Experts from NYU Grossman School of Medicine’s Department of Orthopedic Surgery are presenting their latest clinical findings and research discoveries at the American Academy of Orthopaedic Surgeons (AAOS) 2022 annual meeting, March 22 to 26, in Chicago.
Topics presented will include quality and access implications of regulatory changes related to total joint replacement; how multidisciplinary case conferences improve outcomes among high-risk spine surgeries; and using augmented reality to improve hip fracture repairs.
“Our clinical teams continue to innovate and investigate to provide our patients with the best possible outcomes—that is evident in the diversity of presentations featured this year,” says Joseph D. Zuckerman, MD, the Walter A. L. Thompson Professor of Orthopedic Surgery, chair of the Department of Orthopedic Surgery, and former president of AAOS. “We also congratulate Dr. Claudette Lajam, our chief safety officer and a leader of our orthopedic health equity initiatives, on her appointment as chair of the AAOS Board of Councilors. She is the first Latina chair and only the second woman to serve in the role. Congratulations as well to Dr. Toni McLaurin, our director of diversity, equity, and inclusion, for her selection as member-at-large on the AAOS Board of Directors.”
NYU Langone is ranked among the top 5 hospitals in the nation for orthopedics by U.S. News & World Report; our orthopedic surgeons perform more than 23,000 orthopedic procedures annually, and the department has more than 200 orthopedic physician faculty experts.
At this year’s meeting, NYU Langone orthopedic and sports medicine specialists are presenting 65 papers, 74 posters, 18 videos, and 20 symposia, courses, and special sessions. Notable research from this year’s conference includes the following:
Paper 664: Multidisciplinary Conference for Complex Surgery Leads to Improved Quality and Safety
Surgery to treat complex spinal deformities are known to have high rates of complications, with minor and major complication rates as high as 70 percent among adults. With the goal of decreasing rates of adverse outcomes, NYU Langone initiated multidisciplinary preoperative conferences beginning from February 19, 2019, and studied the effect on quality and safety. Clinical specialists in orthopedic spine surgery, neurosurgery, anesthesia, intraoperative monitoring neurology, and neurological intensive care conducted weekly conferences to review high-risk spinal deformity cases and develop comprehensive, multidisciplinary treatment plans.
The study reviewed 167 patient cases before February 19, 2019, and 96 cases after the conferences began. Patients in the before-conference group averaged 54.6 years old, while the after-conference group averaged 60 years old. Both groups had similar demographics, with a majority of female patients in each (about 70 percent). The after-conference group showed decreased levels of blood loss, a reduced number of intraoperative complications, fewer deep surgical site infections, and a reduced rate of postoperative motor deficits. Other factors, such as operative time, length of stay, postoperative transfusion, and neuromonitoring signal loss, were similar among both groups.
Researchers concluded that a multidisciplinary conference for complex spine surgery patients resulted in decreased 30- and 90-day reoperation and readmission rates, intraoperative complications, and postoperative deep surgical site infections.
“Spinal deformity surgery is one of the most complicated and high-risk operations in our field,” says Charla R. Fischer, MD, co-author of the study, associate professor in the department, and a member of the Division of Spine Surgery. “This single-center study shows how impactful multidisciplinary conferences are before high-risk, complex spinal deformity surgeries. It’s critical for institutions to develop this protocol to achieve the best outcomes for their patients.”
Paper 272: Removal of Total Hip and Total Knee Arthroplasty from the Inpatient Only List: Impact on Health Disparities
In 2020, the Centers of Medicare and Medicaid Services (CMS) removed total hip and knee replacement from the so-called Inpatient Only list, which determines the procedures that are required to take place in a hospital inpatient setting to be eligible for Medicare coverage. Researchers at NYU Langone investigated the impact this regulatory change may have had on health disparities among patients, using joint replacement cases from 2015 through 2021.
In reviewing 11,819 total knee arthroplasty (TKA) and 10,212 total hip arthroplasty (THA) cases, Black and Hispanic patients were less commonly designated as outpatients than were White patients. Black THA patients also had significantly higher rates of readmission than White patients from 2018 to 2020, before THA was removed from the Inpatient Only list. There were no significant differences in readmissions across races or ethnicities.
“The implications of regulatory changes can be wide-ranging and lag behind available data,” says Claudette M. Lajam, MD, senior author of the study and chief safety officer for the department. “Additional study is needed to ensure these broad changes to the Inpatient Only list are not restricting access to high-quality care. As surgeons, we’re making decisions every day that impact lives, and we want to make certain our policies lead to the best possible outcomes for every patient.”
Paper 469: Improving Accuracy and Precision of Cephalad Lag Screw Placement in the Femoral Head During Cephalomedullary Nailing Using a Novel Augmented Reality System
Augmented and virtual reality technologies have seen substantial technological advances in recent years, leading to their increased use in surgery. Researchers investigated the use of augmented reality software, such as ADAPT by Stryker, in improving accuracy and precision in treating hip fractures.
The study reviewed 114 hip fracture cases that were repaired with a cephalomedullary nail from November 2017 to December 2020. The first 57 patients received fracture repair without the software, with the other 57 using augmented reality (AR). The AR system incorporates 2D intraoperative fluoroscopic X-ray images to generate a 3D model of the femoral head. A virtual AR overlay is used to calculate in real-time the ideal nail depth and positioning of the lag screw used to secure the nail through the femoral head.
Results of the study found that a tip-apex distance—a formula used to reduce risk of the screw cutting out of its intended position—of less than 10 mm was achieved in 43.9 percent of cases using AR compared to 3 percent without. Similarly, centering of the screw in the central femoral head zone, viewing from multiple angles, was achieved in 35.1 percent of cases using AR compared to 0 percent of cases without.
“Our study shows that the use of AR can make a substantial impact on preventing complications in the future,” says Sanjit R. Konda, MD, lead author of the study and assistant professor in the department. “As this technology continues to advance, its use may become more attractive to surgeons who want to deliver the very best outcomes for their patients.”