Tag Archives: pediatric orthopedics

Cervical Radiculopathy: Cervical Disc Arthroplasty versus Fusion

For patients with cervical radiculopathy, total disc replacement using artificial disc devices that have become more widely used during the last 10 years presents a potential advance in treatment. It may preserve range-of-motion and decrease the need for later secondary surgery when compared to the standard anterior discectomy and spinal fusion. “Artificial disc devices can yield good results in the right patients,” notes Mark Knaub, MD, assistant professor and associate director of the Penn State Spine Center. However, Dr. Knaub explains that there are significant limitations to their usefulness: “These devices are not appropriate to use in patients with poor bone quality or disc disease affecting multiple levels, nor for patients with a pre-existing fusion, those who present with significant arthritis and those with already limited range-of-motion.” While clinical trials show improvement of symptoms with disc arthroplasty,1,2 there is controversy regarding whether a cervical disc arthroplasty can reduce the frequency of  reoperations, compared with fusion.

Images of: Patient is a healthy, active 40-year-old male with history of radiating right arm pain in a C7 nerve root distribution. He failed conservative treatment. (A) Pre-operative X-ray shows mild spondylosis at C6-7 with preserved disc height. (B) Pre-operative MRI shows a foraminal disc herniation at C6-7. Patient chose to undergo anterior cervical discectomy and disc replacement at C6-7 with complete relief of his right arm symptoms. (C) Follow-up X-ray at 2.5 years after surgery shows no evidence of device-related complications.

Patient is a healthy, active 40-year-old male with history of radiating right arm pain in a C7 nerve root distribution. He failed conservative treatment.
(A) Pre-operative X-ray shows mild spondylosis at C6-7 with preserved disc height.
(B) Pre-operative MRI shows a foraminal disc herniation at C6-7. Patient chose to undergo anterior cervical discectomy and disc replacement at C6-7 with complete relief of his right arm symptoms.
(C) Follow-up X-ray at 2.5 years after surgery shows no evidence of device-related complications.

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Magnetically Controlled Growing Rod System Offers Nonsurgical Distraction for Early Onset Scoliosis

U.S. News & World Report Best Children's Hospital - Orthopedics, 2015-2016A magnetically controlled growing rod system (MAGnetic Expansion Control, MAGEC™) was approved by the United States Food and Drug Administration for treatment of early onset scoliosis in February 2014. Used in Europe since 2009, MAGEC provides a nonsurgical distraction alternative to conventional growing rod systems. Douglas Armstrong, M.D., Penn State Hershey Bone and Joint Institute, and chief of pediatric orthopaedics, Penn State Hershey Children’s Hospital, specializes in treating pediatric scoliosis, and welcomed the new device, explaining, “We currently have 11 patients who have a MAGEC system in place for treatment of early onset scoliosis. The expansion is performed in the clinic every three months, as an office visit.” Continue reading

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Community-based Heel Ultrasound Screening Leads to Osteoporosis Follow-up and Treatment Recommendations

“Providing calcaneal quantitative ultrasound (US) scanning as a free screening can be an effective strategy for improving osteoporosis detection and treatment,” says Edward Fox, M.D., Penn State Hershey Bone and Joint Institute. In a recent study of adults who received free calcaneal US screening at community health fairs and telephone follow-up, Fox, Frances Tepolt, M.D., and Susan Hassenbein, CCRP, demonstrated that nearly half of those identified as high-risk for osteoporosis (T-score less than or equal to -1) sought evaluation from a health care professional within three months. The large majority of these individuals also received recommendations for further bone density evaluation and treatment (Figure).

Heel Ultrasound ScreeningParticipants, none of which had ever had a fragility fracture, were also given access to informational pamphlets about bone health and osteoporosis. Fox emphasizes, “This study is among the first to examine individuals, access to osteoporosis screening results and disease information, prior to the occurrence of any overt signs of disease, like a fragility fracture. With about half of the high-risk individuals seeking follow-up, this study supports that heel US screening has the potential to increase osteoporosis diagnosis and intervention.” Continue reading

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Choosing Between Total Hip Arthroplasty and Hemiarthroplasty for Femoral Neck Fractures: Patient Selection is the Key

Q: Is there a general consensus among orthopaedic surgeons about how best to choose between total hip arthroplasty (THA) versus hemiarthroplasty for their patients with femoral neck fractures?

Davis: No. There are conflicting opinions about which of these procedures is best suited to particular patients. Studies from individual centers tend to emphasize the improved functional outcomes in patients who have a THA, while national registry data tends to demonstrate the lower complication rate with hemiarthroplasty. The differences may relate to the patient populations in each study and the technical skills of the surgeons. Outcomes from each type of study are valuable. Surgeons and patients should balance the risks and benefits to determine the best approach for each individual patient.

Q: Based on your interpretation of the available registry data, what are the main advantages and disadvantages of THA?

Davis: Compared to hemiarthroplasty, THA yields better pain relief and patients are able to walk farther, on average. Disadvantages, however, include longer surgical time, increased dislocation risk, and potential for acetabular component loosening. Several countries have registry data that suggest rates of complications, including dislocation, are higher with THA versus hemiarthroplasty. Also in most hip fracture cases, the acetabular bone stock is softer and the acetabular fixation is less secure than in arthritic hips with denser bone. In my opinion, the literature supports THA as the procedure of choice for younger more active patients and those with pre-existing arthritis. (Figure 1)

Total Hip Arthroplasty (THA)

FIGURE 1A: Patient with femoral neck fracture for THA. FIGURE 1B: Patient X-ray after surgery. FIGURE 2: Appropriate candidate for hemiarthroplasty; 64-year-old man who fell on ice.

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Club Foot: Ponseti Treatment Offers Long-Term Success

Club foot Posneti procedure

Club foot is a congenital deformity that, if left untreated, can cause lifelong disability. William L. Hennrikus, M.D., explains, “Club foot is relatively common, affecting about one of every 1,000 newborns and occurs more often in boys. Siblings are also at higher risk (about four in 100).” The deformity involves the bones, blood vessels, muscles, and tendons of the lower leg (see figure A) and is linked to genetic and environmental factors. Infants with club foot can have other conditions, such as spina bifida or arthrogryposis. Continue reading

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