AAOS24: NYU Langone Orthopedic Surgeons to Present Latest Clinical Research

NYU Langone Orthopedics experts will present their latest clinical findings and research next week at the American Academy of Orthopaedic Surgeons’ (AAOS) 2024 Annual Meeting in San Francisco (Feb. 12-16).
 
Topics presented include: improved outcomes in computer-navigated and robot-assisted total knee replacements; substantial reduction in post-operative complications in patients with significant weight loss before lumbar spinal fusion surgery; using an alternative method to general anesthesia in hip fracture repair improved mental state after surgery; and 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 Zuckerman, M.D., FAAOS, the Walter A. L. Thompson Professor of Orthopedic Surgery, chair of the Department of Orthopedic Surgery at NYU Langone, and former AAOS president. “This year’s group of presentations is a testament to why NYU Langone Orthopedics endeavors to always deliver world-class care to our patients.”

At this year’s meeting, NYU Langone Orthopedics faculty will present 39 posters, 31 e-posters, 34 papers, 31 videos, and 21 symposia, courses, specialty programs, and special sessions. Notable research from this year’s conference includes: 

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 Orthopedics 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,” noted Morteza Meftah, M.D., associate orthopedic surgery professor in the Division of Adult Reconstructive Surgery at NYU Langone Orthopedics and senior study author. “The results indicate that not only are these technologies safe and effective, but they dramatically improve short-term outcomes of our patients undergoing total knee surgery.” 

The retrospective study by 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 home at a higher rate using either computer-navigated or robotic systems than conventional methods. Additionally, perfect activity scores on post-operative discharge Day Zero were higher in robotic (30%) and navigated (19.5%) cases than the conventional group (8%). There were no differences in readmissions or revisions across all three surgical methods. 

Podium Presentation: Trimming the Risks: Weight Loss and its Effect on Obesity-Related Complications in Spine Fusion Surgery
While 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 are not fully understood. Physicians in 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,” stated Tina Raman, M.D., study author and research director 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 obese patients, 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%) compared to the obese group (3.45%). 

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 a common injury that have significant health impacts on patients but altered mental status (AMS) from anesthesia is among 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 at NYU Langone Orthopedics 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, M.D., associate professor in the Division of Trauma and Fracture Surgery at NYU Langone Orthopedics and senior study author. “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 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 who underwent 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 to GA. Additionally, MAC–STILA patients required significantly less narcotic medication up to 48 hours post-operatively compared to GA patients. 

American Orthopaedic Society of Sports Medicine Specialty Session: Patients with Bilateral ACL Reconstruction (ACLR) have 3x the Rate of Posterior Tibial Slope Greater than 12-Degrees Compared to Unilateral ACLR: MRI and Radiographic Evaluation
An increased posterior tibial slope (PTS)—a condition marked by a greater slope of the shin bone 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 shin bone to the thigh bone. Sports medicine physicians at NYU Langone Orthopedics will present findings on a study published in the American Journal of Sports Medicine that compares PTS values between patients who have undergone bilateral versus unilateral ACL reconstruction. 

“Understanding biomechanics and each patient’s unique anatomy helps us to better manage their return to normal activity after surgery,” explained Laith M. Jazrawi, M.D., chief of the Division of Sports Medicine at NYU Langone Orthopedics. “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 to patients who had a unilateral ACL tear.” 

The retrospective compared radiography and magnetic resonance imaging (MRI) captured at NYU Langone among 53 patients who underwent unilateral ACL reconstruction and 53 patients who underwent bilateral ACL reconstruction between 2012 and 2020. The comparisons were matched between patients of similar age, sex, and body mass index. 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 to 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. 

NYU Langone Orthopedics is ranked No. 4 in the nation by U.S. News and World Report, performing more than 34,000 orthopedic procedures annually by over 200 orthopedic faculty physicians.