In The News: May 2011
Rotator Cuff Healing Continues After Arthroscopy
In the largest study to date to evaluate the long-term outcome of arthroscopic rotator-cuff repair (the standard of care for repairing rotator cuffs), researchers at the Hospital for Special Surgery in New York not only found that the procedure provided positive results five years after surgery but revealed that the rotator cuff has the ability to heal itself. Tendons that were incompletely healed at two years post-op appeared to be fully healed by five years, suggesting that rather than deteriorating over time, results may actually improve. The study involved 193 patients who underwent arthroscopic repair and were then evaluated annually for five years. After one year, 64.3 percent had a healed rotator cuff. The percentage went up to 75.4 percent at two years and 81.2 percent after five years. Despite the long-held belief that once a rotator cuff fails to heal following surgery it has no capacity to heal in the future, researchers said their results showed that a rotator cuff does in fact have the capacity to heal itself.
Spinal Botox Injection May Reduce Pain
An injection of botulinum neurotoxin type A (BoNT/A)—commonly known as Botox—has been found to reduce inflammation-related pain when injected into the spinal canal of mice. In a study conducted at Korea’s Seoul National University, a single spinal injection of BoNT/A produced a pain-reducing effect for up to 10 days. The effects were not accompanied by any movement abnormalities, suggesting that BoNT/A did not adversely affect spinal cord function. Although Botox is most familiar for its use in cosmetic plastic surgery, it is also used in the treatment of various neuromuscular disorders. Since it causes temporary muscle paralysis, its pain-reducing effects have been attributed to muscle relaxation. However, recent studies suggest that other analgesic mechanisms may be operating as well. "With its long-lasting effect," said the study’s authors, "BoNT/A may be a useful analgesic in inflammatory pain, opening up many unexplored therapeutic avenues to help us control chronic pain."
Bone-Loss Drugs May Reduce Colon Cancer Risk
Bisphosphonates—drugs commonly taken by healthy women to prevent bone loss—have been found to be associated with a 50 percent reduction in the risk of postmenopausal colorectal cancer. According to research conducted at the Tehnion-Israel Institute of Technology, the finding further supports the role of bisphosphonates as a potential new drug class for cancer prevention. (The drugs had earlier been shown to be associated with a reduced risk of breast cancer.) After evaluating the use of bisphosphonates in 1,866 postmenopausal females, researchers concluded that, "This class of medications has a broad effect—not necessarily limited to a specific cancer site," and, if proven in future trials, could lead to a recommendation for their use by the general population for cancer prevention.
Knee Replacements More Costly, Time-Consuming in Overweight Patients
Total knee replacement (TKR) surgery takes far more time, and is far more costly, in overweight and obese patients than in normal-weight patients, according to a study presented at a recent meeting of the American Academy of Orthopaedic Surgeons. Investigators reviewed 454 TKRs conducted by one surgeon between 2005 and 2009 at the Hospital for Special Surgery in New York, then correlated weight with five factors: anesthesia induction time, tourniquet time, time spent surgically closing the knee after the procedure, total surgery time, and total time spent in the operating room. As a patient’s body mass increased, so did the time it took to perform all parts of the surgery (fatty tissue makes surgery more difficult). In patients who were of healthy weight, the overall operating room time was two hours and increased as weight increased; for very obese patients, it was up to two hours and 24 minutes, a difference of 20 percent. This 20 percent greater utilization of operating-room time, multiplied by five or six TKRs over the course of a day, said investigators, translates into two additional hours, which means staff overtime and therefore greater procedural expense.