Orthopedics Commons^™

Impact Of Covid - 19 Pandemic On Orthopaedics At Northwell Health, New York., B. Petrone, C. Iturriaga, T. Mauri, N. Sgaglione

Journal Articles

The Novel Coronavirus (COVID-19) pandemicplaced an immense strain on healthcare systems and orthopedic surgeons across the world. To limit the spread, federal and state governments mandated the cancellation of all non-urgent surgical cases to address surging hospital admissions and manage workforce and resource reallocation. During the pandemic surge, thousands of surgical cancellations have been required. We outline our experience through the onset and advance of the surge, detail our incident response, and discuss the transition toward recovery.

The Ethics Of Treating Acute Achilles Tendon Ruptures During The Covid-19 Pandemic: A Case Report, P. B. White, M. J. Partan, R. M. Cohn, C. J. Humbyrd, G. Katsigiorgis, A. Bitterman

Journal Articles

No abstract provided.

Covid-19 And Orthopaedics: Recovery After The Pandemic Surge., B. Petrone, C. R. Iturriaga, T. Mauri, N. Sgaglione

Journal Articles

The novel Coronavirus (COVID-19) pandemic has placed an immense strain on health care systems and orthopedic surgeons across the world. To limit the spread, federal and state governments mandated the cancellation of all nonurgent surgical cases to address surging hospital admissions and manage workforce and resource reallocation. During the pandemic surge, thousands of surgical cancellations have been required. We outline our experience through the onset and advance of the surge, detail our incident response and discuss the transition toward recovery. Level of Evidence: Level V.

Educating Surgeons To Educate Patients About The Covid-19 Pandemic, A Saxena, M Bullock, Jr Danoff, Ds Rodd, Sj Fischer, Bm Stronach, Br Levine

Journal Articles

No abstract provided.

5-Aminolevulinic Acid Tumor Paint And Photodynamic Therapy For Myxofibrosarcoma: An In Vitro Study, S. Kenan, H. Liang, H. J. Goodman, A. J. Jacobs, A. Chan, D. A. Grande, A. S. Levin

Journal Articles

No abstract provided.

Association Of Disposable Perioperative Jackets With Surgical Site Infections In A Large Multicenter Health Care Organization, E. J. Stapleton, N. Frane, J. M. Lentz, D. Armellino, N. Kohn, R. Linton, A. D. Bitterman

Journal Articles

No abstract provided.

Interaction Between Low-Dose Aspirin And Nonsteroidal Anti-Inflammatory Drugs Can Compromise Aspirin's Efficacy In Preventing Venous Thrombosis Following Total Joint Arthroplasty, E. Krauss, M. Cronin, N. Dengler, A. Segal

Journal Articles

No abstract provided.

Predicting Elective Orthopaedic Sports Medicine Surgical Cancellations Based On Patient Demographics., B. Petrone, J. Fakhoury, P. Matai, A. Bitterman, R. M. Cohn, L. Lutsky

Journal Articles

Purpose:To evaluate whether patient demographics are associated with cancellation of elective orthopaedic sports medicine surgical procedures. Methods:We retrospectively reviewed the electronic medical records of 761 patients who were scheduled to undergo an elective sports medicine orthopaedic operation from January 1, 2015, to December 31, 2017. The patients were divided into 2 groups: those who underwent the scheduled procedure (group A) and those in whom the operation was canceled for any reason prior to the surgical date and not rescheduled (group B). Univariate analysis assessed patient factors consisting of age, sex, race, language, marital status, occupation status, type of insurance (Medicaid …

Resumption Of Elective Orthopaedic Surgery In The Us Epicenter Of Covid-19, E. S. Krauss, A. Segal, D. Schulman, N. Dengler, T. Bily, M. Cronin, K. Altner

Journal Articles

© 2020 Krauss et al. On March 1, 2020, New York State confirmed its first case of COVID-19. This state has had the largest initial mortality in the United States with more than 479,000 confirmed cases and over 25,000 deaths as of October 10, 2020. All elective surgeries in New York State were suspended on March 23, 2020, due to the national state of emergency. Syosset Hospital is a 75-bed community hospital dedicated primarily to elective surgery. During the COVID-19 surge, the hospital was converted to provide needed beds for the treatment of COVID-19 illness. In anticipation of the resumption …

Surgical Gps Proof Of Concept For Scoliosis Surgery, Austin Tapp, Michel Audette

Computational Modeling & Simulation Engineering Faculty Publications

Scoliotic deformities may be addressed with either anterior or posterior approaches for scoliosis correction procedures. While typically quite invasive, the impact of these operations may be reduced through the use of computer-assisted surgery. A combination of physician-designated anatomical landmarks and surgical ontologies allows for real-time intraoperative guidance during computer-assisted surgical interventions. Predetermined landmarks are labeled on an identical patient model, which seeks to encompass vertebrae, intervertebral disks, ligaments, and other soft tissues. The inclusion of this anatomy permits the consideration of hypothetical forces that are previously not well characterized in a patient-specific manner. Updated ontologies then suggest procedural directions throughout …

Risk Factors For Liposomal Bupivacaine Resistance After Total Hip Or Knee Arthroplasties: A Retrospective Observational Cohort In 237 Patients, Scott Buzin, Arianna L. Gianakos, Deborah Li, Anthony Viola, Sherif Elkattawy, David M. Keller, Richard S. Yoon, Frank A. Liporace

Orthopedic Surgery Resident Research

Purpose: Liposomal bupivacaine demonstrated promise decreasing postoperative pain in total hip and total knee arthroplasty (THA/TKA). Some randomized trials have shown non-superior results; however, confounding variables were not accounted for in such analyses. This study attempts to determine risk factors associated with failure of pain management in patients receiving liposomal bupivacaine.

Methods: Postoperative pain scores were collected following primary or revision arthroplasties between January 2016 and December 2017. Retrospective analysis of institutional total joint quality and outcomes registry was screened and patients undergoing primary or revision arthroplasties who completed a multi-modal pain management including liposomal bupivacaine were included in the …

Opioid Tolerance Influences Outcomes After Lumbar Fusion In Patients With Degenerative Pathology, Noah Levy, Max Detweiler, Dhruv K.C. Goyal, Ariana Reyes, Alexander R. Vaccaro

Phase 1

Introduction: Extended opioid use prior to surgery has been implicated in poorer postoperative outcomes. However, it remains unclear if there is a significant difference in postoperative outcomes among preoperative opioid-naïve and opioid-tolerant patients who undergo lumbar spinal fusion. The purpose of this study was to determine the effect of preoperative opioid use on patient-reported outcome measures in patients undergoing lumbar spinal fusion.

Methods: This retrospective cohort analysis identified 260 patients who underwent lumbar spinal fusion at a high-volume, single institution. There were two cohorts: patients who were opioid-naïve (defined as total opioid consumption of ≤ 7 days in …

A Medial Congruent Polyethylene Offers Satisfactory Early Outcomes And Patient Satisfaction In Total Knee Arthroplasty, Benjamin M. Frye, Caitlyn Patton, Jason A. Kinney, T. Ryan Murphy, Adam E. Klein, Matthew J. Dietz

Faculty & Staff Scholarship

Background

Although a successful operation, almost 20% of patients are dissatisfied with total knee arthroplasty (TKA). The purpose of this retrospective cohort study was to see if a medial congruent (MC) polyethylene would offer satisfactory early outcomes and patient satisfaction after TKA.

Methods

We reviewed prospectively collected data on 327 TKAs using multiple bearings within the same implant system. Ninety-six received an MC bearing, 70 received a cruciate-retaining (CR) bearing, and 161 received a posterior-stabilized (PS) bearing. We evaluated the visual analog scale pain scores and range of motion (ROM) at 2 weeks, 6 weeks, 3 months, and 1 year; …

Ain To Ulnar Motor Nerve Transfer Meta Analysis, Melanie Luikart, Asif M. Ilyas, Md

Phase 1

Background: There are currently few comprehensive studies of end-to-end and “supercharged” reverse end-to-side (SETS) anterior interosseous nerve (AIN) to ulnar nerve transfers for treatment of ulnar neuropathy. The authors performed a literature review existing published literature to evaluate the indications for, and utility of, AIN-ulnar nerve transfer as a treatment method and to inform future treatment decisions.

Methods: A literature review was performed based on the following inclusion criteria: inclusion of anterior interosseous nerve or AIN, ulnar nerve or ulnar motor nerve, transfer or nerve transfer, and outcome, motor, clinical, ulnar neuropathies, ulnar nerve paralysis, treatment or function. Exclusion criteria …

Meta-Analysis Of Repair Techniques For Mixed Nerve Damage, Grant Jones, Zachary J. Herman, Asif Ilyas

Phase 1

BACKGROUND: Injuries to the upper extremity are common and can occur with trauma, surgery, or compression. Particularly, injuries that result in complete transection often require surgical intervention in attempt to restore function and quality of life. Classically, nerve autografts have been used as the gold standard to repair these peripheral lesions. An alternative to the autologous nerve graft is the use of the processed nerve allograft. limited research exists in comparing sensory and motor outcomes of allograft nerve repair in the upper extremity with data for autograft repair. In this systematic review and meta-analysis, we set out to cumulate results …

Functional Outcomes After Lumbar Fusion In Opioid-Tolerant Patients, Max Detweiler, Noah Levy, Dhruv K.C. Goyal, Ariana Reyes, Alex R. Vaccaro, Md, Phd, Mba

Phase 1

Introduction: Prolonged opioid use after lumbar fusion surgery is implicated with increased hospital readmissions, higher postoperative pain scores, and longer return to work time. There are several non-modifiable risk factors for postoperative opioid use including socioeconomic status and gender. The purpose of this study was to determine the effects of opioid-tolerance on PROMs and to determine risk factors for prolonged opioid use after lumbar spine surgery.

Method: Using retrospective cohort analysis, patients who underwent lumbar spinal fusion at TJUH were identified and determined to be either opioid-naïve or opioid-tolerant using the Pennsylvania PDMP. Outcomes included number of opioid tablets consumed, …

3d Printing Of Bone Spurs Before Surgical Removal During Total Knee Arthroplasty, John Paul Prodoehl

Phase 1

Project Background: In the United States, total knee arthroplasty (TKA) is the most performed orthopaedic operation. Among the 700,00 patients who received TKA, 21-25% underwent revision due to knee instability. Proper stability of a TKA depends on soft tissue balance for proper alignment in flexion and extension, and improper soft tissue modification is the primary cause of early implant failure. Soft tissue balancing can be complicated by presence of osteophytes on the distal femur or proximal tibia, which may require removal. The three-dimensional structure of osteophytes is often difficult to visualize with imaging, which could cause incomplete removal. Utilizing 3D …

3d Printing Of Bone Spurs Before Surgical Removal, Matthew Chadwick, John Paul Prodoehl, Katelyn Koons, Chris Li, Lauren Schlegel, Jeffrey Henstenburg, Md

Phase 1

Project Background: In the US alone, total knee arthroplasty is the most common performed orthopedic surgery, with over 700,000 cases per year.1 Overall, 21-25% underwent revision due to instability.2 The stability of a TKA depends largely on soft tissue balance for proper alignment in flexion and extension. Soft tissue balancing in TKA depends on posterior femoral condylar osteophytes, which prevent full extension of the knee and increase tension posteriorly. Pre-operative soft tissue visualization is difficult and this leaves an increased chance for implant failure and revision surgery. Having a 3D model of the bone spur before and during the surgery …

Modified Two-Stage Exchange For Periprosthetic Joint Infection In Uka., Andrew G Yun, Marilena Qutami, Kory B Dylan Pasko

Articles, Abstracts, and Reports

Periprosthetic joint infection (PJI) is a rare complication following unicompartmental knee arthroplasty (UKA), and current management guidelines are still evolving. This report presents a novel surgical technique of resection arthroplasty with an articulated hemispacer as part of a 2-stage exchange protocol. A 66-year-old man developed a culture-negative PJI four months after a medial UKA. Rather than conventional full resection arthroplasty, the patient underwent partial resection with preservation of the lateral and patellofemoral compartments to maintain vascularized bone stock. An articulating hemispacer fashioned from the old implants after sterilization was reimplanted medially to preserve function during the course of antibiotic treatment. …

Isolated Large Glenoid Fracture In Acute Glenohumeral Dislocation In The Elderly: A Novel Indication For Reverse Shoulder Arthroplasty, Tyler Smith, Joseph D'Alonzo, Alfonso Arevalo, Jack Kazanjian

Orthopedic Surgery Resident Research

Case: Two elderly males presented with traumatic shoulder dislocation and bony Bankart fracture consisting of greater than 25% of the glenoid width. Due to several concomitant factors such as polytrauma, activity level, rotator cuff pathology, optimization of comorbidities, risk of complications, and potential for revision surgery, the patients were treated with reverse shoulder arthroplasty (RSA).

Conclusion: RSA may be a satisfactory treatment option for isolated, large glenoid fractures associated with anterior glenohumeral instability in the elderly. These patients are susceptible to rapid deconditioning with prolonged immobilization and may not be medically suited to undergo the prolonged recovery period associated with …

A Head-To-Head Comparison Of The Efficacy And Safety Of Ixekizumab And Adalimumab In Biological-Naïve Patients With Active Psoriatic Arthritis: 24-Week Results Of A Randomised, Open-Label, Blinded-Assessor Trial., Philip Mease, Josef S Smolen, Frank Behrens, Peter Nash, Soyi Liu Leage, Lingnan Li, Hasan Tahir, Melinda Gooderham, Eswar Krishnan, Hong Liu-Seifert, Paul Emery, Sreekumar G Pillai, Philip S Helliwell

Articles, Abstracts, and Reports

OBJECTIVES: To compare efficacy and safety of ixekizumab (IXE) to adalimumab (ADA) in biological disease-modifying antirheumatic drug-naïve patients with both active psoriatic arthritis (PsA) and skin disease and inadequate response to conventional synthetic disease-modifying antirheumatic drug (csDMARDs).

METHODS: Patients with active PsA were randomised (1:1) to approved dosing of IXE or ADA in an open-label, head-to-head, blinded assessor clinical trial. The primary objective was to evaluate whether IXE was superior to ADA at week 24 for simultaneous achievement of a ≥50% improvement from baseline in the American College of Rheumatology criteria (ACR50) and a 100% improvement from baseline in the …

Secukinumab Provides Sustained Improvements In The Signs And Symptoms Of Psoriatic Arthritis: Final 5-Year Results From The Phase 3 Future 1 Study., Philip Mease, Arthur Kavanaugh, Andreas Reimold, Hasan Tahir, Juergen Rech, Stephen Hall, Piet Geusens, Pascale Pellet, Eumorphia Maria Delicha, Luminita Pricop, Shephard Mpofu

Articles, Abstracts, and Reports

OBJECTIVE: To report the 5-year efficacy and safety of secukinumab in the treatment of patients with psoriatic arthritis (PsA) in the FUTURE 1 study (NCT01392326).

METHODS: Following the 2-year core trial, eligible patients receiving subcutaneous secukinumab entered a 3-year extension phase. Results are presented for key efficacy endpoints for the secukinumab 150-mg group (n = 236), including patients who escalated from 150 to 300 mg (approved doses) starting at week 156. Safety is reported for all patients (n = 587) who received 1 dose or more of study treatment.

RESULTS: Overall, 81.8%% (193 of 236) of patients in the secukinumab …

Unmet Need In Rheumatology: Reports From The Targeted Therapies Meeting 2019., Kevin L Winthrop, Michael E Weinblatt, Joan Bathon, Gerd R Burmester, Philip Mease, Leslie Crofford, Vivian Bykerk, Maxime Dougados, James Todd Rosenbaum, Xavier Mariette, Joachim Sieper, Fritz Melchers, Bruce N Cronstein, Ferry C Breedveld, Joachim Kalden, Josef S Smolen, Daniel Furst

Articles, Abstracts, and Reports

OBJECTIVES: To detail the greatest areas of unmet scientific and clinical needs in rheumatology.

METHODS: The 21st annual international Advances in Targeted Therapies meeting brought together more than 100 leading basic scientists and clinical researchers in rheumatology, immunology, epidemiology, molecular biology and other specialties. During the meeting, breakout sessions were convened, consisting of 5 disease-specific groups with 20-30 experts assigned to each group based on expertise. Specific groups included: rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis, systemic lupus erythematosus and other systemic autoimmune rheumatic diseases. In each group, experts were asked to identify unmet clinical and translational research needs in general …

3d Printing Of Bone Spurs Before Surgical Removal, Katelyn Koons, John Paul Prodoehl, Matthew Chadwick, Chris Li, Lauren Schlegel, Jeffrey Henstenburg, Md

Phase 1

Project Background: In the United States, 2% of the population will experience bone spurs, which will not resolve on their own.¹ Of people over 60 who experience a bone spur, 40% will require medical attention.² The soft tissue visualization appears to be difficult with imaging, leaving increased chance of poor balancing of the knee replacement. Osteophyte structure continues to be difficult to visualize in a 3D way and without their proper removal, can lead to increased rate of revision surgery. Having a 3D model of the bone spur may decrease risk of complication and enhance soft tissue modification …

Localized Cytokine Responses To Total Knee Arthroplasty And Total Knee Revision Complications, Nicole Prince, Julia A. Penatzer, Matthew J. Dietz, Jonathan W. Boyd

Faculty & Staff Scholarship

Background

The study of localized immune-related factors has proven beneficial for a variety of conditions, and one area of interest in the field of orthopaedics is the impact of implants and localized infections on immune response. Several cytokines have shown increased systemic concentrations (in serum/plasma) in response to implants and infection, but tissue-level cytokines have not been investigated as thoroughly.

Methods

This exploratory study investigated tissue-level cytokines in a cohort of patients (N = 17) in response to total knee arthroplasty and total knee revision to better understand the immune response to implants and localized infection (e.g., prosthetic joint infection). …

Conversion Total Knee Arthroplasty Needs Its Own Diagnosis Related Group Facility Reimbursement Code, Jonah Stein, Michael Yayac, Md, Gregory K. Deirmengian, Md, Javad Parvizi, Md, P. Maxwell Courtney, Md

Phase 1

Introduction: Conversion from a prior surgery to a total knee arthroplasty (TKA) is a more technically difficult procedure than primary TKA and is associated with worse short-term outcomes and increased complication and readmission rates, despite being undifferentiated under the current bundled payment model. The aim of this study was to determine differences in facility costs between primary TKA and conversion TKA, which we hypothesize are significant, to ensure providers are not penalized for treatment and high-risk patients have the same access to care.

Methods: We retrospectively reviewed a consecutive series of patients undergoing primary TKA at two hospitals within …

Cardiac Risk Factors Predicting 30/90-Day Readmission Rates In Lumbar Decompression Surgeries, Kevin Xiao, Blake Nourie, Joseph Bechay, Dhruv K.C. Goyal

Phase 1

Preoperative cardiopulmonary disease is known to be a risk factor for perioperative complications in deformity surgery and lumbar fusion procedures, however there is a lack of literature evaluating cardiac risk factors and their influence on readmission rates following lumbar decompression surgery. We want to determine whether preoperative cardiac risk factors influenced the 30 and 90-day readmission rates in patients undergoing lumbar decompression surgery. Patient charts from Rothman Institute between were reviewed for history of preoperative cardiac risk factors such as coronary artery disease, congestive heart failure, myocardial infarction, stroke, cardiac catheterization, stent placement, coronary artery bypass graft, aspirin and/or clopidogrel …

Survivorship, Complications, And Outcomes Following Distal Femoral Replacement Using Megaprosthesis, Keenan Sobol, John Strony, Timothy Tan, Md, Scot Brown, Md

Phase 1

Introduction: Distal femoral bone loss is often managed with a combination of modular prostheses, structural and non-structural allografts, and metal augmentation. However, when bone loss of the distal femur is severe, the viability of these methods can be limited.In the setting of severe bone loss, endoprosthetic reconstruction (EPR) with a megaprosthesis has become increasingly popular for both malignant and non-neoplastic indications. The primary aim of this study was to determine the short-term prosthesis survivorship, as well as complications, for patients who presented with non-neoplastic disease indications for megaprosthesis distal femoral replacement (DFR) at a single institution. The secondary aim was …

Selective Serotonin Reuptake Inhibitors Are Associated With Increased Bleeding Related Complications Following Primary Total Hip And Total Knee Arthroplasty, Kyle Plusch, John Stammers, Mbbs, Frcs, Alexus M. Cooper, Chi Xu, Md, Paul Kitei, Md, Javad Parvizi, Md, Frcs, Jess H. Lonner, Md

Phase 1

Introduction: Approximately 10-22% of patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) are diagnosed with depression. Pre-operative depression is associated with poorer patient reported outcomes, costs and increased complications. Selective serotonin-reuptake inhibitors (SSRIs) are first-line treatment for depression due to their efficacy and low side effect profile. There are conflicting studies regarding SSRI-related bleeding complications. This study compares the rate of bleeding-related complications in THA and TKA patients taking SSRI’s to a control group of non-SSRI users.

Methods: A retrospective single institution study of 16,407 primary THA and TKA’s from 2008 to 2018 was performed. Patients with …

Static V. Expandable Tlif Cage Outcomes, Harrison Pajovich, Ryan Nachwalter, Lohit Velagapudi, Joseph Zarowin, Alexander R. Vaccaro, Md, Phd

Phase 1

Static cages were introduced in the 1990s as a solution to degenerative spondylolisthesis, recurrent disc herniation and spinal stenosis. As this procedure was popularized, a new class of expandable Transforaminal Lumbar Interbody Fusion devices was introduced to further improve outcomes that will be studied in this project. It will be explored how expandable cages compare to static cages in TLIF procedures in patient-reported outcomes, complications and restoration of appropriate lumbar lordosis. We conducted a retrospective cohort review comparing those who received expandable and static cages. Eligible patients received TLIF procedure at the Rothman Institute, were ≥18 years of age and …