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Achievements during the Bone and Joint Decade 2000–2010

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Musculoskeletal diseases continue to produce major disability around the world. Advances in therapy – particularly for the inflammatory diseases – have the potential to eradicate the inflammation and thus prevent joint destruction. Surgical advances include minimally invasive and computer-assisted robotic surgery, and advances in arthroscopic surgery. The development of new musculoskeletal tissues – tendons, cartilage and bone using nanotechnology and stem cells – has the potential to revolutionise the way we approach these chronic destructive diseases as well as major trauma. With the rapid increase in these conditions with an ageing population, new models of care will need to be developed to ensure that the right care is delivered at the right time by the most appropriately trained health professional and at a reasonable cost. The Bone and Joint Decade has played a significant role in focussing researchers, clinicians and health educators on these diseases and also in drawing them to the attention of Governments around the globe. While there is still much to be done, the journey has commenced and will continue into the future with education, research and service delivery into these important conditions being further enhanced.

Introduction

The Bone and Joint Decade was established to draw attention to the major problems of musculoskeletal diseases and trauma around the globe and to stimulate education and research leading to better care and clinical outcomes for patients with musculoskeletal diseases. Target conditions for the decade included

  • joint disease

  • osteoporosis

  • back pain and spine conditions

  • childhood musculoskeletal conditions

  • road traffic trauma

Although we are well aware of the burden of musculoskeletal conditions, we forget that every minute of every day a child is killed or seriously injured on the worlds roads. Many of these deaths and injuries are preventable and this has been a major focus of this decade.

From a medical perspective, this decade has seen great advances in the management of inflammatory forms of arthritis driven in part by the wider availability of the biologic agents which have increased in range and number. Biologics are also showing benefit in a greater number of diseases such as ankylosing spondylitis, psoriatic arthritis and connective tissue diseases [1], [2].

Osteoarthritis is increasing with the ageing population and is the major reason for mobility restriction. Despite significant efforts over the past decade to develop markers for early detection, there is still no clear way of identifying which patients will progress rapidly [3]. Treatment remains symptomatic with a combination of pharmaceutical and physiotherapy approaches along with general issues such as maintaining ideal body weight.

Although non-steriodal anti-inflammatory drugs are still the mainstay of treatment for many painful musculoskeletal conditions, there is growing concern about the evidence that all non-steroidal anti-inflammatory drugs (NSAIDs) are associated with an increase in the risk of cardiovascular disease [4]. Musculoskeletal pain is still the most common symptom that afflicts humankind and its management needs to be improved significantly [5].

New osteoporotic agents have also been developed [6] but the standard therapies such as the bisphonates have come under some shadow because of side effects such as bone destruction [7].

All of these advances combine to provide patients with musculoskeletal disease with a more positive message in 2010 than at the beginning of the decade in the year 2000 [8]. So, how has this occurred and how will it be maintained?

The establishment of National Action Networks in nearly 62 countries around the globe has surely raised the profile of these conditions nationally and internationally. Unfortunately, one of our major sponsors – the World Health Organisation (WHO) – has still not recognised musculoskeletal conditions as a priority area despite the overwhelming evidence of their impact on the burden of the disease [9].

Section snippets

Milestones in the Bone and Joint Decade [10]

This table summarises the major activities of the decade.

  • 1998 Inaugural Consensus Meeting held in Lund, Sweden to establish goals and objectives of the Bone and Joint Decade (BJD).

  • 1999 United Nations endorses BJD 2000–2010.

  • 2000 BJD formally launched at WHO in Geneva.

  • 2000 The first BJD world Network Meeting held in Oman and repeated each year

    • -

      2002 Brazil

    • -

      2003 Germany

    • -

      2004 China

    • -

      2005 Canada

    • -

      2006 South Africa

    • -

      2007 Australia

    • -

      2008 India

    • -

      2009 USA

    • -

      2010 Sweden

  • 2003 Global Technical report published by WHO: The

Minimally invasive surgery

Minimally invasive surgery has been the operative signature of the 21st century. The desire to reduce the morbidity of surgery, postoperative pain and length of in-hospital stay has resulted in many innovative ways to perform elective and acute orthopaedic procedures. Examples where minimally invasive surgery has been most successfully deployed include hip [13], [14] and knee [15] replacement surgery, shoulder stabilisation procedures, decompression of rotator cuff impingement [16], [17], [18],

Bioengineering

The growth in interest in cell and tissue repair, regeneration and re-engineering has been the foundation for a ground swell of research into bioengineering [34]. Orthopaedics is a discipline ideally suited to benefit from the outcomes of this research. The need for innovative answers to osteoarticular bone loss from trauma, tumour or degeneration is a prime example of where the efforts in bioengineering can be directed. Already considerable amounts of work have been done looking at ways of

Robotics

Robotics is an exciting area not only as an instrument to undertake more accurate surgery [37] but also as a means of replacing lost limbs. Robotics as a tool for surgery has enjoyed mixed receptions. The complexity of the architecture and computer interfaces together with the overall size, and cost of the machinery has meant that early uptake of this technology was limited. Initially used to assist in joint replacement ‘robodoc’ was an instrument that could precisely mill out bone from the

Joint replacement registries

One of the most important outcomes of the internationality of orthopaedics is the development of national joint replacement registries [41], *[42]. Joint replacement surgery is an exemplar of high-volume high-cost surgery and the need for such surgery in an ageing population is expected to rise dramatically over the next two decades. With the anticipated cost of this surgery to exceed tens of billions of dollars each year, joint replacement surgery will have a significant impact on health

Conclusions

The management of musculoskeletal disease and trauma is becoming ever more complex. Surgeons, physicians, rehabilitationists, nurses and allied health professionals, to name but a few, are involved along with patients and their families. It is one of the best examples in health of ‘team’ care – health professionals of many disciplines working with patients to improve outcomes. Patient involvement has been one of the major platforms of the BJD and will be even more significant in the next

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