fractures in patients using oral glucocorticoids, but there were no studies regarding hip fractures, which are the most severe osteoporotic fractures, often resulting in disability and mortality. We found that older patients prescribed alendronate after starting medium to high doses of oral prednisolone had a much lower risk of hip fracture than patients not taking alendronate.
Author Interviews, Exercise - Fitness, Orthopedics, Pediatrics / 31.05.2017

MedicalResearch.com Interview with: Jacqueline Pasulka, OMS II Des Moines University College of Osteopathic Medicine , Des Moines , IA Division of Pediatric Orthopaedic Surgery & Sports Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago , IL MedicalResearch.com: What is the background for this study? What are the main findings? Response: In this study young athletes were recruited from both sports medicine and general practice clinics and were asked to complete surveys reporting on their sports participation, training patterns, and any sports-related injuries they had over the previous six months. We focused this study on the subset of athletes who met the criteria for being a single-sport specialized athlete based on their reported participation in only one sport and training for eight months or more during the year for that sport. Athletes participating in individual sports were more likely to be single-sport specialized than their team sport peers, and they also reported an earlier age at which they began specializing in their sport. Additionally, injury types differed among these two groups as single-sport specialized athletes in individual sport athletes had a greater proportion of overuse injuries, while single-sport specialized athletes in team sport athletes had a greater proportion of acute injuries.
Author Interviews, BMJ, Osteoporosis / 23.05.2017

MedicalResearch.com Interview with: [caption id="attachment_34794" align="alignleft" width="180"]Jean-Yves Reginster M.D.,PH.D. Professor of Epidemiology, Public Health and Health Economics Head of the Bone and Cartilage Metabolism Unit University of Liège Dr. Reginster[/caption] Jean-Yves Reginster M.D.,PH.D. Professor of Epidemiology, Public Health and Health Economics Head of the Bone and Cartilage Metabolism Unit University of Liège MedicalResearch.com: What is the background for this study? What are the main findings? Response: Whereas several recommendations, issued by scientific societies, recommend to use Symptom-Modifying Slow Acting Drugs (SYSADOAs) for the symptomatic and structural management of osteoarthritis, no medication is currently registered, in this particular indication, by the European Medicines Agency (EMA) or by the Food and Drug Administration (FDA). This study is the first study, conducted, with a SYSADOA which fully complies with the requirements of the EMA for the assessment of drugs to be used in the treatment of osteoarthritis, i.e. a six-month duration, two co-primary endpoints (pain and function) and a three-arm design, with a placebo and an active comparator. The main findings are that pharmaceutical grade chondroitin sulfate provides an improvement in pain and function, which is greater than placebo and not distinguishable from celecoxib, a non-steroidal anti-inflammatory drug currently licensed for the symptomatic management of osteoarthritis.
Author Interviews, Dermatology, Orthopedics, Stem Cells / 22.04.2017

MedicalResearch.com with: Lee Buckler, CEO RepliCel Life Sciences MedicalResearch.com: What is the background for this your company, RepliCel.com? Response: RepliCel Life Sciences is a Canadian regenerative medicine company based in Vancouver, British Columbia that was founded in 2006. The company focuses on the development of cell therapies using a patient's own cells (autologous cell therapy). It is developing treatments targeted at healing chronic tendon injuries that have failed to heal properly, hair restoration, and the treatment of damaged and aged skin.
Author Interviews, Hip Fractures, Mineral Metabolism / 17.04.2017

MedicalResearch.com Interview with: [caption id="attachment_33919" align="alignleft" width="150"]Dr Setor Kunutsor Ba(Legon), MBChB(Legon), MA(Cantab), PhD(Cantab) Research Fellow Musculoskeletal Research Unit University of Bristol Dr. Kunutsor[/caption] Dr Setor Kunutsor Ba(Legon), MBChB(Legon), MA(Cantab), PhD(Cantab) Research Fellow Musculoskeletal Research Unit University of Bristol MedicalResearch.com: What is the background for this study? Response: Bone fractures are one of the leading causes of disability and ill health especially among the ageing population and are a burden to health care systems. There is established evidence that calcium and vitamin D play an important role in bone health. Magnesium is an essential trace element, being the second most abundant intracellular cation after potassium and the fourth most abundant cation in the body. It serves several important functions in the body, which include protein synthesis, nucleic acid synthesis, enzymatic reactions, and has also been shown to be cardio-protective. It is also an important component of bone, with majority (67 percent) of total body magnesium known to be found in the bone tissue. There have been suggestions from both human and animal experiments that magnesium may have a beneficial effect on bone health; however, its relationship with fractures is not very certain.
Author Interviews, Orthopedics / 11.04.2017

MedicalResearch.com Interview with: [caption id="attachment_33820" align="alignleft" width="173"]Christopher M. Larson, M.D. Minnesota Orthopedic Sports Medicine Institute Twin Cities Orthopedics Edina, MN Dr. Christopher Larson[/caption] Christopher M. Larson, M.D. Minnesota Orthopedic Sports Medicine Institute Twin Cities Orthopedics Edina, MN   MedicalResearch.com: What is the background for this study? What are the main findings? Response: Until recently Athletic Hip and Pelvis disorders and the appropriate treatment strategies have not received the same attention as other sports related disorders.  There is significant overlap between intra-articular and extra-articular hip disorders that make this a challenging area of sports medicine from a diagnosis and treatment standpoint.
Author Interviews, NYU/NYMC, Orthopedics, Pediatrics, Radiology / 10.04.2017

MedicalResearch.com Interview with: Ayesha Rahman, MD Chief Orthopaedic Surgery Resident NYU Langone Medical Center. MedicalResearch.com: What is the background for this study? What are the main findings? Response: Children are more vulnerable and susceptible to lifetime adverse events from radiation exposure, caused by imaging . We reviewed literature and found certain pediatric orthopaedic patients are at greater risk for radiation exposure, namely those who have surgery for hip dysplasia, scoliosis, and leg length discrepancy, as they are among those most likely to undergo CT imaging. After reviewing all types of imaging studies performed in orthopedics and how much radiation is involved in each test, we developed several recommendations that pediatric orthopaedic surgeons should follow. Among those recommendations are: utilize low-dose CT protocols or technology that uses less imaging (like EOS), limit CT scans of the spine and pelvis, know that female patients are more susceptible to adverse risk and plan accordingly, and follow the the “as low as reasonably achievable,”principle to limit exposure to parts of the body that are necessary for diagnosis.
Author Interviews, BMJ, Cost of Health Care, Orthopedics / 29.03.2017

MedicalResearch.com Interview with: [caption id="attachment_33519" align="alignleft" width="130"]Bart S Ferket, MD, PhD Assistant Professor, Population Health Science and Policy Icahn School of Medicine at Mount Sinai Dr. Bart Ferket[/caption] Bart S Ferket, MD, PhD Assistant Professor, Population Health Science and Policy Icahn School of Medicine at Mount Sinai MedicalResearch.com: What is the background for this study? Response: The annual rate of total knee replacement in the US has doubled since 2000, and especially in those aged 45-65 utilization of this procedure has increased. The increase in practice cannot fully be explained by an increase in the prevalence of osteoarthritis and population growth, and has been partly attributed to expansion to people with less severe symptoms. The total number of procedures performed each year now exceeds 640,000. The evidence for the benefit of total knee replacement has been based on studies without a comparison group of no total knee replacement, and so far only one randomized clinical trial has been published. Although the published literature shows large improvements of pain, physical functioning and overall quality of life following the procedure, patients included in these studies generally had severe preoperative symptoms. A number of studies have suggested, however, that up to a third of recipients of total knee replacement show no benefit, and that those with poor physical functioning before surgery may show larger improvements. Therefore, the current US patient population undergoing total knee replacement might show less significant improvement in symptoms on average as compared with a hypothetical scenario in which eligibility is limited to those with more severe symptoms.  
Author Interviews, Heart Disease, JAMA, Osteoporosis / 27.03.2017

MedicalResearch.com Interview with: Wallis CY Lau BSc Centre for Safe Medication Practice and Research Department of Pharmacology and Pharmacy Li Ka Shing Faculty of Medicine The University of Hong Kong MedicalResearch.com: What is the background for this study? What are the main findings? Response: Warfarin is a vitamin K antagonist (VKA) oral anticoagulant used for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF), a common heart rhythm disorder. It works by interfering with vitamin K-dependent reactions in the process of blood clot formation. As these reactions also play a role in bone mineralization, there is concern that warfarin use may be linked with osteoporotic fracture. Despite the concerns for fracture risk, warfarin had been an inevitable treatment choice for over 50 years as there were no other alternatives available. Dabigatran is the first non-VKA oral anticoagulant (NOAC) approved for use in patients with NVAF. Recently, an animal study reported that use of dabigatran is associated with a better bone safety profile compared to warfarin in rats, suggesting a potential for a lower risk of osteoporotic fractures over warfarin. However, the actual risk of osteoporotic fractures with dabigatran use in human remains unclear. Therefore, we conducted a population-based cohort study to compare the risk of osteoporotic fractures in patients with NVAF treated with dabigatran and warfarin.
Author Interviews, Dermatology, Orthopedics / 26.03.2017

MedicalResearch.com Interview with: Dr. Jonathan L. Silverberg MD PhD MPH Assistant Professor in Dermatology Medical Social Sciences and Preventive Medicine Northwestern University, Chicago, Illinois [caption id="attachment_24142" align="alignleft" width="128"]Dr. Jonathan L. Silverberg MD PhD MPH Assistant Professor in Dermatology Medical Social Sciences and Preventive Medicine Northwestern University, Chicago, Illinois Dr. Jonathan Silverberg[/caption] Response: Psoriasis is associated with a number of potential risk factors for developing osteoporosis and pathological fractures, including including low vitamin D, chronic inflammation, higher rates of cigarette smoking and systemic corticosteroid usage. We hypothesized that adults with psoriasis have higher rates of osteoporosis and pathological fractures. We examined data from the 2002-2012 National Inpatient Sample, which contains a representative 20% sample of all hospitalizations in the United States. We found that psoriasis was associated with higher odds of osteopenia, osteoporosis, osteomalacia, ankylosing spondylitis, and pathological fractures. In particular, psoriasis was associated with vertebral, pelvic, femoral and tibial/fibular fractures. The associations between psoriasis and pathological fractures were more pronounced in women than men.
Author Interviews, Biomarkers, Exercise - Fitness, Osteoporosis / 23.03.2017

MedicalResearch.com Interview with: [caption id="attachment_33251" align="alignleft" width="117"]Pamela S. Hinton, Ph.D. Associate Professor & Director of Graduate Studies Department of Nutrition and Exercise Physiology Columbia MO 65211 Dr. Hinton[/caption] Pamela S. Hinton, Ph.D. Associate Professor & Director of Graduate Studies Department of Nutrition and Exercise Physiology Columbia MO 65211 MedicalResearch.com: What is the background for this study? What are the main findings? Response: This study builds on our previous work showing that weight-bearing, high-impact physical activity throughout the lifespan is associated with greater bone mass in men.  We previously conducted a 12-month randomized trial of the effectiveness of resistance training versus jump training to increase bone mass in men with low bone density of the hip or lumbar spine. The current study is a follow up study investigating how exercise might work to increase bone mass. The main findings are that exercise reduced circulating levels of a bone protein that inhibits bone formation (sclerostin) and increased levels of insulin-like growth factor-I (IGF-I), a hormone with osteogenic effects.
Author Interviews, Orthopedics / 20.03.2017

MedicalResearch.com Interview with: [caption id="attachment_33141" align="alignleft" width="100"]Patients Can Expect To Return To Normal Function Relatively Quickly After Knee Arthroscopy MedicalResearch.com Interview with: Alexis Colvin, MD Associate Professor, Orthopaedics Icahn School of Medicine at Mount Sinai James N. Gladstone, MD Co-Chief, Sports Medicine Service, The Mount Sinai Hospital Associate Professor, Orthopaedics, Icahn School of Medicine at Mount Sinai MedicalResearch.com: What is the background for this study? Response: Knee arthroscopy is one of the most commonly performed procedures in the U.S. There is minimal literature on when patients can expect to return to daily activity. We sought to help patients understand when they could expect to return to a number of basic activities, specifically in an urban environment where patients need to be mobile early. MedicalResearch.com: What are the main findings? Response: Our findings included: • Patients are off narcotics within 7 days, • Patients stop use of a cane/crutches at 8 days • Patients can drive after 14 days • Patients can go up subway stairs at 20 days • Patients sit on a toilet comfortably at 14 days • Patients return to work at 15 days MedicalResearch.com: What should readers take away from your report? Response: Patients can expect to return to relatively normal function within a short amount of time. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Response: We will also be looking at what other factors, such as age, BMI, medical co-morbidities, etc. can also influence how fast patients recover from this very common surgery. MedicalResearch.com: Is there anything else you would like to add? Response: MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community. Citation: 2017 AAOS abstract Return to Daily Life After Meniscectomy Alexis C. Colvin, MD, New York, NY James Dieterich, BA, New York, NY James N. Gladstone, MD, New York, NY Diana Patterson, MD, New York, NY Arthroscopic meniscectomy is a frequently performed procedure, but minimal guidelines exist for counseling patients on functionality during the recovery period or time to return to daily activities. http://www.aaos.org/uploadedFiles/2017%20Final%20Program_compressed.pdf Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions. More Medical Research Interviews on MedicalResearch.com Dr. Colvin[/caption] Alexis Colvin, MD Associate Professor, Orthopaedics Icahn School of Medicine at Mount Sinai [caption id="attachment_33142" align="alignleft" width="100"]James N. Gladstone, MD Co-Chief, Sports Medicine Service, The Mount Sinai Hospital Associate Professor, Orthopaedics, Icahn School of Medicine at Mount Sinai Dr. Gladstone[/caption] James N. Gladstone, MD Co-Chief, Sports Medicine Service, The Mount Sinai Hospital Associate Professor, Orthopaedics, Icahn School of Medicine at Mount Sinai MedicalResearch.com: What is the background for this study? Response: Knee arthroscopy is one of the most commonly performed procedures in the U.S. There is minimal literature on when patients can expect to return to daily activity. We sought to help patients understand when they could expect to return to a number of basic activities, specifically in an urban environment where patients need to be mobile early.
Author Interviews, Orthopedics / 19.03.2017

MedicalResearch.com Interview with: [caption id="attachment_32956" align="alignleft" width="130"]Michael Hausman, MD Chief, Hand and Upper Extremity Surgery, Mount Sinai Health System; Professor, Orthopaedics, Icahn School of Medicine at Mount Sinai Dr. Michael Hausman[/caption] Michael Hausman, MD Chief, Hand and Upper Extremity Surgery Mount Sinai Health System Professor, Orthopaedics Icahn School of Medicine at Mount Sinai MedicalResearch.com: What is the background for this study? What are the main findings? Response: Lateral epicondylitis has traditionally been thought of as a tendon problem, but tendon pathology has not been well documented. Our study supports our hypothesis that the problem lies within the elbow joint, rather than in the tendon outside the joint.
Author Interviews, Orthopedics / 19.03.2017

MedicalResearch.com Interview with: [caption id="attachment_33134" align="alignleft" width="200"]Dr. Baron Lonner MD Professor of Orthopaedic Surgery Mount Sinai Medical Center Dr. Baron Lonner[/caption] Dr. Baron Lonner MD Professor of Orthopaedic Surgery Mount Sinai Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: Adolescent idiopathic scoliosis is the most common form of scoliosis, lateral curvature of the spine, in the pediatric population. 2-3% of adolescents are affected and approximately 10% of patients require surgery. Operative treatment has traditionally involved a spinal fusion with the use of metallic implants. I personally have been practicing spine surgery with an emphasis on the treatment of the pediatric patient with scoliosis for over twenty years. During the course of my own practice, I have seen significant changes in the way my colleagues and I operatively manage adolescent idiopathic scoliosis (AIS). Being part of a group of surgeons from around the world who contribute clinical data on patients with AIS, with a database of nearly 3000 patients, a group called the Harms Study Group after Professor Jurgen Harms of Germany, an innovator in this area, and housed within the larger Setting Scoliosis Straight Foundation, I felt, now, as we reached the twenty year mark of data collection in January 2015, was the moment to look at trends in our collective experience. Our goal was to evaluate changes in the surgical approach to AIS over this time span and to assess whether or not these changes have been associated with improvements in outcomes for the patient including decreases in complication rates. Perhaps we could learn lessons from this data, contributed by leaders in the treatment of AIS, that might inform future innovations and to be confirmatory of the trajectory of our approach to these patients.
Author Interviews, Orthopedics, Outcomes & Safety / 17.03.2017

MedicalResearch.com Interview with: [caption id="attachment_33051" align="alignleft" width="130"]Brad Parsons, MD Associate Professor, Orthopaedics Icahn School of Medicine at Mount Sinai Dr. Parsons[/caption] Brad Parsons, MD Associate Professor, Orthopaedics Icahn School of Medicine at Mount Sinai MedicalResearch.com: What is the background for this study? What are the main findings? Response: As bundled payment initiatives increase in order to contain health care costs, total shoulder arthroplasty (TSA) is a likely future target. Understanding modifiable drivers of complications and unplanned readmission as well as identifying when such events occur will be critical for orthopedic surgeons and hospitals to improve outcomes and to make fixed-price payment models feasible for TSA. Utilizing the American College of Surgeons National Surgical Quality Improvement Program we identified 5801 patients that underwent TSA with a 2.7% readmission rate and 2.5% severe adverse event rate. Patients with 3 or more risk factors were found to have a significantly increased risk of readmission and severe adverse events within the first two weeks postoperatively.
Author Interviews, Orthopedics / 16.03.2017

MedicalResearch.com Interview with: [caption id="attachment_32879" align="alignleft" width="155"]Alexander S. McLawhorn, MD, MBA Orthopedic Surgery, Hip and Knee Replacement Hospital for Special Surgery New York, NY 10021 Dr. McLawhorn[/caption] Alexander S. McLawhorn, MD, MBA Orthopedic Surgery, Hip and Knee Replacement Hospital for Special Surgery New York, NY 10021 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Hospital for Special Surgery (HSS) researchers saw the need for a shorter, more patient friendly outcome survey for revision knee replacement surgery. This is an area where patient-reported outcomes data are essential to improving quality of care. In fact, knee replacement revisions, which are more complex and heterogeneous than primary knee surgery, are under-studied in this regard. A commonly used knee replacement survey, the KOOS (Knee Injury and Osteoarthritis Outcome Score), is 42 questions and often leaves physicians with partial and unusable information secondary to patient burden and fatigue. Previously, researchers at HSS created the KOOS, JR, which is a shorter, 7-question survey that accurately measures “knee health”, meaning it reflects aspects of pain, symptom severity, and activities of daily living relevant and difficult for patients with knee arthritis. The current research presented at AAOS showed that the KOOS, JR can be extended to knee replacement revision patients and that it is a valid and efficient tool for assessing knee health in this challenging patient population.
Author Interviews, NYU/NYMC, Orthopedics / 16.03.2017

MedicalResearch.com Interview with: [caption id="attachment_33024" align="alignleft" width="200"]Dr Aaron J. Buckland Spinal and scoliosis surgeon and assistant professor Orthopedic surgery NYU Langone Medical Center Dr. Aaron Buckland[/caption] Dr Aaron J. Buckland Spinal and scoliosis surgeon and Assistant professor Orthopedic surgery NYU Langone Medical Center MedicalResearch.com: What is the background for this study? Response: For decades, surgeons performing hip replacements have placed the acetabular component adjacent to the pelvis in a “safe zone” which has been shown to reduce dislocation risk. However, beginning in residency, I would notice that several of my patients with spinal deformities or lumbar fusions, would experience dislocations despite the safe zone placement of these implants. Our initial research demonstrated that there was an increased dislocation risk in patients with lumbar fusions, particularly if they underwent spinal realignment. We investigated this phenomenon further by retrospectively reviewing 107 patients who met the criteria for sagittal spinal deformity, including 139 hip replacements collectively.
Author Interviews, General Medicine, Orthopedics / 15.03.2017

MedicalResearch.com Interview with: [caption id="attachment_32959" align="alignleft" width="130"]Darwin Chen, MD Assistant Professor, Orthopaedics Icahn School of Medicine at Mount Sinai Dr. Darwin Chen[/caption] Darwin Chen, MD Assistant Professor, Orthopaedics Icahn School of Medicine at Mount Sinai MedicalResearch.com: What is the background for this study? Response: Total hip and knee replacement surgery are among the most commonly performed orthopaedic procedures today. Although success rates are high, complications can occur and some may be preventable. The goal of our research was to assess the impact of gender on complications within the first 30 days after hip and knee replacement.
Author Interviews, JAMA, Orthopedics / 14.03.2017

MedicalResearch.com Interview with: Justine M. Naylor, PhD Braeside Hospital, HammondCare, Australia South West Sydney Clinical School, University of New South Wales, Liverpool Hospital South West Sydney Local Health District, Liverpool 2170, NSW, Australia MedicalResearch.com: What is the background for this study? Response: Total knee arthroplasty (replacement) for end-stage arthritis is a very successful procedure for relieving the associated pain and functional impairments. Formalized rehabilitation following the surgery is also considered an essential adjunct to optimise recovery. World-wide, the volume of knee arthroplasty surgeries is increasing each year. In the US, for example, the prevalence of this surgery increased 11-fold from 1980 to 2010. The costs of the procedures (including the acute and rehabilitation costs) are also increasing. Because of these trends, there is concern for the future sustainability of these procedures. Research devoted to identifying the most cost-effective strategies in this field is required. Our group conducted a randomized trial comparing 10-days of inpatient rehabilitation to a simple, clinician-monitored home program in people who underwent total knee arthroplasty for end-stage osteoarthritis. Inpatient rehabilitation in a rehabilitation facility is commonly provided after knee arthroplasty in various countries including Australia, the US and Switzerland, and is comparatively expensive. In particular, it is a commonly available option for people with private healthcare insurance. Essentially, we wanted to compare 2 extremes – a resource-intensive program to one with far less resource requirements. Because patients who experience complications immediately after surgery may require inpatient rehabilitation to aid their recovery, we only included patients who did not experience a significant complication while in hospital, thus, were otherwise deemed able to be discharged directly home.
Author Interviews, JAMA, Orthopedics, Osteoporosis, Testosterone / 23.02.2017

MedicalResearch.com Interview with: [caption id="attachment_32296" align="alignleft" width="152"]Tony M. Keaveny, Ph.D. Professor, Departments of Mechanical Engineering and Bioengineering; Co-Director, Berkeley BioMechanics Laboratory University of California Berkeley, CA 94720-1740 Dr. Tony Keaveny[/caption] Tony M. Keaveny, Ph.D. Professor, Departments of Mechanical Engineering and Bioengineering; Co-Director, Berkeley BioMechanics Laboratory University of California Berkeley, CA 94720-1740 MedicalResearch.com: What is the background for this study? Response: As men age, they experience decreased serum testosterone concentrations, decreased bone mineral density (BMD) and increased risk of fracture. While prior studies have been performed to determine the effect of testosterone treatment on bone in older men, for various reasons those studies have been inconclusive. The goal of this study was to overcome past limitations in study design and determine if testosterone treatment — versus a placebo — in older men with low testosterone would improve the bone. Specifically, we used 3D quantitative CT scanning to measure changes in BMD and engineering “finite element analysis” to measure changes in the estimated bone strength, both at the spine and hip. The study was performed on over 200 older men (> age 65) who had confirmed low levels of serum testosterone.
Author Interviews, Cancer Research, JAMA, MD Anderson, Orthopedics / 12.02.2017

MedicalResearch.com Interview with: [caption id="attachment_31942" align="alignleft" width="114"]Gabriel N. Hortobagyi, MD, FACP, FASCO Professor, Department of Breast Medical Oncology Division of Cancer Medicine The University of Texas MD Anderson Cancer Center Houston, TX 77230-1439 Dr. Gabriel Hortobagyi[/caption] Gabriel N. Hortobagyi, MD, FACP, FASCO Professor, Department of Breast Medical Oncology Division of Cancer Medicine The University of Texas MD Anderson Cancer Center Houston, TX 77230-1439  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Bisphosphonates have been commercially available for several decades as supportive care for patients with bone metastases. They reduce the frequency and severity of bone-related complications. While the optimal dose and short-term scheduling of zoledronic acid (and previously, pamidronate) have been determined, there has been no research to determine how long these drugs need to be maintained nor the optimal dose and schedule beyond the first year of therapy. These questions are particularly important for this family of drugs, since they are incorporated into bone and not excreted from the body for many years. We set out to determine whether a reduction in the frequency of administration of zoledronic acid (every 12 weeks) was able to maintain the therapeutic efficacy of this intervention when compared to the “standard” schedule of administration (every 4 weeks). It was a prospective, randomized, non-inferiority trial that recruited patients with metastatic breast cancer with bone metastases and who had previously received 9 or more doses of zoledronic acid or pamidronate. The primary endpoint was the proportion of patients with one or more skeletal-related events. Four hundred and sixteen patients were randomized in a 1:1 ratio. The two groups were comparable at baseline. After the first year of follow-up, there was no statistically significant difference in SRE rate between the two arms, confirming the non-inferiority fo the every-12-week schedule of zoledronic acid.
Author Interviews, Hip Fractures, NYU/NYMC, Orthopedics / 09.02.2017

MedicalResearch.com Interview with: [caption id="attachment_31877" align="alignleft" width="96"]Afshin E. Razi MD</strong> Clinical Assistant Professor NYU Hospital for Joint Diseases Department of Orthopaedic Surgery New York, N.Y. 1001 Dr. Afshin Razi[/caption] Afshin E. Razi MD Clinical Assistant Professor NYU Hospital for Joint Diseases Department of Orthopaedic Surgery New York, N.Y. 10016 MedicalResearch.com: What is the background for this study? What are the main findings? Response: We did an extensive literature search and through our two previous seminars on this topic we were able to gather information to aid our colleagues on best ways of differentiating causes of hip and back pain. As an orthopaedic surgeon specializing in spine surgery I encounter many patients who present with concomitant back and hip pain. Many of these patients are also referred to me by surgeons who solely take care of hip problems such as total hip replacement or sport medicine specialist who treat younger patients with hip pain. It can be very difficult to properly diagnose the main issue and as such some patients go on to have unnecessary treatments, including surgery, because of their persistent symptoms. It was our goal to try to educate physicians, including orthopaedic surgeons, on the common differential diagnoses, appropriate clinical history and physical examination, diagnostic tools and their evaluations appropriately, as well as treatment options and priorities of which one to be treated first. More recently, it has been noted that some patients who have undergone total hip replacement with significant curvature of the spine had postoperative dislocation of the hip after reconstruction of the spinal malalignment. This article also talks about this newly seen problem.
Author Interviews, Cognitive Issues, Gender Differences, Hip Fractures, Orthopedics / 09.02.2017

MedicalResearch.com Interview with: [caption id="attachment_31853" align="alignleft" width="180"]Ann L. Gruber-Baldini, Ph.D. Professor, Division of Gerontology Director, Program in Epidemiology and Human Genetics Department of Epidemiology & Public Health University of Maryland School of Medicine Dr. Ann Gruber-Baldini[/caption] Ann L. Gruber-Baldini, Ph.D. Professor, Division of Gerontology Director, Program in Epidemiology and Human Genetics Department of Epidemiology & Public Health University of Maryland School of Medicine  MedicalResearch.com: What is the background for this study? Response: While men make up only about 25% of all hip fractures, the number of men who fracture their hip is increasing and we know men are more likely to die than women after a hip fracture. It is also known that those with cognitive impairments, typically due to delirium and Alzheimer's disease and related dementia, are more likely to do more poorly after the fracture. The impact of both sex and cognition on outcomes after hip fracture has not been fully explored.
Author Interviews, BMJ, Orthopedics, Pain Research, Surgical Research / 08.02.2017

MedicalResearch.com Interview with: [caption id="attachment_31841" align="alignleft" width="109"]Jonas Bloch Thorlund Associate Professor (MSc, PhD) Department of Sports Science and Clinical Biomechanics Research Unit for Musculoskeletal Function and Physiotherapy University of Southern Denmark Dr. Jonas Thorlund[/caption] Jonas Bloch Thorlund Associate Professor (MSc, PhD) Department of Sports Science and Clinical Biomechanics Research Unit for Musculoskeletal Function and Physiotherapy University of Southern Denmark MedicalResearch.com: What is the background for this study? What are the main findings? Response: Arthroscopic partial meniscectomy is a very common knee surgery. Research evidence has seriously questioned the effect of this type of surgery for degenerative meniscal tears in middle-aged and older patients. Most young patients with traumatic meniscal injury (from sports or similar) also undergo this type of surgery. There is a general understanding that young patients with traumatic tears experience larger improvements in patient reported pain, function and quality of life. However, evidence for this presumption is sparse.
Aging, Author Interviews, Depression, Geriatrics, Hip Fractures / 16.01.2017

MedicalResearch.com Interview with: [caption id="attachment_34480" align="alignleft" width="133"]Sanna Torvinen-Kiiskinen MSc (Pharm.), PhD student, Kuopio Research Centre of Geriatric Care and School of Pharmacy University of Eastern Finland Sanna Torvinen-Kiiskinen[/caption] Sanna Torvinen-Kiiskinen MSc (Pharm.), PhD student, Kuopio Research Centre of Geriatric Care and School of Pharmacy University of Eastern Finland MedicalResearch.com: What is the background for this study? Response: Antidepressants are widely used among elderly persons, especially persons with Alzheimer’s disease. They are used not only for treatment for major depression, but for treatment of anxiety, insomnia and chronic pain as well as behavioral symptoms caused by dementia. However, antidepressants, as well as other psychotropic drugs, may cause sedation, confusion, orthostatic hypotension and hyponatremia, which increase the risk of falling and fractures. Because of changes in pharmacodynamics and pharmacokinetics due to aging, older persons are at the higher risk of those adverse events. The aim of our study was to investigate whether antidepressant use is associated with an increased risk of hip fracture among community-dwelling persons with and without Alzheimer’s disease.
Author Interviews, Cancer Research, JAMA, Orthopedics / 06.01.2017

MedicalResearch.com Interview with: [caption id="attachment_31008" align="alignleft" width="130"]Charles L. Shapiro, MD Professor of Medicine Co-Director of Dubin Breast Center Director of Translational Breast Cancer Research Director of Cancer Survivorship, Tisch Cancer Institute Mount Sinai Health System Division of Hematology / Medical Oncology: Tisch Cancer Institute New York, NY 10029 Dr. Charles Shapiro[/caption] Charles L. Shapiro, MD Professor of Medicine Co-Director of Dubin Breast Center Director of Translational Breast Cancer Research Director of Cancer Survivorship, Tisch Cancer Institute Mount Sinai Health System Division of Hematology / Medical Oncology: Tisch Cancer Institute New York, NY 10029 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Metastases to bone are frequent in many cancers and cause pain, pathological fractures, necessitate surgical and/or radiation treatments, cause spinal chord compression that can lead to paralysis, and significantly increase health care costs. Zoledronic acid, a bisphosphonate that inhibits bone resorption, is used in standard practice because it reduces the risks skeletal-related events including cancer-related pathological fractures, the need for surgery and/or radiation to bone metastases, and spinal chord compression in patients with breast cancer, prostate cancer and multiple myeloma. However, the optimal dosing interval for zoledronic acid is unknown and based on prior studies and empiricism it is administered monthly along with anti-cancer treatments. In this trial, over 1800 breast cancer, prostate cancer and multiple myeloma patients with bone metastases were randomized to the standard dosing interval of monthly zoledronic acid versus every 3-months zoledronic acid for a duration of two years. The results overall, and in each specific disease site, show that giving zoledronic acid once every 3-months as opposed to monthly did not result in any increase in skeletal-related events.
Author Interviews, Cost of Health Care, JAMA, Medicare, Orthopedics, University of Pennsylvania / 06.01.2017

MedicalResearch.com Interview with: [caption id="attachment_30994" align="alignleft" width="180"]MedicalResearch.com Interview with: Amol Navathe, MD PhD University of Pennsylvania Staff Physician, CHERP, Philadelphia VA Medical Center Assistant Professor of Medicine and Health Policy, Perelman School of Medicine Senior Fellow, Leonard Davis Institute of Health Economics, The Wharton School Co-Editor-in-Chief, HealthCare: the Journal of Delivery Science and Innovatio Dr. Amol Navathe[/caption] Amol Navathe, MD PhD University of Pennsylvania Staff Physician, CHERP, Philadelphia VA Medical Center Assistant Professor of Medicine and Health Policy, Perelman School of Medicine Senior Fellow, Leonard Davis Institute of Health Economics, The Wharton School Co-Editor-in-Chief, HealthCare: the Journal of Delivery Science and Innovation MedicalResearch.com: What is the background for this study? Response: Bundled payments pay a fixed price for an episode of services that starts at hospital admission (in this case for joint replacement surgery) and extends 30-90 days post discharge (30 days in this study). This includes physician fees, other provider services (e.g. physical therapy), and additional acute hospital care (hospital admissions) in that 30 day window.
Author Interviews, Dermatology, Orthopedics / 02.01.2017

MedicalResearch.com Interview with: [caption id="attachment_18200" align="alignleft" width="266"]Psoriasis Psoriasis[/caption] Hsien-Yi Chiu, MD/ Tsen-Fang Tsai, MD Department of Dermatology, National Taiwan University Hospital Taipei, Taiwan MedicalResearch.com: What is the background for this study? What are the main findings? Response: Psoriasis is a chronic, immune-mediated disorder, characterized by red, itchy and scaly skin patches. Over the past several years, accumulating research had shown the effects of psoriasis go far deeper than the skin and psoriasis is associated with multiple comorbidities. Psoriasis shares the inflammatory pathways and several contributing factors with avascular necrosis (AVN), a bone disease presented with death of trabecular bone and collapse of the bony structure. However, previous studies mostly focus on evaluation the increased risk of cardiovascular diseases in patients with psoriasis. No large scale studies have previously explored a potential association between psoriasis and AVN. Our nationwide population-based cohort study investigated this risk in 28268 patients with psoriasis registered in the Taiwan National Health Insurance Research Database. The patients were matched, by age and sex, with 113072 controls without psoriasis. Both the patients and controls were followed to identify those who subsequently diagnosed with an AVN. The results showed that psoriasis was associated with a disease severity–dependent increase in avascular necrosis risk. Moreover, AVN risk was positively associated with male sex, age younger than 30 years, corticosteroid use, severe psoriasis, and concomitant psoriatic arthritis. People with severe psoriasis were 3 times more likely to develop AVN compared with the control group.
Author Interviews, Heart Disease, Occupational Health, Orthopedics / 31.12.2016

MedicalResearch.com Interview with: [caption id="attachment_30872" align="alignleft" width="142"]Kurt T. Hegmann, M.D., M.P.H. Director, Division of Occupational and Environmental Health Chief, Division of Occupational and Environmental Health The University of Utah Health Care Dr. Kurt Hegmann[/caption] Kurt T. Hegmann, M.D., M.P.H. Director, Rocky Mtn. Center for Occupational and Environmental Health Chief, Division of Occupational and Environmental Health The University of Utah Health Care MedicalResearch.com: What is the background for this study? Response: This line of work for us began approximately 20 years ago. Normal tendons never rupture, as the weak point when loading the muscle-tendon unit is either the muscle-tendon junction (i.e., a true muscle strain) or bone-tendon junction. Researchers in the 1960s reported there is poor blood supply in the area of rotator cuff tendon tears, providing one of the two main etiological theories of rotator cuff tears. The other main theory is “impingement syndrome” or a biomechanical impingement in the shoulder joint. Though who experience this might find that they need something similar to this shoulder dislocation surgery. Naturally, both theories could co-exist. Next, we noted rotator cuff tendinitis and shoulder risks from tobacco in other studies. We also reported prior research of increased risks with obesity. These led us to the theory that these rotator cuff tears are likely vascular in etiology. The next problem was to show this.