PLACEBO EFFECT

More than half of doctors offer fake prescriptions to make patients feel better -- and that's OK, most doctors say.
The findings come from a survey of 679 internists and rheumatologists. Doctors in these specialties often see patients with chronic illnesses or chronic pains that are difficult, if not impossible, to cure. Sometimes fake medicine -- placebos -- make such patients feel better.
Fake drugs can have very real benefits. It's called the placebo effect. In clinical trials, many patients who receive placebos do better than real-world patients who get no treatment at all, notes study researcher Jon C. Tilburt, MD.
"Twenty to thirty percent of the benefit seen in rheumatism drug studies are due to the placebo effect. Real changes in health go along with the belief that patients will get better," Tilburt tells WebMD.
Tilburt and colleagues asked the doctors a series of questions, each a bit more blunt than the last:
If a clinical trial showed a sugar pill was better than no treatment for fibromyalgia, would you recommend sugar pills to fibromyalgia patients? Yes, 58% of the doctors said.
Do you ever actually recommend treatments primarily to enhance a patient's expectations? Yes, 80% of the doctors said.
In the last year, did you recommend a placebo treatment to a patient? Yes, 55% of the doctors said.
What did the doctors actually tell their patients? Over two-thirds of those who prescribed placebos told patients they were getting "medicine not typically used for your condition but which might benefit you."
Is it "appropriate" to fool patients this way? Yes, 62% of the doctors said.
"I don't think doctors have anything but the patients' best interest in mind when they give a placebo prescription," says Tilburt. "They are thinking about both the physical and psychological well-being of the patient."
The hard-to-accept truth is that doctors don't have proven treatments for many of the ills that plague their patients.
"With untreatable conditions or chronic conditions when we have run out of treatments, doctors are willing to try virtually anything -- if they are convinced it is safe -- to make the patient feel better, even if the mechanism is a psychological mechanism," Tilburt says.
Placebo Prescriptions: Right or Wrong?
Is it right for doctors to prescribe treatments they believe are not biochemically effective?
Here's the official policy of the American Medical Association:
Use of a placebo without the patient's knowledge may undermine trust, compromise the patient-physician relationship, and result in medical harm to the patient.
A placebo must not be given merely to mollify a difficult patient, because doing so serves the convenience of the physician more than it promotes the patient's welfare.
Physicians may use placebos for diagnosis or treatment only if the patient is informed of and agrees to its use.
Placebo Prescriptions: Right or Wrong?
That last point seems tricky. How can a fake drug work if a patient knows it is fake?
The AMA policy says doctors should explain to patients that they can better understand their condition if they try different medicines, including a placebo. If the patient agrees to this, the doctor does not have to identify which medicine is fake, nor does the doctor have to get the patient's specific consent before giving the patient the fake treatment.
There's nothing wrong with this approach, says medical ethicist Arthur Caplan, PhD, professor of bioethics at the University of Pennsylvania, Philadelphia.
"It is ethical to use treatments that are low risk and have few side effects if you can relieve people's symptoms," Caplan tells WebMD. "Placebos are especially useful in the treatment of the psychological aspects of disease. Most doctors will tell you they have used placebos."
But doctors do often prescribe placebos the wrong way. In today's world, a doctor can't write a prescription for a sugar pill. The doctor has to prescribe something -- and every active medicine carries some risk of side effects.
"What you can use as a placebo is complicated. I have seen people dispensing antibiotics as placebo for mothers who want something for their kids' flu," Caplan says. "Not only does this not help, but it does build up drug resistance and may have some serious side effects for the child."
Most doctors use relatively harmless drugs, such as baby aspirin, as placebos. Clearly, great care must be taken to ensure that the placebo drug's risk is less than the benefit of the hoped-for placebo effect.
"We know it is wrong when doctors give potentially harmful medicines in a manner that may not be warranted," Tilburt says. "If I think it will actually have only a placebo effect, I should not give a patient a sedative. The compulsion by doctors to benevolently promote patient expectations can play out in a way harmful to patients."
In the end, Tilburt suggests, the effectiveness of a placebo treatment may well hinge on the trust patients have in their doctors.
"Maybe it isn't about taking a pill at all," he says. "Maybe it is the relationship between the doctor and the patient that makes the real difference."
Tilburt, formerly with the bioethics department of the National Institutes of Health, is now assistant professor of medicine at the Mayo Clinic, Rochester, Minn. The study appears in the Oct. 24 online first edition of the journal BMJ.

ACL RECONSTRUCTION

http://http://www.hipsknees.info/flash5/HTML/demo.html

this is the link to understand the surgical procedure of reconstruction of ACL using bone tendon bone method... this is for patients information.. u need to instal java to run this movie..

Computer-Assisted Knee Surgery

Computer-assisted surgery helps surgeons align the patient's bones and knee replacement implants with a degree of accuracy not possible with the naked eye. For the first time, doctors have detailed information allowing them to balance the ligaments and it is given to them before they make the necessary cuts.
Computers also help doctors who use smaller incisions instead of the traditional larger openings. Small-incision surgery, most often referred to as minimally invasive surgery, offers the potential for faster recovery, less bleeding and less pain for patients.
Think of it this way. Perhaps you've seen the on-board computers in newer cars that provide driving directions using satellite navigation systems. On-board computers collect data points from satellites and use precise coordinates to give drivers directions from point A to point B. It provides a degree of precision, speed and accuracy not attainable with a map and compass.
Similarly, computers used during orthopaedic surgeries offer visual mapping to help doctors make crucial decisions before and throughout the knee replacement operation. The objective is to combine the precision and accuracy of computer technology with the surgeon's skill to perform surgery.
An advantage is that the doctor has greater "vision" when it counts — during surgery. This supports decision-making and enhances the surgeon's flexibility.
Here's how it works. Computer-assisted surgery uses:
the computer system
cameras
software
specialized surgical instruments
physician training The software and instrumentation of the Ci™ System are designed to work together. (Some systems use traditional surgical tools that must be adapted for use with computers). Imaging technology allows the surgeon to see a computer generated picture representation of a patient's knee joint allowing them the potential to operate with smaller openings and with more precision.


Visual Mapping of Knee Joint

The Ci™ System's lightweight, wireless computer system is used with a small camera array. A digital model is produced that serves as a map for each operation. The cameras take data via infrared signals from reflectors placed on the patient's body and on specially designed surgical instruments. The computer uses the data to track the exact position of the patient and the instruments on a monitor. The combination of computer visualization and special surgical instruments allows doctors to align the knee replacement implant with greater precision than when doing the procedure with the naked eye.
Advocates of the technology say they expect the use of computer-aided surgery to spread rapidly in the next decade because of the following potential benefits:
support for the doctor in pre-operative planning
intra-operative flexibility to adapt the plan based on the data shown during the surgery
improved surgical accuracy and consistency
The future of computer-assisted surgery is exciting and promising. Total joint replacement is a proven procedure that has been successful for decades in helping people live with less pain and greater mobility. Some surgeons will adapt the technology right away; others will await further results while adhering to the traditional hands-on approach they've used for years.

The way a knee replacement will perform depends on your age, weight, activity level and other factors. There are potential risks and recovery takes time. If you have conditions that limit rehabilitation, you should not have this surgery. Only your orthopaedic surgeon can decide whether partial or total knee replacement is right for you.

Refobacin Plus - A New Antibiotic Bone Cement

Antibiotic bone cements have increased in popularity as a complementary treatment to systemically administered antibiotics for
periprosthetic infection. One successful application of antibiotic bone cement is in the 2-stage revision of infected arthroplasties
using antibiotic-loaded spacers, with the advantage of direct antibiotic delivery to the site of infection.
The mechanisms by which the antibiotic is released from the bone cement (PMMA) is still largely undefined. It is believed the
antibiotic is first released directly from the surface and subsequently flows from interconnecting voids and cracks through the
cement rather than by a diffusion process.
Refobacin Plus (Biomet) contains gentamicin and is essentially a high viscosity bone cement, but has an initial low viscosity to
allow for vacuum mixing and adequate delivery