Wednesday, August 15, 2012

Orthopedic Innovation

Innovation within medicine more often arises via persistence and determination than from dramatic breakthroughs.  In fact, many paradigm shifting advancements are not initially embraced by the medical establishment.  In orthopedics, total joint replacement and arthroscopy are two excellent examples.  Sir John Charnley deserves much of the credit for the modern development of hip replacement surgery.  His initial designs used Teflon and those implants typically failed early.  He redesigned his implant to use a novel liner that significantly improved  its longevity.  Use of other materials and techniques over several decades via the hard work of many have led us to the point where we complain when a total hip lasts less than 10 or even 15 years.  (Read more)

Arthroscopy, one of the first minimally invasive types of surgery, at its beginning took longer and was more complicated than open surgery.  The first examination of joint via a "scope" was close to 100 years ago.    Over the last 30 years, it has become the standard of care for evaluating and treating many joint injuries such as ACL reconstruction and Rotator Cuff Repair.  This innovation is the result of contributions of thousands of researchers, surgeons and their patients.  It is also led to less invasive surgery for spine disorders.  (See Spine Surgery Video) (Read more/source)

We are now about a decade into "Biologic Orthopedics".  Therapies such as Platelet Rich Plasma, Stem Cells, Genetic Engineering, and Genome Sequencing are revolutionizing how we evaluate and treat patients.  As we surf the choppy waters of innovation, however, we will not always embrace ideal ideas.  Some "innovations" will fade as fads but others will emerge as commonplace treatments that significant improve the lives of millions of patients.  We need to balance our approach to novel methods of helping our patients.  We must seek their safety and benefit first.   In doing so, we are obligated to consider emerging biologic treatment options because they may be the best and most appropriate.

Allan Mishra, MD

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