Hip Fractures

With ever-increasing life expectancy comes the challenge of treating age-related disorders such as osteoporosis. Although there are effective drugs for treating this metabolic bone disease, they can be expensive and have side effects, limiting their availability to some people. In the search for alternative drug candidates, researchers have discovered and fully replicated a compound from a botanical source, female ginseng, that had potent anti-osteoporotic activity in cellular tests. With ever-increasing life expectancy comes the challenge of treating age-related disorders such as osteoporosis. Although there are effective drugs for treating this metabolic bone disease, they can be expensive and have side effects, limiting their availability to some people. In the search for alternative drug candidates, researchers reporting in ACS Central Science have discovered and fully replicated a compound from a botanical source, female ginseng, that had potent anti-osteoporotic activity in cellular tests. Osteoporosis and low bone mass impact 54 million American adults over the age of 50, according to the International Osteoporosis Foundation. The disease can progress to significant disability, such as hip and spine fractures, and financial burdens, such as lost wages and hospitalization. Several drugs have proven effective in either preventing bone loss or promoting bone formation, but each comes with potential side effects, including injury to jaw and leg bones. Searching for alternative treatments, Hao Gao, Xin-Luan Wang and colleagues turned to female ginseng (Angelica sinensis), which has long been used in traditional Chinese medicine to treat osteoporosis. The researchers performed chemical extraction on the medicinal plant and identified two new compounds, calling them falcarinphthalide A and B, that were structurally unlike anything previously discovered in female ginseng. They also determined potential biosynthetic precursors and metabolic pathways that the plants use to form these compounds. Then, with these mechanisms as starting points, the team devised lab synthesis methods and produced the compounds at quantities sufficient for biological testing. Inspired by the traditional efficacy of female ginseng, the team tested the compounds for their impact on the formation of cells called osteoclasts, which facilitate bone loss. They observed that only falcarinphthalide A and its precursors showed osteoclast inhibitory activity and an anti-osteoporotic effect. Further analysis showed that falcarinphthalide A blocked key molecular pathways involved in osteoclast generation. The researchers say that this study opens up the possibilities for new osteoporosis treatments based on the female ginseng compound, whether in its current form or as a structural template for further drug development.

OrthoDome Forum Features a Video of the Reverse HRS Hip Replacement Procedure; Presentation also Features Five-Year Radiostereometric Analysis and Patient Reported Outcome Measures of the Reverse HRS SAN FRANCISCO, Feb. 15, 2024 /PRNewswire/ -- Hip Innovation Technology, LLC (HIT), a medical device company developing innovative orthopedic device solutions to advance the quality of life and quality of care for patients, today announced that its flagship product, the Reverse Hip Replacement System (Reverse HRS) was showcased at the 2024 American Academy of Orthopaedic Surgeons (AAOS) annual meeting, taking place in San Francisco, CA from February 12 -16, 2024. "We are extremely excited that the Reverse HRS was featured at AAOS in the OrthoDome with a video of an actual hip replacement surgery narrated by Dr. Adolph Lombardi," said George Diamantoni, Hip Innovation Technology's Co-Founder and Chief Executive Officer. "In addition to a bird's eye view of this new hip replacement technology, the presentation also included five-year RSA and patient-recorded outcome measures." The AAOS OrthoDome surgical video and live narration was led by Adolph V. Lombardi Jr., MD, FAAOS, JIS Orthopedics. The presentation featured high resolution video of Dr. Lombardi conducting a hip replacement with the new Reverse HRS. Dr. Lombardi narrated the video procedure and provided updated five-year RSA and Patient-Reported Outcome Measures (PROM) data compiled from Reverse HRS patients. "Total hip arthroplasty is one of the most common joint replacement procedures conducted around the world and can benefit from device improvement and innovation," said Dr. Lombardi. "The Reverse HRS provides patients and physicians an option that minimizes the risk of dislocation at extended ranges of motion in all planes. The addition of the Reverse HRS has the potential to eliminate other common complications associated with THA." Reverse HRS Registrational Trial Underway In 2023, Hip Innovation Technology launched its pivotal clinical research trial under an FDA approved Investigational Device Exemption (IDE). The IDE Study is being conducted to determine the safety and effectiveness of the HIT Reverse HRS in Primary Total Hip Arthroplasty (THA). Safety will be assessed through the collection of device-related adverse events and patient quality of life metrics. Effectiveness will be evaluated using clinical, radiologic, and patient-reported outcomes. Stephen Zabinski, MD, Director of the Division of Orthopaedic Surgery, Shore Medical Center in Ocean City, New Jersey, performed the first surgery using this exciting new technology on January 10, 2023. "I'm pleased to see the Reverse HRS being featured at the 2024 AAOS OrthoDome," said Dr. Zabinski. "As the registrational trial matures, more of the mainstream orthopedic community will appreciate the potential benefits of this technology, especially in complex scenario patients and those deemed high risk for post-op dislocation like spine-pelvic disorders, hyper mobility or increased laxity, hip fractures or revisions." Previous RSA and Patient Outcomes Data The Bone & Joint Open journal, recently published the article, "Radiostereometric analysis and clinical outcomes of a novel reverse total hip system at two years." This publication demonstrated that the Reverse HRS delivered excellent fixation with a predicted low risk of revision at ten years, mean migration below the level of radiostereometric analysis (RSA) detection for both the femoral and acetabular components, and high rates of patient satisfaction including no patients reporting symptoms consistent with soft-tissue impingement within the articulation and no symptoms consistent with adverse reaction to metal debris. Hip replacement surgery, or total hip arthroplasty, is one of the most common joint replacement procedures done in the United States. According to the Agency for Healthcare Research and Quality, more than 450,000 total hip replacements are performed each year in the United States. In fact, by 2030 approximately 850,000 patients are expected to undergo the procedure each year. Total hip replacements are one of the most effective ways to reduce joint pain and improve functioning for patients with advanced hip problems. During the 2015 calendar year, approximately 324,000 surgeries were performed in the U.S. and 50,000 in Canada. HIT has extensively tested the Reverse HRS in over 90 standard and unique pre-clinical experiments to assess the product safety and clinical benefits anticipated by the unique system design. About the Reverse HRS The Reverse HRS is a Metal-on-Polyethylene reverse geometry hip prosthesis designed to improve stability at extended ranges of motion and reduce the risk of dislocation. Like most conventional systems, the Reverse HRS consists of a femoral stem, an acetabular cup and a cobalt-chrome ball that articulates within a polyethylene liner. Unlike existing total hip replacement systems, the ball is placed on a trunnion within the acetabular cup instead of the femoral stem, and the polyethylene liner is attached to a femoral cup, which then attaches to the femoral stem, as opposed to the polyethylene liner being attached to the acetabular cup. This technological difference does not change the center of rotation of the Reverse HRS and it remains similar to a normal physiological hip, or a well-positioned traditional Total Hip Arthroplasty. The advanced Reverse HRS implant is designed to provide greater range of motion in all planes, enhanced hip stability, and to reduce the risk of dislocation. Importantly, the Reverse HRS also provides variability of component placement including higher abduction angles and anteversion of the acetabular cup. The femoral cup articulates around the acetabular ball and overlaps with the acetabular cup as the hip undergoes flexion-extension, abduction-adduction and internal-external rotation. This forgiving design may compensate for suboptimal component positioning which may provide benefits such as extended range of motion, hip stability and reduced likelihood of impingement. The Reverse HRS is designed to uncouple the relationship between component placement, wear and stability. This unique implant design of the Reverse HRS provides optimal surface area contact between the acetabular ball and femoral cup, which may eliminate edge loading. Elimination of edge loading may provide benefits that include reduced high-contact stresses, decreased implant wear and uniform wear, which minimizes generation of wear debris and associated concerns related to osteolysis. About Hip Innovation Technology, LLC Headquartered in Boca Raton, Florida, Hip Innovation Technology was formed in 2011 to provide market-leading orthopedic device solutions that advance the quality of life and quality of care for patients. In partnership with healthcare professionals worldwide, our goal is to identify unmet clinical need, then design, manufacture and ultimately market innovative orthopedic reconstructive and related surgical product solutions. For more information, visit . Contact: John F. Kouten JFK Communications, Inc. (609) 456-0822 [email protected] SOURCE Hip Innovation Technology, LLC

SAN FRANCISCO, Feb. 12, 2024 /PRNewswire/ -- Experts from NYU Langone Orthopedics will present their latest clinical findings and research discoveries at the American Academy of Orthopaedic Surgeons' (AAOS) 2024 Annual Meeting, February 12-16, in San Francisco. Among the topics presented: 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 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, FAAOS, 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 NYU Langone Orthopedics endeavors to always deliver world-class care to our patients." 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 more than 200 orthopedic physician faculty. At this year's meeting, faculty of NYU Langone Orthopedics will present 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 at NYU Langone Orthopedics, 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 post-operative 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 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," 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, 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 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 in patients who have undergone 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 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 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. Media Inquiries Marlene Naanes Phone: 929-923-3102 [email protected] Colin DeVries Phone: 212-404-3588 [email protected] SOURCE NYU Langone Health