NYU Langone Orthopedic Surgeons Present Latest Clinical Findings & Research at AAOS 2023

NYU Langone orthopedic experts will present their latest clinical findings and research discoveries at the 2023 American Academy of Orthopedic Surgeons (AAOS) Annual Meeting March 7-11 in Las Vegas.

Topics featured include:

• Minimally invasive needle arthroscopy in the office to diagnose and treat a common cause of chronic ankle pain
• Improvement of postoperative pain by intraoperative injections in hip fracture surgery
• Use of an additional dose of dexamethasone to reduce postoperative opioid use for pain after knee replacement

“Our clinical teams continue to innovate and explore how we can provide the best possible outcomes for our patients. That’s evident in the variety of presentations this year,” said Joseph D. Zuckerman, MD, Walter AL Thompson Professor of Orthopedic Surgery, Chair of the Department of Orthopedic Surgery at NYU Grossman School of Medicine and Past President of AAOS. “We also congratulate Dr. Claudette M. Lajam, our Chief Safety Officer and leader of our orthopedic health justice initiatives, on her service as Chair of the AAOS Board of Councilors. She was the first Latina chair and only the second woman in that role.”

NYU Langone is ranked #4 in Orthopedics nationwide US News and World Reportwhich performs more than 34,000 orthopedic procedures annually by more than 200 experts from the orthopedic faculty.

At this year’s meeting, the faculty of the Department of Orthopedic Surgery will present 77 posters, 31 papers, 32 videos and 38 symposiums, courses, special programs and special sessions. Notable research findings from this year’s conference include the following.

Video award: In-office needle arthroscopy for the treatment of anterior ankle impingement

Anterior ankle impingement, commonly caused by the accumulation of soft scar tissue or bone spurs that have formed in the ankle, can limit range of motion and is a common cause of chronic ankle pain. While the gold standard procedure for treating the condition has historically been arthroscopy of the ankle, advances in needle arthroscopy have made arthroscopic treatment a practice in the awake state without the need for an operating room or an anesthetist.

“The use of the latest available nanotechnology has significantly improved the patient experience and outcomes of corrective surgery for ankle impingement,” said John G. Kennedy, MD, professor in the Department of Orthopedic Surgery and Chief of the Department of Foot and Ankle Surgery.

The case video of one by Dr. Kennedy’s in-office needle arthroscopy for the treatment of the anterior ankle receives the 2023 Orthopedic Video Theater Plus Award from the American Academy of Orthopedic Surgeons. The case can be viewed in the orthopedic video theater throughout the conference.

Special program: The long-term effect of intraoperative hip fracture injections on function and patient-reported outcomes–a randomized controlled trial

Hip fractures are unpredictable and occurring injuries that require immediate treatment. While adequate postoperative pain control enhances a patient’s ability to successfully complete physical therapy after a hip fracture and return to normal activities, perioperative narcotic pain medications have also shown negative side effects such as delirium and addiction that impact outcomes. To investigate ways to avoid these side effects, NYU Langone researchers conducted a single-blind, randomized, controlled trial to evaluate outcomes when intraoperative injections of local anesthetics were administered.

“We wanted to understand whether using a cocktail of local anesthetics and analgesics during surgery could reduce postoperative pain and curb opioid use,” said Philipp Leucht, MD, PhD, Raj-Sobti-Menon Associate Professor of Orthopedic Surgery and principal investigator in the department for orthopedic surgery. “In addition to the benefits of pain management, we found that this treatment resulted in improved rehabilitation outcomes in some patients.”

The study randomized 186 hip fracture patients across treatment and control groups. The treatment group received an injection of bupivacaine, morphine sulfate, and ketorolac prior to wound closure. The control group received no injection. Patients in the treatment group reported significantly less pain and less trouble sleeping, as well as less anxiety, fear, feelings of helplessness, nausea, and drowsiness than the control group immediately after the procedure and at six weeks. Participants in the treatment group also reported greater walking distance during rehabilitation.

Paper Presentation: Second dose of dexamethasone reduces postoperative opioid use, pain, and length of stay in primary total knee arthroplasty

Although total joint replacement is one of the most effective treatments for end-stage osteoarthritis, pain control can be difficult to manage in the immediate postoperative period and the first few weeks after surgery. NYU Langone surgeons investigated whether a second dose of the commonly used perioperative analgesic dexamethasone could provide enough pain relief to decrease opioid use while reducing length of stay. A retrospective review of 2,256 primary elective patients undergoing total hip arthroplasty and total knee arthroplasty was included in the study.

“We developed an opioid sparing protocol at NYU Langone that aims to reduce the use of narcotics for patients undergoing total joint arthroplasty. Combined with better soft tissue techniques and minimally invasive surgeries, patients can now recover more quickly with less likelihood of developing opioid tolerance or abuse,” said Dr Site Director for NYU Langone Hospital – Brooklyn. “Dexamethasone has been shown to reduce pain enough to reduce opioid use.”

Patients with total knee arthroplasty showed significantly lower opioid consumption up to 72 hours after surgery. Dexamethasone was administered to both groups of patients before the incision and then again after the operation. In addition, the length of stay in total knee arthroplasty patients was reduced and patients were able to return home to a more comfortable healing environment sooner and without additional adverse events.

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