Timing of surgery for knee injuries may not affect outcomes

Rosemont, Ill – Multiple-ligament knee injuries resulting from traumatic knee dislocations – such as high impact car accidents or certain sports are uncommon, and the optimal timing of surgical repair or reconstruction has not been definitively established.

According to a new study published in the December 2009 issue of The Journal of Bone and Joint Surgery (JBJS), patients who undergo surgery more than three weeks after a multiple ligament knee injury (called chronic intervention treatment) may have comparable outcomes to those who undergo surgery within three weeks of injury (called acute intervention treatment) with regard to knee stability. Additionally, researchers found that early mobility is associated with better outcomes than immobilization in those patients who are treated within that three week time period.

“After a review of the available literature, we found that chronic intervention provides results that are at least as good as acute intervention, despite some recent studies showing that acute intervention may be better,” said lead author of the study William R. Mook, MD, who conducted the study with colleagues from the Department of Orthopaedic Surgery at the University of Virginia in Charlottesville.

Dr. Mook and his colleagues surveyed 24 retrospective studies that included 396 knees treated surgically for the most severe multiple-ligament knee injuries. Patients were managed either acutely, chronically, or with a combination of both interventions, which is called staged treatment. The researchers also studied whether the patient’s leg should or should not be mobile or immobilized after surgery.

The study found that:

* patients receiving acute intervention had less stable knees and were not able to bend their knees as far as those who were treated with chronic intervention; and
* patients who underwent staged procedures (treatment from both the acute and chronic intervention stages) reported better outcomes than those treated just early or late.

“The reasons for this are not clear. The patient population is heterogeneous, and surgery can be delayed for a variety of reasons. It is difficult to tell which procedures were delayed intentionally and which were delayed due to other medical reasons occurring as a result of their initial injury,” Dr. Mook said.

This literature review suggests the following:

* Surgical reconstructions within three weeks of the injury and those performed later provide comparable knee stability.
* In patients treated within three weeks of injury, early mobility (compared with immobilization) is associated with better outcomes. However, early surgery is highly associated with range-of-motion limitations.
* Patients reported better outcomes and fewer range-of-motion limitations with a combination of acute and chronic procedures. However, additional treatment for joint stiffness may be required in these patients.
* In patients treated within three weeks of their injury, more aggressive rehabilitation may prevent the need for additional treatment for joint stiffness.

Previous studies have indicated that early treatment provides better outcomes, but that may not be the case. “Although recent evidence suggests that acute intervention is superior to chronic interventions in all outcomes, we found that chronic intervention may provide knees with equal stability as those managed acutely,” Dr. Mook concluded.

Source: American Academy of Orthopaedic Surgeons

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Nationwide Survey Shows Americans Oppose a Cosmetic Tax

$5.8 Billion Tax Targets Middle Class – Mostly Working Women

Arlington Heights, Ill. – A majority of Americans oppose the inclusion of a five percent tax on cosmetic medical procedures, according to a survey. Survey respondents oppose the cosmetic tax by a 52% – 43% margin.

According to the survey, a large majority of respondents, by a 64% – 34% margin, agree that the cosmetic medical procedures tax has no place in health care reform, since these procedures and treatments are not covered by health insurance and the tax will disproportionately impact middle class women.

“It is clear from these results that Americans disagree with this proposed tax,” said Michael McGuire, MD, President of the American Society of Plastic Surgeons (ASPS). “Taxing medical procedures sets a dangerous precedent by inviting the Internal Revenue Service into the physician-patient relationship, and allowing the government to make decisions regarding medical necessity.”

The tax on cosmetic medical procedures was not included in any of the five health reform bills developed and debated in Senate and House Committees. According to the Congressional Budget Office, it is projected to raise approximately $5.8 billion over ten years toward the $856 billion price tag for the proposed Senate health reform bill. However, a similar tax in New Jersey has realized less than one-third of the anticipated revenue and an independent audit of the New Jersey system found that it took $3.39 in expenditures just to collect a single dollar in tax — making a cosmetic tax not only a bad idea but an unreliable way to fund health reform.

According to the survey, there is no significant difference between men and women in their opposition to the proposed tax. On the other hand, respondents over the age of 45 are much more likely to oppose the tax, with opposition increasing among older respondents.

The survey further demonstrates that, by a 49% – 30% margin, respondents were more likely to oppose the tax once informed that sixty percent of all people planning to have cosmetic medical procedures report a household income of between $30,000 and $90,000.

“These numbers confirm what ASPS has been saying all along, that many people mistakenly believe that this is a luxury tax,” Dr. McGuire said. “But in fact, it is a tax on the middle class — despite President Obama’s direct campaign promise not to raise taxes on this group of Americans.”

This survey was conducted by Opinion Research Corporation among a national probability sample of 1,014 adults comprising 506 men and 508 women 18 years of age and older, living in private households in the continental United States. Interviewing was completed during the period December 3-6, 2009.?

Source: ASPS

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Overweight children may develop back pain and spinal abnormalities

Chicago – Being overweight as a child could lead to early degeneration in the spine, according to a study presented at the annual meeting of the Radiological Society of North America (RSNA).

“This is the first study to show an association between increased body mass index (BMI) and disc abnormalities in children,” said the study’s lead author, Judah G. Burns, M.D., fellow in diagnostic neuroradiology at The Children’s Hospital at Montefiore in New York City.

In this retrospective study, Dr. Burns and colleagues reviewed MR images of the spines of 188 adolescents between the ages of 12 and 20 who complained of back pain and were imaged at the hospital over a four-year period. Trauma and other conditions that would predispose children to back pain were eliminated from the study.

The images revealed that 98 (52.1 percent) of the patients had some abnormality in the lower, or lumbar, spine. Most of those abnormalities occurred within the discs, which are sponge-like cushions in between the bones of the spine. Disc disease occurs when a bulging or ruptured disc presses on nerves, causing pain or weakness.

“In children, back pain is usually attributed to muscle spasm or sprain,” Dr. Burns said. “It is assumed that disc disease does not occur in children, but my experience says otherwise.”

According to the Centers for Disease Control and Prevention, 15 percent of U.S. children (age 6 – 11) and 18 percent of U.S. adolescents (age 12 -19) are overweight. BMI, a mathematical ratio of body weight and height, is a widely used measurement for obesity. Lower BMI is associated with being underweight or a healthy body size; higher BMI scores are associated with being overweight or obese. Children above the 85th percentile are generally classified as overweight or at risk of being overweight.

The researchers were able to determine an age-adjusted BMI for 106 of the total 188 patients. Fifty-four had BMI greater than the 75th percentile for age. Thirty-seven (68.5 percent) of these children showed abnormal findings on their spine MRI. Fifty-two patients fell into the lowest three quartiles. Only 18 (34.6 percent) of the children at or below a healthy weight had an abnormal MRI of the spine.

“We observed a trend toward increased spine abnormality with higher BMI,” Dr. Burns said. “These results demonstrate a strong relationship between increased BMI in the pediatric population and the incidence of lumbar disc disease.”

According to Dr. Burns, data revealed in the study could signal a significant public health problem given the health costs of back pain in the U.S.

“Back pain causes significant morbidity in adults, affecting quality of life and the ability to be productive,” he said.

Source: Radiological Society of North America

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’Tis the season for gifting cosmetic surgery

However, discuss procedure with recipient beforehand

Chicago – Maybe you’ve received eye-opening holiday gifts in the past such as new electronics, an exciting vacation or that car you have always craved. The gift of cosmetic surgery is not a new phenomenon, but many are going that route this holiday season as husbands and wives yearn for that perfect present to their loved one.

“It’s the season of giving and cosmetic surgery can fit into that category just as easily as some of the more traditional gifts out there,” said Dr. Patrick McMenamin, MD, President of the American Academy of Cosmetic Surgery. “What better way to ring in the New Year than to get that procedure that you’ve always wanted? And if it’s a present to or from a loved one, that makes it all the better.”

According to a consumer survey by the American Academy of Cosmetic Surgery, 46 percent of consumers say they would forego an expensive vacation or luxury car to pay for cosmetic surgery.

Surgery gift-giving does take some planning, as the procedures are often done before Christmas, so patients are either recovering or showing off their improved looks in time for their holiday gatherings. But make sure this is something you talk over with the surgery recipient beforehand, because surprising someone with cosmetic surgery is not recommended.

“There are a large number of people who really want cosmetic surgery, and they just need that little nudge or incentive to get it done,” said Dr. Mark Berman, AACS President- Elect. “Well, if you’re that spouse or significant other, just make sure you’ve discussed the idea in the past so it doesn’t come as a surprise.”

Source: cosmeticsurgery.org

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