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American Academy of Orthopaedic Surgeons, March 9-13, 2010

American Academy of Orthopaedic Surgeons 2010 Annual Meeting

The American Academy of Orthopaedic Surgeons' 2010 Annual Meeting took place March 9 to 13 in New Orleans and attracted nearly 13,000 physicians and almost 29,000 total attendees. Highlights included presentations that showed the promise of annealed highly cross-linked polyethylene in total joint replacement surgery and addressed the increasing danger of all-terrain vehicles.

"With our partners in industry, we've developed new technology and new materials for the bearing surfaces in joint replacements," said program committee chair, Joseph A. Bosco, M.D., of New York University in New York City. "They don't seem to be wearing out, which is great news. We may have come close to inventing hip and knee replacements which last a long, long time."

Four podium presentations addressed the advantages of annealed highly cross-linked polyethylene, the first generation of which was introduced in 1998 and the second generation of which was introduced in 2005.

In one presentation, researchers from the United Kingdom reported on a study of 54 patients who were randomized to receive hip replacements with either a highly cross-linked polyethylene liner or a standard polyethylene liner. After seven years, they found that highly cross-linked polyethylene was associated with less than half the long-term wear rate of standard polyethylene. "This early data suggests that second generation highly cross-linked polyethylenes have the potential to reduce the risk of revision surgery for wear and aseptic loosening," the authors conclude.


In a second presentation, researchers from Pennsylvania, Indiana, Massachusetts, and New Jersey reported on 39 case studies for the first generation highly cross-linked polyethylene, and 246 cases in a prospective multi-center study for the second generation. "First generation annealed highly cross-linked polyethylenes have performed well out to nine years with low wear and no signs of mechanical failure or osteolysis," the authors conclude. "The second generation sequentially highly cross-linked polyethylene demonstrates extremely low wear out to four years and bench testing has shown insignificant free radical content and mechanical strength equal to virgin polyethylene."


Several studies suggested that platelet-rich plasma may be a promising treatment in knee and other injuries. In one study, Brazilian researchers injected platelet-rich plasma or saline into the knees of injured rabbits and found that platelet-rich plasma was associated with significantly less chondrocyte apoptosis (48.02 versus 67.74 percent). "This therapy should be beneficial on post-traumatic osteoarthritis," the authors write.


A media briefing titled "ATV and Motocross Sports: Increase in Pediatric Trauma Injuries" featured three new studies.

In one study, Jeffrey R. Sawyer, M.D., of the Campbell Clinic in Memphis, Tenn., and colleagues reviewed recent trends in all-terrain vehicle injuries in children. In 2006, they found that an estimated 4,483 children were injured and that 332 (7.4 percent) sustained a injury to the spine. "This is a 140 percent increase in children injured and a 368 percent increase in the number of spinal injuries from 1997," the authors write.


In a second study, Gregg Wendell Schellack, D.O., of Loma Linda University in California, and colleagues studied 110 patients who were injured in all-terrain vehicle accidents over a three-year period. Compared to single-rider vehicles, they found that multi-rider vehicles were associated with a significantly greater risk of primary limb amputation (relative risk, 10.9) and a higher rate of open fractures (64 versus 11 percent).


In a third study, A. Noelle Larson, M.D., of the Texas Scottish Rite Hospital in Dallas, and colleagues studied 299 pediatric motocross injury cases that occurred from 2000 to 2007. They found that 141 cases required hospital admission, including 20 patients who required intensive care unit admission, and that about one-third of the cases were surgically treated. "Despite a high usage rate of helmets and protective gear, severe injuries were still sustained, including femur facture (29), hemiparesis/spinal cord injury (2), and head injury (43)," the authors write.


"The current steps taken by the all-terrain vehicle and motorcycle vehicle industry are not enough," moderator, Kevin G. Shea, M.D., of Intermountain Orthopaedics in Boise, Idaho, said in a statement. "Developing and enforcing a mandatory safety training session before these vehicles can be operated may be an important first step. Better education will be essential, as it is important to educate riders, parents and the public about the potential for serious injury."

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Another highlight included a special symposium in which 10 Academy members discussed their experiences in treating victims of the recent earthquake in Haiti. "Over 300 of our surgeons went down there and donated time," Bosco said.

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