COVID-19 Response

  • We immediately began our efforts to improve our web page so that more Americans and people worldwide could see that we are saving joints and eliminating pain by using our products that only require minimal healthcare resources. Our web page explains the nature of osteoarthritis and avascular necrosis in easy-to-understand terms and detailed terms when necessary. OSI offers no layering of these two diseases with products that promote the status quo, as physicians and patients are burnt out. Our new web page details that if you are suffering from chronic joint pain due to osteoarthritis or avascular necrosis, a surgeon committed to preserving your joint and reviewing the peer-reviewed publications may be able to help you. We aimed to make our successes of saving joints over the past 20 years more broadly available by reaching out directly to those suffering from joint pain.
  • We immediately made known that the resources required for a joint replacement go beyond what is needed at the hospital and include significant resource utilization during the run-up to a total knee replacement. Even further, significant resources are required after the joint is replaced. Thus, many elective procedures were either canceled or postponed during the pandemic. One must carefully consider if going back to doing the “same old things” is economically ideal irrespective of new variants of the coronavirus. Moving joint replacements to an ASC may unburden a hospital, but implant costs, PPE, and personnel requirements likely remain the same.
  • We introduced Surgical-Distancing. These simple two words mean allowing only the critically needed personnel into the operating room. We recognize that fewer individuals in the operating room reign supreme irrespective of a pandemic. That said, an Intraarticular Saucerization of the shoulder, hip, or knee only requires the following personnel: The patient, the surgeon, the scrub technician, the circulator, and anesthesia. OSI follows the CDC guidelines and focuses on contributing to the elimination of real and perceived risks of infection by showing hospitals that a reduction in OR personnel during an Intraarticular Saucerization is an excellent first step toward reducing risks and saving money while providing needed care to the community.
  • PPE is required, but layering it on top of an already burdened system fatigues all of us. Healthcare needs PPE for an unburdened system. OSI helps unburden healthcare by providing products that allow surgeons to perform procedures that align with the incentives of all parties. Patients want sustainable pain relief in the least invasive way, and chronic opioids are not the answer. Hospitals want to save money on reimbursable procedures while meeting CDC, OSHA, and JC standards, and physicians want to work in an environment that values their physical and intellectual contributions and to be fairly compensated for their efforts.
  • OSI’s response to COVID-19 is not the creation of new products directed at individual fears or a desire for avoidance. Our response to COVID-19 is to make the public aware, not just physicians, of our unique joint preservation products that can be safely used during the COVID-19 pandemic. Our raw, unscripted, and on-the-spot testimonials reveal patients wearing their PPE and being very happy with having decided to save their joints.

References

  1. Brannon JK. Nontraumatic osteonecrosis of the femoral head: endoscopic visualization of its avascular burden. Orthopedics. 2012 Sep;35(9):e1314-22. DOI: 10.3928/01477447-20120822-15. PMID: 22955395.
  2. Freund E. BILATERAL ASEPTIC NECROSIS OF THE FEMORAL HEAD: PROBLEMS ARISING IN A COMPENSATION CASE. Ann Surg. 1936;104(1):100-106. DOI:10.1097 / 00000658-193607000-00010.
  3. Hashimoto K, Akagi M. The role of oxidation of low-density lipids in pathogenesis of osteoarthritis: A narrative review. J Int Med Res. 2020;48(6):300060520931609. DOI:10.1177/0300060520931609.
  4. Li F, Zhao Z, Cai Z, Dong N, Liu Y. Oxidized low-density lipoprotein promotes osteoblastic differentiation of valvular interstitial cells through RAGE/MAPK. Cardiology. 2015;130(1):55-61. DOI:10.1159/000369126. Epub 2014 Dec 18. PMID: 25531888.
  5. Dawodu D, Patecki M, Hegermann J, Dumler I, Haller H, Kiyan Y. oxLDL inhibits differentiation and functional activity of osteoclasts via scavenger receptor-A mediated autophagy and cathepsin K secretion. Sci Rep. 2018 Aug 2;8(1):11604. DOI: 10.1038/s41598-018-29963-w. PMID: 30072716; PMCID: PMC6072764.
  6. Moseley JB, et al. A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee. N Engl J Med 2002; 34:81-88. DOI: 10.1056/NEJMoa013259.

This paper concludes that arthroscopy for osteoarthritis is ineffective. However, these authors describe inadequate debridement of the knee, in our view. Further, no description of meniscus function nor the release of the excess fat from the bone is described after debridement. The meniscus appears to have been removed in some cases. The paper describes the procedure as below:

“After diagnostic arthroscopy in patients in the débridement group, the joint was lavaged with at least 10 liters of fluid, rough articular cartilage was shaved (chondroplasty was performed), loose debris was removed, all torn or degenerated meniscal fragments were trimmed, and the remaining meniscus was smoothed to a firm and stable rim. No abrasion arthroplasty or microfracture was performed. Typically, bone spurs were not removed, but any spurs from the tibial spine area that blocked full extension were shaved smooth.”

  1. Kirkley A, et al. A Randomized Trial of Arthroscopic Surgery for Osteoarthritis of the Knee. N Engl J Med 2008; 359:109-110. DOI: 10.1056/NEJMoa0708333.

This paper is a follow-up to the Moseley, et al. paper after the orthopedic community considered its statistical methods inadequate.  Nonetheless, Kirkley, et al. concluded that arthroscopy for osteoarthritis was ineffective after performing, what appears to be, inadequate debridement by using antiquated equipment, as in the Moseley paper. The paper describes the procedure as below:

“Arthroscopic treatment was performed within 6 weeks after randomization with the patient under general anesthesia and with the use of a tourniquet and a thigh holder. The orthopedic surgeon evaluated the medial, lateral, and patellofemoral joint compartments, graded articular lesions according to the Outerbridge classification, irrigated the compartment with at least 1 liter of saline, and performed one or more of the following treatments: synovectomy; débridement; or excision of degenerative tears of the menisci, fragments of articular cartilage, or chondral flaps and osteophytes that prevented full extension. Abrasion or microfracture of chondral defects was not performed.”

  1. Zeya B, Arjuman A, Chandra NC. Lectin-like Oxidized Low-Density Lipoprotein (LDL) Receptor (LOX-1): A Chameleon Receptor for Oxidized LDL. Biochemistry. 2016 Aug 16;55(32):4437-44. DOI: 10.1021/acs.biochem.6b00469. Epub 2016 Aug 4. PMID: 27419271.
  2. Radin EL, Parker HG, Pugh JW, Steinberg RS, Paul IL, Rose RM. Response of joints to impact loading. 3. Relationship between trabecular microfractures and cartilage degeneration. J Biomech. 1973 Jan;6(1):51-7. DOI: 10.1016/0021-9290(73)90037-7. PMID: 4693868.
  3. Martin JA, Buckwalter JA. Roles of articular cartilage aging and chondrocyte senescence in the pathogenesis of osteoarthritis. Iowa Orthop J. 2001;21:1-7. PMID: 11813939; PMCID: PMC1888191.
  4. Mazière C, Louvet L, Gomila C, Kamel S, Massy Z, Mazière JC. Oxidized low-density lipoprotein decreases Rankl-induced differentiation of osteoclasts by inhibition of Rankl signaling. J Cell Physiol. 2009 Dec;221(3):572-8. DOI: 10.1002/jcp.21886. PMID: 19725047.
  5. Bekkering S, Quintin J, Joosten L, van der Meer J, Netea M, and Riksen NP.  Arteriosclerosis, Thrombosis, and Vascular Biology, Volume 34, Issue 8, August 2014; Pages 1731-1738 https://doi.org/10.1161/ATVBAHA.114.303887
  6. Drees, P., Eckardt, A., Gay, R. et al. Mechanisms of Disease: molecular insights into aseptic loosening of orthopedic implants. Nat Rev Rheumatol 3, 165–171 (2007). https://doi.org/10.1038/ncprheum0428.
  7. de Munter W., Geven E.J.W., Blom A.B., Walgreen B., Helsen M.M.A., Joosten L.A.B., Roth J., van Lent P.L.E.M. Synovial macrophages promote TGF-β signaling and protect against influx of S100A8/S100A9-producing cells after intra-articular injections of oxidized low-density lipoproteins. (2017) Osteoarthritis and Cartilage,  25 (1), pp. 118-127.
  8. Belmont, Philip J., MD; Goodman, Gens P., DO; Kusnezov, Nicholas A., MD; Magee, Charles, MD, MPH; Bader, Julia O., PhD; Waterman, Brian R., MD; Schoenfeld, Andrew J., MD, MSc.  Postoperative Myocardial Infarction and Cardiac Arrest Following Primary Total Knee and Hip Arthroplasty: Rates, Risk Factors, and Time of Occurrence. The Journal of Bone and Joint Surgery - Scientific Articles: 17 December 2014 - Volume 96 - Issue 24 - p. 2025-2031

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