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Greetings from Suzhou: Notes from Third International Congress of the Chinese Orthopedic Association BY JOHN MCCORMICK, NOVEMBER 17, 2008

Greetings from Suzhou! Yes that Suzhou - in China.

To follow the orthopedic surgeon, China was the place to be this month. While we know this formidable nation always surpasses expectations, we were truly blown away by the Chinese Orthopedic Association ("COA") mega meeting. Talk about leapfrogging: in the three short years since its formation, COA seems to be rivaled only by the annual AAOS meeting in the USA.

With about 6,000 orthopedic surgeons from all of China's provinces and the world, this fever-pitch gathering was a trove of commercial and clinical insights. In keeping with certain post-meeting write-up habits, we focus here on the scientific aspect.

Below we provide you a matrix of some of the more interesting clinical findings via meta-review of the meeting abstracts. As a filter, we examined the papers for > 2 year follow-up and/or extensive sampling with humans and/or topics of exceptional interest. We noted the high level of attention among surgeons to the possibility of stem cells and, believe it or not, limb lengthening techniques. Caveat: we were only able to review a minority of the hundreds of papers, those that were translated or presented in English.

Enjoy and smokers beware!

Selected COA 2008 Paper and Poster Summary


Topic

Principal Author

Total # Patients

Yrs/Mos follow up

Takeaway

Prospective evaluation of smoking on clinical outcome after lumbar decompression and fusion

Hongxing Jiang

388

1yr / 6mos

Smoking associated with worse baseline clinical profile and lesser degree of improvement overtime as compared with non-smoking status.

A Comparison of Gene Modified Bone Marrow Mesenchymal Stem Cells and Commercially Available BMP (specifically BMP-2) for Spinal Fusion

First Affiliated Hospital of Soochow University

In vitro (rats)

n/a

Stem cells carrying BMP-2 induced spinal fusion vs stand alone BMP-2 protein. Note stem cells used lentivirus vectors encoding BMP-2.

Adult Scoliosis Operative vs. Non-Operative Outcomes


Gang Li

76

2 yrs

Operative cohort reported better outcomes as measured by EQ5D index, EQ5D VAS, SRS-22. SF-12 PCS outcome not significant.

Cementless Hip Stem Fixation - 20 Years of Experience

Richard Rothman

n/a (discussion)

20” yrs

Equivalent pain relief and function restoration compared to cemented hip. < 1% failure rate at 10yrs.

Human embryonic stem cells promoted tendon regeneration

n/a (translation)

in vitro and ectopic in vivo tendon tissue

Cells viable at the tendon wound site > 4 wks after implantation.

Demonstrated safe and practical potential strategy of stepwise differentiation for tendon regeneration.

Multipotency of annulus fibrosus cells a possible role in the pathogenesis of intervertebral disc

degeneration?

Xinlin Yang

In vitro cultured non-degenerative discs of adolescent patients (removed during scoli surgery)

n/a

Potential link of situ differentiation of native annulus fibrosis cells to pathogenesis of disc degeneration.

Total knee arthroplasty (TKA) for Asian population

n/a (translation)

n/a (discussion)

n/a (discussion)

TKA system and operative technique should consider potential anatomic differences (tibial articular surface, lateral bowing of the femoral shaft, etc.).

Results after medial-pivot knee replacements (medial-pivot concept aims to emulate physiological knee kinematics)

Cheng-Yu Fan

58

> 5yrs

The Knee Society score improved from 30.5 to 91.1, and the functional score from 36.7 to 82.3. Avg ROM was 115.4. Two minor complications.

Arthroscopic PCL reconstruction using posterior trans-septal portal

Jin Hwan Ahn

97

~4yrs

Improved pain and function scores. This portal provides excellent visualization, proper tibial tunnel positioning and preserving the remnant bundle of the PCL and eniscofemoral ligament.

Meniscal repair survey

Pascal Christel

Literature review

>2 yrs

After 2 years, whatever the technique or implant, the clinical success rate following meniscal repair varies between 71.5% and 95%. There is no clear established superiority of one particular device.

Treatment of complicated fractures of lower extremity with the Ilizarov’s procedure. Minimal invasive fixation technique and callus distraction

Chuan-mu Chen

70

1-10 yrs

Distraction osteogenesis by Ilizarov’s technique is effective for restoration of limb alignment & length under poor biological conditions due to its minimal invasive fixation technique.

Arthroscopic All-inside Meniscal Repair

Jin Hwan Ahn

140 patients evaluated with 2nd-look arthroscopy

1-11 yrs

84% complete healing, 12% incomplete healing and 3% failure.

Necessity of Combined Surgical Procedures for Total Ankle Arthroplasty

Hong-Geun Jung

16

1-4 yrs

Adjunctive combined surgical procedures are necessary in addressing ankle arthritis with total ankle arthroplasty.

A Randomized Controlled Trial Comparing a Flexible Corrective Brace Vs Rigid Brace for Adolescent Idiopathic Scoliosis

Tsz Ping Lam

n/a

5 yrs

The flexible corrective brace less favorable for curve control when compared with rigid brace.

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