HSS: Only NY Hospital on Healthgrades Spine List
Hospital for Special Surgery (HSS) continues its success, with the recent inclusion in Healthgrades’ 2017 Report to the Nation. The facility has again obtained a 5-star quality rating in the categories of total hip replacement, back and neck surgery, and spinal fusion surgery. And for the third year in a row, HSS was named one of Healthgrades America’s 100 Best Hospitals for Spine Surgery. Interestingly, it is the only New York based hospital to make the Healthgrades America’s 100 Best Hospitals for Spine Surgery list.
The Healthgrades data is derived from an independent analysis of nearly 5, 000 hospitals nationwide using 34 of the most common inpatient procedures and conditions.
“As healthcare value becomes better understood by the public, it is imperative to empower patients to make the right healthcare decision and ratings are an important tool in this process, ” said Louis A. Shapiro, president and CEO of HSS, in the October 18, 2016 news release. “HSS is focused on providing the highest quality of care available and consistent top ratings validate our commitment to an excellent patient experience.”
Todd Albert, M.D., surgeon-in-chief and medical director of HSS, told OTW, “The public and patient education initiatives at HSS offer a multitude of programs and practical information for patients involving their musculoskeletal health as we strongly believe in the value of transparency when it comes to one’s health. These initiatives include lectures, workshops, publications, classes, a patient education library, etc. We also encourage shared decision making, meaning that our physicians and patients thoroughly discuss all treatment options and should mutually come to a decision on the right treatment.”
Closed Drain in THA: Largely Unnecessary
A new prospective, randomized study from Cleveland Clinic indicates that using a closed drain in total hip arthroplasty—along with tranexamic acid and aspirin—did not confer any benefits or disadvantages. Juan Suarez, M.D., an orthopedic surgeon with the Department of Orthopaedic Surgery at Cleveland Clinic Florida, was a co-author on the study. He told OTW, “There are suggestions in the knee replacement literature that the use of drains leads to higher transfusion rates. Drains are often used to avoid hematoma, post op swelling and potentially wound drainage. When we started performing anterior hip replacements we would use a drain in pretty much every case because our initial bleeding was fairly high.”
“For our study, we compared a group of 59 patients who had closed suctions drains placed to a group of 59 patients who did not have such drains.”
“We had strict inclusion and exclusion criteria: all of the patients received tranexamic acid for bleeding control and all received aspirin for deep vein thrombosis prophylaxis. Under these conditions we found no benefit to the use of a drain from the standpoint of wound complications. Our research is unique in that no prior study looking at the use of closed suction drains involved patients receiving tranexamic acid.”
“We found no significant differences between groups in transfusion rate, postoperative decrease in hemoglobin levels, blood loss, complications, or length of stay. And none of the patients developed a hematoma.”
And, says Dr. Suarez, patients would be relieved to avoid a drain. “From a psychological standpoint, patients feel more comfortable without drains or tubes coming out of their bodies!”
“We do know there is a subset of patients who are at a higher risk of bleeding, such as those who have coagulopathy or are on blood thinners, and who may benefit from a drain. We are moving forward on a new investigation to look into that issue.”
Robotic Exoskeleton: Novel Design
Researchers from China and Denmark have altered the approach to creating a wearable robotic exoskeleton for physical rehabilitation. The team, which hails from Beihang University in China and Aalborg University in Denmark, created a lower-limb robot exoskeleton that for the first time features a parallel knee joint to improve the bio-imitability and adaptability of the exoskeleton.
Weihai Chen is a professor at Beihang University’s School of Automation Science and Electrical Engineering, in Beijing, China. He told OTW, “Patients with a stroke or spinal cord injury often have difficulty in walking. According to the National Stroke Association, stroke is the leading cause of adult disability in the U.S. with at least 700, 000 new cases each year and the number of strokes is projected to increase. In China, the stroke prevalence rate is up to 2%. “Every year there are around 500, 000 people in the world getting a spinal cord injury.”
“Recent research has demonstrated that robot assisted training can play a key role during rehabilitation to help these patients regain the ability to walk. Discussion and collaboration with doctors and physical therapists motivated us to make a robot to assist these patients to rehabilitate. Providing comfortable and transparent training is quite important when using the robotic exoskeleton. Considering the complex motion of the knee joint, which is not simply rotation around a single point, but rather the center of rotation moves, we proposed a new design with a parallel knee joint to improve the bio-imitability and adaptability of the exoskeleton.”
“Movement transparency is quite important when using robotic exoskeleton in training or assisting patients. It means when putting on the exoskeleton, the movement of the robot should be synchronized and consistent to the patient’s natural movement. Otherwise, it will exert extra forces on the human joint. The extra force will lead to patient discomfort and an unnatural movement.”
“Bionic mechanical design plays a significant role in reaching this goal. In order to improve the transparency of the robot, we first studied the human body structure, then we built a novel model of the human lower limb. After that, we proposed a biomechatronic design of the lower limb exoskeleton.”
“It is the first time that a parallel mechanism was used at the knee joint to imitate the skeletal muscles. The novel design not only solved the transparent problem in the knee joint, but also had a simple structure.
“Unlike most previous exoskeletons, which simplified the knee joint as a pin joint, our design has two degrees of freedom to make the movement of exoskeleton consistent with patients’ natural movement. It will not put extra force at the knee joint and will provide a more comfortable rehabilitation experience. The design can also be used to detect the complex movement of the knee joint. This will provide for more accurate guidance for the training process.”
“Our research mainly focuses on the rehabilitation of stroke or spine cord injured patients, who damaged their central or peripheral nervous systems. With the help of the robot, the therapists’ work can be much easier. The robot exoskeleton can be a new way to assist the stroke or spine cord injury patients rehabilitate.”
“The robot provides constant and long time training for the patients who lose some ability to walk because of nervous systems injury. Furthermore, when repeated movement training needed, our rehabilitation robot can also be helpful.”
“Our design will not only provide a new method to rehabilitate, but also new measurement of the human lower limb structure. During the daily practice, therapists or maybe orthopedic surgeons can first use the robot to measure the patient’s leg structure parameters. Then, they input the patient’s personal message into the robot control system and start the rehabilitation. The robot releases the therapists from the hard work of rehabilitation. All they need to do is just monitor the process and change the rehabilitation strategy according to the patient’s situation.”
HSS and Spine Sx