Musculoskeletal Care of the Mature Patient
Probably the most important change in Osteoarthritis I have witnessed during my orthopedic career has been in attitudes rather than knowledge. The Boomers look toward continued well-being and extended athleticism and are unwilling to accept impairment and limited function associated with their osteoarthritis. Perception is everything; and new technologies lead to new concepts. Osteoarthritis is common and not necessarily a progressive disorder, with the condition stabilizing in most cases. This is obvious if we compare the number of people in the population with radiographic evidence of OA and the number who come to joint replacement. Recent research has indicated that physical activity optimizes cartilage health and is important in preventing the symptoms even in the presence of radiologic evidence of osteoarthritis. What about these new technologies and their increasing popularity owing to celebrity athletes?
What caused me to focus the blog again on Platelet Rich Plasma and Stem Cell management of osteoarthritis is an article appearing in the September 4, 2011 issue of the New York Times: As Sports Medicine Surges, Hope and Hype Outpace Proven Treatments by Gina Kolata. It is a well-written article and worth a Google. The introduction to the article describes the costly failure of physical therapy, strength training, Platelet Rich Plasma and cortisone injections in the care and treatment of a female marathoner’s hamstring tear. “ Medical experts say her tale of multiple futile treatments is all too familiar and points to growing problems in sports medicine” “Celebrity athletes, desperate to get back to playing after an injury, have been trying unproven treatments, giving the procedures a sort of star appeal.” You know what, I believe the author is right but does that make it wrong? I believe we must start with patients before we focus on populations. Researchers are indeed questioning the new procedures such as PRP and stem cells because there are no rigorous scientific studies to back them up. Yet there is a large group of patients eager for treatment, ranging from competitive athletes to casual exercisers to retirees spending their time on the golf course or tennis court who want to keep going.
So how do you protect yourself from the triad of famous athlete, famous doctor, untested treatment when there is so much marketing by sports medicine “experts”? First of all, make sure your sports medicine physician is a member of the American Academy of Orthopedic Surgeons because these experts are trained in offering care based on credible evidence. The continuing education initiative of the AAOS is the most advanced of any medical specialty. Second, when a procedure is new and unsupported as of yet by a large clinical experience/ data base, seek out a clinical trial and not simply a clinical encounter. In 1979, I was involved in the clinical trial of a cement-less design hip prosthesis which ultimately changed the surgical approach to joint reconstruction in the world. Management of osteoarthritis is complex and needs individualizing; so too, new isn’t always better but sometimes it just may be.
Meanwhile back to that “hamstring tear”. Any supposed chronic hamstring tear is more likely referred pain from a degenerated or herniated lumbar disc but referred pain and missed diagnoses are for another blog
Mitchell B. Sheinkop, M.D.
1565 N. LaSalle Street
Chicago, Illinois 60610