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  • December 02, 2021

    Patients with irreparable rotator cuff tears have new option with subacromial spacer

    BALTIMORE - MedStar Health has become the first health system in the greater Baltimore region to offer patients with massive, irreparable rotator cuff tears, a new arthroscopic approach using a balloon spacer device to cushion the shoulder socket after a rotator cuff tear. On Monday November 29, 2021, Dr. Anand Murthi treated a 65-year-old woman with the procedure that was performed in less than two hours. The patient went home the same day.

    Dr. Murthi inserted the balloon device into the subacromial space located in the shoulder between the upper shoulder bone and the ball-and-socket joint underneath and filled it with saline. The implant mimics the fluid-filled bursa, the natural cushion in the shoulder, which becomes enflamed and painful after a tear.

    Almost two million people visit doctors’ offices because of torn rotator cuff injuries, which most commonly occur in the dominant arm and are one of the most common sports medicine injuries.
    “Athletes are at particular risk for a rotator cuff injury,” said Dr. Murthi, director of shoulder and elbow-surgery for the MedStar Orthopaedic Institute at MedStar Union Memorial Hospital. “But it can affect anyone whose job or activities require a repetitive overhead motion.”

    The inflatable device has been used to treat over 29,000 severe rotator cuff tears over the past ten years in Europe, but it has only been approved by the federal Food and Drug Administration in the U.S. last summer. It’s recommended for patients over 65 who have suffered large, irreparable tears where the tendon has torn and retracted, or whose tear would be impossible to reconnected to the head of the upper arm's humerus bone.

    Patients experience pain relief with this approach because the balloon blocks the humeral head from rubbing with the acromion and forces the humeral head in a more natural position and improves the joint motion.

    The biodegradable balloon will be resorbed in the body over time, giving patients time to heal and strengthen muscles around the injured rotator cuff.

    “Sometimes patients over 65 with degenerated bone conditions are poor candidates for the standard reattachment surgery for repairing rotator cuff tears. The surgery and the recovery both are challenging,” Dr. Murthi said.

    “Current strategies treating massive irreparable rotator cuff tears often present a challenge to surgeons and may require a long and frustrating recovery,” Dr. Murthi added. This new device uses a biodegradable implant which makes me very proud to be able to offer it to our patients. Only a small opening is made to implant it, using a long arthroscopic tube, scope so the recovery is much easier.”

     

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  • December 02, 2021

    Patients with irreparable rotator cuff tears have new option with subacromial spacer

    BALTIMORE - MedStar Health has become the first health system in the greater Baltimore region to offer patients with massive, irreparable rotator cuff tears, a new arthroscopic approach using a balloon spacer device to cushion the shoulder socket after a rotator cuff tear. On Monday November 29, 2021, Dr. Anand Murthi treated a 65-year-old woman with the procedure that was performed in less than two hours. The patient went home the same day.

    Dr. Murthi inserted the balloon device into the subacromial space located in the shoulder between the upper shoulder bone and the ball-and-socket joint underneath and filled it with saline. The implant mimics the fluid-filled bursa, the natural cushion in the shoulder, which becomes enflamed and painful after a tear.

    Almost two million people visit doctors’ offices because of torn rotator cuff injuries, which most commonly occur in the dominant arm and are one of the most common sports medicine injuries.
    “Athletes are at particular risk for a rotator cuff injury,” said Dr. Murthi, director of shoulder and elbow-surgery for the MedStar Orthopaedic Institute at MedStar Union Memorial Hospital. “But it can affect anyone whose job or activities require a repetitive overhead motion.”

    The inflatable device has been used to treat over 29,000 severe rotator cuff tears over the past ten years in Europe, but it has only been approved by the federal Food and Drug Administration in the U.S. last summer. It’s recommended for patients over 65 who have suffered large, irreparable tears where the tendon has torn and retracted, or whose tear would be impossible to reconnected to the head of the upper arm's humerus bone.

    Patients experience pain relief with this approach because the balloon blocks the humeral head from rubbing with the acromion and forces the humeral head in a more natural position and improves the joint motion.

    The biodegradable balloon will be resorbed in the body over time, giving patients time to heal and strengthen muscles around the injured rotator cuff.

    “Sometimes patients over 65 with degenerated bone conditions are poor candidates for the standard reattachment surgery for repairing rotator cuff tears. The surgery and the recovery both are challenging,” Dr. Murthi said.

    “Current strategies treating massive irreparable rotator cuff tears often present a challenge to surgeons and may require a long and frustrating recovery,” Dr. Murthi added. This new device uses a biodegradable implant which makes me very proud to be able to offer it to our patients. Only a small opening is made to implant it, using a long arthroscopic tube, scope so the recovery is much easier.”

     

  • September 30, 2021

    First in Mid-Atlantic Region to Test Efficacy of Regenerative Peripheral Nerve Interface Surgery

    BALTIMORE — Dr. Aviram M. Giladi, research director and upper extremity surgeon at the Curtis National Hand Center at MedStar Union Memorial Hospital, is leading a randomized study to determine the efficacy of a novel surgical approach known as regenerative peripheral nerve interfaces (RPNI), over other procedures, for the treatment of chronic, painful neuromas that develop after finger or hand amputations.

    A neuroma is a benign but chronically painful nerve scar that can form after any cut, crush, or amputation injury. The damaged nerve naturally attempts to heal itself, but because of the trauma it instead grows into a chaotic, disorganized ball-like growth of nerve cells. The result is a debilitating pain that can even impact areas away from the injury site.

    Neuromas can really make a person miserable,” said Dr. Giladi. “Patients can’t use their hands; they lose function and can’t do their jobs. They can’t wear prosthetics.  Most current treatment options are not adequate to relieve the pain.  Depression often follows this chronic pain especially when these patients are no longer able to work or help their families. And certainly, post-traumatic stress disorder from the injury event can accompany these challenges. Quality of life can be substantially impacted by symptomatic neuromas, so there really is a mental health component to the injury and this study will examine that too.”

    Approximately one in 15 patients with hand or finger amputations will develop a symptomatic neuroma and more than half of these patients will undergo revision surgery for neuroma, according to a publication in the Journal of Hand Surgery.

    Non-surgical efforts to mitigate the pain include steroid injections, transcutaneous electrical nerve stimulation, and medications including opioids; however, these options are rarely adequate for neuroma pain. Other surgical approaches have been tried with overall mediocre outcomes.  Therefore, most surgeons only perform “traction neurectomy” – cutting the nerve short and letting it retract, as treatment for painful neuromas; this approach has up to a 50% failure rate.

    Hand surgeons at Curtis National Hand Center have found promise in applying regenerative peripheral nerve interfaces (RPNIs), muscle grafts placed on the injured nerve that serve as targets for the regenerating axons, as a means to promote healthy more natural nerve regrowth and avoid neuromas.  Early findings show that this works approximately 90% of the time to significantly reduce pain.

    Prospective data comparing outcomes of this approach against other surgical options are necessary to confirm early findings and determine the best practice. 

    Amputees in the year-long study will be randomized to undergo one of two different surgical approaches, traditional “traction neurectomy” or RNPIs, with subsequent monitoring for pain, disability, and mental health improvements post-operatively. Such a rigorous study is uncommon in surgery because of the complexity and logistics but is required before a new treatment can truly be determined to be better than current care.  Additionally, this study is unique in combining surgical outcomes, pain, and other mental health components to truly understand the full experience of the patient ailing from a post-amputation neuroma and associated chronic pain and stress. 

    Individuals suffering with symptomatic neuromas are encouraged to call the research team at 410-554-2486, to see if participating in this study is an option for them.

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    About MedStar Health

    At MedStar Health, we use the best of our minds and the best of our hearts to serve our patients, those who care for them, and our communities. Our 30,000 associates and 4,700 affiliated physicians are committed to living this promise through our core SPIRIT values—Service, Patient first, Integrity, Respect, Innovation, and Teamwork—across our more than 300 locations including 10 hospitals, ambulatory, and urgent care centers. As the medical education and clinical partner of Georgetown University, MedStar Health is training future physician leaders to care for the whole person and is advancing care through the MedStar Health Research Institute. From our telemedicine and urgent care services to the region’s largest home health agency, we’re committed to providing high-quality health care that’s also easy and convenient for our patients. At MedStar Health—It’s how we treat people. Learn more at MedStarHealth.org.

  • September 30, 2021

    One-Step Prep and Surgical Advantages Mean Streamlined Procedure, Less Time Under Anesthesia

    BALTIMORE- Using a new fully integrated shoulder arthroplasty system, Dr. Anand Murthi, chief of shoulder and elbow surgery at MedStar Union Memorial Hospital and professor of orthopaedic surgery, became the first surgeon in the U.S. to implant the innovative Depuy Inhance shoulder system during a shoulder replacement procedure last week. The implant, which Dr. Murthi helped to design, was used to replace the arthritic joint of a 65-year old man.

    A surge in the geriatric population with advancements in technical approaches in surgery and improvements in devices, account for a trending increase in the frequency of shoulder arthroplasty, or shoulder replacement. Industry data shows that shoulder replacements are the fastest growing orthopedic joint replacement surgery in the country, tallying nearly 70,000 annually.

    During a shoulder replacement procedure, the ball section of the joint, or the socket part, is replaced using a prosthesis made of polyethylene and metal components. There are different approaches to performing a shoulder arthroplasty including a partial, total, a revision, or a reverse shoulder replacement.

    The Inhance shoulder system was designed by surgeons and engineers using an intuitive approach to patient care with consideration to the multiple reasons why it may become necessary during surgery to change from one approach option to another. It’s the first shoulder system to allow a seamless transition from stemless to stemmed to reverse shoulder implants if necessary. Humeral bone quality, severe glenoid bone loss and damage to the rotator cuff may lead the surgeon to opt from performing a standard shoulder replacement to a reverse shoulder replacement.

    “This is really a leap forward in advancing the technology to replace the shoulder joint,” explained Dr. Murthi, “the intelligent system design means simultaneous steps can take place to prepare the bone and thereby reducing the length of the surgery. That means the patient is under anesthesia for less time.”

    Last week, the total shoulder replacement procedure took under 1.5 hours. The patient went home the same day using regional anesthesia.

    The new shoulder system also has unique intraoperative flexibility. It features a comprehensive size range of anatomic stemless and stemmed inlay humeral implants that share a common geometrical shape to easily fixate to the humerus. The innovative zoned-conforming glenoid, with one-step preparation is novel to the shoulder market. Dr. Murthi and his research team published on this in the Journal of Bone and Joint Surgery.

    The implants are manufactured via state-of-the-art 3D laser and manufactured using an advanced cross-linked Vitamin E polyethylene for its wear characteristics and oxidative stability. This is important to reducing the risk of revision and complications.