Study Finds Ponseti Method of Clubfoot Correction Leads to Lower Surgical Rates and Less Revision Surgery

Less serious recurrence seen with Ponseti casting method

Rosemont, IL – Clubfoot affects one in a thousand babies born in the United States, but with proper corrective treatment and follow-up, infants born with clubfoot can have feet compatible with an active, normal lifestyle. A new study in the February 2010 issue of The Journal of Bone and Joint Surgery (JBJS) compared two common treatment options for clubfoot – Ponseti method and surgical treatment.

“While more conservative treatment methods have become popular in the United States over the last several years, surgical treatment has been the primary option in New Zealand until quite recently,” explained Matthew Halanski, MD, who authored the study with mentors at the Starship Children’s Hospital in Auckland, New Zealand.

“This is the first controlled prospective study to compare the short-term outcomes for clubfeet treated either surgically or with the Ponseti method,” continued Dr. Halanski.

Fifty-five patients with 86 clubfeet were treated as part of the study. Forty patients’ feet were treated with the Ponseti method. Forty-six were treated with surgery and casting. The average number of casts per patient was six in the Ponseti Group and 13 in the surgical group.

The study found that among the patients treated:

* Fifteen feet in the Ponseti group had a recurrence requiring some surgery. Four of these feet had a major recurrence and 11 had a minor recurrence.

* Fourteen feet in the surgical group required revision (follow-up) surgery.

* Only one foot in the Ponseti group required revision surgery.

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New Study Finds Low Mortality Risk Following Knee and Hip Replacement

Risks Lower 26 Days After Surgery

Rosemont, IL – Total hip and total knee replacement surgeries are highly successful and very common procedures for people experiencing pain associated with degenerative joints. With a new hip or knee, and postoperative care prescribed by their doctors, most patients are able to regain a more active lifestyle with considerably less pain.

According to a new study published in the January 2010 issue of The Journal of Bone and Joint Surgery (JBJS), the risk of early postoperative mortality – or death following surgery — was slightly increased for the first 26 days after the elective surgery. The risk of mortality was estimated to be 0.1 percent.

The size of the study and the precise statistical tools used show the increase in early postoperative mortality was highest immediately after the operation. Then, 26 days after the surgery, the increased risk of death was negligible.

“Previous studies suggesting that increased mortality exists for as long as 60 or 90 days post hip or knee replacement surgery may be wrong,” said lead author of the study, Stein Atle Lie, PhD, MSc and professor in the Department of Surgical Sciences at the University of Bergen, Norway who led the study with colleagues from the Department of Orthopaedic Surgery, and the Norwegian Arthroplasty Register at the Haukeland University Hospital in Bergen, Norway. “We believe the risk is tied to a much shorter duration.”

The study included data on 81,856 patients with a total knee replacement and 106,254 patients with a total hip replacement from the Australian Orthopaedic Joint Replacement Registry and the Norwegian Arthroplasty Register. Only patients between 50 and 80 years of age with osteoarthritis were included.

The study found the most important risk factors for increased early postoperative mortality were:

* Male gender; and
* Age, older than 70 years old.

“This very low postoperative mortality after hip and knee replacements should be reassuring for patients considering these surgeries,” explains study co-author Lars B. Engesaeter, MD, PhD and Head of Norwegian Arthroplasty Register, Haukeland University Hospital in Bergen, Norway.

People considering hip or knee replacement should talk to their orthopaedic surgeon about any added risk in relation to their age and follow recovery guidelines closely. Other questions to consider prior to surgery can be found at www.orthoinfo.org.

“We conducted this study to help people contemplating hip or knee replacement,” continues Dr. Lie. “As with all surgeries, there is some increased risk of postoperative mortality. However, we were pleased to find the mortality rate is so minimal — less than one percent — following hip and knee replacements.”

Source: American Academy of Orthopaedic Surgeons

For more information about hip and knee replacements or any other orthopaedic procedure please feel free to contact us that Doctor Juan Sanchez Pulgar will be glad to help you.

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

For more information about Orthopedics and Traumatology Treatments in Argentina don’t hesitate to contact us.

El Dr. Juan Sánchez Pulgar se une al equipo de Sublimis

Sublimis, organización dedicada a  servicios y tratamientos médicos de alto nivel, les informa que el Doctor Juan Sánchez Pulgar, especialista en Cirugía Traumatológica y Ortopédica, se ha incorporado a nuestro equipo médico.

El Dr. Sánchez Pulgar se egresó de la Universidad Católica de Córdoba y  ejerce su profesión desde 1980. Es Miembro Titular de la Sociedad de Ortopedia y Traumatología de Córdoba desde Agosto 1985 y Miembro Titular designado por la Asociación Argentina de Ortopedia y Traumatología desde el 2001.

Además ha sido reconocido como especialista en Ortopedia y Traumatología por la Facultad de Medicina de la Universidad Nacional de Córdoba,  la Asociación Argentina de Ortopedia y Traumatología Infantil y por la Sociedad Argentina de Ortopedia y Traumatología.  También fue ganador del “Premio Anual SAMECIPP” otorgado por la Sociedad Argentina de Medicina y Cirugía del Pie y Pierna en el año 2006.

Sánchez Pulgar  participo como panelista/relator especialista en Cirugía Traumatológica y Ortopédica en conferencias en Argentina, Brasil, Chile, Colombia, Costa Rica, México, Panamá, Perú, Uruguay, Venezuela, entre otros países.