First Major Study Investigates A Growing Orthopaedic Catastrophe In Depth
In just six years, it‟s become the new orthopaedic nightmare.
“We‟ve never seen anything like it,” says Brian J. Cole M.D., M.B.A., Head Team Physician for the Chicago Bulls and Professor and Head of the Cartilage Restoration Center at Rush University Medical Center. “Young active patients get minor orthopaedic procedures then their joints are suddenly destroyed. Patients go through extraordinary levels of pain, their joints becomes useless….and we can‟t do much to help them.”
“These cases are miserable. They‟re life-changing. They‟re a tragedy,” says Daniel J. Solomon, M.D. from Marin Orthopedics and Sports Medicine in Novato, California. In recent years, Dr. Solomon, Dr. Cole, and other top orthopaedic surgeons across the nation have suddenly been referred hundreds of such cases of “chondrolysis”.
The surge in “chondrolyis” (the sudden total destruction of a joint‟s articular cartilage) is a mystery for orthopaedic surgeons. They don‟t know what causes it, they can‟t treat it successfully, and it threatens to entangle them in major lawsuits unfolding across the country.
Several hundred lawsuits have been filed nationwide alleging that pain pumps cause chondrolysis. The intra-articular pumps were used after arthroscopic procedures to deliver pain medication directly to the surgical site. Plaintiff s lawyers have sued the pump manufacturers claiming research studies have found a direct link between the medical device and the onset of chondrolysis.
That legal battle has created a further nightmare for medical and public health researchers. “The litigation,” says Maryam Navaie Dr.P.H., Senior Vice President at Advance Health Solutions in La Jolla, CA “is having a chilling effect on clinicians and researchers. There‟s a lack of large-scale data availability. So far, almost every study has just involved a few case reports, or typically a single medical practice‟s patients. No one‟s looked at this problem globally.” Until now.
The most comprehensive systematic review of chondrolysis ever done will be published in the November issue of the Journal of Bone and Joint Surgery. The independent study (which received no funding from any corporate sponsors or the legal industry) involved 830 chondrolysis cases across the globe and is authored By Drs. Cole, Solomon, Navaie and other prominent researchers. It concludes:
As for the verdict on pain pumps, co-author Dr. Cole says, “Our study doesn‟t find a clear-cut causal relationship between pain pumps and chondrolysis. I wouldn‟t recommend using pain pumps to colleagues, but only because it makes sense to minimize even a possible risk.”
“There‟s more to this story than pain pumps,” says Dr. Solomon, another co-author. “For instance, not everyone who receives a pain pump develops chondrolyis. We found other possible risk factors include thermal injury from the procedure, suture use, radiofrequency devices, a history of trauma, and the biomechanical stresses of surgery.”
However, the study found identifying the role of those possible causes is hampered by orthopaedic surgeons inadvertently misdiagnosing chondrolysis. Upon close examination, the researchers found that many so-called “chondrolysis” patients actually had osteoarthritis or other joint problems. Co-author Dr Navaie says, “The term chondrolyis is just a hodgepodge of different diagnoses and different potential etiologies.”
“That makes it very confusing to understand the cause and the correct approach to this condition,” adds co-author Anthony A. Romeo, M.D., Team Physician for the Chicago White Sox and Professor and Head of Shoulder and Elbow Surgery at Rush. The orthopaedic surgeon also worries that patients incorrectly labeled as having chondrolysis may be denied effective treatments for their true medical condition.
The authors found what‟s needed is a rigorous consistent set of criteria to make a “chondrolysis” diagnosis. Says Dr. Romeo, “That will help us sort out the different risk factors and determine which treatments work and which don‟t. For instance, for a chemical as opposed to a mechanical factor that may lead to the condition.”
Researchers say another goal of their study is to call for better treatments for both focal and global losses of cartilage. But they acknowledge any such treatments are probably years away.
“The immediate goal,” says Dr. Navaie, “is prevention and we won‟t prevent this devastating condition until we have better data and a better understanding of precisely what causes it.”
