Welcome to the final edition of September’s orthopedics highlight! Scroll below to learn about common ortho misconceptions and stem cells!
The Misconceptions in Orthopedics
By Vanessa Cano
Orthopaedics was given its name in the 1700s, however, its history holds the foundation for modern orthopedic practice. The Egyptians had used these practices and were able to describe, not only methods to recognize, but also to manage common orthopedic conditions. The Greeks and Romans followed and began to study medicine in a systematic manner while improving our modern understanding of anatomy and surgical technique. It wasn’t until the middle ages until there would be rapid advancement,thorough descriptions of injuries, and complex surgical techniques along with the development of orthopedic hospitals. This documententive history is what teaches us the importance of recognizing the successes and failures of the past in order to improve patient care and clinical outcomes.
The development of medical practice is extremely diverse in different cultures. In every popular medical culture, there are beliefs and practices that may be overlooked and even unproven. In these cases, these practices have often been seen to obscure facts and evidence. This has led to the creation of a community dedicated solely to finding the myths and misconceptions in orthopaedic practice, hoping to change the narrative of reliable treatment.
For instance, in the early 1900s, evidence-based medicine was being recognized in literature in orthopedic and general surgery. This was initially created to face the enlightened skepticism towards the application of diagnostic, therapeutic, and prognostic techniques. These common misconceptions about evidence based orthopedics include the belief that others ignore clinical expertise, thinking that it is all about statistics, numbers, and constantly looking for evidence – which would be impossible for busy clinicians. Of course, there will always be a bias which can influence clinical decision making. Yet these published reports describing complications and different techniques can prevent repetitive studies of unsuccessful producers. In reality, orthopedic doctors should base their practice on the best evidence currently available and not “the way we’ve always done it” mentality.
Many of our medical beliefs and practices become entrenched in a system that leads us to believe that they are based on science, but without evidence. Though some may hold a certain degree of truth, there is a danger in relying on outdated information. Some of these beliefs include the cracking of knuckles causing arthritis, running being bad for the knees, or osteoarthritis being common in runners. In fact there are beliefs in surgery techniques including changing the scalpel blade after skin incision to limit contamination or bending the patient’s knee when applying a thigh tourniquet. You can find evidence proving that many of these misconceptions can be misleading, such as the ‘dangers’ of knuckle cracking. Changing the scalpel blade and applying a thigh tourniquet have been proven to be unnecessary and yet it is still a common practice. Prolonged running may cause conditions like patellofemoral pain syndrome (runner’s knee), however these common conditions are temporary in nature and are preventable – facts that are often overlooked. Another example is knuckle crackling which comes from gas being dissolved in the synovial fluid and released under pressure that has proven to be harmless. Although there are many more examples of science in orthopaedics being misleading, many have been taken for granted and society still looks upon baseless words of doctors as fact. Orthopedic doctors must recognize the prevalent misconception of their speciality, and critically challenge these false assumptions in order to improve overall patient care.
Orthopedics and Stem Cells
By Avantika Samanta
The simplest of things can change the world. The human body consists of around 37.2 trillion cells, and out of those there are 2-500,000 stem cells. These stem cells are quite unbelievably powerful and are being used in various ways in different medical fields, specifically in orthopedics. Orthopedic doctors treat a variety of musculoskeletal conditions. These injuries/conditions are possibly very painful and dangerous, and can be long term diseases or traumatic injuries. Stem cells are capable of regenerating bone, cartilage and more, an ability that has caught the eye of many within the field of orthopedics. Stem cell regenerative therapy is becoming popular amongst the orthopedics field, so it is beneficial to understand what it is.
To begin with, what is a stem cell? In simplest terms, a stem cell is a cell that has the ability to develop into different types of cells. There are two main kinds of stem cells, embryonic and adult somatic. Embryonic stem cells are obtained from embryos, and are pluripotent –they have the ability to change into any kind of cell. They do however pose certain ethical dilemmas. Adult somatic, or just Adult stem cells are acquired later on in life and are multipotent–meaning they can develop into multiple but not all kinds of cells. In this case, mesenchymal stem cells (MSC) are preferred since they can differentiate into many different tissues and can be obtained from many assorted sources such as bone marrow, skin, umbilical cord, and more.
Stem cell therapy has become popular in orthopedic surgery, especially in musculoskeletal injuries involving tendons, ligaments, the meniscus, and cartilage. Different therapeutic methods can be applied including the use of progenitor stem cells, which are usually acquired from bone marrow, and injecting these cells directly into tissues in an attempt to enhance the repair process. MSC’s go through differentiation, becoming progenitor cells which then support bone formation by osteogenesis. In the case of orthopedic surgery, these MSC’s can be derived from many sources. These include being obtained from bone marrow, adipose, synovial tissue, and peripheral blood. At the moment, adipose derived stem cells (AD-MSCs) and bone marrow derived stem cells (BM-MSCs) are most preferred, but there is still much to be learned. More research needs to be done in order to administer this treatment safely.
Along with this, stem cells are also being used to treat trauma and bone defects. Allografts and bone graft substitutes are standardly used to supplement bone healing, yet poor graft integration and osteonecrosis of the graft remain primary issues with the method. However, bone marrow aspirates that contain a minimal amount of stem cells have been successfully used to enhance the healing of complications such as nonunions (a complication where a broken bone fails to heal). There has also been an advancement in tissue engineering which involves stem cells being used with scaffolds for example including hydroxyapatite (HA). Due to certain circumstances MSCs alone cannot fill the gap in this defect but it can still be beneficial in enhancing healing rates when being used in conjunction with scaffolds.
These are only a few out of many examples of how stem cells are being used in orthopedics. There are seemingly endless possibilities, and these different uses can be talked about for ages. But it is important to know that there are still advancements that need to be made. Scientists ,governments, and everyone involved must discuss ethical dilemmas and accessibility concerns. This revolutionary method must be tailored to perfection before implementing, so it can assist more people in a safe and trustworthy procedure
Works Cited:
Misconceptions:
Maheshgauri DM. Myths and misconceptions in orthopedics. MIMER Med J 2018;2(2):52-55.
Poolman, Rudolf & Petrisor, Brad & Marti, Rene & Kerkhoffs, Gino & Zlowodzki, Michael &
Bhandari, Mohit. (2007). Misconception about practicing evidence-based orthopedic surgery. Acta orthopaedica. 78. 2-11. 10.1080/17453670610013358.
Swarup, Ishaan, and Joseph F O’Donnell. “An Overview of the History of Orthopedic Surgery.”
American journal of orthopedics (Belle Mead, N.J.) vol. 45,7 (2016): E434-E438.
Tejwani, Nirmal C, and Igor Immerman. “Myths and Legends in Orthopaedic Practice: Are We
All Guilty?” NCBI, Clinical Orthopaedics and Related Research, Nov. 2008,
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2565037/.
Stem Cells:
Akpancar, Serkan, et al. “The Current Perspectives of Stem Cell Therapy in Orthopedic Surgery.” Archives of Trauma Research, Kowsar, 16 Aug. 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC5253188/.
Doctor, Orthopedic. “What Is Orthopedics?” Healio, 0AD, www.healio.com/news/orthopedics/20120531/what-is-orthopedics.
G.I, IM. “Clinical Use of Stem Cells in Orthopaedics.” Department of Orthopaedics, Dongguk University Ilsan Hospital, Goyang, Republic of Korea, 0AD, www.ecmjournal.org/papers/vol033/pdf/v033a14.pdf.
Maniar, H H, et al. “The Current Role of Stem Cells in Orthopaedic Surgery.” Malaysian Orthopaedic Journal, Malaysian Orthopaedic Association, Nov. 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC5393127/.
National Library, US. “Stem Cells.” MedlinePlus, U.S. National Library of Medicine, 14 May 2020, medlineplus.gov/stemcells.html,
Porucznik, Mary Anne. “Are They Myth, Miracle, or Something in-between?” Forum Examines Stem Cells in Orthopaedics, 0AD, www5.aaos.org/CustomTemplates/AcadNewsArticle.aspx?id=8836.
Medical Wonders 