With fellowship training in adult reconstruction and trauma surgery, Dr. Gausden has developed expertise in periprosthetic fractures, post-traumatic arthritis and revision joint replacement.

Read the full article at beckersspine.com. 

Dr. Gausden and colleagues compared outcomes between patients who received direct anterior vs. posterolateral THA with robotic assistance. 

“Overall, we found good outcomes with the primary THAs done with robotic guidance in this group of about 2,000 THAs,” Dr. Gausden said. “We found a low risk of dislocation whether you had an anterior or posterior approach,” she added.

“The results were consistent with the literature that perhaps the anterior approach gets you a faster functional outcome, but no difference once you hit 3 months, and certainly no difference once you hit the 1-year mark,” Dr. Gausden said.

Read the full article at healio.com. 

 Dr. Gausden discusses the anterior and posterior approaches to hip surgery as well as what activities patients can safely return to after hip surgery. “Traditionally we would really limit what people could get back to. Most of it was concerned about fracture or implant failure, but now we are really becoming much more aggressive about what we are letting people get back to.” “If you’re a runner, and it’s something that brings you joy and it’s your passion, is it the best exercise on your hip replacement? Probably not, but I’m okay with you getting back to it in smaller doses,” Dr. Gausden explained.

Dr. Gausden explains the traction that robotic surgery has gained in recent years. One thing we haven’t shown yet is that the clinical outcomes are superior. We are working on that. We do know that a robot when added to a surgery does add precision compared to manual instrumentation.”

“Its an exciting time. The addition of robotics has made it easy to collect data on a large scale. Collecting additional data from each case and add that in with post operative data. There’s more wearables that people are using after surgery, so their watch is collecting data. Their phone might be collecting data. They may have censors around their knee or hip collecting data. It’s going to be really exciting to see if those things can help us do a better job of their hip or knee replacement and minimize the risk of complications. Its already low, but we want it to get even lower and optimizing the outcome in the recovery,” explained Dr. Gausden.  

Watch the full interview at youtube.com. 

Certain PROMs are knee-specific and can provide an estimate of overall knee health, or the severity of the knee pathology, from the patient’s perspective. These instruments can be used to identify what patients consider clinically meaningful change – a personal threshold that can help determine if an intervention is appropriate or if less invasive treatment is warranted. If, for example, a patient reports their knee is a 4 on a 10-point scale, where a 10 is a “perfect knee”, total knee arthroplasty would appear to be a good option because surgery is likely to improve that score significantly.  However, a patient with the same radiographic findings may report their knee as an 8 out of 10, and for such a patient, surgery is not likely to result in a meaningful marginal improvement.

Recent research has shown that these measures are somewhat predictive of success or failure of knee replacement and can be used to measure the therapeutic benefit of various treatments for knee arthritis. Two PROMs instruments, knee injury and osteoarthritis outcome score (KOOS) and a shorter version called KOOS JR, were developed by researchers at HSS specifically for patients with knee osteoarthritis. The seven-item KOOS JR, which has been shown to be a robust and valid alternative to the longer iteration of the questionnaire, collects information on pain, stiffness, function in the joint and other parameters. The resulting composite score is highly predictive of how well patients respond to knee replacement surgery. 

Using PROMs for knee patients takes relatively little time. The KOOS JR questionnaire can be administered in just a few minutes by the patient prior to their appointment or even in the office setting. Clinicians can then use these reports to guide patients through their decision process and help them determine when a surgical intervention may be right for them individually. Doing so will not only educate them about their particular condition but also raise the likelihood that they will not be surprised by the outcome of their treatment.

Citing added time, cost, additional staffing requirements and other concerns – regulators and insurers have welcomed the instruments as important potential indicators of quality care. The collection of PROMs data is now routinely mandated by both public and private entities. Though these assessments may add some administrative burden, understanding how they work and how they can benefit both patients and physicians is essential.

However, experts agree that using PROMs on their own to measure quality of care or to guide reimbursement for services is premature. Indeed, no study to date has shown that using PROMs preoperatively is linked to improved outcomes for patients. That question is now the focus of a large randomized controlled trial at HSS. PROMs data – at least for the time being – should be one of many datapoints, including clinician assessment, radiographic imaging, and other measures such as range of motion. 

At present, data from even the most robust PROMs contain a certain amount of noise. Tension exists between the minimal clinically important change in a patient’s condition and the substantial clinical benefit they may experience from an intervention. And significant gaps in the understanding of PROMs remain. Too little is known, for example, about how these instruments perform across different populations of patients or how a person’s native language affects responses to a questionnaire written in English. Meanwhile variables such as age, sex and body mass index can influence results in ways that are not fully understood.

There is a lot of potential for PROMs to improve patient selection, enhance patient-involvement in decision making and allow for better delineation between different treatment options. 

- Alexander S. McLawhorn, MD, MBA, and Elizabeth B. Gausden, MD, MPH, hip and knee surgeons at HSS

Dr. Gausden explained how over the counter and prescription anti-inflammatories are commonly used to treat OA pain. “When someone has a sudden flare, I suggest two weeks of NSAIDs [Nonsteroidal anti-inflammatory drugs] daily, as long as you can tolerate it,” she noted. “Corticosteroid injections are commonly used to treat symptomatic knee pain from OA and can be used if pain is not adequately treated by over-the-counter medications,” continued Dr. Gausden. “Unfortunately, the pain relief is usually best with the first injection, with shots becoming less effective over time,” she added. “A good response would be several months of relief.”

When it comes to surgery, patients will often know when it’s time. “When pain or lack of mobility is affecting you every day—if you’re cancelling plans or modifying your life because of OA—I advise my patients to start thinking about surgery,” advised Dr. Gausden. “Ultimately, the decision is best made by you.”

Read the full article at Healthcentral.com.