August 2002 Bulletin


Write to The Editor, AAOS Bulletin, 6300 North River Road, Rosemont, Ill. 60018-4262


Cross-linked polyethylene in total knee replacements–Counterpoint

It was with dismay that we found the Point/Counterpoint discussion on the use of cross-linked ultra high molecular weight polyethylene in total knee replacements (June 2002 issue) incorrectly titled, giving the impression that the discussion was specifically directed at electron beam cross-linked and melted polyethylene. In the case of the Counterpoint aspect of the discussion, it was not our intent to single out any particular processing method of cross-linking polyethylene. It was our intent to lay out potential disadvantages associated with the use of highly cross-linked polyethylenes in total knee replacements, regardless of processing method. Our concerns regarding fracture, delamination and pitting are voiced on the basis of published fatigue and fracture properties for highly cross-linked polyethylenes and the understanding of polyethylene tibial plateau failure modes. For total knee replacement applications, it is important to characterize not only the wear behavior, but also the fracture behavior of these materials.

Clare Rimnac, PhD, and A. Seth Greenwald, DPhil (Oxon)

AAOS Biomedical Engineering Committee members

Editor’s Note: The Bulletin wishes to apologize for misrepresenting the intent of the article written by authors Rimnac and Greenwald as a result of an incorrect headline, which they did not see prior to publication.

President’s Note: The leadership of the Academy regrets the copy-editing error that led to an incorrect and misleading title on above-referenced article in the June 2002 issue of the Bulletin. (See statement from the Biomedical Engineering Committee on page 46.) In response and to prevent future errors, we have instituted a new policy that provides for more detailed copy review, including review of the final manuscript by the author(s), prior to publication in the Bulletin. The Bulletin is an important vehicle to keep the fellowship informed about the spectrum of issues that orthopaedic surgeons contend with in their professional activities. It is our intent to continue to serve the fellowship and provide timely, accurate information in the areas of patient care, research, medical education, public policy, practice management, governance and advocacy.

Professional Liability Crisis

I commend the Board of Councilors and Ms. Breisch for addressing the current medical liability insurance crisis (June 2002 issue). It is becoming increasingly apparent that in state after state doctors do not have access to available and affordable insurance.

To achieve a meaningful evaluation of premium rates one must compare states that have tort reform including a cap on non-economic damages with states that do not. Regional comparisons blur this distinction; obscuring the real effect a cap has on non-economic damages. The lack of doctor response noted in the article indicates to me that we must do a better job of educating our doctors. Grouping them by regions might make for an easier statistical study but does not result in a valid analysis of the real problem.

States with a cap on non-economic damages control skyrocketing verdicts limiting economic severity. In each case where states have controls on severity there are lower rates than in states where verdicts reflect the jackpot lottery mentality. Orthopedic surgeons in California can afford to practice. Orthopedists in Nevada cannot practice and cannot obtain affordable insurance. The reason…uncapped liability. When companies cannot make predictions about risk, they must assume that verdicts will continue to rise. Therefore they must continue to raise premiums. The math is simple!

Do not believe and perpetuate the propaganda circulated by the Plaintiff’s Bar. Neither carrier losses nor massive medical error is the cause of increasing premium rates. The continuing escalation of jury verdicts is the overwhelming reason.

Control the lottery verdict by having provisions in state law to cap non-economic damages. Let us be part of a real effort to achieve our objectives by providing our legislators and the public with valid arguments.

Jerrald R. Goldman, MD

Lafayette, Calif.

The contingency fee arrangement in the U.S. strongly encourages lawyers to sue physicians and it rewards them handsomely for doing that. Equally, chumming attracts sharks. As one result, a medical professional liability crisis is developing in America, marked by rising professional liability insurance premiums, early physician retirement and difficulties in finding physicians to handle certain problems.

Making the contingency fee arrangement illegal should minimize such effects, as it did in other countries. But, U.S. plaintiffs’ attorneys object that making it illegal would deny "justice" to plaintiffs unable to afford attorneys to prosecute their claims.

However, that is a self-serving untruth and all attorneys know it. How so? At present U.S. citizens accused of a crime who cannot afford their own attorney must have a public defender appointed to handle their defense. The same arrangement could help plaintiffs who urge professional liability actions but who could not afford their own attorneys. Of course that would require new legislation.

But is this not a matter that medical legislative lobbies could pursue? If so (it seems to me), why are they silent on this matter?

Harold M. Frost, MD

Pueblo, Colo.

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