New Promise On The Horizon For Treating Orthopaedic Conditions

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New Promise On The Horizon For Treating Orthopaedic Conditions

http://www.medicalnewstoday.com/medicalnews.php?newsid=40102

Recent advances in gene therapy, stem cells and other promising

applications are offering new hope for patients and helping

orthopaedic surgeons provide state-of-the-art treatment for various

frame-related conditions. During a briefing today at the American

Academy of Orthopaedic Surgeons' (AAOS) 73rd Annual Meeting, a panel

of orthopaedic surgeons and members of the Orthopaedic Research

Society (ORS) discussed how these investigational applications may

someday treat a variety of bone, joint and muscle-related conditions

more readily than many physicians ever imagined possible.

Among the most encouraging techniques is a novel form of adult stem

cell therapy for broken bones. Stem cell therapy is performed in lieu

of the classic " autograft " technique, used on patients with fractures

that are not healing properly. It is not uncommon for bones that are

severely injured to heal slowly. Common causes of injury can range

from a simple fall to high- energy injuries like car accidents or

gunshot wounds. Many patients in these situations undergo multiple

reconstructive operations that often require a bone graft, or

autograft. Autografts require an incision over the pelvis area to

remove some of the patient's own pelvic bone, which is then

transferred to the site of the fracture. Such an incision can be

quite painful and may be complicated by infection, nerve damage,

chronic pain and an unsightly scar. Stem cells offer an effective and

less painful alternative to treat simple and complex fractures,

particularly those that require additional time to fully heal.

L. Jimenez, MD, an orthopaedic surgeon at Illinois Bone and

Joint Institute, Morton Grove, Ill., is experimenting with adult stem

cells to potentially accelerate bone healing and avoid causing

patients further discomfort from the self-donation process. Enriching

donated bone with a patient's own stem cells, Dr. Jimenez replaces

the damaged bone with the stem cell-rich bone. These new cells have

the ability to replace the injured portions with new bone.

" The beauty of these adult stem cells is that they can turn into

almost any kind of cell, including bone cells and vascular cells, "

said Dr. Jimenez, one of only a handful of surgeons in the world

performing the investigational surgery. " The surgeries we've

conducted thus far have had promising results, and to-date, the

patients are doing well. "

Dr. Jimenez still considers autografts the " gold standard " for bone

injuries, but said stem cell therapy -- with continued research --

shows great promise to speed the healing process and avoid the need

for additional operations.

Gene therapy is another cutting-edge technique with the potential to

mend damaged bones and tissues while sparing patients from undergoing

multiple surgeries. Regis J. O'Keefe, MD, PhD, professor of

orthopaedics and director of the Center for Musculoskeletal Research

at the University of Rochester (NY) Medical Center and treasurer of

the ORS, said his laboratory works on methods to introduce genes into

bone-forming to improve the cells' function and increase bone

formation.

One of the concerns with replacing injured bone with donated bone is

that the structural donor bone grafts remain dead, and will fracture

in up to 30-40 percent of the cases, Dr. O'Keefe explained. But by

placing genes with the ability to induce bone formation onto the

surface of a dead bone, the genes provide signals to tissues

surrounding the bone and bring it back to life. The resurrected bone

is then able to grow and thrive.

Researchers are working to improve the safety of gene therapy, which

involves using a non-disease-causing virus to deposit the gene into a

cell. The virus attaches onto the cell's surface and pokes a hole

through the membrane to inject the genes into the cell. Dr. O'Keefe

hopes further research will uncover alternative delivery methods that

do not require the use of viruses.

Currently only two clinical trials are using gene therapy for

musculoskeletal applications. Both trials involve introducing genes

into cells to counteract proteins that cause inflammation in

conditions like rheumatoid arthritis.

" As we better understand the function of individual genes, we may be

able to predict how alterations in the expression of specific genes

can lead to disease, or can even be used to prevent human diseases

from occurring, " said Dr. O'Keefe. Development of this approach can

lead to a " designer medicine " whereby individualized treatments could

be used to prevent debilitating musculoskeletal diseases such

arthritis and osteoporosis.

E. Friedlaender, MD, uses donated bone (allografts) in

orthopaedic surgery and stressed " the future is already here. " Dr.

Friedlaender, orthopaedic surgeon and department of orthopaedics

chair at Yale University School of Medicine, New Haven, Conn., said

allografts can be used to replace diseased or injured bone, tendon

and even cartilage. Ligament allografts are often used for sports-

related injuries to repair or replace the anterior cruciate ligament

in the knee. Some bones like the end of the femur in the thigh, he

noted, can only be substituted with donated bone.

" Allografts are safe and effective, and don't sacrifice normal bone

to repair body parts that are diseased or broken, " Dr. Friedlaender

advised. " Needing to use a patient's own tissue or bone for

reconstruction can increase their hospital stay and prolong

rehabilitation. "

Orthopaedic surgeons are already adept at replacing damaged bone and

have begun to successfully transplant cartilage and tendons. Dr.

Friedlaender predicts that the potential to also transplant muscle

and nerves is in the not-too-distant future. Getting the body to

accept donated bone is still somewhat of a challenge, but has been

largely overcome. The use of allografts to better serve our patients

can only become more widespread if additional bone and cartilage is

donated. Dr. Friedlaender stressed this will happen once the public

knows that patients truly are in need of these generous gifts and are

aware that the science really does work now and, with additional

funded research, will work even better in the future.

An orthopaedic surgeon is a physician with extensive training in the

diagnosis and non-surgical as well as surgical treatment of the

musculoskeletal system, including bones, joints, ligaments, tendons,

muscles and nerves.

With more than 29,000 members, the American Academy of Orthopaedic

Surgeons (www.aaos.org) or (www.orthoinfo.org) is the premier not-for-

profit organization that provides education programs for orthopaedic

surgeons and allied health professionals, champions the interests of

patients and advances the highest quality musculoskeletal health.

Orthopaedic surgeons and the Academy are the authoritative sources of

information for patients and the general public on musculoskeletal

conditions, treatments and related issues. An advocate for improved

patient care, the Academy is participating in the Bone and Joint

Decade (www.usbjd.org) -- the global initiative in the years 2002-

2011 -- to raise awareness of musculoskeletal health, stimulate

research and improve people's quality of life. The Academy's Annual

Meeting is being held March 22-26, 2006 at McCormick Place in

Chicago.

American Academy of Orthopaedic Surgeons

www.aaos.org

www.orthoinfo.org

www.usbjd.org