TORONTO, Patients suffering from painful heel spurs and tennis elbow may soon be able to wave goodbye to the physiotherapist's bench, orthotic devices and cortisone injections that have until now been the mainstay of their treatment.
At least that's the hope of Drs. Robert Gordon and Anthony Galea, of Toronto's Institute of Sports Medicine, who have spent much of the past several months marvelling at the seeming efficacy of an emerging technology in the treatment of two of North America's most common orthopedic complaints.
Dubbed orthopedic lithotripsy (or orthotripsy for short), the therapy is dependent on a specially-designed machine which uses conventional spark plug technology to generate high energy shock waves. Over the course of a 20 to 30-minute treatment session, these electrical charges are fired at the affected area, causing bones to shatter and tendons to perforate.
"When 1,000 shock waves shoot out in 16 kV focused on an area that's just 5 mm by 1.5 cm, you cause microtrauma and encourage revascularization," explained Dr. Gordon, an orthopedic surgeon and sports medicine practitioner. "In 90% to 95% of cases, that one session is all it takes to cause healing. It is quite amazing and impressive."
When shock wave lithotripsy was first introduced 15 years ago for the disintegration of kidney stones, investigators noticed that, in addition, the procedure increased bone density and spurred new tissue growth. Since then, researchers in Europe have successfully applied the technology in the treatment of more than 5,000 cases of heel spurs and tennis elbow as well as nonunion and delayed union fractures, heterotropic calcifications, tendonosis complaints and painful loosened non-cemented joint implants.
"When we first heard of orthotripsy we were very skeptical," admitted Dr. Gordon. "It was quite shocking in that it seemed rather aggressive and scary but the results being reported were so amazing we decided to find out more."
Drs. Gordon and Galea flew down to the Health South Medical Group in Birmingham, Ala., where one of North America's leading orthopedic surgeons, Dr. James Andrews, is conducting U.S. Food and Drug Administration trials of the device. So impressed were they with his results, they underwent a week's training in the technique and promptly arranged to test the technology at their own clinic.
To date, they have treated about 25 patients suffering from heel spurs, tennis elbow and rotator cuff tendonitis with or without calcification. Their preliminary single treatment results echo those reported by colleagues in Europe and the U.S.: 95% success rates for heel spurs, 75% to 80% for tennis elbows, and 65% to 70% for rotator cuff tendonitis.
Among those who have benefited from the new treatment are members of Canada's national track, ski and basketball teams, as well as ballerinas and a professional golfer, said Dr. Galea, an associate professor of family medicine at the University of Toronto and one of the eight physicians attached to the Canadian Olympic Team during last year's Winter Olympics in Nagano, Japan.
"One of the fellows on the track team had markedly slower times this summer because of a heel spur and, when he heard we were doing orthotripsy he was very excited and did it right away," he said. "That athlete is pain-free, back in training and doing very well."
Although the technology has received approval from the Health Protection Branch, Drs. Gordon and Galea insist their use of it will remain investigational until they have accumulated at least six months of followup data. That being the case, orthotripsy has so far been offered free of charge to their Canadian patients. But, if they are convinced of its efficacy and choose to offer the therapy as a regular service, Canadians can expect to shell out between $1,000 and $1,500 per treatment.
While that price tag may seem steep, it compares favourably with the costs associated with the six months of physiotherapy, orthotics and lost work time normally incurred by such patients, said Dr. Galea. It also is significantly less than the $2,000 (US) the Toronto-based clinic is charging its American clientele.
"We've had a lot of Americans come up from California, New York, Tennessee and Alabama for this treatment and their insurance companies are covering all of their costs because they've seen the results and are convinced it will save them money in the long term," he said.
The procedure, which is done under a local anesthetic, is performed at the clinic on an outpatient basis. After treatment, patients are advised to continue with regular stretching exercises but not to return to full activity for six weeks. Their progress is to be monitored at three and six weeks as well as at three months, six months and one year.
The most common side-effect reported is local pain during the 48 hours following treatment. Far less common are the unexplained arrhythmias that have been reported by some European investigators, said Dr. Gordon. He added that the procedure is contraindicated for patients with entrapment of the nerves in the foot or elbow, tumours, infections or fractures.
"I think orthotripsy will be an excellent service for Canadians," enthused Dr. Galea.