New Jersey medical authorities are investigating the incidence of and issuing alerts on unlicensed cosmetic surgery providers after 6 women suffered complications from injections of silicone caulk into their buttocks.

Essex County hospitals began treating the patients, who had sought cut-rate body enhancements from black-market practitioners, in mid-February, according to a published report. Neither the recovering patients, the providers nor their practice locations have been identified. No arrests have yet been made. It is unclear whether the incidents are related.

According to the report, the providers injected the patients with diluted, non-medical-grade, silicone caulk that's intended for home improvement projects. A state health department official quoted in the article warns that such injections can lead to infections, abscesses and other complications.

A New Jersey plastic surgeon further notes that even when done by trained, licensed surgeons with medical-grade silicone, buttock-enhancement procedures carry the risks of scarring and implant shifting.

David Bernard

Rotator cuff surgery may restore a patient's normal shoulder strength, but mobility issues persist in the repaired joint, according to researchers at the Henry Ford Hospital in Detroit, Mich.

Lead researcher Michael Bey, PhD, director of the hospital's Herrick Davis Motion Analysis Lab, used a high-speed, biplane X-ray system to compare the position of the arm bone in relation to the shoulder blade during motion at 3, 12 and 24 months post-op in 14 patients who underwent the procedure. He discovered that the repaired shoulders' motion patterns differed significantly as compared to the patients' healthy shoulders, and that the differences endured over time.

"Although patient satisfaction is generally very high after surgical repair of a torn rotator cuff, the data suggest that long-term shoulder function - in particular, shoulder strength and dynamic joint stability - may not be fully restored in every patient," explains Dr. Bey, who presented his findings at the Orthopaedic Research Society's annual meeting last week.

He's also currently researching the condition of shoulder joints prior to injury. "What further complicates our understanding of rotator cuff tears is that we have also shown that there are subtle yet important differences in shoulder function between the dominant and non-dominant shoulder of healthy volunteers," he says.

Even though rotator cuff repair doesn't necessarily restore normal shoulder function, says Dr. Bey, the surgery is still valuable in eliminating shoulder pain after repetitive strain injuries among older patients.

Daniel Cook

Even with a thorough pre-op education program, more than two-thirds of joint replacement patients don't share the expectations that their surgeons do with regard to post-op pain and movement ability, according to a survey conducted by the Hospital for Special Surgery in New York City.

The results emphasize the importance of fine-tuning pre-op education, say researchers. "Inexpensive educational interventions like a pre-operative class can be used to better align the patient's and the surgeon's expectations prior to surgery," says co-author Alejandro Gonzalez Della Valle, MD, who presented the survey at the American Academy of Orthopedic Surgeons' annual meeting last week.

Dr. Gonzalez Della Valle and colleagues surveyed patients and surgeons prior to 42 total-knee and total-hip replacements. They discovered that the patients and surgeons had differing expectations of surgical outcomes before 68% of the cases.

A little more than half of the patients whose opinions differed from their surgeons' had a more positive expectation regarding post-op pain and ability to walk or do housework, even though the hospital required prospective patients to attend a 90-minute class that explained the procedure and aftermath. "In an ideal world, the expectations of the patient and surgeon should be similar," says Dr. Gonzalez Della Valle.

Kent Steinriede

More and more healthcare campuses are prohibiting smoking both indoors and out. What about yours? Let us know if people are allowed to light up on your grounds in this week's poll question. We'll report the results in this space next week.

Last week, 134 respondents described how they recognize staff that go above and beyond. Here's the breakdown: