Hospital for Special Surgery (HSS) is a hospital in New York City that specializes in orthopedic surgery and the treatment of rheumatologic conditions.Founded in 1863 by James Knight, HSS is the oldest orthopedic hospital in the United States and is consistently ranked as the top orthopedic hospital in the United States. Currently, HSS is ranked #1 in orthopedics, #3 in rheumatology and #22 in pediatric orthopedics by U.S. News & World Report. Bryan Kelly serves as the medical director and surgeon-in-chief, and Louis Shapiro serves as its president and chief executive officer.Areas of expertise at HSS include joint replacement, orthopedic trauma, hand and upper extremity surgery, limb lengthening, foot and ankle surgery, pediatric orthopedics, spine surgery and sports medicine. The hospital performs the most knee replacement surgeries of any hospital in the United States. Trauma surgeons treat fractures and other acute injuries at HSS and work within an Orthopedic Trauma Service that also provides coverage at NewYork-Presbyterian Hospital Weill Cornell Medical Center. HSS physicians with a subspecialty training in the field of spine surgery focus on patients who suffer from congenital or acute spinal disorders as well as from chronic back pain. The sports medicine services at HSS treat athletic injuries of the musculoskeletal system with a special focus on shoulder, elbow, and knee injuries. In addition, orthopedic surgeons at HSS perform limb lengthening, a procedure that uses the body's capacity to create new bone as well as the soft tissues, ligaments, blood vessels, and nerves that surround and support it.HSS also offers professional medical education programs, including continuing medical education lecture series, conferences and symposia. Services are available in person at the New York facility and remotely worldwide through the Grand Rounds partnership "eConsult" platform. The hospital has 327 active medical staff.
Patients with interstitial lung disease (ILD) are at elevated risk of postoperative pulmonary complications (PPCs), including acute exacerbation, which carry high mortality. Surgical decision-making in this population requires careful preoperative risk stratification, medical optimization, and tailored intra- and postoperative management. This review summarizes current evidence to guide perioperative care for patients with ILD. The ARISCAT (Assess Respiratory Risk in Surgical Patients in Catalonia) risk index is widely used for PPC prediction but likely underestimates risk in ILD. Recent studies highlight the high prevalence of comorbid obstructive sleep apnea in ILD, supporting the need for routine screening. Updated American College of Rheumatology guidelines inform perioperative antirheumatic drug management, while International Society for Heart and Lung Transplantation consensus recommendations guide care of patients with pulmonary hypertension and right heart failure, a common comorbid condition. Emerging evidence suggests that perioperative antifibrotic therapy is safe and may reduce the risk of acute exacerbation, although further investigation is needed. Regional anesthesia can be a feasible alternative to general anesthesia when possible, for further risk mitigation in this patient population. Intraoperative lung-protective ventilation and use of the lowest oxygen concentration that maintains safe oxygen saturation remain critical, while judicious fluid management, postoperative extubation to high-flow nasal cannula or noninvasive ventilation, early mobilization, and multimodal analgesia may further reduce PPC risk. Perioperative management of ILD patients is complex due to heightened vulnerability to PPCs. Current evidence supports adapting general perioperative strategies while incorporating disease-specific considerations. As therapeutic advances extend survival, further prospective studies are needed to establish evidence-based perioperative guidelines for this high-risk group.
Osteoarthritis patients undergoing THA or TKA were studied to compare the cumulative incidence of revision after perioperative denosumab versus alendronate. Denosumab was not associated with differences in the incidence of revision after THA but was associated with a higher revision incidence after TKA, mainly driven by aseptic tibial loosening. Osteoarthritis is highly prevalent, and the number of total hip (THA) and knee arthroplasties (TKA) continues to rise. This study aimed to evaluate the risk of revision associated with perioperative exposure to denosumab versus alendronate in patients undergoing THA or TKA for osteoarthritis. This retrospective cohort study used data from the Emilia-Romagna Registry of Orthopedic Prosthetic Implants (RIPO). Patients undergoing primary THA or TKA for osteoarthritis between 2011 and 2023 were included. Perioperative exposure was defined as at least one dispensing of denosumab or alendronate within 180 days before or after surgery. The primary outcome was first revision. Revision risk was analysed using cumulative incidence functions, treating death and emigration as competing events, and groups were compared using Gray’s test. The THA cohort comprised 129 denosumab and 922 alendronate users. Revision occurred in 4 denosumab (3.1
To evaluate the impact of thoracic spine degeneration in adult spinal deformity (ASD) patients on radiographic outcomes. Primary ASD patients undergoing thoracolumbar fusion with T9–L1 upper instrumented vertebra (UIV) and S1/ilium lower instrumented vertebra were included. Thoracic spine degeneration was assessed radiographically using Kellgren-Lawrence (KL) grading and segmented into T1–T5, T5–T9, and T9–L1 arcs per Lafage criteria. Arc degeneration was defined as ≥ 2 levels with KL grade 3 + in an arc and thoracic spine degeneration as ≥ 1 degenerated arc. Proximal zone degeneration was KL grade 3 + in the two levels above the UIV and distal zone degeneration was KL grade 3 + in unfused thoracic levels outside the proximal zone. Patients with no degenerated levels served as controls. Among 272 patients (mean age 65.1years, 74
CONTEXT:Glucagon-like peptide-1 receptor agonists (GLP1-RA) have potent glucose-lowering and weight loss benefits, but their effects on bone remain unclear. OBJECTIVE:To investigate changes in bone mineral density (BMD) in patients using semaglutide (SEM) and tirzepatide (TIR), a dual agonist of GLP-1/glucose dependent insulinotropic polypeptide. METHODS:Single-center retrospective study. Adult patients using SEM/TIR for ≥6 months with DXA scans before initiation and at least 6 months after were matched by age, sex, BMI, and diabetes mellitus (DM) to nonusers with at least 2 DXA scans over the same period. The primary outcome was the percentage change in total hip (TH) BMD. RESULTS:We included 255 patients using SEM or TIR in the GLP-1 RA group (92% female, mean age 64 ± 9 years, BMI 31.0 ± 5.6 kg/m²) and 255 controls. After a median follow-up of 17 months, the GLP-1 RA group achieved a median 5% weight loss. Both groups had significant declines in BMD at TH and FN, with a similar magnitude between groups. In the GLP-1RA group, weight loss was directly associated with bone loss at the TH and FN (r = 0.32 for TH, r = 0.17 for FN, both P < .01). Among patients without DM, greater TH bone loss was noted in the GLP-1 RA group compared to controls (-1% vs -0.6%, P = .04), whereas TH bone loss was similar between groups among patients with DM. CONCLUSION:SEM/TIR use was associated with greater annualized TH bone loss in patients without DM, whereas TH bone loss was comparable between GLP-1 RA and controls in patients with DM. These findings suggest GLP-1 RA's effects on bone may differ by DM status, with weight loss driving bone loss in patients without DM.
INTRODUCTION:Elective caesarean section is a common and painful procedure. Uncontrolled pain following caesarean section can profoundly and negatively on a wide range of patient and healthcare-centred outcomes. The aim of this systematic review was to update existing recommendations for postoperative pain management after elective caesarean section performed under neuraxial anaesthesia. METHODS:A systematic review using the PROcedure SPEcific Postoperative Pain ManagemenT (PROSPECT) methodology was undertaken. Randomised trials evaluating the efficacy of analgesic, anaesthetic and surgical interventions were retrieved. Systematic reviews and meta-analyses of randomised controlled trials were also reviewed. Trials evaluating pain management for emergency surgical deliveries or caesarean section performed under general anaesthesia were not included. RESULTS:Sixty-one randomised controlled trials were included. For patients undergoing elective caesarean section performed under neuraxial anaesthesia, we recommend that clinicians administer intrathecal morphine 50-100 μg or diamorphine 300 μg pre-operatively, and paracetamol, non-steroidal anti-inflammatory drugs and dexamethasone after delivery. If a neuraxial opioid is not administered, clinicians should use one of a range of recommended fascial plane blocks; alternatively, the wound should be infiltrated with local anaesthetic. The postoperative regimen should include regular paracetamol and non-steroidal anti-inflammatory drugs, with opioids used for rescue. The surgical technique should include a Joel-Cohen incision. The peritoneum should not be closed. DISCUSSION:An analgesic regimen to manage pain safely and effectively after elective caesarean section based on up-to-date evidence is presented. Consideration has been given to balancing analgesic efficacy and potential adverse effects. Future research should determine the optimal dose of dexamethasone and epidural long-acting opioid, establish the most effective regional analgesic technique and develop standardised outcome sets to better compare techniques.
