I started by choosing medical journals with a focus on orthopedics. The Journal of Bone and Joint Surgery, the Stone Clinic, and the Journal of Pediatric Orthopaedics are three such organizations, and their web sites are easy to use. The main flaw with all of these sites is that they are written for orthopedic specialists, so some of the articles are hard to understand. Edheads, on the other hand, is an interactive site with flash animations of hip and knee replacement surgeries. It is directed more toward the layman than the specialist, which makes it easy to follow but also gives it a childish air. Orthoseek.com and Swarm Interactive strike a nice balance between these two extremes. Orthoseek.com contains medical definitions in an easy to use format but does not overwhelm the reader with medical jargon. Swarm Interactive is a wonderful site with animated descriptions of many surgical procedures. It is designed for patient education, so the videos are simple enough to be easy to understand but detailed enough to provide a valuable learning experience. YourSurgery.com is another site that aims to educate patients getting ready to have surgery. Unlike Swarm Interactive, Yoursurgery.com is not a free service. To watch one video costs five dollars, and a year-long membership costs one hundred dollars. I am nevertheless including it on my linkroll because it looks like it could be an invaluable resource to any of my readers who do not mind paying for high-quality information. Last but not least is World Ortho (provider of the image above), a site whose navigation system alone won it high marks in my opinion. Possibly the most interesting piece of information on this site is a series of lecture notes from an Orthopedics class. It was very enriching for me to read them, and I hope my readers will find them equally stimulating.
3/29/08
Back to the Linkroll: Further Efforts to Increase the Value of my Blog
A few weeks ago, I decided to update my linkroll by trolling through the web in search of high quality sites to link to. I am continuing this charge with my newest post because I want my blog to become more than just a dead-end sink for my own writing. I want to provide links to other quality sites so that my readers will be able to use my blog as a multi-dimensional source of information. As with my previous post, I relied on the Webby Awards and the IMSA criteria to determine what sites were of a quality high enough to link to from my blog.
I started by choosing medical journals with a focus on orthopedics. The Journal of Bone and Joint Surgery, the Stone Clinic, and the Journal of Pediatric Orthopaedics are three such organizations, and their web sites are easy to use. The main flaw with all of these sites is that they are written for orthopedic specialists, so some of the articles are hard to understand. Edheads, on the other hand, is an interactive site with flash animations of hip and knee replacement surgeries. It is directed more toward the layman than the specialist, which makes it easy to follow but also gives it a childish air. Orthoseek.com and Swarm Interactive strike a nice balance between these two extremes. Orthoseek.com contains medical definitions in an easy to use format but does not overwhelm the reader with medical jargon. Swarm Interactive is a wonderful site with animated descriptions of many surgical procedures. It is designed for patient education, so the videos are simple enough to be easy to understand but detailed enough to provide a valuable learning experience. YourSurgery.com is another site that aims to educate patients getting ready to have surgery. Unlike Swarm Interactive, Yoursurgery.com is not a free service. To watch one video costs five dollars, and a year-long membership costs one hundred dollars. I am nevertheless including it on my linkroll because it looks like it could be an invaluable resource to any of my readers who do not mind paying for high-quality information. Last but not least is World Ortho (provider of the image above), a site whose navigation system alone won it high marks in my opinion. Possibly the most interesting piece of information on this site is a series of lecture notes from an Orthopedics class. It was very enriching for me to read them, and I hope my readers will find them equally stimulating.
I started by choosing medical journals with a focus on orthopedics. The Journal of Bone and Joint Surgery, the Stone Clinic, and the Journal of Pediatric Orthopaedics are three such organizations, and their web sites are easy to use. The main flaw with all of these sites is that they are written for orthopedic specialists, so some of the articles are hard to understand. Edheads, on the other hand, is an interactive site with flash animations of hip and knee replacement surgeries. It is directed more toward the layman than the specialist, which makes it easy to follow but also gives it a childish air. Orthoseek.com and Swarm Interactive strike a nice balance between these two extremes. Orthoseek.com contains medical definitions in an easy to use format but does not overwhelm the reader with medical jargon. Swarm Interactive is a wonderful site with animated descriptions of many surgical procedures. It is designed for patient education, so the videos are simple enough to be easy to understand but detailed enough to provide a valuable learning experience. YourSurgery.com is another site that aims to educate patients getting ready to have surgery. Unlike Swarm Interactive, Yoursurgery.com is not a free service. To watch one video costs five dollars, and a year-long membership costs one hundred dollars. I am nevertheless including it on my linkroll because it looks like it could be an invaluable resource to any of my readers who do not mind paying for high-quality information. Last but not least is World Ortho (provider of the image above), a site whose navigation system alone won it high marks in my opinion. Possibly the most interesting piece of information on this site is a series of lecture notes from an Orthopedics class. It was very enriching for me to read them, and I hope my readers will find them equally stimulating.
3/10/08
Total or Mini: Will a New Hip Replacement Technique Take Over?
As I mentioned I would in my previous post, this week I used my linkroll to find a topic on which to write. What I found was quite interesting. There is a new orthopedic procedure for hip replacement known as a mini, or minimally invasive hip replacement. This is an alternative to the standard total hip replacement. The intriguing thing about this new procedure is that the surgeons performing it claim to be able to create the same end result as a traditional open hip replacement without the long hospital stay associated with such an operation. I feel that this is simply not the case. While it is true that the recovery time is shorter for patients who undergo the mini hip replacement, there are greater risks for long-term complications that negate any initial benefits of the less-invasive surgery.
The total hip replacement procedure is one of the oldest and most successful orthopedic operations performed today. No other joint can be replaced as easily or completely as the hip. The procedure is performed exactly the way it sounds.
The entire hip joint is removed from its socket and sawn off of the top of the femur. An artificial prosthesis (image to the right) is then inserted into the core of the femur and locked into place with methyl methacrylate, a bony cement. Younger or more physically demanding patients can chose a cementless prosthesis which fuses naturally to the bone. Cementless prostheses have micropores that the femur can grow into and create a strong permanent bond. The other end of the prosthesis is inserted into an artificial cup that is placed within the socket of the existing joint in the pelvis.
There are several options for the material and design of the replacement hip. One common pairing is a metal and plastic combination wherein the replacement socket is plastic and the ball joint is metal. Stainless steel is often chosen for its low reactivity, although some patients opt for titanium instead. A newer option is a ceramic prosthesis, although these have not been around long enough to prove their longevity. They have a high standard to meet, though. Traditional total hip replacement with a stainless steel and plastic prosthesis can be expected to last well over twenty years. Eighty percent of all replacements last longer than twenty years, and over half last longer than thirty. Of course, the younger a patient is, the more physically demanding they will be on it and the longer they will need it to last. This is an inherent flaw in the process of joint replacement that can only be solved through the eventual replacement of the replaced joint. A second replacement is known as a revision hip replacement. Revisions do not last as long as the initial replacement, but it is rare for a patient to need more than one revision.
This is due to the fact that a typical candidate for total hip replacement surgery is older (above the age of fifty) with oste
oarthritis of the hip. Osteoarthritis is caused by normal wear and tear on the joint as a component of the aging process, and is detailed in the image at left. In this common form of arthritis, the cartilage separating the two bones wears away and leaves the bones to rub against each other. This can be very painful and in some cases will render the joint immobile. Men around the age of forty-five begin to become candidates for osteoarthritis, and women catch up by around age fifty-five. With this in mind, it is easy to see how pretty much anyone could find themselves in need of a hip replacement at some point in their life. According to the Central Ohio Orthopedics Center, Over 166,000 hip replacements are done annually in the United States, with more than one third of those going to patients below the age of sixty-five.
Given that so many patients are elderly, it is imperative that infection and post-operative complications be kept to a minimum. This is where the mini hip replacement comes in. In the traditional surgery, a relatively large incision is made either posterior, lateral or anterior to the joint. This incision is made large enough to allow the surgeon full access to the joint and the surrounding muscle, tendons, and ligaments. With the entire area in full view, replacement and alignment is a fairly straightforward process. The mini hip replacement, on the other hand, involves two smaller incisions. One of these incisions is made posterior to the joint and the other is lateral. These smaller incisions reduce the risk of infection by limiting the amount of exposure to everything outside of the body. With the two access points it is possible for the surgeon to remove the deteriorated joint, insert the prosthesis, and cement it in place without ever actually seeing what is going on directly. Instead, x-rays and cameras help with the alignment of the prosthesis within the body.
As one can imagine, this is a difficult procedure. In spite of the fact that patients who undergo a mini hip replacement can be walking again the next day, not many surgeons are performing it because it is so much more difficult than the open procedure. Since the surgery itself is more difficult, there is a greater chance for error on behalf of the surgeon. These mistakes usually appear minor, such as a slight misalignment of the prosthesis, but they can lead to larger consequences later. Mini hip replacement recipients are at a greater risk for prosthesis dislocation than total hip replacement recipients. Dislocation of a prosthesis is a very serious problem that can only be corrected by a revision replacement.
From what I have read in the available literature, it seems to me that the mini hip replacement is not yet ready to completely replace the full hip replacement. The benefits of the mini procedure do not outweigh the possible consequences of a surgical mistake. After all, what good does it do to get out of the hospital a few days sooner if you may be setting yourself up for a revision ten years sooner? I cannot say that there is no hope for this new technique though. In the future, surgeons may very well become more proficient at the mini procedure. When they do it will be an excellent alternative for someone who needs a hip replacement but due to poor health cannot risk an open procedure.
The total hip replacement procedure is one of the oldest and most successful orthopedic operations performed today. No other joint can be replaced as easily or completely as the hip. The procedure is performed exactly the way it sounds.
The entire hip joint is removed from its socket and sawn off of the top of the femur. An artificial prosthesis (image to the right) is then inserted into the core of the femur and locked into place with methyl methacrylate, a bony cement. Younger or more physically demanding patients can chose a cementless prosthesis which fuses naturally to the bone. Cementless prostheses have micropores that the femur can grow into and create a strong permanent bond. The other end of the prosthesis is inserted into an artificial cup that is placed within the socket of the existing joint in the pelvis.There are several options for the material and design of the replacement hip. One common pairing is a metal and plastic combination wherein the replacement socket is plastic and the ball joint is metal. Stainless steel is often chosen for its low reactivity, although some patients opt for titanium instead. A newer option is a ceramic prosthesis, although these have not been around long enough to prove their longevity. They have a high standard to meet, though. Traditional total hip replacement with a stainless steel and plastic prosthesis can be expected to last well over twenty years. Eighty percent of all replacements last longer than twenty years, and over half last longer than thirty. Of course, the younger a patient is, the more physically demanding they will be on it and the longer they will need it to last. This is an inherent flaw in the process of joint replacement that can only be solved through the eventual replacement of the replaced joint. A second replacement is known as a revision hip replacement. Revisions do not last as long as the initial replacement, but it is rare for a patient to need more than one revision.
This is due to the fact that a typical candidate for total hip replacement surgery is older (above the age of fifty) with oste
oarthritis of the hip. Osteoarthritis is caused by normal wear and tear on the joint as a component of the aging process, and is detailed in the image at left. In this common form of arthritis, the cartilage separating the two bones wears away and leaves the bones to rub against each other. This can be very painful and in some cases will render the joint immobile. Men around the age of forty-five begin to become candidates for osteoarthritis, and women catch up by around age fifty-five. With this in mind, it is easy to see how pretty much anyone could find themselves in need of a hip replacement at some point in their life. According to the Central Ohio Orthopedics Center, Over 166,000 hip replacements are done annually in the United States, with more than one third of those going to patients below the age of sixty-five.Given that so many patients are elderly, it is imperative that infection and post-operative complications be kept to a minimum. This is where the mini hip replacement comes in. In the traditional surgery, a relatively large incision is made either posterior, lateral or anterior to the joint. This incision is made large enough to allow the surgeon full access to the joint and the surrounding muscle, tendons, and ligaments. With the entire area in full view, replacement and alignment is a fairly straightforward process. The mini hip replacement, on the other hand, involves two smaller incisions. One of these incisions is made posterior to the joint and the other is lateral. These smaller incisions reduce the risk of infection by limiting the amount of exposure to everything outside of the body. With the two access points it is possible for the surgeon to remove the deteriorated joint, insert the prosthesis, and cement it in place without ever actually seeing what is going on directly. Instead, x-rays and cameras help with the alignment of the prosthesis within the body.
As one can imagine, this is a difficult procedure. In spite of the fact that patients who undergo a mini hip replacement can be walking again the next day, not many surgeons are performing it because it is so much more difficult than the open procedure. Since the surgery itself is more difficult, there is a greater chance for error on behalf of the surgeon. These mistakes usually appear minor, such as a slight misalignment of the prosthesis, but they can lead to larger consequences later. Mini hip replacement recipients are at a greater risk for prosthesis dislocation than total hip replacement recipients. Dislocation of a prosthesis is a very serious problem that can only be corrected by a revision replacement.
From what I have read in the available literature, it seems to me that the mini hip replacement is not yet ready to completely replace the full hip replacement. The benefits of the mini procedure do not outweigh the possible consequences of a surgical mistake. After all, what good does it do to get out of the hospital a few days sooner if you may be setting yourself up for a revision ten years sooner? I cannot say that there is no hope for this new technique though. In the future, surgeons may very well become more proficient at the mini procedure. When they do it will be an excellent alternative for someone who needs a hip replacement but due to poor health cannot risk an open procedure.
3/3/08
Building a Better Blog: Getting My Linkroll Up To Date
This week, I again chose not to write a specific blog post, but instead opted to search around the web to find excellent sites that I could add to my linkroll (on the right). Using the Webby Awards and the IMSA criteria, I was able to find high quality personal blogs, Surgical Societies, and other useful sources of information relevant to orthopedics. Ten of these excellent sites are now imbedded in my linkroll and arranged alphabetically. I am sure you will be happy with both their ease of navigation and quality of material. These sites are not maintained by amateurs – they are of the highest caliber and I am extremely happy to link to them through my blog.
Alphabetically, the first of these sites is the Orthopedics page of About.com. It is a bit busy with advertisements, but the content is written in an easy manner and the site is very user-friendly. Next is Dr. Davis’ Back and Wrist Pain Blog, which I left a comment on last week. Dr. Davis’ blog is very informative, but he uses it to promote his own practice so sometimes readers may feel like they are being advertised to indirectly. Netsurgery.com is an excellent source of videos and articles on many aspects of surgery, although the content on their site could probably be about twice the size. The North American Spine Society is, as the name suggests, our continent’s premier society for spine care awareness. Their site is beautifully done, and I found the information on their site to be very professional. Unfortunately, the formatting does not work properly with Firefox on the Mac. The Southern California Orthopedic Institute is a group with a broader interest in Orthopedics (they do not limit themselves to the spine) located in Van Nuys, California. It is hard for me to think of anything I would criticize on this site, as they have been updating and perfecting it since 1995. Spine University is an excellent source of information specifically regarding the spine, as is Spine-Health.com. They are both easy to read since they are directed at patients, but I think Spine-Health was a little busy. As far as information is concerned, though, they are both excellent.
The American Association for the Surgery of Trauma is a group dedicated to teaching the proper treatment of traumatic injuries requiring surgery. Many such injuries require orthopedic surgery, so I deemed this site relevant to my blog. Their site is directed at surgeons more than patients, to the information can be a bit hard to read, but it is quality nonetheless. The American Medical Association is one of the foremost societies for physicians in America, and their site reflects that fact. Like the AAST though, their site is directed at doctors rather than patients, so the site can be hard to use. The Knee Foundation is dedicated to raising money for helping those with knee problems, so their site is focused more on explaining the need for aid than providing information to patients. Trauma.org is an organization very similar to the American Association for the Surgery of Trauma, and their site includes some great photos and videos of trauma surgery. Last, but not least, is Wheeless’ Textbook of Orthopedics, which is an outstanding site full of and encyclopedic amount of information on Orthopedics. The site is very intuitive, and is elegant in design. Navigation is as easy as clicking on a body part represented by the skeleton at right (note: clicking the skeleton here will merely link to the Wheeless' site, clicking on it there will direct you to the area of your interest). If anything, tere is simply too much information on this site, so getting lost or distracted is a definite possibility.
I hope you enjoy these links, as they have proved to be very helpful to me in my general search for information on Orthopedics. I will certainly be citing them in the next few weeks, and I enthusiastically look forward to doing so.
Alphabetically, the first of these sites is the Orthopedics page of About.com. It is a bit busy with advertisements, but the content is written in an easy manner and the site is very user-friendly. Next is Dr. Davis’ Back and Wrist Pain Blog, which I left a comment on last week. Dr. Davis’ blog is very informative, but he uses it to promote his own practice so sometimes readers may feel like they are being advertised to indirectly. Netsurgery.com is an excellent source of videos and articles on many aspects of surgery, although the content on their site could probably be about twice the size. The North American Spine Society is, as the name suggests, our continent’s premier society for spine care awareness. Their site is beautifully done, and I found the information on their site to be very professional. Unfortunately, the formatting does not work properly with Firefox on the Mac. The Southern California Orthopedic Institute is a group with a broader interest in Orthopedics (they do not limit themselves to the spine) located in Van Nuys, California. It is hard for me to think of anything I would criticize on this site, as they have been updating and perfecting it since 1995. Spine University is an excellent source of information specifically regarding the spine, as is Spine-Health.com. They are both easy to read since they are directed at patients, but I think Spine-Health was a little busy. As far as information is concerned, though, they are both excellent.
The American Association for the Surgery of Trauma is a group dedicated to teaching the proper treatment of traumatic injuries requiring surgery. Many such injuries require orthopedic surgery, so I deemed this site relevant to my blog. Their site is directed at surgeons more than patients, to the information can be a bit hard to read, but it is quality nonetheless. The American Medical Association is one of the foremost societies for physicians in America, and their site reflects that fact. Like the AAST though, their site is directed at doctors rather than patients, so the site can be hard to use. The Knee Foundation is dedicated to raising money for helping those with knee problems, so their site is focused more on explaining the need for aid than providing information to patients. Trauma.org is an organization very similar to the American Association for the Surgery of Trauma, and their site includes some great photos and videos of trauma surgery. Last, but not least, is Wheeless’ Textbook of Orthopedics, which is an outstanding site full of and encyclopedic amount of information on Orthopedics. The site is very intuitive, and is elegant in design. Navigation is as easy as clicking on a body part represented by the skeleton at right (note: clicking the skeleton here will merely link to the Wheeless' site, clicking on it there will direct you to the area of your interest). If anything, tere is simply too much information on this site, so getting lost or distracted is a definite possibility.I hope you enjoy these links, as they have proved to be very helpful to me in my general search for information on Orthopedics. I will certainly be citing them in the next few weeks, and I enthusiastically look forward to doing so.
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