Landmark Study: Arthroscopy Beats Open Repair for Shoulder Repair
Well, 200 shoulders can’t be wrong…In the largest study of its kind to date, James P. Bradley, M.D., M.S., has found that in athletes, arthroscopic repair for posterior instability of the shoulder yields better results than an open procedure. Dr. Bradley, a sports medicine specialist with Burke & Bradley Orthopedics at the University of Pittsburgh Medical Center, is also head orthopedic surgeon for the Pittsburgh Steelers. He told OTW,
“Our results, just published in the American Journal of Sports Medicine, show that an arthroscopic repair for posterior shoulder instability has a very high success rate in athletes. In the 1990s many people were looking at anterior stability, but I could see that posterior instability had not been examined closely. Fast forward to today and we have results indicating that arthroscopic repair for posterior instability does indeed appear have better results in athletes than does an open procedure.
We evaluated patients prospectively, and we utilized the American Shoulder and Elbow Surgeons (ASES) scoring system. At 36 months we found an improvement in the mean ASES score, better stability, less pain, and improved function. A full 90% of patients were able to return to play, with 64% of patients able to return to the same level of preoperative play. We also found that using bone suture-anchors in capsulolabral reconstruction meant that patients had even higher ASES scores and a higher rate of return to play.”
New Study Documents Outpatient Partial Knees Safety
There are not many facilities doing same day partial knee replacement surgery. For some orthopedic surgeons, however, it is becoming more routine. Robert S. Gorab, M.D. and Steven Barnett, M.D. are orthopedic surgeons and managing partners of Orthopaedic Specialty Institute in Orange, California and practicing orthopedic surgeons at the Hoag Orthopedic Institute in Orange County, California. Dr. Gorab shared his new results with OTW:
“We performed outpatient partial knee replacement on more than 200 patients; we experienced no readmissions and had excellent outcomes. This work, which has just been accepted by the Journal of Arthroplasty, is unique in that no other research has shown success and safety in an entirely outpatient setting. There are strong implications with respect to safety and cost because patients do not have to remain in the hospital.
We had no adverse events, no infections, and no readmission for DVTs. Most impressive is the fact that we were able to perform this surgery on patients in their 80s in an outpatient setting very safely. These individuals do well if they are in good health and if they receive solid perioperative care.
Those patients who aren’t eligible for this surgery in an outpatient setting are those who have no help at home, those who are physically incapable of managing their recovery and those cases where there is multiple joint involvement. Also, if it is not clear whether the person needs a full or partial replacement, then we will do that in an inpatient setting.
Years ago most lumbar disc procedures were done in an inpatient setting—no longer. The same transition has occurred with ACL [anterior cruciate ligament] reconstruction of the knee. I think we will see the same thing happen with partial knee replacement surgery at other highly specialized outpatient orthopedic facilities in the near future.”
George Thompson, M.D. Wins Lifetime Achievement Award
The Scoliosis Research Society (SRS) has honored pediatric orthopedic surgeon George Thompson, M.D. with a Lifetime Achievement Award for his work in pediatric spinal disorders. Dr. Thompson is chief of the Department of Pediatric Orthopaedic Surgery at University Hospitals (UH) Rainbow Babies & Children’s Hospital in Ohio and professor of Orthopaedics and Pediatrics at Case Western Reserve University School of Medicine. He is only the 11th recipient of this prestigious award.
This award commemorates Dr. Thompson’s extensive career, which has led to innovations in everything from surgical techniques to ways for preventing or decreasing blood loss, making operations safer for children, according to Randall E. Marcus, M.D., Charles H. Herndon professor and chairman, Department of Orthopaedic Surgery, UH Case Medical Center and Case Western Reserve University School of Medicine.
“Abscess” Study Wins Best Clinical Paper Award
Christopher Bono, M.D., chief of spine at Brigham and Women’s Hospital, and deputy editor of The Spine Journal, He tells OTW,
“I’m thrilled that our paper, “Predictors for Success of Nonoperative Management of Spinal Epidural Abscesses,” was honored as Best Clinical Paper at the recent International Society for the Advancement of Spine meeting. The research, a 150 person retrospective study, demonstrates that someone who is neurologically intact can be treated nonoperatively for epidural abscesses. The article is currently under review at The Spine Journal.
This study proves that while nonoperative treatment has a higher failure rate, if someone fails at that level he or she can go on to surgery and be no worse off than if they had first taken the surgical route. The big fear has always been that if you treat this nonoperatively then the patient will experience a catastrophic decline in neurological status, but the truth is that this is exceedingly rare. How will this affect practice? I predict that this work can be of assistance in community hospitals where until now orthopedic surgeons have been immediately transferring patients to surgery because they think that’s what they have to do.”
Baron Lonner, M.D. New Head of Spine at Beth Israel Medical Center
Dr. Baron Lonner is the new chief of the Division of Spine Surgery in the Department of Orthopedic Surgery at Beth Israel Medical Center and director of the hospital’s Spine Institute of New York. He comes to Beth Israel from the NYU Hospital for Joint Diseases where he was a senior attending surgeon and clinical professor of Orthopaedic Surgery. In addition, Dr. Lonner holds leadership positions in the Scoliosis Research Society and sits on the editorial boards of four of the leading spine journals. He has authored more than 70 peer-reviewed publications, regularly presents his research findings at national and international meetings. He has won several prestigious research awards. Dr. Lonner’s research has focused on ways of improving patient care and outcomes in spinal deformity surgery including scoliosis and kyphosis in the pediatric and adult patient. Dr. Lonner received his undergraduate and medical degrees from Boston University, where he completed the accelerated six-year medical program. He completed his residency in orthopedic surgery at Montefiore Medical Center and a fellowship in spine and scoliosis surgery at the Hospital for Special Surgery.
He told OTW,
“I am looking forward to the challenge of expanding the spine division at Beth Israel. I see a great opportunity to serve patient needs and further research in spine. We want to take a multi-tiered, multi-disciplinary approach that takes into account clinical outcomes and value measurements, which are so important to patients and their families. We have established non-operative protocols for conditions such as degenerative diseases in the cervical, thoracic, and lumbar spines, and spinal deformity in children and adults. We have incorporated innovative diagnostic tools such as light-based (radiation-free) surface topography that allows us to follow patients with scoliosis for signs of progression without X-ray in some cases. We have implemented a collaborative approach incorporating multiple team members for the surgical care of patients including the anesthesiologist, pain management, nursing, rehabilitation and physical therapy, social workers, and even specialists in relaxation techniques.
I look forward to growing the spine division with the goal of providing the highest quality of care and utilizing therapies, both non-operative and operative that rely on the highest level of evidence, i.e., evidence-based care. Along with my team, I want Beth Israel’s Spine Institute to be a jewel of spine care providing treatment that is carefully tailored to each patient. In my new role I will draw upon a very important lesson that I have learned over the years, namely, the value of collaboration. Spine care must be well-coordinated and relies on a dedicated team.”