21,000-Patient Mental Health Study; Predicting Knee Pain by Weight Lost; Long-Term Hip Arthroscopy Follow Up Study

21,000-Patient Mental Health Study of Cervical Spine Fusion Patients

It’s an area where many orthopedic surgeons are reluctant to venture…mental health, that is.

Fact is, in the general population, so many with back pain, hip problems, etc., also suffer with mental health issues.

New work from intrepid researchers delves into this arena. “The Impact of Comorbid Mental Health Disorders on Complications Following Cervical Spine Surgery with Minimum 2-Year Surveillance,” is published in the March 23, 2018 edition of Spine.

The study, a retrospective analysis with nearly 21,000 patients, included patients admitted from 2009-2013 with cervical radiculopathy (CR) or cervical myelopathy (CM) who underwent cervical surgery with minimum two-year surveillance

The authors wrote, “…Mental health disorders (MHD) identified: depressive (57.8%), anxiety (28.1%), sleep (25.2%), and stress (2.9%). CR patients had greater prevalence of comorbid MHD than CM patients (p = 0.015). Two years post-operatively, all MHD patients had significantly higher rates of complications (specifically: device-related, infection), readmission for any indication, and revision surgery (all p < 0.05).”

“Nearly 25% of patients admitted for CR and CM carried comorbid mental health disorder and experienced greater rates of any complication, readmission, or revision, at minimum, two years following cervical spine surgery…”

A co-author on the study, Bassel G. Diebo, M.D. is an orthopedic surgery resident at the State University of New York Downstate Medical Center. Dr. Diebo told OTW, “My belief is that treating our patients necessitates understanding how mental health is affected and responds to spinal pathology treatment.”

“Most orthopedic surgeons believe that treating the orthopedic disease will improve both physical and mental health of the patients. This might be true as a concept, but we really need more data to support this.”

“I think the study proposes a possible association (and not causation) between mental health disorders and complications in patients undergoing surgery for thoracolumbar or cervical spinal pathologies. However, in addition to data, the study had the message of raising awareness of the importance of mental health in orthopedics and encouraging more research to better understand this relationship.”

“I think changing the practice requires extensive research including randomized trials. Therefore, following this data we promptly started our randomized trial generously funded by the Cervical Spine Research Society (CSRS) to better understand whether psychological support is effective, and recommended as a complement to surgical treatment of spinal pathologies. Simply put, even if the spinal stenosis is decompressed, the fusion is obtained, and the alignment is achieved, if the patient does not perceive improvement after surgery because of a mental health state, then there is no improvement.”

Predicting Knee Pain by Weight Lost

Whose knee pain gets reduced the most after weight loss?

Answer: The young and those who shed the most pounds.

The new research, “Predictors of the effect of bariatric surgery on knee osteoarthritis pain,” appeared in the February 8, 2018 edition of Seminars in in Arthritis and Rheumatism.

Jonathan Samuels, M.D., associate professor of medicine at NYU Langone Health, co-author on this research, commented to OTW, “A high percentage of obese patients have painful knee osteoarthritis, and have difficulty losing weight as well as treating the knee pain with a self-perpetuating cycle. Some investigators, including our group, have found that most patients who lose large amounts of weight through bariatric surgery experience knee osteoarthritis [OA] pain relief.”

“Some patients benefit much more than the others, so we wanted to identify factors that predicted more successful outcomes with respect to the knee pain.”

The authors wrote, “We reviewed NYU Langone Health bariatrics records (2002-2015) and called eligible patients reporting pre-operative knee pain. Patients were asked to rate their pain on a 10-point scale at three time points: before surgery, one year post-surgery, and time of survey administration. Subjects were asked about pre-operative knee injuries and surgeries, presence of OA in other joints, and OA family history…. Of 125 eligible patients reporting knee pain, we analyzed the 120 patients who had laparoscopic gastric band (LAGB) surgery….”

Dr. Samuels told OTW, “Patients who lost weight with their laparoscopic banding surgeries also experienced marked improvement of their knee pain. We found a significant correlation between the degree of improvement in the body mass index and reduction of knee pain in our cohort. In addition, the patients who experienced the most relief from weight loss surgeries had their procedures at earlier ages, as well as those who never had a traumatic knee injury nor developed osteoarthritis in other joints.”

“It was interesting to see that the degree of obesity at baseline did not influence or limit the knee pain relief—but those who lost more weight experienced more knee relief. For obese patients with persistent and severe knee pain, weight loss surgery should be considered as a treatment option regardless of their age, but even more so in younger patients and those without significant knee injury histories.”

Long-Term Hip Arthroscopy Follow Up Study

Once your hip arthroscopy patient has left the table, what happens to them?

Filling out this cloudy picture is new research from NYU Langone Medical Center. “Independent Risk Factors for Revision Surgery or Conversion to Total Hip Arthroplasty After Hip Arthroscopy: A Review of a Large Statewide Database From 2011 to 2012,” was published in the February 2019 edition of Arthroscopy.

Benjamin Kester, M.D., an orthopedic resident at NYU Langone and first author on this work, told OTW, “We were interested in this work because long-term outcomes after hip arthroscopy are currently not completely understood. While the popularity of hip arthroscopy as a treatment has exploded over the past decade, we may still be under- or over-treating certain populations. We hoped that this study would help us identify which patients are ideal candidates for hip arthroscopy to help improve outcomes and patient experiences.”

The authors wrote, “The New York Statewide Planning and Research Cooperative System database was queried from 2011 through 2012 to identify patients undergoing hip arthroscopy…. We identified 3,957 patients….”

“Importantly,” says Dr. Kester, “we found that younger female patients who did not undergo labral repairs were more likely to require revision arthroscopy. In contrast, female patients over 60, especially obese ones with pre-existing arthritis are at increased risk of requiring a total hip replacement shortly after their arthroscopy.”

“Practically speaking, this information should be used to counsel patients about the risks and benefits of hip arthroscopy. Patients should understand that with certain risk factors they may require future procedures such as total hip replacement.”