Finding novel interventions to treat patients in the early stages of disease through improved understanding of the molecular mechanisms of musculoskeletal disorders has been a focus of orthopaedic research. Over the past twelve months, important advances have been made in understanding the genetic and molecular basis of osteoporosis, osteogenesis imperfecta, and degenerative disc disease; furthermore, molecular pathways that could lead to regenerative therapies have been identified. Although it may take some time before these findings translate to clinical innovation, new and improved implants for end-stage joint degeneration are continually being optimized and analyzed. When taken together, it is clear that a continuum of care for patients with musculoskeletal problems is beginning to emerge. To highlight this continuum, here we present some of the more important findings across the spectrum of understanding and treatment of musculoskeletal disease. In particular, we summarize specific work as presented at the recent meetings of the American Academy of Orthopaedic Surgeons (AAOS), the Orthopaedic Research Society (ORS), and the American Society for Bone and Mineral Research as well as at the International Meeting on Gene Therapy of Arthritis and Related Disorders.
Clinical Treatments for End-Stage Osteoarthritis
The treatment of choice for end-stage osteoarthritis remains total joint replacement. To cater to the increased population of patients under the age of sixty years who are presenting with end-stage disease, considerable efforts have been made to design and track the clinical performance of implants intended to provide increased longevity and improved functionality. Implant modifications have focused on improving the wear resistance and mechanical properties of the bearing surfaces and on altering bearing surface geometry in order to improve range of motion.
High-Flexion Knee Designs
Total knee replacements intended to facilitate increased knee flexion have been available in the United States since 2002. In a biplane fluoroscopic analysis, presented at the recent meeting of the ORS, the degree …
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