Day 3 :
- Bone Disorders, Osteoarthritis and Outpatient Orthopedic Disorders
Sports orthopedics, Medical Devices and Instruments in Orthopedics & Rheumatology
University of Maryland, USA
Time : 09:00-09:25
Ruixin Zhang has completed his Ph.D from Shanxi Medical University in China and postdoctoral studies from National Institutes of Health and Yale University. He has been serving as an editorial board member for seven professional journals. He is an assistant professor in Center for Integrative Medicine , School of Medicine, University of Maryland
Treatment of knee osteoarthritis (OA) pain remains serious challenges. Mechanisms of OA pain have been studied in rodent models. The aim of this study was to investigate effects and mechanisms of electroacupuncture and laser acupuncture on OA-caused pain in an OA rodent model produced by monosodium iodoacetate (MIA). MIA (3 mg/50 µl /rat) was injected into the knee joint cavity in male and female rats. Electroacupuncture, 10Hz, 2 mA, and 0.4 ms pulse width for 30 min, was applied bilaterally at the acupoint GB30 once a day on days 2-9 post-MIA injection. Laser acupuncture was conducted on acupoint Dubi (ST 35) for 5 min per treatment, once a day on days 1-7. Pain was measured with a battery of tests. Functional magnetic resonance imaging (fMRI) was used to study the effect of electroacupuncture on brain network connectivity during the resting state after electroacupuncture treatments. Electroacupuncture treatment increased body weight bearing in ipsilateral hind limb in male and female rats. It inhibited mechanically and thermally evoked pain, and improved rat motion distance and speed. Electroacupuncture -treated rats showed conditioned place preference to the electroacupuncture-paired chamber. fMRI data shows an increased anterior cingulate cortex (ACC)/motor/sensory (M1/S1) connectivity in MIA-injected rats but not in naive or electroacupuncture-treated rats. This suggests that MIA-induced pain affects connectivity between the nucleus accumbens and ACC/motor/sensory cortex and that electroacupuncture modulates OA-induced brain activity. The 200 mW laser treatment significantly improved body weight bearing in the ipsilateral hind limb. Electroacupuncture and laser acupuncture may alleviate knee OA pain.
Griffith University, Australia
Title: Randomized clinical trial of prolotherapy injections and an exercise program used singly and in combination for refractory tennis elbow
Time : 09:25-09:50
Michael Yelland is the Associate Professor of Primary Health Care at Griffith University and a general and musculoskeletal Medicine Practitioner in Brisbane. His teaching, research and clinical interests focus on evidence-based diagnosis and treatment of musculoskeletal pain. These include tendon disorders and spinal pain. He has conducted RCTs comparing prolotherapy injections and exercises in the treatment of chronic painful musculoskeletal conditions, including low back pain, Achilles tendinosis and tennis elbow. He has also conducted three series of single patient placebo-controlled trials of medications for osteoarthritis and neuropathic pain. He is the President of the Australian Association of Musculoskeletal Medicine.
Lateral epicondylosis (LE, \"tennis elbow\") is a common, debilitating and expensive tendinopathy of the lateral elbow resistant to many treatments. Two treatment programs addressing the pathology of LE with preliminary evidence of efficacy are hypertonic glucose+lignocaine injections (prolotherapy, PrT) and an elbow joint mobilization and concentric/eccentric exercise guided by a physiotherapist (P/E). This presentation compares the clinical and disease modifying effectiveness, cost-effectiveness and acceptability of prolotherapy (PrT) injections with a physiotherapy/exercise (P/E) program used singly and in combination. It describes a three-arm RCT in which adults with moderate to severe LE were randomly assigned to PrT, P/E or PrT + P/E, with 40/group. Primary outcomes of their patient-rated tennis elbow evaluation score and global improvement were followed up at 6, 12, 26 and 52 weeks along with pain severity, recurrence, objective biomechanical measures and costs. Structural and biomechanical changes were followed with serial ultrasounds. Recruitment of 120 participants from 204 clinical assessments was completed in June 2014 with completion of 52 week follow-up due in June 2015. Follow-up rates to date have ranged from 82% to 90%. Baseline characteristics for each group were similar. Blinded analysis of results will be completed by August 2015. This trial should provide valuable evidence to inform practitioners in their choice of the most appropriate treatment of their patients with refractory LE, potentially providing substantial benefits to patients, industry and society. The correlation of clinical, biomechanical and ultrasound outcomes will inform the mechanisms of action of these treatments.
University Hospital of North Tees, UK
Title: Radiological evaluation of the rate of interbody fusion using posterior/transformainal interbody fusion with a missed screw technique
Time : 10:35-11:00
Shoaib Khan has completed his M.B.B.S from Dow Medical College, Karachi, Pakistan in 2005 and his M.R.C.S from Royal College of Surgeons of Edinburgh, UK in 2013. He is working as a Research Fellow for Spine in University Hospital of North Tees, Stockton on Tees, United Kingdom
Abstract: Objective: Posterior or Transforminal Interbody fusion has been performed for about 7 decades to treat degenerative lumbar spine disease. The aim of our study is to evaluate the rate of interbody fusion using posterior or lumbar interbody fusion with a missed screw technique. In our study, Interbody fusion was performed at two levels with no intervening screw at the middle vertebral pedicle. Methods: The study involved retrospective radiological analysis of PLIF/TLIF performed at two levels with a missed screw technique in Forty patients. The radiographs were assessed independently bya Consultant Radiologist and a Spinal Surgeon both commenting on fusion rate using Brantigan-Steffee fusion criteria. The criteria include a denser and more mature bone fusion area than originally achieved at the time of operation, no interspace between the cage and the vertebral body, and mature bony trabeculae bridging the fusion area. The procedures were performed by one Spinal surgeon. Results: In our study of 40 patients, we had 24 males and 16 females with an average age of 44.7 years in both groups. The main indication of performing Interbody fusion was degenerative lumbar spine disease. Fusion procedures were performed over a period of 3 years and 6 months from July 2009 to Jan 2013 with an average follow up of 19.8 months. Radiographs as independently reviewed by Radiologist and Spinal surgeon revealed that 29 patients were fused at both levels, one level was fused in 3 patients (L4/5 in 2 patients and L5/S1 in 1 patient), two patients did not have adequate follow to comment on fusion and non fusion was found in six patients Conclusion: Our study concluded that it may not be necessary to insert a screw at the middle vertebral pedicle while performing PLIF/TLIF at two levels.
Addis Ababa University, Ethiopia
Time : 11:50-12:15
I have completed my Doctorate Degree age of 26 years from Jimma, university and post doctoral study from Addis Ababa University. Previous medical director and other time CEO of Abomsa Hospital. Currently, Assistant professor of Orthopedic and Traumatology, at Addis Ababa University, college of health science, Department of Orthopedics and Traumatology. Executive Committee of Ethiopian Society of Orthopedic and Traumatology. Board member of Efa Beri Disabilities’ Charity Organization (EBDCO).
Disability is one of the social problems prevalent in our country. According to the International Rehabilitation Review, about 10% of the world’s population has disabilities of which 80% found in developing countries. In accordance with developmental social welfare policy (1996) of the Federal Democratic Republic of Ethiopia, a total of 23 types of disabilities have been identified in a country. Studies carried out indicate that 85% of all disabled citizens live in the rural areas and with regard to this problem, children and elders are the most vulnerable segments of the society. According to the country’s profile, study on persons with disabilities carried out by Wa’el International Business and Development Consultant (2000) 1,488,892 disabled citizens are found in Ethiopia. Out of this, about 833,653 (56%) are found in Oromia National Regional State. Persons with disability in Ethiopia do not often have access to rehabilitative services; simply because the availability of these services are very much limited. Furthermore, background societal attitudes and prejudice against the victims perpetuate fatalism, that is, the victims and their loved ones would rather learn how to live with the problem accepting it as God’s will than seek remedy for it. The rehabilitative services that are available today for persons with disability in our country emphasize institutional care are costly and, therefore, greatly limited to the number of beneficiaries. Worse yet, the institutions are very few and urban–concentrated and thus exclude the majority of those who need these services.
Civil Service Hospital, Nepal
Title: Total hip replacement for old displaced subcapital fracture neck of femur in elderly patients
Time : 13:05-13:30
Kapil Mani K.C. is currently working in Civil Service Hospital of Nepal, Minbhavan, Kathmandu as an orthopedic surgeon since Second July 2011. He is actively involved to attend the patients in OPD and Emergency department as well as to perform the operations in routine and emergency basis every day. Besides he is involved in teaching and learning activities in the hospital.
Background: The management of displaced subcapital femoral neck fracture in elderly patients is controversial because of high rate of complications associated with internal fixations, hemiarthroplasty, and bipolar arthroplasty. To avoid some of these complications, we did primary total hip replacement for these elderly patients of age more than 65 years. There is high chance of nonunion of fracture with internal fixations, significantly increased wear of bone in hemiarthroplasty and even bipolar arthroplasty resulting difficult total hip replacement like revision arthroplasty. Because of less mobility of patients, replacing the total hip after 65 years for fracture neck of femur, the joint sustains for longer time, and there may not be the need of revision arthroplasty. Patients and Methods: A total of 12 total hip replacements was performed for displaced femoral neck fracture of elderly patients of age more than 65 years in Civil Service Hospital of Nepal and National Academy of Medical Sciences, Bir Hospital for past two and half years. All the patients were operated through modified Harding’s approach. Non-cemented arthroplasty was performed in 8 cases and cemented arthroplasty was performed in 4 cases. In case of cemented arthroplasty, both hybrid and reverse hybrid type were done. Patients were evaluated at 3 months and 1 year after surgery. Results: There were 8 male and 4 female patients of age range from 65 to 77 years. Seven patients were fracture in right side and 5 patients in left side. None of the patients died and developed medical complications after surgery till now. Similarly none of them developed wound problems and landed into the dislocation. Every patient was assessed using Harris Hip Scoring method. Nine of them had excellent and 3 patients had good results. Gait analysis was performed in all patients. We found normal speed and step length at 3 month and one year after surgery. Conclusion: Total hip replacement is one of the best management for displaced sub-capital fracture neck of femur for independently mobile, mentally competent, elderly patients of age more than 65 years with better rehabilitation potential and function of hip and very low revision rate. However, long term follow-up has to be awaited for final results.