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Addressing Arthritis as a Chronic Disease

Alexandra Page, MD

How do you counsel a 15-year-old girl who has had an anterior cruciate ligament (ACL) reconstruction about osteoarthritis (OA)? What do you say about OA to the 45-year-old weekend athlete who, during a routine follow-up visit after rotator cuff repair, incidentally mentions feeling a sporadic knee ache? What do you tell the 30-year-old laborer who has a fracture affecting a joint or his 50-year-old foreman whose knees hurt all day?

For too many orthopaedic patients, risk counseling and prevention of OA isn’t adequately addressed. In most primary care settings, due to other pressing health issues and/or lack of provider exposure or training, joint pain is often minimized or not asked about.

Percutaneous Thermal Ablation Techniques for the Treatment of Musculoskeletal Metastases

Musculoskeletal metastases, particularly those affecting bone, are common and associated with significant morbidity in cancer patients. Percutaneous ablation of soft-tissue and/or bone metastases can provide relief of pain and local disease control for properly selected patients. Although multiple technologies for percutaneous ablation exist, the thermal-based techniques of radiofrequency ablation and cryoablation are the most established and most often used technologies in practice. Focused ultrasound surgery is a noninvasive ablation technique that has shown great promise, but has not yet been incorporated into routine clinical practice. Microwave ablation is another relatively new modality for percutaneous ablation that has shown early promise, but is also not yet routinely used in practice. This article reviews the indications, procedural techniques, and outcomes for percutaneous thermal ablation, specifically radiofrequency ablation and cryoablation, in the management of patients with musculoskeletal metastases.