East Saint Louis, NY, United States
East Saint Louis, NY, United States

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Pope E.J.,NYU Hospital for Joint Diseases | Rokito A.S.,NYU Langone Medical Center
Bulletin of the NYU Hospital for Joint Diseases | Year: 2011

The glenohumeral joint is the most commonly dislocated joint in the body. The prevalence of this condition and the instability that may result from it has been a focus of diagnosis and treatment since the original description of the Bankart lesion in 1923. Now, with the introduction of MRI, lesions causing anterior shoulder instability can be diagnosed more accurately. This has led to improved understanding of the pathoanatomy that must be addressed and corrected during surgical repair. Initial attempts at arthroscopic treatment, including staple repair, transosseus suture repair, rivets, and thermal capsulorraphy were fraught with complications and unacceptably high recurrence rates. The development of arthroscopic suture anchors have revolutionized the treatment of anterior shoulder instability, such that arthroscopic management is now the standard of care. In the hands of experienced surgeons, outcomes for arthroscopic treatment of shoulder instability now approaches the success of open treatment.

Yazici Y.,NYU Hospital for Joint Diseases | Curtis J.R.,University of Alabama at Birmingham | Baraf H.,Center for Rheumatology and Bone Research | Malamet R.L.,Genentech | And 2 more authors.
Annals of the Rheumatic Diseases | Year: 2012

Objectives: To evaluate efficacy of tocilizumab in US patients with moderate to severe active rheumatoid arthritis (RA) and inadequate clinical response to disease-modifying antirheumatic drugs (DMARD). Safety-related outcomes were also analysed. Methods: The rapid onset and systemic efficacy study was a 24-week, randomised, double-blind trial. Patients were randomly assigned 2:1 to tocilizumab 8 mg/kg (n=412) or placebo (n=207) every 4 weeks while continuing background DMARD in both groups. Results: The primary efficacy endpoint, percentage of patients achieving ACR50 response at week 24, was higher with tocilizumab versus placebo (30.1% vs 11.2%; p<0.0001). Percentages of ACR20 and ACR50 responders were significantly higher with tocilizumab versus placebo as early as week 4 and continued to week 24; more patients in the tocilizumab versus placebo group also achieved ACR70 responses beginning at week 8 (p<0.01). Significant improvements associated with tocilizumab versus placebo were seen in routine assessment of patient index data responses, EULAR good response, DAS28 and percentages of patients achieving low disease activity and clinical remission (based on DAS28). A substudy examining early response to therapy showed improved patient global assessment of disease activity (p=0.005) and pain (p=0.01) and DAS28 (p=0.007) with tocilizumab versus placebo at day 7. Safety findings were consistent with the known tocilizumab safety profile; rates of serious infections (per 100 patient-years) were 7.87 (95% CI 4.30 to 13.2) and 1.20 (95% CI 0.03 to 6.66) in the tocilizumab and placebo groups, respectively. Conclusions: This study demonstrated the efficacy of tocilizumab in improving measures of disease activity in patients with RA who failed to respond adequately to DMARD therapy. Rapid improvement in clinical outcomes was demonstrated in a substudy as early as week 1 as shown by DAS28 scores, patient measures and C-reactive protein. Trial Registry no: NCT00531817.

Verma K.,NYU Hospital for Joint Diseases | Lonner B.S.,NYU Hospital for Joint Diseases | Kean K.E.,NYU Hospital for Joint Diseases | Dean L.E.,NYU Hospital for Joint Diseases | And 2 more authors.
Spine | Year: 2011

Study Design. Retrospective analysis of prospectively collected data. Objective. To compare the relative rates of pulmonary recovery and maximal pulmonary function with surgical approach. Summary of Background Data. Anterior versus posterior spinal fusion (ASF, PSF) for the treatment of adolescent idiopathic scoliosis (AIS) has been debated. Although procedures that violate the chest wall may compromise pulmonary function, lung function continues to improve after surgery at variable rates depending upon surgical approach. Methods. We reviewed the medical records from one hundred fifty nine AIS patients (age 15.6 ± 2.2; 113 women; 46 men) treated with spinal fusion from 2003 to 2007 by a single surgeon. Forced expiratory volume in one second (FEV 1), forced vital capacity (FVC), and radiographic measurements were evaluated before surgery and at 1, 3, 6, 12, and 24-months follow-up on average. Four surgical groups were compared: PSF, ASF (open thoracoabdominal approach for thoracolumbar curvature), video-assisted thoracoscopic surgical release with instrumentation (VATS-I), and VATS with PSF. FEV 1 and FVC were fitted to model to evaluate the immediate postoperative pulmonary function (Yo), maximal recovery (Plateau), and rate (K) of pulmonary improvement. Results. Patients in each surgical subgroup were as follows: PSF (Lenke 1: n = 50, Lenke 2,3: n = 20), ASF (Lenke 5, n = 35), VATS-I (Lenke 1 = 31, Lenke 3 = 1), and VATS + PSF (Lenke1: n = 9, Lenke 2-6: n = 13). Early postoperative pulmonary function was higher with ASF and PSF as compared to both VATS groups (P < 0.05). Comparing all curve types, VATS-I showed a small decline of absolute FEV 1 compared to PSF at 2-years follow-up. Comparing thoracic curves, however, no differences in FEV 1 or FVC were noted at 6 to 12 months until 2-years follow-up. The rate of recovery (K) was equivalent for all surgical approaches and curve types. Conclusion. Compared to ASF or PSF, VATS procedures showed an initial decline in pulmonary function, which resolved fully by 6- to 12-months follow-up. Modest declines in maximal pulmonary function with VATS-I were seen when comparing all curve types together but not when comparing Lenke 1 curves alone. VATS procedures for thoracic scoliosis and open approaches for thoracolumbar curve types were associated with minimal to no permanent deficits. Copyright © 2011 Lippincott Williams & Wilkins.

Jain M.,NYU Hospital for Joint Diseases | Samuels J.,NYU Langone Medical Center
Bulletin of the NYU Hospital for Joint Diseases | Year: 2010

The use of musculoskeletal ultrasound (MSKUS) in rheumatology practice and research has increased steadily over the last decade. An ever-growing body of literature shows parity and even superiority of MSKUS when compared to physical examination, plain radiography, and more expensive and static imaging modalities such as MRI. While many use the modality for procedure guidance, investigators continue to demonstrate its ability to impact diagnoses in a variety of rheumatic diseases. Initial efforts focused on establishing MSKUS as a helpful tool for rheumatoid arthritis (RA), especially in the detection of synovitis and joint erosions, but numerous studies are validating the use of MSKUS as a helpful diagnostic tool for the spondyloarthropathies, crystal diseases, osteoarthritis, and other rheumatic diseases. Advances in ultrasound technology are translating into more sensitive and accurate studies. Within the research community, current efforts aim at maximizing the direct clinical impact of MSKUS by developing global or patient- level assessments and simplified joint scoring systems, with improvements in intra- and inter-reader reproducibility.

Alfonso D.T.,NYU Hospital for Joint Diseases
Bulletin of the NYU Hospital for Joint Diseases | Year: 2011

The causes of brachial plexus palsy in neonates should be classified according to their most salient associated feature. The causes of brachial plexus palsy are obstetrical brachial plexus palsy, familial congenital brachial plexus palsy, maternal uterine malformation, congenital varicella syndrome, osteomyelitis involving the proximal head of the humerus or cervical vertebral bodies, exostosis of the first rib, tumors and hemangioma in the region of the brachial plexus, and intrauterine maladaptation. Kaiser Wilhelm syndrome, neonatal brachial plexus palsy due to placental insufficiency, is probably not a cause of brachial plexus palsy. Obstetrical brachial plexus palsy, the most common alleged cause of neonatal brachial plexus palsy, occurs when the forces generated during labor stretch the brachial plexus beyond its resistance. The probability of obstetrical brachial plexus palsy is directly proportional to the magnitude, acceleration, and cosine of the angle formed by the direction of the vector of the stretching force and the axis of the most vulnerable brachial plexus bundle, and inversely proportional to the resistance of the must vulnerable brachial plexus bundle and of the shoulder girdle muscles, joints, and bones. Since in most nonsurgical cases neither the contribution of each of these factors to the production of the obstetrical brachial plexus palsy nor the proportion of traction and propulsion contributing to the stretch force is known, we concur with prior reports that the term of obstetrical brachial plexus palsy should be substituted by the more inclusive term of birth-related brachial plexus palsy.

Kardashian G.,NYU Hospital for Joint Diseases | Christoforou D.C.,NYU Langone Medical Center | Lee S.K.,NYU Langone Medical Center
Bulletin of the NYU Hospital for Joint Diseases | Year: 2011

Perilunate wrist injuries are relatively rare but devastating injuries that can alter the lifestyles of those sustaining them. It is important to recognize the magnitude of the injury and to provide immediate and complete care to the patient. Two of the most important factors affecting outcomes are timing of the care provided and quality of the reduction and carpal alignment following definitive management. This review explores the anatomy, pathoanatomy, and biomechanics, as well as the diagnoses and different treatment options for perilunate wrist injuries available to date and their complications and outcomes.

Shybut T.,NYU Hospital for Joint Diseases | Strauss E.J.,NYU Langone Medical Center
Bulletin of the NYU Hospital for Joint Diseases | Year: 2011

The menisci have an essential function in force transmission across the knee. Injuries to the menisci are common. The indications for repair should be expanded, as the results of partial meniscectomy may deteriorate over time. Tears in younger, higher demand patients should be prepared to optimize the healing environment and be meticulously repaired, particularly in the setting of concurrent anterior cruciate ligament reconstruction. For complex, recurrent, or avascular zone tears, particularly when surgery is limited to meniscal work, consideration can be given to augmenting the repair with a fibrin clot or platelet rich plasma. Partial meniscectomy is a suitable option for lower demand or older patients. Meniscal allograft transplantation is a salvage procedure.

Tian Q.Y.,NYU Hospital for Joint Diseases
Journal of visualized experiments : JoVE | Year: 2012

Progranulin (PGRN), also known as granulin epithelin precursor (GEP), is a 593-amino-acid autocrine growth factor. PGRN is known to play a critical role in a variety of physiologic and disease processes, including early embryogenesis, wound healing, inflammation, and host defense. PGRN also functions as a neurotrophic factor, and mutations in the PGRN gene resulting in partial loss of the PGRN protein cause frontotemporal dementia. Our recent studies have led to the isolation of PGRN as an important regulator of cartilage development and degradation. Although PGRN, discovered nearly two decades ago, plays crucial roles in multiple physiological and pathological conditions, efforts to exploit the actions of PGRN and understand the mechanisms involved have been significantly hampered by our inability to identify its binding receptor(s). To address this issue, we developed a modified yeast two-hybrid (MY2H) approach based on the most commonly used GAL4 based 2-hybrid system. Compared with the conventional yeast two-hybrid screen, MY2H dramatically shortens the screen process and reduces the number of false positive clones. In addition, this approach is reproducible and reliable, and we have successfully employed this system in isolating the binding proteins of various baits, including ion channel, extracellular matrix protein, and growth factor. In this paper, we describe this MY2H experimental procedure in detail using PGRN as an example that led to the identification of TNFR2 as the first known PGRN-associated receptor.

Kiridly D.N.,NYU Hospital for Joint Diseases | Karkenny A.J.,NYU Hospital for Joint Diseases | Hutzler L.H.,NYU Hospital for Joint Diseases | Slover J.D.,NYU Hospital for Joint Diseases | And 2 more authors.
Journal of Arthroplasty | Year: 2014

In order to control the unsustainable rise in healthcare costs the Federal Government is experimenting with the bundled payment model for total joint arthroplasty (TJA). In this risk sharing model, providers are given one payment, which covers the costs of the TJA, as well as any additional medical costs related to the procedure for up to 90. days. The amount and severity of comorbid conditions strongly influence readmission rates and costs of readmissions in TJA patients. We identified 2026 TJA patients from our database with APR-DRG SOI data for use in this study. Both the costs of readmission and the readmission rate tended to increase as severity of illness increased. The readmission burden also increased as SOI increased, but increased most markedly in the extreme SOI patients. © 2014 Elsevier Inc.

Nord R.M.,NYU Hospital for Joint Diseases | Nord R.M.,Washington Township Orthopedic Surgery and Sports Medicine Center | Meislin R.J.,NYU Langone Medical Center
Bulletin of the NYU Hospital for Joint Diseases | Year: 2010

The acceptance and rates of hip arthroscopy are increasing in the United States and abroad and the literature describing it is expanding. Indications for hip arthroscopy include labral tears, loose bodies, femoroacetabular impingement, ruptured ligamentum teres, chondral injuries, adhesive capsulitis, instability, synovial disease, disorders of the iliopsoas tendon, external coxa saltans, tears of the hip abductors, and diagnosis of unresolved intra-articular hip pain. Current techniques in the central and peripheral compartments include, but are not limited to, labral debridement, labral repair, chondroplasty, microfracture, synovectomy, loose body removal, acetabuloplasty, proximal femoral osteoplasty, and iliopsoas release, with other procedures possible in the peritrochanteric space. Long-term outcomes are limited, but early data shows good results for many arthroscopic procedures in the hip when they are performed in the absence of degenerative disease. Improved techniques and technology are allowing for more advanced procedures to become popularized, but long-term outcome data about hip arthroscopy is still relatively sparse.

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