Embedded Files
Mayo Clinic’s goals in fibrosis and arthritis research? We are working to develop pharmacological modalities that both prevent and treat fibrosis in the musculoskeletal system. Similarly, learning more about the pathogenesis of arthritis, and how we might slow or prevent its development, is key. All of our research aims ultimately focus around curing musculoskeletal diseases with innovative diagnostics and therapeutics. Moreover, we want to connect patients to optimal care through predictive analytics and advanced registry technologies. For more information Cano EJ, et al. Phage therapy for limb-threatening prosthetic knee Klebsiella pneumoniae infection: Case report and in vitro characterization of antibiofilm activity. Clinical Infectious Diseases. In press. Successful Transition to Outpatient Total Joint Arthroplasty Matthew P. Abdel, M.D. Cameron K. Ledford, M.D. Figure. Photographs show the facilities in a new wing of the short stay unit at Mayo Clinic Hospital in Jacksonville, Florida. A. A room similar to a hospital room is available after outpatient total joint replacement. B. A physical therapy room is used to help patients reach certain milestones before same-day discharge. A B Joint reconstruction is particularly challenging in the setting of complex bony defects or radiation therapy (Figure). Mayo Clinic routinely uses 3D-printed models to optimize surgical outcomes for individual patients. “This technology allows us to re-create a patient’s bony defects and surgically correct them to restore joint function,” says Cory G. Couch, M.D., an orthopedic surgeon at Mayo Clinic in Rochester, Minnesota, with fellowship training in orthopedic oncology and joint reconstruction. “We are able to model and fill in even very large bony defects created by tumors and tumor resections.” Mayo Clinic has the largest point-of-care additive manufacturing facility in the United States, staffed by radiologists and biomedical engineers. “They work in close conjunction with MAYO CLINIC | OrthopedicSurgeryUpdate 3 3D Printing for Joint Reconstruction in Compromised Bone optimizing outcomes,” Dr. Ledford says. “Once we identify that a patient is eligible and willing to have outpatient total joint arthroplasty, we provide thorough education on both the type of procedure the patient is having and the expectations for postoperative recovery. Patient motivation is key.” At Mayo Clinic, outpatient arthroplasty procedures are scheduled in the early morning. “You have to have a clinical and surgical team with expertise and intraoperative resources performing the surgery at a high level,” Dr. Ledford says. “A successful program requires adherence to evidence-based protocols on preoperative patient optimization, blood conservation, wound and pain management, blood clot prevention, and rehabilitation.” The surgeries are performed using a shortacting spinal anesthesia. Afterward, patients go to a recovery unit and then to a specially designed short stay unit (Figure, see page 2). “Physical therapists work there with patients for one or two hours,” Dr. Ledford says. “Once the patients pass the milestones necessary to safely go home, they’re discharged — usually before dinner.” He notes that outpatient joint replacement can have positive outcomes similar to inpatient procedures, when the outpatient procedure is executed according to protocols. “Mayo Clinic has a history of successful teamwork and an environment designed to optimize surgical outcomes,” he says. “This outpatient arthroplasty program is an extension of that Mayo Clinic value system.” Figure. Images illustrate the case of a 56-year-old man with newly diagnosed metastatic lung carcinoma who presented at Mayo Clinic with excruciating right hip pain and who was unable to walk. A. Anteroposterior X-ray of the right hip reveals pathological acetabular fracture and superior migration of the femoral head into the acetabular defect. B. Obturator oblique X-ray of the pelvis shows a pathological acetabular fracture with loss of the posterior wall and posterior column, and posterior subluxation of the right hip joint. C. Intraoperative photo reveals severe superior and posterior acetabular bone loss. Only the inferior aspect of the acetabulum resembles native anatomical architecture. D. Postoperative X-ray shows the final reconstruction. A highly porous tantalum augment was placed in the superior acetabular defect, followed by insertion of a highly porous tantalum revision shell obtaining a press fit between the augment and the remaining pubis and ischium. An additional buttress augment, also made of highly porous tantalum, was applied as additional fixation to the intact ilium. A cemented stem total hip arthroplasty was also used, due to plans for future radiation treatments. After surgery, the patient experienced significant pain relief and regained the ability to walk. A D B C 4 MAYO CLINIC | OrthopedicSurgeryUpdate Christopher L. Camp, M.D. us,” Dr. Couch says. “Complex joint reconstructions require multidisciplinary care from imaging experts and from radiation and medical oncologists, as well as orthopedic surgeons.” The 3D-printing technology is used in complex reconstructions of the knee, hip and pelvis for individuals with sarcoma or metastatic cancer. The technology also facilitates complex joint replacements associated with infection or the failure of
Google Sites
Report abuse