As everyone knows, our population is aging as our lifespan is gradually increasing. According to the Centers for Disease Control (CDC), nearly 50 million Americans (1 in 5 adults) have been diagnosed with one or more forms of arthritis. The most common type of arthritis, osteoarthritis, is generally caused by wear-and-tear on the joints as we age, and afflicts at least 21 million Americans. Among those 65 years of age and older, at least 50% will have been diagnosed with arthritis. In addition to aging, and injuries, obesity is a risk factor for osteoarthritis.

The human knee joint, which is one of the most complex joints in the body, is especially prone to osteoarthritis. The knee joint’s stabilizing ligaments and protective joint cushions are easily torn by injuries, and are progressively stretched and worn (respectively) by normal physical activities over the years. For most patients with arthritis of the knee, lifestyle modifications, physical therapy, applications of heat or cold, knee braces, and, if needed, anti-inflammatory medications will bring considerable relief of the pain, stiffness and swelling that often accompany degenerative changes of the knee joint.

Arthroscopic surgery is a procedure which allows surgeons to see inside of a joint. Arthroscopic knee surgery is most commonly performed to remove torn cartilage within the knee. The procedure, called a menisectomy, is done using a small camera that allows the surgeon to remove the damaged cartilage through a small incision.

A small incision is made (about 1 centimeter) and a camera is inserted into the joint. Another small incision is made in order to place instruments inside of the joint to remove torn cartilage. Small scissors and shavers are usually used to remove excess cartilage, while the arthroscope allows your surgeon to inspect the rest of the knee joint looking for signs of arthritis, loose pieces of cartilage in the knee, the ligaments of the knee, and other problems inside the joint.

Two new clinical research studies, just published in the prestigious New England Journal of Medicine, have now called into question some of the fundamental assumptions that have made arthroscopic knee surgery such a common procedure.

“Two studies call into question whether many people with arthritis are needlessly undergoing one of the most common operations in America: arthroscopic knee surgery,” wrote Linda B. Johnson of the Associated Press.

This is now the second prospective clinical research trial that has shown absolutely no apparent benefit from arthroscopic surgery for osteoarthritis of the knee in patients who have otherwise been treated with optimal physical therapy and medical treatment. Given that much of the previous clinical data supporting arthroscopic knee surgery as a useful procedure was derived from retrospective data (i.e., a review of patient medical records after the fact), this prospective clinical trial’s finding (as with its predecessor prospective randomized trial) that arthroscopic knee surgery adds nothing to primary medical treatment and physical therapy should really lead to a thoughtful reassessment of the procedure. As with all surgical procedures, there are risks inherent in undergoing arthroscopic surgery. If, as two randomized, prospective clinical research trials now suggest, there is no benefit from arthroscopic knee surgery, then patients undergoing the procedure may be taking on all of the risk of the procedure without any likelihood of benefit. Unless compelling prospective clinical data comes along that disproves the identical findings of these two separate prospective clinical trials, then it might be prudent to defer arthroscopic surgery of the knee for osteoarthritis for now.
A second companion clinical study in the New England Journal of Medicine provides additional insight as to why arthroscopic knee surgery may not provide any benefit to patients with osteoarthritis of the knee.

Magnetic resonance imaging, or MRI, has become the standard imaging test used to evaluate the ligaments and cartilage of painful knee joints. MRI scans easily demonstrate tears and erosions of the cartilage (menisci) lining the knee joint, and because knee pain is often attributed to these types of meniscal injuries, patients with meniscal injuries are often advised to undergo arthroscopic surgery to trim and remodel these damaged cartilages.

This study, which was performed at Boston University, performed MRI scans of the right knees of 991 volunteers between the ages of 50 and 90. All of these volunteers were randomly selected in Framingham, Massachusetts. Additionally, all of these volunteers were asked to complete a questionnaire regarding the presence or absence of osteoarthritis symptoms in their right knees.

Among women between the ages of 50 and 59 years, 19% were found to have tears or erosions of the meniscal cartilage by MRI scanning. Among men between the ages of 70 and 90 ages, 56% had MRI evidence of significant meniscal cartilage tears or erosions. In patients with x-ray evidence of bone erosion (osteoarthritis) within the knee, meniscal abnormalities were twice as commonly observed by MRI when compared to patients without additional signs of osteoarthritis. More importantly, among those patients with radiographic signs of bone erosion (osteoarthritis) within the knee joint and knee symptoms, 63% had meniscal abnormalities identified by MRI. However, a statistically identical 60% of patients with radiographic evidence of osteoarthritis, but without any knee symptoms, had similar meniscal cartilage tears and erosions.

The results of this study strongly suggest that most meniscal tears and erosions, by themselves, probably do not cause significant knee symptoms in most patients. Since meniscal tears and erosions are the most commonly repaired abnormalities within the knee joint during arthroscopic surgery, the findings of this study offer the most likely explanation for the lack of benefit from arthroscopic surgery that was observed in the previous study.

Once again, it is time to reappraise the role (if any) of arthroscopic knee surgery.

SOURCES:
http://www.cdc.gov/aging/
http://www.cdc.gov/aging/orglinks.htm
http://www.arthritis.org/arthroscopic-knee-surgery.php

Last Thursday September 18, 2008, the Coast Guard responded today to a false report of a bomb onboard the ferry Cat, in Bar Harbor, Maine.

At about 8 a.m., a 911 dispatcher notified the Coast Guard that someone had called in the threat.
Coast Guard Sector Northern New England, the Federal Bureau of Investigation, Maine Marine Patrol, Maine State Police, Customs and Border Patrol, and other state and local agencies responded.

Ferry operations were halted and the nearly 330 people aboard were evacuated to safety while authorities swept the vessel and looked for explosives and suspicious objects.

The Coast Guard Cutter Bridle and a 55-foot boat crew from Aids to Navigation Team Southwest Harbor maintained a security zone around the ferry.
Several agencies, including bomb squads with bomb-detecting dogs, conducted thorough sweeps of the vessel. No explosives or suspicious objects were found.
The Cat has resumed its scheduled patrol to Yarmouth, Nova Scotia, Canada. The cutter Bridle and a small boat crew from Coast Guard Station Southwest Harbor escorted the ferry out of Bar Harbor.

“Fortunately the threat did not materialize for this international vessel, but I am extremely pleased with the fast, efficient and professional response we received from our port partners - Customs and Border Protection, Maine State Police, Maine Marine Patrol, Bar Harbor Police, Bar Harbor Fire Department, and Bay Ferries Ltd.,” said Captain James McPherson, commander of Sector Northern New England.

“Our daily interaction with these port partners is key to balancing the effort to protect the passengers and the vessel but also to diligently work to keep the international trade flowing once the risk is diminished. It was great work by all and a testament to everyone’s commitment to cooperation,” he said.

Recently, the FDA overwhelmingly refused to take Avandia, the diabetes drug, off the market, despite studies that showed increased heart attack as a very realistic side effect. Weaknesses in those studies were one of the reasons cited by the FDA for their decision. However, one of the solid conclusions reached was that Avandia does increase heart attack risk.

The FDA did suggest a “black box” warning, the most severe, to warn consumers about the risk. Further suggestions included discouraging joint use of Avandia and insulin, as this also increases heart attack risk. FDA experts also recommended that the drug be investigated further.

In early 2007, Avandia was the second highest grossing diabetes drug in the United States. An analysis of 42 studies showed that there is a 43 percent higher chance of heart attack risk with diabetic patients taking Avandia than those taking any other or no diabetes medication. Avandia is used to control the body’s blood sugar by increasing sensitivity to insulin. Before the studies, this treatment was commonly perceived to decrease heart risks already associated with diabetes. Diabetes affects more than 18 million Americans today.

Congress is in the process of overhauling the FDA’s decision, and points to the Avandia situation as evidence of the FDA’s inability to handle the safety risks of drugs that have been approved for the market.

In the case of Avandia, it appears that the FDA is too lax in dealing with hazards associated with certain drugs. Conversely, many poor countries around the world are not even close to lax with their policies surrounding drugs that should be deemed necessities. Morphine is one prime example, as a pain reliever. Countless poor countries find it extremely difficult to secure this drug even in the cases of uncontrollable cancerous tumors that cause excruciating pain. However, even in these cases, morphine is not allowed due to an intense fear of patient addiction.

Is the FDA too lax in their drug safety control policies? Are foreign countries not lax enough?

See the following articles for more information:
Avandia:
www.msnbc.msn.com/id/20036086/from/ET/
www.fda.gov/bbs/topics/NEWS/2007/NEW01636.html

Morphine:
www.nytimes.com/2007/09/11/health/11pain.html
www.nytimes.com/2007/09/10/health/10pain.html

“By 2011, motion preservation technologies will achieve revenues of US $5.1 billion and account for 50% of the market”

Motion preservation is the hottest topic around in spinal orthopaedics – a sector forecast to achieve 16% growth per year till 2011.

The concept of motion preservation in the spine is an intriguing one and the array of non-fusion technologies being introduced to the market offer a great deal of promise for spinal surgery patients.

As senior medical writer Tessa Neighbour explains, there are an array of non-fusion technologies being introduced to the market which offer a great deal of promise for spinal surgery patients. However, despite the fact that some of these technologies have been in use in Europe and other international markets for many years, the clinical outcomes data available are extremely limited in proportion to the tens of thousands of fusion procedures performed.

Additionally, as regulatory clearance criteria in the United States and Japan are by far the most rigorous in the world, the scarcity of well-designed studies to prove the safety and effectiveness of artificial discs has hindered the launch of motion preservation products, and therefore growth, in these markets.

Cruise ship accidents are often highlighted in the media—after all, a vacation is supposed to be a free time from worry and strife, and accidents are all the more tragic when they happen during such a happy occasion.

While there are many different factors which contribute to the cause of a cruise accident, there are four types of accidents, or any combination of these four, that may occur while on a cruise vacation.

Weather-Related Accidents
Poor weather creates rough seas that can lead to accidents. While crew members and officers make every attempt to avoid bad weather, high winds, choppy waves, and rain increase accident risks. To minimize these risks:
• Wear rubber-soled shoes on deck that can grip a wet surface.
• Close doors firmly to prevent a wind gust slamming them open and potentially causing injury.
• Avoid being on upper decks or near the ship’s bow during extreme weather.
• Use handrails for additional balance in rough seas.
• Secure all cabinets and closets in your cabin to prevent items falling or flying about in rough weather.
• If the ship loses power, stay in your cabin or current location until given instructions

Engineering Accidents
Engineering cruise ship accidents are completely out of passengers’ control. These incidents result from crew errors or performance problems with the ship and include fires, malfunctioning stabilizers, and faulty engines. Because of these factors, ships may run aground, be forced to slow down, or be delayed arriving at or departing from ports of call. While passengers cannot prevent these types of accidents, they can keep disruptions to a minimum by:
• Knowing where their muster station is.
• Following crew directions immediately during a crisis.
• Not asking repetitive questions until the problem is resolved.
• Providing detailed information if asked to make a statement.

Shore Excursion Accidents
While exploring ports of call through various shore excursions, it is possible that passengers will be involved in accidents. Those accidents may be a result of passenger negligence or the hazards of the tour, but problems can be minimized by:
• Following directions of tour operators carefully and asking for clarification if necessary.
• Being honest about abilities and prior experience on tours such as horseback riding, diving, or other physical activities.
• Behaving properly and responsibly to avoid causing potential problems.
• Wearing proper restraints on tour buses and taxis, including using car seats for young children.

Passenger-Caused Accidents
Human error causes the many accidents on board cruise ships. Passengers who are unwise about their actions and behavior put themselves into dangerous situations where accidents are more likely to happen, but by following common sense precaustions many minor accidents can be avoided.
• Try not to overindulge on alcoholic beverages that can impair judgment, balance, and motor skills.
• Use sporting equipment, lounge chairs, etc. only for intended purposes.
• Follow all crew recommendations and instructions, including posted warning labels.
• Enter and exit carefully through all doors: cruise ships often have water guards in doorways that could cause tripping.
• Use handrails on stairways, gangways, and while near the edge of the deck in case of a sudden list or turn.

Recent Cruise Ship Accidents

Each month, there are several reported cruise ship accidents, but most are minor and never make the nightly news. Recent sensational stories have included.
In March 2006, the Star Princess of Princess Cruises caught fire while bound for Jamaica and the resulting blaze damaged 100 cabins on four decks. One passenger died of a heart attack while several others had minor injuries including bruises, abrasions, and smoke inhalation problems. The fire was reportedly caused by an untended cigarette in a passenger cabin.

In July 2005, a honeymooning groom was believed to be overboard on a Royal Caribbean Mediterranean cruise. The man’s death may have been the result of foul play. In April 2005, Norwegian Cruise Line’s Norwegian Dawn was struck by a 70-foot rogue wave caused by bad weather. Windows were broken in several forward cabins and approximately 60 cabins were flooded. Several passengers sustained minor injuries during the event. While most cruise accidents do not rate top story status, other types of incidents include:
Fires in contained areas that do not affect passenger cabins or public areas. Usually these are in the galley or engineering areas of the ship.
• Running aground in shallow waters, a particularly prominent hazard for river cruises or ships sailing along the Amazon.
• Collisions with piers in different ports of call that cause minor damage to hulls or stabilizer fins. These incidents may cause delays or missed destinations.

How Passengers are Compensated
When cruise ship accidents occur, cruise lines make every effort to help passengers continue to enjoy their vacation through various compensations, such as:
• Relocating passengers to unaffected cabins.
• Offering full or prorated refunds.
• Offering credits and discounts on future cruises.
• Providing vouchers for free drinks, photographs, or souvenirs.
• Providing alternative transportation if relocation is unavailable.
The type and amount of compensation is entirely up the cruise line’s discretion, and judgments are often made based on the type of incident, the magnitude of the passengers’ disruption, and the ability to make immediate restitution.

What if an Accident Happens on my Cruise?
The first thing to remember if an accident happens on your cruise vacation is not to panic. Seek help from crew members if necessary, and follow instructions carefully. Report to your assigned muster station if required, and try to avoid causing additional problems or delays with excessive questions or noncompliance.

No one anticipates an accident disrupting their vacation, but if you happen to be involvedin one, please find help. See our website for information on what to do in the event of an injury on a cruise ship: www.hickeylawfirm.com. See also www.cruiseshipassault.com. The bottom line is get medical care immediately, take photos of the area where you were injured, get the names and contact information of witnesses, and report the accident or incident at once. Also, CALL HICKEY LAW FIRM, P.A., TOLL FREE AT: 1.800.215.7117. Our consultations are always free. We work on a contingency fee basis; if we don’t recover, you don’t pay. Personal injury, wrongful death, sexual assaults, and medical malpractice. This all happens on cruise ships and we have handled these types of claims for 28 years.

Fox News recently reported that there is a new technique in hip replacement surgery which is far less painful than traditional hip replacement surgery. The advancement in surgery requires a unique state of the art table.

Doctor George Feliciano of Community Hospital North in Indianapolis specializes in Anterior Approach hip replacement. This requires a special table and unique instruments. The technique positions the patient on the table so that surgeons can insert a special implant. By taking this anterior approach, the incision is substantially smaller than traditional hip replacements. Doctors and patients agree that the procedure is far less painful.

Fox quotes Dr. Feliciano stating that it is now possible to “do a surgery that’s potentially more tissue sparing and less invasive to the tissues that inevitably are between us and fixing that patient’s hip.”

A recent recipient of the surgery, Russell Wagner, has been quoted stating that “Unless they enjoy being crippled and hurting with every step they take, take the operation because as soon as you wake up there’s no more pain.”

The new surgery technique allows patients to bear their full weight the day after the surgery, which also helps speed up the recovery rate. Although the new and improved surgery is less invasive than previously, Dr. Feliciano points out that an intensive physical therapy routine is crucial to a faster, successful recovery.

See our website for information on what to do in the event of an accident involving serious injuries or death: www.hickeylawfirm.com. See also www.cruiseshipassault.com. The bottom line is get medical care immediately, take photos of the area where you were injured, get the names and contact information of witnesses, and report the accident at once. Also, CALL HICKEY LAW FIRM, P.A., TOLL FREE AT: 1.800.215.7117. Our consultations are always free. We work on a contingency basis. Personal injury, wrongful death, sexual assaults, and medical malpractice. We have handled these types of claims for 28 years.

On July 26th 2008 Ting Chen, who taught at an all girls’ school in New York City married her husband ,Ron, who is a youth pastor at Long Island Abundant Life Church in Hicksville, New York, where they were married. That same day they disembarked on the Norwegian Cruise Lines, Norwegian Dawn to enjoy their honeymoon. Little did friends and family know that this would be the last time they would see the bride alive.

On Wednesday July 30th they exited the ship in Bermuda, the port of call, to explore the island. Chen and her husband decided to try out snorkeling for the first time together. Reports say that Chen was playing in the waist deep water with her husband, and that she was next seen floating face-down in the shallow water. While she was on a dive, Ting got into some sort of trouble. Paramedics attempted to resuscitate her at the scene before she was rushed to the King Edward VII Memorial Hospital by ambulance. She was pronounced dead shortly after.

According to Snorkel Park general manager Ray Lambert, “We try our best to maintain a safe, clean operation. There are no rip currents, no major tides or anything that’s considered a hazard. It’s a very popular spot for kids. It was just a tragic accident.”

If you or someone you know has been injured on a cruise ship excursion, call Hickey Law Firm toll free at: 1.800.215.7117. We can help. We know what you are going through. See us at www.hickeylawfirm.com. We have 28 years of maritime law and trial experience. Call us today.

If you have any questions, call us. We care. We handle these cases against the cruise lines. John H. (Jack) Hickey has testified before the subcommittee of Congress investigating crime on cruise ships and the cruise lines. Call us. All consultations are free and strictly confidential. TOLL FREE: 1.800.215.7117.

Total ankle replacements (TAR) have been available to patients in the United States since the early 1970’s. Naturally, these implants have undergone various design evolution phases. A review article published in the September 2008 issue of the Journal of the American Academy of Orthopedic Surgeons (http://www.jaaos.org/) discusses the different types of total ankle replacement implants currently available.

“When we started off, the ankles we used in this country included just two components and we had to use bone cement to fix them and basically they all failed,” said Andrea Cracchiolo, MD, lead author of the article and Director of the Adult Foot and Ankle section at UCLA Medical Center. “The difference between the first generation implants and those today is that you don’t need to use bone cement. The surfaces are such that the bone will grow into the joint much like in total hip replacement.”

As of present, there are four designs that are approved by the Food and Drug Administration for use in the United States. All four designs consist of the two-component designs which are considered fixed implants. Yet, for numerous years now, many surgeons outside of the United States have been using a new three-component ankle design. According to Dr. Cracchiolo, a three-component ankle could possibly allow for additional movement, mobility, and flexibility in the joint. Additionally, it may also be easier for orthopaedic surgeons to implant. Although here in the U.S. a three-component device has been recommended for approval by the Food and Drug Administration, it could take until late 2008 (or longer) before it would be made accessible to U.S. patients.

Although total ankle replacement offers many patients more mobility compared to the option of fusion to repair the injured joint, not every patient is an ideal candidate. As Dr. Cracchiolo explains, patients need a detailed evaluation from a qualified orthopaedic surgeon who feels the procedure may be suitable. “Some patients have such deformity of the ankle or have an ankle that is so unstable that total ankle replacement is not indicated,” explains Cracchiolo.
According to the American Association of Orthopaedic Surgeons there are signs that you may be a candidate for a total ankle replacement. These signs include:

• Having a destroyed ankle, meaning the surfaces of the ankle are gone
• Having advanced arthritis of the ankle
• The condition of your ankle is interfering with daily activities and causing pain
Total ankle replacements can offer patients:
• Better motion of the ankle compared to fusion
• Protection in the small joints below and in front of the ankle from developing arthritis
• Relief of ankle pain

There are approximately 20 total ankle replacement implants worldwide that are currently available or in their final stages of design. Nonetheless, there have only been a limited number of clinical studies involving such implants. Dr. Cracchiolo says, “Great care must go in to selecting not only the ideal patient, but also the implant that should be used. We need more long-term follow up clinical studies on implants here in the U.S. In addition, if patients are young, they should understand that the ankle replacement, just like the hip and knee, is not going to last a life time.”

“As improvements in design continue to evolve, the goal is to develop total ankle replacements that are comparable to hips and knees in terms of quality and longevity,” noted Dr. Cracchiolo.

SOURCE: American Academy of Orthopaedic Surgeons

See our website for information on what to do in the event of an accident involving serious injuries or death: www.hickeylawfirm.com. See also www.cruiseshipassault.com. The bottom line is get medical care immediately, take photos of the area where you were injured, get the names and contact information of witnesses, and report the accident at once. Also, CALL HICKEY LAW FIRM, P.A., TOLL FREE AT: 1.800.215.7117. Our consultations are always free. We work on a contingency basis. Personal injury, wrongful death, sexual assaults, and medical malpractice. We have handled these types of claims for 28 years.

Hickey Law Firm, P.A. is headed up by John H. (Jack) Hickey. Hickey was born and raised in Miami, Florida. For the first 17 years of his career, Hickey represented the railroads, cruise lines, and insurance companies. Now he represents you, the seriously injured, the family of a loved one who has died as a result of someone else’s negligence, the victim of a sexual assault, or the victim of medical malpractice.

Hickey is Board Certified as a Civil Trial Lawyer by The Florida Bar and by the National Board of Trial Advocacy. He is a Past President of the Dade County Bar Association and is on the Board of Governors of The Florida Bar. Hickey has been named by his peers as a “SUPERLAWYER” in the Superlawyer.com publication (the top 5% of all lawyers); as a “Top Lawyer in South Florida” in the areas of personal injury and maritime in the South Florida Legal Guide (2004 to present); and as a “Legal Elite” member in Florida Trend Magazine (2006) (top 1.7% of all lawyers). He is listed in Who’s Who in America, Who’s Who in American Law, and Who’s Who in Emerging Leaders in America. Hickey is rated A/V by Martindale Hubbell, the international directory of lawyers, a rating achieved by only 5% of all attorneys. CONTACT US AND SEE OUR RESULTS AT: www.hickeylawfirm.com and CALL US TOLL FREE AT 1.800.215.7117.