This year’s American Academy of Orthopaedic Surgeons Annual Meeting took place in New Orleans from 6th to 10th March and saw attendees from all over the globe congregate for an outstanding educational and professional development experience focusing on the latest research and advancement in orthopaedic surgery. An incredible spectrum of hot topics in the field and ground-breaking research were presented at the event, a selection of which are reported in this edition of ‘Clinical Highlights’.
New York’s Mount Sinai Health System and their work in orthopaedics was well-represented at the Meeting both through their informative presentations, posters and abstracts covering a wide range of research and also attendance from their surgeons and team. For those with a special interest in spinal orthopaedics, topics such as cost effectiveness in treating acute disc herniation and associated cervical myelopathy and evidence-based management of spinal conditions in elite athletes were presented, in addition to a quality-of-life focused study around correction of adolescent idiopathic scoliosis. Additionally, a keynote presentation focused around real-world effectiveness of tranexamic acid (TXA) in shoulder arthroplasty with Professor Leesa Galatz, MD and her team highlighting the first large scale study assessing TXA use in this patient cohort. It was found that there was a remarkable – but perhaps not unexpected – 38% decrease in transfusion risk accompanied by 45% decreased risk of complications from the surgery, accompanied by a decrease in length of hospital stay. However, more research is required to determine if higher volume of TXA usage would consequently impact upon cost or length of hospitalisation?
From the ‘Round Table’ event program, particular focus was upon the Stanford University-led research community sharing concern around increasing usage of biologics in orthopaedic surgery at a greater rate than there has been solid evidence to support the practice. Notably, certain biologic treatments may not require FDA clearance in the USA which yet further underlines the importance of collecting reliable data in this field to inform regulation and ultimately protect patient safety. It is yet to be determined whether establishing a formal clinical registry for data collection and governance around biologics in orthopaedics is indeed feasible.
Recent years have seen explosive development within the orthopaedic med-tech and e-medicine space with the aim of improving clinical outcomes for patients through revolution of ‘collaborative care’ between patient and physician. At AAOS 2018, DJO presented their latest technology in the form of the ‘X4’, a new brace featuring ‘motion intelligence’ that permits remote patient monitoring during the rehab phase following total knee procedures. This app-enabled, digitally connected device continuously records patient data and transfers it to the relevant medical team to enable asynchronous connectivity throughout the healing process. Whilst this type of technology is likely to enhance patient/physician communication with minimal friction, it must be recognised that such a novel advancement requires further evidence to objectively quantify benefit and as always a balance must be struck between digital progression and cost-effectiveness for orthopaedic departments and the patients themselves.
Another take on ‘collaborative care’ comes from WebPT, a physical therapy software platform. They have teamed up with ‘Modernizing Medicine’ to develop a new interface enabling secure sharing of information between members of the patient’s orthopaedic team aiming to prevent gaps in treatment. In a climate of ever-increasing concerns about patient data protection, platforms aiming to reduce manual processes and improve the efficiency and safety of documentation are likely to become vital in supporting professionals with the goal of achieving the best outcomes for orthopaedic patients. It remains to be seen whether it is plausible that such innovative platforms can be formally integrated into healthcare systems to maintain the momentum of development in this area.
The next AAOS Annual Meeting will be in Las Vegas, 12th-16th March 2019 where the world’s largest orthopaedic event will once again bring together the global community to network, present the latest research and aim to improve patient care.
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