SICOT e-Newsletter

Issue No. 41 - February 2012

 

 

In Memoriam

• Hans Mau

The doyen of German orthopaedics, Prof Dr Hans Mau, passed away on 14 February at the age of 91 in Tübingen. He was born in 1921 in Kiel, studied medicine in Tübingen and Heidelberg, and became a specialist in orthopaedics in 1953. He then spent one year doing a Fellowship at several North American hospitals, including the Hospital for Special Surgery in New York. He became Associate Professor in 1962, and Full Professor, Chairman of the Orthopaedic Department, as well as Chair of Orthopaedics at the University of Tübingen in 1963. Read more...

Editorial by Jochen Eulert, SICOT Secretary General

• Why you should attend the SICOT meeting in Dubai

The around 2,500 submitted abstracts demonstrate well the great interest of the international orthopaedic community in the upcoming combined SICOT/PAOA World Orthopaedic Congress in Dubai which will bring together orthopaedic surgeons and exhibitors from all over the globe. The lectures of the four plenary speakers, Freddie Fu, Gamal Hosny, Chitranjan Ranawat, and Niek van Dijk, will be without a doubt the highlights of the meeting. However, the scientific programme has much more to offer. Read more...

SICOT Events

• Call for Abstracts

The abstract submission deadline is now closed. Thank you for submitting your abstracts. Presenting authors will be notified of their abstract acceptance/refusal on 30 April 2012.

• Registration

Online registration is open! Register here...

• Diploma Examination

Online registration is open! The application and registration deadline is 29 February 2012. More information about the examination can be found here.

• 2nd SICOT Educational Day / 18th SICOT Trainees Meeting

The SICOT Educational Day is an initiative undertaken by the SICOT Young Surgeons Committee. The aim of this day is to provide a comprehensive review course for residents and an evidence-based update for practicing surgeons on a specific theme at each SICOT meeting. The theme is selected in such a way that it is mutually beneficial to residents in their exams and to orthopaedic surgeons in their daily practice. The theme chosen for this year is 'The Knee'. Great teachers from around the world are being brought together to lecture on their area of expertise. Read more...

Please visit the SICOT website regularly for updated information about Dubai OWC 2012.

17th SICOT Trainees Meeting
14-16 May 2012 * Moscow, Russia

• Call for Abstracts

Abstracts may be submitted via e-mail to ph@peterlink.ru until 1 March 2012. 

Topics: Joint Replacement, Vertebral Surgery, Arthroscopy, Acute Trauma, General Orthopaedics, Sports Medicine, Skeletal Reconstructions

The winner of the Best Trainee Paper Award will be selected from among all abstracts submitted and will be awarded at the Closing Ceremony of the meeting. The prize is three years’ free SICOT membership.

Please click here for more information about the 17th SICOT Trainees Meeting.

SICOT News

• CHOP/SICOT Fellowship

The Children’s Hospital of Philadelphia (CHOP) is offering six- or twelve-month research fellowships to US or internationally trained orthopedic surgeons. Prerequisite for the research fellow application is excellent oral and written command of the English language, graduate of medical school and residency program, interest in pediatric orthopedic surgery, submission of a complete application with letter of recommendation before the deadline 28 February 2012 (for the January 2013 fellowship), and on time visa application, where applicable. Read more...

• European Musculoskeletal Review - Volume 6 Issue 4

As part of a Media partnership with Touch Briefings, SICOT members receive free eBook access to Touch Briefings 'European Musculoskeletal Review' Volume 6, Issue 4.

In the latest issue, Professors Uta Kiltz and Jurgen Braun contribute an excellent paper, 'How Should Ankylosing Spondylitis be Managed? Overview of the Latest Updates of the Recommendations Issued by the Assessment of SpondyloArthritis International Society', while Professor Paul Emery and colleagues discuss tailoring therapy in rheumatoid arthritis. Elsewhere in this edition, Peter Kriz and Pierre D’Hemecourt provide a fascinating exploration of overuse injuries in the young athlete.

Directed by an Editorial Board comprising internationally respected physicians, European Musculoskeletal Review’s peer-reviewed articles endeavour to provide a concise and timely update on the latest opinion and advances spanning the breadth of musculoskeletal practice.

SICOT members access the current edition, European Musculoskeletal Review – Volume 6 issue 4, in full and for free in eBook format. Click here to access your complimentary eBook. (If you are a SICOT member, please log in to the SICOT website first with your username (member ID number/e-mail address) and password. Information about resetting passwords is available on the SICOT website.)

For more information please visit: www.touchmusculoskeletal.com  

SICOT Global Network for Electronic Learning - SIGNEL

• Article of the Month

Causes of a painful total knee arthroplasty. Are patients still receiving total knee arthroplasty for extrinsic pathologies?
Nawfal Al-Hadithy, Hamoun Rozati, Matthew Sewell, Alex Dodds, Peter Brooks & Minhal Chatoo
  
Purpose Whilst patients undergoing total knee replacements generally have good relief of their symptoms, up to 20% complain of persisting pain. Revision rates have therefore been rising, particularly so for unexplained pain. We reviewed the causes of painful total knee replacements including extrinsic causes. Read more...

• Case of the Month

Periprosthetic fracture after wrist arthroplasty

A 47-year-old male presented to the emergency department with pain in the wrist after trauma in the form of severe fall from his mountain bike. One year earlier he had received a wrist arthroplasty because of posttraumatic osteoarthritis after a distal radius fracture. The patient is very active, still riding his mountain bike after the implantation of the total wrist joint. Read more...

NEW! Scientific Debate

• Debate Section in the SICOT e-Newsletter

Orthopaedics is a diverse and an ever evolving branch of medicine. Despite the rapid advancements in every subspecialty of this field, numerous controversies persist and every orthopaedic surgeon comes across these in his/her day-to-day practice. Evidence based orthopaedics has probably solved a few, but some questions still remain unanswered. One such example is the dilemma regarding resurfacing of patella during primary total knee arthroplasty (TKA). In the largest randomised controlled trial of patellar resurfacing reported to date (JBJS Am 2011;93:1473-81), it was found that the functional outcome, reoperation rate, and total health care cost five years after primary TKA were not significantly affected by the addition of patellar resurfacing to the surgical procedure. As such, many times we all have to rely on our personal preferences. As part of the SICOT e-Newsletter, we have identified a few such topics of controversies in adult reconstructive surgery which we plan to discuss in our e-Newsletter over the next year. Some of these include:

1. PCL sparing vs sacrificing TKA
2. High tibial osteotomy vs unicompartment knee replacement
3. Patellar resurfacing vs shaving in TKA
4. Arthroscopy for early osteoarthritis knees
5. Resurfacing THR
6. Minimally invasive arthroplasty

SICOT members are invited to send their expert opinions to the Editorial Secretary (edsecr@sicot.org). The debate section will act as a platform for a healthy discussion on these topics of controversy. We anticipate your valuable contributions and hope that readers of our e-Newsletter enjoy this new section.

• Patellar Resurfacing in Total Knee Arthroplasty for Osteoarthritic Knees

The decision to resurface patella or to leave it unresurfaced during total knee arthroplasty (TKA) in an osteoarthritic knee remains controversial. This has led to many randomized control trials. However, none of them provide any consistent result in short- or long-term follow-ups. As an initiative of the young surgeon's group of SICOT, we attempt to discuss both aspects of this situation. This debate is a personal opinion of each author based on his experiences and interpretation of literature, and in no way should be considered as an absolute guideline for management. Read more...

Training & Education

• Orthopaedic Training in Ireland

Surgical training is a journey, where perseverance and stamina is as important as acquiring the knowledge and skills that later will prepare you for your career as a surgeon. Although, geographically, Ireland is next to the United Kingdom and surgeons sit the same exit examination, the orthopaedic training in Ireland is similar but not the same. Read more...

• My Experience of the SICOT Diploma Examination - Prague 2011

I finished my Masters in Orthopaedics in India in 2003 and came to the United Kingdom in 2005 for more specialised training. Having been in practice for the last few years, I was increasingly feeling the urge to refresh my knowledge as many things had changed since I finished my post-graduation back home in India. This idea spurred me into reading afresh, and I decided to apply for the SICOT Diploma Examination to keep myself motivated. The SICOT Congress in Prague provided the perfect opportunity, since it was much closer to the United Kingdom compared to some other recent SICOT meetings. It would also give me an opportunity to interact and compete with the best trainees across the world. Read more...

• Hiranandani Orthopaedic Medical Education (HOME) Research Fellowship

I was awarded the Hiranandani Orthopaedic Medical Education (HOME) Research Fellowship at the Dr L.H. Hiranandani Hospital in Mumbai, India, from 1 September 2010 to 31 August 2011. This fellowship was a perfect opportunity for a young surgeon like me to get involved in active orthopaedic research. This programme is headed by Dr Vijay Shetty and Dr Sanjeev Jain, who contribute to making this Hospital a great place to work. Dr Vijay Shetty is a renowned arthroplasty surgeon and a dedicated academician with great inclination for research, and Dr Sanjeev Jain is also a famous arthroplasty surgeon with his immense experience and vast reading. I was amazed to see both of them so full of energy and enthusiasm. Read more...

Future Events by SICOT Members

• International Biologoc Orthopaedic Meet 2012

Hiranandani Orthopaedic Medical Education (HOME), Orthopaedic division of the Dr L.H. Hiranandani Hospital in Mumbai, India, announces the first "International Biologoc Orthopaedic Meet 2012" (IBOM 2012) to be held in Westin Hotel, Mumbai, on 9 March 2012. For details visit: http://ibom.co.in/index.php

• EGAA International Meeting

The Egyptian Arthroscopy Association is holding its first international meeting on 13-15 March 2012 at the JW Marriott Hotel in Cairo. Read more...

Worldwide News

• Apixaban versus enoxaparin for thromboprophylaxis after hip or knee replacement
  G. E. Raskob, A. S. Gallus,; G. F. Pineo, D. Chen, L-M. Ramirez, R. T. Wright, M. R. Lassen
  J Bone Joint Surg Br February 2012 vol. 94-B no. 2 257-264
  (comment by Bassel El-Osta)

"In order to compare the effect of oral apixaban (a factor Xa inhibitor) with subcutaneous enoxaparin on major venous thromboembolism and major and non-major clinically relevant bleeding after total knee and hip replacement, we conducted a pooled analysis of two previously reported double-blind randomised studies involving 8464 patients. One group received apixaban 2.5 mg twice daily (plus placebo injection) starting 12 to 24 hours after operation, and the other received enoxaparin subcutaneously once daily (and placebo tablets) starting 12 hours (± 3) pre-operatively. Each regimen was continued for 12 days (± 2) after knee and 35 days (± 3) after hip arthroplasty. All outcomes were centrally adjudicated. Major venous thromboembolism occurred in 23 of 3394 (0.7%) evaluable apixaban patients and in 51 of 3394 (1.5%) evaluable enoxaparin patients (risk difference, apixaban minus enoxaparin, -0.8% (95% confidence interval (CI) -1.2 to -0.3); two-sided p = 0.001 for superiority). Major bleeding occurred in 31 of 4174 (0.7%) apixaban patients and 32 of 4167 (0.8%) enoxaparin patients (risk difference -0.02% (95% CI -0.4 to 0.4)). Combined major and clinically relevant non-major bleeding occurred in 182 (4.4%) apixaban patients and 206 (4.9%) enoxaparin patients (risk difference -0.6% (95% CI -1.5 to 0.3)). Apixaban 2.5 mg twice daily is more effective than enoxaparin 40 mg once daily without increased bleeding."

As a continuation of my previous December 2011 article, the prophylaxis topic will probably remain controversial. The above abstract is another new anticoagulation prophylaxis therapy that was introduced late last year and published in the JBJS February 2012 issue. Apixaban, a new factor Xa inhibitor, which has been developed by Bristol-Myers Squibb and Pfizer, was used in this double-blind randomised trial to compare the above drug with enoxaparin. The study is quite powerful with adequate patient numbers to come to a conclusion. The results are seemingly quite positive and they show a significant difference between the 2 drugs (p less 0.001). Major venous thromboembolism occurred in 23 patients in apixaban vs 51 patients in enoxaparin. On the other hand, the number of complications are indeed close. Major bleeding occurred in 31 and 32 patients in apixaban and enoxaparin respectively. Combined major and clinically relevant non-major bleeding events were 182 and 206 for apixaban and enoxaparin respectively. This topic might never be satisfactorily resolved, and more companies are bringing out new thromboprophylaxis treatments, which hopefully will reduce the complication rate and increase the effectiveness in the future. This study did not satisfy me personally, and I am sure there will be many orthopaedic surgeons out there who will share my opinion. It is another drug, comparing relatively known products, versus a new drug and they indeed have different working mechanisms. Despite this, the results are nearly identical. Another important point is: what is the difference between this particular drug and the other available ones such as dabigatran and rivaroxaban? Although there is no satisfactory answer yet, it is up to us orthopaedic surgeons to decide what the best is for our patients.

Industry News

• NORMED

Editorial Department

Editorial Secretary: Hatem Said
Editorial Production: Linda Ridefjord
Editorial Board: Ahmed Abdel Azeem, Syah Bahari, Kamal Bali, Bassel El-Osta, Anthony Hall, Maximilian Rudert

Rue Washington 40-b.9, 1050 Brussels, Belgium
Tel.: +32 2 648 68 23 | Fax: +32 2 649 86 01
E-mail: edsecr@sicot.org | Website: www.sicot.org

Disclaimer: Some of the views and information expressed in this e-Newsletter include external contributors whose views are not necessarily those of SICOT. SICOT is not responsible for the content of any external internet sites.