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Saturday, April 6, 2019

The most exciting technology in orthopedics from 10 surgeons

Ten orthopedic surgeons discuss the technology trends most intriguing for 2019 and beyond.
James T. Caillouette, MD. Hoag Memorial Hospital and Hoag Orthopedic Institute (Irvine, Calif.): I believe that we are on the cusp of developing regional pain management drugs and technologies that will dramatically alter the surgical experience. If we are able to create a sensory block that lasts four to six weeks, it will have vast implications for surgery that would significantly benefit the patients and lower the overall cost of care.
Robert LaPrade, MD. Orthopedic Surgeon (Colorado): I am most excited about technology that will allow us to perform surgeries more efficiently and anatomically. These technologies will ultimately lead to better patient outcomes and more reproducible results among all surgeons. Currently, one of the big dilemmas in my field of complex knee surgery is that many of the procedures that we perform require experience to be able to accomplish the surgeries efficiently, anatomically and successfully. Thus, the development of virtual reality programs to allow aspiring and practicing surgeons to ‘practice’ complex surgeries should enable surgeons to significantly cut down on their learning curves and lead to more efficient and successful surgeries. In addition, the encroachment of the field of robotics into the field of sports medicine may also allow for these surgeries to be more reproducible and successful.
Keith Berend, MD. Joint Implant Surgeons (New Albany, Ohio): I’m excited about the Zimmer Biomet MyMobility Apple Watch platform. Not only is the technology exciting, but the data being collected on more than 10,000 arthroplasty patients will provide predictive analytics that will try to change outcomes.
Shane Nho, MD. Midwest Orthopaedics at Rush (Chicago): There are interesting technologies that incorporate intraoperative image guidance for hip arthroscopy. Stryker sports medicine is introducing a tablet that can be used during surgery to measure the size and location of hip femoroacetabular impingement deformities. In addition, the software is able to assess in real time when the surgical correction has been completed. For surgeons performing hip arthroscopy, the technology will provide the intraoperative guidance that has been missing. I believe that this will allow us to be more accurate as well as more efficient in the operating room.
Adam Yanke, MD. Midwest Orthopaedics at Rush (Chicago): While many surgical treatments are improving, I am currently the most excited about biological augmentation of non-operative and surgical treatments. The technologies that we are employing most frequently are platelet rich plasma, amniotic product injections and bone marrow aspirate injections. These can be applied for non-operative treatment of arthritis and tendonitis or during surgery to improve outcomes of rotator cuff repairs, anterior cruciate ligament reconstruction and meniscus tears.
David Fisher, MD. OrthoIndy (Indianapolis): The technology I am most excited about in the future is in the orthobiologics arena where there may be some breakthroughs in new treatments for musculoskeletal conditions.
Platforms that more efficiently allow surgeons to follow and treat their patients are also exciting.
James Weisstein, MD. Colorado Center of Orthopaedic Excellence (Colorado Springs):Interoperability. In today’s world it’s a necessity for systems to communicate with one another. I know vendors and other membership organizations are working diligently on this, and I also know it’s not as easy to enable this as we’d like to think.
Edward Wang, MD. Stony Brook (N.Y.) Medicine: Ultrasound imaging and office-based arthroscopy, stem-cell treatments for rotator cuff healing and enzymatic treatment of frozen shoulder with collagenase enzyme.
Tom Stanley, MD. OrthoIllinois (Algonquin, Ill.): Stem cells for spinal fusion. The outcomes are more consistent without the complications associated with other biologics.
Scott D. Gillogly, MD. ASPETAR Orthopaedic and Sports Medicine Hospital (Doha, Qatar):Undoubtedly, artificial intelligence is the pervading technology that is only limited by imagination. Sometimes as orthopedic surgeons we only see the cool technology in front of us that greatly enhances surgical challenges such as robotics, 3D image guided hardware placement or slick meniscus repair systems. However, we are so busy we can temporarily miss the extensive data science scope of AI in the ‘softer’ areas of healthcare such as big data mining, integrated treatment protocols and outcomes databases as well as machine learning guided imaging reading, consultation second opinions and complication risk stratification.
These same compelling features of AI driven enhancements extend to administrative areas, population medicine, revenue cycle and supply chain optimization and so on. We are clearly at the tip of the iceberg with AI and so if we are to make an impact to enhance the value of the patient experience and outcomes, this is the future.
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Spinal manipulation can help ease low back pain

Spinal manipulation therapy isn’t routinely recommended as the initial treatment for low back pain, but a research review suggests this approach may work as well as interventions that doctors typically prescribe first.
Based on data from 47 previously conducted trials involving a total of 9,211 mostly middle-aged adults, spinal manipulation eased lower back pain as much as exercise, non-steroidal anti-inflammatory drugs (NSAID) and painkillers. Spinal manipulation also appeared better for improving short-term function.
“At the moment, spinal manipulation is considered a second-line or adjunctive treatment option in international guidelines,” said lead study author Sidney Rubinstein of the Vrije Universiteit in Amsterdam.
“These results would suggest that spinal manipulation is certainly on-par with these other recommended therapies, and can be considered an option,” Rubinstein said by email.
Lower-back pain is one of the leading causes of disability and doctor visits for adults worldwide. It often goes away within a few weeks. But when it persists, lower-back pain might be treated with spinal manipulation, medications like painkillers or muscle relaxers, heat, exercise or physical therapy.
Spinal manipulation is often done by chiropractors but may also be offered by physical therapists or physicians. It can include manually moving joints, massage and exercise. This type of treatment is designed to relieve pressure on joints and curb inflammation and it’s often used for back, neck or shoulder pain as well as for headaches.
For the current study, researchers focused on the gold standard for determining the effectiveness and safety of medical treatments: randomized controlled trials that compare outcomes for patients who are randomly assigned to a specific treatment or to a dummy treatment or no treatment at all.

Spinal manipulation worked better for pain relief than non-recommended interventions like light tissue massage, the current analysis found.
It also worked better than sham manipulation treatments, but the evidence was low-quality, Rubinstein’s team notes in The BMJ.
About half of the studies looked at side effects of spinal manipulation and found little evidence to conclude whether or not this is safer than other approaches. In one study, researchers found one serious adverse event that could potentially have been associated with spinal manipulation.
One limitation of the analysis is that the studies of spinal manipulation were done in different settings, tested different techniques and measured the effectiveness of this intervention in different ways, the study authors note.

“Spinal manipulation may decrease pain from muscle strain, inflammation and spasm in your back muscles and/or impact the way that your body perceives pain through either the brain or the spinal cord,” said Christine Goertz, chief executive officer of the Spine Institute for Quality in Oskaloosa, Iowa.
“The most common side effects resulting from spinal manipulation are mild to moderate joint or muscle pain and/or stiffness,” Goertz, who wasn’t involved in the study, said by email. “These symptoms generally go away on their own within a day or two.”
SOURCE: bit.ly/2I7Y1as The BMJ, online March 13, 2019.
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34 orthopedic devices receive FDA 510(k) clearance in March

The FDA granted 34 orthopedic- and spine-related device clearances in March.

1. Spectrum Spine Expandable Cages from Spectrum Spine.
2. Europa Pedicle Screw System from MiRus.
3. Mutars Proximal Femur Replacement System from implantcast.
4. MLP Special Locking Bone Plate System from Maxxion Medical.
5. Alteon Acetabular Cup System from Exactech.
6. Freedom Spinal Cord Stimulatory System from Stimwave Technologies.
7. ISS-Jazz Screw System and Jazz Cap from Implanet.
8. Arthrex Univers II Shoulder Prosthesis System: Titanium Humeral Heads from Arthrex.
9. Rosa One Spine application from Medtech.
10. MiRus Lumbar Interbody Fusion System from MiRus.
11. Wright Jones Fracture System from Wright Medical Technology.
12. Kuros TLIF Cage from Kuros Biosciences.
13. Mimics Medical from Materialise.
14. The Progressive Orthopaedic Company Total Knee System II from The Progressive Orthopaedic Company.
15. ChoiceSpine Stealth Cervical Spacer System from ChoiceSpine.
16. MectaLIF Anterior Stand Alone Extension from Medacta.
17. Modular Spinal Fixation System from Life Spine.
18. DePuy Synthes Porous Polyethylene Implants and Titanium Wires Portfolio from
Synthes USA.
19. Parcus Twist AP Suture Anchors from Parcus Medical.
20. Klassic Knee System from Total Joint Orthopaedics.
21. Arthrex TensionLoc System from Arthrex.
22. IdentiTi Porous Ti Interbody System from Alphatec Spine.
23. Duo Lumbar Interbody Fusion Device from Spineology.
24. SpineEx Sagittae Lateral Lumbar Interbody Fusion Devices from SpineEx.
25. Corus Spinal System from Providence Medical Technology.
26. Evos Small Fragment Upper Extremity Plates Line Additions from Smith & Nephew.
27. Provident II Hip Stem from StlKast.
28. Prostim Injectible Inductive Graft from Wright Medical Technology.
29. Scarlet AC-T Secured Anterior Cervical Cage from Spineart.
30. Zavation Spinal System from Zavation Medical Products.
31. NuVasive VersaTie System from NuVasive.
32. CastleLoc-P Anterior Cervical Plate System from L&K Biomed.
33. OsteoCentric Bone Plate and Screw System from OsteoCentric Trauma.
34. Responsive Arthroscopy Wedge Push-In Suture Anchors from Responsive Arthroscopy.
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1.62M instrumented spinal fusions per year performed in US: 5 things to know

There are more than 1 million instrumented spinal procedures performed in the U.S. annually, according to an iData Research report.

The report authors analyzed data from several sources, including hospitals and government organizations, and examined hundreds of CPT and ICD codes for the report.
Five things to know:
1. Surgeons perform around 1.62 million instrumented spinal procedures every year, including surgeries that involve multiple procedures during the same visit.
2. There were more than 352,000 interbody fusions performed during the year examined in the report, making it the most common procedure.
3. In 2017, the report estimated that 85.5 percent of cervical fixation procedures in the U.S. were anterior, while the remaining were posterior. However, the analysts said, “Posterior procedures are gaining popularity and are expected to increase more rapidly than anterior procedures.”
4. While the number of spinal fusions is expected to increase, iData CEO Dr. Kamran Zamanian expects growth to slow in the future due to the “increasing prevalence of cervical artificial discs.”
5. While minimally invasive procedures have gained popularity, the report suggests a “significant portion” of interbody spinal fusions require the standard surgical methods.
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6 orthopedic practice mergers, acquisitions in Q1 2019

Here are six orthopedic practices that merged or acquired other groups this year so far.
Three orthopedic groups in Tennessee joined to form OrthoSouth, a Memphis-based organization that includes 35 physicians, 44 physical therapists, seven clinics and two ASCs.
Chester, Va.-based Colonial Orthopaedics’ 97 team members joined Richmond, Va.-based MCV Physicians, a large physician practice affiliated with Virginia Commonwealth University Health System.
Myrtle Beach, S.C.-based OrthoSC absorbed Coastal Interventional Pain Associates and its two physicians.
The Orthopedic Institute and CORE Orthopedics and Sports Medicine, both based in Sioux Falls, S.D., integrated into one practice at the beginning of the year.
Richmond-based OrthoVirginia finalized its acquisition of Virginia Beach-based Virginia Institute for Sports Medicine and now includes more than 100 physicians.
Orthopedic surgeon Jeffrey Miller, MD, merged his practice with Hudson Pro Orthopaedics and Sports Medicine in Hoboken, N.J.
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Guardion Health prices downsized IPO at $4

Guardion Health Sciences (NASDAQ:GHSI) has priced its initial public offering (IPO) of 1.25M common shares at $4 per share. Underwriters over-allotment is an additional 187.5K shares.
Gross proceeds should be $5M, half the size of its plan in November 2018.
Trading commenced Friday.
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Older Heart Attack Patients Get Worse Care

If you’re over 65 and have a heart attack, your care may be compromised, a new study finds.
In fact, you’re less apt than younger patients to receive a timely angioplasty to open blocked arteries. You’re also likely to have more complications and a greater risk of dying, researchers say.
“Seniors were less likely to undergo [angioplasty] for a heart attack and if they do receive the procedure it’s not within the optimal time for the best possible outcome,” said lead researcher Dr. Wojciech Rzechorzek, a resident at Mount Sinai St. Luke’s and Mount Sinai West Hospital in New York City.
“Their prognosis is worse than for younger patients with the same conditions, and this lack of treatment or delay in treatment could be a factor,” he noted.
But a New Jersey heart specialist said the delays in care are not neglect, but necessary.
“One of the most important things to keep in mind is that the older population is often sicker,” said Dr. Barry Cohen, who was not involved in the study. “Their conditions are often much more complicated, and for providers, that can mean treatment can’t be given right away.”
Older patients are more likely to have conditions such as kidney disease, as well as heart failure, diabetes or past heart problems. Before taking any patient for an angioplasty, it’s important to do a risk assessment, said Cohen, who is medical director of the cardiac catheterization lab at Atlantic Health System Morristown Medical Center.
“We’re not stalling, we’re strategically thinking about what is best for the patient, despite the desire to be under 90 minutes for door-to-angioplasty time,” he added.
For the study, Rzechorzek and colleagues reviewed 2014 data on more than 115,000 heart attack patients nationwide. Of those, 54 percent were over 65.
Their review found that seniors were 34 percent less likely than younger patients to have an angioplasty. In the procedure, special tubing is inserted into a narrowed or blocked artery, where a balloon is inflated to open the blockage. Sometimes, a stent is also placed to keep the vessel open.
The study found seniors were 36 percent less likely to receive a stent, and 34 percent less likely to have one placed within 48 hours.
Although both groups received the same drugs and surgical treatments, older patients had worse results, researchers said.
Compared to younger patients, older ones were 62 percent more likely to develop heart failure, and 28 percent more likely to go into shock.
They were also 21 percent more likely to have a cardiac arrest, and 10 percent more likely to need a ventilator to help them breathe, according to the study.
Though older patients stayed in the hospital longer, the cost of their care averaged about $3,231 less than that of younger patients. Researchers suspect that’s because many didn’t have angioplasty, a costly treatment.
Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles, said there is a real problem in how older heart attack patients are treated.
“While the investigators found that older patients had lower adjusted total hospital charges despite lower quality care and worse outcomes, this finding further illustrates how misleading and counterproductive it is for Medicare to be using cost data as a hospital level metric of quality and value,” said Fonarow, who was also not part of the study.
These findings highlight how important it is to improve the quality of care, particularly for older patients with heart attacks in U.S. hospitals, he said.
The study was scheduled to be presented Saturday at a meeting of the American Heart Association, in Arlington, Va. Research presented at meetings is typically considered preliminary until published in a peer-reviewed journal.
More information
The American Heart Association offers more information about heart attack.
SOURCES: Gregg Fonarow, M.D., director, Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles; Barry Cohen, M.D., medical director, cardiac catheterization lab, Atlantic Health System Morristown Medical Center, N.J.; April 6, 2019, presentation, American Heart Association meeting, Arlington, Va.
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