NYU Langone orthopedic experts are presenting their latest clinical findings and research discoveries at the 2024 American Academy of Orthopaedic Surgeons’ (AAOS) Annual Meeting, held February 12 to 16 in San Francisco.
Among the topics presented:
- improved outcomes in computer-navigated and robot-assisted total knee replacements
- substantial reduction in postoperative complications in patients with significant weight loss before lumbar spinal fusion surgery
- an improved mental state after hip fracture repair surgery through an alternative method to general anesthesia in hip fracture repair surgery
- understanding the differences in posterior tibial slope in unilateral versus bilateral ACL reconstruction
“The faculty of our department are always focused on uncovering new, innovative ways to heal while improving the patient experience and outcomes,” said Joseph D. Zuckerman, MD, the Walter A.L. Thompson Professor of Orthopedic Surgery, chair of the Department of Orthopedic Surgery at NYU Langone, and a former president of AAOS. “This year’s impressive group of presentations at the nation’s premier orthopedic meeting is a testament to why the department endeavors to always deliver world-class care to our patients.”
NYU Langone is ranked No. 4 in the nation for orthopedics by U.S. News & World Report, performing more than 34,000 orthopedic procedures annually by more than 200 orthopedic physician faculty.
At this year’s meeting, faculty from the Department of Orthopedic Surgery are presenting 39 posters, 31 e-posters, 34 papers, 31 videos, and 21 symposia, courses, specialty programs, and special sessions. Below are some of the notable presentations from this year’s conference.
Podium Presentation: Use of Technology Improves Short-Term Clinical Outcomes in Total Knee Arthroplasty
The use of technology in total knee replacements, including computer-navigated and robot-assisted surgical systems, has increased in recent years, but the effect on patient-reported outcomes has been unclear. Surgeons at NYU Langone endeavored to determine short-term patient outcomes using these minimally invasive, precision-based technologies.
“Technological innovations have enabled surgeons to improve implant positioning and accuracy, and we’re seeing that positively impact the patient experience,” said Morteza Meftah, MD, an associate professor of orthopedic surgery, a member of the Division of Adult Reconstructive Surgery, and senior author of the study presented at AAOS. “The results indicate that not only are these technologies safe and effective, but they dramatically improve short-term outcomes of our patients having total knee surgery.”
The retrospective study by Dr. Meftah’s group included a review of 16,009 NYU Langone surgeries from January 2017 to October 2023, comparing the use of computer-navigated and robotic surgical systems with conventional techniques in total knee arthroplasty. The results showed that length of stay was shorter and patients were discharged to their homes at a higher rate after either computer-navigated or robotic systems than they were after conventional methods.
Additionally, perfect activity scores on postoperative discharge day zero were higher in robotic (30 percent) and navigated (19.5 percent) cases than the conventional group (8 percent). There were no differences in readmissions or revisions across any of the three surgical methods.
Podium Presentation: Trimming the Risks: Weight Loss and Its Effect on Obesity-Related Complications in Spine Fusion Surgery
Although the benefits of weight reduction have been shown to improve overall health and satisfaction, the effect of preoperative weight loss on complications and outcomes after lumbar spinal fusion is not fully understood. Physicians at NYU Langone’s Spine Center set out to evaluate the association of postoperative complications with significant weight loss prior to lumbar fusion surgery.
“We wanted to understand if there are truly benefits to preoperative weight loss programs ahead of spinal fusion surgeries, and found there were real differences,” said Tina Raman, MD, study author and director of research for the Division of Spine Surgery at NYU Langone. “Our study confirmed a significant reduction in complication risk if patients lose weight before surgery. It’s critical to have those conversations with patients and develop an effective plan leading up to surgery.”
In the study of 702 patients, including 362 with normal body mass index rates, 204 who were obese, and 136 who lost weight over an average of 1,896 days, significant differences were observed between the groups. Patients in the normal group had lower operative time, less blood loss, and shorter lengths of stay than patients who were obese, though there were no significant differences in those factors between the obese and weight loss groups. Deep surgical infections, however, were found to be significantly lower in the weight loss group (0 percent), compared with the group who were obese (3.45 percent).
Podium Presentation: The Monitored Anesthesia Care–Soft Tissue Infiltration with Local Anesthesia (MAC–STILA) Technique Decreases Incidence of Short-Term Postoperative Altered Mental Status in Hip-Fracture Patients
Hip fractures are common injuries that have significant health impacts on patients. At the same time, and altered mental status (AMS) from anesthesia is one of the most prevalent complications immediately following surgical repair. Those cognitive effects then have adverse impacts on outcomes, can delay rehabilitation, and increase costs for the hospital, insurance, and patient. Faculty set out to test an alternative approach to general anesthesia to see if AMS could be mitigated.
“We want patients to be set up for the best recovery possible following surgery, so we looked at how to reduce altered mental status postoperatively,” said Sanjit R. Konda, MD, an associate professor, a member of the Division of Trauma and Fracture Surgery, and senior author of the study presented at AAOS. “By using lighter sedation and adding local anesthetic at the hip-repair site, we saw a significant improvement in our patients after surgery.”
This technique, called monitored anesthesia care with soft tissue infiltration with local anesthesia (MAC–STILA), pairs anesthesiologist-administered sedation with surgeon-administered local anesthetic applied directly on the surgical site. This alternative anesthesia approach can be used in hip fractures repaired with cannulated screws, sliding hip screws, and cephalomedullary nails.
The study reviewed 1,076 procedures between October 2019 and November 2022 in which patients were given either MAC–STILA, general anesthesia (GA), or spinal anesthesia. The review found patients who had MAC–STILA had significantly lower odds of AMS in the short-term postoperative period compared with those who had GA. Additionally, MAC–STILA patients required significantly less narcotic medication up to 48 hours postoperatively compared to GA patients.
Specialty Session: Patients with Bilateral ACL Reconstruction (ACLR) Have Three Times the Rate of Posterior Tibial Slope Greater Than 12 Degrees Compared with Unilateral ACLR: MRI and Radiographic Evaluation
An increased posterior tibial slope (PTS)—a condition marked by a greater slope of the shinbone toward the back of the knee—can increase the risk of injury of the anterior cruciate ligament (ACL), the fibrous connective tissue in the knee that connects the shinbone to the thigh bone. Sports medicine physicians in the Department of Orthopedic Surgery are presenting findings on a study published in The American Journal of Sports Medicine that compares PTS values in patients who have had bilateral ACL reconstruction to those who had unilateral ACL reconstruction.
“Understanding biomechanics and each patient’s unique anatomy helps us to better manage their return to normal activity after surgery,” said Laith M. Jazrawi, MD, chief of the Division of Sports Medicine. “Understanding the posterior tibial slope and the effect it has on the ACL can inform our approach to more-individualized surgical repairs. We set out to determine if there is a much greater slope in patients who had bilateral ACL tears compared with patients who had a unilateral ACL tear.”
The retrospective compared radiography and magnetic resonance imaging (MRI) captured at NYU Langone among 53 patients who had unilateral ACL reconstruction and 53 patients who had bilateral ACL reconstruction between 2012 and 2020. The comparisons were matched between patients of similar age and body mass index and the same sex. Researchers found the rate of a radiographic PTS greater than 12 degrees was 2.4 times higher among patients who had bilateral ACL tears compared with those who had unilateral ACL tears. Additionally, when PTS measurement values on radiographs were compared with MRI, a negligible correlation was found between those two imaging modalities.
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